Gulf War Symptoms Defy Diagnosis:

Doctors Frustrated


WASHINGTON, December 9, 1998 (GulfLINK) - The Department of Defense recently completed an exhaustive study of many of the toxic substances to which Gulf War veterans report being exposed, looking for the possible connections between those substances and Gulf War illnesses.

A civilian epidemiologist and two experts at the Uniformed Services University of the Health Sciences in Bethesda, Maryland conducted the study and recently published their findings in the Journal of Occupational and Environmental Medicine. The project took a hard look at the symptoms of more than 18,000 Gulf War veterans and what they said they were exposed to during extensive examinations in DOD's Comprehensive Clinical Evaluation Program. Researchers examined an impressive list of hazards:

Diesel and other fuels

Passive cigarette smoke

Tent heater fumes

Oil fire smoke

Personal pesticides

Non-US foods

Anthrax immunization

Solvents or other petrochemicals

CARC paint


Non-US water

Botulism immunization

Contaminated food

Malaria prophylaxis

Depleted uranium

Nerve gas/agents

Mustard gas/blistering agents


"While our study did not show that there appears to be a relationship between oil well fires, Pyridostigmine bromide, use of DEET, you know, the personal insecticides, we didn't find any relationship between that and particular symptoms in this study, that has to be taken with the fact that it's all self report and not verifiable." said Dr. (Maj.) Michael Roy, one of the project's researchers.

The study highlights the fact that 40 percent of the symptoms veterans show first appeared more than a year after reported exposures. It says this long latency of symptom onset and the lack of association with any self-reported exposures makes illness related to toxic exposure less likely.

Roy, the lead internist for investigation of symptoms at the CCEP, says he and other doctors are frustrated by not being able to give veterans definite answers about the causes of their illnesses.

 "We like to say 'this is what caused your symptoms and this is what we can do about it.' Unfortunately, many times it's not that simple," he says. "Patients like to have answers, but I think they appreciate honesty and sincerity. If you don't know, they don't want you to try to pull the wool over their eyes so it's important to say you don't know if you really don't know."

Roy began working with Gulf War veterans at Walter Reed Army Medical Center during the war.

"I was actually a resident at the time," he says, "so I spent many a night on call here taking the planeloads full of folks coming back. We saw a variety of things, a diverse population."

Roy says the study does not point to a relationship between any particular symptoms and any specific toxic substances, but it doesn't actually rule anything out either. One reason he says his study can't be more definite is that his exposure data isn't specific enough. The surveys vets filled out really only ask yes or no questions like "were you exposed to oil well fires?"

"One person may say 'yes' if they saw some smoke in the distance," Roy says, "and another may have been right there in the middle of the fires covered with soot."

He says the passage of time is also a factor. Most veterans received quite a number of vaccinations and it might be asking a lot to expect them to remember which ones and how many of each they received.

Furthermore, it's very difficult to prove a negative, Roy says. However, he believes the year he and his coworkers spent on this research will help Gulf War veterans.

"I think it can be of some comfort that a lot of the different exposures that veterans have been concerned about don't really seem to pan out as significant sources of illness," Roy says.

He also says many veterans have conditions that can be treated successfully even if the causes are unknown.

Roy realizes his research doesn't offer the definite answers so many service members want, but he hopes they don't think he and his fellow researchers are part of some cover up.

"We're just here to help," he says. "Nobody's telling me what to say or what to do or controlling what I say or anything. We're just here to try to help people get better. It doesn't matter what caused it or anything. The fact of the matter is people are suffering these symptoms. The question is how to get better."

To learn more, Dr. Roy and others researchers are analyzing the data again, breaking it down by many other factors such as rank, race and number of symptoms. He expects those findings to be published early next year.

The Defense Department has invested more than $130 million in studies related to the health of Gulf War veterans. Currently, there are more than 120 projects and clinical evaluations underway to find explanations for the symptoms reported by our military who served in the Gulf War.