# Information on Gulf War Syndrome



## M&M (Jan 20, 2002)

I remember someone posting here once talking about they themselves having GWS, or maybe a loved one. I don't remember who it was (LOL) but this was posted to the Co-Cure mailing list, so I thought I would share it here.


> quote:EDITORIALThe Long Aftermath of the 1991 Gulf WarJournal: Annals of Internal Medicine, 20 July 2004 | Volume 141 Issue 2|Pages 155-156Author: Simon Wessely, MA, BM BCh, MSc, MD, FRCP, FRCPsychAffiliation: From King's Centre for Military Health Research, King'sCollege London, London SE5 9RJ, United Kingdom.Potential Financial Conflicts of Interest: The King's Centre for MilitaryHealth Research has been supported by grants from the U.S. Department ofDefense, the U.K. Ministry of Defence, the U.K. Medical Research Council,the U.S. Centers for Disease Control and Prevention, and the U.K.Economic and Social Science Research Council.Requests for Single Reprints: Simon Wessely, MA, BM BCh, MSc, MD, FRCP,FRCPsych, King's Centre for Military Health Research, King's CollegeLondon, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UnitedKingdom; e-mail, mailto:s.wessely###iop.kcl.ac.uk.Soldiers fortunate enough to return from war in sound body have oftenencountered further problems (1, 2). Nevertheless, the scale and natureof the problems reported by veterans of what we must now call the firstGulf War came as a surprise. Casualties were fortunately extremely lightand the duration of fighting short. Yet with the passage of time, atrickle, then a flood, of veterans on both sides of the Atlantic beganreporting health problems.It soon became clear that we were not dealing with a new disease, withanything that affected mortality (3, 4), or with any easily defined,known disease entity (5, 6). Nor, as it turned out, was a classicpsychiatric disorder the answer. The textbook war-related psychiatricdisorder, post-traumatic stress disorder, was present, of course, but notin sufficient quantity to account for what was a substantial healtheffect (7). Instead, we were seeing an increase in symptomatic illhealth, as a series of large epidemiologic studies from the United States(8), the United Kingdom (9, 10), Canada, Denmark, and Australia (11) allreported similar findings.There was no shortage of possible culprits. For example, what was then anindisputable threat from chemical and biological weapons made all prudentcommanders insist on the widespread use of medical countermeasures toprotect the armed forces. The United Kingdom chose to vaccinate ourmilitary against not only the usual infective hazards but also againstplague, anthrax, and pertussis, the last chosen deliberately to increasethe speed of protection against anthrax. Given that all medicalinterventions, even preventive measures, have side effects, it isreasonable to ask, as many veterans did, whether these countermeasurescould have inadvertently caused side effects. In our epidemiologicstudies, we did indeed find a very particular interaction betweenunexplained symptoms and receipt of anthrax vaccine, receipt of multiplevaccines, and place of vaccination (9, 12). We also found evidence ofcellular immune activation in our cohort 10 years after the conflict(13). The significance of this finding is not known. However, thesepossible culprits alone do not account for all of the observed illhealth.Other medical countermeasures used in varying quantities by the coalitionforces included pyridostigmine bromide to counter the threat fromchemical weapons and pesticides to reduce the risk for parasiticdiseases, a traditional burden on soldiers fighting in hostileenvironments. However, evidence that these agents have played asubstantial role is hard to come by, perhaps because of almostinsuperable difficulties in determining who was and who was not exposedand the amount of exposure in different individuals (14, 15).Medical countermeasures were not the only hazards of Gulf War service.The battlefield is by every definition a dangerous place and is made moreso by the use of depleted uranium munitions, which provide even morelethal power to those who use them. In thinking about the balance ofrisks and benefits in using depleted uranium munitions in weapons andarmor, we should not forget that for service personnel on thebattlefield, the most immediate dangers arise from the opposing forces. Atank that returns fire presents an immediate life-threatening hazard, onethat is rarely present when soldiers use depleted uranium munitionsagainst the tank. But did these munitions have lingering, long-termhealth effects? Although the evidence remains disputed (16), depleteduranium alone cannot account for a health effect that is as prevalent inrear echelons as in troops in active combat, in the air and sea as muchas on the ground.It was never very likely that Mycoplasma infection accounted for the GulfWar