<DOC>
[105th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:43150.wais]
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
__________
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COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
J. DENNIS HASTERT, Illinois TOM LANTOS, California
CONSTANCE A. MORELLA, Maryland ROBERT E. WISE, Jr., West Virginia
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
STEVE SCHIFF, New Mexico EDOLPHUS TOWNS, New York
CHRISTOPHER COX, California PAUL E. KANJORSKI, Pennsylvania
ILEANA ROS-LEHTINEN, Florida GARY A. CONDIT, California
JOHN M. McHUGH, New York CAROLYN B. MALONEY, New York
STEPHEN HORN, California THOMAS M. BARRETT, Wisconsin
JOHN L. MICA, Florida ELEANOR HOLMES NORTON, Washington,
THOMAS M. DAVIS, Virginia DC
DAVID M. McINTOSH, Indiana CHAKA FATTAH, Pennsylvania
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
JOE SCARBOROUGH, Florida DENNIS J. KUCINICH, Ohio
JOHN B. SHADEGG, Arizona ROD R. BLAGOJEVICH, Illinois
STEVEN C. LaTOURETTE, Ohio DANNY K. DAVIS, Illinois
MARSHALL ``MARK'' SANFORD, South JOHN F. TIERNEY, Massachusetts
Carolina JIM TURNER, Texas
JOHN E. SUNUNU, New Hampshire THOMAS H. ALLEN, Maine
PETE SESSIONS, Texas HAROLD E. FORD, Jr., Tennessee
MICHAEL PAPPAS, New Jersey ------
VINCE SNOWBARGER, Kansas BERNARD SANDERS, Vermont
BOB BARR, Georgia (Independent)
ROB PORTMAN, Ohio
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 EDOLPHUS TOWNS, New York
BENJAMIN A. GILMAN, New York DENNIS J. KUCINICH, Ohio
DAVID M. McINTOSH, Indiana THOMAS H. ALLEN, Maine
MARK E. SOUDER, Indiana TOM LANTOS, California
MICHAEL PAPPAS, New Jersey BERNARD SANDERS, Vermont (Ind.)
STEVE SCHIFF, New Mexico 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
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
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 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 organo-phosphates 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 low-level 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. Pender-gast, 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? ``In a statement today the Pentagon praised the
experiments as important, 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.
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 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 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 long-term 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 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.
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 low-level 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 by the veterans may be due in part to
organophosphate-induced delayed 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 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 long-term 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 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.
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.
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.
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. 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 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-and-a-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 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.
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 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?
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 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 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 one-third 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 primary 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 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. 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.
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
clear-cut. 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.
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 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.
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 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.''
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.
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 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 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;
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 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?
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.
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.
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 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
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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