Chemical/Biological Warfare Pre-Treatment Drug Reaction^[1]

Another area in which further research appears to be warranted is the relationship between some Gulf War Syndrome cases and the administration of the nerve agent pretreatment drug given to US troops to protect them against Iraqi gas attacks. It appears possible that the use of this nerve agent pretreatment drug may have permanently damaged some veterans' health. In addition to research on the effects of the drug itself, the possibility that these drugs might have a synergistic effect either with other drugs, or with chemical agents or other, environmental exposure, should also be thoroughly researched.

Maj. Gen. Ronald Blanck, commander of the Walter Reed Army Medical Center, has said that, "Military intelligence reports indicated there was a real possibility that Iraqi forces would employ biological and chemical weapons; in response to that threat, anthrax vaccine and botulinum vaccine were administered." The Army also gave soldiers a course of pyridostiginine bromide pills, normally used for neuro-muscular disorders. A public interest group, the Public Citizen, had filed a suit to stop experimental drugs being used on soldiers without their consent, but in the patriotic fervor immediately before the war, the suit was dismissed.^[2]

Anthrax and Botulinum Toxoid Vaccines

Maj. General Blanck has advised Committee Staff that the anthrax vaccine was administered to 150,000 soldiers and the botulinum vaccine to 8,000 soldiers.^[3] Both the anthrax vaccine and the botulinum toxoid vaccine were manufactured by the Michigan Department of Public Health. All of the anthrax vaccine is believed to be the same type of vaccine that has been administered to veterinarians and agricultural workers in the United States since the late 1950s and approved by the Food and Drug Administration in 1971. The botulinum toxoid, manufactured using techniques similar to those employed in the production of the tetanus toxoid, has been administered to medical and laboratory workers since the early 1970s. It is still listed as investigational drug (IND). These vaccines are designed to raise the body's level of antibodies should the individual come into contact with the bacteria or toxin.^[4]

While immediate local and some systemic reactions are reportedly experienced with the administration of these drugs, no information was developed by Committee staff that suggests that these vaccinations have widespread long-term risks. Nevertheless, the effectiveness of these drugs, their possible long term effects, and the efficacy of manner in which they were administered does merit further study. No other biological warfare defense program immunizations, other than those commonly administered to travelers, have been identified by Committee staff.

Committee staff has received reports of recurring rumors that experimental recombinant DNA (rDNA) biological defense vaccines were used by the military during the Persian Gulf War. No evidence of any rDNA vaccine immunization program has been uncovered thus far. In addition, there has been some concern raised about the fact that soldiers were told that the immunizations they received were "secret." The issue of the secrecy of the vaccines is one that relates to the need to deny the enemy knowledge of those materials against which your forces have been protected, rather than to the vaccines themselves.^[5]

Pyridostigmine Bromide (Group III)

During House of Representative hearings in 1993, Carol Picou, assigned to a combat support hospital during the Gulf War, recalled that when the ground war began, "we were ordered to take the drug pyridostigmine to protect us against chemical attack. Within, one hour of taking the drug, I began to experience serious side-effects, such as uncontrollable twitching eyes, runny nose, excessive frothing from the mouth, neck and shoulder pain."^[6]Dr. Sidney Wolfe, director of the Public Citizen's health research group, who filed a suit against use of the drug, said it was administered so sloppily that nobody knew who took it. Maj. Gen. Blanck said that there was a risk of minor side effects, but that these were worthwhile to be "prepared for exposure to deadly biological and chemical warfare agents."^[7]

As reported above under Group II disorders, Brian Martin also claimed to have had side effects from the drug pyridostigmine. According to Martin, the drug made him jittery and made his vision "jiggle."

