Sarin Caused Gulf War Syndrome? Doubt it

Sometimes, the federal government deserves all the pummeling they can get from the mainstream press. The Gulf War illness investigation would not be one of them.

Between the Department of Veteran Affairs and the Department of Defense, the federal government has paid literally hundreds of millions of dollars into Gulf War illness-related studies.

Since the outcry in the mid-1990s over the possible exposure of 100,000 soldiers to low-level nerve agent, about every conceivable angle on what might have caused a variety of illnesses has been examined. None of these studies have conclusively proven any direct link to one or more sources -and they still haven't to this day. But when one study suggests that nerve agent is the cause, well, it's newsworthy. Cue the New York Times:

The study, financed by the Department of Veterans Affairs and the federal Centers for Disease Control and Prevention, is the first to use Pentagon data on potential exposure levels faced by the troops and magnetic resonance imaging to scan the brains of military personnel in the exposure zone.
It found signs of brain changes that could be due to exposure, showing that troops who had been exposed at higher levels had about 5 percent less white matter than those who had little exposure.

White matter volume varies by individual, but studies have shown that significant shrinkage in adulthood can be a sign of damage.

The study was led by Roberta F. White, chairman of the department of environmental health at the Boston
University School of Public Health. Dr. White and other researchers studied 26 gulf war veterans, half of whom were exposed to the gases, according to a Defense Department modeling of the likely chemical makeup and location of the plume. The researchers found that troops with greater potential exposure had less white matter.

In a companion study, the researchers also tested 140 troops believed to have experienced differing degrees of exposure to the chemical agents to check their fine motor coordination and found a direct relation between performance level and the level of potential exposure. Individuals who were potentially more exposed to the gases had a deterioration in fine motor skills, performing such tests at a level similar to people 20 years older.

Dr. White says this study and the results of research from other studies provide “converging evidence that some gulf war veterans experienced nervous system damage as a result of service, and this is an important development in explaining gulf war illnesses.”

Wow, that certainly sounds impressive. But wait, there's more...

Phil Budahn, a spokesman for the Department of Veterans Affairs, said the research required further examination.

“It’s important to note that its authors describe the study as inconclusive,” Mr. Budahn said, adding, “It was based upon a small number of participants, who were not randomly chosen.”

Dr. White said she did not describe her study as inconclusive, though she said it would be accurate to call it preliminary.

That is to say, the study bases its findings on 13 of 100,000 potential human subjects, and certainly those 13 individuals' symptoms may not have been indicative of the average. Moreover, one has to question the basic assumption that they were exposed to low levels of nerve agent, rather than one or a combination of several other environmental factors - pesticides, indigenous diseases, pollution, stress, smoke, etc.

You might imagine that I do follow this topic closely, since the Army has dealt with nerve agents for the past sixty years and actually has some hands-on experience with government civilians being accidentally exposed to low-level amounts of agent (not to mention working with the EPA, CDC, and OSHA on worker and general population standards at the chemical weapons disposal facilities). Almost two years ago, I blogged about a similar medical report linking brain cancer to nerve agent exposure. My main point then -
which I will repeat here - is that you cannot begin with the assumption that the test subjects were exposed based on their geographical location at the time of the Khamisiyah incident. The models used provided a prediction of where the gases might have gone - based on a number of assumptions and using a level of exposure that amounts to no ill effects in a general population.

In May
1996, an UNSCOM team revisited the Khamisiyah site and decided that these rockets were binary agent (GB/GF) filled. In July 1996, the CIA
presented its downwind hazard model to the Presidential Advisory
Committee. Based on some modeling and assumptions, they suggested that a downwind hazard of four km might cause acute symptoms of runny noses and headaches, and an area of up to 25 km might have been contaminated at a much lower dosage level that we call the general population dosage limit. That's a 72 hour exposure at 0.013 milligram-minutes/cubic meter), which is lower than the 0.04 mg-min/m3 that govt workers at
Army chemical weapons storage sites have to observe, much lower than the incapacitating dose of 2-3 mg-min/m3, and a hell of a lot lower than the lethal dose of 70-100 mg-min/m3. That model didn't take into account hot desert weather, the 37 other bunkers exploding, or the purity of the chemical agent. But just to be safe, the DOD doubled the hazard area and announced in October 1996 that 15-20,000 troops might have been exposed to nerve agent as a result of these explosions. After re-running the models, refining the results, and adding a significant conservative safety estimate, DOD [Department of Defense] announced in September 1997 that about 99,000 troops might have been exposed to nerve agents, over a three-day period, as a result of the explosion. In 2000, DOD ran another study and upped the number to 101,752, based on troop locations and three different models' hazard plumes. What was lost in the study was the fact that the overwhelming majority of the "exposed soldiers"
were subjected to levels that, had they been exposed to those levels for the rest of their lives, would not have suffered any ill effects from nerve agent. But hey. Scientific details are unimportant and boring, and don't fit into today's news cycle.

Understand this basic principle of toxicology - you can be exposed to dangerous substances and recover from them. The body is a wonderful machine. In addition, if you take the time to look at the DOD's Khamisiyah studyand the assumptions used, the DOD went out of its way to overly exaggerate the possible plumes. They used three different plume models, which is why you see the graphic in the NY Times article that looks like a pair of bunny ears. It's not as if the cloud split and went two different directions - the models disagreed, so one might suggest that the actual number of exposed troops is only half what has been suggested.

Why aren't we seeing it today in Iraq? That's a good question, and since I'm not a doc, I'll pass on an answer, other than to say, I think the medical community has done a much better job with pre- and post-deployment screening and catching potential illnesses. Final thought - I am sure that these soldiers are not faking their illnesses, but don't pin this on nerve agents. The facts just don't support it. The exposure, IF there was any - because you can't base your case on a computer model - would have been so minimal as to be insignificant. There were lots of other environmental challenges in the desert. We don't want to treat soldiers for nerve agent exposure if they weren't actually exposed, do we?

-- __Jason Sigger, cross-posted at Armchair Generalist __

UPDATE: Chem-bio blogger Bugs 'n Gas Gal is thinking along similar lines. She tells DANGER ROOM:

Studies of follow up data on Edgewood CW [chemical weapon] agent test participants have a larger sample size to draw from. It did not find the types of results Gulf War veterans report (i.e., chronic fatigue and pain).
After single (or few) controlled, low-level exposures to different nerve agents (exposures that were probably higher than what Gulf War vets may have been exposed to), long term surveys of these individuals did not turn up much to compare to the Gulf War vets' complaints. Here's a summary:

There was no firm evidence that any of the anticholinergic test compounds tested produced long-range adverse human health effects in the doses used in the Edgewood tests. However, the high frequency of uncontrolled test variables made evaluation of behavioral effects difficult.
The panel concluded that given the available data, it was unlikely that administration of these anticholinergic compounds will have long-term toxicity effects.

There is also a paper published in Military Medicine (2003) reporting the same results. Long story short, I find nothing improper in the statements made by DoD & VA personnel quoted in the NYT article. It remains possible that low level sarin/cyclosarin exposure is the culprit for the Gulf War "syndrome." However, a causal link has not been established in this study and we have not seen the same complaints noted by large numbers of personnel exposed to low level nerve agents under semi-controlled conditions. I certainly wouldn't recommend a knee-jerk form letter be sent to Gulf War veterans because of this study, but comparison of similar brain studies showing brain shrinkage in sufferers of chronic pain and PTSD might add value to the discussion.