The Gulf War Within

When soldiers returning from the war complained of mysterious illness, the Pentagon called it stress. But the real culprit, it appears, was deadly chemistry.

By Peter Radetsky|Friday, August 01, 1997
RELATED TAGS: WEAPONS & SECURITY
Jerry Phillips is 48 years old, six feet tall, and a thick 250 pounds. He has short-cropped brown hair and a beard and wears a black T- shirt and jeans. On his left forearm a tattoo features a smirking devil encircled by the words born to raise hell. You wouldn’t be surprised to see him pull away in a big rig or on a Harley.

Not today, he won’t. This career mechanic and truck driver has trouble concentrating behind the wheel. He can no longer even bear to be around vehicles. He hasn’t worked in six years. He’s mysteriously ill, plagued by chest pains, headaches, dizziness, nausea, memory lapses, confusion. He can’t pass a sobriety test, though he hasn’t had a drink in six years. Sometimes he can hardly breathe. Other times he’s so exhausted it takes him days to recover. No more raising hell for Jerry Phillips. He is a victim of what, for lack of a better term, has been dubbed Gulf War Syndrome.

The Persian Gulf War lasted little more than a month--from January 16 to February 27, 1991. Of the 700,000 U.S. troops sent to the gulf, fewer than 300 died; barely 400 were wounded. By comparison, it’s estimated that 100,000 Iraqi soldiers were killed and 300,000 wounded; another 150,000 deserted, and 60,000 were taken prisoner. The war was an overwhelming coalition victory, more decisive and much quicker than anticipated, the greatest triumph for the American military since World War II.

When the troops returned, however, some were stricken with strange, debilitating maladies: fatigue, diarrhea, skin rashes, muscle and joint pain, headaches, loss of memory, difficulty breathing, gastrointestinal and respiratory problems, and worse. To date more than 110,000 vets have registered with federal agencies as suffering from what is now known as Gulf War Syndrome. More than 40 gws support groups have sprung up across the country; at least eight Web sites offer information and services. Several dozen congressional hearings have investigated the puzzle.

But as far as the Pentagon is concerned, there is no such thing as Gulf War Syndrome. While some vets may be suffering, it maintains, their maladies are hardly unique or mysterious. Rather, they’re par for the course. When you send a large number of healthy young people off into an extremely dangerous and stressful environment--surprise, surprise--some proportion of them come home with a variety of illnesses, says Stephen Joseph, assistant secretary of defense for Health Affairs.

Those illnesses include, in Joseph’s words, musculoskeletal conditions (acquiring a bad hip from falling off the back of a humvee is an example), ill-defined conditions, diseases that would have developed anyway, whether the troops had gone to the gulf or stayed in San Diego, and psychological conditions, the largest single category, which, according to Joseph, are the result of all the psychological and individual stresses that took place in this austere environment.

Jerry Phillips doesn’t agree. Neither do thousands of other sick vets. They consider themselves victims of something more sinister: battlefield exposure to toxic chemicals. Par for the course, nothing. Psychological stress, nothing. Pesticides, petroleum products, smoke from burning oil fields, chemical and biological weapons, even preventive medicines--in the vets’ eyes, these are the culprits that have destroyed their health.

They have a case. After years of denial, the Pentagon has disclosed that some 20,000 soldiers may have been exposed to nerve gas released into the air from bombings of Iraqi ammunition depots that contained chemical weapons. The cia has raised the ante, hinting that the number of troops exposed may actually be in the hundreds of thousands. But even if there were no such exposure, recent animal experiments have shown that a mix of common chemicals used during the Gulf War can cause symptoms similar to those of gws. And epidemiological studies of Gulf War vets have linked the very same chemicals with symptoms of the syndrome.

None of which surprises Jerry Phillips. Maybe because his collection of so-called psychological and individual stresses has torn his life apart. His story is typical--and harrowing. On New Year’s Eve, 1991, Jerry, then a mechanic with the Oklahoma National Guard, shipped out, his destination Dhahran, a town in eastern Saudi Arabia, just west of Bahrain.

They gave us a motor pool where they put the whole battalion, he says in his slow-talking, Oklahoma drawl. It was just a big round shed. We were heating with kerosene, while we’re messing with diesel fuel and gasoline for the trucks. There was no ventilation.

