Gulf war illness

New American research provides leads but no firm conclusions

It is six years since the end of the Persian Gulf war, and we are just beginning to see the publication of scientific research addressing the long term health of those who took part. The four papers on this topic in last week's JAMA1 2 3 4 are therefore of considerable interest. Service men and women deployed in the Gulf were exposed to several potentially serious physical and psychological stressors. These include immunisations, pyridostigmine prophylaxis, pollution from oil fires, and the liberal use of pesticides, a list that continues to grow. The campaign took place in inhospitable surroundings and was conducted under the threat of exposure to some of the most fearsome weapons yet invented. Some adverse effects on health are therefore unsurprising.

The first of the JAMA papers is a survey of all veterans, both deployed and non-deployed, from the state of Iowa.1 It is the first population based survey of its kind and achieved an impressive response rate (76%). It provides strong evidence of a health problem associated with service in the Gulf,5 since the military staff who were deployed were twice as likely to report symptoms as those not deployed (14.7% v 6.6% reporting two or more problems). The biggest differences in reporting rates were for cognitive dysfunction, fibromyalgia, depression, anxiety, alcohol misuse, respiratory problems, and chronic fatigue. There was no increase in risk of more specific illnesses such as cancers. These findings are similar to those reported in veterans of previous conflicts.6 The researchers also asked about the whole range of possible exposures. Each exposure was associated with each outcome, suggesting either that each has the capacity to cause a wide range of problems or that the data were susceptible to recall bias.

The other three papers, from Robert Haley …