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Gulf War syndrome (GWS) is the name given to a variety of psychological and physical symptoms, including increases in the rate of immune system disorders and birth defects, reported by veterans of the Gulf War. It has not always been clear whether these symptoms were related to Gulf War service. Symptoms attributed to this syndrome have often been wide-ranging and sometimes poorly defined. They often include chronic fatigue, loss of muscle control, diarrhea, migraines, dizziness, memory problems and loss of balance. U.S. Gulf War veterans have experienced mortality rates exceeding those of U.S. Vietnam veterans, and brain cancer deaths, amyotrophic lateral sclerosis (commonly known as Lou Gehrig's disease) and fibromyalgia now are recognized by the Defense and Veterans Affairs departments as potentially connected to service during the Persian Gulf War.[1]

Various causes that have been suggested:

[edit] Depleted Uranium, Birth Defects, and Immune System Damage

Because uranium is a heavy metal and chemical toxicant with nephrotoxic (kidney-damaging),[3] teratogenic (birth defect-causing),[4] and potentially carcinogenic[5] properties in lab-animals, some sources believe there a connection between uranium exposure and a variety of illnesses.[6] To date, nobody has proven that anyone who served in the Gulf War received exposures large enough to cause any harm. The chemical toxicological hazard posed by uranium dwarfs its radiological hazard because it is only weakly radioactive. In 2002, A.C. Miller, et al., of the U.S. Armed Forces Radiobiology Research Institute, found that the chemical generation of hydroxyl radicals by depleted uranium in vitro exceeds radiolytic generation by one million-fold.[7] In 2005, uranium metalworkers at a Bethlehem plant near Buffalo, New York, exposed to frequent occupational uranium inhalation risks, were alleged by non-scientific sources to have the same patterns of symptoms and illness as Gulf War Syndrome victims.[8][9]

The increase in the rate of birth defects in the children of Gulf War veterans and in Iraqis is unexplained. Depleted uranium exposure has been hypothesized to be a source of this.[10][11] A 2001 study of 15,000 U.S. Gulf War combat veterans and 15,000 control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers) times as likely to have children with birth defects.[12] However there is evidence to suggest that depleted uranium is not the cause of these birth defects.[13] In a study of UK troops, "Overall, the risk of any malformation among pregnancies reported by men was 50% higher in Gulf War Veterans (GWV) compared with Non-GWVs."[14] A report written by an Irish petrochemical engineer stated that in Iraq, death rates per 1000 Iraqi children under 5 years of age increased from 2.3 in 1989 to 16.6 in 1993 and cases of leukaemia have more than quadrupled in areas where DU was present. I. Al-Sadoon, et al., writing in the Medical Journal of Basrah University, report modest increase many years after the Gulf War. The link between these increases and DU is unproven.[15]

Early studies of depleted uranium aerosol exposure assumed that uranium combustion product particles would quickly settle out of the air[16] and thus could not affect populations more than a few kilometers from target areas,[17] and that such particles, if inhaled, would remain undissolved in the lung for a great length of time and thus could be detected in urine.[18] But according to Drs. Jofu Mishima, Maryanne Parkhurst, and John R. Johnson of the Army's Pacific Northwest Laboratory proving grounds, and Joe DiCicco and Dr. Phil Goldberg of the NRC, those studies ignored uranium trioxide gas—also known as uranyl oxide gas, or UO3(g)—which is formed during uranium combustion,[19] U3O8 being the dominant aerosol combustion product.[20] Uranyl ion contamination has been found on and around depleted uranium targets.[21] UO3 gas remains dissolved in the atmosphere for weeks, but as a monomolecular gas is absorbed immediately upon inhalation, leading to accumulation in tissues including gonocytes (testes[22]) and white corpuscles,[23] but virtually no residual presence in urine other than what might be present from coincident particulate exposure. However, even if true, there are no studies showing that Gulf War veterans received exposures high enough to result in potential harm.

