To the Editor.
—We read the article by Keeler et al1 with great interest. We were deployed in support of Operations Desert Shield and Desert Storm with the 1st Infantry Division and the 1st Cavalry Division. We were responsible for the medical care of thousands of soldiers who were taking pyridostigmine bromide during the preparation for the ground war and during the ground war.Unfortunately, the article suffers from retrospective analysis of data collected in a poorly designed and uncontrolled fashion. No prospective, detailed assessment specific for pyridostigmine effects or the temporal relationship of dosing to such effects was undertaken during Operation Desert Storm. Perhaps this would have been logistically impossible. In fact, the querying of only 30 medical officers is probably insufficient to draw conclusions and accurately assess the overall "incidence of general physiologic response to pyridostigmine and potential adverse effects."Within the XVIII Airborne Corps (the group
Neish SR, Carter B. More on Desert Storm. JAMA. 1991;266(23):3282-3283. doi:10.1001/jama.1991.03470230040015