From Wikipedia, the free encyclopedia

Gulf War illness

Classification and external resources

pyridostigmine, a nerve agent antidote

and one of the implicated toxins

ICD-9 V65.5 (inconclusive)

also nonstandard "DX111"

MeSH D018923

Gulf War syndrome (GWS) or Gulf War illness (GWI) affects veterans and civilians

who were near conflicts during, or downwind of a chemical weapons depot demolition

after, the 1991 Gulf War.[1][2]

A wide range of acute and chronic symptoms have

included fatigue, loss of muscle control, headaches, dizziness and loss of balance,

memory problems, muscle and joint pain, indigestion, skin problems, immune system

problems, and birth defects.[3]

Roughly one in four of the 697,000 veterans who served

in the first Gulf War are afflicted with the controversial disorder, a condition with

serious consequences.[4]

Exposure to toxic chemicals is the cause of the illness. Several specific causes have

been investigated, including pyridostigmine bromide nerve gas antidote,

organophosphate pesticides, chemical weapons, and depleted uranium. Causes which

have been ruled out include post traumatic stress disorder, anthrax vaccinations,[4]

and

smoke from oil well fires. Antidote pills given to protect troops from nerve agents and

insect repellents used during deployment were most closely linked. Exposure to the

destruction of the Khamisiyah weapons depot, where large quantities of the chemical

weapon sarin was stored, is negatively correlated with motor speed.[5]

Epidemiological

evidence is consistent with increased risk of birth defects in the offspring of persons

exposed to depleted uranium.[6]

Methods of preventing or treating Gulf War syndrome vary. While the treatment of

sarin exposure has been studied,[7]

other acetylcholinesterase inhibitors such as

pyridostigmine bromide and organophosphate insect repellents may or may not involve

similar management. Uranium can be decontaminated from steel surfaces[8]

and

aquifers.[9]

Diplomatic reconciliation is a means of prevention of some mental

effects.[10][11]

Contents

1 Classification

2 Signs and symptoms

3 Causes

o 3.1 Pyridostigmine bromide nerve gas antidote

o 3.2 Organophosphate pesticides

o 3.3 Sarin nerve agent

o 3.4 Depleted uranium

o 3.5 Ruled out

3.5.1 Anthrax vaccine

3.5.2 Combat stress

3.5.3 Oil well fires

4 Diagnosis

5 Management

o 5.1 Acetylcholinesterase inhibitors

5.1.1 Nerve agent antidote and insect repellent

5.1.2 Sarin

o 5.2 Uranium exposure

6 Epidemiology

7 Controversy

8 See also

9 References

10 External links

Classification

Medial ailments associated with Gulf War Syndrome has been recognized by both the

US Department of Defense, Department of Veterans Affairs, and Veterans

Administration.[12]

Since so little concrete information was known about this condition

the Veterans administrations originally classified individuals with related ailments

believed to be connected to their service in the Persian Gulf a special non-ICD-9 code

DX111, as well as ICD-9 code V65.5.[13]

Signs and symptoms

Summary of the Operation Desert Storm offensive ground campaign, February 24-28,

1991, by nationality (click for detail).

About one-fourth of the 697,000 U.S. servicemen and women in the first Gulf War have

shown symptoms related to Gulf War Syndrome.

U.S. and UK, with the highest rates of excess illness, are distinguished from the other

nations by higher rates of pesticide use, use of anthrax vaccine, and somewhat higher

rates of exposures to oil fire smoke and reported chemical alerts. France, with possibly

the lowest illness rates, had lower rates of pesticide use, and no use of anthrax

vaccine.[14]

French troops also served to the North and West of all other combat troops,

away and upwind of major combat engagements[15]

.

A 2001 study of 15,000 February 1991 U.S. Gulf War combat veterans and 15,000

control veterans found that the Gulf War veterans were 1.8 (fathers) to 2.8 (mothers)

times more likely to have children with birth defects.[16]

After examination of children's

medical records two years later, the birth defect rate increased by more than 20%:

"Dr. Kang found that male Gulf War veterans reported having infants with likely birth

defects at twice the rate of non-veterans. Furthermore, female Gulf War veterans were

almost three times more likely to report children with birth defects than their non-Gulf

counterparts. The numbers changed somewhat with medical records verification.

However, Dr. Kang and his colleagues concluded that the risk of birth defects in

children of deployed male veterans still was about 2.2 times that of non-deployed

veterans."[17]

In a study of U.K. troops, "Overall, the risk of any malformation among pregnancies

reported by men was 50% higher in Gulf War Veterans (GWV) compared with Non-

GWVs."[18]

Excess prevalence of general symptoms[19]*

Symptom U.S. UK Australia Denmark

Fatigue 23% 23% 10% 16%

Headache 17% 18% 7% 13%

Memory problems 32% 28% 12% 23%

Muscle/joint pain 18% 17% 5% 2% (<2%)

Diarrhea 16%

9% 13%

Dyspepsia/indigestion 12%

5% 9%

Neurological problems 16%

8% 12%

Terminal tumors 33%

9% 11%

Graph showing the rate per 1,000 births of congenital malformations observed at Basra

University Hospital, Iraq[20]

Excess prevalence of recognized medical conditions[21]

Condition U.S. UK Canada Australia

Skin conditions 20-21% 21% 4-7% 4%

Arthritis/joint problems 6-11% 10% (-1)-3% 2%

Gastro-intestinal (GI) problems 15%

5-7% 1%

Respiratory problem 4-7% 2% 2-5% 1%

Chronic fatigue syndrome 1-4% 3%

0%

Post-traumatic stress disorder 2-6% 9% 6% 3%

Chronic multi-symptom illness 13-25% 26%

Although Gulf War illness is the most prominent condition affecting Gulf War veterans,

it is just one health issue to be addressed in the larger context of the health of Gulf War

veterans. Other Gulf War-related health issues of importance include rates of

diagnosable medical conditions and post-war mortality among Gulf War veterans, and

questions related to the risk of birth defects and other health problems in veterans’

family members.

