The health consequences of the first Gulf war
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7428.1357 (Published 11 December 2003) Cite this as: BMJ 2003;327:1357All rapid responses
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Precautionary principle governs publications on health and safety
phenomena that might appear "scientifically controversial" but for which
there is partial evidence of potential or actual harm. Editorial policy
without such tenet opens Pandora's box of abuse by corporate and
government-military propaganda.
Sceptics quote "The Health Consequences of the First Gulf War" by
Daniel Clauw in BMJ as fact rather than opinion based on partial
information. Clauw states: "there is no evidence of excess [...] birth
defects [...] associated with Gulf war deployment."
Araneta et al. conclude [Birth Defects Res Part A Clin Mol Teratol.
2003 Apr;67(4):246-60]:
"We observed a higher prevalence of tricuspid valve insufficiency, aortic
valve stenosis, and renal agenesis or hypoplasia among infants conceived
postwar to GWV men, and a higher prevalence of hypospadias among infants
conceived postwar to female GWVs."
Clauw contradicts research results at DOD Center for Deployment
Health Research (Araneta et al. afilliation). It behooves the author and
BMJ to invoke the precautionary principle and cite the article. Otherwise
they are in the deception business.
The general public is not equipped to digest scientific and
professional publications. Information warriors of the complex behind
illegal radioactive-toxic weapons and equally harmful materials in
consumer products quote freely and profusely from "authors" like Clauw,
pretending this is THE science. Recent example is Reuters dispatch of
December 16, 2003, quoting Clauw.
I am not a medical expert and will not research the other aspects of
GW (and Balkan) Syndrome that Clauw "discusses". But from his attitude
towards the birth defects findings I would not bet an old hat on any of
his statements.
Clauw has self-declared competing interests: "receiving research
funds from the US Army". I am requesting a re-statement by Clauw item-by-
item of the BMJ guideline on conflict of interest. The reader should also
know what was the amount received, and in what percentage of his total
income each year.
Dr Piotr Bein, PEng,
Member: Institute for Risk Research - University of Waterloo;
Consultee: European Committee on Radiation Risk;
Co-founder: www.du-watch.org and du-watch e-list
Competing interests:
researcher and activist against uranium weapons (illegal under humanitarian law)
Competing interests: No competing interests
I can think of two reasons for the photographic solecism spotted by
Alexander Spiers.
1. All the desert camouflage uniforms had been bagged by the
television warriors: generals and other senior officers who fought their
way through press conferences held well away from the places where people
were actually being shot
2. The Government felt there was no need for our lads to wear
properly adjusted NBC defence equipment because it already knew they
wouldn't have to face nuclear, biological, or chemical weapons.
Competing interests:
None declared
Competing interests: No competing interests
To the Editor: The Editorial and research papers on Gulf war illness
were both clear and interesting, but I am puzzled by the cover
illustration. I do not know its provenance but it is incorrect in a number
of details. The soldiers are wearing NBC (nuclear/biological/chemical)
defence equipment and appear to be standing in a desert. Their protective
garments are fashioned from DPM (disruptive pattern material), but the DPM
is of the type used in the European theatre of operations, whereas it
should be of the desert type. In the illustration the soldiers stand out
from their background almost as well as a red public telephone box. Such
conspicuous clothing confers a high risk of being shot. Even worse, their
attire is incomplete. The soldier on the left has no gloves and the
individual on the right is wearing only the cotton inner gloves, which are
not protective against liquid nerve agents or mustard gas. Correct NBC
protection requires the wearing of black neoprene outer gloves that are
impervious to chemical agents. In the event of a chemical attack, these
two soldiers would not survive long enough to develop Gulf war illness.
After years spent teaching soldiers NBC techniques, I find such a
misleading illustration on the cover of a leading international journal
very disappointing.
Competing interests:
None declared
Competing interests: No competing interests
Clauw states: "Firstly, there is no evidence of excess malignancy,
birth defects, or increased mortality associated with Gulf war
deployment."
This comment on birth defects is being widely reported as fact, based
on the this BMJ editorial. This is tragic. This needs to be corrected so
policy makers do not succomb to this perpetuated myth that there are no
elevated birth defects in the Gulf War cohort.
This tragic misinformation must stop.
*****************************************
Birth Defects Res Part A Clin Mol Teratol. 2003 Apr;67(4):246-60.
Prevalence of birth defects among infants of Gulf War veterans in
Arkansas,Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993.
Araneta MR, Schlangen KM, Edmonds LD, Destiche DA, Merz RD, Hobbs CA,
Flood TJ, Harris JA, Krishnamurti D, Gray GC.
