SHEPHERD E X P R E S S _________________________________________________________________
Cover Story - Volume 19, Issue 51, December 17, 1998 - _________________________________________________________________
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 UW 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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