Officials Challenge Gulf War Illness Investigation Report

"The underlying theme of the GAO report appears to be that there is a single [illness] or a few large-scale, Gulf War-related illnesses for which there are specific correct treatments," said Dr. Ed Martin, acting assistant secretary of defense for health affairs. "That conclusion is contrary to scientific evidence to date and the conclusions of at least three independent, expert scientific panels."

Martin's remarks are contained in a five-page letter of rebuttal to the GAO draft report dated May 19. The assistant secretary said DoD only partially concurs with the draft report.

"While the thrust of some of the recommendations has merit, the report suggests some misunderstanding of both DoD clinical and research programs and the role these programs play in understanding Gulf War veterans' illnesses," Martin said. "More importantly, the recommendations do not fully take into account the complex set of health outcomes related to the Gulf War and fail to recognize the significant accomplishments of the department as noted by the Institute of Medicine and presidential advisory committee."

Dr. Joyce Lashof, who heads the presidential advisory committee on Gulf War veterans' illnesses, was equally critical. In a similar rebuttal to the report, Lashof said the GAO report misrepresents her panel's work, lacks substantiation and makes sweeping, misleading statements.

Meeting with reporters at the Pentagon June 16, Bernard Rostker, DoD special assistant for Gulf War illnesses, said the report contains no new information. "Many of the [report's] criticisms you've heard me make from the podium," Rostker said. He said the GAO based its conclusions on "very, very scanty" published scientific research on the effects of low-level chemical exposure. "It's an open question," he countered. "There is not an adequate research base to draw those conclusions."

While the 89-page GAO report hasn't been officially released, The New York Times received the draft copy in early June. In that report, the GAO said efforts to monitor Gulf War veterans' clinical status are necessary to provide direction to research and ensure veterans receive appropriate treatment. The report said the Institute of Medicine, which advises DoD investigators, also supports monitoring veterans' treatment programs. The report recommends the secretaries of defense and veterans affairs develop and implement plans to monitor the clinical progress of veterans who have participated in their post-war examination programs.

In his rebuttal, Martin said DoD's Comprehensive Clinical Evaluation Program to treat Gulf War illnesses "has been reviewed by a series of nationally recognized expert panels, including the presidential advisory committee and ... Institute of Medicine. The [Institute of Medicine] committees specifically commended the DoD for 'its efforts to provide high quality medical care and success in developing the infrastructure necessary to efficiently contact, schedule, refer and track thousands of patients through the system,'" Martin said. "The [institute] further concluded that there is 'no clinical evidence in the [Comprehensive Clinical Evaluation Program] for a previously unknown illness among Persian Gulf veterans.'"

Martin also cited presidential advisory committee findings that the institute's favorable assessment of DoD and VA treatment programs. "Therefore," he said, "the department continues to operate the [Comprehensive Clinical Evaluation Program] and to actively collaborate with VA to share information and to plan accordingly."

Conditions such as chronic fatigue and depression diagnosed in some Gulf War veterans can last years, Martin said. "DoD provides intensive follow-up to those individuals from the [Comprehensive Clinical Evaluation Program] who required care beyond [the initial] evaluation," he said.

The GAO report also recommends DoD and VA give greater priority to research on treatment of ill veterans and the effects of low-level exposure to chemical weapons -- and lower priority to epidemiological studies. Martin said the recommendation appears inconsistent with basic clinical and research principles.

"Research for effective treatments or clinical trials almost always follows rather than precedes the identification of illness and epidemiological studies," he said. "The GAO fails to acknowledge that research results thus far have provided accurate and conclusive results regarding causes of mortality, rates and causes for hospitalization, rates and types of adverse birth outcomes, as well as many other health outcomes."

Martin added that DoD and VA are committed to better understanding the possible health effects of low-level exposure of chemical warfare agents and other environmental hazards. "We do agree that research into environmental factors is critical," he said. For 1997, DoD has allocated $10 million to research the health effects of exposure to chemical warfare agents, other toxins, inoculations and experimental drugs, Martin said, and DoD and VA jointly committed $5 million to study stress, the impact of stress on physical health, and the health effects of low-level exposure to chemical warfare agents.

The acting assistant secretary said DoD only partially concurs with GAO's recommendation that DoD and VA refine and correct clinical and research programs for the diagnosis and treatment of post-traumatic stress disorder. He said DoD and VA will commit at least $5 million this year for basic and applied stress-related research but added that DoD and VA have nationally recognized experts at medical referral centers to assist clinicians in diagnosing and treating post-traumatic stress.

"The [Comprehensive Clinical Evaluation Program] uses state-of-the-art instruments for the diagnosis of post-traumatic stress disorder and other psychological conditions," he added.

The GAO report "differs from ... independently derived findings, upon which much of the DoD and VA research and clinical programs are based," Martin said. GAO's study, he said, lacks the "level of careful and thoughtful assessments carried out by the Institute of Medicine committees and the presidential advisory committee."