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After the 1991 Gulf War, veterans of the conflict from the United States, United Kingdom, Canada, Australia and other nations described chronic idiopathic symptoms that became popularly known as 'Gulf War Syndrome'. Nearly 15 years later, some 250 million dollars in United States medical research has failed to confirm a novel war-related syndrome and controversy over the existence and causes of idiopathic physical symptoms has persisted. Wartime exposures implicated as possible causes of subsequent symptoms include oil well fire smoke, infectious diseases, vaccines, chemical and biological warfare agents, depleted uranium munitions and post-traumatic stress disorder. Recent historical analyses have identified controversial idiopathic symptom syndromes associated with nearly every modern war, suggesting that war typically sets into motion interrelated physical, emotional and fiscal consequences for veterans and for society. We anticipate future controversial war syndromes and maintain that a population-based approach to care can mitigate their impact. This paper delineates essential features of the model, describes its public health and scientific underpinnings and details how several countries are trying to implement it. With troops returning from combat in Afghanistan, Iraq and elsewhere, the model is already getting put to the test.

A uranium bioassay program was conducted involving 103 active and retired Canadian Forces personnel. The total uranium concentrations in each of two 24-h urine collections were analyzed separately at independent commercial laboratories by inductively coupled plasma mass spectrometry (ICP-MS) and by instrumental neutron activation analysis (INAA). The mean and median concentrations were determined to be 4.5 ng L(-1) and 2.8 ng L(-1), respectively, from ICP-MS and 17 ng L(-1) and 15 ng L(-1), respectively, from INAA. The total uranium concentrations were sufficiently low so that isotopic (238U:235U ratio) assays could not be performed directly from urine samples. Isotopic assays were performed on hair samples from 19 of the veterans participating in the testing. The isotopic hair assays were scattered around the natural 238U:235U ratio of 137.8, ranging from 122 +/- 21 to 145 +/- 16 (1sigma). Due to concern expressed in the media over possible depleted uranium exposure and long-term retention in bone, a single bone sample (vertebrate bone marrow) from a deceased member of the Canadian Forces was also analyzed for total uranium content and isotopic ratio by ICP-MS. The sample was shown to have 16.0 +/- 0.3 microg kg(-1) uranium by dry weight and a 238U:238U isotopic ratio of 138 +/- 4, consistent with natural uranium.

In this edition of Psychological Medicine, research findings are reported from two studies of British Gulf War veterans (David et al. 2002; Everitt et al. 2002). Both studies were carried out at King's College ‘Gulf War Illness Research Unit’, which was established in 1996. The two studies were conducted to examine the causes of unexplained symptoms among Gulf War veterans. The results presented in these papers are important because they were derived from well-designed studies that employed a randomized sample of Gulf War veterans and two control populations of non-deployed ‘era’ veterans who served in the early 1990s and troops who participated in another hazardous deployment to Bosnia.In one study, cognitive function and mood disturbances were evaluated using a comprehensive battery of neuropsychological tests and rating scales (David et al. 2002). A significant proportion of Gulf War veterans reporting ill health were found to have both lower cognitive function scores and depressed mood compared to well Gulf War veterans, era veterans and Bosnia troops. Importantly, a strong association was found between depressed mood and poor performance on cognitive function tests. It is noteworthy that among ill Gulf War veterans, most cognitive function measures were within the normal range, although they were significantly lower than those of controls.Based on these and related research findings, the study investigators concluded that lower performance on cognitive function tests could be explained primarily by mood disturbances. However, they could not rule out the possibility that cognitive difficulties had led to depressed mood or that a neurotoxic environmental exposure had caused both health problems.

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