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96–946 PDF 2004

EXAMINING THE STATUS OF GULF WAR RESEARCH AND INVESTIGATIONS ON GULF WAR

ILLNESSES

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

EMERGING THREATS AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

JUNE 1, 2004

Serial No. 108–228

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

NATHAN DEAL, Georgia

CANDICE S. MILLER, Michigan

TIM MURPHY, Pennsylvania

MICHAEL R. TURNER, Ohio

JOHN R. CARTER, Texas

MARSHA BLACKBURN, Tennessee

PATRICK J. TIBERI, Ohio

KATHERINE HARRIS, Florida

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

ELEANOR HOLMES NORTON, District of

Columbia

JIM COOPER, Tennessee

——— ———

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

MICHAEL R. TURNER, Ohio

DAN BURTON, Indiana

STEVEN C. LATOURETTE, Ohio

RON LEWIS, Kentucky

TODD RUSSELL PLATTS, Pennsylvania

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

TIM MURPHY, Pennsylvania

KATHERINE HARRIS, Florida

DENNIS J. KUCINICH, Ohio

TOM LANTOS, California

BERNARD SANDERS, Vermont

STEPHEN F. LYNCH, Massachusetts

CAROLYN B. MALONEY, New York

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

JOHN F. TIERNEY, Massachusetts

DIANE E. WATSON, California

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

LAWRENCE J. HALLORAN, Staff Director and Counsel

KRISTINE MCELROY, Professional Staff Member

ROBERT A. BRIGGS, Clerk

ANDREW SU, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on June 1, 2004 ................................................................................. 1

Statement of:

Bunker, James A., chairman, Veteran Information Network, Gulf war

veteran, Topeka, KS; Derek Hall, Gulf war veteran, United Kingdom;

Janet Heinrich, Director, Health Care-Public Health Issues, U.S. General Accounting Office; Keith Rhodes, Chief General Accounting Office

Technologist, U.S. General Accounting Office; Jim Binns, chairman,

Research Advisory Committee on Gulf War Veteran Illnesses; and

Steve Robinson, executive director, National Gulf War Resource Center,

Inc. ................................................................................................................. 25

Morris, the Right Honorable Lord of Manchester .......................................... 10

Perlin, Dr. Jonathan B., Acting Under Secretary for Health and Acting

Chief Research and Development Officer, Department of Veterans Affairs, accompanied by Dr. Mindy L. Aisen, Deputy Chief Research

and Development Officer, and Dr. Craig Hyams, Chief Consultant,

Occupational and Environmental Health, Department of Veterans Affairs; Major General Lester Martinez-Lopez, Commanding General,

U.S. Army Medical Research and Materiel Command, Fort Detrick,

MD, accompanied by Colonel Brian Lukey, Ph.D., Director, U.S. Army

Military Operational Medicine Research Program, Fort Detrick, MD;

Dr. Robert Haley, professor of internal medicine, University of Texas

Southwestern Medical Center; Dr. Rogene Henderson, senior scientist,

Lovelace Respiratory Research Institute; and Dr. Paul Greengard, Vincent Astor professor and head of Laboratory of Molecular and Cellular

Neuroscience, the Rockefeller University, and Nobel Laureate in Medicine 2000 ........................................................................................................ 126

Letters, statements, etc., submitted for the record by:

Binns, Jim, chairman, Research Advisory Committee on Gulf War Veteran Illnesses, prepared statement of ......................................................... 94

Bunker, James A., chairman, Veteran Information Network, Gulf war

veteran, Topeka, KS, prepared statement of .............................................. 28

Greengard, Dr. Paul, Vincent Astor professor and head of Laboratory

of Molecular and Cellular Neuroscience, the Rockefeller University,

and Nobel Laureate in Medicine 2000, prepared statement of ................. 171

Haley, Dr. Robert, professor of internal medicine, University of Texas

Southwestern Medical Center, prepared statement of .............................. 151

Hall, Derek, Gulf war veteran, United Kingdom, prepared statement

of ..................................................................................................................... 41

Heinrich, Janet, Director, Health Care-Public Health Issues, U.S. General

Accounting Office, prepared statement of ................................................... 47

Henderson, Dr. Rogene, senior scientist, Lovelace Respiratory Research

Institute, prepared statement of .................................................................. 165

Martinez-Lopez, Major General Lester, Commanding General, U.S. Army

Medical Research and Materiel Command, Fort Detrick, MD, prepared

statement of ................................................................................................... 143

Morris, the Right Honorable Lord of Manchester, prepared statement

of ..................................................................................................................... 13

Perlin, Dr. Jonathan B., Acting Under Secretary for Health and Acting

Chief Research and Development Officer, Department of Veterans Affairs, prepared statement of ......................................................................... 129

Rhodes, Keith, Chief General Accounting Office Technologist, U.S. General Accounting Office, prepared statement of ........................................... 70

Robinson, Steve, executive director, National Gulf War Resource Center,

Inc., prepared statement of .......................................................................... 100

Page

IV

Letters, statements, etc., submitted for the record by—Continued

Ruppersberger, Hon. C.A. Dutch, a Representative in Congress from the

State of Maryland, prepared statement of .................................................. 8

Shays, Hon. Christopher, a Representative in Congress from the State

of Connecticut, prepared statement of ........................................................ 3

(1)

EXAMINING THE STATUS OF GULF WAR RESEARCH AND INVESTIGATIONS ON GULF

WAR ILLNESSES

TUESDAY, JUNE 1, 2004

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING

THREATS AND INTERNATIONAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 1:05 p.m., in room

2154, Rayburn House Office Building, Hon. Christopher Shays

(chairman of the subcommittee) presiding.

Present: Representatives Shays, Turner, Sanders, Ruppersberger

and Tierney.

Staff present: Lawrence Halloran, staff director and counsel;

Kristine McElroy, professional staff member; Robert Briggs, clerk;

Jean Gosa, minority assistant clerk; and Andrew Su, minority professional staff member.

Mr. SHAYS. Please be seated. Thank you. A quorum being

present, the Subcommittee on National Security, Emerging Threats

and International Relations hearing entitled, ‘‘Examining the Status of Gulf War Research and Investigations of Gulf War Illnesses,’’

is called to order.

Last weekend, in dedicating the World War II monument and

celebrating Memorial Day, we acknowledged our profound obligation to those of past generations who made noble sacrifice in the

service of liberty. That same duty to remember demands our focus

today on another overdue national remembrance. The living warriors of this generation who fought in Operations Desert Shield and

Desert Storm need just one thing written in stone, a sustained

commitment to research and treatments for the mysterious maladies and syndromes triggered by battlefield exposures. And they

cannot wait 60 years for their deserved testimonial to become a reality.

This subcommittee, with oversight purview of the Department of

Veterans Affairs [VA], and the Department of Defense [DOD],

today convenes our 17th hearing on Gulf war veterans’ illnesses.

Over the last decade, we followed the hard path traveled by sick

Gulf war veterans as they bore the burdens of their physical illnesses and the mental anguish caused by official skepticism and intransigence. It was their determination that overcame entrenched

indifference and bureaucratic inertia, their persistence, and a home

video of chemical weapons munitions being blown up at

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Khamisiyah eventually persuaded DOD and VA that postwar illnesses are linked to wartime exposures.

But characterizing the subtle linkage between low-level toxic assaults and very chronic health consequences remains a dauntingly

complex research challenge. As we will hear in testimony today, efforts to map uncharted neurological pathways between sarin-induced brain damage and diverse manifestations of illnesses are

made even more difficult by unreliable exposure data. The dimensions of Gulf war syndromes may be obscured by epidemiological

conclusions, based on unreliable exposure estimates and plume

models. And promising research hypotheses and treatment concepts still face institutional obstacles to Federal support as both

funding and momentum behind Gulf war illness research appear to

be waning.

So we asked our witnesses to give us their assessment of the status and future direction of Gulf war research. As in the past, we

ask veterans to testify first. Their perspectives always inform and

enrich our subsequent discussion, and we sincerely appreciate the

patience and forbearance of our government witnesses in agreeing

to sit on our second panel.

Just as the liberation of Kuwait was an international mission,

the search for postwar causes and cures has been a coalition effort

as well. Over the years we have been fortunate to be able to form

a close collaboration with our counterparts in the United Kingdom.

Continuing that transatlantic partnership, we are joined today by

the Right Honorable Lord Morris of Manchester. Lord Morris is a

leading advocate for Gulf war veterans in Britain and a strong

voice behind the breakthrough research needed to solve the mysteries of exposure-related diseases.

This is not the first time Lord Morris has joined us. Two years

ago, he and his colleague from the House of Commons, Mr. Bruce

George, added invaluable insight and focus to our discussion, so

much so that their obvious depth of knowledge and rhetorical flare

made some of us feel a little intimidated and, believe it or not,

tongue-tied. They were just so witty and engaging. So when we invited Lord Morris this year, we commoners asked if he would be

just a little less lordly today, and he graciously agreed. He is a valued colleague of ours and a true friend to Gulf war veterans of all

nations.

Welcome, Lord Morris. You honor this subcommittee again with

your presence, and we look forward to your continued contribution

to our work.

And we welcome all the panelists, all the individuals in both

panels. We thank them for being here as well.

[The prepared statement of Hon. Christopher Shays follows:]

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Mr. SHAYS. And at this time I would recognize Mr. Sanders, who

has been at the forefront of this issue at probably all 17 hearings

and probably some hearings I didn’t even know about. Mr. Sanders.

Mr. SANDERS. Thank you very much, Chris. And congratulations

to you and your staff for doing something that is very important,

and that is reminding the men and women who are suffering from

Gulf war illness that we have not forgotten and we are not going

to give up on this issue.

I think in many ways when we look back on the history of how

our country has treated veterans, whether it is exposure to radiation after World War II, whether it is Agent Orange from Vietnam, or whether it is Gulf war illness, I think many veterans understand that the U.S. Government, DOD and the VA, have not

done all that they could to protect veterans who come home from

war with one or another illness. And it’s no secret if one reads the

transcripts that I have been less than impressed by the work of the

VA and DOD in responding to the pain.

What Chris has just said is that time after time, meeting after

meeting, we have heard people coming up here talking about terrible ailments. I have held a number of meetings in the State of

Vermont, a small State that did not send huge numbers of people

over to the first Gulf war, and we heard from hundreds of people

who had one or another serious problems.

Also, what is important about this whole debate is if we can get

a better understanding of the causation of Gulf war illness and the

impact that chemical exposure has on human health, we are going

to learn a heck of a lot in terms of civilian problems as well. This

is not just a military problem. There is a lot to be learned about

how people in this country who are not in the military become ill

as well. So there is a great deal of work to be done.

We are very pleased that our friends from the United Kingdom

are here, and we thank the guests who are going to testify and our

friends in the military for being here as well. So thank you very

much. And I am pleased to be here.

Mr. SHAYS. Thank you, Mr. Sanders.

At this time the Chair would recognize the vice chairman of the

committee, Mr. Turner, who has been a real gift to this subcommittee, and we thank him for being here.

Mr. TURNER. Thank you, Mr. Chairman. I appreciate your convening this hearing today and for your continuing effort on focusing

on the Gulf war illness. I know that your work is to ensure the veterans receive the treatment and medical care they deserve, and

also that there are some very important correlations between the

work and study of the Gulf war illness and the issues that this

committee faces in homeland security and national security.

We all know that the men and women of the U.S. Armed Forces

fought bravely in the Gulf war, and they worked to disarm Iraq.

Many ammunition bunkers and warehouses were destroyed by coalition forces, and many times the forces did not know what they

were destroying. Only years after the war did we learn that some

of these bunkers may have contained chemical nerve agents, thus

exposing these troops to various levels of toxins.

The science and modeling that is being utilized in determining

the root causes of this illness, I think, is very important to us as

6

we look to our attempts at protecting both civilian populations and

our military populations as we face not only further conflicts in the

Middle East, but in protecting our homeland.

It is interesting to me how many times we sit in hearings where

with great certainty people tell us what the effects will be of a certain type of terrorist attack or a certain use of weapon, but in this

instance we struggle in trying to determine what had occurred and

what the effects would be in determining what the outcome had

been. We have a lot to learn from this process not just in looking

at protecting our veterans, but also in the future of protecting our

men and women in uniform and also our communities. Thank you.

Mr. SHAYS. I thank the gentleman.

At this time the Chair would recognize Mr. Ruppersberger.

Mr. RUPPERSBERGER. Yes. Also, Mr. Chairman, thank you for

your continued dedication of this issue and all members on this

committee who have worked hard to keep this issue alive.

There were many veterans of the Gulf war fighting an uphill battle here at home to get their symptoms recognized and diagnosed,

and to get service-connected disability ratings, and to get the support they needed to move forward with their lives. Now, I am

grateful that the Congress was able to respond and enact legislation to complete research to speed up ratings and to compensate

veterans. I am also encouraged that we are continuing to hold

hearings like this one to make sure that these veterans are properly cared for, and to make sure we learn the lessons we as a Nation need to learn to prevent future veterans from facing the same

health care battles.

I realize the main focus for today’s hearing will be on continued

research, the money promised and invested in research. Research

is certainly an important part of the puzzle here, but as the newcomer to the issue and one who prefers to get to the bottom line,

I am most interested in three specific areas: One, after spending

time and money on research for many years, now what have we

learned? Two, where are we in relation to treatment? Are we helping the veterans, and are any of them getting better? Three, what

lessons have we learned? Is our recordkeeping better? Are our

troops getting better physicals prior to deployment and followup?

Do we have the right people on the ground conducting the experiments needed should an event occur so we have the science needed

to diagnose and treat them?

I think today’s hearing is important for many reasons. First and

foremost, the veterans of the Gulf war answered the call of duty,

and many of them came home sick. We owe them the best we can

to find out why and to help them feel better.

Second, we have troops today in the same part of the world for

much longer periods of time.

After so many hearings on disparity of health care for National

Guard and Reserves versus active military personnel, I am worried

we have not learned enough from the Gulf war lessons, illnesses

to prevent another situation on a grander scale. I look forward to

hearing.

Unfortunately I have another hearing; I will be back, but I want

to make sure for the record that my questions will be presented.

7

And I also want to acknowledge Lord Morris. The U.K. has been

a great ally to the United States throughout history, and it is an

honor for you to be sitting at the same dais. Thank you, Lord.

Mr. SHAYS. I thank you, Mr. Ruppersberger, and thank you for

those questions. I think both panelists can know that they have already been asked and can respond maybe even in their statements.

They are very important questions.

[The prepared statement of Hon. C.A. Dutch Ruppersberger follows:]

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Mr. SHAYS. Before recognizing the panel, I ask unanimous consent that all members of the committee be permitted to place an

opening statement in the record, and that the record remain open

for 3 days for that purpose. Without objection, so ordered.

I ask further unanimous consent that all witnesses be permitted

to include their written statement in the record, and without objection, so ordered.

I further ask unanimous consent that the Right Honorable Lord

Morris of Manchester be extended the Parliamentary privilege of

sitting with the subcommittee today and participating, and without

objection, so ordered. And in fact, before I recognize the panel, I

would now recognize Lord Morris.

STATEMENT OF THE RIGHT HONORABLE LORD MORRIS OF

MANCHESTER

Lord MORRIS. Congressman Shays, I count it an honor as well as

a privilege to have been invited again to join members of the subcommittee on the dais for a hearing of profound significance for

veterans, United States and British alike, of the first Gulf conflict.

Troops from our two countries fought shoulder to shoulder in liberating Kuwait, and it is highly appropriate that members of our two

Parliaments should be seen acting together in addressing the problems and needs of veterans of the conflict now in broken health.

I have served in the British Parliament since 1964, first in the

House of Commons for 33 years, representing the city of Manchester—not Manchester, NH, but Manchester in Lancashire, England, the mother of all Manchesters, all nine of them all over the

world. And since 1997, I have been in the House of Lords as Lord

Morris of Manchester.

My involvement in Gulf war illnesses arose from my role as honorary Parliamentary adviser over many the years of the Royal British Legion and as a founding member in 1994 of the Legion’s Interparliamentary Gulf War Group, which comprises Parliamentarians

of the main political parties in the U.K., distinguished medical specialists, researchers, legal experts, and representatives of the exservice organizations, as well as servicemen and women who fought

in the conflict. The Ministry of Defense is also represented.

The Gulf conflict was on a scale bigger than any British troops

had been involved in since the Korean War 40 years before. It was

also the first since 1918 against an enemy known to have chemical

weapons readily available for deployment. Thus, the Ministry of

Defense had to prepare for the liberation of Kuwait on the assumption that such weapons would be used. Indeed, millions of people

across the world had seen for themselves in TV reporting the stark

effects of Saddam Hussein’s use of chemical weapons against the

civilian population of a neighboring Muslim country only months

before the invasion of Kuwait. On November 9, 2001, George W.

Bush said of al Qaeda that they were, ‘‘seeking chemical, biological,

and nuclear weapons.’’ Eleven years before then, British troops deploying to the Gulf faced an enemy who not only possessed, but

had already used some of these weapons, first for the massacre of

Kurds in Halabja in 1988, and then against the civilian population

of Iran in 1990.

11

Aware of the weapons facing the coalition troops in the Gulf, the

Ministry of Defense gave high priority to doing all they could to

safeguard them against the effects of their use. They correctly assessed the threats facing British troops, but not all the health risks

or the measures taken to protect them.

Congressman Shays, while these measures were thought to be in

their best interests, over 5,000 of the British troops deployed, all

of them medically A–1 in 1990 and 1991, have reported illnesses

that they and their medical advisers are convinced were related to

their service in the Gulf.

The jury has now been out for nearly 14 years on the causes of

the still medically unexplained illnesses of our veterans, and I believe this hearing can take us nearer to resolving some of the

issues involved, not least that of the scale of the effects of the destruction by coalition forces of the huge Iraqi stockpile of chemical

weapons at Khamisiyah in March 1991, releasing sarin and

cytosarin, as undoubtedly it did.

The Legion describes veterans with still undiagnosed illnesses as

having had, ‘‘a long, hard fight to have them accepted as war-related.’’ Although epidemiological studies initiated by the MOD confirm

that our troops who served in the Gulf were more likely to be unwell than their peers who didn’t, full official recognition of their

needs has been, in the words of the Legion, difficult to achieve. And

while they and other associations have had many successes in promoting veterans’ interests, there is continuing concern in Britain’s

ex-service community that too many lessons of the first conflict are

still to be resolved.

In seeking a full public inquiry into the issues raised by the illness, the Legion could not be accused of acting precipitately. It did

so in May 1997, 6 years after the conflict ended, not only in fairness to those afflicted, but to maximize public confidence that our

troops would be fully prepared and protected in future deployments. But we still await an independent inquiry, and this, too,

makes the subcommittee’s hearings so important to British as well

as American veterans.

Congressman Shays, the Legion is acting in keeping with its

highest traditions in continuing to press for an independent inquiry. They fully accept the mistakes made in 1990–1991 were not

deliberate; they know as well as anyone in executive government

that decisions about protective measures often have to be made on

a ‘‘needs must’’ basis. But they rightly insist and go on insisting

and believe that any independent inquiry worthy of the name

would strongly insist that the Nation as a whole, not just its sick

veterans and their families, must play its part in meeting the cost

of such decisions.

None of us at Westminster any more, I am sure, than anyone in

Congress or executive government in the United States wants to

see the afflicted and bereaved of the Gulf conflict made to suffer

the strain and hurtful and demeaning indignities that protracted

delay in dealing with their concerns can impose. Yet, sadly, many

veterans feel that such delay has occurred, and their public representatives on both sides of the Atlantic must go on pressing for

the truth about their illnesses.

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Colleagues, of all the duties it falls to Parliamentarians to discharge, none is more compelling than to act justly to citizens who

were prepared to lay down their lives for their country and the dependents of those who did so. There was no delay in the response

of our troops to the call of duty in 1990–1991, nor should there be

any further delay now in discharging in full our debt of honor to

them. For Parliamentarians, you could say, every day should be a

Memorial Day.

Mr. SHAYS. I thank the gentleman very much.