The three studies most representative of Gulf War era veterans in the U.S. and U.K.

have all indicated significant excess rates of birth defects in children of Gulf War

veterans. News articles have reported that rates of cancer and birth defects in Iraq

increased dramatically during the 1990s, specifically in regions where the greatest

quantity of depleted uranium was used in the Gulf War. Conference reports describing

an increased incidence of congenital anomalies in Basrah and increased numbers of

cancer cases, both in Iraqi military personnel who served in the war and in four Iraqi

hospitals, lend some support to these contentions.[4]

Results from two studies, using different methods in different groups of symptomatic

veterans, indicate that Gulf War illness is associated with a low-level, persistent

immune activation, reflected in elevated levels of the cytokines IL-2, IFN-γ and IL-10.

In addition, several studies have reported that NK cell numbers and/or cytotoxic activity

are significantly reduced in veterans with Gulf War illness.[22]

Causes

The United States Congress mandated the National Academies of Science Institute of

Medicine to provide nine reports on Gulf War Syndrome since 1998.[23]

Aside from the

many physical and psychological issues involving any war zone deployment, Gulf War

veterans were exposed to a unique mix of hazards not previously experienced during

wartime. These included pyridostigmine bromide pills given to protect troops from the

effects of nerve agents, depleted uranium munitions, and anthrax and botulinum

vaccines. The oil and smoke that spewed for months from hundreds of burning oil wells

presented another exposure hazard not previously encountered in a warzone. Military

personnel also had to cope with swarms of insects, requiring the widespread use of

pesticides.

United States Veterans Affairs Secretary Anthony Principi's panel found that pre-2005

studies suggested the veterans' illnesses are neurological and apparently are linked to

exposure to neurotoxins, such as the nerve gas sarin, the anti-nerve gas drug

pyridostigmine bromide, and pesticides that affect the nervous system. The review

committee concluded that "Research studies conducted since the war have consistently

indicated that psychiatric illness, combat experience or other deployment-related

stressors do not explain Gulf War veterans illnesses in the large majority of ill

veterans," the review committee said.[24]

Pyridostigmine bromide nerve gas antidote

The US military issued pyridostigmine bromide pills, PB, to protect against exposure to

nerve gas agents such as sarin and soman. PB was used to pretreat nerve agent

poisoning and is not a vaccine however taken before exposure to nerve agents, PB was

thought to increase the efficacy of nerve agent antidotes. PB had been used since 1955

for patients suffering from myasthenia gravis with dosed up to 1,500 mg a day, far in

excess of the 90 mg given to soldiers, and was considered safe by the FDA at either

level for indefinite use and its use to pretreat nerve agent exposure has recently been

approved.[25]

About half of U.S. Gulf War veterans report using PB during deployment, with greatest

use among Army personnel. Concerns have been raised about the possibility of

increased health problems from PB when it is combined with other risk factors.

Given both the large body of epidemiological data on myasthenia gravis patients and

follow up studies done on veterans it was concluded that while it was unlikely that

health effects reported today by Gulf War veterans are the result of exposure solely to

PB, use of PB was causally associated with illness.[4]

Organophosphate pesticides

The use of organophosphate pesticides and insect repellants during the first Gulf War is

credited with keeping rates of pest-borne diseases low. Pesticide use is one of only two

exposures consistently identified by Gulf War epidemiologic studies to be significantly

associated with Gulf War illness.[26]

Multisymptom illness profiles similar to Gulf War

illness have been associated with low-level pesticide exposures in other human

populations. In addition, Gulf War studies have identified dose-response effects,

indicating that greater pesticide use is more strongly associated with Gulf War illness

than more limited use.[27]

Pesticide use during the Gulf War has also been associated

with neurocognitive deficits and neuroendocrine alterations in Gulf War veterans in

clinical studies conducted following the end of the war. The 2008 report concluded that

―all available sources of evidence combine to support a consistent and compelling case

that pesticide use during the Gulf War is causally associated with Gulf War illness.‖[4]

Sarin nerve agent

Many of the symptoms of Gulf War syndrome are similar to the symptoms of

organophosphate, mustard gas, and nerve gas poisoning.[28][29]

Gulf War veterans were

exposed to a number of sources of these compounds, including nerve gas and

pesticides.[30]

Chemical detection units from the Czech Republic, France, and Britain confirmed

chemical agents. French detection units detected chemical agents. Both Czech and

French forces reported detections immediately to U.S. forces. U.S. forces detected,

confirmed, and reported chemical agents; and U.S. soldiers were awarded medals for

detecting chemical agents. The Riegle Report said that chemical alarms went off 18,000

times during the Gulf War. After the air war started on January 16, 1991, coalition

forces were chronically exposed to low but nonlethal levels of chemical and biological

agents released primarily by direct Iraqi attack via missiles, rockets, artillery, or aircraft

munitions and by fallout from allied bombings of Iraqi chemical warfare munitions

facilities.[31]

In 1997, the US Government released an unclassified report that stated, "The US

Intelligence Community (IC) has assessed that Iraq did not use chemical weapons

during the Gulf War. However, based on a comprehensive review of intelligence

information and relevant information made available by the United Nations Special

Commission (UNSCOM), we conclude that chemical warfare (CW) agent was released

as a result of US postwar demolition of rockets with chemical warheads at several sites

including Khamisiyah". Over 125,000 U.S. troops and 9,000 UK troops were exposed to

nerve gas and mustard gas when the Iraqi depot in Khamisiyah was destroyed.[32]

Recent studies have confirmed earlier suspicions that exposure that sarin, in

combination with other contaminants such as pesticides and PB were related to reports

of veteran illness. Estimates range from 100,000 to 300,000 individuals exposed to

nerve agents [33][34]

Depleted uranium

Major Gulf War engagements in which DU rounds were used.

