Gulf War Syndrome Is Real, But Causes Unclear: Report
FRIDAY, April 9 -- The cluster of symptoms experienced by some veterans of the 1991 Gulf War is a real disease, but its causes, treatment and potential cure remain unknown, concludes a new report from U.S. experts at the Institute of Medicine (IOM).
However, newer medical technology, including the ability examine genetic mutations, may hold the key to finally unraveling the mystery of an illness that has plagued one-third of Gulf War veterans for two decades, the experts said.
The panel "identified chronic multi-symptom illnesses, sometimes referred to as Gulf War illness, as a group of illnesses that is clearly associated with deployment," said report committee chair Dr. Stephen L. Hauser, professor and chair of neurology at the University of California, San Francisco School of Medicine.
According to the report, released April 9, service in the Gulf War has long been linked with gastrointestinal disorders such as irritable bowel syndrome, as well as substance abuse, particularly alcoholism, and psychiatric problems such as anxiety disorder.
In addition, service during the Gulf War is associated with fibromyalgia and chronic widespread pain, amyotrophic lateral sclerosis (the neurological disorder also known as "Lou Gehrig's disease") and sexual difficulties.
However, more research is needed to understand the biological underpinnings of these illnesses, Hauser said. That information is vital to developing better treatments, cures and "one day to prevent this from happening in the future," he added.
In 2008, a Congressionally mandated report from the Research Advisory Committee on Gulf War Veterans' Illnesses did point to wartime exposures to "certain chemicals," including pesticides and a drug used to shield soldiers against nerve gas, as the likely cause of veterans' symptoms.
But Hauser said the IOM panel could not confirm that. "We have been unable to identify any particular drug, toxin, immunization or exposure that we feel confident is responsible for these symptoms, which are clearly highly prevalent even 19 years later in our returning veterans," he said.
"We do not understand the etiology and do not fully understand whether this is a single medical problem, or several interrelated problems," Hauser added. "We don't understand the relationship between Gulf War illness and other multi-symptom problems."
Gulf War-linked illnesses affect not only U.S. veterans, but veterans from the United Kingdom, Denmark, Canada and Australia, Hauser noted.
This is the latest in a series of reports on Gulf War illness from the IOM.
According to Hauser, the latest medical technologies may open a door to finding the connection between deployment and Gulf War illnesses. "Modern science gives us a way to explore the underlying cause in a way that was unimaginable five years ago," he said.
Unlocking the secret of Gulf War illness is possible, Hauser said. Not only will this lead to better treatment for veterans, but for civilians who suffer from similar problems, he said.
Moreover, some of these same problems are being seen in soldiers fighting today in Iraq and Afghanistan and even among those not deployed.
"One of the interesting things that we see are the symptoms we have been focused on in the Gulf War, are experienced also by soldiers in current Mid-East wars, but the frequency of these symptoms is high even in those soldiers who are not deployed," Hauser said. "This seems to be an increasing problem in the military population at large."
IOM Committee member Dr. Ezra S. Susser, a professor of epidemiology at Mailman School of Public Health and professor of psychiatry at the College of Physicians and Surgeons at Columbia University in New York City, noted that symptoms observed among Gulf War veterans are "clearly deployment-related."
"This doesn't mean that only people in the Gulf War get these symptoms, but they are at much higher risk than people who were not deployed to the Gulf War," Susser said.
The members of the IOM committee hope the report will spur a new effort to understand Gulf War illness.
"There is a silver lining in the gray cloud," said committee member Dr. Robert Brown Jr., chair and professor of neurology at the University of Massachusetts Medical School. He believes that researchers now have "both the structure and the numbers of cases at hand to enable a frontal assault on this."
Dr. Nancy G. Klimas, a professor of medicine, psychology microbiology and immunology and director of the Chronic Fatigue Syndrome and Gulf War Injuries Research Center at the University of Miami Miller School of Medicine and the Miami VA Medical Center, noted that her own studies have already identified genetic dispositions to Gulf War syndrome.
Among veterans with Gulf War disease, stress activates genetic pathways that are inflammatory, Klimas said. "There is something about an autonomic challenge that triggers an inflammatory response," she said. "There are about 700 genes that activate in a way in these guys that have Gulf War illness that is different from the control population."
This is only one way genes can be used to understand Gulf War illness. "What we hope is that we will be designing studies that are 'virtual' clinical trials," Klimas said. In this way, researchers can change variables in key genes and see what the response is.
Klimas said that, as each year goes by, the search for the causes of Gulf War syndrome gets tougher. "To start 10 years after someone's been ill, it's harder to unravel the confounds," she said. "So you get these overlays of confusing things on top of whatever was there to begin with -- it makes it a very difficult thing to try to untangle."
As a doctor who treats veterans with Gulf War illness, Klimas is looking for research that will find better treatments. "I am interested in studies that will result in therapies," she said. "These guys have been sick for 20 years."
"Now is the time to do more," Hauser added.
For more information on Gulf War Syndrome, visit the University of Chicago Medical Center.
Posted: April 2010
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