[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
GULF WAR VETERANS' ILLNESSES: HEALTH OF COALITION FORCES
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
VETERANS AFFAIRS AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
JANUARY 24, 2002
__________
Serial No. 107-137
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
--------
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WASHINGTON : 2002
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COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
ILEANA ROS-LEHTINEN, Florida EDOLPHUS TOWNS, New York
JOHN M. McHUGH, New York PAUL E. KANJORSKI, Pennsylvania
STEPHEN HORN, California PATSY T. MINK, Hawaii
JOHN L. MICA, Florida CAROLYN B. MALONEY, New York
THOMAS M. DAVIS, Virginia ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
BOB BARR, Georgia DENNIS J. KUCINICH, Ohio
DAN MILLER, Florida ROD R. BLAGOJEVICH, Illinois
DOUG OSE, California DANNY K. DAVIS, Illinois
RON LEWIS, Kentucky JOHN F. TIERNEY, Massachusetts
JO ANN DAVIS, Virginia JIM TURNER, Texas
TODD RUSSELL PLATTS, Pennsylvania THOMAS H. ALLEN, Maine
DAVE WELDON, Florida JANICE D. SCHAKOWSKY, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
ADAM H. PUTNAM, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia ------
JOHN J. DUNCAN, Jr., Tennessee BERNARD SANDERS, Vermont
------ ------ (Independent)
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
James C. Wilson, Chief Counsel
Robert A. Briggs, Chief Clerk
Phil Schiliro, Minority Staff Director
Subcommittee on National Security, Veterans Affairs and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
ADAM H. PUTNAM, Florida DENNIS J. KUCINICH, Ohio
BENJAMIN A. GILMAN, New York BERNARD SANDERS, Vermont
ILEANA ROS-LEHTINEN, Florida THOMAS H. ALLEN, Maine
JOHN M. McHUGH, New York TOM LANTOS, California
STEVEN C. LaTOURETTE, Ohio JOHN F. TIERNEY, Massachusetts
RON LEWIS, Kentucky JANICE D. SCHAKOWSKY, Illinois
TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri
DAVE WELDON, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Kristine McElroy, Professional Staff Member
Jason Chung, Clerk
Sarah Despres, Minority Counsel
C O N T E N T S
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Page
Hearing held on January 24, 2002................................. 1
Statement of:
George, the Right Honorable Bruce, MP, chairman, Defence
Select Committee, House of Commons, London................. 34
Jamal, Goran A., M.B., Ch.B., M.D., Ph.D., FRCP, Imperial
College School of Medicine, London, England; Nicola Cherry,
M.D., Ph.D., FRCP, Department of Public Health Sciences,
University of Alberta, Edmonton, Alberta, Canada; Dr.
Robert W. Haley, M.D., University of Texas Southwestern
Medical Center, Dallas, Texas; Lea Steele, Ph.D., Kansas
Health Institute; James J. Tuite III, chief operating
officer, Chronix BioMedical, Inc.; and Howard B. Urnovitz,
Ph.D., scientific director, Chronic Illness Research
Foundation................................................. 105
Kingsbury, Nancy, Director, Applied Research and Methods,
General Accounting Office, accompanied by Sushil Sharma,
Assistant Director, Applied Research and Methods, General
Accounting Office; and Betty Ward-Zuckerman, Assistant
Director, General Accounting Office........................ 95
Morris, the Right Honorable the Lord, of Manchester, AO QSO,
House of Lords, London, accompanied by Colonel Terry H.
English, Controller Welfare, the Royal British Legion; and
Malcolm Hooper, Emeritus Professor of Medicinal Chemistry,
University of Sunderland................................... 48
Perot, Ross, chairman, Perot Systems Corp.................... 81
Principi, Anthony, Secretary, Department of Veterans Affairs,
accompanied by Dr. John Feussner, Chief Research and
Development Officer; Dr. Mark Brown, Director,
Environmental Agents Service; and Dr. Han Kang, Director,
Environmental Epidemiology Service......................... 11
Winkenwerder, Dr. William, Assistant Secretary of Defense for
Health Affairs, Department of Defense...................... 63
Letters, statements, etc., submitted for the record by:
Cherry, Nicola, M.D., Ph.D., FRCP, Department of Public
Health Sciences, University of Alberta, Edmonton, Alberta,
Canada, prepared statement of.............................. 121
Feussner, Dr. John, Chief Research and Development Officer,
prepared statement of...................................... 12
George, the Right Honorable Bruce, MP, chairman, Defence
Select Committee, House of Commons, London, prepared
statement of............................................... 38
Haley, Dr. Robert W., M.D., University of Texas Southwestern
Medical Center, Dallas, Texas, prepared statement of....... 129
Jamal, Goran A., M.B., Ch.B., M.D., Ph.D., FRCP, Imperial
College School of Medicine, London, England, prepared
statement of............................................... 109
Kucinich, Hon. Dennis J., a Representative in Congress from
the State of Ohio, prepared statement of................... 8
Morris, the Right Honorable the Lord, of Manchester, AO QSO,
House of Lords, London, prepared statement of.............. 50
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut, prepared statement of............ 4
Steele, Lea, Ph.D., Kansas Health Institute, prepared
statement of............................................... 139
Tuite, James J., III, chief operating officer, Chronix
BioMedical, Inc., prepared statement of.................... 151
Urnovitz, Howard B., Ph.D., scientific director, Chronic
Illness Research Foundation, prepared statement of......... 158
Winkenwerder, Dr. William, Assistant Secretary of Defense for
Health Affairs, Department of Defense, prepared statement
of......................................................... 66
GULF WAR VETERANS' ILLNESSES: HEALTH OF COALITION FORCES
----------
THURSDAY, JANUARY 24, 2002
House of Representatives,
Subcommittee on National Security, Veterans Affairs
and International Relations,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:02 a.m., in
room 2154, Rayburn House Office Building, Hon. Christopher
Shays (chairman of the subcommittee) presiding.
Present: Representatives Shays, Putnam, Gilman, Platts,
Schrock, Otter, Kucinich, Sanders, Schakowsky and Tierney.
Staff present: Lawrence J. Halloran, staff director and
counsel; Kristine McElroy, professional staff member; Jason M.
Chung, clerk; Sarah Despres, minority counsel; and Jean Gosa
and Earley Green, minority assistant clerks.
Mr. Shays. A quorum being present, the Subcommittee on
National Security, Veterans Affairs and International Relations
hearing entitled, ``Gulf War Veterans' Illnesses: Health of
Coalition Forces,'' is called to order.
We extend a very warm welcome to our distinguished
colleagues from the United Kingdom. On the right, the Honorable
Lord Morris of Manchester, a member of the House of Lords and a
former member of the House of Commons, and the Right Honorable
Bruce George, a member of Parliament.
Throughout his public life Lord Morris has been a tireless
advocate for the disabled. He currently serves as the
Parliamentary Advisor to the Royal British Legion and is a
member of the Inter Parliamentary Gulf War Group.
Mr. George has chaired the Defence Select Committee in the
House of Commons since 1997. He, too, is a Parliamentary
Advisor to the Royal British Legion. He has been an invaluable
ally and friend to this subcommittee in pursuing oversight of
Gulf war veterans' issues.
I think I'm stumbling over these words because as I went
through a passageway in the Capitol I noticed the bullet holes
from the war of 1812. So I'm just a little uneasy about this.
We welcome their knowledge, expertise and insight, and we
look forward to continuing our collaborative efforts on behalf
of our veterans. I ask unanimous consent they be afforded the
parliamentary privilege of participating as members of the
subcommittee hearing. Without objection, so ordered.
This subcommittee has also been in contact with the
Honorable Bernard Cazeneuve, a member of the French National
Assembly and president of the Commission on Gulf War Illnesses.
Mr. Cazeneuve was unable to attend the hearing today, but his
office offered to provide material for the record on French
efforts to determine post-war health effects. I ask unanimous
consent that the hearing record remain open for 2 days for that
purpose and that, after consulting with the minority, the
material provided be included in the record. It's in French.
So, without objection, so ordered.
The book and film Blackhawk Down vividly depict the unique
physical and moral hazards of modern warfare. In the twisted
streets of Mogadishu, Somalia, elite U.S. Army Rangers fought,
and died, to redeem their pledge never to leave a fallen
comrade behind.
That same debt of honor is owed to the men and women from
the coalition of nations who fought, and prevailed, in the
toxic battlefields of the Persian Gulf war, and they came home
sick. So today we ask again if the delayed casualties of
Operations Desert Storm and Desert Shield are being left behind
by a stunted research effort to find the causes and cures of
their war-related illnesses.
In our previous hearings on management of the joint
Department of Defense [DOD], and Department of Veterans Affairs
[VA], research protocol, witnesses raised troubling questions
about the reach and rigor of an increasingly expensive, if not
expansive, research program. These questions persist.
Why does it appear privately funded studies have yielded
more tangible results and more promising hypotheses than
Federal projects? Does the interagency review process ignore or
actively stifle research that does not conform to preconceived
notions of a war without lingering toxic aftereffects? Is the
Federal research agenda skewed toward long-term epidemiological
studies at the expense of the clinical data needed now by Gulf
war veterans and their doctors? What is known about the health
of veterans from other coalition nations? Are different
approaches by other nations to the use of pesticides, vaccines
and experimental drugs being studied for clues to explain
veterans' susceptibilities and symptoms?
Befitting the importance of the questions under discussion,
we are joined this morning by an impressive list of witnesses,
all of whom share a commitment to improving the health of Gulf
war veterans. VA Secretary Anthony Principi yesterday signaled
a willingness to accelerate and broaden the research effort by
appointing an advisory committee bringing new voices and new
perspectives to these issues. And we sincerely thank you for
doing that, Mr. Secretary. The DOD Assistant Secretary for
Health Affairs will discuss health monitoring of Gulf war
veterans and efforts to translate the medical lessons and
mistakes of that war into better force health protection in the
current and future conflicts. We welcome their participation.
Witnesses from the General Accounting Office will discuss
their ongoing work, undertaken at the subcommittee's request,
to assess differences in health monitoring, health outcomes and
defense strategies among Gulf war coalition members.
Mr. Ross Perot, who has privately sponsored significant
studies into Gulf war veterans' illnesses, will speak to the
need for a renewed focus by VA and DOD on a Federal research
program that is scientifically, not politically, driven. And a
panel of researchers will describe sometimes Herculean efforts
to overcome bureaucratic hurdles in their quest to unravel the
tangled web of genetic, toxicological, neurological and
immunological factors at work in causing the illnesses known as
Gulf war syndrome.
We look forward to their testimony.
In closing, let me once again welcome our colleagues from
the United Kingdom. We appreciate their work on behalf of all
Gulf war veterans. We look forward to continued international
cooperation on research and treatment protocols. The coalition
that prevailed against Saddam Hussein still has men and women
battling for their lives. We know they can't be left behind.
[The prepared statement of Hon. Christopher Shays follows:]
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Mr. Shays. Mr. Secretary, you see a number of members who
are going to speak, but I assure you you will get out of here
by 10:30.
At this time I would invite Mr. Kucinich to give a
statement, the ranking member of the committee.
Mr. Kucinich. Thank you very much, Mr. Chairman and members
of the committee. And to our honored colleagues from across the
pond, welcome. We appreciate your dedication on this issue.
I want to thank the Chair for making it possible for this
interparliamentary exchange here and to Mr. Secretary and the
witnesses, welcome. I want to thank all of you for your
dedication and concern for our veterans and for our active
service personnel.
I want to also thank those who represent the private sector
for their commitment to the health of those who serve this
country.
In particular, Mr. Chairman, before I make my formal
statement I want to thank Ross Perot. Long before other people
began to pay attention to these issues, Ross Perot's voice was
one which raised this issue to a national consciousness. I want
you to know that it's made a difference; and all of us in the
Congress salute you for your passion and involvement, Mr.
Perot. Thank you.
Mr. Chairman, thank you for your continued attention to
this important issue of the health of our soldiers, support for
this country.
Often in our work on military issues in Congress the human
element of our defense, the sacrifices of the men and women who
wear the uniform, their health and welfare, their goals and
ideas, get lost amid endless discussion over hardware, over
bombers and their budgets, over artillery and avionics. But as
the military strategist Colonel John Boyd always stressed, and
as I firmly believe, machines don't fight wars, people do. And
it is these individuals, not our planes, tanks and guns, who
daily place themselves at risk of injury and even death in
serving our country.
We thus have an obligation to the men and women who
continue to suffer illness as a result of their service during
the Gulf war to discover why they're sick and do all in our
power to help them. I know, Mr. Chairman, you share this
commitment. I know that commitment is shared by Mr. Sanders,
who has made this a part of his important work in the Congress;
and it's shared by all of our witnesses.
I would like to draw attention to a few key issues
surrounding Gulf war illness. The Institute of Medicine has
looked at possible connections between certain drugs and
vaccines troops received and Gulf war illness and has concluded
that further research is necessary to make a final
determination. If indeed Gulf war illness can be attributed to
the drugs or vaccines, or some combination, that were issued to
U.S. soldiers, the question of how the Pentagon evaluates the
safety of these treatments assumes paramount importance.
How rigorous are the processes by which the Defense
Department assesses vaccines and other treatments and whether
they are appropriate for American military personnel? If our
soldiers are given unapproved or investigational medication
such as the drug PB which during the Gulf war was used as a
pretreatment for exposure to nerve agents, how does the
Department of Defense assure that these medications are safe?
To the extent possible, proven, science-based criteria for
evaluating the safety of these treatments must be utilized;
and, where such criteria are unavailable, thorough
consideration must be given before exposing American service
members to these substances.
Related to the question of how the Pentagon determines
medical treatments are safe for soldiers is how the Department
of Defense decides what prophylactic treatments are necessary.
The GAO report on Gulf war illness requested by the chairman
makes plain the lack of consensus between the United States,
the French and the British regarding the threat of biological
warfare and of specific chemical agents to allied troops during
the Gulf war. This begs the question: Why did our assessments
different from those of our allies? If our military was relying
on different intelligence than the French and the British
forces, why weren't efforts made to share information? Clearly,
decisions to issue prophylactic medical treatments to counter
potential exposure to chemical and biological agents must be
based on detailed and credible intelligence. I look forward to
hearing the account of the Department of Defense about their
efforts to precisely verify the biological and chemical threats
to U.S. troops before issuing vaccines during the Gulf war.
Finally, I'd like to raise an issue that transcends
questions regarding the health of our troops. There is concern
that Gulf war illness may be connected to the bombing
industrial facilities in Iraq and resulting release of toxic
substances. If this conclusion is borne out, it would seem
logical that the Iraqi civilian population was also impacted.
Did the Department of Defense consider that the bombing of
certain targets may put both American soldiers and Iraqi
civilians at risk and does the Department of Defense consider
this possibility now when choosing now targets in the periodic
air strikes against Iraq?
I hope our witnesses will shed some light on these
questions, and I thank the Chair for holding this hearing.
Mr. Shays. Thank you.
[The prepared statement of Hon. Dennis J. Kucinich
follows:]
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Mr. Shays. The Chair is getting a little nervous with time.
I'm just going to recognize Mr. Sanders just for a brief
comment. We're going to allow you, Mr. Principi, to go. Then
we're going to come back to the statements because I want to
hear from the rest of the Members.
Mr. Sanders. I'll be very brief now.
Mr. Secretary and staff, thank you all very much for
coming.
The bottom line, Mr. Secretary, is that in the recent
statement from the Department of Defense they say, ``we note
that similar poorly explained symptoms have been observed among
veterans after all major wars in the last 130 years,'' etc. My
understanding of that is that, after all of the evidence, after
all of the work, after 140,000 veterans reporting themselves
ill, the DOD today does not believe in Gulf war illness. That
is their position. There have been similar problems after World
War I, World War II. They go back to the Civil War. In their
interpretation there is no Gulf war illness.
I want to applaud you for recognizing and working with Dr.
Feussner and the others to get the study about ALS out. That is
the first time, as I understand it, the government has finally
acknowledged that service in the Gulf is likely to cause a
particular--more likely to cause a particular illness than
nonservice. I believe that is the first of many discoveries
that you're going to find. I hope that you will not continue
the unfortunate position of the government in terms of
radiation illness after World War II, Agent Orange after
Vietnam. Our veterans deserve more.
I appreciate your willingness to jump on this issue. It's a
controversial issue. You have some good people there, but, in
general, the DOD and the VA have not done a good job, and I am
hopeful that you will turn that around.
That's my brief statement.
Mr. Shays. I thank the gentleman. Mr. Sanders has been the
most active member on this committee on this issue, and I thank
him.
I'm going to announce and welcome our first panel, the
Honorable Anthony Principi, Secretary of Veterans Affairs;
accompanied by Dr. Feussner, Chief Research and Development
Officer; Dr. Mark Brown, Director, Environmental Agents
Service; Dr. Han Kang, Director of Environmental
Epidemiological Service; and then testimony as well from Dr.
William Winkenwerder, Assistant Secretary of Defense for Health
Affairs, Department of Defense.
I invite all of you to stand so I can swear you in, please.
[Witnesses sworn.]
Mr. Shays. Note for the record that all five have responded
in the affirmative.
Mr. Secretary, we're going to have you testify. I want to
get you out of here so you can go to your other meetings.
Then we're going to go back to the statements of the
Members; and then we're going to go to you, Dr. Winkenwerder.
Then we'll take questions. Thank you.
STATEMENT OF ANTHONY PRINCIPI, SECRETARY, DEPARTMENT OF
VETERANS AFFAIRS, ACCOMPANIED BY DR. JOHN FEUSSNER, CHIEF
RESEARCH AND DEVELOPMENT OFFICER; DR. MARK BROWN, DIRECTOR,
ENVIRONMENTAL AGENTS SERVICE; AND DR. HAN KANG, DIRECTOR,
ENVIRONMENTAL EPIDEMIOLOGY SERVICE
Secretary Principi. Thank you, Mr. Chairman. Chairman
Shays, Mr. Kucinich, members of the committee, distinguished
parliamentarians, thank you for inviting me to appear before
the subcommittee this morning. I ask that you include in the
record the formal written statement of Dr. John Feussner, the
VA Chief Research and Development Officer.
Mr. Shays. That will be in order.
[The prepared statement of Dr. Feussner follows:]
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Secretary Principi. I am honored to be included in the
ranks of committee members, distinguished parliamentarians and
today's panel of eminent and accomplished witnesses. We are all
united in the pursuit of an answer to questions surrounding the
health of members of the coalition forces. We are united in a
commitment to the health of those men and women who today, more
than a decade after the war, suffer from illnesses we cannot
define, from symptoms we all too often cannot alleviate.
My commitment to these men and women is both professional
and moral. It springs from the obligations I accepted when I
was entrusted with the responsibilities of Secretary. It is
also rooted in my experiences in the Brownwater Navy of Vietnam
when I and my shipmates were exposed to Agent Orange.
I understand that the effects of war are not limited to
those created by bullets and bombs. But no matter how profound
my desire to ensure a complete and professional response to the
medical and benefits needs of the veterans I serve, no matter
how diligently I apply my response to my responsibilities as
Secretary, no matter how unambiguous my instructions to those
who work in the Department, no matter how much weight I assign
to the issue, I can never forget that the resources of time and
attention I devote to addressing the needs of these veterans
pale in insignificance compared to the effects of these
symptoms on the once vigorous men and women who now awaken each
morning to face another day weighted by a burden no less heavy
because it remains undefined, no less debilitating because the
origin remains mired in controversy. That knowledge drives me
to take every step possible to ensure that our government
addresses the needs and concerns of Gulf war veterans afflicted
by symptoms we do not understand.
My commitment to Gulf war veterans is long-standing. The
fires were still burning in Kuwait when, as Deputy Secretary, I
ordered VA to create a registry of Gulf war veterans who
developed health problems, a clinical data base upon which
decisions in the future may be made.
I believe my commitment is reflected in the President's
commitment to veterans. That is why he signed legislation
expanding the scope of conditions subject to presumptive
service connection and extending the deadline before which
those symptoms must appear.
My commitment is reflected in the immediate action I took
when presented with research findings indicating an increased
incidence of ALS in Gulf war veterans, and that is why I
insured the VA's Research Advisory Committee on Gulf War
Veterans' Illnesses include members who will challenge the
conventional wisdom as well as those who support it.
The Advisory Committee will review all relevant research
and investigation as well as the processes for funding
research. They will assess research methods, results, and
implications. Their task is to ensure that research's
fundamental goal is improving the health of ill Gulf war
veterans, either by increasing understanding through basic
research or improving treatment through applied research.
One of my responsibilities as Secretary is to ensure that
every member of my department shares my focus and my sense of
urgency. I acknowledge that clear-cut results through
scientific research and the development of successful medical
treatment require more than strength of will, depth of desire,
and clarity of direction. Nature sometimes resists divulging
her secrets. But I can and will ensure that my department
attacks the problems of Gulf war veterans with unflagging
energy and tightly focused commitment.
Our obligation to the veterans who served in the Gulf is
not contingent on assigning a name to their problems or
discovering the origin of their illnesses. It is enough that
they are ill and that they need our help.
We will tear away the veils of uncertainty and illuminate
the darkness now cloaking understanding. And, regardless of the
results, we have an obligation to provide effective treatment
and timely compensation.
I am pleased that I can count on the leadership of members
of this subcommittee as allies in this cause.
I also want to recognize and thank a tireless advocate for
veterans who shares this room with us this morning. Ross Perot
combines advocacy with direct action in a way that touches the
lives of veterans of all eras but most of all the lives of
veterans who served in the Gulf war. He has been generous with
his advice to me and to other officials of my department; and,
most importantly, his support for veterans is heartfelt and
very profound. We are all indebted to Ross Perot. I believe
that the best way to satisfy that debt is to look to his
example for inspiration as we meet the responsibilities
entrusted to us by the American people.
Thank you very much, Mr. Chairman and members of the
committee.
Mr. Shays. Thank you have very much, Mr. Secretary. I
appreciate you being here.
We're going to let you get on your way. You have either
members of your staff who can respond to questions.
I'm going to at this time to invite Mr. Putnam if he has
any statement.
Thank you, Mr. Secretary.
Mr. Putnam. Thank you, Mr. Chairman; and we thank the
Secretary for his eloquent opening statement.
I'd like to echo his remarks about Mr. Perot. Between the
support of the POWs and his support for Gulf war illness, Mr.
Perot, your commitment to America's patriots is without equal.
We appreciate that.
The researchers who slave away day in and day out to peel
away the questions to find the answer for our veterans are also
to be commended, and we appreciate your presence here to help
us better understand and continue toward that goal.
The young men and women that we ask to serve our Nation and
put themselves in harm's way give up an awful lot for the
freedoms that we take for granted. They leave behind pieces of
themselves, comrades, buddies, and scarred psyches that never
heal. But some of those wounds are not as visible, and they
come back and are in need of additional help and additional
support from the government even if, as the Secretary said, we
don't have an easy name to apply to their symptoms.
So the purpose of this hearing, then, is to continue to
advance the cause of research and resources toward that
objective, to give those young men and women who gave so much
the support they deserve. Mr. Chairman, I appreciate your
commitment to this and Mr. Kucinich's ongoing commitment by
this subcommittee to get to the bottom of this issue.
Mr. Shays. Thank you.
I appreciate all the Members who were willing to let Mr.
Principi make his comments.
Mr. Tierney, do you have an opening statement?
Mr. Tierney. Mr. Chairman, I'll be happy to just put my
remarks in the record so we can get to the witnesses. Thank
you. If we have unanimous consent for that.
Mr. Shays. Then we have Mr. Gilman.
Mr. Gilman. Thank you, Mr. Chairman. I'll try to be brief.
Mr. Chairman, I want to commend you for holding this
morning's hearing to examine the current levels of cooperation
between our Nation, France, and the United Kingdom regarding
ongoing research and illnesses experienced by our veterans of
the Persian Gulf war. It's an extremely important issue.
We're now 11 years removed from that conflict. In that
intervening time we've seen some considerable progress on the
issue of the Gulf war syndrome for the veterans of Operation
Desert Storm. I have a number of veterans in my area who have
been affected by that.
Mr. Chairman, your leadership at the helm of this
subcommittee has been instrumental and served as the driving
force behind much of our progress. It bears noting, however,
that the majority of the movement on this issue has come from
the Congress. While the Department of Defense eventually
admitted to troop exposure to chemical weapons, they did not
believe it was necessary to suggest that the VA initiate
research in the long-term health effects of low-level chemical
exposure. Both DOD and the VA adopted a position that only
definitive, proven linkages between toxic exposure and
illnesses would be accepted as any evidence that military
personnel were becoming sick as a direct result of their
service in the Gulf.
The burden of proof, of course, was then on the veteran,
not the government. Consequently, more than 90 percent of the
veterans' claims for Gulf war-related injuries were denied
prior to 1998.
