/ Maggie Koerth-Baker / 1 pm Thu, Nov 3 2011
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  • Gulf War Syndrome: A lot of questions, few answers

    Gulf War Syndrome: A lot of questions, few answers

    Twenty years ago, the United States sent almost 700,000 soldiers to Kuwait and Iraq as part of Operation Desert Shield and Operation Desert Storm. The war was quick. Bombing began on January 17th and the whole thing was officially over by February 28th. If you started a semester of school just before the first Gulf War began, the conflict would have ended before you even took your midterm exams.

    But this short war left a long tail of consequences.

    Shortly after the War ended, people who’d served in the Gulf began to turn up in Veterans Hospitals, complaining of a range of symptoms: Fatigue, unexplained pain in their joints and muscles, memory problems and cognitive impairment, malfunctioning digestive systems, and more. There wasn’t a clear pattern—different soldiers reported different clusters of symptoms, some of the people who had symptoms had arrived in the Gulf after the fighting ended, other soldiers had boots on the ground from the beginning but no symptoms. As the years went by, epidemiological studies showed no increase in cancers or other deaths in Gulf War veterans, aside from suicides and accidents. Yet, the symptoms were quite clearly linked to service in the Gulf. The same symptoms occur among other groups of military veterans, but are significantly less common. Today, more than 250,000 U.S. veterans report suffering from one or more unexplained symptoms that have, together, come to be known as Gulf War Syndrome. Scientists are still debating the cause, or even if there is one cause.

    In the October 2011 issue of the journal Radiology, Dr. Robert Haley and his colleagues at the University of Texas Southwestern Medical Center published research that identified a nervous system abnormality that exists in some Gulf War Syndrome patients, but not in the healthy veterans who served with them. Haley says it’s evidence that the Syndrome is actually the result of exposure to a miasma of toxins, particularly low doses of sarin nerve gas, extremely high doses of various pesticides, and a drug meant to protect users from the effects of nerve gas.

    But, while everybody agrees veterans are suffering, not everyone agrees with Haley’s conclusions, or his evidence. In fact, some big reviews have discounted it completely. There’s a lot we don’t know, but the stakes aren’t just academic. Research on the cause of Gulf War Syndrome affects the funding, benefits, and well-being of the veterans. Ultimately, this Syndrome represents a big, fat example of what happens when the timetables of good science don’t match up with the timetables of individual health needs.

    New Pieces

    It all began at Khamisiyah. This town in Iraq was the site of a storage center, filled with munitions, including warheads loaded with two different nerve agents, sarin and cyclosarin. In March of 1991, American soldiers blew up the Khamisiyah storage depot, not realizing that there were chemical weapons inside. The diluted chemicals fell on thousands of soldiers who were downwind of the explosion. Nobody was monitoring the air for chemical weapons at the time, and no one reported or was treated for symptoms consistent with nerve gas exposure. But in very low levels, the chemicals were there.

    It doesn’t take much sarin or cyclosarin to cause noticeable symptoms. And we know what those symptoms are. As the chemicals attack the central nervous system, victims first get runny noses, watery eyes, and feel a tightness in their chests. As the poisoning progresses, they lose control of bodily functions, twitch and jerk uncontrollably, and finally lose consciousness. That’s all well documented.

    But we don’t really know what happens to people exposed to minute amounts of sarin. If the chemical is there, but the dose is so low there’s no symptoms, can it still have an effect on your body years later? That’s where sarin and Gulf War Syndrome cross paths.

    Robert Haley thinks he’s found a way to prove that the poison and the illness are more than just passing strangers. His study focused on a neurotransmitter called acetylcholine. Sarin (and certain pesticides that work through a similar mechanism) attack the enzymes that break down acetylcholine. The rhythym of a burst of acetylcholine, followed by breakdown of acetylcholine, followed by a new burst is what allows information to be sent from one neuron to another. If the breakdown doesn’t happen reliably, the message disappears, like an image on a black and white TV suddenly going all white. Haley hypothesized that soldiers who suffered from symptoms associated with Gulf War Syndrome would also have suffered long-term damage to this system.