In early 2004, the UK Pensions Appeal Tribunal Service began attributing birth defect claims from February 1991 Gulf War combat veterans to depleted uranium poisoning.[24]

In the Balkans war zone where depleted uranium was also used, an absence of problems is seen by some as evidence of DU muntions' safety. "Independent investigations by the World Health Organization, European Commission, European Parliament, United Nations Environment Programme, United Kingdom Royal Society, and the Health Council of the Netherlands all discounted any association between depleted uranium and leukemia or other medical problems.[25] However, the birth defects observed in the children of U.S. and UK troops, as well as Iraqi civilians, took several years to manifest, so the later date of the Balkans conflict is significant, and conclusive data has yet to be gathered. Furthermore, Balkans troops are showing the same chromosomal aberrations in lymphocytes as Gulf War troops have shown.[26]

[edit] Neurotoxicity

United States Veterans Affairs Secretary Anthony Principi's 2004 review committee stated that the veterans' illnesses are linked to exposure to neurotoxins. In 2005, 75 mg/L of depleted uranium in drinking water was shown to be a neurotoxin in rats.[27]

[edit] Gulf War Syndrome and Multiple Chemical Sensitivity

The symptoms of Gulf War Syndrome are similar to those of industrial uranium fume exposure[28] than Multiple Chemical Sensitivity.

[edit] Potential Sources of Exposure to Depleted Uranium

The United States Air Force and Army use the 30 mm PGU-14/B armor-piercing incendiary round[29] in the GAU-8 Avenger cannon of the A-10 Thunderbolt II, and in AH-64 Apache helicopters. Most of the uranium munitions used in combat have been in the form of 30 mm and smaller rounds.[30] The Marine Corps uses DU in the 25 mm PGU-20 round fired by the GAU-12 Equalizer cannon of the AV-8B Harrier, and also in the 20 mm M197 gun mounted on AH-1 helicopter gunships.

The US Army uses depleted uranium for antitank munitions in an alloy with around 3.5% titanium. It is used by the US Army in 120 mm or 105 mm calibre by the M1 Abrams and M60A3 tanks and in 25 mm calibre by the M242 mounted on the M2 Bradley. During the February, 1991 Gulf war, about 130 soldiers were exposed to DU in friendly fire incidents involving antitank rounds. Many received embedded DU shrapnel, and all are known to have inhaled DU particles based on residual urine studies many years later. Despite this, soldiers known to have DU shrapnel in their bodies have not shown any adverse health effects because of it.[31]

[edit] Anthrax Vaccine

Anthrax vaccine was blamed by troops early-on as a potential source of the mysterious pattern of illness. The vaccine was particularlly painful when administered, and often caused a severe local skin reaction that lasted for weeks or months.[32]

While the Food and Drug Administration (FDA) approved, it never went through large scale clinical trials, in comparison to almost all other vaccines in the United States.[33]

Data linking squalene in the vaccine to Gulf War Syndrome was "presented in the peer-reviewed February 2000 and August 2002 articles. The published findings (1) strongly suggest that the GWS-like illness being reported by all of the various patient groups is the same illness, (2) strongly suggest that the contaminated vaccine caused the illness in the AVIP group, and (3) further suggest that squalene contamination of one or more 1990-1991-era vaccines accounts for the GWS cases from that era."[34] The sickest veterans tended to have the highest levels of squalene antibodies in their bloodstream.[35]

Even after the war, troops that had never been deployed overseas, after receiving the anthrax vaccine, developed symptoms similar to those of Gulf War Syndrome. The Pentagon failed to report to Congress 20,000 cases where soldiers were hospitalized after receiving the vaccine between 1998 and 2000.[36]

252 Members of a U.S. Air Force Squadron who received the vaccine were surveyed, and 139 of these returned their questionnaires. Of these, 58% reported reactions, often consistent with some features of a Gulf War Syndrome type illness, including: joint and muscle pain (41%), decreased energy and tiredness (29%), reduced concentration (28%), short-term memory loss (24%), and sleep problems (17%).[37]

In 2000, a medical examiner ruled that anthrax vaccine was a contributing factor in the death of a civilian who helped manufacture the vaccine given to U.S. troops.[38] That same year, a Canadian judge ruled that the anthrax vaccine was potentially unsafe, halting the trial of a soldier who had been court-matialled for refusing to take it.[39]

Despite repeated assurances that the vaccine was safe and necessary, a U.S. Federal Judge ruled that there was good cause to believe it was harmful, and he ordered the Pentagon to stop administering it in October 2004.[40] That ban has not been lifted. Anthrax vaccine is the only substance suspected in Gulf War syndrome to which forced exposure has since been banned to protect troops from it.

