The Things They Burned

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On its public health web page, the VA has posted a terse, official statement about burn pits. “At this time,” it reads, “research does not show evidence of long-term health problems from exposure to burn pits.”

This statement is untrue, in the way that official statements are often untrue: not because it contains an outright lie, but because it twists the meaning of everyday words like research and evidence.As the VA knows, there has, in fact, been significant research into burn pits by reputable scientists at established academic institutions, who have published their findings in major, peer-reviewed publications. And that research strongly suggests that long-term health problems among veterans may well have been caused by exposure to burn pits.

One of the first studies was conducted by Miller, the professor of clinical medicine at Vanderbilt. In 2004, soldiers from the 101st Airborne returned from a one-year deployment in Iraq and were stationed at Fort Campbell, not far from the university. Some were so short of breath, they were unable to complete the Army’s two-mile run—one of the military’s most basic tests for physical readiness to deploy. Physical readiness is an important factor in determining “service connection,” the causal link for military-related illnesses that obligates the VA to provide medical care or disability benefits.

A soldier who has completed a tour of duty was, by definition, physically fit prior to deployment. So when healthy soldiers are suddenly unable to complete the same test they passed prior to deployment, there is a baseline indication that something happened to them during their service that caused their health to deteriorate. As Miller later recalled, what each soldier told him was remarkably consistent: “I was elite. I was athletic. I was deployed. And now I can’t do my two-mile run, and I’m not deployable.”

Miller’s study was published in 2011 in the New England Journal of Medicine. In a related paper, he observed that constrictive bronchiolitis “rarely occurs in otherwise healthy and athletic individuals. It is known to result from toxic inhalation.” He also noted that researchers at National Jewish Health in Denver found similar patterns of constrictive bronchiolitis among soldiers exposed to burn pits.

Other academic researchers were also studying how burn pits had injured soldiers. In 2004, Anthony Szema, an occupational medicine and epidemiology expert at Hofstra, noticed a sudden shift in the kind of patients who came to him for treatment. “Before, I mostly saw 80-year-old veterans,” he recalls. “Now I saw young women and men, previously healthy soldiers, who were out of breath and suffering respiratory illnesses, including asthma, and no longer fit to deploy.”

When asthma medication didn’t improve their conditions, Szema began conducting a series of tests to figure out what was wrong. He acquired three sets of dust samples: one from sand taken from the San Joaquin Valley in California; another from a titanium mine in Montana; and a third from a burn pit at Camp Victory in Iraq. When Szema pumped the samples into the lungs of laboratory mice, the result was striking: Mice that inhaled the Camp Victory dust suffered the highest levels of lung inflammation and suppressed T-cells, which form the core of the body’s immune system. The study was published in the Journal of Occupational and Environmental Medicine.

While Szema’s sample size was tiny—only 13 mice—the results matched what he saw among the soldiers he treated. “Humans are not supposed to breathe in particles,” he says. “If we breathe in high concentrations of particulate matter, we will suffer prematurely, of lung disease or asthma, regardless of where the particles are coming from. Humans should not be inhaling smoke. We should not be burning trash. In Iraq, the trash is fueled by jet fuel. Do you want to breathe jet fuel?”

“Humans should not be inhaling smoke,” Szema says. “We should not be burning trash. In Iraq, the trash is fueled by jet fuel. Do you want to breathe jet fuel?”

Szema compares burn-pit exposure to the illnesses suffered by firefighters, police, and other 9/11 workers after the collapse of the World Trade Center. “The exposure is much worse in Iraq,” he says. “Not only were many of these guys deployed for a whole year, but in addition to burn pits, there are tons of other exposure sources. It’s a multifactorial issue. If you’re not dead after the Humvee explodes, then you are going to breathe in bits of the vaporized Humvee. Whatever they aim at you over there, it blows up. Then you head back to base after battle and hang out and breathe in all the smoke from trash fires, because the smoke was in the mess halls and bathrooms and barracks.”

The issue of multifactorial exposure is at the heart of the battle over burn-pit disabilities. Because troops were exposed to so many health hazards, from sandstorms to IED blasts to mine fires, it is extremely difficult—if not impossible—to isolate a single cause behind a rash of ailments with absolute certainty. But for many soldiers, Szema notes, the burn pits delivered a steady stream of toxic chemicals straight into their lungs, day and night. “The lungs are our body’s filters,” he says. “Go to Iraq and your lungs are like the back of an air conditioner you haven’t changed for five years. It’s like Iraq is coming out of their lungs.”