[The prepared statement of Lord Morris follows:]

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Mr. SHAYS. And at this time I will just recognize the panel. We

have Mr. Jim Bunker, chairman, Veteran Information Network,

Gulf war veteran, Topeka, KS; Dr. Derek Hall, Gulf war veteran,

United Kingdom; Dr. Janet Heinrich, Director, Health Care-Public

Health Issues, U.S. General Accounting Office; Dr. Keith Rhodes,

Chief General Accounting Office Technologist, U.S. General Accounting Office; Mr. Jim Binns, chairman, Research Advisory Committee on Gulf War Veteran Illnesses; Mr. Steve Robinson, executive director, National Gulf War Resource Center, Inc.

I would ask the panelists to stand, and at this time I will swear

them in. Raising your right hands, please.

[Witnesses sworn.]

Mr. SHAYS. Note for the record our witnesses have responded in

the affirmative, and I thank them for that.

I think we have been somewhat generous in comment time. We

do a 5-minute and then we trip over another 5 minutes. I am going

to really ask you to stick a little closer to the 5 minutes because

we have a lot of panelists, and we also have two panels.

And also, Mr. Turner, your mic is not working, so we need you

to shift down one or come on the other side of Bernie here, I think.

So at that time, Mr. Bunker, you have the floor. And we have

a light system which goes from green to yellow. It’s kind of on the

other side of Dr. Hall. Green to yellow to red. And if you run a

speck over 5 minutes, we won’t lose sleep, but not much over.

Thank you all for being here.

STATEMENTS OF JAMES A. BUNKER, CHAIRMAN, VETERAN INFORMATION NETWORK, GULF WAR VETERAN, TOPEKA, KS;

DEREK HALL, GULF WAR VETERAN, UNITED KINGDOM;

JANET HEINRICH, DIRECTOR, HEALTH CARE-PUBLIC

HEALTH ISSUES, U.S. GENERAL ACCOUNTING OFFICE; KEITH

RHODES, CHIEF GENERAL ACCOUNTING OFFICE TECHNOLOGIST, U.S. GENERAL ACCOUNTING OFFICE; JIM BINNS,

CHAIRMAN, RESEARCH ADVISORY COMMITTEE ON GULF

WAR VETERAN ILLNESSES; AND STEVE ROBINSON, EXECUTIVE DIRECTOR, NATIONAL GULF WAR RESOURCE CENTER,

INC.

Mr. BUNKER. Mr. Chairman, Lord Morris, members of the committee, on behalf of the Veterans Information Network and myself,

I would like to thank you for giving me time to address the issues

of Gulf war illness and the research problems.

I have formed the Veterans Information Network with a group

of veterans to help get legislation passed within the State of Kansas. This legislation led to the creation of the Veterans Health Initiative and also the funding of a research study within Gulf war

veterans of the State of Kansas. The unprecedented study was done

by Dr. Lea Steele and is best known as the Kansas Study.

The Kansas Study is the first to identify a clear link between

Gulf war veterans’ health problems and the time and place in

which they served. Results suggest that the unexplained health

problems may be due to multiple factors. The study is also significant in that it showed that for one-tenth of 1 percent of the money

that the VA had spent on Gulf war research to that date, that the

State of Kansas had came up with more answers and was able to

26

show more on the illnesses affecting the Gulf war veterans than

the VA or DOD ever did.

This also shows that a State program that is set up can better

utilize the research funding versus DOD and the VA. This study

also made Kansas the clear leader when it came to Gulf war illness

research.

The funding in this study also shows that there are several

issues that need to be addressed with regards to the care and the

health of the troops. The following are my recommendations based

on the work done in Kansas.

One, separate research away from the VA and DOD. It seems as

though it takes an independent entity before meaningful results

and studies will be conducted, as the Kansas Study and other independent study research has shown significantly the problems within the Gulf war veterans versus those from the DOD or the VA.

These independent studies have shown that we need to take the research away from the VA and DOD and let State or private researchers do the work.

The VA’s Research Advisory Committee [RAC], Board could potentially work as a bridge that could be responsible for the funding

of independent research. This needs to be done, for far too often

they ask the VA to fund studies to help the veterans, only that the

studies are never funded by the VA itself. The RAC is in a unique

position to hear about new and innovative studies from the researchers, and have the potential abilities to guide exploration into

previously unaddressed areas of research into the illness of Gulf

war veterans while having a historical perspective of what research

has already begun. I suggest this in the hope that we would not

continue funding research that has already been done.

Essentially, the RAC would still have to work as it is now, but

with the added power of being able to direct the spending of the

VA, not just recommending research.

Further, they would be the overseers of the money that has been

spent in the studies. They would have access to the interim data

of the studies and the power to withdraw the funding or terminate

the study if the study is not following the protocol which it was

submitted—protocol as written in the proposal for the funding that

the researcher wanted.

Get the illnesses that are being diagnosed at a higher rate in

Gulf war veterans presumptive service-connected for these veterans. This is needed now, because many of the veterans are having

claims denied for many of these illnesses even though research has

shown a higher rate of Persian Gulf veterans having these types

of illnesses versus non-Persian Gulf war veterans. We need your

help to change Title 38 so that we can take care of those who

fought for our country.

With most everyone looking at what is causing Gulf war illness,

it seems they are looking at the high rate of illnesses that veterans

are diagnosed with and how getting them treatment for them will

make their lives a lot better.

Table 3 of the Kansas Study as well as other studies showed

some of the illnesses and the rates that they occur within Gulf war

veterans over non-Gulf war veterans.

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Three, there needs to be a closer look at birth defects within children of Gulf war veterans, more so looking at just female veterans

versus nonveterans of females. OK. The studies conducted both inside and outside the VA and DOD have shown a higher number of

birth defects in children of Gulf war veterans. Further research

should be conducted into the types and severities of these defects,

with attention given to the incidence of neurological, behavioral,

learning—excuse me, I’m sorry—difficulties as well as just the

physical abnormalities. I am sure that the Executive Director of

the Association of Birth Defects would be able to cover this area

more than I would.

Track down disease groupings within the Gulf war veterans. One

example of this would be multiple sclerosis, since over 400 Gulf

war veterans have gone to the VA to get help with MS. Many of

the recognized illnesses found in the civilian population such as MS

have higher incidence within a veterans population. DOD and VA

should be working with the civilian entities of these types of agencies who receive civilian diagnosis for conditions due to the fact

that many veterans do not use the VA or DOD health care system,

and at that time tracking these veterans would be—at the current

time, the only health tracking of these veterans would be through

the VA and DOD. So the number of veterans affected with MS is

grossly underestimated. One way to ensure all affected veterans

are counted would be to correlate Social Security numbers of the

veterans with applications for Social Security disability applications for different types of diseases.

Mr. SHAYS. Can you just wrap up here?

Mr. BUNKER. OK. The last two information here is base further

research on proposed model of phase 2 of the Kansas Study, which

has gone into great details within my written statement to you.

And the third one is to have the DOD and the VA to give out better

information on the exposures to nerve gas and sarin.

And then so in conclusion, I would like to say is that the only

way we are going to get good research, and that is to take it away

from the DOD and the VA, and let people like the State of Kansas

do the research.

Mr. SHAYS. Thank you very much. As you know, your full statement will be part of the record, and it was a well written statement. Thank you.

[The prepared statement of Mr. Bunker follows:]

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Mr. SHAYS. Dr. Hall.

Dr. HALL. Thank you. I shall keep this as brief as possible; you

have my full statement. I shall merely draw attention to some salient points.

I was fully vaccinated and immunized, but not deployed. And the

current feeling in U.K. veterans is that we have a hidden reservoir

of nondeployed sick people who have been vaccinated unwisely, but

have developed illness, and, because they haven’t been deployed,

have failed to associate the onset of that illness with the vaccinations that they were given.

My personal illnesses have been purely physical, have been a

cascade of one set of organ failures after another, and I am currently awaiting now chemotherapy to try and arrest the decline in

my health.

As of March 7th this year, I went to the annual general meeting

of our NGFA in Blackpool. There were 92 people with identical

physical histories to me, the same physical symptoms, in the same

chronological order, and in the same timeframe, none of whom

have been deployed. That surely speaks out very loudly that there

was something wrong with the vaccination schedule. My own feeling is that it was probably the combination of pertussis with anthrax that was the root of the problem, the pertussis being the

major problem. There was no clinical need for this to be given

whatsoever; it was given merely to speed up the immune acceleration because of the lack of perceived notice to get troops ready for

deployment. The pertussis that was given, to my knowledge, was

strictly forbidden to be given to adults, yet it was administered

nonetheless.

In terms of questions asked, how is treatment coming along? In

Britain the answer is very badly. There is no specific magic bullet

has been found. Nothing is obvious. And we are still looking into

that.

In response to the question, what have we learned? In Britain I

fear the answer is nothing. It would seem that the lessons we

should have learned from GW–1 have not been learned, and the

same mistakes have been made in GW–2. There are now individuals reporting the same illnesses now as were being reported in

1991.

What can we do for the future? I come with a message, which

is sincere and from heart, and it is quite simple: To say that we

don’t appear to be able to fight the battle on our own. And our earnest request is that we would wish our American colleagues to continue to give us their admirable support in trying to find an answer

to this terrible affliction. Thank you.

Mr. SHAYS. Thank you very much, Dr. Hall.

[The prepared statement of Dr. Hall follows:]

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Mr. SHAYS. Dr. Heinrich.

Dr. HEINRICH. Mr. Chairman, members of the subcommittee, I

am pleased to be here today as you consider the current status of

the Federal Government’s research into the health concerns of Gulf

war veterans. My remarks will summarize findings on the status

of research on Gulf war illnesses based on the report we are

issuing today at your request.

Following the Persian Gulf war in 1991, approximately 80,000

veterans have reported various symptoms such as fatigue, muscle

and joint pains, rashes, headaches, and memory loss. Scientists

have agreed that many veterans have unexplained illnesses referred to as Gulf war illnesses that do not conform to a standard

diagnosis. Possible exposures to several known and potential health

hazards have prompted numerous Federal research projects funded

by Veterans Administration, Department of Defense, and Health

and Human Services to examine possible causes for these symptoms as well as potential treatments. VA is the lead agency for all

Federal efforts and activities on the health consequences of service

in the Gulf war.

Federal research efforts have been guided by a set of 21 research

questions that cover the extent of various health problems, exposures among the veteran population, and the differences in health

problems between Gulf war veterans and controlled populations.

Developed by an interagency research working group, the questions

cover a range of issues, such as altered immune function and neurological deficits, or possible exposure to petroleum combustion

products or other agents such as insecticides.

Since 1991, 240 federally funded projects have been initiated to

address these health concerns. These projects covered several different focus areas, such as brain and nervous system research, and

used a variety of methodologies. From 1994 to 2003, the total dollars expended were about $247

million. Between fiscal year 2000 and 2003, overall funding for

Gulf war illnesses research has decreased by about $20 million.

This overall decrease in funding was paralleled by a shift in VA’s

and DOD’s research priorities, which expanded to include all hazardous deployments. For example, in 2002, VA issued a program

announcement for research in the long-term health effects in veterans who served in the Gulf war or in any hazardous deployment

such as Afghanistan and Kosovo.

Although about 80 percent of the projects are now complete, VA

has not reassessed the extent to which the collective findings of

completed Gulf war illnesses research have addressed the 21 questions that I noted before. The only assessment was published in

2001, when only about half of the studies were completed. This assessment was somewhat limited in that it did not identify gaps or

promising areas for future studies. Without such an assessment,

many underlying questions about cause, course of development,

and treatments remain unanswered.

In 2002, VA established the congressionally mandated Research

Advisory Committee to provide advice to the Secretary of the VA

on proposed research relating to the health consequences of military service in the Gulf war. This advisory committee is charged

with assisting VA in research planning by exploring the entire

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body of Gulf war illness research, identifying gaps, and identifying

potential areas for future study.

According to advisory committee officials, VA’s poor information

sharing and limiting collaboration with the committee about research initiatives has made it difficult for the committee to fulfill

its mission.

VA recently has stated that they will be involving advisory committee members in developing VA program announcements.

In the report being issued today, we also describe the few studies

that have been funded to examine cancer incidence in Gulf war veterans. Thus far no unusual patterns have been detected, but it is

too early to be definitive about cancer incidence in this population.

We are also making several recommendations which the Secretary

of the VA concurs with, that being the Secretary of the Veterans

Affairs conduct a reassessment of the Gulf war illness research

strategy to determine whether the 21 research questions have been

answered, whether they are relevant, and whether they are promising areas for future study; that a liaison who is knowledgeable

about Gulf war illnesses research is appointed to routinely share

information with the advisory committee and ensure that VA’s research offices collaborate with the advisory committee.

Mr. Chairman, that completes my prepared statement.

Mr. SHAYS. Thank you very much, Dr. Heinrich.

[NOTE.—The GAO report entitled, ‘‘Department of Veterans Affairs, Federal Gulf War Illnesses Research Strategy Needs Reassessment,’’ may be found in subcommittee files.]

[The prepared statement of Dr. Heinrich follows:]

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Mr. SHAYS. Dr. Rhodes. And I would just point out that this is

unusual to have two folks from GAO on the same panel, but you

both have different perspectives that impact this story a little differently, and that’s why we felt it was necessary to have both of

you here. Thank you.

Dr. RHODES. Mr. Chairman, members of the subcommittee, Lord

Morris, I am pleased to participate in this international hearing by

presenting our assessment of plume modeling conducted by the Department of Defense and the Central Intelligence Agency to determine the number of U.S. troops that might have been exposed to

the release of chemical warfare agents during the Gulf war in

1990. I presented our preliminary results to you in a testimony on

June 6, 2003. My statement today is based on our final report entitled, ‘‘Gulf War Illnesses, DOD’s Conclusions About U.S. Troops

Exposure Are Unsupported,’’ which is being issued today.

In summary, DOD and the United Kingdom’s Ministry of Defense’s conclusions based on DOD’s plume modeling efforts regarding the extent of United States and British troops’ exposures to

chemical warfare agents cannot be adequately supported. Given the

inherent weaknesses associated with the specific models DOD used

and the lack of accurate and appropriate meteorological and source

term data in support of DOD’s analyses, we found five major reasons to question DOD and the U.K. Ministry of Defense’s conclusions.

First, the models were not fully developed for analyzing longrange dispersion of chemical warfare agents as an environmental

hazard.

Second, assumptions regarding source term data used in the

modeling such as the quantity and purity of the agent were inaccurate since they were based on uncertain and incomplete information and data that were not validated.

Third, the plume heights from the Gulf war bombings were underestimated in DOD models.

Fourth, postwar field testing at the U.S. Army Dugway Proving

Ground to estimate the source term data did not reliably simulate

the actual conditions of either the bombings or the demolition at

Khamisiyah.

Fifth, there is a wide divergence in results among the individual

models DOD selected as well as in the unselected DOD and nonDOD models with regard to the size and path of the plume and the

extent to which troops were exposed.

Given these inherent weaknesses, DOD and MOD cannot know

which troops were and which troops were not exposed.

You had asked about the total costs for the various plume modeling efforts. The total costs for the various plume modeling efforts

to analyze the potential exposure of U.S. troops from the demolition

at Khamisiyah and the bombing of several other sites in Iraq cannot be estimated. DOD organizations and other entities involved

with the plume modeling efforts could provide only direct costs,

that is, contractor costs, which totaled about $13.7 million. However, this amount does not include an estimate of the considerable

indirect costs associated with the salaries of DOD, VA, and contractor staff, or costs of facilities, travel, and equipment. We requested,

but DOD could not provide, this estimate.

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In addition, the CIA would not provide direct and indirect costs

for Gulf war plume modeling because, in its view, our request constituted oversight of an intelligence matter beyond the scope of

GAO authority. The CIA’s contractor, the Science Applications

International Corp., also did not respond to our request for cost

data.

DOD’s and VA’s conclusions there that there is no association between exposure to chemical warfare agents from demolitions at

Khamisiyah and rates of hospitalization and mortality among U.S.

troops also cannot be adequately supported. DOD and VA based

these conclusions on two government-funded epidemiological studies, one conducted by DOD researchers, the other by VA researchers. In each of these studies, flawed criteria were used to determine

which troops were exposed. These flaws may have resulted in

large-scale misclassification of the exposure groups; that is, a number of exposed veterans may have been classified as nonexposed,

and a number of nonexposed veterans may have been misclassified

as exposed.

In addition, in the hospitalization study, the outcome measure,

number of hospitalizations, would not capture the chronic illnesses

that Gulf war veterans commonly report, but which typically do not

lead to hospitalization. Several published scientific studies of exposure involving the Gulf war suggest an association between lowlevel exposure to chemical warfare agents and chronic illnesses.

In our report we are recommending that the Secretary of Defense

and the Secretary of Veterans Affairs not use the plume modeling

data for future epidemiological studies of the 1991 Gulf war since

VA and DOD cannot know from the flawed plume modeling who

was and who was not exposed. We are also recommending that the

Secretary of Defense require no further plume modeling of

Khamisiyah and the other sites bombed during the 1991 Gulf war

in order to determine troops’ exposure. Given the uncertainties in

the source term and metereological data, additional modeling of the

various sites bombed would most likely result in additional costs

while still not providing any definitive data on who was and was

not exposed.

That concludes my summary. I am willing to answer any questions you may have.

Mr. SHAYS. Thank you, Dr. Rhodes.

[NOTE.—The GAO report entitled, ‘‘Gulf War Illnesses, DOD’s

Conclusions About U.S. Troop’s Exposure Cannot be Adequately

Supported,’’ may be found in subcommittee files.]

[The prepared statement of Dr. Rhodes follows:]

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Mr. SHAYS. Before I recognize you, Mr. Binns, I just want to

make a comment, Dr. Rhodes. Your testimony is bringing up a real

sore to this subcommittee, because when we had talked about our

troops being exposed to chemical weapons and our concern about

that, DOD, CIA, everyone said basically our troops were not exposed. But they then started to insert the word, ‘‘no offensive use

of chemical weapons exposed,’’ and our troops—and that word, ‘‘offensive use,’’ was something that just kind of got inserted.

In the meantime, we had a witness who had a video of

Khamisiyah, and blowing up these shells and other munitions that

were in Kahmisiyah. He was to testify the next week on a Tuesday.

At 12 on Friday, the DOD said they would have an important announcement at 4 on Friday. At 4 on Friday, they acknowledged

that our troops had been exposed to chemical weapons, which they

said was defensive. And defensive meant that we had, in essence,

blown up this and were dealing with this plume, so that when we

then had our hearing on Tuesday, the press treated this as old

news.

This was stunning news, because DOD was trying to keep from

the world community and from this subcommittee and others the

fact that our troops had been exposed, and they simply inserted the

word ‘‘offensive use of chemicals.’’

To think now that the CIA would not cooperate with you and the

work that you do as a government organization just blows me

away; to think that they would care so little about our troops who

served there, that they would not have cooperated so that your

study could have been more valid.

The bottom line is you have determined that the plume study is

totally and completely irrelevant. And I would just add that after

they announced at that press conference, they said only a few of

our troops, a few hundred, were exposed. Then they moved it up

to 1,000. Then they moved it up to 10,000. And sitting directly behind you, Dr. Rhodes, is Jim Tude, who 5 years ago said this study

and what’s happened is just simply a joke. And you’re documenting

it in a study that frankly we wish you didn’t have to have done.

But I am sorry to interrupt this hearing to just express my feelings about the outrageous cooperation we have had from the military as it relates to this issue, and there has to be an answer to

this.

Mr. Binns.

Mr. BINNS. Mr. Chairman, members of the committee, Lord Morris, as chairman of the Research Advisory Committee on Gulf War

Veterans Illnesses, I am honored to appear before this body. It was

your committee’s report which led Congress to create the Research

Advisory Committee.

The committee produced an interim report presenting its initial

findings and recommendations in June 2002 after only one meeting. A comprehensive report reflecting our work over the first 2

years is currently undergoing final revision and will be released in

approximately 6 weeks. In my time here today, I will not attempt

to anticipate the full scope of that report, but let me offer an overview.