Department of Defense Center for Deployment Health Research, Naval
Health Research, Center, San Diego, California, USA. haraneta@ucsd.edu
BACKGROUND: Epidemiologic studies of birth defects among infants of
Gulf War veterans (GWV) have been limited to military hospitals, anomalies
diagnosed among newborns, or self-reported data. This study was conducted
to measure the
prevalence of birth defects among infants of GWVs and nondeployed veterans
(NDV)in states that conducted active case ascertainment of birth defects
between 1989-93. METHODS: Military records of 684,645 GWVs and 1,587,102
NDVs were electronically linked with 2,314,908 birth certficates from
Arizona, Hawaii, Iowa, and selected counties of Arkansas, California, and
Georgia; 11,961 GWV
infants and 33,052 NDV infants were identified. Of these, 450 infants had
mothers who served in the Gulf War, and 3966 had NDV mothers. RESULTS:
Infants conceived postwar to male GWVs had significantly higher prevalence
of tricuspid
valve insufficicieny (relative risk [RR], 2.7; 95% confidence interval
[CI], 1.1-66; p = 0.039) and aortic valve stenosis (RR, 6.0; 95% CI, 12-
31.0; p = 0.026) compared to infants conceived postwar to NDV males. Among
infants of male GWVs, aortic valve stenosis (RR, 163; 95% CI, 0.09-294; p
= 0.011) and renal agenesis or hypoplasia (RR, 16.3; 95% CI, 0.09-294; p =
0.011) were significantly higher among infants conceived postwar than
prewar. Hypospadias was significantly higher among infant sons conceived
postwar to GWV women compared to NDV women (RR, 6.3; 95% CI, 15-263; p =
0.015). CONCLUSION: We observed a higher prevalence of tricuspid valve
insufficiency, aortic valve stenosis, and renal agenesis or hypoplasia
among infants conceived postwar to GWV men, and a higher prevalence of
hypospadias among infants conceived postwar
to female GWVs. We did not have the ability to determine if the excess was
caused by inherited or environmental factors, or was due to chance because
of myriad reasons, including multiple comparisons. Although the
statistical power was sufficient to compare the combined birth defects
prevalence, larger sample sizes were needed for less frequent individual
component defects.
PMID: 12854660 [PubMed - in process]
Competing interests:
None declared
Competing interests: No competing interests
Gulf War Illness- A Truer Perspective
Gulf War Illness – A Truer Perspective
EDITOR – I am most grateful for this opportunity to comment and
expand on an article about Gulf War illness and allied topics in the
British Medical Journal of 13 December 2003.
The editorial by Clauw (1) was very contradictory. He states that
Post Traumatic Stress Disorder (PTSD) in Gulf war era veterans was low
compared to other wars but then goes on to implicate its role in Gulf war
illness (GWI), initially by using the older terms, “shell shock” and
“soldier’s heart” and then devoting the whole of his sixth paragraph
describing PTSD as a possible model for GWI. The PTSD model will not
explain the illnesses suffered by personnel who were prepared i.e. kitted
out and immunised, but who were not deployed to the Gulf but stayed in the
UK or Germany.
The treatment of the issue of vaccines is even more confused and
contradictory. Firstly he states that none of the environmental exposures
with the possible exception of vaccines given at the time of deployment
were associated with the development of the symptom complexes. Later he
states, categorically, that the excess morbidity associated with Gulf war
deployment had little to do with specific environmental exposures. However
he goes on to implicate infections and immune stimulation as stressors.
Immunisations can be looked on as “controlled” infections to produce
immune stimulation.
A closer look at the vaccines given would have been very informative.
The Anthrax, Plague, and Pertussis vaccines were all given in regimes
contrary to the manufacturers recommendations. There was also doubt about
the efficacy and safety of some of these vaccines in the Ministry of
Defence (MoD), the Department of Health (DoH) and the National Institute
for Biological Standards & Control (2). Such was the concern about the
Plague vaccine that it was proposed that a “trial” should be undertaken
using personnel of 205 General Hospital RAMC (V) to asses its effect
before giving it to the rest of the troops.(3). The General Officer
Commanding and the Commander Medical of 1(UK) Armoured Division declined
to have the Plague vaccine(4). The Veterans Agency (VA) in the UK awards
War Disability Pensions for “Vaccine Damage”
.
