Pesticides and Multiple Chemical Sensitivity [MCS]
Multiple chemical sensitivity is a disease that is being debated throughout the medical field. While a number of leading medical organizations have published papers that question the existence of multiple chemical sensitivity its diagnosis and its possible treatment, ¹³⁹ a growing number of physicians and scientists have accepted the basic premise that exposure to a wide range of chemicals existing in the modern world can produce synergistic effects and cause a variety of health problems.
MCS expert Dr. Claudia Miller of the University of Texas Southwest Medical Center at san Antonio has focused her research, and co-authored several books over the past 9 years on patients who report developing chronic illnesses and chemical intolerances. These illnesses follow low level exposure to various chemicals, including pesticides, solvents, and combustion products. In subcommittee testimony, she stated: "In 1995, we published a study of 37 patients who had been exposed to pesticides . . . who subsequently reported developing multi-system symptoms and new-onset chemical, food and drug intolerances. Eighty percent of these individuals . . . were no longer able to work or could only work part- time because of their health problems."¹⁴⁰
Dr. Miller testified that common symptoms reported by these patients at the time they were exposed were often flu-like illnesses, fatigue, concentration difficulties, headaches, shortness of breath, musculoskeletal pain, and gastrointestinal symptoms. The patients also reported, according to Dr. Miller, "new and unusual intolerances for common chemicals such as fragrances, traffic exhaust, gasoline, and household cleaning products. In addition, many found they could no longer tolerate alcoholic beverages, various foods, caffeine, and medications."¹⁴¹
Beginning in 1992, Dr. Miller was asked by the Houston VA Medical Center to consult on the first group of sick Gulf War veterans. Dr. Miller evaluated 75 veterans and testified that "These veterans' symptoms and their frequent reports of new-onset intolerances to chemicals, foods, and medications, reminded me of the civilians we studied with histories of exposure to organophosphate of carbamate pesticides or to mixtures of solvents at low levels. Comparison of eight symptom scales derived by factor analysis revealed similar ordering of symptoms in the Gulf veterans and the pesticide-exposed civilians."¹⁴²
Pesticides and insect repellants were heavily used before, during and after the Gulf War, according to Albert Donnay, executive director of the MCS Referral &: Resources in Baltimore. Information he received from the DOD indicates that 21 different pesticides were used but no records were kept of amounts used, what they were used for, or who applied them.
In a memorandum to the Human Resources subcommittee, Mr. Donnay stated: "Officials in DOD responsible for pesticide use have told me that they kept no records of pesticide use during the Persian Gulf deployment. We urge DOD to focus on the chronic effects of pesticide exposures, not just the two pesticides currently being studied (DEET and Permethrin), but all 21 pesticides that the DOD admits sending to and using in the Persian Gulf during Operation Desert Shield and Desert Storm." Mr. Donnay wrote that organophosphate pesticides [showed that] . . . of the top 10 pesticides associated with MCS reports from 1984-1990 by the EPA-funded National Pesticide Telecommunications Network, 7 are on the DOD list of those used in the Persian Gulf. Even if the veterans' exposures to nerve agent fallout were not enough to induce illness, the DOD failed to consider how these may have interacted synergistically [emphasis added] with the veteran's extensive exposure to chemically similar pesticides. None of the CCEP [DOD's Gulf health registry] reports published to date discuss MCS data. We are concerned that MCS [data] was abandoned without any analysis . . . and data are now being withheld from qualified researchers."¹⁴³
The PAC report states, "The Committee concludes it is unlikely that health effects and symptoms reported today by Gulf War veterans are the result of exposure to pesticides during the Gulf War. Lindane is an animal liver carcinogen, but it is too early to see an elevated liver cancer rate in Gulf War veterans." The PAC report draws no conclusion about MCS, but comments that "There is no consensus case definition for MCS, although two recent government-sponsored conferences have attempted to develop one."¹⁴⁴

D. ACUTE V. CHRONIC EFFECTS OF LOW LEVEL CHEMICAL EXPOSURES

In testimony before the subcommittee, Dr. Stephen Joseph, formerly DOD's Assistant Secretary for Health Affairs, stated, "Current accepted medical knowledge is that chronic symptoms or physical manifestations do not later develop among persons exposed to low levels of chemical nerve agents who did not first exhibit acute symptoms of toxicity."¹⁴⁵ This unequivocal statement became the basic medical policy of DOD and VA in terms of diagnosis, treatment, compensation and research of the illnesses affecting thousands of Gulf War veterans.
