Research Advisory Committee on Gulf War Veterans Illnesses

**April 11, 2002**

# Meeting Minutes

**Committee Members:** James Binns, Jr., Chairman; Nicola Cherry, M.D.,
Ph.D.; Beatrice A. Golomb, M.D., Ph. D.; Joel C. Graves; Robert W.
Haley, M.D.; Marguerite Knox; William J. Meggs, M.D., Ph.D., Jack
Melling, Ph.D.; Pierre Pellier, M.D.; Stephen L. Robinson; Steve
Smithson; Lea Steele, Ph.D

**Also Present:** Laura O'Shea

Chairman Binns: Welcomed the committee members and members of the public
in attendance. He noted that materials were available for members of the
public including the agenda. He referred to the sign-up sheet for public
comments stating that the last half hour of the meeting each day was
reserved for public comment. Public submissions were welcome and copies
of additional materials received by the committee were available upon
request. Mr. Binns suggested that the committee members introduce
themselves. He introduced himself as Jim Binns, the former Chairman of
Parallel Design, a medical equipment manufacturing company. He lives in
Phoenix, Arizona.

Dr. Golomb: She introduced herself as Beatrice Golomb, an Assistant
Professor or Medicine at UC, San Diego. Her areas of background include
internal medicine, neurobiology and epidemiology.

Dr. Haley: He introduced himself as Robert Haley, formerly with the
Center for Disease Control. He is now at the University of Texas
Southwest Medical Center, Professor of Internal Medicine and
Epidemiology. He has spent the past eight years working on Gulf War
Illness.

Ms. Knox: She introduced herself as Marguerite Knox, a Gulf War veteran
who also served on the Presidential Advisory Committee for Gulf War
Veterans' Illnesses from 1996-1998. She continues her service in the
South Carolina Army National Guard as a Major in the 4^th^ Medical
Detachment, STARC. In January, she accepted a position with Eli Lilly &
Company as a Senior Sales Representative in the Neuroscience Division.
Formerly, she spent eight years as a Clinical Assistant Professor at the
University of South Carolina in the Acute Care Nurse Practitioner
Program.

Mr. Robinson: He introduced himself as Steve Robinson. He worked in the
Office of the Special Assistant for Gulf War Illnesses and retired. He
is currently working as the Executive Director of a non-profit
organization working for Gulf War veterans known as the National Gulf
War Resource Center.

Dr. Cherry: She introduced herself as Nicola Cherry. She is a physician
epidemiologist, currently a professor at the University of Alberta. She
has been working on Gulf War Syndrome for some time.

Dr. Melling: He introduced himself as Jack Melling. He stated that his
area of expertise is vaccine research, development and production. He is
a resident of Pennsylvania and is currently working in Vienna, Austria.

Mr. Smithson: He introduced himself as Steve Smithson, a Gulf War
veteran. He works for the American Legion national headquarters in
Indianapolis.

Dr. Pellier: He introduced himself as Pierre Pellier. He is a
gastroenterologist by training and has been working in the neurosciences
field for the last nine years. He is heading the neurology and
gastrointestinal department in the global medical affairs department of
GlaxoSmithKline.

Dr. Steele: She introduced herself as Lea Steele, an epidemiologist who
works for a non-profit research institute in Kansas called the Kansas
Health Institute. Until last fall, she was the Director of the Kansas
Persian Gulf War Veterans Health Initiative, a stat-based program to
serve Gulf War Veterans.

Mr. Graves: He introduced himself as Joel Graves from Olympia,
Washington. He is a Gulf War veteran.

Chairman Binns: Mr. Binns thanked the committee members for the hard
work they had completed prior to the meeting over the two months prior
to the meeting. He noted that there was a copy of all materials
exchanged between committee members in a binder on the table. The
Committee members had exchanged over a thousand pages of scientific
literature among themselves and they had received a like amount from
various government sources. The twelfth committee member, Dr. Meggs, had
just arrived. He asked Dr. Meggs to introduce himself.

Dr. Meggs: He introduced himself as Dr. William Meggs, a medical
toxicologist of the East Carolina University School of Medicine.