Steve Hudspeth, assigned to the 1454th Transportation Company, also reported getting very sick from the nerve agent pre-treatment pills. He reported severe nausea and diarrhea that did not abate until he stopped taking the pills after two days. He recalled thinking that "if I'm going to feel like this I might as well be dead." Mr. Hudspeth currently suffers from memory loss, fatigue, sore muscles and joints, insomnia, cough, some night sweats, diverticulitis, diarrhea, kidney stones, bloody stools, urinary urgency, growth on his eye, rashes, tingling and itching sensations, and depression and irritability. ^[8]

Chemically related to pesticides, nerve agents such as Sarin, Soman, Tabun, and VX kill by interfering with the metabolic processes, and cause a buildup of a chemical messenger in the human metabolic process called acetylcholine, which operates in the gap between the nerve and the muscle cells. A buildup of acetylcholine may cause drooling, excessive sweating, cramping, vomiting, confusion, irregular heart beat, convulsions, loss of consciousness and coma. ^[9] Little, however, is known about the consequences of non-lethal exposure to these toxins.

Nerve gas pre-treatment drugs such as pyridostigmine bromide, paradoxically, also meddle with these metabolic processes by creating carbamate-inhibited acetylcholinesterase, which interferes with the actions of nerve gas -- theoretically permitting the process to be partially reversed.^[10]

An article concerning a retrospective study conducted by the military on the effects of administration of pyridostigmine bromide appeared in the August 1991 Journal of the American Medical Association. According to the article 30mg of oral pyridostigmine bromide was administered to 41,650 members of the XVIII Airborne Corps, every eight hours for 1 - 7 days while under threat of nerve agent attack during Operation Desert Storm. The study observed that "about half of the population that received the drug noted Physiologic changes that were not incapacitating. such as increased flatus, abdominal cramps, soft stools, and urinary urgency." "Approximately 1% of the soldiers believed they had effects that warranted medical attention, but fewer than 0.1% had effects sufficient to discontinue the drug. Non-incapacitating symptoms often occurred; however, the military mission was not impaired." Other symptoms noted in the article are headaches, rhinorrhea (running nose), diaphoresis (perspiration), nausea, and tingling of the extremities.

The results of this study and the coincidence of symptoms with many of those now being experienced by the veterans of the Gulf War suggests that the raw data and case histories which formed the basis for this study should be made available to researchers. This data can provide valuable information to conduct a second study of possible long term effects of the administration of this drug on otherwise healthy individuals. Further, another independent study of the additive, synergistic, or even possible potentiating effects of pyridostigmine bromide combined with organophosphate pesticides, insect repellents such as DEET, and/or trace amounts of nerve agents on key neurotransmission regulators and secondary regulators must be considered.^[11]

On April 4, 1994, several members of the 371st Chemical Company, Army Reserve Center, Greenwood, South Carolina, reported to Committee staff that elements of the unit were deployed on several occasions to decontaminate buses used to transport Iraqi enemy prisoners of war (EPWs) to detention camps inside Saudi Arabia. They were never advised of the reason these decontamination missions were necessary.^[12]

A number of military police and other units who guarded the EPWs had close and continuing contact with them. Many individuals in these units are now reporting very high rates of illnesses in their units to Committee staff. The symptoms these Gulf War veterans describe are consistent with those commonly associated with Gulf War Syndrome. Committee staff has also been informed that the 300th Medical Brigade was responsible for the EPW health care during and after the war. While the Committee has received anecdotal information regarding the health status of the Iraqis and their symptoms, certainly medical records were established and retained regarding their care while in Coalition custody.

Given the reported high rate of illnesses among these military police units, and the possible relationship between the illnesses being suffered by these veterans and those which were reported by the EPWs, the raw data from the medical units which treated the EPWs should be immediately released to aid independent research into the causes of these illnesses.

Chemical Agent Resistant Coating (CARC)

CARC coatings need to be resistant to chemicals that are required to decontaminate military equipment that has been exposed to chemical and/or biological warfare agents. After cleaning with these decontamination chemicals, vehicles treated with CARC can be placed back into service immediately, without stripping and repainting. There have been several generations of CARC coatings. According to published sources, the military specifications for these coatings vary with the type of equipment to be used.^[13]

The first generation of CARC contained lead and hexavalent chrome. Later these items were removed and the CARC was made VOC (volatile organic compound compliant). Prior to the Gulf War, the CARC specification was for a "high solids coating without exempt solvent."^[14]

Committee staff has received calls from members of several National Guard and Army Reserve Units in Florida and Michigan who were detailed to apply these coatings to U.S. military vehicles during their service in the Gulf War. According to these veterans, many members of the units are suffering from the symptoms similar to those of other affected veterans. There have also been a number of anecdotal reports received by the Committee suggesting that unprotected exposures to CARC can have neurotoxological effects similar to exposures to other neurotoxins.

