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"Gulf War Syndrome"
Stephen Barrett, M.D.
Ronald E. Gots, M.D.
Between August 1990 and June 1991, war in the Persian Gulf uprooted nearly 700,000 Americans and brought them into a hostile environment . Soon after returning, some began to experience debilitating illnesses. The most common symptoms were fatigue, muscle and joint pain, memory loss, and severe headaches. In 1992, when several members of a national guard unit reported such symptoms, the U.S. Department of Defense conducted an epidemiologic study and found no evidence of a specific disease outbreak. Nevertheless, a registry was set up to which Gulf War veterans could report their symptoms. More than sixty thousand of them have done so.
Many of these veterans are said to be suffering from "Gulf War Syndrome," an ill-defined condition that has enraged veterans' groups, inflamed the public and Congress, and spawned countless stories about mysterious ailments, heartless bureaucrats, and government conspiracies. The mass media's insatiable interest in such topics has nourished all sorts of speculations, and the Internet has enabled thousands of people to share their concerns. With nearly 700,000 potential victims plus another million or more family members and significant others, the issue remains politically heated. Some sufferers claim to have multiple chemical sensitivity (MCS).
The Role of Coincidence
The Institute of Medicine of the National Academy of Sciences has concluded that the term "Gulf War Syndrome" is inappropriate because it implies a singular disorder exclusive to Gulf War veterans [2,3]. Although no such disease pattern has been found, many people are blaming Gulf War service for cancers, birth defects, multiple sclerosis, Lou Gehrig's disease, lupus erythematosus, depression, and a long list of other health problems.
When health problems strike, it is human nature to search for explanations. The key question, of course, is whether these ailments were related to the War or would have occurred anyway. One way to investigate is to determine whether those who served in the war have a higher incidence of health problems than other troops or comparable civilians. In May 1995, President Bill Clinton established a twelve-person Presidential Advisory Committee on Gulf War Veterans' Illnesses composed of veterans, scientists, health-care professionals, and policy experts. By October 1996, approximately 62,000 individuals had completed physical examinations in the VA Persian Gulf Health Registry and the VA had reviewed the results for the first 52,213 . After examining these and other data, the committee concluded:
The Role of Stress
Some veterans-about ten thousand at last count-have symptoms that do not fit the patterns of specific diagnosable diseases. Yet that has happened after every major military conflict. In World War I, this symptom picture was called shell shock. In recent years, it has been called posttraumatic stress disorder (PTSD). Studies have shown that veterans deployed in the Gulf War have a higher rate of PTSD than either nondeployed veterans or the general U.S. population.
The key question is whether stress was a significant causal factor in many of the ill-defined Gulf War cases. The Presidential Advisory Committee concluded that it was. After earlier wars, the general public found such attribution acceptable, but today, emotional causes of disease carry a stigma. Thus a frantic search is under way for other explanations-many of them chemical. Researchers have been considering every conceivable risk factor: pesticides, chemical warfare agents, biological warfare agents, vaccines, pyridostigmine bromide, infectious diseases, depleted uranium, oil-well fires and smoke, petroleum products, psychologic and physiologic stress. More than a hundred federally funded studies and many privately funded studies of "Gulf War Syndrome" have been launched, at a total cost of over $100 million. In December 1996, after reviewing all of the available data, the Presidential Advisory Committee concluded:
Current scientific evidence does not support a causal link between the symptoms and illnesses reported today by Gulf War veterans and exposures while in the Gulf region to the following environmental risk factors assessed by the committee: pesticides, chemical warfare agents, biological warfare agents, vaccines, pyridostigmine bromide, infectious diseases, depleted uranium, oil-well fires and smoke, and petroleum products.
Stress is known to affect the brain, immune system, cardiovascular system and various hormonal responses. Stress manifests in diverse ways and is likely to be an important contributing factor to the broad range of physical and psychological illnesses currently being reported by Gulf War veterans .
The committee also noted:
Even when the war was over, many veterans experienced post-deployment stress on their return from the Gulf. These included financial and employment difficulties, unresolved military pay issues, the revelation of cases of leishmaniasis and the consequent temporary ban on blood donations, increasing numbers of health complaints and "unexplained illnesses," and media accounts of apparent increased numbers of birth defects and cancer.
Thus the most comprehensive review to date concluded that stress alone is the common link to the Gulf experience that could explain symptoms. Furthermore, the committee's report indicts the media for sensationalism and failure to accept the mounting scientific evidence. It also viewed the media as a source of additional stress.
The "MCS" Connection
Ever vigilant for new recruits, MCS advocates have embraced "Gulf War Syndrome" as their own. But the Presidential Advisory Committee on Gulf War Veterans' Illnesses has found no connection. In fact, its 174-page book dismisses MCS in two paragraphs:
There is no consensus case definition for MCS, although two recent government-sponsored conferences have attempted to develop one. MCS patients report many symptoms, including tiredness, lethargy, fatigue, memory difficulties, difficulties concentrating, dizziness or lightheadedness, and depressed feelings when exposed to low levels of common, everyday substances. Symptoms relevant to many different organ systems have been linked to MCS in the clinical ecology literature; symptoms related to the central nervous system are the most common.
The majority of patients diagnosed with MCS have no objective abnormalities on physical examination or on routine laboratory testing. The physicians who use this diagnosis use a variety of nontraditional diagnostic and treatment techniques, none of which have been validated in a controlled trial .
The Presidential Advisory Committee report has not settled the issue. Although the trail remains cold, conspiracy theories and claims that Gulf War Syndrome is a strange or new disease (or is MCS) still flourish. And research projects are still under way.
The concept of a "Gulf War Syndrome" is appealing. It comes at a time when public distrust of Government is at an all-time high. It turns on conspiracies, a favorite theme of television producers. It provides the media with an endless parade of self-perceived victims. It provides a feeding trough for serious scientists, since funding is abundant, and for every charlatan with a newsworthy theory. It is a field day for politicians who solemnly promise to "get to the bottom" of the problem. The big losers in all of this are the ailing veterans whose confusion about what happened prevents them from getting on with their lives.
The same thing can be said about people linked to other fad diagnoses.
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