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Gulf War Syndrome: Another Side of the Debate: In Response

      Dr Haley's letter in reaction to my recent article notes my agreement with the majority of Gulf War illnesses investigators and spokespersons, including those affiliated with the Department of Defense. It should be noted that I am no longer in the military and have not collaborated with scientists in the Department of Defense, nor do I have a special interest in promoting their conclusions. Having seen a large number of patients with Gulf War illnesses, I sought to provide a broad overview of the research on Gulf War illnesses and to put the controversies in perspective.
      I would like to focus on several aspects of Haley's criticism. First, in concluding that large numbers of US troops were exposed to chemical weapons during the Gulf War, Haley and his colleagues represent a minority view. The only well-documented exposure incident occurred at Khamisiyah in March 1991 and has been exhaustively researched by scientists both in and out of the US government.
      • Department of Defense
      US demolition operations at the Khamisiyah ammunition storage point. Gulflink: Office of the Special Assistant for Gulf War Illnesses.
      • Gulf War and Health
      • Institute of Medicine
      Evidence is insufficient to link chronic health problems to specific agents associated with Gulf War [press release, September 7, 2000].
      Any exposure was minimal, did not cause acute illness, and has not been shown to be the cause of long-term health problems.
      • Department of Defense
      US demolition operations at the Khamisiyah ammunition storage point. Gulflink: Office of the Special Assistant for Gulf War Illnesses.
      No other cases of neurotoxic chemical weapons exposure have been confirmed.
      • Gulf War and Health
      • Rostker B
      Haley's references to other exposures
      • Tuite III, JJ
      • Tucker JB
      Evidence Iraq used chemical weapons during the 1991 Persian Gulf War.
      represent early, unconfirmed reports that do not stand up to scrutiny. Virtually every major government or scientific group that has examined the evidence for chemical weapons exposure has found insufficient evidence to link chemical weapons use in wartime to Gulf War illnesses, including the nonpartisan Institute of Medicine
      • Gulf War and Health
      and a US Senate expert panel.
      • US Senate Committee on Veterans' Affairs
      Next, Haley's repeated assertion that low-level, asymptomatic exposures to nerve agents such as sarin may produce severe chronic neurologic illness has not been supported by the bulk of human and animal research.
      • Gulf War and Health
      Follow-up of the Tokyo subway victims provides an excellent case in point that exposures leading to acute illness may have lasting effects,
      • Nakajima T
      • Ohta S
      • Fukushima Y
      • Yanagisawa N
      Sequelae of sarin toxicity at one and three years after exposure in Matsumoto, Japan.
      while subclinical exposures, like those postulated during the Gulf War, do not.
      • Murata K
      • Araka S
      • Yokoyama K
      Asymptomatic sequelae to acute sarin poisoning in the central and autonomie nervous system 6 months after the Tokyo subway attack.
      It is too soon to say if the findings reported by Haley et al regarding vestibular abnormalities
      • Roland PS
      • Haley RW
      • Yellin W
      • Owens K
      • Shoup AG
      Vestibular dysfunction in Gulf War syndrome.
      and abnormal magnetic resonance scans
      • Haley RW
      • Marshall WW
      • McDonald GG
      • Daugherty MA
      • Petty F
      • Fleckenstein JL
      Brain abnormalities in Gulf War syndrome: evaluation by 'H MR spectroscopy.
      among their ill US Navy veterans are important or merely represent epiphenomena. These must be replicated by other research centers before such findings can be generalized. It is my observation and, I believe, that of most physicians experienced in Gulf War evaluations that Haley's patients are much sicker than average and that their findings may best be explained by selection bias.
      Finally, dozens, if not hundreds, of researchers and government officials have independently reached conclusions that dramatically differ from those of Dr Haley. I believe this represents the outcome of careful thought on the part of many sincere individuals who have tried to find answers for ill Gulf War veterans.

      REFERENCES

        • Department of Defense
        US demolition operations at the Khamisiyah ammunition storage point. Gulflink: Office of the Special Assistant for Gulf War Illnesses.
        (Accessed September 18, 2000.)
        • Gulf War and Health
        Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines. Vol 1. National Academy Press, Washington, DC2000: 1-29 (Accessed October 4.2000.)
        • Institute of Medicine
        Evidence is insufficient to link chronic health problems to specific agents associated with Gulf War [press release, September 7, 2000].
        (Accessed October 4, 2000.)
        • Rostker B
        Speech presented to the Worldwide Chemical Conference. Office of the Special Assistant for Gulf War Illnesses, Fort McCleltan, Ala. GulflinkJune 25, 1998 (Accessed September 18, 2000.)
        • Tuite III, JJ
        US Chemical and Biological Exports to Iraq and Their Possible Impact on the Health Consequences of the Persian Gulf War: Committee Staff Report No. 3: Chemical Warfare Agent Identification, Chemical Injuries, and Other Findings. US Senate Committee on Banking, Housing and Urban Affairs, 1994 (Accessed September 14, 2000.)
        • Tucker JB
        Evidence Iraq used chemical weapons during the 1991 Persian Gulf War.
        Nonproliferation Rev. Spring-Summer 1997; 4 (Accessed September 18, 2000.): 114-122
        • US Senate Committee on Veterans' Affairs
        Report of the Special Investigation Unit on Gulf War Illnesses. Washington, DC; 105th Congress. US Government Printing Office, 1998 (Accessed September 14, 2000.)
        • Nakajima T
        • Ohta S
        • Fukushima Y
        • Yanagisawa N
        Sequelae of sarin toxicity at one and three years after exposure in Matsumoto, Japan.
        J Epidemiol. 1999; 9: 337-343
        • Murata K
        • Araka S
        • Yokoyama K
        Asymptomatic sequelae to acute sarin poisoning in the central and autonomie nervous system 6 months after the Tokyo subway attack.
        J Neurot. 1997; 244: 60l-606
        • Roland PS
        • Haley RW
        • Yellin W
        • Owens K
        • Shoup AG
        Vestibular dysfunction in Gulf War syndrome.
        Otolaryngol Head Neck Surg. 2000; 122: 319-329
        • Haley RW
        • Marshall WW
        • McDonald GG
        • Daugherty MA
        • Petty F
        • Fleckenstein JL
        Brain abnormalities in Gulf War syndrome: evaluation by 'H MR spectroscopy.
        Radiology. 2000; 215: 807-817

      Linked Article

      • Gulf War Syndrome: Another Side of the Debate
        Mayo Clinic ProceedingsVol. 75Issue 11
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          To the Editor: In the debate over illness in Gulf War veterans, as with most arguments and disagreements, there are at least 2 sides. In his recent Special Article, Sartin1 presented in detail the side holding that ill Gulf War veterans are suffering only from common symptoms exaggerated by stress and that organic brain injury from environmental causes is implausible. For the past 5 years this view has dominated research and policy positions in Washington.
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