First, I regret to advise you that Gulf war veterans are still ill

in large numbers. Epidemiologic studies consistently show that 26

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to 32 percent of Gulf veterans suffer from a pattern of symptoms

including fatigue, muscle and joint pains, headache, cognitive and

gastrointestinal problems over and above their counterparts who

did not deploy to the Gulf. Twenty-six to 32 percent translates into

between 180,000 and 220,000 of the 698,000 troops who served.

These ill veterans are not getting better. The most seriously ill

include those with diagnosed neurological and neurodegenerative

disease. So this problem remains with us, it is severe, and no treatments have been shown to be effective to any substantial degree.

On the positive side, there has been a flood of new research in

the last 2 years that has finally begun to shed light on the nature

of this illness. By pursuing these new discoveries, medical science

has the opportunity to explain the biological mechanisms at work

in Gulf war illnesses and ultimately to identify treatments to address them.

To illustrate the kind of progress that is taking place, let me

summarize three areas where recent research has changed previous scientific thinking.

First, earlier government reports have concluded that psychological stress is the likely cause of Gulf war illnesses. New studies,

however, have shown that stress does not begin to explain the poor

health of Gulf veterans. For example, a large 2002 study of British

veterans sponsored by the U.S. Department of Defense concluded

that more than three-quarters of ill Gulf veterans have no stress

or other psychiatric disorder whatsoever. The study further concluded that, ‘‘posttraumatic stress disorder is not higher in Gulf

veterans than in other veterans. Alternative explanations for persistent ill health in Gulf veterans are needed.’’

A second scientific breakthrough is reflected in new studies

showing objective evidence of neurological abnormalities in ill veterans. For example, research at the Department of Veterans Affairs

Medical Center in Boston has shown that ill veterans perform

worse on tests of attention, visual-spatial skills, and visual memory. A Department of Defense-sponsored study at the Midwest Research Institute has demonstrated that ill veterans show abnormalities on a wide range of tests of autonomic nervous system function.

Third, until recently it was believed that exposure to very low

levels of nerve gas below the levels that produce symptoms at the

time of exposure did not produce any long-term effects. Within the

past 2 years, however, there have been at least 9 animal studies

demonstrating long-term effects on DNA, behavior, immune function, memory, and responses involving the autonomic nervous system.

This research and more will be discussed in detail in the committee’s upcoming report, but you can readily see that scientific

progress is being made. These are government-sponsored studies

conducted by a wide range of respected laboratories. With due respect to my co-committee member, it is not just Robert Haley anymore. The key question now is what research is being done to followup on these new discoveries.

Let me first address research at the Department of Veterans Affairs. VA has many talented individual researchers. VA also has

strong leadership in Secretary Anthony Principi, who has personVerDate 11-MAY-2000 12:57 Dec 17, 2004 Jkt 000000 PO 00000 Frm 00096 Fmt 6633 Sfmt 6633 D:\DOCS\96946.TXT HGOVREF1 PsN: HGOVREF1
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ally championed this issue. In October 2002, at his direction, VA’s

Office of Research and Development announced a special initiative

to invest up to $20 million in fiscal 2004 in deployment health research, particularly Gulf war illnesses. The Research Advisory

Committee and veterans were extremely heartened by this action.

However, at the committee’s most recent meeting in February, the

Office of Research and Development reported that with fiscal 2004

nearly half over, only one study totaling $450,000 had been funded.

As you can imagine, the committee was extremely disappointed.

The Secretary was equally, if not more, disappointed and communicated forcefully to the Office of Research and Development that

priority be given to this area.

Since then I have seen a dramatic turnaround in the outlook of

the Office of Research and Development toward Gulf war veterans’

illnesses. A new program will be announced in the near future. It

will include new research initiatives specifically dedicated to Gulf

war illnesses. Equally important, it will reflect a purposeful, logical

approach to direct Gulf war illnesses research toward the areas of

greatest scientific opportunity and the development of treatments.

Mr. SHAYS. Mr. Binns, I am going to ask you to—we don’t usually do this. We are just going to ask you to wrap up. Your statement is excellent, and it’s there for us. But——

Mr. BINNS. Let me just make one point, and that is that the vast

majority of the funding for the Department—for Gulf war illnesses

research over the years has come from the Department of Defense.

So that even with this new research initiative that I speak of, there

will still be a dramatic overall decline in Gulf war illnesses research compared to historical levels. Between 1999 and 2002, the

average government research for Gulf war illnesses was approximately $35 million in direct research. This year the Department of

Defense is spending in new research, that is, new initiatives funded

to followup on these breakthrough studies, no initial money.

The Department of Veterans Affairs may spend up to $11 million. So you have a decline from $35 million to approximately $11

million at a time when the research is finally beginning to show

breakthroughs. In addition, the effect of these decisions extends far

beyond ill Gulf war veterans. The new research emerging from the

study of Gulf war veterans’ illnesses has important implications to

the war on terrorism. Terrorist alerts at home and military actions

abroad provide constant reminders of the risk of chemical attack.

It is indeed tragic that at this hour of need, just as the investment

in past research is finally beginning to pay off and point the way

toward success, there are not funds to pursue these discoveries.

It particularly perplexes the members of the committee that

funding for programs like the U.S. Army Institute of Chemical Defense is actually being reduced at this critical moment in our history and that research to develop countermeasures to chemical

threats has not been included in the $1.7 billion NIH

counterterrorism program. Gulf war veterans are no longer the

stragglers from a forgotten war. They are the advanced guard for

all of us.

Mr. SHAYS. Thank you very much, Mr. Binns.

[The prepared statement of Mr. Binns follows:]

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Mr. SHAYS. Mr. Robinson; and then we are going to take questions. And I will go first to Mr. Sanders and then Mr. Turner.

Mr. ROBINSON. Mr. Chairman and members of the committee

and Lord Morris. Headline from the Associated Press on May 2004,

‘‘Nerve Agent Sarin was in Iraq Bomb.’’ And the key statement out

of this document, apparently reported by the Department of Defense, ‘‘No one was injured after its initial detonations but two

American soldiers who removed the round had symptoms of lowlevel nerve agent exposure,’’ officials have said. A person exposed

to a large dose of sarin can suffer convulsions, paralysis, loss of

consciousness, and could die from respiratory failure. But in small

doses, people usually recover completely.

Mr. Chairman, as you know, this battle for veterans’ recognition

of Gulf war illness has spanned over 14 years. And you also know

that it was initially fought in the court of public opinion as to

whether or not veterans were ill because of stress or there was

some real factor involved. Today, we can report that science is unraveling the mysteries of Gulf war illness and there is a political

will to look for answers.

Nothing that happened to Gulf war veterans in 1991 should be

a mystery to anyone in this room because of science that has been

produced today. However, there are still researchers in DOD and

in the VA health care system that refuse to read, recite, promote,

or look at the new science or new committees formed to address

this issue. This continued effort by a few bad people who hold key

positions is the reason we are just now looking at treatment modalities for Gulf war veterans.

Mr. Chairman, I believe you will agree we need a Manhattan-like

project assessment of what has happened, where we are going, and

what we need to do for the future because I know you believe, as

I do, that this risk of exposure to chemical warfare agents can happen here in the United States, in your home and town where even

low levels of sarin may be presented and no one would ever know

it.

It is very important for us to understand what has happened to

ill Gulf war veterans. It is not enough to hold hearings on the issue

to expose the flaws in the system. The time has come for accountability and focused determination. Where needed, Congress must

pass laws mandating research and treatment. When discovered,

Congress must punish those who deliberately lean away from the

veteran or those who purposely manipulate and inhibit science

based on old theories that have long since been found untrue.

Right now there is a Gulf war veteran in the United Kingdom

who is on a hunger strike, and chances are he will die if he goes

through with his hunger strike. And what he is asking for is public

hearings. And we hope that this committee’s work, our testimony

today, and what Lord Morris takes back will encourage the MOD

to hold those public hearings so that the Gulf war veterans will

have the same benefit that we have had for much of the research

that is here in the United States.

What do we know today? For all intents and purposes, the DOD

is not conducting research or investigating things related to Gulf

war illnesses. There is still this belief with some that stress is the

reason why veterans are sick. Recently, soldiers who returned from

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Iraq have had their medical concerns classified as in-your-head

hysteria when they ask for screening for dangerous substances like

depleted uranium, lariam, or exposure to sarin. In all the cases

above, the Department down-played the exposures, and even in the

face of scientific data ignored some of the exposures.

Now, I just recently learned outside in the hall that apparently

the Department is going to produce some document or some evidence that says they took blood from some of these soldiers exposed

to sarin and may, in fact, be tracking them. But we don’t know

that, and we would like for them to be public about it. And certainly our interest has peaked, hoping that they did learn the lessons of 1991. These soldiers also who have had a chemical weapons

exposure should be eligible for a Purple Heart. A chemical weapons

exposure at the hands of the enemy is no different than an IED

attack or an ambush, and it is something we need to look at.

The single most egregious thing that has happened in terms of

DOD research is the lack of population identification. The DOD is

not providing researchers, the VA, or the soldiers unique information identifying where they served or what they may have been exposed to. And simply stating that a soldier served in southwest

Asia is not the kind of data that the IOM or the VA will need to

conduct epidemiological studies.

I have 15 seconds left. One of the things that is most important

in getting doctors to do the right thing by Gulf war veterans is that

the VA and the DOD has to look at and promote the new science.

These are three books that the VA puts out. One is called ‘‘Caring

for the War Wounded.’’ One is called ‘‘Health Effects from Chemical, Biological and Radiological Weapons.’’ And this one is the

‘‘Guide for Gulf War Veterans.’’ These are the veterans’ health initiatives. Clinicians in the VA are supposed to read this to understand what are the exposures of Gulf war veterans. There is nothing in this document that reflects the science that we know today.

This is all information from 1999 and back. It is the stress theory

and it needs to be updated, because if the clinicians in the VA don’t

know what the illnesses are, they don’t know what the exposures

are, they can’t possibly come up with treatments or give the veterans the kind of care they need. I would encourage the committee

to please ask the VA to update this. And I submit the rest of my

statement for the record.

Mr. SHAYS. Thank you very much, Mr. Robinson, and thanks to

all the panelists.

[The prepared statement of Mr. Robinson follows:]

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Mr. SHAYS. And we will start with Mr. Sanders, and we are

going to do 10-minute questioning here.

Mr. SANDERS. Thank you Mr. Chairman.

Chris Shays and I have participated in dozens and dozens of

hours of hearings. And I have to say that this is the most peculiar

process that I have ever seen in my life. Something is wrong here.

We have evidence that over 26 percent of Gulf war vets were made

casualties. That’s probably the largest number of any war in history. Dr. Hall tells us that he recently went to a meeting and that

over 92 people were present who had identical physical symptoms.

I have talked to Gulf war veterans in the State of Vermont, around

the room, where they tell me when they walk into a grocery store

and smell detergents or perfumes, they get sick. Chris and I have

heard people come forward here with terrible, terrible illnesses.

That is one reality that Chris Shays and I and other members of

this committee have heard for years.

And then there is another reality that seems to come from the

officials is—we have heard today from Dr. Heinrich that, A, they

have 80,000 soldiers have reported symptoms, significantly less

than the number that Mr. Binns made. But No. 2, we have 241 federally funded projects spending $247 million.

Dr. Heinrich, is there a Gulf war illness?

Dr. HEINRICH. The experts that we spoke with, sir, have said

that there are unusual symptoms and that they still cannot identify the cause. But it is also clear to us that they are doing studies

to try to further identify what that might be.

Mr. SANDERS. Thank you. That is it. And that’s the insanity that we are dealing with: $247 million and your researchers have come

up with the fact there are symptoms. You could have saved a lot

of money. Chris Shays and I knew there were symptoms.

Mr. Bunker, are there symptoms?

Mr. BUNKER. Yes.

Mr. SANDERS. Mr. Robinson, are there symptoms?

Mr. ROBINSON. Absolutely.

Mr. SANDERS. We don’t have to pay them $247 million. So what

are we doing? I have concluded—and I don’t mean this to be a

mean statement to the members of the DOD, because I know in

their hearts they certainly want all veterans to get a fair shake

and to be well, but something very strange is going on. I do not

know why from day 1 the DOD, to a lesser degree the VA, but both

institutions have been resistant to the very serious crisis that we

are facing and the pain that is going on.

And I would agree for a start with Mr. Bunker who made a very

simple statement and he said, we should get the research money

out of the VA and DOD. I think that’s right.

Let me ask Dr. Heinrich a very simple question. Dr. Haley, who

is a researcher who will be testifying later on, this is what he says

in his report. He says, ‘‘I am encouraged at the progress that has

been made in understanding the new type of brain cell damage

that appears to underlie Gulf war veterans’ symptoms.’’ Is he

crazy? He has been saying this for years. What do you say? And

he hasn’t spent $247 million. Is he right or wrong?

Dr. HEINRICH. What we have seen and what experts have said

to us is that there are concerns that there is neurological damage.

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And I think that’s one reason you will hear the VA talk about new

efforts to fund studies that are really focusing on

neurodegeneration.

Mr. SANDERS. He has gone beyond concerns that there may be

neurological damage. It is incredible to me and to the taxpayers of

this country and all the people who are concerned about veterans

that the VA and the DOD have done so very little.

Mr. Binns, I want to thank you. I am not a great fan of President

Bush, but I think in appointing you and Anthony Principi, we have

some serious people who are trying to deal with this issue. From

your point of view, give us some understanding of why the government has been so lax in coming up with an understanding of the

cause or some kind of treatment, despite the not insignificant sum

of money. Where do you think we should be going from here?

Mr. BINNS. I can’t answer the question of why they haven’t gotten with the program.

Mr. SANDERS. How would you assess $247 million being spent

with the results we have seen?

Mr. BINNS. A lot of the money has been spent in areas which at

least today we can conclude, and earlier you might have been prepared to conclude, were not the areas that would lead to the most

promising answers. For example, in 2003 the VA budget in that

year, according to the recent report to Congress, provided for about

$4.1 million in Gulf war illnesses research. Of that amount, 57 percent went to study stress and other psychological causes; 17 percent went to study things like Web-based training for VA physicians on bioterrorism events. So only 17 percent actually went for

things that we believe are directly related.

Mr. SANDERS. We don’t have a lot of time. I don’t mean to be

rude. Based on all of the evidence, do you agree or disagree with

Mr. Bunker, who basically is saying we need research, these guys

are not going to do it, we should get it out of the VA and the DOD?

Mr. BINNS. I would have agreed with you 4 months ago, but Secretary Principi, as I am sure representatives here from VA will attest, is very concerned about this issue. I wish I could guarantee

that Secretary Principi would be the Secretary of Veterans Affairs

for the next 20 years or so. We are going to have a good program

that is very accelerated coming out of VA. Whether it can continue

and whether there is the sustained effort depends upon many factors, as you well know. I think if you want to guarantee that there

will be this kind of effort both from VA and DOD, Congress would

have to make it a line item budget that there be Gulf war illness

research.

Mr. SANDERS. You can appreciate the frustration that we feel;

$243 million is not an insignificant sum of money. And the question is—you heard from Dr. Heinrich basically they have done very

little with this money—so I think the question is not that there

should not be money, but should we be saying, look, for whatever

reason, the DOD is certainly not going to do it. Maybe the VA will

do something, but we have to get it out of Capitol Hill and start

finding serious researchers in the private sector, who by the way,

if I’m not mistaken—I don’t mean to be personal here, but I think

you came into this issue out of family issues, because you saw a

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correlation between a family member and the illness that our veterans were seeing; is that correct?

Mr. BINNS. Yes. And I think you are right in saying that there

needs to be a mix, I believe, of VA and outside research. The limitation of VA research is that they can only fund VA physicians. Obviously, that is where the veterans are, so there should be a substantial investment there. As I said, I believe they are about to do

that.

On the other hand, you need to have—I don’t know who is the

one to do it, NIH or DOD, but you need to have some agency with

the capability of funding the best talent available outside of the

Federal Government, and you need to have a total funding commitment that is at least at the historical level of commitment. I believe

it’s happening at VA and I think I see it happening in other agencies as well. I don’t believe it will be wasted.

Mr. SANDERS. In your judgment, is Dr. Haley making some important breakthroughs?

Mr. BINNS. He has been the guy out there with the spear, advancing on this evil for many, many years. And he has made continued advances. Today I would say he has squads of troops behind

him, and he has other people in the woods that you will be hearing

from later on that really represent the heavy artillery who are willing to come into this area.

Mr. SANDERS. There is some good news that some breakthroughs

are being made. Unfortunately, they have not been made within

the DOD. And I have a lot of affection and respect for Anthony

Principi and I know his heart is in the right place on this. But I

think we owe it to our veterans not to throw money out there, but

to target that money to serious people within the VA and the private sector and universities who are prepared to work with nongovernment researchers to begin to advance some of the ideas that

are beginning to be developed.

Dr. Hall, let me get back to you. What I heard you say is that

not a whole lot more is happening in the U.K., is that correct?

Dr. HALL. That’s correct. I think we face the same sort of problems in that the money that is being spent is being utilized by people who you might describe as being an employee of central government. They are simply government lackeys who produce what the

government wish to hear. There seems to be no independent research going on, or if there is, it isn’t breaking through the press

barrier to get free publication.

Mr. SANDERS. The chairman has asked me, when you mentioned

92 people with identical physical symptoms at a meeting, how

many people were at the meeting?

Dr. HALL. Approximately 50,000 people deployed, of which 5,000

have reported symptoms; 1,500 are members of the NGVSA; 200

were at the AGM, and of those 200, 92 people who could take my

place.

Mr. SANDERS. What does your government say when you present

them with this information?

Dr. HALL. I have recent correspondence from my Prime Minister

denying that this syndrome exists. And that’s correct as of 2 weeks

ago.

Mr. SANDERS. Denying or decrying?

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Dr. HALL. Denying that this syndrome exists. My ill health problems are officially denied.

Mr. SANDERS. The official position of the Government of the

U.K.——

Dr. HALL. My illness does not exist. It is imaginary, yet I have

x-ray proof and I have MRI scans. My blood chemistry is deranged.

I am now preleukemic. That is not an imaginary condition.

Mr. SHAYS. At this time, we will go to Mr. Turner and then to

Mr. Tierney.

Mr. TURNER. Thank you, Mr. Chairman.

I appreciate all of the testimony we have received today, and

when you look at the issue of both the medical science but also the

analytical science as being applied to determine what happened in

the field of battle, I am fascinated with the discussion on plume

modeling, as I said in my opening statement, because in this subcommittee, so many times we have heard from people who have

testified with seemingly absolute certainty as to what would occur

under certain circumstances with respect to a plume, utilizing the

technology for planning purposes, not only as a guide for what we

need to respond to but what we don’t need to respond to. And that

concerns me greatly because that seems as if the science is not defined enough for us to exclude outcomes.

And in looking at GAO’s report—and it says, DOD’s conclusion

about U.S. troop exposure cannot be adequately supported. When

we talk about the amount of money that’s been spent, I noted in

the testimony, it says the direct costs alone, over $13.7 million

from plume modeling, and that does not include indirect costs of inhouse work that was done. So $13.7 million was spent outside for

the purposes of plume modeling.

And then the conclusion is that—from the GAO is they are recommending that the Secretary of Defense and Secretary of Veterans Affairs not use the plume modeling data in the future, epidemiological studies of the 1991 Gulf war, since VA and DOD cannot

know from the flawed plume modeling who was and who was not

exposed, again giving the issue of not just what may have happened but trying to say what didn’t happen. And then you go on

to talk about the unreliable assumptions that make up the plume

modeling that make it useless, the nature of the pit demolition, meteorology agent purity, amount of agent released and other chemical warfare agent data, all of which, when we try to prospectively

guess about what might happen under circumstances of a terrorist

attack or terrorist incident, are variables that will not be known

and seem to me at times to be almost unlimited.

I would like to hear from you, Dr. Rhodes, and others who might

want to comment, you are recommending that plume modeling not

continue to be pursued because this data is not accurate enough.

Is it possible to undertake plume modeling of this? It seems as if

you are saying both the data they currently have is not reliable,

the moneys that have been invested do not give the adequate return, but also raises the question of can it even be done?

