Gulf War Syndrome

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The Gulf War Syndrome ( english Gulf War syndrome , Gulf War illnesses , including Balkan syndrome called) is a medical term that a sum of diseases summarizes, for the first time in 1991/92 at the home-coming soldiers of the Second Gulf War ( Kuwait and Iraq was observed).

Symptoms

The symptoms that emerged in the returnees from the Gulf region cannot be attributed exclusively to post-traumatic stress disorder . These included joint and muscle pain, unusual tiredness and exhaustion, memory problems, depression, disorders of cognitive and emotional functions - these are the typical symptom groups that have now been proven by numerous studies. In addition, there are dizziness, vomiting and diarrhea , paralysis, hair and teeth loss, swelling of the glands, visual disturbances and amnesia as well as deformities in subsequently conceived Iraqi and American children. Since the same thing happened in several thousand returnees from the Second Gulf War, the American doctors summarized the disease in 1994 under the term Gulf War Syndrome.

causes

After the first descriptions of the Gulf War Syndrome, a very controversial discussion between those affected and those responsible or scientists close to the army began. In addition to suspected poison gas attacks, the use of pesticides, insect repellents, side effects of drugs (e.g. pyridostigmine bromide ), unknown infectious agents, burning oil wells and the like were reported. a. m. in particular, requests for pensions as well as psychological and psychosomatic explanatory models for these illnesses are used.

Uranium ammunition

Bullets that of low-level radioactive but highly toxic depleted uranium ( depleted uranium , DU ) which are blamed by many sources for the symptoms. However, there is disagreement about the actual hazard potential of this ammunition. Uranium ammunition in kinetic energy projectiles , machine guns and various grenades used extensively in the Gulf War. Uranium ammunition has a pyrophoric effect when atomized, i.e. it burns exothermically with the formation of poisonous oxides (ash), whereby the burn-up increases the destructive effect. In addition to being nephrotoxic , DU has also been shown to have a neurotoxic effect. While there are indications of the carcinogenic effects of depleted uranium in the laboratory, a medical study of exposed groups of people during the Gulf War found no statistical correlation, as did nephrotoxic effects (the latter were also missing in animal experiments). Depleted uranium residues in exposed war zones in soil and water were classified as low, but further monitoring is recommended.

Chemical weapons

According to official sources, no chemical weapons were used in the Gulf War . This was justified with the constant monitoring of the ambient air by measuring devices of the US Army. However, the extremely sensitive measuring devices constantly triggered false alarms, which were then attributed to other causes. On the other hand, during the Gulf War, Czech scientists were able to measure low concentrations of toxic gases in certain areas. It was not until 1996 that the US Department of Defense admitted that exposure of around 15,000 soldiers to chemical weapons such as neurotoxins was possible after the detonation of an ammunition depot in which such weapons were stored. Also, many of the symptoms are the same as those of chemical weapons such as the organophosphates sarin and tabun , mustard gas, and other nerve agents . Recent American research supports the assumption of exposure to neurotoxins.

Burning oil wells

It is discussed that burning oil wells released toxins such as dioxins . Against this assumption, the fact that firefighters who were also used to fight fires at oil wells show no symptoms of the Gulf War syndrome.

Vaccines

The Allied soldiers were treated with a range of drugs and vaccinations against the effects of biological and chemical weapons, the side effects of which are difficult to assess. A connection between emulsified squalene as an adjuvant in vaccines and the Gulf War syndrome has been refuted in studies.

Medication

Pyridostigmine bromide is one for the treatment of gravis myasthenia approved drug, which was given to the soldiers to prevent the event of a chemical weapons attack. Pyridostigmine binds reversibly to acetylcholinesterase , thereby blocking the binding sites for chemical warfare agents such as organophosphates and preventing an irreversible blockage of the enzyme. However, pyridostigmine also binds to peripheral esterases which e.g. B. are involved in the metabolic detoxification of pyrethroids . Several soldiers also complained of more or less severe side effects of the drug while taking it. A US Department of Veterans Affairs report published in November 2008 confirmed that various substances that inhibit acetylcholinesterase can cause symptoms similar to those of Gulf War syndrome. Many pesticides and chemical weapons used in the Gulf War are also acetylcholinesterase inhibitors. The soldiers were also given the antibiotic ciprofloxacin as a preventive measure , which is also suspected of having had an influence.

