PROGRESS OF RESEARCH ON UNDIAGNOSED ILLNESSES OF PERSIAN GULF WAR VETERANS THURSDAY, MARCH 9, 1995 House of Representatives, Subcommittee on Hospitals and Health Care, Committee on Veterans' Affairs, Washington, DC. The subcommittee met, pursuant to call, at 9 a.m., in room 334, Cannon
House Office Building, Hon. Tim Hutchinson [chairman of the subcommittee], residing. Present: Representatives Hutchinson, Smith, Quinn, Bachus, Stearns, Ney,
Flanagan, Edwards, Kennedy, Clement, Tejeda, Gutierrez, Baesler, Bishop and Doyle. Also Present: Representatives Buyer and Evans. OPENING STATEMENT OF CHAIRMAN HUTCHINSON OPENING STATEMENT OF HON. CHET EDWARDS STATEMENTS OF DR. KENNETH W. KIZER, UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS STATEMENT OF DR. STEPHEN JOSEPH, ASSISTANT SECRETARY FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE STATEMENT OF DR. RICHARD MILLER, DIRECTOR, MEDICAL FOLLOW-UP AGENCY, INSTITUTE OF MEDICINE OPENING STATEMENT OF HON. JACK QUINN OPENING STATEMENT OF HON. SANFORD BISHOP STATEMENT OF STEVE ROBERTSON, LEGISLATIVE DIRECTOR, THE AMERICAN LEGION OPENING STATEMENT OF CHAIRMAN HUTCHINSON Mr. Hutchinson. The subcommittee hearing on the progress of research
related to undiagnosed illnesses of Persian Gulf War veterans will now come to order. And I would like to take this opportunity to welcome our distinguished
panel of witnesses, most of whom are here, some of whom are, we're hoping, going to make
it with the inclement weather this morning. We thank you for taking time to testify before
our subcommittee this morning. And I look forward very much to hearing your testimony so
that we can determine the progress of the research with regards to the multitude of
undiagnosed illnesses being experienced by our Persian Gulf veterans. I would also like to welcome two members that we expect to be here for
the subcommittee hearing this morning, Representative Steve Buyer and Lane Evans, both of
whom are not members of the subcommittee but have been at the forefront on this issue
since it was first made public 4 years ago. Mr. Steve Buyer is a Persian Gulf veteran who came home to experience
many of the symptoms being felt by many of his colleagues. Mr. Lane Evans was Chairman
during the 103rd Congress of the Veterans' Affairs Oversight and Investigation
Subcommittee. In that capacity he held a number of hearings on this issue. His assistance
was vital in the passage of the three Persian Gulf illness-related pieces of legislation
that were signed into law during the last 2 years. We warmly welcome their participation
this morning. I am pleased that our first subcommittee hearing deals with this very
important matter. There are dozens of studies currently being conducted to determine the
causes of these baffling ailments. I look forward to hearing this testimony so that we can
learn the status of many of these research projects. Persian Gulf veterans deserve, in expeditious fashion, to be told why
they are experiencing these problems. And I am hopeful that the Federal Government is
doing all in its power to find these answers and that money directed for Persian Gulf
research will not be to the detriment of other VA research priorities. This subcommittee also welcomes the President's recent commitment to get
to the bottom of this puzzle. I trust that this subcommittee and the full committee will
be working with the administration to ensure that money going to pay for research is spent
in the most effective manner. The American taxpayer deserves no less, and our veterans
deserve no less. The Veterans' Affairs Committee has led the way in providing assistance
to those veterans whose sicknesses are attributable to service in the Gulf. Three separate
pieces of legislation were passed by our committee and signed into law during the 103rd
Congress. Public Law 103-210 authorizes health care on a priority basis for Persian Gulf
veterans. Persian Gulf 103-452 extends the eligibility for care for Persian Gulf veterans
for covered conditions until December 31, 1995, and Public Law 103-446 permits the
Secretary of Veterans' Affairs to compensate Persian Gulf veterans for undiagnosed
illness, requires the development of a uniform medical evaluation protocol and case
definition or diagnoses, and requires the Secretary to evaluate the health status of
spouses and children of Persian Gulf veterans. Our job is not complete until the questions
are answered, the mystery is solved, and the anxious minds of suffering veterans are
eased. I would like to give special recognition to Bob Stump and to Sonny
Montgomery, who have worked together on a bipartisan basis and have really exemplified the
kind of bipartisan spirit that has historically characterized and been the hallmark of the
Veterans' Committee and whose diligence and hard work guaranteed that Persian Gulf
veterans would be given priority attention as we try to find a reason or reasons for these
illnesses. Once again, I welcome each of our witnesses, and I look forward to your
testimony this morning. I would now like to recognize the subcommittee's ranking member,
Chet Edwards of Texas. OPENING STATEMENT OF HON. CHET EDWARDS Mr. Edwards. Thank you, Mr. Chairman. Let me first congratulate you on
this being your first meeting as Chairman of this important subcommittee. It is a great
responsibility, and I know you'll carry it out very well. I look forward to working with
you. I think it's a compliment to you, and I hope it sends a message to
veterans across this country that the subject of your first committee meeting is on the
Persian Gulf illness problem. There are dozens of issues that deserve hearings that we
will have hearings on, but I think the fact that you chose this, put this at the top of
the list, is a compliment to you, Mr. Chairman, and says, I think for members on both
sides, how important this issue is to all of us. Let me also congratulate Mr. Kennedy, Mr. Buyer, and Mr. Evans, who is
not here, but members who on their own have made this a real cause and brought the
problems of this situation to the attention of other members of this committee through
their leadership. I know we don't always agree on every issue, but I think in this case
these particular members have been real leaders in helping our veterans that served in the
Gulf War. Let me just finally say that to me the bottom line is that we simply
cannot rest until we have done everything possible to understand and to successfully treat
the illnesses of American men and women who answered the call of duty to fight for freedom
in Desert Shield and Desert Storm. That's the purpose of our meeting. Mr. Chairman, thank you for recognizing me. We look forward to hearing
the witnesses. [The prepared statement of Congressman Edwards follows:] S6621 Prepared statement of Hon. Chet Edwards Thank you, Mr. Chairman, for scheduling this session, which represents
the tenth hearing on issues relating to the health status of Persian Gulf veterans held by
the full Veterans Affairs Committee or one of its subcommittees. Today's hearing represents a particularly important step in our efforts
to advance research on undiagnosed illnesses among Persian Gulf War veterans. Its timing
signals the priority we give this issue. More important, I hope this session will provide
a framework for achieving consensus on directions the Federal Government should be
charting in our common search for answers. For the sake of our new members, the first in this series of ten
hearings was held in September 1992. As the chairman indicated, since that time Congress
has enacted several pieces of legislation. Among these are measures providing for
establishment of the Persian Gulf Registry (Public Law 102-585), priority treatment for
Persian Gulf veterans (103-210), and most recently, compensation for those individuals who
are seriously ill but are still undiagnosed (Public Law 103-446). In Public Law 102-585,
we laid the foundation for the Institute of Medicine to provide recommendations on future
directions for Federal research relating to the health of veterans of Persian Gulf
service. In focusing today on the IOM's assessment and on the status of Federal research efforts, I look forward to this morning's testimony. Q04 S6602 Mr. Hutchinson. Thank you, Chet. I really am delighted to have you as
the ranking member and look forward to working with you on a many projects in this
Congress. I cannot think of anybody that I'd be more delighted to serve with. Thank you
for those kind words as well. I want to welcome the witnesses on Panel 1. We're glad to have you here
this morning. It looks like, Dr. Jackson and Dr. Joseph, have arrived, and we're
delighted. I would like to begin by having Dr. Kizer come up to the witness table. We
would remind you that your full statement will be included in the record. If possible,
please keep your comments under 10 minutes. Thank you, Dr. Kizer. Dr. Kizer. Thank you, Mr. Chairman, and members of the subcommittee. I
certainly appreciate this opportunity to discuss with you this morning the various
Department of Veterans Affairs activities relating to Persian Gulf veterans and the
illnesses that have been experienced by some of those veterans. STATEMENTS OF DR. KENNETH W. KIZER, UNDER SECRETARY FOR HEALTH,
DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY DR. STEPHEN JOSEPH, ASSISTANT SECRETARY FOR
HEALTH AFFAIRS, DEPARTMENT OF DEFENSE; DR. RICHARD JACKSON, DIRECTOR, NATIONAL CENTER FOR
ENVIRONMENTAL HEALTH, CENTERS FOR DISEASE CONTROL AND PREVENTION, U.S. PUBLIC HEALTH
SERVICE; DR. RICHARD MILLER, DIRECTOR, MEDICAL FOLLOW-UP AGENCY, INSTITUTE OF MEDICINE STATEMENT OF DR. KENNETH KIZER Dr. Kizer. Let me first reaffirm the VA's commitment to provide
high-quality compassionate medical care to our Persian Gulf veterans, our commitment to
compensate those veterans who have become disabled as a result of their service to the
nation in this conflict, and our commitment to pursue research that may lead ultimately to
an understanding of the cause, or causes, of the illnesses experienced by those who have
served in Desert Shield and Desert Storm. Let me also take this opportunity to emphasize President Clinton's
personal commitment to the Persian Gulf veterans and especially his concern for and
commitment to finding answers to why some of the veterans have become ill. His commitment
in this regard was again demonstrated earlier this week when he announced the formation of
a Presidential advisory committee to broaden the involvement of independent scientists,
physicians, and veterans in this complex issue. In 1993, the President named the Secretary of the Department of Veterans
Affairs to coordinate Government research efforts to find the cause of health problems
being experienced by Persian Gulf veterans. To date, the coordination of research
activities has been provided by the Interagency Research Coordinating Council, a working
group of the Persian Gulf Veterans Coordinating Board. This Board coordinates the
research, clinical, and compensation issues related to Persian Gulf veterans. It is
composed of Secretaries Brown, Perry, and Shalala. The Research Coordinating Council is
chaired by the VA. It monitors the activities and work products of various research
efforts and recommends future research directions. Mr. Chairman, as you know, I'm new to the VA, having been on the job now
about 4 months. Much of the time that I've been here has been spent learning about the
myriad of programs conducted by the VA as well as in drafting a plan to restructure the
Veterans Health Care Service so as to fundamentally change how it conducts its business.
This plan should be submitted to Congress within 2 weeks. I've also spent a considerable amount of time learning about all that's
been done to try to understand the problems experienced by our Persian Gulf veterans,
especially with regards to the various investigative efforts that are underway or that are
planned. I've also focused attention on some gaps in our research program and our
infrastructure in dealing with the problem. With regards to the latter, I might note that
I've done a number of things, including elevating the Office of Public Health and
Environmental Hazards. This is the VA program office that is principally responsible for
Persian Gulf issues. I've elevated it so that it reports directly to me, and I've also
augmented its staff by four FTEs. Currently I am looking to see if additional staff is
needed in that office as we expand our activities in this area. I've also asked the Research Coordinating Council to develop a tactical
plan for future research activities, and I have shared with them some of my thoughts about
what I see as further research needs. If we have time, I'll be happy to discuss some of
those with you this morning. We have also intensified our educational and information dissemination
efforts, as well as our efforts to reach out to nongovernment investigators so as to
benefit from a broader input to our efforts. One of the things that I found in coming into this is that the overall
strategy or overall game plan, if you will, is not perhaps as well-articulated as it
should be. And in the remaining few minutes that I have this morning, I thought it might
be useful to walk through the strategy as I see it, or at least conceptually how I've
organized and how I hope to pursue our efforts in this regard, focusing especially on the
research issues since that is a subject of this morning's hearing. In brief, we have a four-pronged effort or approach to the Persian Gulf
veterans. The first prong involves providing medical care. This involves providing
priority care, which you touched on in your opening comments as well as the Registry exam
program for those veterans who are either ill or not ill but wish to have their condition
documented for the record. We have also named several VA referral centers, and I do expect
to increase the number of such centers in the days and weeks ahead. The second prong of the overall strategy is one of outreach and
education. We have targeted particularly three audiences: first, professional care-givers,
i.e., our physicians and others who need education, to standardize the exam and what it is
they're being asked to look at. If you consider the problem you will see why this is so
important. There is a fundamental difficulty in how a physician is goint to approach the
diagnosis of undiagnosable conditions. And so we've tried to take some steps to
standardize the approaches and make sure that our physicians and other care-givers around
the country are approaching things in a uniform manner. We have also targeted the general public, as well as patients, and have
recently increased the number of information vehicles that we have available to provide to
patients or the public. In addition to printed materials, we have turned to the media and have
focused on not only professional literature contributions but also things that can go in
newspapers and other public forums. We also have established the few hotline which I know
you are familiar with. The hotline has been very well-received and has fielded literally
tens of thousands of calls already. The third prong of our overall approach is disability evaluation and
compensation. These fall into two categories: those who are handled in the routine manner
and those that fall into the under-diagnosed illness category. And, finally, the fourth prong of the effort has to do with research.
Here, again, I conceptualize our research activities into four areas. The first is the
epidemiologic studies that are being pursued and some additional areas that need to be
pursued in the future. This includes both descriptive epidemiologic studies as well as
hypothesis-driven epidemiologic investigations. We have a number of basic science projects underway, and we are looking
at additional ones that may compliment what is already being done. There is an array of clinical investigations underway; these
investigations focus on pulmonary problems or other organ-specific problems, as well as
behavioral, neuropsychiatric, and other clinical conditions. And, finally, the last category of research has to do with the
environmental concerns per se. There are various research activities in this arena. Instead of taking the time to detail each and every project that the VA
is undertaking or to usurp what others may say after me, I would just note for you that we
have provided a listing of these projects for you. This includes an outline of our overall
plan that we'll make available both for the record and for individual members. Attached to
this plan is a synopsis of the various research activities being undertaken by the VA and
Department of Defense, including a description of the individual research project being
undertaken by our three environmental hazards research centers. The latter which ncludes
time lines for when those projects will be completed so that you will have a better
indication of when we can expect to have answers in the future to the different projects
that are being pursued; finally, we are providing a one-page sheet that depicts the
overall oversight structure and describes how the Coordinating Board and the Research
Coordinating Council fit into the overall effort. And with that, let me conclude these comments. I will be happy to answer
questions either now or later. [The prepared statement of Dr. Kizer, with attachments, appears on p.
66.] Mr. Hutchinson. Thank you, Dr. Kizer. The documents to which you refer
will be entered into the record without objection. (See p. 74.) Mr. Hutchinson. We will hold our questions until the entire panel has
testified. We certainly look forward to working with you in your new job, and we welcome
you. The chair recognizes Dr. Joseph. Dr. Joseph. Thank you, Mr. Chairman, distinguished members of the
subcommittee, first let me apologize for getting here in just under the wire. It is an
honor to be here before this subcommittee to talk about our medical and research efforts
related to the Persian Gulf War. STATEMENT OF DR. STEPHEN JOSEPH Dr. Joseph. For the past 2 years, the Clinton administration has been
heavily engaged in caring for our Persian Gulf troops and in trying to solve the difficult
puzzle sometimes known as Persian Gulf illnesses. Just this Monday the President, in a speech before the VFW, described
the collaboration between the agencies on our very aggressive programs of research and
care. But, as he said, we need to go further. And, the President announced that we will
step up our treatment efforts and launch new research initiatives. The departments, as Dr. Kizer has already begun to tell you, will be
funding millions of dollars in new research initiatives. We will be opening specialized
care centers to push forward our diagnostic and treatment efforts, particularly for those
Gulf War veterans whose illnesses have proven most difficult to diagnose. And, as Dr.