The Gulf War Veterans' Claims Act of 1998, which came out
of numerous hearings by this subcommittee on the subject,
directed the VA to look for plausible relationships between
presumed exposures and later ill health. Recent applicability
of this law came last month when the VA announced that it would
now treat amyotrophic lateral sclerosis as a Gulf war service-
connected illness.
Despite all of this, I don't believe that the original
positions of the VA and DOD have very much changed. Both
departments have been critical of oversight reports on this
subject by the General Accounting Office and this subcommittee.
Moreover, it seems that many in these organizations would
prefer to see the lack of a single definitive cause of Gulf war
syndrome to be evidence of a lack of such a disease, rather
than incentive for more research and greater involvement of the
scientific community.
I am, therefore, very much interested to hear how our
government is cooperating with our allies, with France, with
the United Kingdom and the overall research. All three
countries had veterans who became sick after serving in the
Gulf war, and each co-shared research and intelligence.
Moreover, since each country approached the issues of chemical
biological force protection differently and since their troops
were exposed to a different variety of the more than 30 toxins
that have been subsequently identified on the battlefield
environment, shared research and greater cooperation would
potentially help facilitate increased linkages between
exposures and illness.
Accordingly, I want to thank you once again, Mr. Chairman,
for holding this hearing. We look forward to hearing from our
expert witnesses who are before us. Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman.
Ms. Schakowsky.
Ms. Schakowsky. Thank you, Mr. Chairman. I will try to be
very brief.
I'd like to thank Chairman Shays and Ranking Member
Kucinich for giving us yet another opportunity to discuss this
issue. I'm confident that their leadership will lead to
progress on this matter.
I would also like to welcome and thank all of our witnesses
but especially the Right Honorable Bruce George and Right
Honorable Lord Morris of Manchester for traveling from the U.K.
to be here with us.
As you know, in late 1991, almost immediately after the
Gulf war, the first reports of symptoms and illnesses flooded
doctors offices and VA facilities across the country. Veterans
who before the war were in perfect physical health were
suffering from debilitating symptoms. In the years following
the war, the media highlighted stories of the symptoms, ranging
from chronic fatigue, headaches and muscle pains, coupled with
reports of the diagnosis of Gulf war veterans with cancer,
heart and lung problems and Lou Gehrig's disease. This
committee alone has held four hearings on this issue.
I am glad that we have a chance to discuss the GAO's
finding. Their hard work provides further evidence of Gulf war
service and illness. As studies continue and revelations are
made, we should give these soldiers the benefit of the doubt
and provide treatment for those suffering. Individuals exposed
to illness cannot afford to wait until we establish links
beyond a reasonable doubt. Lives are at stake now.
Just over a month ago the VA and DOD released a study that
found preliminary evidence that veterans who served in Desert
Shield/Desert Storm are nearly twice as likely as nondeployed
service personnel to develop Lou Gehrig's disease. As in his
testimony, Secretary Anthony J. Principi said that the VA would
immediately begin providing additional benefits and
compensation to veterans who were deployed in the Gulf and
develop the disease.
The startling confirmation of a 10-year suspicion is
evidence not only for the need to continue and intensify
research on this issue but the need to emphasize findings and
answers, finding answers and solutions. I am pleased to see
that health care providers are helping those suffering from
diseases. I believe it's necessary and fair. In fact, we should
do more. It's our responsibility to do whatever we must to
determine the causes and symptoms and illnesses related to the
Gulf war immediately.
America is at war. Our troops are deployed as we speak
fighting to rid the world of the threat of terrorism. When our
troops return they should not have to wait 10 years to find
that they were becoming ill because we didn't protect them. Our
troops returning from war abroad should not have to fight for
their lives at home. I hope we are all committed to providing
answers for veterans through this time of uncertainty.
I want to thank each of our witnesses, our chairman, and I
look forward to hearing and learning from the coming testimony.
Mr. Shays. I thank the gentlelady.
I would not want to give the impression to any Member that
we don't welcome your testimony because you all have been
giants in this effort for years. I appreciate the panel's
patience, but these have been very hard-working Members who
have cared about veterans for years.
Mr. Otter.
Mr. Otter. I have no statement.
Mr. Shays. Then I have the distinct pleasure to recognize
two of our colleagues from Great Britain. The Republican in me
wants to recognize the Lord, but----
Mr. Sanders. We put him on our side.
Mr. Shays [continuing]. But I would point out that both
members have been members of the Labour Party.
With that, I would welcome Mr. Bruce George, a member of
Parliament, to address this Congress.
STATEMENT OF THE RIGHT HONORABLE BRUCE GEORGE, MP, CHAIRMAN,
DEFENCE SELECT COMMITTEE, HOUSE OF COMMONS, LONDON
Mr. George. Thank you, Mr. Chairman. It's an enormous honor
being here.
Frankly, I find it almost beyond belief that a British
member of Parliament, a member of the House of Lords should be
sitting in this dignified position.
Mr. Shays. You honor us, sir.
Mr. George. Our chairman was incredibly discreet when he
referred to the bullet holes. I would have liked to have asked
him, in light of friendly fire, whether they were ours or
yours. I suspect from history more likely to be yours than
ours.
May I say--and I must apologize. I'm Welsh, and brevity is
not a trait for which the Welsh are renowned--I am glad I have
not brought members of my committee here. Because if they
thought I would be as tolerant as you, chairman, in allowing
personal statements--they know I am not tolerant. There is only
one person allowed a personal statement on the Defence
Committee, and you're looking at him.
Your lax ways--I went into the dining room yesterday, and
my host discreetly sat me with my back to the painting of the
British surrender at Yorktown. Therefore, I discreetly did not
point out our acts of revenge, which were gestures, I must say,
rather than serious military reprisals.
But may I say at the outset, our relations as two nations
have often been rocky and for most of your country's history
they've either been pretty awful or barely acceptable,
inadequate. But, since 1940, I can't think of any two nations
in the history of the world whose relationship has been so very
close. Time and time again, academics and politicians tell us
that this good relationship has terminated. I actively took
part in the debate 6 months on that very subject. And who would
have imagined, I suppose, that a Republican president would
enjoy such an excellent relationship with hardly a left wing
labour Prime Minister. But it is truly exceptional.
I'm so very proud of the support that we have given to the
United States, particularly since the atrocities on September
11th. The conflict which we participated in a secondary but not
unimportant role was merely one stage in a continuing struggle
against terrorism, and we are proud to be participating and
will participate even more in the future.
Something that has been said--and I apologize for
inflicting this on witnesses who have heard this a million
times--fighting a war has always been dangerous. But when I was
watching a study of my local regiment and its history I reached
the inescapable conclusion that the chances of being killed by
disease were infinitely greater than the chances of being
killed either by your soldiers fighting--playing dirty pool, as
my wife would say, until we reciprocated or fighting against
the French. The chances were not high with exceptions for the
First and Second World Wars. But we lost 100,000 men in the
Caribbean in the 1780's and 1790's, and Wellington would not
take any regiment in his peninsula war that had served in the
Caribbean. Appalling diseases that eventually the causes were
discovered.
Even though I am a parliamentarian and we have great fun in
mocking ministers and all sorts of people, I recognize that we
are basically on the same side. Maybe we are rather more vocal
than you are, but we really have to resolve the problem. If, as
some people say, there is a Gulf war syndrome and if there is
not, and I have no idea, then how are we going to treat the
consequences of something that we don't know?
And let us not forget other side of it, namely the
financial side. I was amazed when you instructed your witnesses
to stand up and promise to be honest. It is not something I
could ever demand of witnesses to my committee, and certainly
politicians would never leap and affirm that principle, which
would be an appalling violation of our human rights. One has to
remember that--I think it is the American expression--the first
law of politics is never cheat or lie unnecessarily.
If I might return with your indulgence, Mr. Chairman.
Briefly, I have submitted a rather lengthy document for your
consideration. If I might just for 2 or 3 minutes say the
Defence Committee that I chair has been very, very interested
and involved along with members of the House of Lords. I must
say it's truly amazing coming 4,000 miles to share a platform
with a member of the House of Lords because our relationship is
as hostile in many ways as it has been with the United States.
So it's rather ironic that it is in the United States the two
members of the British Parliament should be sharing a table
together.
But we have been very much involved, working with outside
organizations like the Royal British Legion, in keeping the
issue of the Gulf war syndrome alive. As each month goes by the
temptation to allow the subject to drift away and to concede
defeat becomes enormous. It is very important that members of
legislature, if they could no more than keep the issue alive
and, therefore, keep members of the executive and the medical
profession aware that this is something that really has to be
resolved.
We've had some bad relations with the Ministry of Defence.
If I could just give you a few diplomatic phrases we used. This
was 7 or 8 years ago with the previous government. We said in
our report, in dealing with its own service personnel, the
British public and parliament on the subject of the Gulf war
syndrome, we do not believe that the Ministry of Defence has
been dogged in pursuit of the facts. The culture of denial has
influenced the way the department has handled the whole
question of Gulf-related illnesses and may have contributed to
the administrative failings which led to parliament being
misled.
We went on to say, in using the same phraseology, Mr.
Chairman, that you used, the new government believes that we
have a debt of honor to those who have served their country in
the armed forces and to be determined that a fresh start will
be made in dealing with this difficult and complex issue.
Well, there has been an improvement in research and
activity by the government, but I'm afraid the veterans remain
discontented. We produced a number of reports in the last
parliament, Mr. Chairman. Our very first inquiry, our very
first public session in the last parliament was on Gulf war
illnesses; and, ironically, the very last session in the last
parliament of our committee was on the very same subject.
So we will continue to work with the United States, with
your committee, with the medical profession, with our own
Ministry of Defence in the hope that we will be able to provide
more than hitherto we have been able to.
Our committee has announced its intention to examine the
Ministry of Defence's new proposals for providing pensions and
compensation for armed forces personnel and an improvement on
what has gone before. Unfortunately, the events of September
11th have somewhat delayed that. But even though the committee
has been preoccupied and will be preoccupied with the
consequences of September 11th, we are coming over to the
United States in 10 days. We will never allow the issue of the
Gulf war syndrome to fade into distant memory.
Because every war we fight, each one is different. Maybe
the number of casualties on the battlefield are few, because
that is what our publics demand, but even if we are entering an
era of military history where our casualties are very few, we
are more than aware, as you gentlemen are aware, the casualties
may not be reflected in wounds but in psychological or other
physical damage.
I wish this committee well, and I wish all of those engaged
in the research to achieve what we are all desperately anxious
to achieve, and I on behalf of my committee wish you well.
Because
we have an obligation to our military personnel that must and
I'm sure will be properly discharged.
Thank you for your tolerance.
Mr. Shays. Thank you for your very eloquent statement.
[The prepared statement of Mr. George follows:]
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Mr. Shays. At this time, the Chair recognizes Lord Morris.
STATEMENT OF THE RIGHT HONORABLE THE LORD MORRIS OF MANCHESTER,
AO QSO, HOUSE OF LORDS, LONDON, ACCOMPANIED BY COLONEL TERRY H.
ENGLISH, CONTROLLER WELFARE, THE ROYAL BRITISH LEGION; AND
MALCOLM HOOPER, EMERITUS PROFESSOR OF MEDICINAL CHEMISTRY,
UNIVERSITY OF SUNDERLAND
Lord Morris. As you know, Congressman Shays, I count it an
honor to be here as a parliamentarian with 38 years service in
the two houses of parliament at Westminster, 33 of them in the
House of Commons, to be taking a part in the dias with the
honorable members of your subcommittee in this oversight
hearing on Gulf war veterans' illnesses.
Moreover, I take pride in being here as a representative of
the Royal British Legion of the U.K. together with Colonel
English and Professor Malcolm Hooper and in the company, joke
and company of my very good friend and right honorable
parliamentary colleague Bruce George.
I'm grateful to the subcommittee also for asking me to
contribute a statement for inclusion in the hearing record
which I hope will be of parliamentary and public interest here
in the United States and in providing a British perspective on
the issue your subcommittee is addressing.
It was 38 years ago that I made my maiden speech to the
British House of Commons as a member of parliament before my
home place in Manchester, and this is my maiden speech in
proceedings held under the aegis of the House of
Representatives. Indeed, it could well be a maiden speech in
more ways than one since there can't have been many, if any,
previous speakers in congressional proceedings from the House
of Lords.
Mark Twain, asked for his opinion of Wagner's music, said
famously that, ``Wagner's music is not as bad as it sounds.
This occasion for me is even better than my only ever previous
incursion into congressional proceedings when briefly
addressing the U.S. Senate as a parliamentary guest of this
country in my early years in the House of Commons.''
Congressman Shays, no one here in Washington or in
Westminster wants to see the afflicted and the bereaved of the
Gulf conflict made to suffer the added strain and hurtful and
gratuitous and demeaning indignities that preventable delay in
dealing with their concerns can impose. Yet in fact many
veterans feel that such delay has occurred and that public
representatives must try to help when and wherever they can.
That is what this subcommittee's proceedings are all about, and
I wish its members God speed in all their work.
For it is deeply important not only to gulf veterans and
their dependents. Learning the lessons of the Gulf war is
important also in safeguarding the well-being of our troops now
on active service against those responsible for the hideously
acts of terrorism perpetrated in New York and here in
Washington on September 11th.
The issues my statement addresses include the effects on
the health of our Gulf war troops of the interactive effects of
combining NAPS tablets with an immunization station program of
unprecedented range and severity, of the massive oil pollution
caused by the Iraq's firing of Kuwait's oil wells, of the
destruction by coalition forces of Iraqi rockets at Khamisiyah
containing nerve agents, of the use of organo phosphate
substances as pesticides, and of the heavy deployment of
depleted uranium.
The subcommittee will, I know, constructively address all
of these issues; and veterans organizations in all the
coalition countries are most grateful and indebted to you.
Congressman Shays, of all the duties that falls to
parliamentarians to discharge, none is of more compelling
priority than to act justly to citizens who are prepared to lay
down their lives for their country and the dependents of those
who do so.
There was no delay in the response of our troops to the
call of duty in 1990, 1991, nor should there be any further
delay now in discharging in full our debt of honor to them. In
the words of the Magna Carta, let right be done. Let right be
done to those who served our two countries and the civilized
world so admirably and with distinction in the Gulf war.
Thank you again for asking me to be with you today.
Mr. Shays. Thank you, Lord Morris, for your eloquent
comments.
[The prepared statement of Mr. Morris follows:]
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Mr. Shays. We have been joined by two other members. We
want to get right to our panel. We have been joined by Mr.
Platts from Pennsylvania, Mr. Schrock from Virginia. Do any of
you have any statements you wish to make?
Then we are going to proceed, Mr. Winkenwerder, with--
Doctor, I'm sorry.
I would say that I'm going to be absent for a few moments
because the Speaker has asked me to see him, but I will come
back. Our vice chairman, Mr. Putnam, will take the Chair. You
may begin.
STATEMENT OF DR. WILLIAM WINKENWERDER, ASSISTANT SECRETARY OF
DEFENSE FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE
Mr. Winkenwerder. Thank you, Mr. Chairman, distinguished
members of the committee. I welcome this opportunity to appear
before you today to discuss the Department of Defense's
continuing efforts related to the illnesses and undiagnosed
clinical and physical symptoms of veterans of the Gulf war. I
will provide testimony for your record but would like to
highlight a few key points.
Today as our soldiers, sailors, airmen, Marines and Coast
Guardsmen are deployed throughout the world in support of
Operation Enduring Freedom and other contingencies, we remain
mindful of their sacrifice and are dedicated to providing the
health care they deserve. While we continue to learn lessons
from current deployments, issues and concerns from the Gulf war
remain. I intend to continue our vigorous efforts to address
and resolve these issues. Moreover, I plan to broaden the focus
of those efforts to include current and future deployments.
To that goal, through my Deputy for Force Health Protection
and Medical Readiness and through our Office for Gulf War
Illness and working in cooperation with the joint staff and the
military services, this will provide me with a critical
assessment of deployment health-related processes and issues.
With this information I will closely monitor deployment force
health protection issues so that the military health system can
be responsive to the health concerns of our service members,
veterans, and their families.
One very important area in which we will continue to
advocate the health concerns of service members, of veterans is
through our support of medical research.
I want to just take a point to note here the scope and
magnitude of this research and my views about it. We have
conducted over 193 studies over the past few years, 5 or 6
years, expending about $175 million. In addition to that, there
have been 44 separate investigations of incidents conducted by
the Office of Gulf War Illness that have expended another $160
million. There's been a total of about $350 million that has
been spent in this combined effort of research and
investigation and outreach.
The Department of Defense has funded about $300 million of
that $350 million. So the preponderance of the dollars has come
from the Department of Defense.
What's important, however, is not how many dollars. It is
the following point with respect to research as far as I am
concerned.
It is, first, that we set the appropriate agenda and to
that even I support what Secretary Principi has indicated in
terms of making sure that we cover the waterfront in terms of
the questions that need to be examined and raised and pursued.
One. Two, that we fund and conduct excellent research and that
it is conducted by good researchers. And, three, that we pursue
answers. That's the objective, is to get answers. Sometimes we
don't always get the answers we want or we don't get answers.
But our goal should be to get answers.
The Department of Defense remains an enthusiastic partner
in a cooperative, interagency, federally sponsored research
agenda with the Department of Veterans Affairs and Health and
Human Services.
Our recent joint release of the information concerning Gulf
war veterans and the small but statistically significant risk
of ALS in this population following their service is an example
of our effort. I might have you note that at the same time that
Secretary Principi was presented with this information so was
I. And, as Dr. Feussner can tell you, because he was the one
who presented me the information along with the principal
researchers, upon learning of that information I without
hesitation made the recommendation that we move forward with
this information and release it.
This may have been a turning point for the Department of
Defense. I cannot and will not make any judgments about how we
have approached things in the past, but it is pretty clear to
me that when we have information that indicates that there is a
problem and that it is statistically valid and well-conducted
research, we have a high obligation to bring that information
forward and to take the steps that need to be taken. I am
committed to investigating the possible causes of illness and
treatments for medically unexplained physical symptoms that are
affecting veterans.
Let me just also add that with respect to the whole notion
of Gulf war illness, obviously, the information that I have
seen, and I am--and I would not characterize myself as an
expert, but that I have seen--indicates that there is a clear
increased rate of symptoms and illnesses in this population.
The challenge is tying those symptoms and illnesses to
underlying physiopathological mechanisms. That's what science
and research is all about. When we do that, we can give those
illnesses or symptoms names. And I think that's important for
people. That's important, in my experience as a physician, for
people to be able to put a name to what it is their problem is.
That said, this is difficult research. It's difficult
research because there are many different possible factors that
could be involved. We're dealing with environmental exposures.
We're dealing with information--a situation in which the
information base underlying may not--it's not ideal for getting
the answers that we may want. But that said, that does not mean
that these altered physioclinical pathologic mechanisms don't
exist. The fact that we don't have evidence doesn't mean
something doesn't exist; just means we don't have the evidence.
So our goal should be to pursue that.
In addition, we continue a close collaboration with the
Department of Veterans Affairs to improve medical services for
our veterans. We developed and tested a patient-oriented,
evidenced-based clinical practice guideline that will aid
primary care physicians and caregivers in the assessment of
illnesses that can occur after deployments, and we'll be using
that in the current situation. Implementation of this guideline
will begin next month. Among our many other collaborative
efforts, we also have instituted a common DOD-VA separation
medical examination, which efficiently serves the needs of
veterans, the DOD and the VA.
In conclusion, the Department of Defense is committed to
ensuring the health of our military forces, and you have my
commitment that I will aggressively address the challenges that
lie before us and fully execute my responsibilities to oversee
the health protection, fitness, casualty prevention and care of
the men and women who are asked to defend our country.
Thank you, Mr. Chairman and distinguished committee
members, for giving me the opportunity to discuss the work of
the military health system and our efforts at the Department of
Defense. I would be happy to answer any questions you may have.
Mr. Putnam. Thank you Dr. Winkenwerder.
[The prepared statement of Dr. Winkenwerder follows:]
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Mr. Putnam [presiding]. At this time the Chair recognizes
Mr. Sanders for 5 minutes.
Mr. Sanders. Thank you very much, Mr. Chairman. Frankly I
am very disappointed by the DOD's comments. 140,000 people are
ill. A recent study, as you indicated, came out which suggests,
A, not only is the incident of Lou Gehrig's Disease
significantly higher for people who serve in the Gulf than for
military people who did not, but if you understand that ALS is
an old person's disease and that the persons who served in the
Gulf are primarily younger people, you're talking about
substantially a higher rate of incidence.
After 10 years what you basically have told us is you think
in spending $300 million there may be an illness. You're not
quite sure. I don't hold you personally responsible. I know you
haven't been doing everything for 10 years.
Let me read what I consider--and I think we got to lay
these things right on the table--an insulting statement from
the DOD. This is a letter March 2, 2001, in response to the
GAO's draft report. I will read the last paragraph. This is
signed by Dale Vesser, acting special assistant, ``Finally we
note similarly poorly explained symptoms have been observed
among veterans after all major wars in the last 130 years, and
that the British, Australians, Canadians and Americans have
found similar symptoms among Gulf war veterans despite
different exposures. These observations argue strongly that
health problems among Gulf war veterans are the result of
multiple factors that are not unique to the Gulf War.''
In other words, what the DOD is saying is there is no Gulf
war illness. That's what this is saying. And I think we have to
cut the air right now. If, after $300 million and 10 years of
research, the DOD does not believe that there is such a thing
as a Gulf war illness, that 140,000 people are either suffering
hysterical symptoms or they're lying or they're malingerers,
then say it and get out of the research.
You may note that in 1997, this committee said the
following reluctantly--and I pushed for this statement--finally
we reluctantly conclude the responsibility for Gulf war
illnesses, especially the research agenda, must be placed in a
more responsive agency independent of the DOD and the VA. The
statements of the DOD tell me today that they should get out of
the business. I respect your point of view. You don't believe
in Gulf war illness. That's fine. Let's go to people who do
believe that there's a Gulf war illness.
You are going to see today private researchers, some funded
by Mr. Perot, who are going to come up here today and show us
pictures of brain damage. They don't have much doubt about the
issue. And there is other important research going on. So I
would say, Mr. Chairman, and I know Mr. Shays is not here, that
there is some important research going on that is not going on
with the DOD. We respect and thank them for their work. Let's
get on and deal with people who take this issue seriously.
In my little State of Vermont where we do not have a huge
contingency of people in the Gulf war, I personally have met
with hundreds of people who are suffering. When they go near
perfume or when they go near detergents, they become ill. They
cannot work in many instances. Please do not tell me that
you're still studying whether or not there is a Gulf war
illness. I want serious people to solve this serious problem,
and unfortunately I think the DOD is not that agency to do
that.
Dr. Winkenwerder. Would you like me to respond? I never
made the statement that there is no Gulf war illness. And as
far as I know, I am not--I will check for the record, but I
am--have no information to suggest that the DOD has never
indicated that there is no Gulf war illness.
Furthermore, let me make the point, sir, that we are
committed to finding answers and to funding research that will
provide answers. That is what I have given you. That's what
I've said. That's my pledge.
Mr. Sanders. But can you explain to me, just explain to me,
if the statement is, hey, what this is basically saying--I have
been doing this for 10 years, and the issue is after every war,
there are symptoms. I suspect that's true from the Civil War on
today. Ain't nothing new. If that's your position, then there
is nothing. You are saying people suffer stress in wars. Every
war, they come home, they get sick. Nothing different about the
Gulf war. That's what this says to me. Am I missing something?
Dr. Winkenwerder. That's not what I have said.
Mr. Sanders. This guy is the Acting Special Assistant for
the DOD.
Dr. Winkenwerder. When was the letter dated?
Mr. Sanders. March 2, 2001, in response to the report done
by the GAO.
Dr. Winkenwerder. I'm not sure that what you have just read
is consistent with the statements I have just made to you.
Mr. Sanders. Then talk to each other, please.
Dr. Winkenwerder. I don't know who wrote that statement.
I'll be glad to look at it and be glad to followup with you.
But I think my statement today indicates that, No. 1, we
consider this a serious issue. We are committed to the
research. I personally am committed to taking the steps that
are needed to find answers. That is--I just indicated what the
goal should be. The goal should be--is an agenda that looks
openly at questions, that pursues excellent research and that
finds answers.
Mr. Sanders. But you have spent $300 million, and you have
not found very many answers. The recent study on ALS is a step
forward. I acknowledge that.
Dr. Winkenwerder. We have found that answer. I am going to
leave it to the other researchers who can probably give you a
better summary than I can about the various studies and the
state of the research and what the answers are that we found. I
don't think it would be accurate to say that we don't have any
answers to things that have been investigated.
Mr. Sanders. Thank you.