Dr. Claudia Miller, an expert on low level chemical exposures, stated before the subcommittee that Dr. Joseph's statement was not necessarily true. "I think it is premature for anyone to say that low levels of organophosphates cannot cause chronic health problems," Dr. Miller said. "There is a lot of literature now suggesting that is quite a possibility and there are ways to approach that question scientifically."¹⁴⁶
"Sarin was not the only organophosphate-type exposure soldiers may have encountered in the Gulf: pesticides in this chemical class and pyridostigmine bromide, a related carbamate drug, were also widely used," Dr. Miller stated. "There are now several studies, in addition to our own, linking chronic, multi-system symptoms to [low level] organophosphate/carbamate exposure."¹⁴⁷
Dr. Stephanie Padilla, Environmental Protection Agency [EPA] neurotoxicology expert, agrees. In subcommittee testimony, Dr. Padilla said, "Exposure to organophosphates may produce residual adverse effects . . ." and cause ". . . organophosphate-induced-delayed-neuropathy [OPIDN]. Recent studies . . . indicate there may be long-term health effects associated with exposure . . ." and ". . . one [study] concluded that 'results clearly indicate that there are chronic neurological sequelae to acute organophosphate poisoning. . . .' "¹⁴⁸
In response to Dr. Joseph's statement that chronic symptoms from low level chemical exposure do not later develop unless acute symptoms first appeared, Dr. Padilla testified that pyridostigmine bromide, the anti-nerve gas tablets which the troops were required to take, would dampen or "mask the acute effects" of chemical exposure.¹⁴⁹
The subcommittee also learned that a 1974 study of low level chemical exposures, conducted by Dr. Karlheinz Lohs, then director of the Institute of Chemical Toxicology of the East German Academy of Sciences, concluded that "mustard CW agents are capable of producing a wide range of mutagenic, carcinogenic, hepatotoxic [causing liver damage] and neurotoxic effects. It is important note that even in the case of exposure to very slight amounts which do not necessarily bring on acute symptoms, toxic reactions may set in. How far this may lead to nerve-cell, hematopoietic or parenchymatous lesions depends largely on the state of health of the individual (for example, previous injury to any particular organ), duration of exposure or intervals between exposures and, last but not least, on individual 'detoxification capacity' (enzymatic polymorphism, genetic disposition, and so on.)"¹⁵⁰
Dr. Joseph was not familiar with the Lohs study.¹⁵¹
Also in the 1970's, Dr. Frank Duffy, associate professor of neurology at Harvard University Medical School, and his research associates conducted a study for the U.S. Army's Rocky Mountain Arsenal [RMA], a facility where nerve gas containing munitions were stored and decommissioned. The Army post surgeon, Dr. Maurice Gaon, noted an unusual number of civilian employees with symptom complex including fatigue, sleep difficulties, memory loss, trouble concentrating, irritability, loss of libido, among others. These symptoms were primarily noticed in employees much later following reported exposures to the nerve agent Sarin, an organophosphate, The Army called on Dr. Duffy and his associates to plan and implement a study of these exposures.¹⁵²
This situation provided Dr. Duffy with an opportunity to study the effects of accidental low level Sarin exposures on humans after 1 year, comparing their symptoms with symptoms of rhesus monkeys after 1 year by injecting the primates with low doses of Sarin.