Dr. RHODES. Mr. Turner, you have asked the right question: Can

it even be done? It can be done if you understand exactly what you

want to do with the outcome. If you are trying to plan the evacuation of a city, if you are trying to plan whether or not people

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should seal themselves up in place, that can be done, assuming you

have enough data. The meteorological data is missing from Iraq because it stopped delivering meteorological data to the world in

1981. If I am trying to get to a number, 101,752 troops were exposed, modeling cannot—I repeat—cannot give you that number.

That number is an impossible number to get. It can give you a first

order approximation. It cannot give you a number as precise as

that, which is what is being parlayed at the moment. It is being

proffered as this is the number. That number is incorrect. The data

that were loaded into the models can give you diverging plumes.

And the best we can conclude from looking at the modeling is that

700,000 soldiers, including people in Kuwait and including civilian

populations in Saudi Arabia may have been exposed.

Now from a policy perspective, that’s the best we can proffer to

you based on the modeling. But we can’t give you—I cannot sit

here and say that the number 101,752 is correct and none of the

data shows it. That doesn’t mean don’t model in other scenarios,

an evacuation scenario, or should we shelter in place or something

like that. That can be done. But it has to be done with the understanding that all models are first order approximations. They are

not going to give you reality. They are going to give you a snapshot

of reality. For example, as you see in our testimony, as you pointed

out, the configuration of the munition and how it was detonated

varies on the plume height; how high did it go? As you see in our

report, there was an arbitrary number established, and that was

exactly how DOD described it. It was the arbitrary value of 10 meters when a 2,000 pound bomb can give you upwards of a 400-

meter plume. At 400 meters, that plume is going to start to shelf

and it will spread out where you get the classic mushrooming design. Can I tell you at this point in time exactly how it mushroomed? Can I tell you exactly who was under it? No. But I can

tell you that anyone who was in theater at the time of the

demolitions or the bombings may have been exposed. But I can’t

tell you that it’s you and not I, or that it’s myself and not you.

And that’s the problem with what’s being done with the model,

is that it’s being asked for a degree of precision that it cannot give.

And therefore what we get is the wrong answer, faster, to a greater

degree of precision. And that’s why we say in this instance, not in

all models, but in this incident, in this instance and for these purposes, don’t waste your money.

Mr. TURNER. I do have a followup question. Does anyone want

to comment on the plume modeling? Mr. Robinson.

Mr. ROBINSON. I believe in some cases, once the information was

produced, which we clearly believe is a flawed model, that data was

used for years and years by both DOD and researchers to make

other conclusions that they themselves were also flawed. And I

think it’s important that if an event like this occurs again in the

future, the key No. 1 thing we need, besides retrospective modeling, is what happens when the event occurs, which is identify the

people who were exposed, mark it down in their medical records,

point them toward followup treatment and care, and when they

come back, make sure they receive their care and then do a longterm followup.

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If that had been done after the 1991 Gulf war, those basic steps,

identify who potentially was exposed, tell them what the risks

were, put it in their medical records and then point them toward

people who understand that kind of exposure, we might not be sitting here today. We would know a lot more if we had taken that.

And the last thing is, besides modeling, listen to what the soldiers say. The soldiers reported this early on, that there was a

problem. So if something happens in this war, listen to what the

soldiers say and make sure their information is documented.

Mr. TURNER. One of the things that Mr. Rhodes said that I find

interesting is that, you know, obviously U.S. troops, British troops,

others, they were not the only ones in theater; there were Iraqis

and Kuwaitis. What information do we have, or reports do we have,

of similar types of symptoms occurring in the populations that were

in Iraq or Kuwait?

Dr. HEINRICH. Let me try to answer that. We don’t have a lot of

information about the populations that are in that part of the

world. And there are studies that are being funded now that are

trying to identify, for example, the health of soldiers in Saudi Arabia and other Middle East states.

Mr. TURNER. What about the populations, though? We have been

in Iraq for a year. Obviously we have a strong relationship with

Kuwait. What do we know about the types of expression of these

symptoms that they have in their population? Anything at all?

Mr. ROBINSON. The Government of Kuwait is in fact studying its

National Guard soldiers. It doesn’t make the U.S. news. There are

researchers from the United States from different universities that

are in not only Kuwait but Saudi Arabia and Iraq right now as we

speak, looking to form the baselines for epidemiological studies. It

just doesn’t make the U.S. news.

Mr. TURNER. Thank you, Mr. Chairman.

Mr. SHAYS. Thank the gentleman. At this time the Chair would

recognize Mr. Tierney.

Mr. TIERNEY. Thank you, Mr. Chairman and thank you again for

continuing on with this series of hearings.

I have a number of folks in my district who expressed an interest

in this, not the least of which was recently—a letter from one of

my constituents explaining that his 62-year-old cousin had died, a

fellow that grew up in my town and went to school—from the

school that I graduated from. Enlisted in the U.S. Marine Corps in

1959. His career spanned 42 years, two wars, Vietnam and Operation Desert Storm; 29 years of Active and Reserve service. He was

acknowledged as one of the longest-serving intelligence officers in

the history of the Marine Corps, and he served as an enlisted intelligence specialist and he died after a long illness, which is one of

the reasons we are having these hearings. He served in Kuwait.

Have there been any studies done or any information that we

have that would distinguish the types of symptoms being experienced by individuals in different parts of that operation?

Mr. BUNKER. The Kansas study shows that according to where

a person was stationed made a difference as to the types of symptoms. There was a study done by Dr. Leah Steele and it was published in November 2002.

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Mr. TIERNEY. What are we doing as a result of that? Is some of

our research, Mr. Binns, focusing on that?

Mr. BINNS. The specific finding was that 41 percent of the veterans in that Kansas study who were in the forward area, who actually entered Kuwait or Iraq, fell into the ill population over and

above the control group. One of our recommendations as a committee is going to be that future studies always look at the locations

and at the unit designations of ill veterans, because based on that

limited information, there does appear to be a dramatic difference

compared to how sick they are.

Mr. TIERNEY. Mr. Binns, I know in your work so far, I know that

Mr. Robinson made a point of listening to the veterans and to the

people that were there. Do you find that most of the studies are

doing that? Has there been a change from the earlier reports that

distinctly indicated that they thought there was inadequate regard

for what the veteran participants were saying?

Mr. BINNS. No. I think this is mostly an idea that we are just

initiating now. It has not been applied in the past.

Mr. TIERNEY. So it continues to be an issue.

Mr. Sanders, you had another question to ask, too. Feel free to

jump in on that if you do. With that as a continuing problem, one

of the earlier findings was that there needed to be a better management of the research portfolio. What progress have we made on

that, Mr. Binns, Mr. Robinson?

Mr. BINNS. As I said, within the past 3 months we, at the Secretary’s direction and the leadership of the Office of Research and

Development at VA, have been working much more closely together

than we ever did before on developing a research program that indeed is focused on certain key questions which our research or

reading of research shows are the questions that need to be answered, and is not focused on topics which, while they are perfectly

legitimate topics for VA research, stress, are not relevant to this

topic.

We believe that we are making progress. Hopefully this program

will be announced in the near future by VA and that will be the

start, I would say again, of moving to an organized comprehensive

research plan. There has been a mechanism for coordination between VA and DOD in the past. It does not appear to have been

a coordinated effort but more of a shotgun effort.

Mr. SANDERS. Let me ask a simple question. We are looking at

what I have heard of about 125,000 out of 700,000 who came home

with one or another type symptom. That is a huge number, probably more than any war in our history.

Simple question. Let me start with you, Mr. Binns. You mentioned that—and maybe Mr. Bunker or Mr. Robinson might want

to jump in. Are these people getting better over time? Are they getting worse? Does anybody bother to find out?

Mr. BINNS. They do not appear to be getting better. Some of

them are getting worse.

Mr. BUNKER. In the Kansas study, there was a small number

that appeared they may be getting a little bit better. I can give you

an example. If you had known me 4 years ago you wouldn’t recognize me as the same person. Mr. Tude met me about 3 or 4 years

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ago. I was on two crutches. This time of day, I would be incapacitated because of my cognitive disabilities.

Mr. SANDERS. You have some improvements?

Mr. BUNKER. I had a neurological doctor who ran some tests to

see if I was having seizures, and I wasn’t, but he put me a low dose

of seizure medicine. That medicine he put me on, I have not had

the cognitive dysfunction like I used to have. My productivity has

greatly increased.

Mr. SANDERS. The simple question, one would think that if one

were serious in trying to understand to treat this illness, we would

say, OK, 14 years have come and gone. This percentage is doing

better, this percentage are worse, the rate of mortality is higher,

lower, whatever. Do we know that, Mr. Binns?

Mr. BINNS. No. We know mortality. There have been studies of

mortality and there have been studies of certain hospitalizations

and so on. There are not comprehensive records or studies done of

whether the treatments that are being prescribed in VA hospitals

or elsewhere are effective. And that has been one of our major recommendations in this report coming out, that evidence such as

what Jim is suggesting be developed.

You can’t go and fund a $9 million clinical trial on the basis of

an anecdotal case or two. The problem has been is that there has

been no organized effort to take this kind of information and actively develop it, find a doctor and put him together with some VA

doctors and have him do a small trial and see if it works and why.

That is a key part of this problem, because I believe there are

treatments out there that work.

Mr. TIERNEY. Who is not doing that? Who didn’t do it and who

is now doing it?

Mr. BINNS. Nobody is doing it. We are recommending that VA do

it.

Mr. TIERNEY. Dr. Heinrich, if we are to expand this out beyond

the VA and Department of Defense, who ought Congress charge

with being involved in this research, either coordinating it or conducting some of it? Where would we best be directed?

Dr. HEINRICH. There is a deployment health group with a subcommittee of—for research that does coordinate this across DOD,

VA, and HHS in terms of where would the money be best placed

so it is expended in ways such as Mr. Binns has suggested. It is

a hard question for me to answer.

Mr. TIERNEY. Who would you recommend we go to for the answer, because most of us up here are not medical people.

Dr. HEINRICH. I would suggest that you talk with the leadership

at VA and the people within the Department of Defense that have

responsibility for deployment health.

Mr. TIERNEY. Go back to where the problem has been, basically

is what you’re telling us. I am not sure that is a great idea.

Mr. Robinson.

Mr. ROBINSON. Instead of making an all or nothing, let’s not let

DOD or VA do research. What we need is oversight with teeth that

honest people, ombudsman, nonscientists, scientists, an independent group of people much like the VA Research Advisory Committee could play that role to be involved in the process and be an honest broker. What we have had over the last 13 years is decisions

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being made that necessarily weren’t in the best interest of the veteran. We needed an honest broker in there to say maybe we don’t

go down that road this time.

My recommendation is that the VA Research Advisory Committee be given at least oversight. Maybe you don’t give them the actual authority to choose, but we have to have at least oversight into

what is going on so we can tell the veterans what is or is not happening.

Mr. TIERNEY. Mr. Binns, does your group not have that authority

now; and if it doesn’t, do you think that would be effectively used

by your group and to what end?

Mr. BINNS. My personal opinion is that the more our group is involved, the better the research program will be. And one of the

keys in the last 3 months is that we have been actively involved.

We have been participating in writing the new RFA. We are going

to be involved in reviewing the studies. We have been introducing

key researchers to the VA and they have been listening to us. The

more we are involved, the better.

I also, coming from the private sector, believe in competition. I

think that if you had a treatment development program going on

at VA, that is a logical thing to do. Create another one outside of

VA at some research university to do the same thing and see who

gets there first.

Mr. TIERNEY. Mr. Bunker, you wanted to say something?

Mr. BUNKER. Sir, you are talking about the treatment earlier in

that. I have been trying for 4 years to get money from the Federal

Government to do phase 2 on the Kansas study which would be

looking at how veterans are getting better over time. I cannot get

funding out of the VA because the VA will fund VA projects. That’s

why I said in my testimony, get the research away from the VA.

The RAC has a setup right now and has excellent oversight, because they can give the funding either to a VA researcher or a private researcher. We have a plan there that we want to act on, but

we need the money to do it, and it would be great if we could get

some of the money out of the VA or from the Federal Government

to do the next step and look at the health of the veteran and look

at what’s going to make him better.

Mr. TIERNEY. Mr. Sanders, anything you want to add?

Mr. SANDERS. Mr. Binns, let me go back to you. Has there been

much discussion or are you aware of the correlation between the

symptoms associated with Gulf war illness and symptoms that we

see in the civilian society? Lou Gehrig’s Disease comes to mind.

Mr. BINNS. There is certainly an overlap which has been recognized by VA and DOD over the years between Gulf war illnesses

and conditions like fibromyalgia or chronic fatigue syndrome or

multiple chemical sensitivity. Our committee has focused in its initial 2 years on the scope of Gulf war illnesses and the neurological

connections and exposures which may explain neurological interconnections.

We are about to begin focusing on treatments and we are going

to be looking at the experience of both civilian and government doctors in those areas. Our next meeting is at the East Orange Veterans Administration Medical Center where Dr. Ben Adelson is one

of the chief NIH researchers on chronic fatigue and fibromyalgia.

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Mr. SANDERS. Would you agree it might be a fertile field of study

to see a correlation between how people in the civilian society and

perhaps their exposure relate to people?

Mr. BINNS. Yes.

Mr. SANDERS. I yield back.

Mr. SHAYS. Lord Morris, you have the floor.

Lord MORRIS. Dr. Hall spoke movingly and with unmistakable

integrity and commitment. I was delighted by his plea for more

U.S.-U.K. cooperation. He speaks highly representatively of U.K.

veterans. Dr. Hall referred to the pertussis vaccine used in the

U.K. It was produced by the French manufacturer Mariere and was

not licensed for use in the U.K. Nevertheless, 40,000 doses of vaccine were used. Although he was not deployed to the Gulf, as Bern

Sanders noticed, Dr. Hall had the same vaccinations as people who

were. He presents the same illnesses that so many veterans of the

Gulf war are presenting. Does he know of anyone else? He must

have had many, many contemporaries. Does he know of anyone

else who was not deployed and not subjected to the multiple immunization program, but is presenting the same kind of illnesses? I

don’t.

Dr. HALL. No, sir, I don’t. I only know a few people who are supposed to—or have GWS, who were vaccinate, but none deployed. I

think we have a hidden reservoir of immunized, nondeployed personnel who just do not make the critical association between their

current health status and the vaccinations they were forced to undergo. And as a result of that, it never ever enters their mind that

they may have GWS.

Currently, we are in the middle of trying to complete a demographic study of all traceable veterans involved in GW1. Until we

get comprehensive replies, we are not going to be in a position to

make a statement about the various incidents of illness in those

who were deployed as opposed to those who weren’t deployed. The

only person I know well who is nondeployed is currently on this

hunger strike.

Lord MORRIS. As he knows, I continue to press again and again

for an independent inquiry. And I can tell you what he said this

afternoon, very urgent in my mind and continuing to press.

Turning to Dr. Rhodes, the Ministry of Defense’s original estimate is that only one servicemen could possibly have been exposed

to the fallout at Khamisiyah. How many of the British troops does

he think could potentially have been exposed? Moreover, can the

MOD’s reported view, the highest theoretical dosage that the troops

received was well below the level at which the first noticeable

symptoms occurred and could have no detectable effect on health,

still be valid?

Finally, Dr. Rhodes, how do you believe your findings would

help—will help American and British troops, researchers, and clinicians?

Dr. RHODES. Thank you, Lord Morris.

In answer to your first question, how many; the U.K.’s Ministry

of Defense claim that there is only one U.K. soldier who was exposed as a result of the Khamisiyah demolition, based on—the conclusion made by the Ministry of Defense is based on the Department of Defense and CIA modeling. That modeling is specious at

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best. Therefore, that assumption made by the Ministry of Defense

is also specious. It cannot be correct, because it has no basis in reality.

I have heard the Ministry of Defense defend their position, but

knowing the modeling that was assigned, that their assumption

was based on, I realized that number cannot be valid. What is the

correct number? The correct number is, no one knows. I am not trying to trivialize the point here, but the main thrust is that all U.K.

troops deployed in the theater of operations for the entire time at

Al Muthanna, Muhammadiyat, Ukhaydir, Khamisiyah, when all of

these sites were destroyed, could possibly be exposed and that is

the reality.

That leads to your second question, the answer to your second

question about percentage being below the dose at which symptoms

would be expressed. That is also unknown, because the assumptions about the concentration of agent inside each of these locations

varied wildly. Some said that it could have been as low as zero concentration, some were 18, some were upwards of 50 percent. As

those numbers vary, I do not know how one mathematically derives

any estimation of dosage.

Which leads to the answer of your last question: What can the

understanding of the limitations that the models do for the allied

troops, those that were deployed? One cannot assume, based on

these models and based on these efforts, that we know who was

and was not exposed. Therefore, don’t force the veteran to prove

that he’s sick. That’s how we can help, is to say you are expressing

symptoms. The symptoms can now be seen scientifically in the

framework of possible exposure to low-level nerve agent, and then

they aren’t viewed as individual symptoms but can be, as Mr.

Binns is talking about in the data collection, they can now be

viewed in more of a mosaic. They can be viewed more as, these

might be a collection of symptoms that add up to something else.

And that way we are able to help the veterans, both U.K. and

United States.

Mr. SHAYS. Mr. Binns, you have been a giant in trying to get this

government and the Department of Veterans Affairs to take seriously Gulf war illnesses, and you have had impact on that. And for

you to reiterate before this committee, first I regret to advise Gulf

war veterans are still ill in large numbers, to say epidemiological

studies consistently show that 26 to 32 percent of Gulf war veterans suffer from a pattern of symptoms including fatigue, muscle

and joint pain, headaches, cognitive and gastrointestinal problems

over and above their counterparts who are not deployed to the

Gulf, that 26 to 32 percent is a rate which rivals the darkest hours

in American history—that translates into 180,000 to 220,000 of

this 698 troops who served in the Gulf war—and then say these ill

veterans are not getting any better is just depressing.

And we have not had a hearing very recently and I am just almost at a loss for words. Why are we losing steam? Why is it, because we haven’t had hearings to make this in the public’s eye? Is

it just, old soldiers never die, they just pass away? What is it?

Mr. BINNS. I think that the personnel and the attitudes of the

Department of Veterans Affairs and Department of Defense, that

while they may have changed at the top and the bottom—that is

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to say, individual researchers and also at the Secretary level, VA,

at least, and DOD obviously has been busy with other things—in

the middle you have had a group of people who were really the

same people who were involved in running Gulf war illnesses research when you wrote your 1997 report. And until there was convincing new science—and that has been difficult to marshal until

recent years because it has been primarily private research and

isolated research, but now that we have government research—and

I want to give credit to the Department of Defense research program. They are the ones who produced most of this research that

we have been citing from. The evidence has reached a tipping point

where a public official like Secretary Principi will no longer accept

excuses. Before that we were providing our information.

To be fair, we have not published our report. Our report will be

out in 6 weeks and it will address all of these areas comprehensively. If we had gotten our report out a year ago, perhaps it would

have influenced things to move faster. I think now is the time to

move. There is a tipping point now both in the science and the reason for taking action, both the veterans are still ill and we have,

as Congressman Turner has pointed out, a much larger issue at

stake.

Mr. SHAYS. Explain to me the funding issue so I know where the

requirement lies. We are starting to learn valuable information,

but the funding is going down. Is that a discretionary determination on the part of VA, DOD, or Congress? Tell me where the read

is here.

Mr. BINNS. My understanding is that none of these items are line

items at the moment and therefore it is discretionary to VA and

DOD. And at VA we have seen the initiative announced by the Secretary 2 years ago was not fulfilled due to a variety of factors. Now

we have new initiatives coming out of VA that we believe will increase the level of funding of VA total, approximately $15 million

a year. But that will be dramatically below the $35 to $40 million

level of 1999 to 2002 for the Federal Government as a whole.

Mr. SHAYS. And the $35 million is in general terms a fairly small

sum.

Mr. BINNS. If you were to set this in terms of what is it going

to take us to do the job in 4 years, I believe the sum would be larger.

Mr. SHAYS. You see, what I am wrestling with among a lot of

other things, I mean obviously I wrestle with the fact that we have

17 hearings and DOD came in and said they are not sick, and VA

said they are not sick and it is more of a mental issue that impacts

them physically but it is mental stress. And then we have the sick

veterans come and demonstrate they were sick through documentation and also through just visual reality. And so you know, at least

the epidemiological studies have determined they are sick, they are

not well. So we know that.