Kizer mentioned, the President announced that he will be forming a presidential advisory
committee to look into medical research and other aspects of this problem. I want to frame our efforts, both clinical and research, in an analogous
way to what Dr. Kizer has done. And, I'll summarize my testimony, but will be happy to go
back into the details as you wish. As you know, we deployed almost 700,000 people to the Persian Gulf. And
it's important to recognize that the vast majority of these people came back healthy. In
fact, our DNBI, our disease non-battle injury rate, in the Persian Gulf was lower than
with any conflict deployment in the military's history. But we all know that soon after
the ending of the Gulf War, veterans began to complain of a variety of symptoms that were
not readily explainable. To try and sort through to the bottom of this, I established in DOD the
Comprehensive Clinical Evaluation Program (CCEP) in June of 1994. We were attempting to
seize the needle, rather than the whole haystack. We wanted to start with the patients,
provide to them the care and caring that is our responsibility. At the same time, that we
were diagnosing their individual symptoms and illnesses, we began to get some sense of
direction, and leads, into what might be the overall causes of their problems. We set up a national hotline. Since that time in June, we have had over
15,000 people registered through that hotline. About 12,000 of them wished to enter into
the systematic tiered process of medical evaluation. We have between eight and nine
thousand persons in that medical evaluation process now. We have completed a comprehensive
evaluation on over 4,000. And we have scrubbed the data and entered into our clinical
database data now on over 2,000. When I made my first preliminary report in December, we had 1,000 people
in the database. We now have 2,000. And our expectation is that we will have fully between
eight and nine thousand comprehensive medical evaluations finished by late spring this
year. I need to enter a word of caution here. The CCEP was not designed as a
sophisticated research or epidemiological program. It was designed primarily to provide
care and diagnoses to our individual patients. This is the way to start with a needle: to
work back from those individual diagnostic and treatment efforts, while providing care to
our people, to develop leads, hypotheses and insights into what may be key questions to
ask. I can say that based on the findings now of over 2,000 patients, that
over 84 percent have a clear diagnosis or diagnoses which explain their condition. And,
that probably is the largest number of people ever subjected to this kind of comprehensive
medical evaluation in this sort of setting with an ill-defined and mysterious set of
symptoms. The most important thing about that is that those diagnoses represent
essentially the entire spectrum of medical diagnoses. And they range all the way across
that medical spectrum. Infectious disease accounts for relatively few of these diagnoses. Less
than 3 percent of those first 2,000 patients have an infectious disease. About 20 percent
of those patients have psychologically related medical conditions. Most of these
conditions are relatively common in the general population. And indeed the distribution of
all of these diagnostic categories is quite common and quite reflective of the general
population. In this group they include such diagnoses as depression, anxiety, tension
headache, and dstress-related disorders. These patients have been provided appropriate treatment, and many have
responded well. I think it's very important to underscore that these people are hurting
just as much from their symptoms as if they had diabetes or arthritic knees. The good news
is, as with most of the patients whose diagnoses we're able to establish, that we are able
to provide treatment. Most of these patients are finding significant relief. Now, about 16 percent of those first 2,000 patients have less clearly
defined symptoms. We are not yet able to establish a definitive diagnosis or diagnoses.
That's the group that represents the mystery. That's the group that we need now to go
further on through our specialized care centers, and see if we can whittle down those
ill-defined conditions into firm diagnoses. The diagnostic proportions as we said in December when we issued the
first preliminary report on the first 1,000, haven't changed in the second 1,000. And
there is no clinical evidence to date for a new or unique agent causing illnesses among
Persian Gulf veterans. That preliminary finding is entirely consistent with what the National
Institutes of Health workshop found. I'll just quote from their report, ``No single
disease or syndrome is apparent but rather, multiple illnesses with overlapping symptoms
and causes,'' end quote. That really has been the finding of every group that has looked
at the issues and patient data, and our findings to date are consistent with that. It's important to say right away that is not a statement that says we
stop looking. That is not a statement that says we close the book or rule out any
particular cause of symptoms or illnesses. We've got to keep working. We've got to keep
investigating. And our principle is we look at all possibilities and we let the chips fall
where they may as we find things to rule in or to rule out. I won't repeat what Dr. Kizer has said about the coordinated research
activities and the Persian Gulf coordinating boards. We are in a very intensive research
program. And in 1995 we will be spending in DOD an additional $10 million on a variety of
research activities. These fall into three large areas: epidemiologic research looking at
the distribution of symptoms in large populations, including reproductive health issues;
affects of pyridostigmine, the pretreatment preventative for chemical warfare attacks that
some have thought might be related to these symptoms; and clinical research, research that
will look at ways to better treat and identify symptoms in individual patients and groups
of patents. The first $5 million of these $10 million will be spent on peer-reviewed
independent investigator activities. And the second $5 million will be spent partly that
way and partly in research conducted within the Federal Government. All that research is worked through the coordinating board, as Dr. Kizer
said. There's one last area that I want to touch on in my introductory
remarks: the issue of chemical and biological exposure, which has been the subject of
intense media coverage and public interest. Let me summarize what we know of the exposure
of our troops to chemical and biological weapons. Hundreds of false chemical alarms that were activated due to dust, heat,
smoke, and low batteries have led many to believe that chemical agents were used. I'm sure you all saw the statement in USA Today in the last week where
General Schwartzkopf is quoted as saying, quote, ``There's absolutely no evidence that we
ever ran into during the war or anything that's come up since the war that I know of that
says they used them.'' And that really summarizes what our position is. This has been looked at by a number of groups: Defense Science Board,
our internal looks, the declassification efforts. And we have found no evidence that would
lead to the conclusion that chemical or biological warfare agents were used in the Gulf. But, again, this is not a statement that says we stop looking. We look
everywhere. We pursue all leads. And we let the chips fall where they may. So let me close by reiterating the President's personal commitment to
the Persian Gulf vets and quote his words at the VFW meeting this week, ``We must listen
to what the veterans are telling us and respond to their concerns. We will leave no stone
unturned. And we will not stop until we have done everything that we possibly can for the
men and women who, like so many veterans in our history, have sacrificed so much for the
United States and our freedom.'' We're committed. I think we're on the right track. I think we do have to
focus on the needles and not the haystack. And we fully intend to pursue this to the best
possible conclusion Thank you, Mr. Chairman. [The prepared statement of Dr. Joseph appears on p. 111.] Mr. Hutchinson. Thank you, Dr. Joseph. The chair recognizes Dr. Jackson. Dr. Jackson. Good morning. Thank you, Mr. Chairman, members of the
subcommittee. STATEMENT OF DR. RICHARD JACKSON Dr. Jackson. I am Dr. Richard Jackson. I am the newly appointed Director
of the National Center for Environmental Health at the Centers for Disease Control and
Prevention, CDC. We're pleased to have the opportunity to meet with the subcommittee on
our efforts and those of the Department of Health and Human Services in evaluating the
health status of Persian Gulf veterans. The health of our military personnel and veterans
is an important issue with the administration, as evidenced by Monday's announcement of
the formation of the presidential advisory committee. As you know, CDC has a long history of involvement in veterans' issues,
dating back to the formation of CDC as the Communicable Disease Center after World War II. I'd like to go through a number of the activities CDC has pursued in
relation to this. One was our first involvement. This was in response to concerns about
the health effects of exposure to smoke from the burning oil wells. Beginning in April 1991 researchers from several Federal agencies went
to the Persian Gulf to assist the Kuwait government officials in developing a research
project to determine if the air pollution created by the burning oil wells had potential
to cause health problems. We surveyed a cross-section of workers in Kuwait City in May of 1991 and
of fire-fighters in the oil fields in October of 1991. Blood samples were tested for 31
volatile organic compounds. These are the fumes that you would smell, for example, when
you put gasoline in your car. And we compared the blood levels for these chemicals with a
reference group of Americans, people living in the United States. This is a reference
group that we get from every 10 years' survey of the American people. As would be expected, the fire-fighters had more of these chemicals in
their blood than did the average American. But the chemicals remain in the blood only for
a short period of time. And the long-term health effects on the fire-fighters are unknown. We also examined blood levels of soldiers who were not fire-fighters.
Blood levels of these volatile organic chemicals were about the same or lower than those
found in the American reference group. In addition, our laboratory collaborated with the Department of Defense
in a study of 30 members of the 11th Army Cavalry Regiment. Only one compound,
tetrachloroethylene, was found to be elevated. This compound is not associated with
emissions from oil fires, but, rather, is a substance found in degreasing agents. In other
words, it's used as a dry cleaning solvent. It's used to clean weapons. Another question that has been raised is whether an infection called
Leishmaniasis could explain some of these symptoms. Leishmaniasis is a disease somewhat
like malaria. It's spread by sand fleas. When personnel returned from Operation Desert Storm, CDC published an
article in its February 1992 weekly report that described cases of Leishmaniasis
identified in persons who had served in the region. The article identified federal
organizations to contact for information regarding Leishmaniasis, and we worked with the
staff at Walter Reed Army Medical Center and others to get information out to the medical,
public health, and lay communities. From December 1991 through February 1995, CDC received 1,632 specimens
from persons who served in the Persian Gulf region. Most of them, 93.5 percent of the
specimens, tested were negative. Six and a half percent showed low levels of reactivity. The next question we were asked is: Is there some issue around
reproductive outcomes, birth outcomes? In December 1993, CDC met with Congressman Sonny
Montgomery regarding reports of a cluster of infant health problems among children born to
Persian Gulf veterans in Mississippi. CDC and the Mississippi Department of Health
assisted the VA Medical Center in Jackson, MS in the investigation of this reported
cluster. The investigation found no increase in expected rates in the total
number of birth defects or the frequency of premature birth and low birth weight. The
frequency of other health problems in the children, such as respiratory infections,
gastroenteritis, and skin diseases, also did not appear to be elevated. There's a caveat on this. This is a small group. And when you have small
groups, it's very hard to get an accurate assessment as to whether this really reflects a
much larger population. You're only looking at about 50 children. I'd like to talk briefly about an investigation that's underway right
now in Pennsylvania. We are conducting an investigation of a reported cluster of illnesses
of about 60 members of the 193rd Pennsylvania Air National Guard. All those affected have
been deployed to the Persian Gulf during Operation Desert Shield and Desert Storm. The investigation is being conducted in three phases. The first phase
will describe the clinical signs and symptoms and health concerns among a sample of the
ill Persian Gulf veterans. This is being done at the Lebanon, PA VA Medical Center. Phase II is a survey of the Air National Guard unit in comparison to
other units to document the prevalence of health problems. The third phase is what's called a case control study, where you
interview people who are ill and you interview people who are well and you compare their
histories and what they report to see if we can find risk factors for this unusual cluster
of disease. The last is an assessment of the health status of Persian Gulf veterans
from Iowa. After a request from Congress, CDC is implementing a telephone survey of
Persian Gulf veterans who listed Iowa as their home of record. This study is being
conducted in collaboration with the Department of Public Health in Iowa and the University
of Iowa. It includes a detailed assessment of Persian Gulf veterans' health concerns as
well as questions about the health of family members. This study will consist of a random sample of 2,000 military personnel
who served in the Gulf theatre of operations and 2,000 Gulf era military personnel who
served at other sites. We expect to begin data collection in July and to have a final
report for you in the Summer of 1996. In addition to these studies, CDC has been active as a participant in
the Persian Gulf Veterans Coordinating Board. Health and Human Services has been involved
in fostering coordination and communication among the Federal agencies involved in the
research, and has detailed a staff member to the Persian Gulf Veterans Coordinating Board.
The person will serve as a liaison to the Coordinating Board and to the other agencies,
including Department of Defense. We also have staff participating in the Department of Veterans Affairs
Persian Gulf Expert Scientific Committee and, of course, are looking forward to working
with the new presidential advisory committee. I'll briefly touch on future research needs. Studies should be conducted
on representative samples of Persian Gulf veterans with complete assurance of
confidentiality. Obtaining data on a comparable control group of veterans is essential.
It's often easy to get information from people who have identified themselves as ill, but
you need to ask those same questions of people who are not ill. The VA is planning a mail and telephone survey of a nationally
representative group of Persian Gulf War veterans. And our CDC Iowa study will complement
the VA study and provide in-depth information on Persian Gulf War veterans' health status.
These will tell us if the prevalence of illnesses among the veterans is higher than
expected. I'd like to close with a few recommendations. All of these studies will
contribute to our understanding of the effects of military service in the Gulf theatre of
operations. However, most of our studies are limited by their retrospective nature. We're
going back and asking people to recollect their exposures from 3, 4, 5 years ago. This has
been true of previous CDC studies of military personnel, be it Agent Orange or others. Baseline data on the health of military personnel is often lacking. And
it limits the ability to conduct definitive studies. One way to fix this problem is to
take a more proactive approach in evaluating the veterans' concerns, health concerns. It
would call for much closer consultation with the Departments of Defense and Veterans
Affairs as to what baseline data would be useful in evaluating the health of military
personnel further on down the line. We'd like to have improved information on the number of troops deployed
during a military conflict, information on potential exposures, surveillance systems to
address health outcomes and identification of risk factors for stress-related reactions. Health and Human Services believes that the health of our veterans
should be a very high priority. And we will work energetically with the other Federal
agencies who deal with these issues. Thank you, Mr. Chairman. [The prepared statement of Dr. Jackson appears on p. 119.] Mr. Hutchinson. Thank you, Dr. Jackson. Dr. Miller, you're recognized. Dr. Miller. Good morning, Mr. Chairman and members of the subcommittee. STATEMENT OF DR. RICHARD MILLER Dr. Miller. My name is Dr. Richard Miller. I am the Director of the
Medical Follow-Up Agency, a division of the Institute of Medicine in the National Academy
of Sciences. Public Law 102-585 directed the Secretaries of Veterans Affairs and
Defense to seek to enter into an agreement with the National Academy of Sciences to
establish an expert committee. That committee's task is to assess how the VA and DOD have
collected and maintained information potentially useful for evaluating the health
consequences of service in the Persian Gulf War and to make recommendations concerning
whether there is a sound scientific basis for epidemiologic studies of those health
consequences. The IOM committee released a first report on January 4th of this year.
The intention of the report was to describe initial findings and make initial
recommendations to the VA and DOD regarding potential Persian Gulf War health effects
research and related issues. There are many research projects that have been completed or are now
underway within the VA and DOD related to health consequences of Persian Gulf War service.
And the IOM committee reviewed approximately 50 of these as of September of last year,
when the report was finalized. The earliest research activities within the DOD were focused on the
effects of the burning oil well fires, while the VA conducted early studies in response to
Public Law 102-25 assessing the occurrence of post-traumatic stress disorders. Subsequent
efforts were generally in response to local outbreaks or clusters of undiagnosed illness. The IOM committee felt that while all of these activities have been
appropriate and credible, efforts now need to be focused on answering carefully formulated
and highly specific research questions. The VA was also required by Public Law 102-585 to establish the Persian
Gulf veterans health registry. Although the information in this registry is of little use
for research purposes because of the self-selected nature of the participants, the IOM
committee agreed that it was important that the data be reviewed on a regular basis for
possible sentinel events. The report made initial recommendations in three categories: data and
databases; coordination and process; and, finally, consideration of study design needs.
