Teaching and Learning Resource (TLR)

1. Title

‘Gulf War Syndrome’

2. Keywords

‘Gulf War Syndrome’; environmental and health risks; scientific uncertainty; contested knowledge claims.

3. Introduction

The Gulf War began in August 1990, when Iraq invaded the small neighbouring oil state of Kuwait. It ended in February 1991 with the expulsion of Iraqi forces, by a military alliance drawn mainly from Europe and the United States (the so-called ‘Gulf Alliance’). Since the ending of hostilities, an increasing number of Gulf War veterans - mainly in the UK and the USA - have claimed to be suffering from a range illnesses arising from exposure to environmental and health risks in connection with their service in the Gulf.

The symptoms and conditions reported are highly variable - but with chronic fatigue, joint and muscle pains, severe headaches, sleep disorders and depression amongst the most common. Suicides, birth defects amongst offspring conceived after the War, and miscarriages (mainly amongst partners of male veterans), have also been attributed to the range of conditions which have become popularly known as ‘Gulf War Syndrome’.

Possible causes are almost as numerous as the range of alleged symptoms and conditions themselves. The most commonly mentioned are exposure to organo-phosphate insecticides, sprayed on tents, equipment and elsewhere; side-effects from the numerous vaccinations given, particularly against biological weapons, and from the anti-nerve agent NAPS; exposure to chemical warfare agents, including mustard gas and the nerve gas sarin; radiation exposure from depleted uranium-tipped missiles, used by the Gulf Allies themselves; and exposure to smoke containing NOx, SO2 and inhalable particulates, from Kuwait’s burning oil wells.

In essence, the veterans’ case centres around three key claims:

1. The military authorities exposed service personnel to unreasonable medical and environmental hazards.
2. During and since the conflict, the military authorities have variously failed to generate, record and act on information of relevance to veterans’ illnesses; have withheld and destroyed information; have distributed misleading information; and have obstructed enquiries by others.
3. Diagnosis and treatment of their illnesses have been impeded, in part by the unprecedented nature of their medical conditions, but also by the military authorities’ own obstructive behaviour.

There is intense controversy over almost all aspects of these claims, however: UK and US governments and military leaders alike have consistently denied the existence of ‘Gulf War Syndrome’ - though all now acknowledge that veterans are disproportionately subject to a range of physical and psychological illnesses which may be, directly or indirectly, connected with their service in the Gulf.

But after more than eight years of debate - involving alleged sufferers and their supporters, government and military authorities, medical and environmental scientists, and the mass media - there remains no unanimity of view. Indeed, this controversy displays many characteristics which have been attributed to contemporary environmental and health risks in general: uncertain science, infused with the diverse values and interests of claims-makers; competing expert and ‘lay’ claims; and a ‘power struggle’ for credibility and influence over public and political opinion. In common with many such risks, furthermore, this issue centres on mainly technological (as opposed to natural) hazards - and, in particular, on unprecedented exposures to a combination of technologies, whose adverse (and, especially, synergistic) side-effects may not be well known.

4. Aim

This TLR aims to develop students’ powers of interdisciplinary and critical thinking, in relation to an issue which displays many characteristics of contemporary environmental and health risks in general.

5. Learning outcomes

Students who have successfully engaged with this TLR will:

• Have considered the perspectives and ‘positioning’ of claims-makers in the debate about ‘Gulf War Syndrome’, with particular reference to stakeholders’ interests and capacities for influence over public and political opinion.
• Have reflected on the uncertain and contested nature of scientific knowledge - especially knowledge of technologically-induced environmental and health risks.
• Have gained experience of active learning, involving group-based textual analysis and discussion (class-based mode of use only: see How to use TLR, below).

6. Pre-requisites

Some of the issues raised by this TLR could be addressed on the basis of ‘common sense’ and a grounding in the science of environmental and health risks. However it is intended that students should have had at least some prior exposure to those major themes identified in the Learning Outcomes.

The main pre-requisite, then, is an ability - or, at least, the potential - to consider scientific knowledge in terms of ‘claims-making’ activity, and in terms of its provisionality and contestability. Hence students whose prior educational experiences have explicitly or implicitly encouraged the concretisation of an ‘unproblematic’ view of scientific knowledge (as ‘truth’ or ‘fact’) will be particularly challenged by this TLR.

Students should also be capable of active learning, including participation in group discussions and plenary feedback sessions (class-based mode of use only: see How to use TLR, below).

7. How to use TLR

I. Class-based discussion

The text (see Annex One) and discussion questions (see Instructions to students, below) should be distributed one or two weeks in advance of the main class meeting, in conjunction with an oral briefing. Between 10 and 30 minutes may be required for these preparatory activities, depending on students’ familiarity with the intended mode of learning, the kind of subject matter, and the proposed learning tasks.

