Sunday, February 26, 2012

Linking side effects that develop many years after an exposure to the exposure

Over the past two weeks, several people asked me about illnesses they developed a number of years after exposures to the Gulf War, to anthrax vaccine, and to other toxic products.  Because this is an extremely complex subject, and a recurring issue, I thought I should address it in the blog, rather than try to discuss it separately with each person who approached me.

Here are the big questions embodied by the issues raised, imho:
  1. Did the exposure cause (or perhaps contribute to) the illness?
  2. Is there is a convincing way to link the original exposure to an illness that only became known many years later?
  3. What kinds of compensation might the person be eligible for?
Some illnesses are known to only be caused by specific exposures, but they are a small minority of illnesses.  An example:  eosinophilia myalgia syndrome, caused by a contaminant in the supplement L-Tryptophan, manufactured by the Showa Denko company of Japan.  This happened to be an early product made from genetically engineered bacteria.  It was a new illness caused by a new toxicant.  This is a very rare occurrence.

Some illnesses are related to a toxic exposures, but not everyone with the illness is known to have been exposed.  Parkinson's disease is much more common in farmers and others exposed to pesticides, but also occurs in the absence of a pesticide exposure.   This probably reflects the general idea that illnesses are due to an interaction between exposures, genetic predispositions, and other factors, such as nutritional state.

Both the VA and wikipedia list the illnesses that have been assigned, over time, as due to Agent Orange (contaminated with the dioxin TCDD) for purposes of a VA disability rating and medical treatment.  Congress granted veterans the "presumption" of disability if they served in Vietnam and developed a designated illness. 

This VA benefit is distinct from an initial settlement of $180 million made by the manufacturers of Agent Orange and attorneys for a Vietnam Veteran class action in 1984. 

Per wikipedia:
In 1991, the US Congress enacted the Agent Orange Act, giving the Department of Veterans Affairs the authority to declare certain conditions 'presumptive' to exposure to Agent Orange/dioxin, making these veterans who served in Vietnam eligible to receive treatment and compensation for these conditions.[63] The same law required the National Academy of Sciences to periodically review the science on dioxin and herbicides used in Vietnam to inform the Secretary of Veterans Affairs about the strength of the scientific evidence showing association between exposure to Agent Orange/dioxin and certain conditions.[64]
Through this process, the list of 'presumptive' conditions has grown since 1991, and currently the U.S. Department of Veterans Affairs has listed prostate cancer, respiratory cancers, multiple myeloma, type II diabetes, Hodgkin's disease, non-Hodgkin's lymphoma, soft tissue sarcoma, chloracne, porphyria cutanea tarda, peripheral neuropathy, chronic lymphocytic leukemia, and spina bifida in children of veterans exposed to Agent Orange as conditions associated with exposure to the herbicide. This list now includes B cell leukemias, such as hairy cell leukemia, Parkinson's disease and ischemic heart disease, these last three having been added on August 31, 2010.
Note that diseases were still being added to this list as recently as 18 months ago, for exposures that occurred 40-50 years earlier!

My point is that it can take a long time to identify a statistical relationship and make a causality assessment between an exposure and an illness.  And it can take a long time to develop a related illness after exposure.  In the case of Agent Orange (and probably related herbicides) the connections were only made because of federal legislation that asked the National Academy of Sciences to keep looking into possible connections.

Similar legislation does not exist for most other exposures.  So potential connections are not being made.  And the scientific research that might be used to make them may be sponsored by the manufacturer of the putative toxic substance, with the goal of obscuring a relationship.  For example, despite overwhelming evidence to the contrary, Showa Denko tried to blame overuse of L-tryptophan, rather than a contaminant, for cases of eosinophilia myalgia syndrome.

So it all comes down to politics.  Did Congress face enough pressure to investigate the potential linkage?  Was legislation passed to provide some type of compensation?  Was a viable mechanism set up to review the medical literature in order to identify any linkage?

In the case of illnesses meeting the definition of Gulf War syndrome, if you were physically in the Gulf, and later developed the condition, veterans are eligible for disability benefits and care.

In the case of anthrax vaccine, Congress has provided no remedy for vaccine-related injuries.  There as yet exist no standards for what constitutes an anthrax vaccine injury.  It is difficult or impossible to perform the necessary studies in an unbiased manner, as the Defense Department will not share its data.  And since only soldiers currently receive anthrax vaccine, there is no other modern data.  The Gulf War studies maybe confounded by multiple other exposures, and suffer from the long time that elapsed between the exposures and the self-reports of vaccinations and injuries.

Unless and until the US public demands access to the scientific data it paid for, I see no remedy for this state of affairs.


Mark Shapiro said...

Readers are encouraged to visit the 'Agent Orange Action Group' at

Meryl Nass, M.D. said...

Now, there is a possible compensation mechanism for products designated as emergency pandemic drugs and vaccines, such as smallpox and anthrax vaccines.

DHHS can determine if you have an illness caused by the vaccine, and can then compensate you (up to over $300,000) for an injury, if you received the drug/vaccine after 2006. However, this remedy provides no funding for attorneys, and since there are no existing standards, DHHS will have lots of leeway for their decisions. Also, there is a short statute of limitations.


Anonymous said...

Dr. Nass,
I am a former Soldier who got the series of 5 Anthrax shots before going to Iraq in 2006-2007. I now have Parkinsons Desease at age 47! Can you email me at please? I have several questions to ask. Thank you! Jon Morris

Anonymous said...