According to a published report in 1993, Dr. William Johnson, formerly of the Eisenhower Army Medical Center at Fort Gordon, Georgia, noted in a report prepared for Congress, that many of these soldiers worked 12 hour days in poorly ventilated enclosures -- initially with no respirators. This report is consistent with information received by Committee staff.

While these duties were certainly necessary to perform, the failure to provide appropriate safety equipment to these individuals should be investigated further, not only for its impact on the health of the individuals but also for its impact on the ultimate readiness of these units to perform their mission. The chemical nature and the hazards associated with exposure to the various CARCs should be easily identified. Further, a study into the rates and types of illnesses being experienced by these units could be easily undertaken since the units would be readily identifiable.

Committee staff has developed no information to date that suggests these coatings represent a hazard once they are applied and cured.

Depleted Uranium Ammunitions

Several different armor-penetrating munitions used during Operation Desert Storm were tipped with depleted uranium (DU) and encased in aluminum. The Persian Gulf War marked the first time such shells were used in combat. The penetrators are made of uranium rods from nuclear power plants and according to James Mathews, in an article that appeared in the Journal of the National Cancer Institute in July 1993, the uranium is depleted of the more volatile material, including the potent isotopes U-235 and U-238. ^[15]

According to Mathews, "When depleted-uranium penetrators strike their target, the aluminum covering is torn away and a large portion of the kinetic energy is dissipated as heat. The heat of the impact causes the depleted uranium to oxidize or burn momentarily."^[16]

When uranium particles enter the body, they become lodged in bones or major organs, affecting the bone marrow and producing DNA damage. In previous congressional testimony, Mathews reports, Maj. Gen. Ronald R. Blanck, commander of Walter Reed Army Medical Center, Washington, D.C., stated that "careful analysis of [servicemen exposed to] depleted uranium suggests there will be no significant increase in risk to health, either in the short or long-term." Medical evaluations have been conducted by the Boston VA Medical Center on a number of soldiers identified as having the greatest potential for inhaling or ingesting depleted uranium dusts, mainly soldiers that prepared damaged battlefield vehicles for shipment back to the United States.

"The results of those examinations have shown no effects of uranium toxicity, and no uranium residues or byproducts were detected," said Blanck.^[17]

The U.S. Armed Forces Radiological Research Institute is conducting a five year study into the hazards associated with U.S. military equipment and munitions that use depleted uranium. The preliminary results of that research should be made available to researchers and physicians to provide a basis for determining if exposure to unexpended or expended depleted uranium munitions is a serious health hazard.

Finally, individual dosimeters were reportedly issued to many of the soldiers who fought in the Persian Gulf War to measure radiological hazards. It has been reported to Committee staff that at least some of these dosimeters were collected from the soldiers who participated in the conflict prior to their leaving the Gulf.^[18] In order to facilitate the research currently underway, and to provide information to researchers as to the level of exposure by location, the Department of Defense should release information regarding the readings from these dosimeters. If this information is not readily available, the National Institute of Standards and Technology could easily assess the level of emission related to these materials, if necessary, to provide information to both scientific and medical researchers attempting to find a cause for the illnesses being experienced to those individuals who may have been exposed to these materials. This information is also vital to ensure that if a danger exists, appropriate safeguards will be taken, whenever possible, in future conflicts.

Environmental Exposures

With the initiation of the "ground war" on February 24, 1991, Iraqi forces set fire to over 600 oil wells located inside Kuwait. The contamination from these fires had a dramatic impact on the environment and the smoke was so thick that often there was darkness. In the areas where the fires were burning, Coalition soldiers were covered with and inhaled oil and soot. Even when they were able to shower, often they had no clean uniforms to replace the oil soaked ones. Other environmental hazards that have been previously considered include heater fuel fumes, pesticides, insect repellent, petrochemicals, and electromagnetic radiation from radar’s and communications equipment. While many researchers have discounted these exposures as causing Gulf War Syndrome since these exposures are not unique to the Gulf War environment, nevertheless, the results of the research that has been conducted in these areas by the Department of Defense and the Department of Veterans Affairs, including available data sets, case histories and diagnostic breakdown information, must be made available to assist medical researchers in furthering their research, and physicians in treating their patients.

