Gulf War syndrome

The balance of evidence is currently against there being a distinct Gulf War syndrome. Yet irrespective of the emerging professional consensus, Gulf War syndrome is established as a popular, media and social reality anyway. Investigating how and why this concept developed is important, but the answers will not come from statistics, but social sciences.

Gulf War syndrome (GWS), sometimes known as Gulf War illnesses (GWI), is claimed as a medical condition with a wide variety of symptoms apparently contracted by people who were in the area of Kuwait around the 1990-1991 Gulf War, the one where George H. W. Bush and multinational armed forces (the "Coalition") kicked Saddam Hussein out of Kuwait in a short military operation, before stopping at the borders of Iraq. A number of causes connected to the war have been advanced, although there is no certain evidence linking any of the causes with symptoms described.

It is recognised as a medical condition by the US Department of Defense and US Department of Veterans Affairs. However, despite studies showing Gulf War veterans tend to self-report symptoms at rates far higher than other veterans, other researchers dispute the existence of GWS/GWI and say that there is not sufficient evidence to point to a distinct syndrome or to identify the causes of health problems reported by veterans.

History
Saddam Hussein's troops invaded Kuwait on 2 August 1990; within 2 days the country was almost entirely subdued. Over the following months Coalition military personnel and support staff were deployed to bases in Saudi Arabia and elsewhere to prepare for military action. Military action began on 17 January 1991. On 28 February, George H. W. Bush declared that the war was over and Kuwait liberated.

697,000 US personnel served, along with 53,462 British, 18,000 French, and large numbers of Saudi and other Middle Eastern troops. Hundreds of thousands of Iraqis served on the other side, though their health is less often considered.

Reports of various ailments among former soldiers began over the next few years, and the US Congress created the Research Advisory Committee on Gulf War Veterans' Illnesses (RAC-GWVI) in 1998 to investigate more thoroughly. Since then, many studies have been conducted, but no consensus has been reached on the symptoms or cause of GWS/GWI.

Symptoms
Symptoms attributed to GWS/GWI include:
 * Fatigue
 * Headache
 * Memory problems
 * Muscle/joint pain
 * Diarrhea
 * Dyspepsia
 * Neurological problems
 * Tumors

Possible causes
A number of physical factors have been blamed. Note that a combination could be involved.
 * Nerve agents such as sarin and soman, which Saddam was believed to possess. There is some evidence that chemicals including sarin were released during or after the war.
 * bromide, used to protect against nerve agents which the Coalition feared Saddam would use. It is on the WHO Model List of Essential Medicines, a list of important pharmaceuticals needed by any health system. Soldiers were administered a dose of 90 mg. This is far less than the dose used in treating certain illnesses such as myasthenia gravis, and other uses of pyridostigmine bromide do not seem to have the serious side effects reported in GWS.
 * Iraqi biological agents, including anthrax and botulinum. Anthrax is a not very contagious but very unpleasant disease with a wide variety of symptoms from skin lesions to respiratory collapse and serious gastrointestinal problems; it is also hard to diagnose due to its resemblance to other respiratory and gastrointestinal diseases. Botulism is caused by botulinum toxin, and symptoms start with tiredness and weakness and possible visual problems, before leading to muscle weakness which can affect lungs and leave victims unable to breathe without a ventilator.
 * Vaccines against Iraqi biological agents which were administered to Coalition troops.
 * Depleted uranium (DU), used in munitions such as artillery and tank shells due to its high density. Depleted uranium is slightly radioactive, though not enough radioactivity to cause serious health problems while in its solid form. In its vaporized form DU is extremely toxic, causing symptoms similar to lead poisoning and cancer.
 * Smoke from burning oil wells, which Saddam to provide smokescreens and to destroy Kuwaiti oil production after the war. However, there is no evidence of GWS in firefighters who travelled to Kuwait after the war to fight fires.
 * Pesticides used against disease-carrying insects, including The health effects of organophosphates and other pesticides are themselves highly controversial.
 * Microwave and other electromagnetic devices and weapons used to jam or interfere with Iraqi communications and radar. Although this seems similar to arguments over electromagnetic hypersensitivity, levels in Iraq were much higher than anything produced by a mobile phone mast.

