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43–150 CC 1997

THE STATUS OF EFFORTS TO IDENTIFY PERSIAN

GULF WAR SYNDROME: RECENT GAO FINDINGS

HEARING

BEFORE THE

SUBCOMMITTEE ON HUMAN RESOURCES

OF THE

COMMITTEE ON GOVERNMENT 

REFORM AND OVERSIGHT 

HOUSE OF REPRESENTATIVES

ONE HUNDRED FIFTH CONGRESS

FIRST SESSION

JUNE 24, 1997

Serial No. 105–35

Printed for the use of the Committee on Government Reform and Oversight

(

(II)

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT 

DAN BURTON, Indiana, Chairman 

BENJAMIN A. GILMAN, New York 

J. DENNIS HASTERT, Illinois 

CONSTANCE A. MORELLA, Maryland 

CHRISTOPHER SHAYS, Connecticut 

STEVE SCHIFF, New Mexico 

CHRISTOPHER COX, California 

ILEANA ROS-LEHTINEN, Florida 

JOHN M. MCHUGH, New York 

STEPHEN HORN, California 

JOHN L. MICA, Florida 

THOMAS M. DAVIS, Virginia 

DAVID M. MCINTOSH, Indiana 

MARK E. SOUDER, Indiana 

JOE SCARBOROUGH, Florida 

JOHN B. SHADEGG, Arizona 

STEVEN C. LATOURETTE, Ohio 

MARSHALL ‘‘MARK’’ SANFORD, South 

Carolina 

JOHN E. SUNUNU, New Hampshire 

PETE SESSIONS, Texas 

MICHAEL PAPPAS, New Jersey 

VINCE SNOWBARGER, Kansas 

BOB BARR, Georgia 

ROB PORTMAN, Ohio 

HENRY A. WAXMAN, California 

TOM LANTOS, California 

ROBERT E. WISE, JR., West Virginia 

MAJOR R. OWENS, New York 

EDOLPHUS TOWNS, New York 

PAUL E. KANJORSKI, Pennsylvania 

GARY A. CONDIT, California 

CAROLYN B. MALONEY, New York 

THOMAS M. BARRETT, Wisconsin 

ELEANOR HOLMES NORTON, Washington, 

DC 

CHAKA FATTAH, Pennsylvania 

ELIJAH E. CUMMINGS, Maryland 

DENNIS J. KUCINICH, Ohio 

ROD R. BLAGOJEVICH, Illinois 

DANNY K. DAVIS, Illinois 

JOHN F. TIERNEY, Massachusetts 

JIM TURNER, Texas 

THOMAS H. ALLEN, Maine 

HAROLD E. FORD, JR., Tennessee 

———

BERNARD SANDERS, Vermont 

(Independent) 

KEVIN BINGER, Staff Director 

DANIEL R. MOLL, Deputy Staff Director 

JUDITH MCCOY, Chief Clerk 

PHIL SCHILIRO, Minority Staff Director 

SUBCOMMITTEE ON HUMAN RESOURCES

CHRISTOPHER SHAYS, Connecticut, Chairman 

VINCE SNOWBARGER, Kansas 

BENJAMIN A. GILMAN, New York 

DAVID M. MCINTOSH, Indiana 

MARK E. SOUDER, Indiana 

MICHAEL PAPPAS, New Jersey 

STEVE SCHIFF, New Mexico 

EDOLPHUS TOWNS, New York 

DENNIS J. KUCINICH, Ohio 

THOMAS H. ALLEN, Maine 

TOM LANTOS, California 

BERNARD SANDERS, Vermont (Ind.) 

THOMAS M. BARRETT, Wisconsin 

EX OFFICIO

DAN BURTON, Indiana HENRY A. WAXMAN, California 

LAWRENCE J. HALLORAN, Staff Director and Counsel 

ROBERT NEWMAN, Professional Staff Member 

R. JARED CARPENTER, Clerk 

CHERRI BRANSON, Minority Counsel 

ELIZABETH MUNDINGER, Minority Counsel 

(III)

C O N T E N T S 

Page 

Hearing held on June 24, 1997 ............................................................................... 1

Statement of: 

Heivilin, Donna, Director of Planning and Reporting, General Accounting 

Office, accompanied by Kwai Chan, Director of Special Studies and 

Evaluation Group, General Accounting Office; and Sushil Sharma, Assistant Director of Special Studies and Evaluation Group, General Accounting Office .............................................................................................. 34

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

Gilman, Hon. Benjamin A., a Representative in Congress from the State 

of New York, prepared statement of ........................................................... 24

Heivilin, Donna, Director of Planning and Reporting, General Accounting 

Office, prepared statement of ....................................................................... 41

Pappas, Hon. Michael, a Representative in Congress from the State of 

New Jersey, prepared statement of ............................................................. 32

Sanders, Hon. Bernard, a Representative in Congress from the State 

of Vermont, prepared statement of .............................................................. 7

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

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

Towns, Hon. Edolphus, a Representative in Congress from the State 

of New York, prepared statement of ........................................................... 22

(1)

THE STATUS OF EFFORTS TO IDENTIFY PERSIAN GULF WAR SYNDROME: RECENT GAO 

FINDINGS 

TUESDAY, JUNE 24, 1997 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HUMAN RESOURCES, 

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 10:20 a.m., in room 

2154, Rayburn House Office Building, Hon. Christopher Shays 

(chairman of the subcommittee) presiding. 

Present: Representatives Shays, Snowbarger, Pappas, Sanders, 

Kucinich, and Allen. 

Staff present: Lawrence J. Halloran, staff director and counsel; 

Robert Newman, professional staff member; R. Jared Carpenter, 

clerk; Cherri Branson and Elizabeth Mundinger, minority counsels; 

and Ellen Rayner, minority chief clerk. 

Mr. SHAYS. I’d like to call this hearing to order and first apologize to my colleagues. It’s my practice to start the hearings on 

time. And I was at the Budget Committee giving the two reconciliation bills to the committee on behalf of Mr. Kasich, and I was not 

allowed to leave by the committee. So I’m a little late and I apologize. 

I did want the subcommittee to wait because I consider this an 

extraordinary hearing today and wanted to participate in all of it. 

In March 1996, we began these hearings on Gulf war illnesses 

because many veterans were telling us the Federal response to 

their plight was blind and passive. They found the research 

unfocused, their diagnoses skewed toward stress, and their treatments inconsistent or ineffective. 

It became clear to us very quickly our veterans were right on all 

counts. 

The subcommittee’s goal, like theirs, is to see that all Gulf war 

veterans are properly diagnosed, effectively treated, and fairly compensated. 

Today the General Accounting Office [GAO] will discuss their report, ‘‘Gulf War Illnesses: Improved Monitoring of Clinical Progress 

and Re-examination of Research Emphasis are Needed.’’ Significant 

findings in this report confirm what sick veterans, physicians, research scientists, and others have been telling this subcommittee 

consistently over the course of eight previous hearings. 

This GAO report, much of our earlier testimony, and more we 

will hear on Thursday, all speak of an official approach to Gulf war 

2

illnesses still permeated by diffidence, denial, and a desire to embrace preordained, unsubstantiated conclusions. 

Sadly, the diffidence, denials, and desire to jump to convenient 

conclusions continue. The official response to this report by the Department of Veterans’ Affairs [VA] and the Department of Defense 

[DOD] betray the same arrogance and myopia that blinded them 

to the obvious probability of low-level chemical warfare agent exposures until just last year, when Khamasiyah forced their eyes to 

open slightly. 

In response to the findings and recommendations in this report, 

the VA and DOD attempted to ignore the message and attack the 

messenger, challenging GAO’s methodology and expertise. It is disappointing the departments took defensive, even petulant, exception to GAO findings and recommendations to improve the quality 

of health care for Gulf war veterans and refocus the research agenda on treatment. 

Just as distressing was the position taken on this report by the 

President’s Advisory Committee on Gulf War Veterans’ Illnesses 

[PAC]. GAO challenged the PAC’s conclusions supporting stress as 

a major cause of Gulf war illnesses, minimizing the threat of Leishmaniasis, and dismissing the long-term health effects of organophosphates exposure. 

DOD and, to a lesser extent, the VA endorse these conclusions. 

By entering into a joint defense of the status quo with the very departments they are charged by the President to oversee, I fear the 

PAC may have lost sight of a solution and become part of the problem. 

When the President’s Advisory Committee issued their final report in January, the Special Assistant to the President and Senior 

Director for Gulf War Illnesses, Rear Admiral Paul Busick, said the 

administration’s future mission for the PAC was ‘‘To address the 

issue of the process that the Department of Defense is using to get 

to the answers that we need, in terms of investigations into lowlevel chemicals and those kinds of issues.’’

Yet, when the GAO, complying with a congressional mandate, reports persistent flaws in that process ‘‘are likely to prevent researchers from providing precise, accurate and conclusive answers 

regarding the causes of veterans’ illnesses,’’ the administration’s 

watchdog only growls at the messenger. This report, and the telling 

responses it has evoked, add weight to the argument that the riddle of Gulf war veterans’ illnesses will never be solved from inside 

the Pentagon or the VA. 

Today, on Thursday, and in the weeks ahead, this subcommittee 

will discuss how issues affecting the health of Gulf war veterans 

can be liberated from the constraints of military doctrine and medical bureaucracy and how the Gulf war research agenda might be 

more effectively controlled by an independent body veterans and 

others can trust. 

As in the past, the GAO plays an important role in those discussions. And we welcome their testimony. 

At this time the chair would recognize Mr. Sanders. 

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

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Mr. SANDERS. Thank you very much, Mr. Chairman. And let me 

just express to you my pride in working with you and my belief 

that you have taken this whole issue as far as it has gone, plus 

you’ve worked in a nonpartisan way. You’ve been extraordinarily 

persistent. So I congratulate you and your staff for all of the work 

that they have done. 

With your permission, Mr. Chairman, I would like to submit a 

document for the record. And this document is a letter to the Presidential Advisory Committee dated June 20, 1997, drafted by my office and signed by 86 Members of the Congress. And in this letter, 

86 Members of the Congress agreed that the Presidential Advisory 

Committee needs to reassess its conclusion that ‘‘current scientific 

evidence does not support a causal link between Gulf veterans’ illnesses and exposures while in the Gulf region to the following environmental risk factors assessed by the committee: pesticides, chemical and biological warfare agents, vaccines, pyridostigmine bromide, infectious diseases, depleted uranium, oil well fires, and 

smoke and petroleum products.’’

In other words, when I took this letter around to our colleagues, 

I found very few Members who believed that stress and stress 

alone was the cause of Persian Gulf illness. I think all of us recognize the important role that stress plays, but very few Members—

and I think very few people in the United States of America—believe that stress alone, as the Presidential Advisory Committee 

suggested, is the cause of Persian Gulf illness. 

While we have not yet received a formal response from the Presidential Advisory Committee, as you indicated in your comments, 

once again, they are defensive, and, once again, they continue to 

go forward and suggest that anybody who is talking about the role 

that chemicals have played doesn’t understand what they are talking about. I think—let me just give you a couple of examples of the 

problems that I’ve had with the Presidential Advisory Committee. 

A couple of weeks ago I wrote a letter to the committee because 

I noticed that, interestingly enough, the DOD in 1995 did a study. 

And you know what their study concluded? Their study concluded 

that pyridostigmine bromide combined with DEET and combined 

with hermathrine has a synergistic effect much more than the additive effect. When you combine the three it has a significant effect 

on lethality. I found it very interesting that in the Presidential Advisory Committee final report, the word ‘‘significant’’ was changed, 

and it became a ‘‘slight.’’ The word ‘‘significant’’ went to ‘‘slight.’’ I 

found it interesting in reading New York Times articles that when 

the DOD itself had done the right research—New York Times, 

Wednesday, May 14 headline: ‘‘Study Links Memory Loss to Nerve 

Gases in Gulf.’’ Interestingly enough, the researcher, Dr. Pendergast, says, ‘‘I don’t think it’s too early to draw conclusions. The type 

of exposure regime that we employed in the animals and the type 

of exposures that our troops experienced in the Gulf are analogous. 

And the types of memory deficits that we’ve seen in the animals 

and those reported by Gulf War patients are extremely similar.’’

In other words, the DOD researcher says, I think we’re making 

progress. What does the DOD say in response to their own study? 

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portant, but the Department said, ‘These initial findings require 

replication in other species, including non-human.’ ’’ ‘‘The Pentagon also questioned whether the experiments in which 

the rats were infected with the chemicals over a 2-week period offered many clues to the health problems of the veterans. ‘The 

shroud of administration and duration of exposure does not parallel 

any known human exposure to troops.’ ’’ So in other words, you have this irony. The DOD does the research. The guy that does the research says, I think we’ve made 

an important finding. And the DOD attempts to minimize what 

their own research has done. On and on we have had testimony 

from witnesses here who have told us they were—Dr. Tucker, remember Dr. Tucker? Fired because he had the courage to go outside of the parameters established by the PAC. 

Dr. Mira Sheyavitz, who is a physician who formerly worked at 

the VA hospital, Northampton, MA, believed that chemicals played 

a role. She developed a protocol for treatment—did not get her research funded. 

Dr. Claudia Miller, who you have had before this committee, also 

was in line to receive funding to look at chemicals; did not get 

funded. 

Dr. James Morse, after concluding that PB and DEET, when 

combined, produce toxic effects on cockroaches, was terminated 

from his employment with the Department of Agriculture. 

On and on and on it goes. When conclusions arise that seem to 

go beyond the paradigm established by the DOD and VA, those researchers get the short shrift. I agree with you, Mr. Chairman. I 

think the time is now to say, thank you very much, DOD and VA, 

you’ve had your opportunity, you’ve had the last 5 years—you 

haven’t done it. I think we’ve got to go outside the DOD and the 

VA. I think we need a Manhattan-type project, as I’ve said before. 

I think the National Institute of Environmental Health Studies 

might be a good start. They are interested in looking at the role 

that chemicals have played. And I also want to conclude simply by 

congratulating the GAO for their research and in helping us understand the failures of what the DOD and the VA have done. Thank 

you very much, Mr. Chairman. 

[The prepared statement of Hon. Bernard Sanders and the letter 

referred to follow:]

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Mr. SHAYS. Before recognizing other Members, I would just like 

to ask unanimous consent that all members of the subcommittee be 

permitted to place any opening statement in the record and that 

the record remain open for 3 days for that purpose. And without 

objection, so ordered. And further ask unanimous consent that all 

witnesses be permitted to include their written statements in the 

record. And without objection, so ordered. 

[The prepared statements of Hon. Edolphus Towns and Hon. 

Benjamin A. Gilman follow:]

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Mr. SHAYS. And at this time, the vice chairman of the subcommittee, Mr. Snowbarger. 

Mr. SNOWBARGER. Thank you, Mr. Chairman. With the opportunity to place opening statements in the record, I’m anxious to 

hear what the witnesses have to say today. And I’ll pass on an 

opening statement. 

