News About Gulf War Illness

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Veterans returning from the 1991 Gulf War began reporting a range of physical and psychological symptoms, from fatigue, muscle pain, rashes, and diarrhea to cognitive problems and functional impairment. These symptoms became known as Gulf War Illness (GWI). Despite extensive research, the causes of GWI have yet to be identified.

An article recently published in the New York Times highlights research conducted by scientists at Georgetown University Medical Center that suggests that the symptoms of GWI are biological in nature.

This study is just one of many that have examined Gulf War symptoms. More than a decade ago, the RAND Corporation conducted an extensive review of the scientific evidence on eight possible causes of GWI: infectious diseases, pyridostigmine bromide, vaccines, war stress, chemical and biological warfare agents, oil spills, depleted uranium, and pesticides.

We interviewed Bernard Rostker and Ross Anthony, both economists and experts at RAND's GWI, about the background of the Georgetown study. Rostker, formerly Special Assistant to the Deputy Secretary of Defense, commissioned the RAND study, and Anthony is one of the study's principal authors.

Question: What exactly are the findings of the RAND study in this area?

Answer: Rostker: RAND examined the scientific evidence on the possible causes of the symptoms reported by Gulf War veterans. RAND could not find a specific cause in the literature. The group did not find smoking guns.

However, they identified several possible causes that could not be ruled out-including pyridostigmine bromide and pesticides-and stressed the need for further research in these areas. RAND also recommended further research into the susceptibility of individuals to various occupational hazards in the battlefield.

Question: What new evidence does the Georgetown study provide?

Answer: Anthony: The researchers used exercise testing as a diagnostic tool and found that veterans who reported Gulf War-related symptoms had neurological damage to parts of the brain associated with heart rhythm and pain.

They confirmed that physical changes in the brain were related to Gulf War symptoms. The study sample size was small-28 veterans reporting symptoms and a control group of 10 asymptomatic veterans-so the results should be interpreted with caution.

Question: But does the evidence of neurological damage contradict the RAND conclusions?

Answer: Rostker: No. The Georgetown study concludes that GWI is real. RAND never believed that people made up the symptoms. However, RAND found no factors that could explain the symptoms when it examined the entire population of veterans who reported symptoms.

As a special advisor, I asked RAND to summarize what the science at the time said about possible causes; it was not a study. The Georgetown research team clarifies that they are not trying to explain the cause of the neurological damage they have found.

Question: Are there dimensions of the new study that complement the general knowledge base created specifically by the RAND study?

Answer: Anthony: It is significant that the researchers have identified two symptom clusters. To me, this suggests that the battlefield is a messy place and that exposure to chemicals and other agents can affect different people.

As with allergies, people may be more or less susceptible to IMF-related problems depending on their physical and mental state. As Rostker noted, RAND suggested that more research is needed to determine a particular person's sensitivity to the “dirty” battlefield.

Some physicians believe that Gulf War symptoms were caused by combat stress, which were psychological rather than physical. However, this study shows clear biological evidence.

Answer: Rostker: RAND never claimed that the symptoms were psychological; the team simply could not identify a physical cause based on the available evidence.

Answer: Anthony: In addition, several studies, many of them conducted at RAND, have shown that mental health problems such as stress have real physical consequences, but that the magnitude of these effects varies considerably, both individually and as a function of the extent and duration of exposure.

Therefore, the dichotomy between physical and psychological causes is unlikely to be relevant here. As Rostker has pointed out, and as the Georgetown study shows, there may be multiple causes and even multiple sets of symptoms associated with participation in the first Gulf War that RAND and the Georgetown study have not been able to fully explain. Bernard Rostker and C. Ross Anthony are both senior economists at the nonpartisan, nonprofit RAND Corporation. 

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