-Caveat Lector-
October 19, 1999
http://www.nytimes.com/yr/mo/day/news/washpol/gulfwar-syndrome.html
Survey Links Gulf War Syndrome to Nerve-Gas Antidote
By STEVEN LEE MYERS
WASHINGTON -- A scientific survey underwritten by the Pentagon has concluded
that an experimental drug given to American troops during the Persian Gulf
war to protect against a nerve gas may be responsible for the chronic
illnesses afflicting tens of thousands of veterans.
The report, to be released at a news conference on Tuesday, is the first
commissioned by the Pentagon to identify a possible cause for the illnesses,
which have collectively come to be known as gulf war syndrome. It sharply
contradicts two earlier Government studies -- by a Presidential commission
and by the Institute of Medicine -- that ruled out the drug as a cause.
The drug, pyridostigmine bromide, or P.B., was distributed to 250,000 to
300,000 of the nearly 700,000 American troops sent to the Persian Gulf in
1990 and 1991 as a "pretreatment" for potential Iraqi attacks with the nerve
agent soman. While the drug has been used since 1955 to treat a rare
neurological disorder, its use as an antidote to soman is still regarded as
experimental.
More than 100,000 veterans have reported experiencing symptoms associated
with gulf war syndrome, including chronic fatigue, muscle pain, memory loss
and sleep disorders. But because of the Pentagon's acknowledged shoddy
record keeping in the war, it may be impossible to know how many of those
took the drug and in what quantities.
After years in which the Pentagon has systematically discounted possible
explanations for the ailments, including stress, exposure to oil-well fires
and depleted uranium used in American bombs, the report is something of a
breakthrough.
Wary of the reaction of veterans' groups and their supporters in Congress,
Pentagon officials Monday played down the findings of the survey, which was
conducted over two years by the Rand Corporation, a nonprofit research
organization financed by the Defense Department.
"This is not a Eureka," said Dr. Sue Bailey, a physician who is the
Assistant Secretary of Defense for Health Affairs. Dr. Bailey and other
officials said they accepted the report's findings but added that more
studies were needed before a direct scientific link could be established.
They also said the Pentagon would continue to keep the drug in its arsenal
of vaccinations and antidotes for troops who might face attacks with
chemical and biological weapons, even though the survey's conclusions also
raise questions about its effectiveness against soman.
The report, which runs 385 pages and was written by Dr. Beatrice Alexandra
Golomb, is based on the findings of scores of medical studies on
pyridostigmine bromide. Dr. Golomb is a professor at the University of
California at San Diego and a physician at the Veterans Affairs medical
center in San Diego.
Her report cites studies that have linked the drug to side effects similar
to those experienced by some veterans. One study, by Hebrew University in
Israel, linked the drug to neurological disorders in mice. Another, by the
University of Texas and Duke University, concluded that when mixed with
other chemicals it could cause nerve damage.
Dr. Golomb's report goes on to suggest that the drug's short-term effects
can become chronic because it causes abnormal levels of the nerve-signaling
chemical acetylcholine. The chemical is involved in many important
functions, including sleep, muscular activity, memory and pain, which have
all been cited as problems for ill veterans.
The report said research showed that individual reaction to the drug
depended on different factors, including stress, physiology and exposure to
other agents, including pesticides and even nicotine and caffeine. That
would explain why only some veterans have reported illnesses.
"One cannot rule out the possibility that long-term effects of P.B. might
occur and might participate in the production of neuropsychological and
other deficits reported by some" veterans, Dr. Golomb concludes.
Scientists and veterans' advocates have long pointed to pyridostigmine
bromide, as well as other experimental drugs given to troops in the gulf, as
one of the possible culprits in the still unexplained illnesses attributed
to gulf war syndrome. Separate reports by the House and Senate identified it
as such and called for further research into the drug's effects.
Dr. Bernard D. Rostker, the Under Secretary of the Army who is the
Pentagon's senior official overseeing gulf war illnesses, said the Pentagon
had strongly supported several studies on pyridostigmine bromide, including
Rand's, because of those concerns. He said the Pentagon was already spending
$20 million on additional research into the possible links considered in
Rand's report.
"That does not mean we have made a direct relationship between the two," he
said, referring to the drug and the syndrome. "It means we don't have enough
information."
The initial reaction on Capitol Hill was harsh. Representative Christopher
Shays, a Connecticut Republican who is one of the most outspoken critics of
the Pentagon's handling of the issue, accused the Pentagon of moving slowly
to study the drug and of "restating the obvious need for aggressive
research."
"The sad news is how little has been learned in eight years about
organophosphate poisoning and the delayed neuropathies that appear to play a
role in the illnesses suffered by gulf war veterans," Shays said.
Under a special waiver from the Food and Drug Administration, the Pentagon
distributed thousands of packets of pyridostigmine bromide to the troops as
they deployed to Saudi Arabia in 1990 following Iraq's invasion of Kuwait.
Troops were ordered to take three flat white tablets each day as long as
they were in the region, although it appears they did so erratically.
Pyridostigmine bromide is the only known treatment for soman, a deadly gas
developed by the Soviet Union. Although Iraq is known to have made weapons
with other nerve agents, including sarin, no evidence has surfaced to
suggest Iraq ever made weapons with soman.
Dr. Golomb also reported that some studies on animals suggested that the
drug might not be very effective against soman at the doses given and may in
fact increase susceptibility to other chemical weapons.
The drug has not been given to troops since the gulf war, but Dr. Rostker
said the findings would not change the Pentagon's policy to use it whenever
commanders determine that an enemy might have soman.
"Its continued use is warranted given the fact that an exposure to soman
would result in almost immediate death," Dr. Rostker said.
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