Archive

 

PRESIDENTIAL SPECIAL OVERSIGHT BOARD
FOR DEPARTMENT OF DEFENSE INVESTIGATIONS OF
GULF WAR CHEMICAL AND BIOLOGICAL INCIDENTS

PUBLIC HEARING

Tuesday, October 19, 1999

Fort Lewis, WA

 

 

P A R T I C I P A N T S:

Secretary Jesse Brown

Rear Admiral Alan M. Steinman

Dr. Vinh Cam

CSM David

Mr. Roger Kaplan

CAPT Brian Peterman

Dr. Peter Spencer, MD

Dr. John Russell, Ph.D.

Mr. Michael Kiser

Mr. Michael Killen

Ms. Lisa Spahr

Dr. Aristo Vojdani, Ph.D.

Ms. Denise Nichols, RN

Mr. Edward Noble

 

C O N T E N T S

Opening Remarks ;

Secretary Jesse Brown

Special Oversight Board Update ;

Mr. Roger Kaplan

Factors that Associate with Gulf War Illnesses ;

Dr. Peter Spencer

Transuranium and Uranium Research ;

Dr. John Russell

Veteran Service Organization Comments

Mr. Michael Kiser, Disabled American Veterans ;

Mr. Michael Killen, Veterans of Foreign Wars ;

Ms. Lisa Spahr, American Legion;

Multiple Chemical Sensitivity ;

Dr. Aristo Vojdani

Veterans Comments

Ms. Denise Nichols ;

Mr. Edward Noble ;

Final Remarks ;

 

P R O C E E D I N G S

SECRETARY JESSE BROWN: Good afternoon. I would like to welcome all of you to our Special Oversight public hearing. Before we start the formal aspects of our hearing, there are some housekeeping duties that we must tend to. In that respect, I'm going to ask our staff member, Roger Kaplan, to represent the White House official by opening up the meeting. Roger?

MR. ROGER KAPLAN: Thank you, Mr. Secretary. On behalf of the White House, I officially begin the proceedings tonight. Before we go further, though, I've been asked by the Madigan Army Medical Center personnel to let you know that in case of a fire or emergency, if you leave from your rear, please go out the emergency exits and make a right and go out beyond the pond. If you choose to use the exits on the stage, then make an immediate left. If you go out the right -- to your right rear door and then make the first left, you'll go to the rest rooms. And also, there is a water fountain there. Thank you very much. Mr. Secretary?

SECRETARY JESSE BROWN: Thank you, Roger. As most of you know, I am the vice chair of the Presidential Special Oversight Board. I would like --

UNIDENTIFIED SPEAKER: We can't hear you.

(Discussion off the record.)

SECRETARY JESSE BROWN: Again, good afternoon and welcome. I'm Jesse Brown, vice chair of the Presidential Special Oversight Board. I would like to thank General Hill, General Brautigan, and the Fort Lewis medical community for allowing us the honor of having our hearing here. Also, I'm so delighted to see so many of my friends, people that I have met over the years from the veterans' communities. We have Mike Kiser, DAV national service officer; Mr. Michael Killen of VFW; my good friend Jane Adderson; Lisa Spahr; Denise Nichols; and Ed Noble. And of course, we have looks like half of the VA here today, and I'm glad that they are here. If any of our veterans have any problems whatsoever, I'm so delighted that our director of the regional office assistant director, Jim Vance, whom I have known for a number of years, and he just is an outstanding public servant, the kind of person that we all would want on our team. And he's responsible for making sure that we have the support that we have here today from the Veterans Administration. I'm going to ask the VA team to stand and be recognized.

(Applause.)

SECRETARY JESSE BROWN: Our chairman, Senator Rudman, is unable to attend this hearing due to a long-standing prior commitment. Two other Board members are also unable to attend: Admiral Zumwalt, former Chief of Naval Operations, is hospitalized; and General Cisneros also had a long-standing prior commitment.

This is the sixth public hearing that the Board has held. After the Board members make their opening remarks, I will have staff member Roger Kaplan give you a brief history of the Board and a summary of our responsibilities and activities. As many of you know, I served in the President's cabinet as a Secretary of Veterans Affairs for a little over four years. I have dedicated my entire life to serving veterans and their families, and, quite frankly, very proud of my tenure as secretary and, of course, my nearly 30 years as a national service officer with the Disabled American Veterans. Likewise, I am a member of many of the veterans organizations.

For the record, I want to state if there are any persons here in the audience this afternoon who wish to address us, make it clearly understood that I will accommodate you. All you have to do is let us know that you want to make a statement or express an observation and it will be done. For those of you who have questions involving compensation, pensions, and other VA issues, we have representatives from -- in the audience from Department of Veterans Affairs, and I have already introduced them, and they will be very, very happy to assist you.

Having said that, I now wish to continue with the hearing and the purpose for which we are here this evening.

Prior to issuing our interim report in August of 1999

Hi, Jim, I'm so glad to see you -- we heard testimony from the Defense Department, the CIA, and other expert witnesses from the scientific community. We also heard from the CIA on their investigation of potential chemical releases as a result of coalition bombing activities during Desert Storm, and from the Office of the Secretary of the Defense, Health Affairs, and the joint staff on issues related to pre- and post-deployment health screening.

On the subject of depleted uranium, this evening one of our presenters, Dr. John Russell, is from the University of Washington United States Transuranium Registry. We have asked Dr. Russell to come before us to give a general overview on the relationship between the registry and any evidence that the registry may contain that addresses the relationship, if any, between the depleted uranium and symptoms of Gulf War illnesses. There has been significant medical research conducted, and that research must go forward. Our government has spent more than [$]120 million in research just on the subject of Gulf War illness. And money should never, ever, be a question when it comes to the health of our soldiers.

The Defense Department medical research program will and must continue. Hopefully, that research will continue to give the war experience some information from which they can generate hypotheses and design the future medical research. The Board supports continuing medical research into causes of undiagnosed illnesses.

As most of you know today, it was announced in Washington, D.C., that PB cannot be ruled out as a cause of illnesses of Persian Gulf veterans. I want to tell you that we here on this Board were delighted with that finding. We were delighted primarily because from the very beginning, we believed in our hearts that our veterans were sick, unlike some wanted to attribute it all to stress and psychological reasons and so forth. We felt that there was an organic that was a physical reason for their illnesses. And this report leads us in the right direction. So I think what we must do is to continue to put forward with this research for two reasons. Number one, so that we can find out what is wrong with our veterans and then develop a treatment protocol so that they, too, can live a quality life. And the second reason is that certainly we want to learn from the lessons of history. We do not want to condemn our citizen soldiers, our sons and daughters, to future problems that are associated with their then responding to the needs of the United States of America.

Our Board is interested and the Department plans for the future for integration and applications of the lessons learned today from the Gulf War, investigative activities into future servicemen, medical surveillance, care, screening, and deployment. This Board and this staff will always be receptive to veterans and will see that the veterans are pointed in the right direction to receive the appropriate health care and benefits. In all cases, veterans are encouraged to continue to work with the Department of Veterans Affairs, their outreach efforts, and their individual congressional representative, and of course, our veterans organizations, because they are there to help our veterans through what sometimes can be a bureaucratic jungle. While the Board's charge is to oversee the Department of Defense investigative activities into events and circumstances that can explain potential causes of Gulf War illnesses, we are clearly sensitive and sympathetic to the needs of our veterans and will always listen to you first.

With that, our hearing purpose here today is to receive testimony from veterans, organizations, individuals, the Transuranium Registry, and outside experts on the causes of Gulf War illnesses. Before we begin, I will ask our distinguished Board members for their comments at this time.

RADM ALAN STEINMAN: Thank you, Mr. Secretary. It's certainly a pleasure to have our Board support a public hearing in the great Pacific Northwest. Our previous Board hearings have all been in Washington, D.C., or in one instance in San Antonio, Texas. This is the first time our Board has been held on a military base, which I think is particularly important because it gives our active-duty members and our Gulf War veterans a chance to participate in hearings other than in Washington, D.C. And holding the hearing in this facility is also particularly appropriate because it is -- in my opinion, Madigan Army Medical Center is one of the premier military medical hospitals in the country, if not the world. And it has one of the best Gulf War CCEP programs; the most aggressive, successful programs in the country, as well. So I look forward to hearing the comments and opinions of our invited scientific speakers and, of course, from our Gulf War veterans themselves. Thank you.

SECRETARY JESSE BROWN: Thank you, Admiral. Dr. Cam?

DR. VINH CAM: Can you hear me?

UNIDENTIFIED SPEAKER: Yes.

DR. VINH CAM: I'm very honored to serve on this Board and I look forward to hearing your concerns and working with everyone in this office. Thank you.

SECRETARY JESSE BROWN: CSM David Moore?

CSM DAVID MOORE: Yes. First of all, thank you for providing the opportunity for us being here. With 35 years of military service, combination of active and reserve, you can see I have a particular interest. And if there ever was an opportunity to give something back to the soldier, I'm honored that I could be given an opportunity to sit as oversight with Board members who care, who are concerned about the condition, the illnesses of our veterans. With that, I've served on many boards, civilian and military, but this one is foremost for me to really get involved for the soldiers. What we do, there's no doubt in my mind, will have a profound impact for the future daughters and sons of this country. There are times that we send them off in harm's way. They will feel confident in their minds that America cares. Thanks for being here.

SECRETARY JESSE BROWN: Thank you so much, Sergeant Major. I mentioned our interim report, which was presented almost nine years to the day following the August 2nd, 1990, invasion of Kuwait by Iraq. Roger Kaplan, will you briefly address our interim report and a short background briefing on the Board.

MR. ROGER KAPLAN: Yes, Mr. Secretary. First slide, please, Dave. Okay, the next slide. In February 1998, the President signed the executive order which created the Special Oversight Board. The Board was created in response to a recommendation from the President's Advisory Committee in which they had requested that Department of Defense not conduct further investigations. The White House determined that it was in everyone's best interest to continue the Department of Defense's involvement, but to have an oversight board to review their progress and their activities. And amongst the keys was that we would not conduct our own scientific research. However, that did not prevent us and does not prevent us from leveraging research done not only by the Department of Defense, by the Department of Veterans Affairs, but also by outside investigators. And we feel that we have done this to a strong degree. In fact, tonight we're hearing from several experts in this field. We're also required to produce two reports: An interim report nine months after our first public hearing, and the final report 18 months after that first hearing. And for the functions of the President, the Secretary of Defense fulfills that. However, those reports go directly to the White House and do not remain just at the Pentagon.

