===> I posted the following articles on or about Dec 23rd as
complements to Louis's Dec 21st forwarding "Uranium-tipped
bullets and Iraqi children" (Guardian), but for some reason
they failed to appear. The current cat-and-mouse games over
northern Iraq, however, threaten to make these hellish weapons
of immediate relevance once again (and those responsible are,
beyond the gee-whiz panache of uniform amd regalia, nothing
more than sociopathic criminals fit to be publicly hung).
David Tenenbaum writes on science, health and the environment,
and is an editor at the University of Wisconsin - Madison's
engineering school. Doug Hissom is city editor and a columnist
at the Shepherd Express, Milwaukee's alternative newspaper.
valis
SHEPHERD
E X P R E S S
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Cover Story - Volume 19, Issue 51, December 17, 1998 -
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Our Walking War Casualties
One in Seven Gulf War Veterans Receives Disability Payments
BY DAVID TENENBAUM
When Anthony Hardie enters a supermarket, he skirts the detergent
aisle, where he knows the chemical-laden air could trigger muscle
and joint pain. The former cross-country runner and decorated
veteran of the Persian Gulf War is easily fatigued and has trouble
remembering his studies at UW-Madison.
As a part-time worker with the Dane County Volunteers in Prevention,
Probation and Prison, Hardie, 30, helps steer "at-risk" kids and
adults away from trouble. But eight years ago, as a full-time
employee of Uncle Sam's army, Hardie put himself in jeopardy when
the U.S.-mobilized coalition drove Iraq's army from Kuwait. Although
the threat of large Iraqi biological or chemical attacks never
materialized, many U.S. veterans think some kind of biological or
chemical insult - intended or not - is causing the complaints they
lump together as Gulf War Syndrome.
These complaints include strange skin rashes, sleeplessness, muscle
and joint pain, disabling fatigue and difficulty in concentrating.
It's tough to know how prevalent this mysterious condition is, but
extrapolating from the evidence shows that about 100,000 veterans -
or about one-seventh of the once-healthy Desert Storm force -
now get disability payments from a nation that seems, if not
scornful, at least bored by their problems. Roughly 12 percent of
the illnesses are categorized as "unexplained" by the Department
of Veterans Affairs (VA).
Kind-eyed and articulate, Hardie now focuses on a single mission--
to get justice, and treatment, for the thousands of veterans who
haven't felt right since the desert war. His quest is controversial,
since some experts still contend that Gulf War syndrome is a random
collection of unrelated ailments that could be expected among
700,000 soldiers, including 10,400 from Wisconsin.
The government's initial response was to deny that a problem existed.
"First of all, we do not believe it is a syndrome," Lieutenant
Colonel Douglas Hart, a Pentagon spokesman, told The New York Times
in 1993. "It is just some symptoms that we don't have an
explanation for."
As more and more vets fell ill, the government blamed their
symptoms on post-traumatic stress disorder, even though the
psychological trauma in the gulf seemed less severe than that
which triggered the disorder during the American war in Vietnam.
The medical establishment and the government have looked without
success for a unique disease associated with Gulf War service.
Four blue-ribbon panels have found nothing, and in April the VA
said it "has neither confirmed nor ruled out the possibility of
a singular Gulf syndrome."
The government says it has paid $121 million for studies of the
issue, and those studies are now revealing intriguing hints of
an organic, not psychological, basis for the baffling illness.
Far from being random complaints or malingering, Gulf War syndrome
may actually be a reaction to the unprecedented brew of poisons -
nerve gas, anti-nerve-gas medicine, insecticides, toxic artillery
shells and intense oil smoke - in and around the battlefield.
Some doctors, however, are firmly convinced that bacteria are
causing the symptoms.
Will the new studies identify one single cause of Gulf War illness?
Probably not soon. For one thing, advocates of biological causes
disagree among themselves, and many believe that the eventual
explanation will be more complex than the usual "X caused Y."
