Why has the recognition of Gulf War illness taken so long?

Nineteen years after the conflict an estimated 25% of the 700,000 veterans of the 1991 Persian Gulf War (GW) suffer from a chronic encephalopathy, often debilitating, linked epidemiologically with low level exposure to chemical warfare nerve agent, organophosphate (OP) pesticides, and pyridostigmine bromide anti-nerve agent medications. In the years immediately after the Gulf War, however, when initial research failed to identify the nature of the illness or the sources of chemical exposures, the traditional tendency of medicine to attribute chronic fatiguing, painful and cognitive illness to psychological states became government policy, guiding decisions on research funding, training of medical personnel, and influence over scientific and public opinion. Extensive government-funded epidemiologic studies demonstrated a strong link between deployment to the war theater and increased rates of individual symptoms, but government policy prevented the testing of a case definition of the illness. Privately funded studies, using similar case definitions, developed enough evidence of an organic basis for the illness and links to chemical exposures to stimulate a few government-funded studies that supported this view. Recently, the Institute of Medicine found the evidence of a link between deployment and Gulf War illness to be convincing and called on the government to begin an all-out effort to find treatment. Key to this effort will be objective biomarkers to distinguish homogeneous subgroups with variants of the illness from the larger background of unrelated conditions, mechanistic human and animal studies, and then clinical trials of treatments directed at the mechanisms. The entrenched bias toward psychological explanations will remain a challenge to getting the required studies funded.