Gulf Vets & Mcs: Agent Orange Again?

When the Persian Gulf War ended two years ago, the 540,000 U.S. troops began returning amidst exclamations of low casualties and a relatively quick and painless war for the allied forces. Soon after, however, complaints of rashes, itching, aching joints, hair loss, tooth loss, and fatigue were being reported to Army physicians by some returning soldiers.

Last fall, the ABC news program "20/20" and National Public Radio's "All Things Considered" covered the story of these "unexplained illnesses. " On both programs sick veterans expressed their frustration with the Army's responses to their illnesses. The Army had offered them a range of responses from saying the symptoms were too non-specific to be diagnosed to saying - as the Army Surgeon General's office concluded in a 60-page report - that stress was the main cause.

Since these two programs aired, there has been little major news coverage or follow up. For the sick veterans and their supporters, however, the matter has not only remained a grave health issue, it has taken on a political dimensions as well.

There are veterans and physicians who believe the cause of these illnesses is multiple chemical sensitivity (MCS) brought on mainly by petrochemical exposure in the Persian Gulf. The government's unwillingness to believe this unconventional diagnosis, they say, has as much to do with saving money and pleasIng the powerful Chemical Manufacturers Association and the petrochemical industry as it does with differing medical opinions.

Speculation has surfaced that the government is handling this matter in much in the same way it handled the Agent Orange controversy after the Vietnam War. In the earlier case, the government insisted for years that a link could not be proven between Agent Orange exposure and sick Vietnam veterans. Only recently did the Veterans Administration (V.A.) acknowledge that soft tissue sarcoma and non-Hodgkin lymphoma - from which many Vietnam veterans suffered and died - were "as likely as not" linked to Agent Orange exposure.

Today some fear that the government's lack of faith in the unconventional diagnostic procedures used by environmental physicians on Persian Gulf veterans is only compounded by the enormous stake petro and other chemical industries have in maintaining that their products do not make people sick.

"The Chemical Manufacturers Association has 20 full-time lobbyists in Washington and they are extremely powerful," said Dr. John Boyles, a Centerville, Ohio based otolaryngologist (ear, nose, and throat specialist) who has treated eight veterans for MCS. "They know all about environmental medicine, they know all about multiple chemical sensitivity, and they say it doesn't exist."

A series of telephone interviews with sick veterans, environmental physicians, and government officials has revealed a web of differing opinions. Not even the numbers can be agreed upon. The Army Surgeon General's office says there are about 300 cases, yet Dr. Boyles predicts the number could reach into the thousands because of misdiagnosis of veterans' symptoms. Numbers aside, the fact remains that there are sick veterans who are not receiving the treatment they feel they need.

Sgt. Ronald Brandes of Milan, Indiana is one of those soldiers. Brandes was two months away from retirement from the reserves when his unit was called up for service. He chose to re-enlist for six years in order to go to the Gulf. While in Saudi Arabia, Brandes was exposed to an enormous amount of petrochemicals. He explains: "The water that we took our showers with was laced with fuel oil, diesel fuel [from fuel transport trucks that had not been properly cleaned]. In our heaters that we used in the tents at night we burnt whatever type of fuel we had. I'm a mess sergeant, so I was exposed to the cooking heaters all day, and we kept our flaps down due to the sand blowing. "And then they had the oil fires, of course. We saw the smoke quite a bit from it. And we put diesel fuel on the ground to keep the dust down, so basically our tent was surrounded by diesel fuel." Brandes started feeling ill while in the Gulf, but attributed it to the heat and the different environment. Three days after his arrival home, however, he reported to the hospital where he was stationed at Fort Van Harrison with rashes, severe sweating, itching, fatigue, and aching joints. (see GULF VETS & MCS, page 5)

(FROM PAGE ONE) They treated me somewhat for the itching---said it was fatigue and stress," said Brandes. "But I ran my own business prior to leaving for the Gulf, and I felt I knew what stress and fatigue was and it didn't feel like this is what I had." Brandes was contacted by Major Richard Haines of New Albany, Indiana. Haines is a former National Guard division officer who - familiar with MCS - became alarmed when he learned of the unexplained illnesses. He began doing research and collecting information. Now 1,500 work hours and $16,000 of his personal savings later, he has a huge data base containing information about MCS and over 250 sick veterans.

Haines put Brandes in touch with Dr. Boyles. Brandes tested positive for petrochemical poisoning and is now being treated successfully by Dr. Boyles. The Army, however, will not acknowledge or pay for this treatment.

"At this point I have not asked the government for anything but medical attention," Brandes said. "Like I told the doctors and I told my unit, all the money in the world isn't nothing with: out your health. Basically I have not asked the government for a dime, no compensation in any way other than medical treatment - get me better, get me back on my feet. And maybe 1 get to see a doctor once a month.

"And like I told them when I started seeking outside help. once a month doesn't get it. I feel so bad in between seeing the doctor, you know I just feel like my insides are dying sometimes. And, you know, the doctor at Fort Knox, the internal medicine doctor is really trying to help me but they don't want to acknowledge petrochemical poisoning."

Brandes did request that the Army test him for petrochemical poisoning, but said one doctor replied, "It's a very expensive test, but - not that money is a problem - we don't feel it's necessary."

Last October, having received little or no response from Army officials after updating them (through his chain of command) on the information he had collected on sick veterans, Haines presented his findings to the American Academy of Environmental Medicine (AAEM). AAEM Assistant to the President Earon Davis described the 500-member organization as being "on the cutting edge of medicine." Their role, however, is considered controversial by government and medical establishments. At any rate, the academy agreed to Haines' request to examine sick veterans for evidence of chemical sensitivity.