Mr. SHAYS. I thank the gentleman. Mr. Kucinich, you have the 

floor. 

Mr. KUCINICH. Thank you very much, Mr. Chairman, members 

of the committee. I want to thank you again for your persistent efforts in this area of studying the Gulf war syndrome. As I’ve had 

the opportunity to be on this committee and to hear the Chair’s appeal for more information, I keep thinking about the men and 

women who were called to serve this country and who do serve this 

country, and how when they move forward to defend this country, 

if they become hurt as a result or injured or ill as a result of that 

defense, then it’s the country’s responsibility to defend them. 

And it’s very clear from the evidence which has been presented 

that our country has failed to defend the people who have defended 

this country. The Department of Defense, in its many years of dealing with this, has become twisted in its approach. As it focuses its 

efforts in protecting America’s interests against outside enemies, 

when confronted with the serious possibility of its own ineptitude, 

its own failures, its energies have become twisted and rechanneled 

to calling our very own troops an enemy. And the insistence of our 

troops on simple justice somehow becomes an impediment to the 

working of the Department of Defense. 

It’s unfortunate that those who have handled this issue in the 

Department of Defense have not had the perceptiveness or the concern to determine the true causes of the Gulf war syndrome as this 

study has done. And you know, Mr. Chairman, as I think about it, 

you wonder, what does this say about the ability of those who are 

running the Department? 

Because I don’t think we can look at these things in isolation. 

Because if we would take something as important as the treatment 

of our very own soldiers, or in this case, the mistreatment, and use 

that as a measure of how the Department is run, it really raises 

questions much larger than the scope of this committee about the 

Nation’s defense. How do we treat our soldiers? How do we treat 

our veterans? Do they deserve the kind of cover-up which has ensued throughout the history of dealing with this Persian Gulf syndrome? 

I’m grateful to be on a committee which has the integrity and the 

willingness to look into questions that other branches of the Government haven’t. And I’m looking forward to the presentation of 

the GAO report. And once again, I want to thank Chairman Shays 

for his dedication to the American people and to veterans and to 

those in the service who really rely on you and on this committee 

for an opportunity to receive some simple justice. Thank you. 

Mr. SHAYS. Thank the gentleman. Mr. Allen. 

Mr. ALLEN. Thank you, Mr. Chairman. 

Mr. SHAYS. I’m sorry. Mr. Pappas, you would be recognized. Excuse me, Mr. Allen. 

31

Mr. PAPPAS. Thank you, Mr. Chairman. I want to thank the folks 

for being here today. And Mr. Chairman, I want to commend you 

for calling this hearing, which is really the continuation of an effort 

that you began, I know, prior to my serving in Congress. But certainly I’ve been fortunate to participate in other hearings concerning the Persian Gulf war syndrome. 

The recent GAO report that has been issued on the subject is, 

quite frankly, very disturbing. The notion that both the Department of Defense and the Department of Veterans’ Affairs did not 

do a thorough job in addressing the health concerns of our Gulf 

war veterans unfortunately is not surprising when one considers it 

took the Pentagon to admit that at least 20,000 soldiers were presumed to be exposed to chemical weapons. 

Mr. Chairman, in past hearings conducted by the subcommittee, 

veterans have testified about their difficulty in getting a proper diagnosis and treatment from both the DOD and the VA doctors. Unfortunately, many of them, it was suggested that they are just suffering from some mental illness. But this report underscores the 

need to have an independent panel review this evidence and help 

address the concerns of our Nation’s veterans. 

I look forward to hearing the testimony by the GAO today on 

their study. I hope corrective measures can begin soon to help our 

veterans, who are coping with their illness. We certainly owe it to 

them. I thank the chairman. 

[The prepared statement of Hon. Michael Pappas follows:]

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Mr. SHAYS. I thank the gentleman. I’m sorry, Mr. Allen. You do 

now have the floor. 

Mr. ALLEN. Thank you, Mr. Chairman. I appreciate your leadership, that of Mr. Sanders and the other members of this committee, 

in examining the effectiveness of the Federal Government, especially Departments of Defense and Veterans’ Affairs, in identifying 

the causes and the appropriate treatment for the deteriorating 

health of so many of our veterans who served in Desert Storm. 

There are about 697,000 men and women of our armed forces 

who served in the Persian Gulf. And hundreds of thousands are 

suffering from a series of debilitating ailments. And it is disheartening and alarming that the Federal agencies responsible for their 

medical care have failed on three fronts, according to this recent 

GAO report. 

The GAO found that, No. 1, that the Departments of Defense and 

Veterans’ Affairs have failed to determine whether ill veterans 

have improved or deteriorated since their first diagnostic examination. Second, the current research will not provide precise, accurate, and conclusive answers because of the formidable methodological problems. And this research also lacks a precise, focused approach. Third, the President’s Committee reached several conclusions in its final report without sufficient evidence. It seems clear 

to me that the Federal Government has failed in its efforts to address the cause and treatment of Gulf war illnesses, and renewed 

efforts must be undertaken to improve the monitoring of clinical 

progress and to explore new avenues in medical research. 

I do not underestimate the difficulty of this project, because the 

causation of these kinds of illnesses is so much more complex than 

the kinds of illnesses that most doctors, including military doctors, 

are trying to deal with on a normal basis. It requires more information, more comprehensive information from a wider variety of 

sources than is typical. But nevertheless, the fundamental point is, 

we sent our men and women to the Persian Gulf. We have ignored 

their concerns and their complaints for too long. And it is time to 

figure out how to set the record straight, how to take care of the 

veterans who have been suffering, how to figure out what happened, and now what we do about it. 

And I want to thank those who are here to testify today. I look 

forward to hearing your testimony. Thank you, Mr. Chairman. 

Mr. SHAYS. I thank the gentleman. At this time we will call our 

first and only panel. That’s Dr. Donna Heivilin, Director of Planning and Reporting, General Accounting Office, accompanied by 

Mr. Kwai Chan, Director of Special Studies and Evaluation Group, 

and Dr. Sushil Sharma, Assistant Director of Special Studies and 

Evaluation Group. All three are at GAO. 

[Witnesses sworn.] 

Mr. SHAYS. For the record, all three have responded in the affirmative. Please be seated. I extended my apology to the committee for being late, and I would like to extend my apology to the 

three of you and to our guests as well. It is good to have you here 

today. And thank you. Dr. Heivilin, we’re not going to put a clock 

on your testimony. This is just one panel. And by the way, we will 

be having the DOD and the VA come before us on Thursday, so I’m 

sure we will be hearing more about their view of your report. But 

34

we want you to give your testimony, maybe not in its entirety, but 

almost. 

STATEMENTS OF DONNA HEIVILIN, DIRECTOR OF PLANNING 

AND REPORTING, GENERAL ACCOUNTING OFFICE, ACCOMPANIED BY KWAI CHAN, DIRECTOR OF SPECIAL STUDIES 

AND EVALUATION GROUP, GENERAL ACCOUNTING OFFICE; 

AND SUSHIL SHARMA, ASSISTANT DIRECTOR OF SPECIAL 

STUDIES AND EVALUATION GROUP, GENERAL ACCOUNTING 

OFFICE 

Ms. HEIVILIN. All right. Mr. Chairman, members of the subcommittee, I’m very pleased to be here today. Thank you for the 

invitation. I will submit the full statement for the record and I will 

summarize somewhat. I’ll skip a few of the areas, like background. 

In our work which we released yesterday, which was mandated 

by the 1997 National Defense Authorization Act, we addressed 

three issues. The first issue was the DOD and VA provisions for 

following up on the illnesses of the Gulf war veterans. The second, 

we looked into the coherence of the Government’s research strategy. And the third issue we looked at was the consistency of key 

official conclusions with the available data on the causes of the 

Gulf veterans’ illnesses. 

I’d like to summarize our conclusions about those three issues 

and then provide a little more detail. First, regarding the first 

issue, DOD and VA have made no provisions to followup on the 

condition of the Gulf war veterans. We found neither DOD nor VA 

have any means of knowing whether the Gulf war veterans who 

are ill are better or worse off than when they were first examined. 

As to the second issue, which is the coherence of the Government’s research strategy, we believe that the Federal research has 

not been pursued proactively. Although health problems surfaced 

in the early 1990’s, the vast majority of the research was only 

started in 1994 or later. And some will not be completed until the 

year 2000 or beyond. About 80 percent of it is still ongoing. The 

majority of the research—close to one-half—is focused on descriptive epidemiological studies as prevalence of cause. Little of the research is looking into effective treatments. 

The epidemiological research is to determine the nature and 

cause of a particular illness. And the objective is to develop clues 

as to the treatment through building hypotheses and refining them 

and improving them. An example where this worked really well 

was research that was done into cholesterol, in which the researchers were able to relate higher blood levels of cholesterol to heart 

disease. And from there they went on to develop hypotheses and 

treatment for people who had high cholesterol so that their susceptibility would be lower in the future. 

The problem, when we looked at the epidemiological research 

that’s going on with the Gulf war veterans, is that there are scanty 

records on who was exposed to what, when, or on the vaccines or 

doses of drugs and amounts that were given to individual veterans. 

And their memories are unreliable or they may not have known 

what they were exposed to at the time that they were exposed. 

Consequently, it’s quite likely that many of the epidemiological 

35

studies will produce results that are inaccurate or difficult to interpret when they’re finished. 

Another large number of the studies—about a third of them—are 

pursuing the hypotheses that stress is a major contributing factor 

to the illnesses. We didn’t find this research supportive of the Presidential Advisory Committee’s conclusion that stress is a major contributing factor to the range of symptoms the veterans are reporting. And some hypotheses, such as symptoms are due to exposure 

to pesticides and chemicals used in the Gulf war, were initially 

funded only with private funds. 

The bottom line is that not much of the research as currently 

being carried out is going to result in answers on how best to treat 

these illnesses. And it is unlikely to reveal the causes of the illnesses when the research is finished. 

Our third issue drew the most controversy. We found the support 

for some official conclusions regarding stress, Leishmaniasis, and 

exposure to chemical agents was weak or subject to alternative conclusions. We believe you should not close the doors prematurely to 

causes without evidence. Six years after the war, we know little 

about the causes of the illnesses conclusively. The link between 

stress and the veterans’ physical symptoms is not well-established. 

The prevalence of post traumatic stress disorder may be overestimated. 

Leishmaniasis needs to continue to be considered as a possible 

future risk, since it can lie dormant for up to 20 years. And there 

is substantial evidence that organophosphate compounds, which 

were in pesticides used during the war and in chemical nerve 

agents Iraq possessed, might be associated with delayed or longterm health effects. A number of the veterans were evidently exposed to chemical fallouts. And although we have no evidence that 

they used it, Iraq had weaponized the biological agent aflatoxin, 

whose health effects appear years after exposure, generally in the 

form of liver cancer. 

I would like to spend a little bit of time talking about the methodology we used in doing our research. To address the first evaluation question—whether DOD and VA had a way of following up 

and knowing whether the veterans were in better health now or 

worse health than they were when they were first examined—we 

reviewed the literature, agency documents, conducted structured 

interviews with DOD and VA officials. We asked some questions 

designed to identify and contrast their methods for monitoring the 

quality and outcomes of treatment and diagnostic programs and 

the health of the registered veterans. 

For our second objective, which concerns the coherence of the research strategy of the Government, to answer the question we conducted a systematic review of pertinent literature and agency documents and reports. We also interviewed representatives of the Persian Gulf Veterans Coordinating Board research working group 

and officials of VA, DOD and the Central Intelligence Agency. We 

surveyed primary investigators—over 70 percent of them—who 

were doing the epidemiological studies. 

And because of different methodology standards applied to various types of research and because of the overwhelming majority of 

36

federally-sponsored researches categorized as epidemiological, we 

limited our survey to those responsible for those studies. 

With the help of an expert epidemiological consultant, we devised 

a questionnaire which assessed critical elements of those studies, 

including quality of exposure measurement, specificity of the case 

definition, steps taken to ensure adequate sample size, and specific 

problems that the primary investigators may have encountered in 

implementing their studies. 

We also reviewed and categorized descriptions of all 91 projects 

which were identified by April 1997, based on their apparent focus 

and primary objective. And finally, to review the progress of the 

major ongoing research efforts, we visited Walter Reed Army Institute of Research, the Navy Health Research Center, and two of 

VA’s environmental hazards research centers. 

On the third objective, we reviewed the major conclusions of the 

PGVCB and the Presidential Advisory Committee to determine the 

strength of evidence supporting their major conclusions. The purpose of this review was not to critique their efforts, per se, but 

rather, to describe the amount of knowledge about the illnesses 

that has been generated by research 6 years after the war. We reviewed these conclusions because they are the strongest statements 

that we found on these matters by any official body. 

The Presidential Advisory Committee’s report was significant because the panel included a number of recognized experts. It was assisted by a large staff of scientists and attorneys. And in addition, 

they conducted an extensive review of the research. Thus, we believed that evaluating those conclusions would provide important 

evidence about how fruitful the Federal research had been thus far. 

We reviewed scientific literature and we consulted experts in the 

field of epidemiology, toxicology, and medicine. To ensure that the 

staff conducting this work had the appropriate backgrounds, we 

staffed this job with staff who had expertise in epidemiology, psychology, environmental health, toxicology, engineering, weapon design, program evaluation and methodology. 

And in addition, using the process we have to bring in experts 

that we don’t have assigned full-time on a job but whose expertise 

we can use when needed in conducting our research, we included 

experts from our organization who have expertise in chemical and 

biological warfare and military health systems. We also had medical experts review our work. And we had extensive discussions 

with experts in academia in each of the substantive fields relevant 

to the issue. 

And finally, we talked to a number of authors of the studies that 

we cited in the report to ensure that we had correctly interpreted 

their findings. And we had independent experts review our draft 

report. In addition, we were in compliance with all of the general 

practices and policies that we have inside of GAO to ensure that 

we had quality assurance in doing our work. 

I will now spend some time talking about the fact that DOD and 

VA have no systematic approach to monitoring the Gulf war veterans’ health after the initial examination. Over 100,000 of about 

the 700,000 Gulf war veterans have participated in the VA and 

DOD examination programs. Nearly 90 percent have reported a 

wide array of health complaints and disabling conditions. 

37

Most commonly reported symptoms are fatigue, muscle and joint 

pain, gastrointestinal complaints, headaches, skin rash, depression, 

neurological and neurocognitive impairments, memory loss, shortness of breath, and sleep disturbances. Officials in both DOD and 

VA claim that regardless of the illnesses, the veterans are receiving 

the appropriate treatment. 

Both agencies have tried to measure and ensure the quality of 

their initial examinations through standards such as training that 

is given to medical physicians and the standards for physician 

qualification. However, these mechanisms don’t ensure a given 

level of effectiveness for the care that is provided or permit identification of the most effective treatments. 

