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From the Townsend Letter for Doctors & Patients
August/September 2002

The Soldier's Exposure to Toxic Substances
review by Katherine Duff

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Gulf War Syndrome: Legacy of a Perfect War
by Alison Johnson

Gulf War Syndrome as an illness and as a controversy has been with us since the end of the war in 1991. Many veterans are still trying to cope with their illness while being kept in limbo over compensation and medical care. Now there is talk of pursuing another war with Iraq and it is clear no lessons have been learned that will prevent this illness from occurring again.

The debate surrounding Gulf War Syndrome (GWS) has to do with the source of the illness physiological, arising from toxic exposures versus psychological, stemming from stress. In her book Gulf War Syndrome: Legacy of a Perfect War, Alison Johnson brings her mathematician's mind and her knowledge about chemical injuries to this issue. She reveals the information from official records the government released only under pressure from some members of Congress information that points to the numerous toxic substances encountered by the soldiers as the likely cause of GWS.

The Department of Defense (DOD) has maintained that the exposures experienced by the troops in the Gulf War could not have caused GWS. In many instances they have denied that the exposures even took place. The Veterans Administration shares that view. Ill veterans seeking help at VA hospitals across the country will usually have the following entry in their medical records, "Patient is malingering for secondary gain.

Johnson enumerates many of those toxic exposures, starting with the nerve agents Saddam Hussein had stockpiled. One of the first targets hit during the war were 28 chemical weapons factories where sarin, VX and tabun had been manufactured. Coalition bombers attacked all the major facilities where chemical and biological weapons were known to exist. While the U.S. had its share of chemical weapons detection monitors going off, they were usually explained away as "false alarms. But Saudi Arabia had contracted with the Czechs to supply chemical weapon detection services to the Saudi forces. Known for their expertise in the field, the Czech units detected mustard gas and sarin and passed that information on to the Americans, who chose to ignore it. Upon returning home, 11 to 15% of the Czech troops have sought help for illnesses with symptoms similar to GWS.

Another significant exposure occurred at the end of the war when a large weapons storage complex known as Khamisiyah, was blown up. A misunderstanding of how Iraq labeled their weapons led them to believe the weapons were not nerve agents. Consequently, the demolition broke the weapons apart and allowed release of the nerve agents. DOD denied for five years that troops could have been exposed but had to admit the truth when a member of the demolition team gave a videotape of the incident to a congressional subcommittee that was investigating GWS.

Add to these exposures of war, those the troops encountered in protecting against pests by using Saudi pesticides, drinking water stored in diesel drums, keeping the sand down with diesel, the anthrax vaccines, the pysridostigmine pills and more, and the toxic cocktail becomes evident. Even though soldiers were becoming ill during the war and continued to become ill after their return to the States, the DOD has maintained that low-level exposures cannot cause health effects.

Holding to the "stress theory, DOD research has focused on supporting that theory. One large study has $8 million to be spent on psychiatrists and counselors and another $4 million to be spent on exercise equipment for the veterans. But as Johnson states, "Exercise and counseling won't keep veterans' teeth from falling out, it won't reverse demyelination of nerves and it won't cure sleep apnea or chronic diarrhea or the host of other health problems that the veterans are experiencing.

As the author points out though, productive research is taking place. Ross Perot, concerned with the plight of the veterans, funded research by Robert Haley, M.D. and his team at University of Texas Southwestern Medical Center at Dallas. Beginning with a survey that identified three separate syndromes, they were able to identify exposures unique to each of the syndromes. Another significant contribution from Haley's work has to do with the gene that controls production of the PON-Q enzyme. This enzyme destroys the nerve agents sarin and soman as well as the pesticide diazinon in the body. Haley's team has found that sick veterans have low PON-Q levels in their blood and well veterans have high PON-Q levels.

Haley was eventually able to secure federal funding for research but not before having to endure an investigation and the criticism of DOD's man in charge of GWS, Bernard Rostker, an economist. Haley was cleared of charges that he misused government funds and he was awarded $3 million for research.

Another recipient of a grant from Ross Perot is Mohamed Abou-Dania, PhD from Duke University Medical School. He hypothesized that normal detoxification mechanisms can be overwhelmed by concurrent administration of certain toxins, allowing excessive amounts to reach the nervous system. Abou-Dania has performed studies on the effects of exposure to combinations of chemicals such as those experienced by GW soldiers. In one study, rats were given combinations of chemicals in the doses experienced by the troops. The rats did not look much different than controls but when they were challenged to do tasks, there were deficiencies in their behavior. In their investigation the researcher looked to the nervous system, and in particular the blood-brain barrier. What they found is the blood-brain barrier had breaches and leaks that could have resulted in chemicals and bacteria and viruses penetrating the brain and chemicals in the brain leaking into the bloodstream. Further examination of the brain tissue revealed a breakdown of many cells in the brain, including those of the nervous system that support neurons.

The research described in this book is not only fascinating but may eventually provide answers to many other health problems. Multiple chemical sensitivity, which is reported by many of the ill veterans, may find some answers in what is learned about GWS. The incidence of amyotrophic lateral sclerosis (ALS) has affected these veterans at rates higher than the general population, as even the VA had to finally admit. And besides the potent nerve gas exposures, most of the chemical exposures experienced by the soldiers in the Gulf War can be found, though in lesser amounts, in our own daily lives.

Gulf War Syndrome is a complicated story of a tug of war that Alison Johnson has ably captured in this book. The outcome of the debate whether we will rely on new science to find answers to this debilitating illness, or old science that failed to account for numerous exposures at once but offers the excuse to do nothing, will affect us all. And in the meantime there are still over 100,000 veterans trying to live with Gulf War Syndrome, with more probably on the way.


Gulf War Syndrome: Legacy of a Perfect War
by Alison Johnson

MCS Information Exchange, 2 Oakland Street, Brunswick, Maine 04011 USA
Softbound, 234 pp., 2001, $14 plus $2 book rate or $4 priority
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