When the Pentagon released a study this week saying anti-
might be a cause of Gulf War illness, it held out a glimmer of hope to
veterans suffering from the mysterious combination of memory loss,
insomnia, aching joints and disequilibrium that together have been called
Gulf War syndrome. Could these pills be the smoking gun?
Not exactly -- not yet, anyway.
Bernard Rostker, the Pentagon's top Gulf War illness specialist, limited
himself to stating that in contrast to previous studies of oil well fires
and depleted uranium, the Rand Corp. study released on Tuesday found that pyridostigmine bromide, handed out in tablet form to about 250,000 warriors, couldn't be ruled out as a cause of the disease.
"For the first time they did not reach a conclusion that the issue under
study was not likely a cause of Gulf War illness," Rostker said. "They
reached the conclusion they just don't know."
Since 1994, the Pentagon has spent $133 million researching a Gulf War
illness. (The existence of a "Gulf War syndrome" -- a politically loaded term -- is still not widely accepted.) Hundreds of millions more are budgeted.
But it is the Pentagon's own haze of secrecy that created the single
largest obstacle to this scientific inquiry. The military didn't want Iraq to know which troops were getting inoculated or medicated with different agents to counter biological and chemical attacks.
Iraq, as it happened, never attacked with biochemical agents of any kind,
but the Pentagon managed to lose most of the records that would have helped epidemiologists figure out who got jabbed or fed with potentially harmful substances.
Troops got their boosted anthrax-
transport plane flying over from Germany. Records weren't kept. Blister
packs of pyridostigmine bromide, known as PB, were handed out, and some
officers ordered their people to take 3 a day for a while. Some troops did, some
didn't. Some continuing taking the pills longer than others. Records
weren't kept.
The U.S. and British militaries had decided to issue PB, a
semi-experimental drug with limited civilian uses, out of fear that the Iraqis
had an extremely deadly nerve gas called soman. PB is the only substance
known to counteract soman, if used in advance.
The Iraqis, it turned out, didn't have any soman. They did, however, have sarin gas. And evidence has since surfaced that PB can actually enhance the nerve-damaging qualities of
sarin, which may have been released into the atmosphere by demolition of Iraqi stockpiles.
Soman works by blocking an enzyme that limits the circulation of the
neurotransmitter acetylcholine. Floating unhindered among the synapses,
acetylcholine causes brain damage. PB blocks the same enzyme -- but it's
supposed to block it temporarily so that the soman can't take the enzyme
out of circulation. Beatrice Golomb, the scientist who authored the PB
study, says research needs to be done into whether PB's effects are always
temporary.
In 1997 the Pentagon let on that a toxic, sarin-containing plume belching
forth from the remains of a bombed Iraqi stockpile at Khamisiyah may have
drifted into the lungs of as many as 100,000 U.S. troops. Some evidence
suggests that PB, combined with organophosphates -- substances contained in sarin, or pesticides, or certain insect repellants -- can damage the brain stem.
Voilà, says Robert W. Haley of University of Texas Southwestern Medical Center at Dallas, who believes he has found the Gulf War syndrome. Haley, a respected scientist whose studies have been published in JAMA and elsewhere, says his research on 249 members of the 24th Naval Mobile Construction Battalion shows that the troops exposed to PB in combination with one of the organophosphates were more likely than controls to suffer brain stem damage. Troops who had a defect in the gene that makes the enzyme that metabolizes sarin were also more likely to be brain-damaged. It adds up to a clinical syndrome, Haley says: Gulf War syndrome.
Elsewhere in the research community, though, Gulf War syndrome isn't an
accepted term. Although numerous veterans -- perhaps 120,000 of the 700,000 who went to the Gulf, and thousands more who weren't even deployed -- complain of similar symptoms, scientists have failed to confirm Haley's findings of a syndrome clearly linked to a risk factor. The Veterans Administration's main treatment for these vets is cognitive behavioral therapy.
Haley says the V.A. and the Pentagon dragged their feet on funding research that
would duplicate his because they are wedded to the idea that the sick vets
are just stressed out.
Other scientists are skeptical of Haley's findings, though. "It's very unlikely there'll be a single cause," says Simon Wessely, a British researcher whose work has shown limited, weak associations between PB -- and between large-scale inoculations -- and a feeling of unwellness among veterans. "A lot of our data suggests it's an interaction of causes, insults and stresses. The American smoking-gun thing -- I would be surprised."
Because of the lax record-keeping, the only way to correlate risk factors
like PB or pesticide exposure or anthrax vaccination is by asking the
troops. But troops can't be expected to remember what they got, says
Wessely, and the sick veterans are more likely to remember getting
something than the well ones -- a phenomenon known as recall bias.
"Recall bias is a crock," responds Haley, whose research was funded
entirely by H. Ross Perot until last year, when Defense Secretary William
Cohen intervened in the peer review process to secure $3 million for the University of Texas team. "Wessely doesn't know what he's doing. He's wasted a huge amount of
money because he didn't understand the disease."
Meanwhile, computer models now indicate that the toxic plume from
Khamasiyah probably wafted into the breathing room of fewer than a thousand GIs -- not the 100,000 the Pentagon originally reported. And the truth, if there is one, of Gulf War illness, or syndrome, is still lost in the fog of war.
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