In July 2005, a U.S. soldier was awarded a disability pension for medical problems which developed after his anthrax vaccination, after a Federal Appeals Court ruled in his favor.[41]

On December 15, 2005, the Food and Drug Administration released a Final Order finding that anthrax vaccine is safe and effective. All vaccines cause adverse events in a subset of those to whom they are administered.[42] Women who receive the vaccine get pregnant and deliver children at the same rates as unvaccinated women. Anthrax vaccination has no effect on pregnancy and birth rates or adverse birth outcomes.[43]

[edit] Chemical weapons

Many of the symptoms of Gulf War Syndrome are identical to those experienced in organophosphate poisoning. Gulf War veterans were exposed to a number of sources of these compounds, including nerve gas and pesticides.[44][45]

Over 125,000 U.S. troops and 9,000 UK troops were exposed to nerve gas and mustard gas when an Iraqi depot in Khamisiyah, Iraq was bombed in 1991.[46]

Some, including Dr. Richard Guthrie, an expert in chemical warfare at Sussex University, have argued that a likely cause for the increase in birth defects was the Iraqi Army’s use of teratogenic mustard agents. Plaintiffs in a long-running class action lawsuit continue to assert that sulphur mustards might be responsible.[47] According to the CDC Toxicological Profile, for sulphur mustards to have produced as many birth defects as have been observed, they would have had to have also produced several dozen times as many cancers as observed.[48]

[edit] Controversy

There is controversy over whether or not Gulf War syndrome is, in fact, a physical medical condition related to sufferers' Gulf War service (or relation to a Gulf War veteran).

[edit] Evidence for

United States Veterans Affairs Secretary Anthony Principi's panel found that pre-2005 studies suggested the veterans' illnesses are neurological and apparently are linked to exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug pyridostigmine bromide, and pesticides that affect the nervous system.

"Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience or other deployment-related stressors do not explain Gulf War veterans illnesses in the large majority of ill veterans," the review committee said.

In November, 2004, the anonymously-funded British inquiry headed by Lord Lloyd[49] concluded, for the first time, that thousands of UK and US Gulf War veterans were made ill by their service. The report claimed that Gulf veterans were twice as likely to suffer from ill health than if they had been deployed elsewhere, and that the illnesses suffered were the result of a combination of causes. These included multiple injections of vaccines, the use of organophosphate pesticides to spray tents, low level exposure to nerve gas, and the inhalation of depleted uranium dust.[50][51] The report was the first to suggest a direct link between military service in the Gulf and illnesses suffered by veterans of that war and directly contradicts other theories which have suggested GWS is not a physical illness, but a response to the stresses of war.

Although not identifying Gulf War syndrome by name, in June of 2003 the High Court of England and Wales upheld a claim by Shaun Rusling that the depression, eczema, fatigue, nausea and breathing problems that he experienced after returning from the Gulf War were attributed to his military service.

A new British study comparing 24,000 Gulf War veterans to a control group of 18,000 men found that those who had taken part in the Gulf war have lower fertility and are 40 to 50% more likely to be unable to start a pregnancy. Among Gulf war soldiers, failure to conceive was 2.5% vs. 1.7% in the control group, and the rate of miscarriage was 3.4% vs. 2.3%. These differences are small but statistically significant.[52]

In January 2006, a study led by Melvin Blanchard and published by the Journal of Epidemiology, part of the "National Health Survey of Gulf War-Era Veterans and Their Families", stated that veterans deployed in the Gulf War had nearly twice the prevalence of chronic multisymptom illness (CMI), a cluster of symptoms similar to a set of conditions often called Gulf War Syndrome.[53]

[edit] Evidence against

Similar syndromes have been seen as an after effect of many conflicts — for example, 'shell shock' after World War I, and post-traumatic stress disorder after the Vietnam War.

Another possibility is that some or all of the symptoms experienced are unrelated to service in the Gulf. A study for the United Kingdom Ministry of Defence found no correlation between service in the Gulf and death from illness.

A 14 November 1996 article in the New England Journal of Medicine found no difference in death rates or hospitalization rates between Persian Gulf vets and non-Persian Gulf vets.

Additionally, some reported symptoms cannot be verified or connected to Gulf War service. Pfc. Brian Martin, a Gulf War veteran who has appeared on multiple talk shows and given interviews to many newspapers and magazines about Gulf War syndrome, reported developing lupus erythematosus, which news articles claim had been verified by federal medical exams, despite the Department of Veterans Affairs's denial of having had any patients with it. Army Reservist Michael Adcock (the first veteran whose death was widely attributed to Gulf War syndrome) and Navy Seabee Reservist Nick Roberts both claimed that their lymphoma developed soon after their Gulf War service, despite lymphoma taking several years to develop.