Next slide, please. As we said, we report to the President of the United States. Though we do report through the Secretary of Defense, we also send reports straight to the National Security Council. We do have some review of our own activities. There's Congress, of course. There's the White House, director of OMB. Department of Defense can look in on us. So it's a two-way street. In addition, there's -- we feel, in fact, more important is the scrutiny that we receive from veteran service organizations, from the media, and the public at large. And, of course, most important, the individual Gulf War veteran.

Next slide. We conduct our activities under the prescribence of the Federal Advisory Commission Act, also known as "Sunshine in Government." This requires that our meetings be public unless there's a pretty darn good reason why they should not. And none of our activities are such that we would preclude public participation in our meetings. We ensure that at least 30 days in advance, we advertise through the Federal Register, which is a requirement. We also send out fax messages to veterans organizations. We also inform the media. We invite speakers, both in the research community, and we also request that veterans speak. And as I said, it's open to the public.

Next slide. Board members were mentioned by Secretary Brown. However, he did not go into some of the particulars of them. We are very pleased to note that five of our seven Board members are combat veterans, and that all but one of our Board members are veterans themselves.

Senator Warren Rudman certainly is known from his experience and accomplishments in the Senate; also back in his home state of New Hampshire. Less known about the Senator is that he won a Silver Star in the Korean War as a rifle company commander, also receiving a Purple Heart and a Bronze Star metal.

Secretary Brown did a great job as the second secretary of the Veterans Affairs ever, and we'd like to say the first secretary for Veterans Affairs. He was severely wounded in combat in Vietnam as a young Marine, did a great job working as a national service officer in the DAV -- Disabled American Veterans -- eventually becoming their executive director.

Dr. Vinh Cam is not a veteran. However, due to her experiences growing up in not one but two Indo-Chinese wars, I think she gets some credit for having been in a combat zone. She's built a pretty successful record as an immunotoxicologist and has worked for the EPA and also in New York City on a number of important commissions.

General Cisneros served two tours in Vietnam, was commander of U.S. Army South, which was the Army command in Panama. He led the forces that captured the dictator, Manuel Noriega. And his son served in the Gulf War. He's currently the president of Texas A&M, Kingsville campus.

Command Sergeant Major David Moore commanded a Howitzer section in the 101st Airborne Division during Vietnam; a distinguished career as a senior enlisted adviser in the Army Reserve, and was the, in fact, command sergeant major for a major engineering command during the Gulf War. He's also a retired police major and he is now a county coroner in suburban Chicago area. We like to refer to him as our most subpoenaed board member because of his requirements to go to court.

Rear Admiral Steinman served with the Public Health Service, though most of his duty was in support of the Coast Guard. In fact, he was the Surgeon General of the Coast Guard prior to his retirement. An expert on cold weather injuries; highly published. And we also have the very distinguished Admiral Elmo

Zumwalt, veteran of three wars: World War II, Korea, and Vietnam. He was the youngest Chief of Naval Operations ever; serves on more than half a dozen charitable boards of directors; and is now fighting a courageous battle against cancer. And we, of course, all wish him well as he recovers from surgery from earlier this week.

Next slide, please. There is a staff that supports the Board. Of the eight members, six of them are also veterans or are currently serving in active duty. As you can tell, we have a number of Ph.D.s in there in microbiology, epidemiology, toxicology. So we have a fairly qualified staff to look at some of the more technical aspects.

Next slide, please. As mentioned earlier, there is a requirement for two reports. The interim report was sent to the President in August of this year. And nine months from that date, which is May, we will also then send a final report to the President.

Next slide. This is, briefly, meetings that we've held. These are -- we continue to plan meetings for the future.

Next slide. This is a brief note about our first public hearing, which was a two-day hearing. We led off by listening to veterans of the Gulf War, followed by DoD agency representatives. And also, very important, hearing from national veterans service organizations, who were given ample time to talk to us about their concerns on how to conduct effective oversight. We view this as sort of a keystone meeting for us, and it really set the pace for our activities since then.

Next slide. Our interim report, as we have mentioned several times, the scope is looking at everything in the OSAGWI, the Office of Special Assistance for Gulf War Illnesses, the lead Department of Defense organization is done; and also to specifically look at some of their reports on potential chemical incidents and also some environmental exposure reports dealing with depleted uranium and well fires. We also looked at six of twelve recommendations that the Presidential Advisory Committee had listed in their special report, which was a requirement that was placed on the us by the National Security Council. As you can tell, our overall view is that OSAGWI is a credible, effective organization. This does not mean that we found everything to be a hundred percent, but certainly overall, it was functioning well.

There were a number of case narratives -- four to be exact -- which we recommended that they go final with their reports, switching from an interim status to final after they corrected some editorial mistakes and the like. We, however, sent back a couple of reports which we said they needed to do a little more work on; in particular, looking at oil well fires.

Next slide. We also took a look at the four Presidential -- or, rather, the six Presidential Advisory Commission recommendations. With four of them, we looked in very close detail. We found some concerns, which we communicated to the Pentagon, on their definitions of deployments and the activities that needed to take place. There were several recommendations which we felt were no longer applicable and chose not to continue; the reports (inaudible) to continue. To date, we have now completed our analysis of eleven reports. We've sent them to the Special Assistant. A number of them, slightly over half, we've requested that they go final. Others we've found some problems, though as of yet, we have found nothing that would be critically bad. Our overall assessments in some ways mirrored that of the General Accounting Office, in that we generally agree with their conclusions, though sometimes we're in some disagreement as to how they got there.

Next slide, please. We do have several reports that we're looking at. They're, with the exception of ASP Orchard, in their final stage, waiting for final approval by our Board members. Other reports we're waiting on from the Office of the Special Assistant. As they're received, we will analyze and evaluate them.

Next slide. This is a schedule of what OSAGWI has left to do. A number of reports are in fact the second version in which they've received our comments, received and incorporated the comments from the General Accounting Office. And, as I said, once received, we will evaluate them.

Next slide. And this is the last bit. It looks somewhat daunting, but our own analysis of this indicates that we'll be able to review all of these studies as long as they come to us as promised.

Next slide. Here's some contact information on us. The most important ones are actually at the bottom, which is our Web site, www.oversight.ncr.gov. On this Web site, we have transcripts of all of our previous public hearings. We have our interim report, and there's additional information on the Board, HealthLinks, and the like.

Mr. Secretary, I'm completed with the briefing.

SECRETARY JESSE BROWN: Thank you very much, Roger. We are now ready to proceed. Each presenter is requested to identify him or herself, identify your organization and your purpose addressing the Board. Our first presenter is Dr. Peter Spencer.

Dr. Spencer?

DR. PETER SPENCER: Mr. Secretary, distinguished Board members, veterans, colleagues, ladies and gentlemen, I'm honored to have the opportunity to present for you this evening. And I represent the Portland Environmental Hazards Research Center. My name is Peter Spencer. PEHRC is the joint initiative of the Portland Veterans Affairs Medical Center and Oregon Health Sciences University Center for Research on Occupational and Environmental Toxicology, on which I serve as director and senior scientist. I'd like to present before you this evening the results of five years of efforts on the part of Gulf War veterans and our team of between 25 and 30 investigators in trying to come to grips with factors that associate with illness among veterans returning from the theater of operations in Southwest Asia.

We in 1994 -- next slide -- competed for a grant request nationwide. We're fortunate to be one of three centers which won a sizable grant to address this. In fact, our grant request was focused initially on the impact of environmental factors on military service, but then it became very clear that our first priority should be the issue of unexplained illness among Gulf War veterans. And indeed, we have spent the majority of the time during the last five years focused on this issue. As I said, I'm merely a spokesman for the efforts of Medical Director Dennis (inaudible) and his team of clinicians at the Portland VA; and the McCauley epidemiologists at the OHSU and her colleagues, including one of her colleagues, Michael Lazarus, who is this evening showing these slides.

Now, at the time of our grant request, we had recently attended an NIH meeting on the Gulf War -- on illness among Gulf War veterans, and it was there decided the best way to handle this problem of unexplained illness was to treat illnesses among veterans in the following tentative fashion. That is, that it would be expected that among -- some individuals returning from Southwest Asia would have picked up certain illnesses. These were expected illnesses. It would not be surprising if some people returned with malaria. As it turned out, very few did. Then there was a category of unexpected illnesses, and those could be split between two types. There were illnesses which were unexpected but explained. And one of those turned out to be a form of a protozoan disease, Leishmaniasis, which had an unusual presentation known viscerotropic Leishmaniasis. This was an illness which was explained but unexpected. And then the focus of our attention during the last five years has been -- on the right, the lower right -- the issue of what has came to be known very early as "Gulf War Syndrome"; that is, unexplained and unexpected illnesses among Gulf War veterans.

We have approached this in what is known as a population-based clinical case control study. This means that we are not counting the numbers or rates or the prevalence or the incidence of people in the country with this illness. We are asking a different question. We are randomly selecting people in the Pacific Northwest and we are asking what are the differences in the experience of exposures in the Gulf theater of operations between those who returned home well and those who returned home with unexpected, unexplained illness. That is the sole purpose of our study. We have kept that focus throughout.

The next slide shows our sampling frame, which consisted of a Department of Defense database of some 19,000 individuals within the Pacific Northwest who reported Oregon or Washington as their home state of record. It turned out that 11,000 of those were no longer in Oregon or Washington, and so we ended up with a sampling frame of over 8,000, from which we took a random sample of about 2,200. We found that 321 of those were ineligible because they were nondeployed, deceased, or out of state at the time of attempted contact. We then mailed to the -- we then received mail responses from the balance of eligible people of 2,022. We were only, however, able to locate 1,760, and responders were 1,119, representing about a 50-percent -- 55-percent response rate from all mail surveys from locatable veterans. Our response rates, while lower than desirable, are comparable to the national rates. This means that what you will hear from me over the next few minutes is applicable to approximately 55, 60 percent of a randomly selected population of veterans in the Pacific Northwest.

We have not allowed the veterans to find us. We have gone out and found veterans in a random fashion, because this is way to conduct such a scientific study. We hope, therefore, that the results that we have found are representative of the 100 percent of veterans in the Pacific Northwest, although we are certain only that these results apply to the sample that we have been able to get access to; about 55 to 65, 60 percent. Among the responders, we found -- on the left -- that 320 were ineligible for clinical study because, on the basis of short telephone interviews, they became ineligible. They were greater than 100 miles from the test site and it just became too difficult to address the problem for them. Of the 26 Vietnam veterans -- we didn't want to have Vietnam veterans in this particular study -- 25 refused additional contact by our personnel and 17 had symptoms which predated the Gulf War.

