Veterans from the
Vietnam War had trouble convincing people they were really sick from something unknown,
and now, unbelievably, Gulf War veterans are having to fight that very same battle!
It was finally
discovered that most Vietnam illnesses were due to a mixture of herbicides, contaminated
with dioxin, the most notable of which was called Agent Orange.
Gulf War illness
symptoms have included memory loss, balance disturbances, sleep disorders, depression,
exhaustion, body pain, chronic diarrhea and concentration problems.
The November 30, 1999
report of research conducted at the University of Texas (UT) Southwestern Medical Center
in Dallas, provides one of the first concrete signs that this illness may be more than
just a "syndrome." Lower than normal levels of the chemical NAA or
N-Acetyl-Aspartate were found in the brains of the 22 Gulf War veterans studied, and this
may provide a telltale link to the mysterious illness.
Write to the President
and your representatives in Congress today, urging further studies and support for ailing
Gulf War veterans and their families.
Office of the Clerk
June 2, 2003
Robert W. Haley, chief of epidemiology at the University of Texas Southwestern
Medical Center at Dallas, has published almost two dozen studies suggesting a
link between Gulf War illnesses and nerve gas. "My own view is you probably
won't see anything on the order of what we saw after Gulf War One because it
appears there was no exposure to nerve gas during Gulf War II," said Haley,
who serves on the Department of Veterans Affairs advisory committee on Gulf War
National Academies' Institute of
Sept. 7, 2000 Press Release
Vanee Vines, Media Relations Associate
Mark Chesnek, Media Relations Assistant
(202) 334-2138; e-mail <email@example.com>
FOR IMMEDIATE RELEASE
Evidence Is Insufficient to Link Chronic Health Problems To Specific Agents Associated With Gulf War
WASHINGTON -- A comprehensive assessment of the available scientific literature reveals
that there is not enough evidence to link long-term health problems with exposures to
certain drugs, chemicals, and vaccines known to be present during the Gulf War, says a new
report by a committee of the National Academies' Institute of Medicine.
The committee evaluated the published, peer-reviewed research on the agents of greatest
concern to representatives of Gulf War veterans' organizations for any evidence of a link
between long-term health effects and exposure to sarin, pyridostigmine bromide (PB),
depleted uranium, and the vaccines to prevent anthrax and botulism. Most of these studies
involved exposures in occupational settings, terrorist attacks, and clinical trials. Only
a small number studied veterans who may have been exposed to these agents while serving in
the Gulf War theater.
Because little information exists on actual exposure levels -- a critical factor when
assessing health effects -- the committee emphasized that it could not draw specific
conclusions about the health problems of Gulf War veterans. At most, it found limited
evidence from three studies that might suggest a link between long-term health effects and
exposure to the nerve agent sarin at levels great enough to cause an immediate, intense
reaction. But alternative explanations for this link could not be ruled out, and none of
these three studies involved Gulf War veterans. On the other hand, the committee found
limited, suggestive evidence of no link between exposure to uranium and kidney disease or
-- at low exposure levels -- lung cancer.
"We'd like to give veterans and their families definitive answers, but the evidence
simply is not strong enough," said committee chair Harold C. Sox Jr., professor and
chair, department of medicine, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.
"Without data on the levels of exposure in the Persian Gulf theater, answers will
Gulf War veterans who have experienced chronic health problems following their service are
asking whether exposure to various chemical or biological agents might be responsible.
Thousands of troops did come in contact with a number of agents before, during, and after
the war. Because Iraq had used biological weapons in the past, troops were given vaccines
to protect them in the event of an attack.
More than 150,000 U.S. troops are estimated to have received vaccines to protect them from
either anthrax or botulism. As further preventive measures, some troops were given packets
of the drug PB to be used in case of a chemical attack. If taken in advance, PB can blunt
the effects of exposure to some chemical warfare agents. During the war, an estimated
250,000 troops took the drug. While the nerve agent sarin is not believed to have been
used during hostilities, some troops may have been exposed to low levels of it during
cleanup operations after the war. Also, as a result of friendly fire incidents, some
troops were exposed to depleted uranium.
The U.S. Department of Veterans Affairs initially requested an Institute of Medicine study
of potentially harmful chemical, biological, or environmental agents to which Gulf War
veterans might have been exposed. Congress subsequently mandated a similar study listing
33 specific agents. This report is the first of a series; the next committee will review
the scientific literature on pesticides and solvents.
Weighing the Evidence
The committee reviewed all relevant studies published in peer-reviewed journals. Because
only a small number of studies directly involved Gulf War veterans, the committee extended
its review to include research involving any human population that had contact with these
agents at any dose. It carefully assessed the quality, limitations, and applicability of
each study and used five categories to describe the strength of all the evidence.
