Funding Continues for Illness Scientists Dismiss
Gulf Syndrome Has Believers in Congress
By David Brown
Washington Post Staff Writer
Sunday, December 3, 2006; Page A01
Fifteen years after the end of the 1991 war with Iraq, a Texas researcher is in
line to get as much as $75 million in federal funding to press his studies of
"Gulf War syndrome," even though most other scientists long ago discounted his
theories.
Epidemiologist Robert W. Haley has been trying for 10 years to prove that
thousands of Persian Gulf War troops were poisoned by a combination of nerve
gas, pesticides, insect repellents and a nerve-gas antidote. With the help of
$16 million in past funding obtained by his backers in Congress and the
Pentagon, Haley has argued that his "toxicity hypothesis" is the best
explanation for the constellation of physical complaints that many veterans
reported after returning from the Gulf.
Haley and his supporters, who also include a powerful cluster of veterans and
government advisers, are undeterred by the scientific consensus against him.
As recently as September, a panel of the National Academy of Science's Institute
of Medicine reached the same conclusion that half a dozen other expert groups
had: Gulf War syndrome does not exist. After reviewing 850 studies --
essentially all the scientific literature on the topic -- the 13 scientists
wrote that "the nature of the symptoms suffered by many Gulf War veterans does
not point to an obvious diagnosis, etiology [cause], or standard treatment."
"Gulf War syndrome" became a catchall name for a spectrum of
non-life-threatening complaints that up to 30 percent of the conflict's veterans
say they have experienced at some point since the end of the war in 1991. The
most commonly cited symptoms are fatigue, memory loss, poor sleep, mood changes,
digestive troubles and rashes.
The ground war lasted four days and resulted in 147 battlefield deaths, but
almost 199,000 of the 698,000 people who were deployed have since qualified for
some degree of service-related disability. Of those, 3,317 people are disabled
by "undiagnosed conditions."
From 1994 through 2003, the departments of defense, veterans affairs, and health
and human services sponsored 256 studies of Gulf War syndrome, at a total cost
of $316 million.
Scientists Cry Foul
--------------------------------------------------------------------------------
The size, timing and purpose of the latest appropriation has elicited muffled
outrage among scientists who say there is little more to gain from pursuing
Haley's ideas.
"This is a tremendously egregious misuse of government funding," said Gregory C.
Gray, who headed the Navy's Gulf War illness research center in San Diego before
retiring in 2001. He now directs the Center for Emerging Infectious Diseases at
the University of Iowa's College of Public Health.
"After hundreds of millions of dollars and a decade or better of research, we
really haven't made any significant findings," said John R. Feussner, who was
VA's chief research officer from 1996 to 2002 and is now chairman of medicine at
the Medical University of South Carolina. "What is the chance we will find
something now? Not as high as zero."
At VA, people will not talk on the record about the appropriateness of Haley's
grants -- almost all awarded outside the usual competitive routes.
"This is a very sensitive topic around here right now, in part because this
might be seen as an apparent shift in how VA selects and funds research," said
one official, speaking anonymously so as not to offend members of Congress. A
former VA official, also unwilling to be quoted by name, was more
straightforward: "Everyone is dismayed."
Haley's research was originally underwritten by billionaire H. Ross Perot. It
later gained the support of VA's Research Advisory Committee on Gulf War
Veterans' Illnesses, on which Haley sat until recently, and of a politically
diverse group of legislators that includes Reps. Christopher Shays (R-Conn.),
Bernard Sanders (I-Vt.) and Dennis J. Kucinich (D-Ohio).
Haley's chief congressional patron is Texas's senior senator, Kay Bailey
Hutchison (R), who chairs the Appropriations Committee's subcommittee on
military construction and veterans affairs. A year ago, she inserted an earmark
in the 2007 federal budget that will channel $15 million to the University of
Texas Southwestern Medical Center, where Haley is a professor and chief of
epidemiology. The grant can be renewed four times, for a total of $75 million
over five years.
VA cemented the arrangement Nov. 14 when it signed a contract saying UT
Southwestern will "conduct and manage research projects in order to answer
central questions on the nature, causes and treatments of Gulf War veterans'
illnesses," said VA spokeswoman Karen Fedele.
Hutchison twice declined a request to talk to The Washington Post for this
article, as did Haley.
Just how much money will go to Haley's research is unknown. Other scientists
will be able to apply for funding, but the awarding of grants will bypass VA's
usual mechanisms and instead go through "a process established by and headed by
the dean of the medical school" at UT Southwestern, Fedele said.
Haley's backers say a lack of focus and money are the chief reasons a cause and
treatment for the Gulf veterans' ailments have not been found. Hutchison
spokesman Marc Short said the senator "doesn't want people to stop doing Gulf
War illness research as long as there are symptoms out there that we don't
understand."
The Conventional Wisdom
--------------------------------------------------------------------------------
Outside Haley's circle, most experts think the syndrome is rooted more in
medicine, psychology and culture than in toxicology.
They have concluded that it is the product of a medley of factors, including the
stress of the war and the fear that Saddam Hussein might use chemical or
biological weapons. For some people -- particularly reservists, in whom the
symptoms are more common -- it may be a physical expression of the disruption
that deployment caused in their lives. Some of the physical complaints may
simply be the ordinary ups and downs of people's health, magnified by public and
media attention. Gulf War syndrome may also be the military manifestation of
something long seen in civilian medicine: symptoms whose cause is never found
despite extensive testing and diagnostic studies.