Depleted uranium (DU) was widely used in tank kinetic energy penetrator and

autocannon rounds for the first time in the Gulf War. DU is a dense, weakly radioactive

metal. Munitions made from it often burn when they impact a hard target, producing

toxic combustion products. Roughly 320 tons of DU were used during the February,

1991 conflict.[35]

After military personnel began reporting unexplained health problems

in the aftermath of the Gulf War, questions were raised about the health effect of

exposure to depleted uranium.

The use of DU in munitions is controversial because of questions about potential long-

term health effects.[36]

Normal functioning of the kidney, brain, liver, heart, and

numerous other systems can be affected by uranium exposure, because in addition to

being weakly radioactive, uranium is a toxic metal.[37]

Because uranium is a heavy

metal and chemical toxicant with nephrotoxic (kidney-damaging),[38]

teratogenic (birth

defect-causing),[39][40]

immunotoxic,[41]

and potentially carcinogenic[42]

properties,

uranium exposure is associated with a variety of illnesses.[43]

The chemical

toxicological hazard posed by uranium dwarfs its radiological hazard because it is only

weakly radioactive, and depleted uranium even less so. DU has recently been

recognized as a neurotoxin.[44]

In 2005, depleted uranium was shown to be a neurotoxin

in rats.[45]

Epidemiological evidence is consistent with increased risk of birth defects in

the offspring of persons exposed to DU.[6]

Early studies of depleted uranium aerosol exposure assumed that uranium combustion

product particles would quickly settle out of the air[46]

and thus could not affect

populations more than a few kilometers from target areas,[47]

and that such particles, if

inhaled, would remain undissolved in the lung for a great length of time and thus could

be detected in urine.[48]

Uranyl ion contamination has been found on and around

depleted uranium targets.[49]

In 2001, a study was published in Military Medicine that found DU in the urine of Gulf

War veterans.[50]

Another study, published by Health Physics in 2004, also showed DU

in the urine of Gulf War veterans.[51]

A study of UK veterans who thought they might

have been exposed to DU showed aberrations in their white blood cell chromosomes.[52]

Mice immune cells exposed to uranium exhibit abnormalities.[53]

In the Balkans war zone where depleted uranium was also used, an absence of problems

is seen by some as evidence of DU munitions' safety. "Independent investigations by the

World Health Organization, European Commission, European Parliament, United

Nations Environment Programme, United Kingdom Royal Society, and the Health

Council of the Netherlands all discounted any association between depleted uranium

and leukemia or other medical problems."[35]

In Italy, controversy over the health risks

associated with the use of DU continues, with a Senate investigation committee was due

to release its report into 'Balkan Syndrome' by the end of 2007.[54]

Since then, there has

been a resurgence of interest in the health effects of depleted uranium, especially since

it has recently been linked with neurotoxicity.[44]

The aerosol produced during impact and combustion of depleted uranium munitions can

potentially contaminate wide areas around the impact sites or can be inhaled by civilians

and military personnel.[55]

During a three week period of conflict in 2003 Iraq, 1,000 to

2,000 tonnes of DU munitions were used, mostly in cities.[56]

Depleted uranium may

have been standard ordnance in the arsenals of both sides during the 2008 South Ossetia

war.

Military personnel examine the remains of a Scud during the Gulf War.

Ruled out

Several potential causes beyond vaccinations, stress, and oil well fires—explained in

more detail below—have been ruled out. Other ruled-out potential causes include Scud

missile fuel and infectious diseases. Limited evidence from several sources suggests

that an association with the combined effects of multiple neurotoxicant exposures and

receipt of multiple vaccines can not be ruled out.[57]

Anthrax vaccine

Iraq had loaded anthrax, botulinum toxin, and aflatoxin into missiles and artillery shells

in preparing for the Gulf War and that these munitions were deployed to four locations

in Iraq.[58]

During Operation Desert Storm, 41% of U.S. combat soldiers and 75% of

UK combat soldiers were vaccinated against anthrax.[59]

Like all vaccines, the early

1990s version of the anthrax vaccine was a source of several side effects. Reactions

included local skin irritation, some lasting for weeks or months.[60]

While the Food and

Drug Administration (FDA) approved the vaccine, it never went through large scale

clinical trials, unlike most other vaccines in the United States.[61]

While recent studies

have demonstrated the vaccine’s is highly reactogenic [62]

, there is no clear evidence or

epidemiological studies on Gulf War veterans linking the vaccine to Gulf War

Syndrome. Combining this with the lack of symptoms from current deployments of

individuals who have received the vaccine led the Committee on Gulf War Veterans’

Illnesses to conclude that the vaccine is not a likely cause of Gulf War illness for most

ill veterans.[4]

Combat stress

Research studies conducted since the war have consistently indicated that psychiatric

illness, combat experience or other deployment-related stressors do not explain Gulf

War veterans illnesses in the large majority of ill veterans, according to a Veterans

Administration review committee.

Oil well fires

During the war, many oil wells were set on fire in Kuwait by the retreating Iraqi army,

and the smoke from those fires was inhaled by large numbers of soldiers, many of

whom suffered acute pulmonary and other chronic effects, including asthma and

bronchitis. However, firefighters who were assigned to the oil well fires and

encountered the smoke, but who did not take part in combat, have not had GWI

symptoms.[63]

Diagnosis

Multisymptom illness is more prevalent in Gulf War I veterans than veterans of

previous conflicts, but the pattern of comorbidities is similar for actively deployed and

nondeployed military personnel.[64]

Management of potentially comorbid toxic

exposures requires awareness of the toxins involved.[7]

Exposure to the destruction of

the Khamisiyah weapons depot, where large quantities of the chemical weapon sarin

was stored, is negatively correlated with motor speed.[5]

Epidemiological evidence is

consistent with increased risk of birth defects in the offspring of persons exposed to

depleted uranium[6]

and uranium exposure has also been associated with increased

cancer rates.[65][66][67][68][69][70]

Management

Diplomatic reconciliation is one means of prevention,[10][11]

beyond battlefield air

quality management, which often conflicts with established tactical policy. For

example, most organized armies practice "secure and hold" tactics which require

occupation of areas before they can be decontaminated.