Mr. Putnam. Gentleman from the State of Vermont has
expired. We have a vote ongoing. We have 10 minutes remaining
in the vote. We will recess and come back as quickly as
possible. Contrary to the agenda, at the conclusion of the
questions for this panel, we will be taking up Mr. Perot as the
next panel. With that, committee stands in recess.
[Recess.]
Mr. Putnam. The subcommittee will reconvene. Before the
recess, Lord Morris had asked for time, and I think it's
appropriate that the Chair recognize the gentleman from Great
Britain.
Lord Morris. Mr. Chairman, can I put two brief points to
Dr. Winkenwerder? The first, I understand from a highly
authoritative source that the clinical neurology immunology
studies in which Professor Simon Wessely is involved have
basically confirmed the Ruch Zummler hypothesis. Do you have
any comments on that? And in regard to the recent statement by
the Secretary for Veterans Affairs about the increasing
significance of motor neuron disease among Gulf war veterans,
how does he respond to the Secretary's obvious concern about
that finding?
Dr. Winkenwerder. I'm sorry, the second question had to do
with the finding of ALS increased rates?
Lord Morris. I am basing myself, Mr. Chairman, on the
recent published statement by the Secretary on Veterans Affairs
about motor neuron disease, the incidence of motor neuron
disease among Gulf war veterans in the United States. We have
cases as well, some very deeply concerning cases in the United
Kingdom.
Dr. Winkenwerder. And your question is about what are my
thoughts----
Lord Morris. How do you react?
Dr. Winkenwerder. Well, I don't know what research has been
done in the U.K. in this issue, but I would urge given the
findings that we have such research be done.
Lord Morris. And on the first point about the research in
which Professor Simon Wessely is involved on fatal neurology,
immunology and the finding that the Ruch Zummler hypothesis is
basically confirmed, which I think is a very important finding,
what is the DOD's response?
Dr. Winkenwerder. To be quite candid, I am not familiar
with that work, and I am kind of getting the feeling that Dr.
Feussner is and let him respond.
Dr. Feussner. Yes, sir. Two issues. We are quite familiar
with Dr. Simon Wessely's work. Dr. Simon Wessely has
collaborated with us in regards to the large-scale U.K.
epidemiological study. The initial parts of that study were
funded by the Department of Defense, and I think the follow-on
analyses are going to be funded by the Minister of Health.
The hypothesis that you are referring to is a scientific
hypothesis that basically addresses the issue of imbalance in
the immune system between the several components of the immune
system, and you're quite correct. Dr. Wessely, I believe, will
be publishing a paper in the British Medical Journal next month
which will confirm that there is an immunological imbalance in
patients who were deployed to the Gulf. I think that will be--I
haven't read Simon's piece carefully, but I think that will be
a first observation of a significant immunological
perturbation. And then the question is going to be what are the
clinical consequences of that.
I think with regards to your second question, the--I would
make two comments. The first is that we are aware of the
situation with motor neuron disease in the U.K. and that there
are several U.K. veterans suffering from motor neuron disease.
I think that, as with the earlier studies that were done in the
United States by the VA and by DOD, there has not been an
increased--observed any incidence of such neurological
diseases.
This study that the Secretary had commented on and Dr.
Winkenwerder had commented on is actually the first in a series
of research projects that has shown a significant increase in
the rate of ALS, almost a twofold increase. It is a study, in a
sense, that is a bad news/good news study. The bad news is that
there's an increased rate of the disease. The good news,
inasmuch as it is good news, is that the disease is very rare.
So the absolute rate of the disease is quite low among the
deployed veterans, about six or seven patients per million.
But we're going to continue with DOD. The ALS study was a
joint project between DOD and VA and was a jointly funded
project between VA and DOD, and we're going to continue to do
some follow-on research in this area, and then we'll bring in
the National Institutes of Health as well.
Mr. Putnam. Followup? Dr. Winkenwerder and Dr. Feussner, as
the respective heads for VA and DOD's medical system and as
clinicians, what is your advice to Gulf war veterans who may be
at risk of having ALS as a result of exposure to
organophosphates and pesticides and other things such as that?
What is your advice to them?
Dr. Winkenwerder. The advice I would have for any veteran
that has symptoms that give that individual the sense that
something is not right and that something is going on with me
that doesn't feel right, that person needs to obviously get to
a physician and, if needs be, get to a specialist, get to a
neurologist, someone that can conduct a detailed evaluation of
those symptoms. I think the fact now that this information is
out there, is public, should give clinicians across the
country, at least here in the United States, a heightened
sensitivity to the possibility of symptoms that could be early
and may be related to this particular disease.
Dr. Feussner. Mr. Chairman, if I may respond, I would echo
Dr. Winkenwerder's comments. I would say, however, that we
should clarify that the cause of ALS or factors that cause any
individual patient to develop ALS are not known. And one of the
additional motivations that we had in doing this study is if
there was a cluster of ALS developing among Gulf war veterans,
in addition to knowing that, it could provide us an opportunity
to do additional basic research to try to look at what factors
or what exposures may be associated with development of the
disease.
About 10 to 12 percent of ALS cases is due to genetic
mutations, and in the follow-on studies we will conduct jointly
with DOD, we'll look at both the interview information we have
on the Gulf war veterans looking at exposure issues, and then
we'll also do subsequent DNA analyses to see if any of these
patients have the genetic--the underlying genetic abnormalities
that could lead to ALS.
So I'm afraid we can't really tell the veterans what to do
to avoid the disease because we don't know what causes it, and
I'm also afraid that the treatments--there is no cure for this
disease, and the treatments are symptomatic. And I think the
best we can offer is to offer the patients who have ALS the
best medical therapy we can give them.
Mr. Putnam. The GAO's testimony states there is unpublished
data regarding Gulf war illnesses collected by the Department
of Veterans Affairs. What were Dr. Kang's findings regarding
Gulf war illnesses? Dr. Kang.
Dr. Kang. I'm not sure exactly which research project the
GAO report you are referring to. Almost all of our completed
study is published, so perhaps if I know which project that
statement refered to, I can provide more detailed information.
Dr. Feussner. The most recent study that Dr. Kang was
involved with has not been published, and that is the physical
examination component of the phase 3 or the phase 3 of the
national survey. Dr. Kang can correct me if I am wrong, but
those data have not been published because the study has just
been completed and the data are currently being analyzed.
Preliminary results from the phase 3 study were presented at
our research meeting in December. That's a study that includes
about 2,000 veterans, about a little over 1,000 spouses of the
veterans, and about 1,600 children. And in addition to the
previous studies that looked at self-reported symptoms, this
particular study involves physical examination and neurological
examinations required of the veterans, the spouses and the
children looking for array of medical diagnoses among the
veterans, the spouses and the children. Those data have not
been published in part because that manuscript has not been
prepared, and the data analysis is incomplete. I would expect
that those data or that analysis will be completed in a
manuscript submitted perhaps this calendar year.
Does that answer your question, sir?
Mr. Putnam. Does that include the potential for vaccine--
potential role for, say--the potential role of the anthrax
vaccine, was that reviewed?
Dr. Kang. That started. It did not include etiology of any
adverse health outcomes. So we didn't study cause and effect.
So that study does not answer the question.
Mr. Putnam. Thank you.
At this time, the Chair recognizes the Right Honorable Mr.
George for 5 minutes.
Mr. George. One of the few good things that come out of any
war is that if the politicians and military are smart enough,
sometimes they are and sometimes they are not, you can learn
how better to fight the next one, although you must not always
look backward in projecting the future.
I want to ask Dr. Winkenwerder and Dr. Feussner if they
could comment on lessons learned. Dr. Winkenwerder, to what
extent has the Department of Defense learned from the Gulf war
experience in terms of how to better protect the health of
military personnel for subsequent wars, and in particular, what
do you think you have gained from the Gulf war and maybe other
deployments in other dangerous areas so that your men and women
are exposed to less risk?
And a question to Dr. Feussner, again the lessons of the
past. We, as I mentioned, or I should have mentioned, in my
presentation--the British Minister of Defence is undertaking a
study of compensation for sick or injured Armed Forces
personnel, and my committee is monitoring that in coming up
with our own proposals. What has Veterans Affairs, perhaps the
Department of Defense, learned about the most appropriate
methods of compensating the sick or injured Armed Forces
personnel from the experience--the scarring experience I am
sure you have had over the last decade in dealing with the
problems of veterans of the Gulf war? Thank you.
Dr. Winkenwerder. Mr. George, that is an excellent question
and I think cuts to the heart of what are we doing and what
have we learned and what we are going to do going forward. I
would say this is a good news and bad news story, bad news in
the sense that sometimes our best lessons are our most painful
lessons. But as those lessons occur, changes can be made, and I
think in this case have been made. And I will talk just about a
few of them.
To try and summarize, I think in order to understand and
respond to and treat people in the Gulf war situation, it is
important that we collect the information so there is a
baseline of information. And that needs to occur both before
people get deployed on the battlefield even before the fight
begins, if you will, and then after. And with that kind of
information, it's much easier to draw a picture of what might
have happened to any given individual.
I think that's one of the problems that we face with the
Gulf war situation. The data base to start with was not
optimal. So we've learned a lot about that. Currently and just
in the past 2 to 3 years, we have begun doing pre- and
postdeployment assessments so that there is a standardized form
that the medical provider goes through, a checklist of
information, and that is collected prior to deployment, also
after deployment.
Another sort of predeployment activity relates to
assessment of battlefield risks. The U.S. Army Center for
Health Promotion and Preventive Medicine [CHPPM] does an
industrial hazards assessment for base camps and for
surrounding areas. And it is sort of an on-the-ground sample
assessment of air, water, other risks. And that has been done
in the current deployment in Afghanistan.
There is also the Armed Forces Medical Intelligence Center,
which gathers information regarding things that might be known
about various installations or plants or chemicals, and that
gets incorporated into the medical planning effort.
In addition to that, it's very important that information
be collected during the engagement, and we have a reporting
system that is known as the DNBI, disease non-battle injury,
surveillance. Weekly reports are generated from the
battlefield, from the unit level, and are placed into software
systems for each of the services and then aggregated up to DOD
wide level again through this CHPPM organization. We have
future plans to have this more realtime, but even now we
believe it serves as an early warning system for chemical,
biological or radiologic weapons. And I can tell you that this
information is being collected.
I was just visiting last week with our Central Command
headquarters with General Franks and Deputy General DeLong and
the leader of our Special Operations Command--so many of our
forces are Special Operations right now--and spoke with the
medical leadership of those commands, and they are collecting
that information.
One of the things that we're working on as just an example
is Palm Pilot sorts of tools. Particularly you can imagine for
the Special Operations soldier, that kind of soldier could be
out in the field--who knows where they are for what period of
time. They are in small units. So it's difficult to collect
that information, but we're funding a Palm Pilot system for
that kind of collection of information.
So the other thing that has changed since the Gulf war is
immunization tracking. Again, that has been placed on the
software so that we have that information about who got what
vaccines at what point in time. And then the final stage is
really the capability to do the research and analysis, and we
have done three things there. One is to set up a research
center, the Naval Research Center in San Diego, and that was
done just 2 years ago; and second, a clinical center, which is
at the Walter Reed Army Hospital here locally, that looks at
things like development of practice guidelines. And then
finally, the deployment of the Health Surveillance Center,
which is part of the CHPPM organization that I spoke of
earlier.
So I think we're doing a lot more. I feel much better about
what we're doing today than what we've done in the past. Time
will tell how effective all these efforts are at getting to
answers that have been elusive in the past.
Mr. George. And if--with your permission--there is
something called an Afghanistan War Syndrome. Although the
numbers perhaps involved will be rather different, are you
collecting information or examining multi personnel upon return
to be able to get off to a swift start should there be any
psychological or physical injuries or illnesses as a result of
this current conflict?
Dr. Winkenwerder. Absolutely. And to that end, there is a
clinical practice guideline. One of the important things is as
people come back, they're not all going to come to one place.
They are going to be seen in multiple places. So the question
is what sort of a standardized tool that care providers will
have across all services so the right questions get asked and
the right information gets collected, and that is this clinical
practice guideline that is going into implementation just next
month.
Dr. Feussner. Might I respond as well, sir? I would only
add at least three lessons learned. The axiom in clinical
medicine, the first task for the physician is listen to the
patient. And I think the first lesson we have to learn from
this experience is when our patients tell us they are sick and
how they are sick, we have to pay attention to that and try to
figure out how and why as quickly as we can.
I think the second lesson we've learned, and it has
sometimes caused us difficulty with the Congress, is that there
can be a long latency time from the time that a soldier may be
exposed or a patient may be exposed to the time they develop
the disease. The ALS situation is a case in point. We looked in
1993, 1994 and 1997 and found nothing. And it's important that
we kept looking because it took time for this illness to
develop.
And then I think the third lesson I would say is we
sometimes get confused, and we think we have to understand
something before we can treat it. And this committee has been
particularly persistent in asking us to think out of the box
and not be hostage to that paradigm, but rather to try and come
up with therapeutic strategies that might improve the patients
simultaneous to doing research and trying to understand the
disease.
Mr. Putnam. I'm sorry. We need to come back to Mr. Sanders.
I apologize. And then we are going to seat the next panel.
Mr. Sanders, you are recognized for 5 minutes.
Mr. Sanders. I would like to ask Dr. Feussner a question.
Dr. Feussner, let me quote from the 1997 report that this
committee published on Gulf war illness. Dr. Rosker, who worked
for the DOD, was basically saying back then that the incidents
of ALS was typical with the general population. And as I
understand it, about 1 in 100,000 people come down every year
with ALS. And I am going to quote from the report.
However, in Dr. Rosker's claim the director of the Cecil B.
Day Laboratory for Neuromuscular Research at Mass General
Hospital, Dr. Robert Brown, stated the following: The incidence
of new cases of ALS is about 1 in 100,000 individuals in our
overall population. Thus it is true to say that group of
700,000 individuals might in the aggregate be expected to show
seven or so new cases of ALS over a year's time. However, these
statements about aggregate populations must be interpreted
carefully. In particular, they assume an age spread that
reflects an entire population. If one looks at the age of onset
of ALS, the mean onset age is 55. The number of cases showing
onset below the age of 40 is probably no more than 20 to 25
percent or so of the total.
In other words, what he's saying is we assume we have a
younger population in the Gulf. And your study indicated that
there was already a fairly--that people who served in the Gulf
had a significantly higher rate of ALS than those military
personnel who did not. But what about if we take the age factor
into consideration? Are we not looking at a substantially
higher rate of ALS, say, for people below 40 years of age?
Dr. Feussner. I would like to say three things about that.
And I think you know that one of the factors that motivated us
to continue looking at this disease is that the cases of ALS
that were identified, the soldiers, patients who had ALS were
much younger than we would have expected. ALS is supposed to be
quite rare in individuals under 45, and many of our patients
who have ALS are, in fact, under age 45 so it motivated us to
continue looking. Is the concern that our patient population,
while not having a rate greater than the general population,
did represent a skewing of the development of disease to a
younger age.
So you are correct on two counts: One, that was a factor
that kept us onto this problem; and two, that most of the
patients that we've identified with ALS are younger, and that
is in spite of the fact that there is no increased rate of ALS
among our soldiers when compared to the general population. I
think that is not a fair comparison, and that's why in this
study we compared the deployed population to the nondeployed
population.
Mr. Sanders. I don't know if you can give me this answer in
your head, but if you took 700,000 people who are the same age
as the young people who went over to the Gulf in 1991, how much
greater would be the incidence for those who went to the Gulf
than for the general population of young people who did not?
Dr. Feussner. I don't know if I can do that calculation in
my head. What I would say is that you're correct. The incidence
rate is about 1 to 2 per 100,000 of the general population. The
rate we have observed among the Gulf deployed population is a
fraction of that. It's about 0.7 per 100,000, or about 7 per
million. When we did the analysis, we did age-adjust the data
so that the rate would reflect the age skewness in our patient
population. So we believe that the rate of approximately 2 is
an accurate number.
Mr. Sanders. As you know, I have been very disappointed
overall by the VA and the DOD's research not only because I
think it has been unfair to the people who serve, but because
if there's a silver lining out of the disaster that so many
people are facing today is that we can learn a lot about
illness in the general population. For instance, many of the
symptoms that people in the Gulf have developed are not
dissimilar from people who have been exposed, for example, to
chemicals in the general population.
Specifically with regard to ALS--what is the VA going to do
in terms of working with the ALS community and the private
folks. Given the fact that you have done a major
epidemiological study in terms of genetics, in terms of perhaps
developing some correlation between exposure to certain types
of environmental hazards, might we learn something from that in
terms of better understanding ALS in general and how it
affected--how it affects people in the civilian population?
Dr. Feussner. Well, the answer to your question is
absolutely. And one of the--again, as you say, if there is a
silver lining in this, if we did identify a cluster of ALS
patients in the Gulf war, then that would give us an
opportunity not only to know that fact, but then also to see if
we could gain some clues about cause, maybe even treatments.
In the current study, the current study is not done. The
initial data that we presented in a shared way with VA and DOD
leadership is just the rate. We have additional information on
a subset of those patients in the study that had in-home
interviews that talked about occupational exposures, family's
history, etc. Those analyses are ongoing and hopefully will be
finished this calendar year. We did ask the patients to give us
samples of DNA, and we also asked them to give us urine samples
to look for heavy metal toxicities. We will contract with the
CDC to do the heavy metal analyses, and one of the
investigators, I believe, at the University of Kentucky will
follow on with a DNA analysis.
From the beginning, you may recall, Congressman Sanders,
that we engaged both the ALS Association of America in the
original discussions about whether to do a study. The ALS
Association helped us identify patients by putting this study
information on their Web site and did actively refer veterans
to us during this study. And we also engaged the help of the
American Academy of Neurology thinking that almost all patients
who have ALS would go see a neurologist. The study is still
open. And the number that the veterans can call to continue to
identify themselves as having ALS is still open.
So we are going to continue to collect information on
additional cases or new cases that we identify, both through
the ALS, the Neurology Society, from the patients themselves,
but we've always created a coordinated mechanism with the VBA,
Veterans Benefits Administration, so that as additional
patients are identified by VBA, they will notify us.
One of the things we did to facilitate Secretary Principi's
action was--as you know, this information is private and
confidential, and the patients asked us to keep information
private and confidential. We contacted the--we attempted to
contact the 40 Gulf war veterans who were deployed with ALS to
gain their permission to give their personal identifier
information to VBA, the benefits side, to facilitate patients
being contacted by the VA and getting compensation.
Mr. Sanders. Let me conclude, Mr. Chairman, by saying,
thank you, Dr. Feussner, for your work on this study. To the
best of my knowledge, correct me if I'm wrong, this is the
first part acknowledgment on the part of VA or DOD that service
in the Gulf could result in a higher rate of incidence of a
particular disease; is that correct?
Dr. Feussner. Yes, sir.
Mr. Sanders. For many, many years people up here have been
saying that there are a lot of folks who are ill because they
served in the Gulf. This is the first time it has been an
official acknowledgment.
This is my prediction, Mr. Chairman: In the years to come
you are going to hear a lot more acknowledgments. This is the
tip of the iceberg.
And I want to thank you, Mr. Feussner, for your work.
Mr. Putnam. The Chair recognizes the gentleman from New
York Mr. Gilman for 5 minutes.
Mr. Gilman. Thank you, Mr. Chairman.
Gentlemen, I address this to the whole panel. There has
been a great deal of talk in programming recently about a
possible U.S. return to Iraq as part of the ongoing war on
terrorism. Should that occur, it's a safe assumption that
Saddam Hussein will probably utilize all means and weapons at
his disposal. If that happens, the battlefield will be as
toxic, if not more so, than it was in 1991 at the Gulf war.
What is DOD doing to prepare for this kind of a repeat on
health problems among the veterans of our military? I address
that to any of our panelists.
Dr. Winkenwerder. I will attempt to answer that question
for you. There are a number of things that we would be doing
should that eventuality occur, and they range all the way from
the level and types of protective equipment and clothing that
we would use and things that we've learned in that regard to
improved detection devices.
And as I read the history, and again, I'm coming into this
with not believing I'm an expert on it, but just trying to
learn some of the history, that although we had some things in
place at that time, they were not optimal. I think we are
further along in that area. In the area of vaccine, a whole
other subject. I think it would be fair to say that the sort of
rushed timeframe that the vaccine had been administered to
troops at that time, we should not be in that position again.
So I think we're in a better position. If there are more
specific details that will be useful to offer up to you, we
would be glad to provide that to you.
Mr. Gilman. What about the series of vaccinations that we
undertook at the last--in the Gulf war that we found to be
debilitating?
Dr. Winkenwerder. I am going to have to maybe refer that to
Dr. Feussner. I can't comment on that.
Dr. Feussner. I think one of the U.K. studies actually done
by Simon--by Dr. Wessely looked at the issue of the vaccination
patterns, and there were some differences among the Coalition
partners this regard. I think one of the lessons we should
learn from this research effort is the U.K. investigators found
that when the soldiers got all their vaccinations all updated
all at once just as they were getting ready to deploy, that
subset of the soldiers had a higher rate of subsequent symptoms
and illnesses than when that was not the case. And I think one
of the things that DOD has worked on specifically is to have
the base immunizations done in the basic way so that by the
time deployment might occur, the only additional immunizations
that might be required would be the ones that are specifically
related to the perceived threat in that war.
Mr. Gilman. Besides phasing them out, is there any
deleterious effect of combining all of them in one big
mouthful?
Dr. Feussner. I think that the U.K. study suggests that
there are some deleterious effects to giving them all at once.
And it's conceivable that the question that Lord Morris asked
previously about the imbalance--the immunological imbalance,
that's an observation that is going to require additional
follow-on research to see what may be contributing to that
imbalance.
Mr. Gilman. Are we prepared to respond to that today?
Suppose there was an outbreak of hostility with Iraq next week
or next month? Are we prepared to answer that problem?
Dr. Winkenwerder. What I can tell you is that for most of
the sort of base immunizations schedule, that information I am
familiar with suggests that we're well vaccinated and prepared
in that regard. With respect to the----
Mr. Gilman. That's not what I'm asking. I'm asking about
the deleterious effect of putting them all together in one
human being.
Dr. Winkenwerder. I do not believe we would be in that same
situation today. But what I want to add onto is that because of
the fact of the limited supply that has occurred recently
because of the shortage of the anthrax vaccine and for
protection against that particular biowarfare agent, that
obviously given the timeframe you asked the question today,
there would be people who might not be vaccinated at all, and,
of course, those that are in theater that fall into the group
that we're protecting right now, they are fully vaccinated, the
Special Operations forces.
Mr. Gilman. I submit your response is pretty ambiguous, and
I hope you can tie this down.
Mr. Putnam. Mr. Gilman----
Mr. Gilman. One more question, Mr. Chairman.
What studies is DOD funding relating to the anthrax vaccine
and the health effects? This subcommittee conducted numerous
hearings on the anthrax and its impact upon military personnel.
Where are we today with regard to your studies?
Dr. Winkenwerder. First of all, I would just say there has
been quite an effort over the last 12 to 18 months working with
the FDA and DOD and BioPort, the manufacturer of the vaccine,
to look at the manufacturing process to ensure that--in
particular FDA believes that the vaccine is safe and effective
and that any concerns that might relate to any effects that the
vaccine could have are not there, that they feel good about
that situation.
Mr. Gilman. Are you satisfied with the quality of the
anthrax vaccine coming from BioPort?
Dr. Winkenwerder. I believe it is a good vaccine. Based on
the information I have seen, I believe it is safe and
effective. If you're to ask me is it a perfect vaccine, I would
say no. It is the vintage, if you will, of the technology and
the timeframe in which it was originally made is not the same
technology that we would use today. And so, therefore, I think
there is an opportunity to develop, and we should be investing
and developing an improved 21st century vaccine.
Mr. Putnam. Mr. Gilman, your time has expired. We have
agreed to--Dr. Winkenwerder, I know that Chairman Shays agreed
to have you out by noon, and we need to seat the second panel.
With that, we will excuse panel one and allow a few moments for
the second panel, which will be Mr. Perot, chairman of Perot
Systems.
This time we will seat the second panel, Mr. Ross Perot,
chairman of Perot Systems. Out of deference to your skiing
accident, we are going to allow you to remain seated for the
swearing in, and please raise your right hand.
[Witness sworn.]
Mr. Putnam. For the record, the witness responded in the
affirmative.
We welcome you to this subcommittee, and we look forward to
your testimony at this time. You are recognized for your
opening statement.
STATEMENT OF ROSS PEROT, CHAIRMAN, PEROT SYSTEMS CORP.
Mr. Perot. Thank you very much. What I would like to do is
make a very brief opening statement and then have these tough
questions that have just been asked, just hit them straight on
with me, and then I will go in for my word-for-word testimony,
but you have got that already copied.
