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Nov. 24, 2020 - Skeptoid
18:23
Skeptoid #755: Examining Gulf War Illness

Some researchers believe there is no such thing as Gulf War Illness, and the rest have more questions than answers. Learn about your ad choices: dovetail.prx.org/ad-choices

Transcriber: nvidia/parakeet-tdt-0.6b-v2, sat-12l-sm, and large-v3-turbo
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Time Text
Separating Fact From Fiction 00:07:27
Many soldiers returning from the Gulf War in 1990 reported a whole constellation of nonspecific medical symptoms that's come to be known as Gulf War illness.
It turns out to be a controversial diagnosis, as some say it's real and some say not so fast.
Today, we're going to separate the fact from the fiction surrounding this mysterious condition.
That's coming right up on Skeptoid.
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Examining Gulf War Illness.
The Gulf War, which ran from the end of 1990 through the beginning of 1991, saw the largest coalition of international military forces, 35 in all, since World War II.
The largest single deployment was by the United States, which sent some 670,000 personnel to the Middle East.
The war exposed many to conditions no major forces had yet faced in the real world, such as oil fires on a biblical scale, depleted uranium ammunition, pesticides, prophylactic treatment against nerve agents, and others.
When the troops returned home, some began reporting unexplained physical ailments, including fatigue, muscle and joint pain, cognitive and sleep problems, skin ailments, and gastrointestinal issues.
Eventually, as many as a third of all returning veterans reported it to some degree.
It's come to be known as Gulf War illness, and today it is a leading cause of disability among U.S. veterans.
The only problem is that some researchers aren't sure that it exists at all, and most of the rest still have more questions than answers.
Initially known as Gulf War syndrome, today Gulf War illness, or GWI, is a major focus of the U.S. Department of Veterans Affairs, which pays out hundreds of millions of dollars each year in benefits to veterans who are at least 10% disabled due to symptoms associated with GWI.
By itself, GWI is not a condition veterans can claim compensation for.
They must have a demonstrated disability, and that's what the compensation is for.
So that's an important factor for us to establish up front.
These people are suffering from genuine, proven disabilities.
We should be very, very clear on that point.
The reality of Gulf War illness as an actual cluster of symptoms or as a syndrome that is associated with some cause encountered in the Gulf War is one question.
And whether the disabled veterans suffering is real is a separate question.
It is common for some people to confuse a look into the reality of Gulf War illness with doubt of the reality of the veterans' disabilities.
That is not the case.
The severity of the symptoms varies widely and is generally overstated.
While it's true that up to a third of Gulf War troops have reported symptoms associated with GWI, only about 2% have applied for compensation.
This means they function reasonably well, statistically, about as well as the rest of us who didn't deploy to the Gulf War.
But it is important to keep those 2% in mind and to learn what we can about their disabilities and make sure we do not in any way trivialize them.
The number of papers that have been published on Gulf War illness is staggering.
It's literally in the thousands.
Journals in diverse sciences have published articles, not just medical journals, but also environmental, pharmacologic, military, geopolitical, and journals that specialize in every physiological system that's included in the cluster of symptoms.
Neurology, psychology, ophthalmology, pain, gastroenterology, cardiology, pulmonology, dermatology, and of course, fibromyalgia and chronic fatigue.
So for anyone, myself included, to set out to survey the literature is a bit of a fool's errand.
On top of that, whatever else it might be, Gulf War illness is big business.
There are hundreds of thousands of potential patients, and the world's largest wallet paying not only for their treatment, but also paying disability compensation.
Do a Google search and you'll find the internet is loaded with ads from ambulance chasing lawyers trying to get veterans to sue for benefits.
With so much money at stake, we should expect to see lots of researchers giving this plenty of attention for the foreseeable future.
But luckily for independent researchers wanting to learn more about this, there's one obvious place to go for the closest thing to a summary, and that's a program within the U.S. Department of Defense called CDMRP, Congressionally Directed Medical Research Programs.
One of these programs is the GWIRP, Gulf War Illness Research Program.
Their role is to fund research into Gulf War illness, to better understand it, improve diagnosis, and ultimately to improve the quality of life for sufferers.
A lot of their funding comes from the VA, and each year, the VA provides a summary to Congress.
So by turning to these sources, the closest things we have to consensus white papers, we can get a pretty good idea of the Gulf War illness landscape.
And unfortunately, it's still not a very clear picture.
Not even close.
This highlights the difficulties associated with studying Gulf War illness, or even with writing about it for that matter.
The most obvious is that the symptoms attributed to it are those generally termed symptoms of life, meaning things that happen to everyone to some degree.
Fatigue, headaches, joint pain, sleep problems, cognitive lapses, pretty much every box that Gulf War illness checks.
Nearly all of us feel some of these things some of the time.
But to complicate it even more, the percentage of deployed Gulf War veterans who report Gulf War illness is approximately the same as the percentage of people in the general population who report the same symptoms.
This leaves us in something of a logical limbo.