Acetylcholinesterase inhibitors

Nerve agent antidote and insect repellent

In 2008, a paper published in the Proceedings of the National Academy of Sciences

suggested that excess illnesses in Gulf War veterans could be explained in part by their

exposure to organophosphate and carbamate acetylcholinesterase inhibitors.[71]

A

federal report released in November, 2008, agreed, stating that exposure to two

substances "are causally associated with Gulf War illness":[72]

pyridostigmine bromide, an acetylcholinesterase inhibitor intended to protect

against nerve agents,[73]

and

pesticides and insect repellents (often acetylcholinesterase inhibitors)

Sarin

Exposure to sarin, a nerve gas, is a possible comorbidity. Chemical weapons classified

as nerve agents are also strong acetylcholinesterase inhibitors. A 2004 review discusses

symptoms, signs, and treatment of nerve agent exposure.[7]

Uranium exposure

Genotoxic mutagens such as uranium should be treated with chelation therapy[74]

or

other means shortly after exposure.[75]

Incorporated uranium becomes uranyl ions,

which accumulate in bone, liver, kidney, and reproductive tissues. Uranium can be

decontaminated from steel surfaces[8]

and aquifers.[9]

Epidemiology

Epidemiologic studies have been performed evaluating many suspected factors for Gulf

War illness as seen in veteran populations. Below is a summary of epidemiologic

studies of veterans displaying multisymptom illness and their exposure to suspect

conditions from the 2008 U.S. Veterans Administration report.[76]

A fuller understanding of immune function in ill Gulf War veterans is needed,

particularly in veteran subgroups with different clinical characteristics and exposure

histories. It is also important to determine the extent to which identified immune

perturbations may be associated with altered neurological and endocrine processes that

are associated with immune regulation.[22]

No studies that have evaluated birth

outcomes and birth defects among Gulf War veterans and their children have assessed

whether there is any connection between reproductive outcomes and uranium exposure

in the Gulf War.[77]

Very limited cancer data have been reported for U.S. Gulf War

veterans in general, and no published research on cases occurring after 1999. Because of

the extended latency periods associated with most cancers, it is important that cancer

information be brought up to date and that cancer rates be assessed in Gulf War veterans

on an ongoing basis. In addition, cancer rates should be evaluated in relation to

identifiable exposure and location subgroups.[78]

Epidemiologic Studies of Gulf War Veterans: Association of Deployment

Exposures With Multisymptom Illness[79]

Preliminary Analysis

(no controls for

exposure)

Adjusted Analysis (controlling

for effects of exposure)

Clinical

Evaluation

s

GWV

populatio

n in

which

associatio

n was

assessed

GWV

populatio

n in which

associatio

n was

statisticall

y

significant

GWV

populatio

n in

which

associatio

n was

assessed

GWV

populatio

n in which

associatio

n was

statisticall

y

significant

Dose

response

effect

identified

?

Pyridostigmine

bromide 10 9 6 6 ✓

Associated

with

neurocognitiv

e and HPA

differences in

GW vets

Pesticides 10 10 6 5 ✓

Associated

with

neurocognitiv

e and HPA

differences in

GW vets

Physiological

Stressors 14 13 7 1

Chemical

Weapons 16 13 5 3

Associated

with

neurocognitiv

e and HPA

differences in

GW vets

Oil Well Fires 9 8 4 2 ✓

Number of

Vaccines 2 2 1 1 ✓

Anthrax

Vaccine 5 5 2 1

Tent Heater

Exhaust 5 4 2 1

Sand/Particulat

es 3 3 3 1

Depleted

Uranium 5 3 1 0

Controversy

Similar syndromes have been seen as an after effect of other conflicts — for example,

'shell shock' after World War I, and post-traumatic stress disorder (PTSD) after the

Vietnam War. A review of the medical records of 15,000 American Civil War soldiers

showed that "those who lost at least 5% of their company had a 51% increased risk of

later development of cardiac, gastrointestinal, or nervous disease."[80]

A November 1996 article in the New England Journal of Medicine found no difference

in death rates, hospitalization rates or self-reported symptoms between Persian Gulf

veterans and non-Persian Gulf veterans. This article was a compilation of dozens of

individual studies involving tens of thousands of veterans. The study did find a

statistically significant elevation in the number of traffic accidents suffered by Gulf War

veterans.[81]

An April, 1998 article in Emerging Infectious Diseases similarly found no

increased rate of hospitalization and better health overall for veterans of the Persian

Gulf War vs. Veterans who stayed home.[82]

Despite these studies, on November 17, 2008 a congressionally appointed committee

called the Research Advisory Committee on Gulf War Veterans' Illnesses, staffed with

independent scientists and veterans appointed by the Department of Veterans Affairs,

announced that the syndrome is a distinct physical condition. The committee

recommended that Congress increase funding for research on Gulf War veterans' health

to at least $60 million per year.[83]

In January 2006, a study led by Melvin Blanchard

and published by the Journal of Epidemiology, part of the "National Health Survey of

Gulf War-Era Veterans and Their Families", stated that veterans deployed in the Persian

Gulf War had nearly twice the prevalence of chronic multisymptom illness, a cluster of

symptoms similar to a set of conditions often called Gulf War Syndrome.[84]

See also

Beyond Treason an 89-minute 2005 documentary that covers the Gulf War

syndrome.