But I first want to thank you and your committee for
staying on top of this problem for all these years while our
men and women have been suffering. They haven't had a lot of
advocates, and you have certainly been there. I really got
excited during the Presidential campaign when President Bush
and Vice President Cheney promised that they would face this
problem and deal with it, and I see great progress now being
made--I don't think there's a minute we have to worry about
Secretary Principi standing on principal going wherever it
takes and doing whatever it takes to get it done. But what we
have is almost 10 years of where these men have been neglected
and women have been neglected and children have been neglected.
And I think it's very important that the American people
understand the whole strategy under the Clinton administration
was public relations and to denounce this whole thing as
stress. And if any of you want to get into the stress
situation, I'd be glad to take that one head-on with you
because that's history.
Now, this great doctor who just joined the Defense
Department who was talking to you, he's new. He's just getting
his feet on the ground. I've spent enough time with him to feel
very comfortable that once he understands this, he will do
things. There are holdovers who were carefully moved around at
the end of the administration before the last administration
went out who are still in key positions, and some of them have
testified today who are part of the stress team.
Now the captain of the stress team is a man named Bernie
Rosker. Fortunately he has gone back to the RAND Corp. He
bounces back and forth. If you wonder was there really a stress
team, I'm sure you know, but the American people don't know, it
did exist. I've got the document here that describes their
strategy written by them. So there's a Forrest Gump somewhere
in their organization.
No. 3, they spent a fortune on public relations, and only
in America would they hire a person who had been a lobbyist for
the tobacco industry to lead the effort. How would you like to
be a wounded marine corporal and have to put up with all that?
How would you like to be a Tiger that flew in the Air Force who
was Captain America who is in a wheelchair dying and only has 2
or 3 months? I have his pictures in my office, his two little
children on each side. I know from listening to you today those
are the people that you care about.
Now, the thing that I cannot understand and will never
understand is that for over 30 years, I have worked with the
Pentagon on wounded soldiers. You say, well, what were you
doing? I was getting calls from generals and admirals in the
middle of the night about privates and corporals and sergeants
who had some terrible problem that couldn't be fixed in the
military, and we would get the top doctors in the civilian
world to do it. And the touching thing in my memory is most of
those doctors would never send me a bill. They did it from the
heart. And what they've done was just incredible.
Now that always existed. And suddenly Desert Storm occurs,
we have all of these problems, and nobody's doing anything. The
men came to see me in 1993. They brought pictures of themselves
going into combat. They looked like Captain America and
Superman. In my office, they look liked people coming out of
Dachau. That got my attention.
So then I enlisted the aid of one of the top medical
schools in the world, medical school that has more Nobel Prize
recipients than any other medical school and impeccable
credentials. They chose a doctor who worked for the CDC for 10
years, who received its highest award, and on its 50th
anniversary received an award for one of the five greatest
contributions in the history of the CDC. Dr. Haley's an
epidemiologist. You don't want to hear the abuse this great man
has taken, but he's ignored it and kept working for the troops.
You get into all these problems like anthrax. You don't
need a medical degree to understand the problem. BioPort is a
mess. BioPort should not be able to keep that contract. For
years they never met any goals or objectives. You heard all
this squishy stuff this morning. This is plain Texas talk. I am
not part of the stress team. For years they got bonuses that
equaled or exceeded their salaries and didn't accomplish their
goals.
The damage that was done to our Tigers in the Armed Forces
is incredible. Hundreds of pilots have left the Air Force
rather than take the shot. $6 million to train one pilot.
That's a high price to pay, right? They didn't want to leave
the Air Force. A lot of them went into the Reserves and
National Guard, and then they insisted they take the shot
there. And they had seen what it had done to their buddies, and
they wouldn't take it. And none of this comes out in this
squishy stuff you heard this morning, and I know that's what
you are looking for. It got so bad that the attorney general of
Connecticut filed a lawsuit against the U.S. Government because
they were losing all the talent in the Air National Guard.
And then the kinds of things that have come up, for
example, when ALS first came up and everybody dismissed it, I
contacted the government and said, I will fund the research.
All I need is the names of the people who have it, and it is a
fairly small number out of 100,000. And they said, we can't
give you that because it would violate confidentiality. I said,
OK, write them all, tell them I will do it, and 100 percent of
them are going to contact me because nobody else is helping
them, and we'll move forward on the research. Oh, we can't do
that. So they just let them rot and die. Now that's history.
I can go on and on and on about specific cases like this.
Now keep in mind you are going to hear about these numbers,
about what was spent examining these veterans. What you get
from a doctor is an annual physical. When Dr. Haley came in, he
came in with an open but skeptical mind. He studied all this
very carefully. And then his first theory--now if you're a
medical researcher, you start with a theory, then you test your
theory with a limited sample. And then if that confirms your
theory, you do a broad-scale test. He had the finest, most
sophisticated brain-scanning equipment available in the world,
and each of these physicals, if I recall correctly, cost about
$65,000. We did these physicals on a broad array to get the
initial theory tested. He can show you--I can't--he can show
you the brain scans, and you as a lay man can see the damaged
parts of the brain, and you can ask him, well, what is the
effect? And you will see a direct correlation between the
damaged parts of the brains and the problems these men have.
Now, this is the way it's always been. One of the most
senior officers in the Pentagon, a military officer, called me
and said, I have a man who served with me. I have the highest
regard for him. He's a colonel and has got this problem. Can
you put him in the study? And we put him in the study, and his
brain was damaged. The good news is that as he walked out of
the office, he casually mentioned to Dr. Haley that he had an
identical twin. That's a researcher's dream. We can show you
pictures of the identical twin's brain, and it's a clear,
functioning brain. We can show you the pictures of the officer
who was damaged, and, you know, his brain has been damaged.
Now, the points you keep raising, and now that we know this
goes on, what have we done to prepare if we go into Iraq? We're
not ready. I am not going to give you the squishy answer. We're
not ready, and the sooner we start, the sooner we finish. For
example, on anthrax, which is--you're not going to get it done
in BioPort. You are going to take care of some of these
buddies. I said all I want to know is who are the investors.
Nobody will tell me who are the investors in BioPort. That
sounds off a big bell in my head.
Then I said, well, you know, I did start to do some
research on my own, and it turns out the leading investor and
the point person is a person from Lebanon. Now, only in America
would you have someone from Lebanon controlling something this
sensitive. Oh, he's an American citizen now. Well, he married
an American girl. That takes care of that.
But you see, this is the kind of stuff I keep finding
again, again and again, and there is no pressure on them to
perform. And no matter how much damage this shot does, and
believe me, I have talked to all the Tigers that have been
damaged, there is a group of Air Force officers who have taken
this as a major mission. They had to get out of the Air Force,
but, boy oh boy, they are all over it for their friends, and
the medical data they have pulled together are overwhelming.
It's the kind of information you keep reaching for. They just
pull together everything that's been done.
You can see you can't give this shot. When you guys--when
the members of this panel started talking about having a lot of
shots at once and does that cause damage, the answer is an
absolute yes. And if you look at the preservatives and all the
things that are in a shot that have nothing to do with a shot,
and you compound too much of that all at once, that should
never be done. Now you've got soft answers on what's happening
there.
I think as quickly as possible, and I know the new
administration--I know that Principi and I am certain that
Rumsfeld wants to do the right thing, but we have got to get
past--you say, what's our problem with the new administration
wanting to do that? They have a lot of the old players still in
place. Some of them have testified here today. They are still
in place. I understand it's very difficult to get rid of people
in the government if they are career employees, but you could
transfer them. Put them on your staff or something, but get
them away from this.
I don't have to tell you, it's obvious that everyone is
committed to the men and women who fight for our country. And
thank God for you, because this has been--interesting enough
today, we've got Enron going on, and we've got the Walker trial
going on, and all the cameras are over there. All the cameras
should be here with concern about our fighting forces. And we
understand the press and all that stuff. We've got to switch
from the stress PR theme and go hard-minded into research.
But, for example, in anthrax--see, I've offered to do the
research on ALS, and they wouldn't give me the names. Well, you
can't do the research. I love having 700 or 800 people you have
to work with. That's better than a million. Then the Dr. Kang
that was here a while ago, you see, I don't think you could
figure out the papers that he had, but he had one paper on the
damage to the children. I have seen pictures of these damaged
children. We're not talking about something that is a fantasy.
This is not something that is buried inside their bodies. We
need to immediately identify those children because here is a
great research paper written by a doctor that was here, but it
was never printed. It was never published because they weren't
sure that the families weren't lying about the conditions of
their children. Right away you can see--and I will take care of
it. Identify the children and get the top doctors in the area
where these children live, and have the top doctors provide you
in days in 400 cases, and open or shut we know if it's real or
not real. But it is real, and you will stop getting all this
blurred conceptual talk, and you'll get action.
There is new technology called genetic sorting. Don't ask
me to explain it. I am not smart enough. But the doctor who is
the quarterback on this has great credentials, highly regarded
throughout the medical community. He's done all kind of
research for many government agencies, including DARPA. He
believes that he has a new technology that will develop safe
vaccines that can be FDA-approved in less than a year. That's
what we need. We don't know all the chemical and biological
weapons that are out there, but wouldn't it be neat if we had
something that really could work in that timeframe? I am
prepared to fund that research. I won't ask the government. I
will fund that research. I need collaboration from the Centers
for Disease Control and from the National Institutes of Health,
and I prefer not to have these other groups involved because
they still have the holdovers. I want really qualified doctors
working with this team of geniuses, and within a year they are
either going to make their goal or they're not. I will ask them
to come up with an anthrax vaccine now.
Worst case--and there may be three or four other things
like that need to be pursued, but this is the type thing we
need to do, and we need to do it without all of this hazard
going to look.
I can sum up everything I have said so far. A very
prominent Senator that all of you know and respect--former
Senator now--after all this occurred, I went to see him because
he has been concerned about the veterans. And when I discussed
this with him, he said, Ross, don't you know what your problem
is? And I said, no, sir, I wish I did. He said it's the perfect
war syndrome.
This was the perfect 100-hour nonwar. And nobody wants to
admit that we have all these casualties. Forget that. Let's
assume that maybe that did exist. Right now if the whole Nation
would take the position you on this committee are taking, we
could move in and solve this problem. Now I know your
questions, I listened to all of you. That's what you want. You
want action this date. Not talk and not theory and not
obfuscation about well, you know, maybe this maybe that and so
on and so forth. You want to get something done. And I thank
you so much for all you're doing and now, please ask me any
direct questions. If you think I give you a soft answer, nail
me.
Mr. Putnam. Thank you, Mr. Perot, for your typically
mealymouthed warm, noncommittal remarks that typify your
personality. I'm going to attempt to make up to the
distinguished chairman emeritus that I had to cutoff on the
last panel by allowing him to ask the first questions.
Mr. Gilman. Thank you very much. It's a real honor to have
Ross Perot before us today. And we thank you for your precise
and eloquent testimony. The Pentagon has repeatedly stated that
the results of many of these private studies were not peer
review. Your testimony indicates otherwise.
What standards does DOD and the VA use in determining peer
review status?
Mr. Perot. All of Dr. Haley's work, he's written over 10
publications that I know of that are in our top medical
journals before they ever print a word of it the top doctors in
that field, take it through peer review, and that peer review
is public and you know who those doctors are. In the Pentagon
when they take something through peer review, it's secret and
you don't know who did it, if anybody did it.
I'll stick with the civilian side on that one. Where you
get the top doctors and nothing that Dr. Haley would have come
up with would have been allowed to be printed unless the finest
doctors in the private sector in our country had endorsed it.
Mr. Gilman. I note that you mentioned that Dr. Haley, after
being denied appealed to the chiefs of staff and they partially
funded his work so he could continue. Is he still continuing?
Mr. Perot. He continues but we don't get collaboration.
It's like Ft. Detrick. If Ft. Detrick does anything productive,
I hope someone will tell me. Because all Ft. Detrick does on
this one is shut things down. I could go on and on. It doesn't
stop at Ft. Detrick. A lot of this is ``has been.'' I think
things are going to be much better. The reason I bring things
like this up is all these are career people. They were doing
things that were good for their career. These are things now
that should be bad for their career and they need to be
transferred out of those jobs and get people in those jobs who
care about the troops and want solutions and basically are not
interested in how things look but how things are.
Mr. Gilman. What can we do to assist Dr. Haley in his
continued work?
Mr. Perot. I think the best thing that we can do is right
now Congress funds his work. I'd like to see his work funded as
long as it's worth it. He would be the first to see--he could
be doing 50 things now that are not controversial. On the other
hand, he is a first--I love to find people of principle and
people of character and integrity. He's involved with this
because he has seen the families, he has seen the children. He
has seen the wives which we haven't talked about yet.
Some of them are affected too. Many of them I think were
affected when they washed the clothes that came home before the
men got home that were covered with chemicals. Then they got
some of it. But anyhow, they are affected. He's been through
this with all of them. He works 7 days a week. This is a
mission for him. He ignores the criticism. He ignores the cheap
shots and so on and so forth that keep coming from the stress
team and the hundreds of millions of dollars that are being
spent on PR. I can show you some of the letters these people
wrote that are just bizarre.
Mr. Gilman. What more, then, should we do to help him?
Mr. Perot. I would say that the work that he's doing that
you think is worthwhile, Congress should just continue to fund
it directly. And I know that he would be more than comfortable
to have the Center of Disease Control or some group that knows
how to do this overseeing his work. Certainly he would expect
to have it overseen. But have a group within the CDC or some
group like that--now Dr. Haley may have a better idea when he
talks to you, but based upon everything I've seen so far, no
question about his integrity, no question about standing on
principle. You know, once he knows something is there, he won't
back off just because everybody is pressing him to back off.
What happens again and again when he comes up with the
theory which is step one, they say, well, we need to replicate
it. That's step 2. They should fund it and let him do it on a
much broader base. Then they won't let him do it and they don't
ask anybody else to do it. Don't you find that interesting?
Mr. Gilman. Very interesting. Mr. Perot, regarding anthrax,
why do you suppose the government has relied on a sole source
production contract in a crude 1950's technology vaccine.
Mr. Perot. I think it's an Arkansas business deal.
Mr. Gilman. What should we be doing to correct that?
Mr. Perot. I'd like to know. I expect to see some names
we've read about in the paper when we get all the investors.
That's the first thing I want to see is who's cashing in on
this thing. But the point is they can't stand scrutiny. But
here's what you keep hearing from the bureaucrats in the
Pentagon: It's all we've got. Well, let's assume you've got
Lysol and you want to give me a shot. That's all you've got,
I'd rather take the risk, right?
Mr. Gilman. Ross, we can't thank you enough for your
eloquent testimony today in pinpointing some of these problems.
How do we better prepare ourselves to avoid future problems of
this nature?
Mr. Perot. I think, first off, we need to understand we're
in a whole new era. We can be in wars where we don't even know
who the enemy is. Terrible things can be--let's assume that
we've got some segments of population, which I don't think we
do, that don't care about our troops. Our whole population is
as vulnerable to these chemical weapons as our troops are. They
can be distributed anywhere. We don't know what to do now when
that happens. Think of the chaos on the anthrax that came up
here in Washington. That was fortunately tiny and not so big.
But we don't know what to do. We've got to be prepared as a
Nation to know how to deal with this. And that's going to take
tremendous research from some of our most talented people.
Now, an interesting problem you'll have, a huge number of
people in Dr. Haley's category, they're up here in the
stratosphere, the best of the best, they wouldn't want to touch
this now because all you do is get beaten up when you find
something. So we have to have a new environment where the best
of the best are willing to work on it.
Mr. Gilman. We can't thank you enough for your time and for
your great testimony. Thank you. Thank you, Mr. Chairman.
Mr. Shays. Thank the gentleman. Before recognizing Mr.
Sanders, I just would like to explain, Mr. Perot, when you use
these phrases like an Arkansas business deal, I don't know if
our Brits understand that. So you may have to translate some of
that.
Mr. Perot. Whatever it takes.
Mr. Shays. I also would like to counsel our two colleagues
from Great Britain that we invited you to come to participate,
but not to show us all up, which is what I'm hearing has
happened so far. And before recognizing Mr. Sanders, I would
just ask unanimous consent that all members of the subcommittee
be permitted to place any opening statement in the record and
that the record remain open for 3 days for that purpose.
Without objection, so ordered. I ask further unanimous consent
that all witnesses be permitted to include their written
statements in the record and without objection, so ordered.
Mr. Sanders, you have the floor. I'm sorry, Mr. Sanders, if
you have any documents that you want to submit, you refer to,
we'd like that for the record. Some of them are----
Mr. Perot. Here's one I love. Bronze Anvil. Now, you are
sitting up here totally focused on wounded men and women. This
is totally focused on PR. This is the stress team strategy. It
is sick. Now, I'd like you to ask for the Defense Department to
give it to you. Bronze Anvil. If they don't give it to you,
tell them I have it.
Mr. Shays. We will have you to give it to us, if you would,
since you referred to it. Then we're going to ask to make sure
that the Defense----
Mr. Perot. Do it however you want to. This is absolutely
unacceptable.
Mr. Shays. We want to make sure they're both the same hire.
Mr. Perot. Fine. Fine.
Mr. Shays. Mr. Sanders, thank you for your patience.
Mr. Sanders. Thank you, Mr. Chairman. And thank you very
much, Mr. Perot. I want to thank you for funding many important
aspects of the research that is going on right now. Some of us,
as you know, have been very frustrated over the years with a
lack of progress. You heard the DOD talk about $300 million in
research. And yet the results have not been terribly
significant. I want to thank you for funding people like Dr.
Haley and other people. It's been very important for us.
You talked a moment ago when you said that we're not
prepared for potential disasters that might befall the United
States right now. You talked the possibility of a terrorist
attack. I would agree with you. Take it a step further, though,
would you or would you not agree that, in fact, one of the
things that we might learn from Gulf war illness is that many
of the illnesses being suffered by the people who served there
are being suffered by people today in the United States of
America----
Mr. Perot. Oh.
Mr. Sanders [continuing]. As a result of chemical exposure.
In general. Do you see us----
Mr. Perot. Absolutely. Huge. There's a huge bonus from all
of this, if we ever crack it, to the civilian population. And
we do have people who are sensitive to chemicals, who are more
vulnerable to chemicals and others and so on and so forth. One
of things that I would like to make sure everybody understands
is why pesticides kill insects and don't kill us, normally. We
have blood barriers in the brain that keep the pesticide from
going into our brain. The insect doesn't have that. But, there
are some interesting theories, I don't know if they've ever
been proved or not that some of these things we've given our
troops tend to damage the blood barriers in the brain.
Mr. Sanders. That's right. We've heard evidence to that.
Mr. Perot. That's valuable nationwide. Worldwide.
Mr. Sanders. Several years ago I met with a number of
Vermont men and women who were over in the Gulf. What they told
me, and I will never forget, is that when they're exposed to
perfume, when they're exposed to detergents they become very
sick. I don't think it takes a genius to figure out that these
people are suffering from chemical problems. Obviously there
are many people in the civilian society who are suffering from
similar type problems. Would you agree that the issue of
multiple chemical sensitivity is an important issue that has
not been fully explored?
Mr. Perot. Absolutely. I would say going back--absolutely.
We need to explore it. And going back to wars, we need to never
forget. See, we're focused on chemical, biological, but as you
all know, you can carry a nuclear weapon with the destructive
power that you dropped on Hiroshima in a suitcase and you can
carry one with half that power in a briefcase. And when you
think how vulnerable our borders are and how easy it is to get
in and out of our country and so on and so forth, you realize
that carefully planned and positioned like we thought bin Laden
might have been, incredible damage can be done and we don't
know who the enemy is.
Now, in all of this, to wait 10 years and do nothing on
problems that we have faced in a prior war, there is no excuse.
President Bush said it beautifully. He said when something like
this comes along, your only response to the military is no
excuse. But we start now.
Mr. Sanders. Let me ask you this, Mr. Perot. My time is
running out. Because this has gone on Republican
administrations and Democratic administrations. One of the
saddest aspects of this whole business is, as you know, the
government denied at the beginning that exposure to nuclear
radiation for our World War II veterans was a problem. I
believe it was a lawsuit from the American Legion that brought
it about. And Agent Orange, as you know, has been a horrible
example of government in activity. It took lawsuits on the part
of, again, the veterans' organization, and we're dealing with
Gulf war illness today. Why do you think the government has, it
seems, to be always reluctant to acknowledge these illnesses?
Mr. Perot. It's a pattern. And we need to break--let's
learn from history and let's not repeat the pattern. Now, for
example, you mentioned the exposure of our men to radiation,
then you mentioned Agent Orange is a huge one that for 20 years
people fought long, lonely battles. My roommate for 4 years at
the Naval Academy died from Agent Orange, Dick Meadows, a close
friend of mine, one of the founders of the Delta Team died from
Agent Orange. These were people that literally dedicated their
lives to their country and we were in denial the whole time.
So these are things that we need to move on and just say
all right, we're going to learn from history. We're going to
stop living in denial. And every time something like this comes
up--see, if we had spent a fraction of the money that we had
spent on PR trying to solve these problems, we would be
prepared if we had to face Iraq in the future and things like
that.
One thing I have to mention to you, you probably already
know it, the top technologist on the chemical and biological
weapons and the ones that had all the weapons systems that we
used were the Czechoslovakians. Don't you find that
interesting? Those are the people that knew the most about this
going into Desert Storm. Then a doctor who defected from
Czechoslovakia who was working on all of this during the cold
war who worked for the CIA and then worked for the Pentagon, so
he must not be a total nut case, I heard him speak about how
they developed this technology.
They took our men who were POWs out of Vietnam and brought
them over there and used them as medical guinea pigs. They
would expose them to these various chemical biological agents
and then try to develop methods to treat them, then they
developed the alarm systems that went off and so on and so
forth. Anybody that survived that, they exposed them to nuclear
radiation and then tried to figure out how to treat them.
So the technology we used in Desert Storm is a by-product
of a number of our POWs who gave their lives as guinea pigs.
This is not the way to do things. The way to do things is all
right, here's the problem, let's fix it. Right. Let's just go
to work and get it done. There are always solutions. It just
takes dedicated high talent teams totally committed, no
bureaucracy. Now the teams that always win are the ones that go
around the clock. They're on fire to do it. It's their life and
so on and so forth. Whether it's the Wright brothers inventing
the airplane, Thomas Edison inventing the electric light. You
know, how could two bicycle repairmen invent the airplane? Dr.
Langley had all those government grants. I don't want to
wander, but do you see how things really get done?
Mr. Sanders. Yeah. OK. Well, thank you very much.
Mr. Shays. Thank you.
Mr. Platts.
Mr. Platts. Thank you, Mr. Chairman. Mr. Perot, I just want
to thank you for your testimony. As a new Member of Congress
and of this committee, your testimony has given a great deal of
history of the ongoing struggle that these brave men and women
of our armed services have faced over the last 11 years, and I
commend you for your efforts in trying to assist them and keep
this issue in the forefront. I commend you for your
involvement, as you reference over 30 years, in responding to
those calls from generals and admirals. I'm also sad to hear
that is necessary. That we as a Nation aren't providing the
assistance as we should to every brave American who served
their Nation. So as one who is working hard to get more up to
speed on this issue, your testimony and frankness today has
been very helpful to me and I thank you for being here. Thank
you, Mr. Chairman.
Mr. Perot. Thank you.
Mr. Shays. I thank the gentleman. At this time we'll
recognize Lord Morris.
Mr. Morris. Mr. Chairman, I, too, pay warm tribute to Ross
Perot for the force and clarity of his testimony to the
subcommittee. He heard earlier today speakers for the
administration say that one lesson that had been learned from
Gulf war experience was that it's dangerous to give as many as
14 inoculations all at the same time. But how does that help
reservists? How does it help reservists now being deployed who
haven't had their immunizations topped up from time to time?
When you come in as in the case of reservists in the Gulf war,
in need of a mass immunization program, how does it help them?
How does it help the reservists? We are calling up reservists
in the United Kingdom.
Mr. Perot. I understand. We have got to have good, safe
vaccines. The time to develop them is when things are quiet. We
had a 10-year quiet period. Didn't do a thing. Let's start
today and start developing good, safe vaccines. Once we have
good safe vaccines, let's assume there were 14 we were going to
have to give to this young tiger going into the reserves, I
would suggest that we look at which ones can we give them in
advance that are the safest and so on and so forth and not wait
until the last minute. Then he takes--then one of the things
you have to do when you give a whole lot of ones is look at the
menu and look at the preservatives and look at the cumulative
things of hitting the body at once. And at some point you just
can't do it. Then you say, well, we'll have to keep this man
out of harm's way until we have time to properly inoculate him,
or if it an absolute emergency and he has to go anyhow, that's
the risk you take. And he would take that risk rather than
being permanently damaged by all these shots at once. No
question.