The data and database recommendations reflected the IOM committee's concern with the
database resources that are necessary to conduct research, including the lack of a data
system linking medical information on an individual during active duty and continuing into
the era of VA-provided services. Also the IOM committee recommended prompt completion of the DOD's
geographical information system that will provide potentially useful information on troop
locations to be used in future research. The location of troops can provide a surrogate
for potential exposures received in the Persian Gulf theatre, essential information in
evaluating health outcomes. The initial recommendations involving coordination reflected the IOM
committee's concern that new projects need to contribute substantively to the total
Persian Gulf health research agenda, that they be actively and fully coordinated between
the VA and DOD, that they be focused in design, peer-reviewed, and not duplicative of
efforts of other agencies. The IOM committee felt that specific research questions should be
addressed with input from epidemiologists as well as subject matter experts. The research
that the IOM committee recommended included: a VA-DOD collaborative population-based
survey to obtain data on symptom prevalence and health status; evaluation of potential
health effects from exposure to lead; a long-term study of the mortality of Persian Gulf
War veterans; well-designed studies of potential adverse reproductive outcomes, laboratory
studies of possible interactions of pyridostigmine bromide, DEET, and permethrin; and
further work in the area of diagnosis of Leishmania tropica infections and the study of
the epidemiology and ecology of those infections. The IOM committee met in January of this year with representatives from
the Persian Gulf Veterans Coordinating Board to discuss the IOM report recommendations and
the VA/DOD response. The meeting was useful for all parties involved, and the IOM
committee agreed that genuine efforts are being made to respond to their recommendations. The IOM committee will continue to evaluate the research efforts for the
coming year and a half and will review progress in the areas of concern in the final
report. The committee is, in fact, meeting today for the seventh time. And their final
report will be available in late Summer of 1996. Thank you, Mr. Chairman. [The prepared statement of Dr. Miller appears on p. 130.] Mr. Hutchinson. Thank you, Dr. Miller. I want to thank the panel. For
some of us, we may yearn for Dr. Rowland to be back. Much of the testimony is very
technical but we appreciate it. I know the members will have a lot of questions. I do want to for the benefit of the members, that members who were
present before the gavel went down will be recognized by seniority, Republican, Democrat
alternating. Those members who came in after the gavel went down, will be recognized in
the order in which they appeared following the long tradition of the full committee. We
will be operating under the 5-minute rule. Dr. Kizer, both the Department of Defense and the Defense Science Board
Task Force on the Gulf War Health Effects have concluded that no chemical or biological
warfare agents were used in the Gulf War. We've heard that assertion here during the
testimony this morning. Dr. Kizer, you recently remarked in USA Today that you lack confidence
in Pentagon assertions that troops were not exposed to chemical or biological agents. What
is the basis for that assertion? Dr. Kizer. Let me try to respond to that. That was a comment that was
made when I was having a wide-ranging, free, and open discussion with our expert advisory
panel a couple of weeks ago or thereabouts. My comment was in no way intended to mean that I don't believe DOD
officials or that the DOD has not been fully forthcoming. What it was intended to focus on
was the fact that I have not yet reviewed that data personally. So I can only rely on what
I have been told. I also have some questions about what exactly were the exposures that
occurred over there, not necessarily biological/chemical warfare, but the whole array of
potential environmental exposures. It's not clear to me, at this point, that anyone has
rigorously documented what exactly were the environmental conditions that were confronted
by our troops. And, as I said, being relatively new to this job, I have not yet had the
benefit of hearing some of the DOD briefings and other things that Dr.Joseph and I have
talked about. Hopefully I'll be hearing more about those in the weeks and months ahead. Again, I think there are some questions about what actual exposures
occurred and whether we had all the monitoring that would have been necessary to document
that. I'm withholding judgment, I guess, until I've heard more. Mr. Hutchinson. In your mind you were expressing, not prejudging that
the jury was still out as far as you were concerned,. You wanted to look at exactly what
the evidence was? Dr. Kizer. That's correct. Again, I was talking to what I viewed as peer
scientists and investigations. I'm withholding judgment until I've had the opportunity to
become more personally knowledgeable myself. Mr. Hutchinson. Let me ask this question of the panel in general. Any of
you can respond to this. The Journal of the American Medical Association August 3, 1994
states that ``A collaborative Government-supported effort on Persian Gulf illnesses has
not been established'' and there is not a uniform protocol across the military, VA, and
civilian physicians. Could you respond to that, comment on that? Dr. Joseph. I'd be delighted to respond to that. I think that statement
is inaccurate. It's inaccurate on both the research and the clinical sides. I've said in my testimony, and I know we've said it many places before,
the clinical protocols for DOD and the VA have been worked together, developed together.
They're virtually identical. We have joint bodies that review all research proposals, plan
the research studies, and that look at the clinical data as well. I guess I'd have to say, Mr. Chairman, that it's an easy shot. An easy
shot that one can always say about every Government activity. And, we can talk about
whatever level of detail you want. I've never known of an interagency activity in Government that has had
as intensive and close coordination, particularly between VA and DOD, as this one has. Does that mean that everything is perfect and that we never disagree on
something? Of course not. But if you look at the number of actions working and the
results, the way that the research is funded and conducted, and the way the clinical
studies are funded and conducted, I think that statement in JAMA is just inaccurate. Mr. Hutchinson. Would any of the rest of you want to comment on that?
[No response.] In Arkansas we had a lot of our reservists who were involved in the Gulf
War. The 142nd in my district performed admirably. The fact is that 50 percent of those
afflicted with Persian Gulf illnesses have been reservists. Are studies looking at factors
such as age and physical conditioning as a possible difference in the levels of
psychological preparedness as a basis for the current research? Dr. Joseph. Yes, we are, sir. Certainly on the clinical side, in both
the preliminary report we put out in December and the next version, which you'll see
shortly, we do all the demographic cuts: Reserve, active duty, gender, age, branch of
Service, et cetera. I would like to drop back to something that__ Mr. Hutchinson. Before you leave that__ Dr. Joseph. Yes. Mr. Hutchinson (continuing). Is there any correlation that has been
found? Dr. Joseph. No significant correlation. There really is nothing. If you
look at the two groups, among veterans in the comprehensive clinical evaluation program,
our CCEP, they are slightly older than the representation of age in Gulf service as a
whole. There are small differences, but there's nothing that leaps out at you. And I would
also say_again, this is preliminary data, but it is 2,000 people_we have found no
clustering by unit of service in that initial 2,000. Dr. Kizer mentioned, and I think Dr. Miller also mentioned something
that is going to be one of the most important pieces of this puzzle. That's the study the
Army is working on to give us a geographic location by small unit by every day, every
place in the Gulf. Army has been working on that about 18 months now. The study will not be
completed until sometime next spring, not this spring. It's a very complicated job. Once we have what is essentially a map by location and by time of all
small units in the Gulf, we then can take any of these questions, whether it's Reserve,
active duty, gender, particular symptoms in a group, particular histories of exposure, et
cetera, and lay it over that map and come up with whatever leads there are. That's
probably the key study and it takes that amount of time to get it done. When we have it,
we can give you discrete answers for a lot of the questions you pose. Dr. Kizer. If I might, your question also raises an issue, again as
someone new coming in and looking at this, that points to whether there are differences
between the reservists versus the regulars. But there's another group that, in my
judgment, we should be looking at. That's our coalition forces. They came with different backgrounds. In many cases they had different
preparatory or prophylactic measures. It occurs to me that there were significant numbers
of them and that we should be looking in a collaborative way with the governments of the
countries involved: Britain, France, Canada, et cetera, for what has happened in their
troops, whether they have the same experience as our troops, and whether their different
preparatory and prophylactic measures in any way correlate with the symptomatology being
found in those groups of soldiers. Mr. Hutchinson. Thank you. Let me yield to Mr. Edwards. Mr. Edwards. Thank you, Mr. Chairman. Since Mr. Kennedy has been so
active on this issue, I'd like to yield my 5 minutes of time to him for questions. Mr. Hutchinson. Mr. Kennedy, you're recognized. OPENING STATEMENT OF HON. JOPEPH P. KENNEDY II Mr. Kennedy. Thank you very much. First of all, I want to thank Mr. Edwards for his consideration in
yielding. I really appreciate it, Chet, very much. Thank you. I also want to thank the chairman, Tim Hutchinson, for holding this
important hearing this morning. I think it was really significant that you chose to make
this one of your first hearings. And I think for many of who serve on the committee who
felt that this issue has not gotten the attention that it needs in the past, it really is
telling an important demonstration of your commitment, Tim. So I really appreciate the
fact that you've chosen this morning to hold this hearing. I want to thank our panelists as well for coming forward. I think that
there are a number of questions that I have after listening to your testimony. First of
all, Dr. Joseph, you talked with some emotion about the fact that this is the most
coordinated and comprehensive effort that you've seen in your experience in terms of
interagency coordination and the like. And, yet, I think Dr. Kizer just pointed out what
from at least my perspective has been a disturbing pattern that has developed over the
course of the last few years, which is that as each one of these issues develop, there's
always resistance on behalf of the Department of Defense towards accepting the notion that
there might be some kind of issue here. Now, I don't suggest for a second that at the moment there hasn't been a
growing awareness on the part of the Pentagon that there is a problem, but it has been
like pulling teeth, I mean, just hearing Dr. Kizer mention the fact that there is a
potential of the coalition forces. I mean, I remember when I tried to bring up the fact that we were
hearing testimony, we were hearing from people overseas, there was a great deal of
resistance on behalf of the department to take that into account. We've since heard, I've gotten letters, people have called my staff, of
people in the news media that were serving in the Persian Gulf who themselves are now
having many of the same kinds of physical complaints. There was a great deal of scorn that was directed at the family members
of individuals that served in the Persian Gulf and the kinds of transfers that at least
wives that did not serve, of people that did serve, and husbands of women that served were
beginning to complain of some of these illnesses. And that again was treated with a great
deal of scorn. The problem is, as I'm sure you're well-aware, that there has been a
certain lag time in recognition and in acceptance of the fact that there might be a
problem. And when you talk about your numbers of 8 or 9 thousand people in toto, of 1,000
people being processed_right? Well, I didn't quite get it because I thought you said 2,000
people went through but there are only 1,000 people__ Dr. Joseph. I'll be happy to repeat that. I don't want to interrupt you. Mr. Kennedy. Okay. Well, I guess my concern is that, as I understand it,
there are over 15,000 people who have registered in the Department of Defense registry.
There's something on the order of 43,000 people who have registered in the VA registry. Now, that's not to say that every single one of those people has these
direct complaints, but is an indication if somebody others to sign up with a registry
that, maybe, in fact, they came in and registered because they do have something that
they're concerned about. And so it seems like there's a much larger universe out there. Okay.
Well, you're shaking your head. So why is that not true? Dr. Joseph. Let me focus on what's a wide-ranging question. I'll first
talk about the universe, and then I'll talk about the lag time that you alleged. What I said in my testimony is that on the DOD side we set up the
hotline last summer and we've had 15,000 people register through that hotline. Of those
15,000 people, about 3,000 say they have no symptoms but they just want to be on the
register. Of the 12,000 who have called in with symptoms, we already have in the medical
examination process between 8 and 9 thousand. And we have completed that medical
examination process for over 4,000. We then take the completed exams and scrub the data: go back and quality
check all the lab data and the rest. We have scrubbed the data on the 2,000. So it goes
15, 12, 9, 4, 2. The 1,000 number is where we were 3 months ago, in December. We were at
that same final point, if you will, on only 1,000 people. We've doubled that number
between December and now. Mr. Kennedy. I see. So let me just ask you: When you__ Dr. Joseph. So I think we're reacting to that universe, I think, quite
effectively. Mr. Kennedy. Okay. When you talk about the 2,000, you say in your
testimony 84 percent of those 2,000__ Dr. Joseph. That's correct. Mr. Kennedy (continuing). Have explicable illnesses. Dr. Joseph. That's right. Mr. Kennedy. Do you attribute any of those explicable illnesses to
chronic fatigue syndrome? Dr. Joseph. No, we would not consider chronic fatigue syndrome in that
grouping. What we have done__ Mr. Kennedy. Can you break it down? Because when you broke it down, it
didn't exactly add up to 200. You get 20 percent or something. I wrote it down. You said 3
percent have infectious illnesses. Twenty percent have psychological problems. But where
did the rest of the 70 or whatever__ Dr. Joseph. Musculoskeletal problems, skin disorders, gastrointestinal
disorders, whatever. Mr. Kennedy. Wouldn't musculoskeletal problems, skin disorders and
things like that be the kinds of illnesses that people are complaining about? Dr. Joseph. Yes, of course. Of course. Mr. Kennedy. So you're saying that you would have a skin disease and
absolutely make assurances it has no relationship to this inexplicable illness__ Dr. Joseph. Well, the word ``inexplicable''__ Mr. Kennedy (continuing). Because of the symptom? Dr. Joseph. That's right. Mr. Kennedy. It would have absolutely no relationship to service in the
Gulf, you're saying? Dr. Joseph. No, I'm not. I'm most clearly not saying that. Mr. Kennedy. Oh, okay. I'm getting confused. Dr. Joseph. Let me try to ``unconfuse'' you, then. Mr. Hutchinson. Your time has been extended. Mr. Kennedy. Thank you very much, Chairman. Dr. Joseph. Let's try to take a diagnostic spectrum. Let's suppose you
served in the Gulf and you fell off a ``Humvee'' and injured your right knee. Now you have
chronic arthritis in that knee. You have an explicable, clear, garden variety medical
diagnosis that is clearly related to your service in the Gulf. That's way over here. Way over at the other end is this 15 percent of people that I'm saying
we're most concerned about. They came back from service in the Gulf, have chronic fatigue,
trouble sleeping, aches and pains, et cetera, and are symptomatically ill with these
symptoms. And, we don't have yet an explanation or a diagnosis to fit them. Mr. Kennedy. And you have cleared having any psychological problem as
well? Dr. Joseph. In that group? Mr. Kennedy. In that group. Dr. Joseph. At least at present we can't identify what the specific,
clear diagnostic problem is. That's way over on the other end. And, there are numerous
people in the middle. Suppose you served in the Gulf and you're back now 4 years. You have
diabetes and you noticed the onset of the symptoms of your diabetes while you were serving
in the Gulf. There it might be a more open question whether that__ Mr. Kennedy. I appreciate that. Dr. Joseph. So what I'm trying to say is there is an entire spectrum in
that group. Mr. Kennedy. I appreciate that. I'm just trying to understand. In terms
of the overall numbers, you still leave a very large range. And I'm trying to understand.
You're saying about 16 percent of the people have this illness that is inexplicable, 20
percent of the people have psychological, 3 percent of the people have the__ Dr. Joseph. Right. Mr. Kennedy (continuing). Infectious illness. And so the rest of the
people have illnesses. The only question I really have is that the rest of those people,
there are 60-70 percent of the people you talked about, do they fall off a truck and hurt
their knees or is there some group_I mean, I just remember General Blanck testified last
year that 25 percent of the people had chronic fatigue syndrome. So I'm trying to
understand what that larger category is__ Dr. Joseph. Right. Mr. Kennedy (continuing). And whether or not there is any open
discussion. You've got 15,000 people in your registry. The VA has 43,000 people. And I
don't want to make any presumptions. You say it's all so well-coordinated. I'm just
concerned that, in fact, there's a hell of a lot more people out there, Doctor, than, in
fact, we have been able to take into account, which then leads me to another question that
I want to ask Dr. Kizer. But, in any event, I'm pointing out that there seems to be the potential
for a gap in your numbers that leaves very much open to debate what has actually happened
to that 60 or so percent that has yet to be specifically accounted for. Dr. Joseph. I don't think so. Mr. Kennedy. Okay. Dr. Joseph. I'll be happy to share, or send up later, the specific
diagnostic categories and percentages. Mr. Kennedy. Right. Dr. Joseph. There is one more thing I want to say. In referring to that
16 percent for which we still don't have a clear diagnosis, you used the words ``this
illness.'' What all our experience is showing us to date is that in that 16 percent, it is
probably not a question of this illness, but rather these illnesses. Mr. Kennedy. I appreciate your__ Dr. Joseph. That's a very important differential. Mr. Kennedy. No. I understand. I think all of us understand the
perspective that you're bringing, Dr. Joseph. And what you've got is Dr. Kizer sitting
right next to you saying that he is still open to the notion that there might be a
specific cause of these illnesses if you want to choose to describe it that way. And so what you've got again is, instead of coming across as having an
open mind to the notion that there might, in fact, be a specific event, a specific bug, a
specific exposure, a specific kind of_whether chemical, biological, whether it's some
bacteria that lives in the desert, hell, I don't know, but there might well be something
that our troops and everybody in the theatre was exposed to that affects a certain number
of people a certain kind of way and has a multiple myriad of different symptoms that can
be brought upon a human being as a result of that exposure. That is something that Dr.
