toxic chemicals and 'gulf war illness?'

Toxic Chemicals Blamed for Gulf War Illness

By Steven Reinberg
Washington Post - HealthDay Reporter
Monday, November 17, 2008; 12:00 AM

MONDAY, Nov. 17 (HealthDay News) -- Gulf War illness, dismissed by some as a psychosomatic disorder, is a very real illness that affects at least 25 percent of the 700,000 U.S. veterans who took part in the 1991 Gulf War.

It's likely cause was exposure to toxic chemicals that included pesticides that were often overused during the war, as well as a drug given to U.S. troops to protect them from nerve gas, a frequent weapon of choice of former Iraqi leader Saddam Hussein.

And no effective treatments have been devised for the disorder.

Those are three key conclusions of a Congressionally mandated landmark report released Monday by a federal panel of scientific experts and veterans.

"It is very clear that Gulf War illness is a real condition that was not caused by combat stress or other psychological factors," said Lea Steele, scientific director of the Research Advisory Committee on Gulf War Veterans' Illnesses, which issued the report, and an associate professor at Kansas State University.

"This is something we need to take seriously," Steele said. "These folks were injured in wartime service, much as people who were shot with bullets or hit with bombs."

The committee presented the 450-page report to Secretary of Veterans Affairs James Peake.

Gulf War illness is frequently described as a collection of symptoms that includes memory and concentration problems, chronic headaches, fatigue and widespread pain. Other symptoms can include persistent digestive problems, respiratory symptoms and skin rashes.

The panel also said Gulf War veterans have much higher rates of amyotrophic lateral sclerosis (ALS, or Lou Gehrig's Disease) than other veterans, and soldiers who were downwind from large-scale munitions demolitions in 1991 have died from brain cancer at twice the rate of other Gulf War veterans.

In reaching its conclusions, the panel reviewed evidence about a wide range of possible environmental exposures that could cause Gulf War illness. That review included hundreds of studies of Gulf War veterans, research in other groups of populations, animal studies of toxic exposures, and government investigations about events and exposures during the Gulf War, which began after Hussein invaded Kuwait.

Speculation about the causes of Gulf War illness has included exposure to depleted uranium munitions, vaccines, nerve agents and oil well fires.

The new report says the illness was caused by soldiers' exposure to certain chemicals, Steele said.

"When you put all the evidence together there are two chemicals that jump out as the main causes," she said. One is a drug called pyridostigmine bromide, which is a cholinesterase inhibitor that was given to the troops to protect them against nerve gas.

"It turns out that people who took those pills have a higher rate of Gulf War illness," Steele said. "And people who took more pills have even higher rates of Gulf War illness."

In addition, soldiers were exposed to pesticides that were also cholinesterase inhibitors, Steele said. "The strongest evidence points to pyridostigmine bromide and pesticides as causal factors," she said. "This type of illness has not been seen after other wars."

While pyridostigmine bromide is still in use, its use is more limited than it was in the first Gulf War. It's currently being used against one type of nerve agent, but is not being given out on a widespread basis, Steele said.

"The Gulf War was the only time a lot of people used this drug," she said.

Steele added that the U.S. military has also cut back on its use of pesticides since the 1991 war.

There are other factors that, while not likely causes of Gulf War illness, can't be ruled out, Steele said. These include exposure to nerve agents, exposure to smoke from oil well fires, and vaccines given to the troops. The panel ruled out depleted uranium and anthrax vaccine as causes.

The panel also found government research and funding into Gulf War illness wanting. "There has not been sufficient attention given to Gulf War illness. It's a real problem," Steele said.

"In recent years, both the Department of Defense and the Department of Veterans Affairs have reported a lot of studies that weren't Gulf War illness as Gulf War research," Steele added. "Some of the money was misused."

The panel noted that overall federal funding for Gulf War research has declined substantially in recent years; the group urged lawmakers to devote $60 million annually to such programs.

When veterans with Gulf War illness go to Veterans Administration hospitals for treatment, their problems often aren't taken seriously, Steele said. "VA docs often know nothing about it and aren't able to help them. Sometimes they treat them as if they are head cases or malingering," she said.

