SHODDY record keeping and the difficulty of tracking down veterans of the
Gulf War almost six years later could scupper belated attempts by the British
government to understand the illnesses that have struck down hundreds of
people.
The British government first rejected calls to study Gulf War syndrome three
years ago, and as recently as 1995, armed forces minister Nicholas Soames
dismissed large epidemiological studies as 鈥渦nnecessary鈥�. But last week, the
Ministry of Defence (MoD) launched two studies costing 拢1.3 million, after
being forced to admit that it had misled Parliament over the extent to which
veterans of the war were exposed to organophosphate insecticides.
Patricia Doyle of the London School of Hygiene and Tropical Medicine, who
heads the first study, plans to focus on reproductive health. Her team will send
a questionnaire to each of the 50 000 British veterans to gather data on
infertility, miscarriages and stillbirths. Doyle will also study low birth
weight and congenital abnormalities among veterans鈥� children. Veterans鈥�
responses will be compared with those of 50 000 military personnel who did not
serve in the Gulf War.
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The second study, led by Nicola Cherry of the University of Manchester, will
check whether there is any excess ill health in 6000 veterans compared with 6000
controls. If the researchers find evidence of Gulf War syndrome, they will do
detailed clinical studies on affected individuals.
But both projects could be jeopardised by the state of military records. 鈥淭he
whole problem is that the medical record taking is so atrocious that the
epidemiology will be extremely difficult,鈥� says one official familiar with the
planned studies who asked not to be identified. 鈥淭he standard of record taking
is not going to make this any easier,鈥� confirms Doyle.
One problem is that there is little information on the doses of
anti-nerve gas tablets taken by British soldiers. The MoD is now talking with
its US counterpart about developing electronic dog tags to allow doses to be
recorded automatically. 鈥淭he records kept on the Gulf War were not up to the
standards that modern technology allows,鈥� concedes an MoD spokesman.
Many paper records are thought to have been lost or damaged. Similar glitches
have blighted efforts to investigate Gulf War syndrome in the US (This Week, 19
October, p 8).
Doyle鈥檚 study faces severe logistical problems. Congenital abnormalities
among veterans鈥� children are likely to be very rare events, she says. 鈥淪o we
need big numbers to respond.鈥� Doyle admits that her study will probably not
produce any reliable conclusions unless more than 80 per cent of the veterans
reply. Response rates for posted questionnaires are rarely this high. 鈥淓ven with
interested groups you wouldn鈥檛 expect to get anywhere near 80 per cent
responding,鈥� says a spokeswoman for the market research group MORI.
The MoD could in theory compel its employees to fill in the questionnaires.
But if it did this, Doyle believes veterans might not give full and frank
answers for fear that their job prospects would suffer.
There is still the danger that only those who believe themselves
affected by Gulf War syndrome will respond, which would distort the results.
Finally, it may be difficult to trace the 30 per cent of veterans who have since
left the armed forces. 鈥淚t would have been easier to start this three years
ago,鈥� says Doyle.