Wessely's War

Of all the job titles Simon Wessely thought he might hold in his life, researcher ranked among the least likely. He wanted to be a physician. "I certainly didn't see myself in a laboratory," Wessely says. So the Sheffield, England native collected the necessary degrees, but wasn't in practice long before he realized he found general medicine unchallenging. Wessely moved on to psychiatry and in time found his true niche. In one of life's delicious little twists, Wessely is today considered one of the leading researchers on Gulf War syndrome. His studies on scores of veterans reveal that fighting in the Gulf did affect their health, causing still undefined ailments, and that multiple vaccinations play at least a small role in their infirmities. His findings have forced governments and the medical community to re-evaluate treatment of Gulf War veterans. "We haven't found the smoking gun and I don't think we will," says Wessely, psychiatric epidemiologist and head of general hospital psychiatry at London's Institute of Psychiatry. "But we have shown beyond a shadow of a doubt that something has happened and attention must be paid. It's not aberration or media frenzy." Wessely asserts that no single solution can explain illnesses like Gulf War syndrome, and his multidisciplinary team of researchers includes a war historian, who compares the syndrome with illnesses from past wars. Having a historian on the team "has been worth its weight in gold." This unique, interdisciplinary approach has attracted worldwide attention from scientists, and has attracted multiple government funders. "I would think that he is on the cutting edge," says Benjamin H. Natelson, head of the Gulf War Research Center in Piscataway, NJ. "He's just tops in the way he thinks about research problems and doggedly gets answers. His work is very important." If Wessely's experience can be a lesson to others, he might call the course managing a career, in bites. "You achieve certain targets, and you move up along the ladder," he reflects. "Tackle problems where you can see where the outcome will be in the time available." Population Translation Some researchers question the real world value of Wessely's studies, arguing that it's hard to translate findings from thousands of subjects into information a clinician can eventually employ. "I don't think he had done any one thing that has changed things," says Natelson. "The important thing about Wessely is his energy and creativity and his ability to pull a diverse group of people as smart as him together to focus on this problem." Wessely's easy-going manner and quick wit can mask his professional status. Living in London with his wife, Claire, a physician, and two sons, Wessely worries as much about his children's soccer games as about his prestigious preoccupations. Partly that is because, as head of section for hospital psychiatry, he must slog through daily administrative tasks. "A lot of my time is spent writing grants and running people and programs and the institution," he notes. Art Roots a Science Career By the time he was 12, Wessely knew he would pursue medicine. Nevertheless, this son of a linguist father and a musician mother admired the arts, and eventually earned an undergraduate degree in art history from Cambridge University. He completed his medical training at Oxford University Clinical School, where he graduated in 1981. But despite his early career dreams, inspired by watching Doctor in the House on television, the physician grew fatigued with the healing profession in the flesh. He did fancy psychiatry, however. The fascination lured Wessely to London to train at Maudsley Hospital, England's main psychiatric center. He cringed when he found out that research would be mandatory: "Research was what people did who should have been teaching me." Still, to remain in good standing, the young scholar produced his first paper in 1985. Called Dementia and Mrs. Thatcher, it was published in the British Medical Journal and made a big hit with the media. It also made a big impression on Wessely. "Having been forced to do research, I discovered I loved it," he says. Following a professor's recommendation, Wessely accepted an epidemiology fellowship at the London School of Hygiene and Tropical Medicine. The multidisciplinary thinker had discovered his focus. "That was a turning point," he says. "I found that I loved epidemiology and found the subject matter fascinating and elegant." Wessely fused epidemiology and psychiatry into a study of the incidence, prevalence, and root cause of psychiatric disease, a combination that led to people largely ignored by other researchers. His initial focus: chronic fatigue syndrome. "There is a bit of me that likes challenging areas," he observes. From the start, Wessely applied the philosophy that a single solution could not answer most questions and that arts and culture played an important role in understanding psychiatry. "In other disciplines the history and cultural may be interesting but most likely won't influence current work," he says. "But in psychiatry those things are quite relevant." Defining Terms In the early 1990s, following the Gulf War, Wessely heard about soldiers suffering from undefined ailments. Few scientists knew or cared enough to investigate their complaints. "No one really took them on or could get a grip on them or their problem," Wessely relates. "And yet they seemed to me to be extremely interesting." Even academics fascinated with the possibility of a new disease could find no funding to investigate it. "If you are working on schizophrenia there are very discreet pots [of research money]," Natelson says. "Gulf War Syndrome and Chronic Fatigue Syndrome don't have hooks in them that allow them to fall into a clear niche. But Simon was able to attract [large] amounts of funding from our own Department of Defense, which is pretty significant." Wessely found that soldiers' complaints mirrored those of chronic fatigue syndrome patients, and his experience in the disease gave him entrée to government funding circles. The US Defense Department and the British Ministry of Defense financed his Gulf War Syndrome studies. At the time, scientists theorized that the Gulf War had no ill effects upon those who served. Wessely's studies have proven otherwise, though he still can't pinpoint which factors cause symptoms. "The evidence now is overwhelming that something happened to this group of people," he says. "We were able to show that the Gulf War was very different." The unique maladies could be attributed, in part, to soldier's pre-war inoculations, Wessely's team found. In an article published in the May 2000 issue of BMJ, the team concludes that, "Multiple vaccinations in themselves do not seem to be harmful but combined with the "stress" of deployment, they may be associated with adverse health outcomes."1 Wessely says only a diverse, multidisciplinary team could produce solid results. But even with the success of his work, he regrets that psychiatrists and biomedical researchers may never work together on a regular basis. "The idea of having a broad-based, integrated approach of psychiatry and medicine together has become more remote instead of less," he says. Still, the lone scientist in the lab cracking the case on his own is now a relic of the past. "The kind of questions we're tackling are increasingly those addressed in a multidisciplinary fashion and that is the way forward." Wessely's advice to young scientists remains fairly simple: If you're bored, move on to something else. And one other thing: Don't follow in his footsteps. "You have to have fairly strong nerves," he says. "It's not for everyone." Bob Calandra (rotoca@aol.com) is a freelance writer in Philadelphia. 1. M. Hotopf et al., "Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study," British Medical Journal, 320:1363-7, 2000.

Wessely's War

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