We recruited -- on the right -- to about 800 clinical studies and we ended up examining 443. Now, the people that we excluded for exclusory -- for diagnostic reasons -- next slide -- were because people had clear- cut diagnosable illnesses, as you can see here. We, as I explained, were interested in understanding unexplained illness among the Gulf War veterans.

The next slide. The characteristics of our population -- and I'm sorry this is so small. One of the things we tried to do in this presentation is present the latest available data, literally being crunched over the last few weeks and days. But unfortunately, this has limited the quality of the presentation material before you this evening. Suffice it to say that our random sample of subjects compared with cases of controls were similar in terms of mean H, similar racial grouping. The percentage of reservists and National Guard that we had in our particular survey was slightly higher than the sample frame, so it is biased from that point of view to some extent. We had a slightly higher proportion of people who registered in the Persian Gulf War Registry. However, these subjects were randomly found -- excuse me -- these subjects were found by us and not the other way around. And that's important for scientific reasons. In terms of branch of service, the Army was slightly over-represented among the cases versus the controls, as it turned out in our case control study. The mean armed forces qualifying test measure was similar across the board. So with those qualifications, we set about a study in which we submitted then a detailed questionnaire to a large population, which sought information on military service history and duties in the Gulf War; exposures during the Gulf War, including chemical, environmental, biological, physical, and psychological factors; health history and health symptoms experienced during the Gulf War; and life-style factors and psychosocial adjustments after the war. We developed a tentative case definition. This was back in 1995, long before the CDC had come up with theirs. One must have a case definition, obviously, in order to identify cases.

The next slide. You'll see the three symptom types that are grouped broadly on the fatigue, cognitive/psychological, and musculo-skeletal, and the specific types of complaints received from the veterans that they related to their current health. We originally included complaints relating to the gastrointestinal system and the skin, but these formed such a minor component of the totality of complaints, that we dropped these from the final case definition. Fully 87 percent of our subjects complained of cognitive/psychological symptoms, about 42 percent of fatigue, and about 38 percent of the musculo-skeletal problems. Now, when the CDC did finally publish their case definition, we were pleased to see that of the 35 symptoms that they chose, there were over -- there were 26 that we had already selected some years earlier for our purposes. Whereas our case definition requires that -- required that veterans had any one of these symptoms -- that is, any one of these (indicating) -- that these were present during or after deployment to the Gulf, that the symptoms lasted for one month or longer, and that they occurred in the three-month period preceding recruitment into the case control study. As you'll see, the CDC definition which was published some years later by DeCuder, et al., was actually more conservative than ours, so ours tended to bring more veterans into the study than the CDC definition allows, largely because the CDC definition requires more than one symptom category to be present. There is not a precise overlap, but there's a good enough overlap that in fact our data can be interpreted either by the CDC case definition or our definition, with similar results.

Next slide. Now, of the 799 recruited for clinical study, we, on the basis of the working case definition, ended up with 107 potential controls and 336 potential cases defined by our definition. We, however, went through a further filter, ending up with these numbers at the bottom. You'll see that the number of controls was less than we had perhaps hoped, and a smaller proportion than the number of cases in the total number of veterans that were seen. Now, this number does not affect the validity of our results, but it does reduce the power to assign a role to an individual exposure factor or group of factors. We ended up with slightly larger numbers here (indicating) or smaller numbers here (indicating) because, for example, a number of people had, upon clinical examination -- and each of these veterans was good enough to come in and subject them -- allow themselves to be subjected to a very detailed clinical assessment. And 78 were excluded upon examination because they actually had diagnoses which could go on under separate medical care for treatment of their conditions. Thirteen only had back pain, which removed them from the unexplained group to the potential control group, and so they served the study in that particular sector. Now, the results of the clinical examination, both the hands-on clinical examination, a neurobehavioral assessment, and also serology were assessed by a team of clinicians representing neurology, rheumatology, internal medicine, neuropsychology, epidemiology. And only after individuals had been screened through this system were we comfortable in saying that this particular person could be counted as a case of unexplained illness among -- or a control therefore.

The next slide.

DR. VINH CAM: Excuse me, Dr. Spencer. Would you please tell us how you selected the controls. It looks like you move certain people from the case to the other side and vice versa.

DR. PETER SPENCER: Yes. For example, with regard to the controls, the exclusory medical diagnoses included things like irritable bowel syndrome, major depression, or they were currently nonsymptomatic. It only applied to a small number; six in that particular case. And one of them was, in fact, found to have unexplained symptoms on clinical examination; therefore, moved across from the control group to the case group.

The next slide, you'll see, then, how the case definition that we used compares with the CDC case definition. There is considerable comparison, then, on the mean age, the gender, racial grouping, mean days in theater. There is a little disparity between the percentage who were officers. It's larger among the controls than among either of the cases, as applied by those different definitions. In addition, we thought it was extremely important to for reasons that will become clear, to both over-sample and look specifically at people who were in the Gulf for specific periods of time. And I will refer to the pre-combat period here, which represents about 8.8 percent of our cases here or 10.5 percent if we define it by the CDC case definition. The pre-combat period refers to those veterans who arrived in the Gulf on or after August the 1st, 1990, but returned home before or on December the 31st, 1990. That is to say, they were there only for most of Desert Shield. And the post-combat period refers to veterans who arrived after the combat period, on or after April the 1st, 1991, and who stayed until up to July 31st, 1991. This provided us an opportunity to compare individuals within these discrete deployment periods.

Next slide. Before I refer to the results of that, our study group had a special interest in neurological problems. And while we found very little evidence of any concrete neurological signs, it was impressive that indeed a large majority of our cases complained of symptoms which fell within this cognitive/psychological group. And we were able to capture all of these people within our case definition because we only -- we allowed such people to enter into the study if they just had this one single symptom type; whereas the CDC definition requires at least two such symptoms, thus may exclude some people with these specific cognitive/psychological symptoms. You can see there that sleep problems were dominant, mood swings were widely reported, memory and concentration difficulties, anxiety and depression, difficulty with speech on occasion. These represent very important components of this unexplained illness, which again, using current technology, we are unsuccessful in defining with specific neurological investigative techniques. Although I have to say that we have not been as fortunate as Dr. Robert Haley has in being able to examine these veterans with such advanced techniques as he has been able to use.

Another component that we drew from our study -- the next slide -- is that there was a considerable number of people with musculo-skeletal complaints, and a number of who could be defined as having fibromyalgia, which is a complaint of body pain throughout the body, complaint of body pain throughout the body, and also objective evidence upon examination by rheumatologists of 11 of 17 simple tender points, specific spots in the body. Chronic fatigue was evident, moderately commonly. Clinical sensitivity was also present to some extent. And you'll see these numbers of 50, 45, and 39, respectively, throughout the total population of 241 cases that we included. And the point of this particular exercise is to show you that these three poorly understood conditions have overlapping symptoms and represent, frankly, a nightmare to sort out in terms of their precise etiology and, obviously because of that, their appropriate treatment. I mentioned that we did extensive serology. And the bottom line is that we found pretty much nothing; that is, an examination of a type of routine serological studies performed in clinics, looking at various functions, really turned up very little, indeed. We did find 12 subjects with an elevated Lyme disease titer, but 11 were normal on retest and one was excluded. We did find that a small number of people had an elevated creatine phosphokinase level, but this was found subsequently to be related to strenuous activity in the prior 24 hours. The only significant thing we found among both males and females was that the body mass index was slightly elevated over normality, to the extent that it could be classified as pre- obese. That's just a general reflection on the -- probably on the American population, who tend to eat a little bit too much. Now, turning to the question which fascinated us from the outset and is a burning question to this day; namely, the factors which associate with illness, the causes of unexplained illness among Gulf War veterans. From the point of view of a toxicologist, this question is problematical in relationship to the Gulf War unexplained illness because, as you well know, there were very few documented exposures. People running around measuring things were few and far between. And scientists like to use hard data measurements which they have some confidence in because the instruments work properly, the report records have been carefully assembled, and the data are at hand. The problem with investigating factors that associate with Gulf War unexplained illnesses is that pretty much no such data are available. One way which we circumvented this problem was to say, well, it would be reasonable to propose that people who were in the Gulf only for a pre-combat period, which we defined, versus people who were only in the Gulf for a combat period, which includes both the Desert Storm period and also the period immediately following Desert Storm when we blew up the depot at Khamisiyah, and indeed includes all known releases of chemical warfare agents in the theater of operations. But these two groups really had different compound exposures. If we can't get the individual exposures with hard data, we certainly have hard data on when veterans were deployed. We can check that both by asking the veterans and also quizzing the DoD and matching one upon the other. And we can conclude at least we think we can -- on the basis of published information by the Presidential Advisory Committee on Gulf War veterans illnesses that, for example, chemical weapons were not released into the atmosphere during Desert Shield. I think pretty much everybody agrees with that. And so if illness occurred among this particular class, then we could cast doubts upon the suggestion that chemical warfare agents were important. Pyridostigmine bromide was only administered, according to the PAC report, in the opening days of January 1991. So these people presumably would not have been exposed to pyridostigmine bromide, nor would they have been exposed to some of the investigational vaccines such as botulin and toxoid vaccine. Now, this is a crude surrogate, but at least it's hard data. We do know when we were deployed. We can conclude that there were different potential compound exposures, although we don't know exactly what those exposures were.

Next slide.

RADM ALAN STEINMAN: Excuse me, sir. These are self- reported exposures?

DR. PETER SPENCER: No, these are not.

RADM ALAN STEINMAN: Not?

DR. PETER SPENCER: No, these are not. What I'm talking about here is that these are exposures which are known to have occurred in the Gulf to some people. But this is simply a theoretical construct that you can say that there were -- there was not, as far as we know, in the theater of operations during this period of time, potential exposures to chemical weapons or use of pyridostigmine bromide or injections of botulin and toxoid vaccines. Just as in the cleanup period, we know there was no active combat. We can all agree upon that one.

RADM ALAN STEINMAN: What is a theoretical construct

(inaudible).

DR. PETER SPENCER: Thank you for clarification.

And the next slide shows you that

DR. VINH CAM: Dr. Spencer, was that based on some kind of population size?

DR. PETER SPENCER: No. This is simply a theoretical construct based on all the data that we had assembled, "we" being all reports have assembled over the past nine years, in terms of the potential exposure factors. And my point is simply this: That these represent different compound -- aggregations of potential exposure. This one is different from this slide. There was no combat here. There was no combat here. So fighting -- actively fighting in a tank or a helicopter, your enemy is important in relationship in Gulf War illnesses, then you shouldn't see cases here or here.

Next slide.

SECRETARY JESSE BROWN: Dr. Spencer, before we go to the next slide, can you give me your general observation on what impact the recent RAND report on PB would have on this theoretical model that you have here. Is it consistent with the model or inconsistent?