A detailed look at the drugs and chemicals to which veterans were exposed
is also very worrying. Most personnel took NAPS (Nerve Agent Pretreatment
Set) tablets containing pyridostigmine bromide (PB) 30mg tds. There was
extensive use of organophosphate insecticides, smoke and oil from oil well
fires, various munitions and propellants and depleted uranium. Most
worrying was the detection of chemical warfare agents (5). These may have
been delivered by the Iraqis or as a result of coalition bombing of Iraqi
arms dumps. However what is certain is that American troops blew up an
Iraqi arms dump containing at least 8.5 tons of Sarin and cycloSarin at
Khamisiyah. The original estimate of the number of troops exposed was
20,000 but this was later raised to 100.000 including possibly 10-15,000
British(6). Recent animal studies have shown that exposure to low levels
of Sarin can reduce brain levels of acetyl cholinesterase (7) which may
result in cognitive dysfunction.
Clauw goes on to state that most visits to primary care are for chronic
somatic symptoms and syndromes, but he neither quantifies nor supports
this glib statement with references. He then mentions the use of
functional imaging techniques in looking at chronic central pain and then
without any explanation proceeds to question Haley’s work using Magnetic
Resonance Spectroscopy (8). Nor is there any mention of Haley’s work with
structural equation modelling (9) or recent work on Paraoxonase and its
protective role against atheroma (10).
I found this editorial confused and lightweight. However its saving
grace is in the final paragraph. I agree that the ill Gulf war veterans
have a very real illness. However I strongly disagree with the statement
that the veterans are not served well by “focusing inordinate attention on
specific exposure(s)”. I think it does not serve the veterans well by
trying to somatasise all their illnesses and putting it all down to
“stress”. There is a obvious cause for the great variety of illnesses
suffered by the veterans and I have outlined it above. The cause of their
illnesses is the “cornucopia of toxins”(11) to which they were exposed.
It is paramount that both primary and secondary care physicians are given
accurate and pertinent information so that they can effectively recognise
and treat these patients, numerous of who have taken their own lives, are
in prison for such crimes as murder and manslaughter, or have been forced
to join the ranks of the ex-servicemen and mentally ill who are homeless
and destitute. This information is available. It only needs to be
disseminated widely.
Nigel H Graveston, Consultant Anaesthetist, Burnley General Hospital,
Burnley, Lancashire, BB10 2PQ
ngraveston@doctors.org.uk
Competing interests: Nigel Graveston is a former major in the RAMC
and is a veteran of the first Gulf War. He is vice-chairman of and
formerly medical adviser to the National Gulf Veterans & Families
Association, Offices 58-60 The Pavilion, 536 Hall Road, Hull HU6 9BS.
Nigel Graveston suffers from Gulf War Illness.
References
(1) Clauw D. The health consequences of the first Gulf war.
BMJ2003;327:1357-8 (13 December)
(2) Background to the use of medical countermeasures to protect British
forces during the Gulf War (Operation Granby), paras 33-91 Annexes A,
B1,B2 &C Ministry of Defence, Whitehall, London, October 1997
(3) Implementation of the immunisation programme against biological
warfare agents for UK forces during the Gulf conflict 1990/1991. paras 140
-7. Ministry of Defence, Whitehall, London, 20 January 2000
(4) Ibid paras 148-155
(5) Author’s personal experience and personal communications from numerous
other veterans.
(6) Gulf War Illness- Dealing with the Uncertainties. Parliamentary Office
of Science and Technology, Houses of Parliament, London. December 1997
(7) Henderson RF et al. Response of Rats to Low Levels of Sarin.Toxicol.
Appl. Pharmacol. 2002;184:67-76
(8) Haley RW, Marshall WW, McDonald GG, Daugherty MA, Petty F,
Fleckenstein JL. Brain abnormalities in Gulf War Syndrome: evaluation with
1H MR spectroscopy. Radiology 2000; 215: 807-817
(9) Haley RW, Luk GD, Petty F. Use of structural equation modelling
to test the construct validity of a case definition of Gulf War syndrome:
Invariance over developmental and validation samples, service branches and
publicity. Psychiatry Research 102 (2001) 175-200.
(10) Hotopf. M. et al. Paraoxonase in Persian Gulf War Veterans J Occup
Environ Med. 2003;45:668-675
(11) The Coroner for the County of Chester at the inquest into the cause
of death of Major Ian Hill RAMC, 24 November 2003, The Coroner’s Court,
Winmarleigh Street, Warrington, Cheshire.
The MoD reference can be found at www.mod.uk or from
Dr Stephen Trout,
Gulf Veterans Illness Unit,
MoD, 7th Floor, Zone A,
St Georges Court,
2-12 Bloomsbury Way,
London WC1A 2SH
Competing interests:
Competing interests: Nigel Graveston is a former major in the RAMC and is a veteran of the first Gulf War. He is vice-chairman of and formerly medical adviser to the National Gulf Veterans & Families Association, Offices 58-60 The Pavilion, 536 Hall Road, Hull HU6 9BS. Nigel Graveston suffers from Gulf War Illness
Competing interests: No competing interests