By Thomas D. Williams

This story Web-posted November 30, 1999; 11:30 a.m

Brain scans of some Persian Gulf War soldiers show damage by exposure to wartime chemicals, a new Pentagon-sponsored study reveals. The study, combined with earlier related studies, contradict claims by the Pentagon since the Gulf War that low-level chemical agents were not common on battlefields, or, if they were evident, that they could not have been seriously harmful to veterans. Many veterans have complained of persistent illnesses in the years since the war.

It basically penetrates the denials that they were not sick from Gulf War-related exposures, said Dr. James L. Fleckenstein, a professor of radiology at the University of Texas and one of those responsible for the study. Now we can move from a point when Gulf War syndrome was debated, to a time when Gulf War disease can be diagnosed, and hopefully an effective treatment can be developed.'' It confirms what we have known for a long time, that there were serious exposures to chemical warfare out there in the battlefields,'' said former U.S. Sen. Donald W. Riegle Jr., a Michigan Democrats chairman of a Senate committee, it was Riegle who first gathered evidence  in 1993 and 1994 that Gulf War soldiers had been exposed to chemical warfare.

The evidence revealed in part that hundreds of thousands of chemical alarms  had sounded after winds carried chemicals over battlefields during allied bombings of Iraqi chemical weapons plants. More than 100,000 of the 690,000  Gulf War veterans who served at the height  of the 1990-91 war, have reported suffering from symptoms such as memory  loss, loss of balance, sleep disorders, depression, exhaustion, joint pain,  diarrhea and problems with concentration. These symptoms, the studies say,  are consistent with veterans' exposures to chemicals, including chemical warfare, anti-chemical warfare drugs and pesticides. A group of Navy Seabees  as well as some Army soldiers took special magnetic  resonance brain scans, which showed they have 10 percent to 25 percent lower  levels of a certain chemical in the brain stem and gray matter than healthy  soldier-subjects, the new study shows. The brain stem controls some of the body's reflexes, and the gray matter controls movement, memory and emotion.

A total of 46 service people were studied. The collection of data took three  to four months, and was completed in September 1998. The Department of  defense is always interested in high quality research that provides us information concerning the complex set of health problems being encountered by our Persian Gulf War veterans,'' said James Turner, a pentagon spokesman. We look forward to seeing the work in a peer-reviewed scientific journal of stature. Until then, it would be inappropriate for the department to comment on an unreleased research paper we haven't seen.''

He said the defense department is continuing to care for active duty Gulf War veterans experiencing problems they believe are associated with their service during the war. So far, he said, the department has provided special physical exams for 38,135 veterans and some family members.

Last month, a report from the Rand Corp., also funded by the Pentagon, revealed that the use of the drug pyridostigmine bromide (PB) by 250,000 soldiers during the Persian Gulf War ``cannot be ruled out'' as a cause of lingering illnesses in some veterans. The PB pills were supplied to service members by the military despite the experimental nature of their use, and despite the fact that they were effective only against soman gas and dangerous to use in the face of potential sarin gas, accessible to the Iraqis. Fleckenstein and Dr. Robert Haley, n associate professor of internal medicine and chief of epidemiology, both working at the University of Texas Southwestern Medical Center in Dallas were in charge of the brain scan study.

It is a significant follow up to earlier studies by Haley of Gulf War veterans, and was funded by the U.S. Department of Defense and the Ross Perot Foundation of Dallas.

Haley said the findings were significant not only becauset hey show the veterans were telling the truth about their exposure to chemical warfare, but because their brain injuries may be treatable. He said brain cells are not missing in the patients examined, just damaged or atrophied. Although there is no known treatment as of yet, Haley added, there is medical research underway to regenerate nerve cells. Some of these veterans are profoundly disabled, some barely able to drive to the store,'' Fleckenstein said.

``The findings suggest a substantial loss of brain cells in the areas that could explain the veterans symptoms. The results were released in a press conference Tuesday at the 85th Scientific Assembly of the Radiological Society of North America. Twenty-two sick Gulf War U.S. Navy veterans studied had lower levels of certain chemicals in the brain than was detected in 18 healthy veterans. That study was consistent with a second one of six Gulf War Army veterans.  The doctors doing the study were not told which veterans were healthy or which had symptoms of illness, Haley and Fleckenstein said. In earlier research, Haley said, he and Texas research doctors identified three primary symptoms indicating brain impairment in sick Gulf War veterans.