Kizer I think is still open to and something that I think I'm concerned that we still
haven't created a playing field that is actually going to allow us to make that ultimate
determination. So let me just ask Dr. Kizer while I've still got my yellow light
whether or not there is in your opinion right now a study that will end up enabling us to
draw that conclusion at some point? Whether it's 2, 3, 4 years from now, but at some point
will we be able to draw that conclusion given what we have going on today? Dr. Kizer. I don't think any of the individual studies by itself will be
able to give you a definitive answer. I think in the composite, though, that we'll
certainly be able to narrow the issues down. I also believe that out of the 40-plus
studies that are currently being pursued, there will be some new hypotheses that will
further open up avenues or potential areas that will need to be explored in the future. I'm not sure whether we'll ultimately find an answer, or a series of
answers, that will explain this. I think the studies have to be done, and we have to judge
the results based on where they point us to in the future. Mr. Kennedy. I appreciate the chairman's indulgence. Thank you. Mr. Hutchinson. Thank you, Joe. We recognize Mr. Tejeda. The order will be Jack Quinn then Steve Buyer.
The gentleman from Texas, Mr. Tejeda, is recognized. Mr. Tejeda. Mr. Chairman, what I'd like to do is submit some questions
for the record and yield the balance of my time to Mr. Kennedy. Mr. Hutchinson. Without objection. (See p. 149.) Mr. Kennedy. Thank you very much, Frank. I didn't know I was going to
get__ Dr. Joseph. Could I come back on that__ Mr. Kennedy. Sure. Dr. Joseph (continuing). Mr. Kennedy, if I might? I think we're talking
a bit at cross-purposes because I agree with every part of the statement you just made
with reference to leaving these issues open. I said in my testimony three or four times that we've got to be very
careful. We are very determined not to foreclose any possibilities and not to say that we
have ruled out any particular cause or causes until that is absolutely scientifically
clear. I think where our cross-purposes discussion comes in is that I believe
that all the data on the table tell us one very important thing_I think I hear you saying
this_that whatever series of causes there are for whatever groups of illnesses in the
people who served in the Gulf, there is no one unique, single overriding cause for all or
most of that series of illnesses. That is the essential thing that we know fairly
definitively so far. Mr. Kennedy. And all I'm saying is I don't know that. I don't know what
I think that there are_in my district, Massachusetts Institute of Technology, I have
spoken with multiple chemical sensitivity experts, some of the top people in the field in
this country. And they will tell you that you can be exposed to a myriad of different
chemicals and that those chemical exposures potentially can provide a wide range of
different symptoms that the human body can then demonstrate. So I just don't know, Doc. I don't know what happened out there. I know
that the Department of Defense had a whole bunch of different instruments that kept going
off. It scares the hell out of people that we're serving in the theatre because they don't
know whether or not they were exposed. I know and I couldn't agree with you more that I don't think there's any
evidence to suggest that Saddam Hussein sent in a chemical warfare agent that exploded in
one particular theatre because a hell of a lot more people would have been exposed in that
particular area. But whether or not something exploded in the air, whether or not there
were shelters that could have been hit by bombs that then created some_whether there were
bugs in the sand, I don't know. And I guess I would look to somebody like Dr. Jackson to just sort of
come in at a certain point here and kind of set the record straight as to how you conduct
an epidemiological study that ultimately would enable us to capture whatever knowledge the
human race has been able to develop and bring that to bear on the range of exposures that
these individuals had in this particular area for a particular period of time and enable
us to draw some conclusions so that we're not feeling_and I don't think you're doing
anything evil, Doc, Dr. Joseph. I just think you're taking 15,000. Kizer has got 43,000. We can talk about Leishmaniasis. We can get bogged down on whether or
not there were chemical or biological agents. Hell, I don't think any of us know. But it
does seem to me that it should be possible to be able to conduct a universal study, look
at all of these guys we're serving, all the troops we're serving, everybody there was
serving, the kinds of illnesses and exposures that they're having, and be able to draw
some kind of conclusion. The VA is now treating the people in terms of their illnesses, whether
they be physical or psychological. That's great. They're getting some money from the
Government for their disability. That's great. But all they really wanted to know was
whether or not there was something that they were exposed to that could have drawn this
conclusion. There's no sense in us pretending that they might not have been exposed to
anything that could have happened out there. Is it possible? Dr. Jackson, is this appropriate for you to answer,
whether it's possible to create a universal study that will enable_Dr. Kizer said that
even with what we've got to date we might be able to come to a conclusion. But we might
not be able to. Is it possible to create a study that would enable us to make this
determination once and for all? Dr. Jackson. Congressman, I don't know how one could do a survey of
700,000 individuals, look at all their exposures everywhere they had gone, compare those
with 700,000 other individuals, that level of detail. What's really needed is a
scientifically based sound sample of individuals, just the way a poll looks at the profile
of the American people before an election. If you do a random survey of the population, you interview those
individuals. You find out where they were, what were your exposures, and you draw some
conclusion from that sample. And that's what we're proposing to do with__ Mr. Kennedy. Isn't that exactly the opposite of what Dr. Joseph_Dr.
Joseph is saying you find the needle in the haystack, and you're saying you look at a
haystack. Dr. Joseph. You do both of these. Mr. Kennedy. Okay. Dr. Joseph. You do both. Mr. Kennedy. I'm just repeating what you said. Isn't that true? He's
saying you look at the guys who are sick, and you're saying you look at a comparison. Dr. Joseph. No, sir. I'm saying you start with the people who are sick.
You start with the needle so then you can know what questions to ask about the haystack.
That's my comment. Dr. Jackson. May I just comment quickly on the questions you ask because
it's very important how you word the questions? Number one, the population you interview
is very important. People that call up and self-refer are different from people who don't
call up. And you need to get that sample that's an actual profile of the population.
That's what the Iowa study is doing. Number two, the questions. We've got two advisory committees that will
be working on that. One is a science advisory panel, which obviously you need, but the
other is a veterans' panel, people who actually have real life experience with this that
will help us formulate the questions, make sure that we're asking about exercise training
or whatever questions are needed. We've already had one meeting of one of those panels already. So we'll
be including all of those as well. Mr. Kennedy. Well, is your conclusion that you're going to have the
data, you'll be able to make the best presumption possible, the best answers possible or__ Dr. Jackson. If I may, I don't want to raise false hopes. At the end of
this, we will be able to say, one, are the rates higher than people who did not serve in
that theatre? Number two, if they are higher, how are the people that had higher rates
of symptoms different, different age, different level of training, different areas that
they worked in? We're going to refer that over to the geographic systems that would look
at that. That's about as much as we'll get out of that. Mr. Kennedy. Thank you, Mr. Chairman. Mr. Hutchinson. Thanks, Joe. The gentleman from New York, Mr. Quinn, is recognized. OPENING STATEMENT OF HON. JACK QUINN Mr. Quinn. Thank you, Mr. Chairman. I, too, want to, Tim, say to you
that I appreciate the effort that you've put in to make sure that this is one of our first
hearings this year and want to suggest, Mr. Chairman, that we continue this line of
questioning with some other panels, as I know you plan to do this year, and would ask
unanimous consent to insert into the record some opening remarks. Mr. Hutchinson. Without objection. [The prepared statement of Congressman Quinn follows:] S6621 Prepared statement of Hon. Jack Quinn Thank you, Mr. Chairman for calling this hearing. I am pleased that one of our first hearings is focusing on the troubling
experiences of some of our Persian Gulf War veterans. I think we need to continue to pay
special attention to the servicemen and women who have returned and are experiencing
unexplained illnesses. Research efforts appear to be well underway. While I understand few
projects have come up with definitive conclusions, I hope today will give this
subcommittee more information on planning and investigations phases. The witnesses who have come to testify before us this morning will help
me respond the many questions and concerns of the veterans and their families in my
district. The unexplained illnesses_fatigue, rash, muscle pain, stomach
ailments_and the particularly troubling reports of problems among vets' spouses and
children. The biggest obstacle seems to be that there is no common or underlying problem
that can be identified. We owe it to our vets to keep trying to find one. I am pleased to note that a researcher at University of Buffalo is
involved in one of the multi-project efforts. I look forward to hearing more about these
efforts this morning. President Clinton recently formed an advisory panel to advise him on the
issue of Persian Gulf Syndrome and requested a $13 million increase in research money. We
can see we have a commitment from the Administration, VA, DOD and other agencies. I am glad to be here this morning_so that our vets will know there is also a commitment by the Veterans' Affairs Committee and all of our colleagues in Congress. S6602 Mr. Quinn. I at the same time want to mention a gentleman that I
represent, upstate New York, Buffalo, NY_and I'm pleased to note that one of the
researchers at the University of Buffalo is involved in one of the multifaceted projects.
And we've been in touch with him as well as some people at the Buffalo VA and others in
our end of the world up there in Buffalo and western New York. I guess a couple of reactions and then maybe a general question to the
entire panel for my benefit this morning. I guess I've sat here now for a little over 2
years on the committee and want to make special note of the work that Joe Kennedy and Lane
Evans and Steve Buyer have done in this regard. Just to say as an observer a little bit until about now, when I plan to
jump in a little bit more what the gentlemen have begun, we're not making this stuff up. I
mean, we hear from constituents. We hear from people back home. We hear from people all
over the country who are concerned. I've sat this in this room around this table and have heard from vets
and their families, men and women, who have explained to us absolute horror stories of
their experiences and their fears, fears of the unknown. I see some young people joined us
in the back of the room a few minutes ago. They're fearful for their children and other
things. So we're not going around trying to make this stuff up or to look for
these kinds of concerns. They come to us. You gentlemen_and the other thing I want to
mention before I make is an observation that I'm pleased to see after some prodding here
some headway being made. I think the President's announcement of an advisory panel and
some money to this effort is something we all should support. And I want to do that. I think the fact that we have the four of you here this morning from
four different areas shows that we're working on it from a couple of different directions.
And I think that's very helpful. But the four of you represent work for the American people, I think,
remind us all that you work for the American people. In a sense so do we back in our
districts. We have oversight over that. And our job in representing the American people is
to make sure that those of you who do work for them are doing the best you possibly can. Mr. Chairman, when we do some more of these hearings later on this year,
one of the things we might suggest is since we're not the only ones hearing from all
different sides, that we invite some of the panelists back to hear those mornings when we
hear from the servicemen and servicewomen and their families firsthand what's going on.
I'm sure you've heard it in your interviews over the course of the last couple of years. I just would ask you for some advice, each of you this morning. When we
go back home or we pick up the phone or we answer letters from people who say to us along
the line of the questioning that Mr. Kennedy just hit, ``What's taking so long? How many
studies do you have to do for me to convince you that I'm sick, that things aren't going
very well for me?'' I'm a school teacher. I understand that you can't rush into these
things. I understand that overnight you can't decide what's wrong and what's right without
some study, some science, some medical information to give you that. What advice would you give me or anybody else around the table this
morning on a response to these people? When the chairman calls them back again this year
to testify on the Hill, they'll say ``Here we go again. We'll go back to Washington, and
we'll sit in front of the panel. We'll tell them again what we told them last year and the
year before.'' Dr. Kizer, I ask you to start and work your way across. What advice
would you give me to give to my constituents? Dr. Kizer. First I would encourage you to tell them to come into the VA,
and we're going to take care of them. That is one of the things that's fundamentally
different about how this problem is being approached than other problems in the past, such
as problems with Agent Orange and others. We have decided that it makes much more sense to take care of people, to
treat their conditions, to give them the best care that we can, even though we may not
know exactly what's causing it or even in some cases if it can't be clearly linked to what
may have happened. Having been involved very closely with the AIDS epidemic and with other
problems in the past, we've heard these same questions there. We're 15 years into the AIDS
epidemic. Why don't we have answers? We still don't have answers. The war on cancer was
declared 35 years ago. We don't know what causes most types of cancer. And you can go down
the list of other medical conditions that we don't have answers to. The research that needs to be takes time. If you're going to do good
research and get good results, you can't rush it. We need to explore all possibilities. I
think we need to keep a very open mind. And anything that's reasonable needs to be
pursued. And that is indeed the approach that hopefully we're taking. But, again, I would go back to what I said at the outset. What's
different here is that we're saying you don't have to wait until science has those answers
because we don't know when that's going to be. It may be years. It may be never. But in the meantime let's take care of the people. They served the
country. Let's take care of them in the best way that we can. And so I think for your
constituents, you need to encourage them to come in and get the care that they deserve. Mr. Quinn. Thank you. The only difference when we talk about this kind
of illness and AIDS or cancer, of course, is that we have heard from some people who said
that the reason they're ill in the sickness is because they were in the service of their
country. A mother said that she sent away a 19-year-old son who was the star of
the football team. And then 11 months later she told us he was dead. And there's some
connection to the service to our country in there. And that's why we're interested. That's
why we all should be interested. Dr. Kizer. Sure. And I understand that. But from a science point of
view, it's not that much of a difference. Mr. Quinn. May I take just an additional minute to get a response from
the other members, Mr. Chairman? Dr. Joseph. Here's how I'd answer your constituent, ``The number of
studies we have to do before we're convinced that you're sick is zero.'' What Ken Kizer
has just said, and what I've said about our clinical program is strong encouragement to
them to come in so that we can take care of what ails them and try to figure out what is
causing it. I would not be quite as pessimistic as Dr. Jackson about how soon we
will learn or how fully we will learn what this whole puzzle looks like. Although he's
right that we are unlikely to get a complete perfect answer, I think a number of the
studies now going on will help: the VA survey, the Naval studies that look at comparisons
between hospitalization rates, mortality rates, other kinds of exposures and reproductive
issues. The way imperfect science and medicine work is that you probe an issue from many
different directions. You don't get a full or a perfect answer from any one of those
probes, but you begin to get knowledge that enables you to move on and work with it. So, I'm a little more optimistic. Although I think he's right in a
perfectly scientific sense. I think that's the answer to the constituent. We don't know,
but we're moving in the right direction. Each year we'll have more to say about how much
we do know. That takes time. Mr. Quinn. Dr. Jackson, can you add a brief comment? Dr. Jackson. People that are ill need to be taken care of. And science
may give us some answers that may take a long time. You want to make sure people get the
care that they need before they'll not wait for the science to come in. Mr. Quinn. Dr. Miller. Dr. Miller. My only comment is that we have on our committee one Persian
Gulf vet who reminds the full committee frequently of the urgency of these issues and
pushes them very hard. Mr. Quinn. I appreciate you. Dr. Kizer, for your line to explore all
opportunities and to keep an open mind I think is key to all of us and all of our efforts
in this area. I appreciate the time, Mr. Chairman. Mr. Hutchinson. Thanks, Jack. The gentleman from Illinois, Mr. Flanagan, is recognized. Mr. Flanagan. Mr. Chairman, I ask unanimous consent to place a statement
in the record. Mr. Hutchinson. Without objection. [The prepared statement of Mr. Flanagan appears on p. 60.] Mr. Flanagan. Good morning, gentlemen. I thank the chairman for having
these meetings. And I thank Mr. Kennedy for his commentary and his questioning. I have a couple of questions for Dr. Miller along the same vein that we
have been pursuing with Mr. Kennedy, and that is the coordination of the efforts and the
value and efficacy of what has gone before and our plans for the future to continue to
deal with this in relation to your study with the Institute of Medicine. Your statement before this committee and the report of the Institute of
Medicine as issued indicate a somewhat critical review for the research efforts that the
Department of Defense and the VA have recommended a better focus to coordinate their
efforts. How can these departments better coordinate their information-gathering and
research efforts? Dr. Miller. I think the committee in the report made highly specific
recommendations for coordination, and realizing that those were made last September and
that I think they feel somewhat better now than they felt at that time. But their emphasis on coordination was not only information-sharing, but
something beyond that to ensure integration and a lack of duplication across the research
program. And I think their recommendations were very clear and they have been taken to
heart by the VA and the DOD. Mr. Flanagan. Well, I'm glad it's that because Dr. Kizer this morning
was talking about the fact that he did not have a comprehensive research organization
insofar as it applied to the ensure spectrum of the number of people he has to look at for
the Gulf coordinating boards and the difficulties and benefits that have been gleaned from
that. I'm glad that we're moving in that direction. Dr. Miller, you have also alluded to the fact that the Department of
Defense and the Veterans Administration should focus their efforts on specific research
questions. Could you elaborate on what those questions might be? Dr. Miller. I think the specific research questions were detailed in the
testimony. And I will reiterate. Mr. Flanagan. Could you extrapolate on those a little bit because we're
learning a little bit today about not just what they're called, but what they're doing,
too? Dr. Miller. All right. I will go more slowly over the collection of
recommended studies, the first of which was a collaborative population-based survey to
obtain data on symptom prevalence and health status and evaluation of potential health
effects from lead; a long-term study of the mortality of Persian Gulf War veterans;
well-designed studies of potential adverse reproductive outcomes; laboratory studies of
potential interactions of pyridostigmine bromide, DEET, and permethrin, three substances
that were widely used during the Gulf War; and further work in the area of diagnosis of
Leishmania tropica infections and the study of the epidemiology and ecology of this
tropica Leishmaniasis. Dr. Joseph. If I might jump in here for a minute? Mr. Flanagan. Yes, please, because I read the testimony and I heard you
repeat it again now. Could you ell us something about what these specific research
questions are going to do and how we're going to get a little closer to the answers we're
looking for? Dr. Joseph. I believe with the possible exception of lead, every one of
those categories is either currently funded research or is in the 1995 plan. I'm not sure
about lead. Somebody will remind me in a moment. But each of the others I believe we have
moved to fund. Mr. Flanagan. All right. Well, I have been listening through most of the
morning and Mr. Kennedy's 15 minutes, Mr. Quinn particularly. I must say that the level of
urgency to find the root cause of the problem does not seem to be there at the level that
we have it. I know that you're scientists and you operate on a much more elevated
plane and there are methodologies by which you approach and where you're going, but you
are responsible to the same American people that we are. And they need an answer. I remain still uneasy as to the direction we're going, not just the
speed by which we're getting there, but the efforts that are being expended to get there.