It's possible that the bizarre range of symptoms logically follow
from exposure to various blends of chemicals and pathogens. Indeed,
it's looking increasingly likely that the cause of the syndrome
lies in the chemical, physical and biological environment of the
Gulf War battlefield.
FIGHTING TURNS INWARD
Anthony Hardie grew up in Onalaska, near La Crosse, and enlisted
in the Army as a ticket to college. He served in Africa before Iraq
invaded Kuwait in 1990. Then, with training in French, he served as
a liaison to troops from the nations allied with the U.S. Returning
to the States shortly after the war, he was confident that his skin
rashes, memory problems and fatigue could be cured with the right
pill.
Not so. In the years since the war, no doctor has been able to
identify, let alone cure, Hardie's problems. Convinced that the
solution lay in activism, he became a board member of the National
Gulf War Resource Center, a Washington pressure group devoted to
finding a political and scientific solution to the medical enigma.
"We were fighting for the government," he says, "and now we're
fighting a different war--against the government." Hardie's
apartment on Madison's near east side contains filing cabinets
crammed with data on Gulf War syndrome. Conspicuously absent is
the American flag he fought under eight years ago.
In 1991, Hardie worked in Army psychological operations (a task he
describes as a blend of public relations and propaganda). Looking
back, he traces his troubles to a night in February, in Khafji,
Saudi Arabia, just before the ground offensive into Kuwait. Hardie
had been sleeping near an open window when a noise like a freight
train woke him and left him feeling "extremely confused--I couldn't
figure out what was going on." His skin was covered with bumps--67
on his forehead alone--that he attributed at the time to mosquitoes.
Within days, the ground war began, and Iraq torched Kuwait's oil
wells, producing billows of black smoke that turned day into night
and caused a persistent hack called "Kuwait cough." After two months
of breathing this brew, Hardie returned to the States, where he says
his family found him "very distant, almost unreachable." Eight
months later, a doctor diagnosed asthma. Hardie found that running
left him feeling drained and exhausted. (Hardie was not alone.
According to Benjamin Natelson, the medical director of the Gulf War
Research Center at the VA's New Jersey Health Care System, half of
the vets with severe Gulf War symptoms seem to have chronic fatigue
syndrome, a condition that can cause long-term disability.)
By 1993, Hardie was making a series of unsatisfying visits to VA
doctors, seeking relief for memory problems and constant nausea.
That December, he left the Army with a bronze star and a medal as
the outstanding noncommissioned officer among the 12,000 soldiers
in the U.S. Army Civilian Affairs and Psychological Operations
program. The confusing curse of Gulf War syndrome would not,
however, leave him, and the military doctors classified him as
disabled. They sent me a check," Hardie recalls, "and said I'd get
disability for the rest of my life. I felt bought off. I was not
looking for compensation. I was a cross-country runner looking
to go back to college and be a runner, and get on with my life."
Hardie's view of his troubles changed in 1994, when a former
soldier who had also been stationed in Khafji told him that Iraqi
prisoners from the area "reported heavy casualties from chemical
weapons that had blown back on them."
And the veteran's face, Hardie noted, "was covered with all sorts
of little bumps."
WITCHES' BREW
Although U.S. forces were never exposed to the ultimate threat -
wholesale Iraqi chemical or biological attacks - chemical weapons
could play a role in Gulf War illness.
Iraq, of course, freely used them in the 1980s, toward the end of
its war with Iran. Furthermore, chemical-weapon sensors did sound
the alarm during the Gulf War. Although the Pentagon contended that
the detectors malfunctioned, Hardie and other veterans suspect the
Iraqi attacks were purposely designed to deliver a low-level dose
meant to confuse and disable the American forces. About one-seventh
of the U.S. forces were exposed to Iraqi chemical weapons. In 1996,
after years of denials, the Pentagon conceded that a few hundred
soldiers had been exposed to sarin and possibly other nerve gases
when they blew up a giant ammunition dump in southern Iraq.
