Invited commentary: how would we know a Gulf War syndrome if we saw one?

Abstract

Here we address a general issue raised by questions about the Gulf syndrome and toxic exposure to troops engaged in the Persian Gulf War: where and how does a new category of illness or disease become established, and how can that process be improved? Persian Gulf War veterans have reported health problems that many suggest are related to service in that war during the period 1990-1991. A variety of complaints have been recorded by health care providers throughout the country, but, for the most part, these have not resulted in a clear diagnosis or explanation except for a very small number of complaints which have led to clear diagnoses such as leishmaniasis or malaria. Several distinguished review panels have examined the evidence that service in the Gulf is related to alleged chronic health problems (1-6). While these reviews have caused participants to be impressed and concerned about the veterans' complaints, no review panel has arrived at a definitive understanding of the veterans' illnesses. The review panels generally agree that there is unlikely to be a single explanation for the veterans' complaints. Consequently, health scientists supported by both private and public funds have been engaged in laboratory, clinical, and epidemiologic studies to find the cause or causes of the illnesses. Stress related to war, historically associated with health problems (7), as well as particular features of the Gulf War (major involvement of reserve troops, first major conflict with a volunteer force, substantial number of women soldiers) have been regularly cited as important contributors to complaints and disability among Gulf War veterans. An unknown number of