Beginning in November 1993, Committee staff began receiving reports that a number of Department of Defense civilian personnel at the Anniston, Alabama and Sharpsite, California Army Depots were beginning to experience symptoms consistent with those of the Gulf War veterans. These individuals were assigned to clean, repair, and upgrade military vehicles and other equipment returning from the Southwest Asia theater of operations.^[19]

No further information has been developed regarding these reports. Further investigation, however, appears warranted into what, if any, hazardous substances may have been transported on equipment that would cause these symptoms. This type of information may assist in narrowing the scope of the research in determining the causes of Gulf War Syndrome.

Over the past seven months, Committee staff has interviewed in varying detail over 1,000 Gulf War veterans who claim to be suffering from many of the symptoms commonly associated with Gulf War Syndrome. As a result of these interviews, it has been learned that most of the spouses and many of the children of Gulf War veterans are suffering from many of the same symptoms. Several published reports have recently appeared that suggest that Gulf War Syndrome may be transmittable, that it may be causing miscarriages, and that it may be causing birth deficiencies and some birth defects in newborns. ^[20]

During a February 21, 1994 Gulf War veterans round table meeting held in Lansing, Michigan, Chairman Donald W. Riegle, Jr. met with 9 Gulf War veterans and their wives to discuss their health problems. Of the 9 Gulf War veterans present, 20 additional individuals in their immediate families who were also suffering from many of the same symptoms were also identified.

In an effort to determine the scope and nature of symptom transmission, a survey of those individuals who have contacted the Committee is currently underway. The purpose of the survey is to determine the symptoms currently being suffered by the Gulf War veterans, those being transmitted to family members, and the number and rate of birth deficiencies being experienced within this population. The final results of this survey will not be available until later this year.

The issue of the possible transmission of Gulf War Syndrome is one that recrafts the issue of national security. Surely there are some aspects of the Department of Defense's chemical and biological warfare defense programs that merit secrecy. However, when the secrecy of those programs interfere with the safety of the citizenry, then one must understand that the notion of national security rests primarily in the security of the people and not in the secrecy of vulnerability.

Conclusions

The ability of someone to resist an illness, disease, or the adverse effects of a medication varies with each individual. Not everyone who received nerve agent pre-treatment drugs exhibited adverse effects. According to the Centers for Disease Control not everyone who is exposed to nerve gas will cross a toxic threshold at the same time. Certainly, there is a threshold beyond which such exposure will surely be lethal. This is what has come to be accepted as the effect of nerve gas exposure.

The results of this investigation suggest that there is, in fact, a relationship between dosage and harmful effects. A number of units who believe they suffered a direct chemical weapons attack report illness rates over 50%. The Czech chemical decontamination unit, which suffered only indirect exposure and might be expected to be well prepared against chemical exposure, reports an illness rate of 10%. The extent of exposure in the larger population in the Gulf at the time, and the rate of illnesses, is unknown. The number of Gulf War veterans who have signed up for the Persian Gulf Registry examination is now over 17,000.

Nerve agents like Sarin Kill by disrupting the metabolic processes, causing a buildup of a chemical messenger (acetylcholine) by inhibiting the production of acetylcholinesterase, a key regulator of neurotransmission. Nerve agent pretreatment drugs (NAPP) administered to U.S. servicemen and women, such as pyridostigmine bromide, also disrupt these metabolic processes by creating a carbamate-inhibited acetylcholinesterase, which preempts the action of the nerve agent. Several veterans suffering from Gulf War illnesses have testified before House and Senate Veterans Affairs Committee and believe that these illness are related to the permanent adverse side effects from this drug. Further, the efficacy of the biological warfare defense inoculations merits further research.