The government’s response to these studies has been emblematic of its past approach to service-related illnesses among veterans. First, it sought to debunk the early research. Then, it manipulated its own studies to ensure that the outcome would arrive at the word so many burn-pit soldiers have come to dread: inconclusive.

In 2009, the VA commissioned a major study of burn pits, focused on the Balad base. The study was conducted by the Health and Medicine Division—previously known as the Institute of Medicine—at the National Academy of Medicine. HMD’s mission is to “provide independent, objective analysis” that will help “solve complex problems and inform public policy decisions related to science, technology, and medicine.” In practice, however, HMD faces the same pressure any other consulting organization faces: to produce results that will please its client. More than half of all funding for HMD and the National Academy of Medicine comes from the federal government, including 13 percent from the VA. The HMD study on burn pits, in short, was underwritten by the very agency potentially facing billions of dollars in insurance claims from veterans exposed to burn pits.

In 2011, after two years of study, HMD issued a report entitled “Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan.” The report wasted no time dismissing the “concerns” expressed by ailing veterans. The public furor, it suggested, had been created by “articles in the popular press” and “anecdotal reports.” Such reports, HMD warned, “do not demonstrate causality or even association; the committee looked instead to the epidemiologic literature on the exposed populations, and on populations similarly exposed.”

HMD’s own conclusion amounted to one big scientific shrug. Its researchers reported that they were “unable to say whether exposures to emissions from the burn pit at Joint Base Balad have caused long-term health effects.” They conceded only that service in Iraq and Afghanistan “might” be associated with long-term health effects. They also recommended further study—not of burn pits, but a “broader consideration of air pollution.”

A closer look at the study, however, reveals that the HMD shaped the methodology and data to avoid linking burn pits to the widespread suffering among veterans. The research protocol it followed required a “risk assessment process” for contamination that was first developed by the Nuclear Regulatory Commission in 1983. The process sounds straightforward enough: First, you study the contamination level of a specific place, such as Balad. Then, you figure out the inherent toxicity of the chemical and how many people were exposed. After that, you review research published on comparable contaminations—cancer among victims at Chernobyl, say, or residents of Love Canal. The result, in theory, should yield a scientifically rigorous prediction of how likely the contamination was to make people sick.

When it comes to burn pits, however, that kind of risk assessment simply isn’t possible. In its report, HMD concedes that the Defense Department does not possess adequate data on Balad. It doesn’t know what was burned, or how often soldiers worked in the pits, or how many troops lived nearby, or how long they lived there. It doesn’t know the frequency of smoke exposure, or the combination of pollutants involved, or what other contamination soldiers might have been exposed to, either on base or off. The Pentagon was conducting a war, not a science experiment. And as in past wars, it did not pause to assess whether its own practices—something as seemingly mundane as burning trash—might be placing soldiers at serious risk. After Vietnam, the government was unable to say exactly how much Agent Orange soldiers were exposed to. After the Gulf War, it could not account for the combination of toxic elements that contributed to veterans falling ill: depleted uranium, smoke from burning oil wells, vaccinations, sarin gas. The VA, in fact, still refuses to refer to the debilitating condition suffered by Gulf War vets as a “syndrome.” It prefers a more revealing term: “medically unexplained illnesses.” For the military, the health and well-being of veterans is simply another known unknown.

Faced with a lack of accurate data on human exposure in Iraq and Afghanistan, HMD had a clear alternative, one that would meet the prevailing scientific standard for such research: a review of toxicity studies on animals. While such a review would not be comprehensive, it would help determine whether burn pits had made soldiers sick. That, in turn, would allow veterans to know if their ailments were service-related, which would force the VA to provide them with treatment and disability. But instead of following established scientific protocol, HMD made a decision that fatally undercut its findings: It refused to consider animal studies in reaching its conclusions.

HMD researchers had been working for years to skew their studies in favor of the VA. In 1994, when HMD published its first study on the impact of Agent Orange on U.S. soldiers, its own research standards required it to rely on both human and animal studies. That study confirmed a link between Agent Orange, a military herbicide, and widespread health problems among Vietnam vets.

