David Brown, M.D., described the most recent Institute of Medicine report on Gulf War Illnesses this week. Brown tried to deny the existence of the illness back in 2006, with reporting that was either uninformed or misleading. Here’s what he wrote in 2006:
As recently as September, a panel of the National Academy of Science’s Institute of Medicine reached the same conclusion that half a dozen other expert groups had: Gulf War syndrome does not exist.
Brown neglected to discuss the many expert groups that did acknowledge Gulf War Illnesses’ reality. I rebutted his comments then. He continues to undermine the illnesses’ reality in 2010, ending his article with the following statement:
Some others, however, argue that “Gulf War syndrome” is an amalgamation of physical complaints that are extremely common in all populations, civilian and military.
This time, the IOM report was very clear that not only are the illnesses real; up to 250,000 Gulf War soldiers have been (and remain) affected. The IOM does not know the cause(s). Nor does anyone else, with certainty, since the data needed to sort out the exposures are not available.
The IOM therefore found a statistical association between multiple illnesses and Gulf War service, but did not state the association was causal. What else could the IOM do? The illnesses themselves are poorly understood pathologically. The exact exposures cannot be pinned down (for any one individual). Given that, how could causality be proven? You might infer causality, but you can’t prove it. The IOM panel chairman got it right:
“We concluded that these symptoms are highly prevalent, persistent, and apparently disabling in this veteran population, even two decades after the war,” said Stephen L. Hauser, the panel’s chairman and a professor of neurology at the University of California at San Francisco. “They defy efforts, thus far, to fully understand their cause.”