The evidence cited above and the statements of the witnesses will have to be evaluated on their own merits in this regard. During the course of this investigation, a medical questionnaire was received from one of the veterans currently suffering from Gulf War illnesses. This questionnaire like, the other evidence and statements must be weighed on its own merits. The following information is solicited on this document, an overprint to SF600:

1. What diseases of injuries did you have in the Southwest Asia region?

2. Are you receiving any medicine, or other treatment, at the present time?

3. Do you have fever, fatigue, weight loss, or yellow jaundice?

4. Do you have any swelling of lymph nodes, stomach, or other body parts?

5. Do you have any rash, skin infection, or sores?

6. Do you have a cough or sinus infection?

7. Do you have stomach or belly pain, nausea, diarrhea, or bloody bowel movements?

8. Do you have urinary problems such as blood or stones in urine or pain and burning with urination?

9. Have you had nightmares or trouble sleeping?

10. Have you had recurring thoughts about your experiences during Desert Shield/Desert Storm?

11. Do you have any reason to believe that you, or any members of your unit, were exposed to chemical warfare or germ warfare?

Forms such as this suggest that the military expected, for whatever reason, to see symptomologies such as those that are currently being experienced. This information, as well as the information maintained in the medical records of U.S. Forces and the Iraqi EPWs may provide information that will assist medical researchers in determining causal links. This issue should be further investigated.

The Need for Immediate Primary Scientific Research and Advanced Medical Research

Thousands of veterans of the Gulf War are reporting symptoms of memory loss, muscle and joint pain, intestinal and heart problems, fatigue, rashes, sores, and running noses. A number of veterans who have exhibited these symptoms since returning from the Gulf War have subsequently died. Physicians have been unable to diagnose the cause of the disorders.

The following symptoms have been identified as those most commonly reported by veterans:

• recurring severe headaches
• fatigue
• joint and muscle pain (particularly in knees, ankles, shoulders, and back)
• memory loss (often described as an inability 'to concentrate)
• recurring rashes (sometimes severe and often causing skin discoloration or described as mosquito bite-like or small with watery pustules)
• lumps at joint areas
• lumps under skin
• depression, irritability
• night sweats
• insomnia
• urinary urgency and frequency
• diarrhea (sometimes bloody) or constipation
• gastrointestinal problems (nausea, swollen stomach, gas)
• dizziness or blackouts
• blurry vision
• photosensitivity (excessive sensitivity to bright lights)
• shortness of breath
• coughing

Symptoms most commonly reported by veterans (cont.):

• abnormal hair loss
• bleeding gums (or other serious dental problems)
• swollen lymph nodes
• sinus infections
• chest pains

female veterans only:

• chronic or recurring vaginal yeast infections
• menstrual irregularities
• excessive bleeding and severe cramping

Little is known about the long-term consequences of exposure to low levels of nerve gas, and even less about complications, which might arise from using combined agent weapons. Further, little is known about other difficulties associated with interfering with the neurotransmission process. Non-lethal exposure to pesticides, however, has manifested itself in memory loss. Nearly every bodily process requires a properly functioning nervous system to operate.

The following is a summary, not offered as diagnostic evidence, suggesting how some of the symptoms noted could be rooted in neurotransmission-related disorders:

Memory-loss: Although neuroscience is a long way from explaining the memory functions of the human brain, considerable strides have been made towards understanding how neurons are modified by experience and how those modifications are maintained for extended periods of time. The ability to remember is regulated, however, by neural processing.^[21] On August 25, 1993, Dr. Howard Hu, a researcher with Physicians for Human Rights who participated in the investigation of the use of nerve gas by the Iraqi government against the Kurds, suggested that the effects of non-lethal exposures to nerve agents could be similar to those involving non-lethal exposures to pesticides. Dr. Hu said these disorders are generally neuropsychological and include memory loss. ^[22]

Muscle Pains: Myasthenia Gravis is a disease causing progressive muscle weakness. It has been shown that the disease is an autoimmune reaction to the acetylcholine-gated channels in the neuromuscular junction. According to Lloyd D. Partridge and L. Donald Partridge, many drugs and toxins, including pesticides and nerve gas, are known to exhibit their effects through specific actions at the neuromuscular junctions, blocking the action of acetylcholinesterase. ^[23]