[edit] References

  1. ↑ Barber, Mike. "First Gulf War still claims lives", Seattle Post-Intellingencer, 2006-01-16.
  2. ↑ Error on call to Template:cite web: Parameters url and title must be specifiedRaabe, Otto G. (2001). . Retrieved on 2006-02-24.
  3. ↑ Hindin, Rita; Brugge, Doug; Panikkar, Bindu (2005). "Teratogenicity of depleted uranium: A review from an epidemiological perspective." Environ. Health 4:17.
  4. ↑ Miller, A. C. (2004). Carcinogenic Potential of Depleted Uranium and Tungsten Alloys. Retrieved on 2006-02-24.
  5. ↑ ATSDR (1999). Toxicological Profile for Uranium. Retrieved on 2006-02-24.
  6. ↑ Miller, A. C.; Stewart, M.; Brooks, K.; Shi, L.; Page, N. (2002). "Depleted uranium-catalyzed oxidative DNA damage: absence of significant alpha particle decay." J. Inorg. Biochem. 91:246–52. Abstract
  7. ↑ Bonfatti, John F. (2004-12-16). Former Marine suffered from secret uranium work at Bethlehem fought battle. Retrieved on 2006-02-24.
  8. ↑ Lombardi, Kristen. "Stirring Up the Toxic Dust", Village Voice, 2005-06-21.
  9. ↑ Domingo, J. L. (2001). "Reproductive and developmental toxicity of natural and depleted uranium: a review." Reprod. Toxicol. 15:603–9. Abstract
  10. ↑ Hu Q. Y.; Zhu S. P. (1990). "Induction of chromosomal aberrations in male mouse germ cells by uranyl fluoride containing enriched uranium." Mutat. Res. 244:209–14. Abstract
  11. ↑ Kang, Han; Magee, Carol; Mahan, Clare; Lee, Kyung; Murphy, Frances; Jackson, Leila; Mantanoski, Genevieve (2001). "Pregnancy Outcomes Among U.S. Gulf War Veterans: A Population-Based Survey of 30,000 Veterans." Ann. Epidemiol. 11:504–11. Abstract
  12. ↑ Error on call to Template:cite web: Parameters url and title must be specified. Retrieved on 2006-02-24.
  13. ↑ Doyle, Pat; Maconochie, Noreen; Davies, Graham, Maconochie, Ian; Pelerin, Margo; Prior, Susan; Lewis, Samantha (2004). "Miscarriage, stillbirth and congenital malformation in the offspring of UK veterans of the first Gulf War." Int. J. Epidemiol. 33:74–86.
  14. ↑ Al-Sadoon, Imad; Hassan, Genan G.; Yacoub, Alim A-H. (1999). "Depleted uranium and health of people in Basrah: epidemiological evidence." Med. J. Basrah Univ. 17(1&2).
  15. ↑ http://www.deploymentlink.osd.mil/du_library/du_ii/du_ii_tabl1.htm
  16. ↑ Mitsakou, C.; Eleftheriadis, K.; Housiadis, C.; Lazaridis, M. (2003). "Modeling of the dispersion of depleted uranium aerosol." Health Phys. 84:538–44. Abstract
  17. ↑ Horan, P.; Dietz, L.; Durakovic, A. (2002). "The quantitative analysis of depleted uranium isotopes in British, Canadian, and U.S. Gulf War veterans." Mil. Med. 167:620–27. Abstract
  18. ↑ Ackermann, R. J.; Thorn, R. J.; Alexander, C.; Tetenbaum, M. (1960). "Free Energies of Formation of Gaseous Uranium, Molybdenum, and Tungsten Trioxides." J. Phys. Chem. 64:350–55. "gaseous monomeric uranium trioxide is the principal species produced by the reaction of U3O8 with oxygen."
  19. ↑  see note 15 (MilRefs) [54]
  20. ↑ Salbu, B.; Janssens, K.; Lind, O. C.; Proost, K.; Gijsels, L.; Danesi, P. R. (2005). "Oxidation states of uranium in depleted uranium particles from Kuwait." J. Environ. Radioactivity 78:125–35.
  21. ↑ Giffin, Noel (1996). Alpha Particles. Retrieved on 2006-02-24.