We found they had no monitoring mechanisms for determining 

the quality, the appropriateness or the effectiveness of the care 

that they’re getting after the initial examinations. 

We believe such monitoring is important because undiagnosed 

conditions are not uncommon among the ill veterans, and treatment for the veterans with undiagnosed conditions is based on 

their symptoms. And veterans with undiagnosed conditions or multiple diagnoses may be seeing multiple providers. And without the 

followup, we cannot say whether these ill veterans are any better 

or worse today than they were when they were first examined. 

The issue—I’ll spend a little time now delving a little deeper into 

the second issue, which is that the Federal research strategy lacks 

a coherent approach. As I said earlier, we do not believe that the 

illness and the factors that might have caused the problems have 

been pursued proactively. And although the health problems began 

surfacing in the 1990’s, the vast majority of the research was not 

initiated until 1994 or later. 

Although many of the—we have about 91 studies ongoing—over 

four-fifths of them are not yet complete. And many of the results 

will not be available until the year 2000. We found that some of 

the hypotheses received early emphasis while some hypotheses 

were not initially pursued. The research on the exposures to stress 

received early emphasis. And research such as research on lowlevel chemical exposure was not pursued until it was legislated, in 

1996. 

The failure to fund some research cannot betray us to the absence of investigator submissions. There were proposals. According 

to the DOD officials, three recently funded proposals on low-level 

chemical exposure had previously been denied funds. And we found 

that additional hypotheses were pursued in the private sector. A 

substantial body of research suggests that low-level exposure to 

chemical warfare agents or chemically related compounds such as 

pesticides is associated with delayed or long-term health effects. 

Regarding the delayed health effects of organophosphates, the 

chemical family that’s used in many pesticides and chemical warfare agents, there is evidence from animal experiments, studies of 

accidental human exposures and epidemiological studies of humans 

at low-level exposures that certain of these compounds, including 

sarin nerve agents, to which some of the troops may have been exposed, cause delayed chronic neurotoxic effects. 

It has been suggested that the ill-defined symptoms experienced 

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layed neurotoxicity. This hypothesis was tested in a privately supported study. In addition to clarifying the patterns among veterans’ symptoms by using statistical factor analysis, the study demonstrated that vague symptoms of the ill veterans are associated 

with objective brain and nerve damage compatible with the known 

chronic effects of exposure to low levels of organophosphates. 

And it further linked their illnesses to exposure to a combination 

of chemicals, including nerve agents, pesticides, and flea collars, 

DEET, which is a roll-on insect repellant, and PB tablets. Toxicological research indicates that PB, which the Gulf veterans took 

to protect themselves against the immediate life-threatening effects 

of nerve agents, may alter the metabolism of organophosphates in 

ways that activate delayed chronic effects on the brain. 

Moreover, exposure to combinations of these chemicals has 

shown in animal studies to be far more likely to cause morbidity 

and mortality than any of the chemicals acting alone. We found 

that the bulk of the ongoing research in the illnesses focuses on the 

epidemiological study of the prevalence and the cause of the illnesses. I discussed that earlier, so I will move on into some of the 

things that we have noted as challenges to the researchers who are 

conducting these studies. 

First, as I said, they found it difficult to gather information about 

exposures to such things as oil well fire smoke and insects carrying 

infection. DOD has acknowledged that the records of the use of PB 

and vaccinations to protect against chemical and biological warfare 

exposures were inadequate. There is research going on right now 

to try to find the majority of the records, which seem to be missing. 

Gulf war veterans were typically exposed to a wide array of 

agents. And it’s difficult to isolate and characterize the effects of 

the individual agents or to study their combined effects. Most of 

the studies on the Gulf war veterans’ illnesses have relied only on 

self-reports for measuring most of the agents to which they have 

been exposed. And it is difficult years after the war to be accurate 

and not to be biased about the recollection of what in fact they 

were exposed to during the time that they were over in the Gulf. 

As a result, the findings from these studies may be spurious or 

equivocal. Classifying the symptoms and identifying illnesses of 

Gulf war veterans has been difficult. From the outset symptoms reported by the veterans have been varied and difficult to classify in 

one or more distinct illnesses. Moreover, several different diagnoses 

may provide plausible explanations for some of the specific health 

complaints. 

It has thus been difficult to develop a case definition—that is, a 

reliable way to identify individuals with a specific disease. And this 

is a criterion for doing effective epidemiological research. 

In summary, as I stated earlier, the ongoing epidemiological research will not be able to provide precise, accurate, and conclusive 

answers regarding the causes of the illnesses because of these formidable methological problems. 

I’ll move now to our last area of investigation, which was the 

support for key Government conclusions, which we found to be 

weak and subject to alternative interpretations. As I had mentioned, we looked at the conclusions drawn by the Presidential Advisory Committee because this is the major printed statement 

39

about the Gulf war illness and the research that was being endorsed. 

DOD endorsed the Committee’s conclusions about the likelihood 

that exposure to 10 commonly cited agents contributed to the explained and unexplained illnesses of the veterans. We found evidence to support three of these conclusions either weak or subject 

to alternative interpretations. And I’ll discuss those now. 

First, the Committee concluded that stress is likely to be an important contributing factor to the broad range of illnesses currently 

being reported by the Gulf war veterans. But while stress can induce physical illness, the link between stress and these veterans’ physical symptoms has not been firmly established. For example, 

a large scale federally funded study concluded that for those veterans who deployed to the Gulf war and currently reported physical symptoms, neither stress nor exposure to combat or its aftermath bear much relationship to their distress. 

The Committee stated that epidemiological studies to assess the 

effects of stress invariably found higher rates of post traumatic 

stress disorder in Gulf war veterans than among individuals in 

nondeployed units or in the general U.S. population of the same 

age. Our review indicated that the prevalence of PTSD among the 

veterans may be overestimated due to problems in the methods 

they use to identify it. 

Specifically, these studies to which the Committee refers have 

not excluded other conditions such as neurological disorders that 

produce symptoms similar to PTSD and can also elevate scores on 

the key measures of the PTSD. Also the use of broad heterogeneous 

groups of diagnoses in data from DOD’s clinical program may contribute to overestimation of the extent of the serious psychological 

illnesses among the Gulf war veterans. 

Second, the Committee concluded that it’s unlikely that infectious diseases endemic to the Gulf region are responsible for longterm health effects on the forward veterans except in a small number of known individuals. Similarly, the PGVCB concluded that because of the small number of reported cases, the likelihood of 

Leishmania tropica as an important risk factor widely reported has 

diminished. While this is the case for observed symptomatic infection with a parasite, the prevalence of asymptomatic infection is 

unknown. 

And such infection may re-emerge in cases in which the patient’s 

immune system becomes deficient some time in the future. As the 

Committee noted, the infection may lie dormant up to 20 years in 

the human system. And because of this long latency, the infected 

population is a hidden population and even in classic forms of 

Leishmaniasis, it’s difficult to recognize. We believe that it should 

be retained as a potential risk factor for individuals who suffer 

from immune deficiency. 

Third, the Committee concluded that it’s unlikely that the health 

effects reported by many of the veterans were the result of biological or chemical warfare agents, depleted uranium, or oil well fire 

smoke, pesticides, petroleum products, and PB or vaccines. However, our review of the conclusions indicated that while the Committee found no evidence that biological weapons were deployed 

during the war, the United States lacked the capacity to promptly 

40

detect biological agents, and the effects of one agent, aflatoxin, 

would not be observed for many years. And this agent was 

weaponized by the Iraqis. 

Evidence from various sources indicates that chemical agents 

were present at Khamasiyah, Iraq and elsewhere on the battlefield. 

The magnitude of the exposure to chemical agents has not been 

fully resolved. And as we recently reported, 16 of the 21 sites categorized by the Gulf war planners as nuclear, biological, and chemical facilities were destroyed. 

However, the United Nations Special Commission found after 

that war that not all the possible NBC target had been identified 

by U.S. planners. The Commission has investigated a large number 

of the facilities suspected by the U.S. authorities as being NBC-related. And regarding those, the Commission has not yet inspected, 

we determined that each was attacked by coalition aircraft during 

the Gulf war. And one of these sites is located within the Kuwait 

theater of operation in close proximity to the border where coalition 

ground forces were located. 

Also, exposure to certain pesticides can induce a delayed neurological condition without causing immediate symptoms. And available research indicates that exposure to PB can alter the metabolism of organophosphates. This is the chemical family of some of 

the pesticides that were used in the Gulf war as well as certain 

chemical warfare agents. The metabolism can be altered in ways 

that enhance chronic effects of the brain. 

In our report we have three recommendations coming from the 

work that I have just described. First, because of the number of 

Gulf war veterans who continue to experience illnesses and that 

these illnesses may be related to their service in the war, we recommended that the Secretary of Defense and the Secretary of Veterans’ Affairs set up a plan for monitoring their clinical progress 

so that we can help promote effective treatment, better direct the 

research agenda, and we also recommended they give greater priority to research on effective treatment for the ill veterans and on 

low-level exposures to chemicals and their interactive effects and 

less priority to further epidemiological studies. 

We also recommended that the Secretaries of Defense and Veterans’ Affairs refine the current approaches of the clinical and research programs for diagnosing PTSD consistent with suggestions 

recently made by the Institute of Medicine. The Institute noted the 

need for improved documentation of screening procedures and patient histories, including their occupational and their environmental exposures and the importance of ruling out alternative 

causes of impairment. 

Mr. Chairman, this concludes my prepared remarks and Dr. 

Sharma and Mr. Chan will be happy to help me answer questions 

that you may have at this time. 

[The prepared statement of Ms. Heivilin follows:]

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Mr. SHAYS. Thank you very much for your testimony. I’m struck 

by the fact that you broke a basic rule of investigators that are trying to get at the truth in this sense: An individual who is investigating political corruption in a community and determined that 

there were about 250 people who had been corrupted by the process 

of civil service, getting promotion, buying their way; he said he succeeded because in the end what he did was just went after one at 

a time. And the others hid behind the rocks. And then he tipped 

that rock. Finally, they realized that he was going after all of them, 

but by then it was too late. 

You have had a very clear criticism of not just the VA but the 

DOD and the Presidential Advisory Commission on Gulf War Illnesses. I don’t think you have many friends left in that community. 

And I’m concerned about it, frankly. But I congratulate you for 

your courage. And I know that your report will be thoroughly digested by many. In the end, I think that it will result in some significant progress. So I really am in awe of your courage, frankly. 

In your statement on page 18—let me just say one more thing. 

It is no accident that this committee is the one that has had now 

our ninth hearing on Gulf war illnesses. And the reason is that we 

oversee the Department of Veterans’ Affairs for waste, fraud, and 

abuse. We’re not the statutory committee that provides legislation. 

We’re not the appropriators. 

I have found a tremendous reluctance in Congress on the part of 

the Armed Services Committee in the House and the Senate to 

thoroughly examine the DOD and its work because of the relationship that exists between that committee and the DOD. I have 

found a surprising reluctance on the part of the Veterans’ Administration Committee to thoroughly examine what the Veterans’ Administration has done. I have found a reluctance on the part of individuals to look at what the CIA has done, and, frankly, the Advisory Committee as well—the President’s Commission. So this is a 

very refreshing opportunity for us to have you look at all three and 

point out some very, very serious problems with the work of these 

departments. 

Now, on page 18 you talk about—actually it begins on 17. You 

talk about ‘‘evidence from various sources indicates that chemical 

agents were present at Khamasiyah, Iraq, and elsewhere on the 

battlefield. The magnitude of the exposures to chemical agents has 

not been fully resolved. As we recently reported, 16 of the 21 sites 

categorized by Gulf war planners as nuclear, biological, and chemical facilities were destroyed.’’ And then you go on. ‘‘However, the 

United Nations Special Commission found after the war that not 

all the possible NBC targets had been identified by U.S. planners.’’

What do you mean first by that? What do you mean, had not 

been identified? There are more than 16? 

Mr. CHAN. Let me try to explain the number system here. 

Mr. SHAYS. Yes. 

Mr. CHAN. One is the 21 targets that we’re talking about, the 

sites. Those were the sites considered before the war as NBC targets. And I cannot talk about what the combination—how many of 

each. At the same time—— Mr. SHAYS. I’m not looking for a breakdown of nuclear, biological, 

or chemical. 

68

Mr. CHAN. Right. 

Mr. SHAYS. But there were 21 sites before the war. 

Mr. CHAN. But in fact, what we did is found out after the war, 

that DOD had identified 34 so-called suspected sites where chemical weapons could have been either stored or placed somewhere. 

And it’s with those 34 sites that we went to the CIA, the DIA, and 

UNSCOM to ask, how many of these sites had been inspected and 

what did they find in those sites. 

It is through that process we found that not all the sites had 

been inspected by the United Nations. You don’t want me to go 

through that litany over what happened, but—— Mr. SHAYS. Not all of the 34 sites? 

Mr. CHAN. Right. 

Mr. SHAYS. How many were inspected? 

Mr. CHAN. Initially CIA told us a number. 

Mr. SHAYS. They did not tell you a number? 

Mr. CHAN. Yes, they did. But then they decided it’s secret, classified, subsequently. 

Mr. SHAYS. OK. 

Mr. CHAN. So I cannot tell you how many were not inspected. 

Mr. SHAYS. Right. 

Mr. CHAN. Whereupon, they identified the sites. And since they 

obtained the information by UNSCOM they classified those 

uninspected sites as secret NONFOR. That means no foreigners 

can see it. So as a result, we went back to the U.N. and asked them 

to tell us. And they directed us to the DIA for that set of information. DIA, in turn, said, no, you’re incorrect, CIA didn’t tell you the 

accurate numbers—in fact, all 34 sites have been inspected. 

Whereupon, they directed us to a specific person in CIA to confirm that fact. And we went back to CIA, and CIA sent us a memo 

saying, we stand by from our first letter that was sent to you, 

which was classified. So, we are left with two sets of information. 

And whereupon, I sent a letter to the U.N. asking them, listing all 

the sites and saying, to check the ones they inspected. 

And they came out with a different set of numbers, which is a 

little more than the CIA, but confirmed, in fact, these were 

uninspected sites. So what I did is ask our own staff to investigate 

and look at the data in terms of bombing. In our own study for a 

different one we have over one point some-odd million pieces of 

data on every single bomb wherever it was dropped and when and 

so on. And we confirmed that those uninspected sites had been 

bombed by allied aircraft. 

So as a result, we said, OK, then, why weren’t they inspected if 

they were bombed and they were suspected chemical sites? Whereupon, United Nations basically said, you know, the inspection criteria is our own, not of the United States, which we accept. But 

in our report to you, in this report we issued today, basically, we 

just said that we left that issue open. Because we really don’t 

know—one—whether there were, in fact, chemicals stored in that 

place. And we were disallowed in telling you where it is, because 

while we were told it was not really classified, per se, but, in fact, 

it’s highly sensitive for people to know what it is. And so that’s the 

language we arrive at in our final report. Did I answer your question? I’m just as confused. 

