Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Misinformation
- James I. Moss (12 December 2003)
-
Strange equipment.
- Alexander SD Spiers (15 December 2003)
-
Television warriors
- Michael O'Donnell (16 December 2003)
-
Re: Misinformation
- Piotr Bein, none (19 December 2003)
-
Gulf War Illness- A Truer Perspective
- Nigel H Graveston (21 December 2003)
|
|
|||
|
James I. Moss, Research Associate University of Florida
Send response to journal:
|
Clauw states: "Firstly, there is no evidence of excess malignancy, birth defects, or increased mortality associated with Gulf war deployment." This comment on birth defects is being widely reported as fact, based on the this BMJ editorial. This is tragic. This needs to be corrected so policy makers do not succomb to this perpetuated myth that there are no elevated birth defects in the Gulf War cohort. This tragic misinformation must stop. ***************************************** Birth Defects Res Part A Clin Mol Teratol. 2003 Apr;67(4):246-60. Prevalence of birth defects among infants of Gulf War veterans in Arkansas,Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993. Araneta MR, Schlangen KM, Edmonds LD, Destiche DA, Merz RD, Hobbs CA, Flood TJ, Harris JA, Krishnamurti D, Gray GC. Department of Defense Center for Deployment Health Research, Naval Health Research, Center, San Diego, California, USA. haraneta@ucsd.edu BACKGROUND: Epidemiologic studies of birth defects among infants of Gulf War veterans (GWV) have been limited to military hospitals, anomalies diagnosed among newborns, or self-reported data. This study was conducted to measure the prevalence of birth defects among infants of GWVs and nondeployed veterans (NDV)in states that conducted active case ascertainment of birth defects between 1989-93. METHODS: Military records of 684,645 GWVs and 1,587,102 NDVs were electronically linked with 2,314,908 birth certficates from Arizona, Hawaii, Iowa, and selected counties of Arkansas, California, and Georgia; 11,961 GWV infants and 33,052 NDV infants were identified. Of these, 450 infants had mothers who served in the Gulf War, and 3966 had NDV mothers. RESULTS: Infants conceived postwar to male GWVs had significantly higher prevalence of tricuspid valve insufficicieny (relative risk [RR], 2.7; 95% confidence interval [CI], 1.1-66; p = 0.039) and aortic valve stenosis (RR, 6.0; 95% CI, 12- 31.0; p = 0.026) compared to infants conceived postwar to NDV males. Among infants of male GWVs, aortic valve stenosis (RR, 163; 95% CI, 0.09-294; p = 0.011) and renal agenesis or hypoplasia (RR, 16.3; 95% CI, 0.09-294; p = 0.011) were significantly higher among infants conceived postwar than prewar. Hypospadias was significantly higher among infant sons conceived postwar to GWV women compared to NDV women (RR, 6.3; 95% CI, 15-263; p = 0.015). CONCLUSION: We observed a higher prevalence of tricuspid valve insufficiency, aortic valve stenosis, and renal agenesis or hypoplasia among infants conceived postwar to GWV men, and a higher prevalence of hypospadias among infants conceived postwar to female GWVs. We did not have the ability to determine if the excess was caused by inherited or environmental factors, or was due to chance because of myriad reasons, including multiple comparisons. Although the statistical power was sufficient to compare the combined birth defects prevalence, larger sample sizes were needed for less frequent individual component defects. PMID: 12854660 [PubMed - in process] Competing interests: None declared |
|||
|
|
|||
|
Alexander SD Spiers, Retired Home: Cookham Dean, BERKS
Send response to journal:
|
To the Editor: The Editorial and research papers on Gulf war illness were both clear and interesting, but I am puzzled by the cover illustration. I do not know its provenance but it is incorrect in a number of details. The soldiers are wearing NBC (nuclear/biological/chemical) defence equipment and appear to be standing in a desert. Their protective garments are fashioned from DPM (disruptive pattern material), but the DPM is of the type used in the European theatre of operations, whereas it should be of the desert type. In the illustration the soldiers stand out from their background almost as well as a red public telephone box. Such conspicuous clothing confers a high risk of being shot. Even worse, their attire is incomplete. The soldier on the left has no gloves and the individual on the right is wearing only the cotton inner gloves, which are not protective against liquid nerve agents or mustard gas. Correct NBC protection requires the wearing of black neoprene outer gloves that are impervious to chemical agents. In the event of a chemical attack, these two soldiers would not survive long enough to develop Gulf war illness. After years spent teaching soldiers NBC techniques, I find such a misleading illustration on the cover of a leading international journal very disappointing. Competing interests: None declared |
|||
|
|
|||
|
Michael O'Donnell, FRCGP. Former GP turned journeyman writer Loxhill GU8 4BD
Send response to journal:
|
