Persian Gulf War Spawns Enduring Medical Mystery, Anger by Veterans

David L. Wickes symbolizes the central paradox of so-called Gulf War illness.

To anyone who knows him, there is not much doubt that Wickes is sick. In peak condition only a few years ago, the 46-year-old Pennsylvania veteran has been suffering from persistent aching in his joints, debilitating bouts of diarrhea and unexplained boils and lumps.

Wickes finds no mystery in these ailments: He is sure he got them while serving as an aircraft mechanic in the 1991 Persian Gulf War in Iraq, where he drank the water, was bitten by sand flies and breathed fumes from burning oil wells.

Tens of thousands of other Gulf War veterans have registered complaints about their health since returning from the Mideast.

*

Yet, experts who have studied the medical records of thousands of Gulf War veterans such as Wickes said that while the ailments from which the veterans are suffering are genuine, they are cropping up no more frequently among the veterans than they are in the general population.

Pentagon and Veterans Affairs Department studies show that the death and hospitalization rates of Gulf War veterans are similar to those of military personnel who did not serve in the war. The studies have been unable to pinpoint a single cause for any “Gulf War illness.”

“The clinical experience to date reveals no evidence for a single, unique illness . . . representing a ‘Gulf War syndrome,’ ” said Dr. Stephen C. Joseph, assistant secretary of defense for health affairs, who has been overseeing the Pentagon’s studies.

Such findings are a source of considerable frustration and anger among Gulf War veterans, many of whom have become convinced that the government is trying to cover up some kind of war-related catastrophe that may have caused their illness, possibly to avoid paying benefits to veterans.

“How can a soldier go from peak physical condition to sick--or dead--in three years?” asked Chris Kornkven, a Gulf War veteran and former Army electronics specialist who heads the National Gulf War Resource Center. “It doesn’t make sense.”

The veterans also resent the suggestion, another key part of the Pentagon and VA studies, that at least some of their ailments are psychosomatic--caused by, or at least exacerbated by, stress. “These things are very real,” Kornkven said.

The benefits at stake are substantial. If the ailments are considered to be service-related, the veterans would qualify either for free health care at VA hospitals or for monthly disability checks.

*

To Kornkven and other Gulf War veterans, it seems that pinpointing the problem should not be that difficult. Most cases appear to involve a handful of symptoms: aches, pains, digestive problems, memory loss, depression, nerve disorders, fatigue and loss of weight.

The pollutants to which Gulf War soldiers were exposed also are no secret.

U.S. aircraft bombed Iraqi chemical weapons plants. Soldiers took controversial pills to protect themselves against chemical agents. U.S. antitank shells contained depleted uranium. Iraqi Scuds rained down on troops. Iraqi oil wells burned for weeks. Parasites were rampant.

And just last summer the Pentagon disclosed that Iraqi ammunition bunkers that U.S. forces blew up in March 1991 contained rockets filled with sarin and mustard gas--potentially exposing some troops to deadly nerve agents.

But subsequent reviews, the latest by the blue-ribbon Presidential Advisory Committee on Gulf War Veterans’ Illnesses, have supported the Pentagon’s contention that there still is no link between what happened in the Persian Gulf and the symptoms that are plaguing the veterans.

*

Philip J. Landrigan, a physician at Mount Sinai School of Medicine in New York, pointed out that all the symptoms Gulf War veterans have exhibited could be caused by any of a dozen or more factors, some of which may not be directly related to what happened in Iraq.

“There’s only a limited number of ways that the human body can respond to any given exposure,” Landrigan said. “It’s the rare exposure that produces something that stands out like a red flag.”

In addition, Landrigan said, because of the chaos that inevitably surrounds the battlefield--and poorly kept records--medical detectives have no way of knowing precisely which contaminants a soldier was exposed to and, therefore, which of them might be to blame.

Dr. Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania, pointed out that to complicate the situation, many of the symptoms--and the suspected contaminants--interact with one another, making it doubly hard to pinpoint a cause.

To be sure, some medical experts have been critical of the Pentagon and VA surveys.

They have said that while the government studies have involved thousands of veterans, they have been designed primarily to see if there were any broad-scale health differences between Gulf War veterans and others--and not to find any kind of cure.

The Pentagon study, for example, included a substantial number of Gulf War veterans who said they were healthy and had not experienced any Gulf-related illnesses.

In addition, this study compared their health to that of a broad cross-section of Americans--many of them older and less fit.

Critics also contended that the new studies showing that Gulf War veterans have had no greater rates of hospitalization or death have also missed a key point: Most of those suffering from Gulf War ailments are not sick enough to require hospitalization or to die prematurely--and therefore are not counted in the studies.

The medical vacuum left by the studies has spawned a spate of theories by private physicians and scientists around the country about what is causing the Gulf War veterans’ symptoms--ranging from immune deficiencies to the impact of sand parasites.

But officials, both at the VA and the Pentagon, have insisted that the private efforts so far have been too small-scale and unscientific, with sponsors either unable or unwilling to provide their evidence for review by their peers.

Because physicians have not been able to find a specific cause for the Gulf War veterans’ symptoms or even diagnose a “Gulf War syndrome,”it has made it difficult for veterans to qualify for benefits.

Although Congress recently has liberalized some of the restrictions for such benefits--and many veterans qualify for free care anyway because their ailments can be diagnosed apart from being related to Gulf War illnesses--most have to pay cash or use private health insurance.

Gulf War veterans’ groups plan to press Congress next year to do what it did for Vietnam War veterans, who contended that they were sprayed with Agent Orange defoliant: liberalize standards further so that virtually any reasonable claim is paid.