Mr. Morris. I am most grateful.
Mr. Shays. At this time the Chair recognizes Bruce George.
Do I need to say you have 5 minutes, sir?
Mr. George. I shan't take 5 minutes.
Mr. Shays. You have 5 minutes.
Mr. George. Thank you, Mr. Perot. The last thing I will do
is to ask you a hostile question, because clearly, the
admiration for you on this side and on that side of this room
is enormously high. I thank Mr. Shays for helping to interpret
Texan into English, although I did manage to work out what Mr.
Perot had said. I hope everyone is protected by privilege,
although I can't imagine anyone is wealthy enough to wish to
sue Mr. Perot for any indiscreet language he might use.
What I want----
Mr. Shays. Mr. Perot, did he understand what he just said?
Mr. Perot. Did he say someone might sue me? I say come on.
Mr. George. Absolutely.
Mr. Perot. Bring their helmets and their teeth guards when
they come. Then we'll get this dang thing out on the table. If
they want to get it out on the table, no better way than for
someone to come whining in like that.
Mr. George. I think most people are aware of what a
formidable adversary you are. I want to ask you this: We
politicians must explain, interpret things for Americans. We
play soccer which is an international game. And it's becoming
fairly popular in this country. But when I was a kid and we
played soccer, wherever the ball went we all ran after it. When
the ball was kicked up the other end of the pitch we would all
run after it with no sense of strategy or tactics. Now as a
politician, I can recall myself and my colleagues whenever the
media raised the possibilities of the cause of the Gulf war
syndrome, then parliament was filled with people asking hostile
questions. I can just recall some of the causes: Bacteria,
sand, organic chemicals including organophosphates, burning oil
wells, known illnesses such as post traumatic stress disorder,
chronic fatigue syndrome and multiple chemical sensitivity,
exposure to depleted uranium contained in shell tips and tank
armor, chemical and/or biological attack from the Iraqis,
medical counter biological chemical warfare measures, etc. And
all of these were seen to be causes.
If you were a betting man, and I have no idea if you are,
what advice would you give a foreigner to perhaps where the
answer lies? It is in any of these, all of these, others,
combination.
Mr. Perot. Everything that anybody brings up that has
possible validity, I would put a small high talent team of
medical scientists on it, say check it out. That doesn't cost
much money. Then you find out is this fact or fiction. One of
the things that people working on, now let's go back to World
War II, the real question was did you have flat feet? Remember
that? The real question in future wars might be what is your
genetic make up because your genetic make up could make you far
more vulnerable to all of this.
Why don't we solve that, know it and know how to offset it?
I would have everything you brought up, unless the geniuses
told me, no, these go fit together, I would just have them
start off testing theories finding out if it has any validity
and learning quickly. This doesn't take long if you get it away
from your bureaucracy and you get it into the researchers and
you put them under tremendous pressure to come up with answers,
you not take forever. God created the heavens and earth in 6
days. It doesn't take forever to get great things done.
Now, we don't have God working on this, but the point is
good things tend to happen when dedicated teams just hit the
wall and go do it. If we did that in everything you mentioned
and any new ideas that come up, that had any validity, but you
can't have a bureaucracy trying to cover up for their mistakes
looking at what to do and what not to do. You've got to have
people dedicated to science and research doing it.
And based on everything everyone has told me, the Center
for Disease Control, the National Institutes of Health are the
ideal places to run this because of the professionalism and the
quality of those organizations. If they turn out not to be, I
would turn it over to the highest and best medical schools in
our country. And just leave the full pressure on them to get it
done for our whole Nation and not live in denial. We've been in
denial forever. You know if you're drinking too much the first
thing to do is admit it, right? Well, that's the problem we've
had. You heard some of this testimony this morning from old
members of the stress team. I couldn't even understand what
they were saying they were so vague. The point being is what we
need is somebody who goes for the facts and gets you the
answers, right? Just put the teams on the field and do it. And
for a fraction. I promise you this: For a fraction of what they
have spent over the past 10 years accomplishing nothing, it all
adds up to almost $500 million, you can get it done for a whole
lot less than that. You'll have answers. You'll have our
population protected. More importantly anywhere there is
infectious disease in the world let's assume in Africa or
India, suddenly millions of people have a new disease, if
genetic sorting works in a few months we can figure it out and
have a safe vaccine for them. That's what we ought to be doing.
That never even comes up in the discussions up here.
Mr. Shays. Do you want the last word?
Mr. George. No. I don't think it is physically possible to
have the last word except--even my wife has taught we that. And
she's American, so I won't tangle with her.
Mr. Shays. So you have some humility, Mr. Perot. You're an
awesome gentleman. I would invite you to make any closing
comment would you like.
Mr. Perot. I'll keep it brief. First, I've told you so many
bad stories. I want to tell you--I have told you that for
decades I've been called on. I want to tell you one story about
how the men and women in the Armed Forces take care of one
another. Desert Storm was just completed. I'm sitting at home
on a Sunday afternoon. An AT&T operator calls me. He said Mr.
Perot, your number is unlisted but you have to talk to this
lady. Suddenly I'm talking to a lady named Gail Campbell. Her
husband is a sergeant. He was in the barracks that was hit by
the SCUD missile. She has been talking to his doctor over the
telephone, a Commander Wallace. When I was in the Navy, No. 1,
we wouldn't have had the technology to do that. And No. 2, an
enlisted man's wife probably couldn't talk to a doctor anyhow,
he's too busy. And Dr. Wallace had told her, Commander Wallace
had told her that her husband was going to die within 72 hours
and her purpose in calling me was to ask if I could get tickets
so that she and her daughters could see her husband before he
died. I said certainly, they'll be at the Pittsburgh airport
but tell me what you know about his wounds. She knew all about
his wounds. Then I asked her how do you know so much? Then she
told me she had been talking to commander Wallace. I said I
happen to know the top trauma doctor in the United States.
Would you allow me to have him call commander Wallace. She gave
me his telephone number. Dr. Wygelt, the top trauma doctor
fortunately he was at home, he called across the world--now
keep in mind let's go back to the American Revolution, we had
to send messages to France, George Washington sent a message
and Ben Franklin had to go on a sailing ship. Bing, you're
talking to the doctor in Bahrain.
Then the doctor said--here is my kind of doctor. He said I
can't save him, but the right team of specialists could. That's
the magic word there. Dr. Wygelt called me, he said my team
would leave immediately. I hadn't asked him. But he'll be dead
when I get there. But said Ross, the good news is there are
three geniuses called up in Desert Storm, big genius doctors.
You got to get all three of them in the room immediately, but
they can save him. He gave me their names. I called the
National Command Center of the Pentagon. There is a General and
Admiral on duty around the clock. Imagine how busy they were at
that time.
I never forget Admiral Roberts, he took the call, the names
and everything I gave him. Never said a word. The only words he
said, Don't worry, Ross, I'll take care of it. There's a whole
lot different from what you've heard over here today. I'll take
care of it.
A few hours later, Dr. Wygelt, the genius doctor in the
country called me laughing. He said, Perot, you're not going to
believe this, but Commander Wallace just called me. The three
genius doctors are in the room with the sergeant. The sergeant
is stabilized and today he is back at work in Greensburg, PA
because generals--General Neal was a Marine general. I didn't
know this until several months later. They sent a Marine
general out to find the three doctors. He found them. And when
I finally got to meet General Neal and thank him he said--he
made it clear that's why they called in the Marines because we
get something done. But to make a long story short, that's all
I've ever seen. Isn't that wonderful? That's what we need to
have from this point forward even over here on the civilian
side of these bureaucracies. When you get out in the field keep
in mind those generals and colonels and admirals would go out
to rescue a private or a seaman with shots being fired
everywhere. And if we had that environment in Congress and in
the Defense Department, the VA, we'll have state-of-the-art
medical technology that will benefit people all over the world.
My last comments I want to quote from the chaplain of the
U.S. Marine Corps. Put it all in perspective. It is the
soldier, not the reporter, who has given us freedom of press.
It is the soldier, not the poet, who has given us freedom of
speech. It is the soldier, not the campus organizer, who has
given us the freedom to demonstrate. It is the soldier who
salutes the flag, who serves beneath the flag, and whose coffin
is draped by the flag. Think of Sergeant Chapman. Great young
tiger we just lost who allows the protester to burn the flag.
Now, I think that puts--I know I'm preaching to the choir.
But that's why we have to do whatever it takes to make sure
that our people in the military have everything they need,
including the proper medical shots and the proper after action
and so on and so forth. And I know that you will do everything
you can to see that they get it. If I can ever help you in any
way, don't hesitate to call me. I'll give you a number where
you can reach me around the clock.
Mr. Gilman. Mr. Chairman, before Mr. Perot leaves the panel
table, we can't thank you enough for your good work over the
years and particularly with regard to this issue. God bless you
and Semper Fi.
Mr. Shays. That comes from kind of the dean of this full
committee, many years of service here. He speaks for all us.
Thank you for being here.
Mr. Perot. Privilege to be here and don't hesitate to call
if I can help.
Mr. Shays. The committee is pleased to call Dr. Nancy
Kingsbury who is Director of Applied Research and Methods,
General Accounting Office, accompanied by Dr. Sharma, Assistant
Director of Applied Research and Methods, and Dr. Ward-
Zuckerman, Assistant Director.
Dr. Kingsbury, I want to personally thank you and
obviously, on behalf of my committee, for your willingness to
be panel three and not panel two. And also to thank the General
Accounting Office for the outstanding work that the people do
99 percent of the time. It's quite a record of accomplishment.
We are absolutely dependent upon your work. So you're going to
deliver your testimony and then all three can be prepared to
respond to questions.
Ms. Kingsbury. Do you want to swear us in, sir?
Mr. Shays. I do need to swear you in. I'm a little out of
practice here. My vice chairman has been doing all that.
[Witnesses sworn.]
Mr. Shays. Note that all three of our witnesses have
responded in the affirmative. Doctor, you may begin your
testimony.
STATEMENT OF NANCY KINGSBURY, DIRECTOR, APPLIED RESEARCH AND
METHODS, GENERAL ACCOUNTING OFFICE, ACCOMPANIED BY SUSHIL
SHARMA, ASSISTANT DIRECTOR, APPLIED RESEARCH AND METHODS,
GENERAL ACCOUNTING OFFICE; AND BETTY WARD-ZUCKERMAN, ASSISTANT
DIRECTOR, GENERAL ACCOUNTING OFFICE
Ms. Kingsbury. Mr. Chairman, I've had a wonderful career at
GAO and at GAO I've had a wonderful time working with this
subcommittee on this issue. I have to say that never in my
wildest dreams did I think I would have to follow an act like
that.
So, that said, you have my full statement for the record. I
would like to briefly read my oral statement. I'll move it as
quickly as I can. Then if you have any questions that will be
fine. I think we're all now very anxious to hear the
researchers who came to join us. So I look forward to their
testimony as well.
First of all, I want to say as much as I'm pleased to be
here, I have to acknowledge that Dr. Sharma, Dr. Ward-Zuckerman
have been with this issue since the mid 1970's on behalf of
this subcommittee and others in the Congress. It gives me a
great deal of pleasure, and I think it gives our institution a
great deal of pleasure right now, to have help to bring in
issue to the day when the sunshine could start showing on it.
And we look forward to a lot more progress being made in the
future.
As you know, starting in 1997, 1998 we reported on the
status of DOD's and VA's monitoring of veterans with symptoms
that may have been caused by their service in the Gulf war and
on the research strategy then underway with funding from DOD,
VA HHS and notably the private sector. At the time, we observed
that more could be done to monitor the health status of Gulf
war veterans and whether that status improved or declined over
time. What treatments were used or possibly useful and we made
recommendations accordingly. We also recommended that the
research into the possible role of low level of exposures to
chemicals and/or the interactions of medical interventions
during the war be further expanded. I think what we've heard
this morning is those recommendations were sorely needed then
and are still needed now.
In 2000, we reported further on the government's investment
in Gulf war illness research and observed that basic questions
about the causes, course of development and treatment of Gulf
war veterans' illnesses remained unanswered. While a lot of
research was underway at the time, some studies were taking
longer than expected or had not yet been released. We made
further recommendations to improve the scope and effectiveness
of research and to address certain coordination and contracting
problems we identified.
As epidemiological research on Gulf war illnesses, both
here and abroad, began to be published in the late 1990's and
2000, some differences emerged in the health status of veterans
of coalition countries that warranted further exploration. And
to that end, you asked us to review the extent to which the
United States the U K and the French had differing perceptions
of the threat in the Gulf war, of chemical and biological
exposure, their respective approaches to chemical and
biological defense and the extent of illnesses reported by each
country's veterans.
We issued our report to you on these matters in April 2001.
Because of your continued interest in these matters, we
continue to monitor the research into veterans health status in
each of these countries through the present time, including
additional visits to the U.K. and France in the fall and early
winter of 2001.
Our statement today summarizes our updated assessment as a
stimulus for you to bring together the key players for this
hearing.
We found that the United States, the U.K., and France
differed in their assessments of the types of weapons of mass
destruction that Iraq possessed and the potential for its using
these weapons in the war. For example, with respect to
biological agents, both the United States and the U.K. regarded
anthrax and botulitum toxin as potential threats, but only the
U.K. thought it likely that Iraq would use plague. France did
not identify any imminent biological warfare threat.
All three countries thought Iraq might use some form of
chemical weapon, but they did not agree about the specific
agents that might be employed. The three coalition members also
took different approaches to defense against these weapons of
mass destruction. The sensitive of the detectors they used
varied widely and the French forces had greater access to
collective protection and a greater reliance on individual
protection than other forces.
In addition, the three countries varied not only in the
extent to which they used drugs and vaccines to protect against
the perceived threats, but also in the drugs and vaccines that
they used and their policies on consent to use them.
Finally the forces were deployed in different parts of the
region and experienced different exposure to other
environmental protections, for example, pesticides or dangers,
for example, the oil smoke that has been commented about this
morning.
With regard to the health of veterans, we found that
research indicated that veterans of the conflict from the
United States and U.K. reported higher rates of post war
illnesses relative to their compatriots deployed elsewhere.
To date, there is little, if any, evidence of emerging
health problems in French Gulf war veterans compared to non
deployed forces although a new epidemiological study is
planned. The disparity in the numbers of illnesses reported by
the three countries' veterans do not point unambiguously to any
single or multiple causative agents. It is accompanied by
multiple differences in the veterans' reported experiences and
exposures. This complexity creates significant methodological
obstacles to achieving definitive research results.
Nonetheless, recent population-based studies are suggesting
that there may be a statistically significant correlation
between the symptoms of illness in Gulf war veterans and
reported exposure to chemicals and/or vaccines.
Research continues to emerge, some of it presented here
today on a variety of hypotheses about the possible causes for
the various symptoms that have been identified that are only
just beginning to be explored. We agree that with Mr. Perot,
that much more work remains to be done with respect to possible
causes so that problematic exposures or circumstances can be
avoided in a future conflict, and equally importantly, on
workable treatments.
We hope this hearing helps stimulate that much-needed work.
I want to return because of the questions on the anthrax
vaccine issue to the recommendations we made to this committee
just a couple of months ago, that somebody needs to accept the
responsibility for better monitoring of adverse reactions to
vaccines under any circumstances. I want to put that back into
record for the moment. I think I'll end my statement there, Mr.
Chairman. I'll be happy to answer questions along with my
colleagues.
Mr. Shays. Thank you very much.
Before asking questions, I would like to ask if Derek Lee
might be present in this room? Is Derek Lee a member of the
Canadian parliament? If anyone knows where he might be, I'd
love to speak with him and actually invite him to participate
in this hearing if he's here.
Mr. Gilman, would you like to begin?
Mr. Gilman. Yes. I appreciate your presentation and Mr.
Chairman, I appreciate our exploring further the anthrax
question. You heard Mr. Perot's statement with regard to the
lack of credibility with regard to what we've done with our
anthrax investigation. And that the anthrax program is still a
problem. And I recall when your colleague, who is with you
today, testified with regard to Dr. Sharma, testified with
regard to anthrax when we were in this subcommittee, under Mr.
Shays, was fully exploring this problem. Have those problems
been cleared up? Are we still concerned about the quality of
the anthrax vaccine? Has the manufacturer really resolved the
problem today?
Ms. Kingsbury. You heard Dr. Winkenwerder express his
confidence that those problems had been resolved. We have not
seen the evidence that was presented to FDA to reestablish the
licensure for that vaccine. Until we see it, we're not going to
be in a position to comment. I think there are questions
remaining about whether adequate tests have been done on that
vaccine to assure its safety and efficacy that we would want to
look at if we were to continue such work.
Mr. Gilman. Have you requested that information?
Ms. Kingsbury. We have not because at the moment, we don't
currently have a pending request for work on that issue. But
we've been certainly following the information. I don't think
we get the information until the license was issued.
Mr. Gilman. I would like to make a request of General
Accounting Office to pursue that information for us and to
present it to our committee.
Dr. Sharma, are you satisfied with what you've seen so far?
Mr. Shays. Let me make sure that's a request. Is that a
doable request?
Ms. Kingsbury. I believe so, sir, but I'm not sure what the
timing will be on it. We'll have to look into it for you.
Mr. Shays. So the committee will just expect that will come
back to the committee.
Mr. Gilman. Dr. Sharma, have you examined the status now
bio report and the qualities of the vaccine?
Dr. Sharma. No, I have not. Because we do not----
Mr. Gilman. Would you put that mic a little closer to you.
Mr. Sharma. We have not examined any data that was
submitted to FDA in support of relicensure of this vaccine. So
I am not in a position to make any comment about the quality of
this vaccine today.
Mr. Gilman. Has that information been requested of the FDA?
Mr. Sharma. No, because we do not have any request and as
you're asking, we will try to obtain that information.
Mr. Gilman. Thank you. Dr. Zuckerman, do you have any
thoughts about the anthrax quality?
Dr. Zuckerman. No, there's not an issue I've worked on. I
said that's not an issue I've worked on.
Mr. Gilman. That's not an issue that you work on.
Ms. Kingsbury. These two folks are responsible for two
different bodies of work for this subcommittee.
Mr. Gilman. We're very much concerned about the quality of
anthrax, its impact on the human body and whether BioPort, an
appropriate agency to provide this anthrax. We welcome your
pursuing that further for us and presenting your report to our
committee. With that, Mr. Chairman, I hope that would be
recognized as a formal request. Thank you, Mr. Chairman.
Mr. Shays. Thank the gentleman.
Mr. Platts. No question. At this time----
Mr. Platts. No questions. Apologize, I need to run to
another hearing. But do appreciate the testimony that's been
provided I can take with me.
Mr. Shays. I appreciate your participation in this hearing.
Thank you. I think then what we'll do is we'll go to you, Mr.
George.
Mr. George. I thank you. The effusion of praise this
committee directed to Mr. Perot I would wish to direct to the
General Accounting Office whose work I view from afar and it is
of exceptional quality. You made the journey over to the U.K.
seeking information from the British Ministry of Defence. I'm
sure you were hospitably received. Did you receive the
information, did you get access to information from the
Ministry of Defence that you wished--were you satisfied with
your meetings and the quality and quantity of information and
has it helped in any way in your pursuit of the cause of the
Gulf war syndrome?
Mr. Sharma. I would like to thank you in this regard.
Because since you intervened on our behalf, we have been
getting all the information that we need. We have been quite
satisfied with the quality of the information. And the team has
made themselves available to us, but we really want to thank
you for making this possible.
Mr. George. Well, thank you. Having helped you get more
information, I must now turn my talents on getting more
information from my own committee, maybe Dr. Sharma, you can
reciprocate by helping me, because our Ministry of Defence are
a wonderful bunch of people but a little bit on the secretive
side. And we do have one or two battles with them over the
information we get. I must say how envious I am of individual
members and a committee being able to elicit information from
the GAO, which is not something that we have in the U.K. We
have an excellent counterpart to your organization, but
responding to individual requests is something we merely aspire
to.
A second question I'd like to ask you is this: It sounds a
simple question but it's--I'm sure the answers are complicated.
Although I have a healthy mistrust for bureaucrats, which again
is reciprocated, I am not convinced they are frauds, crooks,
malevolent, stupid, they've had 10 years to advance----
Mr. Shays. I'm tempted of what they think of you, though.
Mr. George. I'm sure they think far worse of us. With some
justification I might add, Mr. Chairman. After 10 years of want
of success, why is it because the causes are too complicated?
And I do recall my ailment of psoriasis, not cirrhosis,
psoriasis, which the cause is yet to be found. People die of
cancer after vast amounts of expenditure, charitable donations.
Is this too big to be solved? Are the researchers in my country
and yours not up to the task? Should we be more patient? Have
they misspent money? Is there any justification in the
conspiracy theories that one hears? Your organization knows
where the bodies are buried. You know where there's been
success and where there has been failure. Can you advance to me
why you think researchers in my country and yours,
administrators in my country and yours, politicians in my
country and yours have not yet come up with the goods? Why?
Ms. Kingsbury. Whatever answer I give will be puneous. I
appreciate the starting point which is that bureaucrats--and I
have considered myself proudly to be a career bureaucrat my
entire 32-year career with the Federal Government--good
bureaucrats take leadership and try to follow it. And I think
that's probably what's going on now. We met this morning with
the secretary of Veterans' Affairs. I was very encouraged by
what he was saying. I think the people who work for him who are
good civil servants will listen to him and move with him in the
direction he wants to go. That's my hope. That is how it's
supposed to work. That said, in talking to some of the
researchers who were here today, and I am not a public health
researcher myself, but I do have methodological background, I
am persuaded.
The other thing that's changing is the nature of the
research is getting much more sophisticated. I'm not sure we
could have had the findings that are beginning to emerge today
in the gene area and others in the brain scan area 5 and 7
years ago. The difficulty is that 5 and 7 years ago, there was
a tendency to respond to that fact by denying there was a
problem. And I think that's unfortunate.
But I'm very encouraged by both the commitment that we seem
to be hearing, Mr. Perot's healthy skepticism notwithstanding,
and the development in the science itself. If we can just now
get some resources invested with the top people, as Mr. Perot
suggests, the potential for making some real progress not only
to help the Gulf war veterans, but to help many other people
suffering from diseases such as ALS that have no viable
treatment today, we might find a way to help them. I'm happy to
be alive while that's possibly happening.
Mr. George. Thank you.
Mr. Shays. Thank you. At this time we'll recognize Lord
Morris.
Mr. Morris. Briefly, and just one question, Congressman
Shays, can the witnesses say how compulsory it was for U.S.
troops deployed to the Gulf to have anthrax vaccine? And how
compulsory it is now for those now deploying, those U.S. troops
now on active service?
Ms. Kingsbury. My understanding was that it was compulsory
for the previously deployed troops and it is compulsory for the
special forces that are deployed in Afghanistan. I think they
have pulled back from the compulsory vaccination program for
much of the rest of the military in recent months, but that's
because of the shortage of vaccine, not, I think, yet because
of a change in their view of whether or not the program should
be compulsory. I think the debate is going to continue with the
help of this subcommittee I suspect.
Mr. Shays. This has been a very long battle for a lot of
people. One of the things that I'll never forget was in the
process of our committee working on this years ago, there was a
question whether our troops were exposed to chemical weapons,
chemical weapons, not chemicals, chemical weapons. And we began
to notice that they started to say the Defense Department, they
weren't exposed to offensive use of chemical weapons. And the
word ``offensive'' began to be a word we noticed.
Then we found a witness that actually came before our
committee who was scheduled to testify the next week on a
Tuesday, where he actually had the videotape of our blowing up
Khamisiyah, and he actually had pictures of some of the
projectiles, some of which were, in fact, chemical weapons. And
so DOD had a press notice at 12 on Friday there would be a
press conference at 4 on Friday to disclose that our troops
have been exposed to defensive chemical weapons, in other
words, in the sense that we had blown up this chemical
offensive weapons, but it was defensive.
And they had that press conference. And then when we had
our hearing on that Tuesday, they acted like, well, this is an
old story. Well, it wasn't an old story. It was a stunning
story. But it told us something about the mentality of the
challenge that the Department of Defense had dealing with the
whole issue of Gulf war illnesses. I began to conclude that it
was almost a sense that we wanted people to think that the only
cost in the war was the money spent in which we actually made
money from our allies, and the very sad number of people killed
and injured, some by friendly fire. But it was a small amount
and we celebrated as a Nation without having to come to grips
with the fact that some men and women came back sick and
injured and 10 died. It was almost like they didn't want there
to be a bad part to the story.
Well, in my judgment, the only bad part to the story was
the failure of men and women to have the acknowledgment on the
part of their own country that they had been injured and in
some killed in battle, but it was a deferred death.