Chairman Binns: The Secretary expected the Committee to work with
scientific excellence in mind. The charter charged them with measuring
federal research efforts against the standard of improving the health of
Gulf War veterans. He suggested a model other than the scientific method
for advancing scientific knowledge. The method is known as the "product
development model," the basis of all high-tech research done in this
country. It is the model that produced all of the equipment used in
medical laboratories, from personal computers to MRI scanners. Unlike
the scientific model which begins with a hypothesis, the product
development model begins with a customer need. Researchers are often
directly involved with the customer. In the product development model,
researchers use literature, trial and error and intuition to develop a
product. In the scientific method, funding proposals are reviewed by
scientific peers and funding is provided on a conservative basis.
Although this conservative funding bias also exists in industry,
successful companies push breakthrough advancements and support the
creative ideas of researchers. The scientific method is less risky than
the product development model. The test of research in the scientific
model is peer review. In the product development model, the test of
research in the marketplace is whether or not the product works. Most
importantly, the scientific method is slow but the product development
model is fast. Risk taking carries rewards for those who succeed.
Placing emphasis on breakthrough opportunities and giving advanced
thinkers a chance to move more quickly than those with conventional
ideas produce faster results. He notes how quickly things change in the
high-tech field. In contrast, at the rate that Gulf War research has
developed, the last Gulf War veteran will die prior to any advancements
in veterans' health in this area. He suggested that they not abandon the
scientific method, but rather inject some of the customer focus and
speed that characterizes the product development process into the
committee's thinking and activities on Gulf War illness research.
Federal research must be measured against the results related to getting
ill Gulf War veterans well.

He moved to open the discussion about the committee's goals and
objectives. He stated that topics of major interest include:
communication and receipt of input from veterans; communication with
outside experts so that their expertise is utilized; and integration of
research completed to date and how we accelerate the follow-through on
research that is promising.

Mr. Robinson stated that is very important that they receive input from
individuals and groups. It was suggested that a website be developed
where veterans could submit information and communicate with the
committee. He suggested that the Gulf War veterans form a working group
to receive data and control it through the website.

Chairman Binns recommended that veteran committee members form a working
group and look at the entire issue rather than try to resolve it today.

Chairman Binns asked what the best way to handle communication is versus
just receiving inputs.

Mr. Robinson stated that it is important that veteran views can be
presented to the committee.

Mr. Smithson suggested development of the Web site as a committee and
link it from the committee members' organizations and the American
Legion Resource Center. He also suggested that they invite other
veterans' service organizations to provide links to their website from
ours to give it the most exposure to veterans.

Mr. Robinson solicited other ideas for gathering veteran feedback. He
noted that the main goal is to ensure that veterans and Veterans Service
Organizations can give the Committee direct input.

Public Attendee Nichols noted that the VA facilities must make computers
available to veterans who don't have access to computers. She also
suggested that VA centers nationwide do videoconferencing to allow
veterans to see what is happening in committee meetings and to make
comments.

Dr. Meggs suggested soliciting information from groups who have
performed studies on drugs and supplements that have been successful for
treating the symptoms of Gulf War Illness.

Mr. Robinson suggested creating a survey for Gulf War veterans and
distributing it through the Web site or through VA centers.

Ms. Knox recommended the collection of hand written letters from
veterans for those who do not have computer access or close access to VA
facilities.

Dr. Pellier noted that it was important to conduct market research to
determine veteran needs.

Mr. Robinson suggested that Gulf War veterans want treatment that works.
He stated that when traditional methods did not work, they sought
non-traditional therapies.

Dr. Pellier suggested that a survey may be the best way to access
veterans' desires and needs.

Dr. Golomb suggested that finding treatments that are effective can
sometimes lead to what the cause of the problem is, which in turn can
identify new avenues of effective treatment.

It was suggested that veterans may want to understand the nature of
their disease as well as treatment for the disease. They may want
validation of whether they are physically sick or mentally sick.

Dr. Melling stated that the product method is risky and may appear to be
wasting taxpayer money.

