Unknown: Gulf War Syndrome

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Gulf War syndrome (GWS) is an illness associated with combat veterans of the 1991 Gulf War. It is controversial because of the wide variety of

symptoms claimed as its characteristic features and because of the lack of a standardized definition of it. A report issued by the Institute of Medicine (IOM) in 2006 concluded, “although veterans of the first Gulf War report significantly more symptoms of illness than soldiers of the same period who were not deployed, studies have found no cluster of symptoms that constitute a syndrome unique to Gulf War veterans.”

Description

GWS has been described in various ways: as an immune system disorder, a form of amyotrophic lateral sclerosis (Lou Gehrig 's disease), a type of chronic fatigue syndrome, a skin disorder, a cause of birth defects in veterans ' children, a disease of the digestive tract, a neurological disorder, or a lung disease. Specific symptoms include loss of energy and muscle control, headaches, dizziness and loss of balance, memory problems, difficulty concentrating, muscle and arthritis-like pains in the joints, indigestion, skin rashes, shortness of breath, and even insulin resistance (a condition that precedes diabetes). Other symptoms reported by veterans have included diarrhea, chest pain, irritability, sleep disorders, night sweats, bleeding gums, hair loss, and depression.

GWS was first reported in late 1991, shortly after veterans of the brief conflict began returning home. Many veterans began to complain of health problems that they thought were the result of service in the Persian Gulf. In 1998 Congress passed two laws directing the National Academy of Sciences to evaluate the medical and scientific evidence related to what the media had named Gulf War syndrome. The task was given to the Institute of Medicine, which has issued a series of reports on these health problems. It was the IOM 's 2006 report that stated that there is no unique group or cluster of symptoms that can be identified as Gulf War syndrome.

Demographics

About 700,000 American men and women served in the Gulf War in 1991; about 30 percent of them have registered with the database set up by the American Legion to track illnesses related to the war. Studies conducted by the Institute of Medicine and the National Academy of Sciences (NAS) surveyed 19,000 veterans of the Gulf War. Other medical reports by doctors in the field covered an additional 80,000 soldiers.

Causes and Symptoms

The causes of the symptoms associated with GWS are as controversial as the assortment of symptoms. Some that are still considered as possible causes as of 2006 include:

• Infectious diseases, particularly those caused by parasites carried by sand flies
• Combustion products from weapons that used radioactivity-depleted uranium
• Side effects from an anthrax vaccine that was used in the early 1990s
• Exposure to chemical weapons, particularly nerve gas and mustard gas
• Combinations of these causes

Other possible causes that have been eliminated since 1991 include:

• Toxins in the smoke from oil well fires
• Biological weapons
• Nitric acid compounds that were used in Iraqi rockets
• Multiple chemical sensitivity (MCS, another controversial condition that lacks an exact diagnosis)
• Over consumption of aspartame, an artificial sweetener used in soft drinks

Psychological stress is still considered a major factor in causing the physical symptoms associated with GWS, however. The findings of the various IOM studies that identify stress as a cause of many of the symptoms are not accepted by everyone, however. As one epidemiologist explains, “This has been stigmatized—the idea that there may be stress-related illnesses. I think that there 's still a certain perception among some people that for some reasons, stress and psychological illnesses aren 't real, which is certainly not the case.”

One reason why some people have difficulty accepting that psychological stress could cause the physical symptoms of GWS is that the war itself was very short in duration. Thus many assumed it was a low-stress war. This assumption was wrong, however, because the troop buildup took several months before actual combat began. In addition, the soldiers

had heard rumors of chemical and biological weapons as well as the existence of Iraqi missiles; they could not know in advance that the war would be brief; and the desert climate was itself a stressful environment.

Identifying a New Disease

Gulf War syndrome (GWS) is controversial. It is one of a series of war-related syndromes in American history that have never been clearly defined. Since the Civil War (1861–1865), American war veterans have reported a higher rate of stress-related physical and mental symptoms than their civilian counterparts. In 1871, physician J. M. Da Costa wrote about Civil War veterans describing what he called “irritable heart syndrome.” This condition resembled what was later called shell shock in World War I (1914–1918), battle fatigue in World War II (1939–1945), and posttraumatic stress disorder (PTSD) in the Vietnam conflict (1954–1975).

A doctor at the Naval Medical Research Institute compared studies of the veterans of these wars and concluded there were two general categories of war-related illness, one physical and one psychological, but neither has been clearly defined based on laboratory tests or other precise measurements. The diagnosis of physical or psychiatric disorders depended on the soldier 's own description of symptoms and the doctor 's impression.