Insecticides and repellents

The use and spread of pesticides in the Gulf War is also unclear. First, both the British and the US Department of Defense stated that overall very little pesticide was used and that the soldiers made little use of the corresponding agents. It was not until the end of 1996 that an employee of the British Department of Defense admitted that the use of organophosphate-containing pesticides was much more widespread than had previously been officially admitted. In addition, an unknown number of soldiers used so-called flea collars containing chlorpyrifos , an organophosphate. On the one hand, the uniforms were to be impregnated with the insecticide permethrin to ward off insects ; on the other hand, the capacity of the respective factories was insufficient, so that spray cans with a permethrin-containing product were distributed to soldiers so that they could impregnate the uniforms themselves.

To repel insects, diethyltoluamide ( DEET ) was used in 75 percent ethanolic solution or as lower-dose lotions and sticks; in the USA only 30 percent preparations are allowed. DEET is also available in German commercial insect repellants, but in a lower dose. DEET can definitely have neurological side effects in overdose. In some cases, deaths from frequent use all over the body have even been reported. The frequency of use by soldiers is again unclear. Staff from the army’s own research institutes speak of a very seldom use of the funds. In contrast, independent bodies speak of more frequent use of insect repellants.

Stress and Post Traumatic Stress Disorder (PTSD)

Studies by the US Department of Defense to clarify the diseases of Gulf War veterans concluded that only mental illnesses such as B. Depression, war-related stress disorders ( Posttraumatic Stress Disorder , PTSD ) and adjustment disorders occurred more frequently than in comparable population groups. Furthermore, chemical factors are insignificant for the diseases. Haley and Wadman criticized the approach used in these studies and, in particular, the way in which the diagnosis was made. Milner et al. found that the sick soldiers were neither diagnosed with PTSD nor other psychiatric diagnoses. The U.S. Institute of Medicine also came to the conclusion in 1999 that mental illnesses were rare in the Gulf War, accounting for around 6.5% of all soldiers flown out of Asia.

Combined effects of drugs and pesticides

Abou-Donia et al. and Abou-Donia and Wilmarth found in animal experiments with chickens that the substances pyridostigmine bromide and DEET and permethrin or chlorpyrifos together develop a synergistic neurotoxic effect. Neurological deficits and pathological effects on axons were observed in the chickens, which otherwise only occur at much higher doses of DEET and permethrin or chlorpyrifos . This has been confirmed by the authors et al. a. attributed to the fact that the use of pyridostigmine lowers the breakdown rate of permethrin and DEET in the body and, in turn, increases their neurotoxicity due to the inhibition of breakdown enzymes. The results with regard to the synergistic effect of pyridostigmine, DEET and permethrin were confirmed by McCain et al. On rats.

Haley et al. and Haley and Kurt then carried out three related, army-independent epidemiological studies and concluded from their results that the combined effects of pyridostigmine bromide with organophosphates (chemical weapons or insecticides), other insecticides ( pyrethroids ) and insect repellents (DEET) with characteristic symptom complexes of the Gulf War were significant correlated.

These results from 1997 were largely confirmed by the US expert report submitted in 2008:

  1. The combined effects of the drug pyridostigmine bromide and various pesticides and repellants are the likely cause of Gulf War Syndrome.
  2. Mental illness, war-related stress or a post-traumatic stress disorder cannot explain the Gulf War Syndrome.

