NYT: Debating the Evidence on Gulf War Illnesses -- Critics see weak data, but strong conclusions

When a Department of Veterans Affairs panel produced a provocative report last week on the illnesses of veterans of the 1991 Persian Gulf war, it stepped into a treacherous territory where patients' suffering meets scientists' skepticism.

By dismissing combat stress or other psychological causes and finding a "probable link" between the veterans' health problems and exposures to pesticides, sarin or other chemicals, the Research Advisory Committee on Gulf War Veterans' Illnesses suggested that it was correcting the record based on the latest scientific evidence.

But some outside scientists, including several whose earlier gulf war studies found scant support for the chemical theory, wondered whether the committee was instead stretching thin data to tell veterans what they wanted to hear.

"What is their motive in drawing strong conclusions from weak evidence?" asked Dr. Harold C. Sox, editor of The Annals of Internal Medicine, who led an earlier gulf war study for the Institute of Medicine. "I think the process the V.A. used was flawed. They asked experts to testify who had at least the appearance of a conflict of interest. And they didn't have a methodology for assessing the strength of the evidence."

Whatever the eventual consensus, the disagreement makes clear that gulf war illnesses have joined a constellation of contentious health issues that pit the frustration of ailing patients against scientists' demands for meticulous data.

Like patients who believe their ills can be traced to silicone breast implants or Agent Orange, the ailing veterans complain of a daunting variety of symptoms: headaches, joint pain, fatigue, diarrhea, skin rashes, dizziness and even hair loss.

Gulf war illnesses - like multiple chemical sensitivity, chronic fatigue syndrome and fibromyalgia - have been attributed to numerous possible causes. Some veterans have blamed the anthrax vaccine, smoke from oil fires and exposure to depleted uranium for their ailments.

"You're dealing with a will-o'-the-wisp," said Dr. Marcia Angell, former editor of The New England Journal of Medicine and the author of a 1996 book on the breast implant controversy.

"If someone says rhubarb causes colon cancer, the presumption is that it doesn't until there's objective scientific data," Dr. Angell said.

Patients with multisymptom syndromes often suffer from depression, too, leading some researchers to believe that some of the ailments are psychosomatic.

But when patients are told their illness has a psychological origin, it can add to feelings of isolation and frustration.

"I think in general the less competent doctors tell their patients, 'It's all psychological,' '' said Dr. Paul Greengard, a Nobel Prize-winning neuroscientist at Rockefeller University, who says he believes that a neurotoxin role in gulf war illness is plausible. "That's the last escape for doctors who can't find an answer."

Financial issues can complicate the picture. With breast implants, lawyers for women who said they had been harmed sought damages from manufacturers. With gulf war illnesses, as with Agent Orange, a finding that a sickness is "service-connected" can open the door to benefit payments.

Faced with such thorny medical controversies, the government's response is often to appoint a committee. But the committee's makeup may influence its conclusions.

For example, the V.A. committee that produced the new report included four gulf war veterans and six medical scientists, four of whom had published previous studies of gulf war health problems.

The committee noted that Desert Storm was a brief war in which few soldiers saw close-quarters combat that could cause lasting psychological harm.

Dr. Lea Steele, a Kansas State University epidemiologist and the panel's scientific director, said the committee found evidence that troops might have suffered neurological damage from exposure to pesticides or to sarin, a nerve gas possibly released when American forces destroyed Iraqi weapons depots.

In contrast, the Institute of Medicine, composing a different committee to study the effects of sarin on gulf war veterans, deliberately chose no veterans and selected six scientists who had never studied gulf war illnesses.

In August, that group found "insufficient evidence" that low-level exposure to sarin from the destruction of Iraqi arms could cause long-terms neurological effects.

"Our committee understood that the issues were highly politically charged," said Dr. Jack M. Colwill, chairman of the Institute of Medicine committee. "But we sat down and focused on the scientific evidence."

James Binns, a former Defense Department official who headed the new V.A. committee, said he believed his group reached a different conclusion because it considered animal studies of sarin that the Institute of Medicine panel ignored. He acknowledged, however, that panel members' backgrounds played a role.

Mr. Binns said that when Anthony J. Principi, the secretary of veterans affairs, selected the panel, he "looked for people who were open to reaching new conclusions."

Another member of the V.A. panel, Dr. Beatrice Golomb of the University of California at San Diego, said that if stress had been wrongly blamed for gulf war illnesses, there was a precedent. For decades, doctors told their patients that gastric ulcers were caused by stress.

Then a group of maverick researchers proved that most cases were caused by a bacterium, Helicobacter pylori. Today, stress is believed to play a minor role or none at all. "The medical community was very resistant to accepting a new idea," Dr. Golomb said, adding that, with gulf war illnesses, too, "it's challenging, because there have been very strongly staked out positions."

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I worked with a guy that had Gulf War Illness. When I knew him, I didn't know he had it. It was after he left that my boss told me. I felt sorry for the guy. Something was clearly wrong, and apparently it was only after his time in Iraq that he had come down with whatever it was that was sapping the life out of him.

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