Haley adamantly rejects that view, especially the stress argument. In three
papers published in the Journal of the American Medical Association in January
1997, he outlined six distinct neurological syndromes he identified in several
dozen former members of the Navy Reserve "Seabees" construction unit who served
in the Gulf. He has spent much of the past decade studying them, focusing on the
three most disabling syndromes. For one series of papers, he took 165 measures
of neurological function.
Among the things he and his colleagues reported was that in 12 veterans with the
most severe complaints, a deep-brain structure called the left basal ganglion
was smaller than usual. (The right one was normal.) He also found that some ill
veterans tended to have a less active version of the enzyme paraoxonase-1, which
breaks down the nerve agent sarin. Veterans with symptoms were also more likely
to have abnormal eye reflexes and subtle changes in the daily variation of heart
rate. What remains unclear is the significance of these results.
Poisoned on the Battlefield
--------------------------------------------------------------------
Haley's most controversial claim is that many veterans suffering from the
syndromes were probably exposed to a nerve agent during the war.
Nerve gas was released after the war, during the destruction of 816 pounds of
sarin and cyclosarin at a storage complex in Khamisiyah, Iraq, in March 1991.
The Defense Department modeled the "plume zone" from this explosion and in 1997
notified 98,910 veterans that they may have been briefly exposed downwind of
Khamisiyah. That number was later increased to about 102,000.
Haley's backers consider those letters proof that the veterans were exposed to
nerve gas. That is the view of James H. Binns Jr., a retired businessman and
former deputy assistant secretary in the Defense Department who chairs the VA
Gulf War illnesses research panel. "There is no contradicting that there was
low-level exposure to sarin gases as a result of destruction of Iraqi weapons
depots," he said in an interview.
Defense officials, however, have always been careful to talk of "potential
exposures," not definite ones.
No one doing the demolition reported any symptoms of sarin poisoning at the
time. Neither did anyone in the plume zone. Few doubt that air containing the
vaporized compound drifted over troops, but there is no evidence that anyone
actually came in contact with sarin. Furthermore, the Seabees Haley studied were
far outside the plume zone, as were most other soldiers who later complained of
persistent symptoms. For sarin to be part of the mix of toxins causing Haley's
syndromes, there would had to have been other releases -- something experts say
is extremely unlikely.
"I haven't spoken to anyone in the military or in intelligence who believes it
is credible that there was deliberate use of sarin and nobody noticed," said
Simon Wessely, a psychiatrist and leading British researcher of Gulf War
illness.
Evidence that low-level exposure to sarin can lead to chronic illness is equally
sparse.
Brain-wave tracings of monkeys exposed to low doses sometimes show changes,
although the animals' behavior does not change. Rats exposed to low doses of
nerve agent and pesticide perform worse in mazes, but most are back to normal in
three months. The relevance of those findings to human illness that includes
symptoms as diverse as joint pain and chronic diarrhea is unknown.
The few studies of people who were exposed and survived are also not very
enlightening. American and British soldiers exposed to non-fatal doses of nerve
gas as human guinea pigs decades ago suffered no chronic illness, but some
survivors of two sarin attacks by terrorists in Japan in the 1990s reported
tiredness, headaches and vision changes up to five years later.
There is also little evidence that simultaneous exposure to toxins -- even
without nerve gas -- has lasting effects. A study published in October found
that, properly used, DEET insect repellant, the anti-nerve-gas pill
pyridostigmine bromide and insecticide-impregnated uniforms did not cause
physical or mental impairment.
Overall, most scientists who have investigated the question share the same
conclusion: The chance that thousands of people suffered poisoning they did not
recognize at the time, and are now ill with a disease that has never been seen
before, is close to nil.
But while the scientific establishment has always been skeptical of Haley's
findings, 10 years ago Pentagon officials saw them as possibly the key to the
mystery of Gulf War syndrome.
Support Lost, and Regained
--------------------------------------------------------------------------------
"In my opinion, Haley was researching the very essence of Gulf War illness,"
recalled Bernard Rostker, an economist who headed the Defense Department office
devoted to that subject. In 1997, his office provided $3 million to Haley out of
discretionary funds when the Dallas scientist failed to win a grant through the
military's usual competitive funding mechanism.
They money was to give Haley a chance to confirm his findings in a larger,
representative sample of veterans. But he did not do that, which became clear
when Rostker toured the Dallas research ward in 1998 and encountered only
previously examined veterans.
"I thought Dr. Rostker was going to blow a gasket right then and there,"
recalled Michael E. Kilpatrick, deputy director of deployment health support at
the Pentagon, who was on the visit.
Haley eventually did test 336 additional veterans reached through the Dallas VA
hospital, identifying 29 with one of his six syndromes. Among the 249 Seabees he
had examined earlier, he found 25.
"Basically, Haley stiffed the government," Rostker said recently. He refused to
give Haley more money, and Hutchison began inserting budget earmarks to fund
Haley's work.
Pentagon and VA officials still say the crucial question that needs answering is
whether Haley's syndromes can be found in a larger group of veterans.
To that end, the government is spending more than $10 million to ask a random
sample of 10,000 veterans about symptoms, and to study the brains of several
hundred who are clearly ill, using MRI scanners. Along with the new
appropriation, that will extend efforts to examine Haley's theory to almost the
20th anniversary of the conflict.