    To test that, Haley measured blood flow in soldiers’ brains. Anything that inhibits the enzymes that break acetylcholine down should also slow blood flow to certain parts of the brain, including the hippocampus. If previous exposure to sarin had damaged those systems, Haley thought, then the brain might not respond in a normal way when the acetylcholine system was put to the test. He took 57 soldiers from a single battalion, some who had symptoms associated with Gulf War Syndrome and some who didn’t. The soldiers were assigned, at random, to get either an injection of a saline placebo, or an injection of a drug that would inhibit acetylcholine breakdown. Then Haley looked at how the different brains responded.

    He saw a clear difference. Both healthy soldiers and those with symptoms of Gulf War Syndrome showed normal blood flow to the hippocampus under normal conditions, and with the saline injection. With the injection of the inhibiting drug, however, the picture changed. The healthy soldiers’ brains responded exactly as expected: Blood flow to the hippocampus slowed, and the people got tired. Some of the sick soldiers, however, had a very different experience. When exposed to the drug, their brains didn’t seem to know how to respond. In some, blood flow to the hippocampus actually increased, in others it decreased far more than was normal, and for some blood flow stayed exactly the same. Haley says this is evidence of damage. Those soldiers’ acetylcholine systems no longer functioned as they should.

    Old Puzzle

    That seems pretty damning, but Haley’s new study has its faults. While it does mark a replication of results from one of his own earlier studies, Haley’s research has focused exclusively on small sample sizes within a single unit—the 24th Reserve Naval Construction Battalion. When the Khamisiyah storage depot was demolished, that unit wasn’t in a location where they would have been likely to receive even a small dose of the sarin. Haley believes they may still have been exposed to sarin gas from another source, or that the damage is due to exposure to the high levels of pesticides that Gulf War veterans remember applying directly to their clothing and skin.

    Haley has also chosen to define Gulf War Syndrome differently than most other researchers. The Centers for Disease Control defines it as, “as the presence, for 6 months or longer, of one or more symptoms from at least two of the following clusters: general fatigue, mood and cognitive abnormalities, and musculoskeletal pain.”

    Instead, Haley has used surveys of the 24th Reserve Naval Construction Battalion to split the Syndrome into Syndromes, based on clusters of symptoms. In a 1997 paper, he identified six different syndromes. This new paper focused on three of those: Veterans who reported problems with attention, memory, and reasoning; those who reported far more serious cognitive problems with disorientation, confusion, and balance; and veterans whose symptoms clustered around joint and muscle pain and fatigue.

    That makes it difficult to directly compare Haley’s results to those of other scientists. It also muddies the results of his own work. The veterans with confusion and muscular-skeletal symptoms showed damage to their acetylcholine systems, just as I told you before. But the veterans with memory and attention problems didn’t. Their brains seemed to be functioning normally, and it’s hard to say what, if anything, that means.

    Haley’s work hasn’t been replicated by others, says Simon Wessely, head of the department of psychological medicine at King’s College, London. Using larger samples, drawn from multiple British military units, Wessely found no neurological differences between people experiencing symptoms of Gulf War Illness, and those who were not. A 2004 American study turned up similar results. All of this suggests to Wessely, and other researchers, that Gulf War Syndrome is psychological in nature—not that soldiers are making up their symptoms, or that they really aren’t impaired, but that the symptoms stem from legitimate psychological causes, like post-traumatic stress disorder.

    There could be more to it than that, however. Other researchers have found neurological differences between Gulf War veterans who were likely to be downwind of Khamisiyah and those who weren’t.

    Roberta White, professor of environmental health at Boston University, found that the volume of white matter in veterans’ brains varied with their exposure to Khamisiyah—those who likely had high exposures had lower volumes of white matter. In a separate study, White’s team found that likely higher exposure to sarin from Khamisiyah also correlated with poor performance on cognitive tests.