Well, I was sitting doing paperwork when the Saudis come through and fog the area for insects. About once a week they did that. There was no prior notice. You’d hear trucks start up, and here they’d come about 40 miles an hour, fogging all over everything. With what, we don’t know, but it just hung inside these plastic-covered sheds.

I started getting sick to my stomach and light-headed. My mouth was numb around my lips, my arms were tingling, my chest was hurting. So they took me to the dispensary.

Because Jerry was over 40, and overweight, the dispensary doctors treated him for a heart attack. But they could find nothing wrong with him. After four days, he was discharged and sent back to work.

I was feeling better, he says. I had had ivs, oxygen, clean air. But while I was gone the Saudis had come through and fogged again. Well, I come back, and I’m sitting there about ten minutes, and I start the same thing. Numbness, chest pains, tingling, and everything.

When I got to the dispensary, the doctor laughed and said, ‘We’re going to send you out of here and get you a stress test.’

By April, Jerry was back in the States. By May, having been shunted from hospital to hospital, presented with diagnosis after diagnosis of psychiatric depression, and given prescription after prescription for antidepressant drugs such as Prozac, he was back home in Oklahoma. And in bad shape.

He had a month off, and all he did was sleep, recalls Jerry’s wife, Connie. I’d leave for work; he’d be on the couch going to sleep. I’d come home; he’d wake up for a few minutes. I’d go to school; he’d go back to sleep. I’d come home later at night, wake him up, and he’d go to bed.

When he went back to work, Jerry found he could no longer tolerate the tools of his trade. I’ve worked around solvents and paints and chemicals all my life, he says. I never had a problem with them before. Now it’s like I’m drunk. I get disoriented and light-headed, with fuzzy vision.

Today Jerry Phillips is living on Medicare, social security, and va disability, after a long battle to convince various governmental and military agencies of the validity of his impairments. This is a guy who used to think wd-40 would make a good cologne, and now even the slightest chemical odor makes him ill. The Pentagon might contend that there is no such thing as Gulf War Syndrome, but don’t tell that to the Phillipses.

What is going on with these Desert Storm vets? It’s a hard question to answer. The Pentagon certainly hasn’t been able to answer it to anyone’s satisfaction except its own. One reason may be that to the military, chronic illness arising from this, its shining hour, is unwelcome and dubious, the last thing the Army wants to deal with. Pentagon staffers (who refuse to be identified) admit as much. They claim that the Army is a victim of its own success. Had the war lasted longer and been more arduous, producing Iraqi-level U.S. casualties, say, no one would have had the inclination to squawk about a little disorientation, chest pain, and nausea.

Another possible reason is less callous and more disturbing. Despite loudly trumpeted fears about Saddam Hussein’s ability to wage chemical and biological warfare, the military was ill-prepared for the possibility of chronic illness due to chemical exposure in the gulf.

Their doctrine was that the effects of chemical agents were acute--immediate, severely debilitating. Either they kill you right away, or they don’t do anything, says James Tuite, a former Senate staffer who spearheaded Congress’s early inquiries into Gulf War Syndrome and now continues his investigations independently. Well, that may be warfare doctrine, but it’s not health management and safety doctrine. I have a farm in southern Virginia, and I went to the agricultural extension office there. I said, ‘We know that nerve agents are basically just pesticides for people--let’s look at how they warn people who are exposed to pesticides.’ I pick up an epa document. Big letters: ‘If you experience flu-like symptoms or rashes, immediately seek medical assistance.’ Vets were reporting these flu-like symptoms during the war--rashes, diarrhea, nausea, vomiting--but they were treated as a nuisance: ‘You’re in a foreign country. Don’t worry about it.’

And so vets continued to be exposed--and continued to fall ill.

The chemicals the soldiers encountered fall into four broad categories. The first is petroleum. Petroleum products such as kerosene, diesel fuel, and leaded gasoline were employed for fuel and heating and used to dampen down sand and dust. Troops in Kuwait and eastern Saudi Arabia were also exposed to smoke from oil-well fires.

