Sept. 7, 2000 (Washington) -- While the Gulf War ended nearly a decade ago, the battle over its long-term health effects continues to simmer, and a new report from the nonprofit Institute of Medicine (IOM) adds fuel to the fire. A panel of experts convened by the IOM, a part of the National Academy of Sciences, says there isn't enough evidence to conclude that exposure to four suspected chemicals is linked to Gulf War illnesses.
Specifically, the high-level review looked at the possible health effects of the chemical weapon sarin, as well as pyridostigmine bromide (PB), a drug used to protect soldiers against chemical attacks. The analysis also included the impact of weapons containing depleted uranium and the effects of vaccines against anthrax and botulism -- possible biological terrorist weapons.
"When it comes to the long-term health effects of these substances, the bottom line is we simply don't know enough to say whether there is a connection between exposure to these agents or combinations of agents and specific health outcomes," said IOM panel chair Harold Sox Jr., MD, of the Dartmouth-Hitchcock Medical Center in New Hampshire.
The study was paid for by the U.S. Department of Veterans Affairs (VA) in an effort to pinpoint the broad range of complaints reported by many of the 697,000 soldiers who served during the Persian Gulf conflict in 1990 and 1991. Ultimately, 33 specific substances will come under IOM scrutiny. The vague health issues include fatigue, memory loss, and joint and muscle pain, which persist in spite of treatment.
IOM's research staff reviewed thousands of scientific articles about comparable chemical exposures in the workplace or other environments. New evidence could be the basis for new treatments or broader disability claims to the VA for Gulf Service, but it was not to be. "In essence, it would be a disappointment to that veteran, but the good news is ... you could still get treatment," Mark Brown, PhD, director of the environmental agents service at the VA, tells WebMD. Brown says it's highly possible the additional IOM reports will shed new light on the illnesses.
"The biggest impediment to analyzing the impact of these substances has been -- and remains -- the lack of information about the actual exposures and doses experienced by individual soldiers," Sox said.
What that suggests to Robert Haley, MD, an internist at the University of Texas Southwestern Medical Center in Dallas, is that the military establishment has been mistaken in its approach to Gulf War illnesses from the start. Haley has published a number of studies showing a connection between multiple chemical exposures and disease in Gulf vets. He says taking PB can actually accelerate the damage it's supposed to prevent in some cases.
"Congress has bestowed on [the Department of Defense] and the VA all funding authority for the research on Gulf War illness. ... They spent half-a-billion dollars on the problem. Today, the IOM said that is all wasted," Haley tells WebMD.
Sox said Haley's work is "intriguing" but feels there are problems with his research approach.
It's estimated that 150,000 U.S. troops received protective vaccines, while some 250,000 soldiers took PB tablets. Sarin probably wasn't used during the war, but an unknown number of troops were exposed during post-war clean-up operations. Without more specific details about what happened to those soldiers, the panel says, conclusions about long-term health effects aren't possible.
Here's a summary of the report's key findings:
- Sarin: It is a chemical so lethal, just two drops can be fatal in the short-term. However, in the long run and at lower doses, the effects are not clear. The panel suggests studying victims of two Japanese terrorist attacks. Based on limited evidence, it appears that their symptoms persisted for three years. The panel sees "a limited suggestion of association."
- PB: The tablets were taken to blunt the effect of an expected chemical attack. Used as a treatment for the muscle disorder myasathenia gravis, PB does have some short-term mild side effects, but whether it can damage nerves in the long run is unknown.
- Depleted uranium was used in the Gulf for various offensive and defensive purposes. It's relatively radioactive and may have been inhaled or ingested as dust. No link was shown to cancer. Again, the long-term effect is unknown.
- Vaccines: The panel says the most obvious effect was short-term irritation at the injection site.
In 1996, the IOM concluded in a report that there wasn't convincing evidence of a new disease unique to Gulf War troops.