In Search of a Gulf War With No Gulf by vmd15294

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									In Search of a Gulf War With No Gulf War Illness
By GINA KOLATA

The New York Times – 3/24/03

fficials at the Department of Veterans Affairs and the Defense Department say they
learned valuable lessons from their attempts to grapple with the mysterious illnesses —
known collectively as gulf war syndrome — that plagued some veterans of the last gulf
war.

This time, they are coordinating their efforts in an effort to forestall another outbreak of
symptoms or, if one does emerge, to understand it.

The endeavor involves intense monitoring and measurement of the health of the troops
and their exposures to microbes or potential toxins. Doctors and researchers will be able
to track the medical records of troops before, during and after the war, and will have
more detailed information on the location of troops during the war, what drugs and
vaccines they received and when, and what substances they might have encountered in
air, water and soil.

"We weren't as prepared following the last gulf war as we will be with this one," said Dr.
Robert Roswell, the under secretary for health at the V.A.

Veterans groups have been closely following the new effort. Michael O'Rourke, the
assistant director of health policy for the Veterans of Foreign Wars, a group with 2.7
million members, said he was encouraged. "I believe we learned some lessons," Mr.
O'Rourke said.

The lessons emerged from a chastening experience after the last gulf war. About 700,000
men and women were deployed in 1991 and about 15,000 to 20,000 of them later
complained that they had a troubling chronic illness with symptoms like fatigue, aches
and pains, difficulty thinking or faltering memories. The complaints became known as
gulf war syndrome or gulf war illness, and they took doctors by surprise.

Medical experts have been unable to identify a specific cause for the symptoms, and
when they suggested they might be a reaction to stress, some veterans were scornful,
suspecting that the government knew of a problem and was covering it up.

Suspicions grew when the Pentagon sporadically increased its estimates of how many
troops might have been exposed to toxic substances.

But researchers who were asked to investigate threw up their hands in dismay. There was
so little medical and exposure data that scientists could not fully investigate possible
causes of the symptoms.
They said they lacked crucial data on the troops' health before, during and after the war,
they lacked necessary information on who might have been exposed to what in the
Persian Gulf, and doctors with the V.A. did not have clinical guidelines for assessing
veterans' health. With data that were skimpy and unreliable, it was almost impossible to
conduct good studies.

"We didn't have the base line information we needed," said Dr. William Winkenwerder
Jr., the assistant secretary of defense for health affairs. "We didn't have good capture of
events in the theater, and there wasn't a systematic capture of information when they
came out." Until then, he said, such data were not viewed as important. "It was never
viewed as a critical thing to do for the service member," he said.

That will not happen this time.

"People will come back with symptoms, of course, and they will believe they are related
to the gulf," said Anthony J. Principi, secretary of veterans affairs. "But I believe we will
be able to find answers: Was it the vaccine? Was it low levels of exposure to chemical or
biological agents?" (He added that it would be immediately clear if troops were exposed
to high levels of chemical or biological agents because they would get sick.)

Finding the answers to those questions was the goal repeatedly stressed by expert
committees that investigated the illnesses reported by veterans of the previous gulf war.

"One of our recommendations from the first report was that the military collect the data
that might be useful" in investigating the illnesses, said Dr. John C. Bailar III, who was
chairman of an Institute of Medicine committee that published its report in 1996. "Even if
the ultimate result is to rule out any exposure, that is worth noting."

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