69

Mr. SHAYS. Well, no. We’re not going to be confused by the time 

we’re done here. Maybe not today. 

Mr. CHAN. OK. 

Mr. SHAYS. Really, what you’re describing to me is as blistering 

as your report appears to be, you left out a lot of very interesting 

information that needs to be examined. 

Mr. CHAN. Yes. 

Mr. SHAYS. And what you can say on the record—and we’ll sort 

out the differences and what’s secret and what isn’t later—that 

originally we went in thinking there were 21 sites. We realized 

during the process of the war there were 34 potential sites. And 

that right now we do not have a clear picture as to how many of 

those sites were actually examined after the war. Is that correct? 

Mr. CHAN. Right. And the United Nations basically agrees that 

some of these sites were not inspected by them. 

Mr. SHAYS. And let me just say, so not only do we not know if 

all of them were done, we do know that some weren’t. 

Ms. HEIVILIN. Right. 

Mr. CHAN. Right. Correct. 

Mr. SHAYS. I mean that’s fair. So therein lies the next 

Khamasiyah potentially. 

Mr. CHAN. Right. 

Mr. SHAYS. If any of them particularly were in the theater of the 

Kuwait battle. Now, were any of those sites in that theater? 

Mr. CHAN. No. They were not. 

Mr. SHAYS. None of those sites were? 

Ms. HEIVILIN. In Kuwait? Was that your question? 

Mr. SHAYS. Pardon me? 

Mr. CHAN. They were not in Kuwait. 

Ms. HEIVILIN. They are not in Kuwait. 

Mr. CHAN. In Iraq. 

Mr. SHAYS. No, but in the Kuwait theater. 

Mr. CHAN. Oh, theater of operation. Yes. 

Ms. HEIVILIN. Yes. 

Mr. SHAYS. So in other words, our troops went outside of Kuwait, 

obviously. I care where our troops were. 

Mr. CHAN. Yes. 

Mr. SHAYS. Where our troops were, I call that the Kuwait theater. 

Mr. CHAN. Theater of operation, yes. 

Mr. SHAYS. Theater of operation. OK. Were any of those sites in 

that theater of operation? 

Ms. HEIVILIN. Yes. 

Mr. CHAN. Yes. 

Mr. SHAYS. In addition to Khamasiyah? 

Mr. CHAN. Yes. 

Mr. SHAYS. Now, in Khamasiyah, the only reason that was 

known today was that a veteran actually who was there in the 

demolition team—— Mr. CHAN. Mm-hmm. 

Mr. SHAYS. Because the difference in some of these sites is—that 

in some of these sites we bombed them and destroyed them that 

way. 

Mr. CHAN. Correct. Yes. 

70

Mr. SHAYS. So we were kind of a ways from it. Then the question 

was, which way did the plumes go? And we know they went in 

some direction. And we’re pretty sure they didn’t all go in the direction we originated before. 

Now, the significance of Khamasiyah is, that that was the site 

where our soldiers actually went right up to it and laid the charges 

and blew it up. 

Mr. CHAN. Mm-hmm. 

Mr. SHAYS. And when they blew it up, some originally were 3 

miles away or closer—much closer in fact—and as they blew this 

up they started to go farther away because you had artillery shells 

and so on going 6 miles and beyond. You had rockets that were 

going beyond the 6 miles. And you had a soldier who had pictures 

and identified the fact that this was also a chemical depo. 

The reason why this information became public was that this soldier was invited to our hearing, had the video, had gone to the 

media, and was to testify on a Tuesday. On a Friday afternoon, at 

4 o’clock after an announcement that the DOD would have an important announcement at 12—at 4 o’clock on a Friday afternoon—

announced for the first time that our troops may have been exposed to chemicals—defensive. 

Now, what’s fascinating is that the CIA Director at the time had 

said that there was no offensive exposure to chemicals, which is a 

wonderful work that allows him to not be in violation technically 

of the law because the difference between offensive and defensive. 

We blew up this depo. Now, is your testimony that there were 

other chemical plants potentially or biological plants or depots in 

the Kuwait theater of operation that may not have been examined? 

Mr. CHAN. Yes. But let me correct it. This is in regards to chemical sites only, not biological sites. 

Mr. SHAYS. OK. A chemical site like Khamasiyah. 

Mr. CHAN. Yes. 

Mr. SHAYS. So the word is still out as to whether there’s another 

Khamasiyah? 

Mr. CHAN. I think one can draw the conclusion that we don’t 

know what is there since it wasn’t inspected. And our report states 

that we intend to address this question and find out the reason 

why. 

Mr. SHAYS. Who intends to examine this question? I missed who 

he said. 

Ms. HEIVILIN. We’re still looking into it. 

Mr. CHAN. It’s an open question in our report that’s incomplete. 

And this is a different report. And I left the language saying, 

there’s an open question, we—implying GAO—will examine it, because it’s open. I didn’t want—it may be nothing, it may be something. And that’s the implication. 

Mr. SHAYS. OK. At this time let me call on Mr. Sanders. 

Mr. SANDERS. There’s so much to discuss and so little time. Mr. 

Chairman, let me briefly, before I ask our guests a question, let me 

briefly summarize something. And then I would like them to respond to it. The Presidential Advisory Committee ruled that stress 

is the likely cause of Persian Gulf illnesses and that chemicals and 

other types of exposure are likely not to have caused the problem. 

71

Very briefly, let me read very short summaries of a number of 

studies. 

Robert Haley, M.D., University of Texas: This research project 

that he did concluded that many veterans are suffering from three 

primary syndromes due to subtle brain, spinal cord, and nerve 

damage, but not distress. You dealt with—I know you talked to Dr. 

Haley. 

Muhammad Abudonia, a Duke pharmacologist—his summary 

conducted on hens concluded that pyridostigmine bromide in combination with DEET and hermathrine cause neurological deficits in 

the test animals which are similar to those reported by Gulf war 

veterans. You’ve talked to him as well, I believe, or at least studied 

his work, right? 

In 1995, the DOD published its own study which concludes, ‘‘There is a significant increase in the lethal effects in rats given 

pyridostigmine bromide, hermathrine and DEET simultaneously.’’ You may have been familiar with that study, as well, right? 

More recently, Dr. Abudonia conducted another research project. 

And this showed that when rats were given pyridostigmine bromide and then put in stressful conditions—which, God knows, is 

what existed in the Persian Gulf—pyridostigmine bromide was able 

to cross the blood brain barrier leading to suppressed ACHE levels. 

Another study conducted by Friedman, Coffer, Shemer and others at the Hebrew University in Israel presents evidence that 

stress may make the blood brain barrier permeable to PB. Dr. 

Garth Nicholson, University of Texas, conducted research which indicates that many of the symptoms of Gulf war syndrome may be 

caused by chronic pathogenic microplasma infections. 

Dr. Satu Somani, who testified before this committee, sat just 

where you do—he writes or tells us that ‘‘Experimental proof and 

historical evidence of symptoms such as impaired concentration 

and memory, headache, fatigue and depression of the workers who 

worked in the organophosphate industry with those considerations, 

I consider that illness associated with Gulf war veterans may be 

due to low-dose sarin exposure and intake of pyridostigmine and 

exposure to pesticides and other chemicals.’’

And on and on and on it goes. So my first question: Given what 

amounts to over a dozen different studies, how does the DOD, the 

VA, and the Presidential Advisory Committee continue to believe 

that stress alone is the cause of Persian Gulf illness? 

Ms. HEIVILIN. That’s the question we have also. And I don’t think 

we really have an answer to why they continue to believe as they 

believe. Actually, what you’re suggesting goes to the conclusion, 

and the recommendation we have that they move their research so 

that they are putting less emphasis on epidemiological studies and 

more emphasis on treatment and causes of the nature that you are 

suggesting. 

Mr. SANDERS. I mean, are these researchers and the others, are 

they quacks? Are they dummies? Are they not held up in respect 

in the scientific community? Should we throw out all of that research, or is this useful research? 

Mr. CHAN. Well, I think if I can go back to the PAC’s comment 

to our report and also to their own report, which is one of the criteria that they use in selecting research articles that they examine 

72

and include in their findings—in fact, peer review reports. And the 

list you have, many of them are, in fact—were peer reviewed. And 

so it does not satisfy the requirement why they were excluded. And 

I think if you look at on page 44 and 45, we list over a dozen-anda-half different articles that we cite similar to what you have stated. And we found that at least there are plausible evidence that 

suggest otherwise. 

I must add a quick comment in your question is that why we 

don’t know the reasons why they included and excluded articles. 

It’s certainly our criteria, our methodology is—is that when one 

draws these conclusions, one must ask, are there conflicting data 

and results out there? And when we found that, we try to reserve 

behind it and examine those information, speak with the authors 

and so on, make sure we didn’t misinterpret their stuff, and ultimately raise the question is, when something is uncertain, we 

would leave that stone still assume is unturned. OK? And that’s 

the way we approach it. 

And maybe that’s why we used the word ‘‘possibly’’ open for interpretation, because we did not try to attempt to see why some of 

these articles were excluded. 

Mr. SANDERS. Thank you. One of the areas of frustration—and 

I think you make this point in your report—is that we have lost 

so much time. 

Ms. HEIVILIN. Yes. 

Mr. SANDERS. So much time. Let me mention something to you. 

And I would appreciate if you might comment. In 1993, in invited 

testimony before the Subcommittee on Oversight and Investigations of the Committee on Veterans Affairs, Dr. Claudia Miller, 

who is at the University of Texas, called for a specialized research 

facility, an environmental medical unit, in order to test scientifically whether ill Gulf war veterans were sensitive to very low levels of common chemicals, as many of them were reporting. 

Although congressional appropriations for half the cost of the facility were obtained through a bipartisan effort and DOD agreed to 

fund the remainder, DOD failed to implement the project. No such 

research facility currently exists that would allow physicians to diagnose or rule out chemical sensitivity in the veterans. 

She came forward with this proposal which received initial approval in 1993. This is 1997. We still have not even done that. 

Would you want to comment on that? 

Ms. HEIVILIN. Well, it’s impossible for us to audit or to evaluate 

and know precisely the motivations of people. What we look at—

and that’s what you’re telling us about—is we look at the actions 

and we look at the programs and we look at the results of those 

actions and programs. And again, when we looked at the research, 

we found that the research was very heavily focused in a couple of 

areas and there was very little research going after the kinds of 

things that you’ve just been describing to us. 

As to what the motivations were for the agencies in doing what 

they did do, we really can’t attest to that. 

Mr. SANDERS. OK. Now, I’m going to ask you a really hard question. I think one thing—you know, as I’ve said a million times, this 

chairman over here is responsible for as many of the breakthroughs as any Member of Congress, and I’m delighted to serve 

73

with him. And I think what neither he or I or any other member 

of this committee wants to do if we come back here is 2 years and 

4 years from now go over the same discussion again, and beat up 

on the DOD and beat up on the VA and so forth and so on. 

Ms. HEIVILIN. Mm-hmm. 

Mr. SANDERS. Now, I personally—and I speak only for myself—

have reached the conclusion that for whatever reason—and we can 

speculate something, for example, that there is reluctance for the 

DOD to go forward in this area because they, in fact, administered, 

among other things, pyridostigmine bromide. Right? And we all 

know that nobody ever intended to do any harm to our own people. 

There’s no question about that. 

But if they are the folks who administered pyridostigmine bromide to hundreds of thousands of vets, there may in fact be consciously or unconsciously a reluctance to go forward, which might 

suggest that that drug in combination with other chemicals may be 

part of the problem. 

Whatever the case may be, do you think, based on your analysis, 

that DOD and VA are in fact capable of getting to the root of the 

problem, capable not only of giving us an understanding of the 

cause of the problem, but of developing, more importantly, a treatment? One of the frustrations that many of us have had—we want 

treatments. Maybe not all the treatments will work. But I have 

mentioned, and others know of, different treatments out there 

which might be experimental. 

When I talk to veterans who are hurting, they say, hey, give us 

a shot at it, maybe it works, maybe it doesn’t work. But why don’t 

we have the opportunity to take advantage of those treatments? 

Now, I have reached the conclusion that the DOD and VA, for 

whatever reason, are not going to be able to do the right thing. Do 

you want to give us your view? Do you think that they’re capable? 

Should we continue to go forward with them or look or other agencies? 

Ms. HEIVILIN. We’re certainly not seeing evidence of a nature 

that says that they’re moving out smartly on these issues. Maybe 

as an example in a related area—there were two other reports we 

did as a result of this mandate in the armed services legislation 

last year. And one of them was to look at what the progress was 

in coming up with vaccines or anti-agents for future chemical and 

biological agents that our soldiers, sailors, and airmen might encounter in the future. 

It’s a classified report, but I’ll talk about what I can in an unclassified way. Basically, we looked at all of the known biological 

agents held by nations that we could possibly go to war with or 

that are unfriendly with us, not only that hold, but ones that could 

be quickly produced. And we looked at where DOD was in having 

FDA approved drugs—investigational drugs—and only something 

in R&D. 

And in the last few years, there has been absolutely no progress. 

Over a number of years, there has been no progress. We made a 

recommendation that they move out smartly, so to speak. And they 

agreed with us. But as I said, there’s been no progress over the last 

few years. 

74

Mr. SANDERS. Mr. Chairman, I’m going to stop speaking here in 

a moment. 

Mr. SHAYS. You have the floor. 

Mr. SANDERS. Oh, I have the floor. Let me just say this, Mr. 

Chairman. You know, when a coach on a basketball team or a 

manager on a baseball team continues to produce a losing record, 

we can sit down and talk to the coach or the owners of the team 

sit down and talk to the manager, but finally at a certain point you 

make the conclusion whether that individual is capable of doing the 

right thing for his team. 

Well, we are the owners of this team. And we have an obligation 

to tens and tens of thousands of men and women who put their 

lives on the line defending this country to do the right thing by 

them. And I have concluded, not with a great deal of happiness, 

that, for whatever reason, the VA and the DOD are not going to 

do the right thing. 

I think it is a waste of our time to keep kicking and prodding 

and pushing and questioning them. We can do that for the next 20 

years. I think ultimately we have got to conclude that there are 

some serious researchers out there, some people with minimal research who have done some cutting edge work. There are perhaps 

institutes within our own Government, such as the National Institute of Environmental Health Sciences, who want to go forward. 

I think other Members of Congress share our frustration. I would 

think that the best thing that we can probably do right now is conclude that the DOD and the VA are not going to do the right thing, 

for whatever reason, find people in Government and in the private 

sector who can work together on an emergency basis. One of the 

frustrations that I’ve had—and I think I hear that from you as 

well—is that there is no sense of urgency. 

Studies come out which indicate something. And what’s the plan? ‘‘Well, we’ll continue to do studies. And maybe in 5 years we’ll have 

another study.’’ Where does it end? Where are the—unless I am missing something, Mr. Chairman, one would have thought that after all of this 

time, we would be hearing reports of a dozen different treatment 

protocols, some of which may be working, some of which may not 

be working. Right? It seems to me what we would have been hearing if one believed that there was a sense of urgency. 

