Two Studies Look at Gulf War Illness Causes, Treatments
By Douglas J. Gillert
American Forces Press Service
WASHINGTON, Sept. 29, 1999 The Defense and Veterans Affairs departments are conducting two new studies on the possible treatment of illnesses reported by thousands of Gulf War veterans.
One of the studies is focusing on mycoplasma, tiny bacteria that some scientists and physicians think could be the root cause of many of the symptoms veterans have reported. The second, more complex study aims at changing behavior patterns to alleviate disease symptoms and improve the quality of Gulf War veterans' lives.
The Naval Health Research Center in San Diego and Walter Reed Army Medical Center in Washington represent DoD in the studies, which also involve 28 VA medical centers. Participants are all veterans of the Gulf War and volunteers who know they're sick but don't know why.
Between 80 and 85 percent of Gulf War veterans who have sought health care have been successfully diagnosed, according to Army Dr. (Lt. Col.) Charles Engel, chief of the Gulf War Health Center at Walter Reed. (Between 15 and 20 percent remain undiagnosed.)
"That's a real dilemma in medical care, because physicians use diagnosis to tailor treatment," Engel said. "If you don't have a diagnosis, you don't know what to do for the patient." (Fifteen to 20 percent
A Gulf War veteran himself, Engel knows well the biological and other exposures service members faced there, such as oil well fires and kerosene lanterns burned inside tents.
"These are things I was exposed to as well," he said. "Thus far, science hasn't given us complete information about the relationship of those exposures to the illnesses that Gulf War veterans experience and similar illnesses people in the general population experience. It's frustrating -- for the doctors and the Gulf War veterans."
If mycoplasma is the culprit for at least some of the reported illnesses, a common antibiotic used to treat teen-age acne could be the cure. During the mycoplasma study, participants will receive either the antibiotic doxycycline or a placebo. To qualify for the study, participants must suffer from what scientists call "chronic multisymptom illness" -- a combination of fatigue, pain and memory disturbance.
"We want to develop a sense of how people on the antibiotic do compared to those who don't get the antibiotic," Engel said.
Mycoplasma exist inside and outside human cells, similar to viruses. Doxycycline attacks and kills the bacteria. The study should prove whether the bacteria are behind veterans' ailments.
"The antibiotic trial represents an opportunity to look for a good, off-the-shelf, readily available treatment for many veterans who are ailing with chronic symptoms," Engel said. "If the study is negative, it can also provide some relatively compelling information that perhaps symptoms are not being caused by this organism.
"Positive or negative, the results will be useful to the Gulf War veteran community and to the scientific community."
Some 450 veterans from all service branches are participating in the mycoplasma study.
Meanwhile, more than 1,400 veterans are helping doctors understand the relationship their lifestyles have on their illnesses. Lucille Mitchell, a former Air Force nurse who suffered symptoms similar to Gulf War veterans and eventually got help at Walter Reed helped to set up the behavioral clinical trial there.
Rather than offering a cure, which is impossible until doctors know the origin and cause of the veterans' illnesses, the study will help veterans learn to cope with their pain and suffering, Mitchell said. The program's goal, she said, is to help the veterans purge negative thoughts and lifestyles in order to cope with their illnesses.
An exercise physiologist is evaluating participants to learn their physical limitations, then designing individual exercise programs, Mitchell said.
"We don't want to discourage them but build a program that will help them improve their exercise activity," she said.
A psychologist will train the veterans to control pain with relaxation techniques and other strategies, Mitchell added.
"Quality of life is what's so important to people who are suffering," Mitchell said. "So we want to give them more quality of life by allowing them to take more control of their lives."
Both the mycoplasma and behavioral studies at Walter Reed are open to more volunteers, Mitchell said. She said people wanting information about either program should call the hospital at (202) 782-6563 or DSN 662-6563. More information about these and other Gulf War illness initiatives is available on the Internet.
"There's a lot of misinformation and misperception about Gulf War illnesses," Engel said. "We have a Gulf War illness health literature database on the Web that is available to anyone at http://www.wramc.amedd.army.mil/departments/gulfwar." [link no longer available] We teach [the veterans] how to use it and the nuts and bolts of reading an article out of the medical literature and out of the medical news media -- how to decide whether the article is believable."
The veterans also learn to be good health care consumers, Engel said.
"A lot of people with chronic illness don't understand that there are seldom good, clear-cut answers to chronic illness. What they're left with are rehabilitative strategies that involve life style changes."
Unfortunately, Engel said, many people suffering chronically become victims of the medical system. "In their quest for answers, they see a lot of physicians, get a lot of diagnostic tests. All the tests and medications and referrals they get are well intended, but also need to be well coordinated by physicians. Otherwise, patients can end up on multiple medications with multiple -- and possibly adverse -- side effects.
"So we try to take a big picture approach to this cluster of symptoms that Gulf War veterans often describe fairly consistently."
Although the current studies are only for Gulf War veterans, Walter Reed may soon expand its operations into a new Deployment Health Clinical Center to treat veterans of all deployments.
"When you go off on deployments, you're not working in places approved by the Occupational Safety and Health Administration," Engel said. "Nobody promised you that you would be, but just the same, you come back with questions. What about the oil well fires? What about the [medicines they gave me]? What about the vaccinations I took?
"We need to broaden our sense of what health is for returning veterans. These are, by and large, young folks who are free of the illnesses we think of in the elderly and that show up clearly on diagnostic tests. Sometimes, the difficulties they experience are more hidden. We have to expend a fair amount of effort trying to understand the veterans' perspective of the deployment rather than homing in on the thousand or so diseases doctors typically look for in the course of routine medical care."
The studies veterans are asked to join demand their time, and may include frequent travel away from home, Engel said. This discourages many from volunteering. But it's important they step forward and get into these programs, he said.
"It's about veterans helping veterans," he said. "This is an opportunity for people who've stepped into harm's way and paid some health consequences to be a part of the solution.
"What we are dedicated to doing here at the Gulf War Health Center -- and soon the Deployment Health Clinical Center -- is developing systems of care so that we can be there for veterans in ways that go beyond just giving a pill or assigning a surgery."