Originally created 10/10/96

Panel finds no evidence of Gulf War illness



WASHINGTON - A prestigious committee of scientists, epidemiologists and physicians reported Wednesday there is no evidence of a mysterious chronic illness arising from military service in the Persian Gulf War.

The group suggested, however, that the effects of psychological stress seen in all wars may be more noticeable among gulf war veterans because that conflict was so nearly devoid of more dramatic and lethal injuries.

A firm conclusion that nerve gas wafted over U.S. troops in the gulf could have opened the door to benefits for some veterans. But even if ailments known collectively as "gulf war syndrome" are found to result from chemical agents, the medical community has no cure or treatment.

Recent revelations that some soldiers may have been exposed to small amounts of nerve gas are unlikely to explain the lingering physical complaints of many veterans, the committee said. Nevertheless, it said such a possibility "has to be explored" in future research.

The observations were made by an 18-member committee assembled by the Institute of Medicine, which was asked by Congress and the Defense and Veterans Affairs departments to review current research on "the health consequences of service during the Persian Gulf War."

The institute is a nonprofit organization affiliated with the National Academy of Sciences. The current committee formed three years ago and issued its initial findings last year. Wednesday's 140-page document is the final, more-detailed report.

Since the end of the gulf war in early 1991, an unknown number - though possibly tens of thousands - of gulf war veterans have experienced chronic illness. Among their commonly mentioned complaints are fatigue, headache, skin rashes, muscle and joint pain, loss of memory and mood changes.

Thought these illnesses have come to be called gulf war syndrome, there is no clear-cut medical definition of the illness. Like the Institute of Medicine committee, several previous "blue-ribbon" scientific panels have said they doubt a distinct, gulf-related chronic illness exists.

A firm conclusion that nerve gas wafted over U.S. troops in the gulf could open the door to benefits for some veterans. The medical community is not ready with a cure or even treatment if ailments known collectively as gulf war syndrome are found to result from chemical agents.

For some, a definitive finding of chemical weapons exposure could shorten what Phil Budahn of the American Legion called "a rather time-consuming, cumbersome administrative process" for veterans with undiagnosed symptoms to receive financial aid.

And research linking chemical exposure to long-term ailments such as cancer could lead to broad new benefits policies offered by the Veterans Affairs Department, VA spokesman Terry Jemison said.

"There's the potential we would either identify some new clinical entity not yet characterized or a traditional disease that may be related to their service in the gulf," Mr. Jemison said. In either case, the VA would provide free treatment and, potentially, disability payments for sufferers.

Such a development appears to be a long way off.

First, the military has not yet determined that soldiers in the Persian Gulf were actually exposed to the sarin nerve gas released by an Army demolition team destroying Iraqi bunkers in March 1991, just after the war ended. Second, medical experts say sarin exposure results in obvious symptoms - death or severe, immediate illness - not the subtle, delayed symptoms of headache, stomach ailments and fatigue commonly associated with gulf war syndrome.

"Current medical literature suggests ... that long-term effects arise only when exposure was significant enough to cause symptoms at the time, but research in this area is limited and more is needed," the VA stated in a fact sheet released this week on gulf war illness.

Dr. Stephen Joseph, head of the Pentagon's gulf war illness efforts, said the military has been unable to confirm some 26 field readings taken during the gulf war by U.S. and allied soldiers that indicated the presence of chemical agents. In most cases, Joseph said, the equipment used was not sufficiently precise to identify the presence of chemical agents without corroborating evidence. None has been found. A law enacted last year enabled the VA to pay disability benefits to gulf war veterans suffering from undiagnosed illnesses. So far, though, 26,000 gulf war veterans receive compensation for known ailments or injuries while only about 550 are receiving payments under the new law, Jemison said. That's among a total of nearly 700,000 who served.

Dr. Michael Hodgson, associate professor of medicine at the University of Connecticut, who has consulted with veterans groups on gulf war illness, criticized the military not conducting a full-blown scientific survey to try to isolate the cause or causes of gulf war illness. The straightforward medical exams offered by the Pentagon and the VA amount to what he called a "19th century" approach to the problem.

