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What's causing Gulf War illness?


WASHINGTON (November 6, 2002)
Research into the causes of unexplained Gulf War illnesses will get $20 million in FY 2004, the Department of Veterans Affairs announced on Oct. 28.
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" Clearly, the past decade has not covered the VA in glory. "

—VA Deputy Secretary Leo S. Mackay


That's twice the funding such research has received from the VA in any previous year.

In addition, the theory that Gulf War illnesses have a neurological basis, and may have been caused by chemical exposure, will receive considerable attention, in part because of a spate of new studies published over the past five years.

"Clearly, the past decade has not covered the VA in glory," said VA Deputy Secretary Leo S. Mackay, in an Oct. 28 address to the Research Advisory Committee (RAC) on Gulf War Illnesses. "However, since taking office last year, this Administration -- under Secretary Principi's leadership -- has begun to change that...there is increasing objective evidence that a major category of Gulf War illnesses is neurological in character. Some of you have been stating that for some time, and I applaud your persistence."

"...[T]he VA intends to send a message to researchers," Mackay said. "We want to underscore the fact that research into Gulf War illnesses is an area ripe for important discoveries. That there is honor in this work. Not only to improve the health of veterans of the Gulf War, but to protect American troops and civilians in the future. And that there is money to support new hypotheses. We want the best researchers and the best ideas brought to bear on this longstanding problem."

The announcement follows publication of a new British study, funded by the Department of Defense, which discredits the theory that most unexplained Gulf War illnesses are psychosomatic, or the result of post-traumatic stress disorder (PTSD).

The study, published in the Sept. 14 issue of the British Medical Journal, found that psychological factors alone could not explain all the symptoms experienced by afflicted Gulf War veterans.

"Whatever the nature of ill health in Gulf veterans, it was not explained by events or exposures conventionally understood to be psychologically traumatic," concluded the study.

To date, the federal government has spent more than $213 million on 224 different research projects on Gulf War illnesses with a wide range of symptoms including chronic fatigue, sleeping problems, irritability, bouts of dizziness, memory loss, chronic pain and concentration problems. A June RAC report estimates 25-30 percent of Gulf War veterans suffered from unexplained illnesses. That's between 175,000 and 210,000 of the roughly 700,000 veterans who served in that war.

Some hail the recent announcement as a major shift in government policy.

Steve Robinson, executive director of the National Gulf War Resource Center, a veterans' advocacy group, said he was stunned.

Robinson also serves on RAC, the group Mackay addressed last week.

Another member of that committee, Dr. Robert Haley, called Mackay's announcement "big news."

Not, he said, because of the increase in research funding, but because of a major change in policy and attitude at the VA regarding Gulf War illnesses.

The big change, Haley said, is in focus -- from combat stress and PTSD to a neurological basis for the symptoms.

"[VA Secretary] Principi is on a roll here," Haley said. "This is a major sea change at the VA. For eight years we've run into bureaucrats who tried to stop us every step of the way."

Robinson also praises Principi, as well as Mackay, for leadership in the research initiative, but he had nothing but contempt for the bureaucrats in the VA and the DoD, who Robinson thinks have been trying to cover up the true nature of Gulf War illnesses for more than a decade.

"The department [of defense] lied for almost seven years" about the presence of biological and chemical agents in Iraq during the Persian Gulf War, Robinson said.

It wasn't that long ago, he said, that those who demanded investigating neurological causes were "ridiculed and demonized."

Dr. Vinh Cam has also been advocating intense research into neurological causes for years.

Cam served from 1998-2001 on the Presidential Oversight Board on Gulf War Veterans' Illnesses established by President Clinton.

But Cam's opinions were generally disregarded by the Oversight Board , she said. And when she pressed for more research into neurotoxicity, immunotoxicity, genetic polymorphism and the synergistic effects of various pesticides and chemicals as possible causes, Cam said she was pressured by other members of the commission, including Chairman Warren Rudman, "to go along with the overall tone" of the report, which focused on stress research, she said.

Cam, a researcher herself, had done work for Rockefeller University on Lou Gehrig's disease and multiple sclerosis, maladies that have symptoms similar to those Gulf War veterans were experiencing. Her scientific opinion: neither combat stress nor PTSD were the right areas to look for answers.

"I'm glad that they're finally doing something in that area," Cam said. "I had pointed out that they should look beyond stress."