I can think of two reasons for the photographic solecism spotted by Alexander Spiers. 1. All the desert camouflage uniforms had been bagged by the television warriors: generals and other senior officers who fought their way through press conferences held well away from the places where people were actually being shot 2. The Government felt there was no need for our lads to wear properly adjusted NBC defence equipment because it already knew they wouldn't have to face nuclear, biological, or chemical weapons. Competing interests: None declared |
|||
|
|
|||
|
Piotr Bein, unemployed, formerly researcher with Environment Canada V6R 2X2, none
Send response to journal:
|
Precautionary principle governs publications on health and safety phenomena that might appear "scientifically controversial" but for which there is partial evidence of potential or actual harm. Editorial policy without such tenet opens Pandora's box of abuse by corporate and government-military propaganda. Sceptics quote "The Health Consequences of the First Gulf War" by Daniel Clauw in BMJ as fact rather than opinion based on partial information. Clauw states: "there is no evidence of excess [...] birth defects [...] associated with Gulf war deployment." Araneta et al. conclude [Birth Defects Res Part A Clin Mol Teratol. 2003 Apr;67(4):246-60]: "We observed a higher prevalence of tricuspid valve insufficiency, aortic valve stenosis, and renal agenesis or hypoplasia among infants conceived postwar to GWV men, and a higher prevalence of hypospadias among infants conceived postwar to female GWVs." Clauw contradicts research results at DOD Center for Deployment Health Research (Araneta et al. afilliation). It behooves the author and BMJ to invoke the precautionary principle and cite the article. Otherwise they are in the deception business. The general public is not equipped to digest scientific and professional publications. Information warriors of the complex behind illegal radioactive-toxic weapons and equally harmful materials in consumer products quote freely and profusely from "authors" like Clauw, pretending this is THE science. Recent example is Reuters dispatch of December 16, 2003, quoting Clauw. I am not a medical expert and will not research the other aspects of GW (and Balkan) Syndrome that Clauw "discusses". But from his attitude towards the birth defects findings I would not bet an old hat on any of his statements. Clauw has self-declared competing interests: "receiving research funds from the US Army". I am requesting a re-statement by Clauw item-by- item of the BMJ guideline on conflict of interest. The reader should also know what was the amount received, and in what percentage of his total income each year. Dr Piotr Bein, PEng, Member: Institute for Risk Research - University of Waterloo; Consultee: European Committee on Radiation Risk; Co-founder: www.du-watch.org and du-watch e-list Competing interests: researcher and activist against uranium weapons (illegal under humanitarian law) |
|||
|
|
|||
|
Nigel H Graveston, Consultant Anaesthetist, Burnley General Hospital Burnley General Hospital, Burnley Lancashire BB10 2PQ
Send response to journal:
|
Gulf War Illness – A Truer Perspective EDITOR – I am most grateful for this opportunity to comment and expand on an article about Gulf War illness and allied topics in the British Medical Journal of 13 December 2003. The editorial by Clauw (1) was very contradictory. He states that Post Traumatic Stress Disorder (PTSD) in Gulf war era veterans was low compared to other wars but then goes on to implicate its role in Gulf war illness (GWI), initially by using the older terms, “shell shock” and “soldier’s heart” and then devoting the whole of his sixth paragraph describing PTSD as a possible model for GWI. The PTSD model will not explain the illnesses suffered by personnel who were prepared i.e. kitted out and immunised, but who were not deployed to the Gulf but stayed in the UK or Germany. The treatment of the issue of vaccines is even more confused and contradictory. Firstly he states that none of the environmental exposures with the possible exception of vaccines given at the time of deployment were associated with the development of the symptom complexes. Later he states, categorically, that the excess morbidity associated with Gulf war deployment had little to do with specific environmental exposures. However he goes on to implicate infections and immune stimulation as stressors. Immunisations can be looked on as “controlled” infections to produce immune stimulation. A closer look at the vaccines given would have been very informative. The Anthrax, Plague, and Pertussis vaccines were all given in regimes contrary to the manufacturers recommendations. There was also doubt about the efficacy and safety of some of these vaccines in the Ministry of Defence (MoD), the Department of Health (DoH) and the National Institute for Biological Standards & Control (2). Such was the concern about the Plague vaccine that it was proposed that a “trial” should be undertaken using personnel of 205 General Hospital RAMC (V) to asses its effect before giving it to the rest of the troops.