James Binns is chairman of the U.S. Department of Veterans Affairs' Research Advisory Committee on Gulf War Veterans' Illnesses.

"We have no treatments that work," said Binns, a Vietnam veteran and former Pentagon official. "I would like to see the new administration take this more seriously. When you look at all the studies, it's as clear as the nose on your face that this [Gulf War illness] is real."

It took 20 years to admit that Agent Orange, a defoliant used in the Vietnam war, caused illness, Binns said. "It's now coming up to 17 years on Gulf War illness," he said. "Troop exposures [to these chemicals] were a serious but honest mistake. Covering it up rather than trying to help them has been unconscionable."

More information

Learn more about Gulf War illness from the University of Chicago Medical Center.

SOURCES: Lea Steele, Ph.D., associate professor, Kansas State University, Manhattan, and scientific director, Research Advisory Committee on Gulf War Veterans' Illnesses; James Binns, chairman, U.S. Department of Veterans Affairs' Research Advisory Committee on Gulf War Veterans' Illnesses

Boston University School of Public Health

MEDIA RELATIONS

For Release 11 a.m. EST, November 17, 2008

Contact: Lisa Chedekel, 617-414-1401; chedekel@bu.edu

Gulf War Research Panel Finds 1 in 4 Veterans Suffers from Illness Caused by Toxic Exposure

Washington, DC – (Nov. 17, 2008) – At least one in four of the 697,000 U.S. veterans of the 1991 Gulf War suffer from Gulf War illness, a condition caused by exposure to toxic chemicals, including pesticides and a drug administered to protect troops against nerve gas, and no effective treatments have yet been found, a federal panel of scientific experts and veterans concludes in a landmark report released Monday.

The Congressionally-mandated Research Advisory Committee on Gulf War Veterans’ Illnesses presented the report today to Secretary of Veterans Affairs James Peake at VA headquarters in Washington.

Scientific staff support to the Committee is provided by the Boston University School of Public Health (BUSPH). The full report is posted at: http://sph.bu.edu/insider/racreport

“The extensive body of scientific research now available consistently indicates that Gulf War illness is real, that it is the result of neurotoxic exposures during Gulf War deployment, and that few veterans have recovered or substantially improved with time,” the report says.

The 450-page report brings together for the first time the full range of scientific research and government investigations on Gulf War illness and resolves many questions about the condition.

“Veterans of the 1990-1991 Gulf War had the distinction of serving their country in a military operation that was a tremendous success, achieved in short order. But many had the misfortune of developing lasting health consequences that were poorly understood and, for too long, denied or trivialized,” the Committee’s report says.

The report found that Gulf War illness fundamentally differs from stress-related syndromes described after other wars. “Studies consistently indicate that Gulf War illness is not the result of combat or other stressors, and that Gulf War veterans have lower rates of posttraumatic stress disorder than veterans of other wars,” the Committee wrote.

The report concludes: “A renewed federal research commitment is needed … to achieve the critical objectives of improving the health of Gulf War veterans and preventing similar problems in future deployments. This is a national obligation, made especially urgent by the many years that Gulf War veterans have waited for answers and assistance.”

Panel Chairman James H. Binns, a former Principal Deputy Assistant Secretary of Defense, said the report “provides a blueprint for the new Administration to focus resources on improving the health of Gulf War veterans and avoiding similar consequences in future military deployments.”

Committee Scientific Director Roberta White, PhD, associate dean for research at Boston University’s School of Public Health, stated: "Veterans of the first Gulf War have been plagued by ill health since their return 17 years ago. Although the evidence for this health phenomenon is overwhelming, veterans repeatedly find that their complaints are met with cynicism and a 'blame the victim' mentality that attributes their health problems to mental illness or non-physical factors."

White said the Committee’s findings "clearly substantiate veterans’ beliefs that their health problems are related to exposures experienced in the Gulf theatre. It provides a state-of-the-art review of knowledge about Gulf War veterans’ health concerns that can guide clinicians and researchers, and offers a scientific rationale for the new Administration to further our understanding of these health problems -- most importantly, by funding treatment trials to develop effective treatments of the veterans’ symptoms."