I would think that there would be this huge interest to say, well,

you know, we are going to be sending more people into battle and

we want to learn from this and we value the men and women who

serve. So it is not just dealing with the veterans who are sick now,

it is also the veterans who may become sick who we could prevent

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from becoming sick. So there is every logic that says we should

deal with this.

With the plume studies, Dr. Rhodes, it seems to me unless I am

going to hear something different in the next panel, you kind of hit

the ball out of the park. In a negative way, you are basically saying

the plume studies are basically worthless; is that true?

Dr. RHODES. Yes.

Mr. SHAYS. And we have given out money and we are doing research based on, in your judgment, a worthless plume study; is

that correct?

Dr. RHODES. Correct.

Mr. SHAYS. The fact that you suggest no more be done and the

fact that DOD and others say they don’t intend to, you came to the

same conclusion. In one sense, you’re not going to do more, but the

difference is they have not yet said to you they agree with your

analysis; is that correct?

Dr. RHODES. No. Actually, we did collect comments. And after

some clarification with the Department of Defense, they did say

that the modeling of these events, because that was the bone of

contention, the modeling. The Department of Defense assumed that

we were striking a prohibition against all modeling. We clarified

the point that we were talking about, just about Khamisiyah,

Muhammadiyat, Ukhaydir, the 1991 modeling event, bombing

event. And after clarification, they did say that they thought that

the modeling would not be fruitful.

Mr. SHAYS. And there is no question in Khamisiyah that there

were significant amounts of chemical weapons, correct?

Dr. RHODES. Correct.

Mr. SHAYS. There is no dispute about that. What’s interesting,

we talk about 125-millimeter rockets were identified at Bunker 7.

The rockets were found to be filled with combination of sarin and

sarin nerve agents; 122-millimeter rockets containing the same

nerve agents were also found at a pit area close to Bunker 73. It

was not until 1996 that UNSCOM conclusively determined that

CW agents were in Bunker 77.

Then you have in your report in September just for review, 1996,

DOD estimated that 5,000 troops were within 25 miles of

Khamisiyah in October 1996. They extended this radius to 50. It

estimated 20,000 U.S. troops had been within the zone. In July

1997 from the first plume analysis, DOD estimated that 98,910

U.S. troops have potentially been exposed. And in 2000, additional

analysis led DOD to estimate that 101,752 U.S. troops had potentially been exposed. Is there any question, though, that tens of

thousands of troops were exposed, you just don’t know who they

are? Are there hundreds of thousands or can’t we even say that?

Dr. RHODES. None of the modeling efforts are going to be definitive enough to give you a number.

Mr. SHAYS. What do we know? Basically we know there are lots

of chemicals and there were plumes in the air and that potentially

hundreds of thousands of troops could have been exposed, or tens

of thousands, but we don’t know who they were.

Dr. RHODES. If you look at the aggregate models of the ones that

DOD used and did not use, it actually shows it going out into the

Gulf and covers Kuwait. In some cases it goes up into Iran and

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Saudi Arabia, and most of southern Iraq is covered. So at that

point, you have now reached the complete limit of understanding

of how many people are involved, because you can’t even talk about

troops as the earlier discussion, about what about civilian populations. Sarin doesn’t care whether you wear a uniform or not. But

we don’t know who’s there, and so all we can say is everyone in

this area from this time in March until this time, or from this date

or during this 3-day period or however people want to break the

time down, everyone in theater has the possibility of being exposed.

And as I stated to Lord Morris, percentage in relation to dosage,

to express symptoms, impossible to calculate.

Mr. SHAYS. Dr. Heinrich, I am a little confused as to the—this

happens periodically, because I am not quite sure when you were

asked the question about Gulf war illness, your response to Mr.

Sanders was, frankly, unclear to me given that you have been involved in this process for awhile. It seems to me that your answer

was kind of, like, blah. I don’t know if you believe there is a Gulf

war illness or you are using some technical language that says people think there is. Do you believe there is a Gulf war illness?

Dr. HEINRICH. The evidence we looked at says that there are significant numbers of people that have these symptoms that we are

calling Gulf war illness. And I think the scientists and the literature show that there is acceptance.

Mr. SHAYS. Is your trouble that we call it Gulf war illness? If lots

of people come home sick from Iraq to the tune of tens of thousands, do you have any doubt about that in your studies and your

research?

Dr. HEINRICH. In our review of the research, no. It is very clear

that there were numbers of people coming back reporting the

symptoms, right.

Mr. SHAYS. Reporting them. And in fact, hasn’t it been demonstrated that there are reports of being sick. They have come

home sick. Is there any doubt in your mind?

Dr. HEINRICH. No.

Mr. SHAYS. Is it the issue we call it Gulf war illness or something

else is that—where you get your hang-up?

Dr. HEINRICH. I think the researchers are still trying to better

understand what the possible causes are, such as the neurological

damage.

Mr. SHAYS. It seems like an easy answer. Our soldiers reported

that they came home sick. Studies have confirmed they came home

sick. We refer to this as Gulf war illness, but we don’t know what

caused it. That to me is like the basic simple answer. Is there anything you would disagree with?

Dr. HEINRICH. No, sir.

Mr. SHAYS. Is there anything that any of you—Mr. Bunker, I

didn’t ask you any questions, but I appreciated all your testimony.

I will just say, Mr. Robinson, you have appeared before us before.

You just have this simple, common logic that I wish more people

dealing with this issue had. You’re not emotional about it, you’re

just matter of fact, and it is appreciated. I just wish it somehow

could get through to more people.

Mr. Bunker, any comment you want to make, or Dr. Hall, Dr.

Heinrich, Dr. Rhodes, Mr. Binns, Mr. Robinson before we close out?

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Mr. BUNKER. Mr. Chairman, what I would like to say is real simple and down to the point and that is that we all know we’re sick.

We’ve been exposed to a lot of different toxins. You may never find

out exactly what made us all sick. I, along with a lot of other people, want to get better. I’ve been putting a lot of personal effort into

trying to get better.

I’ve improved a lot since I was exposed and treated for nerve

agents in the Gulf Theater itself and evacked out. From what I am

now to what I was in March 1991, I’m a whole different person. A

lot of that is myself.

We need research, need full research into treatment. We don’t

give a damn what made us sick; we want to get healthy. The VA

and the DOD is not doing the job, and the funding has to be taken

away from them and the research has to be done someplace else.

Mr. SHAYS. I will just comment on your comment, Mr. Bunker.

I didn’t ask you any questions, but basically that’s the theme

that has come out. You kind of set it in play. When I was speaking

to Bernie, because we’ve been dealing with this issue so long, and

it is just getting to the point of why do we have to keep doing this?

His comment to me was, the bottom line is, how do we get money

to serious people to do serious research? Your point has at least

reached two of us here.

Dr. Hall.

Dr. HALL. Sir, just as a final comment, I would just like to ask the $64,000 question, that is, how many abattoir workers——

Mr. SHAYS. How many what?

Dr. HALL. How many abattoir workers, slaughterhouse men,

sheep dippers, people in trades of that ilk, how many of those develop symptoms of Gulf war syndrome? The answer is zero. Could

that be because none of them received multiple immunizations and

vaccinations on the same day?

The answer to that question may also explain why then there

have been very, very few local civilians affected because of low-dose

exposure. I would put money on it. It is because none of them were

vaccinated against all rules and regulations.

Mr. SHAYS. Thank you, sir.

Dr. Heinrich.

Dr. HEINRICH. I would like to clarify one point in my testimony,

and that is, the number that we used, the approximately 89,000

veterans, is from the number of people who have joined the Gulf

war registry and who sought out these full physicals for the unexplained illness. It doesn’t include everybody who came back sick,

because some people came back and it was clear that there was a

particular cause or particular problem.

Mr. SHAYS. The bottom line is, the number is higher than the

89,000?

Dr. HEINRICH. Yes.

I would also like to build on what Mr. Binns had said earlier in

response to the question with Mr. Tierney. I think that there is a

great deal of hope in the working relationship of the advisory committee and the VA staff. I think that there are strategies there that

can really be very powerful as people assess the science and really

think through where it is potentially most beneficial to focus more

work.

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But the fact of the matter is, you can’t just put an announcement

out there either, as they learned. You really have to seed the area

with interest in the scientists so that they’ll come forth and respond to those calls for research.

Mr. SHAYS. Thank you.

Dr. Rhodes.

Dr. RHODES. I would just like to echo a point that Mr. Turner

made in his opening statement, and that is, if we refuse or if we

don’t do a good job of understanding the science behind both the

modeling as well as the exposure and whether Gulf war illness is

tied to low-level exposure, Mr. Turner is absolutely right. We’re

giving our opponent a new weapon and that will be, they’ll be able

to kill us over time and a long way from the battlefield.

It is an issue of taking care of our veterans. That is the paramount issue. But it is also the issue of paying attention to what

really went on and what really did occur so that we can be ready.

Mr. SHAYS. Thank you, Dr. Rhodes.

Mr. Binns.

Mr. BINNS. In answer to your perplexing decisionmaking over

how to get this work done by the right people, the first issue is the

amount of money involved which, as we have said, is declining; and

I agree with you that even going to the levels that were spent over

the years, in 1999 to 2002, is not necessarily the right amount. It

could be north of that.

Second, I would keep the money at the VA for those programs

that they are dedicating to Gulf war illnesses research if they come

out with—and I say ‘‘they;’’ it should be announced within 2

months certainly, the program that we have been working with

them on—that program deserves funding.

As to the rest of the funds, I agree that outside researchers

should be engaged because VA is limited in the number of projects

it can apply because it can fund only VA doctors. So you need to

have people involved.

If you want a fresh team—first, I think DOD deserves funding

for certain of their programs, such as the Chemical Defense Institute, which has done dramatically wonderful work here and which

is actually being cut back surprisingly at this time in our history.

If DOD is, because of its other priorities, not able to focus on Gulf

war illnesses research right now, the other logical organization is

the NIH.

Mr. SHAYS. What is so amazing is, we do happen to be in the

Gulf and we do happen to be involved in a war and so on. When

you say this to me, I am doing something I don’t like to do. I’m

smirking. It is like, hello?

I’m sorry to interrupt you.

Mr. BINNS. Absolutely. The Congress has appropriated in the

past 2 years $1.6 billion to NIH for bioterrorism research. In the

2005 proposal, there is, I think, $44 million for radiological weapons medical countermeasure research, but there is no money in

that budget for chemical counterterrorism research. So NIH, both

as a Gulf war illness research provider, if you will, that could contract with the best outside civilians and NIH as a source of discovering what we can do to protect ourselves in the future better than

duct tape and plastic sheeting is definitely an avenue to consider.

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I think at the grass-roots level, most of the people you’ll be hearing from today from those agencies would agree with me.

Mr. SHAYS. Thank you, Mr. Binns.

Mr. Robinson, you have the last word.

Mr. ROBINSON. I think if we go back and look at the Institute of

Medicine studies that have been conducted, currently they will

state and the future ones will also state that a lack of data collected in 1991 is going to prevent us from being able to go back retrospectively and uncover the cause for what appears to be a chronic, multisymptom illness.

They just didn’t collect the data at the time. They didn’t do what

they should have done. They didn’t do medical records. That is all

well known, and it’s preventing us from finding maybe the cause.

We may never find the cause in some cases. However, right now

DOD is allowed to have discretion in the implementation of public

laws specifically designed to prevent this event from ever occurring

again. If we allow them to have discretion in those public laws, and

we let them make false statements about the risk of the exposure,

we’re just repeating the same mistakes all over again.

What I would encourage the committee to do is to demand tracking systems that provide meaningful data so that clinicians can cull

information from it. DOD needs to sponsor treatment and research

into alternative therapies that the veterans are already seeking on

their own.

When the veterans were met with this stone wall, they did what

any person would do, they turned somewhere else and they have

found, some of them, treatments that aren’t sponsored by the VA,

aren’t funded as a result of their wartime service that helped them.

And it cost them thousands of dollars to get this kind of treatment,

but currently the VA does not pay for it.

We also need DOD to release all of the studies that have been

done that were bought and paid for with taxpayer money—specifically, one study that I’m referring to is a RAND study on the anthrax vaccine; that has never been released—and what other studies are out there that have been written and never been released.

If we can continue to study Gulf war illnesses where warranted,

many opportunities will still exist, and I hope this committee will

pursue them because I know we will.

Mr. SHAYS. Thank you. You’re triggering a conversation here.

How old is the RAND study, for instance?

Mr. ROBINSON. The RAND study for anthrax, I believe it was

written—it was begun in 1999. There is a researcher that worked

on it, Dr. Beatrice Golomb.

Mr. SHAYS. Let me just say on the broader issue of lessons

learned about deployment health from the Gulf war to the present,

our subcommittee will conduct a briefing tomorrow at 2 p.m. in

Room 2247. It is an open meeting. DOD health affairs, veterans

service organizations, the Institute of Medicine and the veterans

will brief Members and staff on predeployment physicals, medical

recordkeeping, postdeployment health screening and other efforts

to protect the health of servicemen and women.

Gentlemen and lady, thank you very much. We appreciate your

testimony. Our apologies to the second panel, but they can respond

to a lot that was said here and it will be helpful to have that. We

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will ask the second panel to come up and thank you all on the first

panel.

Our next panel is Dr. Jonathan B. Perlin, Acting Under Secretary for Health and Acting Chief Research and Development Officer, Department of Veterans Affairs, accompanied by Dr. Mindy L.

Aisen, Deputy Chief Research and Development Officer, Department of Veterans Affairs, and also accompanied by Dr. Craig

Hyams, Chief Consultant, Occupational and Environmental Health,

Department of Veterans Affairs.

The second testimony is from Major General Lester MartinezLopez, Commanding General of U.S. Army Medical Research and

Materiel Command, Fort Detrick, accompanied by Colonel Brian

Lukey, Dr. Colonel Brian Lukey, Director of U.S. Army Military

Operational Medicine Research Program, Fort Detrick, MD.

Our third testimony is Dr. Robert Haley, professor of internal

medicine, University of Texas Southwestern Medical Center.

Our fourth testimony is from Dr. Rogene Henderson, senior scientist, Lovelace Respiratory Research Institute.

And our final testimony is from Dr. Paul Greengard, Vincent

Astor professor and head of the Laboratory of Molecular and Cellular Neuroscience, The Rockefeller University, Nobel Laureate in

Medicine 2000.

I don’t know how many Nobel laureates we have had, but it is

very nice to have you.

A large panel. An extraordinary opportunity to do a good amount

of learning.

We are going to ask you to try to stay within the 5 minutes. If

you trip over a minute or so, we can live with that, but it would

be helpful to kind of get into the questioning. We’re happy to have

you respond to anything that the other panelists said. We’re happy

to have you submit your testimony and speak ad lib. We’re happy

to have you read from notes. We’re happy to have you do whatever

you like within your timeframe.

We’ll start with, I guess, as I called you, it would be Dr. Perlin.

Dr. Perlin, you are first and then we’ll go to General MartinezLopez and then to Haley, Henderson and Greengard.

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STATEMENTS OF DR. JONATHAN B. PERLIN, ACTING UNDER

SECRETARY FOR HEALTH AND ACTING CHIEF RESEARCH

AND DEVELOPMENT OFFICER, DEPARTMENT OF VETERANS

AFFAIRS, ACCOMPANIED BY DR. MINDY L. AISEN, DEPUTY

CHIEF RESEARCH AND DEVELOPMENT OFFICER, AND DR.

CRAIG HYAMS, CHIEF CONSULTANT, OCCUPATIONAL AND

ENVIRONMENTAL HEALTH, DEPARTMENT OF VETERANS AFFAIRS; MAJOR GENERAL LESTER MARTINEZ-LOPEZ, COMMANDING GENERAL, U.S. ARMY MEDICAL RESEARCH AND

MATERIEL COMMAND, FORT DETRICK, MD, ACCOMPANIED

BY COLONEL BRIAN LUKEY, PH.D., DIRECTOR, U.S. ARMY

MILITARY OPERATIONAL MEDICINE RESEARCH PROGRAM,

FORT DETRICK, MD; DR. ROBERT HALEY, PROFESSOR OF INTERNAL MEDICINE, UNIVERSITY OF TEXAS SOUTHWESTERN

MEDICAL CENTER; DR. ROGENE HENDERSON, SENIOR SCIENTIST, LOVELACE RESPIRATORY RESEARCH INSTITUTE;

AND DR. PAUL GREENGARD, VINCENT ASTOR PROFESSOR

AND HEAD OF LABORATORY OF MOLECULAR AND CELLULAR NEUROSCIENCE, THE ROCKEFELLER UNIVERSITY,

AND NOBEL LAUREATE IN MEDICINE 2000

Dr. PERLIN. Mr. Chairman, Mr. Sanders, members of the subcommittee, Lord Morris, thank you very much for the opportunity

today to discuss the current status of VA’s research program on

Gulf war veterans’ illnesses. With me today is Dr. Mindy Aisen,

VA’s Deputy Chief Research and Development Officer and to my

left is Dr. Craig Hyams, VA’s Chief Consultant for Occupational

and Environmental Health.

Mr. SHAYS. I have erred. I was so eager to hear from you, I

haven’t sworn any of you in. So everything you have said so far is

totally irrelevant. I am so sorry. We do know that you would come

and testify and tell the truth without being sworn in, but we are

an investigative committee so it has legal implications and we

swear you in.

[Witnesses sworn.]

Mr. SHAYS. Note for the record all our witnesses have responded

in the affirmative. I also want to say to each and every one of you,

we have nothing but the highest respect for each and every one of

you. We appreciate your expertise. We appreciate your work. We

appreciate the service you do whether in the private sector or the

public sector.

We are very grateful that you are here. You have honored us. We

intend to listen to you and learn from you. Thank you.

The bottom line is you have introduced who is with you. We will

assume that was under oath and we will go from there. We will

start the clock now.

Dr. PERLIN. Thank you, Mr. Chairman. My full statement has

been submitted for the record. I would just like to go over a few

points.

As we know, the United States deployed nearly 700,000 military

personnel during Operations Desert Shield and Desert Storm in

1990 and 1991. Within months of their return, some Gulf war veterans reported various symptoms and illnesses that they believed

were related to their service. Of particular concern have been the

symptoms that have eluded specific diagnosis.

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In an effort to better understand the health problems experienced by Gulf war veterans, VA, DOD and HHS have supported research projects related to Gulf war veterans illnesses. From fiscal

year 1994 through fiscal year 2003, the three departments have

funded 240 projects at a cumulative cost of $247 million. Of these,

VA funded 91 projects, 8 in conjunction with DOD, totaling $53.3

million. As of September 2003, 182 of 240 projects had been completed.

While each department funds its Gulf war research independently, each closely coordinates its efforts with the others to avoid

duplication of effort and to foster the highest standards of competition and scientific merit.

Studies have shown that some Gulf war veterans have reported

a variety of chronic and ill-defined symptoms, including fatigue,

cognitive problems, gastrointestinal and musculoskeletal problems

at significantly higher rates than the rates reported by nondeployed veterans. We also know that deployed Army and Air

Force veterans have a higher prevalence of amyotrophic lateral

sclerosis, also known as Lou Gehrig’s disease.

VA has sponsored several important research and epidemiological initiatives responding to the needs of these veterans. They include the following outlined in greater detail in my full statement:

$9.6 million exercise behavioral therapy study conducted between

1999 and late 2001 involving 1,092 veterans at 18 VA and 2 DOD

medical centers; behavior therapy trial conducted between May

1999 and December 2001, including 491 Gulf war veterans at 26

VA and 2 DOD sites; a national health survey of Gulf war veterans

and their families, which began in 1995 and has provided researchers much valuable information not only about Gulf war veterans,

but about their spouses and children; VA’s ALS study, conducted

in cooperation with DOD and representing the largest prevalence

study devoted to ALS, as well as VA’s expansion of the ALS study

to include a national registry for veterans with ALS and a genetic

tissue bank for investigating this horrific disease.

