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.


Could post-traumatic stress disorder
explain the illnesses that many Gulf War veterans are suffering?

Tuite No. There certainly is a phenomenon of PTSD in some of the veterans, but I think it's a limited number. Matthew Friedman did a presentation to the Persian Gulf Scientific Expert Panel again last month, in which he said, of the veterans he examined, about 7 percent were suffering from PTSD. He is a noted PTSD expert.

Ware: If you intend the narrowly defined diagnosis of PTSD, then I would agree that I don't think that is the explanation for what we're seeing.

What about a less-than-traumatic stress
disorder?

REAL AUDIO Ware: Well, this deserves a little discussion, I think, because, first, the word "stress" potentially connotes a lack of appreciation of what we're talking about here. We're talking about 600,000 people who, in many cases, essentially, unexpectedly were uprooted from their families and work situations, sometimes older troops, not active duty soldiers but reserves,

"The word 'stress'
potentially connotes
a lack of appreciation
of what we're talking
about here." ... Ware

who unexpectedly were called back into duty, mobilized, sent over to the Gulf. It was a frightening place to be. There was an anticipation of chemical warfare, of SCUD attacks. The Iraqi army was going to be incredibly formidable and there was going to be great casualty. People were in physically uncomfortable conditions. And I say that, when any of us goes through those kinds of dislocations and experiences, we are going to have a different perception of our health status. On the IOM (Institute of Medicine) panel we had some very interesting testimony about self-perception of health and how sensitive self-perception of health is to one's environment and one's conditions. And so the possibility that the fearfulness, the discomfort, the inconvenience, in other words, the experience of deployment itself as separate from any chemical or other exposures of the troops might have been a factor that both increased the prevalence of certain kinds of signs and symptoms and made people more sensitive to them, I believe, is a very plausible contributor. That's not to say that every single person who's ill should be assessed as an instance of stress-related illness.

Tuite Again, this issue of Gulf War syndrome has dynamics. I think that stress or stress-related disorders, as a result of their service in the Gulf, play a very small role, but a role in this issue. The reason I say that is

"I think that stress or stress-related
disorders, as a result of their
service in the Gulf, play a very
small role, but a role in this issue." ... Tuite

that we don't seem - again, looking at what the global reporting situation is - we've got soldiers in the rear reporting illnesses and certain clusters at as high a rate or higher rates than soldiers in the front. It doesn't seem to be, based on my experience, affecting one age group versus another. The whole issue of stress and war is a very questionable one in itself because many of the wars after which these stress phenomena were observed were wars in which there were serious toxic exposures. The sociology of this particular war is very different than other wars that we've fought in the past. This was a war which was fought by volunteers and people who were in the reserves who had very good jobs, families, lives to go back to. Whatever happened to them in the war, it's costing them their careers, their retirement, their health care, their family's health care and their jobs. So we're seeing a phenomenon here that really doesn't mesh with phenomena that we've seen in prior wars. If you're asking me: can we rule out stress-related disorders in any of the soldiers who came back that are reporting Gulf War syndrome? Of course not. Of course, you're going to have in the general population numbers of individuals who are going to have these kinds of disorders. But to sit there and say that it's some sort of overriding or explanatory diagnosis for individuals who are reporting Gulf War Syndrome, I think, it is an effort to attach a pejorative connotation to individuals, and pejorative not in the sense that there's anything wrong with a psychological disorder, pejorative in the sense that you deny medical care to people who may benefit from it, physiological medical care, under the heading of: if-I-can't-explain-what-it-is-then-it-must-be -something-wrong-with-you.

Ware: It's a complex issue and it's emotionally charged, no question about that. And it's seen as a sign of lack of care and regard for the illnesses of the troops. So you almost can't approach this issue without being seen as disrespectful and dismissive.

There's a recently published historical
review of veterans' health since the Civil War that
suggests a war syndrome involving fatigue, headaches, memory loss.
 Is this a clue?

Tuite In the Civil War, with the kinds of injuries that were sustained, you had terrible problems with bacteriological infections. Could these infections cause some of the toxic problems and some of the damage that we're seeing? After World War One the soldiers who were sick reported symptoms very similar to Gulf War veterans. Many of them were on battlefields in which chemical weapons were used. Vietnam: We're looking at soldiers being exposed to highly toxic herbicides. And now the Gulf War comes up. Is it a phenomenon that's associated with post-war stress or is it a phenomenon that's associated with organic damage as a result of complications from exposures during the war? I don't know that we've actually taken the time to try and find out.

Is there possibly a

Ware: I think that the points that Jim made are valid, that wartime experience is atypical, not only in terms of the psychological and physical environment but also in terms of looking at it in kind of an occupational perspective. The kinds of chemicals, the kinds of activities, the kinds of living conditions. I think that it's very dislocating across a whole spectrum. And so, including the possibility of different kinds of chemical exposures, so I can see in general, looking over the entire history of warfare, a role for a variety of factors, all are more prevalent in wartime conditions.



Syndrome? || Chemical Weapons? || Vaccines? || Stress? || Cover-up?
Conclusions

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