I remain without a concrete warm fuzzy feeling inside saying ``We're going to get there
eventually.'' It might take 30 years or 40 years or longer. I remain very uncomfortable
that we're moving in the right direction. I think we're collecting a lot of information in a duplicative,
difficult, cumbersome fashion without a lot of coordination. And I'm not sure that that's
taking us where we want to go. We are just doing something. Perhaps I'll give each of you
a chance to throw a bomb back at me and make me feel better about that. That's where I stand now. And I'm deeply uneasy about this. Dr. Kizer. Well, I don't think that that is a fair characterization of
the projects that are underway. Some of the things that were talked about earlier are
indeed being done. For example, you asked ``Well, what are they going to show?'' Well, the
project underway is looking at 15,000 Persian Gulf veterans and 15,000 of a control group
of veterans to determine whether there are differences in the symptoms in those two groups
to determine whether there is a different array of illnesses occurring in those who served
and who didn't. This is fundamental, threshold-type question that needs to be answered. And you can go down the list of other projects. Some of them are much
more narrowly focused. Others are more broadly focused. But they're all part of answering
the big picture question of why and what it is we actually do or don't know. Mr. Flanagan. Thank you, gentlemen. Thank you, Mr. Chairman. Dr. Joseph. If I might, I would invite you__ Mr. Flanagan. Yes, sir. I'm sorry. Dr. Joseph. I would invite you to interview one of the 40 or 50 military
physicians who are working full time going from ground zero to__ Mr. Flanagan. No one is demeaning anybody's efforts in getting this done
by__ Dr. Joseph. It's 9,000 people against__ Mr. Flanagan. It's the coordination efforts involved in the information
data collecting and actually congealing that into some sort of level of solutions. Without
specific research questions or without a direction in which we're going that we've talked
about, my concern is not misplaced. I really have a problem with whether we're flying to
get to the answer or not and not the level upon which the work is being done or the
information is being collected. Dr. Joseph. I guess I'm responding to your comment about sense of
urgency. I think if you talk to some of the people, you might get a sense of our sense of
urgency. Mr. Flanagan. Thank you, Doctor. Mr. Hutchinson. Thank you, Mike. The gentleman from Indiana, Mr. Buyer. Steve. Earlier we recognized your
great commitment to this issue and your personal involvement in it. We are glad to have
you join the subcommittee today. And you are recognized. Mr. Buyer. Thank you, Mr. Chairman. And let me congratulate you and our
ranking member_again, I think everyone is saying it_for making this the first hearing. It
shows your commitment. I appreciate it from both of you. I give special recognition to Joe
Kennedy and Lane Evans. Joe took on this issue early on. When I came to the Congress, I learned very quickly about institutional
barriers within the medical community, whether it was the private medical community,
whether it was VA, whether it was the DOD. And I think even by what I've heard today, some
of the downward pressures still exist. And I'll get into that, Dr. Joseph. Let me make a couple of comments. One I'll be very careful and tactful
in the comment, especially based on a conversation that Mr. Tejeda and I had in making
sure that we keep the Veterans' Committee in a bipartisan spirit. I appreciate President Clinton getting involved. As a matter of fact,
I'll welcome anyone in America to get involved in the issue of Gulf War veterans. If the
President were here, I would say ``Mr. President, what took you so long?'' So I know all four of you like to reach out and put your arms around the
President's statement. Let's not forget who it was said, when it was said, and why it was
said. So let's not forget about political theatre involved in a very sensitive issue of
policy. When you think about how far, in fact, we've had to go in the last
2\1/2\ years, any time when you're trying to pioneer a new issue, you're out there plowing
up that ground, there's always somebody behind also putting the soil right back in the
furrow. I'm calmer today than what I was in December. And that's fine. You can
take shots at us in December, when we're out of session. I understand that things like
that happen and occur. I have some specific questions. Let me get to them. One that puzzled me,
Dr. Jackson, your comment puzzled me when you said that baseline data is difficult. When
you say baseline data is difficult, the confusion to me is we're dealing with a pool of
individuals here who are perhaps the most physically fit in the country because we only
take the most physically fit. We have a drug-free environment. They're all HIV-tested. And
you're saying that we have a difficult baseline data to begin with. Confuse me. If you're having problem getting information, I'm sure that Dr. Joseph
would be more than happy to cooperate with you. If not, call me. I'm sure that Jesse Brown
would be more than happy. Jesse has been very cooperative in this effort. So please
explain that to me. Dr. Jackson. Sir, what I meant to convey is to find out what the
individuals who were not ill, what their exposures were, where they were, their
background, demographics, other such information in this survey in Iowa, and compare those
answers of the well individuals with individuals who became ill by the baseline in that.
What is the background rate of how many times do they take pyridostigmine, other such
things, the ill compared to the well? So I was looking for information from the well
population. Mr. Buyer. Are you having difficulty getting that information from DOD? Dr. Jackson. No. We're doing this through the interview survey. We're
actually interviewing the veterans themselves, both the individuals in the theatre and
veterans who did not serve in the theatre. This is the Iowa study. Mr. Buyer. All right. To Dr. Joseph, here's part of the problem that
I've had for a long time. And I had this conversation with Dr. Blanck in December. First
you make the comment that the CCEP, the purpose is to go in in regard to the treatment. So
I salute you. I mean, that's part of the struggle that we had. How do we get those who are suffering from physical ailments for which
they themselves don't know what happened to their bodies? So we worked very hard. We got
them access into the VA. And I congratulate you for setting up the program. I shifted the focus when all of us were focusing on the veteran side. I
jumped over to the active duty side. I remember when I talked about the downward pressure,
I remember that at that time, even at the meeting we had over at the Pentagon and by the
testimony of the Surgeons General, was that we only had like 167 on active duty. Steve, that's it, 167. I didn't believe it. Joe didn't believe it. And
now your testimony is we've got 15,000. That's less than a year since that last hearing. So when you say that 84 percent have clear diagnosis of their
conditions, let's only focus in on the other 16 percent. Here's where my difficulty with
this whole issue, Dr. Joseph, has been. We've had this conversation. I'm not a doctor.
You're a physician. You're trained for known diagnoses. Sometimes you need to take a step
back and go ``Time out.'' What happened here? What happened to all of these soldiers? When they go
to the Gulf and they're physically fit and then they come home and begin to have problems
with their bodies, you can treat all the flu. You can treat their respiratory problems.
You can treat pneumonia. I mean, you have specific diagnoses for those problems. But
somehow you have to just take a step back and go ``Well, what is all of this? What caused all of it?'' So I agree with you when you can say 84 percent
have clear diagnoses. My own physical problems have very clear diagnoses. And I'm one of
the lucky ones because I have improved so much over the last 2 years. I mean, I can run up
to 3 miles now. And I did a stationary bike for an hour last night. I was so thrilled and
excited. And I can play basketball and do things. But I still have some of the respiratory
problems. I still have asthma. And I'm allergic to everything green, very clear diagnosis.
I'm just as puzzled as anyone else out there what happened. I've also, you know, been an advocate_Mr. Chairman, may I__ Mr. Edwards. If I could ask unanimous consent, Mr. Chairman? You were
very gracious in letting Mr. Kennedy on our side, who has been involved in this issue so
personally, have extra time, let us yield to him. I'd like to ask unanimous consent to
give Steve an extra 5 minutes so he also can continue. Mr. Hutchinson. If there's no objection. Gentlemen? Mr. Buyer. Help me here. When you say that you only want to focus on the
16 percent, tell me that's not true. Dr. Joseph. No. That's not true. I didn't say ``only.'' Let me let you
finish. Mr. Buyer. No, no. That's part of my question to you, that I want to be
reassured here today that whatever research efforts we're doing, it's for a larger
picture__ Dr. Joseph. Of course. Mr. Buyer (continuing). And that part of this, in your questioning,
hopefully you can tell me: How are you labeling these discharges from the active duty
side? Okay. Tell me what you're labeling them. And for the disabilities now, what are you
calling them? So are you calling them your known diagnosis? And when you do that, you're giving up the big picture. I mean, there's
a tendency right now, ``Let's not call it the Gulf War syndrome. Let's get away from
that.'' So help me out here. Dr. Joseph. Somebody asked me last night a pointblank question, ``Is
there a Gulf War syndrome?'' My answer was, ``Of course there is. Because, any collection
of illnesses and/or symptoms that relate to a particular focus you can call a syndrome.'' If they had asked me the question ``Is there a Gulf War illness?''; I
would have said ``Everything we know so far says there is not.'' What there is in this
large group of people, in these 15,000 people_I agree with you entirely; I mean, we
looked, and that's what we found_is a collection of illnesses and symptoms. Some of which
are quite easily explainable, some of which are frustratingly unexplainable at the moment.
Then there's a whole spectrum in between. When I said we're now going to concentrate on the 16 percent that are
way off on this end, didn't mean ``only.'' I meant that that's where we've got to go to
try and find whatever root causes, not root cause, root causes, are to be found in that 16
percent. That's certainly the way to hit pay dirt more quickly than to go back and look in
the things that are more easily explained, that fit into our_if imperfect, at least kind
of understandable_system of medicine. Yes, there is a syndrome. No, I don't believe there is an illness. And
yes, we have to keep pressing on. I think in one of the first conversations you and I had,
I likened this to trying to peel away the layers of an onion: take the easiest ones first,
the most explainable first, and keep working in towards the center. Whether or not there's going to be a core at that center that we never
explain, I don't know. I don't think anybody can. Mr. Buyer. Does any of the research mirror that theory? Dr. Joseph. I think that it does. I think it mirrors it in several ways.
First, I've said several times that the clinical approach gives us an idea of what the
needles might be and where to look in the haystack. Then, second, there have been_and these have come in for some criticism
from the IOM_a series of research probes to look at things that either people are very
concerned might be root causes, like pyridostigmine, or that, for one reason or another,
might be a root causes, like the oil fires. The third mirror, the most important one, is these broad
population-based studies that look at comparing hospitalization rates in people who went
to the Gulf with people who didn't go to the Gulf, at reproductive outcomes and
miscarriage rates, et cetera, et cetera. As I said earlier, when we have that geographic map to lay all of this
research over, then we will really see if things pop out. It's that combination of
approaches; learn from the clinical program what you can in terms of which directions to
go, pursue the specific leads, and then do the larger, broad-based epidemiology that Dr.
Jackson is talking about to try to put it into perspective. Mr. Buyer. To answer the question that I asked earlier, how are those on
active duty_what do you call it when you're discharging? Dr. Joseph. Well, you remember that Under Secretary Dorn issued a policy
that no one was to be discharged against their will who did not have a diagnosis. That
policy is still in effect. I will double check to be sure I'm right, but I believe if
someone has a firm diagnosis coming through the CCEP_let's take an easy one, way over
here, chronic arthritis of the right knee_and would be boarded out on that basis, that
would be the discharge diagnosis. Mr. Buyer. All right. See, there is a reason I wrote that right into
law. I mean, I wrote that in the law because, to my colleagues, I was so incredibly
frustrated. And the whole idea of giving_I mean, this is an incredible radical idea
to give compensation to undiagnosed illnesses. And I didn't mean doing that on the active
duty side. That's where we forced the issue first. And the frustration that I share in the challenge that I think we share
at the moment is they say ``Well, we're not going to discharge those who are the unknown
diagnosis.'' In other words, we didn't want these guys kicked off of active duty. We want
to extend our compassion and care to them, make sure they're taken care of and not just
thrown out into Dr. Kizer's care. Okay? The challenge here is, ladies and gentlemen, to make sure that when they
say it's a known diagnosis, are we losing a bigger picture here? And that's why I want to
make sure that we're not just sending them out the door on a catch-all diagnosis because
that's what we've had from the very beginning. So I want to make sure to my colleagues
there's a bigger picture out here, too. It's a difficult challenge that you face, Doctors. It really is because
of the efforts, actually from a lot of us, that want there to be the cause. What was the
cause? What was the cause? Causation is very, very difficult, especially when illness is
multifaceted. If I could, can I have just one last, Mr. Chairman? Mr. Hutchinson. Without objection. Mr. Buyer. Dr. Kizer, before you arrived with the Veterans Affairs, I
had had a conversation with Jesse Brown. And he contacted NIH in the research to look at
the cocktail mix of the inoculations. So I'm curious as to where that particular study is
going. And so, Doctor, if you know that or whomever can answer that one. And to Dr. Kizer: If you would tell me that of the $250 million in the
research and development budget of the VA, how much is devoted to this issue? Thank you, Mr. Chairman. Dr. Kizer. Let me try to answer your latter first. We will be spending
at least $5 million of the research budget for Persian Gulf issues next year, but I would
hasten to add that I believe we will be spending more than that. I am currently reviewing our whole research budget and what it's
allocated for. I'll be looking at not only what we're spending on Gulf War issues and
concerns, but what we're spending in a number of other areas. I may be making some
adjustments in the future. So while we are committed to spending at least $5 million, that may
increase in the future as we look at other studies that may need to be funded. Mr. Buyer. And to the cocktail mix? Dr. Kizer. I'm sorry? Dr. Joseph. I think I can speak to that. The initial set of studies
looking at the possible interactions between pyridostigmine, insecticides, et cetera, are
underway and will be completed this year, I think towards the middle of the year. The studies looking at the possible effects of vaccines and
immunizations and other issues, pyridostigmine, are in the 1995__ Mr. Buyer. Dr. Dorn had testified to us, this particular committee, my
colleagues, that the inoculations that were given were the five series of shots they took
to Vietnam. They had no idea what the effect is on the human body. They give you all those
shots. On top of it, some of these guys take botulism. They take two shots of
Anthrax. You take your nerve agent pills, change the dye, put you under stress. They have
no idea what that does to the human physiology. So I know you said you wanted to also look at the insecticides. I think
that's a good idea. But I want to make sure that they are in the 1995__ Dr. Joseph. All of that is going to be done. Well, one, Mr. Buyer, those
are in the 1995 research proposal as independent investigator peer-reviewed research. Two, I wouldn't agree with Dr. Dorn that we have no idea what the
effects of multiple immunizations are. We have a lot of information and knowledge about
that. Mr. Buyer. And when you say that ``you'' are going to do that, DOD has
a__ Dr. Joseph. Everything runs through the coordinating research__ Mr. Buyer. So NIH out there isn't doing something on its own? Dr. Joseph. I'm sorry. That I can't answer. I don't know what's in the
NIH budget with regard to vaccine effect research. Mr. Buyer. I'll check that out. Dr. Joseph. I'm speaking about VA and DOD. Mr. Buyer. Okay. I appreciate the indulgence of my colleagues. Thank
you, Mr. Chairman. Mr. Hutchinson. Thanks, Steve. The gentleman from Georgia, Mr. Bishop, is recognized. OEPNING STATEMENT OF HON. SANFORD BISHOP Mr. Bishop. Thank you. Let me just briefly again thank the chairman for
this hearing. I think it's certainly appropriate for us to have a progress report. I'd
like to thank Mr. Kennedy, Mr. Evans, Mr. Buyer for their leadership in seeing that this
issue stays on the front burner. My concerns I think have already been raised, but they really are
underscored. And I think I can't underscore it enough. And the veterans that I have in my
district and that I hear from across the country are asking ``Why is it taking so long?