Since then, the Pentagon's exposure estimate has mushroomed to
nearly 100,000, though officials maintain that the concentration of
the nerve agent was too low to trigger any known health problems.
Even if they didn't get a whiff of chemical weapons, Gulf War vets
were exposed to other chemicals with effects on the nervous system,
including insecticides, insect repellents and anti-nerve-gas potions.
Much of the attention has focused on pyridostigmine bromide (PB),
a defensive agent that was supposed to protect against chemical war
agents. The idea seems sound: PB temporarily blocks a nerve pathway
that nerve gas destroys, so disabling some nerve function in the
short term preserves it all in the long term.
But what happens when PB is combined with insecticides and insect
repellents - which can all cause nerve damage - that were used in
the Persian Gulf? The laboratory evidence is unsettling. In 1996,
Mohamed Abou-Donia of Duke University published a report in the
journal Fundamental and Applied Toxicology on the treatment of
chickens with various combinations of PB, the insect repellent
DEET and the insecticide chlorpyrifos. While acknowledging that
the study was not designed to pinpoint the cause of Gulf War
syndrome, Abou-Donia concluded "the use of PB concurrently with
exposures to pesticides and other chemicals in the Gulf War may
be related to some of the complaints of the service personnel."
He speculated that the chickens were unable to break down the
compounds when exposed to several at once. More laboratory
evidence about PB was presented last June at a conference on
Gulf War syndrome, supported by the departments of Defense and
Veterans Affairs. A group at the Portland, Ore., Environmental
Hazards Research Center found that PB added at low concentrations
to spinal-cord nerve-cell cultures caused spontaneous contractions
in muscle cells attached to the nerve cells. Two weeks of exposure
produced obvious nerve degeneration.
And researchers at the University of Florida reported that PB,
along with DEET and permethrin, an insecticide used by the troops,
can all affect human immune cells growing in the lab.
DEADLY SIDE EFFECTS
Are these just isolated laboratory effects? Not according to
Robert Haley, director of the division of epidemiology at the
Texas Southwestern Medical Branch at Dallas, who has found that
certain combinations of these chemicals were particularly damaging.
In January 1997, Haley's research team published three articles in
JAMA (the Journal of the American Medical Association) comparing
symptomatic Navy construction workers to those who did not attribute
problems to Gulf War syndrome. He sorted the symptoms into three
categories and found that the symptoms correlated with self-reported
chemical exposures.
"It appears that three different kinds of neurological injury were
due to three profiles of chemical exposure," Haley reported.
PB, the medicine that was supposed to protect against nerve gas,
was implicated in the most severe syndrome. Many soldiers complained
about side effects from PB, Haley says, and "The ones who had
exposure to chemical warfare agents and who had bad side effects
from PB, were the ones who couldn't work." They had the most severe
Gulf War syndrome after the war.
A key argument against attributing Gulf War syndrome to low-dose
nerve poisons is the assumption that unless the nerve agents cause
dramatic effects during exposure, they will not cause delayed
effects. The argument is rooted in studies of Iraq's previous
chemical attacks, where obviously injured survivors later developed
other nerve problems.
Yet there is evidence that sarin, a common nerve gas, can produce
delayed toxicity.
In 1993, the Journal of Applied Toxicology published a report by
Indian toxicologist K. Husain, who had treated mice with low doses
of sarin. Husain noted muscular symptoms that began four days after
the end of the 10-day exposure, supporting the idea that delayed
nerve damage could be afflicting Gulf War veterans.
Another suspected syndrome culprit is uranium. This radioactive
element powers nuclear electric generators, and it makes potent
armor-piercing cannon shells. Uranium's extreme density gives the
shells an awesome punch, and the metal burns on impact, melting
through heavy armor.
Exposure to the uranium can cause cancer and birth defects.