Studies aiming to identify GWS as a distinct illness are part of epidemiology. Epidemiologists track the frequency and spread of diseases—mental and physical—in large populations. They decide whether a “new” disease or disorder is a previously unrecognized condition or whether it is a different form of a known disease. They could not determine a standard set of diagnostic criteria that defines GWS. The lack of a definition is a major social and medical problem. Naming a disorder has a powerful effect on people 's perception of the condition, the way doctors treat patients, and how patients understand their illness. The controversy surrounding GWS was intensified by media reports of a wide range of unusual health problems among veterans.

Diagnosis

There is no standard diagnostic description of Gulf War syndrome. The findings from the studies carried out by the IOM and NAS showed that the majority of soldiers in the patient sample had illnesses that could be identified by current diagnostic criteria. In many cases, the soldiers would have had these health problems whether or not they had been sent to the Persian Gulf. The smaller group included veterans with the mix of physical and psychological symptoms associated with GWS. The important finding in regard to this smaller group is that their symptom cluster can also be found in about 10 percent of people in ordinary doctors ' offices or health clinics. Thus, it is difficult to maintain that GWS is a distinctive syndrome when a considerable number of civilians report the same vague cluster of symptoms that do not point to any specific disease.

Treatment

Treatment is based on the individual veteran 's symptoms.

Prognosis

The prognosis varies according to the individual veteran 's symptoms.

Prevention

There is no known way to prevent future illnesses that may be related to service in this particular war. The Institute of Medicine has noted that early reports of increased rates of cancer or birth defects among Gulf War veterans and their families are inconsistent. In addition, the IOM points out that cancer is a disease that can take years to develop, so that it will be some time in the future before epidemiologists can tell whether veterans of this particular war have increased rates of cancer compared to people of the same age who were not in combat.

The Future

Epidemiologists have noted that unexplained symptoms among veterans are likely to recur after each war because humans still do not understand the complicated relationship between chronic but nonspecific symptoms and physical or emotional illness. In addition, researchers also do not understand all the social as well as medical factors that cause people—civilians as well as combat veterans—to feel sick. Recommendations for the future include better physical and psychological screening of soldiers before as well as after combat as well as more extensive studies of chronic health problems in civilians as well as military personnel.

Another recommendation for the future concerns better communication between doctors studying war-related syndromes and the general public. One difficulty is the complexity of the medical research involved in tracking down any new disorder and defining its diagnosis. Explaining these complications requires a high degree of skill in preventing misunderstanding by listeners used to ten-second sound bites. Another common problem in communicating with the public is the uncertainty built into the practice of medicine. Many people think of medicine as a neat and tidy branch of science with no loose edges. Perhaps most important, however, is educating the public about a truth that many find hard to accept: that conditions like Gulf War syndrome are evidence of the human mind 's ability to convert fear and other strong emotions into physical symptoms rather than diseases in the usual sense.

SEE ALSO Chronic fatigue syndrome; Posttraumatic stress disorder

WORDS TO KNOW

Epidemiology: The branch of medicine that deals with the frequency, distribution, and control of disease in a population.

Multiple chemical sensitivity (MCS): A controversial health condition related to a patient 's belief that his or her symptoms are caused by exposure to environmental chemicals.

Syndrome: A group of signs or symptoms that occur together and characterize or define a particular disease or disorder.

For more information

BOOKS

Showalter, Elaine. Hystories: Hysterical Epidemics and Modern Media, Chapter 9, “Gulf War Syndrome.” New York: Columbia University Press, 1997.

Wheelwright, Jeff. The Irritable Heart: The Medical Mystery of the Gulf War. New York: Norton, 2001.

PERIODICALS

Barber, Mike. “First Gulf War Still Claims Lives.” Seattle Post-Intelligencer, January 16, 2006. Available online at http://seattlepi.nwsource.com/local/255812_gulfvets16.html (accessed April 7, 2008).

Hyams, Kenneth C., F. Stephen Wignall, and Robert Roswell. “Review: War Syndromes and Their Evaluation: From the U.S. Civil War to the Persian Gulf War.” Annals of Internal Medicine 125 (1996): 398–405. Available online at http://www.gulflink.osd.mil/medical/med_syndrome.htm (accessed April 7, 2008).

Magill, Michael K., and Anthony Suruda. “Multiple Chemical Sensitivity Syndrome.” American Family Physician 58 (September 1, 1998): 721–728. Available online at http://www.aafp.org/afp/980901ap/magill.html (accessed April 6, 2008). This is a short article about MCS and its possible relationship to Gulf War syndrome.

WEB SITES

Public Broadcasting Service (PBS) Frontline. Last Battle of the Gulf War. Available online at http://www.pbs.org/wgbh/pages/frontline/shows/syndrome/ (accessed April 7, 2008). This is a Web site devoted to the controversy over Gulf War syndrome. It includes interviews with doctors, veterans, and political leaders from the late 1990s as well as examinations of the role of the media in fueling the controversy.