And I don’t think that the DOD or the VA have that feeling. So 

I think we owe it to work with our colleagues in the House to go 

outside of the DOD and VA, develop a sense of urgency, get some 

funding, get some time lines for those people who are willing to 

look at many of the questions that the GAO have asked. And I just, 

at this point, want to thank all of you. Yes, Mr. Chan? 

Mr. CHAN. Let me give a different perspective. I think so far 

what we have been discussing may be sort of half of the pie and 

not the entire thing. And I’m sensing that a lot of the criticisms 

that we’re making on the health research, they are what scientists 

call systematic, deliberate, bring the evidence forward and arrive 

at some conclusions. 

And that’s a very noble approach to solve a problem. The trouble 

that we’re seeing that when you have multiple agents with mixes 

that everybody agrees, to solve the factorial answer, what are the 

75

various combinations without knowing the dose response and all 

that stuff, we’re saying that, basically, you can’t take step 1 to 2 

to 3 to 4, but you may have to jump over the hoop of No. 3 because 

we cannot establish cause and effect. 

Now, it’s the paradigm you go through to examine these things 

in that light. And what a lot of the official agency’s comment was, 

we have not seen evidence of this, so, therefore, we don’t do the research. Now, there’s a different side of that pie, which is pushing 

without much debate, is, in fact, what exactly happened in that 

war? What are the operational possibilities? What is it that the 

enemy, the Iraqis, what they could have done? Could they have 

used chemicals? Could they have used biological? 

And it suggests something a little different. Now, one can take 

that and say, let’s make that assumption and move ahead with research rather than re-examining potential—we need the existence 

of such things before we go and prove cause and effect. And I think 

what we are hearing—myself, anyway—from the veterans, is that, 

‘‘I was there. I saw the depleted uranium being hit and burned and 

so on.’’

Well, one can take that and say, well, there may be 10 cases or 

none, I don’t know. But why can’t we just take that and fire the 

weapon, see if, in fact, the smoke can have particles like that, see 

if, in fact, there’s a health effect as a result of toxic exposure, rather than saying, well, we found only a handful and it’s not showing 

up in the health status of these people right now, without really 

due consideration on how well the protocol is in determining 

whether they’re really sick of those things. 

So you have sort of a mismatch that, I think—it’s very difficult 

to—I don’t think that the DOD and the VA—I think that they’re 

doing the best kind of research they can given the evidence, but I 

think they’re using very strict criteria and research at arriving at 

those conclusions. So you may be right. And our concern is, if you 

can’t jump these hoops, then maybe we’ll never get there. 

Mr. SANDERS. That’s right. And let me just mention something. 

Again, I say this as somebody who is not a scientist. And I defer 

to you with your scientific backgrounds. A couple of months ago, 

sitting right up there was a gentleman named Major Donnelly from 

Connecticut, I think. And we heard a very sad and tragic story. 

And he is ill with Lou Gehrig’s Disease right now. 

And one of the things that he said which moved me is that he 

said that his symptoms became exacerbated—if my memory is correct—when he was out jogging at a military base and they were 

spraying for pesticides. It was triggered. Again, I’m not a scientist, 

but that does tell me something that we might want to investigate. 

I went home, and last month we had a conference in Vermont, 

in the State of Vermont, which we focused on Persian Gulf illness—and Bob Newman, by the way, of your staff, was there and 

did a wonderful job in speaking to our vets about what he knows 

about the problem. And I was in the room with about 15 vets in 

my small State who are hurting. And I asked him a very simple 

question. I said, tell me something, when you go out into unfriendly 

environments, do your symptoms flare up? 

76

Very simple question. I’m not a scientist. One guy said—he started laughing, because his wife was sitting next to him. He said, 

‘‘Yeah, whenever my wife puts on perfume I get sick.’’ OK? Another guy says, ‘‘Yeah, I used to work in a service station. 

I was a mechanic. I can’t work around fuel anymore. The fumes 

from fuel get me sick.’’ Another guy said—no offense to anybody from New Jersey—‘‘I 

was in New Jersey recently, around the petrochemical plants, and 

I got really sick when I was exposed to that.’’ Almost everybody in the room said that their symptoms flare. 

And what got me, and really concerns me is, I’m wondering tens 

of thousands of men and women who were over there are full of 

these toxins right now who could at least be helped if we could 

avoid—maybe this type of pesticide in your food may make you 

more ill. I don’t know. 

But to get back to your point, Mr. Chan. I think those are the 

questions that need to be pursued. We also learned in some of the 

studies that I indicated—there are at least two studies that now 

indicate—Dr. Haley being one—that there may be actual neurological damage. All right. Now, that is something that is pretty definitive, right? If somebody has neurological damage, why aren’t we 

testing now 10,000 people to see if there’s neurological damage and 

if it correlates to what we call Persian Gulf illness? Mr. Chan. 

Mr. CHAN. Well, I think the DOD comment about that study is 

that it’s sample size is small, it’s not generalizable and so on. And 

I thought that when DOD responded that way, I thought, well, 

then replicate it. 

Mr. SANDERS. Exactly. If it’s too small a study then do a big 

study. 

Mr. CHAN. If it cannot be, then we end up proving the case. I 

don’t understand that. In a logical way of research, there’s a hypothesis. And maybe it’s localized to that particular unit. 

Mr. SANDERS. Right. 

Mr. CHAN. And in fact, because of their movement, they were exposed to something entirely different while another group may 

have totally very healthy groups. I don’t know. 

Mr. SANDERS. And in Great Britain there was also another study 

which indicates neurological damage. Isn’t that correct? It would 

seem to instead of criticizing—— Mr. SHAYS. You asked him a question. 

Mr. SANDERS. OK. You think I should give him a chance to answer the question I asked him? OK. Why not? 

Mr. CHAN. Someone behind me wants to answer the question? 

Mr. SANDERS. No. You. 

Mr. CHAN. I just said that, you know, the idea of epidemological 

studies is really to generate new hypotheses and so on. And I have 

no doubt their limitations in a very small study that you refer to. 

And our own team basically said, instead of rejecting, let’s try it 

out somewhere else. And it may work, it may not work. That’s the 

approach I think we’ve been taking in regards to this report. 

Mr. SANDERS. Thank you very much. 

Mr. SHAYS. I thank the gentleman. We’re going to be coming 

back again. But Mr. Sanders has been an early and active participant in these committees and really has been an equal partner 

77

with me in this effort. There’s no Republican or Democrat in this 

process. Mr. Sanders, thank you. And Mr. Allen, you have been extraordinarily patient. And I appreciate it very much. 

Mr. ALLEN. Thank you, Mr. Chairman. I appreciate the chance 

to be here and hear what you have to say. And I’m pleased with 

the direction this conversation is going right now. Because I think 

we need a paradigm shift here. So many people think about diseases or symptoms as being caused by a single agent. There’s a 

virus, there’s a bacterium, and it produces the same kinds of symptoms in particular people. And you figure out the causation. You 

figure out the appropriate treatment. And the treatment works for 

everyone. But what we have with the Gulf war syndrome, what we 

have with the illnesses that are reported are a wide variety—almost 700,000 people went there. They were exposed to different 

chemical and biological agents at different times. And in their subsequent life, they come in contact with—whether it’s perfume or insecticide or whatever it may be—other kinds of chemicals that may 

set off a chain reaction. 

So in this case, the complicating factor, it seems to me, is that 

every case is somewhat different from every other case. And until 

we recognize that and accept it, we are going to be in trouble. And 

that’s why I thought, Mr. Chan, your suggestion for research. You 

know, even if you have only a few cases, we’re not looking for one 

common cause here. That’s not what these studies are about. We’re 

trying to figure out a combination of causes that may have certain 

kinds of effects, and then get to the basic point, which is how do 

we help the veterans who are suffering through these illnesses. 

So what I would like to do is to talk for a minute about your recommendations, particularly the first two recommendations. Where 

do we go from here? And setting aside for a moment Mr. Sanders’ suggestion that we just give up on the VA and the Department of 

Defense, let’s look at—someone’s got to do this. And one of your 

recommendations is that DOD and Veterans’ Affairs set up a plan 

for monitoring the clinical progress of Gulf war veterans. Can you 

take that a step further? 

I mean, we have hundreds of thousands of veterans out there 

being treated by doctors all around the country. How do we manage this? What steps would you take to implement that recommendation? 

Ms. HEIVILIN. I think that in responding to that, the VA, particularly, thought we were asking for a much more complicated system 

than we were asking for. But recognizing just what you said, not 

all of them are being treated in either DOD or the VA. It would 

require that you have some system for maybe statistically sampling. Or, if you think we need to get larger numbers in the group, 

going to all of them for periodic examinations, collecting information on how they’re being treated, and whether in fact they’re getting better or not. And if you had information on their symptoms 

and their treatment, and if they’re better or not, you could then do 

some comparison. 

You could go into the data base and pull out clusters of people 

that have the same symptoms, look to see if they’re being treated 

the same way and if they’re better, and you may identify from that 

some treatment that is working better than other treatments for 

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certain set groups of symptoms. We’re not asking—at least initially—for anything really complicated. 

But it would require a system for doing that. It would require 

that we get information from each of the people who have registered—maybe from their doctors—or have them fill out a form, 

periodically on what I said—follow up on what the symptoms look 

like, are they better or worse, and what treatment are they getting. 

And then we can do some comparison, some studies. 

Mr. ALLEN. So if I understand what you’re saying, you’re not saying you have to look at all 700,000, but you try to cluster some 

symptoms and look at groups that have similar symptoms and then 

try to work from that base? Is that fair? 

Ms. HEIVILIN. Yes. 

Mr. CHAN. Right now, with all the information, it looks like a 

sort of a randomized trial going out there—everybody treating everybody and not knowing any results. And some people may go outside the system and go to private physicians for the information. 

The illness analysis is not the illnesses but the individual. OK? 

That’s what you’re looking for. 

And then the question is, what are the combination of illnesses 

they have. Not that she has headaches and I, in the control group, 

also have headaches. But she may have multiple symptoms which 

I don’t have, but somebody else has. Let’s say, joint pains and so 

on. The question becomes, if they are being treated symptomatically, what is working out there? What is not working? How 

do we make sure that in fact that can be shared among others and 

so on? What’s the right way to do that? 

I don’t think we know if there are multiple symptoms out there— then there’s no magic bullet to solve these things. But if it’s going 

on already—they’re being treated—it seems like it’s one way to 

capture the information by which one can determine other successes that would be helpful for others. 

I think we sort of start off thinking not very ambitiously how 

this is. And I must say I was quite disappointed by the agencies’

disagreement with these particular points. 

Mr. ALLEN. Let me turn to the second recommendation. You suggest we should give greater priority on research on effective treatment for ill veterans and on low-level exposure to chemicals and 

their interactive effects, and less priority to further epidemiological 

studies. Can you talk to me a little bit about the epidemiological 

studies? 

I mean, they’re designed to try to figure out causation. That’s 

partly what we’re talking about. But is it because those studies, 

you feel, have been on the wrong track? You said earlier that onethird of them have been related to stress, which, in light of everything that was going on out there, you can understand. But that 

does seem overweighted. 

What kinds of research are you recommending that is different 

from the kinds of studies that have been done before and would be 

focused on effective treatment for veterans and on dealing with 

these low-level exposure to chemicals kinds of issues? 

Ms. HEIVILIN. Well, first, the epidemiological studies—you were 

asking about the problem with them. And I’m going to separate 

them from the stress studies. The epidemiological studies, the priVerDate jun 06 2002 10:37 Jul 09, 2002 Jkt 010199 PO 00000 Frm 00082 Fmt 6633 Sfmt 6602 W:\DISC\43150 pfrm15 PsN: 43150
79

mary problem, because they’re descriptive, is trying to figure out 

what the symptoms are and figure out the causes related to the exposures that the soldiers and sailors and airmen had. The problem 

is that the data is not accurate. The records from the Gulf on who 

took what vaccine when and who took what drug when is scanty. 

The records about exposures is scanty, also. And when you try 

to rely on memories of people who have been there and you start 

asking them, say, 4 years after it happened there are problems. I 

was there a month after the war and if you asked me exactly 

where I was on any particular day, I’d have to go back to my diary 

and hope that I had noted where I was and then try to remember 

what I was exposed to. But I’m sure I don’t know what I was exposed to. I have maybe a little idea. But I wouldn’t even know if 

there was something in the air some place I was, other than if I 

had happened to be in Kuwait, which I wasn’t, I was hearing people talking about how bad the air was up there when they were 

up there because of the oil fires. 

But that is what is, in our minds, resulting in or going to result 

in epidemiological studies that will have very little use, because 

we’ll have a lot of questions about the accuracy of the conclusions. 

The other group was the stress, and we had different—looking at 

stress is a primary focus, and we have problems with other things 

in looking at stress. Then your other issue was, what kind of 

work—— Mr. ALLEN. What next. Where should we go? 

Ms. HEIVILIN. I don’t think we’re recommending that they stop 

the funding of anything that’s ongoing. What we’re suggesting is 

that they shift the future funding in this area to studies that will 

do something like what we were describing for tracking the 

wellness or the illness of the veterans who were exposed. We could 

use that data and then pull out—hopefully there would be clusters 

of symptoms of people that are experiencing better health than 

other people with the same symptoms, and take a look at what 

kind of medications, what kind of treatments they’re getting. That 

would be one set of the studies. 

Then the other set would be looking at and experimenting, probably with animals, on what is the effect of some of the combination 

of chemicals that were being experienced by some of our people 

that were over in the Gulf. There is the possibility of using accidental exposures, if, in fact, that data is available for human 

beings. There’s always the problem that accidental exposures may 

not be and probably isn’t exactly like the exposures that the veterans experienced, and they may not have all of the combinations. 

So animal research is probably the area that we have to move into. 

Mr. ALLEN. Just going back to your first recommendation. 

Shouldn’t we have a major outreach effort? One of the things that 

strikes me is, when we had Major Donnelly here, who said, it acts 

up when we go out and go running. And it was a base down in 

Texas where they had just sprayed for mosquitoes, I think he was 

saying—— Ms. HEIVILIN. Mm-hmm. 

Mr. ALLEN. There may be a lot of veterans who suffer symptoms 

who don’t have a clue what the cause is. And they might be helped 

by some sort of outreach effort that said, look, you were in the 

80

Gulf, a lot of people have experienced certain kinds of symptoms—

here are the kinds of things that may set off, that may have ill effects on you that you would never attribute to your past exposure. 

But for example, whether it’s pesticides, whether it’s perfume, 

whether it’s something. 

So that some of the veterans who are out there—and they may 

not have even gone to a doctor yet. They just know that sometimes 

they feel lousy and they don’t know why they feel lousy. But it 

would be a way to call their attention to things in their environment that might help them. 