So when I read this letter that you received from Dale
Vesser, acting special assistant sent to Mr. Chan, I wanted to
know what your reaction was to all of it. Was this business as
usual? Tell me your reaction, not particularly on that last
paragraph, that's been dealt with, but whatever you like, this
is on your document on appendix 7. But it was a one-page
document responding to your report on coalition warfare, Gulf
war allies differed in chemical and biological threats,
identified and use of defensive measures. So this letter that
Mr. Sanders rightfully was outraged with, what was your
reaction?
Ms. Kingsbury. When we get a letter like that, we often
respectfully request the Department to either clarify it or
perhaps revise it because it didn't make a lot of sense to us.
If they don't and they send it to us anyway, we do respond to
it in the report. I bring your attention to page 24 of the
report where we said, finally, DOD asserts that health problems
among Gulf war veterans are common to veterans of many wars
over the past 130 years, and the result of multiple factors not
unique to the Gulf war.
We note that our report draws no conclusions regarding the
cause or causes of health problems reported by veterans of the
Gulf or other conflicts. We were just saying more research
needed to be done. Nevertheless, we were hesitant to compare
clinical data across two centuries or to draw a conclusion by
comparing the illnesses of military populations from different
historical periods.
In other words, we answered it routinely,
straightforwardly, and to some extent, a little bit
bureaucratically. We didn't think it was, frankly, worth
arguing about.
Mr. Sanders. Can I jump in? Let's see if we got it right.
Mr. Perot urged us to do some straight talking, so let's talk
about straight talking. They just told us, the DOD told us they
spent $300 million on research. I interpret what Mr. Shays just
told you as to say Gulf war illness does not exist, the same
problems exist after every single war. There is no specific
problem called Gulf war illness. Is that a fair interpretation
of that letter?
Ms. Kingsbury. That's certainly the implication of the
letter, yes, sir.
Mr. Sanders. Give us your opinion of an agency that has
spent $300 million on research who presumably remains in the
lead in research and basically tells us, we're doing the
research, we're spending taxpayer money, we don't believe
there's a problem. Can you tell us why you think the U.S.
Congress should continue funding such an agency?
Ms. Kingsbury. There is--thanks for the laughter. It gives
me a minute to think. I look back on that decade of research
with every bit as much disappointment, sir, as you do. You
would have thought we would have gotten further for that amount
of money. I can only come back to the table and say we can only
hope that the new initiative that Secretary Principi mentioned
this morning, the new advisory council revisiting what this
research ought to be combined with the improved sophistication
of the research methodologies available would suggest that if
we continue to invest in this going forward, we will make more
progress in the next few years. That's the only thing I can
hope.
Mr. Sanders. My point is I respect people who say hey look
we don't believe it. That's OK. But why if they don't believe
it, why do we continue trying to tell them to do work in areas
they don't believe and take that money and give it to people--
there are people in this room who very seriously believe that
there is a thing called Gulf war illness, and the tens of
thousands of our people are suffering from that. I don't know
why we would want to continue giving another nickel to people
who don't believe there's a problem.
Ms. Kingsbury. I think you have a good point and those
decisions are Congress's to make.
Mr. Shays. Now that was a bureaucratic answer.
Ms. Kingsbury. I know where I am not supposed to go, sir.
Mr. Shays. Actually, you're totally right. It is our
decision. You gave a very straightforward answer actually. I
was just poking fun.
In the report--in what letter it made reference to French
veterans and their experience. Why do you believe French
veterans have not reported as many illnesses since the conflict
as the U.K. and the United States?
Ms. Kingsbury. I'm not in a position to talk about single
causes. It's clear they treated their veterans differently with
respect to their exposure to medical countermeasures. It's
clear that the veterans, French veterans were deployed in
different places and may have had different exposures. It's
clear that they had better collective and individual
protections strategies, vis-a-vis medical countermeasures as a
choice to deal with these threats. Somewhere in that mix of
differences, some of those answers lie. But we don't have
enough information to say what it is.
Mr. Shays. OK. In your testimony, you said according to
studies in both the U.K. and the U.S. veterans of the Gulf war
who reported receiving biological warfare inoculations for
anthrax or other threats were more likely to report a number of
symptoms than non Gulf war veterans who did not report
receiving such inoculations. This pattern was observed in data
collected in the United Kingdom in an unpublished data
collected by the U.S. Department of Veterans Affairs. Why do
you think the VA has not published its finding regarding the
link between advance symptoms and the anthrax vaccination?
Ms. Kingsbury. I don't know why they didn't publish it. We
are aware of it. We have asked them. They said to us what they
said to you this morning, things about the analysis not being
completed and that sort of thing. I'm not in a position to
second-guess it. We consider it to be valid, useful information
that ought to be in the public domain.
Mr. Shays. Other challenges we have is the Inspector
General, a few years ago, did a major study on our mask, our
protective masks in the Army and determined that these new
masks that only about 40 percent of them actually did not
function properly. And I was prevented from disclosing that
information because they kept that information--they said the
same thing you said, further study was necessary. And about 8
years later, we had further study and it pretty much affirmed
what the Inspector General had found that the masks we had our
soldiers take--excuse me, use, they didn't know how to store it
well, they didn't know how to maintain it as well as they
should. And that, but even the new masks did not meet the
standards that they had been required and under contract to
provide.
And so when I hear that kind of response, more study
needed, I just wonder in the light of our having to depend on
BioPort for anthrax, if this isn't an effort to just kind of
put off that dialog until it's more convenient for the military
to deal with it.
So at any rate, Dr. Sharma, do you have any sense of it?
Mr. Sharma. No, I think Nancy has answered just about
everything you had asked.
Mr. Shays. Now, do you have any questions you want to ask?
Lord Morris. Referring to the destruction of Iraqi weapons,
my understanding is that the agents released were sarin and
cyclosarin. Do you have any comments on the significance of
that action?
Mr. Sharma. In one of our reports--and we'll be happy to
send you a copy of this report; we did this at the request of
Chairman Shays--we looked at what does the research show about
the health effects of low-level exposure to chemical warfare
agents. We did the study because the committee was told in
absolute terms that there are no health effects and there is no
research or data that shows that low-level exposure to chemical
warfare agents could have any effect.
But we looked at the published literature, and most of the
research that we looked at was DOD because this is kind of the
stuff--you know, you just don't see it on the street--and that
research showed that low-level exposure, to sarin particularly,
has adverse health effects, and these effects essentially
affect different categories of troops.
For example, pilots who have a very specific function to
perform and their tasks are very carefully monitored, they
experience myopia. And because of that, the Air Force concluded
that these effects are very serious because it will impair
their ability to land or target.
So, yes, we did find some evidence to show that sarin does
have long-term adverse health effects.
Have I answered your question?
Lord Morris. Yes.
Mr. Shays. Before recognizing my colleague from Great
Britain, Mr. George, most State legislators have great
experience in the whole issue of low-level exposure to
chemicals because we pass laws dealing with occupational health
and safety, protecting the worker in the workplace from low-
level exposure to chemicals.
And it's almost like there's a different mind-set at the
military that somehow those same basic concerns that apply to
the general worker in the work force shouldn't apply to our
military; and if anything, they should apply even more so
because the military is ordered to.
So I think of one of our constituents in Connecticut who
spent every day for--day in and day out, 8 hours a day, in a
tent that had no ventilation, spraying Iraqi prisoners with
chemicals that in the United States of America we would not
allow them to do--not to spray for 8 hours and certainly not to
be ventilated.
And he was under orders, and by the way, he passed away.
Mr. George.
Mr. George. Thank you. In your latest report you indicated
that very, very few French veterans have been subject to this
debilitating ailment--disease. And the French Government,
probably because there haven't been many problems, hasn't done
very much research.
Would French research on a more significant level give
American or British researchers greater insights into the
ailments within--amongst veterans? I had thought that it was
the French obsession with garlic.
Garlic was a very useful protection in Romania, as I
recall. But their lack of proximity to the action might be an
explanation.
If somebody else--if Mr. Perot funded French research,
would that give you more of a chance of understanding what the
problems are now, to deal with them?
Ms. Kingsbury. First of all, I think our experience in
looking at the French situation, while they have not done
research until recently, their veterans' organizations were
very public about looking for these kinds of problems, and the
availability of compensation was well known. So my own best
guess is the research will not uncover a whole lot more.
That said, systematic research into what their exposures
were, what their experiences were, what their medical
conditions are, by contrast if nothing else, may be helpful in
further informing the U.K. and U.S. research. I will leave that
question to the researchers themselves to answer with more
sophistication than I can, but I can't imagine it wouldn't be
at least somewhat helpful.
Mr. George. I would like to have Mr. Perot offer advice to
our French colleagues.
One last question, if I may: GAO identified differences
between the United States, U.K. and France in the use of
medical countermeasures. Now, in the U.K., the Ministry of
Defence is conducting a vaccines interaction research program
at our chemical weapons research establishment at Port Down to
assess whether the combination of NAPS tablets and vaccines
might have given rise to adverse health effects. This research
is not due out until next year.
Has there been any similar research been undertaken in the
United States?
Mr. Sharma. Not to the best of my knowledge.
Mr. George. And last, very last, is the GAO evaluating care
and treatment programs for Gulf veterans to assess which ones
work best to alleviate the symptoms of ill health?
Mr. Sharma. We made a recommendation to the Department of
Defense and the Veterans' Administration to monitor patients
over time to see if they are getting better or worse. Typically
they are in much better positions because they have the medical
data bases. They are seeing the patients. And their response
was that it's a very difficult thing to do to monitor people
over time.
We have, you know, not monitored them over time. But we
have looked at the research, you know, which essentially is
showing over and over that there seem to be more sicker than
those who were not deployed.
Mr. Shays. I thank all of you for your testimony.
Dr. Kingsbury, any last word before we get to the next
panel?
Ms. Kingsbury. Thank you again for the opportunity to
participate, sir.
Mr. Shays. We always appreciate your work and thank you
again, as a government official, for allowing another panelist
to go ahead of you.
It's my pleasure now to introduce our final panel and to
express to each of them their patience in waiting to testify.
Dr. Goran Jamal, Imperial College School of Medicine, London
University; Dr. Nicola Cherry, Department of Public Health
Services, University of Alberta; Dr. Robert Haley, Southwestern
Medical School, University of Texas; Doctor Lea Steele, Kansas
Health Institute; Mr. James Tuite III, chief operating officer,
Chronix Biomedical, Inc.; Dr. Howard Urnovitz, scientific
director of the chronic illness research foundation.
This is an outstanding panel. We could have each of you
testify on your own. I appreciate your willingness to testify
with each other.
I need to swear you all in. If you would rise, please.
[Witnesses sworn.]
Mr. Shays. For the record, all our witnesses responded in
the affirmative.
All of our panels are very important, and this panel is
equally as important as the preceding ones. You all have an
advantage in one sense. You have heard testimony that has been
given to the committee by others, so you know in the course of
testifying if you want to make reference to anything you have
heard, or any question. You know, we welcome that; that's
helpful.
And I would also say to any panelist who had spoken before,
if you want to address this committee with any footnote of some
comment, we welcome that as well. So if you have heard
something in the other panels that you think you need to make a
comment on, that helps us do our job better.
Dr. Jamal, I think you are first. And we are going to try
to be close to the 5 minutes. And obviously you may run over a
little bit.
STATEMENTS OF GORAN A. JAMAL, M.B., Ch.B., M.D., Ph.D., FRCP,
IMPERIAL COLLEGE SCHOOL OF MEDICINE, LONDON, ENGLAND; NICOLA
CHERRY, M.D., Ph.D., FRCP, DEPARTMENT OF PUBLIC HEALTH
SCIENCES, UNIVERSITY OF ALBERTA, EDMONTON, ALBERTA, CANADA; DR.
ROBERT W. HALEY, M.D., UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL
CENTER, DALLAS, TEXAS; LEA STEELE, Ph.D., KANSAS HEALTH
INSTITUTE; JAMES J. TUITE III, CHIEF OPERATING OFFICER, CHRONIX
BioMEDICAL, INC.; AND HOWARD B. URNOVITZ, Ph.D., SCIENTIFIC
DIRECTOR, CHRONIC ILLNESS RESEARCH FOUNDATION
Dr. Jamal. Yes, Mr. Chairman, I will try my best.
Mr. Chairman, members of the subcommittee, Right Honorable
Bruce George and Lord Morris, it's a great honor to be here
today to discuss the involvement of myself and my research team
on studies of the Gulf war syndrome and related subjects.
I should perhaps begin by stating something about my
background. I am a consultant neurologist and senior clinical
lecturer and London and Glasgow Universities since 1988. My
qualifications are M.B., Ch.B., M.D., Ph.D., FRCP. I head an
active research team and have written two theses and more than
145 original publications.
Mr. Shays. Let me say this for the advantage of all the
witnesses. You're here because you are truly experts. So I
don't want you to take your 5 minutes to document that. And we
are going to start the clock over, but we really--I can't
emphasize enough, you are all pros, you are all experts and
that's why you're here.
Dr. Jamal. In 1993, we completed some research concerning
possible long-term effects of organophosphate compounds, and
these findings were serious to our scientists from three
British Ministries of MAFF, the Department of Health and Health
and Safety. Following advice, the government of the day formed
the medical and scientific panel with representations from the
three government departments in February 1994, to which I was
appointed. Soon afterwards, I became concerned about the
quality of advice given to ministers on the subject.
In 1995, we were selected from amongst 12 major regional
neuroscience centers by a joint scientific committee of the
three government departments to conduct extensive research on
possible long-term effects of organophosphate compounds. In the
meantime, my expert advice was sought in some British and
international British legal courts for organophosphate-related
neurological damage. The Medical and Scientific Panel committee
tried to enforce a new code of conduct in late 1996, which
would have effectively prevented me from providing expert
advice to the courts.
As a result, I resigned from the committee in December
1996. This was accompanied by media publicity highlighting
faults in the system of provision of impartial and unbiased
scientific advice to responsible ministers, and the secrecy and
closed-shop style surrounding such a system. And as a result, I
was awarded the 1997 award of the Freedom of Information
Campaign in Britain.
All attempts by labor ministers after 1997 to reinstate me
on the committee were unsuccessful. A nomination by the Royal
College to go on the committee was also turned down.
In early 1997, largely through my expert evidence in
courts, two major cases were won in Australia and Hong Kong.
And I won't go into the details of this, Mr. Chairman, because
it is in the long version of my submission.
Our involvement in Gulf war syndrome started around the
middle of 1994 with a study completed in February 1995 and
eventually published in March 1996. That was the first study on
Gulf war syndrome published. We found evidence of neurological
abnormalities and markers of neurological dysfunction in a
group of veterans compared with an age-and-sex matched control
group. We discussed the possible potential causes and called
for further neurological research.
We used sound methods, which we used and extensively
published in peer review journals. We sent a copy of our
findings to the Minister of Defence in May 1995 and welcomed
any discussions on the findings. We were visited in August 1995
by a delegation headed by Wing Commander Bill Cocker, who was
the head of the medical assessment program in Britain.
Following the visit, Bill Cocker recommended referrals to our
department and that our work should be supported. This was
ignored, and a year later he was transferred to another post
outside of the U.K., away from the medical assessment program.
The publication of our paper in March 1996 attracted huge
national and international media attention and it was followed
a month later by publication of an important study on
neurological damage in an experimental animal model from Duke
University in South Carolina.
Following this, I was invited to one meeting at the MOD in
which I was promised supply of pertinent information and
support, but none of that materialized. At that meeting, I
raised the question of organophosphate use, which was
dismissed. I pushed for this information through a
parliamentary question, and in October 1996, the then-Minister
of Armed Forces, Nicholas Soames, conceded that the country and
Parliament were misled about this matter.
It's ironic that not only before but even after such
announcement, and while we were heavily involved in research on
the long-term effect of organophosphates on behalf and through
funding of three government departments, the MOD has never
sought our advice about this to date.
In January 1997, Dr. Haley's works were published. This was
high-quality research in several papers which confirmed and
shed favorable light on the nature and extent of the
neurological damage. Dr. Haley's group have published several
more high-quality papers since then on the subject.
In addition to repeated requests on every available
opportunity for funding, we have made several formal written
and detailed proposals for research. These included submission
to the MOD in 1995 and 1996, a joint proposal with the
Institute of Occupational Medicine in Edinburgh, to the MRC
committee in 1996, a joint proposal with Oregon University and
two other U.S. institutions to the U.S. Department of Defense,
and a joint proposal with 15 other senior academics from five
British universities to the MOD.
All proposals have been turned down. No explanations have
been forthcoming as to the reason, even to questions from
members of both houses. The MRC has failed even to provide a
written reason for refusal or even an indication whether the
proposal was put through the customary referring process. In
the case of joint U.K.-U.S. proposal of 1995, the MOD did not
agree to provide us with a satisfactory letter of support.
We continue to do research with limited resources, the only
source of this being an income from royalties from equipment
invented by myself in the late 1980's; and I have donated
entirely the proceedings of that for the research fund.
We have published a total of eight papers on the subject
and related subjects. Our most recent paper is on abnormalities
of the autonomic nervous system in Gulf war veterans. This is
part of the nervous system that autonomically, i.e., outside
the individual's control, regulates the functional conduct of
all the vital internal organs during rest, exercise, and
physical as well as mental challenges. Its proper functioning
is absolutely vital for the well-being of every individual.
We have found a unique pattern of autonomic lesion in these
people, which points to a possible underlying neurotoxic cause.
Our autonomic findings explain many of the incapacitating
symptoms. We have also jointly examined with the Cyclotron Unit
of the Hammersmith Unit in London two veterans using a carbon-
11-labeled biomarker of neurotoxicity.
This is a very expensive technique, Mr. Chairman. Using PET
scanning and ligand binding, we found a unique pattern of
neurological damage. We need funding to pursue this further and
we need to study larger numbers with this expensive technique.
We think that the underlying cause of Gulf war syndrome is
multifactorial, as mentioned in our first publication. And
today, more than 6 years later, this still stands as the most
plausible explanation. In order to go forward, we need to have
bi- or multinational studies, combining mechanism and causative
research, carefully interlaced with proper epidemiological
surveys. Such has been successfully applied in our studies on
the long-term effects of organophosphates.
We would very much welcome the opportunity to put our ideas
into research and in close collaboration and liaison with Dr.
Haley and other groups in the United States, both to reproduce
their valuable work on the U.K. and European scene, as well as
to proceed further ahead. This is important not just to
understand the illness of the veterans so that we find best
ways to treat them but also to help in designing proper medical
protection programs based on best science against likely
potential threats on the health of troops in the future and
similar circumstances.
Mr. Chairman, that concludes my statement. I will be happy
to answer any questions.
Mr. Shays. Thank you. I'm sorry I made you read so quickly.
You have come all the way from Great Britain, and it's an honor
to have you before our committee.
[The prepared statement of Dr. Jamal follows:]
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Mr. Shays. Dr. Cherry.
Dr. Cherry. First, could I thank the committee for inviting
me to speak? I am here in my capacity as principal investigator
of one of the U.K. studies. I am a epidemiologist and a
physician and have spent most of my working life looking at the
effects of chemicals on the nervous and reproductive systems.
Mr. Shays. You have been doing what?
Dr. Cherry. Principal investigator of one of the key U.K.
studies of Gulf war.
Mr. Shays. You have been spending ``most of your life'';
that's the part I wanted to make sure I heard.
Dr. Cherry. Most of my working life looking at the effects
of chemicals on the nervous system and the reproductive system.
Mr. Shays. That makes you fairly unique in the world. We
lost so many experts in that area. Thank you.
Dr. Cherry. With that background in interest, we responded
to a call from the Medical Research Council to put together a
proposal to carry out an epidemiological study of Gulf war
veterans, the same research Dr. Jamal put in his proposal.
This was in two parts. The first was a large questionnaire
study of people who went to the Gulf and those who didn't to
look at the extent to which those who went to the Gulf were in
good health and see if we could identify exposures that might
be responsible. And the second part of the study was to look in
detail at people who have become ill, and to try and identify
what the illness was and to document as best we could, with the
help of the MOD or other sources, what the exposures have been.
At the time we put the proposal in, it was approved and
both stages were approved. But in practice, the funds didn't
become available to do the second stage. So I can only talk
today on the questionnaire study. And as you all be aware
questionnaire studies, as such, have their limitations. They
can generate hypotheses. They can identify problems. But they
are not necessarily the best means of answering those problems.
What we found--and I will be very brief about this because it
is in my written testimony and in the published papers--we
found, indeed as I think probably every other study has done,
there was an excess of ill health in people who went to the
Gulf.
I perhaps should say a word here. I think the
epidemiological studies that have been done both in the U.K.
and the United States have been excellent. There have been
difficult questions. On the whole, the quality of the
epidemiological logical work has been first rate, including
people on this panel.
We found, as I say, from that study that people who have
been to the Gulf perceive themselves as having health problems
to a much greater degree than people who haven't. And 14
percent of those people with ill health, we felt that was
attributable to their direct experience in the Gulf--14 percent
had got ill health.
We also looked at the self-report exposures. And by setting
up very harsh criteria we were able to produce relationships
that we felt were defensible in every way except self-report.
And there we found, as has been referred to here, exactly the
same pattern which was found by Dr. Wesley in the U.K. troops,
that with increasing numbers of vaccinations was increase in
health. And I think that is quite an independent study, and
that it is fortunate that we are in a position to be able to
say we are getting exactly the same finding.
Again, as has been mentioned in the last few minutes, we
know the vaccines used weren't identical. It is interesting to
hear that similar data may be existing in the United States,
but we haven't actually yet seen it.
The other major result that we reported related to people
handling pesticides, which is a relatively small group of
people who went to the Gulf in the U.S. forces, probably about
6 or 7 percent, not a large number, who 8 hours a day or for
substantial periods of their time were handling these
pesticides. And they had neurological symptoms that were
consistently related to the handling of pesticides. Those were
the main results of that epidemiological study.
We also carried out the first stage of the U.K. mortality
study, which was carried out 8 years after the Gulf. And at
that point, we weren't able to identify significantly great
number of deaths in those who had been to the Gulf. But 8 years
is too soon to have found the sorts of illnesses, such as ALS
and cancers, we have been looking at.
The second part of the proposal wasn't funded, eventually;
and in that, one of the many good things we wanted to do was to
assess whether we could find objective signs of neurological
damage to work with the MOD and elsewhere to get information on
exposures that might help us look at the strength of that
relationship. Since we couldn't, at that point, take that
forward, we did--in fact, were able to look at another group
which has lessons for the Gulf war, I think. And this was
initially put actually to the MRC-MOD panel who was possibly
funding this work that wasn't funded.
I responded to the Chair's comment about protecting the
health of workers, because it was the U.K. health and safety
executive who was prepared to fund the work that we are now
reporting, which was looking at the effects of organophosphates
on people who were exposed to sheep dips, which is a big issue
in the U.K.
Mr. Shays. Exposed to what?
Dr. Cherry. In sheep dipping. You dip the sheep so they
don't have skin problems. This is a study which is now
completed.
Mr. Shays. I have been wondering if my two colleagues from
Great Britain have had trouble understanding your accent.
Dr. Cherry. The colleagues from Great Britain have?
To cut a long story short, the sheep dippers who have
become ill after handling the organophosphates do have a
different genetic makeup. They don't simply express the gene.
The genetic polymorphises are different than those who become
ill. I would hope that it would appear by today, but it will be
appearing in an answer in the next 2 weeks.
That's all I want to say in terms of our research.
Could I just say one thing about why I think it is perhaps
difficult to get research funded? The epidemiology has been
good, and so there is a question about why it has been
difficult for, I think, everybody who has been here today,
difficulty to get the funding to followup the hypotheses that
have been generated by the research. And I think there are
obviously three possible reasons.
One is the one, and I like the phrase ``the stress team''
being against it. I think part of the problem is that many of
the hypotheses go into areas of basic research where the people
who are asked to advise on the research aren't really aware of
the background to the Gulf war. To do research on the Gulf war
we had to be very open-minded. There may be things that are
happening--maybe something new is happening; we have all made
that commitment, to have an open mind--the review doesn't
necessarily come from that position--and second, though we have
to be very open-minded about the hypotheses, we're going to
test. We mustn't throw out science at the same time.
So there is a dilemma. You have got to have studies that
can test the hypotheses. There's no point in doing the studies
if, in the end, you've got no answers. So you somehow have to
get people who are sufficiently open-minded about the
hypotheses, but good in the science and also able to review the
research and give it credibility in the scientific community.
I am sitting here today feeling very privileged to have
been appointed yesterday to the Research Advisory Committee on
Gulf War Illness, as I think the next two witnesses have been.
And perhaps in that position we'll be able to affect both the
open-mindedness in testing the hypotheses and the quality of
the research.
Thank you.
Mr. Shays. Thank you very much, Dr. Cherry.
[The prepared statement of Dr. Cherry follows:]
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Mr. Shays. And, Dr. Haley, good to have you here. And you
have the floor.
