New Study Can't Rule Out 'PB' Connection to Gulf War Illnesses
By Douglas J. Gillert
American Forces Press Service
WASHINGTON, Oct. 19, 1999 Anti-nerve agent pills given to troops during the Gulf War cannot be ruled out as a possible cause for some of the illnesses veterans of the war have reported.
New concerns about pyridostigmine bromide, an investigational drug administered to service members deployed for the Gulf War, are raised in a RAND study released by the Pentagon Oct. 19. Pyridostigmine bromide, or PB, was given the troops because it's the only medication available to protect humans against soman, a deadly nerve agent known to be present in the Gulf Region before and during the war. The Pentagon estimates 250,000 troops received packets of the drug.
The information is inconclusive, however, and will require further study, officials said.
After reviewing medical literature on laboratory animal studies, the RAND Corporation won't rule out a possible connection between PB and undiagnosed illnesses reported by thousands of Gulf War veterans. According to RAND, conditions such as heat and stress -- health factors during Desert Storm -- may cause the brain to absorb larger amounts of PB. This, in turn, may lead to PB affecting acetylcholine, a nerve-signaling chemical that regulates sleep, pain, mood, muscle function and thinking.
The Pentagon administered PB to troops even though the drug was not fully licensed by the Food and Drug Administration. The risks of soman were considered greater than the possible health risks of the drug, said Dr. Sue Bailey, assistant secretary of defense for health affairs.
"This department is focused on providing the best possible protection against those deadly weapons," Bailey said. "In this case, pyridostigmine bromide was the best protection available to us for soman."
The RAND review of medical literature uncovered evidence "consistent with several mechanisms that could cause some personnel to have increased effects from PB," said Dr. Beatrice Golomb, the principal RAND investigator. "PB is thought not to cross into the brain in very high quantities, but there is some research in animals suggesting that there may be some conditions, such as heat and stress, that could allow quite a bit of it to cross into the brain."
Golomb said RAND found evidence consistent with theories of how PB might lead to long-term health problems by affecting acetylcholine. "Evidence from animal studies does suggest that there can be long-standing or even permanent changes in regulation of this chemical with agents of the kind that PB is," she said.
Golomb said the earlier findings are consistent with veterans' reported symptoms, but "it's certainly not at the point where we could say with any conclusiveness that PB is a contributor or caused all these illnesses in Gulf War veterans."
Nonetheless, this is the first Gulf War illness research commissioned by DoD that doesn't fully rule out a causal relationship. Past RAND studies ruled out connections to Gulf War illnesses, with depleted uranium, for example, said Bernard Rostker, DoD special assistant for Gulf War illnesses.
Although RAND has not been able to reject the hypothesis that PB caused some of the Gulf War illness symptoms, neither does their report conclude a causal relationship, Rostker said. "We just don't know enough at this point," he said.
The Defense Department has contracted for nearly $20 million in additional research on PB. Additionally, this report will be looked at by the Institute of Medicine in Bethesda, Md.
Although the RAND report released by the Pentagon Oct. 19 points a troubling finger at PB, Rostker said DoD could continue the drug's use.
"PB is and remains the only effective treatment for exposure to soman on the battlefield," Rostker said. "Soman is a particularly quick-reacting nerve agent, and the normal post- exposure treatments would not be effective. PB is and would continue to be not only the treatment of choice but the only treatment we have, if it is even suspected that soman could be used on the battlefield."
The Pentagon's experience with PB and other force protection issues in the Gulf has helped with later deployments, Rostker said.
"When our troops were in Kosovo, we conducted extensive environmental reviews based upon industrial pollutants and war damage," he said. "We took those into account where we bivouacked our troops. That kind of inquiry was not available during the Gulf War and was never available before.
"The Gulf War was a medical triumph in terms of traditional communicative diseases. We're now becoming more sensitive to some of the environmental hazards and placing a lot more emphasis on environmental medicine."
Bailey echoed Rostker's assessment. "In our recent deployments," she said, "we have applied the lessons that we have learned from the Persian Gulf deployments. We are tracking all of the possible long-term effects. That's the real lesson that we have learned about this medication and are applying to future force health protection."
Despite the possible health problems associated with use of an investigational drug like PB, Bailey said she wouldn't hesitate to use other experimental drugs in the future.
"I feel no hesitancy to use any drug that will protect our forces against a deadly threat," she said.
Related Site of Interest: Gulflink