Their disabilities were consistent with the soldiers' exposures to chemical nerve gas, side effects from PB tablets and insect repellants, and pesticides used in soldiers' flea collars, the earlier study said critics of the Pentagon quickly reacted to the new study.  Why is Dr. Haley able to figure this out when our government friends and their scientists were unable to do so for so long?'' said retired U.S. Army Maj. Barry Kapplan of Union. Kapplan, a Gulf War veteran, spent tens of thousands of dollars trying to cure a variety of illnesses he and family members contracted and which he believes were related to his war exposures. It's nine years late and a whole bunch of medical bills short,'' he said.

What is this going to do for the veterans now? It's so long after the Gulf War, it's hard to believe veterans can still be treated. Riegle, the former senator who now works for an international public relations firm whose work includes health-related issues, called the new study a chilling and persuasive finding. It demonstrates again that the Pentagon has worked hardest not to get to the full truth. And, we have all those walking wounded who need medical help and compensation, and they are not getting it,'' Riegle said. These findings lend new urgency to bring this issue back to the forefront. I think the president has an obligation to act as the commander in chief, if the Pentagon doesn't

DoD, RAND Release Study of Nerve Agent Drug

WASHINGTON, Oct. 19, 1999 (GulfLINK) - The Department of Defense and the RAND Corporation released today the latest in a series of reportson the potential health issues affecting Gulf War veterans. The review examines the safety and effectiveness of pyridostigmine bromide, used during the Gulf War as a pre-treatment to protect military personnel from the nerve agent soman. The review of the scientific literature, sponsored by the Office of the Special Assistant for Gulf War Illnesses, was performed to identify hypotheses or theories that might link the drug to illnesses in Gulf War veterans and to evaluate evidence pertaining to these hypotheses.

"The purpose of this report is to examine an issue that has been of great interest to veterans. This work breaks new ground and presents a great deal of information that wasn't available to decision makers during the Gulf War," said Bernard Rostker, the Pentagon's special assistant responsible for overseeing the Defense Department's investigations of Gulf War illnesses.

"It is the most thorough review of an important issue in the search for answers to Gulf War illnesses." Pyridostigmine bromide is the only known protection against the deadly nerve agent soman, which was thought to be a serious threat during the Gulf War. All U.S. troops received packets containing PB pills during the war and DoD estimates that approximately 250,000 personnel took at least some PB.

The FDA approved pyridostigmine bromide in 1955 for use in treating myasthenia gravis, a neuromuscular disease which causes muscle weakness and fatigue. However, when FDA granted permission for use in the Gulf as a pre-treatment for the nerve agent soman, the permission was as an investigational new drug - this classification signifies that it had not been approved for general commercial marketing as a nerve agent pre-treatment. Rostker said the decision to use the drug should be considered in an operational context.

"This is the first battlefield use of pyridostigmine bromide as a pre-treatment drug. During Operation Desert Storm, the threat of the use of nerve agents by Iraq was very high. Pyridostigmine bromide was then - and still is today - the only known pre-treatment available to prevent death from exposure to the nerve agent soman." According to Rostker, during the Gulf War if troops had been exposed to soman without the protective benefit of PB, the mortality rate of those exposed would have been nearly 100 percent within a two-minute period.

After lengthy deliberation, permission to use the drug was granted by the FDA in 1990. In conjunction with this approval, the Defense Department agreed to some special requirements, including special labeling, record keeping, and the provision of information "to medical and paramedical personnel, and to individual service members for ... products intended for self-administration."

Actual implementation was inconsistent, record keeping inadequate, and information - prepared for distribution to the troops - not delivered. These inconsistencies have fueled veterans' concerns, Rostker said. "Very early on, some veterans have cited PB as a possible source for their illnesses," he said. "And in response, a number of research projects through the Research Working Group of the Persian Gulf Veterans Coordinating Board - the Departments of Defense, Health and Human Services and Veterans Affairs - were initiated. About half of these studies are complete. In light of the on-going work, we believed that a scientific review of the literature was needed to synthesize the body of knowledge into a single source that can be used as a foundation for work."