Ms. HEIVILIN. I think the more we can do of that nature, the better. We had some concerns. And we did write about it in the report 

that the registry is likely to not be complete. Some of the people 

who are on active duty might not want to register because they 

think that might affect their efficiency rating or the way they’re 

looked upon by their superiors. 

There might be other people that say, I just don’t want to do it. 

I’ll go to my own private doctor. I don’t trust whoever. It’s not going 

to do anything for me. But Dr. Sharma, I would like to invite you 

to comment a little bit more about the research that we were talking about. 

Mr. ALLEN. Yes. 

Mr. SHARMA. Let me first answer your question about the first 

recommendation. We find it quite interesting that on the one hand 

we hear that the DOD and VA really don’t know what caused this 

illness. The purpose of the Federal research strategy is to identify 

the natural course of the disease or diseases that veterans are experiencing. Now, how do you study the natural course of the disease? Obviously, you follow the patient over time to ascertain, 

whether they are getting better or worse. Whether should we do it 

through a research project or through the research that they’re getting, the fact of it is, the veterans are ill, they are receiving treatment—some of them from the VA system, some of them from the 

Federal system and DOD system, others are going on their own. 

That’s not the issue. The issue here is, those people who are within 

the system, do we know are they better or worse? And if we do 

monitor their clinical progress, not only will we have some clues 

about what made them better or worse, but also it will provide us 

some understanding of the natural course of the disease. 

During the war, veterans were exposed to multiple agents. We 

will never be able to figure it out—to what and at what level and 

for how long. But at least we can then try to follow, try to understand whether they’re getting better or worse. 

Now, as far as your second point is concerned about the type of 

research, VA, in particular, seemed to be making a point of clinical 

trial. And I wanted to re-emphasize here, we are really not talking 

about clinical trials. 

We are not talking about—veterans are not receiving treatment 

that are unproven therapies. They are receiving symptomatic treatment for something very specific, whether it be tension headaches 

or joint pains or whatever. The issue here is: are those traditional, 

proven therapies working on them? If they are not working, then 

that suggests something, that perhaps it is something very unique. 

81

It’s not a common tension headache. Perhaps it’s not a common 

gastrointestinal problem. This is something very unique. 

We seem to find this wall that from the VA’s side that ‘‘This is 

the protocol. This is the only way one could study.’’ We find this 

very difficult to accept. What we are proposing is something very 

simple, something very logical, something that’s not going to cost 

a lot of money, something that most health care providers should 

be and must be interested in—finding out whether, as a result of 

their clinical services, are people getting better. 

Mr. ALLEN. Mm-hmm. 

Mr. SHARMA. This is an issue of accountability. What are we 

doing? As a result of our efforts, are we being responsive to the 

public or not? That’s the very simple issue that we are addressing 

here in this recommendation. 

Mr. ALLEN. Thank you very much. Mr. Chairman, I have one 

more question. I just wonder if we’re doing any better in Bosnia in 

terms of recording what chemicals our troops may be exposed to 

over there. Because, although it’s not the same situation, it seems 

to me something to think about, something to deal with. 

Ms. HEIVILIN. We’ve looked at whether they’re doing a better job 

on the records of what kind of medicines and what kind of vaccines 

the troops are getting in Bosnia than they did in Saudi Arabia. 

And it is better, but it’s not good enough. And we have a report 

that we put out May 13 that discusses that. 

Mr. ALLEN. Good. Thank you very much. Thank you, Mr. Chairman. 

Mr. SHAYS. I thank the gentleman very much for his questions. 

I’m trying to sort out a few issues and have them a part of the public record. And I think I’d like to go back to where Mr. Sanders was 

just a bit. In the third hearing, on June 25, 1996, Dr. Stephen Joseph appeared before us. Now, he is now the former Assistant Secretary of Defense for Health Affairs. 

And one of the points that he made that just rings in my ear—

because it seems to me if you have this philosophy, then you’re 

really not going to go into a certain room that you need to go into. 

He said, ‘‘The most important thing that I really have to say about 

this is that the current accepted medical knowledge is that chronic 

symptoms or physical manifestations do not later develop among 

persons exposed to low levels of chemical nerve agents if they did 

not first exhibit acute symptoms of toxicity.’’

Now, in your statement you rightfully point out that the Congress—that basically, support for some—in your report, you point 

out that we didn’t look at low-level exposure to chemicals until 

1996, when it was mandated by Congress to do that. So before 

then, there was simply no work done by the DOD or VA. 

Now, the VA accepted the fact—wrongly, but accepted the fact—

that the DOD was correct when they said our troops weren’t exposed to chemicals. But even if they thought they might have been 

exposed to low levels of chemicals, it was the person in charge of 

health affairs for DOD who said that basically there’s no accepted 

medical knowledge that chronic symptoms or physical manifestations do not later develop among persons exposed to low levels of 

chemical nerve agents. 

82

Now, in my work as a State legislator, one of the most active 

things we did in the State legislative bodies was to deal with environmental chemicals in the workplace. And we were very strict in 

not allowing businesses to expose their workers to low-level chemicals because we felt, based on medical science, that low-level exposure over time results in serious illness. 

Have you all examined this issue in any way, and if so, would 

you respond to it? 

Mr. SHARMA. We looked at, first of all, the Federal research protocol, and we found that indeed there were at least three proposals 

that were submitted prior to 1996 but were not funded. And the 

argument that was given to us at the time was, because obviously 

they were not aware of Khamasiyah, and since there was no exposure, what’s the point of studying or funding those studies. 

The second thing was that the research evidence is not as clearcut. If you take a look at the PAC report—the research they have 

cited—and the research that we have cited, we have an interesting 

finding. For whatever reason, the research that we looked at, that 

we examined, which was peer-reviewed, very clearly suggests—and 

based on that we have concluded that there’s substantial evidence 

that animals exposed to low levels of chemicals do exhibit symptoms that are very similar to the kinds of symptoms that Gulf war 

veterans are experiencing. 

Now, one of the criticisms that the agencies had about this type 

of research after we sent them the draft—‘‘Well, you can’t extrapolate those results from animals to humans.’’ The fact is the symptoms are very similar to Gulf war veterans. Obviously there are 

some ethical issues. You cannot do that kind of research on human 

beings knowing that exposures have very adverse effects. So you 

have to follow the next best model. 

Can you learn something? We have some evidence from accidental exposure research. Indeed, DOD had some funded—— Mr. SHAYS. Did you look specifically at the basic principle that 

was exposed by Mr. Joseph that said that current acceptable medical knowledge is that chronic symptoms of physical manifestations 

do not later develop among persons exposed to low levels of chemical nerve agents? 

That’s the question I’m really asking. That was the guiding principle that basically let the DOD say, ‘‘We’re not going to look.’’

If people weren’t literally dying on the field, then they weren’t 

exposed to chemicals in any serious way. And if they were exposed 

to low-level chemical exposure it’s meaningless. Now, I’m just interested to know if you got into this issue. Did you all start with the 

premise that low-level exposure is serious or not serious? Enlighten 

me a little bit here. 

Ms. HEIVILIN. I think we started with the premise that nothing 

should be ruled out unless you had conclusive evidence that it 

wasn’t important or that it was not something that happened. 

Mr. SHAYS. OK. So what we have in testimony before our hearings is that soldiers said continuously that alarms went off, detecting some level of chemical exposure. Now, DOD will tell you that 

all of them were false alarms. All of them. That they were all false 

alarms. The Czechs are the only ones who seem to have some credibility in terms of their detection and because of their followup. 

83

We had individuals who were in the FOX vehicle with the better 

equipment who came in, said they detected it. And DOD minimizes 

and totally refutes the testimony of their own soldiers who were 

trained. Now, the bottom line is that the DOD has said from day 

1 that, in essence, if you didn’t have acute symptoms, if they didn’t 

see people drop on the battlefield because of chemical exposure, 

they really weren’t exposed to any serious chemical exposure because low level doesn’t result in serious illness in the future. 

That is one hell of an assumption to me. Now, we have soldiers 

who come and testify that tell us why animals were just dead all 

around with no insects on them. And when we had veterans who 

came and testified of actually having the alarms go off and going 

into a bunker, then being told they can come out of the bunker. 

They come out and there’s a mist in the air, they start coughing 

up blood, throwing up—except those who had the protective gear 

still on—and they went right back into the bunker. 

They’re being told later by the DOD that they weren’t exposed 

to chemicals. And one of the feelings that I get from your report 

is, listen to the veterans. The veterans, as far as I’m concerned, 

have been voices in the wilderness with no one listening. So I’d like 

you to just comment on that whole area. 

Ms. HEIVILIN. We’ve heard some of the same stories you have. 

And important to this area, we have a request that we’re looking 

at from the House Veterans’ Affairs Committee to look at the lost 

records, the lost documents known as CINCCOM NBC logs. Most 

of them have not been found. What we’ve found in going after that 

question is that the Defense Criminal Investigative Service is conducting a major investigation into the whereabouts and the handling of these logs, which would be an important piece of what 

you’re talking about. 

Mr. SHAYS. My concern is that when they do their work, they’ll 

then label it top secret. I don’t mean to be facetious, but whenever 

we go down an interesting little area, then we aren’t able to publicly pursue it. 

Ms. HEIVILIN. What we are doing—and this won’t be top secret— is we’re looking at all of the various groups that are looking into 

different questions in this area. And we’re going to fairly quickly 

have a matrix that is going to tell you and tell us exactly who is 

looking at what in this area, trying to come up with information 

and what they think their estimated time is for getting that information. We will then look at the gaps in the investigations going 

on, which will give us a piece of information about what needs to 

be done. 

It may not answer the questions you’re asking. One of the things 

that I think we believe is there’s going to be a lot of questions unanswered for a very long time, maybe forever in this area. 

Mr. SHAYS. The one thing that I am absolutely convinced of is 

that we are going to hold everyone accountable, including Congress 

and ourselves, that if some people feel that it’s going to take so 

long that no one is going to care in the end, and they can just outlast the various investigations, they’re just wrong. They’re just 

wrong. 

Pyridostigmine bromide—PB—and you did what I usually do, 

since I can’t say it well, I just say PB—was to protect against sarin 

84

exposure. This is a drug that is used for degenerative nerve disease. And it’s not to be used in the way that DOD used it unless 

they had permission from the FDA. It becomes, in essence, because 

it is a drug used for another reason, an experimental drug. 

This experimental drug was—the FDA gave the DOD permission 

to use PB. They had only two requirements. One is that they warn 

the soldiers that it is an experimental drug, which, by the way, our 

soldiers were ordered to take, which astounds me—an experimental 

drug which our soldiers were ordered to take. They had one other 

requirement besides notifying our soldiers. They were supposed to 

keep records. Did you uncover in your work that our troops were 

notified or not notified? 

We have testimony from others that they were not notified in 

every instance—in most instances. And that we have testimony 

that they were not—that the DOD did not keep any accurate 

records on who ended up taking this drug and who didn’t. Was this 

something that in your work you came across, and can you comment? 

Mr. CHAN. I think we have seen reports on it. We did not look 

into the recordkeeping of who took—— Mr. SHAYS. I’m not expecting that you were. This is not an evaluation of your report. 

Mr. CHAN. Right. 

Mr. SHAYS. I’m just asking if you have. I want it to be part of 

the record. Yes. 

Ms. HEIVILIN. In looking into that, many of the veterans were 

not notified. We were told that the reason they weren’t is that the 

United States didn’t want the Iraqis to know what we were protecting the troops against, what we were doing. 

Mr. SHAYS. The DOD basically, because they felt that low-level 

exposure was not harmful to chemicals, basically began new studies after Congress ordered them to in 1996 and after Khamasiyah 

became public, which, by the way, they knew before it became public. This is not information that was new to them when it was new 

to the public. The only difference was that they were forced to acknowledge it, again, because a soldier, besides his word, had a 

video that documented it. That’s the only reason they came forward. 

Now, what’s interesting to me is, the VA have very few people 

who have any expertise in chemical exposure. When we have asked 

the VA to produce a document of the thousands of doctors who 

have the expertise, practically no one showed up on that list. 

Now, I’m interested to know if you got into this area as well. Did 

you get into the ability of the VA to properly diagnose and treat 

chemical exposure? Was that an area that you looked in? 

Ms. HEIVILIN. No, we did not. 

Mr. CHAN. We didn’t look at that. 

Mr. SHAYS. Has any committee asked you to look into this? 

Ms. HEIVILIN. Not that I’m aware of. I don’t think so. 

Mr. CHAN. No. 

Mr. SHAYS. There are only two countries in the world, to our 

knowledge, that have any expertise in chemical exposure. One of 

them, I believe, is Denmark. 

Mr. SHARMA. That is correct. 

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Mr. SHAYS. And the other I am certain is Israel. 

Mr. SHARMA. That is correct. 

Mr. SHAYS. Dr. Sharma, do you have any knowledge of these two 

countries and this? 

Mr. SHARMA. I’m aware that both these countries do have very 

good protection. But we do not know the details. In the course of 

our investigation we became aware of this issue. I would just make 

a comment to your statement that in the VA there is no expertise. 

And while we did not look at the VA, we did look at one research— actually two: the research by Dr. Haley and by Dr. Zamal of England. 

And they point out something very interesting. And that is—this 

is a message that sort of has been missed in critiquing these studies—that when you do normal physical exams or medical exams, 

you will miss the subtle signs of brain damage that these people 

are experiencing, which suggests that when you are looking at 

these people you need different types of protocols that are more 

sensitive to detecting these kinds of changes that we are seeing in 

veterans. 

Again, as I can tell you, we did not look at, but we do know from 

the research point of view that the current medical exams would 

not be able to see changes and they would not be adequate. 

Mr. SHAYS. In the VA facility in West Haven, CT, they change 

their protocol a little earlier than some because the doctors that 

participate from Yale—one of them had a background in environmental health. And so they then had a bit more sensitivity to that 

issue. And that’s really the only reason why one facility went forward. Now, you mentioned visiting two VA facilities where there 

seemed to be some expertise. Do you remember what those two facilities in your statement—on chemical exposure? You went to two 

VA facilities—— Mr. SHARMA. No. Those were two VA research centers. 

Mr. SHAYS. OK. 

Mr. SHARMA. But they were not—we did not look at specifically. 

Mr. SHAYS. And you went to them because why? 

Mr. SHARMA. Because we wanted to see what kind of research 

they were doing and the kinds of problems that they were experiencing. We had a protocol that we used. We wanted to talk to some 

of the primary investigators of those large studies. 

Mr. SHAYS. Right. And so it was not your intention that, we’re 

going to just go and we’ll pick out two VA facilities and look at the 

great job they’re doing? These were two that were charged to get 

into this area? 

Mr. SHARMA. Yes. 

Ms. HEIVILIN. Yes. 

Mr. SHAYS. I just want the record to show that. 

Ms. HEIVILIN. Right. 

Mr. SHAYS. Thank you. Mr. Sanders. 

