The US Congress has approved up to $75m for further research into Gulf War syndrome. The funds being awarded to veteran researcher Dr. Robert Haley.

Gulf War syndrome is as controversial a subject as ever, but last week there was good news for those thousands of veterans suffering from the mysterious illness, as the US Congress agreed to fund further research.

Chief Epidemiologist Robert Haley from The University of Texas Southwest Medical Center in Dallas will receive up to $75m over 5 years to continue research into the cause(s) of Gulf War syndrome. Dr. Haley and his team have been conducting epidemiologic, clinical and laboratory research on the "Gulf War syndrome" and related neurologic illnesses in Gulf War veterans since March 1994. He believes their symptoms are the result of combined exposures to various chemicals in Iraq including pesticides, insect repellents, diesel and JP4 fuels, anti-chemical warfare drugs, and decontamination solutions.

Dr. Haley is quoted in The Dallas Morning News as saying, "These people are ill, and it's not psychological. They are debilitated. There are people in wheelchairs that used to run marathons, and it was after serving in the Gulf War. I think we have to take care of these people, and I think we have to keep doing research."

The objectives of the research include seeking to determine the cause(s) of veterans illnesses, identifying areas of damage or dysfunction in the brain and nervous system responsible for the symptoms, developing a cost-effective battery of clinical tests that can diagnose the illness, searching for underlying genetic traits that might predispose to the illness, and performing clinical trials of promising treatments.

Initial studies identified three primary syndromes that appear to be unique, found that the syndromes are associated with subtle dysfunction of the brainstem and lower parts of the brain, and found that higher rates of exposure to combinations of chemicals in the war were associated with higher rates of gulf war syndrome.

Additionally, the teams genetic studies have identified a genetic trait that might explain why some servicemen sustained brain damage from exposure to neurotoxic chemicals while others working alongside them remained unharmed.

The teams Southwestern Medical Center website reports that most recently, "Research using magnetic resonance spectroscopy has demonstrated a loss of functioning brain cells in deep brain structures of ill Gulf War veterans."

Despite these findings many have reacted angrily to the extra spending on research into an illness they don't believe even exists. Many base their stance on a report published bythe National Academy of Sciences in 2006 entitled 'Gulf War and Health'.

The Committee on Gulf War and Health responsible for the report did not collect any original data, instead focusing on 850 previously undertaken, peer-reviewed epidemiological studies. What the skeptics latched onto is the reports conclusion that there was "no unique syndrome, unique illness, or unique symptom complex in deployed Gulf War veterans."

To many however, this just highlights the difficulty that multi-symptom syndromes present when it comes to diagnosis, determining cause, and finding suitable treatments. The fact is, that of nearly 700,000 veterans of the first Gulf War, about 100,000 in the months and years afterwards have reported health problems. A vast number of these cannot be easily labelled as suffering from post traumatic stress disorder (PTSD) or other solely psychiatric conditions. They also often cannot be diagnosed with specific physical ailments, so something that is not currently understood is clearly going on with this large proportion of veterans. Some of the most commonly reported symptoms include chronic fatigue, sleep disturbances, unexplained aches and pains, headaches, irritability, muscle spasms, skin rashes, memory loss, poor concentration, gut problems (irritable bowel syndrome), and multiple chemical sensitivity.

Those who are quick to jump on this reports closing lines are quick to skip over the fact that it also raises serious doubts about the quality of the research on which it drew to reach these conclusions. The report noted that the original studies' conclusions were often affected by many common limitations, including "use of a population that was not representative of the entire Gulf War population, reliance on self-reports rather than objective measures of symptoms, low participation rates, and a period of investigation that was too brief to detect health outcomes with long latency such as cancer."

Every study that The Committee on Gulf War and Health reviewed found that Gulf War Veterans "report higher rates of nearly all symptoms examined than their nondeployed counterparts....In many studies, investigators found a higher prevalence not only of individual symptoms but also of chronic multisymptom illnesses among Gulf War-deployed veterans than among the nondeployed."

So this report acknowledges that there is a higer prevalence of "chronic multisymptom illnesses among Gulf War-deployed veterans than among the nondeployed", yet it concludes that there is "no unique syndrome, unique illness, or unique symptom complex in deployed Gulf War veterans." The authority of such a contradictory report should be questioned by anyone who is prepared to look beyond its questionable conclusions.

A study carried out at The University of St. Andrews in Scotland and published in the October edition of Environmental Health Perspectives reinterviewed 390 veterans about their health problems. Originally interviewed 5 years ago, the study found no significant changes in their health status since that time. The authors conclude "The symptom outbreak following the 1991 Gulf War has not abated over time in registry veterans, suggesting substantial need for better understanding and care for these veterans."

It should be clear that there are many thousands of Gulf War veterans who are suffering from a (or a number of) "multisymptom syndrome(s)" that has so far remained unexplained. The only logical, and compassionate, conclusion is that more research is desperately needed to unravel the complexities involved in the illness(es) the verterans are suffering from. The extra $75 in funding for Dr. Haley's team at the Southwestern Medical Center can only be seen as a good thing in this regard.

Finally, it is worth considering the history of chronic fatigue syndrome (CFS) when the arguments over the existence of Gulf War syndrome surface. The suffering of those with CFS was dismissed for decades before it was finally accepted as a clinical diagnosis. CFS patients were usually considered to have some form of psychosomatic illness brought about by stress, exactly how many currently seek to dismiss the symptoms of Gulf War veterans.

The similarities between CFS and Gulf War syndrome are great and the fact that Gulf War syndrome is not recognised whilst CFS is, smacks of inconsistency in the extreme. Both are multisymptom syndromes whose exact causes have not been determined. The Committee on Gulf War and Health's conclusions that there is "no unique syndrome, unique illness, or unique symptom complex in deployed Gulf War veterans," should not stop efforts to define Gulf War syndrome. The definition of CFS includes only a core of a few symptoms that patients have and surely a similar definition could be produced for Gulf War syndrome based on the most common complaints of fatigue, aches and pains, sleep disturbance etc. Despite the fact that CFS is considered a single "unique syndrome", vast amounts of research have actually shown that there are various subsets of patients within the diagnosis. One group of CFS patients may show a particular biological abnormality whilst another group does not, for example. If this is the case for chronic fatigue syndrome and it is officially recognised, why is the same not true for Gulf War syndrome?

In reality, many researchers and specialist physicians consider Gulf War syndrome, CFS and other related conditions such as fibromyalgia and multiple chemical sensitivity (MCS), to have similar mechanisms and that perhaps they are variations on the same illness. Indeed, research by the Veterans Association shows that of servicemen registered in the VA Registry, 28% met the formal criteria for CFS and 36% had MCS, although none had been so diagnosed originally. This is not surprising since the primary symptoms of fatigue, aches and pains, sleep disturbances, and and neurocognitive problems are common to each syndrome. Research has also shown distinct biochemical abnormalities common to these illnesses such as high oxidative stress and low glutathione levels, abnormal brain blood flow and neurotransmitter levels, as well as changes to the gut flora.

Perhaps the continued funding of Dr. Robet Haley's research will help to work towards official recognition of the illness that has brought misery to so many veterans.



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