Sufficient evidence of a causal relation, the strongest level of evidence, means
that many studies have established a clear link between exposure to an agent and a health
outcome. Among the other requirements, there must be a plausible biological explanation
for the relationship. Evidence that establishes a link between exposures and symptoms with
reasonable certainty, but fails to meet the higher standard of proof needed for causality,
is characterized as sufficient evidence of an association. When a limited number of
studies suggests that a link exists, but without reasonable certainty, the evidence is
said to be limited or suggestive of an association. If several studies of adequate
quality consistently fail to show a positive association at any level of exposure, the
evidence is described as limited or suggestive of no association. Evidence that
lacks sufficient quality, consistency, or statistical power to draw any conclusion is
judged to be inadequate or insufficient to determine whether an association exists.
Most of the evidence concerning long-term effects fell into this last category.
The nerve agent sarin is so potent that as little as 100 milligrams -- the equivalent of
about two drops -- penetrating the skin, eyes, or mucous membranes can cause convulsions
and death. In its gaseous state, as little as 50 milligrams can be fatal. At lower levels,
exposures can cause overstimulation of nerves and muscles within seconds or hours,
creating symptoms such as severe cramping, difficulty breathing, twitching, pinpoint
pupils, and heavy sweating. These widespread symptoms, called an acute cholinergic
syndrome, clear up within days to months. After reviewing the accumulated science on
short-term effects, the committee judged the evidence as sufficient to establish a causal
relationship -- that exposure to a high-enough dose of sarin can cause an acute
But the evidence concerning long-term effects of sarin is much weaker, the committee said.
Three studies -- two involving victims of terrorist attacks in Japan and one involving
industrial accidents in the United States -- linked neurological and psychological
symptoms that persisted for six months or longer following exposure to sarin. In one of
the studies, some symptoms persisted for up to three years, the longest that any of the
subjects were tracked. The doses of sarin in all three studies were high enough to trigger
an intense, immediate reaction -- acute cholinergic signs and symptoms. Among the
conditions that persisted over the long term were fatigue, headaches, blurred vision, and
symptoms of post-traumatic stress disorder. Because of the limited number of studies, and
because alternative explanations for the effects could not be ruled out, the committee
described this evidence as "limited or suggestive of an association." The
committee recommended further research to track the health of the victims of sarin attacks
Available evidence does not permit any conclusion as to whether long-term health effects
are associated with sarin exposures that were too low to produce any short-term signs or
symptoms, the committee said. However, based on the findings of a study on nonhuman
primates, it is reasonable to hypothesize that such an association could exist, and the
committee recommended further research.
PB is a drug routinely used in the treatment of myasthenia gravis -- a disease that causes
weakening of the muscles. While effective, the drug can produce gastrointestinal and
muscular symptoms that are transient, mild, and tolerable. Troops in the Gulf War were
given packets of PB tablets to take in advance of a chemical-weapons attack, in the hope
of moderating the effects of nerve agents. Recommended doses were lower than those
commonly used by doctors to treat patients with myasthenia gravis.
After reviewing the evidence of PB's short-term effects, the committee characterized it as
sufficiently strong to demonstrate an association between exposure and the immediate onset
of mild, transient symptoms. But it said no conclusion could be drawn about its
association with long-term health problems. One series of studies has suggested that PB,
either alone or in combination with other chemicals, may be related to some chronic
neurological changes or damage reported by Gulf War veterans. But the validity of this
association is uncertain because of weaknesses in study design, and it requires further
investigation, the committee said.
During the Gulf War, some tanks and munitions containing depleted uranium caught fire or
exploded. As a result, a number of military personnel inhaled or ingested depleted
uranium. Flying fragments of the material injured others. In its depleted form, uranium is
40 percent less radioactive than in its natural state. The health effects of uranium have
been widely investigated, mostly in occupational settings, but the committee found
weaknesses in many of these studies. Based on this evidence, it said that no conclusion
can be drawn about the effects of depleted uranium and the development of lymphatic or
bone cancer; nonmalignant respiratory disease; diseases of the nervous system,
gastrointestinal tract, and liver; and other health outcomes. Still, the committee did
conclude that there is limited evidence of no association between exposure to uranium and
kidney disease, nor between exposure to low levels of uranium and lung cancer. At high
levels of exposure, however, the evidence about lung cancer was unclear. The committee
recommended follow-up research on veterans with embedded fragments of depleted uranium,
and other long-term studies.
The short-term local and systemic effects of the vaccines used to prevent anthrax and
botulism have been documented, and the committee characterized the evidence as sufficient
to demonstrate an association. Redness, swelling, and tenderness at the site of injection
were typical side effects, lasting up to 48 hours. A small number of subjects in studies
experienced systemic effects similar to those associated with any vaccination, such as
fever that lasted for 24 to 48 hours.
Whether long-term adverse health effects are associated with vaccinations to prevent
anthrax and botulism cannot be assessed, the committee concluded. No published,
peer-reviewed studies have systematically used active surveillance to evaluate long-term
health effects. But that situation is not unusual, as few vaccines have been monitored for
adverse effects over long periods of time. The committee recommended that such studies be
conducted to determine whether the vaccines produce chronic effects.