The results, according to Dr. Duffy, indicated that "low levels of exposure to the nerve agent Sarin can produce long-lasting effects. It was perfectly clear that not only were people, after [low level Sarin] exposure showing long-term effects, but it was widely accepted in the pesticide industry that exposure to related compounds like malathion and parrathion or the chlorinated hydrocarbon insecticides let to long- term consequence."¹⁵³
Dr. Duffy stated: "It has been suggested that since Army personnel did not appear to suffer acute symptoms which could be clearly recognized as resulting from acute Sarin exposure, that this explanation for Gulf War Syndrome must be irrelevant. This is not necessarily a valid assumption. First, the low level exposure to the monkey group demonstrated no symptoms . . . and second, most of the exposed Army personnel at RMA suffered relatively minor symptomatology."¹⁵⁴
According to the NY Times, Dr. Frank Duffy and his research colleagues Dr. James Burchfiel of the University of Rochester and Dr. Peter Bartels of the University of Arizona, "said in interviews that the Pentagon seemed intent on ignoring or dismissing their evidence. Their research, which studied the effects of low doses of Sarin on humans and primates, showed the exposure resulted in long-term or chronic, perhaps permanent, changes in brain waves, which could be connected with . . . symptoms common among Gulf veterans."¹⁵⁵
In a 1987 letter to Robert Hall of the Hawaii Institute for Biosocial Research, Dr. Duffy also noted the possible confusion between organophosphate-delayed-neuropathy and stress: "I applaud your effort in raising the level of consciousness about the serious potential for long-term effects due to exposures to these [organophosphate] compounds. It has been our experience that the side effects of minimal but continual exposures to the compounds mimic the symptoms associated with a stressful life [emphasis added]. Accordingly, most individuals are unable to determine whether their irritability is related to a stressful life or to a recent organophosphate exposure. This is a serious issue."¹⁵⁶
Results of U.S. Air Force [USAF] studies on the health effects of sublethal, low dose exposure to nerve agents, published in 1992, bear on the question of acute v. chronic symptoms. The study was ordered because some AF personnel (e.g., bomb loaders and medical personnel) worked in potentially contaminated environments. USAF's Armstrong Laboratory conducted the studies of nerve agent behavioral toxicity in laboratory rhesus monkeys, and concluded that: "Behavioral deficits [in primates] can be reliably detected in the absence of any overt [acute] signs of toxicity. This is especially important when assessing the effects of low-level exposures to extremely toxic compounds such as OP [organophosphate] nerve agents." The Air Force studies suggest that ". . . repeated low-dose exposure to soman [a nerve agent] caused progressive and lasting inhibition of ChE [cholinesterase enzyme] . . ."¹⁵⁷
Also disputing Dr. Joseph's statement was Dr. Seymour Antelman, University of Pittsburgh professor of psychiatry, who in a letter to the editor of the New York Times, stated: "[Dr. Joseph's] view . . . is almost certainly wrong. My research, published in leading scientific journals and the subject of a June 21, 1988, Science Times article, has shown that the effects of chemicals can develop and grow over time, and need not be present at the time of exposure. Such 'time dependent sensitization' is more likely after exposure to a low level stimulus."¹⁵⁸
In May 1996, 7 weeks prior to DOD's first admission of chemical exposures, Major General Ronald Blanck, commander of the Walter Reed Army Medical Center and the army's chief physician, said, "Clearly there is some evidence of low level exposure."¹⁵⁹
Two VA physicians -- Dr. Victor Gordan of the Manchester (NH) VA Medical Center and Dr. Charles Jackson of the Tuskegee (AL) VA Medical Center -- began to suggest soon after the war that the sick Gulf veterans they had examined were exposed to chemicals. However, their views did not receive much attention from VA headquarters, DOD, or the news media.
