Antibiotics Defeat GWS

Antibiotic May Defeat Gulf War Syndrome

Veterans set to begin trials of medication here, across U.S.

By Susan Duerksen

UNION-TRIBUNE STAFF WRITER

April 14, 1999

SAN DIEGO—Eight years after the Persian Gulf War, the government is about to start testing a simple antibiotic as a possible cure for the mysterious health problems plaguing many veterans of that conflict.

Ailing veterans in San Diego and across the country will receive the antibiotic in a major scientific trial, based on the theory that bacterial infection may cause at least some cases of the so-called Gulf War syndrome.

Specifically, the researchers will be looking for strains of a very small, little understood type of bacteria, called mycoplasma.

A mysterious malady with baffling origins

Finally, the military is focusing on a likely cause of Gulf War syndrome

For more information: Gulf War veterans who wish to volunteer for the studies using antibiotics, exercise or cognitive therapy can contact the Naval Health Research Center after April 19 at: (619) 524-0069

Military research about Gulf War syndrome: http://www.nhrc.navy.mil

U.S. Centers for Disease Control and Prevention: http://www.cdc.gov.

Garth Nicolson’s research: http://www.immed.org.

If mycoplasma is the culprit, that’s good news: It’s treatable. And it’s bad news because it means the debilitating illness is probably contagious—as some military families already are convinced—and may well be spreading among nonmilitary communities.

"We’re not dealing with a black plague," said Dr. Charles Engel, director of the Gulf War health center at Walter Reed Army Medical Center in Washington D.C. "Most people feel relatively comfortable it is not infectious in the way that would result in some sort of catastrophic epidemic.

"But it may well be that we’ll find out micro-organisms are responsible for a lot of these multi-symptom illnesses."

Beginning this month, Gulf War veterans can sign up—at 30 military and

Veterans' health centers, including one in San Diego—for the antibiotic study or another study testing exercise and behavior-change counseling.

They are the first potential treatments to be tested for the complex of symptoms afflicting an estimated 100,000 of the 700,000 troops who were deployed in the war against Iraq.

The condition is marked by extreme fatigue, joint and muscle pain, concentration and memory problems, rashes, fever, diarrhea and other symptoms that last six months or more.

For years, Gulf War veterans complained that their health problems were not taken seriously or were considered psychological. Now, the Defense Department and the Veterans Affairs Department have about 120 projects under way trying to pin down the cause, characteristics and prevalence of the illness.

The two departments are spending a combined $20 million to investigate treatments -- $8 million for the antibiotic trial and $12 million to buy exercise equipment and pay therapists for the second study.

The idea that Gulf War illness is infectious still faces skepticism five years after it was first proposed by a maverick biochemist, Garth Nicolson, now based in Huntington Beach. Instead, some scientists suspect veterans are experiencing reactions to chemical exposures, stress or a mixture of wartime conditions.

But Nicolson reports finding Mycoplasma fermentans, a species of the smallest type of bacteria, in the blood of almost half of the 600 sick Gulf War veterans he has tested.

He also finds the bacterium in almost all family members of infected veterans who share the symptoms, he said.

And, most significantly, he reports that getting rid of the mycoplasma usually makes the veterans feel much better.

In 1995, Nicolson began publishing his discovery in a variety of scientific journals that the common antibiotic doxycycline helped Desert Storm veterans recover and cleared M. fermentans from their blood. Of those he has monitored, 75 percent have fully recovered, he said.

"The hypothesis is plausible. It could be true," said Engel, one of the leaders of the Pentagon and VA study. "But most of the evidence Mr. Nicolson has presented is in a very preliminary state. Usually a trial like this, that involves treatment of people, wouldn’t go forward based on this level of evidence."

Moving fast

In this case, the researchers say, political and public pressure has

speeded up science, so that a potential treatment and cause are being tested at the same time.

"We want this study done quickly," said Dr. Sam Donta, an infectious disease specialist at the Boston Veterans Affairs Medical Center who is heading the study. "If it works, it will spawn additional studies."

And if it doesn’t work, that won’t necessarily eliminate mycoplasmas as the cause, Donta said. "We may not have the right drug or the right dose.You’ve got to start someplace."

Nicolson said the official study of his methods is long overdue and may not be designed well enough to find accurate answers.

"As a first step, it’s OK," he said. "I’m not entirely satisfied with it. I have concerns about the statistical analysis."