    The confusing part is that results like these doesn’t necessarily tell you much about Gulf War Syndrome. Linda Chao, with the Center for Imaging of Neurodegenerative Disease and and the department of radiology at the University of California San Francisco, has run a couple of studies looking for neurological differences in a group of more than 400 Gulf War Veterans. She found that neurological damage didn't correlate with people who experienced Haley’s definition of Gulf War Syndrome, nor with people who experienced the Syndrome the way the CDC defines it. But she did find that neurological damage correlated with likely exposure to sarin from Khamisiyah.

    In other words, the people with neurological damage were exposed to sarin, and some of them show observable evidence of that damage, but those people aren’t necessarily ones reporting symptoms of Gulf War Syndrome.

    Right now, Gulf War Syndrome is like a puzzle with pieces missing. The theory linking it to toxin exposure makes sense in a lot of ways, but doesn’t line up with all the evidence. Studies are often contradictory, seldom replicated by independent researchers, and frequently use small sample sizes. Meanwhile, hundreds of thousands of people are receiving treatment and benefits (or not, as the case may be) based on an incomplete picture. Haley’s new, small study presents some important questions, but doesn’t do much to help clarify the situation.

    Instead, if we really want to understand Gulf War Syndrome we need two things: More studies using large sample sizes drawn from a wide swath of Gulf War veterans (something Haley says he’s turning his research towards next), and more attempts to replicate the findings of other researchers. Without that, all we have is a lot of important questions, and no answers.

    Find Out More:

    The Gulf War and Health — National Academies summary of research, published in 2010.

    Acetylcholinesterase Inhibitors and Gulf War Illness — a 2008 research paper by Beatrice Golomb of the University of California San Diego. It looks at epidemiological evidence of whether sarin and pesticides can damage the acetylcholine system in the way Haley has proposed, and what the symptoms of that damage would likely be.

    GulfLink — The primary Department of Defense website for Gulf War Illness information.

    IMAGE: Defense Department photo: Military personnel examine a Scud missile shot down in the desert by an MIM-104 Patriot tactical air defense missile during Operation Desert Storm.

    / / COMMENTS

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    1. not to put bb down but this is shockingly well written and researched compared to most “tweet style” journalism here.

    2. In the Hiroshima museum, they sell a book that makes it crystal clear that the symptoms of the Gulf War Syndrome are exactly the same as for the victims of Hiroshima and Nagazaki, exactly the same as for workers in uranium mines and exactly the same as for the iraqis that have been bombed. There is no question about depleted uranium being the source of the syndrome.

      What US government says is not interesting. They still haven’t admitted that the Agent Orange they dumped over Vietnam is causing the birth defects.

    3. I hope there is an answer out there for the men and women suffering with this so called syndrome. I have a good friend who served in Iraq, and he has some really weird growths in his throat among other things. There are a tremendous number of young people who are becoming old people way before their time simply because they served time in the military.

      1. Unlike their beneficiaries of “freedom and democracy”, who never got a chance to grow old, at any pace.


        1. Kinda thinking that the Vets I see at the clinics and hospitals are not the idiots that dreamed up these fiascos. You’re entitled to your option though.

    4. Reason Magazine did a big piece on this a while back.  It’s older now, but a lot of the points still stand – http://reason.com/archives/1997/03/01/gulf-lore-syndrome/singlepage

    5. Thanks for writing this. 

      One of the greatest crimes in this (aside from the failure to do a large scale study on GW Vets in 20 years) is the fact that Vets can only get disability for GWS if they are classified as having an unknown diagnosis. 

      So, for example, if you go in for joint pain you’ll probably be diagnosed with degenerative joint disease. Then, hey, you have a diagnosis! That means that you don’t have GWS! Goodbye and don’t let the door hit you in the ass on the way out.

      My current VA doc was unaware of this. He said that he always thought it was strange that he was told to make sure that he provided a diagnosis when he was doing GW compensation physicals.


    6. Memory problems?  Gastro-intestinal distress? Difficulty focusing?   That sounds similar to “Soldier’s Heart”, a common ailment reported by US Civil War veterans.  

