Commentary: Adding to our comprehension of Gulf War health questions

Weaponised uranium and adverse health outcomes in Iraq: a systematic review

Background

The US military first deployed depleted uranium (DU) weapons in Iraq during the Gulf War in 1990 and in the 2003 invasion of Iraq. Research into the health impacts of DU has been mired in debate and controversy. Research funded by the US government has denied the health risks posed by DU to the Iraqi population, while opponents have claimed that DU is responsible for increased rates of birth defects and cancers in Iraq. Others assert that the public health impacts of DU weapons remain uncertain. This systematic review identified, appraised and synthesised all human observational studies assessing adverse health outcomes associated with DU exposure among the Iraqi population. To our knowledge, no systematic review has been conducted on the topic previously.

Methods

We searched 11 electronic databases for human observational studies published between 1990 and 2020 that measured association between exposure to weaponised uranium and health outcomes (including cancer, birth defects, immune system function and mortality) among the Iraqi population. We assessed risk of bias using the Navigation Guide’s risk of bias tool and rated certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO: CRD42018108225).

Results

Our searches identified 2601 records, of which 28 met our inclusion criteria. We identified five additional eligible reports from other sources. Two articles reported the results of multiple relevant studies; our final set included 33 articles reporting on 36 eligible studies. Most studies (n=30, 83%) reported a positive association between uranium exposure and adverse health outcomes. However, we found that the reviewed body of evidence suffers from a high risk of bias.

Conclusion

The available evidence suggests possible associations between exposure to depleted uranium and adverse health outcomes among the Iraqi population. More primary research and the release of missing data are needed to design meaningful health and policy interventions in Iraq.

Severe tissue trauma triggers the autoimmune state systemic lupus erythematosus in the MRL/++ lupus-prone mouse

Tissue damage associated with a severe injury can result in profound inflammatory responses that may trigger autoimmune development in lupus-prone individuals. In this study, we investigated the role of a large full-thickness cutaneous burn injury on the early onset of autoimmune disease in lupus-prone MRL/++ mice. MRL/++ mice (chronic model) exhibit autoimmune symptoms at >70 weeks of age, whereas MRL/-Faslpr mice (acute model) develop autoimmune disease in 17–22 weeks due to a lymphoproliferative mutation. Autoimmune disease developed in MRL/++ mice (4–15 weeks post injury) is manifested by skin lesions, vasculitis, epidermal ulcers, cellular infiltration, splenomegaly, lymphadenopathy, hypergammaglobulinemia, elevated autoantibodies and renal pathologies including proteinuria, glomerulonephritis and immune complex deposition; complications that contribute to reduced survival. Transcription studies of wound margin tissue show a correlation between the pathogenic effects of dysregulated IL-1β, IL-6, TNF-α and PGE2 synthesis during early wound healing and early onset of autoimmune disease. Interestingly, MRL/++ mice with healed wounds (30–40 days post burn) strongly rejected skin isografts. Conversely, skin isografts transplanted onto naive age-matched MRL/++ littermates achieved long-term survival. Collectively, these findings suggest that traumatic injury exacerbates inflammatory skin disease and severe multi-organ pathogenesis in lupus-prone mice.

Risk and the social construction of 'Gulf War Syndrome'

Fifteen years since the events that are held by some to have caused it, Gulf War Syndrome continues to exercise the mind and energies of numerous researchers across the world, as well as those who purport to be its victims and their advocates in the media, law and politics. But it may be that the search for a scientific or medical solution to this issue was misguided in the first place, for Gulf War Syndrome, if there is such an entity, appears to have much in common with other 'illnesses of modernity', whose roots are more socially and culturally driven than what doctors would conventionally consider to be diseases. The reasons for this are complex, but derive from our contemporary proclivity to understand humanity as being frail and vulnerable in an age marked by an exaggerated perception of risk and a growing use of the 'politics of fear'. It is the breakdown of social solidarities across the twentieth century that has facilitated this process.Unfortunately, as this paper explores, our inability to understand the social origins of self-hood and illness, combined with a growing cynicism towards all sources of authority, whether political, scientific, medical or corporate, has produced a powerful demand for blame and retribution deriving from a resolute few who continue to oppose all of the evidence raised against them.Sadly, this analysis suggests that Gulf War Syndrome is likely to prove only one of numerous such instances that are likely to emerge over the coming years.