Environmental issues with war

References

1. ^ Iversen A, Chalder T, Wessely S. "Gulf War Illness: lessons from medically

unexplained symptoms." Clin Psychol Rev. 2007 Oct;27(7):842-54.

2. ^ Gronseth GS. "Gulf war syndrome: a toxic exposure? A systematic review."

Neurol Clin. 2005 May;23(2):523-40.

3. ^ University of Virginia. Gulf War Syndrome

4. ^ a b c d e f Gulf War Illness and Health of Gulf War Veterans

5. ^ a b Toomey et al (2009) "Neuropsychological functioning of U.S. Gulf War

veterans 10 years after the war" J Int Neuropsychol Soc PMID 19640317

6. ^ a b c Hindin, R. et al. (2005) "Teratogenicity of depleted uranium aerosols: A

review from an epidemiological perspective," Environmental Health, vol. 4, pp.

17. at PubMed

7. ^ a b c Schecter, WP (2004) "Cholinergic symptoms due to nerve agent attack: a

strategy for management." Anesthesiol Clin North America 22(3):579-90. PMID

15325720

8. ^ a b Francis, A.J. (2005) "Decontamination of uranium-contaminated steel

surfaces by hydroxycarboxylic acid with uranium recovery." Environ Sci

Technol 39(13):5015-21. PMID 16053105

9. ^ a b Wu, W.M. et al (2006) "Pilot-scale in situ bioremedation of uranium in a

highly contaminated aquifer. 2. Reduction of u(VI) and geochemical control of

u(VI) bioavailability." Environ Sci Technol 40(12):3986-95. PMID 16830572

10. ^ a b Curle, A. (1997) "Public mental health. III: Hatred and reconciliation." Med

Confl Surviv 13(1):37-47. PMID 9080785

11. ^ a b Jentleson, B.W. (1996) "Preventive Diplomacy and Ethnic Conflict:

Possible, Difficult, Necessary" UC Berkeley Policy Paper 27, Institute on Global

Conflict and Cooperation

12. ^ Gulf War Veterans' Illnesses: Illnesses Associated with Gulf War Service

13. ^ Department of Veterans Affairs A Guide to Gulf War Veterans' Health

14. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes (page 78)

15. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes (page 68)

16. ^ Kang, H., et al.' (2001). "Pregnancy Outcomes Among U.S. Gulf War

Veterans: A Population-Based Survey of 30,000 Veterans". Annals of

Epidemiology 11 (7): 504–511. doi:10.1016/S1047-2797(01)00245-9.

PMID 11557183.

http://www.annalsofepidemiology.org/article/PIIS1047279701002459/abstract.

17. ^ Department of Veterans Affairs (2003) "Q's & A's - New Information

Regarding Birth Defects," Gulf War Review 12(1), p. 10.

18. ^ Doyle, P., et al. (2004) "Miscarriage, stillbirth and congenital malformation in

the offspring of UK veterans of the first Gulf war," International Journal of

Epidemiology, 33(1), pp. 74-86; PMID 15075150.

19. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes (page 70), This table applies only to

coalition forces involved in combat.

20. ^ I. Al-Sadoon, et al., writing in the Medical Journal of Basrah University, (see

Table 1 here). This version from data by same author(s) in Wilcock, A.R., ed.

(2004) "Uranium in the Wind" (Ontario: Pandora Press) ISBN 097361532X

21. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes (page 71)

22. ^ a b Page 262 (PDF page 270) of the November, 2008 U.S. Veterans

Administration report

23. ^ VA Press Release

24. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses 2004 Report

25. ^ PBS Frontline. PYRIDOSTIGMINE BROMIDE Use in the First Gulf War

26. ^ U.S. Department of Defense, Office of the Special Assistant to the

Undersecretary of Defense (Personnel and Readiness) for Gulf War Illnesses

Medical Readiness and Military Deployments. Environmental Exposure Report:

Pesticides Final Report. Washington, D.C. April 17, 2003.

27. ^ Krengel M, Sullivan K. Neuropsychological Functioning in Gulf War

Veterans Exposed to Pesticides and Pyridostigmine Bromide. Fort Detrick, MD:

U.S. Army Medical Research and Materiel Command; August, 2008.

W81XWH-04-1-0118

28. ^ Friis, Robert H.; Thomas A. Sellers (2004). Epidemiology for Public Health

Practice. Jones & Bartlett Publishers. ISBN 0763731706.

29. ^ Spektor, Dalia M.; Richard A. Rettig, Lee H. Hilborne, Beatrice Alexandra

Golomb, Grant N. Marshall, L. M. Davis, Cathy Donald Sherbourne, Naomi H.

Harley, William S. Augerson, Gary Cecchine, United States Dept. of Defense

(1998). A Review of the Scientific Literature as it Pertains to Gulf War Illnesses.

Rand Corporation. ISBN 0833026801.

30. ^ "Campaigners hail 'nerve gas link' to Gulf War Syndrome - Scotsman.com

News". News.scotsman.com.

http://news.scotsman.com/topics.cfm?tid=847&id=1311632004. Retrieved

2009-11-24.

31. ^ The Riegle Report

32. ^ Khamisiyah: A Historical Perspective on Related Intelligence by the Persian

Gulf War Illnesses Task Force (9 April 1997)

33. ^ Beatrice Alexandra Golomb.Acetylcholinesterase inhibitors and Gulf War

illnesses

34. ^ Navy Times. Review says chemicals caused Gulf War illness

35. ^ a b Global Security. ``Depleted Uranium``

36. ^ Miller AC, McClain D. (2007 Jan-Mar). "A review of depleted uranium

biological effects: in vitro and in vivo studies". Rev Environ Health 22 (1): 75–

89. PMID 17508699.

37. ^ E. S. Craft, A. W. Abu-Qare, M. M. Flaherty, M. C. Garofolo, H. L.