  22. ↑ Schröder, H.; Heimers, A.; Frentzel-Beyme, R.; Schott, A.; Hoffmann, W. (2003). "Chromosome aberration analysis in peripheral lymphocytes of Gulf War and Balkans War veterans." Rad. Prot. Dosimet. 103:211–19. (PDF file)
  23. ↑ Williams, Martin. "First Award for Depleted Uranium Poisoning Claim", The Herald, 2004-02-04. CHECK URL
  24. ↑ Depleted Uranium [DU]. Retrieved on 2006-02-24.
  25. ↑  see note 22 (Schröder) [55]
  26. ↑ Briner, W.; Murray, J. (2005). "Effects of short-term and long-term depleted uranium exposure on pen-field behavior and brain lipid oxidation in rats." Neurotoxicol. Teratol. 27:135–44. Abstract
  27. ↑ Durakovic, Asaf (1999). "Medical Effects of Internal Contamination with Uranium." Croat. Med. J. 40:49–66. Abstract (PDF file)
  28. ↑ FAS (1999). PGU-14/B API Amor Piercing Incendiary [DU 30mm Ammunition]. Retrieved on 2006-02-24.
  29. ↑  see note 25 (GlobalSecurity) [56]
  30. ↑  see note 12 (Rand) [57]
  31. ↑ Chan, Kwai-Cheung (2000). Testimony before the Committee on Government Reform, House of Representatives.
  32. ↑ Burdeau, Cain. "Expert: Antrax vaccine not proven", The Clarion-Ledger, 2001-05-16.
  33. ↑ Autoimmune Technologies, LLC. Anti-squalene antibodies link Gulf War syndrome to anthrax vaccine. Retrieved on 2006-02-24.
  34. ↑ Rodriguez, Paul M. (1997). Breakthrough on Gulf War Illness. Retrieved on 2006-02-24.
  35. ↑ "Effects of Anthrax vaccine downplayed", Vermont Guardian, 2005-12-10.
  36. ↑ House, Kate (2000). Survey indicates wide variety of reactions to anthrax vaccination. Retrieved on 2006-02-24.
  37. ↑ Evenson, A. J.; Martin, Tim (2000). Medical examiner links death to anthrax vaccine BioPort official shocked by word of employee's autopsy. Retrieved on 2006-02-24.
  38. ↑ Associated Press. Judge Agress Anthrax Vaccine Unsafe; Halts Court Martial. Retrieved on 2006-02-24.
  39. ↑ Trowbridge, Gordon. "Court asked to allow mandatory inocculations", Marine Corps Times, 2005-12-14.
  40. ↑ Fisher, Frank. Significant Anthrax Immunization Complications Court Decision in favor of a Vet (Docket for 04A988). Retrieved on 2006-02-24.
  41. ↑ http://www.nap.edu/catalog/10310.html
  42. ↑ Wiesen, A. R.; Littel, C. T. (2002). "Relationship between prepregnancy anthrax vaccination and pregnancy and birth outcomes among US Army women." J. Am. Med. Assoc. 287:1556–60. Abstract full text available
  43. ↑ Hooper, Malcolm (2000). New findings in OPs and Gulf War Syndrome. Retrieved on 2006-02-24.
  44. ↑ "Campaigners hail 'nerve gas link' to Gulf War Syndrome", The Scotsman, 2004-11-13.
  45. ↑ Craig, Ian (2004-06-14). Did Iraqi nerve gas trigger Gulf War sickness?. Retrieved on 2006-02-24. check URL
  46. ↑ http://www.gulfwarvetlawsuit.com/
  47. ↑  note 5 chapter 3 [58]
  48. ↑ Report of the Independent Public Inquiry on Gulf War Illnesses check URL
  49. ↑ BBC News. Call to recognise Gulf War effect. Retrieved on 2006-02-24.
  50. ↑ Press Association. "Inquiry backs 'Gulf War syndrome' claims", The Guardian, 2004-11-17.
  51. ↑ MacKenzie, Debora. "Gulf war veterans have fertility problems", New Scientist, 2004-07-14.
  52. ↑ "Study finds multisymptom condition is more prevalent among Persian Gulf vets", Washington University Record, 2006-01-20.

[edit] See also

[edit] External links

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