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November 16, 2004 - Veterans And Exposure, Psychosomatic?

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. 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.

"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."

Faced with 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."

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