A 1998 report "Case Narrative: Depleted Uranium Exposures,"
published by three activist groups, estimated that 631,000 pounds of
uranium shells were used in the war, and that up to seven pounds of
uranium remained around each Iraqi tank they killed. The shells are
made of "depleted uranium," which is what remains after the more
radioactive isotope, U-235, is extracted for use in atomic weapons
and electric generators. Depleted uranium, containing an unnaturally
high proportion of the isotope U-238, is stockpiled by the millions
of pounds at Department of Energy installations. Although less
radioactive than natural uranium, it is still dangerous.
Uranium is a toxic heavy metal that can cause kidney disease among
those who ingest or inhale it. According to Tara Thornton, executive
director of the Military Toxics Project, many U.S. soldiers scrambled
over destroyed Iraqi tanks without the protective equipment that Army
rules supposedly required, and could easily have inhaled uranium dust.
To date, the military has acknowledged that depleted uranium could be
affecting only the few soldiers who were wounded and still carry
pieces of the metal. But a recent study by Hari Sharma, a radiation
chemist at the University of Waterloo in Ontario (who trained with
Glenn Seaborg, the discoverer of plutonium), indicates that more
soldiers were exposed.
>From urine tests performed almost eight years after Desert Storm,
he calculated that some U.S. veterans ingested one to 10 grams of
depleted uranium.
It's hard to give a lot of credence to Sharma's study, however,
because it hasn't been published and subjected to peer scrutiny yet.
Sharma says he first wants to look for a link between the depleted
uranium in artillery shells and possible health effects.
"I think of this [study] as just whetting the appetite" for further
investigation, he says. Ultimately, if depleted uranium does cause
disease, Sharma adds, "I think it should be banned as a means of
conducting warfare."
STRANGE BACTERIA
A completely different take on Gulf War syndrome pins the cause on
something as straightforward as biological infection. Certainly,
traveling to strange territory exposed soldiers to new bacteria and
viruses. And they were under threat of biological attack from the
Iraqi military, which possessed loads of biological weapons and may
have had orders to use them.
The bacterial hypothesis would also explain the appearance of
symptoms in veterans' families.
Several doctors have presented evidence that sick vets are
responding to antibiotic treatment. Unfortunately, the quality
and design of their studies are subject to question, and the
double-blind experiments that could prove or disprove their cases
have not been completed. Worse, the doctors who believe in the
hypothesis disagree among themselves.
One camp points to a bacteria called mycoplasma. Charles Hinshaw,
a past president of the American Society for Environmental Medicine
who practices in Wichita, Kansas, says antibiotics have been
effective on all five of his patients who showed signs of mycoplasma.
Each "improved in cognitive function, headaches, fatigue and joint
pain," he says. "I had an electrician who practically had to quit
work--and now he's back at work."
Garth Nicholson, a former cancer biologist at the University of
Texas Medical School in Houston, says he commonly finds mycoplasma
bacteria in ill Gulf War veterans, and most improve when treated
with doxycycline and other antibiotics.
"About 45 percent of veterans [with Gulf War syndrome] show evidence
for infectious disease," said Nicholson, who is now director of the
Institute for Molecular Medicine in Huntington Beach, California.
"If they are treated properly, they recover or do much better."
Nicholson says the mycoplasma probably came from biological weapons:
"It was common knowledge that there were large laboratories in
Baghdad and Basra for studying mycoplasma."
The controversial mycoplasma hypothesis got a boost on Oct. 22,
when the Department of Veteran Affairs offered a randomized clinical
trial of doxycycline to hundreds of Gulf War vets.
Nicholson calls the new study "a huge turning point" and
a vindication of his position. But the VA, in announcing the trial,
was more equivocal.
"Although there is no established, definitive link between infection
with this organism and Gulf War veterans' illnesses," the department
said, "undetermined numbers of ill veterans are taking the antibiotic
doxycycline for up to 12 months in hopes of improving their health."