"Petrochemicals, over long term exposure, get deposited in the fat, and that's a proven fact," said Dr. Boyles, a member and former president of the AAEM, explaining how they are able to test for MCS. "What happens is even after you're taken away from this bad environment, it keeps coming out of your fat. What we're talking about is people who have either had a big exposure to solvents and chemicals or continued long exposure to the point where they then become allergic to chemicals and then even small doses will cause them to become sick while the same doses won't affect most of the population.

"Well, these guys were subjected to such huge doses for such a long period of time that many of them developed sensitivity problems. Now they come back home and try to go back to jobs that involved chemicals that they never had any trouble with before and now they have trouble. Now they have trouble being around perfumes and gas fumes and anything like that. And their immune systems are low enough that almost all of them have fungus problems. These guys are really ill."

The Army and V.A., however, see things differently. According to the Army Surgeon General's spokesperson Peter Esker, "There is no common thread" linking the unexplained illnesses of the 344 soldiers they have on record. He insists that the Army has not ruled out any possibilities and that "there are physicians across the spectrum of the Army Medical office looking at this, at the environmental aspect, at chronic fatigue."

There's no separate little cell of researchers looking at this," Esker said. "Each patient that we are seeing is being treated on an individual basis."

As for the V.A., in August 1992 it announced the establishment of three Environmental Medicine Referral Centers to "deal with Persian Gulf veterans whose symptoms defy explanation through the usual diagnostic and therapeutic endeavors of a local V.A. center." The centers are located in Washington, D.C., California, and Texas.

"The purpose of the referral centers is to have a locus, if you will, of specialty collaboration available," said V.A. spokesperson Terry Jemison during a March telephone interview from Washington, D.C. The basic criteria for referral is that the patient has essentially stumped the local diagnostician and the primary care givers at the local V.A. medical center."

Other than unexplained illness, Jemison said he "does not know if there is any essentially unifying diagnostic indication there. The chemical hypersensitivity is the one diagnosis that we've seen that is probably the only diagnosis that is repetitive. We've seen several cases of that." Once at a referral center, Jemison said, patients are treated on an individual basis. "The tests that are being done are what tests are medically indicated in conjunction with the work up that is necessitated by the veteran's symptoms," he said. "There is no set protocol of special tests for veterans who come to referral centers."

When asked about the testing and treatment being performed by doctors such as Dr. Boyles, Jemison expressed cautious skepticism.

"There's been a couple of reviews of what the literature shows with regard to the efficacy or the effectiveness of the [AAEM recommended] treatments that have been very contradictory," he said. There haven't been large-scale epidemiological studies to show that there is value, clearly and unequivocally, in those sorts of methods of provocation neutralization therapy, sweating out toxins, and of vitamin and mineral supplements [methods used by AAEM physicians on patients like Brandes]. It's an area that is certainly very interesting, that we would view generally as being something of a research challenge - one that we would expect to raise with our contractors. We hope to, in the near future, be engaging in a multimillion dollar scientific study on the Persian Gulf environment and health effects that will take place over a number of years."

Dr. Boyles submits that one of the biggest problems is that MCS is hard to test for and that there is no genuine marker. He adds that there are sophis- (see GULF VETS & MCS, page 14)

(FROM PAGE 5) -ticated immunological tests that can be done, but they are expensive. "But just because we don't understand the physiological mechanism doesn't mean it doesn't exist," Boyles said. "When you get large numbers of people with exactly the same story and exactly the same symptoms and you find the lab abnormalities with the immunological tests - they're all alike - that's not psychological."

Again, the V. A. , while not at all excluding the possibility of MCS, disagrees. Jemison explalned: The VA's inclusion of a major portion of its recent telecast [to VA hospitals around the country] to be dedicated to the area of MCS I think also is a recognition by the government that mainstream medicine does not have all the answers. But at the same time , we are very conservative with our patients and careful not to subject them to time and expense that might detract from mainstream care that might otherwise help them get better. We are moving cautiously in looking more at research possibilities as to what might be done in that area."

For those who believe in the sort of testing and treatment being performed by Dr. Boyles, however, the V.A.'s argument is reminiscent of the Agent Orange issue.

"To what extent we understand the biomedical nature of disease is helpful," Davis of the AAEM told American Legion magazine. "But by the time we have definitive data, half the people are dead. The fact that these people are sick, on its own, is enough to demand action. It boils down to whether we're a just, honest and compassionate society, or whether veterans and MCS victims are expendable and we should just let them die."

On March 30, the V.A. announced the appointment of a 16-member panel that includes environmental physicians to look at MCS, chronic fatigue, and post-traumatic stress syndrome.

Major Haines is optimistic. "I see it as a breakthrough because 1 think that they will consider modem environmental medicine testing and treatment," Haines said. Meanwhile, Ron Brandes is still not able to return to work. As he continues to struggle daily with his illness , Major Haines continue to lobby Congress and to get information to veterans who might be sick. Dr. Boyles and other environmental physicians continue to test and treat sick veterans. And the Army and V.A., instead of providing more support for treatments that involve environmental medicine, continue treating sick veterans only in conventional ways, on an individual basis.

If you are or know of a veteran who has experienced health problems since returning from the Gulf and would like more information, contact Maj. Richard Haines at (812) 948-9366.