On the lookout for Gulf War illness

The wells are burning again, the air is a witch’s brew of sand and dust and smoke, and tens of thousands of veterans watching at home can practically feel the acrid gas in their lungs and on their skin.

“I can’t even look anymore,” said Larry Stewart Jr., 32, of Sacramento, who served in an armored tank division in southern Iraq during Operation Desert Storm in 1991. “We’re in the same place, against the same enemy; I only hope those young guys who make it back aren’t affected the same way I was.”

Stewart is among about 100,000 men and women who in the early 1990s reported fatigue, rashes, joint pain and memory loss, among other torments, after the 1991 Persian Gulf War. For years, government officials dismissed the complaints -- first described, collectively, as Gulf War syndrome -- even as 1 in 7 Gulf War veterans came forward reporting similar problems. After scores of studies and reams of congressional testimony, there’s still no agreement about what might cause these symptoms, and the government does not recognize them as part of a unique syndrome, limiting the amount of free health care and disability benefits that veterans can claim.

Now, as U.S. forces dig in for more intense battles in the same hostile desert, veterans of the 1991 war wonder whether a new generation will face the same health problems and lingering doubts about their origin. In congressional hearings late last month, Defense Department officials faced questions about how closely the department is tracking the health of active soldiers so that any symptoms that occur later can be linked to a cause. At the same time, a Department of Veterans Affairs advisory committee is preparing a report that reviews the current science on post-Gulf War symptoms. These findings and medical information collected about U.S. troops now fighting in Iraq, will help determine what kind of care veterans of both Gulf wars can expect in the years to come.

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Toxins in question

In the latest report, the VA focuses on exposure to a broad class of nerve agents called organophosphates as a possible cause of many symptoms. These include the toxin sarin, used in chemical weapons, and pesticides. Military personnel who were sent to the Persian Gulf in 1991 were 25% to 30% more likely to report symptoms such as joint pain, headaches, sleep disturbances and difficulty concentrating than troops who were not deployed, according to Dr. Beatrice Golomb, a UC San Diego scientist who directs the VA’s research advisory committee. “Something absolutely happened to those soldiers,” she said. “I think anyone who has looked at the evidence now agrees with that.”

Yet doctors have had difficulty linking specific symptoms to a single underlying cause, largely because they lack sufficient medical data on the state of soldiers’ health both before and after the war.

For instance, researchers who have studied Gulf War veterans cannot rule out a variety of other chemicals possibly responsible for the pain and neurological problems. Soldiers were exposed to numerous agents, including the anthrax and botulism vaccines, and depleted uranium, a heavy metal used both in armor and munitions. Many also took pyridostigmine bromide tablets to help protect themselves against a chemical attack. “There’s just no way to know for sure all the exposures, because you can’t re-create what happened to us out there,” said Steve Robinson, a former Army Ranger who served in northern Iraq in 1991. He is now executive director of the National Gulf War Resource Center, an advocacy group for veterans.

Defense Department officials have promised to track the health of troops more carefully this time. Soldiers are required to fill out medical forms before and after deployment, answering several questions about their mental and physical health, including whether they noticed any change during or after the tour of duty. The military is gathering air, soil and water samples to better understand the environment in which the troops operate, said Barbara Goodno, a spokeswoman for the Pentagon’s health support division. Compared to the 1991 conflict, the equipment also is much improved: Gas masks seal more tightly, chemical suits are lighter and biological detection systems are more sensitive.

Veterans’ groups and some politicians say these measures still fall short of what is needed. In particular, critics of Pentagon policy on this issue are pushing for comprehensive medical exams of all soldiers before and after deployment. At last month’s congressional hearings, Rep. Christopher Shays (R-Conn.) challenged department officials to do more. “They’re doing a questionnaire instead of a physical exam, when it’s clear our men and women need a complete exam” if we’re going to learn anything, said Shays, a leading critic of the government’s handling of Gulf War-related complaints since the 1990s.

A more serious effort to identify the causes of Gulf War illnesses would require a variety of tests, some doctors say, including complete cognitive evaluations and blood samples taken just before deployment, which many soldiers and reservists are not getting.

Gulf War syndrome is so hard to define because the symptoms themselves are as numerous as the possible causes; they also are similar to those of other poorly understood conditions, such as chronic fatigue syndrome and fibromyalgia. The mental stress of war itself can cause some of these problems, studies have shown, and that’s what many doctors say is behind the fatigue, pain and memory problems.

Yet many veterans strongly object to any suggestion that the problem is in their heads. Joel Graves, 49, of Lacey, Wash., was a Marine captain with the 2nd Armored Division, which operated near the infamous “Highway of Death,” the road to Basra where thousands of Iraqis were killed by airstrikes. “As we went along, we passed through the thick, heavy smoke of burning oil-well fires, burning vehicles, burning bodies and the incessant misty rain,” he said. After dinner on that day, he said, many soldiers became ill. “Some were bedridden for several days. We assumed, at first, that it was food poisoning. Then we heard that chemical alarms were going off in units around us.” The alarm systems detect toxins in the air and signal soldiers to put on their masks and chemical gear.

This mix of smoke, toxic gases and other factors is the literal fog of modern warfare, and the military does not yet know what lasting effects, if any, these have on the body. The debate over causes and treatments will ultimately depend on medical science, which only recently began to come together.

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Scientific support

Dr. Robert Haley, a professor of internal medicine and epidemiology at the University of Texas Southwestern Medical Center in Dallas, has been studying Gulf War vets since the early 1990s. Using brain imaging techniques, Haley has compared the brains of 22 veterans who reported post-Gulf War symptoms such as fatigue and memory problems with those of 18 veterans of the war who had no such complaints. He found that the sicker groups had evidence of neuron damage in an area of the brain called the basal ganglia, which is involved in coding and storing automatic tasks. “We know this is the same area of the brain that degenerates in Huntington’s disease, and people with early Huntington’s have the same kind of problems these vets do: the trouble with concentration and balance, the aches and pains, the personality change.”

Coalition bombing of suspected Iraqi chemical factories might have released the nerve agent sarin into the air, both in northern Iraq and during the destruction of munition depots in the Iraqi city of Khamisiyah. Doctors working with the VA report that exposure to this agent and other organophostates may over time lead to detectable brain damage. Some people’s bodies make an enzyme that protects the brain from these toxins, which lowers their risk of developing many of the neurological problems when exposed to nerve agents, said Golomb, the UC San Diego researcher.

The Pentagon has acknowledged that about 100,000 soldiers might have been exposed to low levels of sarin near Khamisiyah in the 1991 Gulf War, but it does not consider this proof that the nerve agent was responsible for a unique neurological syndrome.

At the same time, the VA has begun to examine the vets’ symptoms and treatment options more closely. In a study of more than 1,000 former soldiers published early this month, VA researchers reported that a four-month program of mental health counseling helped to improve concentration, emotional control and social functioning of some veterans. An exercise program helped relieve some fatigue, insomnia and daily distress. Though the effects were modest, the study represented “the first credible trial of an intervention for symptomatic Gulf War veterans,” said Matthew Hotopf, a leading Gulf War syndrome expert at King’s College, London, in an editorial that accompanied the study. About 18% of the veterans who received one or both of the therapies showed some improvement in mental and physical function.

The vets who are still struggling with symptoms more than 11 years after the war say that’s a start. But many of them doubt there’s any quick therapy that will restore them to their former health. For soldiers in the Persian Gulf now, they say, the best protection is their own discipline: Track your medical record, if possible. And use your chemical warfare equipment when the alarm sounds.