Mr. SANDERS. Thank you, Mr. Chairman. Let me pick up on the 

point that Chris was making. And then if you could tell us, in your 

research, whether you see this as a pattern in terms of the DOD 

and the VA. The chairman mentioned that we heard for 5 years 

that there was no chemical exposure in the Persian Gulf theater. 

And then, in fact, it was as a result of probing from this committee 

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which finally got the DOD to acknowledge that there was an exposure at Khamasiyah. And I believe at one recent hearing Bernard 

Rostker, who represents the DOD, freely acknowledged that there 

may well have been other exposures as well. And I think that’s 

where we are right now. 

But from the very beginning there was a reluctance and—I think 

it’s fair to say—cover up in that area of acknowledging that. The 

chairman just mentioned that this all took place despite the fact 

that alarms were going off all over the theater. And the conclusion 

reached by the authorities that, ‘‘Yeah, we have highly trained 

technicians who are manning the instruments. The alarms went 

off, but, hey, despite all of the alarms, the conclusion is there was 

no other additional exposure in that area.’’ We heard testimony—and I’d like you to maybe comment on 

this—at a recent hearing from Dr. Tiedt, who is a pharmacologist 

in Maryland—and I’m sorry, I can’t remember exactly where. And 

he said that there were past studies done in fact by the DOD, if 

my memory is correct, dealing with the potentially dangerous effects of pyridostigmine bromide. And he was very, very concerned 

about the use of that drug. 

I think the DOD official position, and the VA, is that based on 

everything that they know, it will not cause a problem. I was very 

interested. And the reason I’m asking these things is that it seems 

to me that there is a pattern out there. But I want you to comment 

on that based on your research. I mentioned earlier and I want to 

repeat something that I thought was interesting. 

In 1995, the DOD itself did a study at Fort Detrick. This is the 

finding. ‘‘The principal finding is there is significant increase on 

the lethal effects of rats given pyridostigmine bromide, 

hermathrine and DEET simultaneously.’’ Now, you know what was very interesting to me—when that 

study was commented on in the PAC final report, you know what 

happened to the word ‘‘significant?’’ It came out: ‘‘A 1995 DOD 

study with rats reported that PB caused a slight increase in 

lethality of DEET and hermathrine when compared to expected additive values.’’ The word ‘‘significant’’ went to the word ‘‘slight.’’

We have seen instances where researchers lost their jobs. I don’t 

know that today there is a conclusion or an understanding. And I’d 

like you to help me on this one. Dr. Jonathan Tucker, Ph.D. served 

on the Presidential Advisory Committee staff as senior policy analyst responsible for investigating incidents of chemical and biological agent exposures. He was summarily dismissed after aggressively attempting to understand the extent of chemical exposures. 

In other words, instance after instance, people come up with 

ideas. We have amazing things. One more thing—and I’d like you 

to comment on this. New York Times—April 17, 1996 headline: 

‘‘Chemical Mix May Be Cause of Illness in Gulf War.’’ ‘‘Researchers 

from two universities suggested yesterday that Gulf war syndrome 

might have been caused by exposure to ordinary harmless doses of 

two or more chemicals that together might cause nerve damage.’’

Six paragraphs down the line from the New York Times—‘‘The 

Department of Defense said that the new report raised ‘some interesting hypotheses’ but that the Department had no direct knowledge of the details of the work.’’

87

A year earlier, the DOD itself had done a study which came up 

with almost exactly the same conclusion. Why would they not have 

said, ‘‘Gee, that’s interesting. We did similar work a year ago. 

We’ve got two separate studies coming up with similar conclusions. 

Boy, we should get going.’’ My point, and I think the point that the chairman was making, 

is that it seems to us that wherever evidence comes forward that 

might suggest that the cause of the problem has something other 

to do than stress, those conclusions, that analysis, is dismissed. Researchers who are working on that are given short shrift—in some 

cases, actually fired. Is that a kind of pattern that you detected in 

your study of the DOD and the VA? 

Mr. SHARMA. We found similar kinds of experience with some of 

the studies. And I will just use one. For example, Dr. Duffey, who 

testified here. His work was indeed supported by DOD. They were 

aware of the fact of what one would expect with low-level exposure 

to certain agents. They were some other reports that we cited. They 

were not considered. At least we have not seen that they have 

looked at. There are a lot of instances where we have found that 

work has been published. It’s quite good work. The issue is the perspective. 

I mean, you can do 100 studies and still say questions remain 

and we need to do more. 

Mr. SANDERS. Right. 

Mr. SHARMA. Or, in the absence of no contrary evidence, if you 

have a few studies, it leads you to believe that, yes, there is some 

suggestion that we are dealing with—how much is enough or exclusion of certain types of research when it is indeed there. And I 

agree with you. 

Mr. SANDERS. So the examples that I have given and that the 

chairman has given, you have found to be not untypical of the approach of the DOD and the VA. Is that what I’m hearing you saying? 

Mr. SHARMA. Yes. 

Mr. CHAN. I think in a broader sense, what we have tried to do— we found often more questions were raised rather than the doors 

closed—and that we finish answering that question. The example 

that you and Mr. Chairman keep bringing out about the FOX vehicle and the detection—and, as I said, that’s the other side of the 

pie, that I don’t think the research is being looked into. 

But it opens more questions about the sensitivity of our detection 

equipment. If they are very sensitive, and that, for some reason, we 

adjusted our equipment that way, which basically implies that 

we’re trying to reduce the operational effectiveness of our soldiers, 

because every time an alarm is sounded, that means I have to put 

on the gear. And I’ve tried those things. Maybe I’m a little small 

in stature to carry those things. But you can’t even put your finger 

into the trigger to fire something. 

So in a way, from an operational point of view, you’re defeating 

yourself. That’s the first point. The second point is, that if, in fact, 

it’s set up in such a way that other agents may trigger such 

alarms, then I think it’s important for the Department of Defense 

to investigate and find out what is the possible false alarm rate 

that can create these things. 

88

What it implies is that the enemy can use other agents to create 

these things to disrupt operation of the war and the battle itself, 

which is not a reasonable thing to do because that’s not a very good 

piece of equipment. Because if every time tear gas can generate 

some alarm that you stop the operation and say, everybody put on 

a suit, that doesn’t serve the soldier well. Because after a while, 

the soldier is going to ignore those alarms. 

So it opens up a whole set of questions. And when you turn 

around to the other end—from a doctrinal point of view, the question is, would the enemy use full, pure chemical against us knowing that our response will be severe against them. So that question—you see what I’m saying—it opens up another set of questions. 

I mean, they would be not very intelligent to use that kind of 

thing against us knowing that we’d retaliate, not necessarily in 

kind, but in massive retaliation against whatever, because that’s 

our doctrine. So the next possible question is, well, if you’re the 

enemy, you don’t want that to happen, what would you do? Possibly reduce the purity? One other question is, could that be a possibility? Could we in fact design systems whereby it can trigger our 

equipment while at the same time does not achieve the immediate 

acute response that one would expect, so that there’s no incident 

that triggers the entire sequence of events that they don’t wish on 

themselves. I’m talking about the enemy here. 

So what I’m saying is, these things you can test. You can try it 

out. When we captured the equipment through the United Nations, 

did we look into the purity of those chemicals and see what mixture is being used? If they were destroyed, why were they destroyed before we have a chance? And we enter with a whole tree 

of questions there. And this is beyond the health issues. 

And we were stuck, to be honest with you. And that’s why we 

said, OK, even in looking at the bomb sites, the inspected stuff, it 

doesn’t quite make sense to us. We reach a certain impasse and we 

say, OK, we don’t understand. We need to investigate further. 

Mr. SANDERS. Let me change gear a little bit here and ask you 

another question. It would seem to me that we have a difficult 

problem. No question about that. Solutions are not easily arrived 

at. But it would seem to me fairly common-sensical that the VA 

and DOD would be as aggressive as they could in trying to look at 

whatever safe, at least, treatment protocols there were out there. 

Mr. CHAN. Mm-hmm. 

Mr. SANDERS. In other words, I talk, again, to the vets in the 

State of Vermont who said, ‘‘We’re willing, as long as it’s not going 

to make us worse, we’re willing to look at alternatives. We know 

that maybe they won’t cure us. But we’re really hurting right now. 

We can’t go to work. Give us something. Give us an option. Maybe 

it fails.’’

Mr. CHAN. Mm-hmm. 

Mr. SANDERS. It seems to me—I know—that there are treatment 

protocols out there. And I think the VA and the DOD will tell us, 

well, they don’t know if they’re going to work. That may be true. 

But don’t you think we owe it at least to the vets to allow them 

to take advantage of different types of treatments. And then we 

can learn from that. In other words, if there is a treatment out 

89

there and we send vets to it and it doesn’t work, it doesn’t work. 

But then we know it doesn’t work. 

But doesn’t that make more sense than saying, well, we don’t 

have enough evidence yet to suggest that this could work. Am I 

missing something here? What do you think in terms of—what I’m 

asking is, in looking at different treatment protocols, is the VA and 

the DOD looking at alternative treatments even if they’re not 100 

percent guaranteed right now? 

Ms. HEIVILIN. You’re talking about human clinical trials. 

Mr. SANDERS. Yes, right. 

Ms. HEIVILIN. In order to do that you have to have a hypothesis 

and a proposed treatment. 

Mr. SANDERS. Sure. 

Ms. HEIVILIN. And I don’t think anything that’s been done has 

gotten that far yet. 

Mr. SANDERS. Well, there has been. I know. For example, Dr. 

William Ray of the Environmental Health Center in Dallas has 

claimed that he has treated dozens and dozens of Persian Gulf veterans. That’s what he says. He says he has had some success. We 

know veterans who have gone to him. Is his treatment effective or 

not? I don’t know. But I think that we should at least try it out. 

The evidence is that nobody gets worse as a result of this treatment. 

I know, because I entered into the record of one of our past hearings. Again, Dr. Mira Sheyavitz in Northampton VA hospital based 

her treatment on a diagnosis of multiple chemical sensitivity. She 

claimed—and I read some testimony from some of the veterans 

themselves. They said, ‘‘Yeah, I underwent this treatment. I felt 

better.’’ Now, in the long run, will that treatment work? I don’t know. 

But it would seem to me that if you have even some inkling that 

there might be some success—Nicholson is another example. Why 

would we not go forward so long as we knew that people were not 

going to become ill, obviously. Am I missing something here? 

Mr. CHAN. This is consistent with our first recommendation— what are the health effects and whether they are improving or not. 

And in doing so, hopefully, as we responded earlier, to say, let’s 

find out are there things that appear to be working, even for a 

small percentage of people. And examine it that way. 

Ms. HEIVILIN. Mm-hmm. 

Mr. SANDERS. Right. 

Mr. CHAN. And I think we’re not coming out with new 

hypotheses and so on. But try to gather the data out there first, 

and they might capture some of those cases that you mentioned. 

Mr. SANDERS. OK. I would just conclude that line of questioning 

by saying, Mr. Chairman, that we owe it to the vets at this point 

to begin to look at alternative types of treatment, to monitor the 

success or failure of those treatments, rather than just say, well, 

we’re not 100 percent sure that treatment can work, we don’t want 

to look at it. 

Mr. CHAN. Mm-hmm. 

Mr. SANDERS. OK. I yield back, Mr. Chairman. 

Mr. SHAYS. Thank you. I think we’re going to get you out in the 

next 15 or so minutes. I’d like to ask you, though—as it related to 

90

the issue of the various sites that may have had chemical or biological agents that were destroyed, you mentioned that the numbers are difficult to determine of what sites were actually looked 

at and what weren’t after the war. You said some of it was classified information. You were having a hard time sorting out the 

numbers. 

We’ll get to that even if I have to have confidential briefings. But 

it raises the question of whether there’s anything—let me back up 

and say to you, one of my frustrations in this hearing is that I 

know of studies that were done on protective gear that are classified. I can’t talk to you or publicly disclose information about the 

protective gear that our soldiers use because it’s classified. 

Is there anything in your report that would have been better had 

you not been limited by classification? By better I mean stronger, 

more specific. 

Mr. CHAN. Well, I think that it does help if it’s declassified. This 

will allow us to tell you where those sites are. 

Mr. SHAYS. Is there anything else in your report? 

Mr. CHAN. I’m sorry. 

Mr. SHAYS. No. That’s clear there. 

Mr. CHAN. Yes, sir. 

Mr. SHAYS. I mean, it would be very helpful to know that. Anything in addition to? Any other area that you walked down and you 

had walked back or you decided you couldn’t make certain points 

because you couldn’t back it up because the information was classified? 

Mr. CHAN. Yes, I did. 

Mr. SHAYS. Pardon me? 

Mr. CHAN. Yes. 

Mr. SHAYS. OK. The answer is yes? 

Mr. CHAN. Yes. 

Mr. SHAYS. OK. I want you to say it in a full sentence. 

Mr. CHAN. I’m sorry. Yes——

Mr. SHAYS. You don’t need to apologize. You’ve just answered 

yes. Now I want you to tell me what ‘‘yes’’ means. 

Mr. CHAN. That there is other information that would make the 

report stronger if we could discuss it in an unclassified manner. 

Mr. SHAYS. I have one other area. Well, actually, a few more. In 

your report, which you provide the agencies to have a response. 

And I think it’s very appropriate that you did. The Department of 

Veterans’ Affairs’ comments to the General Accounting Office report. They respond on page 6 of their response; they say, ‘‘The VA 

strongly disagrees, though, with assertions contained within the 

GAO report that the epidemiological research to date has been inappropriate and is not likely to yield definitive conclusions.’’

It’s on page 84 of your document. It’s on page 6 of the document 

they submitted to you. Then they say:

The pursuit of epidemiological research has led to some of the most important 

findings and conclusions regarding Persian Gulf veterans illnesses to date. Epidemiological studies have shown so far that: 

1. Persian Gulf veterans have not experience a high disease specific mortality rate 

in comparison to their non-deployed counterparts; 

2. Persian Gulf veterans in the military have not been hospitalized more than 

their non-deployed counterparts; 

91

3. Based on a study of military hospitalization records birth outcomes among 

spouses of Persian Gulf veterans and among female Persian Gulf veterans are no 

different than among their non-deployed counterparts; and 

4. Persian Gulf veterans are experiencing a greater prevalence of self-reported 

symptoms.

Then they go on to say, ‘‘Were it not for these epidemiological 

studies, we would still lack answers to vital questions about Gulf 

war veterans’ illnesses.’’ I have a big question mark by that. Because it says, ‘‘We will 

still lack answers to vital questions.’’ What answers do we have 

from what I just read? What answers do we have? Or let me put 

it this way. Do you want to comment in general about this response 

to your report, this area here? 

Mr. CHAN. Yes. We did a general comment. And I think we can 

answer it specifically about these references. One of the recommendations made by the President’s Advisory Commission is 

that they need to look at the population broadly to determine are 

there prevalence. And we don’t disagree with that. And the idea behind those is to generate hypotheses whereby one can focus on further research. And we don’t disagree with that. 