Dr. Haley noted the example of the NIH AIDS research program which
involved duplicative funding and risky ideas to reach a breakthrough in
ten years. It was noted that perhaps the Committee needed to inspire the
VA system and the country to adopt an aggressive policy for Gulf War
research based on good science.

Dr. Meggs suggested speaking with physicians who have treated Gulf War
veterans to glean treatment knowledge that might be relevant to future
research.

Dr. Golomb suggested contacting people identified in literature who have
relevant experience.

Dr. Melling recommended targeting people who wish to participate and
inviting them to a solicitation for people with relevant experience.

Several committee members noted the necessity of communicating the
existence of the committee to people with relevant experience.

Dr. Pellier suggested that it was important to include occupational
health physicians in the discussion as well.

Dr. Golomb indicated that perhaps medical journals would be willing to
do public service advertising on the committee's behalf. She also stated
that she would be a part of a small group of people gathering all of the
data that comes in.

Dr. Steele suggested that the group identify areas where outside input
would be useful that they need outside input on. After identifying those
topics, they could seek out experts in those fields and have them talk
to the committee if they are willing.

Dr. Golomb suggested that it would help to look into missing pieces of
evidence in proving existing theories. She suggested talking to experts
to glean this information. It is important for people with relevant
experience pertaining to a new theory that no committee member has
explored to know that the committee exists.

It was stated that in order to reach veterans in other countries, any
publications could be printed in other languages. A website could reach
international communities, gather information, and disseminate
information to the scientific community. It was suggested that they seek
to involve veterans and veterans service organizations and Gulf
veterans' organizations in other countries.

Chairman Binns noted that a doctor had contacted him about organizing a
symposium based on the idea that there may be a neurodegenerative common
element to Gulf War Illness. The doctor is in touch with members of the
community who study neurodegenerative problems. He suggested tapping
into other funds in the community by innovative methods. The question
was raised as to whether or not it is acceptable for the committee to do
fund raising. No definitive answer was given regarding the fundraising
question.

Ms. Knox suggested that Persian Gulf veterans in France do not seem to
have the same issues as those in the U.S. She stated that it may be
because the social system in France gives complete access to care. She
indicated that perhaps veterans are not getting the empathy they need
from the VA system. Perhaps VA employees need to be given more
information and training on Gulf War illnesses.

Other committee members commented that training of VA employees had been
done in the past and that a training booklet was also distributed. It
was suggested that the material was not widely read among VA physicians.
The committee members stressed the need for training among VA physicians
so that culture and attitudes can be changed regarding Gulf War
Illnesses. While medication and standard treatments are important, the
doctor-patient relationship is vital to building patient trust. It is
important for the doctor to believe the patient even when an illness is
unexplained.

Dr. Haley commented that physicians are frustrated because VA Central
Office is indicating that nothing is really wrong with Gulf War
veterans. Clinical trials showing effective treatment would help
physicians gain a better understanding of this problem. Being able to
make a plausible diagnosis that is treatable is vital to getting
physicians interested in the problem. The myriad of symptoms experienced
by Gulf War veterans makes it very difficult for physicians to diagnose
and treat a specific illness. It was suggested that collaboration with
the French and Australian physicians might help us treat U.S. Gulf War
veterans.

Dr. Melling suggested that in some cases, coalitions of patients with
illnesses have gathered in groups and educated their physicians. He
suggested that if two or three leading field experts could be persuaded
to endorse the study, other physicians might be drawn to participate.
Some physicians may not want to participate because of the political
implications and a lack of funding for research in this field.

It was noted that September 11 may encourage funding so that the United
States is prepared to face the same enemies and their threats in the
future. Preparing the armed forces to fight future wars has been
highlighted. Many of the people who worked at Ground Zero are
chronically ill, indicating that we may be dealing with exposure to
toxic chemicals. Scientific research on exposure to toxic chemicals is
relevant to society as a whole, not just to the veteran population. Even
if chemicals are not fatal, they can induce chronic illness.

