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.

Twenty years from now will people
still be debating what happened with Gulf War sickness?

Ware: I think it's the most likely outcome, although I hope for a better outcome than that.

Tuite I believe, and I truly believe this, that given the advances that we're now making in the biological sciences, while we may never be able to say that chemical "x" caused a specific injury, we may be able to say what is wrong with a soldier, diagnose him and then find out, if we have to rely on symptomatic treatments, if there are other kinds of treatments that can be formulated.

Is it possible that the perception
by some people of a cover-up has in some way caused or aggravated
the syndrome?

Tuite No, because the initial reports of this possibly being as a result of low-level agent exposure, and when the committee's investigation was in its heyday, if you will, there weren't all of these allegations of cover-up at that time. There were allegations that there may be a problem here: we're having an investigation, it looks like the troops were exposed, the Pentagon's investigation was still ongoing, and the numbers of soldiers that came forward went through the roof. In the last year, where the cover-up has come to the forefront as the issue rather than the Gulf War syndrome itself, we haven't seen that kind of increase in the registry roles. We're seeing a sort of stabilization in the number of soldiers who were coming forward and registering, despite the fact that right now there's probably the highest level of press coverage involving the fact that the Pentagon may have deceived Congress and the public on this issue.

Ware: I think the phenomenon exists largely independently of the public perception of whether there's been a cover-up.

Jim Tuite, you told the Presidential
Advisory Committee on Gulf War Veterans' Illnesses,

REAL AUDIO Tuite I meant exactly what I said: the fact that we had soldiers who were exposed to a variety of toxic substances during the war, who were told that in fact there was no relationship between their exposures and their illnesses, were told that they were mentally ill, were cast off, if you will, by the government. The fact that reports have continued to come out from the government telling them that what they saw didn't happen, that the detections they made and the training that they had was worthless, that the sensors that they had didn't work. Saddam Hussein was not responsible for tens of thousands of casualties and, in fact, we have very good reason to believe that the exposures that these soldiers sustained during this war could have resulted in tens of thousands of casualties. Not because of the fact that the exposures were present, not because there were low levels of nerve gas in the air, but because when our alarms went off, when our soldiers detected chemicals, when the Czechs detected chemicals, when the French detected chemicals and when the British detected chemicals, we told them that it wasn't enough to hurt you, you don't have to wear the equipment, you don't have to listen to the alarms. In fact, many units were told to disable the alarms. That's a problem. That's a problem because, in fact, there is literature that indicates that low levels can hurt you and, while it may not be the consensus in the community, it's certainly a debatable issue that is going to need to be resolved, not only for the benefit of those who were injured in the Gulf but for the benefit of those who may be injured as a result of those poorly conceived policies in the future.

Ware: I don't think we know whether, and the magnitude of, excess morbidity among the group of soldiers deployed to the Gulf. So we know that there are some individuals who are ill. I've emphasized that we would anticipate illnesses, some unexplained illnesses, in any group of 650,000 individuals, especially under those circumstances. So where I would not have

"We have not demonstrated
that there is excess
morbidity and we don't
know the magnitude of it." ... Ware

been able to make that statement is, I don't believe that we know. We have not demonstrated that there is excess morbidity and we don't know the magnitude of it.

Tuite My response to that is, if we had a phenomenon in our general population where 10 percent or 12 percent of the individuals in this country between the ages of 25 and 40 were complaining of some unknown chronic illness, whether we had a handle on it or not, we would be up in arms. We would be in hysteria. And we would be doing everything we could to try and resolve that problem. We would be doing epidemiologies and cluster studies to try and find out what happened here in this country to cause that to happen. And my concern is, that we sit there and we write it off to stress, we write it off to low-levels-can't-hurt-you. I mean, even you've acknowledged that that is a debatable agenda item in the scientific community. And this is what these soldiers were told. They didn't wear their masks. They ignored their alarms. Now if in fact there is any correlation, if in fact these agents were detected and confirmed, as indeed the Pentagon even admits occurred on some occasions, then we are responsible for, if you will, irresponsible behavior in terms of protecting their safety. And, again, we've got 10 to 12 percent of these individuals now coming forward, complaining of symptoms, symptoms that they directly attribute to their experience in the Gulf. Yes, some of them would have happened anyway. But, I mean, if you're telling me that 12 percent of the people in America, in that same age group are in the same straits, then I'm not surprised that we have the health costs in this country that we do.

Ware: Actually 50 percent of visits to doctors' offices are for diffuse symptoms of the type that are mentioned here, which do not lead to a diagnosis.

Tuite And, then again, that would go back to my point before. Because the doctor is ignorant it doesn't mean that the patient is faking.

Ware: No, I'm speaking to the point that this phenomenon is common in general experience, that people are ill, they don't feel well, they go to the doctor, the doctor can't explain it.

Tuite What percentage of those individuals, though, have chronic illnesses? I'm not talking about a one-time, "I don't feel good I'm going to the doctor," but, "I haven't felt good for the last five years, I can't remember any more."

Ware: Well, we would have to discuss more carefully how to make the comparative.

Tuite I understand.

Ware: And I don't think that the evidence is strong enough to really do this quantitatively, but it is true that some of these phenomena are prevalent in general populations.

Tuite And I guess my concern is, and the point that I've been trying to make is that you, and I are now sitting there talking from general knowledge, the comments that we are making are for the most part anecdotal, you know, are based on what we've read. My concern is, again, we've got a cluster here of the American population that shares a common experience. We need to do the studies.

Ware: I agree with you 100 percent, provided that they're carefully reviewed, and we don't waste the public's money.

Anything further?

Tuite No, except that, again, the point that I just made. We really do need to take a look at this as not a political problem, not a cover-up problem. We have to assume that toxic exposures occurred. Regardless of whether or not those exposures are related to the illness, we have to assume that this occurred or may have occurred, that many or all of the soldiers may have been exposed, because I don't know how we're going to differentiate one person from another. We have been able to in the past. And then from there, move on to do the kind of independent, peer-reviewed, scientific research that is necessary to identify the magnitude and nature of the problem and to find out the course, consequence and potential treatment for the illnesses being suffered by these veterans.

Ware: I hope that the transcript of this will reflect that we both feel that every effort should be made to care for the individuals. I think of your opening statement about this is a group of individuals who served our country and went to the Gulf in the military service, and I think the country should err on the side of making every effort to attend to their illnesses and to their health problems. I hope that we can separate that question of caring for individuals from the question of whether we understand it, and can make a determination about whether there is a Gulf War Syndrome and a story about exposure that explains it.

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

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