Nicholson's position is further challenged by a second major voice
for the infectious hypothesis, Louisiana internist Edward Hyman,
who argues that doxycycline is "almost useless" against Gulf War
syndrome.
Instead, Hyman blames the syndrome on a systemic infection with
streptococcus, staphylococcus, or enterococcus bacteria that live
naturally in the Persian Gulf region. He says he began using
intravenous antibiotics against what he calls "systemic coccal
disease" in the 1950s.
More recently, Hyman says he has cured two to three dozen Gulf War
patients who showed microscopic evidence of these bacteria:
"I'm talking about a 100 percent cure rate."
This explanation will be easier to assess after Hyman concludes
a double-blind test. He expects to learn how independent doctors
evaluate antibiotic-treated veterans compared to those who took
a dummy drug.
Clearly, the advocates for a biological basis for Gulf War syndrome
would help their cause if they could get their stories straight.
For example, epidemiologist Robert Haley, who pins the major blame
on chemicals, says Hyman's patients "got worse after quitting"
antibiotics. Haley calls mycoplasma, the other purported infectious
agent, "a more shadowy issue. ... We're waiting for confirmatory
evidence to show us that we should take it seriously."
Critics of Nicholson question his credibility; he has, after all,
claimed that the mycoplasma's DNA carries traces of HIV. He argues
that somebody was trying to convert the bacterium into an AIDS-
carrying biological weapon--an assertion that suggests he harbors
a certain conspiratorial outlook.
SOLVING THE PUZZLE
The concerted scientific effort now under way may finally solve the
riddle of Gulf War syndrome. The scientific test of Nicholson's
mycoplasma hypothesis, for example, is elementary, and the large
study now starting may offer a definitive word on it.
Far more difficult to prove will be the compelling "multifactorial"
hypothesis--the idea that various combinations of chemical,
biological and psychological factors combined to cause a disease
that will not occupy a category because it is actually many diseases.
The limited amount of existing evidence for the multifactorial
hypothesis already challenges a medical system that depends on
pigeonholes like "mind" and "body."
A better understanding of the relationship between these once-
separate entities could, for example, explain why antibiotic
treatment seems to improve the thinking and memory of vets
complaining of Gulf War syndrome symptoms.
"You sock them with a dose big enough to kill the pathogen," says
Hyman, "and suddenly they are not confused, they can find their way
home in their automobile without getting lost."
Furthermore, Hinshaw, the environmental medicine doctor, says
antibiotics also seem to reduce sensitivity to environmental
chemicals--another common complaint among Gulf War veterans.
No look at the Gulf War enigma would be complete without at least
a brief mention of politics. The VA says it's doing everything
possible to unravel a mysterious condition it believes may not exist.
But cynics note that the last thing the military wants is to find an
expensive problem among veterans, especially if it might deter
soldiers from volunteering for the next war with Iraq.
Just as military and veterans' bureaucrats were slow to recognize
the human toll of spraying Agent Orange - a herbicide contaminated
with deadly dioxin - over the length and breadth of Vietnam, they
were slow to recognize that veterans of the "victory" in Desert
Storm were returning with a real disease.
Having learned from the activism of Agent Orange vets and AIDS
patients, Gulf War vets are pressing their case, and their
political pressure has sparked real VA funding for scientists--
including outspoken researchers like Haley, Nicholson and Hyman.
The whole question of Gulf War syndrome has had another consequence:
a reassessment of the United States' Gulf War victory. Many ailing
veterans think Saddam Hussein managed, unnoticed, to spread low
levels of poison on the battlefield, and is now snickering at an
enemy that will think twice before sending ground troops in his
direction.
To these bitter veterans, Gulf War syndrome demonstrates that
Hussein was the real victor. "Saddam's bit was to confuse, to damage
us in the long run," says Anthony Hardie. "He said, 'Let's use low-
level weapons and destroy their military permanently, and not just
for today.'"
Whether he's right or not in this assertion, Hardie feels used by
his government. "We were really betrayed, sold out by our own folks.