It was suggested that the closed peer review groups for reviewing grants
only support research that follows certain policy positions rather than
including creative, breakthrough ideas. Due to the closed nature of the
research peer review group, creative people were discouraged and stopped
submitting grant proposals.

Chairman Binns suggested that the committee should not underestimate the
support of VA leadership for this project.

It was suggested that veterans be included in the peer review groups and
that the names of peer group members be made open to the public.

Various committee members noted that a substantial amount of money
needed to be given to fund this and that it should be made available for
people who are not in the VA. The VA currently does not fund people
outside of its organization.

Susan Perez from the Veterans Benefits Administration (VBA) Data
Management Office: The Gulf War Veterans' Information System was created
to help give external stakeholders a clear picture of Gulf War veteran
characteristics. It is taken from a variety of data sources and systems.
In 1992, Congress passed Public Law 102-585 mandating VA to keep track
of data on veterans. A system with Gulf War veteran information was
created and placed on a website in the 1997-1998 timeframe. This data is
not perfect, but VBA is attempting to clean it up. DMDC provides an
updated list of Gulf War veterans on a quarterly basis. This information
is used along with information from the active duty file, VBA's
compensation and pension master record, and the Beneficiary Identifier
Records Locator system, and the Pending Issue file that identifies
veterans and beneficiaries with pending VA claims. The total number of
Gulf War veterans is computed by taking everyone who served from August
2, 1990 to the present. The total number is subdivided into deployed and
non-deployed. The breakdown of subsets of Gulf War veterans was
explained in detail. Conflict service includes those veterans who served
from August 2, 1990 up through July 31, 1991. The theater period
encompasses the second period of the war form August 1, 1991 up through
the present date. Each quarter, VBA compares the new data received to
the prior data received from DMDC. Then the list is validated against
VBA data sources to determine which veterans have pending claims and
those who are drawing benefits.

The Gulf War Veterans' Information System reports were discussed. There
are 5.4 million Gulf War service members in total. Conflict Gulf War
veterans who served in the first year of the Gulf War remain constant at
700,000. Service members in the second year of the war to the present
(August 1991 to present) have a population of 430,000 and growing. The
non-deployed population totals over 4 million. Approximately one in five
service members since 1990 have been deployed to the Gulf War. Thirty
five percent of conflict veterans have filed a claim for service
connection with VBA. These claims are not necessarily claims for Gulf
War Syndrome or related Gulf War illnesses.

Twenty six percent of theater veterans have filed a claim for VBA
benefits. Thirty one percent of conflict veterans have claims that have
been fully processed. Twenty-four percent of theater veterans have a
claim where a decision has been made by VBA. Among conflict veterans, 27
percent have claims that were granted (at least one condition considered
service connected). Twenty-two percent of theater veterans have a
granted claim. Conflict veterans are twenty four percent more likely to
have a claim granted than theater veterans. Three percent of conflict
veterans and two percent of theater veterans have pending claims. Among
living veterans, 19.8 percent of Gulf War Conflict and 16.6 percent of
Gulf War Theater veterans have service-connected disabilities. It was
noted that VBA was looking to stratify by disability of the veteran in
the near future.

Deputy Secretary MacKay enters the room and is introduced. He emphasized
the importance of the committee's work. He stated that the
administration was committed to hearing all credible voices and
investigating new paths of research in order to relieve the health
problems and pain of Gulf War veterans. He stated that he was proud of
the committee members.

**[Presentation by Lea Steele, Ph.D.]{.underline}**

She stated that most veterans have not volunteered to participate in the
Gulf War registry, leaving us with limited information on those who are
ill and the illnesses they have. A population-based study is necessary
for scientific purposes.

Epidemiologic studies can give us patterns of death in veterans and in
comparison groups, hospitalization rates, diagnosed conditions, and
symptoms. They can also link an illness to certain exposures.

It was noted that diagnosed conditions are what the doctor tells the
patient they have and symptoms are what the patient tells the doctor
that they have. Therefore, diagnosed conditions are more objective than
symptoms.

