DANKOSKY: So Dr. Steele, what do we know about the causes? Because there have been a number that we've heard about over the years. Maybe we can run through a few of them. One of the things that is mentioned sometimes is stress or PTSD, something that we've heard a lot about from these last few wars, Iraq and Afghanistan. How much does stress have to do with it, do you think?Why is it, that if someone postulate that "stress" (or "lack of resilience" or some other "psychological fault" of the patient) is causative for a (hard to grab) disease, that there is so little scepticism? Why are people not challenged more if they spread their "psycho-stress confusion"? And we are not talking here about physical stress, no here supposed psychological stress (combined with some sort of supposed defect of the patient) should be able to cause physical disease like GWI? A disease that is unique to the gulf war veterans?
STEELE: That's a really good question. I think for many years after 1991, after the war got over, a lot of folks really didn't know what to make of Gulf War Illness or Gulf War Syndrome. But at this point, now 22 years later, we actually have a lot of students that tell us a lot about what may have caused Gulf War Illness.
Most of the studies early on looked at things like stress and post-traumatic stress disorder, but we now know very definitely that Gulf War Illness, specifically in 1991 Gulf War veterans, is not a stress-induced or trauma-induced kind of disorder. The rates of things like post-traumatic stress disorder are very low in 1991 Gulf War veterans, much lower than we're seeing in current returning veterans from Iraq and Afghanistan.
However, there is a long list of potential causes that different people have looked at over the years, many things like the vaccines that veterans receive, the oil well fires that many of us remember from that time, all kinds of chemical toxicants that they were exposed to.
And just looking over the broad range of studies, at the many epidemiologic studies that have been conducted in this population, we know that several of these risk factors or toxicants have risen to the top in terms of the strength of evidence that suggests that they are connected with Gulf War Illness.
And at this point we can say that the highest risk factors relate to use of prophylactic medication given to veterans to protect them from nerve agents. That pill was called pyridostigmine bromide. In addition, there was extreme overuse of pesticides in some groups of veterans during the 1991 Gulf War. And so those are also linked to higher rates of Gulf War Illness.
And then we also know that some veterans were exposed to very low levels of nerve agents during the Gulf War, and there's also some evidence supporting an association between Gulf War Illness and the nerve agent exposures that happened during and after the war.
Overall, though, the studies consistently show no link between for example serving in combat and higher rates of Gulf War Illness.
I'm sure the Theologians of the Wessely School have an explanation for why there are so many gulf war veterans have GWI – this will be an explanation however that does not create clarity, but an explanation that creates confusion instead…