In addition, other non-physical causes could be factors.
 * Post-traumatic stress disorder or combat stress.
 * Mass hysteria.

Negative studies
A 1996 review published in the New England Journal of Medicine failed to find an increased level of illness or death in Gulf War veterans compared to other veterans. Knoke and Gray in 1998 reached similar conclusions: "active-duty Gulf War veterans did not have excess unexplained illnesses resulting in hospitalization in the 4.67-year period following deployment."

Research fails to indicate an increase in mortality rate, although there is some increase in suicide rates consistent with that seen in other combat veterans. Research has failed to find increased cancer rates in UK veterans. However, the Iowa Persian Gulf Study Group and subsequent studies have found veterans have reported higher incidences of many symptoms than control groups. Higher reporting rates could have many causes other than a higher presence of physical disorders; this is one of the main issues on GWS/GWI research.

Research Advisory Committee on Gulf War Veterans' Illnesses
This US Congressional-appointed body (the RAC-GWVI) found GWS was a real and distinct physical condition. The RAC-GWVI continues to fund research on GWS and report the result of studies. It has repeatedly criticised the US Department of Veteran Affairs for its response and claims GWI is linked to chemical exposures, although the US Institute of Medicine disputed its findings.

Kings College London
KCL has conducted considerable research, mainly on British veterans, but has found less clear evidence. A KCL study comparing British veterans of the Gulf War and Balkans wars found "the Gulf veterans were between two and three times more likely to report each and every one of the 50 somatic symptoms that were inquired about". They believed this could not be explained entirely by psychological disorders, but noted the limitations of studies based on self-reporting of symptoms. As a result, in 2001 they suggested that there was not a distinctive pattern of symptoms associated with GWS, although there was clearly something going on that might be investigated as a social rather than medical phenomenon.

They restated this position in 2008, claiming that while there is evidence of health problems in Gulf veterans, there is no identifiable constellation of symptoms that could be classed as a syndrome: "What we believe is that there is substantial evidence to suggest the existence of an identifiable Gulf health effect but that effect does not amount to a discrete disorder or indeed syndrome."

Robert Haley
Haley is an American epidemiologist who claims to have evidence of central and peripheral nerve damage in Gulf War veterans and blames this on some combination of pesticides and chemical weapons. However, his studies lacked a control group and have been criticised by other researchers.

Animal research
There are various studies in animals which might indicate causes of GWS/GWI, although animal studies should be treated with caution because physiologically animals are not people and experimentally it is hard for animal studies to match conditions experienced by human beings.
 * Organophosphates

Other studies
A large amount of research is carried out, with both positive and negative findings. The RAC-GWVI maintains a list on their website, and databases such as Medline list many more. For example:
 * Rayhan et al in 2013 found GWI patients had a higher level of migraines than controls, and suggested a common link between GWS/GWI and chronic fatigue syndrome (CFS). This is one of many studies to hint at a link between GWS/GWI and CFS.

Cause of murder?
GWS was cited as a factor in the by former US soldier Louis Jones, Jr; it was not accepted as mitigation and Jones was executed in 2003.

Elaine Showalter
In her controversial book Hysterias, feminist academic Elaine Showalter claimed a wide range of things including GWS, chronic fatigue syndrome, recovered memory syndrome, multiple personality disorder, satanic ritual abuse, and alien abduction were all instances of hysteria. This theory was not exactly popular, with Showalter receiving death threats as a result.

Conspiracy
Conspiracy theorists claim that veterans with GWS were "poisoned by our own germ warfare agents developed by the U.S. military and sold in the 1980s to the Iraqis, who then used them against us in the Gulf War." As mentioned above, chemical and biological agents may have been released accidentally, but there's no evidence of deliberate use.

Woo cures
"The Good News. The Solution to The Gulf War Syndrome lies in the implementation of safe and effective naturopathic/homeovitic protocols which serve to detoxify the body of various viral, bacterial, fungal, chemical and metallic toxins while restoring neuro-immunological competence to the individual (patient)..."I'm sure scientists will be rushing to implement that as soon as they figure out what the hell it means.

Historical comparison
Other conflicts have produced distinctive illnesses, such as "shell shock" after World War One, and the high incidence of PTSD after the Vietnam War.