Both U. S. and U.K. studies find no excess in disease-related deaths in
Gulf War veterans compared to veterans of the same era who didn't serve
in the Gulf War. Monitoring the mortality in Gulf War veterans for many
years to come is important so that it can be determined if there is an
increase in deaths due to diseases that develop over a longer period of
time. Certain conditions such as pain, migraine headaches, depression,
etc are found more commonly in Gulf War veterans than in veterans who
did not serve in the Gulf. Other conditions such as heart disease,
cancer and diabetes are not more common among Gulf War veterans. Most
infectious diseases are not elevated in Gulf War veterans.

Discussion of Symptoms: Gulf War veterans report significantly higher
symptom rates than veterans who didn't serve in the Gulf. Symptoms are
similar in veterans from different countries. Symptoms reported in Gulf
War veterans that are not common in other groups of patients include
persistent mouth sores, burning seminal fluid and persistent watery and
sometimes bloody diarrhea. More common symptoms among Gulf War veterans
include headaches, memory problems and joint pain.

People often question the validity of self-reported symptoms. Dr. Steele
noted that all symptoms are self-reported by definition rather than
clinically validated. In the absence of additional abnormalities in
blood work or other clinical evaluations, symptoms are the only thing
physicians have to go by at this time.

Although all symptoms found in Gulf War veterans are also experienced by
other veterans, they are experienced at higher rates by these veterans.
The symptoms also occur in a different pattern than you see in non-Gulf
War veterans. Dr. Steele noted that many studies often group symptoms
together into groups or "illness complexes." She stated that many
different approaches have been used to study Gulf War veterans and that
it was important to adopt a common methodology for studies to make them
comparable. Narrow and broad case definitions (i.e., definition of Gulf
War illness) also affect results of studies.

Dr. Steele stated that on average, studies show that twenty-five to
thirty percent of Gulf War veterans are affected by multi-symptom
illness than non-Gulf veterans. Based on this estimate, registries
underestimate the number of Gulf War veterans who are ill.

Studies show that ground troops are most affected by Gulf War illness.
Officers tend to be affected at a much lower rate than enlisted. Dr.
Steele's study showed that veterans at sea had the lowest rate of
illness. Those in Saudi Arabia and Bahrain had an intermediate rate of
illness and people in Kuwait or Iraq (battlefield areas) seemed to have
the highest rate of illness. Rate of illness was related more to the
time period that the veteran served versus the amount of time they
served.

Summary: Epidemiologic studies show that Gulf War veterans have more
health problems, diagnosed and undiagnosed, than comparison veteran
groups. The health problems appear to be related to the veteran's
experiences during the war. Gulf War veterans' symptoms are not unique,
but they have a unique pattern and frequency. Dr. Steele stated that she
does not believe that it is possible to answer whether a unique Gulf War
Syndrome exists without further studies and information. However, it can
be said that Gulf War veterans experience unexplained health problems
that are linked to Gulf War service.

Despite numerous studies, the following questions remain unanswered:\
1) What is the case definition of Gulf War Illness?

2\) How many veterans are affected by Gulf War Illness?

3\) What subgroups are at high and low risk?

4\) What is the clinical course of illness, the prognosis of illness?

5\) What is the association of the illness with wartime experiences?

6\) What treatments are effective for this illness?

Dr. Golomb noted that in the Gulf War population, there was an increase
in accidental death but not in suicidal death suggesting that there is a
cognitive problem that affects people's ability to stay free of
accidents. She also noted that the character of the illness in Gulf War
veterans is unique because it often involves musculoskeletal complaints
versus war-related syndromes of previous wars. The fact that people
became ill with other conflicts does not imply it is the same illness.
With other conflicts, risk factors included infectious disease and
nutritional deficiencies, among other, Dr. Steele agreed stating that
Gulf War Syndrome fits under the psychiatric/neurologic type of
disorder.

It was noted that in general, military personnel are much healthier than
the general population and those who go to war are the healthiest among
the military personnel. Even considering the "healthy soldier effect,"
there is a huge elevation of symptoms among Gulf War veterans.