A former department chairman at a renowned cancer research center in Texas, Nicolson has a role in the government’s study. He taught the researchers the technique he developed for finding mycoplasma in blood, and he will recheck their results on 10 percent of the blood samples tested.

Only veterans who test positive for mycoplasma can participate in the antibiotic study.

Others who are sick probably are suffering from other infections or toxic

exposures, Nicolson said. He believes those same factors, along with the multiple vaccines given before deployment, could have weakened some troops’ immunity enough to let mycoplasma infection take hold.

The organism may have been present in the gulf either as a biological weapon or as a normal part of the bacterial stew carried in some people’s respiratory tracts. It can ride there harmlessly unless impaired immunity allows it to infect the blood system, one theory goes.

Nicolson believes M. fermentans is an airborne bug and "moderately contagious," striking mostly at people with weakened immune systems.

Some species of mycoplasma are known to be transmitted in saliva or through coughing and sneezing, and there’s some evidence that fermentans may be spread in similar ways, said Joseph Tully, chief of mycoplasma research for the National Institute of Allergy and Infectious Disease in Bethesda, Md.

However, he said the evidence is not yet strong enough to warrant concern about an epidemic. "At this point, I don’t think that’s a real risk," Tully said. "But I tell people, I just don’t know."

Veterans’ views

Among many veterans’ families and advocacy groups, there is no doubt the illness is contagious.

Joyce Riley, an Air Force Reserve nurse from Missouri, tracks more than 10,000 sick Gulf War veterans through the American Gulf War Veterans Association she founded five years ago. She said at least 80 percent of them have family members who also are sick enough to seek medical treatment. "We know it’s communicable," Riley said. "We’re very concerned about the spread of this disease."

But Engel said relatively few family members have sought care at VA and military medical clinics. The family members who are sick could have Chronic Fatigue Syndrome, or Fibromyalgia Syndrome, two other disorders with very similar symptoms, he said.

The VA now is trying to determine whether those families have more such disease than the general population.

One major VA study is exploring whether the illness has spread to Veterans' spouses and children, but results are not expected for another two years, said Timothy Gerrity, the VA’s chief research and development officer.

The antibiotic study starting this month will include 450 Gulf War veterans who test positive for M. fermentans.

Half of them will take doxycycline daily for a year, while the other half will take a phony pill, or placebo. No one will know who is taking which until the study is over.

All participants will be re-tested for mycoplasma infection after six months, again after taking the drug for a year and once again six months after they finish the drug.

Donta said he also hopes to give doxycycline to a smaller group of veterans who are sick, but don’t have mycoplasma infection. If they get better, the problem could be one of the many other microorganisms vulnerable to the antibiotic.

Doxycycline, a member of the tetracycline family, is among the most commonly used antibiotics, said Dr. Gregory Gray, of the Naval Health Research Center on Point Loma, who is leading the study locally. He said many people take it for years at a time to treat acne.

It may be difficult to get veterans to sign up for the study, the researchers admitted, because many can get doctors to prescribe doxycycline for them and they may not want to risk the 50 percent chance of wasting a year on a placebo.

"We’d like to appeal to veterans on behalf of the larger veteran community," Engel said. "This is a unique opportunity for them to provide scientific information regarding a treatment that is potentially helpful to other veterans."

Another approach

The second study starting this month will test whether exercise and "cognitive behavioral therapy"—either separately or in combination— can ease the veterans’ symptoms and improve their physical functioning. The study will involve 1,360 veterans, including an expected 68 in San Diego.

Some will undertake an aerobic exercise program, some the cognitive therapy, some will get both and some neither.

Engel, a psychiatrist and epidemiologist, said he has been using both types of therapy at the Walter Reed center for four years. He said the patients generally have "a very slight reduction" in physical symptoms and a greater reduction in their distress.

"Most Gulf War veterans come here very actively concerned about many health issues," Engel said. "The concern they have . . . is becoming one of the more debilitating aspects of their illness."

Cognitive behavioral therapy uses relaxation techniques, guided imagery to relax muscles and patients are gradually encouraged to resume activities they believe they can’t do, Engel said.

"We’re not trying to tell them this is in their head," he said. "Rather than reassuring them, you help them design their life."

In the next few weeks, notices are expected to be mailed to many veterans and veteran organizations, seeking volunteers for both studies. The local Naval Health Research Center has set up a special phone line for interested veterans to call (619) 524-0069.

Eligible veterans can choose which study they want to take part in, Gray said.

SHASTA CFIDS