Other factors

There are countless other unsubstantiated theses, for example spoiled aspartame from overheated drinks (Coca-Cola Light) or damage from parasites has been considered. A short, incomplete list of further points:

Recognition as a war suffering

Since the causal link between the symptoms and the military operations was difficult to establish, the Gulf War Syndrome was denied by the US and British governments. Since the summer of 2005 it has been officially recognized by the British government for the description of diseases in soldiers. Up to 6,000 of the 54,000 British soldiers who were involved in the Gulf War can benefit from this through higher compensation. A body commissioned by the US Congress found in a paper published in 2008 that the Gulf War Syndrome was real and arose from exposure to neurotoxins during the Gulf War, several studies indicate that the syndrome was not due to combat or stress be. A combined effect of the drug pyridostigmine bromide, which was prescribed prophylactically against nerve toxins, with insecticides and insect repellants is suspected.

Critical theses

In her 1997 book Hystorien, the US publicist Elaine Showalter describes the Gulf War Syndrome as a war neurosis and criticizes the fact that the soldiers are not treated appropriately psychotherapeutically .

literature

  • Anke Bauer, Kurt Lohmann: The Gulf War Syndrome. Chemistry or psychiatry? ( Memento from March 22, 2011 in the Internet Archive ) In: Journal for General Medicine. 75: 681-683 (1999). (PDF file; 33 kB)
  • Philip J. Landrigan: Illness in gulf war veterans: Causes and consequences. In: JAMA. 1997; 277, pp. 259-261.
  • AEM Marei, LO Ruzo, John E. Casida: Analysis and persistence of permethrin, cypermethrin, deltamethrin, and fenvalerat in the fat and brain of treated rats. In: J. Agric. Food Chem. 1982; 30, pp. 558-562.

Web links

Wiktionary: Gulf War Syndrome  - explanations of meanings, word origins, synonyms, translations
Commons : Gulf War Syndrome  - collection of pictures, videos and audio files