Rincavage, M. B. Abou-Donia (2004). "Depleted and natural uranium:

chemistry and toxicological effects". Journal of Toxicology and Environmental

Health Part B: Critical Reviews 7 (4): 297–317.

doi:10.1080/10937400490452714.

38. ^ Health effects of uranium

39. ^ Hindin R, Brugge D, Panikkar B (2005). "Teratogenicity of depleted uranium

aerosols: a review from an epidemiological perspective". Environ Health 4: 17.

doi:10.1186/1476-069X-4-17. PMID 16124873.

40. ^ Arfsten D, Still K, Ritchie G (2001). "A review of the effects of uranium and

depleted uranium exposure on reproduction and fetal development". Toxicol Ind

Health 17 (5-10): 180–91. doi:10.1191/0748233701th111oa. PMID 12539863.

41. ^ Wan B, Fleming J, Schultz T, Sayler G (2006). "In vitro immune toxicity of

depleted uranium: effects on murine macrophages, CD4+ T cells, and gene

expression profiles". Environ Health Perspect 114 (1): 85–91. PMID 16393663.

42. ^ [1]

43. ^ ATSDR - Toxicological Profile: Uranium

44. ^ a b Jiang G, Aschner M (2006). "Neurotoxicity of depleted uranium: reasons

for increased concern". Biol Trace Elem Res 110 (1): 1–17.

doi:10.1385/BTER:110:1:1. PMID 16679544.

45. ^ Anandan N, Shetty S, Patil K, Ibrahim A (1992). "Acute urinary retention

caused by anterior urethral polyp". Br J Urol 69 (3): 321–2. doi:10.1111/j.1464-

410X.1992.tb15541.x. PMID 1568112.

46. ^ [2]

47. ^ Mitsakou C, Eleftheriadis K, Housiadas C, Lazaridis M (2003). "Modeling of

the dispersion of depleted uranium aerosol". Health Phys 84 (4): 538–44.

doi:10.1097/00004032-200304000-00014. PMID 12705453.

48. ^ Horan P, Dietz L, Durakovic A (2002). "The quantitative analysis of depleted

uranium isotopes in British, Canadian, and U.S. Gulf War veterans". Mil Med

167 (8): 620–7. PMID 12188230.

49. ^ Salbu B, Janssens K, Lind O, Proost K, Gijsels L, Danesi P (2005). "Oxidation

states of uranium in depleted uranium particles from Kuwait". J Environ

Radioact 78 (2): 125–35. doi:10.1016/j.jenvrad.2004.04.001. PMID 15511555.

50. ^ Hodge S, Ejnik J, Squibb K, McDiarmid M, Morris E, Landauer M, McClain

D (2001). "Detection of depleted uranium in biological samples from Gulf War

veterans". Mil Med 166 (12 Suppl): 69–70. PMID 11778443.

51. ^ Gwiazda R, Squibb K, McDiarmid M, Smith D (2004). "Detection of depleted

uranium in urine of veterans from the 1991 Gulf War". Health Phys 86 (1): 12–

8. doi:10.1097/00004032-200401000-00004. PMID 14695004.

52. ^ Schröder, H; Heimers, A; Frentzel-Beyme, R; Schott, A; Hoffmann, W

(2003). "Chromosome aberration analysis in peripheral lymphocytes of Gulf

War and Balkans War veterans". Radiation protection dosimetry 103 (3): 211–9.

PMID 12678382. edit

53. ^ Wan B, Fleming J, Schultz T, Sayler G (2006). "In vitro immune toxicity of

depleted uranium: effects on murine macrophages, CD4+ T cells, and gene

expression profiles". Environ Health Perspect 114 (1): 85–91. PMID 16393663.

54. ^ Anes Alic (October 29, 2007). "Depleted uranium, depleted health concerns".

ISN Security Watch. http://www.isn.ethz.ch/news/sw/details.cfm?id=18290.

55. ^ Mitsakou C, Eleftheriadis K, Housiadas C, Lazaridis M Modeling of the

dispersion of depleted uranium aerosol. 2003 Apr, Retrieved January 15, 2009

56. ^ Paul Brown, Gulf troops face tests for cancer guardian.co.uk 25 April 2003,

Retrieved February 3, 2009

57. ^ Veterans Administration (November, 2009) p. 11 (PDF page 21)

58. ^ Anthony H. Cordesman. Iraq and the War of Sanctions: Conventional Threats

and Weapons of Mass Destruction

59. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes (page 73.)

60. ^ GAO-01-92T Anthrax Vaccine: Preliminary Results of GAO's Survey of

Guard/Reserve Pilots and Aircrew Members

61. ^ The Clarion-Ledger: Mississippi's News Source

62. ^ Pharmacoepidemiology and Drug Safety.Short-term reactogenicity and gender

effect of anthrax vaccine: analysis of a 1967-1972 study and review of the 1955-

2005 medical literature

63. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes (pages 148, 154, 156)

64. ^ Kelsall et al (2009) "Physical, psychological, and functional comorbidities of

multisymptom illness in Australian male veterans of the 1991 Gulf War," Am J

Epidemiol 170(8):1048-56. PMID 19762370

65. ^ The History of Uranium Mining and the Navajo People

66. ^ Lung Cancer in a Nonsmoking Underground Uranium Miner

67. ^ Uranium mining and lung cancer in Navajo men

68. ^ Navajo Uranium Workers and the Effects of Occupational Illnesses: A Case

Study

69. ^ Uranium Mining and Lung Cancer Among Navajo Men in New Mexico and

Arizona, 1969 to 1993

70. ^ Lung cancer among Navajo uranium miners.

