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

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.