Dr. Haley, while a member of the VA research committee, is also an epidemiologist at the University of Texas Southwestern Medical Center in Dallas, and he has personally conducted pioneering research into the neurological causes.

The studies he has conducted, he said, have found brain damage in afflicted veterans, "almost certainly from sarin nerve gas," he said.

He said, however, that the "cocktail theory" is also plausible -- that is, that a combination of nerve gas, nerve gas antidote tablets as well as over-exposure to pesticides and DEET-based insecticides could have "a synergistic effect" which resulted in the Gulf War illnesses. But the stress theory, he said, doesn't explain anything.

Using magnetic resonance spectroscopy, Haley and his colleagues have determined that test subjects had lost brain cells in their brain stems and basal ganglia. Brain damage in the brain stem can cause problems with attention and balance; damage in the basal ganglia can cause depression, concentration difficulties and otherwise inexplicable pain. All of these have been reported as symptoms of Gulf War illnesses.

Part of the $20 million pledged by the VA for new studies will "create a Center of Excellence in medical imaging," Mackay said in his Oct. 28 address. This decision, Haley said, is also indicative of the new seriousness the VA is showing in neurological research.

Haley's initial studies, however, were not funded by the federal government. They were funded by H. Ross Perot.

"Thank goodness for Ross Perot," Haley said. If not for Perot, Haley thinks Gulf War illnesses would have been written off as "stress-related" back in 1995.

"[The federal government] channeled all the research to the psychological theories," Haley said. "They were clearly orchestrating all this so no research would go down that road [neurological research]."

"Don't get me wrong. I am one to resist conspiracy theories," Haley said. He sees no diabolical plot here, only "a very cynical comedy of errors."

He believes certain elements of the DoD and VA thought, "We're never going to be able to solve this, so let's just make it go away."

"It's bureaucracy," Haley said.

DoD spokesperson Barbara Goodno called Haley's work "preliminary" since it dealt with only a small group of veterans. Therefore, she said, the area "requires further study."

"The effort to build on those studies is underway," Goodno said. "There is a great deal to be learned from this work. Not only for veterans but for society at large," she said.

But that's how these studies work, Haley said. It takes a series of such small studies to build up a convincing body of evidence. Some of them have already been done.

Two other research teams -- led by Dr. Han Kang in Washington and Dr. Michael Weiner in San Francisco -- replicated his findings. Both Kang and Weiner are funded by the VA.

"In science," Haley said, "the name of the game is replication."

Goodno said the DoD is supportive of the new turn that research is taking.

"The Department of Defense supports all actions focused on achieving a better understanding of the illnesses of Gulf War veterans," she said. "To that end, DoD has been involved in a collaborative effort with the departments of Veterans Affairs and Health and Human Services since 1994. The investigative effort has not been restricted; in fact, the changing nature of the studies reflect an effort to build on the findings of earlier research, scientific breakthroughs and improved technologies."

Other veterans' groups, think that the recent VA announcement doesn't go far enough.

Kirt Love, director of the Desert Storm Battle Registry, is also a Gulf War veteran afflicted by an unexplained illness he attributes to his tour of duty in the war.

Love thinks the area of research specified by last week's VA announcement is too limited, and that RAC is still understaffed and underfinanced.

Love advocates the creation of a database of tissue samples from Gulf War veterans, as well as a comprehensive reporting system in order to get as many veterans as possible in research programs.

"They can recommend all the research in the world," he said, "but if they can't get people in the door, nothing's going to happen."

Love is also bothered by the "the high attrition rate" of anyone involved in Gulf War illness issues, whether they are committee members or employees of the DoD or VA.

According to Love, most of these people, such as Dr. Cam, last only a few years at their posts. This means that new people keep coming to the issue with little experience. (Dr. Cam said she tried to gain membership on RAC, after her term on the Presidential Oversight Board lapsed. She was passed over.)

Love is also bothered that afflicted veterans like himself are kept at the fringes of the discussion.

"I'm living the whole thing," Love said. "It's not easy -- it's a nightmare."

The DoD, he is convinced, does not want research to make any real progress.

"They want it to fail," he said, "so they can wrap it up."

Love is most worried, however, that no significant lessons have been learned from what happened in the first Gulf War, as the U.S. is poised to enter another war in the same region.

"We going to be repeating the same mistakes with Gulf War II," he said.

Posted December 23, 2002

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