Dr. Haley. Well, what I want to do is very briefly describe
some of the main findings that we have come up with,
emphasizing the key finding in science, which is the ability
for others to replicate your work. That is the key thing.
I would submit that--in fact, I am going to disagree very
dramatically with Dr. Feussner's comment. I read these this
morning, and I was dismayed and shocked with what I see as a
piece of scientific fraud, and I am really, really upset. This
is a white paper.
I don't know if Dr. Feussner intended this as some sloppy
staff work, but basically they have minimized our work, the
work of physical scientists and emphasized their work in very
dramatic ways, including complete inaccuracies of what we have
done, leaving out key aspects, suppressing published data. And
I just think that you should be shocked by this; and I would
like the opportunity to reply to this in a detailed manner
later.
But let me----
Mr. Shays. Let me say that would be very helpful to us, and
you might have an opportunity to come back to publicly talk
about that.
Dr. Haley. I would love to, because part of the problem
that we have holdovers from the last administration is during
the stress era that Mr. Perot referred to, and these people are
selectively quoting literature. They are masking findings. They
are withholding their own findings that would bear importantly
on these issues if they don't agree with the stress policy. And
I am just fed up with it.
I think it is scientifically dishonest. In fact, in
academia we would call this scientific misconduct, and they
would be eliminated from the faculty if they did stuff like
this.
Let me show you some findings. This was the main finding
from our initial study. We collected symptoms of 249 members of
the Seabees battalion. We applied a well-known technique called
factor analysis that attempts to see if there is a structure to
the data, if there are actual Gulf war syndromes that would be
structured that would reflect those.
This shows the factor analysis, and you see there are three
very high points on this graph. I won't go into all the
details, but this is a result of the factor analysis showing
there appear to be three clinical entities, three unusual
clusterings of symptoms that could well be--three possible Gulf
war syndromes.
In this document they say on page 13 that there are no Gulf
war syndromes, no evidence of Gulf war syndromes.
In fact, aspects of this have been replicated by the CDC
study that found the first and third syndromes. The British
study found the first and third syndrome, and those two studies
didn't ask the questions that would have found the second
syndrome.
Dr. Kang at the VA previewed a study 3 years ago at the
Conference on federally Sponsored Research in which his factor
analysis of 10,000 Gulf war veterans and 10,000 nondeployed
veterans replicated the same thing, exactly the way we had it.
And the identities of those three--the symptom characteristics
of these three were almost identical to what we found.
Moreover, he found No. 2, the second syndrome, which in our
study was the most serious. And people who were exposed to
nerve gas, had nerve gas exposures around where the alarms went
off were seven times more likely to have this syndrome 2 in our
study. Dr. Kang's study showed that; in his study, this was the
most serious also.
It was a neurological-type syndrome, and it was 6.9 times
more likely in people who were exposed to nerve gas. He found
the identical thing we had; and yet 3 years later, that study's
not published. It has been withheld from publication.
This study says there is no evidence that there is a Gulf
war syndrome. Well, in fact, there's evidence there are three
Gulf war syndromes at least; and the second one--there's two
studies, including their own study, that Dr. Feussner and his
staff are aware of, that shows the second one is highly
associated with nerve gas exposure. So I take complete issue
with this.
Now, the second point is, we looked at the possible genetic
predispositions to this problem. There is an enzyme called
paraoxynase, the PON enzyme that you have heard of,
particularly the Q form of this enzyme. This enzyme's only
purpose in the toxicological area is protecting your brain from
nerve gas. It doesn't help you much against common pesticides.
It's very, very specific.
Our theory was that the reason people, some people got sick
and others didn't is that some people were born with low levels
of this body enzyme. So when the nerve gas cloud came over,
they would be the ones who would be damaged.
Here's the results that suggest that. These are our
controls, syndrome 1, 2 and 3, those same three big dots. Here
is the level of that enzyme in the blood. And that level of
enzyme--whatever you have today what is you have all your life.
It doesn't change day to day.
What we see is, the controls are distributed primarily here
above about 70 on this scale, as you can see. And the syndrome
2, the most severe ones, the ones where there is a strong
association both in our study and Dr. Kang's unpublished study
associated with nerve gas, these guys have very low levels of
PON. This means that these were the ones who were unprotected
by their own body enzymes.
So this not only explains why some people got sick while
others working right next to them didn't, but it also links the
disease to the cause. This suggests that sarin is the cause
because that's all this enzyme does, protects you from sarin.
So if it wasn't sarin, why would this relationship be true?
This work has been addressed by Dr. MacNess and others at the
University of Manchester. They have a similar finding, but not
exactly. There are differences that we are still working out.
But this is a promising research that was not mentioned by Dr.
Feussner's commentary. He just left this out, which is one of
the most important findings of the entire investigation.
Third, as to the nature of the brain injury, what causes
the symptoms in Gulf war syndrome and what we hypothesize by
knowing the symptoms--the neurologist will look at the symptoms
a person has and they will ask, now what part in the brain or
what part of the body, if you had an injury there, would
explain these symptoms?
Well, if you have difficulty in concentrating, you have
pain that isn't related to the body, if you have chemical
sensitivities, if you have all of these symptoms of the Gulf
war syndrome, what is the one organ, if you could injure it,
that would produce all of those symptoms? It's the brain. In
fact, it's not just any part of the brain, it's the deep brain
structures, specifically--here is a side view of the brain--
specifically, these deep brain structures down in here, the
brain stem and the basil ganglia. These are the areas that if
they are damaged, they will produce the symptoms of the Gulf
war syndrome.
We also know that sarin and other organophosphates have a
selective effect on these areas. They are most likely to affect
this area of the brain.
What we did is, we did the standard brain imaging called
Magnetic Resonance Spectroscopy. It is like an MRI scan, but
it's an MRS scan that measures the chemical composition of a
specific area like this. And we put a box right there in the
brain stem. We put another one in the basil ganglia and we did
the scan and found the chemical signature.
Now, here's what you find when you do such a scan. You see
these squiggly lines; each one of these peaks tells you the
concentration of a certain chemical in that part of the brain
that you're studying. And this big peak here is called NAA.
What happens is in diseases like multiple sclerosis, strokes,
Alzheimer's disease and areas where the brain is sick, those
brain cells show a reduction in NAA. And if that disease is
cured and those cells recover, NAA goes back up. So it is a
good barometer of the health of those neurons.
This is a typical scan of one of our controls, one of the
well veterans who does not have Gulf war syndrome, and you see
a very large healthy peak of NAA. Here is the peak in a veteran
with our syndrome 2, the Gulf war syndrome that both our study
and Dr. Kang's study show is 6 to 7 times more common in people
who were exposed to nerve gas.
What we see is a dramatic reduction, and this is true
throughout the group with syndrome 2. They all have this
reduction indicating those brain cells in these deep brain
structures are injured and sick. And that is just the area that
would account for the symptoms.
Now, in here, Dr. Feussner says without even mentioning who
did this study, that there is some little pilot study including
only 12 veterans and they found something having to do with
brain chemistry. In fact, this had about 40 patients in it, not
12 patients. It has a very, very strong finding.
And then he says we have funded another study at the
University of California San Francisco to try and see if this
is true. That is a complete fabrication. When we published this
study--actually presented it to scientific meetings, the
Radiological Society of America about 1\1/2\ years ago, Dr.
Michael Weiner of the University of California at San
Francisco, who is the No. 1 magnetic resonance spectroscopy
brain imaging expert in the world--he has written most of the
literature on this, using this technique in the brain--he
called me up and said, Dr. Haley, I doubt your findings; I want
to disprove you. And as we do in science I said, That's great;
what can I do to help?
I flew out about 3 days later and showed him how to pick
our syndrome 2 patients, the ones with the nerve gas exposure
profile. I showed him how to pick the patients so he would pick
them exactly right--went to his clinic and picked 11 Gulf war
veterans with syndrome 2; and he picked 11 controls, and we
shared our exact brain scanning protocol with him so he would
do it exactly the way we did it. He put one of these little
boxes right in the basil ganglia like this, used MR
spectroscopy and got the same thing we did. That is a direct
replication of our findings.
In science that is extremely important. We have letters
going back and forth from Senator Rudman's Presidential
oversight board saying, Don't fund Haley's work until someone
replicates it. This has been directly replicated, and we are
still in the hold-out mode; and they are still saying that this
isn't replicated, we're going to replicate it maybe within 5
years. This study can be done in 3 months.
There's a lot more to this, but what I'm saying is, this is
what we're putting up with. The reason you don't have the real
scientific world working on this is because this is the kind of
stuff you get. You get these bureaucrats in here basically
minimizing your work, lying, saying the things that have been
done have not been done and trying to give a completely skewed
picture.
By the way, most recently, unpublished yet, we have
recently completed two studies that directly replicate Dr.
Jamal's work, his original study using quantitative sensory
testing. We have shown that there is exactly the same pattern
he found in Gulf war veterans in the U.K. versus controls. We
found the same thing in American veterans. And also his
autonomic findings he just published, we have a study ongoing
that shows exactly the same thing, that the brain areas injured
by chemical exposures, or whatever else, in these deep brain
structures have affected primarily the autonomic nervous
system, the sympathetic and parasympathetic nervous system. And
we've now got very strong evidence that is now functioning in
these veterans, so we now have replication.
I would love the opportunity to respond in detail and show
you what an unfortunate----
Mr. Shays. You have that commitment. Done. If you come
before the committee, you have that commitment as well.
I have totally lost control of this panel and I guess I
asked you to do the impossible. So I am going to concede that
better judgment told me I should allow you to go beyond 5
minutes.
[The prepared statement of Dr. Haley follows:]
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Mr. Shays. And now we are with--thank you--I think Dr.
Steele.
Ms. Steele. I timed it for 5 minutes.
Mr. Shays. This is a wonderful panel and thank you all for
being here.
Ms. Steele. My name is Dr. Lea Steele, and I am also a
epidemiologist and senior health researcher at the Kansas
Health Institute. Since 1997, I have conducted studies on the
health of Gulf war veterans for the State of Kansas.
Like veterans from other States and countries, Kansas
veterans have reported enormous health problems since returning
from Desert Storm. In 1997, the Kansas legislature funded a
State program to look into these concerns. Our first objective
was to find out if Gulf veterans had more or different health
problems than veterans who did not serve in the war.
In 1998, we launched a population-based study of over 2,000
Kansas Gulf war-era veterans. Our study results were published
about a year ago in the American Journal of Epidemiology.
Briefly, the key findings from our research are as follows:
First, we identified a pattern of symptoms that
distinguishes Gulf war veterans from veterans who did not serve
in the Gulf war. Overall, about one-third of Kansas Gulf war
veterans reported a pattern of chronic symptoms that include
joint pain, respiratory problems, neurocognitive difficulties,
diarrhea----
Mr. Shays. Move the mike. You are getting the puff sound.
Ms. Steele. These symptoms that I have described
individually can happen in anyone from time to time, but what
we see uniquely in Gulf war veterans is a pattern of several
symptom types together that can persist for years. These
conditions range in severity from relatively mild to severe and
quite disabling.
Our second major finding is that Gulf war illness occurs in
clearly identifiable patterns. For example, Army veterans are
affected at much higher rates than Air Force veterans, and
enlisted personnel, more than officers. Most importantly,
illness rates differ by where and when veterans served in the
Persian Gulf area. Veterans who served primarily on board ship
during the war had a relatively low rate of illness. The
highest rate, about 42 percent, was seen in veterans who
entered either Iraq or Kuwait, countries where the ground war
and coalition air strikes took place.
To be clear, what I am saying is that overall more than 40
percent of veterans who entered Iraq or Kuwait had this pattern
of chronic symptoms that we're calling Gulf war illness. But
more than half of the Gulf war veterans in our study were never
in Iraq or Kuwait. They remained in support areas during their
deployment.
We found another striking pattern in this group. Veterans
who were in theater only during Desert Shield, but left before
the air strikes began had a very low rate of illness, only
about 9 percent. There was a somewhat higher rate for those
present during Desert Storm, but who left by March 1991, just
after the cease-fire. The highest rates of illness were found
in veterans who stayed in the region for at least 4 or 5 months
after the war ended; and I am talking about veterans who served
in support areas and were never in battlefield areas.
Just related to this and relevant to some earlier comments
about whether looking at veterans in different countries might
be instructive to us, I can tell you that American veterans,
groups of American veterans, can be identified who have high
rates of illness and low rates of illness. I will tell you
specifically in Kansas we have groups of veterans who were
stationed in some areas, for example, eastern Saudi Arabia, who
have moderately high rates of illness. People by the Red Sea
and western Saudi Arabia have low, low rates of illness. I
think it would be very instructive to compare the experiences
and exposures of different groups of veterans who are clearly
defined and have clearly different illness experiences.
Let me touch on my third major point and that is that
veterans who did not deploy to the Persian Gulf, but said they
received vaccines from the military during the war may have
some of the same health problems as Gulf veterans. Preliminary
data from our study indicates that about 12 percent of Kansas
veterans who did not serve in the Gulf, but said they received
vaccines during that time had symptoms of Gulf war illness. By
comparison, less than 4 percent of Gulf era veterans who did
not receive vaccines had these symptoms. In veterans who never
served in the Gulf region, the rate of Gulf war illness
symptoms was three times higher for those who said they got
vaccines during the war, compared to those who did not.
All right, so what does all of this mean? It means, first,
that Gulf veterans are affected by excess health problems and
that these conditions are connected to their experiences during
the war. The patterns we described cannot be explained by
chance, by a veteran overreporting or by stress.
Second, it suggests that veterans are affected by a number
of different problems caused by a number of different
exposures. Veterans who were in a position to experience more
exposures had the highest rates of illness.
Gulf veterans may be dealing with a number of pathologies,
illnesses that may have been caused by different combinations
of different things in different people. In turn, these
problems show up as different combinations of overlapping
symptoms in different people. From the health scientist's
perspective, the scenario is quite complex.
I believe the take-home message from our research is that
these complexities are not insurmountable, that questions about
these health problems can be answered. We should not accept the
view that methodologic difficulties mean we can never really
know if or why these men and women are ill. Our major finding
may actually be that we had clear findings.
In the context of the many millions of dollars in Federal
research expenditures, our Kansas study consumed relatively
little time and few resources, 2 years, about $150,000, and yet
we were able to make significant progress. As I said, these
questions are complex but not unanswerable.
And one final comment: Let me say that the majority of Gulf
veterans in our study only reported specific symptoms because
we asked about them. Most have never come forward to the VA to
request medical care or disability compensation. Among the
thousands of veterans I have met or interviewed many are
suspicious of the government and many tell me they don't want
benefits. They want their health back and they want answers. It
should go without saying that their service demands that we
exert our best effort in finding those answers.
[The prepared statement of Ms. Steele follows:]
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Mr. Shays. Mr. Sanders has to leave, and I want to give him
an opportunity to make a closing comment.
Mr. Sanders. I have another meeting.
I want to pick up on a point that Dr. Haley made. What
often happens--and you and I have spent dozens of hours at
hearings like this, hearing from some of the best people. What
often happens, we hear presentations like this and hear
presentations from the government.
What I would respectfully suggest is that we do something
different, perhaps, the next time; and that is, we allocate 5,
6 hours, however long it takes, and we have on one panel--Dr.
Haley made some very serious allegations, correct--I want the
government to be able to respond or not be able to respond. I
want the panel to be here in full and I want the reward, so to
speak. I want to know what is at stake, the huge amounts of
money this government spends in research. I want that debate to
take place face to face.
And I think for too long--is the DOD here anymore? I think
we have some people here in the back. But the people who spoke
are not here, and we keep going around in a circle. Let's have
it out.
You made some charges, let's have that debate and let the
result of that debate be where we continue to spend our
research dollars.
Thank you for an excellent hearing. I apologize for having
to step out.
Mr. Shays. What we found in the beginning was, the
government witnesses would testify; then we would have the sick
veterans testify, but the government officials would have left.
So what we did is we had our veterans speak first so they would
stop denying at least one thing--they would deny that they were
even sick--first, saying they were sick, and the next thing was
to connect the sickness to their service in the Gulf.
But in the beginning they were even denying that people had
rashes. They were denying that people were literally sick when
they were sick.
So I think your suggestion is an excellent one, and I think
that's what we'll do. We will have a real dialog and mature
debate about all the different information and have it on the
same panel.
Mr. Tuite, you have the floor.
Mr. Tuite. Is that better?
Chairman Shays, members of the subcommittee, Lord Morris
and Mr. George, thank you for your invitation to present
testimony today. I provided the subcommittee with a written
statement which I will summarize here.
Having previously testified on some of the scientific
findings made by myself and others, today I would like to
address issues affecting the scope and pace of the scientific
research on Gulf war illnesses and then suggest four
initiatives to address the problems. I commend you for our
ongoing interest in the health of Gulf war coalition veterans.
Continuing oversight will be necessary to ensure the
provision of appropriate care to these veterans. As you know,
the 1998 Gulf War Veterans Act established a time line for
reviewing the science to determine what illnesses might have
been connected to wartime exposures, to assist the Secretary of
the Department of Veterans' Affairs in making determinations of
service connection for veterans who are suffering from often
debilitating chronic and degenerative diseases. However, the
time lines outlined in that legislation have been waved aside
by the implementing agencies.
Millions of dollars spent on this issue have been wasted,
in my opinion, on badly designed internal studies and ongoing
reviews of the literature. Literature reviews are a basic
fundamental step for any researcher. Stand-alone literature
reviews reduce the funding available for basic research and
treatment and delays caused by the bureaucracies' technical and
policy reviews of the reviews waste precious time in providing
health care to suffering veterans.
Continuing oversight is also necessary to ensure that
scientific findings are not suppressed or delayed by
bureaucratic concerns over political fallout or embarrassment.
Inadvertent or even intentional bias can be imposed on a
scientific study design or methodology as a result of the
government's control of research conducted using government's
funds.
Study design and research results should not be stifled.
Rather, the open, independent, scientific peer review process
should be allowed to evaluate the scientific validity and
importance of the study and its results. Research and the
unconstrained dissemination of research results can only
further the effort to assist Gulf war veterans.
In addition to government research, increased efforts need
to be made to encourage greater private sector participation in
these research efforts. There are a number of indirect
deterrents to private partnerships with the government in
addressing some of the public health and other issues.
For example, in some cases, the U.S. Government will retain
a nonexclusive, nontransferable, irrevocable and paid-up
license to practice inventions developed in cooperative
research. If the discovery in question will be used primarily
for government purposes, rather than confront this obstacle,
private companies often opt to avoid these types of
arrangements.
In some cases, the royalties being paid to the Federal
Government add to health care costs; in other instances, they
are affecting the health of the biotechnology industry,
particularly in the case of low-margin diagnostics. When profit
margins are tight and under pressure, paying a several-
percentage-point royalty to the Federal Government may push a
diagnostic out of the realm of good business sense. This
practice can discourage private-sector firms from working with
the government agencies in tackling even high-priority public
health issues. In cases such as this and other important
veterans' issues, public health issues and food safety issues,
waivers to some of these financial deterrents need to be
encouraged.
A further deterrent and perhaps a more important deterrent
to private sector involvement in Gulf war illness issues is the
official stigma that has been attached to this issue. Denials
by the government that any problem existed and the government's
efforts to debunk or undermine scientific medical research
conducted outside of the government agencies or outside
government control may have resulted in a reluctance on the
part of many researchers and the pharmaceutical and
biotechnology industries to become involved in efforts to
identify treatments for these soldiers. When the government
would be the primary market for such diagnostics or therapies
and the government insists that the illnesses are psychological
and not physiological, few researchers and fewer companies will
risk their reputations or capital.
Our understanding of the nature of the health consequences
of many of these exposures may not only help us in treating
these veterans, but also may be of great value in our current
war against terrorism.
We must look forward to innovative solutions to these
problems if we are to move forward. We are all here today to
assist in accomplishing that goal. To that end, I encourage the
committee, the Department of Defense and Veterans' Affairs and
the White House to demonstrate leadership and support of our
veterans by promoting private-public partnerships with the
pharmaceutical and biotechnology industries for the purpose of
identifying treatments for Gulf war veterans and removing
deterrents to such partnerships. This could be accomplished by
establishing programs similar to those used with the so-called
``orphan diseases.''
Attempting to return to the time line cited in existing
legislation to expedite the determination of illnesses that are
presumed associated with many of the varied exposures suffered
by these veterans.
Focusing research increasingly on treatment and looking for
success stories in veterans who have received treatments that
have improved the qualities of their life.
And establishing an appropriate mandatory diagnosis-based
data collection system within the VA and DOD to be published
and updated annually of all Gulf war veterans receiving care in
the government health system, listing specific diagnoses and
categories of illnesses. Annual mailings to all veterans who
served in the Southwest Asia theater of operations; would
solicit their health information for inclusion.
We must keep in mind that many Gulf war veterans were in
Reserve components and are now receiving health care outside of
these systems. This information would allow the Secretary of
Veterans Affairs to identify statistically significant
increases in the incidence of illnesses and make determinations
of service connection. The information system should be capable
of distinguishing who served during what phase of the
operation, before, during and after the war, to determine if
there is a significant difference in the illness rates between
these populations.
Old technology treatment protocols are not providing us
with the answers we need in part because of the varied and
multiple exposures experienced by the veterans affect different
individuals in different ways. A one-size-fits-all treatment
protocol will fail. Unconventional or outside-the-box thinking
that takes advantage of the newest advances in genomics
research is also needed.
The success of such an initiative will require the kind of
public-private cooperation that I have suggested. If this can
be done, the Gulf war soldiers can be aided, and we will have a
much better understanding of the health of the Coalition forces
and the conditions that led to their illnesses. With the
information that is developed, we may also be able to aid
millions of other Americans with similar chronic illnesses.
More real progress has been made by the Department of
Veterans Affairs in recognizing the problems of Gulf war
veterans in the last few months than was made in the proceeding
years. More remains to be done. I hope that I have provided
some suggestions for alternative approaches to be taken that
might prove useful, and I thank the committee for the
opportunity to testify and ask that the full text of my
statement be included in the record.
Mr. Shays. Your testimony will be part of the record. Thank
you so much.
[The prepared statement of Mr. Tuite follows:]
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Mr. Shays. Now we will hear from Mr. Urnovitz. Doctor.
Sorry.
Mr. Urnovitz. Thank you. Thank you, Chairman Shays. I'm
grateful to your subcommittee for allowing me to present my
views on the status of Gulf war syndrome research. And my
entire response is also submitted in the written testimony.
So what is the status of Gulf war syndrome research? It's a
stalemate. My purpose today is to explain why. It's my opinion
that cluster diseases like Gulf war syndrome are genomic in
nature. Government-funded doctors take the position that
cluster diseases are caused by germs. In the late 1800's, Louis
Pasteur hypothesized that bacteria might be a cause of human
disease, starting a major revolution in medicine, the germ
theory. However, the theory that germs cause most, if not all,
human disease fell apart immediately in the early 1900's when
doctors investigated the transmissible agent in polio.
The conceptual failure to see that a single germ does not
always cause diseases is why we have not cured or prevented all
of the so-called viral diseases. In fact, the common perception
that vaccines can stop all diseases is just plain wrong.
This book I hold in my hand, this remarkable book I hold in
my hand, is the 1957 final report of the polio virus vaccine
field trial. It contains no evidence to support the claim that
it was the antibodies to the polio virus that prevented some
cases of childhood paralysis. This report and the medical
literature I have read so far calls into question the use of
antibodies as surrogate markers for a protective response to
germs like polio and certainly anthrax. In fact, it's my
opinion that the strategy of anthrax protection through
vaccines is based on very weak science.
I applaud the work of the early polio virus researchers who
were true pioneers. I believe we should view the early polio
vaccine efforts as we view Columbus' voyage. Columbus did not
discover America. He found a new world that allowed his
successors to discover the Americas. Doctors Salk and Sabin did
not prevent all cases of childhood paralysis, but they did show
us the way to do it and perhaps how to prevent many chronic
diseases through postexposure treatment.
So why haven't we eliminated diseases like Gulf war
syndrome, AIDS childhood paralysis, mad cow disease? Why don't
we have a foolproof way to prevent illness from chemical and
biological terrorism? I blame this genome versus germs
stalemate on the largest, most powerful medical research entity
in the world, the U.S. Department of Health and Human Services,
HHS.
In my opinion the most recent request of HHS to control all
inquiries from Congress and the media on medically related
issues is an another sign that HHS is completely out of
control. Over the last year and before September 11 events, I
have repeatedly asked that HHS officials explain why the agency
allowed 93 employees to abuse the power of their positions by
signing a public document calling for the end of a scientific
debate on the role of viruses in human diseases. This flagrant
violation of medical ethics can be documented on my Website,
chronicillnet.org, under government relations, clearly
establishes a government sanction against important independent
medical discovery.