The second group of chemicals comprises pesticides and insect repellents. Their use in the gulf was unrestricted and widespread. In addition to institutionalized applications for insect control, individual soldiers sprayed the substances on their uniforms, rubbed them on their skin, even wore animal flea and tick collars around their necks. Prominent among the chemicals used were permethrin, chlorpyrifos (Dursban), and diethyltoluamide, or deet, compounds found in many commercial and household products. The Saudis also widely applied pesticides. As records are spotty, no one knows which ones, but it’s likely they were the same as those used by American troops.

The third category of chemicals includes drugs and vaccines. Pyridostigmine bromide is one of them--a drug that protects the body from the toxic effects of nerve gas. It has been used for decades in patients with myasthenia gravis, a chronic disease marked by extreme fatigue and weakness of muscles, but it has never been approved for general use. During the Gulf War it was given to troops for use in case of chemical attack. Persian Gulf troops were also vaccinated against common infectious diseases as well as against two agents of biological warfare, anthrax and botulism toxin. While the infectious-disease vaccines are routinely given to military personnel and civilians, vaccines against anthrax and botulism are less widespread.

Finally, there are biological and chemical weapons. To what extent troops were exposed to these agents remains unclear. Even though during the war U.S. commanders were warned of the presence of toxic chemicals by coalition detection experts, and chemical warning alarms sounded frequently, Defense officials reported no evidence of such exposure. But in the spring of 1996, prompted by pressure from congressional inquiries and the outcries of thousands of vets, the Pentagon announced that up to 400 U.S. troops may have been exposed to chemical weapons--including the deadly nerve agent sarin--following the bombing of an Iraqi ammunition depot just days after the end of the war. In September 1996 the figure was revised upward to more than 5,000 soldiers, in October to 20,000. Then last March came the cia’s hint that hundreds of thousands may have been exposed. It has also been revealed that Army officers had been warned that the Iraqi depot contained chemical weapons but failed to alert the troops who blew up the site or soldiers downwind from the blasts.

These disclosures confirmed suspicions on the part of many veterans that the military had known about chemical exposure from the beginning and was trying to cover up its own carelessness, or complicity, in the matter. I can tell you unambiguously that the Department of Defense has lied about the exposure of troops, states Tuite. They’ve gone so far to try to protect their reputation in what was perceived as the greatest moment in 50 years of American military history that they’ve severely undermined their credibility.

In late February the Pentagon announced that some 80 percent of its logs recording exposure to chemical or biological weapons, including those pertaining to the ammunition depot bombings, had disappeared. Immediately the American Legion called for a criminal investigation. Tuite was doubly upset because when he had requested the logs during his Senate investigations in 1994, the Pentagon had informed him that there were no such records. Now the same officials were declaring that the logs did exist after all but had mysteriously disappeared. These were the same folks who testified in our hearings that there was no information. I call that perjury. I’ve got a new mission in life: uncover the conspiracy.

But cover-up or no, conspiracy or no, all the chemical exposures in the world may be irrelevant if they don’t cause the kind of problems afflicting Gulf War vets. Just what is the effect of the exposures experienced by troops during the Persian Gulf War?

Evidence that low levels of toxic chemicals can cause long-term, chronic illness has been available for at least two decades. In the mid- 1970s, Pentagon-sponsored studies led by neurologist Frank Duffy, now of Harvard Medical School, examined almost a hundred workers at the Rocky Mountain Arsenal outside Denver who had been exposed to low doses of sarin. These people suffered few problems at the time but later on complained of fatigue, memory loss, sleep disturbances, a decrease in sexual drive-- ailments similar to those now reported by gulf troops. When at least a year had passed since the workers had been exposed, Duffy and his team tested the electrical activity in their brains. He found that the patterns were significantly different from patterns in the brains of unexposed people working at the same facility but duplicated those in monkeys Duffy had exposed to the nerve agent. His conclusion: Low levels of exposure produce long-term changes in brain function, leading to a constellation of neurological symptoms. The Army awarded Duffy a medal of commendation for his efforts.

But despite duffy’s medal, the military today holds tight to the all-or-nothing doctrine that if toxic chemicals don’t kill you in the short run, they have no effect at all. There is no credible evidence for chronic illnesses caused by exposure to . . . nerve agents at concentrations too low to produce signs or symptoms of acute . . . poisoning, reads a recent Pentagon report. Such a process cannot be reasonably advanced as having a role in Gulf War illnesses.