DR. PETER SPENCER: Mr. Secretary, if you would allow me to delay direct response of that question, I will show you later which is broadly consistent. And what we see, in fact, is that by looking at pre- combat -- by looking at the pre-combat period, by looking at the combat period, by looking at the post-combat period as I defined before, or a combination of exposures -- that is, people who were there for Desert Shield and Desert Storm or Desert Storm and Desert Cleanup -- taking these by individual symptoms, in fact you can see the cases of unexplained illness, we defined it, in fact appear in all three deployment periods. And in fact, you can see the proportion is the same. There are in fact no significant differences among these. However, let me qualify that immediately by telling you that the power to distinguish differences among these is extremely limited in our study because of the small numbers of subjects who were present for these discrete deployment periods. And we have urged the VA nationally to -- among their various approaches, to use the much greater population at their disposal, to apply a similar type of analysis to see whether or not this can be confirmed. But the point still can be made that there are individuals with unexplained illness who have no exposure to combat, no exposure to PB, unless the PAC report was wrong in terms of when PB was issued. My understanding was that it was issued around January 1st, 1991. But I will return to the point about PB momentarily, if I may.

Next slide. When we looked at the relationship between illness and the number of exposure factors that we reported -- that were reported, now self-reported data by veterans in response to the questionnaire, we were able to assign odds ratios to these individual reports. And so a value of one means cases and controls have an equal chance of having, for example, slept or worked in a tent. A value of three would mean that cases were much more likely by a factor of three, then, to have been exposed, for example, to vehicle repair. Now, these types of analyses are very interesting and can keep academics going for months on end, but they actually have limited value. We do see from these analyses interesting things. For example, Mr. Secretary, towards the bottom, use of PB pills, 1 to 21 pills per day, had a 3.15 odds ratio and was very significant. In terms of the reproducibility, that 0.95 figure here is a measure of reproducibility of the self-reported data; that is, the veteran said on the questionnaire and said at the time of the clinical interview that, indeed, he took or she took that number of pills. And so one can get very excited about these rather large odds ratios, but you'll see that there are other factors entering into a potential etiology of this disease. But before we get too excited, we have to remember that all of these variables are acting at the same time, and the only valid way really to look at this is to conduct a complex statistical analysis, which is beyond my capability but certainly not beyond my colleagues', which allows the individual factors to emerge from the computer depending on their relative importance. And in order to do this type of factor analysis, one can only do it with a certain number of clusters. And so the first job undertaken by the statisticians was to then determine to what extent these 42 categories --

next slide -- could be reduced to about nine clusters for analysis. And these, then, are the variables which co-associate one with the other. You can see here, for example, that in this Cluster 5 let's see -- Cluster 4, you can see that it's entirely reasonable that the computer linked these -- because individuals who answered one component, "drank alcohol," were likely to have answered the second or third, "drank alcoholic substances," etcetera, etcetera. You can see how the computer would have linked these because the self-reported data fed those three factors into that particular cluster. You can see pyridostigmine bromide turns up here. Now, these clusters were then entered into what is a multivariant analysis to try to build the best possible model that could explain, as much as possible, the number of self-reported exposure factors, but could associate with being a case of unexplained illness. The only three clusters which entered into our final model are these. Cluster No. 5, we refer to as the sun and insect cluster. Cluster No. 1 refers to individuals who reported taking prescription medications -- to the best of our knowledge, this does not include PB -- and also sought medical attention while in the Gulf. And Cluster No. 8, for want of a better term, refers to the combat cluster: Being exposed to depleted uranium, being exposed to open chemical decontamination bottles, burn surfaces, insecticide, etcetera, etcetera, and also scored on what is known as the Team Combat Exposure Scale, which is a measure of stresses encountered in the Gulf. Again, that's all self-reported data.

The next slide, then, shows you that the multivariant analysis includes these three clusters in our case definition using our case definition. We also have to place in years of education into our model. Gender does not enter into our model. If we then reanalyze our data using the CDC more conservative definition, we find that females are somewhat more likely to have illness and enter into the final model. Education is also a factor; that is, as education increases in terms of the number of years, the chance of entering into the model decreases and the same three clusters enter into this multivariant model. One of the differential proportions of these three factors, if you hold the education -- well, one of the different proportions, and they're shown down here. First of all, this multivariant model can explain approximately 40 percent of the variance in these data. Cluster 1 excuse me -- the majority contributors appear to be Cluster 5 and the education component, with Cluster 8 close behind, and Cluster 1, and the gender issue somewhat less important in this particular model.

Now, if I could now directly address Mr. Secretary's question, a very important question as to whether or not today's announcement by RAND Corporation, that we should continue to address the issue of pyridostigmine bromide not only in relationship to our knowledge of it causing acute illness among the substantial proportion of people who took the drug in the Gulf as a nerve gas antidote enhancer, but also in relationship to unexplained illness. While, as you all noted, pyridostigmine bromide did not appear in our final model, and we do not believe it is a significant factor in terms of explaining our particular population, we have done a study in which we -- we have done a sub-study, a sub-analysis, in which we have examined the relationship between pyridostigmine bromide and this combat exposure score. And to cut to the quick, we find that the chance of experiencing a PB-related illness was greater -- using the PEHRC definition, was greater if there was a high Keane combat scale. And looking at the CDC definition, it's more amply confirmed there. That is, all other things being equal, if you just put out these two factors, it does seem that illness -- that is, self- reported illness, self-reported symptoms -- can be related to exposure to pyridostigmine bromide in the presence of excess or an increased level of -- increased score on this combat scale. But again, it does not appear in our final model.

Now, in conclusion, the first conclusion we would offer is that the CDC multi-symptom case definition parallels but is more conservative than the PEHRC case definition. We would recommend use of the CDC case definition instead of our definition, for future studies.

Secondly, cases of unexplained illness are found among veterans in our population who served in the Gulf before, during, and after Desert Storm. Factors causing illness were therefore or, therefore, appear to be present throughout the period August 1, 1990, through July 31, 1991. So that again, we have called upon the VA nationally to confirm and extend those data because of our small numbers in that particular analysis.

Thirdly, the presence of cases before and after the combat period appears to be incompatible with an etiology associated with exposure to chemical warfare agents or use of investigational vaccines or drugs such as PB.

Fourth, among veterans who report high combat-related stress, however, the use of PB was associated with a significantly higher odds of being either a PEHRC case or a CDC case. This association was not found among veterans who reported lower levels of combat stress.

Fifth, we were interested in looking at the interaction of a number of chemicals used in the Gulf. We find from our data the self-reported exposures to PB, to the insect repellant DEET, to the insecticide (inaudible), or to organo- phosphates which you will recall turned up in flea collars in those very few veterans who now use those collars, but none of these materials enters in the multivariant case model using either the PEHRC or the CDC case definition. And finally, for veterans of similar age and gender, self-reported exposures which we have characterized as some insect exposure, plus medical attention/treatment, plus what we've called combat exposures, seem to explain approximately 40 percent of the multivariant case model using the CDC definition. I thank you very much for your attention and for the honor of presenting before the Board. I apologize for the quality of the material, in terms of the slides that I presented, but we did want to present this important group the latest available data that we had. Thank you.

SECRETARY JESSE BROWN: Thank you, Dr. Spencer. Can someone check his mike, please? Thank you very much, Dr. Spencer. Do any of the Board members have any questions?

RADM ALAN STEINMAN: Dr. Spencer, thank you for that interesting presentation. Just some comments and questions. Can we have copies of the slides?

DR. PETER SPENCER: They are available for you.

RADM ALAN STEINMAN: That would be helpful. A couple comments, observations, regarding the predeployment of symptomatic patients in your cohorts. It seems to -- that would seem to match the findings of the Goss-Gilroy study that the Canadians carried out. Are you familiar with that?

DR. PETER SPENCER: Some of them.

RADM ALAN STEINMAN: In which they had -- among other things, they found that one of the Canadian destroyers had a complete change-out of crews before the shooting started. And they went and looked at a comparison of the incidence of signs and symptoms among the two groups (inaudible) to fighting when the destroyer (inaudible), they found identical (inaudible) found interesting.

DR. PETER SPENCER: Pardon me. You used the term "predeployment."

RADM ALAN STEINMAN: I'm sorry. Pre-Desert Storm.

DR. PETER SPENCER: All of our veterans were deployed to Southwest Asia (inaudible), pre-combat.

RADM ALAN STEINMAN: Pre-combat is what I meant to say rather than predeployment. One of the interesting findings I found in your data, and it's hard to explain, is the exposure to the sun. Why would that -- why do you think that would lead to a higher incidence of signs and symptoms among cases of controlled?

DR. PETER SPENCER: Extremely difficult to explain, and what I can say is simply conjecture. First to say that we assembled together some seven symptoms which were consistent with exposure to the outdoors, and we refer to that as exposure to the sun. You'll notice that that particular exposure coalesced with reports of insect bites and problems associated with insects. It is reasonable, then, that those would coalesce together, first of all. The second point would be that it would not be inconsistent -- if I can use another negative -- it would not be inconsistent with exposure to some transmissible agent from insects associated with bites. However, we have no evidence to support a transmissible agent. We simply didn't look. We do know, of course, that malaria was extremely uncommon. We do know that Leishmaniasis could occur; was extremely uncommon. There were some suggestions that there might have been higher exposure using some serology data, but there was no evidence of active infection amongst the vast majority of subjects that we looked at. Another possibility is that exposure to sun leads to dehydration, and dehydration will result both in loss of water, of course, but also loss of salt. And there is one material which can express toxicity in the setting of both dehydration and loss of salt, and that is actually the bromide components of pyridostigmine bromide. And I've recommended to the Department of Defense many years ago that they consider utilizing pyridostigmine chloride instead of pyridostigmine bromide, to avoid the potential toxicity associated with the bromide (inaudible). Having said that, we don't have any evidence other than conjecture to wonder whether or not that might have been a factor, save one thing; and that is that an early report of the acute illnesses associated with veterans in the Gulf, a study which looks at the presentation of tens of thousands of people following exposure to pyridostigmine bromide, and you will recall that the large majority of those people had mild, acute illnesses associated with the pyridostigmine anticholinesterase component. But that report does note that a very small number of people did have exposure to -- excuse me -- did have symptoms consistent with bromism. It's been completely forgotten, but here we are. It is noteworthy, I think, that when Europeans go to fight in the desert, Europeans tend to swallow salt tablets every day and Americans don't seem to do this. One wonders whether that might be a factor. It's a long way of saying I have not the foggiest idea of what the importance of those individual factors are. I have purely speculated and I wouldn't want to (inaudible) speculation.