Although VA’s and other Federal research have provided valuable insight into Gulf war veterans’ illnesses, much remains to be

done. For example, the following are under way: New initiatives include an ALS treatment trial, expanded neuroimaging, establishment of a dedicated scientific merit review board for Gulf war and

deployment health-related research projects. VA is also funding the

Gulf war health effect studies that the Institute of Medicine has

been conducting.

VA continues to fund the clinical health surveillance of Gulf war

veterans who received large exposures to depleted uranium oxides.

VA epidemiologists have been conducting a cancer prevalence pilot

study to determine the feasibility of using State cancer registries.

VA appreciates and has learned from two recent GAO studies. In

its draft report on Federal Gulf war illness research strategies,

GAO states that the VA has not identified gaps in current research

or promising areas of future research. GAO also states that VA has

not readdressed the extent to which the collective findings of completed Gulf war illnesses research projects have addressed the key

research questions. In general, we in VA agree with GAO’s recVerDate 11-MAY-2000 12:57 Dec 17, 2004 Jkt 000000 PO 00000 Frm 00131 Fmt 6633 Sfmt 6633 D:\DOCS\96946.TXT HGOVREF1 PsN: HGOVREF1
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ommendations in these areas and, in fact, had earlier begun to address these issues.

In a second report, GAO evaluated DOD’s conclusions about U.S.

troops’ exposures to chemical warfare agents based on DOD and

Central Intelligence Agency plume modeling. It was GAO’s finding

that the models were faulty and recommended that VA and DOD

not use the plume modeling data for future epidemiological studies.

VA has concurred with this recommendation.

VA has taken positive steps toward laying the groundwork for

improved collaboration with the Gulf war research advisory committee in improving the quality of VA’s Gulf war research portfolio.

The research advisory committee will recommend scientific experts

to serve as research review panel members of a soon-to-be-established scientific merit review board for Gulf war research proposals. VA will consult with the research advisory committee regarding the relevancy of proposals that have been identified as being

fundable. VA and the research advisory committee will also work

together to identify researchers who can partner with VA investigators.

Mr. Chairman, let me conclude by emphasizing the following.

Over the past decade, VA has supported an extensive and robust

Gulf war research portfolio. We have taken positive steps to address the proposed recommendations in the draft GAO report on research related to Gulf war veterans. VA has taken positive steps

to improve collaboration with the research advisory committee. As

VA’s and other Federal research programs continue to provide

more results, we will substantially increase our understanding of

Gulf war veterans’ illnesses. This will enhance our ability to diagnose and treat them. All newly gained knowledge will enhance prevention and intervention in illnesses of service members in future

deployments.

Mr. Chairman, this concludes my testimony. Dr. Aisen, Dr.

Hyams and I will be pleased to answer any questions that you or

the other subcommittee members may have. Thank you.

Mr. TURNER [presiding]. Thank you.

[The prepared statement of Dr. Perlin follows:]

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Mr. TURNER. Next we will hear from Major General Lester Martinez-Lopez, Commanding General of U.S. Army Medical Research

and Materiel Command, Fort Detrick, MD.

General.

General MARTINEZ-LOPEZ. Mr. Chairman, distinguished subcommittee members, and Lord Morris, thank you for the opportunity to briefly discuss the Department of the Army’s science and

technology program addressing Gulf war veterans’ illnesses and

general deployment health concerns.

As Commander of the U.S. Army Medical Research and Materiel

Command, I am responsible for the medical research that focuses

upon Gulf war illnesses and force health protection for the Department of Defense. In my remarks, I will discuss some of the accomplishments of the Gulf war illnesses research program.

My command was asked to organize and direct the research effort for the DOD in 1994, and we have made enormous progress

in the past decade. We sense the frustration of this subcommittee

in that no single problem or solution to our sick veterans has

emerged from the research investment. This in no way should detract from the search for causes and treatments for our veterans

with very real symptoms and illnesses. It is equally important that

we continue to seek better ways to evaluate and predict health hazards that our young men and women may encounter in current and

future deployments so that we can better protect them.

As a result of the Gulf war experience, the DOD and the Department of Veterans Affairs medical research programs have grown

closer, with an unprecedented level of collaboration and coordination. For example, at this very moment, researchers from at least

three different VA centers are collaborating with DOD investigators to interview soldiers at Fort Lewis, WA, who have just returned from Iraq. This effort is part of an ambitious study, jointly

funded by VA and DOD, to identify the most sensitive neuropsychological tests that can be used to detect early signs of a

change in neurological status of soldiers following a deployment.

This was one of the important diagnostic gaps identified in our

Gulf war experience.

Another example is the DOD support to the neurodegenerative

disease imaging center at the VA medical center in San Francisco.

This center is developing state-of-the-art methods to use objective

brain measurements to explain subjective symptoms of chronic

multisymptom illnesses. Currently, they are about halfway through

a major study involving Gulf war veterans.

Between 1994 and 2002, the U.S. Army Medical Research and

Materiel Command invested $182 million to support 154 projects.

We have pursued multiple lines of investigation to treat the Gulf

war veterans. Thirty-eight of these projects continue and many of

these address key questions identified in earlier projects.

The results of some of this research identified areas to followup

work on suggested findings, while others ruled out potential

causes. For example, infectious diseases proved to be unlikely explanations after we investigated several candidates such as

leishmania. However, our investment in leishmaniasis was important anyway, as we have encountered new clusters of soldiers inVerDate 11-MAY-2000 12:57 Dec 17, 2004 Jkt 000000 PO 00000 Frm 00145 Fmt 6633 Sfmt 6633 D:\DOCS\96946.TXT HGOVREF1 PsN: HGOVREF1
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fected with this parasitic disease in Afghanistan and Iraq and can

better diagnose and treat these soldiers.

We supported numerous surveys of the veterans with a focus on

hazardous exposure and symptoms. One study compares British

Gulf war veterans with U.S. Gulf war veterans to study symptom

reporting and likely exposure histories. Several large-scale surveys

focused upon nervous system dysfunction and have either ruled out

differences between deployed and nondeployed forces, or have discovered findings suggestive of chronic multisymptom illnesses, including chronic fatigue syndrome and fibromyalgia.

Other DOD programs, such as our efforts in force health protection research, started because of issues raised in Gulf war illnesses.

These studies will followup on important Gulf war illnesses studies

such as the joint VA and DOD study that suggests that deployed

Gulf war veterans may have a higher rate of ALS than nondeployed forces.

We are moving on a wide front to address the issues that began

with sick Gulf war veterans looking for an answer to their diseases.

Our continuing research in early detection methods and monitoring

will help identify individuals earlier than ever before, increasing

their opportunities for treatment and helping to mitigate further

exposures of other troops.

Our continuing research on neurotoxicology ranges from work by

Dr. Paul Greengard, a Nobel laureate, to the establishment of a

military version of the famous Framingham heart study, our own

millennium cohort study. In 2002, the Assistant Secretary of Defense for Health Affairs directed transition of this program to a

more forward-looking effort we call force health protection. The primary emphasis of the program is prospective with a goal of protecting current and future service members put into operational environments. The program’s scientific focus areas rely heavily on lessons learned from research on Gulf war illnesses.

Mr. Chairman, this concludes my remarks. I will be pleased to

answer your questions.

Mr. TURNER. Thank you.

[The prepared statement of General Martinez-Lopez follows:]

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Mr. TURNER. Now we will hear testimony from Dr. Robert Haley,

professor of internal medicine, University of Texas Southwestern

Medical Center.

Dr. HALEY. Thank you, Mr. Chairman. Mr. Chairman, members

of the committee, Lord Morris, in thinking through what I was

going to say today, I wrote out some comments and I’m going to

summarize them briefly. But, really, from the point of view of trying to analyze why did our research group sort of get out front on

this early and come up with clues, I think that’s an important

thing for us to talk about because it’s a clue to where so much of

the effort went wrong and perhaps how we can bring it back to relevancy.

I think the reason we got out front early is that we really had

the ability to think through and try to answer and address the pivotal questions that would drive the investigation one direction or

the other. We also had independent funding early, so we were free

to go ask the question that we thought was pivotal and try to get

an answer.

Let me talk about some of the pivotal questions. The first one is

Gulf war syndrome: Is it a real illness or not? We went out and

studied a unit, a battalion, got their symptomatology and did factor

analysis, which is the way you do that, and came out with very

clear evidence that there is a Gulf war syndrome, there is a disease

and it appears to have three variants.

Since then Dr. Han Kan at the VA has done a nationwide study

and replicated those same three factors in his study. Others have

not been able to do that, but I will talk about the reasons for failure in a little bit.

The second pivotal question was, is this illness a psychological

illness or a reaction to stress or is it a brain cell injury, an organic

illness? There we did studies comparing the sick and the well,

those who satisfied the case definition of the illness versus controls,

used brain imaging, the most sensitive thing that will detect brain

cell injury which is called MR spectroscopy. It is a brain chemical

analysis.

With that we found, in fact, there is strong evidence that the

basal ganglia have abnormal metabolism in the sick Gulf war veterans compared to the well. This is a pivotal question that drives

it toward a physical illness rather than stress. There is no other

way to explain that finding other than this is a brain cell injury.

This finding has now been reproduced by Dr. Michael Weiner at

UC, San Francisco, and the San Francisco VA. The VA has now invested in his outfit with a big imaging center to follow that up.

That was a really good move that General Martinez-Lopez mentioned.

Also, this has been replicated again. Just recently, about 2 weeks

ago, an article from the University of Mississippi and the Mississippi VA found the same thing except both basal ganglia and the

hippocampus, two different deep brain structures.

So it appears that we’re really making progress in the pivotal

question, is it psychological or is it physical? Is it organic?

The next question is, what’s the basis of the actual symptoms to

show brain cell injury doesn’t necessarily explain the symptoms

and so many of the symptoms we think are autonomic in nature;

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that is, they are a dysfunction of the autonomic nervous system.

You might call it the automatic nervous system.

We have a study that will be published in the next couple of

months, which demonstrates definite autonomic dysfunction in veterans meeting this Gulf war syndrome. There are two other groups

that have similar findings produced at national meetings. We think

that is going to explain a lot of the symptomatology and maybe provide a little beachhead for directing treatment.

And then, of course, the question, if there is one brain illness,

brain cell injury, could that have kicked off a neurodegenerative

disease; and that’s what got us looking toward ALS, finding the

first cluster. And now the VA study has come along and replicated

that, so that appears to be real.

The next question is, is there an environmental etiology or cause

of this? Of course, we then did an epidemiologic study, the first

study that looked at risk factors for this case definition. We found

in our study that sarin was by far the strongest risk factor for this

illness. Nine other studies have done this epidemiologically using

self-reported reports. All of them have found that sarin is the

strongest risk factor. Those are self-reported studies so there is a

possibility of other explanations, as you know.

We also found that there is a geographical risk; that is, soldiers

who were deployed up front, particularly on the fourth day of the

air war when the Czechoslovakian team detected chemical weapons, we found that group to have the highest risk of this Gulf war

syndrome, which is a neurological problem. Dr. Lea Steele in the

Kansas study showed the same—similar finding.

We then looked at a genetic finding. If sarin is the cause, then

you would expect people who have a greater risk, a greater susceptibility to sarin would be sicker. That is exactly what we found

from a genetic point of view. The paraoxonase enzyme is the enzyme in your body that protects you from nerve gas, and Gulf war

veterans meeting this case definition of Gulf war syndrome were

born with low levels of this defensive enzyme. And so that connects

the disease with the cause.

Then I think we are going to hear later from Dr. Henderson. Her

animal studies, I think, are critical, following up about eight or

nine other animal studies, animal laboratory studies showing brain

cell damage from combinations of low-level chemical exposures. I

won’t steal her thunder and talk too much about her study except

to point out that what she found in her profound study was lowlevel exposure to sarin produces brain cell injury injust the same

parts of the brain that we found brain cell abnormality, the basal

ganglia; and then the University of Mississippi group found it in

the hippocampus.

So there appears to be a great deal of evidence emerging that is

linking all of these things up. This is still a hypothesis because

there is not enough replication from other studies. The reason for

that, it’s not because others have tried and failed; it is because

there is no effort to replicate, and that is the problem.

In my handout, I went through reasons that we failed. I won’t

go through those again; you can read them in the handout. But I

think there are five or six main reasons that $247 million worth

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of research sort of went off in other directions. That was not fruitful.

In conclusion, my main point is, I think, in looking back on the

history of medicine and understanding new diseases, there are

standard ways of going about it; and all we did in our studies was

go about this in the way you usually investigate an epidemic of a

new disease, and we found a lot of interesting things. We now see

that the scientific world is starting to buy into this, is getting interested in it and there are people who want to do research, but as

Dr. Binns, Jim Binns, mentioned, there just isn’t funding right

now. We need to fix that.

Mr. TURNER. Doctor, thank you very much.

[The prepared statement of Dr. Haley follows:]

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Mr. TURNER. Next we’ll hear testimony from Dr. Rogene Henderson, Senior Scientist, Lovelace Respiratory Research Institute.

Doctor.

Dr. HENDERSON. Thank you, Mr. Chairman, for this opportunity

to speak to the subcommittee.

Since the conclusion of the Persian Gulf war in 1999, there have

been complaints among some veterans of diverse health symptoms

that include mood changes, concentration problems, muscle and

joint pains, skin rashes, chronic fatigue, sleep disturbances, chronic

digestive problems and loss of sexual drive. The cause of these illnesses is unknown, but one theory is that some veterans of the

Persian Gulf war were unknowingly exposed to subclinical levels of

nerve gases.

Potential long-term effects of single or repeated exposures to subclinical levels of nerve gas have not been well studied. The

Lovelace Respiratory Research Institute received funding through

a competitive process sponsored by the Department of Defense to

study the effects of single and repeated exposures of rats to the

nerve gas sarin at a level that did not produce acute symptoms of

nerve gas poisoning. The Lovelace studies were designed to use inhalation exposures of rats under normal and heat-stressed conditions to determine the interactive effect of heat stress and subclinical levels of sarin, first on the levels of cytokines and apoptotic cells

in the brains of rats, second on the immune system of the rats, and

third on the cholinergic muscarinic receptor sites in the brains of

the heat-stressed and nonstressed rats.

Rats were exposed to one-tenth and one-twentieth the acutely

toxic level of sarin for 1 hour a day for 1, 5 or 10 days and observed

for alterations at 1 day and 30 days after the exposures. Half of

the rats were exposed under normal temperature conditions and

half under heat stress conditions, that is, 90 degrees Fahrenheit.

None of the rats showed symptoms of acute nerve gas poisoning.

There were two major findings. First we found a suppression of

the immune system. The repeatedly exposed rats even without heat

stress showed a reduced ability to mount an effective immune response. White blood cells in the rats did not respond well to antigens. Tests were made to determine if this effect was caused by increased corticosteroids in the blood of the rats due to stress of the

exposures because you would expect if the corticosteroids were high

that you would have a suppressed immune response.

But the opposite was found. The rats had unusually low levels

of blood corticosteroids. The reduction in the immune response

could be prevented however by treating the rats with a ganglionic

blocker, indicating that the effects of the sarin were through the

autonomic nervous system.

Our second finding, which Dr. Haley has referred to, was an

interaction between the heat stress and sarin in causing alterations

in certain brain cells in the rats. The brains of the rats repeatedly

exposed to low levels of sarin under heat stress conditions showed

alterations in the densities of the muscarinic acetyl choline receptor sites in areas of the brain responsible for memory and cognitive

function.

Of great interest was the fact that in most cases these alterations were delayed and did not appear until 30 days after the exVerDate 11-MAY-2000 12:57 Dec 17, 2004 Jkt 000000 PO 00000 Frm 00167 Fmt 6633 Sfmt 6633 D:\DOCS\96946.TXT HGOVREF1 PsN: HGOVREF1
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posures. This suggests that there may be an opportunity for intervention to prevent these effects in exposed persons.

These initial studies raise many questions. What are the behavior problems associated with alterations in the density of receptor

sites in the brain? What is the temporal pattern of the response?

How long will the ill effects last? When did the delayed effects first

occur and how long will they last? What interventions could be

used to prevent the delayed effects? In terms of

immunosuppression, what is the mechanism by which sarin causes

immunosuppression? Does this suppression increase the susceptibility of exposed persons for mycrobial infections? How can the immune system be restored to normal function?

Finally, is it possible that the low blood corticosteroids that we

observed, if these are also observed in humans, could be used as

a marker for subclinical exposure to a nerve gas?

As we have heard, there is a problem of who is exposed, because

it is not obvious since they are at subclinical levels. Could this be

a biomarker for exposure? At the present time the DOD has funded

us to do additional research on the effects on the immune system,

and we are seeking additional funding to continue our studies on

the effects on the brain receptor sites.

Thank you for this opportunity for talking to you. We hope that

the information that we have found and what we hope to find in

followup studies will be useful for development of prevention and

therapeutic measures for both our military exposed during hostile

actions and for civilians exposed in potential terrorist attacks.

Thank you.

Mr. TURNER. Thank you, Doctor.

[The prepared statement of Dr. Henderson follows:]

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Mr. TURNER. Next we’ll hear testimony from Dr. Paul Greengard,

Vincent Astor professor and head of the Laboratory of Molecular

and Cellular Neuroscience, the Rockefeller University, Nobel Laureate in Medicine 2000.

Doctor.

Dr. GREENGARD. Thank you, Mr. Chairman, for the opportunity

to testify on the topic of Gulf war illnesses. This afternoon and in

testimony presented to the committee at prior hearings, other witnesses have summarized evidence indicating that exposure of U.S.

military personnel to acetylcholinesterase inhibitors during the

first Gulf war represents a probable contributing factor to Gulf war

illnesses. In fact, various of our Gulf war veterans were exposed to

three distinct classes of these inhibitors, including chemical warfare agents such as sarin, pesticides and pyridostigmine.

The sarin incident which occurred this past month in Baghdad

underlies the importance of accelerating efforts to develop therapeutic substances to combat chemical warfare agents and of developing treatments for our military personnel who have already been

exposed to such agents. The good news is that we have technology

available today to mount a program for the development of such

therapeutic substances.

The rationale is as follows. The chemical warfare agents all

achieve their lethal actions by preventing the breakdown in the

brain of a substance known as acetylcholine, which Dr. Henderson

just mentioned. As a result, in those individuals who are exposed

to these agents, there are high levels of acetylcholine in the brain

for prolonged periods of time.

We now have the technology to determine precisely how acetylcholine modifies nerve cells in the brain. Data already established

indicate that acetylcholine can directly affect 17 distinct proteins in

the human brain. These proteins are called acetylcholine receptors.

It is possible, using techniques which have already been established, to identify which subset of these 17 receptors is primarily

responsible for the toxicity caused by chemical warfare agents. It

is also possible to determine precisely how those receptors that are

involved produce the toxicity.

Elucidation of those mechanisms would immediately permit a

search for therapeutic agents. Such agents could have the ability

to reverse the chemical changes induced in the brains of Gulf war

veterans by these lethal agents. The same research should lead to

the development of therapeutic substances that could prevent the

lethal effects of these agents in the event of a chemical warfare attack either within the United States or on U.S. citizens deployed

to other regions of the world.

The single major point that I wish to emphasize in this brief

presentation is that the technology now exists for a rational approach to treat Gulf war illnesses and to protect our military and

civilian populations from the consequences of future chemical attacks.

Thank you.

[The prepared statement of Dr. Greengard follows:]

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Mr. TURNER. Thank you.

I now will begin a question period. We’re going to continue with

our 10-minute question periods as with the other panel, and we’ll

start with Mr. Sanders.

Mr. SANDERS. Thank you, Mr. Chairman.

Dr. Perlin and General Martinez-Lopez, you’ve heard Dr. Haley,

Dr. Henderson and Dr. Greengard give us some reasons for optimism. Yet, as I understand it, General, the DOD is putting zero

money into Gulf war research this year.

Can you explain to me, given the fact that we have seen some

significant breakthroughs, why we would not be working with

these researchers?

General MARTINEZ-LOPEZ. Sir, we’re still pursuing this level of

research. In other words, the research that is being done to my left,

by these distinguished scientists, this research has been funded

and will continue to be funded by the Department of Defense. But

the focus of the Department has shifted to force health protection.