      War will f*** you up, and not just physically.

      1. Doing the research for this, it occurred to me that Gulf War Syndrome would probably be a hell of a lot less controversial if there was more acknowledgement that:
        A) War fucks you up an not just physically
        B) Having physical symptoms with psychological causes doesn’t mean you’re a bad person or that you’re nuts or stupid
        C) We have a social responsibility to care for ALL disabled veterans and treat the psychological consequences of war with the same respect and seriousness we give the physical consequences.

        1. I think an even more important responsibility is to not send them to war, period.

          If the fight comes to us, that’s one thing. But sending soldiers overseas to combat the cause of the month is developing a pattern of causing more harm than good.

          Being a veteran these days earns nothing but street cred in a presidential race.

    7. I find it hard to believe that soldiers would blow up an arms depot without knowing exactly what was inside, outside of some emergency situation.

      1. Several of my friends who were there feel this. Especially the guys in armor. But I don’t think that has panned out in any tests.

        It’s probably more than one thing causing problems.

        @boingboing-7160c7db52df96e5fe196a6c9ce73f83:disqus  re: “We have a social responsibility to care for ALL disabled veterans”

        Yeah – the gov. can’t take care of the small number of vets they are supposed to. My friend had issues with his kidneys that some of the doctors thought it might be from agent orange and wanted to run more tests. The VA wouldn’t pay for it because “He never set foot on Vietnam.”

        He was on the USS Enterprise which has a brazillion gallons of it and everyone was exposed when the ship caught fire.

    8. I’m not sure I see any problem with the fact that Haley split GSW in to multiple syndromes, if anything I see this as a step forward. The problem with defining something as a syndrome is that it is not a diagnosis per se, it is merely a clustering of symptoms that commonly appear together, and they don’t have to appear as a consistent gestalt, as this article points out. Therefore, it is perfectly possible for a syndrome to encapsulate, were the data to be teased apart sufficiently, multiple distinct medical conditions.

      Far from muddying the waters, this research would appear to make things clearer. The vets who exhibit damage to their acetylcholine systems showed confusion and muscular-skeletal symptoms, those who have intact acetylcholine systems have different symptoms. It’s not an enormous leap to suggest that this could be due to different exposure levels to nerve agents. That gets split off as a distinct medical condition (assuming additional research supports that), and then the hunt begins for what is causing memory and attention problem.

      I have a personal issue with the concept of syndromes, or more specifically, their effect on the thinking of some in the medical fraternity. The problem as I see it is that there are those who are too readily willing to consider a syndrome as a diagnosis, whereas it is more specifically a set of possible medical conditions. However, once you are diagnosed with a syndrome that can be the point where the medical investigations end. Instead, that should be the point where an attempt is made to drill down to the root cause.

      In the interests of disclosure I should say I have a personal issue in this. For many years I have suffered severe bowel problems which have been repeatedly classified as IBS. My argument is that IBS covers such a broad range of symptoms it is not a diagnosis, but repeatedly I hit a brick wall when I was just told that I had IBS. Eventually, after much cajoling it was suggested that I be medicated with bile acid sequestrants as a test to see if my symptoms were due to bile acid malabsorption, and while things aren’t perfect now, the difference has been like night and day. So for years I’ve been suffering with something that appears to have been easily treatable, but completely discounted because I already had a diagnosis of IBS. Personally, I believe that any effort to decompose a syndrome into specific concrete diagnoses should be applauded.

    9. If governments manipulate a bunch of innocent/ignorant kids with good hearts to go and do unethical stuff by convincing the kids that they’re doing the stuff for real honest-to-goodness intentions, the least those governments can do is pay for the consequences (IE craziness, sickness, et cetera). Cheapskates as well as liars.

    10. If they want to investigate these problems then they should also include the Iraqi citizens who don’t receive even basic medical care and have lived through having family members killed, themselves maimed, and lived in fear for years.  They should have Gulf War syndrome in spades.

