Scaring our veterans sick

Howard Fienberg explains how the spectre of Gulf War syndrome continues to haunt America

What is the cause of this mysterious ailment? Candidates include vaccinations, biochemical warfare, oil fires, and depleted uranium. Some say it's infectious, others that it is genetically based. The name of this disease? Gulf War syndrome (GWS).

As you might guess, people are thoroughly (and quite rightly) confused as to the precise nature of GWS. The possibilities seem limitless. Veterans and non-veterans alike have learned to fear the syndrome, despite the fact that few know anything tangible about it. But lack of concrete knowledge has not stopped a flood of speculation, rumour, alarm, and charges. The media, the Clinton administration and Congress have all at various times claimed to understand GWS, often relying on the self-reports of the same fearful veterans.

Without a doubt, the veterans are experts at determining how they feel. However, few have medical training. Laymen mistakenly confuse symptoms (pain, headaches, fatigue) for a disease syndrome and rush to judgement on the putative cause of the condition felt.

It is still unclear to what these symptoms can be attributed. But almost every scientific, epidemiological and medical study has found no evidence of an all-encompassing syndrome. These have included studies by the military, the Centers for Disease Control and Prevention, the National Institutes of Health, the Rand Corporation, the Institute of Medicine, and innumerable prestigious universities. The mandate of the Presidential Advisory Committee (PAC) on Gulf War Veterans' Illnesses was extended in 1996 because the US government refused to accept the verdict that PAC could find no evidence of GWS. PAC returned the same conclusion a year later.

Evidence demonstrates that some Gulf War veterans are ill. Full stop. The health studies published in January in the Lancet and the British Medical Journal bolster the conclusions of dozens of studies in Canada and the USA that the great number of different symptoms and possible causes offer no evidence of an all-encompassing syndrome. This is not to question whether or not any veterans are ill. This is not to say that they are all suffering from psychologically based illness, though some of them may be (and even they are still sick). But their illnesses match those afflicting ordinary individuals over time - and usually at a lower rate.

In addition to misunderstood symptoms, causes are sometimes misdiagnosed. Veterans can fall prey to the post hoc fallacy, confusing correlation with causation. Just because one event occurred after another event does not mean it is a result of that event. Careful study has demonstrated that some veterans carried illnesses before they ever set foot in the Gulf. A striking example is American army reservist Michael Adcock, the first death widely attributed to GWS. He died in 1992 of lymphoma, which his family blamed on the Gulf, and testified to that effect before Congress. In reality, he started to show symptoms of lymphoma six days after deployment to the Gulf. That practically excludes a Gulf link, since lymphoma usually takes more than 10 years to develop.

Scrutiny reveals other misguided diagnoses. For instance, Denise Nichols testified before Congress that her daughter was one of two she knew who had developed congenital cataracts after their parents had returned from the Gulf. Congenital meaning, unfortunately, 'from birth' - both daughters had been born before the war. She missed the meaning, and hence, so did Congress and the media at large.

Of what effect is the inconsistent and incoherent media coverage on Gulf War syndrome? A study in Psychosomatic Medicine (November/December 1998) pinpointed stress and anxiety disorders as a prime cause of GWS. A study in the American Journal of Epidemiology (15 August, 1998) showed that large increases in reporting of symptoms by veterans corresponded to periods of intense media coverage of possible chemical weapons exposure (see graph). Now that the estimates of soldiers possibly exposed has officially been reduced from 100 000 to 10 000, to hardly any, veterans' fears appear even more misplaced.

It may be possible that veterans' legitimate illnesses have been somewhat obscured - but it may also be that we are, in some ways, merely scaring our veterans sick.

Howard Fienberg is a research analyst for the Statistical Assessment Service, a non-profit, non-partisan organisation researching science and the media based in Washington DC

The usual suspects

Joyce Riley von Kleist - Spokesperson of the American Gulf War Veterans' Association, and part of the right-wing 'Patriot' militia movement, she claims that the US deliberately exposed soldiers in the Gulf to biological agents, causing GWS. She believes this to be part of a larger conspiracy to weaken Americans and strengthen the 'New World Order'.

Howard Urnovitz - In 1996, he claimed to have discovered a mystery infectious virus in veterans that explained the supposed birth defects in their children. He is not a disinterested scientist. ChronicIllnet, the sponsored web page of his company Calypte Biomedical, trumpets its 'miracle' cures for GWS and cancer.

Robert W Haley - An epidemiologist at the University of Texas South-Western Medical Center, he is one of the few legitimate scientists who believes in a unique GWS - he links it to 'generalised injury to the nervous system' from toxic chemicals. Haley and his colleagues published three studies in the Journal of the American Medical Association in 1997, but the results were neither striking nor consistent enough to distinguish ill veterans from healthy ones. Subsequent correspondence criticised the research; one letter claimed Haley's team had 'advanced from unmerited speculation to fantasy'. After being denied federal research funds in open scientific competition, Haley's patron, Ross Perot, cajoled Pentagon officials into funding him anyway.

Pietr Hitzig - He claims he can treat GWS with FEN/PHEN, a drug-combo popularised as a weight loss medication. There have been rumblings that it is a health risk, though the science is inconclusive. Dr Hitzig lost his Maryland medical licence for prescribing this drug-combo for every symptom and illness that came his way. His practice continues... over the internet.

Howard Fienberg