Date: Wed Jul 06 1994 00:00:16 Subj: Bandwagon Syndrome SKEPTIC - The band wagon syndrome

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Date: Wed Jul 06 1994 00:00:16 From: Sheppard Gordon Subj: Bandwagon Syndrome SKEPTIC ------------------------------- The band wagon syndrome Byline: Jim Schnabel 07/03/94 DENVER POST A subversion of medical science by politics is underway at the White House, which announced its support on June 9 for legislation that would compensate those who suffer from the mysterious and controversial "gulf war syndrome." Veterans Affairs Secretary Jesse Brown called the proposal "revolutionary" and "unprecedented," and rightly so, since the compensation - which Brown estimates at about $50 million per year - comes in the absence of any medical conclusion that "gulf war syndrome" actually exists. The proposal may win votes among veterans this November, but to validate a nonexistent syndrome by legislative fiat, as the administration and its congressional allies may do here, could also lead to a flood of spurious claims, drawing funds from taxpayers and other veterans' programs and causing needless anxieties among veterans and their families. News accounts of the mysterious affliction began in 1992 with reports that some 300 gulf war veterans suffered a range of symptoms including pain in the joints, skin rashes, shortness of breath, chest pain, insomnia, fatigue, mental impairment, nightmares and hair loss. Initial suspicions fell on smoke from gulf oil fires, Iraqi chemical and biological weapons and hard-to- diagnose tropical diseases such as leishmaniasis. When the Veterans Administration announced a registry for gulf war syndrome victims, the number of claimants rose from 300 to 24,000. Studies of British and American veterans and their experiences during the gulf war have shown, however, that these symptoms, which vary substantially from claimant to claimant, are not clearly related to any common factor, and often have causes obviously unrelated to gulf service. The most recent such study, by an outside scientific panel led by Nobel laureate Joshua Lederberg, was published on June 23 and was surely known to the White House well in advance of publication. Because of such studies, the VA has been unable to invoke the existing statutes that empower it to compensate veterans for service-related disabilities. The proposed compensation legislation would instruct the VA to make an exception in this case. How much all of this will ultimately cost is unclear, because there are no blood tests or other "objective" diagnostic procedures that can weed out spurious claims. Of course, 24,000 claimants is only a tenth of what the VA had to contend with after a similar registry was set up for Agent Orange victims, but some gulf war vets are clearly after big money. Earlier this month a group of them filed a $1 billion lawsuit in Houston alleging that 11 chemical companies, which allegedly sold the raw materials for chemical weapons to Iraq, are responsible for their ailments. The Pentagon and Lederberg's panel have said there is no evidence that American troops were exposed to chemical weapons during Desert Storm, but it is possible that the companies named in the suit, rather than endure expensive litigation and negative publicity, will settle for a smaller but still prodigious sum. The administration's promotion of gulf war syndrome can't help but encourage such lawsuits to continue. Unfortunately, most authorities outside the medical profession - and many within that profession - seem unaware of how easily the official validation of a syndrome can lead to an epidemic of claims, whether the syndrome exists or not. This is especially so when (a) diagnosis confers some secondary benefit, such as financial compensation, the avoidance of responsibility or merely ego-boosting attention, and (b) when the symptoms of the "syndrome" are already common in the population. These symptoms, though perhaps unrelated, may suddenly take on a new and cohesive significance in the minds of their many sufferers and may intensify through the same psychosomatic mechanisms that give us the powerful "placebo effect." A good example of this kind of social phenomenon is the epidemic that occurred in Kiev in the anxious years after Chernobyl. A group of schoolchildren developed a collection of symptoms including fatigue, pallor, abdominal pain, headache and mental impairment. Ukrainian doctors decided to call the syndrome "vegetative dystonia," attributed it to radiation exposure from the Chernobyl disaster, and prescribed a variety of dubious procedures requiring two to six weeks' hospitalization. Soon three-quarters of Kiev's child population had reported the symptoms. UCLA pediatrician Richard Stiehm, visiting Kiev in 1991, realized that the syndrome was occurring too long after Chernobyl to be blamed on acute radiation poisoning and that it was also nonexistent among people receiving high-dose radiation treatments in hospitals, who should have suffered the same symptoms if they were indeed radiation-related. Stiehm, writing in the American Journal of the Diseases of Children, diagnosed vegetative dystonia as nothing more than "psychological fallout," which is to say, mass hysteria. Unfortunately, mass hysterias are nothing new in America, home of the Salem witch trials, satanic ritual abuse claims and even a "UFO abduction" epidemic. Avoiding such hysterias requires careful attention to the power of suggestion by authority figures, and the discouragement of spurious self- victimization. Mass illness can be created more easily by suggestion and incentive than by any chemical or biological agent. Of course, the intrusion of politics into medical controversies isn't always objectionable, since public health is a legitimate political issue. Nor can it be concluded that the victims of gulf war syndrome are merely hysterics and malingerers. But it does seem that by trying to create a medical syndrome where medical science does not yet agree that one exists, the administration and its congressional allies are overstepping the usual boundaries in such matters, and in so doing may bring about the very public health disaster they wish to avoid. Jim Schnabel is a science writer whose recent focus has been psychologically based disorders.

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