health effect. Future historians of medicine and culture may puzzleover why people thought that it was a plausible explanation for GulfWarï¿½related unexplained illnesses. They may conclude that the origins ofthis belief had nothing to do with the circumstances of the 1991 Gulf Warbut more to do with the alleged involvement of Mycoplasma species inother contested diagnoses, most particularly the chronic fatiguesyndrome. This purported connection has never found much favor outsidethe United States. Nevertheless, for whatever reason, increasing numbersof U.S. veterans were beginning long-term, potentially hazardousantibiotic treatment to deal with the alleged infection. It would havebeen easy for professionals to ignore this and simply express skepticismand disapproval. However, to their credit, the U.S. Department ofVeterans Affairs and the U.S. Department of Defense chose the moreopen-minded, and expensive, option. They subjected this theory to theonly scientific test that matters, the rigors of the large,well-conducted randomized, controlled trial.The report of that trial, by Donta and colleagues, appears in this issue(17). We are fortunate that it was large enough and conducted diligentlyenough to give an unequivocal answer for both its primary and secondaryend points. Doxycycline treatment has no effect on the health ofsymptomatic Gulf War veterans. Furthermore, serologic evidence ofMycoplasma infection was unrelated to health. In the future, we cannotrecommend long-term treatment with doxycycline or similar compounds forsymptomatic veterans.It would, however, be naive to expect that this negative trial will bethe end of the matter. Those who firmly believed in the central role ofMycoplasma infection in Gulf War veterans' illnesses before the trial didso in the absence of evidence that the rest of us would find compelling.The trial results will not easily persuade adherents to the infectiontheory of Gulf War veterans' illnesses to change their minds, and we maysoon hear their reasons for rejecting the conclusions of the study. Weshouldn't let attempts to discredit the trial results deflect us fromDonta and colleagues' main conclusion: We need to look elsewhere for theanswer to the Gulf War health problem.So what is the answer? Regrettably, we do not know. An equallywell-designed and well-conducted study of behavioral interventions forthe same problems, also conducted by the Department of Veterans Affairs,was not a complete failure, but neither can we call it a great success(18). The trial compared cognitive behavioral therapy with gradedexercise therapy, alone and in combination (19). These interventions werebased on models derived from studies of the chronic fatigue syndrome,which may be an imperfect model of Gulf War veterans' illnesses.Symptomatic Gulf War veterans, at least in the United Kingdom, are notfeeling any better (20), and the simple truth is we do not really knowwhy nor what to do about it. It is now time to consider the problems ofsick Gulf War veterans in the context of other unexplained or ill-definedsyndromes that have arisen in the aftermath of other wars, in other timesand other places. Indeed, Gulf War veterans' illnesses overlap not onlywith previous postconflict syndromes, such as soldier's heart or theeffort syndrome, but also other unexplained and controversial diagnosesfound in nonmilitary settings, such as the chronic fatigue syndrome,multiple chemical sensitivity, or fibromyalgia (21).It remains our moral obligation to continue to support and assistdisabled veterans of the 1991 Gulf War, even if for many we cannotclearly define the exact nature of their problems. The United States iswell placed to do this. The public frequently criticizes the Departmentof Veterans Affairs, but some of us who are passionately concerned withthe health of exï¿½service personnel look across the Atlantic with someenvy. In the United Kingdom, we make no special provision for our servicepersonnel once they leave the military, relying instead on ourcomprehensive health care provision. While this policy is certainlyappropriate for most health problems faced by veterans, it may not besuitable for the difficult, complex, yet clearly service-related enigmas,such as Gulf War veterans' illnesses, that provide us with the greatestclinical and epidemiologic challenges.


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## Ian (Apr 18, 1999)

MrsMason,Thanks for posting, that was interesting.The Gulf War Syndrome - does it exist? debate seems to rumble on in the UK (although there are some pretty debilitated ex-soldiers out there).The author of this editorial heads a CFS unit at a London hospital which has been criticised, rightly or wrongly, for putting too much emphasis on CBT. So it's good to see a degree of open mindedness in his article .Ian


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