Panel finds there is no single "Gulf War syndrome"

WASHINGTON — An expert panel reviewing hundreds of studies has concluded there is no single "Gulf War syndrome" afflicting thousands of veterans of the first war in Iraq, although they have suffered vague symptoms at a much higher rate than other veterans.

They have also experienced post-traumatic stress disorder (PTSD) and depression two to three times more frequently than other veterans, the panel found. Less certain is a possibly higher risk for the neurological ailment Lou Gehrig's disease, and possibly a rare birth defect in their children.

"We can't identify a Gulf War syndrome," said Lynn Goldman, a physician and epidemiologist who headed the 13-member committee appointed by the National Academies Institute of Medicine (IOM).

Previous blue-ribbon panels, including several convened by the IOM, one by the Defense Department and one by the White House under President Clinton, reached the same conclusion.

In preparing the report, Goldman and her colleagues read 850 studies done in the years since soldiers in an Army Reserve unit in Indiana began reporting a constellation of symptoms that included fatigue, joint and muscle pains, difficulty concentrating and memory problems in the months after returning from the Gulf in 1991. The panel gave more credibility to large, well-designed and controlled studies; it did no original research of its own.

The largest and most representative study found that 29 percent of Gulf War veterans reported physical complaints arising from several body systems, compared with 16 percent of servicemen and women who were not sent to the Gulf. This was not just an American phenomenon; British, Canadian, Australian and Danish troops deployed to the Gulf also reported more symptoms than their nondeployed counterparts.

Gulf War veteran advocates say they have never claimed that they suffered from an all-encompassing syndrome.

"I think this report still shows that there are higher reports from Gulf War veterans of illnesses, and we should give them the benefit of the doubt," said Julie Mock, of Woodinville, who serves as president of the National Gulf War Resource Center.

Mock is a Gulf War veteran who after her return suffered night sweats, rashes, swelling of the joints and fatigue. Eventually she was diagnosed with service-related multiple sclerosis, a disease that attacks the sheathing of nerves.

Under legislation that expires at the end of this year, Gulf War veterans are presumed to have service-related claims for disability if they report any of a wide range of symptoms, and Mock's group is lobbying to extend that deadline indefinitely.

The IOM panel concluded that "unexplained illnesses are the most prevalent health outcome of service in the Gulf War."

However, the array and severity of symptoms vary, and many are typical of other conditions (such as fibromyalgia, multiple chemical sensitivity and chronic fatigue syndrome), the causes of which are unknown.

"The nature of the symptoms suffered by many Gulf War veterans does not point to an obvious diagnosis, etiology [cause], or standard treatment," the panel wrote.

Three studies examined by the panel found a slightly increased rate of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, in Gulf veterans. Overall, 107 cases of the fatal disease were found in about 700,000 men and women deployed. Goldman and her colleagues said this trend should be followed with continued surveillance for the disease.

Among the 850 papers examined were several with less-certain findings.

One found a slight increase in brain cancer among the 100,000 soldiers theoretically exposed to sarin gas after rockets containing the nerve agent were unwittingly destroyed in a large ammunition dump in Khamisiyah, Iraq, after the war. That disease remained extremely rare, however, with only a handful of tumors even in the "exposed" group.

That finding is questionable for two reasons, however.

There is no evidence that any soldiers suffered actual exposure to sarin, which causes well-recognized symptoms at very low concentrations. In addition, brain tumors generally grow 10 to 20 years before being found. This study was done nine years after Khamisiyah, suggesting that many of the tumors in the soldiers had probably formed before the detonation.

Nevertheless, the brain-tumor finding "provides another lead that should be followed" by future studies, Goldman said.

One study also found a slightly increased rate of birth defects, especially of the urinary tract, among Gulf war veterans. Another reported five cases of a rare, disfiguring defect called Goldenhar syndrome in babies of Gulf veterans conceived soon after the war, compared to only two in nondeployed veterans. The children with Goldenhar were profiled in a Life magazine article that helped popularize the idea that soldiers had been exposed to persistent toxins during the war.

Because the number of defects was so small, however, these differences could have easily happened by chance alone.

A big problem with evaluating the source of illness in Gulf veterans is that little information was gathered on their exposure to pesticides, smoke and battlefield contaminants — and even to vaccines and drugs administered by the military.

"Even just a few measurements on the ground would have made a huge difference," Goldman said of the Khamisiyah detonations, one of the most controversial, but unproven, exposures.

The panel advised the military do a better job of assessing the health of soldiers immediately before and after deployment — as is being done in the current Gulf War — as well as gathering better data on toxic exposure in future wars.

Steve Robinson, a Gulf veteran who directs government relations for Veterans for America, supported that suggestion in particular.

"The IOM report confirms that many Gulf War veterans are seriously ill and that they were exposed to many types of poisons, but the link remains unclear because the military failed to collect exposure data in 1991," he said. "Veterans for America believes the military cannot let this mistake happen again. ... Lessons learned should be lessons followed."

Seattle Times staff reporter Hal Bernton contributed to this report.