71. ^ Golomb, B. (2008) "Acetylcholinesterase inhibitors and Gulf War illnesses"

Proc Natl Acad Sci; Reuters; MedPageToday.com

72. ^ "Gulf War illness is real, new federal report says" on CNN

73. ^ Research Advisory Committee on Gulf War Veterans’ Illnesses December 12-

13, 2005 Committee Meeting Minutes

74. ^ Sawicki, M; Lecerclé, D; Grillon, G; Le Gall, B; Sérandour, AL; Poncy, JL;

Bailly, T; Burgada, R et al. (2008). "Bisphosphonate sequestering agents.

Synthesis and preliminary evaluation for in vitro and in vivo uranium(VI)

chelation.". European journal of medicinal chemistry 43 (12): 2768–77.

doi:10.1016/j.ejmech.2008.01.018. PMID 18313802.

75. ^ Spagnul, A et al (2009) "Calixarene-entrapped nanoemulsion for uranium

extraction from contaminated solutions." J Pharm Sci PMID 19780139

76. ^ Gulf War Illness and Health of Gulf War Veterans (page 220-221)

77. ^ Page 96 (PDF page 105) of the November, 2008 U.S. Veterans Administration

report

78. ^ Page 45 (PDF page 55) of the November, 2008 U.S. Veterans Administration

report

79. ^ Gulf War Illness and Health of Gulf War Veterans (page 222)

80. ^ Enserink, M. (2001). "MEDICINE: Gulf War Illness: The Battle Continues".

Science 291 (5505): 812. doi:10.1126/science.291.5505.812. PMID 11225619. edit

81. ^ New England Journal of Medicine. Disease and Suspicion after the Persian

Gulf War. Volume 335:1525-1527, November 14, 1996

82. ^ Knoke JD, Gray GC (1998). "Hospitalizations for unexplained illnesses

among U.S. veterans of the Persian Gulf War". Emerging Infect. Dis. 4 (2): 211–

9. PMID 9621191.& PMC 2640148.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640148/pdf/9621191.pdf.

83. ^ News Services, "Gulf War Syndrome Is Real, Panel Concludes", Washington

Post, November 18, 2008, p. 14.

84. ^ Record: Study finds multisymptom condition is more prevalent among Persian

Gulf vets

External links

Research

Research Advisory Committee on Gulf War Veterans' Illnesses, publishers of

the 2008 Gulf War Illness and the Health of Gulf War Veterans: Scientific

Findings and Recommendations (7.4 MB PDF)

Uranium Medical Research Centre, founded in 1997 by Dr. Asaf Durakovic,

M.D., formerly Chief of Professional Clinical Services in the U.S. Army's 531st

Medical Detachment during the Desert Shield phase of the 1991 Gulf War and

former Veteran's Administration official

Associations

American Gulf War Veterans Association

National Gulf War Resource Center

Veterans of Modern Warfare

Video

Conspiracy Test: Gulf War Illness investigative report by the Discovery Channel

- part 1, part 2, part 3, part 4, part 5

Categories: Gulf War syndrome | Genetic disorders | Immune system disorders |

Military personnel | Neurological disorders | Syndromes | Gulf War

Hidden categories: All articles with dead external links | Articles with dead external

links from April 2008 | Articles with dead external links from November 2009 |

Wikipedia semi-protected pages | NPOV disputes from December 2009 | All NPOV

disputes | Articles to be expanded from January 2010 | All articles to be expanded |

Articles to be expanded from December 2009

• Gulf war syndrome: is it due to a systemic shift in cytokine balance towards a Th2

profile?

• Change in immune parameters seen in Gulf War veterans but not in civilians with

chronic fatigue syndrome.

Related links

Up to date as of November 16, 2009

The World's No.1 Science and Technology News Service - New Scientist - New

Scientist

BBC NEWS | Health | Call to recognise Gulf War effect

Inquiry backs 'Gulf war syndrome' claims | UK news | guardian.co.uk

Research Advisory Committee on Gulf War Veterans' Illnesses - Research

Advisory Committee on Gulf War Veterans' Illnesses Home

Topic: Scud Missile Attacks and Inhibited Red Fuming Nitric Acid Hazards

National Gulf War Resource Center - ngwrc.org - Welcome home Gulf War, OIF

and OEF vets.

ATSDR - Toxicological Profile: Uranium

Health effects of uranium

Pregnancy Outcomes Among U.S. Gulf War Veterans: A Population-Based Survey

of 30,000 Veterans

Former Marine suffered from secret uranium work at Bethlehem, fought battle

New York News - Stirring Up the Toxic Dust - page 1

Balkans troops are showing the same chromosomal abberations in lymphocytes as

Gulf War troops have shown.

Depleted Uranium

Post Conflict Assessment Iraq

Uranium Medical Research Centre - Uranium Medical Research Centre

Gulf War Illness Public Inquiry

December 20, 2005 Headlines | Effects of Anthrax vaccine downplayed

The Clarion-Ledger: Mississippi's News Source

Campaigners hail 'nerve gas link' to Gulf War Syndrome - Scotsman.com News

Relationship between prepregnancy anthrax vaccinat...[JAMA. 2002] - PubMed

Result

AVIP - Questions and Answers

Study finds multisymptom condition is more prevalent among Persian Gulf vets -

Record: Study finds multisymptom condition is more prevalent among Persian

Gulf vets

American Gulf War Veterans Association - American Gulfwar Veterans

Association

First Gulf War still claims lives - First Gulf War still claims lives

What is Really Behind the Gulf War Syndrome? - Trinicenter.com - WHAT IS

REALLY BEHIND THE GULF WAR SYNDROME ?

BBC NEWS | Health | Sarin 'Gulf war syndrome cause'

Paranoia Magazine :: The Conspiracy & Paranormal Reader

Science/AAAS | Sign In

"Hospitalizations for Unexplained Illnesses among U.S. Veterans of the Persian

Gulf War" - EID Vol. 4 No. 2: Hospitalizations for Unexplained Illnesses among

U.S. Veterans of the Persian Gulf War

Is an Armament Sickening U.S. Soldiers?