Large numbers of British Gulf War veterans also are ill. "Recognition of the full extent of the illnesses suffered by these veterans of the conflict and the obligation owed to them is long overdue,” said Marshal of The Royal Air Force Lord David Craig, Chief of the Defence Staff (the British equivalent of Chairman of the Joint Chiefs) during the 1990-1991 Gulf War. “They are victims of the war, as much as any one struck by a bullet or shell. Moreover, medical treatments for their conditions are needed to protect current and future military personnel at similar risk."

The Committee evaluated evidence related to a broad spectrum of Gulf War-related exposures. Its review included hundreds of studies of Gulf War veterans, extensive research in other human populations, studies on toxic exposures in animal models, and government investigations related to events and exposures in the Gulf War.

Gulf War illness is typically characterized by a combination of memory and concentration problems, persistent headaches, unexplained fatigue and widespread pain, and may also include chronic digestive problems, respiratory symptoms and skin rashes.

The new report says that scientific evidence “leaves no question that Gulf War illness is a real condition,” and it cites dozens of research studies that have identified “objective biological measures” that distinguish veterans with the illness from healthy controls. Those measures relate to structure and functioning of the brain, functioning of the autonomic nervous system, neuroendocrine and immune alterations, and variability in enzymes that protect the body from neurotoxic chemicals.

The panel cited two Gulf War exposures consistently found to be causally associated with Gulf War illness: (1) the drug pyridostigmine bromide (PB), given to troops to protect against nerve gas, and (2) pesticides that were widely used, and often overused, during the Gulf War.

The Committee found that an association between Gulf War illness and several other exposures could not be ruled out. These included low-level exposures to nerve agents, extended exposure to smoke from oil well fires, receipt of large numbers of vaccines, and combinations of neurotoxic exposures.

Department of Defense reports indicate that about 100,000 U.S. troops were potentially exposed to low-level nerve agents as a result of large-scale U.S. demolitions of Iraqi munitions near Khamisiyah, Iraq in 1991. In 2007, a federally funded study led by White, chair of Environmental Health at the Boston University School of Public Health, found evidence that low-level exposure to nerve gas could have caused lasting brain deficits in Persian Gulf troops. The extent of the changes – less brain “white matter” and reduced cognitive function -- corresponded to the extent of the exposure, that study found.

In addition, the Committee said, Gulf War veterans have significantly higher rates of amyotrophic lateral sclerosis (ALS) than other veterans, and troops who were downwind from the Khamisiyah demolitions have died from brain cancer at twice the rate of other Gulf War veterans.

The report found that historically, federal Gulf War research programs have not been effective in addressing Gulf War illness. While the Committee applauded promising new programs at VA and DOD, it noted that overall federal funding for Gulf War research had declined dramatically in recent years. The panel urged policymakers to devote $60 million annually for such programs.

The Committee further recommended that the VA instruct the Institute of Medicine (IOM) to re-do its previously completed Gulf War and Health reports, saying the IOM’s series of reports have been “skewed and limited by a restrictive approach to the scientific tasks mandated by Congress, an approach directed by VA in commissioning the reports.”

The Research Advisory Committee on Gulf War Veterans’ Illnesses is a panel of prominent scientists and veterans, charged with reviewing federal research on the health of Gulf War veterans. The Committee was mandated by Congress and appointed by the Secretary of Veterans Affairs. Additional information about the Committee and its activities can be found on its website: www.va.gov/RAC-GWVI.

Media Contacts:

James Binns, Committee Chair: (602) 684-0116; jimbinns@aol.com

Dr. Roberta White, Committee Scientific Director: office: (617)638-4620; cell: (617)939-6171; rwhite@bu.edu

Dr. Lea Steele, Committee Scientific Director during report preparation: (785)945-4136; Lea.Steele@hughes.net

Additional contacts, veteran members of the Committee:

Steve Smithson, Gulf War veteran and Deputy Director of the American Legion for Claims Services: office: (202) 861-2700; cell: (202) 445-0149; ssmithson@legion.org

Anthony Hardie, Gulf War veteran: (608)-576-8508; Anthony.Hardie@dva.state.wi.us

www.va.gov/RAC-GWVI.

Full report of RAC-GWVI -- Nov. 17, 2008