Six degrees of Kevin Bacon--Al Eskan Disease and "Dirty Dust"

Military Medicine, Sep 2000 by Clooman, Clifford C, Tenglin, Richard, Butler, Frank, Leitch, Robert A

To our readers:

In the August 2000 issue the page number where the letters to the editor continue is wrongly stated, The correct page number is 625, not 240.

The Role of the Sand in Chemical Warfare Agent Exposure among Persian Gulf War Veterans: Al Eskan Disease and "Dirty Dust"- Vol. 165, No. 5

Dear Editor:

Particulate matter may indeed enhance the effect of chemical agents. The adsorption (not absorption) of chemical agents onto the right size particulate matter may, also, enhance their toxicity, at least in pulmonary exposures. Someday there may be a proven cause (that meets Koch's postulates) for the "Gulf War Syndrome"-- and it MAY have something to do with chemical weapons. But what is certainly true is that the article "The Role of the Sand in Chemical Warfare Agent Exposure among Persian Gulf War Veterans: Al Eskan Disease and `Dirty Dust"' published in the May issue of Military Medicine, is speculation portrayed as fact.

This article concludes, "that the microimpregnanted sand particles in the theater of operation/Persian Gulf War depleted the immune system and simultaneously acted as vehicles for low-intensity exposure to chemical warfare agents and had a modifying-intensifying effect on the toxicity of exposed individuals." This conclusion may be true but there is insufficient evidence offered in this article to support that conclusion. Indeed, it is the nature of the supportive "evidence" that is offered that leads us to refer herein to the popular game "Six Degrees of Kevin Bacon." In this game participants are challenged to link Kevin Bacon, an actor, to any other actor. This can purportedly be done every time through not more than six linkages. That this can be done does not, however, imply that the two actors, thus linked, are related. Nor do the relationships set forth in this article establish any definitive causality (the coffee causes pancreatic cancer problem of multivarient analysis). A hodgepodge of loosely connected information is provided with linkages made through the frequent use of such words as "speculate," "probability," "could," "may," and "might." Much information that is provided to support various assertions does no such thing (see p. 325-- "Possibilities of exposure, without any attempt to prioritize, include the following...").

Worse, although extensive references are provided, a number of important but unsupported assertions are made, to wit, "...the absorption of CS agents onto particles (inert or bioactive) can advance, modify, or alter their action and, most importantly, camouflage their presence with fatal consequences (italics added) of nonrecognition." A bold, but unfortunately unsupported, statement. At one point, the comment is made "Whether the coalition forces had any exposure to CW agents is debated extensively and remains as controversial as the quantity and quality of the exposure." While at another point, the statement is made that "Recent evidence (not referenced) suggests that chemical warfare (CW) exposure may have been nearly widespread."

Much of what is presented in this article does not seem even remotely related to the issue at hand (p. 327, "The Czechoslovakian contingent... deployed with... the UAZ-- 469CH [which] was due to be replaced because it was found to provide inadequate protection against CW agents as well as against small-caliber weapons and splinters, [It] initially had 169 personnel, one of whom shot himself dead on January 16, 1991"-perhaps we are left to presume that his suicide had something to do with a low level chemical agent exposure).

At one point it is noted (p. 331) that "the `yellow dust,' characteristic of dried mustard gas and used by Soviet-- supplied insurgents in Laos, matches in appearance the yellow dust that coated tents and outdoor coats in the KTO" (no reference). And that, "The so-called `white dust' could easily be produced by the incinerated depleted uranium rounds" (Reference-"Depleted Uranium Education Project: Metal of Dishonor: Depleted Uranium. How the Pentagon Radiates Soldiers and Civilians with DU Weapons. New York. International Action Center, 1997-is this a reputable scientific publication?).

The authors note that "exposure to the Arabian sand is the one common denominator experienced by all service members deployed to... Operation Desert Shield/Storm." Certainly a true statement but it would also be true to say that they all breathed the same air. While we know that oxygen toxicity does occur if given in a high enough concentration for long enough, the mere fact that a group of people, all breathing the same air, develop a collection of disparate medical conditions, does not therefore prove they are all suffering from oxygen toxicity.

Perhaps the best example of the abandonment of the scientific method for speculation is the suggestion on page 333 that the Curse of Tutankhamen and Lawrence of Arabia's pulmonary illness were also caused by sand-- triggered immunodepletion. Weapons of mass destruction, the Mummy's Curse and Lawrence of Arabia-it makes great reading but is it fact of fiction?