Why is it that the process that we understand is being undertaken is taking so long and
moving so slowly?'' Could you isolate for us those factors that have contributed to what
some of our veterans and their families consider to be the snail's pace at which it is
developing? I know that putting this in perspective certainly would suggest that we are
much further along than we were, for example, in dealing with Agent Orange following the
Vietnam conflict. But could you shed some more light on it? Because I just don't know what
to say to my veterans when they continue to ask over and over again ``Why is it taking so
long? What is the problem? We know that we have been affected? Why are they stonewalling?
Why are they stalling?'' That's, of course, unfair to you. And I'm not suggesting that you have
not been moving with dispatch. But could you please give me some guidance there on how I
can respond to those kinds of questions that I repeatedly get? Dr. Kizer. Certainly. And I'll defer to my colleagues here to follow up
on my comments. I would certainly tell you that you can tell your constituents that if
they have some ideas on how the research can be done more quickly or better, we are very
open to hearing those ideas. We have a wide array of some of the best minds in the country, the best
scientists in the country working on this. They are doing the best they can. Good science
takes time. I think it's imperative that you and your constituents, understand that. This condition is not unlike many other conditions where despite lots of
money, and lots of research projects, we still don't have answers to basic questions. And
we're certainly open to considering any ideas that you, your colleagues, or your
constituents might have that could speed the process up, because we'd like to find the
answers quicker, too. Dr. Joseph. I don't think there's any snail's pace on the diagnostic and
treatment side. We want anybody who is still out there. This goes both for the VA and DOD,
I know. Anybody who is still out there who is ill, who is symptomatic, we want them in so
we can help figure out what ails them and treat that. I really have nothing to add to what Dr. Kizer said about the research
side. Good science takes time. You don't necessarily get more good science with more
money, although sometimes you do. It takes time to figure out what questions to ask, then
to do the research_particularly when it's large population-based research, and then to
interpret the answers. That's often frustrating, but that is the reality. Dr. Jackson. Sir, every doctor knows people who have suffered because a
patient was given a wrong diagnosis, someone rushed to a judgment, gave them the wrong
pills or sent them for the wrong surgery. I think it's very important that we get good
medicine to these folks. That's what's being talked about, number one. Number two, especially in the area of environmental health, there have
been many arenas where science was half-baked and ended up making a decision that turned
out not to be the right decision later on as further information came in, not saying
that_I am suggesting that it is a slow and sometimes cumbersome process. Could it be improved? Probably always. Dr. Miller. Sir, I have nothing helpful to add to what has already been
said. Dr. Kizer. I'd like to add just a couple of points that I think are
relevant. And some of it goes back to what Mr. Buyer was saying, that insofar as these
studies can help try to answer the question of why individuals have a certain diagnosis.
But there are many diagnoses, or conditions, that people have and for which they are
treated quite effectively, but for which we still don't know what causes it. I'm referring
to conditions like diabetes and arthritis. Insofar as the studies that are being undertaken here can further the
science in really understanding what is causing these conditions and whether there were
things either in the environment or otherwise that caused our soldiers to come back with
conditions that are diagnoseable that may be common in the population. That's a very
important step forward. Likewise, I would add that we need to view this as an opportunity to
gain information about some very important questions about the role of environmental
factors in causing illness. There are many concerns, whether they come from the industrial
setting or environmental deterioration that's occurring. The Gulf War presents some
particular opportunities to look at how the environment affects human well-being. Mr. Bishop. I yield back the balance. Mr. Hutchinson. Thank you, Sanford. The gentleman from Alabama, Mr. Bachus, is recognized. Mr. Bachus. Thank you. Gentlemen, I just want to give you my impression so far on the Gulf War
veterans and what we found. Tell me as I go along as to whether I'm straying from the
path. Okay? Now, we had 700,000 basically, 697,000, men, women that went to the Gulf
War. Now, of those that came back, I think the largest study shows that the mortality rate
is actually less than the general population. Dr. Joseph. That's a preliminary study. That's correct, the comparable
populations. Mr. Bachus. Comparable populations. So maybe even two-thirds of the
mortality rate of the comparable population. So our men and women who served in the Gulf
War are not dying at any more accelerated rate than men and women who stayed in this
country and maybe even less so because there none were suffering from AIDS. That's
correct? Dr. Joseph. Our present level. Mr. Bachus. Now, at one time_and I think these figures are a little
outdated, but we had 34,000 on the Persian Gulf registry. Now we've got maybe 44,000. Dr. Kizer. The VA registry. Mr. Bachus. But at the point we had 34, about half of those had been
diagnosed and you all felt like you had a pretty good handle on what their condition was.
Is that right? You put them in a computer and you__ Dr. Kizer. That's correct, yes. Mr. Bachus. Okay. Let's just focus for a minute on those 17,000.
Somebody I think with the VA_the lady in the blue dress, are you with the VA? Dr. Kizer. Yes. Dr. Murphy. Mr. Bachus. Was that incorrect, though? I know you were shaking your
head ``No,'' and I don't want to get bad information. Mr. Hutchinson. Could you identify yourself for the record? Dr. Murphy. Yes. I'm Dr. Frances Murphy, the Director of the
Environmental Agent Service at VA. Mr. Bachus. Have we sort of looked at 17,000? Dr. Murphy. We've actually now have got computerized data on the first
27,000 individuals on the registry. And the undiagnosed illness rate is about 20 in that
population. Mr. Bachus. Okay. So it's 16 to 20? Dr. Murphy. It has hovered between 15 and 20 percent. Mr. Bachus. Okay. But now what I want to do only because at the point
where we had 34, I've got statistics that you all supplied me when we had 34,000 and
17,000 had been put in the computer. So that's why I want to talk about those 17,000. Now that we have 20 we've got a lot of changes, 20 or 27. Have we
basically go the same findings that we had when we had 17,000? Dr. Murphy. Yes. The symptoms, diagnostic categories, look the same in
the computerized data on over 27,000 veterans as compared to the 17,000. Mr. Bachus. So let's just go with the 17 or the 27 if it hasn't changed
much. When you run these people through the laboratory, you don't find anything distinct.
Well, I'm sorry. Let's back up. We've got this population. Of that population when it was
17,000, you had about 3,000 that fell in the unexplained illness category. Is that right? So this is what sometimes I guess the press talks about, maybe the
Persian Gulf illness, because the others have asthma, they have sinus trouble, they have
allergies, they have_I mean, they could have any number of conditions, even cancer. But
let's talk about the 3,000 that we can't explain. There's no laboratory abnormality with those people, is there? Dr. Murphy. In most cases, sir, the standard diagnostic tests do not
show a characteristic abnormality, but you're correct. Mr. Bachus. Characteristic one. Now, with cancer or with AIDS or with
Agent Orange, that wasn't true, was it? I mean, you did have a distinct laboratory with
cancer, you go through_or do you? I mean, by ``distinct,'' if it's a certain kind of
cancer, don't you have__ Dr. Kizer. Well, not really. It depends on when in the condition that
you're talking about, whether it's confined to a particular organ, or whether it's
metastatic. There is a whole number of questions you would have to ask and answer before
you could say yes or no to that. Mr. Bachus. Well, I'm just wondering. If you run someone through a
laboratory and x rays and everything with cancer, you usually can find it, can't you? And
you can say ``This is a certain kind of cancer'' or this is_with AIDS you certainly can,
can't you? Don't you give a test and__ Dr. Kizer. Sure. And if you take the AIDS patient, for example, there
are certain tests that are used. Depending on where they are in the course of HIV disease,
you may or may not find the abnormality. In other words, if you did not know that they were HIV-infected, you may
or may not find any abnormality depending on where they were in the course of their
disease. And the same pretty much applies to other conditions you're talking about. Mr. Bachus. Is there any one organ system that these_I mean, they have
symptoms, but is it sort of confined to any one organ system or with these 3,000? Dr. Kizer. No, sir. Mr. Bachus. And there's no one physical symptom? There's no connecting
physical symptom or physical sign of any illness, is there? Dr. Kizer. There's a collection of symptoms that in the composite
perhaps characterize these individuals, things such as__ Mr. Bachus. Talking about the fatigue, 17? Dr. Kizer. Fatigue and__ Mr. Bachus. Headache? Dr. Kizer. Headaches, muscle aches, loss of attention. Mr. Bachus. Joint pain? Dr. Kizer. Things of that type, yes. Mr. Bachus. And then the psychosomatic, the forgetfulness, the lack of
concentration and all of that. Let me ask you this: If you went out and you got a general population
and you ran them through the same test, wouldn't you get maybe 14 percent with headaches__ Dr. Kizer. Well, if you__ Mr. Bachus. (continuing). Or 17 percent with fatigue or__ Dr. Kizer. The answer is yes, depending on the population. Perhaps
another way of looking at it, which is what I think I may hear you asking, is that if you
looked at, say, a university medical center where people come to be evaluated often with
unusual or exotic conditions, how many of those people would be discharged without having
a diagnosis. And you would find that about 15 to 20 percent, or so, of individuals who
come to our most sophisticated tertiary medical centers leave without having a diagnosis. Mr. Bachus. That's what I'm asking. I mean, I'm searching for something
here that you don't find in the general population. You know, the only thing that I can
find that you don't find in the general population_and I could be wrong, but I just want
to know: Where am I wrong? The only thing that sticks out here is that 17 percent of these men and
women were in the National Guard or the Reserves, but 50 percent of them with this
undiagnosed illness are reservists or National Guard. I mean, that appears to be the only
thing that sticks out. Mr. Hutchinson. The time of the gentleman has expired. We'll let you
answer that question, if you like, or comment on that and then move on. Dr. Murphy. I'm not sure that that statement is correct. We have not
broken the veterans with symptoms but no diagnosis down to active duty and reservists for
the undiagnosed illnesses and certainly__ Mr. Bachus. Is that true? Okay. Dr. Murphy. There are a number of individuals still on active duty who
have__ Mr. Bachus. Oh, I know there are a number of them. I mean, obviously,
even from what_you know, we were supplied this information at one time. Maybe I
misinterpreted it, but apparently__ Dr. Murphy. We will check those statistics for you. Dr. Joseph. Everything you've said, Mr. Bachus, up to this point with
reference to the VA is quite accurately duplicated in our system. The percentages are
remarkably similar. Your line of reasoning I would agree with, everything you've said with
respect to our system until that last statement. I don't believe that statement is as
sharply defined as it__ Mr. Bachus. Everyone else has been given an additional 5 minutes. I'd
like__ Mr. Hutchinson. We're going to get real strict next time. Without
objection. Mr. Bachus. Let me follow through. And I'm going to back up because I
just want to sort of find out where I'm wrong, where I'm right. So I'm wrong on the
National Guard part. Okay. Is there a difference? Is there a statistical difference? Dr. Joseph. It's too early to be sure from our numbers in DOD whether
there is a significant statistical difference between Reserve and active duty. Mr. Bachus. You know, let's suppose that there's one and a half times
this number, the National Guard or reservists. Are they older? Dr. Joseph. In our system the people with symptoms are older than the
average age of people who went to the Gulf: 34 years, as opposed to about 28 years,
average age. Right. So, that might be another indication that older populations, older
groups, have a bit more incidence. Dr. Kizer. Sir, I might just interject that the question you're asking
is actually the major question in one of the studies that's currently underway. We're
looking at 15,000 individuals who served in the Gulf and 15,000 veterans who did not serve
in the Gulf, but were otherwise a comparable population, with the intent of actually
comparing the symptomatology found in those two groups to see if there is a difference. Mr. Bachus. Okay. I guess my point from all I've seen and read is that
there is at least the possibility that if we went out and got 700,000 people out of the
general population, particularly a comparable population, that_you know, you look at these
figures: 17 percent with chronic fatigue of the ones that are the undiagnosed illness. To me that's just not a large number. I mean, it is. Now, somebody's
going to come along and say ``If you're the one that's sick, it is.'' And I'm not talking
about that. I'm just talking about that if you've never gone to the Gulf War and you have
an undiagnosed illness and you have chronic fatigue, it is a big problem, too. But your
rash, 16.8 percent__ Dr. Murphy. If I could clarify, these numbers are from people who have
come into us voluntarily seeking a health examination. The epidemiologic studies that are
about to start will randomly select individuals who are representative both from Gulf War
service and those who served at the same time but were not deployed to the Gulf. And in
that way we'll actually be able to determine what the percentage in that whole population
is and compare Gulf War veterans to non-Gulf War veterans. Mr. Bachus. I think that__ Dr. Murphy. And that's a very important piece of information because
until we do that, we will not be able to draw the conclusions that you are, in fact,
drawing. Mr. Bachus. Let me say this. I'm not drawing any conclusions other than
that everything I've been given_and let me say this. I served in the military and was
diagnosed as having asthma while serving. I had it as a child and outgrew it. And I was in
the Medical Corps. So I'm certainly not talking as_I mean, I don't have any more knowledge
than that, but, I mean, I didn't know what I had. Dr. Joseph. I think you're asking the $64 question, Mr. Bachus, but
there's still the question behind that one. And that's where I'd associate myself with the
remarks of Mr. Buyer and Mr. Kennedy. If we end up, by your logic train, with that small, if you wish, number
of people who are not yet diagnosed or have nothing specified on a laboratory exam, let's
suppose that's where we get as we peel the onion. That still does not answer the question:
Are there any specific causes of illnesses within that group that we have not yet
identified? That's why we have to keep going on. It is not answerable solely by a
statistical or even__ Mr. Bachus. Let me say this. I'm not__ Dr. Joseph. I don't know the answer either. There is no answer from the
one approach. Mr. Bachus. I'm certainly not dismissing what these veterans are going
through. And I hope no one takes my remarks as that. I'm simply trying to get a handle on
this myself because the VA center at Birmingham I'm not sure doesn't have more of these
veterans that have come in. I went to Meridian, MS for the hearings that we suddenly heard we had
two National Guard units in and around Meridian that their children were being born with
higher rates of birth defects. We really don't know because of the small population, but
when the Mississippi Public Health Department and everybody looked into that, they found
that maybe that statically wasn't an abnormal occurrence there. But that doesn't say we're
not concerned about them. I'll ask one other quick question. The President just announced $13
million more to research the cost of Persian Gulf illnesses or research into that. I look
at the budget, and I see $5 million in there for that. Is this $13 million in addition to
that $5 million or where does that additional money come from? Dr. Joseph. These are monies_and they do come up to between $13 and $15
million_that are programmed in the 1995 budget. Mr. Bachus. So they are already in the budget? So this isn't new money? Dr. Joseph. No, sir. Mr. Bachus. Okay. I mean, he said that the VFW was committing $13
million additional money. It's not any addition to what's already in this budget proposed.