All right. So how do we break the stalemate? Let me share
with you some of my thoughts. First, if science and government
wish to continue any kind of responsible partnership, a new
paradigm must be developed that allows for scientific and
public discourse on fresh research ideas. Second, the Federal
structure must resolve to end the de facto government sanctions
that exist as a result of an inherent bias against innovative
research.
Third, we must leave behind a dim decade of ``denying
clues'' that has deprived Gulf war veterans of a possible
pathway out of illness. We must not continue to allow stale
dogma to trash true science.
I am certain we will overcome this stalemate. Scientific
discovery and new treatment modalities will prevail. For
example, German scientists asked me if my Gulf war syndrome
research could be used as a basis for a mad cow disease test in
which the animals did not have to be killed to make the
diagnosis. It only took 2 months, one other scientist, to
generate the data to file a new patent for a new testing
method. We begin validation studies next month, and we hope to
be saving the German beef industry and protecting the food
supply by this summer.
I see no reason why we cannot design a similar program for
Gulf war syndrome research; that is, to identify new diagnostic
markers and start a discovery program to produce antigenomic
drugs to dampen down the Gulf war syndrome veterans' ailments.
These same antigenomic medications would better protect our
troops against biological and chemical weapons than still
unproven vaccines.
The role of Congress should be to do what it does best,
keep the pressure on. As you are all too aware, we are engaged
in a long-term war that involved hideous brands of terrorism
and a life-and-death necessity to realize we don't have years
to change the way we protect our troops and our people against
chemical and biological warfare. At best we have months. You
will never be able to protect the citizens of this country, if
HHS is not held accountable for its actions that continue to
discourage scientific discovery in the ways I've described.
In conclusion, I want to thank the subcommittee for its
leadership in trying to understand the complexities surrounding
the treatment of Gulf war syndrome. I also want to thank the
staff of the GAO for its first class reports on Gulf war
syndrome-related issues as well as calling them as they see
them. I also thank the subcommittee for recognizing my
contributions that I made to the medical literature and for my
modest attempt at trying to keep the scientific debate open.
I would ask that my full text and both my oral and written
statements be submitted for inclusion in the record of the
hearing. Thank you.
[The prepared statement of Mr. Urnovitz follows:]
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Mr. Shays. What excellent testimony we've received from all
of you. I am going to call on my colleague Mr. George to ask
the first round of questions, but I have a number of questions.
I am going to inject myself, though, into a comment that you
made in regards to, Mr. Urnovitz, Doctor, as it relates to what
HHS is doing. They're doing this as the result of the war on
terrorism. We are a committee that has in this full committee
jurisdiction over the terrorist issue. As you know we spent--
we've probably had close to 30 hearings on this issue. And we
intend to look at just your concern because the implications
are gigantic. They're gigantic. A number of you have raised
other concerns as well that I'll share with you in the course
of our questioning.
You're on.
Mr. George. Thank you.
What has emerged this morning and this afternoon is how the
Americans beat the Brits in the American War of Independence.
It was clearly the Brits have got more staying power than the
Americans, but that is something that I won't push too far. I
shan't make any party political speeches, but things are
getting slightly better with the British Government. Maybe our
British witnesses will object. The government seems to be more
prepared to disseminate information, more money spent on
research, although minuscule compared to the United States.
They seem rather less dogmatic than their predecessors. Despite
that, the problems remain.
And where I am truly perplexed is this: I have said for
years and years there is a Gulf war syndrome. Not enough
research has been done in the United Kingdom. And more research
has been done, but when that research is published by very
distinguished academics and very distinguished universities,
are published in very distinguished journals, then I am less
certain I even understand the problems.
And what I ask, and, please, I ask those who are responding
and those in the audience not to shoot the messenger, but I
would like your views on a number of reports published in the
U.K. and say whether this is bad research, whether it is part
of a conspiracy by the government, which I doubt, to undermine
the whole case of the concept of the Gulf war syndrome that I
believe exists. So I don't ask any individual specifically, but
perhaps you would comment.
There was some research done by a team from Guys, Kings and
St. Thomas' School of Medicine entitled, ``Ten Years On: What
Do We Know About the Gulf War Syndrome?'' And this was
published in the Royal Journal, the Journal of the Royal
College of Physicians. And it coincided with the 10th
anniversary of the ending of the Gulf conflict. It said this,
The paper noted that a syndrome implies a unique constellation
or sign or symptoms, and that, this is the contentious part,
``the balance of evidence is against there being a distinct
Gulf war syndrome.'' It said in its report that, ``no evidence
has emerged to date of either distinct biomedical abnormalities
nor premature mortality.'' But it goes on to say that it noted,
``Gulf service has affected the symptomatic health of large
numbers of those who took part in the campaign.''
The team speculated, says our Ministry of Defence, that the
most plausible causes were exposures that affected the majority
of those in theater such as medical countermeasures or psycho
or social factors.
The question I wish to ask is is it that there's a dispute
over the definition of what a syndrome is, or is this research
an aberration? Is there such a thing as the Gulf war syndrome?
It's an elementary question that I as a politician have been
asking, simply have no idea from scientific evidence if there
is an answer.
Mr. Shays. Why don't we go right down. That's a wonderful
way to start the panel. So thank you for asking.
Dr. Haley. This was one of the major conclusions of what I
said a moment ago is that a syndrome is defined, as you said, a
group of symptoms that hang together. Many people have the same
symptoms. Well, the people coming back from the Gulf war, large
numbers complain of the same constellation of symptoms. And
factor analysis, which is just a mathematical way of showing
that, demonstrates that. It's been seen in almost every study
that's been done. The unpublished, the withheld study from Dr.
Kang and his work shows that the Syndrome II, which is the most
severe, is found only in Gulf war veterans. At the end of that
abstract that he previewed at the meeting 3 years ago, he said
this could be seen as a unique Gulf war syndrome. And now the
VA people continue to say, well, there is no unique Gulf war
syndrome, when, in fact, their very study says that there is.
There is a Gulf war syndrome. You're right. It's been shown, it
just hasn't been published, and they won't talk about it.
Mr. Shays. Anyone else?
Dr. Jamal. If I may comment. I think the point I would make
is that in any epidemiological cross-sectional study that you
do, the first and the most important step you have to do is to
define what you are looking for. If you can't define the end
target, then you may actually miss it. The epidemiological
cross-sectional study may confuse the picture. And that is what
we've done in the case of the long-term low-level exposure to
organophosphate.
I think that is one of the problems. And the U.K.
authorities, up until even now, they're not interested in
funding mechanismal causative research. I give you a small
example. The autonomic study that we did, we found that there
are--this is very elusive to clinical examination. Even the
best neurologists will not detect abnormalities. It's just what
the patient tells you. Until you go and do very detailed high-
cost studies, you will not detect what is wrong with the
patient.
Now, if you do cross-sectional question survey study, and
you're unaware about that, you do not look for that, you will
not find the answer.
Dr. Cherry. I am probably going to fall out with the rest
of the panel for what I say now. We did try very hard to find a
unique syndrome. We didn't find one. What we did find was that
the clusters of symptoms that the people from the Gulf war had
were not different or unique, but there were just a great deal
many more of them who fell into the clusters that were sick.
So though we tried and spent a lot of ingenuity in trying
to get the right methodology to find a unique syndrome, we
didn't. I don't think that means that people who went to the
Gulf war aren't sick. I'm sure that from our findings and from
everybody else's findings on this panel that there are
neurological problems much more frequently in people who went
to the Gulf war than people who didn't. But statistically we
were unable to find that there was a unique syndrome that
wasn't found in the rest of the population.
Mr. Shays. Dr. Steele, Mr. Tuite.
Ms. Steele. I think when you ask if there's a unique Gulf
war syndrome, you're actually asking two questions. One, is
there a single unique syndrome. I think just from the data that
we've heard today it sounds like no, there are several things
going on, different things in different people. So if some
official person says there is no single unique Gulf war
syndrome, are they saying there's nothing wrong or are they
just saying there's not a unique new syndrome.
So when you make conclusions you have to distinguish if
you're really saying is there really anything wrong with Gulf
war veterans or are you just saying no, there's no single
unique syndrome.
The second point is that when you look at the symptoms that
Gulf war veterans have, these are symptoms that you would find
in the general population. If you ask anyone, any group of
people, what symptoms you're experiencing, some people in those
groups will have symptoms. So similarly, when you ask people
who are veterans who didn't go to the Gulf war if they have
symptoms, some of them will have symptoms. Then if you compare
their symptoms to people who did go to the Gulf war, you'll see
there are some similarities in the symptoms.
Many of the studies that are cited for that report that
you're describing have emphasized the similarities in the
symptoms without really trying to see if there are differences
in the patterns in which the symptoms occur. And I think Dr.
Cherry and Dr. Haley both have pointed out you really need to
look at the quantity of symptoms that these folks are
experiencing. They're experiencing lots of symptoms at the same
time, and the symptoms persist. It's really quite different
than the kinds of symptoms we see in the nondeployed
population.
So my conclusion would be that there are Gulf war-related
illnesses, perhaps not a single syndrome.
Mr. Tuite. Again, you know, I think a lot of this has to do
with what Dr. Urnovitz talked about earlier. We're mixing two
different issues. We've got the environment, and we've got the
host. The hosts will respond differently to the environment. As
Dr. Haley found, certain patients who responded in a certain
way to certain exposure events had more serious manifestations
and represented one cluster of symptoms.
So we may see multiple symptoms, some of which may be
dominant and others may be lesser, and you are going to see
some of those in the general populations because you have
people that may have more severe susceptibilities and maybe
less severe exposures so that it's not going to be unique to
the Gulf war. But the fact remains that we have a cluster of
people from the Gulf war who should not be experiencing these
illnesses or this collection of syndromes, if you will, to the
extent that they are. They're far in excess of what you should
see in the general population.
Mr. Shays. Dr. Urnovitz.
Mr. Urnovitz. You know, the absolute beauty in history,
years from now when they look back, they're going to say the
Gulf war syndrome took us to the 21st century for one reason,
they couldn't find a germ that caused this disease. They had to
look closer. So, you know, I don't normally wear ties, so since
I got one on, I'm going to give you my philosophy of life in
less than 30 seconds. You know what we're looking at here? I
believe Gulf war syndrome, we learned that the body can repair
itself and heal fantastically. It's a really amazing mechanism.
You know how it does it? It does it in order of billions and
billions of instructions that have to be followed. One gene
gives one protein, goes to cells, this and that; it's a
fantastic system, truly something worth studying. You throw a
monkey wrench at any one of those billion pathways, and you can
get any kind of syndrome you want.
Gulf war syndrome is an example of mean age young people
28-ish years old being exposed to one of the filthiest wars
we've ever been, and then you throw in some things to throw off
these mechanisms, whether they're vaccines, which are genes, or
squalene, or anything of those other things. You've got now a
double hit. What I just outlined in my testimony is--and the
Brits are not free of guilt here because they also signed this
petition.
Mr. Shays. Go for it.
Dr. Urnovitz. And not only did Columbus not discover
America, you taxed us without representation. I want to point
that out, too.
Mr. Shays. Don't get carried away.
Dr. Urnovitz. We're doing a very good job of taxing
ourselves.
Mr. George. We didn't do very well, I might say.
Dr. Urnovitz. What I'm showing you here is we have never
had a better opportunity to nail cancer, nail AIDS and
everything else, because throw the germ theory out. It's the
genome. And now we got to get complicated, which means we can
do it. We have the tools to do it. Where in the pathway did it
get thrown out and how do you get the people back on track
again. That's the deal.
Mr. Shays. I've got to ask this question, if I could. Dr.
Haley, you were nodding your head when Dr. Jamal spoke, when
Dr. Cherry spoke, Dr. Steele. When Mr. Tuite spoke, you started
to squint, and you had no reaction with the good doctor here.
So I'm curious.
Dr. Haley. I simply ran out of nods.
Mr. Shays. Fair enough. Will the record please show that
Dr. Haley nodded after all witnesses followed, and when he
didn't nod, he meant to, but didn't have the energy.
Do you have a followup question?
Mr. George. Yes. Thank you. Perhaps you can see why
politicians are a little bit confused; how politicians actually
are generally people of goodwill, but the signals we're getting
are very varied. And it's very difficult to make policy when
the advice that is being proffered lacks consistency. It's not
to attribute any blame to those who are proffering it, but it's
an indication of the immense complexities that none of us can
truly understand.
And I've seen so many of these people coming before the
Defence Committee in their wheelchairs looking appallingly
sick, and some have died. And it's very emotional seeing people
who have suffered, people who have gone off to fight on your
behalf. We're desperate to find the answers, and so far we have
failed miserably. But we have these misconceptions in the early
days--Mr. Chairman, oh, please don't go. We'll be inquorate.
No, I was told it was two for a quorum. It's three in the U.K.
I anticipated in the very early days that these men and
women would be dying like flies. They looked seriously ill when
they came to see us, but, again, another study, a British
study, pointed out that amongst the Brits the mortality levels
were statistically almost identical between a group selected
that didn't go and the group that did go. Now, is it because
our people are pretty hearty and resilient eating their
different fatty foods? Is there any difference between the
statistics in the United States? So does the Gulf war syndrome
merely debilitate but not kill people off? Or is the research
being done, in fact, done by another very, very distinguished
university, and the Medical Research Council appears to endorse
it--yes, Manchester University.
Dr. Cherry. We did it.
Mr. George. I'm sorry to keep pointing the finger at you.
The statistics presented to us by our Ministry of Defence were
as of the 31st of December 2000, 477 military personnel died as
opposed to 466 of a similar sample group of veterans who did
not attend. How do we answer those questions? Perhaps Dr.
Cherry, as you were involved in that research.
Dr. Cherry. It is the case that up 'til now neither in the
United States or the U.K. has there been an excess in the
overall mortality.
Mr. George. But I think you said earlier it may happen in
due course. It means that over a 10-year period there hasn't
been----
Dr. Cherry. If you looked how long it took for people to be
exposed to asbestos. I'm taking a wider point here. Asbestos,
it takes people 40 years to die after they have been exposed to
asbestos. I'm not suggesting there is asbestos in the Gulf. But
with chronic disease you may have a latency of up to 40 years
before you see a very serious epidemic. I'm not saying we're
going to see it, but the fact that you haven't seen it at 8
years, 9 years doesn't mean there's not something later on.
Mr. George. Right.
May I ask one final question again directed at Dr. Cherry--
I'm sorry, but perhaps any others who would wish to join in,
with your approval, chairman--the findings that you led at
Manchester University that Gulf veterans suffer more ill health
than service personnel who do not go to the Gulf, and your
accumulated findings and research have been published.
Now, the question to you and others--our distinguished, our
very eloquent witness is here with his checkbook at the ready--
what kinds of research should now focus on what subjects? Given
we've had 10 years' experience of research, much of which had
use, much of which was of no consequence whatsoever, what now
should the British Government, the DOD, the Veterans'
Administration, private benefactors, in the light of what we
have learned so far, where should now the focus be?
And second, and it is a difficult question, is it better--
and I hope you will say no--is it better to say should the
energies be put on if not researching the causes, at least
delivering better services to those who have survived, or
should there be the same balance as there has been between
research into causes, symptoms and indeed services provided to
our military personnel?
Thank you, Mr. Chairman.
Mr. Shays. Let me say that I'm intending to have this panel
end by about 7 of or basically about 10 of. I invite Mr. Perot
and any other panelists to spend about 4 minutes with any
comments they want. Then I intend to close this by 3. So just
so we know--yes. So if we could have the question answered. Is
there a response? I haven't given you a lot of time.
Dr. Cherry. There are three or four reasons for doing
research at this point. The most pressing is if you can find
causes that would help us treat the people who are sick at the
moment, if we can understand why they're sick, we're much
closer to being able to treat it. So that's one good reason.
The second is a very obvious one. We don't want to expose
people in the future to things that have made people sick now.
And that really, again, is causal research.
The third--and again, we're looking for causal research--is
where the Gulf war may help us understand basic disease
mechanisms. For example, in ALS, if we can understand why
people who went to the Gulf get ALS, we may, in fact, be able
to prevent ALS in the much larger population.
And the fourth area of research is even if we don't know
the cause, can we actually make people function less badly? And
you may need research for that, too. That's not simply sitting
down and making recommendations. You may need to do clinical
trials and so on to see what works and what doesn't. But the
first three are all causal research.
Mr. Shays. I'm going to go to you, Mr. George--I mean,
excuse me, Mr. Lord Morris. Then I will ask a few questions.
Then we will try to finish up here.
Mr. Morris. Congressman Shays, we meet under your
chairmanship in a subcommittee of the House Government Reform
Committee, and we heard this morning Ross Perot's refreshingly
forthright views on government institutions and personnel. What
changes in those institutions did Dr. Haley or perhaps Dr.
Steele, Mr. Tuite or Dr. Urnovitz think would or might have
made life better for veterans with Gulf war-related incidents?
If the interactive effects of NAPS tablets and up to 14
inoculations could have had adverse effects on Gulf war
veterans with undiagnosed illnesses, what about interactive
effects of having so many government departments involved in
addressing their problems?
In other words, do we have here not only medical issues to
consider, but crucially also that of defects in government
machinery?
Mr. Tuite. Can I address that early on? Because I was
really--in the early days when we were actually trying to get
something done about this issue, I was pretty heavily involved.
And I can say that initially we didn't know what happened, and
we spent a lot of time trying to find out what had happened.
And the agencies that are now doing the research were the
keepers of that information.
And so as we went forward and the layers of the onion
started to peel away, we found out that they were exposed to
this and they were exposed to that, and I think that the number
of different exposures now is up to more than 30 that we're
looking at, including the time-compressed administration of
multiple vaccines. Those agencies had become entrenched in the
process, both in the process of Congress going to those
agencies to try and get information, in the--I guess in the
battle over what was right and what was wrong so that as we
went forward, I think that we were maybe wrong in using those
agencies to lead us out of the problem as well.
And perhaps we should have taken a more open-minded
approach to how you solve a problem, because it was very clear
at that point that we had agencies that had a vested interest
in outcomes leading a process that was supposedly open and
peer-reviewed. That was just not happening. That's one of the
reasons why here we are 10 years later, and we're still asking
what is wrong with these soldiers.
Ms. Steele. I concur with Mr. Tuite. That's really the core
issue. It's manifested itself in different ways to make
problems and the research not turning out, but the core thing
is what he said.
Dr. Haley. Can I make a parallel?
Dr. Urnovitz. Seniority, please.
Mr. Shays. No, I'm going to let you go first. You always
get the last word. I'm curious what he'll say if he gets the
last word.
Dr. Urnovitz. Someday you're going to learn how to
pronounce my name right.
Listen, it's really quite straightforward. I wrote this is
a complete heresy. I'm telling you there was no polio virus
epidemic. None of you guys flinched. Well, you know, nobody
nodded either. I wrote this in Santa Maria Sopra Minerva in
Rome in the room that Galileo was excommunicated in. The reason
being is that's where we are today is many of our government
doctors say that the Earth is in the middle and the sun goes
around it, and we're not funding anything else, and we're not
going to communicate, and that's the end of it.
If I could ask one thing from this committee, we have laws
in place that you can't lie to Congress, but now we find out
you can't fire them either. So we're in a really interesting
position of some interesting jobs program here, and I might
apply.
Back to Mr. George's question. You know, we've got it right
now, and we can do it right now is the GAO came up with a
report that tells you where to look. And I wouldn't do just a
British study and I wouldn't do just an American study or
French. I would do a French-British-American study. I would
also do the Czechs and everybody else that was involved, and I
would also do the Balkan War syndrome that went on, and I would
also do the current guys so we can look at a current war right
now.
Where's their blood? You've got the markers. Do I need to
point them out to you? You've got brain scans, you've got OP
tests, you've got antisqualene antibodies, you've got genetics
tests. We've given you the markers to go out and do something
with it. GAO told you what study needs to be done. This is not
difficult. It would take about a year. I'm sorry Mr. Sanders
left, but this is my comment to him is he is right. We gave you
guys $300 million. Give us 30-, we'll blow the world away and
cure diseases in the meantime. By the way, I said it under
oath.
Mr. Shays. You know what's crazy? I believe you.
Dr. Haley. I think it would be very instructive to answer
this question to look at the parallel in the research programs
that have virtually solved the AIDS problem, HIV/AIDS versus
the Gulf war syndrome. 15 years ago the AIDS problem was in the
same type of mess that we have been in for 10 years in the Gulf
war issue. There was back-biting, there was denial, there was
conflict of interest in the research. And then through the
activism of the AIDS victims to the point of almost violence,
the Congress gave NIH a very strong mandate: Solve this
problem. So they started a classic NIH research program with
peer review done by study sections where the names of the peer
reviewers are published so it's fair and above board, and you
get thorough scientific peer review.
The word went out--with hundreds of millions of dollars
available, the word went out to every university all over the
world there's money, it's a fair process. If you make
discoveries, you're going to be celebrated, and you'll get more
grant money.
What we have here is 10 years, we have the word is out, it
has been out for many years, that if you apply for a grant in
the DOD through our peer review process in Gulf war syndrome,
and if you don't find the findings that the policy wants, then
you are going to be crucified. You will never get more money.
You will be berated. You will be maligned. You will be lied
about.
And so, I mean, when I--I was meeting with some Harvard
doctors the other night. Just before I came they were giving a
course down at our university. We are having dinner, and they
said, what do you do? I said, well, I research the Gulf war
syndrome. They said, are you kidding? What are you doing?
You're going to ruin your career. This is dangerous. We would
never do that.
And that's the word all over the major universities. The
good researchers would never get into this. That's one of the
problems our Veterans Research Advisory Committee that we're
going to be on--that's one of the major things we're going to
face, that no reputable researcher who doesn't already believe
in the stress theory is going to get involved in this.
Mr. Shays. Let me tell you the other thing that concerns
me. When I was at the press conference, those of you who are on
the advisory panel are being now told you won't get the money
because you are on the advisory panel, it's a conflict of
interest, which could really make me suspect.
You all have been an extraordinary panel. The two bookends,
though, are basically going more than just saying misinformed,
but you're saying lying. And, you know, I've always viewed it
this way: That when we look at the thousands of doctors who
work for the Department of Veterans Affairs, they don't have
any of the expertise you have. Their whole line of work is
different. They didn't notice it. They didn't think about it.
It didn't fit into any of their studies.
When we questioned them, how many people had any ability
and background in, say, chemical exposure, in the course of
thousands and thousands of thousands they could think of two
doctors, and so then we thought it was unfair. We said, get
back to us. They still came back two doctors. So I basically
began to view it as kind of like at the universities, the
scholars teach what they taught, not what the students need to
learn. And I thought it was more like that, that was more the
problem. Now I get the sense if that was the problem, there's
been more a defensive mechanism that now gets into discrediting
everyone, which is a really deadly way for them to head.
So, in one sense I feel a little depressed because the
opposition seems to have gotten hardened in some ways, but in
another sense I feel that you all have not been intimidated.
You all are out there. Your work is becoming known. It is
becoming respected. And you know what? Galileo went through the
same thing, didn't he? So I don't feel sorry for any of you. I
am just grateful as hell that you're doing your work. The one
thing I note was Copernicus the one who was threatened to be
beheaded--or Galileo. But none of you have had those kind of
threats. And anyway, you have Ross Perot to protect you.
I will allow our previous panel to use 2 or 3 minutes if
they want any closing comments. Anybody in any of the previous
panels who want to make a comment? Do you have any comments
from the GAO?
Ross, if you have comments, I would like you to move
yourself up while she's speaking.
Ms. Kingsbury. I want to say I am thrilled with the outcome
of this panel. We haven't solved the problems here yet, guys,
but we've at least opened the door. I'm very proud we were able
to be a part of it. I appreciate your support of us in that
respect. I hope we can continue to help you in going forward.
Mr. Shays. It has to be fairly brief, Ross.
Mr. Perot. Yes, sir. I just want to commend all of you on
this last panel. I think you've done an outstanding job.
Several things I intended to bring up they've explained. The
one thing that's still on my mind is the gas mask and the
chemical suits that our troops are using now. I think we should
have somebody make sure they're the best of the best, because
there's a whole range of gas masks. Some are pretty good, some
are bad. Up at the upper end there are some that really give
great protection. Our troops deserve the finest protection.
So someone should look into that quickly and make sure that
because of procurement policy or what have you the quality of
the equipment they have to wear when they're exposed to these
things is the best that money can buy. It would be an easy
thing to check. Thank you.
Mr. Shays. I thank you very much. I thank the panel. And I
will draw this hearing to a conclusion. Thank you all so much.
And I have a feeling, and certainly if I have anything to do
with it, we will all be back.
[Whereupon, at 2:56 p.m., the subcommittee was adjourned.]
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