COULD GULF ILLNESSES HAPPEN AGAIN IN IRAQ
13 Jan 2003
Source: Baltimore Sun, January 13, 2003
Veterans ask if gulf illnesses could happen again in Iraq
Questions raised about health risks, protection
By Erika Niedowski, Sun Staff
It has been 12 years since the Persian Gulf war and Steve Robertson still can't explain his aching knees and ankles, his sometimes terrible mood swings and his trouble remembering things.
Maybe it was exposure to chemical agents or the pills he took to protect against them. Perhaps it was the anthrax vaccine he received or the smoke he inhaled from landfill fires near where he was stationed in Saudi Arabia. Maybe it was a combination.
"That's going to be a question mark in my mind for the rest of my life," said Robertson of Falmouth, Va., who served as a military police officer in the Army National Guard and is now on retired reserve.
After spending $213 million in the past decade sponsoring 224 medical studies of the mysterious health problems of gulf war veterans, federal officials have come up with this explanation: Something happened, but they don't know what.
Now, with the buildup of U.S. troops in the Persian Gulf once again, questions have emerged about whether the military is ready to protect its soldiers from potential health threats in the region.
"If we don't learn from [the] history of the gulf war, we're going to repeat it, God forbid, in this next situation that may come up," said gulf war veteran Steve Smithson, a member of the Department of Veterans Affairs' Research Advisory Committee on Gulf War Veterans' Illnesses and head of the American Legion's Persian Gulf task force.
The difficulty is in trying to prepare for - and prevent - something that is not understood. In addition to possible chemical and biological agents, a range of potential health hazards have been studied as possible causes of gulf war-related illnesses, including oil well fires, depleted uranium munitions, pesticides, vaccines against infectious diseases and anti-nerve gas tablets.
For years, the government explained away the wide range of symptoms, collectively known as "gulf war syndrome," as stress-related. Some frustrated veterans were told that their problems were all in their heads.
Despite the battle over medical diagnoses and disability benefits, consensus now exists on at least a few points: that gulf war veterans have reported far more symptoms than veterans of other conflicts - two to three times more - and that those symptoms are real.
But while some researchers have suggested that the symptoms are caused by brain damage resulting from exposure to low levels of chemical agents, the Defense Department has not pointed to a single cause, instead classifying many as "unexplained."
"We can't prove that these things aren't due to something they were exposed to in the gulf," said Dr. Francis L. O'Donnell, a medical consultant at the Pentagon who has tracked gulf war illnesses.
Military officials say that, since Operation Desert Storm in 1991, the Defense Department has introduced improved protective masks and clothing, including a new lightweight suit designed to be less cumbersome, as well as more reliable chemical detectors. It is also requiring inoculations against smallpox - even though the vaccine can pose health risks.
But a report in the fall from the General Accounting Office, the investigative arm of Congress, found that "serious problems" persist in biological and chemical weapons preparedness.
The report said the military doesn't have enough protective suits and risks a worsening shortage; in the past few years, hundreds of thousands of defective suits have had to be destroyed. The Pentagon's inspector general testified before Congress in October that the military had only 5 percent of the specialized shelters needed to provide treatment to troops in the event of a biological or chemical attack.
Col. Erik Henchal, commander of the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, in Frederick, said last week that the military is not prepared to defend against some lethal toxins that are thought to be part of Iraqi leader Saddam Hussein's biological arsenal.
O'Donnell said that efforts to protect troops' health have improved since the gulf war in everything from record-keeping to communication.
The military has gotten better at "medical surveillance," or collecting baseline health information on its troops, he said. That was not the case with the gulf war: Military officials have not been able to say with certainty which soldiers received the anthrax vaccine or took PB, or pyridostigmine bromide, anti-nerve gas pills.
"The idea is just to monitor the health of the force," said O'Donnell. "It just was done on a spotty basis during the gulf war. I think that lesson has been taken very seriously."
O'Donnell said the military has stepped up its "environmental surveillance," scrutinizing areas for potential threats ranging from air and water pollution to malaria. All soldiers are to be given a "medical threat briefing" before they are deployed.
