Late Breaking News
Despite Signiﬁcant Dollars Spent on Gulf War Illness Research, Many Questions Remain Unanswered
- Categorized in: June 2009 Issue
WASHINGTON, D.C.—In the push to direct attention and resources to illnesses and concerns of the nation’s most recent veterans, are problems faced by veterans from previous Middle East conﬂicts being neglected? Speciﬁcally, is Gulf War Illness, the signature ailment of veterans who served in the 1990 Gulf War, being neglected? Those are the questions that members of the House VA Subcommittee on Oversight are interested in answering over the course of several hearings examining the impact of toxin exposures during the Gulf War and the subsequent research and response efforts by the Departments of Defense and Veterans Affairs.
“It has been almost 19 years since the United States deployed some 700,000 service members to the Gulf in support of Operations Desert Shield and Desert Storm,” Rep. Harry Mitchell, D-Ariz., subcommittee chair, said at the ﬁrst of those hearings held May
19. “When these troops returned home, some reported symptoms that were believed to be related to their service. Still today, these same veterans are looking for answers about proper medical treatment and the beneﬁts that they bravely earned. While we hear about numerous studies and millions of dollars spent on Gulf War Illness research, many questions remain unanswered. In the end, we still don’t know how to respond to Gulf War veterans who asks: “Why am I sick or will I get sick?”
“Subsequent hearings on this issue will take a multi-level view of the methodology and conclusions of Gulf War Illness research and how the review of information was compiled and why certain methods were employed,” he explained.
A Misunderstood Illness
Gulf War illness, also known as Gulf War Syndrome, is an illness reported by combat veterans of the Gulf War characterized by a wide range of symptoms, including chronic fatigue, loss of muscle control, muscle and joint pain, memory loss, and breathing problems. GWI has never been fully understood, and its causes and the exact nature of the illness, have been a source of scientiﬁc examination and debate since it was ﬁrst documented. VA and DoD have conducted a number of studies on veterans reportedly suffering from GWI, and have concluded that combat-deployed Gulf War veterans suffer from more multisymptom illnesses than their nondeployed counterparts. And a report released in November 2008 by the federally mandated Research Advisory Committee on Gulf War Veterans’ Illnesses estimates that one out of every four Gulf War veterans is afﬂicted with GWI.
However, veterans’ advocates contend that understanding of GWI remains incomplete, and the illness and those afﬂ icted misunderstood. “Is VA doing enough for Gulf War veterans?” Paul Sullivan, executive director of Veterans for Common Sense asked at the hearing. “The answer is, ‘No.’ They remain frustrated and angry at our government’s lack of action. As a Gulf War veteran, I have personally experienced VA’s denials and delays.”
“We have three questions that we need answered,” he said. “Why are we ill? Where can we get treatment? And who will pay for our care and disability beneﬁts? There are few treatments for us. And VA disability beneﬁts are very difﬁcult to obtain,” Sullivan noted. “And VA’s Web site now says that experts say there is not a Gulf War Syndrome.”
The contention that there is no actual syndrome stems from an Institute of Medicine report released in 2006 stating that what is commonly referred to as GWI is actually not a single disease process, but actually a number of separate illnesses. While the theory that GWI actually consists of multiple concurrent diseases is not scientiﬁcally controversial, and is not to clinicians treating Gulf War veterans, a new revelation, the media attention the report received, might have helped muddy the issue of the existence of GWI for the general public and physicians unfamiliar with treating veterans, veterans advocates contend.
Sullivan quoted from VA Congressional testimony in 2007 stating that Gulf War veterans are suffering from a wide variety of common, recognized illnesses rather than a multisymptom illness that evades diagnosis. He also noted that DoD leaders in testimony in 2008 characterized the symptoms of ill Gulf War veterans as “wear and tear problems.”
“Unfortunately, the history of Gulf War Illness both with DoD and VA is one of misdirection, denial and ﬁlled with, some would say, mendacity,” declared Rick Weidman, executive director of the Vietnam Veterans of America. “You could pass legislation speciﬁcally prescribing [care], but all you need is top leadership that says we have a covenant with the men and women who risked life and limb for the Constitution [and] we are going to do everything humanly possible to ﬁgure out how they were lessoned, whether that be physically, psychologically or economically.”
Currently, there is no real VA protocol for treating GWI and no real method to track veterans suffering from it. “We need to have a protocol and we need to have a real registry,” Weidman declared. “The reason why they don’t follow through is to minimize the problem.
If you don’t have stats, you don’t have a problem.”
A Real Disease
It’s the hope of veterans’ advocates that VA and DoD will take note of the ﬁndings of the November 2008 ﬁndings of the federal advisory committee on GWI, which stated unequivocally that the illness exists and that there is solid evidence as to its cause. “Our committee had several main ﬁndings,” explained Lea Steele, Ph.D., former scientiﬁc advisor to the committee. “First, Gulf War illness is real. The same types and patterns of symptoms are consistently identiﬁed in diverse groups of Gulf War veterans. Secondly, Gulf War illness differs signiﬁcantly from trauma and combat stress disorders seen after other wars. [PTSD rates] are actually low in Gulf War veterans compared to veterans of other wars. And studies do not show a similar pervasive unexplained illness in veterans of other wars, including the current war.”
The other major ﬁnding was that evidence points consistently to two causal factors. The ﬁrst is the use of pyridostigmine bromide pills, which were given to protect troops from the effects of nerve agents. The only widespread use of PB pills was during the Gulf War. The second causal agent is the extensive use of pesticides. Both act as neurotoxicants through their effects on an important neurotransmitters in the brain and nervous system. “The evidence all suggests that these exposures made these veterans ill and their illnesses parallel to what you would expect from these kind of exposures,” Dr. Steele explained.
Later testimony from DoD revealed that military leaders are rejecting the committee’s ﬁndings regarding PB in favor of the IoM report of 2006, which determined that the evidence of the origins of GWI was inconclusive. “We view PB as a very, very important tool in our armament to protect our troops against nerve agent exposure,” explained Craig Postlewaite, DVM, DoD deputy director of force health readiness and protection programs. “The only change that we have made is that we are better in our documentation now so we can track who was given these medications, so if we ever have to go back and do an analysis, we’ll have better data.”
As to whether GWI is a single pathology, or multiple diseases process, Dr. Steele called the argument a moot point. “Our committee found this question to be trivial,” she said. “The clear result from Gulf War studies is that a large number of veterans suffer from this consistent pattern of illness, however it is labeled. This is not controversial scientiﬁcally. There are no ﬁndings to the contrary. Despite the unusual or complex or difﬁcult to diagnose nature of Gulf War illness, there is every justiﬁcation from a scientiﬁc perspective for this problem to be clearly addressed in the same way as other long-term health care problems.”
But whether GWI is one illness or a dozen, whether it was caused by PB or other toxins, the problem remains that not only does proven treatment remain elusive, but so does clinicians’ ability to identify when a patient suffers from it.
“The heart of the problem is that there is no clear diagnostic test yet to determine who has it and who doesn’t have it. And that has been a source of frustration for both veterans and clinicians,” Dr. Steele explained. “And funding for Gulf War illness research has declined dramatically since 2001. Our committee has called for an increase in our commitment to ﬁnd effective treatment and diagnostic tests for Gulf War illness and other health care issues.”