It was discussed that data from DMDC is not always accurate in defining
veterans who were deployed. Also, VA defines theater conflict
differently from DOD.

Presentation of Nicola Cherry recorded as inaudible.

Presentation by Jack Melling, Ph.D.

Summary of various types of vaccines: Active vaccines produce an immune
response to help resist disease; passive vaccines give an antibody
protection by way of an immunoglobin from somebody else who donates it;
prophylactic is given in advance of exposure as a preventative;
therapeutic is given after exposure to prevent disease.

All types except therapeutic were given to Gulf War personnel. Viral,
bacterial, toxic and depot adjuvants were used. He noted that because
vaccines mimic infection, they may have multiple effects. Various
agencies safeguard the manufacturer of vaccines. Vaccines must meet the
following criteria. They must be quality (produce the same product over
various years), safety, and have efficacy (percentage of people you can
protect). Safety and efficacy are variable. Reactions to vaccinations
range from injection site swelling to systemic reactions. Reactions may
be mild, moderate or severe. The duration can be short or long.

In summary, Dr. Melling concluded that although we don't know if the
vaccines affected Gulf War veterans, we cannot rule out that they did
not. He also pointed out that when these vaccinations were tested for
safety, they were given individually.

**[Presentation by Robert W. Haley, M.D.]{.underline}**

Dr. Haley spoke of the nature of the disease Gulf War Syndrome. He
stated that it was an epidemic. In line with other epidemics, Gulf War
syndrome had a spike in occurrences and then new cases did not occur.
Many of the symptoms that Gulf War veterans report are related to the
nervous system. Other neurological diseases such as Parkinson's,
Huntington's, etc. present with symptoms long before they are diagnosed.
He suggested that perhaps they should perform the same diagnostic tests
on Gulf War Veterans --blood, brain, tissue studies-that they do to
diagnose other neurological diseases. He noted the necessity of
developing a case definition for any study.

Enter Secretary Principi. The Secretary expressed appreciation for the
committee's efforts. He stressed the need to expand knowledge of Gulf
War veterans in order to pursue treatment for a disease rather than just
treating symptoms. He instructed the committee to think creatively as
well as scientifically, challenging theories that do not contribute to a
cure. He asked to the committee to help VA researchers to identify new
paths to lead to greater understanding of the health issues faced by
Gulf War veterans.

Secretary Principi presented certificates to each member of the
Committee.

Dr. Haley continued his presentation. He stated that it is difficult to
identify organic brain dysfunction using neuropsychological tests. He
discussed several possible diagnostic tools to help determine an organic
cause for Gulf War syndrome. He noted that one study showed that
pyridostigmine rushes into the brain under very stressful conditions.
The mycosplasma issue has not been well-supported by science and
questions remain unanswered. The Th1 and Th2 theory is a good theory
that has not been tested. He stated that he felt that GulfWar illness is
a multi-system illness rather than a pathology affecting cells and
different organs. In medicine, physicians tend to look for one type of
injury causing the patient's problems. However, the symptoms of Gulf War
veterans indicate that they are associated with the nervous system. The
array of symptoms is similar to those that present in the early stages
of diseases of deep brain structures. A study would begin with
developing a syndrome definition, performing neuropsychological testing,
neuromuscular and autonomic tests, brain scans. Begin with several
hundred patients and then focus on a smaller group as the study
continues. After determining a hypothesis, a population study would be
accomplished with a random sample. He discussed the papers he published
based on his studies. The first paper discussed the case

definition. Then he evaluated neurological function in a smaller group.
They administered a questionnaire on symptoms and exposures to 249
veterans in a single battalion. A case definition is only valuable if it
correlates with organic measures. Impaired cognition, confusion, ataxia
and arthro-myo-neuropathy were the most prevalent symptoms among the
veterans studied. He concluded certain study findings support the
proposal that neurologic symptoms of Gulf War veterans were caused by
chemical exposures. Other factors that may be related to Gulf War
syndrome include blood-barrier permeability, stress, and genotypes.

