WASHINGTON - Will United States troops return home from Iraq with the mysterious illness that still makes war hell for thousands of veterans of the 1991 Persian Gulf conflict?
Experts cannot predict whether a new outbreak of Gulf War Syndrome will occur in the war's aftermath. But the military medical system has braced for it, with new procedures to help researchers nail down the causes and a new treatment regimen for the elusive illness.
“We have learned many lessons over the last decade,” Dr. William Winkenwerder, assistant secretary of defense for health affairs, said at a Pentagon briefing.
“We wanted to have a better baseline of information when people are deployed that tells us about their health, better surveillance in the field, and collection of information in a more disciplined way to look at people after they return.”
Some veterans groups believe that the lessons learned will be enough to prevent a wave of Gulf War Syndrome II rivaling the first.
“I would be surprised if it happened,” said Stephen Robinson, executive director of the National Gulf War Resource Center. “The first gulf war was unique in some ways. It was a toxic soup with bad gas masks and defective or unused protective equipment.
“This war is different so far, without widespread exposures to toxic materials, and [the U.S. Department of Defense] has learned its lessons and taken more precautions to protect troops against exposures.”
Almost $250 million has been spent on Gulf War Syndrome research over the last 12 years, according to a report last month in Science, the journal of the American Association for the Advancement of Science.
Study after study has blamed the lack of basic information cited by Dr. Winkenwerder for hampering science's search for causes of Gulf War Syndrome.
Gulf War Syndrome appeared soon after the homecoming of almost 700,000 Americans involved in Operation Desert Storm. Troops from other countries were affected as well. It took military officials years -and prodding by the U. S. Congress and veterans' groups - to acknowledge that the condition really existed.
Estimates of the number of Desert Storm veterans with symptoms range from 20,000 to more than 150,000.
Symptoms vary widely, but include severe fatigue, headaches, muscle and joint pain, dizziness, asthma, rashes, forgetfulness, and problems with attention span, concentration, and memory.
Potential causes run the gamut from exposure to insecticide in dog flea collars to exposure to weapons of mass destruction to psychological stress.
Troops sometimes wore flea collars to protect against mosquitoes and flies. About 100,000 personnel were exposed to low levels of sarin, a nerve gas, which drifted over the desert after U. S. troops detonated an Iraqi ammunition depot without knowing it contained sarin-filled rockets.
Other suspects include depleted uranium in tank-busting shells; smoke from oil-field fires; side effects of vaccines against anthrax and botulism; nerve gas antidotes; solvents used to clean weapons and equipment, and pesticides in military bug repellants.
In February, the Institute of Medicine completed an analysis of 3,000 Gulf War Syndrome-related studies. It could reach no conclusions about the causes because little information was available on the exposures of individual service members.
It echoed previous comments from Dr. Harold C. Sox, Jr., a Dartmouth University physician who chaired IOM's committee on Gulf War Syndrome.
“The biggest impediment to analyzing the impact of these substances has been the lack of information about the actual exposures and doses experienced by individual soldiers,” Dr. Sox said. “Without that crucial piece of information, we cannot draw conclusions regarding whether the agents present in the gulf theater are the cause of health problems among veterans who served there.”
DOD has taken a number of steps to correct those problems, Dr. Winkenwerder said. Congress ordered some in a 1998 law.
They include basics like gathering and computerizing better information on the predeployment health of military personnel and “who-is-exposed-to-what-where” data on troops in Iraq. If a toxic exposure incident occurs, officials will know exactly which units were in the area.
New environmental monitoring squads, which travel with battlefield units, take soil, water, and air samples, and test personnel for exposure to various contaminants.
In one incident last week, a dozen soldiers with the 101st Airborne Division developed rashes and other symptoms after exposure to suspected nerve gas agents found at a military installation near Karbala, 60 miles south of Baghdad.
Preliminary tests were positive for the nerve agents sarin and tabun and the blister agent Lewsite. Army laboratories were doing further tests to verify composition of the material.
Officials acknowledge that such record-keeping was sloppy in the first gulf war. Physicians sometimes were unable to even document whether a soldier had gulf war symptoms prior to deployment, or had postdeployment exposure to possible causes like anthrax vaccine or the nerve gas antidote.
Congress and the Pentagon have squabbled recently over DOD's implementation of one provision of the 1998 law.
It mandated that the military perform a full physical exam, including blood samples, on each soldier before shipping out and after returning to the United States. But DOD has decided to delay the “return-home” testing for up to a year, until the soldier's next scheduled medical exam.
Dr. Michael E. Kilpatrick, deputy director of deployment health support at DOD, said the sheer numbers of personnel deployed in Iraq - which may approach 250,000 - would make such testing too costly and time-consuming.
“The first days home are really the `golden hour' for detecting changes from the predeployment status,” Mr. Robinson countered. “All traces of an exposure could disappear if you wait months.”
DOD and the VA also have a treatment regimen ready for a second wave of GWVI cases. It involves an intensive three-week program based on treatments that relieve symptoms of chronic fatigue syndrome, fibromyalgia, and other illnesses that have symptoms similar to GWVI and no cause or cure.
The treatment involves cognitive behavioral therapy and aerobic exercise. The therapy teaches ways of adapting lifestyle to cope with symptoms.
A major clinical trial, described in March in the Journal of the American Medical Association, found that the approach does give “modest” relief for some GWVI symptoms.