RADM ALAN STEINMAN: Just another couple comments, vis-a-vis the RAND reports released today sort of backs up one of your findings in that the combination of stress and PB seem to be associated with higher incidence (inaudible) at least theoretically based on some previous studies that those two cofactors can work in synergy to produce (inaudible.) The one thing the RAND report did is they seemed to have ruled out bromism as a cause, based on at least the review of the literature.

DR. PETER SPENCER: I have not had an opportunity to read it. I'm delighted to hear that. Thank you for that information. With regard to the question of stress, there is a small number of animal studies which suggest that exposure to pyridostigmine bromide in the presence of physical stress might increase the penetration of the pyridostigmine bromide to the brain, resulting in depression of cholinesterase. I'd like to see these confirmed and extended in terms of regional brain cholinesterase changes. But indeed, as you point out, although we do not believe that pyridostigmine bromide is a prominent component of the cause of this illness, there is, nevertheless, evidence that individuals who had a severe -- who reported a high combat exposure value did seem to have an increased risk of being a case relative to those who have a low combat exposure value, both taking PB.

DR. VINH CAM: Dr. Spencer, just a very quick question. Are you pursuing any other research now related to the Gulf War diseases?

DR. PETER SPENCER: Research other than Gulf War diseases?

DR. VINH CAM: Yes.

DR. PETER SPENCER: Oh, yes, indeed.

DR. VINH CAM: Would you care to let us know those, briefly?

DR. PETER SPENCER: My particular area of interest concerns the adverse effects of chemicals on the nervous system. And my research looks at a wide variety of chemicals, either natural or synthetic, in relationship to a whole variety of neurological conditions.

And one of my pet hobbies is to try to understand why on the island of Guam there has been an extraordinarily high prevalence or incidence of a terrible degenerative disease which has features reminiscent of those that we see among people with Lou Gehrig's disease, Parkinson's disease, and Alzheimer's disease. And I hope that by understanding the etiology of this clearly environmentally driven, (inaudible) neurodegenerative disease, we may not only contribute to the health of the Chamoro people of Guam, but also lay light -- shed some light on the etiology of the lookalike diseases worldwide. We have not forgotten that 2 million U.S. servicemen passed through Guam after the Second World War and 10,000 construction workers. And we are aware of the potential of looking at that population for the possibility that they might have also been exposed to factors that we suspect are driving that disease in Guam.

So, yes, I do look at other things other than Gulf War illnesses. I might say that I'm privileged to be asked to assist the VA in their current goal to understand if Gulf War veterans are experiencing a higher-than-expected level of amyotropic lateral sclerosis. And it's my understanding that the study will be moving forward along those lines to assess that particular problem.

SECRETARY JESSE BROWN: Thank you very much, Doctor. Does anybody have any questions?

DR. ARISTO VOJDANI: May I make a comment?

SECRETARY JESSE BROWN: Yes.

DR. ARISTO VOJDANI: I don't think, based on serology data, you can exclude infectious agents because -- I don't think based on serology

SECRETARY JESSE BROWN: Can you identify yourself?

DR. ARISTO VOJDANI: My name is Aristo Vojdani. I'm one of the presenters later on. I don't think based on serology data, you can exclude infectious agents. There are many articles in scientific literature, when serology is done, 50 to 55 percent of cases of Lyme disease and chlamydia are missed if serology alone is done. But when they use DNA technology such as CCR, 95 percent are detected, only 5 percent are missed.

DR. PETER SPENCER: I think that's a fair comment. I'm in total agreement.

SECRETARY JESSE BROWN: Thank you very much, Doctor.

Dr. Russell?

DR. JOHN RUSSELL: Good evening, everyone. I'm honored to be here. I first must correct our Honorable Secretary. I'm a Cougar, not a Husky. My colleagues would be furious over that. First of all, let me show you -- I want to give you a bit of history about what the United States Transuranium and Uranium Registry is and what it does and what it has done and how that relationship to depleted uranium comes about; and that is because they are all alpha emitters. The name itself, transuranium and uranium, means "greater than uranium." We're talking about products not only of uranium, but heavier than uranium, as well.

Can I have the first slide? Maybe it will work better this way. I was still a student at the time working part-time at Argonne Laboratory in suburban Chicago when the affidavit was going around in the early to mid 1960s to encourage the EEC to form the National Plutonium Registry. And that was primarily driven by the enormous amount of animal data that was accumulating on the toxicity and pathology of primarily plutonium and americium in animal systems; rats, mice, and primarily dogs. Several years later, the sister registry, the United States Transuranium Registry -- or excuse me -- Uranium Registry was formed to complement these studies ongoing on plutonium. And several years after that, they were combined for the sake of saving money and because the primary interest of both registries were exactly the same.

Could I have the next slide? Anytime you deal with people instead of animals, you have a variety of problems that you have to deal with. And some of you in the audience may be familiar with some of the extremely horrid and bad publicity that the registry has encountered over its 30 years or so of operation. And partly the early registry program brought it on itself because, one, even though we knew our existing worker population at the national lab systems primarily and some of the lab contractors, like the uranium -- various uranium mine corporations and businesses, many medical professionals realize that chasing the ambulance is really a bad label to get, but ambulance chasers, as lawyers, suffer that same problem. However, in order to get to the people you're trying to help, you have to have some vehicle in which you approach your worker population at large.

Normally our operation is we do not approach any worker directly. That is done by their health physics programs and/or their medical programs at their facilities. All of our forms are examined by the Washington State Attorney General's Office to make sure they are legal and to make sure that there is no verbiage in it that is confusing or potentially confusing to our registrants. And since 1992, when I joined the program from Argonne National Laboratory and we brought the program from the Hanford Environmental Health Foundation to WSU, it was an effort to try to change the image of the program from the horrid public impression of the program stealing bodies, and we still -- in fact yesterday, there was a report in the paper where some newsman was asking some former uranium worker and he was saying someone from the registry tried to buy his body back in the early 1980s. We still suffer those same kinds of problems. But generally, this is the outline in which we follow. We're constantly enrolling new registrants. Unfortunately for statistical purposes, we know our population of registrants is extremely skewed. Many of our registrants openly tell us, "We joined the registry because I'm sick and I used to work 30 years at Hanford or Mound or Los Alamos." So for that reason, in order to try to utilize that data for epidemiological purposes, it was absolutely useless because of that skewness of this population. We also have individuals who tell us they join the registry simply because their loved one who was the former worker is gravely ill and they need the autopsy done and because we will pay for the autopsy. And unless -- when I tell them that unless your loved one has positive bioassay readings during their deployment years and/or a significant exposure of (inaudible) or greater, they don't qualify. But we still have people who call five, six days a week, trying to find some way to avoid burial expenses or whatever. And we have to tell them, "Hey, we're not a government subsidy program that, you know, provides you with burial opportunities."

Can I have the next slide? We also instituted, back in 1992, a renewal program. And that was -- we were getting calls after I got there from people who had joined the registries, like I was still back in the '60s as a student, and they had never contacted the registry's office again. And, you know, people retired and moved to Florida; they moved to Puerto Rico, Mexico. We've got registries all over the states and several foreign countries. And when they move, of course, they don't send us an address, no phone number, or anything. So the program registrant list at the HEHF -- Hanford Environmental Health Foundation -- made it routine that if you didn't contact the registry office every other year or so, they would throw your records away and shred them because it was too costly to keep them going. So we still occasionally will have a registrant's family call -- invariably it's at night, Friday night -- and tell us that the person is dying and they have this old registry card from 1982 or whatever. And of course, I go to my computer file and I can't find that person anywhere, simply because they've never kept contact with the program. And so in those cases, because legally all of our forms are out of date and/or nonexistent, I can't take that person, even if they did have a good bioassay exposure record at their facility, simply because legally we have no legal right to have that person's tissues and/or his body. So we have a lot of different pieces of information that we have to keep updated on in order to maintain our legal standing in handling and working with registrants.

Next slide, please. Some of the special long-term studies I've outlined here to tell you some of the other things that the registry has done and is doing. I've written a number of papers here in the early, mid 1990s on thorotrast distribution and retention. Some of you probably don't know what thorotrast is, but thorotrast is a thorium dioxide solution that is extremely good in terms of an X-ray contrast medium. That's what it was used for back in the '50s, '60s, and even in the '40s. The only problem was, they didn't realize that thorium is radioactive and it has a half-life in the tens of thousands of years. And unfortunately, there are thousands of Europeans, Japanese, and Americans walking around with deposits of thorium in them from medical procedures that were done on them decades ago. In fact, the last thorotrast patient I had -- most of these -- because it is a particulate material -- that is, it aggregates once it's in the system -- it picks up very commonly like all aggregate materials and particulate materials, it's concentrated primarily in the reticuloendothelial system. That's the bone marrow, spleen, liver, endolymphatic node systems. And because it is radioactive, it radiates the person from day one. And because it is particulate also, it's -- very little of it is excreted from the body.

However, what we're finding is not only in our studies here in America, but in Europe and Japan as well, the maladies suffered by these people are very similar. That is, they either die of liver cancer or a variety of blood (inaudible) and/or leukemias. And we use some of those studies to look at and determine our output risk coefficients. They also have an ongoing program for whole body counter. That's what in vivo counter calibration is. And we're looking at endogenous uranium distribution levels. Most people don't realize that from day one on this planet, man has been irradiated and is being irradiated, both extraterrestrial radiation as well as the radiation from the various rock strata that we're exposed to every day.

Anyone in this room, if you were counted in a whole body counter, you would almost certainly have a spectrum of a small amount of uranium and a small amount of plutonium, because plutonium and all the weapons testing has fallen out, no matter where you are in the world. And if the whole body counter you are being counted in is sensitive enough, it will pick that spectrum up. So you can't get away from it. And we also need to look at the pulmonary deposition and clearance and how it's affected by one's age, one's sex. And of course, we have published several papers on how that deposition and clearance mechanism is affected, especially if you're a smoker. Cigarette smoking seems to alter one's ability to clear some particulate and some ionic material from the lung tissue itself.

Next slide. So we're constantly looking at ways to improve our biokinetic models for the actinide compounds. And we're doing constantly comparative biokinetics, like I said, with plutonium, the different isotopes of plutonium, and histopathology and its deterministic effects that we see. And we're beginning to move into the oncogen and biomarker studies. We also have an ongoing program in which we're trying to and are very close to starting, a graduate program in nuclear pharmacy. Most people don't realize it -- and they probably don't in this medical facility -- that there are only two university programs in the entire states that produce a graduate candidate in nuclear pharmacy. Most people in pharmacies who handle radioisotopes learn it on the job. The institutions are the University of New Mexico and the others are Purdue. Our program hopefully is going to start at Washington State and the Tri Cities next fall. But we're looking at -- that's what the -- the NHRTR is our National Human Radiology Teaching Repository, and the NMWG is the Nuclear Medicine Working Group, of which I was a member and am still a member. And we're trying to get our nuclear pharmacy program off the ground. And it fits very nicely with our overall study program, what the registries are about.