What does that leave? Stephen Joseph’s psychological and individual stresses. Veterans Administration studies indicate that close to 45 percent of Gulf War vets experienced significant psychological distress; among them, 9 percent suffer from post-traumatic stress disorder. Post-traumatic stress disorder, or ptsd, is a diagnosis that gained currency after the Vietnam War, partly to explain the apparently stress- related illnesses that have been a part of wartime experience for ages. It’s been known for a long time that war is stressful, and a number of people will crack, says Duffy. It used to be called shell shock.

Much about ptsd is not well understood, including the mechanism that causes illness. It may be that extreme stress alters normal brain function. It’s certainly true that stress weakens the immune system. Whatever the reasons, the outcome can be a series of symptoms that persist even after the original trauma is long gone: sleep disorders, difficulty concentrating, memory problems, anger, depression, jumpiness--in other words, many of the very problems associated with Gulf War Syndrome. No wonder the Pentagon blames stress rather than toxic chemicals--ptsd has been the war-related illness of choice for decades.

But many veterans chafe at the suggestion that their suffering is all in their heads or a function of some psychological weakness, notions they consider not only inaccurate but demeaning. In fact, they dread setting foot in Veterans Administration hospitals. You’re afraid to have any testing from the va, because they can always make it look like it’s psychiatric depression, says Connie Phillips.

When epidemiologist robert Haley of the University of Texas Southwestern Medical Center in Dallas decided to investigate the possible role of chemicals and psychological stress in gws, he thought the truth would not be hard to come by. And he was pretty sure he knew what that truth was. I got into thinking this was a psychological problem, not a real illness, he says. There was nothing to this chemical business, and we were going to be the heroes who disproved it. He was in for a surprise.

Haley and his team designed a study to track down the relationship between exposure to chemicals and symptoms of gws, and to test the effects of those chemicals. In April 1996, in collaboration with researchers at Duke University Medical Center, the team announced the consequences of exposure to combinations of Gulf War chemicals in hens (which are often used for such studies because they react to chemicals much as humans do--including falling off their two legs if they become disoriented). When the team gave the animals single doses of the insect repellent deet or the insecticide permethrin or the anti-nerve gas drug pyridostigmine bromide, even at three times the doses soldiers most likely received, they could detect no signs of illness. But when they combined two of them, the hens began to lose weight and develop diarrhea, shortness of breath, weakness, stumbling, tremors. When the animals were exposed to combinations of all three chemicals, they grew even more ill, sometimes becoming paralyzed and dying. Lab tests showed widespread nervous system damage in the birds.

The inference was inescapable: exposure to a combination of these chemicals, or ones like them, might have caused Gulf War Syndrome.

But why would a combination of exposures cause problems where single exposures did not? The answer, the researchers found, involved an enzyme in the blood called butyrylcholinesterase (BuChE), whose job it is to remove foreign chemicals from the body. It acts like a scavenger and culls foreign invaders such as pesticides. But there’s only so much BuChE in the bloodstream. An exposure to deet or permethrin alone causes no problems--there’s enough BuChE to handle any one invader. Not so with multiple doses, which overwhelm the BuChE supply. The result is an accumulation of toxins in the bloodstream that soon make their way to the brain and nervous system.

When pyridostigmine bromide is added to the mix, the consequences become even more dire. The drug protects against nerve gas by temporarily shielding the target of nerve agents, another bloodstream enzyme called acetylcholin-esterase, or AChE, which regulates the nervous system and is involved in many biological functions. But AChE and BuChE are similar, and pyridostigmine doesn’t differentiate very well between them. It inadvertently tends to shield them both, in effect removing both from circulation. Thus, in the presence of pyridostigmine, even less BuChE is available to combat deet and permethrin.

Now comes the kicker. Recall that pyridostigmine’s primary task is to temporarily neutralize AChE. AChE’s normal function is to modulate nervous system activity, in effect dampening the fire so that our behavior remains balanced and consistent. But if soldiers were exposed to chemicals such as deet and permethrin or took higher-than-recommended doses of pyridostigmine as an added precaution against nerve gas attacks, they may have disrupted that balance. Without AChE to moderate it, the nervous system can become overexcited. The upshot can be tremors, muscle spasms, and other gws-like symptoms. So at the same time that it was promoting these problems by neutralizing BuChE, pyridostigmine may have been exacerbating them by getting rid of AChE--a double whammy.

