2. Gulf War Syndrome

3. Chemical weapons in history

4. The nerve of this gas

5. Agent Orange revisited

6. Dioxin on trial

7. Most poisonous substance?

Update: Gulf War Syndrome

In a 1996 photo, Brian Martin, 33, snuggles with his daughter, Jasmine, 5, at home in Niles, Mich. Martin said he still suffered headaches, memory loss and swollen joints and was unable to work due to gulf war syndrome. Martin is one of 700,000 GIs who served in the Gulf between August 1990 and April 1991. Courtesy: AP Photo/Paul Rakestraw

U.S. and Allied soldiers talk tactics.
XVIII Airborne Corps photograph by MAJ Dennis P. Levin. Courtesy U.S. Army

Gulf war syndrome still eludes science
Soon after returning from the Persian Gulf war in 1991, U.S. veterans began complaining of strange symptoms: fatigue, joint pains, memory loss. The complaints were hard to dismiss -- after all, these soldiers had been in combat-ready condition when they were shipped east to drive Iraq's army from Kuwait.

At first, the Pentagon denied that the syndrome existed, then asserted that it could have been caused by war-time chemical exposure. Although Iraq had repeatedly warned of its willingness to use chemical weapons, there was no hard evidence that it did. Nor could the incineration of Kuwait's oil fields have caused the problem, since many of the ill vets had not been exposed to the huge clouds of petro-fumes.

On Oct. 9, 1996, a prestigious committee of the National Academy of Science's Institute of Medicine concluded that there was no evidence for a mysterious chronic illness associated with Persian Gulf War service.

All ahead reverse!
The report barely hit the headlines when the dam broke. One revelation after another bespoke the possibility that some combination of toxic chemicals or biological agents had caused the syndrome.

It turned out that a major Iraqi ammunition dump detonated by U.S. soldiers had contained nerve gas, and that Gulf-War symptoms were appearing in ever-more vets.

After the Pentagon shifted into reverse and admitted that its vets were not simple malingerers, it turned gulf war syndrome into a heavily researched -- and exceedingly frustrating -- medical conundrum. Soldiers in the Gulf region were exposed to a bewildering variety of nasties: oil smoke, nerve gas, vaccines, depleted uranium, fuel, insecticides, anti-nerve-gas medicines -- in addition to the usual dislocation, boredom, exhilaration and terror of wartime.

"Gulf war syndrome" now encompasses two broad categories of complaints:

neurological symptoms -- fatigue, memory loss, difficulty concentrating and sleep disturbances, and physical symptoms -- digestive problems, joint pain, and heart and circulatory difficulties.

As we write in 2001, the U.S. government has spent $155 million researching the syndrome, and nobody can say for certain what caused gulf war syndrome -- or indeed whether it is a unique medical entity rather than a bundle of diseases seen after other wars but called by other names.

Blowing up in your face
122mm sarin-filled rockets
Courtesy United Nations Special
Commission (UNSCOM)

The 1996 announcement that broke the dam of skepticism concerned the destruction of the giant Kamisiyah ammunition dump in southern Iraq on March 4, 1991, the day after Iraq surrendered. To destroy the arsenal, members of the 37th Engineering Battalion had set explosives under rockets that, unknown to them, contained the deadly nerve gas Sarin. The evidence of possible contamination began spreading like nerve gas across a desert battlefield:

The Pentagon announced that a pit holding at least 300 rockets containing sarin and cyclosarin, a related compound, had been demolished March 10.

The New York Times reported that Kamisiyah had been bombed extensively before the ground campaign, meaning GIs could have been exposed before their assault (see "U.S. Jets..." in the bibliography.)

The Pentagon continued to raise its estimate of the number of downwind troops who might have been exposed to chemical weapons during demolition efforts.

Courtesy Central Intelligence Agency

The Kamisiyah dump contained up to seven tons of sarin, according to press reports. Since it takes just a millionth of a gram of sarin to kill, that amount could, theoretically, kill millions. The only "good" data on Sarin's human toxicity come from a subway-poisoning episode in Tokyo, but the high doses in the subway may not shed much light on the low doses the GIs got in the desert (see "Sarin Savagery" in the bibliography).

Still, the revelations provided a possible material basis for the syndrome. Politicians of both parties, and activists who had pushed for action on gulf war syndrome, quickly demanded research, treatment and compensation.

Another question-mark
Five years later, the issue remains about as intractable as ever. Nobody can explain what combination of insults -- whether from vaccines, toxins or pathogens -- caused the syndrome. As researchers desperately chase an elusive target, some have advocated far-fetched theories about causes and treatments.

In 1997, Robert Haley, an epidemiologist at the University of Texas Southwestern Medical Center, published studies that differentiated three components of gulf war syndrome:
- memory, attention and reasoning;
- confusion and balance;
- and muscle aches and weakness.
Haley correlated each of these syndromes with specific chemical exposures, but critics questioned his small sample and lack of controls.

Edward Hyman, a retired New Orleans doctor, thinks gulf war syndrome reflects a chronic bacterial infection. Hyman got $3.4 million in 1996 direct from Congress to study 36 people, but he has yet to publish his results. Apparently, he failed to use standard double-blind procedures to reduce bias.

A southern California researcher, Girth Nicholson, also received $3.4 million to study 491 gulf war patients, who will get either a placebo or an antibiotic. Like Hyman, Nicholson attributes the syndrome to an infection that can only be cleared by long-term antibiotic treatment.

Backdrop
A soldier is checked for contamination at the Tactical Operations Center (TOC) military police desk before being allowed to enter the building.
XVIII Airborne Corps History Office photograph by PFC John F. Freund. Courtesy U.S. Army

Behind the disputes over gulf war syndrome is a long-standing argument over the effects of low doses of chemicals. At one extreme are those who believe exposure to many chemicals can lead to multiple chemical sensitivity. At the other, many scientists say that if an effect is not been measured in the lab, it doesn't exist.

Still, veterans take gulf war syndrome seriously. By 1996, an estimated 50,000 to 60,000 U.S. veterans had sought medical evaluation for the syndrome from doctors in the military or Department of Veterans Affairs.

But in 2001, despite continuing studies, the existence and cause of gulf war syndrome are both in question. At a meeting in Virginia in January, 2001, John Feussner, the top research official in the Department of Veterans Affairs, told Science magazine, "We're going to look as long as there's a chance we're going to find something."

Science reported that researchers reported no major insights at the 2001 meeting, and seemed to accept that the conundrum might be insoluble (see "Gulf War Illness: the Battle Continues" in the bibliography).

In their heads?
It's possible -- although anathema to many gulf war activists -- that gulf war syndrome is the name for a more generalized post-war syndrome. After World War I, the lingering effects of war were called "shell shock"; after World War II, "battle fatigue," and after the U.S. war in Vietnam, "post-traumatic stress syndrome."

According to this theory, gulf swar syndrome is a more heavily publicized and intensely researched version of the physical and psychological impact of waging war.

Who invented chemical weapons? Why?