Lea Steele, Ph.D.
Good morning and thank you for inviting me here today. I'm Dr. Lea Steele, an epidemiologist and associate professor at Kansas State University. I first became involved in Gulf War research 10 years ago when I directed a state-sponsored research and service program for Gulf War veterans in Kansas. Our work there provided important insights about Gulf War illness. I am now "on loan" from my university to the federal government to serve as Scientific Director of the federal Research Advisory Committee on Gulf War Veterans' Illnesses. Our Committee has reviewed and analyzed a vast amount of scientific research and government investigative reports that provide extensive information on the Gulf War and the health of Gulf War veterans. We will be issuing our scientific findings and recommendations in a major report to be released later in the year. My purpose today is to share with you some highlights of what the Committee has learned in the course of our scientific work.
First, I want to distinguish between the condition known as Gulf War illness and other health issues related to the 1991 Gulf War. Gulf War illness is a complex of symptoms found at high rates in Gulf War veterans-an illness not explained by standard diagnoses and medical tests. This symptom complex affects Gulf War veterans from different units across the U.S. and also from some allied countries. It affects more Gulf War veterans, by far, than any other identified health condition.
There are also other health issues related to Gulf War service. A problem of great concern is ALS, as you've heard. According to a large VA study, ALS affects twice as many Gulf War veterans as other veterans of that period. This neurodegenerative disease usually strikes people over age 55, but one study has reported that Gulf War veterans may develop ALS at much younger ages. A more recent study has suggested that those who have served in the military, in general, are at increased risk for ALS. If true, this could raise even greater concerns, since Gulf War veterans have ALS at twice the rate of other military veterans.
Brain cancer has also been recently identified as a Gulf War health issue. You may be familiar with a well-known incident near Khamisiyah, Iraq, in March of 1991. The Pentagon has estimated that about 100,000 U.S. military personnel were potentially exposed to low-level nerve agents in connection with demolitions at a large weapons depot that contained sarin and cyclosarin. A 2005 study found that veterans who were downwind from those demolitions have died from brain cancer at twice the rate of veterans in other areas of theater.
There might also be problems related to other diagnosed diseases, but studies are lacking. The Research Advisory Committee has recommended research to assess conditions such as multiple sclerosis, Parkinson's diseases, and cancer in Gulf War veterans. While all of these issues are important, far fewer Gulf War veterans have ALS or brain cancer than the very large number affected by Gulf War illness. So I will focus my scientific comments today on what we know about Gulf War illness.
First, let me briefly describe what Gulf War illness looks like, in case you don't have a complete picture from veterans who have testified or whom you know personally. Veterans with Gulf War illness have multiple, persistent symptoms that affect different body systems. These include neurological-type problems--severe headaches, memory and concentration problems, dizziness, and mood changes. Persistent and widespread pain is also a prominent feature of Gulf War illness, as well as a profound fatigue. Other troubling symptoms include gastrointestinal problems--we know many veterans have had persistent diarrhea for 15 years. Respiratory symptoms--coughing and wheezing--are also common, as well as unusual skin lesions and rashes. Veterans with Gulf War illness experience multiple different types of symptoms together, which is why we call it a symptom complex or multisymptom illness. We now know quite a lot about Gulf War illness-how many veterans are sick, who is most affected, and what may have caused this condition. Here are some of the highlights.
- Gulf War illness is a big problem.
25-30 percent of veterans who served in the Gulf War are affected by this complex of symptoms as a consequence of their Gulf War service. This has been shown by multiple studies, including VA's most recent large follow-up study. That means that Gulf War illness affects between 175,000 and 200,000 of the 700,000 Americans who served in the Gulf War.
- Gulf War illness was not caused by psychological stress.
Comprehensive studies have found no connection between Gulf War illness and combat experiences in the war. In fact, rates of psychiatric conditions like PTSD are considerably lower in Gulf War veterans than veterans of other wars. This stands to reason since, in contrast to current deployments, severe stress and trauma were relatively uncommon in the 1991 Gulf War. A decisive victory was achieved after a four day ground war; most troops did not see combat and were never even in areas where battles occurred.
- Research studies consistently identify links between Gulf War illness and neurotoxic chemicals.
Many different Gulf War exposures have been suggested as causes or contributors to Gulf War illness. These include the smoke from over 600 burning Kuwaiti oil wells, receipt of numerous military vaccines, depleted uranium munitions, and low-dose exposure to chemical weapons.
The most consistent and extensive amount of available evidence implicates a group of chemicals to which veterans were exposed that can have toxic effects on the brain. These chemicals include pills (NAPP pills or pyridostigmine) given to protect troops from the effects of nerve agents, excessive use of pesticides, and low levels of nerve gas in theater. Many of these chemicals have a similar type of action; they adversely affect the neurotransmitter acetylcholine. Studies also show that these chemical toxins can act synergistically, that is, combined exposures are worse than any single exposure by itself.
A link between Gulf War illness and exposure to neurotoxic chemicals is also compatible with what we know about biological processes affecting ill veterans. Diverse studies have identified abnormalities in the brain and the autonomic nervous systems of sick Gulf War veterans. Diverse types of brain scans and neurocognitive tests have identified problems that affect different brain processes and areas. For example, in recent months, news stories have widely reported on studies showing that Gulf War veterans have reduced volume in specific brain regions.
- Effective treatments for Gulf War illness are urgently needed.
Studies show that few veterans with Gulf War illness have recovered or even substantially improved over time. As a result, many Gulf War veterans have been sick for as long as 16 years. Effective treatments for Gulf War illness have not been identified-very few have even been studied. The Research Advisory Committee continues to identify research that can lead to treatments that improve the health of ill Gulf War veterans as the highest priority area of Gulf War research.
In short, Gulf War illness is real, it is serious, and it is still widespread among veterans of the 1991 Gulf War. It is not the result of psychological stress and is not the same thing that happens after every war. Progress has been made in understanding "big picture" questions about Gulf War illness and health issues affecting Gulf War veterans. The Research Advisory Committee believes that remaining important questions can also be answered and must be addressed. The federal government has a continuing obligation to attend to the health problems affecting veterans of the 1990-1991 Gulf War. Further, a more complete understanding of Gulf War illness is required to ensure that similar problems do not affect future American troops deployed to war.