(3). The General Officer Commanding and the Commander Medical of 1(UK) Armoured Division declined to have the Plague vaccine(4). The Veterans Agency (VA) in the UK awards War Disability Pensions for “Vaccine Damage” . A detailed look at the drugs and chemicals to which veterans were exposed is also very worrying. Most personnel took NAPS (Nerve Agent Pretreatment Set) tablets containing pyridostigmine bromide (PB) 30mg tds. There was extensive use of organophosphate insecticides, smoke and oil from oil well fires, various munitions and propellants and depleted uranium. Most worrying was the detection of chemical warfare agents (5). These may have been delivered by the Iraqis or as a result of coalition bombing of Iraqi arms dumps. However what is certain is that American troops blew up an Iraqi arms dump containing at least 8.5 tons of Sarin and cycloSarin at Khamisiyah. The original estimate of the number of troops exposed was 20,000 but this was later raised to 100.000 including possibly 10-15,000 British(6). Recent animal studies have shown that exposure to low levels of Sarin can reduce brain levels of acetyl cholinesterase (7) which may result in cognitive dysfunction. Clauw goes on to state that most visits to primary care are for chronic somatic symptoms and syndromes, but he neither quantifies nor supports this glib statement with references. He then mentions the use of functional imaging techniques in looking at chronic central pain and then without any explanation proceeds to question Haley’s work using Magnetic Resonance Spectroscopy (8). Nor is there any mention of Haley’s work with structural equation modelling (9) or recent work on Paraoxonase and its protective role against atheroma (10). I found this editorial confused and lightweight. However its saving grace is in the final paragraph. I agree that the ill Gulf war veterans have a very real illness. However I strongly disagree with the statement that the veterans are not served well by “focusing inordinate attention on specific exposure(s)”. I think it does not serve the veterans well by trying to somatasise all their illnesses and putting it all down to “stress”. There is a obvious cause for the great variety of illnesses suffered by the veterans and I have outlined it above. The cause of their illnesses is the “cornucopia of toxins”(11) to which they were exposed. It is paramount that both primary and secondary care physicians are given accurate and pertinent information so that they can effectively recognise and treat these patients, numerous of who have taken their own lives, are in prison for such crimes as murder and manslaughter, or have been forced to join the ranks of the ex-servicemen and mentally ill who are homeless and destitute. This information is available. It only needs to be disseminated widely. Nigel H Graveston, Consultant Anaesthetist, Burnley General Hospital, Burnley, Lancashire, BB10 2PQ ngraveston@doctors.org.uk Competing interests: Nigel Graveston is a former major in the RAMC and is a veteran of the first Gulf War. He is vice-chairman of and formerly medical adviser to the National Gulf Veterans & Families Association, Offices 58-60 The Pavilion, 536 Hall Road, Hull HU6 9BS. Nigel Graveston suffers from Gulf War Illness. References (1) Clauw D. The health consequences of the first Gulf war. BMJ2003;327:1357-8 (13 December) (2) Background to the use of medical countermeasures to protect British forces during the Gulf War (Operation Granby), paras 33-91 Annexes A, B1,B2 &C Ministry of Defence, Whitehall, London, October 1997 (3) Implementation of the immunisation programme against biological warfare agents for UK forces during the Gulf conflict 1990/1991. paras 140 -7. Ministry of Defence, Whitehall, London, 20 January 2000 (4) Ibid paras 148-155 (5) Author’s personal experience and personal communications from numerous other veterans. (6) Gulf War Illness- Dealing with the Uncertainties. Parliamentary Office of Science and Technology, Houses of Parliament, London. December 1997 (7) Henderson RF et al. Response of Rats to Low Levels of Sarin.Toxicol. Appl. Pharmacol. 2002;184:67-76 (8) Haley RW, Marshall WW, McDonald GG, Daugherty MA, Petty F, Fleckenstein JL. Brain abnormalities in Gulf War Syndrome: evaluation with 1H MR spectroscopy. Radiology 2000; 215: 807-817 (9) Haley RW, Luk GD, Petty F. Use of structural equation modelling to test the construct validity of a case definition of Gulf War syndrome: Invariance over developmental and validation samples, service branches and publicity. Psychiatry Research 102 (2001) 175-200. (10) Hotopf. M. et al. Paraoxonase in Persian Gulf War Veterans J Occup Environ Med. 2003;45:668-675 (11) The Coroner for the County of Chester at the inquest into the cause of death of Major Ian Hill RAMC, 24 November 2003, The Coroner’s Court, Winmarleigh Street, Warrington, Cheshire. The MoD reference can be found at www.mod.uk or from Dr Stephen Trout, Gulf Veterans Illness Unit, MoD, 7th Floor, Zone A, St Georges Court, 2-12 Bloomsbury Way, London WC1A 2SH Competing interests: Competing interests: Nigel Graveston is a former major in the RAMC and is a veteran of the first Gulf War. He is vice-chairman of and formerly medical adviser to the National Gulf Veterans & Families Association, Offices 58-60 The Pavilion, 536 Hall Road, Hull HU6 9BS. Nigel Graveston suffers from Gulf War Illness |
|||