      Also, to some of the comments here, I’m not sure how those operations protected our individual rights since Iraq wasn’t ever about to invade the US.  In fact our individual rights seem to have decreased since then.

    11. I don’t think depleted uranium accounts for all the problems soldiers have had. The data regarding the serin exposure is pretty interesting and makes sense. The thing is I don’t think it’s just one thing. GWS is nice to say but it’s probably a little too broad.

      I think soldiers should be taken care of. You give up certain rights that you would otherwise have in the civilian world in return the VA is supposed to take care of you in case of problems occuring from your service.

    12. Oh, I’m sure we’ll have answers to all of these questions and more some day. 

      Like the day after the government can protect itself from legal liability.  Then they’ll trot out their very best agent to give us all the scoop.  You guys have met him, right?  Agent Orange?

    13. This sort of thing seems so incredibly easy to nail down if everything weren’t redacted. Are civilians in the ‘host’ countries suffering from similar symptoms?  If so, do they correspond to soldiers who served in these specific areas? Then lets audit what happened in this one specific spot (I realize it would be multiple locations)…

    14. Those symptoms are rather vague, from this description I suffer from Gulf War Syndrome as well, although I’ve never been there, been no soldier, haven’t been exposed to Sarin, and so on.

    15. I’m sort of surprised there was no mention of the US’s treatment of our troops as guinea pigs for all sorts of stuff that they aren’t told what it is.  Anthony Swofford recounts this happening to him during his service in Desert Storm in his book Jarhead (dunno if that part was in the movie version.)  I knew a vet that affirmed he was given medical treatments with insufficient explanation. (That cat is a little ‘off,’ too, but correlation does not imply causation, I know.)

      If we’re looking for a combination of causes (sarin, pesticides, psychological damage, and as the commenters suggest, uranium,) then what about the stuff their COs ordered them to take?

      This is a really informative read given the info available, though.  Good job, Maggie.

    16. My brother was 44 this year when he passed away from Esophageal Cancer in May of this year. Prior to that he had had the “weird” rashes on his body after coming home from the Gulf war in the 90s. He told me he felt if he hadn’t of taken that vaccine the government gave him to “protect” them, he would have been fine. Regardless of what this research here shows, there actually HAS been other research showing many of these troops dying of cancers like Esophageal, Lung, etc… non-smokers, pretty healthy soldiers who should be retiring now, are dying way too young.

    17. This makes sense in a lot of ways.  I’ve been sick for 20 yrs and I have the PTSD, muscle pain, joint pain, skin problems, severe major depression, CFS and a whole lot of other stuff wrong with me.  But I don’t feel crazy, just got some issues. 

      I don’t think we’re ever going to get to the bottom of this because there are too many things we were exposed to that react different way, i.e. depleted uranium, burn pits, sarin & cyclosarin, PB Pills, pesticides, etc.  So we as vets have to endure our daily miserable delima.

      As far as receiving medical care, the VA here in Dallas has been great but the Regional Office in Waco is another story.  I’m going on 15 months and NO answer on my claim.  This is ridiculous.  I have all the diagnosis from the doctor in VA and went to a Gulf War research study in DC that came back with 7 DX’s but still no answer from this outfit.  I believe it is a repeat of what happened in Vietnam, gotta wait another 20 yrs before they say yeah, they’re sick get em all back pay, well the ones that are still alive, it will be cheaper that way.


      1. You were also exposed to combat against an amorphous foe that is willing to die in order to kill you and your brothers, and is indistinguishable from the people you’ve been ordered to protect, in a place where the road itself can spontaneously explode.  I don’t think it’s fair to ask you to just “get over it.”

        Thank you for your service.  It’s nothing short of a war crime that our government isn’t taking care of you after all you’ve given.

      2. You are suffering from an experimental anthrax vaccine: http://www.vaccine-a.com/book.html . Specifically, they put squalene in the vaccine as an adjuvant, which causes these symptoms. Pass this around.

        1. re: “We meet an Army sergeant whose skin became so diseased that doctors, in a desperate attempt to cure him, removed every square inch of skin from his body.”

