New Treatment Trials Help Gulf War Veterans

WASHINGTON, March 31, 1999 (GulfLINK) The federal government plans to begin medical treatment trials in April to evaluate two possible therapeutic approaches to improve the health and quality of life of Gulf War veterans.

The two newest trials, Antibiotic Treatment Trial and Exercise-Behavioral Therapy approach two critical areas of concern for Gulf War illnesses studies and the Research Working Group, which provides guidance and coordination for research sponsored by the Department of Defense, Veterans Affairs and Health and Human Services.

"We feel the time is right to explore effective treatment options for these types of conditions," says Timothy Gerrity, Ph.D., special assistant to the VA's chief research and development officer and the caretaker of the Research Working Group�s day-to-day activities. "That led to VA and DoD launching large scale, multi-site treatment trials of Gulf War veterans and their illnesses. The focus of one treatment trial is a combination of aerobic exercise and cognitive behavioral therapy."

That trial, called EBT for Exercise-Behavioral Therapy, will be conducted at 20 different sites and will study more than 1,300 Gulf War veterans. Gerrity stresses that the illnesses Gulf War veterans have are real, physical ailments, and that despite its name, cognitive behavioral therapy is not psychotherapy.

"This technique has been applied in many illnesses that are firmly bound in the body, from chronic back pain to the pain associated with cancer," he says.

However, Gerrity says this treatment trial won't get researchers any closer to knowing the cause of sick veterans' symptoms. Nor will this therapy be a cure for Gulf War illnesses, even if it is effective in relieving some symptoms.

"It is a means by which we can reduce the suffering and the pain while we continue to go on to better understand it through research. When it comes to making someone feel better, and making someone well, the issue of what caused it is not necessarily important," Gerrity says.

The second trial, called the Antibiotic Treatment Trial, focuses on the theory that Gulf War veterans are infected by an organism called Mycoplasma fermentans incognitus. No definitive link has been established between this organism and Gulf War illnesses, but an unknown number of sick veterans are already taking the antibiotic doxycycline in hopes of curing this possible infection. This trial will hopefully determine whether 12 months of antibiotic treatment using doxycycline will improve the health of veterans who have tested positive for Mycoplasma fermentans incognitus. This trial will involve 450 patients at 30 different facilities.

These treatment trials are just the latest of more than 120 research projects the federal government currently has ongoing in search of the nature, causes and possible treatments of Gulf War illnesses. Those projects cover a broad spectrum of approaches, from basic laboratory research to large-scale studies focused on veterans� symptoms, and are being carried out by a variety of scientific and medical groups across the country. Uniting that extensive diversity of scientific research is the job of the Persian Gulf Veterans Coordinating Board�s Research Working Group. The group provides guidance and coordination for more than $120 million of vital research related to the Desert Shield and Storm deployments.

The Research Working Group monitors the state and direction of research, identifies gaps in the medical knowledge and understanding of Gulf War illnesses and identifies theories worth testing. Its Annual Report to Congress includes recommendations for the direction of future research. Gerrity says when the next report is released this spring it will emphasize the need for sound research on improved diagnosis and treatment of the symptoms Gulf War veterans have shown.

Gerrity says the need for a large number of projects remains because the question being asked "Why are these veterans sick?" is a difficult one.

"Any problem related to the appearance of unidentified illnesses is going to require a multiplicity of approaches," Gerrity says. "We have a number of risk factors that we need to look at in terms of trying to gain some insight into whether or not these exposures could really have caused the illness."

Aside from possible exposure to oil fire smoke, pesticides, depleted uranium, nerve agents and a number of other potentially toxic substances, Gerrity says stress itself is a harmful exposure.

"Anything that you are exposed to heat, cold, chemicals, and events that impact upon you emotionally can affect the body," Gerrity says. "We need to think of these much more as a whole than as separate individual entities."

Gerrity says the research done so far has shown the undiagnosed illnesses plaguing Gulf War veterans to be similar to some other symptom-based illnesses, such as chronic fatigue syndrome. "But we're not saying that what Gulf War veterans have is chronic fatigue syndrome," Gerrity says, "because we're seeing a pattern that does not fit together with CFS." For example, research in civilian populations shows that CFS occurs twice as often in women as in men.

The research direction recommended by the Research Working Group looks to the future as well as the past. "With respect to Gulf War veterans there is a new focus on diagnosis and treatment. With respect to future veterans it's looking at prevention, at how we can intervene before we have a problem."

Recommending research directions is only part of the Research Working Group's significance. The importance of the group's work collecting and disseminating scientifically peer-reviewed research information was demonstrated in June, 1998 by the success of its Conference on Federally Sponsored Research on Gulf War Veterans Illnesses Research in Washington. More than 280 scientists, physicians and others from around the world took the opportunity to examine each other's efforts to understand the nature of Gulf War illnesses. Gerrity says the sharing of results is only half the benefit of such conferences. He says it also creates a forum of interaction amongst the researchers.

"What is discussed in the hallways is often more important than what is discussed inside the meetings. It is those discussions that lead to collaborations, to the fertilization of ideas."

Gerrity expects this year's meeting to be even better because it will be open to the public, adding an element of outreach. He says last year's meeting was restricted to the scientific community because until then the group did not have a lot of results to present.

Seeing solid results from the research sponsored by DoD, VA and HHS is the most important and gratifying facet of his job, Gerrity says.

"I can honestly say today that we have made a lot of progress, and that we're moving ahead quickly. You're going to see in the next 12 months a large number of publications come out."

And Gerrity says each bit of information published could be the key to helping our veterans who suffer from undiagnosed Gulf War illnesses.