It's not just stress, which the Pentagon was trying to claim.
Our only stress is the stress of not getting health care--seven years
after the war."
For more information contact www.geocities.com/~gwvw or
www.gulfweb.com/ngwrc.
_________________________________________________________________
Revisiting Pvt Schramm's Gulf War Syndrome
BY DOUG HISSOM
When former Army Private and Gulf War vet Robert Schramm was
interviewed in 1996, he was suffering from constant flu-like
symptoms including severe headaches, joint pain and extreme fatigue.
"I want to sleep all the time and I got these super headaches,"
he told the Shepherd Express at the time.
His story was like thousands of other suffering Gulf War veterans at
the time who, instead of receiving medical help from VA hospitals,
were tested repeatedly for some hidden malady. Those tests have
remained inconclusive.
"I got tired of banging my head against the wall," Schramm, 29, said
last week. He founded the Midwest Gulf War Veterans Association,
a group that advocated a more radical approach to the Gulf War
Syndrome and the reasons behind it than many other veterans' groups.
Schramm's group has since disbanded because he is no longer involved.
Why?
"I'm cured. I pretty much gave up on the issue," he said. "I've given
up on the Gulf War stuff."
Schramm underwent an intensive four-month antibiotics regimen and
for six months after that, he had no symptoms of what's been known
as Gulf War Syndrome. Six months later, the flu, sleeplessness and
headaches returned. Two more weeks of higher doses of antibiotics
followed and Schramm says he hasn't had the disease symptoms for
about a year.
"I had to convince a doctor to treat me even though he didn't
believe me," he said. The VA doctors here would have nothing to
do with the antibiotics treatment, the Pewaukee resident said.
Schramm was in the 9th Psychological Operations Unit stationed at
King Fahd International Airport from Jan. 16, 1991 through Feb. '91,
and then was sent to Kuwait. He watched Scud missiles explode
overhead when they were hit by US Patriot defenses; then he breathed
air made toxic from countless oil well fires.
Schramm said in 1996 that he thought the Scuds he saw explode were
filled with chemical or biological weapons, and that explained why
he was sick. After one instance, he said, all the men in his tent had
"extremely horrible" headaches. He quit the military in December 1991
because he couldn't stand breathing printers' chemicals after the war.
After he returned home, his doctors' conclusions on the causes
ranged from psychological to stress-related, but not directly war
environment-related. At first he was denied a disability claim; then
the VA offered him a 10 percent disability payment (about $90 per
month), which he still gets. He said the VA is supposed to contact
him every year about his condition but he hasn't heard from them.
"Giving 10 percent disability is what they do to persistent vets,"
he said.
Logic would suggest that VA doctors would be fascinated to learn
about how Schramm became free from symptoms of Gulf War Syndrome.
"I wrote to the VA about it. I wrote to anybody and everybody who
might have an interest," he said. "Nobody seems to care or believe
me.
"They told me nothing was wrong before; why would they believe I'm
cured of something I was never suppose to have in the first place?"
But a lot of vets out there can't afford the drugs Schramm received,
and they're still relying on the VA to help them. Schramm says 80
percent of the vets he's been in touch with can't find doctors to
treat them. He's heard that maybe the VA in Minneapolis uses the
antibiotic treatment method.
So Schramm now drives a truck three times a week to St. Louis and
back and is a staunch member of the Libertarian Party, "working to
get government out of our lives."
The Midwest Gulf War Vets group is still listed on the Internet,
from which Schramm says he gets about one call per month. He refers
the caller to other sources of information and occasionally gets
a thank-you. "Mostly it's from grandparents, calling about their
grandkids who've been stuck living with them since the war."
And not unexpectedly the experience has soured Schramm toward his
government.
"It's a sobering experience that I'd rather not revisit. Believing
in something so strongly and having no one around you that supports
you, thinking you're a strange guy, a crazy guy."
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