I am a former Marine that suffer from many medical issues that began after receiving 5 anthrax shots that were mandatory. I now suffer from migraines, dizziness (vertigo), muscular problem on the left side were I received a shot that left my arm numbed for an entire day. I get left back pain, shoulder pain left neck pain heart palpitation and many other issues. Before the shot the left my left arm numbed for a day I was in great health and the government will not take responsibility for it every time I mention it at the VA they always change the subject.

Meryl Nass, M.D. said...

My home number is 207 412-0004 and I will be home evenings next week if you wish to discuss this with me.

Meryl Nass, MD

Anonymous said...

Is there anyone to talk to about these symptoms? I feel like I have lost the last 12 years of my life after having to get the anthrax vaccine in 2002 (I wasn't even going to Iraq with my unit). I'm in so much pain, lots of inflammation, my brain
doesn't work and lots more.

Meryl Nass, M.D. said...

I can speak with yo next Monday evening at my home number of cell.

207 412-0004 or 522-5229. MN

Unknown said...

What about people who received the shots before 2006 I'm a veteran off the navy and received the shots before a 6 month deployment to the middle East in 2000 and years later I have anxiety vertigo and muscle twitching on my right side that no Dr can explain

Unknown said...

I am a veteran of OIF, and OEF. I received 4 out of the 6 Anthrax vaccine. I have many of the side effects.

Tierney said...

I just found out today (after it took the va 12 years to finally give me my immunization records), that I was immunized with lot fav 043. 2 years ago started having more frequent and worse migraines, neurological issues, pretty much the whole gamut. I am looking to get as much info as I can since I am now completely disabled and not sure what to do next. I am apprehensive about sharing it with my primary care doctor since I go through the VA for my health care.

Meryl Nass, M.D. said...

I can be called at 207 412-0004 (preferably weekends) for those who wish to discuss their illness with me--Meryl Nass, MD

Unknown said...

Christopher A. Gutierrez enlisted in 10/06/1997 released date 10/05/ 2001. He was diagnosed with Paroxysmal Nocturnal Hemoglobinuria in 2001 by Dr. Robert H Thomas He also had Severe Aplastic Anemia in 2001 and was told he had an 11 year life expectancy. They could not run his blood for lab work because it coagulated by the time it got to the lab. He received the Anthrax shots that were not FDA approved. He had a hard time swallowing, urinated blood, had abdominal pain, hard time breathing during attacks, blackouts, underwent a bone marrow transplant and multiple lung transplant. He passed away Aug 2016 from major lung complications and more.

PNH is not hereditary and cannot be passed on. In order for PNH to occur 2 things happen a gene mutation and a bone marrow disruption. Many soldiers have symptoms like Chris and are going undiagnosed, untreated and not compensated.

2 governments reports mentioned in Vaccine Syndrome (a documentary in are and Record of 35,000 soldiers who died from severe adverse affects from the Anthrax Vaccine and the reported adverse reactions.

Page 8. Gulf War Illness and the Health of Gulf War Veterans

Vaccines. Receipt of multiple vaccines over a brief time period is a common feature of overseas military deployments. About 150,000 Gulf War veterans are believed to have received one or two anthrax shots, most commonly troops who were in fixed support locations during the war. Although recent studies have demonstrated that the anthrax vaccine is highly reactogenic, there is no clear evidence from Gulf War studies that links the anthrax vaccine to Gulf War illness. Taken together, limited findings from Gulf War epidemiologic studies, the preferred administration to troops in support locations, and the lack of widespread multisymptom illness resulting from current deployments, combine to indicate that the anthrax vaccine is not a likely cause of Gulf War illness for most ill veterans. However, limited evidence from both animal research and Gulf War epidemiologic studies indicates that an association between Gulf War illness and receipt of a large number of vaccines cannot be ruled out.

I am trying to file compensation with VA with no hope they will actually do anything. Most are afraid of being tested further from what is happening to them because they will just take their blood and dismiss the problem like they just continue to do.

Please contact me at

Anonymous said...

I received my Anthrax shots in 1999 and 2000. I'm started to become fatigued in the months after that. I also started to get rashes becoming more severe in nature. This eventually led to three brain surgeries Two Strokes five blood clots and a host of other issues. This was only two and a half years after my service. I have no family history, my entrance and exit physical were fine. The only abnormal thing I ever put in my body was the anthrax vaccine. Which was mandatory by the way. Looking for help.

Rosie Rose said...

I received the series of Anthrax vaccines in 1999 and then received booster shots through out the years before deployments until I retired in 2012. Depending on the arm I received the shot in the lymph node in my arm pit would swell for a day or two. I have now been diagnosed with B Cell Lymphoma. I am 45 year old very healthy person, always have been, who either runs or swims daily and eats healthy and this hit me out of nowhere. I am wondering now if the anthrax shots I received over the years is linked to the lymphoma. I am afraid to file a claim with the VA because they will just dismiss it. Any help would be great. You can email me at

Stephanie Hillis said...

My Dad is 75 and had the anthrax series as a DOD employee In approx 1995/1996 before going overseas. He now has moderate/severe Parkinson’s Disease. He is not eligible for VA care. He has Medicare & BC Fed, but it seems if the government is responsible he should get some sort of compensation! He is miserable.

Unknown said...

My husband retired in 2009. He received 2 anthrax shot instead of the 5 because he had a reaction after the second one. Since 2014 he was having some symptoms nobody was able to tell what is was and now almost 3 years ago finally a doctor told him he has peripheral nephropathy. The doctor mentioned that maybe he was exposed to something that is now showing. I don't remember the year he had those shot but it was between 2001 to 2009. His last 8 years in the military he basically was more in the desert than in the USA. DO you think his symptoms are related somehow to the Anthrax? What kind of test can be done?