Panel Confirms Gulf War Syndrome Is Real and Causes Are Definable

http://www.medpagetoday.com/PublicHealthPolicy/MilitaryMedicine/11814

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By John Gever, Senior Editor, MedPage Today
Published: November 17, 2008
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WASHINGTON, Nov. 17 – The Gulf War illness was caused by pyridostigmine bromide pills taken by U.S. troops to neutralize the effects of nerve gas attacks and by exposure to neurotoxic insecticides, according to a VA advisory panel.These two factors amounted to a definable scientifically valid illness with significant nervous system symptoms often still affecting veterans of the 1991 conflict in Kuwait and Iraq, said the Research Advisory Committee on Gulf War Veterans’ Illnesses.

Exposures to neurotoxic compounds including insecticides — which thousands of soldiers took as protection against nerve gas — are the most likely causative candidates, added the report.

“Scientific evidence leaves no question that Gulf War illness is a real condition with real causes and serious consequences for affected veterans,” the report said.

At the same time, the report exonerated a number of other suspects in symptoms reported by returning veterans of Operation Desert Storm, including depleted uranium, anthrax vaccine, infectious diseases, and stress.

The committee was established and funded by congressional mandate. It delivered the report today to VA Secretary James Peake. The department is under no obligation to follow the report’s recommendations, which run counter to the VA’s long-standing position on Gulf War illness. The VA’s press office did not respond to requests for comment on the report.

The report estimated that about 175,000 to 210,000 of the approximately 700,000 deployed personnel “are affected by a complex of multiple symptoms, variously defined, over and above rates in contemporary military personnel who did not deploy to the Gulf War.”

Symptoms typically include a combination of memory and concentration problems, persistent headache, unexplained fatigue, and widespread pain, and can also include chronic digestive difficulties, respiratory symptoms, and skin rashes.

Much of the report echoed a meta-analysis on acetylcholinesterase inhibitor exposure published earlier this year by Beatrice A. Golomb, M.D., Ph.D., of the University of California San Diego, a member of the committee. (See Chemical Exposures in Gulf War Caused Veterans’ Illness)

The committee was chaired by James H. Binns, former principal deputy assistant secretary of defense. Its scientific director was Roberta F. White, Ph.D., chair of environmental health in Boston University’s School of Public Health.

Multiple insecticides and bug repellants were widely used during the war, the report said. Subsequent studies have found dose-response effects with these agents, as well as neurocognitive deficits and neuroendocrine alterations in Gulf War veterans.

“All available sources of evidence combine to support a consistent and compelling case that pesticide use during the Gulf War is causally associated with Gulf War illness,” the report said.

In addition, as many as 250,000 personnel sent to the region took pills containing the carbamate pyridostigmine bromide to protect against potential nerve agent exposure.

Dose-related effects in veterans have been identified for this agent, according to the report.

Other key findings of the committee’s report:

  • Exposures to low-level nerve agents such as sarin during destruction of Iraqi stockpiles, close proximity to oil-well fires, effects of multiple vaccinations, and combinations of exposures cannot be ruled out as causes of Gulf War illness.
  • Gulf War illness is associated with diverse biological alterations that most prominently affect the brain and nervous system.
  • Gulf War illness differs significantly from multi-symptom conditions such as fibromyalgia in the general population, although there are similarities as well.
  • Gulf War veterans have significantly higher rates of amyotrophic lateral sclerosis than other veterans.
  • Gulf War veterans potentially exposed to nerve agents have died from brain cancer at elevated rates.

The committee recommended that Congress budget at least $60 million annually for new research on Gulf War illness.

It said research into treatments was the most pressing need. The report also called for studies into objective biological markers of the syndrome as well as additional epidemiological research.

The findings contradict several earlier studies commissioned by the VA, including a series conducted by the Institute of Medicine, that found no consistent evidence of an illness or set of symptoms unique to Gulf War veterans.

In fact, the Research Advisory Committee criticized the Institute of Medicine reports as “skewed and limited by a restrictive approach.”

In commissioning those reports, the VA had required the institute to exclude animal studies in analyzing possible effects of Gulf War exposures.


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