          Unless this means something other than the obvious – it isn’t possible.

          1. With the exception of the head, it is possible.  They use full-body debridement to treat severe cases of necrotizing fasciitis, as it travels along the layer between muscle and skin (the fascia, hence the name).

            It’s a horrific treatment, but it’s not death.  Not going to say it’s a better alternative…

    18. Read “Vaccine -A” by Gary Matsumoto: http://www.vaccine-a.com/book.html . This investigative journalist uncovers the truth about Gulf War Syndrome. It is caused by the use of squalene as an adjuvant in the anthrax vaccine administered to soldiers in that conflict. There are some who received this vaccine and did not even go to the Gulf, but got the symptoms anyway. Most of Matsumoto’s references are from scientific peer-reviewed literature.

    19. Thanks Maggie, I have a friend that suffers from one version of the syndrome.  Someone should really figure this out.  First because these vets deserve effective treatment, but also because a lot of  the potential factors still present in our current war-zones

    20. If small doses of sarin, a neurotoxin, can cause these problems, then does it not stand to reason that the PB pill, which contained a small dose of neurotoxin, could also cause similar symptoms?

      1. Military treatments have one priority: keep the soldier fighting.  Once the soldier has left the battlefield, what happens to him is no longer tactically significant.  I’m pretty sure they’d prescribe massive doses of steroids, if they hadn’t taken to keeping soldiers in the field long enough to start seeing the side effects.

    21. How are so many here(including apparently the author of the article) oblivious to depleted uranium munitions and it’s effects on not only soldiers firing the weapons but the environment we fire them upon?   If Boing Boing’s newly inspired journalists feel like earning their stripes that would be a great subject to inform it’s readers about.

      Iraq, Afganistan, Libya and who knows who’s next.   All areas that are now covered in “minor” amounts of radiation from our armor piercing uranium laced munitions.

      1. I think we should try to be as technically accurate as possible here.  The “depleted” part of DU is important.  It means it’s no longer giving off radiation like normal uranium (also keep in mind that many aircraft have a lot of beryllium in their fuselage, which is also slightly radioactive).  DU has only been shown to be hazardous when vaporized and inhaled (which does NOT mean it ISN’T hazardous via other vectors of exposure).  DU is most commonly used in tank ammunition and armor, not because it’s radioactive (again, it isn’t very) but because it’s really, really hard.  The only way to reduce it to an airborne powder is to hit it REALLY hard against something else that’s REALLY hard.

        Thankfully no such situation ever arises in tank combat.  Unless any tank manages to hit any other tank, ever.

        In the name of safety, our guys will typically throw a tarp over a destroyed tank to prevent DU dust from blowing about. They do this after the tank has stopped burning, and after the area’s no longer dangerous, and after they have nothing better to do, and after they decide they feel like it. If they have a tarp on hand.

    22. For another account of the long-term damage that sarin can inflict, check out Haruki Murakami’s excellent, heartbreaking piece of citizens’ history, “Underground: The Tokyo Gas Attack and the Japanese Psyche.” What this substance does to people is horrific, and the symptoms mentioned here line up with what the victims of the Aum attack on the Tokyo subway system continue to experience years later.

    23. The diagnostic criteria for GWS are essentially the exact same as those for Fibromyalgia Syndrome. It’d be interesting to see a study utilizing the same ACH-blocking chemicals with brain scans of fibro patients. 
      Despite not being exposed to neurotoxins, the general consensus does seem to be that people who develop fibro experienced a combo of physical/emotional trauma plus serious viral illness (which could be considered a type of chemical shock to the brain). I wonder if their brains look the same as GWS sufferers. There are already extant studies showing hippocampal abnormalities in patients with FMS. 

    24. it was hilarious the number of Khamisiyah-related letters i received from DA and VA.  “you were near there and exposed…” … next letter:  “OK, you were near there, but everything’s cool, you are fine..”   next letter: “huh, well…you were there and uhmm we’ll get back with you.”   classic .gov


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