In the details
• During the First Gulf War, the Defense Department issued pyridostigmine bromide, or PB pills, to troops to protect them from soman, a nerve agent.
Soman is an organophosphate that deactivates the enzyme acetylcholinesterase, which causes acetylcholine, a neurotransmitter, to build up in the nervous system. Excess levels of the neurotransmitter cause muscle fatigue, paralysis and death.
• The study focused on the gene that produces the enzyme butyrylcholinesterase, which protects the nervous system from organophosphates and some other toxins by breaking them down.
• In the study group, 28 veterans had variations of the gene that produced weaker forms of the enzyme, which limited their body's ability to fight toxins. If they took the PB pills, they were 40 times as likely to contract Gulf War illness.
• Veterans with gene variations that produced the stronger forms of the enzyme were still susceptible. If they took the PB pills, they were three times as likely to contract the illness.
Veterans suffering from Gulf War illness suffer from persistent headaches, cognitive problems and chronic pain and fatigue.
Source: Environmental Health, ehjournal.net
A government-issued pill intended to protect troops from nerve agents may have made some troops more vulnerable to a chronic condition marked by headaches, cognitive problems, pain and fatigue, researchers say.
People with certain genetic variations were 40 times more likely to contract Gulf War illness if they took pyridostigmine bromide, or PB, pills that the Defense Department issued to protect them from soman, a nerve agent, during the 1990-91 war, researchers concluded in a study funded by the U.S. Army Medical Research and Materiel Command and published this month in the journal Environmental Health.
The study of 304 veterans provides compelling evidence that the illness has a physical rather than mental origin, experts said.
Veterans with Gulf War illness share symptoms such as persistent headaches, cognitive difficulties, widespread pain and fatigue.
Although that profile overlaps symptoms from conditions such as post-traumatic stress disorder, Gulf War illness produces symptoms such as musculoskeletal problems that combat-stress illnesses don’t, and relatively few Gulf War veterans saw combat, said Lea Steele, a researcher with Baylor University Institute of Biomedical Studies and lead author of the study.
“The only possible conclusion is that something else caused it,” Steele said, though she cautioned that “you don’t want to say it’s definitive with one study.”
The study’s participants didn’t know whether they had the genetic variation that made them more susceptible.
The research provides “extremely hard, convincing evidence that the cause of Gulf War illness must be toxic exposures,” said James H. Binns Jr., a Vietnam War veteran and Phoenix businessman who formerly chaired the Department of Veterans Affairs Research Advisory Committee on Gulf War Veterans Illnesses.
The Department of Veterans Affairs, which has held to the theory of a mental cause, said it “welcomes all additions to its scientific literature review.”
One-fourth to one-third of the 700,000 people who deployed to the Middle East contracted the illness. With no ready explanation for why others didn’t become ill, early research seized on stress as a possible cause.
“VA scientists will review this new article and make sure that the Institute of Medicine Committee, currently engaged in a biennial review of Gulf War health issues, is aware of it and includes its findings in the literature review,” said Walinda West, a spokeswoman with the VA in Washington.
West said the agency “is committed to its investment in Gulf War research,” noting that it formed a research group Jan. 15 to study Gulf War-related brain cancer possibly associated with exposure to chemical nerve agents during demolition of a munitions depot in Khamisiyah, Iraq, in March 1991 after the ceasefire.
The VA expects to complete that study by spring, she said.
Pills had interim approval
As for Gulf War illness, “There’s been a theory for a long time that there’s probably a gene-environment interaction that determined which people got ill and which people escaped,” said Robert F. White, chair of environmental health at the Boston University School of Public Health.
The study in Environmental Health “doesn’t explain everything,” White said. “It needs to be replicated. … But it’s kind of the first step in determining the genetic end of this.”
Other studies have linked PB pills to Gulf War illness but were based on veterans self-reporting illnesses.
When the pills were issued, the Food and Drug Administration hadn’t yet approved them as a pretreatment for possible soman exposure but gave interim approval for the Gulf War. The Defense Department sought approval on the belief that Iraq used soman and other nerve agents against Iran in the 1980-88 Iran-Iraq War.
Binns has criticized the VA for its reluctance to accept the growing body of evidence for the physical causes of the illness, but he doesn’t fault the government’s decision to give troops the pills.
“I think people made the best decisions they could on the information that was known in 1991,” he said.
Going forward, the study should alert the Pentagon to risks that troops face and the necessity for screening them before issuing PB pills, he said.
It’s unclear whether the Defense Department continued to issue them after that war.
Enzymes play role
One Gulf War veteran said finding a genetic link between the pills and illness is welcome news.
“That’s what I said to Congress when I was there,” said the Rev. Barry Walker, 75, of East Palestine, Ohio. “I blamed that pill.”
The former Army chaplain served in post-war Korea, the Vietnam War, and was nearby when a Scud missile struck the barracks of the Hempfield-based 14th Quartermaster detachment in the First Gulf War.
He became a national advocate for treating Gulf War illness as a physical malady, based on his experience and that of other veterans. The VA’s insistence of treating it as a mental illness similar to post-traumatic stress disorder has been frustrating, he said.
“I don’t believe it’s that,” he said. “I have PTSD, but that’s because I saw too many wars.”
The physical symptoms he experienced after the Gulf War, which include fibromyalgia and fatigue, aren’t what he experienced from Korea or Vietnam, he said.
“I had sore back after Korea, but that’s because I was blown out of a Jeep,” he said.
Steele, the study’s author, said scientists studying Gulf War illness largely accept a physical cause.
Several enzymes play a role in the body’s response to toxic chemicals, and variations in those enzymes could explain why some troops were more vulnerable than others. This study of one enzyme explains, at most, only 10 percent of the cases, she said.
“We really need to look at the other enzymes as well,” Steele said.
Brian Bowling is a Trib Total Media staff writer. Reach him at 412-325-4301. or firstname.lastname@example.org.