The Gulf War

The Debate

At the root of the controversy over Gulf War Syndrome are a few scientific, medical and factual questions.
FRONTLINE sponsored a debate between two leading experts with different perspectives on the issues: Jim Tuite III, former lead investigator of a U.S. Senate committee's inquiry into Gulf War Syndrome, who points to Iraqi nerve agents as the explanation for many veterans' sickness; and Jim Ware, environmental statistician at the Harvard University School of Public Health, who tilts toward battlefield stress as a more likely cause.
An edited transcript of their in-depth discussion on Dec. 18, 1996, is printed below, covering five principal areas.
Also available are excerpts of Real-Audio exchanges from the debate between Ware and Tuite.

What about vaccines and other factors?

Are PB (pyridostigmine bromide) anti-nerve
gas pills a likely cause of Gulf War illness?

Tuite I certainly believe that the pyridostigmine bromide is an issue that we need to look at in conjunction with some of the other exposures. There are several reasons why I say that. One is that pyridostimine bromide does exactly the same thing that nerve gas does. It's called an esterase inhibitor. It does it, ostensibly, in a reversible fashion. Theoretically, it doesn't penetrate the blood-brain barrier. But a recent study by some Israeli doctors has found that, at least in laboratory animals under stress - in this case, physiological stress - that, in fact, the pyridostigmine can penetrate the blood-brain barrier.

Ware: It's true that you can't rule it out. I don't regard it myself as one of the more likely factors. I don't believe that, in the dosages that it was used, it would have the kinds of health effects that people report.

Can pesticide exposure explain Gulf
War sickness?

Ware: Well, pesticide exposure would be part of this sort of complex chemical mix that we're talking about. It is true that pesticides were used in the Gulf to spray areas where troops were bivouacking and things of that nature. I'm not aware of any evidence that would tie it in any way to the health experiences of the troops.

Tuite Again, looking at it in isolated cases, are there five or six soldiers who were in an area where pesticides were misused, and they might have symptoms very similar to what we're seeing here as a result of those exposures? Certainly that's possible. Do we have the kind of global use of pesticides that would explain this phenomenon? I don't think we have the global exposure to anything except for the oil smoke and to the fall-out from the nerve agents if, in fact, one ascribes to that particular exposure. So I think that, yes, you cannot exclude it as a suspect, but I don't think it will end up being the answer to what's causing Gulf War Syndrome.

And the combination of PB, pesticide
and insect repellents?

Tuite Again, given the fact that many soldiers who are sick didn't take the PB. Given the fact that when the soldiers developed these preliminary symptoms, during the air and ground war, was during the winter in Saudi Arabia, and insects weren't a big problem at the time, as big a problem as they might have been in March, April, or May. And given the fact that follow-on studies by Dr. Abou-Donia with sarin also indicate this synergism, I don't know how you can separate them. Certainly, it's one of the suspects or one of the factors that you need to consider in individual cases.

Ware: The kinds of exposures you're talking about now are ones for which there's very poor data. Who actually used pyridostigmine bromide? Who used Deet (insect repellent)? How much Deet did they use? Where were the pesticides sprayed? Who got exposed to those pesticides? These are things we'll probably never know. And, so, only over time will we be able to discover whether epidemiologic research can, in fact, untangle and come to any firm conclusion.

There's a laundry list of other factors:
vaccines, infectious agents, oil-fire smoke, and depleted uranium

Ware: Two of those we can rule out kind of quantitatively, depleted uranium dust and infectious agents. In the one case, you know something about their prevalence, in the depleted uranium dust. And in the case of the infectious agents, if someone has leishmania, you can diagnose it. It's not that no one had either of those problems, but those are not an important contributor.

Oil-fire smoke and vaccines?

Ware: With the vaccines, again, you know, it would be very surprising if the vaccines played a role, unless there were something like this complex chemical interaction, which one can't rule out but for which there's no real evidence. I shouldn't say no real evidence. There are a couple of interesting

"...the evidence that the oil fires are
the critical factor is not there." ... Ware

studies. But there's not a very strong body of evidence that would pull that together. As far as the oil fires, it doesn't either. It's amenable to more study, but thus far, the evidence that the oil fires are the critical factor is not there.

Tuite Yes, with the exception of the vaccines. And I'm not talking about anthrax or botulinum toxin. I'm talking about other vaccines that may have been administered in this dynamic. I think that you will see clusters of individuals or groups of individuals who, for example, have leishmaniasis. I think there are 35 or so individuals who have been diagnosed with leishmaniasis. Some hydrogen sulfide was detected by the Fox vehicles during the oil fires, and certainly there are some people who might have been particularly susceptible and may be ill as a result of that. And depleted uranium dust, again, you're going to see clusters. People who were in areas where this stuff was used. I mean, if you're going to see depleted uranium, it will be among the tankers who were using it, upclose and personal and then climbing over the Iraqi tanks. But that phenomena should not be manifesting itself yet. Most medical research says that inhalation of radioactive particles or radioactive dust usually takes anywhere from eight to ten years to cause the kind of chronic illnesses that we're seeing in the soldiers.

Are you agreeing with him that these
are not likely to be significant factors?

Tuite With the exception of, again, some of the dynamics of the vaccines, I would agree with that as well. There may be some unknown dynamic with some of the vaccines that we're not aware of. I think it would probably be more of the common vaccines rather than the anthrax or the botulinum toxin.

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