Gulf War and Health: Volume 4. Health Effects of Serving in the Gulf War -

Institute of Medicine

Study: Gulf War syndrome doesn't exist - More health news- msnbc.com

Veterans for Common Sense - Veterans For Common Sense

Reproductive and developmental toxicity of natural...[Reprod Toxicol. 2001 Nov-

Dec] - PubMed Result

Effects of short-term and long-term depleted urani...[Neurotoxicol Teratol. 2005

Jan-Feb] - PubMed Result

- MarineCorpsTimes.com

''Khamisiyah: A Historical Perspective on Related Intelligence by the Persian Gulf

War Illnesses Task Force, 9 April 1997'' - Khamisiyah: A Historical Perspective on

Related Intelligence

CADU - Cadu News 17 - Spring 2004

Combat exposure, posttraumatic stress disorder sym...[J Nerv Ment Dis. 1999] -

PubMed Result

ScienceDirect - The Lancet : Health of UK servicemen who served in Persian Gulf

War

ScienceDirect - Clinical Psychology Review : Depression and physical illness: The

prevalence, causation, and diagnosis of comorbidity*1

Wiley InterScience :: Session Cookies

Somatic complaints, stress reaction, and posttraum...[Behav Med. 1988] - PubMed

Result

Physical Health Symptoms in Peacekeepers: Has the Role of Deployment Stress

Been Overrated? - Stress, Trauma, and Crisis: An International Journal

PsycNET - Display Record

Is Gulf War Syndrome Due to Stress? The Evidence Reexamined -- Haley 146 (9):

695 -- American Journal of Epidemiology

The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study --

Ismail et al. 325 (7364): 576 -- BMJ

JAMA -- Abstract: Self-reported Illness and Health Status Among Gulf War

Veterans: A Population-Based Study, January 15, 1997, The Iowa Persian Gulf

Study Group 277 (3): 238

PsycNET - Display Record

My Life Living With Depleted Uranium - Scoop: My Life Living With Depleted

Uranium

The Anthrax Vaccine: Is It Safe? Does It Work?

AVIP - Questions and Answers

AVIP - Questions and Answers

Autoimmune Technologies LLC, New Orleans

Documentary: Beyond Treason

In Vitro Immune Toxicity of Depleted Uranium: Effects on Murine Macrophages,

CD4+ T Cells, and Gene Expression Profiles - In Vitro Immune Toxicity of

Depleted Uranium: Effects on Murine Macrophages, CD4+ T Cells, and Gene

Expression Profiles

Inside camp of troubles - New York City News - Breaking News in New York -

NY Daily News

''New York Daily News'' Special Investigation: Poisoned? - New York City News -

Breaking News in New York - NY Daily News

Army to test N.Y. Guard unit - New York News, Traffic, Sports, Weather,

Entertainment and Gossip - NY Daily News

Soldiers demand to know health risks - New York City News - Breaking News in

New York - NY Daily News

Depleted uranium, depleted health concerns - Security Watch / Current Affairs /

ISN

Gulf war syndrome: the legal case collapses - Gulf war syndrome: the legal case

collapses | Society | The Guardian

"Q's & A's - New Information Regarding Birth Defects,"

The quantitative analysis of depleted uranium isot...[Mil Med. 2002] - PubMed

Result

Modeling of the Dispersion of Depleted Uranium Aerosol : Health Physics

A review of the effects of uranium and depleted uranium exposure on reproduction

and fetal development -- Arfsten et al. 17 (510): 180 -- Toxicology and Industrial

Health

ScienceDirect - Journal of Environmental Radioactivity : Oxidation states of

uranium in depleted uranium particles from Kuwait

part 2 - YouTube - GULF WAR ILLNESS -- CONSPIRACY TEST -- Part 2

part 3 - YouTube - GULF WAR ILLNESS -- CONSPIRACY TEST -- Part 3

part 4 - YouTube - GULF WAR ILLNESS -- CONSPIRACY TEST -- Part 4

part 1 - YouTube - GULF WAR ILLNESS -- CONSPIRACY TEST -- Part 1

part 5 - YouTube - GULF WAR ILLNESS -- CONSPIRACY TEST -- Part 5

U.S. Soldiers Are Sick of It - U.S. Soldiers Are Sick of It

Dr. Hari Sharma (2003): "Investigations of Environmental Impacts from the

Deployment of Depleted Uranium Munitions" - Investigations of Environmental

Impacts of Depleted Uranium

In vitro immune toxicity of depleted uranium: effe...[Environ Health Perspect.

2006] - PubMed Result

Neurotoxicity of depleted uranium: reasons for inc...[Biol Trace Elem Res. 2006] -

PubMed Result

Gulf War Syndrome Chronology - Gulf War Syndrome

(see Table 1 here) - DEPLETED URANIUM AND HEALTH OF PEOPLE IN

BASRAH:EPIDEMOLOGICAL EVIDENCE

Depleted uranium-catalyzed oxidative DNA damage: a...[J Inorg Biochem. 2002] -

PubMed Result

Induction of chromosomal aberrations in male mouse...[Mutat Res. 1990] -

PubMed Result

30 mm PGU-14/B armor-piercing incendiary round - PGU-14/B API Armor

Piercing Incendiary [DU] 30mm Ammunition

Environmental and health consequences of depleted uranium use in the 1991 Gulf

War

A review of the effects of uranium and depleted ur...[Toxicol Ind Health. 2001] -

PubMed Result

Frequently Asked Questions

Gulf soldier wins pension fight - BBC NEWS | UK | Scotland | Gulf soldier wins

pension fight

Health Effects