If the veterans hadn't deployed to the Gulf War at all, they would still be just as likely to experience the same symptoms they report now.
The Logical Limbo of Symptoms 00:02:18
So how can we assert that the deployment was the cause?
It's this similarity in prevalence to the general population that is the first real difficulty in studying Gulf War illness.
When we look at hospitalization rates comparing the 670,000 who deployed to members of the military who did not deploy to the population at large, we find that the studies report numbers that are all over the place.
What's clear is that there is no broadly agreed upon increased incidence of hospitalization among deployed Gulf War veterans.
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Unacceptable Causes and Stress 00:06:25
Another difficulty is that soldiers coming home from wars throughout history have always brought home such symptoms.
Nothing about the numbers or the symptoms are unique to Gulf War veterans.
Through most of history, we didn't know the cause.
For the first two World Wars, we typically called it shell shock, though today we diagnose it as anything ranging from acute stress all the way to post-traumatic stress syndrome.
After the Vietnam War, when soldiers came home with essentially the same cluster of symptoms, we pinned the blame on Agent Orange.
Now, all of this is to be expected, as being in a war is quite obviously a traumatic experience.
And it's a very arguable point that governments have a responsibility to treat that trauma, or compensate for it, for all who fought.
The physiological cause for that trauma is acute stress, with its many tentacle-like causes and effects.
Acute stress is well known to cause all of the physical symptoms attributed to Gulf War illness.
This leaves us in another logical no man's land.
How can we attribute the symptoms to something specific to the Gulf War when they were also reported by people who went to every war?
Yet another difficulty is that after more than a quarter of a century of research, military health authorities still have not found an acceptable match between the symptoms and a cause.
They have, however, found a number of unacceptable causes.
For a long time, they've had pesticide exposure listed as a cause, and also a drug given in advance to protect against a nerve gas attack called PB or pyridostigmine bromide.
While these both sound plausible, and deployed veterans were indeed exposed to these substances, serious problems remain with them.
The PB association is particularly problematic.
PB has been a prescription drug since the 1950s, and no long-term health problems have ever been found to be associated with it.
Further, only about half of deployed veterans took PB, most only briefly, and there were no reported overdoses taken.
And further still, PB has actually been used experimentally as a treatment for some of the conditions on the Gulf War illness list.
About two-thirds of the troops used pesticides to one degree or another, but there doesn't appear to be any association between those who did and those who report Gulf War illness symptoms.
Researchers have also nominated lots of other causes.
One was depleted uranium penetrators, of which nearly a million were fired during the conflict.
The danger from this comes not from radioactivity, as many people think, as it isn't significantly radioactive, but from heavy metal toxicity.
Exposure to this would have required that you be right next to a round when it strikes a target and vaporizes in the air.
This would have happened to very, very few survivors of the Gulf War.
Certainly not a third of everyone deployed.
And its symptoms are not a match for those attributed to Gulf War illness.
One of the pesticides nominated was the bug repellent DEET.
However, millions of backpackers, hikers, and fishermen have been practically bathing in DEET for decades with no ill effects.
And yet this hypothesis would require that, from only a few months of normal intended usage, a third of veterans were permanently disabled by it.
The proposed causes for Gulf War illness simply don't fly.
A final difficulty with studying Gulf War illness is that it has no symptoms or groups of symptoms which are unique to it.
As already discussed, these symptoms are all common in the general population, both individually and combined with one another, including people diagnosed with conditions like chronic fatigue and fibromyalgia, and people with no diagnosis at all.
It is in fact thin ice to even declare that there's anything at all that can be said to characterize Gulf War illness.
Any doctor attempting to make a diagnosis of Gulf War illness with any patient must face the fact that there are plenty of people with exactly the same symptoms who have totally different diagnoses, and plenty with no diagnoses.
The only difference between them is a non-medical one.
It's that this person was deployed to the Gulf War.
From my survey of the literature, I found that Gulf War illness has a lot in common with many other elusive phenomena that we talk about on Skeptoid.
It's the search for a boogeyman that we can blame when there's a problem that we can't easily solve.
The disabling symptom experienced by so many veterans are certainly a very real problem, but they're so diverse and so common that they almost certainly do not represent a single condition with a single cause.
Our human nature compels us to search for easy, graspable answers to complicated questions.
The compounding issue of so much money being at stake in this case means that there's a lot of motivation from countless people to find and identify and crucify that boogeyman.
Without any doubt, deployed soldiers who were exposed to stressful and traumatic experiences that go beyond anything those of us who stayed home went through.
And it is absolutely appropriate to consider the question of compensation and provide it wherever appropriate.
But that is one question.
The reality of a Gulf War illness is another question.
It's one that has a pretty apparent answer.
It has all the signs of being little more than a spectral boogeyman.
Moreover, it's a boogeyman that's simply not needed, given the reality of acute stress and the real physiological harm that it has caused those veterans, and which can absolutely be disabling.
As in so many other aspects of life, often it is more productive and useful to focus on the solution rather than hunt for a boogeyman we will never catch.
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