According to the VA, about 208,500 claims for a service-connected disability have been filed by the 572,520 veterans who served in the gulf war and are eligible to make claims. About 161,700 claims had been granted as of August.
Overall, the percentage of service members in the ongoing gulf war "era" who are receiving disability is 11.8 percent, compared to 9.5 percent for Vietnam veterans, 5 percent for Korean War veterans and 10.4 percent for World War II veterans.
Tens of thousands have complained about joint and muscle pain, chronic fatigue, headaches, breathing problems, diarrhea, memory loss, sleep disturbances and seizures, among other things.
Steve Robertson, the guardsman who now lobbies Congress for the American Legion in Washington, knows his health problems haven't been as debilitating as those of some fellow servicemen. His worst symptoms - a hacking cough and persistent diarrhea - cleared up after a few years.
But the 52-year-old is nowhere near the condition he was in before his deployment to the gulf on Valentine's Day 1991. He gave up playing in his three basketball leagues because of coordination problems, and his memory lapses have forced him to constantly make lists. He tires often and can be easily irritated.
"I have a very low tolerance for issues," he said. "Someone can say something to me [and] I'll go from zero to 90. I get very upset. I really have to focus on it both at work and at home. It's changed my life. I've had to make adjustments for what I'm not able to do anymore."
Rich Fales, 44, of Silver Spring, who served with Robertson, suspects that inhaling thick smoke from landfill fires is responsible for most of his health problems, which have included coughing up blood and trouble breathing.
"My lungs have not returned the way they're supposed to be," he said.
Science of war
Dr. Robert W. Haley, chief epidemiologist at the University of Texas Southwestern Medical Center in Dallas, believes that the mystery surrounding gulf war illnesses is slowly being unraveled.
He has published numerous studies suggesting that some can be explained by brain damage resulting from low-level exposure to nerve agents and other chemicals. He found that the sickest veterans had damage in the part of their brains responsible for automatic functions such as breathing and digestion.
"I think it's safe to say that the rank-and-file bureaucracy is still skeptical and still negative on all of this," said Haley, another member of the gulf war illness research advisory committee. "What's different is there's now a countervailing force."
Two recent Army-sponsored studies found that low levels of sarin gas affected body function and behavior in laboratory animals for some time after exposure, even though it did not produce immediate symptoms.
The Pentagon has said that more than 100,000 troops may have been exposed to sarin when a large ammunition storage facility in southern Iraq was destroyed in March 1991. But the Defense Department contends, at least officially, that low-level exposure is unlikely to cause long-term health problems.
Government officials said last year that gulf war veterans are nearly twice as likely as other soldiers to develop amyotrophic lateral sclerosis, or Lou Gehrig's disease, which cannot be treated and is often fatal within two to five years.
Mike Donnelly, 43, who served in the gulf as an Air Force fighter pilot, is in his seventh year with the disease. He is unable to speak but wrote a book about his experiences.
"He's totally immobile and he can't eat, so he's fed by a feeding tube," said Tom Donnelly, his father. "He's dependent on a ventilator for respiration. He is helpless, basically. He's lifted from bed to wheelchair and back at the beginning and end of every day."
Tom Donnelly is convinced that his son, who lives in South Windsor, Conn., was exposed to chemical nerve agents during bombing missions.
"In the fullness of time, it will be substantiated by research and, indeed, it's beginning to happen now," he said.
Dr. Mohamed Al-Ibrahim, executive chief of staff for the VA Maryland Health Care System, said more work must be done to understand gulf war illnesses. Researchers at the VA Medical Center in Baltimore tracking veterans exposed to depleted uranium have found no link to serious illness.
"There have been no persistent and significant abnormalities, but that study is ongoing," Al-Ibrahim said.
Steve Robinson, a gulf war veteran who serves as executive director of the Silver Spring-based National Gulf War Resource Center, fears that some mistakes made in the gulf may be made again. The military is not doing enough, he said, to screen soldiers' health before, during and after their service.
"Those things aren't being done now," he said. "So if you're asking me: Is it a possibility something like gulf war illness could happen again? Yeah, if the military doesn't do its job."