Thursday, September 30, 2004

Gulf War Syndrome Revisited
How Seriously is Our Government Looking Out for the Troops?

As reported on Medscape News, researchers have found evidence of an abnormality in the functioning of the autonomic nervous system in a small group of patients with GWS. The abstract of the article -- Blunted circadian variation in autonomic regulation of sinus node function in veterans with Gulf War syndrome -- is here, and the news report about the research is here. They studied 22 veterans with GWS and 19 matched controls. They found a loss of normal functioning in the parasympathetic branch of the autonomic nervous system.

The autonomic nervous system (ANS) is a subset of the nervous system. It consists of two parts: the sympathetic and the parasympathetic systems. The ANS connects the brain with major organs, and is involved in regulation of such functions as heart rate and blood pressure.

In the veterans with GWS, there was a loss of functioning in the parasympathetic system. Normally, the heart rate slows during sleep. This did not happen in the GWS group. The findings are similar to that which is seen in early diabetic neuropathy.

Unfortunately, the findings do not suggest any particular course of treatment, nor do they provide much indication of the possible causes of GWS. The study is notable for two reasons, though. One is the very low P values recorded for the differences seen between the patients and the controls. This indicates that the investigators are on to something real, even if the significance is not entirely clear at this point. Second, the study shows that scientists are taking the issue seriously. That was not the case early on. If fact, as this Congressional record shows, the UK pursued this problem more aggressively that the US did. The UK testimony, given by one of the authors of the study on autonomic dysregulation, is here. This document provides a synopsis of the research on GWS, for the technically inclined. The author, Robert W. Haley, M.D., is less than pleased with the efforts of the US government:

Right now I am encouraged at the progress that has been made in understanding the new type of brain cell damage that appears to underlie Gulf War veterans’ symptoms. Up to a year or so ago, anyone who would give credence to anything other than stress as a cause of the problem was a pariah, but we are now seeing a broad change in viewpoint in the scientific community. Just last month I attended an NIH-sponsored meeting on responding to chemical terrorism, and the scientists in attendance were discussing the chronic brain effects of sarin nerve gas as a given. So the good news is that the bureaucratic resistance to research toward a biological explanation has finally been overcome, and the scientific world is poised to jump in and study the problem broadly. The bad news is that, just as clear directions are emerging for productive research to begin, funding for research on this problem has dried up.

I'm not quite sure what to make of his last point. One would think that, if the government is serious about its commitment to the health of our soldiers, the funding would not be cut. It seems especially surprising if there is evidence that the same research would have applications in the understanding of the effects of chemical weapons. Sure, if there is a chemical attack in the USA, using nerve gas, a lot of people could be killed; the research would not help them, but it could be extremely important to those who survive.