Is that correct? Dr. Joseph. This is money in the 1995 budget. Mr. Bachus. Okay. Thank you. Mr. Hutchinson. Okay. The time of the gentleman has expired. The gentleman from New Jersey, Mr. Smith, is recognized with gratitude
for your service on this committee as ranking member of the subcommittee in the last
Congress and your contribution on this issue. Mr. Smith. Thank you very much, Mr. Chairman. And, again, I want to
applaud you for holding this hearing and the ranking member. I think it's very important
that we move as quickly as possible. And I know under your stewardship and leadership, it
will be accomplished. I do have a couple of questions. I apologize for coming late. We were in
the middle of an International Relations Committee dealing with Croatia and NATO and the
situation in the former Yugoslavia. So I do apologize for being late. A couple of questions. I know most of the more salient questions have
already been asked. Just let me ask Dr. Kizer: Of the approximately 17,250 veterans on the
VA registry who are ill or who are being evaluated, what is the typical treatment regimen
for those presenting symptoms of fatigue? And if you could describe the typical protocol
of these men or women who are presenting themselves? Dr. Kizer. I'm not sure I understand your question. Are you talking
about the treatment for those who have undiagnosed fatigue or fatigue is their complaint
but they don't have a diagnosis otherwise? Mr. Smith. Fatigue is their complaint. What is done with those
individuals? And I think it would be helpful for the subcommittee just to hear what is
done for those who present themselves and who walk through, how they are treated, who have
problems that have manifest themselves. Dr. Kizer. Again, I'm not sure that I fully understand your question. Mr. Smith. The first question is about the fatigue. Somebody comes
forward, complains of this chronic fatigue, repeatedly says, you know, ``This is something
that I think is attributable to my service in the Persian Gulf.'' How are they treated?
What happens then after that point? I don't think it's a very difficult question. Dr. Kizer. The first thing is to rule out, or to rule in, a treatable
cause of fatigue. Are they anemic? Do they have some other thing that is treatable? If you
end up without a treatable condition, or the cause of their fatigue is not diagnozable,
then there is no specific treatment available for those individuals. That has been a source of concern, both in the private and government
sector. And this whole question about what is causing fatigue in these individuals is a
subject of scientific investigation and some controversy. Mr. Smith. What kinds of explanations are given to them in terms of what
might be the source? Dr. Kizer. Again, if you cannot rule in a cause, they are left without a
diagnosis. And that's generally what they are told, i.e., that it is unknown what is
causing their condition. Mr. Smith. Are they apprised of any studies or when information might be
available to them? I mean, is there any hope given that this mystery might be resolved in
the near term? Dr. Kizer. I think that in general they are. I mean, one of the reasons
for having them in the registry is so that we can have access to them and so that if
information does become available at a future time that may be useful in treating them,
then they would be able to be summoned back. At present there is no study or data on the horizon that will answer
that question_that is, there is no study that a treating physician could tell the patient
that ``We are going to know the answer in six months,'' ``in a year,'' ``in two years,''
or ``five years''. Generally, these patients are advised to keep in touch, and we'll
follow them along. Mr. Smith. Do they feel they're being dealt with in a way that is
sincere? I've been on this committee for 15 years, and I remember in the early goes when
now Minority Leader Mr. Daschle and I raised the Agent Orange issue over and over again.
The sense of being given the run-around was very, very deep and, as we have seen in
retrospect, very well-justified. Do they have a sense that this isn't just some charade or
this is something of genuine meaning? Dr. Kizer. I think many, if perhaps even most, of these individuals are
very frustrated when they are not able to be told what is causing their illness. And it is just as frustrating for their physicians as it is for the
patient. Doctors are in the business of treating people and making them better. And when
the physician can't advise a patient ``This is what you have, and this is what we're going
to do to make you better,'' it's very frustrating for both parties. In these cases there are some individuals, I'm sure, who go away feeling
like they're getting the run-around or that they're not being treated adequately, despite
the fact that they may have had absolutely everything possible done for them. And they're
likely to seek care elsewhere. Frankly, their unhappiness is understandable, but, by the same token, if
you cannot find a cause, of if you cannot find something to treat, then it would be
imprudent to do something that is not based on some medical reason. Mr. Smith. Have we been in contact with the Kuwaitis or are we
knowledgeable of any studies that might have been done on Kuwaitis who have been showing
similar signs of illness, perhaps due to the oil fires or__ Dr. Joseph. DOD has extensive contacts, discussion, and shared
information with partners in the Gulf, not only those from that region, but also from
Europe. Mr. Smith. What is the result of that? What have we learned? Dr. Joseph. In great part, the other nations involved, particularly the
Gulf nations themselves, shed absolutely no light on the issue and do not describe any
similar significant groupings of illness. We've had the same answers from the oil
companies who have been in that region for a long time. There is, as you may know, in the U.K. and perhaps to a lesser extent
some of the European nations, a group of Gulf War vets who are presenting with similar
symptoms. I think the U.K. is somewhat behind us in how they're responding. We have had a number of missions from DOD to the Gulf, looking at
environmental issues and talking with medical authorities, both civilian and medical. And
the short answer is, they've come up empty. Mr. Smith. With regards to this small group of soldiers from the U.K.,
how do they overlay with their deployment with U.S. military? Dr. Joseph. You mean geographically? Mr. Smith. Geographically. Were they working side by side? Did they have
a similar experience from those who have presented themselves with__ Dr. Joseph. In some instances, yes. But, that's a hard question. I'm not
sure I can give you an accurate answer. I mean, there__ Mr. Smith. That might help solve some of the mystery, particularly if
there was a detonation of chemical weapons and they, too, were in proximity to where that
may have happened. I know the DOD discounts that, although they__ Dr. Joseph. Let me answer the question the way you asked it, trying to
be helpful and responsive. There is no known circumstance of our own deployment with
another nation's troops where anybody, that I'm aware of, has shown a similar set of
symptoms, or a similar concern about illness. In fact, the one specific circumstance that I know about is a group of
British soldiers who went, in after the war, deep into Iraq_this is in the published
literature; it's not classified_and whose job it was to seek out possible bunkers or
collections of chemical munitions. This group_I think it's about 60 individuals_over quite a long period of
time took steady doses of pyridostigmine. And, they report no ill effects in that unit.
But, again, that's a tiny sample vignette and not intended to prove anything. I know of nothing in the other direction. Mr. Smith. Okay. I thank you and yield. Mr. Hutchinson. Thanks, Chris. I would recognize the ranking member, Mr. Edwards. Mr. Edwards. Thank you, Mr. Chairman. I would just conclude by first asking unanimous consent that several
questions could be submitted for the record from Mr. Kennedy and from me and as well as
any other members of the committee. Mr. Hutchinson. I have a request from Mr. Bilirakis for his statement to
be inserted in the record as well. Without objection. [The prepared statement of Mr. Bilirakis appears on p. 63.] Mr. Edwards. Let me just finally compliment you again for picking this
subject as the first meeting under your chairmanship. I think that again, Dr. Joseph, Dr. Kizer, along with the statements and
questions you heard from both sides of the aisle underscore the level of concern about
these issues. And I hope you will let us know how we can work with you to keep pushing
ahead and stay committed until we find out everything we possibly can about the problems
that we're facing. But I want to thank you all for coming. This is an important issue. Mr. Chairman, I thought it was an excellent meeting where we got into
depth on questions, and I want to congratulate you. Thank you. Mr. Hutchinson. Thank you, Chet. Dr. Joseph, before we dismiss this panel, we do have Mr. Robertson, who
has been patiently waiting from The American Legion to testify. And we're grateful for
that. You mentioned way back in your early comments about the tracking or a
road map_I think you used the term ``road map''_study on where our troops were, what they
were exposed to and so forth. Explain that to me. When is that scheduled to be completed? Dr. Joseph. The geographic study is intended to put a time and place
marker on every small unit every day during the Operation Desert Storm/Desert Shield. It's
been running, I believe, for about 18 months. And it's expected to be completed in early
1996, in the Spring of 1996. What I said is that once we have that map, that will give us a grid of
that area and what units were in what locations, when. For example, once we have that
grid, we can take all our patients from the CCEP, classify them by symptoms, classify them
by whatever anybody wishes, and place them over that grid. Mr. Hutchinson. I think I understand the value of it. I think I've heard
this frustration expressed in a lot of ways during the questioning today_in the length of
time that this kind of thing takes. It's been rejected that we're moving at a snail's
pace, but that's the feeling of veterans. When we hear about this study having gone for months and there is going
to be another, I guess for a layman it's very difficult to understand why it should take
that long in order to determine where our troops were on what day and what movements there
were and what they were exposed to. I know that it surely must be a frustration for the VA not to have that
kind of vital information available. I don't know what could be done to expedite that, but
I really share the frustration of my colleagues in the length of time that this whole
process is taking. Mr. Buyer. Mr. Chairman, would you yield? Mr. Hutchinson. I would yield. Mr. Buyer. To clear up, I want to clear something up here before you all
leave here today. The President made his announcement at the VFW that there was going to
be his pledge of the intensification of the efforts and a pledge of monies for new
research. Now I hear today in answers to my colleagues' questions that this really isn't
new money for new research. We have ongoing research occurring right now. So I want to make sure
that the record is very clear, Mr. Chairman, given the answers today that this is not a
commitment to new research. There's ongoing research and projects that are presently at
hand. Mr. Hutchinson. Thank you. If there is anything inaccurate in what Mr.
Buyer just said_I think he reflected your answers correctly, but we would certainly like
for you to respond in writing to it. Dr. Joseph. I'd be happy to respond in writing. I believe that I'm
giving you the correct answer and it was in my testimony, that we have $10 million newly
programmed for research in the 1995 budget. I believe that's the correct answer to your
question. If I'm off-base_we'll respond to that in writing. I'm quite sure about__ Mr. Hutchinson. Let me thank the panel for your willingness to be here
patiently and take questions for a couple of hours and your forthrightness as well. Thank
you very much. You're dismissed. Dr. Joseph. Thank you very much, Mr. Chairman. Mr. Hutchinson. You're excused. Mr. Hutchinson. If Mr. Robertson, The American Legion, would be seated,
Mr. Robertson, the hour is late, thank you for your patience. You are Legislative Director
with The American Legion. We appreciate your willingness to testify. We emphasize we'd
like to keep your comments under 10 minutes, and all of your statement will be entered
into the record. You are recognized. Mr. Robertson. Thank you. STATEMENT OF STEVE ROBERTSON, LEGISLATIVE DIRECTOR, THE AMERICAN LEGION Mr. Robertson. I'd like to start off by thanking the subcommittee.
Thanks to you and your work and the leadership of members of this subcommittee, Persian
Gulf veterans are better off than they were 4 years ago, when they first brought this
problem to your attention. The panel that we just heard remind me of the hearings that we heard on
mustard gas, radiation exposure, Agent Orange exposure, and the first Persian Gulf
hearing, where we were told that this was only a problem of stress of having to relocate
to another part of the world. I think it's kind of interesting to note that we have not heard from any
of the Persian Gulf veterans from Persian Gulf to a redeployment back over there when
Saddam Hussein relocated his troops along the border. None of those soldiers have been coming to the VA registries or the
active duty registry, to the best of our knowledge, complaining of similar medical
problems that they predecessors have. And they weren't exposed to the bombing runs. They
weren't exposed to the oil well fires. They weren't exposed to the pyridostigmine bromide.
They weren't exposed to the Anthrax inoculations. So evidently we did accomplish one thing
with some lessons learned, and some precautionary measures were taken as a result of that.
I'm glad to hear the mention of the Brits and the Canadian soldiers by
some of the remarks because it is a problem. They are running into the same brick wall
that we were running into initially before the committee got involved. And their
government system over there is a little bit different than ours. I do understand that the
House of Commons is beginning to take an interest and apply to these veterans. When the Institute of Medicine released their report, we agreed with all
of their recommendations with the exception of one, where it talked about disregarding the
biological and chemical agents as a possible cause of the medical problems. Senator Riegle went to a lot of effort to produce three reports in his
Banking Committee. And I wish that people would read these three reports because if you
can read the third and final in that series and walk away saying that biological and
chemical agents should be disregarded from any research, I'd like to talk to you at length
in private because I think that you're missing the big picture here. I've asked to submit the testimony of James J. Tuite, III before the
State of Colorado joint session of their Committee on Veterans' Affairs on February 28,
1995 as an attachment to our testimony in support of this belief. Mr. Hutchinson. Without objection, so ordered. Mr. Robertson. And the other issue that I really am quite surprised is
the fact that the U.N. in their inspections of Saddam's nuclear chemical and biological
delivery capabilities have ongoing questions about the biological capabilities of Saddam
Hussein. Obviously the Department of Defense has convinced a lot of people that
biological and chemical agents do not have any factor in the medical problems experienced
by Persian Gulf veterans. And I would encourage the U.N. to talk to the Department of
Defense so that their concerns can be also put at ease. The Leishmaniasis issue that The American Legion has continually talked
about, we still believe a lot of questions have still not been answered. Even Dr. Jackson
in his testimony today said that this disease was spread by sand fleas. It's spread by
sand flies. There is a difference. And we're not aware of any gold standard test that you can give somebody
before they donate blood to tell you whether or not they are a carrier of Leishmaniasis. I
would like the committee to consider having hearings with the experts on Leishmaniasis to
find out how little we know about Leishmaniasis. I might also point out that the DOD repeatedly says that there have been
only 30 cases of Leishmaniasis identified. Well, if you check their records, about 20 of
them came from one division in the initial year of the investigation. Yes, they have
identified very few since that first year, but there's something that just doesn't work
out right. We would encourage the committee to have some hearings from
nongovernment medical experts in fields like the chronic fatigue syndrome, multiple
chemical sensitivity, the study of microplasms, the possibility to support the theory of
manmade viruses that we may be experiencing as part of our problem. I'd also encourage you
to listen to the Persian Gulf veterans themselves, the ones that have gone to the VA
health care program, and the famed CCEP. I've completed both of them, and I'll be more
than happy to comment on those. Also The American Legion is pushing to encourage a full epidemiological
study. We have asked this repeatedly in every testimony that we've presented before this
committee and committees in the other body. And then, finally, The American Legion made a public statement that we
encouraged all Persian Gulf veterans not to donate blood until we figure out what the
problem is that's causing the rest of the veterans to be sick. We have also asked our
membership, veterans, members of the Auxiliary, Sons of The American Legion, to increase
their participation in blood donation programs to make up for the shortfall. There are 3.1
million veterans. And we figure that we can do our part, too. The thing that we're very concerned about, until we have the answers we
don't want to jeopardize the national blood supply. And I think that that's a very
realistic request. You don't have to be a member of The American Legion to donate blood.
