From a political and sociological point of view I believe it is the right thing to do to give veterans the benefit of the doubt and to accept the idea that the symptoms and illnesses that they label as Gulf War syndrome are worthy of evaluation and treatment. At minimum on that basis, I believe it is correct to provide medical care with respect to those complaints. In fact, I would go further. I have recommended that veterans deserve full medical coverage from their government without requiring the patient to prove a service connection first. (I am an orthopaedic surgeon employed by the Veterans Administration). Anyone who serves in the armed services has the potential to be put in harms way when the government determines that it is in the country’s best interest. Some pay a very high price for their service. I construe this willingness to be put in harms way as part of a social contract with the government who then has the obligation to care for those who have served.

In contrast, it is important that labels and diagnoses in medicine be based on science and strict criteria. Proper treatment and proper understanding depend upon the ethical application of science.

I believe we should be able to reassure veterans that their symptoms, illnesses, and mental health needs will be appropriately addressed and treated. In that way they will not need to feel threatened if the scientific evidence does not allow us to uniformly agree that “Gulf War Syndrome” is the appropriate diagnostic label to explain those symptoms, and they need not worry that the lack of that label would then deprive them of compassionate and adequate treatment. This would allow us to continue to treat veterans as patients and continue to study the scientific issues.

A true diagnosis cannot be achieved by consensus without science but treatment should not be withheld or compromised because of the political controversies surrounding scientific uncertainty.

Not sure why acrobat search failed you, but I found 5 cited refs co-authored by Vasterling: #127, 1520, 1708, 1709, & 1710 of the reference list.

FWIW, none of them is the 2006 JAMA paper you cited.

How can anyone who has looked at the subject objectively and critically be 100% sure they know whether GWI is real or not?

The study seems pretty sure that GWI exists, even though they don’t know what it is, and, presumably, can’t even be sure it is a single condition.

I suspect that:

If GWI is real, it is smaller than is popularly reported.
If GWI is real, it is possibly not a single distinct syndrome, but is several distinct conditions with different causes that are getting lumped together under the GWI label.

I wonder if, in the end, how much more it would cost to not expend any more time and money and resources on further study and instead provide blanket disability claim coverage for Gulf War vets similar to what was done with Vietnam vets for Agent Orange exposure. It may be easier to officially say “We don’t know, so we’ll cover it just in case.”

i had acrobat do a search for “vasterling,” and nothing came up. so, all of the neuropsych research done by jennifer vasterling and colleagues with gulf war-experienced tropps is apparently not incorporated. maybe acrobat search did not work right.

one major study from vasterling and colleagues notes neuropsych diffs between two army cohorts: similarly composed -all from Stryker Brigade, I believe – but some with Gulf war exposure and some not; extensive neuropsych battery conducted BEFORE and after on all. what more could you ask for? DK why this 2006 study not included:

Ref, and brief results:
Vasterling JJ, Proctor SP, Amoroso P, Kane R, Heeren T, White RF. Neuropsychological outcomes of army personnel following deployment to the Iraq war. JAMA. 2006 Aug 2;296(5):519-29.
“Iraq deployment, compared with nondeployment, was associated with neuropsychological compromise on tasks of sustained attention (beta = 0.11; P<.001), verbal learning (beta = -1.51; P = .003), and visual-spatial memory (beta = -3.82; P<.001). Iraq deployment was also associated with increased negative state affect on measures of confusion (beta = 1.40; P<.001) and tension (beta = 1.24; P<.001). In contrast, deployment was associated with improved simple reaction time (beta = 4.30; P = .003). Deployment effects remained statistically significant after taking into account deployment-related head injury and stress and depression symptoms. CONCLUSIONS: Deployment to Iraq is associated with increased risk of neuropsychological compromise.”

Thanks for this article, Dr. Hall.