Joint Pains: When the force generated by a muscle acts on a load, there is a requisite exchange of energy between the muscle and the load. A failure of the nervous system to send impulses to effector muscles can result in the failure of effector muscles to provide the resistance necessary to protect joints from excessive torque. This failure, and the resultant joint pain, is consistent with the action of any agent or medication which functions by disrupting the communication process operating in the gap between the nerve and the muscle cells. ^[24]

Gastrointestinal Disorders: As a combined neural operation, the neural signals that control digestive functions, such as in the complex nervous system of the gut, are largely, but not entirely, independent of the central nervous system (CNS). Many of the control functions are conducted by local nerve networks and the endocrine systems. These digestive functions, however, depend on the ability of the CNS and local nerve networks to function properly. ^[25]

Heart problems, running noses and virtually every other problem lumped under the heading of Gulf War Illnesses can be explained by neurophysical and neuropsychiatric disorders. Some of the non-chemical warfare related diseases involving a disruption in the acetylcholine-gated channels in the neuromuscular messenger junctions, such as myasthenia gravis, while treatable, are irreversible. Neurotransmission disorders resulting from disrupted physiological processes, such as those regulating acety1cholines (including toxin acetylcholine and acetylcholinesterase) may be the contributing to the symptomologies observed. Detection of these types of disorders may only be possible using highly sophisticated, computer-read electroencephalograms (EEG). Further, given the possibility that some of these individuals were exposed to biotoxins and other biological agents, scientists and physicians will need to use sophisticated procedures including DNA plasmid screening, bacteriological screening, mycological screening, viral screening, and toxicological screening.

Conclusions

Thousands of American servicemen and women are reportedly suffering from memory loss, muscle and joint pain, intestinal and heart problems, fatigue, rashes, sores, and running noses as a result of their service in the Gulf War. A number of veterans who have exhibited these symptoms since returning from the Gulf War reportedly have died. Members of their immediate families are now beginning to contract some of the illnesses. Physicians have been unable to diagnose or treat the cause of the disorders.

Despite the Department of Defense's position that no evidence exists for exposure to chemical warfare agents during the Gulf War, this investigation is establishing that there is substantial evidence supporting claims that U.S. servicemen and women were exposed to low level chemical warfare agents and possibly biological agents and toxins from a variety of sources. This exposure may account for many of the Gulf War Illness symptoms. Little is known about the long-term consequences of exposure to low levels of nerve gas, although most are known to have cumulative toxic effects.

Even less is known about complications, which might arise from exposure to combined agents and combined agent weapons. The combined agent strategy is intended to frustrate efforts at diagnosing these illnesses. Non-lethal exposure to pesticides can result in memory loss, and nerve agents are chemically related to pesticides. Many of the veterans complaining of Gulf War Syndrome illnesses suffer from, among other disorders, memory loss. Many of the identified chemical and biological agents interfere with the body's neurotransmission processes, affecting the regulation of acetylcholine, neurotoxin acetylcholine, and other necessary enzymes required by nearly every bodily process. In order to detect irregularities such as those which might be caused by exposure to nerve gas, computer-read electroencephalograms are needed; a physician probably would not be able to recognize the abnormalities in during a visual EEG interpretation.

If biotoxins or biological agents were used or released in the Gulf War, detection requires that physicians and scientists have some idea of what they are looking for. Further, if mycotoxins or viruses were used or released, they would be difficult to detect without the aid of advanced laboratory screening methods.

Non-lethal exposure to chemical warfare agents, some biological agents, mixed chemical/biotoxin agents and/or the administration of nerve agent pretreatment drugs could explain many of the symptoms of the Gulf War illness, as well as the inability to diagnose the disorders. Other possible causes for Gulf War syndrome have been suggested, such as exposure to pesticides, petrochemicals, burning landfills and oil wells, depleted uranium from anti-tank munitions, or exposure to other environmental hazards. Many of these possibilities already have been investigated and discounted. Additionally, these types of exposures are not specific to the Middle East or to the Gulf War and the evidence for these hazards causing the large number of unexplained illnesses is less than compelling. Each of these possible causes of unexplained illnesses, however, should be systematically researched.