Ironically, then, the very measures urged on troops to protect them against danger may have intensified their problems afterward. The decision to use these chemicals was made to protect soldiers from indigenous diseases in the gulf, says Duke pharmacologist Mohamed Abou- Donia. Without protection, there may have been thousands of deaths. But it appears that, for some veterans, the precautions prevented one set of problems and created another.

Hens, however, are not human beings. The second part of the researchers’ effort, announced with much publicity last January, applied their animal findings to people. Haley and his colleagues surveyed 249 members of a naval reserve battalion to ascertain their physical ailments and wartime exposure. Sure enough, vets who reported gws symptoms also reported exposure to the same chemicals as in the animal studies. The team went on to find three categories of illnesses, all stemming from neurological damage associated with chemical exposure. The first, impaired cognition syndrome, is marked by distractibility, memory problems, depression, insomnia, and fatigue; the second, confusion-ataxia syndrome, by thinking and reasoning problems; the last, arthro-myo-neuropathy syndrome, by joint and muscle pains, increased difficulty lifting heavy objects, and tingling or numbness of the hands, arms, legs, and feet.

If Haley was surprised by the results so far, he was now in for a real shock. The study also involved a psychological analysis of the vets to determine the role of stress in gws. The conclusion: stress is not involved. The psychological testing revealed no more evidence of post- traumatic stress disorder or other psychological maladies in these people than in anyone else with chronic illnesses. Whatever else might be happening with these people, it was not stress.

This makes it real hard for the Defense Department people, says Haley. They can’t say it’s stress anymore. If they want to argue that, they’re just ignoring the facts. Which Haley is not willing to do: At every stage our data have refuted my original ideas. I’ve had to eat my words.

The Pentagon’s Stephen Joseph is not ready to eat his. Joseph, who left government service in April, remains unconvinced by any data that anyone has come up with so far. Nobody can find a recognizable clinical pattern except Haley, and I think his study is very speculative. Duffy’s stuff is based on experiments done on very small samples of primates and humans that may not be relevant to any situation in the gulf. If you were defending your Ph.D. thesis on the basis of either work, you wouldn’t get very far. For Joseph, the likelihood of gws being anything other than a familiar by-product of battlefield stress remains remote.

Nevertheless, the Pentagon has earmarked $42 million in grants for research. One of those applying is Haley. We are proposing the Manhattan Project of gws, he says. To take this thing and come up with a diagnostic test and treatment within three years is our goal.

Another is Duffy. He wants to measure electrical activity in the brains of gulf vets. Though he has observed chemical exposure causing profound changes in that activity, he says, the imprint of stress is negligible. In general, there’s little or no change in brain electricity as a result of stress. Measuring brain activity might be a way to make clear once and for all where effects of chemical exposure end and those of stress begin.

The implications of these investigations reach far beyond the military. No matter how many tens of thousands of troops may have been exposed to nerve gas from bombings of Iraqi munitions depots, some of the chemicals implicated in the Texas-Duke studies are not warfare agents but substances common to everyday domestic life. If these vets’ chronic illnesses really are the result of exposure to low levels of such chemicals, all of us are at risk.

Beyond the question of whether gws is caused by chemicals or stress lurk other mysteries. For example, not every soldier who was exposed to chemicals has become ill. Seven hundred thousand American troops were in the gulf, but only 110,000 have registered as suffering from Gulf War Syndrome. Why? Are some people more susceptible than others? As with allergies, might this susceptibility be genetic? Might it be the result of prior exposure, or nutritional factors? Or, Haley’s findings to the contrary, might stress be involved? Might some troops be suffering from stress alone? Might the pressures of the battlefield have rendered others especially vulnerable to the effects of chemical exposure? In a new study, Abou-Donia exposed rats to Gulf War chemicals and found that stress weakened the blood-brain barrier, facilitating uptake of chemicals into the brain. Perhaps a combination of stress and chemical exposure might be involved in gws after all.

Haley, for one, would be happy if the powers that be admitted even that much. If the Defense Department would agree that this is a physical injury, a brain injury, aided and abetted by acute stress, that would be a huge step. That would be headlines.
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