David Addelstone, co-director of the National Veterans Legal Services Program, said the VA has done a poor job reviewing claims for benefits that go beyond basic care for service-related injuries or ailments to which all veterans are entitled.

The VA conceded that while some 60,000 gulf war veterans have signed up for exams, the paperwork on all but the most recent 750 patients was inadequate to show which ones had unexplained illnesses. Of those 750 examined, 6 percent had unexplained illnesses.

The Pentagon, CIA, VA and a host of outside health organizations continue to investigate various aspects of gulf war illnesses. The Pentagon is pumping $15 million into research on effects of low-level exposure to chemical agents. The VA is overseeing some 70 Persian Gulf research initiatives. And the CIA is studying wind patterns to find out who might have come under a lethal cloud.

Debate about a mystery illness, however, increased this summer after the Pentagon revealed that thousands of soldiers may have been exposed to small amounts of poison gas when two Iraqi munitions dumps were intentionally destroyed in March 1991. Some veterans believe the gas has caused long-lasting nervous system damage even though there wasn't enough of it to cause acute problems or death.

Though it's unclear whether any soldiers had contact with the poison gas, more than 15,000 were close enough to the explosions that exposure was theoretically possible, according to recent Defense Department announcements. The Pentagon and Central Intelligence Agency are now "modeling" both the explosions and the weather at the time to estimate the likelihood that any gas that was not incinerated made contact with troops.

The IOM committee's job was to review research on Gulf War illnesses and to suggest ways the military could improve data collection in the future. As part of that work, however, the panel also offered its observations about the possible causes of chronic illness in veterans, based on current research, past research, and longstanding biological principles.

"The committee has not identified scientific evidence to date demonstrating adverse health consequences specifically of (gulf war) service other than the documented incidents of leishmaniasis (a rare tropical infection), combat-related or injury-related mortality or morbidity, and increased risk of psychiatric sequelae (consequences) of deployment," the members wrote.

There are now more than 30 scientific studies of gulf war illness under way. Some are attempting to answer basic epidemiological questions such as whether there is more illness among soldiers who went to the gulf than among soldiers who served elsewhere. Others are laboratory experiments aimed at trying to learn about the effects of pesticides, chemical fumes, anti-nerve agent drugs, and other "exposures" soldiers faced. Almost none of the studies has been completed.

"The committee recognizes that studies provided thus far do not comprise a comprehensive scientific investigation of the health consequences of service in the (gulf)," the members added.

As have several other expert panels, the IOM committee paid great attention to the psychological stress caused by rapid deployment to the gulf, the harsh conditions there, ubiquitous fears of gas attacks, and sudden re-entry to American life. It also noted that these - and more obvious combat-related stresses - were probably the cause of chronic illnesses reported among veterans of every American war back to the Civil War. The gulf war, however, was different in one important way, the panel said.

"Puzzling reactions and symptoms seen during and after prior conflicts may have been incorrectly attributed to battle casualties and infectious diseases that were considered unavoidable and even relatively acceptable outcomes of war," the committee members wrote. "Thus, the lower prevalence of battle injuries and infections in the gulf theater may have unmasked psychophysiological symptoms that were present in earlier conflicts but attributed to injury and casualty."

This aspect of the report was immediately criticized by a staff member of a House subcommittee, chaired by Rep. Christopher Shays, R-Conn., that has held four hearings on "Gulf War Syndrome" in the last year.

"While we feel stress could have played a part in some of the illnesses of these veterans, we still think there is something much larger going on here," said Robert Newman. In particular, he noted that most of the IOM committee's work was done before the possible nerve-gas exposure from the munitions dump were known.

The chairman of the IOM panel, however, said those revelations would not change the report because no link has been made between gas exposure and symptoms in soldiers. In fact, said, John C. Bailar III, it's not even known if the troops near the Iraqi dumps have an unusual number of chronic physical complaints.

"If that link is demonstrated by further research, then the situation changes dramatically," said Bailar, who is an epidemiologist at the University of Chicago.

Associated Press reports were used in this story.