Many of the issues of force health protection exactly deal with

issues that are very relevant to Gulf war illnesses. One does not

eliminate the need of the other.

Mr. SANDERS. Dr. Perlin, how is the VA responding to the research that we have heard?

Dr. PERLIN. Thank you, Mr. Sanders. You are absolutely correct.

The research that has been presented, these hypotheses, are very

intriguing and deserve further study. It has really been in these

past few months that we have forged a close working relationship

with the Gulf war research advisory committee, and for that, we

greatly appreciate Mr. Binns’ leadership. These are exactly the

sorts of things that we want to take to further study.

For example, the research that Dr. Haley described will come to

further evaluation at the new neuroimaging center in San Francisco. Dr. Michael Weiner runs that. This imaging center allows us

not only to see the actual structure of the brain in individuals who

may be experiencing or who are experiencing these sorts of symptoms, but because it is actually magnetic resonance spectroscopy,

actually allows us to look at the brain function. In fact, in all these

sorts of avenues, there are really the bases for hypothesis-driven

research that we can translate into greater understanding.

Mr. SANDERS. Thank you.

Dr. Haley, what excites me and I think people who are struggling

with Gulf war illness is, as I understand it, what you are saying,

that through brain imagery, you can actually see the brain damage

and make a correlation between that brain damage and the symptoms that the individual is suffering.

Am I right in that?

Dr. HALEY. That is correct. Brain research, neuroscience, has

progressed dramatically in the last 10 years. If we had tried to address it with these techniques in 1992 or 1993, we wouldn’t have

had these techniques available by and large. So there is a great

panoply of techniques that are available and there is an explosion

going on right now. Every month we see new techniques.

And so we now have the tools to do it, and so I think—and we

have the clues and now is the time to put money into this and

study Gulf war veterans as well as new, emerging issues of force

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health protection in the current operations. Now is the golden moment to fund research.

Mr. SANDERS. Let me ask you a question a little bit outside the

general area of your work.

Many of us have been extremely dissatisfied with the lack of

progress made by the DOD and VA over the years, and we have

been impressed by your work and other people’s work. Give us an

idea of how funding could be most effective to those people who are

doing the most serious research.

Dr. HALEY. It is a tough question. I think Jim Binns really

summed it up perfectly, and Steve Robinson, in the combination of

their comments.

For one thing, I think there has been a change in viewpoint in

this whole field. We see the scientific community now starting to

buy into the issue, to the idea that even low-level chemical exposures in susceptible individuals can produce brain cell injury. That

no longer makes you a pariah to say that. It used to, but it is now

a popular concept. So I think you are going to see naturally the

government agencies wanting to fund that research because it’s not

so controversial.

We were at a meeting at NIH just a month or so ago with DOD

people, NIH people, private researchers there, and it was just a

given that low-level nerve gas can produce symptoms and chronic

illness.

Mr. SANDERS. Because of brain damage?

Dr. HALEY. Yes, because of physical brain cell damage.

There is now a new alliance forming between NINDS, National

Institute of Neurological Diseases and Disorders and Stroke, and

the Defense Department, Fort Detrick, and the Institute for Chemical Defense to look at those issues, particularly as they relate to

defense against chemical terrorism. That is unfunded yet.

Mr. SANDERS. We are all obviously concerned about the potentials of chemical terrorism, but we are also concerned about a number of civilian diseases. Are you learning anything in your research

that can help us with chronic fatigue syndrome, fibromyalgia or

multiple chemical sensitivity or other type diseases?

Dr. HALEY. It remains to be seen because we haven’t applied

these techniques to those. We have plans actually to do that and

part of our funding, congressional funding through Fort Detrick, is

to look and compare chronic fatigue syndrome, firbromyalgia, multiple chemical sensitivity and other similar illnesses with Gulf war

illness. So we and, I’m sure, others will be doing that as well.

Let me get back to the funding issue because that is what is critical. I think what you want to see is a mosaic of funding. You don’t

want all the funding to be in one place, and I think that was one

of the places where perhaps we went wrong before. The Persian

Gulf veterans coordinating board that sort of oversaw all the research in the government really had a strong agenda and, I think,

led all of that in a direction.

I think what you want to see, you would like to see NIH with

this NINDS-Defense Department collaboration, you would like to

see that go. We have a new collaboration funding research with

NIH, VA and the ALS association funding research on ALS. You

would like to support that with government funding.

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You would like also to have some funding specifically directed for

Gulf war veterans to understand that particular group and have

some good oversight by the VA research advisory committee, as

was suggested earlier, in collaboration with VA research and development. That is emerging as a good model. I think all of these

ought to be supported.

Mr. SANDERS. Let me ask Dr. Henderson and Dr. Greengard the

same question.

It appears that we may be making some significant breakthroughs not only with understanding the symptoms of Gulf war

illness, but perhaps other diseases and preparing us, God forbid,

from any chemical terrorist attacks. What’s your suggestion as to

how we can move forward most effectively in better understanding

these problems?

Dr. HENDERSON. I think you have your heavy science hitters,

your heavy hitters in NIH, and you would like to bring those heavy

hitters in on this problem. But you also have to have the DOD

working collaboratively with them.

I was at the same meeting that Dr. Haley attended where NIH

was working with DOD together to see how NIH can contribute to

this problem. I think that type of collaboration is essential. It can’t

just be one agency. It has to be, if it can be achieved, intergovernmental cooperation, interagency cooperation.

I would recommend that NIH and DOD work together on this.

Mr. SANDERS. Thank you.

Dr. Greengard.

Dr. GREENGARD. I would just as soon not get into the issues of

which agencies. I get nervous just coming to Washington, let alone

saying which agency should be the recipient of your beneficence. I

have had very good experience with the Department of Defense in

two ways. I’ve been doing some work for them, medical research in

another area, not chemical warfare or Gulf war illness, and I

gradually began to learn about the problems of chemical warfare

agents. I was almost oblivious of it, as I think a large segment of

the scientific population are.

Much of the work that we have done in the past has been concerned with how nerve cells communicate with each other, what

goes wrong in various neurological and psychiatric disorders, how

drugs that affect these disorders, treat these disorders, achieve

their actions, and using this information to try to develop better

drugs.

The situation with these cholinesterase inhibitors is quite analogous. You can take an example. For example, Parkinson’s disease

is associated with the loss of the neurotransmitter dopamine.

Neurotransmitters are chemicals that communicate between nerve

cells. You can think of victims of these chemical warfare agents, it

would be the same as if they had been congenitally consigned to

a life with too much of the neurotransmitter acetylcholine.

These are very solvable problems. Just like it has been possible

to make great progress in understanding Parkinson’s disease and

finding treatments for it, it is quite analogous to the chemical warfare agents.

The technologies are there. The major principles of the science

have been established. It is just a matter almost of engineering

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now to do this. The problem is that there is no money available.

When I got interested in the chemical warfare problems, because

they are so analogous to some of the things we have dealt with, I

talked to various people that I know in various branches of the government, and there is practically no money anyplace.

Mr. SANDERS. Let me just go back and conclude, going back to

General Martinez-Lopez and Dr. Perlin.

Do both of you now accept the premise that one of the possible

causes of Gulf war illness is brain damage associated to low-level

exposure to sarin and perhaps other agents?

General MARTINEZ-LOPEZ. I think there’s enough science there,

sir, to take that as a very serious consideration. In other words, I

think, yes, there may be some soldiers from the Gulf war that were

affected because of the level of exposure to sarin.

Mr. SANDERS. Dr. Perlin.

Dr. PERLIN. Given the research contributed by people such as Dr.

Greengard, I think it is quite plausible, quite believable, that there

is damage from low-level exposure to nerve agents, and that can

be a basis of, in fact, multiple diseases and nerve dysfunction.

Mr. SANDERS. Thank you. Thank you very much.

Thank you, Mr. Chairman.

Mr. TURNER. Thank you, Mr. Sanders.

Dr. GREENGARD. Should I continue, sir?

Mr. TURNER. Yes.

Dr. GREENGARD. We have gotten support from the Department of

Defense in terms of a certain amount of funding for chemical warfare research, but it has been very small, because they had a very

small pot to give money out of.

Also, we have collaborated with the Institute for Chemical Defense where we have done experiments with people there with

sarin that have shown chemical changes in the brain in the same

regions that Dr. Haley and Dr. Henderson talked about.

Here are three entirely different approaches all coming to the

same conclusion. These chemical warfare agents are causing disruptions in the region of the brain called the basal ganglia. That

happens to be a region we know an enormous amount about.

Mr. SANDERS. These are animal studies?

Dr. GREENGARD. Yes, sir.

Mr. SANDERS. With rats?

Dr. GREENGARD. Yes. They were done in collaboration with this

Institute for Chemical Defense because you can’t get sarin very

easily.

Mr. SANDERS. You have more or less replicated in rats what Dr.

Haley has seen in Gulf war veterans?

Dr. GREENGARD. We have replicated in rats that there is damage

in this same region of the brain. The measurements are somewhat

different. A simple answer to your question would be ‘‘yes’’ with

some small caveats.

Mr. SANDERS. What you’re saying basically is, more money is

needed to continue this research?

Dr. GREENGARD. Yes. Just like what Mr. Binns said, bioterrorism, $1.7 billion to NIH, radiation $44 million, chemical zero.

I’ve been going around and everybody says, this is really needed

and your ideas are very, very good. Let’s do it. But we don’t have

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any money. Call me again next year. I’m afraid I’ll get an even

worse answer next year.

Mr. SANDERS. Thanks.

Dr. GREENGARD. Or give you a worse answer next year.

Mr. SANDERS. Thank you.

Go ahead.

Dr. HENDERSON. I would just like to point out one thing that may

seem obvious to everyone. The reason I said you have to have collaboration with DOD is they have the sarin.

I mean, for our work, we thought about, well, we will go to NIH

for funding. And, you know, you want the sarin to be under good

control, and so I’m glad the DOD has it. And that’s something to

consider, that they have to be involved.

Mr. SANDERS. Thank you.

Mr. TURNER. General, I have a question for you, just to follow on

what Mr. Sanders had been asking you.

In reading your testimony, it reads like a great commercial trailer for what’s to come. And looking at it, it says: Expected to announce their findings within the next few months. The next sentence: The final results of this important study will be available

soon. Next: This is an area for continued research. Next: We are

on the edge of significant advances. Next: Are providing us with a

deeper understanding. Next: Is providing new insight.

But there are no conclusions. And so what I want to ask you is

really a follow-on to what Mr. Sanders has said. In hearing the testimony of the three doctors who are currently undertaking research

in this, did you hear anything that they told us that you disagree

with or that you would be concerned or caution us on?

General MARTINEZ-LOPEZ. Sir, research is a journey. You know,

it doesn’t happen overnight. And there is—what we have learned

in the Department of Defense—by the way, just as a matter of

record, most of the 154 research projects have been extramural. It

has not been internal to a department. We have gone to academia.

We have to seek people of the caliber I have to my left to do that

research for us.

And yes, we have discovered some things, as I said before. You

know, we discovered—at the beginning, we thought there was

something there, and now, we don’t think that is where the money

is. So we know where not to look at, and now we have some good

leads here that we need to pursue.

But many of these are hypotheses that before we embark into

treatments and solutions, we have to know for sure that that is

what we are dealing with. And so that’s why we incorporated with

the VA system, to develop a center down in San Francisco to replicate and even expand on Dr. Haley’s work, because I would think

there is a hint there that we should pursue. So I am optimistic. But

again, I am optimistic that we are going to find solutions, I mean,

and part of the way—by the way, there are some treatments that

we have found that may help people with many of the multiple

symptoms, you know, cognitive therapy and some exercise.

Now, how does it work? We don’t know. We know that some of

them are getting better. But we need to pursue far more avenues

than that. We need to look at better solutions than that. So again,

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I tend to be optimistic, sir. But I guess history will tell whether we

are right or wrong.

Mr. TURNER. Dr. Haley and Dr. Henderson and Dr. Greengard,

one of the things that I thought was important about your testimony is that discussion not only of the issue of the Gulf war veterans and the symptoms that they are experiencing, but also taking

the research that you are undertaking, that you are doing, and

looking at other applications that are more prospective.

Yes, we have the issue of treatment of our veterans and the importance of their care, but we also have the issue of, we are currently back in the Gulf again, and we have the danger of men and

women in uniform who might be exposed to these agents again. We

have, as you all recognize, the issue of preparedness for terrorists,

possible attacks in this country and in other countries, the prospects of a country using these weapons in the offensive, not just as

we heard the distinction of defensive use where we have undertaken destruction of them. And also a fourth category, we have the

issue of, as you, Dr. Henderson, indicated, that the Department of

Defense does currently have stockpiles of these types of weapons

that they are undertaking destruction of. And certainly, the information as to what are tolerable levels of exposure applies to how

we undertake destruction of our own weapons.

And I wonder if each of you could speak for a minute about how

you might have looked and, the research you have undertaken, how

it might have applications in the issue of terrorist preparedness, in

the way that we are currently protecting our troops, some of the

equipment that they may have, issues of what we are considering

tolerable exposure, or if you have even looked at the issues as to

what we currently have as standards in the destruction and disposal of our own weapons.

Dr. HENDERSON. Well, I think our research applies to all of those

fields. And that’s what makes it interesting, and that’s also why

you will get NIH-type scientists interested in this, because it is

really basic research that tells us how the body works and how

we—how our nervous system works. And it can be—this type of research will be of significance, as you said, for terrorist protection,

homeland defense, if there is money there.

We are all seeking money, of course, to continue our research, so

we look for places where it might be applied. But I think this isn’t

just in the interest of Gulf war veterans, though it certainly is. It’s

in the interest of our understanding of how the nervous system

works and how we can protect ourselves against terrorist attacks

and, as you say, disposal of weapons. So I think it is very astute

you observed that. I think that, too.

Dr. GREENGARD. Well, I certainly agree with that. What happened in the Gulf war is a picnic compared to what can happen.

I mean, it is very possible to develop these. One bit of good news,

almost all of the effective chemical war agents belong to the same

class, these cholinesterase inhibitors. So it should be possible to develop antidotes against all of that category.

The other type of chemical warfare agent is called Nitrogen mustards, and they are just not very practical for a variety of reasons.

It is a nightmare scenario what chemical warfare can do. And I

have to say, as a citizen, I am amazed how we hear all our leaders

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talking about the dangers of chemical warfare, and I go around to

various branches of Government, and they say, ‘‘We have no

money, we like your idea, we have no money to do anything about

it.’’

Dr. HALEY. Actually, we spend a great deal of time thinking

about that. That is another one of those pivotal questions. I think

it is a critical one.

And the question, I think it really evolves to the issue of, could

we come up with a way of protecting people—our soldiers, for example—from low-level nerve gas or high-level nerve gas in other

ways other than a gas mask that you have to have on at the time

that you are exposed? And with low-level, you may not know you

are exposed.

So one of the things we did early after finding out about the peroxidase enzyme and this gene that produces an enzyme that protects you from nerve gas—in your blood, you have this enzyme, and

it destroys nerve gas when it gets in your blood. And people with

low levels of that seem to have been the ones that got Gulf war

syndrome.

So we reasoned: What if you could boost the level of peroxidase

in a person’s blood? And so we developed a collaborative project on

our campus where we took the gene, the pawn gene, the peroxidase

gene that makes this protective enzyme, and we put it on a virus,

benign virus and put it in a gene therapy device, put it in mice,

and then we showed that doubled or tripled the level of peroxidase

in the blood of those mice. And then when you expose them to

chlorpyrifos, which is a pesticide that simulates nerve gas, that you

would protect the mice. The mice who had the gene therapy were

protected from it compared to the controls who had the ill effects.

And so gene therapy is one possible way of protecting troops. You

could put a little blister under the skin that was manufacturing

peroxidase, boost the level in their blood, and give them the enzyme, kinetics of this enzyme. If you just double or triple the level,

you might produce infinite protection from nerve gas.

But, see, the idea came from the fact that we had done a case

control study in peroxidase in Gulf war veterans. And so the more

research you do in this, the more ideas, and then you spin off an

idea that no one had ever thought about.

But let me make one other comment that, really, I think your

point is an excellent one. You know, the whole field of psychiatry,

the psychiatric diseases, is being revolutionized by these same techniques we are talking about. What is depression? What is mania?

What is bipolar disorder? What is schizophrenia? What is a phobia?

You know, what are these psychological diseases that we used to

think were diseases of moral turpitude? You know. What they are,

it is clear that what they are is combinations of damage to brain

cells in certain areas of the brain that damage receptors so brain

cells can’t respond the way they should, damage to the internal

machinery of certain nerve cell, brain cells. And, adaptations of the

brain to those injuries, which goes under the term plasticity. The

brain is constantly changing and molding and adapting to these

changes. And so that’s what we think psychiatric diseases are.

And so sarin damage is just another one of these same illnesses

of brain cells and plasticity that we may be able to prevent once

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we understand them. And as Dr. Greengard points out, there may

be ways, as in Parkinson’s disease, that we can respond once they

occur. Once the disease occurs, we may be able to cure them by understanding that. But what that requires is funding.

If you look back at the history of all the great campaigns that

solve disease problems, my favorite one is the HIV/AIDS problem

because it started out very similar to Gulf war syndrome. It was

a disease that nobody wanted to study and no Government agency

wanted to fund anything about it. It was a pariah disease, and

then, through various political changes, it became a high-priority

disease. And in just a decade, with very strong funding, we understand the immune system, we understand HIV/AIDS, we are coming out with a new and better treatment every year.

That same story could be true of Gulf war veterans, but it’s going

to take a real commitment to it. And right now, that commitment

to research this is not there. The Congress has not made a commitment to this. It is a dead issue, and nobody is going to fund it. We

are going to move on into the future of deployment health, which

we ought to be doing, too. But right now, the funding is dead for

Gulf war illness and for these sorts of things that we are talking

about. There just isn’t any money.

Mr. TURNER. Thank you, Doctor.

Next, I would like to recognize again our guest, Lord Morris of

Manchester, who is in the House of Lords of Parliament of the

United Kingdom.

Lord MORRIS. Thank you, Mr. Turner.

Can I ask Dr. Perlin if he can say more about the findings of the

Harvard School of Public Health, showing increased risk of ALS—

which in the U.K., as you may know, we call motor neuron disease—in veterans as opposed to non-veterans? As you are aware,

in the U.K., we still don’t regard this devastating condition as Gulf

war related, notwithstanding prevalence rates no less significant

than those in the United States that led Mr. Principi to accept the

link. Has the veterans agency seen any reason to reconsider that

decision?

Reverting to Dr. Hall’s evidence today, can Dr. Perlin say how he

thinks the VA would respond in such a disturbing case as his?

And Mr. Turner, turning to Dr. Henderson, she referred to some

very interesting research, some very interesting research that

seems extremely important in terms of linking sarin exposure to

post Gulf war symptoms. However, rats aren’t humans. Is there

any plan anywhere to extend or replicate this research in higher

mammals, such as primates?

And turning now to Dr. Haley, please say why in the U.K. our

studies have been so unrevealing despite such a large sample, unlike U.S. studies. Again, if he were to study U.K. troops, how would

he do it differently?

As you may know, Mr. Chairman, Professor Haley has been very

widely read and is very highly regarded on both sides of the British

Parliament, and it would be extremely interesting to have his comments on those two points.

Dr. PERLIN. Thank you, Lord Morris.

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You asked me two questions, one, how we would respond to a situation such as Mr. Turner’s terribly tragic situation and, second,

to expand a little bit on our work on ALS.

Let me start with the question about Mr. Turner, is that we

would hope that for any veteran who presents to us in distress,

with disease, even if we didn’t understand the etiology, the basis

of that disease, even if we couldn’t give it a name, that we would

treat that individual. And in that, we were absolutely bound, with

the Research Advisory Committee, in seeking to find ways to effectively treat the veterans who approach us.

The ALS may not have shown up in as large a number in the

U.K. because—as you know, it is a horrific disease, Lou Gehrig’s

disease, as it is sometimes known in the United States, and it is

fortunately a somewhat rare disease, but it is a terribly tragic disease. And our research in large found that the rates of Gulf war

veterans were approximately twice that of background population.

