[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 -------- 77-881 U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 2002 ____________________________________________________________________________ For Sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpr.gov Phone: toll free (866) 512-1800; (202) 512�091800 Fax: (202) 512�092250 Mail: Stop SSOP, Washington, DC 20402�090001 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 ---------- 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:] [GRAPHIC] [TIFF OMITTED] T2953.001 [GRAPHIC] [TIFF OMITTED] T2953.002 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:] [GRAPHIC] [TIFF OMITTED] T2953.003 [GRAPHIC] [TIFF OMITTED] T2953.004 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:] [GRAPHIC] [TIFF OMITTED] T2953.005 [GRAPHIC] [TIFF OMITTED] T2953.006 [GRAPHIC] [TIFF OMITTED] T2953.007 [GRAPHIC] [TIFF OMITTED] T2953.008 [GRAPHIC] [TIFF OMITTED] T2953.009 [GRAPHIC] [TIFF OMITTED] T2953.010 [GRAPHIC] [TIFF OMITTED] T2953.011 [GRAPHIC] [TIFF OMITTED] T2953.012 [GRAPHIC] [TIFF OMITTED] T2953.013 [GRAPHIC] [TIFF OMITTED] T2953.014 [GRAPHIC] [TIFF OMITTED] T2953.015 [GRAPHIC] [TIFF OMITTED] T2953.016 [GRAPHIC] [TIFF OMITTED] T2953.017 [GRAPHIC] [TIFF OMITTED] T2953.018 [GRAPHIC] [TIFF OMITTED] T2953.019 [GRAPHIC] [TIFF OMITTED] T2953.020 [GRAPHIC] [TIFF OMITTED] T2953.021 [GRAPHIC] [TIFF OMITTED] T2953.022 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:] [GRAPHIC] [TIFF OMITTED] T2953.023 [GRAPHIC] [TIFF OMITTED] T2953.024 [GRAPHIC] [TIFF OMITTED] T2953.025 [GRAPHIC] [TIFF OMITTED] T2953.026 [GRAPHIC] [TIFF OMITTED] T2953.027 [GRAPHIC] [TIFF OMITTED] T2953.028 [GRAPHIC] [TIFF OMITTED] T2953.029 [GRAPHIC] [TIFF OMITTED] T2953.030 [GRAPHIC] [TIFF OMITTED] T2953.031 [GRAPHIC] [TIFF OMITTED] T2953.032 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:] [GRAPHIC] [TIFF OMITTED] T2953.033 [GRAPHIC] [TIFF OMITTED] T2953.034 [GRAPHIC] [TIFF OMITTED] T2953.035 [GRAPHIC] [TIFF OMITTED] T2953.036 [GRAPHIC] [TIFF OMITTED] T2953.037 [GRAPHIC] [TIFF OMITTED] T2953.038 [GRAPHIC] [TIFF OMITTED] T2953.039 [GRAPHIC] [TIFF OMITTED] T2953.040 [GRAPHIC] [TIFF OMITTED] T2953.041 [GRAPHIC] [TIFF OMITTED] T2953.042 [GRAPHIC] [TIFF OMITTED] T2953.043 [GRAPHIC] [TIFF OMITTED] T2953.044 [GRAPHIC] [TIFF OMITTED] T2953.045 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:] [GRAPHIC] [TIFF OMITTED] T2953.046 [GRAPHIC] [TIFF OMITTED] T2953.047 [GRAPHIC] [TIFF OMITTED] T2953.048 [GRAPHIC] [TIFF OMITTED] T2953.049 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:] [GRAPHIC] [TIFF OMITTED] T2953.050 [GRAPHIC] [TIFF OMITTED] T2953.051 [GRAPHIC] [TIFF OMITTED] T2953.052 [GRAPHIC] [TIFF OMITTED] T2953.053 [GRAPHIC] [TIFF OMITTED] T2953.054 [GRAPHIC] [TIFF OMITTED] T2953.055 [GRAPHIC] [TIFF OMITTED] T2953.056 [GRAPHIC] [TIFF OMITTED] T2953.057 [GRAPHIC] [TIFF OMITTED] T2953.058 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:] [GRAPHIC] [TIFF OMITTED] T2953.059 [GRAPHIC] [TIFF OMITTED] T2953.060 [GRAPHIC] [TIFF OMITTED] T2953.061 [GRAPHIC] [TIFF OMITTED] T2953.062 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:] [GRAPHIC] [TIFF OMITTED] T2953.063 [GRAPHIC] [TIFF OMITTED] T2953.064 [GRAPHIC] [TIFF OMITTED] T2953.065 [GRAPHIC] [TIFF OMITTED] T2953.066 [GRAPHIC] [TIFF OMITTED] T2953.067 [GRAPHIC] [TIFF OMITTED] T2953.068 [GRAPHIC] [TIFF OMITTED] T2953.069 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:] [GRAPHIC] [TIFF OMITTED] T2953.070 [GRAPHIC] [TIFF OMITTED] T2953.071 [GRAPHIC] [TIFF OMITTED] T2953.072 [GRAPHIC] [TIFF OMITTED] T2953.073 [GRAPHIC] [TIFF OMITTED] T2953.074 [GRAPHIC] [TIFF OMITTED] T2953.075 [GRAPHIC] [TIFF OMITTED] T2953.076 [GRAPHIC] [TIFF OMITTED] T2953.077 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:] [GRAPHIC] [TIFF OMITTED] T2953.078 [GRAPHIC] [TIFF OMITTED] T2953.079 [GRAPHIC] [TIFF OMITTED] T2953.080 [GRAPHIC] [TIFF OMITTED] T2953.081 [GRAPHIC] [TIFF OMITTED] T2953.082 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:] [GRAPHIC] [TIFF OMITTED] T2953.083 [GRAPHIC] [TIFF OMITTED] T2953.084 [GRAPHIC] [TIFF OMITTED] T2953.085 [GRAPHIC] [TIFF OMITTED] T2953.086 [GRAPHIC] [TIFF OMITTED] T2953.087 [GRAPHIC] [TIFF OMITTED] T2953.088 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. 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