In Human Resources subcommittee testimony, Dr. Gordan, who has treated 544 Gulf veterans since 1991, stated, "What is strikingly consistent in these veterans' stories are: 1) a drastic change in their health status from very good to perfect, as it was before deployment to the Gulf War, to poor to fair after their return from the war; 2) the large variety and number of symptoms suggesting dysfunction of more than one organ system in their bodies; and 3) the very consistent history of being exposed to chemicals in the Gulf, including the strong belief [by veterans] of being exposed to chemical warfare. These consistent stories point very strongly toward the environmental hazards as the cause of causes of these unexplained illnesses. Unless the science addresses these environmental hazards, we will never be able to adequately explain and hopefully solve these medical problems."¹⁶⁰
Dr. Gordan concluded, "Chemicals . . . are the greatest masquerader in the modern medicine . . . because they penetrate into all sorts of systems and organs, and those organs get dysfunctional, and those dysfunctions bypass symptoms, and symptoms can mimic so-called quantifiable disease, including arthritis, even PTSD." [emphasis added]¹⁶¹
In the same hearing, Dr. Jackson, an environmental physician covering Agent Orange and Gulf War illnesses, said, in reference to the chairman's earlier question to the VA, "Well, one of the questions that you asked to Dr. Mather was whether or not one person in the VA had made the clinical opinion that there was a veteran exposed to chemical and/or biological agents, and yes, there was. We did this back 3 years ago."¹⁶²
Attributing the illnesses he was seeing to the product of multiple chemical exposures, Dr. Jackson said, "Symptoms of the veterans are not inconsistent with those of the farm and veterinary workers with chronic low dose exposure to organophosphorus insecticides."¹⁶³
Dr. Jackson added, "Recent DOD and CIA revelations concerning the destruction of tons of mustard and Sarin in Iraq have supported the probability of exposure to the . . . agents."¹⁶⁴ "We have gone on record as saying that we believe this is a significant factor. . . . It was not a popular opinion, nor was it the official opinion of the VA."¹⁶⁵
Dr. Frances Murphy, the VA's Director of Environmental Agents service, offered the department's official opinion, which supports Dr. Joseph, in testimony before the Human Resources subcommittee: "Studies of low level chemical warfare agent exposure were not given high priority . . . because military and intelligence sources had stated that U.S. troops had not been exposed to chemical agents. Current body of research proves that low level exposures cannot cause health effects [emphasis added]."¹⁶⁶
The results of a study conducted by Dr. David Schwartz and his University of Iowa Medical school research colleagues were recently published in the Journal of the American Medical Association [JAMA]. ¹⁶⁷ The Schwartz study, supported by the Centers for Disease Control and Prevention, found that Persian Gulf veterans are reporting more medical and psychiatric conditions than their military peers who were not deployed to the Gulf War. gulf veterans reported an 11 percent higher prevalence of symptoms of cognitive dysfunction or problem thinking, but only a 1 percent increase in PTSD.¹⁶⁸
Dr. Robert Haley and his research colleagues at the University of Texas Southwestern Medical Center also completed a study in early 1997 of Gulf veterans, the results of which were published in three articles in JAMA. according to the study, "Some Gulf War veterans may have delayed, chronic neurotoxic syndromes from wartime exposure to combinations of chemicals" and that "clusters of symptoms of many Gulf War veterans reflect a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems."¹⁶⁹
People have asked why most Gulf War veterans have not reported illnesses while only some veterans were affected. Dr. Kenneth Olden, director of the National Institute of Environmental Health sciences, was recently quoted in the press: "We've known for a long time that when several hundred people are exposed to the same environmental toxicants, some people get sick and others don't. There are a number of enzyme systems that detoxify chemicals. If you have too little -- that's a problem." ¹⁷⁰
The results of a second study by Dr. Haley on Gulf veterans was published in August 1997 by the National Academy of Neuropsychology.¹⁷¹ The new study compared the brain-related and psychological functions of ill and well Gulf veterans, and found no evidence of psychological problems, including PTSD or other stress related illnesses. Some Gulf veterans, the study says, suffer from a form of brain damage found in toxic poisoning victims.
A New York Times article reported, "Stephen C. Joseph, the Pentagon doctor overseeing the investigation of the Gulf War Syndrome, is under attack on the political battlefield. Senator John D. Rockefeller 4th (D-WV) has called him arrogant and demanded his resignation. "Dr. Joseph is at the heart of a culture that has never looked at this problem seriously enough," said one senior White House official involved in this issue. The uproar involves . . . questions over how the Pentagon responded to veterans' health complaints and its refusal to acknowledge that the veterans might have reason to worry about exposure to chemical or biological agents, anti-nerve gas pills, or other environmental factors in the Persian Gulf."¹⁷²
As a result of increased congressional and news media attention on issues surrounding the Gulf War veterans' illnesses, then DOD deputy Secretary John White assumed the role of DOD spokesman of Gulf issues in October 1996.
Dr. Joseph resigned in March 1997.
