Report Casts Doubt on Gulf War Syndrome

A recent study published by the National Academy of Sciences cast doubt on the reality of Gulf War Syndrome (GWS) as a specific disease or syndrome.

About 60,000 of the nearly 700,000 Gulf War veterans began reporting health problems in the months and years following their military service. Complaints include insomnia, irritability, hair loss, chronic fatigue, muscle spasms, skin rashes, memory loss, diarrhea, headaches, and unexplained aches and pains. Some veterans believe that GWS is also responsible for birth defects and cancer; others claim that GWS is a sexually transmitted disease that threatens the health of not only the veterans but their spouses and partners as well.

The precise etiology of Gulf War Syndrome is very difficult to pinpoint; nearly everyone agrees that many veterans are suffering; the question is whether the symptoms are related in any way to military service and have a common cause.

The controversy over Gulf War Syndrome—now in its second decade—highlights the difficulties of scientific and medical certainty. Part of the problem is that the symptoms are so diverse—and so common—that attributing a specific cause to a specific illness can be difficult or impossible. Is a skin rash or persistent cough caused by toxic chemicals inhaled years ago at an Iraqi munitions dump, or toxic chemicals inhaled over months or years from a nearby, polluting factory upwind? Or neither, or both?

In the real world, correlation can be very difficult to distinguish from causation: Links that may seem obvious are not always clear. For example, many lifelong smokers never get lung cancer, while many non-smokers do.

Study limitations

In 1996, a panel appointed by President Clinton concluded that "significant evidence supports the likelihood of a physiological stress-related origin" for many GWS ailments. The Pentagon was criticized in later years for not doing more to track which American troops were exposure to which toxins, as well as inadequate pre- and post-deployment health measures. (Some veterans may be sick when they leave the military, but without having a statistical baseline to determine how healthy they were to begin with, such numbers are difficult to interpret.)

 In 1998, Congress passed two laws that contracted the National Academy of Sciences to "review and evaluate the the scientific and medical literature regarding associations between illness and exposure to toxic agents, environmental wartime hazards, and preventive medicines or vaccines associated with Gulf War service."

For its new report, the Committee on Gulf War and Health did not collect any original data, instead focusing on 850 potentially relevant, peer-reviewed epidemiological studies. The committee published its finding in a 2006 report, "Gulf War and Health." The report noted that the original studies' conclusions were clouded by many common limitations, including "use of a population that was not representative of the entire Gulf War population, reliance on self-reports rather than objective measures of symptoms, low participation rates, and a period of investigation that was too brief to detect health outcomes with long latency such as cancer."

Every study examined found that Gulf War Veterans "report higher rates of nearly all symptoms examined than their nondeployed counterparts....In many studies, investigators found a higher prevalence not only of individual symptoms but also of chronic multisymptom illnesses among Gulf War-deployed veterans than among the nondeployed."

However,  the report notes, "there are no clear objective diagnostic criteria that can be used to validate the findings, so it is not clear whether the literature supports a true excess of the conditions of whether the associations are spurious and result from the increased reporting of symptoms across the board."

"No unique syndrome"

The report states that despite the effort and resources devoted to examining GWS, "The information has not been sufficient to determine conclusively the origins, extent, and potential long-term implications of [Gulf War service] health problems....The difficulty in obtaining meaningful answers...is due largely to inadequate predeployment and postdeployment screening and medical examinations, and lack of monitoring of possible exposures of deployed personnel."

The study found that there was "no unique syndrome, unique illness, or unique symptom complex in deployed Gulf War veterans."

As expected, veterans were at increased risk for several psychiatric illnesses, such as post-traumatic stress disorder, anxiety, and depression. Among those symptoms that could be measured with diagnostic tests, studies did not find an increase in cancer, birth defects, cardiovascualr disease, or peripheral neuropathy. Veterans were at greater risk of respiratory illnesses, and there was some evidence that veterans had an increased likelihood of amyotrophic lateral sclerosis.

Many Gulf War Veterans angrily rejected the latest study's findings, as they did previous reports and studies that did not support their conclusions. Often this is because they mistakenly believe that if the syndrome is not proven "real," that somehow relegates the suffering veterans to liars, hoaxers, or fabulists. Instead, as with mass hysteria, those truly suffering from the illness are not faking or imagining the symptoms; instead they are simply misattributing the cause.

Benjamin Radford, managing editor of Skeptical Inquirer magazine, wrote about conversion disorders in "Hoaxes, Myths, and Manias," co-authored with Robert Bartholomew.