By 1998, though, when HMD began its studies of Gulf War exposures, it had made a subtle but significant change to its standards for “categories of evidence.” Animal studies could still be discussed in its reports, but they were no longer considered valid evidence as part of its final conclusions. The science, in short, was being rigged to reach a desired outcome.

In Anthony Szema’s study, dust samples from Camp Victory (top) injured the immune system in mice. Electron microscopy of the dust (above) found particulates that likely caused lung scarring in veterans.Photographs by Nina Berman (x2)

A year earlier, a congressional investigation had called the government’s approach to studying Gulf War illnesses “irreparably flawed.” In response, Congress created the Research Advisory Committee to conduct an independent study. The RAC reviewed evidence from nearly 2,000 scientific studies and government reports, including both human and animal studies. Unlike HMD, which stated that it was not its responsibility “to determine whether a unique Gulf War syndrome exists,” the RAC found that the illness was “real” and that it “affects at least one-fourth of those who served in the war, is not associated with psychiatric illness, and was caused by toxic exposures including pesticides, pyridostigmine bromide pills, and possibly oil well fires, multiple vaccinations, and low-level nerve gas released by the destruction of Iraqi facilities.”

When it came time to study burn pits, however, HMD once again relied on flawed methodology. Lacking human data on Balad, researchers decided instead to look at two nonmilitary populations it defined as similar to soldiers who served at Balad: firefighters, including those exposed to chemical blazes and wildfires, as well as incinerator workers. HMD acknowledged that the experience of firefighters is “likely to differ from the chronic exposures to burn-pit emissions that military personnel experience.” But it still contended that this group was “the best available representation of exposures to mixtures of combustion products.”

It’s not hard to see how HMD’s methodology would corrupt its findings. Firefighters inhale smoke only for brief periods, unlike the around-the-clock exposure experienced by soldiers who lived and worked next to burn pits in Iraq and Afghanistan. And incinerator workers, by definition, inhale cleaner-burning smoke that has been run through an incinerator—the very same equipment that KBR failed to deploy at Balad and other military bases. Demonstrating a low risk to firefighters and incinerator workers would tell you next to nothing about the connection between burn pits and ailing veterans.

“You have a concern about people coming back, people getting ill, and then do you go do a study by comparing their health to people back home?” says James Binns, who chaired the RAC that studied Gulf War illnesses. “This was a study designed not to detect the problems, but to dilute the problems.”

In an email to the New Republic, HMD defended its methodology. It cited the complex mix of chemicals released by the burn pits, and said that it did not know “if the black smoke that everyone complained about had been sampled.” While it would have been “nice,” HMD added, to have reliable studies in which animals were exposed to burn-pit emissions with the same intensity and frequency as soldiers, “these types of studies are difficult, expensive, and time-consuming to conduct.”

The VA employed a similar form of scientific self-dealing in 2009, when it conducted a national survey on the health of more than 20,500 veterans who had been deployed during the wars in Iraq and Afghanistan. Steven Coughlin, a senior epidemiologist at the VA’s Office of Public Health, used data from the survey to study the link between burn-pit exposure and respiratory illnesses such as asthma and bronchitis. Coughlin, who had run the public health ethics program at Tulane University and who co-wrote the ethics guidelines for the American College of Epidemiology, found a positive correlation between soldiers exposed to the burn pits in Iraq and Afghanistan and the onset of chronic ailments. But when he shared his findings with his supervisor at the VA, he was ordered to stop looking into the data for such connections.

“We set the findings aside,” Coughlin says. “Tabled them. Discarded them. They decided not to include the burn-pit exposures, and focus simply on the frequency of respiratory illness. They wanted to ‘simplify’ the analysis. It became clear that they were trying to suppress the findings and downplay the associations instead of highlighting them.”

Coughlin resigned from the VA in 2012. It was untenable, he concluded, to conduct scientific research on behalf of an agency that, like any insurance company, had a direct financial motivation to deny claims to its patients. “There’s a conflict of interest within the VA,” Coughlin says. “As they find new deployment-related health conditions, like the conditions associated with Agent Orange exposure during Vietnam, it ends up costing them billions of dollars.”

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