And we have been, by virtue of our electronic health records and,

effectively, a captive population, putting together a registry. And I

would ask—you want to ask another question, but I would like to

ask after that Dr. Aisen, who is our deputy chief research and development officer and also a neurologist to expand on some of the

exciting work that is coming forward in ALS, both in terms of the

study, understanding the molecular, the genetic basis of it, potential mechanisms, susceptibility, and new modes for treatment. But

you appear to have another question, sir.

Lord MORRIS. Yes. As you know, the condition is found more frequently in older people than in younger people. In the case of Gulf

war veterans, we are talking, for the large part, almost wholly

about younger people?

Dr. PERLIN. Yes, you are absolutely correct.

Let me turn to Dr. Aisen to expand on both the research findings

and about the approach.

Dr. AISEN. Sir, the numbers are small, but I think, at the moment, we have identified 40 Gulf war I veterans who have ALS.

And this is defined by physical examination by neurologists. And

so that gives us an incidence and prevalence of about 6.7 per million as opposed to 3.5 per million.

It is absolutely occurring in a younger population, and that is the

finding that caused Mr. Principi to declare this a deployment-related condition and extend benefits to these veterans. We are creating

the registry. We estimate we have about 3,300 veterans throughout

the country who have ALS, and that includes Gulf war deployed

and nondeployed. And we are creating a DNA bank.

We have a number of animal studies and some new clinical trials

that emanate directly from those animal studies that we are about

to unroll this summer. Those would be my comments about ALS.

Dr. HENDERSON. I really like your idea about moving up to primates. And I think, whenever you do studies in rats, people say,

‘‘Well, what does it have to do with humans?’’ And the primate—

studies in primates would be a link.

The problem is funding. And right now, we are struggling to get

enough money to followup in the rats to really define what we are

finding there and, you know, develop strong hypotheses that we

might do in primate studies. And then, I think it would be approVerDate 11-MAY-2000 12:57 Dec 17, 2004 Jkt 000000 PO 00000 Frm 00184 Fmt 6633 Sfmt 6633 D:\DOCS\96946.TXT HGOVREF1 PsN: HGOVREF1
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priate to go to primates. But they are expensive studies, and right

now, we don’t have that type of funding.

Dr. HALEY. Can I follow that also a little bit?

In just looking at Dr. Henderson’s studies, there are several critical questions that need to be followed up in those studies that

aren’t funded yet. And they need to look at what other receptors

are involved. They have looked at the muscarinic acetylcholine receptors. But as you know, there are dopamine receptors and other

receptors that might also be damaged and not functioning. And you

need to know the answers to all of that before you go to primate

studies so that you could also correlate it with similar nondestructive studies in humans.

And so we are working in that direction. But that’s why we really need funding now to be targeted at some of these basic questions

where we have tremendous clues, but they are just waiting to be

followed up.

Let me also comment on your question about the ALS study. You

mentioned the Harvard School of Public Health study. That’s a

very confusing finding, and I would urge caution on that until we

see it published, because it is a fundamentally different—that

study is fundamentally different from the two studies on Gulf war

veterans. In the Gulf war veterans, you are looking at all-military

populations within the military. In the Harvard study that has not

been published yet, they were comparing ALS in military populations, primarily from World War II and Korea, with people who

didn’t serve in the military.

And we know there is a very great difference between those two

populations, and many reasons that you would have different rates.

For example, in people who didn’t serve in the military, nonmilitary people are by and large much less healthy, less educated

and so forth, and are more likely to die of other causes before they

can die of ALS. And so you would automatically have less ALS in

that population. And so until some of those issues—we have to see

whether those issues have been really cleverly answered in this

study, or is this just, you know, a simplistic study that found a

spurious finding that they shouldn’t have come out with? And we

don’t know that yet.

So I would urge no interpretation of that finding until we really

see the results.

And, finally, you asked me a question, why do I think the studies

in the U.K.—the epidemiologic studies of Gulf war veterans—have

been so unrevealing? And they have been. I know why, and this

has affected a number of the studies in this country. The large epidemiologic studies by and large have been unrevealing, also. And

the reason for it is a very simple thing that is the epidemiology

101, we say, in the basic course that we teach students in epidemiology.

When you see an epidemic and you are trying to investigate an

epidemic of a new disease, the very first thing you do is come up,

design a case definition. That is, you define the disease; you write

a sentence that says a case of toxic shock is low blood pressure, red

skin, and high fever. And then you go in and you apply that case

definition. You find some people who meet it, and there are the

cases, and find some people who don’t meet it, and there are the

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controls. And you compare them on all sorts of things. And that’s

where you solve the problem.

Well, early on, our Persian Gulf Veterans Coordinating Board, a

strategic error in this whole thing was the Persian Gulf Veterans

Coordinating Board made a policy, and the policy was: There is no

Gulf war syndrome. Now, in a scientific sense, we would have said,

‘‘Well, OK, that’s fine. We will go ahead and see if there is one.’’

Well, no, that was a policy. And so researchers were basically forbidden, if they wanted funding, to come up with a case definition

because they would be defining a Gulf war syndrome. You see?

Lord MORRIS. It’s called writing the minutes before the meeting.

Dr. HALEY. Exactly. Writing the minutes before the meeting. And

so coming up with a case definition was forbidden, and so a whole

generation of epidemiologic studies were done by DOD, VA, and by

the King’s College group in London. They didn’t have a case definition, so they were comparing surrogates for their case definition.

They were comparing deployed versus nondeployed. That’s too general. The few ill are lost by averaging with all the ones who aren’t

ill. Hospitalization and mortality were used as proxies for illness.

Well, but they don’t measure the illness because that isn’t the disease.

And so all of those epidemiologic studies were complete busts, including the King’s College studies. And we have seen scores of publications from those all saying there is no problem. And the reason

for it is they were forbidden to come up with a case definition and

apply it in a proper epidemiologic study.

As soon as case definitions were applied, we have come up with

great findings. Others are now doing the same thing. We are finally off to the investigation.

Now, what would I do differently? I would redo a survey in the

U.K. in which I administer, say, a telephone questionnaire that

where the survey has been designed in order to develop and determine a case definition, whether each respondent satisfies the case

definition or not, and then you would determine the prevalence of

the disease. You could then pick sick and well on the basis of that

case definition, and do brain imaging and genetic studies and so

forth. And you would be off to the races.

Mr. SHAYS [presiding]. I may be inaccurate on this description,

but it seems to me the VA is looking at things retrospectively. And

DOD is retrospective and also prospective. And I am wondering,

speaking to our military folks, if that doesn’t color how we give out

grants. Because there is the temptation not to just focus on the veterans, but to look at the broader picture. And in the process, since

DOD is the one providing some of this funding for VA, if that is

not one of the explanations of why we are not seeing money get

out.

General MARTINEZ-LOPEZ. I tend to believe, sir, that the collaboration and the way we go about the peer review and, right now,

the way we are trying to work it out between the two Departments

would take into consideration—not only you take into consideration

the gaps and you take into consideration what needs to be known,

not only for yesterday, to answer the mail to the Gulf war veterans,

but also to answer the mail to the future, to the soldiers that we

are going to be deploying forward.

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So if the collaboration and the management of the portfolio

works out right, and we have the right peer review process bringing external peers, like the RAC and other systems that will keep

us honest, I think we can really advance and make the difference

and find out the right solution. So, again, I am optimistic that we

are on the right track and that we can do that.

Mr. SHAYS. I’m not quite sure how that is responding to my question, but let me ask another question, and maybe we can. I’m going

to read just a statement.

On October 30, 2002, the VA, news released by the VA Deputy

Secretary, Dr. Leo S. Mackay, Jr., announced the Department of

Veterans Affairs planned to make available up to $20 million for

research into Gulf war illnesses during fiscal year 2004. However,

VA has only funded one research project related to Gulf war illness

research at the cost of $450,000 for fiscal year 2004.

My question is, why hasn’t the VA funded more than one research project for fiscal year 2004?

Dr. PERLIN. Let me just be clear on this. We could have done better. We intended to be very ambitious about this. It was a confused

period where this organization was trying to really understand the

findings that it had developed, a forward-looking portfolio.

In point of fact, over that period of time—and though not a justification, but simply a chronology of what did occur, there were six

letters of intents to review. Four researchers actually submitted

proposals. Only one was funded that specifically applied.

Our portfolio is really meant to involve three areas, the retrospective, particularly the epidemiology, the concurrent, directed

very much at devising therapy, and the prospective, the clinical

trials to actually get ahead of the curve. And that really will be the

basis for the forthcoming portfolio of research activity that we actually enjoy a much closer working relationship with Research Advisory Committee on framing.

Mr. SHAYS. Thank you.

Let me ask you this. I appreciate the honest, straightforward answer here. How has the VA notified researchers about the funding

available for Gulf war illness research?

Dr. PERLIN. I’ll turn to Dr. Aisen on that, and we’ll actually continue with some of the outreach efforts.

Dr. AISEN. We do monthly conference calls. We have talked to

the field at length about this. We have asked the Research Advisory Committee to help us alert people who have other talents and

might not be thinking about working in the area of Gulf war illnesses to think about applying their talents into our area and to

this area.

I think there is a fundamental viewpoint that we are trying to

convey very clearly to the entire field of VA researchers and the

academic affiliates that train some of the people who then come to

work in the VA. And that is that these veterans are sick. We don’t

know everything about why they are sick. We don’t clearly have a

classification for their illnesses. We don’t yet have a firm idea

about the neuro-imaging findings, the metabolic changes, the patterns of neurodegenerative.

Mr. SHAYS. And tell me, based on that, what am I supposed to

conclude?

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Dr. AISEN. I think that we have gone from a philosophy that

says, this is not a legitimate area for serious scientists to look at,

to one that says, absolutely, it is an area for serious scientists and

clinicians to think about. And I think, to that end, we are getting

more and more applications, and I think we will have high-quality

applications to choose from. And we will have a merit—you know,

in the end, it’s the dry quality merit review, the dry intellectual

rigor that’s going to produce real science. But I think that we have

invited the field and the whole group of people in our VA field to

submit applications. And we have made it very clear that quality

will be funded.

Mr. SANDERS. If I could just jump in. I don’t want to beat a dead

horse here, but when you say there has been a change of thought

in the VA, where previously it was not thought that—Gulf war illness perhaps was not thought to be an area of serious scientific

concern, I don’t know what I could say, because we were up here

14—well, 12 years ago anyhow, whatever it was. We thought it was

an area of serious scientific concern. We had people from the VA

and the DOD, and we tried. I’m glad to see that there is a conversion, but I think it is a very sad day that tens and tens of millions

of dollars essentially went nowhere because the VA and the DOD

did not recognize the reality, if you would like. The great debate

is that, is it an illness? Of course, it was an illness. We saw the

people dying in front of our eyes. And it is a sad thing that it took

so long—better now than never, but it is a sad state of affairs that

it took so long for the VA to recognize that.

Dr. AISEN. Let me just respond to that. I misspoke. And, you

know, I am relatively new at this. But just to contrast the number

of letters of intent that we received for the last round, which was

6 or 4, we got 66 this time. So I think that this approach has

helped a great deal. And I do not mean to denigrate prior attempts.

And I think that, throughout the years, the comments made

about proactive versus retrospective and prospective, we have done

clinical trials, we have looked at antibiotics, which was the therapy

that was considered to be beneficial. We looked at exercise behavioral therapy. We have been attempting these treatments. They

didn’t work. But science is difficult, and clinical medicine is difficult. And just because an expensive trial didn’t work doesn’t mean

people weren’t trying.

Dr. PERLIN. Mr. Sanders, Mr. Chairman, if I might reframe part

of that—is that. I think we are at a much more fortunate point now

in terms of our understanding. The previous work has laid a

groundwork. It has been treatment and hypothesis. And I am very

pleased that we have the opportunity to ask investigators—not,

bring us something on illnesses afflicting Gulf war veterans, but we

have major leads. That we can attract people to the work Dr.

Greengard has mentioned in terms of acetylcholinesterase, acetylcholine receptor function, is very promising. The opportunity to

partner and really leverage the great investment of the Department of Defense and Michael Weiner’s imaging, neurofunctional

imaging center, is really a $7 million effort. So we now have something to attract people to. And, as Dr. Aisen said, 66 new letters

of intent.

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Mr. SANDERS. I think, if I can, Mr. Chairman—again, I don’t

want to argue the past. What’s important is where we go from

here.

But I will never forget, sitting up here, the constant resistance

that we had from the DOD and the VA, basically that we are here

because we asked them to be here but we don’t really think—it is

probably a psychological problem. Yeah, if you force us to do something, I guess we’ll have to do something, but we really don’t believe it.

That really was what I took out of that for so many years. But

forget that. I mean, the good news—let me just say where I think

we are, and people tell me if you think I’m right or wrong. But it

appears that, in the last couple of years, some very—what I think

everybody up there now agrees—serious scientific breakthroughs

have been made which deserve further pursuit of. And what is now

distressing, if we have made, after all of these years, some major

breakthroughs, what we are hearing from some of the researchers:

OK, we are ready to go, but we don’t have the money now to do

that research.

Is that a fair summary of kind of where we are at, perhaps?

Dr. PERLIN. I think this is a very complex illness. And you heard

Dr. Greengard discuss Parkinson’s and the research there. We understand the neuro-chemical basis of that, but we don’t have perfect cures. We have good treatments. So I don’t want to diminish

some of the importance of the research that has gone before.

As you know, also in direct response to your point, where is the

money for this? Our secretary, Secretary Principi, is absolutely passionate that we do good research in the interest of veterans, in the

interest of veterans suffering with Gulf war illness. And toward

that end, we will be working and are working very closely with the

Research Advisory Committee to find the funds to frame these

sorts of promising evidence-based, hypothesis-driven research programs. And we will do that.

Mr. SHAYS. I’m going to continue with my question, but my staff

helped me understand what you were saying, General MartinezLopez, that you were basically saying to me, in response to the

question that the coordination between the VA and the DOD and

the rigorous peer review will keep DOD, bridge the apparent conflict between the prospective and retrospective research. That’s basically what you were saying to me.

General MARTINEZ-LOPEZ. Yes, sir. What I’m saying is we need

to manage the portfolio. In other words, you have to manage the

portfolio and do some retrospective studies still. But still, we need

to do some basic science to understand some of the mechanisms,

and we need to do some prospective treatment trials to see if they

work or not. And also, with this redeploying, as I told you, sir, in

the testimony, we need to apply some of the lessons learned.

In other words, do some interventions early on as they come back

to—not only from the standpoint of treatment but also from the

standpoint of research to understand better what is happening

here. And that will help us to look back.

So you manage the portfolio and you peer review the portfolio,

I think we will be on far better footing to answer some of these

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questions from a scientific basis. That is not just the Department

or the VA, but there are checks and balances built in.

Mr. SHAYS. Your response to my question was not the failure of

the answer. It was the failure of me to comprehend it. So I just

want to——

General MARTINEZ-LOPEZ. I’m sorry, sir.

Mr. SHAYS. I said, your response to my question was not the failure of your response; it was the failure of my ability to understand

what you were saying. And I thank you for being responsive.

I am looking at both VA and DOD, and I am thinking, you

weren’t here 12 years ago or 10 years ago. And that’s the good

news. And—no, it’s really the good news. But we remember when

Dr. Haley was a wolf crying in the wilderness. And he had some

funding from Ross Perot. And I listened to him, and he seemed to

make so much sense to me, but nobody else seemed to agree. You

know, he seemed to be in a whole different area.

And one of the things we learned—and I would just say this to

the VA, what I would bring to the table was the recognition that

as the State legislature for 13 years, we passed laws all the time

about the chemicals that you could use and OSHA’s requirements

and you didn’t do things with certain chemicals. And yet, DOD was

just oblivious to this. I mean, we had one gentleman who ended up

with ALS. We had someone else who—excuse me, was a pilot, but

we had someone who passed away in Hartford from cancer, liver

cancer. And he was spraying the detainees with Lindan for 8 hours

a day with no ventilation. And there was just something intuitively—we wouldn’t allow that in the private sector. And so then

you have Dr. Haley talking about, you know, these chemicals matter.

And what I want to say is, when I heard Dr. Haley and Dr. Henderson and Dr. Greengard, they basically—and this was staff

again, saying, you know, the last few witnesses are a powerful

antidote to the stress lobby that we have been hearing for so many

years.

We just know that we could be doing a lot better. And I would

plead with the VA and DOD to break away from the history that

exists in both Departments.

And I would just say one more thing to VA, when we questioned

how many doctors, of the thousands that you have—and all of them

well-meaning and capable—how many of them were in occupational

safety, the chemical side of the equation, they could only give us

two out of thousands. And so, you know, there was a general feeling on our part that a lot of the doctors who were hearing these

cases just didn’t have the kind of experience and the background

that our three witnesses at the other end of the table had.

And Dr. Greengard, you go down in record as having the shortest

statement of anyone ever. And I’m not sure if that is just you are

a cautious man or if you are a man of few words, but I would like

you to tell me, is your presence here—can I infer from that it is

a—not a vindication but a—I mean, you bring to the table a Nobel

Laureate background. Can I infer from this that you are bringing

your reputation to the table as well to say people like Dr. Haley

were on the right track?

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Dr. GREENGARD. Yes. There are two issues. One is whether people like Dr. Haley were on the right track. And I believe they were.

The jury is still out on the percentage of Gulf war victims due to

chemical warfare agents—there is no question in my mind that

Gulf war illness is an illness. It is absurd not to say it is. And some

very bright people were misled. For example, Joshua Lederberg

headed a really blue-ribbon committee that concluded—he is at the

same university that I am. They concluded that Gulf war illness

was nonexistent, that it was a stress of our troops in very unpleasant conditions. Why they came to that conclusion, I have no idea.

I haven’t read all that information.

The other issue, which is absolutely black and white, I bring my

reputation to the table here, is that chemical warfare illness is an

issue that can be treated like any other disease or potential disease. The scientific knowledge, is there now to combat it.

Now, so there are really those two issues. What percentage of

Gulf war illnesses is due to exposure to these nerve agents, that’s

one question. And then the other is, can we do anything about

chemical warfare, by understanding how these nerve agents work?

And as I said, the science knowledge is there now to work out.

What happens—we have talked about receptors. But downstream

of these receptors are a bunch of biochemical steps which occur

which are being elucidated. And so we already know several—from

this work I said we do with the ICD—several biochemical reactions. And there are undoubtedly dozens more. One can find out

what those dozens are and then develop chemical treatments to

prevent them.

For example, let’s say that these nerve agents cause too little of

a certain compound. Then one can use drugs that prevent breakdown of that compound to raise it to cure the illness.

In terms of the likelihood of success, the most likely is that we

can find out how these nerve agents work and then develop antidotes which will prevent the side effects. I think there is a very excellent chance that can happen.

It seems such an obvious thing. I’ve talked to several of the scientists I most respect to say, does this seem logical to you? And we

have gone through it. Everybody agrees. There are no flaws in this

logic. So to find out how these toxic substances are working is really just a straightforward thing.

The chances that, based on that, one would be able to prevent—

develop preventatives is very good. There is a somewhat lesser

chance but still a real chance that one could develop—combat or reverse the effects on people who were exposed by treating them

shortly after an attack.

And the last one, the Gulf war veterans is certainly an enormously important problem. I’m somewhat less optimistic there, but

it’s still the best chance, because we can find out, for example, from

animals what the biochemical changes are—and we are talking

about many, many different biochemical changes now—and then,

either by using biomarkers in living Gulf war veterans or doing autopsies on deceased Gulf war veterans, find out what percentage of

those have the same biochemical changes that we can produce in

experimental animals.

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Mr. SHAYS. I would like to conclude by just pleading with the VA

and the DOD to see the opportunities here, and not to—I think we

have come too far, and I think we have been a little too slow recently. And I would welcome you—if we have to put a line item,

we will do it. But I would like not to have to do it. I would like

to see some energy in DOD and the VA on this area that we have

just talked about. And I just think there would be huge benefits to

our veterans and to our soldiers of the future.

I am ready to just adjourn here. If there is any last comment,

I will be happy to hear it. Otherwise, we will just adjourn. And I

thank all of you very much.

[Whereupon, at 4:45 p.m., the subcommittee was adjourned.]

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