Next slide.

As you can see, we've even experimented with looking at some of the monoclonal antibody compounds that have been used experimentally in cancer therapy. For the sake of time, I'll skip the rest of that and go to the next one.

Here's an outline of what kind of program funding we have on the various programs that we're involved in. Our basic grant is here on the top, and that comes out of a branch of DOE. And that's roughly a million dollars. And that funds most of our core program research on seeking registrants who are former workers at these various facilities that I mentioned before. We have the second program of 260 or so mill 260,000 rather, is an international health program (inaudible) study that we have going on with the Russians. And oddly enough, those -- the next program, as well, the $112,000 Russian tissue repository, that's at the Mayak facility in Ozersk, which is at the southern tip of the Urals. And in fact, for those of you in the military, it is in fact the site where Francis Gary Powers was shot down photographing back in 1959. Our program people, including myself, were there last year. And I'll show you a little data a little later as to why we're interested in their particular program. That facility was built within a matter of two years or so after Hanford was put together, and it was laid out almost exactly the same because of various pieces of information they were gaining as fast as we were producing it. And then we have a small $50,000 grant from a different branch of DOE in which we have become the repository for all of the computer records from the decades of animal research that was done at the various universities and national labs around the country. And since those programs were terminated in the early 1990s, some of which the studies were not finished even yet, we archived all of the record information and some of the tissue samples in paraffin primarily, and some of the pathology slides. And we've had a number of requesters to use, you know, samples from the facility collection based on what it was that the individual scientist was doing. And we have some collaborative work with another colleague of mine named Tony Brooks, who used to work at Loveless in New Mexico and then he worked at Hanford P&L site and now he's on the faculty of WSU.

Next slide. As most of you would realize, our cohort of registrants are very old for the most part. And that's what one would expect. It's very difficult to try to encourage someone who is in their 20s or 30s to join the registry and in hopes of if they get contaminated on the job, that sometimes, many years later when they've retired, that we might to want look at the retaining compounds that are in their organ systems for some speculation in biokinetic parameter studies and/or pathology studies. So for the most part, our cohort is relatively old. Most of our people are 60-years-plus. And what I've calculated here are the probability of deaths per year in these five-year increments, or death statistics.

Next slide. And in fact, I had this slide made for something I did earlier in the summer. These are our registry stats as of June the 30th. And you can see that we have a total of 901, and we have living registrants. Inactive registrants are those individuals who at one time joined the registry, may have stayed in the registry for years, and then their spouse or whatever changed their mind and they withdrew. And when they do that, we have to destroy their records, but we do keep tabs of who they were and keep account of them.

We have to try to encourage DOE that it isn't anything that we have done necessarily, per se, as a registry to make these people withdraw. They simply do that on their own. And it's also a benefit to individuals who want to change their mind. And once they sign those documents, they can still change their mind. And I also give them the opportunity that even when they have died and their spouse after the individual's death says, "Gee, you know, I really didn't want Fred to sign that and I don't want to have him autopsied," we allow them to do that, even though legally we don't have to because their signatures are on those legal forms. But we allow them some measure of comfort of allowing them to do that. And the bottom plot here is our computer site, that you can access through the Web. We like to keep track of how many individuals take a look at that per month, and you can see the activity ranges between 400 and 500 tabs a month. So it gets quite a bit of activity. And it varies, you know, during the year.

Next slide. This is a comparison of what our information is so far. And we've autopsied, you can see on here, some 250 or so individuals since 1968, looking at the distribution and retention of plutonium and/or americium. Not so much uranium because they have been very hard to get a hold of. I'll talk about them a little in a moment. But we compare our statistics to what the International Commission on Radiological Protection, ICRP, what they propose and what we are actually finding in people, because much of that data that the models for the ICRP are based on were primarily animal studies. And in our case, because we do get a number of people who are whole body donors -- that is, they actually donate their entire body to scientific research. We've had, in fact, two physicians over the years that I have been there who have donated their whole bodies to research. And you can see that the distribution and retention of the skeleton and liver, they're reasonably similar. They're about 45 percent. And we have found that the muscle and the rest of the body somewhere between 10 percent, plus or minus a couple. But the residence time, we have found some differences between what we are actually seeing, because again, we have whole bodies, many years postexposure and the ICRP didn't have that advantage. And we're finding that the residence time is running down around ten years or so in our program.

Next one. And this one is for americium, the same picture. And again, what we're finding primarily is that americium is retained actually a lot shorter than plutonium, per se. Americium for the most part is a lot more soluble. And what it comes down to is most of these compounds, the more soluble they are in the physiological systems, the more readily they are eliminated. And it makes sense. But these are the dynamics of what one actually sees. And by knowing these parameters, one can then calculate back calculate what you think. If you know the day and/or month and/or time of the exposure or accident, you can get some idea of what the dose would be if you knew that 45 percent or so of the intake versus what's in the urine and/or feces, you can get some idea of what the intake dose would be in the liver and/or skeleton and/or some of the other organ systems by knowing these different factors.

I'm always asked are we seeing any abnormal causes of death in our registries. And I've had a lot of talks with the downwinders in and around the Hanford facility and they don't like to hear the facts because -- as you can see here, this is out of a paper that was published in 1995 by Baruch Gold, who was a visiting physician/epidemiologist from Beersheba University Medical School. He spent a year with us. And again, because of the skewness of our population, we didn't attempt to do standardized mortality ratios on these people. But the kinds of diseases that we see here in looking at the age and/or sex of the various registrants, the kinds of diseases were those that one finds in an aging, white male population. No real surprises here. And this is in spite of the varying organ doses or body doses that these individuals would have had in their systems. And this was published in 1995 in the Journal of Health Physics.

Next slide. This project 2.1 is the ongoing study that we have with the Russian population at Mayak. And one of the reasons is, as you'll see in a moment, they didn't have any kind of a health physics control protection program whatsoever in their early years. Their personnel who are still alive, and those who are dead, suffered enormous intakes compared to the average American individual who is in our registry. And I mean by the order of magnitude and greater, as you'll see in a moment. So it is an effort by us that, gee, you know, we can not only enlarge the case number of our cohort, but we can also get some dose characteristics at a very wide range now. And that will help overall in terms of looking at our dose distributions: Are they in fact altered by a greater amount of retained plutonium in these tissues? One would assume that if you have greater irradiation per day, per year, etcetera, over time, that the tissue damage consequently ought to accelerate some of the excretion. Would one actually see that?

The next slide. Let me preface this by telling you it was at a meeting an international meeting in Vienna in 1993, and my colleague and the former director of the registry, Ron Kathren, who was a physicist, was at a meeting in Vienna and he presented all the wonderful information of the USTUR (inaudible), and a Russian colleague gets up and the person presents information about the Russian registry. The other Russian people who were there didn't know about the Russian tissue program. It, in fact, had been going on almost as long as our own registry, but it was entirely secret.

What we see and have learned now -- this stands for DRMIA, is the Dose Reconstruction at the Mayak Industrial Facility. They have about 1500 cases -- they've got about a thousand cases with body burns greater than 1500 becquerels. They have some autopsy program of some 870 cases, as you can read, who have body burns between 40 and 175 kilobecquerels, and americium going all the way from two to four and a half kilobecquerels. And down here at the bottom, you see our body burns are primarily 500 becqs and below. So if you can't find anything wrong with people with 1700 becquerels, you can forget about looking at someone who has 0.1 nanocurie or whatever.

Next slide. This is a plot of liver concentration. And what you see -- in fact, when I first saw this, my first thought was the Russians either have very insensitive instruments because they can't measure anybody down at the 500 becquerel level and below, or they have so many of them, they're so common, they forget about them and only count the people with the higher body burns. Because what you see on the left are the USTUR cases and you see the liver concentration goes from 0.003 up to about 0.10; maybe a couple of cases there at 30. And all the rest of those crosshatch marks are liver concentrations in Russian workers.

Next slide. My work on the NCRP Committee 5717, they're charged with coming up with a model and the biokinetic parameters for describing what actually happens when a soldier experiences a wound from depleted uranium shrapnel and/or any other of these particular actinide compounds. So our first job is to look at what we think the kinetics would be in the various parts of the physiology of the system that we would have to then try to model. And what you see here is we have an accidental injection; or in this case, a soldier would get a puncture from a fragment. Some of that fragment would be soluble, some of it would be insoluble. We also know that by talking with Dr. McDiarmid of the University of Maryland Medical School, who are doing the clinical follow-up studies on -- I think there's 32 or 33 cases who actually had been documented, by bioassay, to actually have shrapnel in their bodies. And some of that shrapnel isn't depleted uranium; it's steel and certain other casing materials from the various weaponry. But on the right-hand side, you see where (inaudible) becomes soluble. There are some studies in primarily our (inaudible) systems which we know that the soluble to colloidal component does occur and in fact it can be resolubilized, and that can go on and return to the blood. The colloidal material is in limbo; depends on pH of the system, the amount of bicarbonates, and other buffers that are in the blood and the concentrations of the materials. And the other avenue is from the particulates to be held up in the lymph nodes, primarily by phagocytosis. Some of that material, again, if it's partially soluble, like uranium will oxidize real easily, and some of that stuff ends up -- unless it's a highly fired oxide, ends up into the blood.

Next slide. Now, along with that schematic that I just showed you is this particular schematic in which I'm looking at physiologically, pathologically, what's going on in the tissues when an injury occurs. So we have to model that. And what we see is we have cell injury, you have a loss of cell contact, and you have some cell repair of the activity. You have an infusion of neutrophils, monophages and monocytes and macrophages and (inaudible). And that's what most people realize. But you're also getting some beta-transforming growth factors coming in here. And see on the right-hand side, you have some decreased activity in cell turnover rates and activity. And you can see the two pathways that one follows here, coming down to hyperplasia, etcetera. But now what we have to do, mathematically speaking, is by using the clinical information that we have on how much activity in terms of counts per minute of uranium or americium or plutonium would be available in these various component areas in order to build the biokinetic model. And that's where we are at the moment.

Next slide.

DR. VINH CAM: Just curious, did they ever measure levels of (inaudible)?

