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January 04, 2005 Volume 41 Issue 01
The Medical Post
http://www.medicalpost.com/mpcontent/article.jsp?content=20050103_200101_4740

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Canadian Forces doubt U.S. study on Gulf War syndrome


Cite 'insufficient evidence' that veterans suffer disproportionate neurological injury

By Mark Cardwell

OTTAWA – Medical experts within the Canadian military are downplaying a major American study that concluded the mysterious illnesses suffered by thousands of soldiers who served in the Persian Gulf in 1991 are likely due to exposure to neurotoxins rather than stress and psychiatric problems.

About 4,500 Canadians served in the Gulf War, and about 10% have had significant medical problems, said a Canadian military spokesman.

"Canadian Forces agrees with many of the key findings and recommendations of the report, many of which have already been made by other expert panels," said Dr. Mark Zamorski, an epidemiologist and the acting head of the post-deployment health section of the Department of National Defence in Ottawa. "However, some (findings and recommendations) are at odds with those of a number of other expert panels."

Released Nov. 16, the study from the U.S. Research Advisory Committee on Gulf War Veterans' Illnesses found that one-quarter to one-third of all U.S. Gulf War veterans suffer from a variety of persistent ailments, including headaches, memory problems, pain, fatigue and other chronic symptoms.

The committee concluded that, in most cases, these illnesses, which are commonly referred to as Gulf War Syndrome, could not be explained by stress or psychiatric illness.

At the same time, the committee concluded in its 143-page report that sufferers had a higher incidence of neurological problems than the general public, including "a significant excess in the rate of amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease."

"Gulf War illnesses are complex and are likely the result of a number of factors related to service in the 1991 Gulf War," said Dr. Lea Steele, the U.S. committee's scientific director. "Studies consistently indicate that stress and psychiatric illness do not explain the health problems of most ill veterans. In contrast, a growing body of scientific evidence implicates substances to which veterans were exposed during the war, including a variety of neurotoxins. Other exposures may also have contributed to these problems, and will be addressed in future reports."

While agreeing with the report's finding that "a substantial portion of Gulf War veterans are ill with a broad variety of symptoms and illnesses, that many of these are not explained by exposure to traumatic stress in theatre, and that treatments to improve the health of Gulf War veterans are urgently needed," Dr. Zamorski said the Canadian military disagrees with two other conclusions of the report.

There is, he said, "insufficient evidence to conclude that Gulf War veterans suffer disproportionately from neurological injury."

Dr. Zamorski said the Canadian military also is hesitant to conclude there is a probable link between exposure to neurotoxins and the development of Gulf War illnesses.

Credible evidence lackingÂ

"Certainly there are a number of ill Canadian Gulf War veterans who have little or no credible evidence of exposure to the neurotoxins implicated by the committee."

The Canadian military blamed what it calls "three discrepancies" in the committee's make-up and mandate that influenced the final report: an overly heavy representation of neurotoxin scientists, a too-selective interpretation of relevant study literature and, as Dr. Zamorski put it, "legitimate differences of opinion as to what level of scientific data is needed in order to establish convincing evidence of cause and effect."

He added, however, the Canadian military shares the U.S. committee's view that some "interesting research findings in the area of neurological symptoms and abnormalities in Gulf War veterans should be investigated further."

While the Canadian military does not recognize the term Gulf War Syndrome, Dr. Zamorski said it "does acknowledge that many, many Gulf War veterans are ill and that their condition is very likely related to their service in the region."

He also said estimates vary about how many Canadians who served in the Persian Gulf region in 1991/92 are suffering from deployment-related illnesses.

One indication, he said, is a year-old figure from Veterans Affairs showing that 681 Gulf War veterans released from the military since their deployment to the Middle East have applied for illness-related pensions. Of that number, 368 applicants have been successful.

Many more veterans are suing the defence department over their medical problems.

Dr. Zamorski estimated as many as 10% of Canadian personnel who served in the region have had—and, in many cases, continue to have—significant medical problems.

"The simple fact of the matter is we don't know how many people are affected," he said. "We'll probably never know."