Is it real?

The Mayo Clinic Proceedings published an article in 2000 that summarized the scientific evidence that had accumulated on “Gulf War Syndrome”. After review of the initial data, the results of the preliminary studies concluded that, although many veterans had subjective feelings of illness, there was little objective evidence for a single condition afflicting Gulf War veterans.

Since that time more studies have been performed and now the Institute of Medicine (IOM) has issued the final of a series of comprehensive reports encompassing more than 14 years of scientific data. The authors of this review have stated that, “although deployed veterans report more symptoms and more severe symptoms than their nondeployed counterparts, there is not a unique symptom complex (or syndrome) in deployed Gulf War veterans.” Other findings published stated that mortality and rates of hospitalization were no higher among Gulf War veterans, and no increase in birth defects was seen. Some of the objective measures of disease such as pulmonary function testing and peripheral nerve electromyography also showed no differences between deployed veterans and their nondeployed peers.

The IOM’s authors did once again note that these Gulf War veterans experienced various symptoms and were diagnosed as having multi-symptom conditions, such as fibromyalgia and chronic fatigue syndrome and psychiatric disorders at a higher rate than their peers.

Many of the theories and hypotheses causing the infirmities are still under question. The Mycoplasma theory has not been confirmed nor has the chemical weapon theory. The IOM looked at a number of potentially toxic medications (eg, pyridostigmine), anthrax and other vaccines, depleted uranium, and chemical munitions but found them to be either of negligible significance or unverifiable and heavily tainted by recall bias. By far the most contentious issue has been the potential exposure to chemical agents, particularly resulting from the demolition of Iraqi chemical weapon stocks at Khamiseyah in March 1991. But even after a decade of review of military records, epidemiological investigation, and computer modeling there has been a failure to answer the simple questions: were servicemen significantly exposed to sarin and cyclosarin, and did anyone become ill from this exposure? The fact remains that studies to date of possibly exposed troops have not indicated any major health effects.

The latest IOM report represents the current understanding but is far from conclusive in any fashion. The controversy will remains and the underlying cause may never be known.

Since we now have another large group of veterans returning from the current war, we need to consider what factors lead to unusual post-conflict illnesses among veterans and how to care for these people.