We would encourage everyone to do that. Again I would like to say that I appreciate the committee's work. There
are some people who have obviously been in the limelight of carrying this issue. I know
that Mr. Edwards was one of the first people that dealt with the Zuspann family when they
were having their tough times. And just in closing, I would like to say that there's going to be a
meeting March 10th through the 12th down in Dallas, Texas of various Persian Gulf support
groups. I'll be attending that, and I'll be more than happy to report back to the
committee the results of that meeting. Thank you very much. And I'm prepared to answer any questions you may
have. [The prepared statement of The American Legion appears on p. 134.] Mr. Hutchinson. Thank you for your testimony. We certainly appreciate,
the subcommittee appreciates, your willingness to come today. I hope that you realize that
the purpose of the hearing was primarily to hear a progress report from Defense as well as
VA and that it is not in any sense an unwillingness to listen to the veterans' personal
stories. And I, for one, thank you for your service in the Persian Gulf and the good work
of your organization. Certainly it is good to have cynics and skeptics on the kind of
testimony we just heard, and I think you are one and have raised important questions. Now,
would you reject the kind of strong testimony we heard earlier concerning chemical and
biological agents? I think also you have made reference to possible mustard gas burns in
the Persian Gulf theatre. To your knowledge personally, or your organization's knowledge, have you
been in direct contact with individuals who have experienced either the chemical,
biological, or mustard gas? Mr. Robertson. Well, obviously if we knew what was causing the problems,
we'd be standing up on the front steps on the Capitol saying ``We've found the answer.''
What we're basing our statements on are eyewitness accounts, personal testimonies that are
documented in the Riegle report; for an example, people being given medals for detecting
chemical agents on the battlefield, being given Purple Hearts for the exposure to the
mustard gas agents. Now, you can't have it both ways. You can't award medals for these
actions and then turn around and say that they weren't present on the battlefield. That's
not correct. That's inaccurate. So either the fellows' Purple Hearts were awarded for the
wrong reason or this guy's meritorious medal was awarded for not detecting chemical agents
on the battlefield. You can't have it both ways. Mr. Hutchinson. Mr. Edwards. Mr. Edwards. Mr. Robertson, I'd just like to ask: Having heard the
testimony, what is your level of satisfaction about the VA's and DOD's commitment to doing
everything they can to get to the bottom of these problems? Mr. Robertson. I think that Secretary Jesse Brown is very, very sincere
in what he's trying to do. I think Secretary Perry and General Shalikashuili are very,
very committed to this. But I think there's a breakdown somewhere in the system on both
sides. The VA registry physical that I was exposed to_and I have not been_I'd
recently received a letter inviting me to come back and file a claim with the VA and to
come back and have them look at me again. But the initial physical I had was nothing much
more than what I would have gotten for an insurance policy. I mean, it wasn't thorough at
all. And I didn't even get a response back as to the results of the physical. The comprehensive clinical evaluation that I'm still in the process, the
last part of it, over in the Department of Defense is very, very thorough. But I think
that the mindset that they're operating from has discouraged me personally, remarks like
``These are medical problems that you would have had, whether you went to the Persian Gulf
or not.'' Well, next time I promise you I won't go to the Persian Gulf. We'll make it
easier. That's like saying that you would have died, whether you went to the
Persian Gulf or not. The Persian Gulf gave you the opportunity to speed that process up. I think when you go in with that mindset of trying to discredit a person
because he's complaining or she's complaining of medical problems, then it taints the way
you're doing your research. For an example, they spotted a spot on my lungs. And they said, ``Well,
we need an x ray from you before the Persian Gulf.'' Well, I was in the Air Force for
12\1/2\ years. You're going to tell me the DOD medical system doesn't have my x rays from
when I was in the Service or if there had been a spot on my lungs it wasn't somewhere in
my DOD medical records. So he instructed me to go back to the last place I had a chest x ray,
which was at Fort Meade when I was being outprocessed for my return to the Persian Gulf.
So he compared a chest x ray from just 3 months ago to the one that I had immediately
after return from the Persian Gulf. And he said, ``The same spot is there.'' Now, it would seem to me that you would want something before the
Persian Gulf to compare that x ray with to see if there was a spot that had manifest while
I was in the Persian Gulf or after my return. So those kinds of little things are somewhat
confusing to me. The statistics that they keep wanting to spout out about how these are
similar to the general population, I would like to see the general population take the
Army PT test. I would like to see them take the Marine Corps test, the general population,
and see how they score on the PT test. The soldiers who went to the Persian Gulf, as Mr. Buyer pointed out very
clearly, were among the healthiest in the country. And to compare them against the general
population I think is deluding statistical data. Mr. Edwards. Do you have in your written testimony specific suggestions
of other things you'd like to see done that are not being done? Mr. Robertson. As far as the CCEP? Mr. Edwards. In general as far as the VA and DOD and__ Mr. Robertson. Yes, sir. We specifically want them to continue looking.
And if you look at the testimonies that we heard today_this is not admitted_we need to
look at the biological and the chemical aspect. None of these testimonies that I saw today
specifically addressed what they're doing in that area. I think God has said that there weren't chemical and biological agents
in the world and everybody is supposed to believe it. Now I need to find out who God is
because somebody has stopped the debate in all of these research problems on the
biological and chemical aspects. At least that's what I'm perceiving. Mr. Edwards. Very good. Thank you. Thank you, Mr. Chairman. Mr. Hutchinson. Thank you, Chet. Mr. Buyer? Mr. Buyer. I'll pass for the moment. Mr. Hutchinson. Mr. Bachus, you are recognized. Mr. Bachus. Mr. Hollingsworth__ Mr. Robertson. Mr. Hollingsworth is a shorter guy. I'm Steve Robertson.
Mr. Hollingsworth was snowed in this morning in West Virginia. Mr. Bachus. You're Mr. Robertson? Mr. Robertson. Yes, sir. Sir, you know, the general population was
receiving Anthrax inoculations. They weren't receiving all the series of shots before we
even went over. People on active duty as a general rule go to the sick call whenever
they're having the least medical problems. And they're identified at a very early stage, I
mean preventive medicine-type stuff. A lot of the aviators are getting annual physicals as
a requirement to meet the flight requirements. So I think any medical problems that a soldier had before he went to the
Persian Gulf was well-identified. The private sector I don't think is that
health-conscious as far as going to the doctor whenever they come up with an earache or a
toothache or some other kind of medical problem. They're not as quick to go as a military
person is. Mr. Bachus. They have taken medicine and given it to the general
population in other cases. And they found no different result. Mr. Robertson. And I doubt very seriously that population was sleeping
near diesel stoves that were emitting fumes. I doubt very seriously that they were exposed
to the other things that we were being exposed to in the Persian Gulf. I guess the thing that I'm looking at, sir, is that you can't compare
apples and oranges, and that's what they're trying to do. They're trying to take someone
who just walks in off the street and treat them the same way that a Persian Gulf veteran
was being treated. That was one of the dirtiest environments that I've ever been in
personally. And I was stationed in Turkey and Sicily when I was on active duty. Both of
those countries health-wise weren't the greatest of conditions, but it was nothing
compared to what we were in in Saudi. Mr. Bachus. Do you agree that here we are 2 or 3 years down the line and
we've investigated this, we should have investigated it, but we still have identified
nothing to explain apparently this, the undiagnosed diseases, what they are? Mr. Robertson. That's where I go back to the biological and chemical
warfare. The American Legion has never said we thought it was one specific thing. As a
matter of fact, we've even said we thought it may be a synergistic thing that together
these things may have caused the problems. But the more I look at this and the more dead ends that people seem to
be telling us, that ``There's nothing to this. You would have all been sick had you stayed
right in your own house'' makes we wonder and compare this to the AIDS epidemic, where
initially no one knew AIDS was. And it took 15 years for them to even identify what AIDS
was. We still haven't come up with a cure for AIDS because we know so little about it. So I propose to you the Saddam Hussein we know we sent him. We know the
biological and chemical agents the U.S. Government allowed to go over there. We know that
Germany provided him with biological agents. We know that the Soviet Union provided him
with biological and chemical agents. Now, what he did with those and what he wound up with we don't know. We
know that he had the delivery systems. The U.N. has already told us that and has verified
that, that he had the capability to deploy stuff. No one in this room can tell me what was in the warhead of every Scud
that was destroyed or allegedly destroyed in the Persian Gulf. No one can tell me what was
in the warhead that hit the barracks that were a mile and a half from my location in
Dahran. And until they can give me a definitive answer saying ``We know
absolutely 100 positive percent that none of the Scuds had chemical agents or biological
agents, that there was no fallout from any of the factories that we blew up that were
supposed to be producing biological, chemical, or nuclear weapons,'' until somebody can
tell me 100 percent that we weren't contaminated or exposed to these agents, then I think
it's still a factor that has to be put on the table, especially when you look at the way
that we're trained to look at biological agents in the battlefield. There is no detection capability for biological agents on the
battlefield, none whatsoever. They tell you to look for dead animals. They tell you to
look for soldiers that have medical problems that are undiagnosable, and you can't treat
them. Now, I'm not a rocket scientist, but it seems to me what we're facing
right here, we've got soldiers with a medical problem that they can't figure out what's
wrong with. And nothing's working to treat it or make them feel better. Mr. Bachus. You know, I've read Senator Riegle's reports. There have
been responses to it. And they have identified what some of the biological warfare has
been in the past, what agents are used and what the symptoms were from those agents. These are my comments and we were prepared to deal with the Anthrax and
botulism. That's why we got the inoculations for anthrax and botulism. As a matter of
fact, there was only a limited number of troops that could get inoculated for botulism
because there wasn't enough to go around for everybody. So they basically concentrated on
the guys in the very front. Mr. Bachus. Let me ask you this. I'm just trying to search for something
that gives us a clue. You know, they have studied those soldiers who were given the
Anthrax and they've studied those that didn't. It's my understanding you found no
statistical difference. Is that true? Dr. Murphy. The VA has not studied vaccinations for Anthrax. Mr. Bachus. The VA has not? Mr. Robertson. Sir, I think you're going to find trouble finding a study
that's concentrated or focused on biological or chemical agents, on either one of them or
both of them together. Mr. Bachus. Last night_I may be wrong_I thought I read a report that I
was supplied that said they studied immunization populations against non-immunization
populations and did not__ Dr. Mather. DOD. Mr. Bachus. DOD Mr. Hutchinson. The time of the gentleman has expired. Mr. Buyer? Mr. Bachus. Can I ask: Did they find a difference? Dr. Mather. I don't believe so. Mr. Robertson. And I don't know. Mr. Hutchinson. Could you identify yourself so we'll have that in the
record? Dr. Mather. Dr. Susan Mather, VA. Mr. Hutchinson. Okay. Thank you, Dr. Mather. Mr. Buyer? Mr. Buyer. Thank you, Mr. Chairman. Steve, I appreciate your efforts on this cause and have for a lot of
years on The American Legion. I don't thoroughly embrace the Riegle report as strong as you do
perhaps. And I perhaps look at it with a little more jaundiced eye. Something that we have
not covered, though_actually, I like to jump into bigger pictures here today. A bigger picture deals with the United States as a principal signatory
to the chemical weapons convention. Immediately after the election Glenn Browder and I
went to Moscow, went to St. Petersburg and to Moscow. And, of course, our efforts are to
focus on the destruction of biological and chemical weapons. It's a good thing to do. I was bothered when I learned, though, that here Russia, believe me,
they want our money to help in that process because most of their weapons in regard to the
chemical, most of them are weaponized. We have weaponized, too, in Alabama. We've got to
destroy that stuff. A lot of it also is in bulk. Their problems are intensified. I was bothered when here we want to destroy the chemicals and biological
stockpiles. Yet, their scientists are still continuing with the discoveries of new types
of biological warfare agents, whether it was in the use of E. coli or DNA. Docs, am I
saying the right thing? Isn't that what they call it, rDNA? Dr. Murphy. Recombinant DNA. Mr. Buyer. Say it again. Dr. Murphy. Recombinant DNA. Mr. Buyer. Oh, you say it nicer than I could. It's funky altering stuff.
It's funky stuff; right? I mean, it's really wild. It's what? Dr. Murphy. It's bad organisms. Mr. Buyer. It's great stuff. All right. I won't call it funky stuff.
It's great stuff, Mr. Chairman, I guess, if you're talking about altering microorganisms.
No? Oh, I'm back to funky. Let me just tell you when I say ``funky,'' this is some weird stuff. To
me it is. I mean, to have that kind of research. And then the questions go with regard to
Iraq. Now, I am bothered somewhat when they say an absolute not because when
you also then look at what the United Nations special commission came up with_I mean,
believe me, I'm not a conspiracy theorist, Steve. I'm not. I don't buy into those kinds of
things. But I like to look at this big picture here. I'm not going to draw immediate conclusions from it, but when you look
at that, what do U.N. inspectors reveal in their inspections with regard to biological
warfare in that stimulant research in Iraq suggested that they were looking at the
genetically altered microorganisms, that funky stuff, Doc, that you think is all so great. How much cooperation was there with Russia and Iraq? I don't know. This
chemical, Novachok? Mr. Robertson. Novachok. Mr. Buyer. Novachok. Is that? You know, I don't know a lot about this
one and whether or not even if that Soviet binary agent was even in Iraq. Are you familiar
with that or am I beyond what your__ Mr. Robertson. No, sir. I was just like you. I put on a uniform and went
where they told me to go and do what they told me to do. Mr. Buyer. Well, when you look at what they found at the Muthana
facility, 13,155 mm artillery shells loaded with mustard gas, 6,200 rockets loaded with
nerve agent, 800 nerve agent aerial bombs, 28 Scud warheads loaded with the nerve agent
Sarin, 75 tons of nerve agent Sarin__ Mr. Robertson. That's what was detected by__ Mr. Buyer (continuing). 60 to 70 tons of_pardon? Mr. Robertson. Sarin was what was detected by the Czechs on the
battlefield, sir. Mr. Buyer. Right, just above KKMC. Mr. Robertson. Yes, sir. Mr. Buyer. And it's 250 tons of mustard gas. I mean, I'm uncomfortable
with DOD just saying a blanket no. I mean, you know one thing I've never asked, Steve and
Mr. Chairman_maybe it came out_was whether we ever took chemical weapons to the Gulf. I
don't even know. Mr. Robertson. Sir, you're in a much better position to ask that
question than The American Legion. Mr. Buyer. Maybe I will submit that question, Mr. Chairman. It would be
interesting to see what the answer is because whether that got us in trouble with our own
chemical weapons convention would be rather kind of interesting. But I kind of threw that out there today, Mr. Chairman, because_I know
we've got a vote_I threw that out there because there's a lot of evidence out there that
suggests that Iraq in its relationship with Russia was close and that they had a lot of
biological/chemical weapons capabilities, even with what we, the United States, were doing
with some dual-use things at the time that we don't like to talk about. But to say a
blanket no from the DOD is rather alarming because we should keep all the options open. Thank you, Mr. Chairman. Mr. Hutchinson. Thank you, Steve. And you're right. We do have a vote.
Mr. Robertson, I want to thank you for your testimony. Mr. Bachus. Can I ask one question to the VA about what he raised? I
understand that the__ Mr. Hutchinson. Without objection. Mr. Bachus. Is the VA hospital in Birmingham conducting some studies on
chemical warfare agents or nerve gas or__ Dr. Mather. They are looking for clinical effects, effects you would
expect where there has been exposure. We have no__ Mr. Bachus. Neuro-cognitive? Is that the__ Dr. Mather. Neurotoxic or nuerocognitive effects. We have no way of
telling whether or not the exposures actually occurred. The studies in Birmingham are
looking at whether the veterans have the kinds of signs that you would expect in the case
of exposure to neurotoxic agents. Mr. Bachus. Wouldn't that be a start to__ Mr. Hutchinson. Spencer, we're really going to have to wind it up. Why
don't we submit the question? Mr. Bachus. Can you give us the results of that? Mr. Hutchinson. If we'll submit the question in writing, we could ask
for a written response on that and make certain that you get that. Mr. Robertson, thank you very much. And I want to thank all the
witnesses today. In particular, thanks to Mr. Edwards for his cooperation in the hearing.
And I want to assure you I think you've raised important issues, and they will be
monitored and pushed. And with that, the subcommittee hearing is adjourned. [Whereupon, the foregoing matter was concluded at 11:49 a.m.] |