The main class discussion can accommodate up to 20 students (or conceivably more, if ‘team’ taught). Between 10 and 20 minutes may be required (depending on prior experience) for further briefing and preliminary questions - which should, in particular, ensure that students are clear about organisational arrangements and learning intentions.

For classes of six to eight students or more, the following two-stage exercise is then suggested (for smaller classes, alternative arrangements may be preferred):

1. Mainly unsupervised discussion and note-making in groups of four to six students, with the tutor(s) in a roving/advisory role. Some division of student labour is conceivable at this stage (e.g. if the groups focus on different stakeholders), but is not highly desirable. Between 40 and 50 minutes can be profitably devoted to this stage.
2. Plenary session, involving feedback from group spokespersons, along with class discussion and tutor-led summary/conclusion. Again, between 40 and 50 minutes might be devoted to this stage, depending on the class size. Careful time management is recommended, particularly with larger numbers. For example, formal group feedback might be restricted to Question 1, with each spokesperson invited to introduce one or two new stakeholders only (perhaps on a rotating basis, until no further suggestions are forthcoming); Question 2 could then be examined in a tutor-led ‘brain-storming’ session.

Question 1 might be considered with reference to the following framework, which could be used electronically or in conjunction with a whiteboard, OHP, flipchart etc:

Finally, the discussion could be written up as an individual assignment, supported by further research (see Recommended reading) and fully referenced.

II. Text-based examination

NB The following suggestion is merely indicative of ways in which the kinds of learning outcomes under consideration here could be tested under examination conditions. However examination ‘security’ may be breached if the text and discussion questions provided here are themselves used.

This TLR could form the core of a synoptic, text-based examination; it would be particularly appropriate for courses which aim to develop students’ powers of interdisciplinary and critical thinking, in relation to contemporary environmental and health risks. If used in this way, it is recommended that the text itself (Annex One), along with the examination briefing notes (Annex Two), be distributed to students approximately three to four weeks before the examination. Additional sources (see Recommended reading) might also be made available at this stage. For a two-hour paper, two compulsory questions should be used (see Instructions to students: Questions 1 and 2); they should be issued on the day of the examination only.

Such an examination has the following merits:

• The questions require a display of higher level thinking skills, as opposed to those of ‘recall’.
• The questions are ‘synoptic’ - they extend beyond the specific case of ‘Gulf War Syndrome’ (to test wider powers of interdisciplinary and critical thinking, in relation to contemporary environmental and health risks).
• Use of two compulsory and synoptic questions largely removes the ‘chance’ element which characterises many essay-based examination papers (particularly where each question tests a discrete portion of the syllabus).
• The ‘security’ of the assessment is protected, by preventing the use of ‘prepared’ answers (of uncertain origin).

It is strongly recommended, however, that students who are not accustomed to this type of examination be carefully supported in their preparation - for example, by oral counselling (in addition to the briefing notes) and by incorporating text-based analysis tasks (formatively assessed in some cases, if possible) into the programme of learning activities (see, for example, The Brent Spar Conflict: Making Sense of the Greenpeace Case; Killer Rabbit Virus on the Loose!).

8. Instructions to students

Some or all of the following may be used, depending on students’ prior learning:

1. Identify the main ‘stakeholders’ - including organisations, ‘communities of interest’ and other actors - who have advanced claims in favour of, and against, ‘Gulf War Syndrome’. In each case:

• Comment on any pre-existing circumstances - e.g. values, ‘interests’ or associations - which might predispose them toward (or, conceivably, against) the view they have taken.
• Consider how influential (e.g. how powerful, how authoritative) they might be as claims-makers, in the eyes of those whom they are seeking to persuade.

2. According to the widely-held ‘common-sense’ view, science principally involves the discovery and sharing of ‘facts’ and theories (which explain those ‘facts’) about the world (cf Chalmers, 1988: 1(1)). Sometimes things we believed to be true turn out to be false, but this kind of ignorance - along with uncertainties and gaps in our knowledge - can usually be eliminated by further investigation. In this view, the stock of scientific knowledge gradually increases as new ‘facts’ and theories are discovered, uncertainties resolved and errors corrected.

How does the account of ‘Gulf War Syndrome’ provided here challenge this ‘common-sense’ view of scientific knowledge? Give particular attention to:

• The veterans’ second and third key claims - in particular, their implications for the availability and reliability of scientific knowledge pertaining to ‘Gulf War Syndrome’.
• The selectivity and provisionality of scientific knowledge - especially in relation to questions such as what problems to study, which tests and other enquiries to conduct, which methodologies to use, what evidence to look for and to record, which interpretation to favour where (as is often the case) conclusions are ‘underdetermined’ by the evidence.
• The ‘reductionist’ nature of science, which may militate against recognition of synergistic relationships.
• The problem of so-called ‘Type-II’ statistical errors in testing for adverse environmental or health side-effects.