Dr. Haley continued stating that his psychological tests clearly
conclude that Gulf War syndrome is not any psychological illness.
However, neuropsychological tests of brain function show differences
with attention and concentration problems among Gulf War veterans. No
organizational or memory problems were shown. Other than this finding,
neuropsychological tests have been disappointing.

Neurophysiological studies: Goran Jamal in the U.K. conducted a study
that showed a remarkably reduced ability to detect changes in cold
sensation.

Nerve conduction studies did not show anything. Platform posturography
tests have shown subtle effects in Gulf War veterans as well as
abnormalities of vestibular function in Japanese exposed to sarin nerve
agents.

The 24-hour continuous cardiogram showed that in Gulf War veterans,
heart rate does not slow down as much during sleep as it does in other
individuals.

Nuclear scanning may be used to measure blood flow. MRIs have not shown
structural abnormalities in Gulf War veterans. Magnetic resonance
spectroscopy can be used to measure increases and decreases of chemicals
in the brain and brain damage. Proton spectroscopy measures three main
chemicals the brain. This technology can indicate brain cell neuronal
abnormality but it does not indicate what caused the abnormality.

His studies showed that neuronal health (measured by NAA) was
drastically reduced in the brains of Gulf War veterans. Basal ganglia
and brainstems were abnormal in one subset of veterans.

His studies also showed a decrease in the choline-to-creatine ratio in
the basal ganglia, the opposite of what is seen in depressed patients.

He concluded that different groups may have different symptoms and
different distributions of brain cell injury.

He described another experiment where the hypothesis is that Gulf War
Syndrome is due to neurotoxic damage to the basal ganglia and there
fore, abnormal brain dopamine activity would be present in these
patients. The study showed that the lower the NAA and the more abnormal
the neurons were, the higher the dopamine production. The study suggests
that there may be a relationship between the cellular abnormality from
spectroscopy and actual dopamine production, a physiological measure of
how the basal ganglia are functioning.

Dr. Haley discussed genetic studies focusing on the possibility that
genetic difference make some people highly resistant to chemical damage
while others are susceptible. He suggested that people born with low
levels of the enzyme butyryl-cholinesterase (which prevents
organophosphate molecules from traveling to the brain) may be those with
Gulf War Syndrome. The second hypothesis involves the enzyme
paraoxonase, which destroys organophosphates by hydrolyzing them.
Studies have also suggested that persons with low PON-Q enzymes may be
more susceptible to Gulf War Syndrome. PON-Q is very active against
sarin, soman and VX, but not common pesticides.

Dr. Haley concluded that his findings support the proposal that
neurologic symptoms of Gulf War veterans are caused by chemical
exposures. Genetic studies allow determination of exposure based on
genes in the absence of records.

He noted that there is literature supporting the theory that
organophosphates attack basal ganglia and deep brain structures.

Dr. Haley said that based on the age of Gulf War veterans, the number of
Gulf War veterans who have ALS is of epidemic proportions.

Public Attendee Nichols stressed the need for the death count to be
updated. She also stated that he had tried IV therapy and that it
improved her vision and memory function.

Public Attendee Eddington identified himself as the Director of
Government Relations for the Vietnam Veterans of America. He stressed
the need to for the committee to obtain all relevant documents related
to Gulf War issues, both classified and unclassified. He stressed the
need to get information on Gulf War issues to veterans. He stated the
need to change corporate culture to respect the importance of Gulf War
issues.

Public Attendee KirtLove: He stated that clinics should inform Gulf War
veterans that studies are taking place. He stressed that a baseline exam
of these veterans was needed. He stated that he did not believe VAMCs
were making literature readily available to veterans and training
doctors about Gulf War symptoms and illnesses.

Mr. Eddington: He commented that there was much documentation on
ammunition storage sites and other possible exposures that had never
been evaluated.

Dr. Haley suggested modeling all likely exposures such as oil wells and
match it with the VBA database.

Mr. Robinson recommended that the exposure models also be matched with
DoD Conference and Clinical Evaluation Records.

Chairman Binns thanked everyone for their participation and the meeting
was adjourned.