On Contested Illnesses

The L.A. Times reported this week on the release of a 450-page report produced by the Research Advisory Committee on Gulf War Veterans' Illnesses.  According to the article, the Committee "was chartered by Congress because many members thought that veterans were not receiving adequate care. On the 15-member committee appointed in 2002, scientists made up about two-thirds and the rest were veterans."

I have not yet had the chance to do anything other than skim the report, but the Times article notes a number of points of interest for a medical humanities audience. 

First, Gulf War Syndrome has been the subject of vigorous contest, across academic, policy, and grass-roots discourse.  Its status as a contested illness has proven a rich source of fodder for all manner of scholars, but such status has very real consequences for all manner of suffering people and caregivers (who ought always remain central in a medical humanities analysis, IMO).  The Article notes that

The report broke with most earlier studies by concluding that two chemical exposures were direct causes of the disorder: the drug pyridostigmine bromide, given to troops to protect against nerve gas, and pesticides that were widely used -- and often overused -- to protect against sand flies and other pests.

Second, policy discourse among scientific bodies and committees is also a fascinating and significant subject of inquiry in thinking about the ways in which contested issues related to health and illness are framed, negotiatied, and acted upon.  The article notes:

Several reports had already been issued by the prestigious Institute of Medicine, an arm of the National Academy of Sciences, blaming stress and other unknown causes for the soldiers' symptoms.

"There's something about going to the Gulf and serving in the Gulf that has caused something bad and persistent and real, but we have not found any evidence for a specific cause," said Dr. Harold C. Sox, chairman of a 2000 institute study and editor of the journal Annals of Internal Medicine.

Veterans blame the institute's reports for the difficulties they've faced in getting treatment for their problems.

The lack of identifiable causes is a familiar bugaboo for those familiar with the literature on contested diseases, which, IMO, highlights the importance of diseasecausalityin assessing social and cultural conceptions of illness and health.

Third, I have already suggestedthe close links between state military activity and human subjects experimentation.  In a prior post, I observed Goodman, McElligot, and Marks's claim that

the history of unethical research is primarily a history of the ways in which unuseful bodies are made useful to the state.  My initial response to this thesis was to doubt that state involvement is really either necessary or sufficient for unethical research to occur.  But the further one delves into the history of unethical research, the more and more plausible this claim begins to seem.

In this context, it is worth noting that

The major causes of the disorder appear to be self-inflicted. Pyridostigmine bromide was given to as many as half of the troops in the fear that the Iraqis would unleash chemical warfare against them.

According to the report, at least 64 pesticides containing 37 active ingredients were used during the war. They were sprayed not only around living and dining areas, but also on tents and uniforms, White said.

The full report is available for download here.  Look for a future Medical Humanities Bibliography on Contested Illnesses. 

Comments

[Eugene Raikhel]

Hi Daniel,

You've probably seen this, but there is a special commentary section on Gulf War illness in the last issue of Social Science and Medicine that's worth checking out -- and adding to your bibliography:
http://www.sciencedirect.com/science/journal/02779536

[Daniel Goldberg]

Thanks, Eugene. I had seen it, but promptly forgot about it, so the reminder is helpful. I also caught Deborah Swoboda's recent article in Health on Gulf War Syndrome, Multiple Sensitivies Syndrome, and CFS. It's an interesting take, if you haven't seen it yet.