One of the most frequently asked questions by the veterans, public and press is why the DOD for 5 years continued to deny that troops were exposed to chemical warfare agents or that low level exposures caused illness. The U.S. News & World Report in an article "Gulf War Mysteries" stated:¹⁷³
If exposure to chemicals is ever tied to widespread illnesses among veterans, the government may face other dilemmas. A link could open the door to thousands of disability claims, plus legislation mandating greatly expanded health coverage for veterans. The repercussions could reach to future battlefields as well. an official determination that chemicals have seriously harmed U.S. soldiers would be an admission of vulnerability, likely to encourage Iraq and other potential foes such as North Korea to use chemical weapons if they ever face off against the United states in the future. The next time the alarms start going off, the all- clear may not be so quick to follow."

E. EXPOSURES AND VA MEDICAL PROTOCOLS FOR GULF VETERANS

[NOTES]

139. These organizations include the American Academy of Allergy and Immunology, the American College of Physicians, the American College of Occupations Medicine and the Council of Scientific Affairs of the American Medical Association. See also supra note 97, p. 7.
140. Statement of Claudia Miller, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 511.
141. Ibid.
142. Ibid., p. 512.
143. Memo from Albert Donnay, executive director, MCS Referral & Resources Center to Robert Newman, subcommittee staff, September 18, 1996 (in subcommittee files).
144. PAC Report, p. 81.
145. Statement of Stephen Joseph, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 221.
146. Testimony of Claudia Miller, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 271.
147. Statement of Claudia Miller, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 511-512.
148. Testimony of Stephanie Padilla, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 252-254.
149. Ibid., p. 268.
150. Lohs, Karlheinz, Delayed Toxic Effects of Chemical Warfare Agents (New York: Almqvist & Wiksel International for the Stockholm International Peace Research Institute, 1995), pp. 14-15.
151. Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 248.
152. Statement of Frank Duffy, Human Resources Subcommittee hearings, No. 1, p. 228.
153. Testimony of Frank Duffy, Human Resources Subcommittee hearing, No. 1, p. 226.
154. Statement of Frank Duffy, Human Resources Subcommittee hearings, No. 1, p. 230.
155. Shenon, Phillip, "New Look Urged on Gulf Syndrome: Important Evidence Withheld by Pentagon, Scientist Says," New York Times, December 10, 1996, p. A1.
156. Letter from Frank Duffy letter to Robert Hall, March 26, 1987 (in subcommittee files).
157. Somani, Satu, Chemical Warfare Agents, (Academic Press, 1992), containing the study by Hargraves and Murphy, "Behavioral Effects of Low-Dose Nerve Agents," pp. 125-154.
158. Letter to the editor, Seymour Antelman, New York Times, November 15, 1996 (in subcommittee files).
159. Statement of Ronald Blanck to the PAC, May 2, 1996.
160. Testimony of Victor Gordan, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 282.
161. Ibid., p. 291.
162. Testimony of Charles Jackson, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 275.
163. Statement of Charles Jackson, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 280.
164. Ibid.
165. Ibid., p. 295.
166. Testimony of Frances Murphy, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 141, 109.
167. Schwartz, et al., "Self-reported Illness and Health Status Among Gulf War Veterans." Journal of the American Medical Association, January 15, 1977, Vol. 277, No. 3, p. 238.
168. Statement of David Schwartz at National Press Club, January 15, 1997 pp. 1, 3 (in subcommittee files).
169. Haley, et al., "Is There a Gulf War Syndrome?" Journal of the American Medical Association, January 15, 1997, Vol. 277, No. 3, p. 215; "Evaluation of Neurologic Function in Gulf War Veterans," Journal of the American Medical Association, January 15, 1997, Vol. 277, No. 3, p. 223; and "Self-reported Exposure to Neurotoxic Chemical Combinations in the Gulf War," Journal of the American Medical Association, January 15, 1997, Vol. 277, No. 3, p. 231.
170. Sternberg, Steve, "Study Seeks Genes That Make People Vulnerable to Toxins" USA Today, September 18, 1997, p. A3.
171. Horn, Haley, et al., "Neuropsychological Correlates of Gulf War Syndrome." Archives of Clinical Neuropsychology, August 1997, Vol. 12, No. 6, pp. 531-544.
172. Shenon, Philip, "Pentagon Health Chief Fights Claims of Gulf Cover-Up," New York Times, November 3, 1996, p. 30.
173. "Gulf War Mysteries: Why Americans May Never Know What's Making These Veterans Sick," U.S. News & World Report, November 25, 1996 [cover story].