DR. JOHN RUSSELL: Yes. The clinical study at McDiarmid, I haven't seen any alteration whatsoever. In fact, the first long-range study was published last year, August or September, in the Journal of Health Physics, on those particular 33 veterans. Here I'm looking at -- the enormous population of people that we have in our registry, primarily their mode of intake, accidental intake on the job, has been through inhalation. We have a small number of people, primarily machinists, who have punctured their finger while they were machining, you know, plutonium metal or uranium or one of the other materials. And then we have a combination of individuals who have suffered both; that is, not only during months and years of work they were involved in small inhalation intakes, which we would call chronic. And we have a few registrants who we know from bioassay that suffered inhalation in an acute form; that is, only one. And we know the exact date of those occurrences. So what I've modeled here is looking at what kind of concentration in primarily the bone, liver, and remaining tissues soft tissues -- do those concentrations look like years post- retirement. And this is for wounds.

Next one. This is for wounds and inhalation, acute. That means the guy got an snout full one time, one day. And what does that concentration look like? And you can see it's settling around ten years post. And then there's an outlier way up there. I haven't had a chance yet to find out who that case was and what's wrong with that data point; is it in fact real and can I come up with a scientific explanation for that.

The next one. And here's wound and inhalation, chronic. That is, the worker accumulated, because his bioassay was partially positive, only this month and five months from now, two years from now, and there was no real large single intake in his records of bioassay, he's listed as a chronic person. That is, he has -- his work involved handling plutonium materials throughout his work history, every day, every week. And what we see is we only have three cases in our registry who fit this profile. And they are really quite spread around.

The next one.

SECRETARY JESSE BROWN: Doctor, we have two individuals that have to make presentations.

DR. JOHN RUSSELL: I'll be done pretty soon. This is a summation of the inhalation data for the acute. And what we're seeing here is we're running around 15 years in the concentration. And they seem to be running just above the zero line here. This is another one for chronic, and you can see we're running right above the baseline.

Next one. And this is the retention time for over -- and the ratio of bone to liver. And we use that because we do know that over time, as uranium, americium, plutonium, and a variety of other actinides, as they solubilize from your lung or other wound site, over time they will slowly translocate to the bone and/or liver. So once we know what that bone and/or liver ratio is, we can get some estimation of knowing what the kinetic picture looks like to be able to back calculate what the various organ doses probably were during the actual intake and when, in fact, the intake actually occurred.

Can we have the next one. Okay. For those of you who might be familiar with the Sequoia Fuels accident, this is the best piece of information I can point you to in terms of what actually has happened in a reasonably large group -- I think it was 31 individual workers who were exposed to uranium hexafluoride in an accident at the Sequoia Fuels in Oklahoma back in 1984. And I won't go into the details of that study, but what actually happened was, of those individuals, the worst two cases, one person completely -- died on the scene, and that was because uranium hexafluoride hydrolyses very quickly on contact with moisture. So that means moisture is in your eyes, your throat, your nose, and of course in your respiratory tree. And hydrochloric acid is very potent stuff. It corrodes and will scar all of that lining tissue -- eyes, nose, and everything else -- in addition to burning your arms and limbs.

But the bottom line is, of the -- I think the 17,000 milligram intake in the worst-case scenario of one of these workers, two to three months after that exposure accident, that person was completely normal in the clinical sense. And I don't think any of the individuals that I have seen of the veterans fit anywhere near that order of intake of uranium. And of course, you've got to remember, uranium is uranium. When we say depleted, we're simply talking about it because primarily the component of the activity has been taken out of it. But chemically speaking, it's still uranium. Any questions?

SECRETARY JESSE BROWN: Yes, I have one question. Very fine presentation. Can you tell us, in language that I can understand, whether or not, based upon your evaluation of all of this information, if there is a relationship between the problems that our veterans from the Persian Gulf War are experiencing and depleted uranium?

DR. JOHN RUSSELL: I would say radiologically speaking, of the data that I saw -- in fact, our NCRP committee had McDiarmid come and talk to us last fall so we could see what that clinical information looked look like before it was published. But data we saw from the bioassays and fecal measurements, what few there were, I would be hard-pressed to say the physiological problems that those soldiers are experiencing have anything to do with depleted uranium.

SECRETARY JESSE BROWN: Thank you.

Dr. Vojdani, do you have --

DR. ARISTO VOJDANI: Yes. The last comment about that individual who had certain levels of uranium and you did not see any clinical --

DR. JOHN RUSSELL: They did the standard blood chemistries --

DR. ARISTO VOJDANI: I know. But just because you didn't see abnormality, that doesn't mean that another individual will be -- will have the same amount and will have some clinical effect.

DR. JOHN RUSSELL: It's possible. It doesn't mean that it's true. It's possible. There is a difference.

SECRETARY JESSE BROWN: Thank you very much, Doctor. Now I would like to --

MRS. VIRGINIA HAZEN: We aren't allowed to ask questions?

SECRETARY JESSE BROWN: Yes, ma'am, but we have two individuals that have to leave by 8:30. Dr. Russell, can you stay for a little while? And we'll get him back up here. But we would like for them to make their presentations.

Mike, will you please come forward?

Mike Kiser from the DAV.

MR. MICHAEL KISER: Mr. Secretary, members of the Board, we appreciate this opportunity to provide some comments regarding the Persian Gulf War syndrome, or illness, as it may be. The DoD has provided to you and to the veteran community that there were approximately 697,000 military personnel in the Persian Gulf arena during the time period in question. And we believe based on this large number, that there is some concerns that a Persian Gulf War veteran may be disadvantaged in the VA system in terms of medical treatment and how their claims are adjudicated. Part of this stems from a narrowly defined department regulation for undiagnosed illnesses. Simply put, doctors are trained to assess and define disabilities, treat these people, and provide them with a diagnosis. The way the regulation currently reads is that the only way a veteran can prevail is if the doctor does not provide a diagnosis. This puts the veteran at a significant disadvantage in his claim.

We believe that there has to be a very close relationship between the VA hospital system and the regional office personnel adjudicating these claims. There are those who would believe that a physician should diagnose and treat a veteran with no concern to the claims adjudication process. However, we believe that an informed physician who considers the veteran's symptoms in relationship to his service in the Persian Gulf may be more inclined to provide an assessment of an ill-defined health problem relating to the veteran's symptoms. This may very well be accomplished by having a case manager, if you will, for the veteran at the VA hospital system versus having to be assigned a treatment team, if you will, and then the veteran goes into a team analysis project at the VA hospital system.

We are certainly cognizant of the fact that it's very difficult to try to treat veterans for an ill-defined illness. Only when a doctor acknowledges his or her uncertainty regarding an ill-defined health problem does the Persian Gulf War veteran have a fair chance at being properly compensated for his undiagnosed illness. Although what I have laid out here is a hypothetical scenario, we believe that Persian Gulf War veterans face a real dilemma in getting properly medical treatment for Persian Gulf War illnesses.

I am certain that the committee is knowledgeable of House Veterans Affairs Committee Chairman, Bob Stump's Secretary to -- or a letter to Secretary Togo West, where he suggested that perhaps the agency has narrowly defined Persian Gulf War illnesses -- or undiagnosed illnesses. It's dated June 3rd, 1998. He indicated that Congress's intent was to service- connect Persian Gulf War veterans who suffer from symptoms of illness which cannot be clearly defined. And this is inconsistent with the provisions of 38 USC 3.317 as it applies to Persian Gulf War veterans.

So we would ask that perhaps the committee can endorse the letter from Congressman Stump's office to Secretary Togo West, that the agency should revisit their regulation on how Persian Gulf War veterans' claims are adjudicated.

The Veterans Administration, under the direction of former Secretary Jesse Brown, acted quickly and decisively to treat and compensate Persian Gulf War veterans for undiagnosed illnesses thought to be related to their service in the Persian Gulf. However, to this date, 7,749 claims for undiagnosed illnesses have been filed under 38 USC 3.317. Only 2,934 claims have been granted. Well, if one takes that percentage of 697,000 veterans and only 2,934 have been granted, that's a percentage of four one- thousandths of a percent.

We recognize that the agency has made a genuine effort to address health-care issues and claims adjudication associated with PGW veterans. However, it appears that the Persian Gulf War veteran is disadvantaged by the very system that's designed to help him.

To highlight Congressman Stump's letter, it indicates on June 3rd, 1998, as Congress continues to hear from Persian Gulf War veterans who believe their health-care problems are of service origin, it has become increasingly apparent to us that the department is too narrowly implementing the landmark legislation initiated by this committee to provide compensation to the veterans.

The Persian Gulf War Veterans Act in 1994 provided for the payment of compensation to Persian Gulf War veterans suffering from chronic disability resulting from undiagnosed illnesses, which become manifest or compensable to grieve within a period described by this regulation. VA regulations implementing that law (inaudible) 38 USC 3.317 effectively limit compensation to illness by history, physical examination, and laboratory tests cannot attribute to any other known clinical diagnosis. It is important to note here that the Congressman goes on further to indicate, "Neither the language of the law nor its clear intent compels so strict a limitation as described above." So I would ask that the committee report out an endorsement of this letter from Congressman Stump to redefine the regulation so that the veterans can receive appropriate compensation through the claims adjudication process, to consider a case manager system through the VA hospital system for Persian Gulf War veterans. And it was heartening to hear Secretary Brown in his opening remarks indicate that he was pleased with the committee report that came out today about the exposure to veterans through PB pills. And in fact, Dr. Spencer's report seemed to support and suggest that same item.

That's all I have at this time and I appreciate the opportunity to come before the committee. Thank you very much.

SECRETARY JESSE BROWN: Mike, before you leave, I have a question here. Do you think this matter could be resolved through a clarification in the Physician's Guide? I guess the VA has a Physician's Guide.

MR. MICHAEL KISER: They certainly do. And they use the Physician's Guide for compensation and pension examinations. Perhaps a rewriting of the Physician's Guide when addressing particular claims -- part of the claims process problem may be -- I believe that there are more than 7,000 claims that have been filed for Persian Gulf War illnesses, but it's how the claim is actually brought forward to the regional office and by the veteran and the representative.

If, in fact, the veteran sought treatment for these disabilities in service, then it would be, of course, a direct service connection. However, if there is not any evidence of any disability in service and he files for the condition post-service, if in fact he doesn't use the term "I am applying for an undiagnosed illness condition for compensation benefits," then it's not recorded as such by the VA. But should a rewrite of the Physician's Guide be accomplished to indicate special guidelines for examining physicians, may very well be the answer.

SECRETARY JESSE BROWN: Let me just say for the record, this appears to be outside our mandate, but I'm going to instruct the staff to take a very, very close look at this and also consult with our attorneys to see if we can express an opinion. At least write the VA and advise them that there is some question on whether or not they are interpreting the intent of the Congress (inaudible).