9. Stimulus Material

See Annex One.

10. Degree stage

This TLR is intended primarily for students operating at academic Level 3 or above. However, see Pre-requisites (above) for further guidance.

11. Resource requirements

Resource requirements depend, in part, on whether the TLR is to provide a focus for class-based discussion, or for a text-based examination:

• For class-based discussion, the teaching accommodation should permit small group and plenary discussions, and should be equipped with whiteboard, OHP, flipchart and/or computer and associated projection facilities (see above, How to use TLR).
• For a text-based examination, the relevant briefing notes should be used (see Annex Two).
• For either mode of use, students should have access to the main stimulus materials (Annex One) and any additional sources considered appropriate (see Recommended reading), along with the questions to be used (see Instructions to students).

12. Preparation

For either mode of use, preparation should include class-based oral briefing, along with private reading of the main stimulus materials (Annex One) and other sources considered appropriate (see Recommended reading). For a text-based examination, students should also consult the relevant briefing notes (Annex Two). For further details, see How to use TLR (above).

13. Links with other TLRs

The following TLRs examine aspects of scientific uncertainty and contested knowledge claims, in relation to environmental and/or health risks:

· Environmental Risk: A Philosophical Analysis

· Environmental Risk and NIMBYism

· Killer Rabbit Virus on the Loose!

· The Brent Spar Conflict: Making Sense of the Greenpeace Case

The first two are mainly theoretical in nature, whilst the third and fourth involve text-based analysis of specific cases.

14. Follow-up activities

Particularly for students who are familiar with the ideas explored in Environmental Risk: A Philosophical Analysis and/or Environmental Risk and NIMBYism, the following additional questions might be used:

1. The literature on environmental and health risks is characterised by a debate about the virtues and limitations of ‘expert’ and ‘lay’ knowledge. What light does the account of ‘Gulf War Syndrome’ shed on this debate?
2. To what extent, if any, have government and the military authorities adopted a ‘precautionary’ approach toward the health of Gulf War personnel (either before, during and/or since the conflict)? What, if anything, might such an approach have led them to do differently?

15. Recommended reading

I Science : its uncertain and contested nature, and its authority

Barnes, B (1985) About Science (Basil Blackwell)

A very accessible book about the nature of science. Chapter 4 (“Expertise in Society”) considers how science is used to give authority to claims

Chalmers, A (1988) What is this Thing called science? (Open University Press)

Kuhn, T (1963) ‘Scientific paradigms’. In B Barnes, ed (1972) Sociology of Science (Penguin)

II ‘Gulf War Syndrome’

Books

Bloom, S et al, eds (1994) Hidden Casualties: The Environmental, Health and Political Consequences of the Persian Gulf War (Earthscan)

See especially pages 134-37, 237-44 and 286-89

Sadiq, M and McCain, JC (1993) The Gulf War Aftermath: An Environmental Tragedy (Kluwer)

Mainly concerned with (non-human) environmental consequences. Chapter 7 deals with civilian and military health issues

Academic Papers

David, A and Wessely, S (1999) ‘ ... [to follow] ...’ The Lancet, 353 (3), ... [to complete]

Haley, RW et al (1997) ‘Is there a Gulf War Syndrome?’ Journal of the American Medical Association, 277 (3), 215-22

Landrigan, PJ (1997) ‘Illness in Gulf War veterans’ Journal of the American Medical Association, 277 (3), 259-61

Other Sources

Daily Mail (various articles: see Annex One)

Guardian, The (various articles: see Annex One)

‘Horizon - Gulf War Jigsaw’ BBC Television, 14 May 1998. Programme transcript available at http://www2.bbc.co.uk/horizon/gulfjigsaw/shtml

House of Commons Defence Select Committee (1995) Gulf War Syndrome. House of Commons Paper No. 197, Session 1995-96 (Stationery Office Books)

Mail on Sunday, The (various articles: see Annex One)

Ministry of Defence website: http://www.mod.uk/policy/gulfwar/index.htm

Kleiner, K (1997) ‘Doctors dissect Gulf sickness mystery ... ’ New Scientist, 18 January, page 8

National Gulf War Veterans’ and Families’ Association website: ... [to follow] ...

Times, The (various articles: see Annex One)

(1) Chalmers, A (1988) What is this Thing called Science? Open University Press

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