Resolving the Gulf War syndrome question.

One central health question remains unanswered 7 years after the war with Iraq: Is there a "Gulf War syndrome"? Within a few months of returning home in 1991, some of the 750,000 Gulf War veterans from the United States, Great Britain, and Canada began complaining of fatigue, headaches, joint pains, sleep disturbances, cognitive difficulties, and other physical (somatic) symptoms (1). Approximately 1 year later, these diverse symptoms were conceptualized as a unique health problem, which has become the subject of intense scrutiny and controversy (2, 3). Greater than 10 percent of veterans have been clinically evaluated for illnesses possibly related to service in the Persian Gulf (4-7). Most of the illnesses reported by veterans were found to be caused by wellknown medical and psychologic conditions, but in about 20 percent of examinations, physical symptoms could not be definitely explained (5-7). Numerous assessments have suggested possible links between unexplained symptoms and various wartime health risks, including psychologic stress and exposure to chemical and biologic warfare agents, pesticides, pyridostigmine bromide prophylaxis, depleted uranium, oil well fire smoke, vaccinations, and endemic infectious diseases (7). A series of six expert panels in the United States have analyzed available scientific data but did not identify a unique "Gulf War syndrome" (8-13). The inability to confirm a distinctive syndrome has generated much frustration among health care providers and researchers trying to aid Gulf War veterans and has led to both frustration and mistrust among veterans and their representatives, the media, and various review groups. Several explanations have been offered for the failure to confirm a unique physical disease among Gulf War veterans with unexplained symptoms, despite extensive clinical and research efforts. An examination