Individual evidence

  1. ^ A b c d e Bauer, Lohmann: The Gulf War Syndrome. Chemistry or psychiatry? ( Memento from March 22, 2011 in the Internet Archive ) In: Journal for General Medicine. No. 75, 1999, pp. 681-683. (PDF file; 33 kB)
  2. ↑ Research Advisory Committee on Gulf War Veterans' Illnesses ( Memento of the original from May 10, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 12–13, December 2005, Committee Meeting Minutes, pp. 13–16 (PDF).  @1@ 2Template: Webachiv / IABot / www1.va.gov
  3. ↑ GlobalSecurity.org: Depleted Uranium (DU)
  4. ↑ G. Jiang, M. Aschner: Neurotoxicity of depleted uranium: reasons for increased concern . In: Biol Trace Elem Res . tape 110 , no. 1 , 2006, p. 1-17 , doi : 10.1385 / BTER: 110: 1: 1 , PMID 16679544 .
  5. ↑ MD Sztajnkrycer, EJ Otten: Chemical and radiological toxicity of depleted uranium. Department of Emergency Medicine, Mayo Clinic, Rochester, USA 2004, PMID 15080241 .
  6. ^ Robert H. Friis, Thomas A. Sellers: Epidemiology for Public Health Practice . Jones & Bartlett Publishers, 2004, ISBN 0-7637-3170-6 .
  7. ↑ Dalia M. Spektor, Richard A. Rettig, Lee H. Hilborne, Beatrice Alexandra Golomb, Grant N. Marshall, LM Davis, Cathy Donald Sherbourne, Naomi H. Harley, William S. Augerson, Gary Cecchine, United States Dept. of Defense: A Review of the Scientific Literature as it Pertains to Gulf War Illnesses . Rand Corporation, 1998, ISBN 0-8330-2680-1 .
  8. ^ AA Brimfield: Chemicals of military deployments: revisiting Gulf War Syndrome in light of new information. In: Prog Mol Biol Transl Sci. 2012; 112, pp. 209-230, Review, PMID 22974741
  9. ^ Research Advisory Committee on Gulf War Veterans' Illnesses. (PDF) ( Memento of the original from May 10, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. 12-13 December 2005, Committee Meeting Minutes, pp. 148, 154, 156.  @1@ 2Template: Webachiv / IABot / www1.va.gov
  10. ↑ see also: Statement on the risks discussed in connection with squalene. ( Memento from March 16, 2010 in the Internet Archive ) of the Paul Ehrlich Institute, November 12, 2009.
  11. ↑ Phillips et al: Antibodies to squalene in US Navy Persian Gulf War veterans with chronic multisymptom illness. In: Vaccine. 2009 Jun, 12; 27 (29), pp. 3921-3926, PMID 19379786
  12. ↑ a b Gulf War illness is real, new federal report says. Reported to CNN on December 9, 2008.
  13. ↑ Gregory C Gray, Han K Kang: Healthcare utilization and mortality among veterans of the Gulf War. In: Philosophical Transactions of the Royal Society B: Biological Sciences . tape 361 , no. 1468 , 2006, PMID 16687261 .
  14. ^ Robert W. Haley: Is gulf war syndrome due to stress? The evidence reexamined. In: American Journal of Epidemiology. 1997; 146, pp. 695-703, PMID 9366616 .
  15. ↑ Meredith Wadman: Critics claim US inquiry was "irreparably flawed". In: Nature . 1997; 390, p. 4, doi: 10.1038 / 36163 .
  16. ↑ Monica C. Sillanpaa, Lynne M. Agar, I. Boaz Milner, Edward C. Podany, Bradley N. Axelrod, Gregory G. Brown: Gulf war veterans: A neuropsychological examination. In: Journal of Clinical and Experimental Neuropsychology. 1997; 19, pp. 211-219. doi: 10.1080 / 01688639708403852
  17. ↑ Lois M. Joellenbeck, Philip K. Russell, Samuel B. Guze: Strategies to protect the health of deployed US forces: medical surveillance, record keeping, and risk reduction. US Institute of Medicine, National Academies Press, 1999, ISBN 0-309-06637-9 .
  18. ↑ Mohamed B. Abou-Donia, Kenneth R. Wilmarth, Ali A. Abdel-Rahman, Karl F. Jensen, Frederick W. Oehme, Thomas L. Kurt: Increased neurotoxicity following concurrent exposure to pyridostigmine bromide, deet, and chlorpyrifos. In: Fundam. Appl. Toxicol. 1996; 34, pp. 201-222, PMID 8954750 .
  19. ↑ Mohamed B. Abou-Donia, Kenneth R. Wilmarth: Neurotoxicity resulting from coexposure to pyridostigmine bromide, deet, and permethrin: Implications of gulf war chemical exposures. In: J. Toxicol. Environ. Health. 1996; 48, pp. 35-56, doi: 10.1080 / 009841096161456 .
  20. ↑ Wilfred C. McCain, Robyn Lee, Mark S. Johnson et al: Acute oral toxicity study of pyridostigmine bromide, permethrin, and deet in the laboratory rat. In: J. Toxicol. Environ. Health. 1997; 50, pp. 113-124. doi: 10.1080 / 009841097160528
  21. ^ Robert W. Haley, J. Hom, PS Roland et al .: Evaluation of neurologic function in gulf war veterans. In: JAMA . 1997; 277, pp. 223-230, doi: 10.1001 / jama.1997.03540270049026 .
  22. ^ Robert W. Haley, Thomas L. Kurt, J. Hom: Is there a gulf war syndrome? Searching for Syndromes by Factor Analysis of Symptoms In: JAMA. 1997; 277, pp. 215-222, doi: 10.1001 / jama.1997.03540270041025 .
  23. ^ Robert W. Haley, Thomas L. Kurt: Self reported exposure to neurotoxic chemical combinations in the gulf war. A cross-sectional epidemiologic study. In: JAMA. 1997; 277, pp. 231-237, doi: 10.1001 / jama.1997.03540270057027 .
  24. ↑ Nerve gas and pills made soldiers sick . In: Spiegel Online. November 19, 2008.