Gulf War Syndrome, Round 38

Don't believe the latest hype.

Here we go again.

"VA, DoD find Lou Gehrig Risk in Gulf War Service," boomed the Copley News Service. "U.S. Reports Disease Link to Gulf War," proclaimed the New York Times. It's "A Measure of Vindication for Ailing Gulf Vets," declared the Raleigh News and Observer. All the major TV news broadcasts ran with the story about the new study, providing an identical spin.

This game has continued for eight years now, and as always the pawns are America's vets. Somebody purportedly finds a link between Gulf service and some health problem. But the studies are either unreproducible or outright refuted. This one is different in only one way, but it's a big one.

The Defense Department, exhausted by years of defending itself against charges of cover-ups and callousness, finally -- indeed eagerly -- capitulated. It announced it would immediately start paying benefits to any Gulf War vet with the muscle-wasting and ultimately fatal disease amyotrophic lateral sclerosis (ALS). Such payments are labeled "presumptive," because ALS can strike anyone and no vet will ever be able to prove that, but for his service, he wouldn't have gotten it.

The dam is now cracked and will probably soon begin to crumble. We will begin making presumptive payments for more and more illnesses among Gulf vets. And that's a shame for several reasons.

First, the study (paid for by Defense Department and the VA) is worthless. Second, even if the study were valid, it would not -- indeed could not -- establish the existence of a Gulf War Syndrome, yet that's how it's being used. Seven hundred thousand Gulf vets and their spouses will now live in permanent fear of contracting something that doesn't exist.

Here's what's wrong with both the study and the uncritical response to it.

The secretary of veterans affairs, Anthony Principi, has called the study "preliminary," and with good reason. It is not finished, it has not been published, it has not been reviewed by other scientists, and in the wake of the announcement, it still wasn't available for outside critique.

Conversely, there have been a plethora of previous studies making every possible health comparison between Gulf vets and non-Gulf vets. They looked at specific diseases and complaints, all diseases combined, hospitalizations, deaths, diseases in offspring, and miscarriages. Many were published in peer-reviewed medical journals, such as The New England Journal of Medicine and the American Journal of Epidemiology. None found any links between Gulf service and illness.

Even Principi admitted that two prior studies had specifically looked for an ALS link and found none. A major British study also looked for an ALS link and it found none. Why should an aberrational study become the defining one?

Yet this study actually wasn't aberrational: It too found no link between ALS and Gulf service. Here's what it did find.

Of the nation's 700,000 Gulf vets, 40 were identified with ALS. Among 1.8 million vets who didn't deploy to the Gulf, 67 cases were identified. Adjusting for age and other variables to which we are not privy, that comes out to a risk of contracting ALS of 6.7 per million among Gulf vets, and 3.5 million among non-deployed vets. That's the doubling that Principi spoke of and the media parroted.

But a more accurate way to express the numbers is that the expected rate of cases among Gulf vets, according to the researchers, was 33 and instead there were 40. That's a mere 21% elevation. Suddenly the differences between the groups don't look very different. It looks like chance variation could easily affect the outcome.

This is all the more so when you look at the breakdown between the services.

Curiously, the highest rate of ALS was among Air Force Gulf vets, who had 2.7 times that of their non-deployed counterparts. Army soldiers had twice the risk, and Navy and Marine Corps veterans did not show rates of disease that were statistically higher than those not deployed. Yet Air Force servicemen were least likely to be in forward areas, where all the alleged toxins were. (You might think the Navy had few personnel in forward positions, but sizeable numbers of Navy combat engineers were in the area.)

Are blue uniforms a risk factor for ALS? Doubtful. This merely shows that when you're dealing with a tiny number of cases in a huge overall population, just a few can cause a huge statistical swing. Resample these groups in a couple of years and the apparent increase may well disappear.

That has been the experience of the Air Force researchers who for decades have followed a group of men who sprayed Agent Orange and as a result had extremely high exposures. One year there would be an excess of one disease but three years later it would disappear, only to be replaced by a slight excess of another. The latest slight excess is diabetes, but that too could well disappear by the next examination time.

What's more, it turns out that whether the Gulf vets actually had any excess of ALS depends on the group to whom you compare them.

An exact comparison to the civilian population is impossible because, as noted, the researchers didn't release their data. But the incidence of ALS in the U.S. male population is about two per million per year. So for 1.8 million such persons over ten years we'd expect 36 cases. Consider that the vast majority of vets deployed were men, that men are 50% more likely to get ALS than women, and that there are almost no ALS cases in persons under age 20 and -- voila! -- the rate of ALS among Gulf vets appears to be about the same as among civilians.

It's not that the Gulf vets are sicker than we would expect, but that the non-Gulf vets are healthier.

Arguably vets are the better control group, but this does call into question compensating people who have disease rates no higher than civilians. And again it shows that tiny numbers lead to unreliable outcomes -- or outcomes that can be thrown off by the smallest of errors.

The study also committed a whopper. The researchers told the New York Times that they identified ALS cases among Gulf vets in part by appealing to GWS activist groups. There are no activist groups for the non-deployed vets they used as controls.

This would be like conducting a public opinion poll in which the men surveyed were drawn from liberal groups and the women surveyed were contacted by random dialing, then announcing that the results show men are more likely to be liberals.

In short, every headline about the study should have been a variation of "Yet Again, No Link Found between Gulf Service and Illness." But even if the study had shown a link -- indeed, even if it had shown a cause-and-effect association -- it could not establish the existence of this beast known as Gulf War Syndrome.

The findings applied to a mere 40 vets and one illness. Yet tens of thousands of Gulf vets (150,000 according to the Raleigh paper, using a fabricated number) have complained of over 120 different illnesses that they claim are service-connected. Does establishing that a man robbed one bank prove that he robbed a thousand?

No matter; the activists have spoken and the media have given them a bullhorn. As U.S. News & World Report put it, "The findings were heralded by some veterans groups as a major victory in their 10-year fight to have their symptoms connected to their deployment in the gulf."

A Boston Globe editorial touting the study said, "At a time when US soldiers are again in harm's way, the military must be alert to all possible hazards." Right. That includes the hazard of telling soldiers going into harm's way that while they may survive the war unscathed, they could actually become exposed to some undetectable sort of magical pixie dust that will make them sicken and die years or even decades later. There's never a good time for nonsense like this, but during a war is the worst time of all.