Some research has examined whether the cumulative effect of several vaccines in a short
span of time can have long-term adverse consequences. However, the committee found
shortcomings in these studies, and concluded that the evidence is inadequate or
insufficient to determine whether an association exists.
The study was sponsored by the U.S. Department of Veterans Affairs. The Institute of
Medicine is a private, nonprofit institution that provides health policy advice under a
congressional charter granted to the National Academy of Sciences. A committee roster
Pre-publication copies of Gulf War and Health, Volume 1: Depleted Uranium, Sarin,
Pyridostigmine Bromide, and Vaccines are available from the National Academy Press at
the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. The cost of
the report is $54.00 (prepaid) plus shipping charges of $4.50 for the first copy and $.95
for each additional copy. Reporters may obtain a copy from the Office of News and Public
Information at the letterhead address (contacts listed above).
Full Report [GO]
INSTITUTE OF MEDICINE
Division of Health Promotion and Disease Prevention
Committee on Health Effects Associated with Exposures During the Gulf War
Harold C. Sox Jr., M.D.* (chair)
Joseph M. Huber Professor of Medicine
Department of Medicine
Dartmouth-Hitchcock Medical Center
Michael Aschner, Ph.D.
Department of Physiology and Pharmacology
School of Medicine
Wake Forest University
Patricia A. Buffler, M.P.H., Ph.D.*
Dean Emerita and Professor of Epidemiology
School of Public Health
University of California
Lucio Guido Costa, Ph.D.
Professor and Director of Toxicology
Department of Environmental Health
University of Washington
Firdaus Dhabhar, Ph.D.
College of Dentistry
Ohio State University
Anthony L. Komaroff, M.D.
Professor of Medicine
Harvard Medical School;
Brigham and Women's Hospital; and
Editor in Chief
Harvard Medical Publications
Janice L. Krupnick, Ph.D.
Clinical Professor of Psychiatry
Department of Psychiatry
Georgetown University, and
Herbert E. Lowndes, Ph.D.
College of Pharmacy
Ernest L. Mazzaferri, M.D., M.A.C.P.
Emeritus Professor and Chair
Department of Internal Medicine
Ohio State University
Demetrios J. Moschandreas, Ph.D.
Professor of Environmental Engineering and Associate Chair
Department of Chemical and
Illinois Institute of Technology, and
Institute for Science, Law, and Technology
Charles E. Phelps, Ph.D.*
University of Rochester
Samuel J. Potolicchio, M.D.
Department of Neurology
George Washington University Medical Center
Jean F. Regal, Ph.D.
Professor of Pharmacology
Department of Pharmacology
School of Medicine
University of Minnesota
Marc Schenker, M.D., M.P.H.
Professor of Medicine and Chair
Department of Epidemiology and
School of Medicine
University of California
Peter H. Schur, M.D.
Professor of Medicine
Harvard University, and
Clinical Immunology Lab
Brigham and Women's Hospital
Francoise Seillier-Moiseiwitsch, Ph.D.
Department of Biostatistics
School of Public Health
University of North Carolina
Walter C. Willett, M.D., Dr.P.H.*
Professor of Epidemiology and Nutrition, and Chair
Department of Nutrition
Harvard School of Public Health
Scott L. Zeger, Ph.D.
Professor and Chair
Department of Biostatistics
School of Hygiene and Public Health
Johns Hopkins University
Carolyn Fulco, M.S.
Cathy Liverman, M.L.S
*Member, Institute of Medicine
1/6/2003 Link added:
War Syndrome Defined - Evidence and Conclusions
British Soldiers Show Symptoms
Helps More With Gulf War Illness
Study Looks at Gulf War Vets'
12/20/00 News and
12/19/00 Press Releases:
Presidential Panel: No Gulf War Illness Coverup - ABC
D.O.D. Updates Its Environmental Exposure Report
on Depleted Uranium - 12/19/00
Use in the Gulf War - 12/19/00
Vaccine Use in the Gulf War - Shortfalls Identified, Improvements Neede - 12/19/00
Academies' Institute of Medicine - Press Release
(see full text above)
Gulf War Scars - ABC News
Gulf War veterans
suffered brain damage - CNN
of Texas Southwestern Medical Center at Dallas
Gulf War Registry
Storm Justice Foundation
Latest additions to GULFLINK
Joyce Riley on GWS
- Office of the Special Assistant for Gulf War Illnesses
National Academies - Institute of Medicine
Seymour Hersh vs. The Pentagon
Frontline - Last Battle of
the Gulf War
Hampshire Gulf War Syndrome Association
War Veteran Resource Pages @ gulfweb.org
Division of Epidemiology - UT
Southwestern Medical Center
Looking at Possible Cause of Gulf War Syndrome
Gassed in the Gulf - Did the CIA and the Pentagon cover
Reference for Gulf War-Related Research
January 22, 2002