The nearly 400-page RAND report details seven hypotheses, providing extensive data on each. With regard to the possible link between PB use and Gulf War illnesses, the author, Dr. Beatrice Golomb, believes many questions remain unanswered and calls for further research.

The effectiveness of PB in guarding against the effects of soman is unclear, says Golomb. She suggests that the decision to use the pre-treatment drug in the future should be carefully weighed. "The DoD must always balance the risks of war, to include the potential for use of deadly nerve agents such as soman with the possible side effects from drugs such as PB," Rostker said. "Currently, PB is thought to be an essential part of the medical protection our troops have for soman, which is extremely lethal. However, PB does have known short-term side effects and we need to continue our efforts to protect our troops against deadly nerve agents."

The Defense Department will forward this report to the Institute of Medicine, to further their work related to Gulf War veterans' health concerns. As part of their charter, the Institute was charged to review the scientific and medical literature regarding adverse health effects associated with exposures during the Gulf War.

The review will include recommendations for additional scientific studies to resolve areas of continued scientific uncertainties related to the health consequences of Gulf War service.

Pyridostigmine bromide is one of the issues the Institute will review, Rostker said. Any veteran with health concerns should contact the DoD's Comprehensive Clinical Evaluation Program or the VA's Persian Gulf Registry to schedule an exam. Both programs offer a comprehensive clinical evaluation./

To schedule an exam, veterans should contact the CCEP at (800) 796-9699 or the VA's Registry at (800) 749-8387. RAND is a non-profit institution with a long history of independent research. This paper, as well as the RAND literature reviews on stress, depleted uranium, and oil well fires, and a comprehensive review of Military Use of Drugs Not Yet Approved by the FDA for CW/BW Defense is posted on GulfLINK (http//www.gulflink.osd.mil). The Post Traumatic Stress Disorder Page is maintained by the PTSD Team at the VA Medical Center in Phoenix, AZ. GulfLINK: Persian Gulf War Veterans Illnesses Home Page. (Sponsored by the Department of Defense) Gulf War Veteran Resource Pages. Information provided by a private (non-government) group.

• American Gulf War Veterans Association
• Gulf Veteran Resource Pages - the first and primary source of information on the Web for Gulf War Veterans suffering the mysterious collection of maladies known as Gulf War Syndrome.
• Gulf War Veterans of Wisconsin - assists Wisconsin residents affected by the complexities of Gulf War related illnesses. Keeps the public informed of issues that affect their veterans' well-being
• Gulf War Veterans Resource Links
• Heroes of the Desert Remembered - tribute page to soldiers, sailors, airmen, and marines who gave their lives during Operations Desert Shield and Desert Storm.
• Operation Desert Shield/Storm Association - provides assistance to Gulf War Veterans, their families, civilians and current Active Duty military members.
• Persian Gulf War Veterans Coordinating Board
• Tribute to Desert Storm Veterans - brief history of the conflict in the gulf
• Alex & Mary's Gulf War Diary - chronology of the main events in Iraq's confrontation with the United States since the end of the 1991 Gulf War.
• Desert Storm - information on all aspects of the war, including POWs, the weapons, and the soldiers.
• Desert-Storm.com - information on machines, soldiers, and more.
• Fog of War  marking the anniversary of the Iraqi invasion of Kuwait. From the Washington Post.
• Fratricide at Umm Hajul - Desert Storm friendly fire incident and cover up.
• Frontline: The Gulf War
• Gulf War
• Gulf War Chronicles - a day by day account.
• Gulf War Photo Gallery
• Gulf War, The - information about the Gulf War from PBS in conjunction with their 1996 Frontline television special.
• GulfLINK - Dept. of Defense Office of the Special Assistant for Gulf War Illnesses. News, medical information for Gulf War veterans, and reports on continuing suspicions about Iraqi biological weapons.
• Iraqi Invasion of Kuwait: An Eyewitness Account - the author was involved in the events leading up, during, and after the invasion by Iraqi forces.
• Mistakes of the Gulf War - essay suggesting that miscalculations and mistakes led to Saddam maintaining his regime.
• National Committee for Missing and POWs Affairs - contains information on Kuwaiti POWs and MIAs captured during the Gulf war.
• Operation Desert Storm Debriefing Book - information on the Gulf War
• Pat's World - aircraft battle damage photos from Desert Storm.
• Target Baghdad - aviation photo gallery.