The problem that we find—I think I will just use one example 

of it. It’s easier to discuss one research rather than all four of 

them. And I’m sure my colleague can add more. Initial studies that 

were done—and it’s done peer review in a perfectly reasonable way 

and scientifically and so on. OK? 

Now, if I take myself out of that research and ask the question, 

what have I gained out of this, what was done was really taking 

the entire 600-and-some-odd thousand veterans of Gulf war and 

comparing them to a control group, which is the people who didn’t 

go to the war. First, we don’t know what kind of people these people have, in fact, whether they actually landed on shore or not, 

were they exposed to anything of these 690,000 people. 

The scientific paper basically recognized a couple of things. This 

is on mortality. I’m sorry. I’m talking without telling you what it 

is. Basically they arrive at the fact that when we compare them, 

there’s no significance in terms of higher mortality with the exception that after the war they’re subject to post-war problems and 

stress and all that. 

I personally, as a researcher, I look at it—and my colleague may 

disagree with me—that the paper recognized that before the war 

began—that there’s self-selection going on. That means those who 

went to the war were healthier. So you start with the health measures that’s higher than the other cohorts that you’re comparing. 

And when they finish the war, they’re equal. 

So I don’t know the delta of better health that they begin with. 

Now, the authors recognize that this is one of the problems they 

had, which is a perfectly reasonable assumption. But when one 

concludes in public that there is no higher prevalence of mortality 

with the Gulf war veterans as a result of this paper, I think it’s 

not quite correct to say that. 

An example, could they have done—taken a control group and go 

through the same screening before they went to—even though they 

didn’t go to the Gulf war—could we use them in the control 

group—will we reduce the number? Could we do a pre-post? That 

means, if they were healthy, can we compare them that’s a single 

92

treatment, which is the war, and after the war, are they worse off? 

And that’s another way to measure. 

So I think it’s open up to a lot of interpretations with these four 

studies. But ideas generate hypotheses. And we’re not quite sure 

what hypotheses they generate with the exception that now the 

mortality is not any higher or significantly higher than the control 

group. 

Ms. HEIVILIN. Can I comment, too? It’s important in each of 

these—and we didn’t look at every single study and we didn’t 

evaluate every single study. In fact, we were looking at whether 

hypotheses were generated from the studies. But we did look a little bit at the birth outcomes among the spouses. And that population—it’s kind of important to note that that population excludes 

the most at risk population. It was births that were taking place 

in the DOD hospitals. 

And when a pending birth is declared at risk, they’re usually 

sent somewhere else outside of the DOD general hospitals. And of 

course, the veterans who were not still married and in active duty, 

which would probably also include some of your highest at risk 

population, your illest veterans—would not be included. 

Mr. SHAYS. So, you responded, first, Mr. Chan, to the mortality. 

And you’re responding to the——

Ms. HEIVILIN. Birth defect piece. 

Mr. CHAN. Birth. 

Mr. SHAYS. Now, there are really two issues here. One is that 

high risk pregnancies are less likely to take place in a military hospital. 

Ms. HEIVILIN. Right. 

Mr. SHAYS. The second, though, is to me—veterans don’t go to 

military hospitals as a general rule. They’re veterans. 

Ms. HEIVILIN. Right. If they’re out. 

Mr. SHAYS. If they’re out. 

Ms. HEIVILIN. Well, of course, in that registry, you have people 

that are still in the service, too. 

Mr. SHAYS. No, but that’s the point. It’s only people who are still 

in the service. 

Ms. HEIVILIN. Right. 

Mr. SHAYS. We’re talking about most who don’t have access to 

the military hospital. 

Ms. HEIVILIN. Right. 

Mr. SHAYS. It strikes me—and this is my primary point—it 

strikes me that the VA’s approach to the causes of Gulf war illnesses, this research program is designed to find out what it isn’t, 

not what the problem is. In other words, it’s almost like they check 

off a list and say, well, it’s not this, it’s not this, it’s not this. 

I have a general feeling that the DOD and VA basically don’t believe our veterans. That’s the bottom line. So it’s almost as they’re 

trying to say, ‘‘OK. You’re wrong. Because it’s not this. You’re 

wrong because it’s not this and it’s not this.’’

They’re not coming to say, ‘‘OK. It’s not this, this or this, therefore it is this.’’

I’m just curious to know, is this the typical way their research 

happens? 

93

Ms. HEIVILIN. Well, the researchers undoubtedly exposed all of 

the limitations of their study—if you would read the actual outcome of the research. You’re asking what——

Mr. SHAYS. I’m asking something a little different. 

Ms. HEIVILIN. Right. 

Mr. SHAYS. If you don’t know the answer to my question, I’m not 

asking you to——

Ms. HEIVILIN. No. I understand. Do they typically do that? 

And——

Mr. SHAYS. The question that strikes me—and I’m just interested 

if you had that same view—that the VA, in particular, basically is 

justifying their good work by saying, ‘‘We’ve learned it’s not this 

and we’ve learned it’s not this and we’ve learned it’s not this.’’

Now, I may even question what they learned, because I don’t 

think they learned that. But it’s an interesting—it’s not like, 

‘‘We’ve learned it is this. We’ve learned it is that.’’

Ms. HEIVILIN. Mm-hmm. 

Mr. SHAYS. Maybe in my unscientific mind, I’m just simply observing that’s not all that significant. If it was, I was curious to 

have a response. 

Mr. CHAN. Well, if one does research in this manner—let me say 

that if you look at prevalence and find no high prevalence and conclude that the case is closed—yes, I agree with you. Because, in a 

way, the concept behind the current research is generally new—you 

know, you look at a broad population of people. You’ve decided it 

didn’t happen with them. Then you look at a subpopulation. That’s 

possibly the next step you take. 

Now, as I said before, when you have these steps of research you 

go through, at some you have to look at cause and effect and treatment—the etiology and all that. If you stop right up front and say 

there’s no high prevalence, then it’s over. You see what I’m saying. 

And I think that’s sort of the problem. Because, you know, it 

won’t generate new——

Mr. SHAYS. Mr. Chan, you’re really making a very important 

point, it seems to me. What I think I’m hearing you say is that the 

VA is basically saying there’s not a problem. 

Mr. CHAN. Well, in regards to these, they certainly have expressed to us that finally this issue had been addressed in terms 

of birth defects and——

Mr. SHAYS. It’s not a problem. There’s no greater mortality. 

There’s not a problem. 

Mr. CHAN. Well, I can read it in the web site—and this is from 

the GULFLink, which basically said June 12, 1997: The latest medical study on——

Mr. SHAYS. Who is this and who is writing this right now? 

Ms. HEIVILIN. VA web site. 

Mr. CHAN. It’s Mr. Rostker’s web site. 

Mr. SHAYS. OK. 

Ms. HEIVILIN. DOD. I’m sorry. 

Mr. SHAYS. DOD. 

Mr. CHAN. DOD. I’m sorry. 

Mr. SHAYS. Yes. 

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Mr. CHAN. ‘‘The latest medical study on birth defects among the 

children of veterans demonstrates that children of Gulf war veterans do not have an increased risk of birth defects.’’ Mr. SHAYS. It seems like all our—OK. 

Mr. CHAN. If you go to the second page—it basically sets the limitations of the studies, which is what—— Mr. SHAYS. And the limitations of the study, in some cases, discredit the study. 

Ms. HEIVILIN. Yes. I think it gets to our bottom line—you don’t 

close out possible causes and possible treatments until you’re absolutely sure. So you would close out this group of the population as 

not having problems. Let’s look at—just as you said—let’s look at 

the next group. Let’s look at another group. 

Mr. SHAYS. OK. 

Mr. CHAN. But in this case here, let me add, though, that they 

said, ‘‘The limitation of this study being addressed in other research projects on reproductive health that are currently underway.’’ So—— Mr. SHAYS. But it sounds to me, again, like the VA is using its 

resources to make studies to prove what it isn’t. 

Mr. CHAN. Mm-hmm. 

Mr. SHAYS. In spite of the fact that some of their assumptions 

call into question the validity of their report. 

Ms. HEIVILIN. Well—— Mr. SHAYS. But the whole emphasis is proving what it isn’t, 

which then applies—well, why are we even going through this process? Instead of saying, ‘‘We know that our veterans are sick. What 

is it?’’ Now, let me just ask two more points unless you want to make 

another comment. I just—— Ms. HEIVILIN. Can I just make one? 

Mr. SHAYS. Sure. 

Ms. HEIVILIN. I can see value of this kind of a study if you 

have—which you may have—many of your active duty people, personnel, who were in the Gulf, who are worried about this possibility. So it would be researched to see if, in fact, you could put 

that worry to rest or not. 

Mr. SHAYS. Well, if I was a family giving birth to a child, and 

either my wife or it served in the Persian Gulf, I would take no 

comfort whatsoever that the VA had done a study in a military 

hospital that showed that there was no greater defect rate in 

births, given that it is military active personnel, and given that in 

most cases, the acute births are not going to be done in military 

hospitals. 

Ms. HEIVILIN. Right. I was just commenting about the value of 

such a study. 

Mr. SHAYS. Right. Well, let me just take the last two points. 

Given what we have learned of the handling of this whole process 

by DOD and the VA, should we assume that if similar conflicts 

occur in the future, would our forces still be at risk the same way 

they are now? Are there protocols in effect that you have learned 

of that say basically in the future this won’t happen? 

It relates the Bosnia question that was asked by Mr. Allen, but 

I wanted to ask it more generically. 

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Ms. HEIVILIN. We’re getting into classified information. And we 

have recent studies that we could talk about in—— Mr. SHAYS. When we’re done with this public hearing, I’d love it 

if you would meet with Mr. Sanders and I just for a few minutes, 

just to have a clear sense of where your limits are. 

Ms. HEIVILIN. I can’t discuss that answer in an unclassified 

forum. 

Mr. SHAYS. No. I understand. Let me just put it this way. 

Ms. HEIVILIN. OK. 

Mr. SHAYS. I don’t want any more generic conversation about 

this issue in private. 

Ms. HEIVILIN. OK. 

Mr. SHAYS. Let me just—first, and finally say to you, is there any 

question you wish we had asked, any area that you wish we had 

gotten into? If there is then let’s do it now. Let’s not have you tell 

me afterwards, why didn’t you ask this question? 

You ask a question I should have had the good sense to ask and 

then answer it or forever hold your peace. I’m serious about this. 

This is not even meant to be funny. I don’t want to learn later that 

you wanted me to protect you; be asking a question that you didn’t 

want to voluntarily come forward with. Is there any question that 

I could have asked in this very important hearing that we didn’t 

ask, an area that we should have gotten into? 

Mr. SHARMA. I think there is a question that I often ask myself. 

Mr. SHAYS. OK. 

Mr. SHARMA. If I was a veteran, what does this all mean to me? 

Mr. SHAYS. Very good. 

Mr. SHARMA. I have Congress—— Mr. SHAYS. Dr. Sharma, if you were a veteran, what does this 

all mean to you? Probably the best question I’ve asked all day. 

Mr. SHARMA. I think I would be, I would be very confused and 

disturbed. On the one hand I hear about the very people who are 

caring for me are giving some contradictory information. Research 

is not going to be conclusive. I don’t know what’s going to happen 

to me. And I think that’s an issue that is facing the veterans. And 

we all must try to address that concern. 

Mr. SHAYS. Mr. Chan. 

Mr. CHAN. I think that the question that concerns me is, at what 

point, timewise, will these things be resolved? And I think one of 

the real problems that you have posed before about taking a different approach to look at this problem—and I was thinking, if I’m 

a veteran, I want to have a group—be it VA, DOD or anybody else 

you’re talking about—that, as a veteran, the credibility itself has 

to be based on the fact that if this group tells me that there’s nothing there, that’s an acceptable answer to me, then I think the matter would be closed. 

It’s a very difficult thing to say. But I don’t know how to say it. 

Mr. SHAYS. You said it. 

Mr. CHAN. OK. 

Ms. HEIVILIN. My concern in this whole area is how the military 

personnel feel about the credibility of the organization to protect 

them, take care of them, and respond to their needs. And a lot of 

what we’re talking about here looks like there hasn’t been the kind 

of response you would expect there to be. And I think it’s important 

96

that in the future, starting right today, that in this kind of a situation, that there be a credible response. 

Mr. SHAYS. Mr. Sanders. 

Mr. SANDERS. Mr. Chairman, just let me thank all of our guests 

for their testimony and their very hard work, which is very helpful 

to us. Just one question. And maybe you have researched it and 

maybe you haven’t. 

When I spoke to vets in the State of Vermont and in testimony 

that we have heard before this committee, we have heard from 

women who believe that they have been made ill with symptoms 

not dissimilar from their husbands’ as a result of sexual contact or 

whatever. There is a case in Vermont of a woman who was jogging, 

I guess, 5 miles a day, and then after a while became so ill she 

could hardly walk without help. 

Is that anecdotal? Is that just something that happens to people 

or have you, in your research, developed any patterns to suggest 

that women or maybe even kids—we heard some testimony, you recall, from a woman whose kids were ill as well. Do you have any 

conclusions on that? 

Mr. SHARMA. In this study we did not do any original research. 

We looked at the research that has already been published in context of the conclusions that have been reached, in context of some 

other issues that were relevant. We did not collect original information from veterans. 

Mr. SANDERS. Based on your review of the research, what should 

I tell some women in the State of Vermont who believe that they 

have been made ill? Is there research to suggest that that is, in 

fact, the case or that there is no correlation? 

Mr. SHARMA. It’s quite possible. They were exposed to a wide variety of exposure agents. We do not understand the precise mechanisms. And it’s quite possible that their symptoms might be due to 

those exposures. 

Mr. SANDERS. But that’s a question that remains unanswered, 

like many others. 

Ms. HEIVILIN. Right. 

Mr. SANDERS. Mr. Chairman, let me just thank our guests very 

much for their efforts. 

Mr. SHAYS. I thank the gentleman. We just want to get together 

with you for about 2 minutes after the hearing in a room. 

Mr. CHAN. Sure. 

Ms. HEIVILIN. OK. 

Mr. SHAYS. But let me just, as my closing statement, say that I 

truly appreciate the findings of the GAO report, because it provides, really for the first time, a peer review opinion to so many 

concerns of the thousands of veterans who have contacted our committee or appeared before our committee. 

So I thank you for your work. I’m sure you’ll conclude that there 

are parts that aren’t perfect. I, too, found it good that you made 

it Gulf war illnesses instead of Gulf war illness. And I have some 

criticisms like that. But for the most part, you have been a very

97

impressive panel. And you have, I think, been extraordinarily helpful to this committee. 

Mr. CHAN. Thank you. 

Mr. SHAYS. And with that, we will close this hearing. 

[Whereupon, at 12:55 p.m., the subcommittee was adjourned.]

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