MR. MICHAEL KISER: Thank you very much.

SECRETARY JESSE BROWN: So we'll do what we can. Thank you so much for bringing that to our attention.

MR. MICHAEL KISER: You bet. Thank you. Any other questions?

SECRETARY JESSE BROWN: Mike Killen from the VFW.

MR. MICHAEL KILLEN: Secretary Brown, the committee members, my name is Mr. Michael Killen and I've been asked to represent the Veterans of Foreign Wars here in the statement before you. I've been given a few minutes to speak to the committee, and I'd like to thank the committee for allowing me this time.

The Veteran of Foreign Wars continues to urge the Department of Defense and the Department of Veterans Affairs to provide health care for all active-duty military veterans whose health has been adversely affected by the Persian Gulf War, and to continue to conduct all necessary tests to determine the cause of these illnesses.

The Veterans of Foreign Wars continues to urge Congress to adequately fund appropriate medical and scientific research, and the Department of Defense, Health and Human Services, and the Veterans Affairs to implement all relevant laws that support such research effects into the causes of these illnesses.

So it's a matter of coincidence that I come before you this evening as the report was submitted and published today. This goes on to support the VFW's stand and position that -- the need for continued research and testing and studies of these illnesses.

This study does not rule out the possibility of the PB pills, but it goes on to say we need further studies to look more into this and many other illnesses that affect many Gulf War veterans that have suffered from -- suffering from as a result of their service.

I wrote this (inaudible). I'm trying to wing it as I go.

SECRETARY JESSE BROWN: Take your time.

MR. MICHAEL KILLEN: I appreciate that. We are not only looking to the causes, but we're looking to the treatment, as well, of the illnesses or manifested symptoms of illnesses that many Gulf War veterans suffer from as a result of their exposure to various toxic substances and environmental hazards during the Gulf War. The VFW will continue to closely monitor this issue and to continue to urge appropriate corrective action as needed with regards to the Persian Gulf War veterans and their illnesses. And once again, I'd like to thank you for allowing me this time this evening.

SECRETARY JESSE BROWN: Thank you very much, Mike. It was good seeing you again. I guess I can speak for the Board on your observations that we concur with the need for further research until we find the cause of these problems and, as a result, we can work out an appropriate treatment plan and also use that information to develop an appropriate public policy to prevent further exposure to our citizens. So thanks again for your fine comments.

MR. MICHAEL KILLEN: Thank you.

SECRETARY JESSE BROWN: I'm going to ask Dr. Russell to come back up because I know there were some people who had some questions. And then we'll move to the next presenter.

Dr. Russell from Washington State.

DR. JOHN RUSSELL: There you go.

SECRETARY JESSE BROWN: Mike, Dr. Cam would like to ask you questions before you leave.

MR. MICHAEL KILLEN: Yes, sir.

DR. VINH CAM: I just wondered, are you aware that there's a number of treatment programs that have been undertaken by the VA?

MR. MICHAEL KILLEN: Yes, ma'am, we are aware of that. And we will continue to (inaudible) seek further treatment of these illnesses.

DR. VINH CAM: Thank you.

MRS. VIRGINIA HAZEN: We're from Tri Cities as a matter of fact, so we try to keep up with what's going on over at Hanford. And one of the things that was expressed in the newspapers in that area was that low levels of radioactivity are much more harmful low levels of radioactivity are much more harmful than a large insult. Just like if you had a large insult of Infection to your body, you get over it, it's done, it's over. But when you are exposed on a routine basis for long periods of time to something, it continues to attack your systems, your organs, or whatever. And I was wondering what you thought about that.

Because -- let me tell you why. Because a lot of reservists get second-best in this country for training purposes. And when the active duty use MOPP gear to train and fire and use depleted uranium weapons, a lot of times those MOPP suits end up being given to us to train with, and they're just loaded with the aftermath of the whole thing; the powder or the fragments or the radioactivity or whatever. And there's so many different ways that these people have been exposed to things. And the other thing is that I understood that when firing these weapons, that sometimes the depleted uranium actually are almost, like, vaporized so that they get

DR. JOHN RUSSELL: It does.

MRS. VIRGINIA HAZEN: -- in the lungs, they inhale it. Therefore, they go home with this and they become sicker over a period of time, as well. And of course, it's all the other stuff they were exposed to.

You know, it doesn't take a rocket scientist for the American people to look at the screen and say look at these kids over there who were hyped up, ready to go, not scared, and did a great job, it doesn't take a rocket scientist to figure out that all the smoke that we saw, all that stuff that we saw, was going to make these kids very sick when they came home. I don't know why they keep reviewing the reviewed and the reviewed, the same old material. The gentleman that spoke a while ago from Portland -- you know, I tried to get on the registry. I've been trying so hard for almost ten years. And because there are so many of us who didn't set foot on the soil, we're denied that. And I don't know how you can honestly say that a study an adequate study has been done without control groups, without finding out the link between those who were prepared for deployment and those who actually were deployed. Those who prepared for deployment were exposed to just as many things. They were given injections, as I was, and now I'm at a point where my liver is involved, my pancreas is involved, I'm taking insulin, my spleen is now enlarged as of last month. I've had rectal bleeding. I've lost hair. And I'm going to continue to lose my hair, I was told about two weeks ago. I've lost my teeth. I'm losing a lot of calcium from my bones. Sounds like a lot of different things: Vaccines, viral, or a combination, or our training. Because I'm telling you, that gear we put on was totally second-best. I mean, we get the dregs of everything when we train in the field.

So I just thought I'd throw that out there for you. And I really recommend don't stop now, please, for God's sake. I don't know if you know a woman named Liz Schlumberg. Very nice nurse, loved life. (Inaudible) she got sick before she left. She said on her way she was feeling ill. Well, my friend Liz spent two weeks in the VA Seattle intensive care unit on a ventilator. She died last month. The same month, another young man died, 27 years old, started out (inaudible), ended up with a wheelchair and shot himself in the heart. Denise attended that funeral. I didn't get to attend my friend's funeral because I live about 500 miles away from here. I didn't know about this meeting. I don't know how you can call this a substantive meeting. There were -- I was told there would be 200 people here, but they're all people -- I don't see any veterans sitting back there. I see a couple, but I don't see them. And the word does not get out. All the money that you spend going to all these meetings, flying planes, eating good food, going to nice hotels, and rereading the same garbage, because we didn't learn anything new today. I don't know about these people back here, but I didn't learn anything new today. And it's scary.

Our families are getting sick. My daughter is sick. A very active young lady. She has her own horses, breeds them; jumps from airplanes; she's a nurse; snowmobiles. This whole past year, she has been acutely ill and can't work. And the last medication we paid for her, $500 for 90 pills. That is one sick kid. And I'm very sick and I don't know how much longer I'm going to be here. I don't know how I can help my daughter. But by God, I'm madder than ever because my daughter is sick now and her son, her three-year-old. And, you know, I don't know what you expect us to wait for. Ten years? My God. It's unbelievable. But I would like you to get the word out for these meetings a little better, because you've got to hear from people. Some are so sick, they can't get here. (Inaudible) changed from the University of Washington to here. They don't know. They're sick. Most of us are home most of the time.

SECRETARY JESSE BROWN: We're going to have to --

MRS. VIRGINIA HAZEN: I'm sorry. I just wanted to throw that out.

SECRETARY JESSE BROWN: No, that's fine. I would like to ask Dr. Russell to comment.

DR. JOHN RUSSELL: I have a comment to make, please. As I was saying, radiologically speaking, from what levels of depleted uranium I have seen in these 31 follow-up cases, the levels radiologically just can't be solely responsible for the whole spectrum of maladies that I have seen listed that the Gulf War veterans are suffering from.

However, let me preface that by saying this: When I was at Argonne back in -- I think in '84/'85, a couple of my colleagues and I, Dave Gredena and Carl Braino, we did a series of experiments in rats in which we used multiple insults to the animals to look at what the effects might be in terms of inducing pre-cancerous lesions in their livers. And we did that by using a standardized protocol we've been using for several decades, and that is the administration of a very small, very small, microgram quantity of known liver carcinogen, diaphalmytrocamine (phonetic). And we followed that by a whole body exposure to either gamma or neutrons in our reactor. And because of cost, we had to cut the experiments off at a hundred days. But what we found is that it didn't make any difference which element of our insult came first; we actually did see a synergistic response in the number of pre-cancerous lesions in the liver of these animals.

Unfortunately, the proposal I sent in to NIOSH and DOE didn't get anywhere. And I'd sent in one in 1995, in which I wanted to screen as many of our archived liver and lung samples in our repository for pre-cancerous lesions and then try to match that up with what we know about the various job activities that our registrants did.

Who were exposed to the solvents in large quantities? What kinds of solvents? Are they chlorinated, halogenated hydrocarbons? Are they (inaudible)? Get some handle on what kind of multiple insults these people might have actually experienced, even though either of them alone wasn't sufficient to actually cause the phenomenon that they suffered from, but maybe multiple insults, either from radiation and chemicals, might in fact produce a very different set of circumstances. And I'm still exploring and experimenting with trying to get that proposal funded now, because we do know that some of these compounds actually do act synergistically and there are a few that actually act multiplicatively.

So it is certainly possible that in a very quick succession, for soldiers who got a whole battery of inoculations and a whole spectrum of materials and then were exposed to an inhalation of all that oil smoke and diesel smoke, etcetera, that might have produced a very different experimental scenario. That's why it's very hard to mock and set up in a laboratory setting, but it's worth taking a closer look at.

SECRETARY JESSE BROWN: Thank you very much, Doctor. Do you have a question, sir?

UNIDENTIFIED SPEAKER: I have a quick question. On your study of the 31 individuals, I was curious. Did you only take into account those service members who were wounded with fragments of depleted uranium, or did you also take into account, in any of those 31 people, anyone who might have been exposed through breathing it while it was burning?

DR. JOHN RUSSELL: I didn't do that study. The Army itself and the VA Hospital, University of Maryland's Medical School, they started with several thousand veterans, as I know. First, the people who were in the theater in the neighborhood of depleted shells before they were actually fired, in the tanks, people who later went into burning tanks, people who were around and nearby burning tanks, and slowly began to cull that number down in terms of who actually did get close physical contact with depleted uranium, shrapnel and/or inhalation of dust. And then they were followed by -- once we identified that population, which has now narrowed down from several thousand people, and so you can get a better handle on who you have to work with, what your cohort looks like.

They did bioassay; and that is, they took a urine sample and then counted it for uranium. And now the numbers come down to very small number, the 31 or so cases. And it turns out in every one I think but one of those 31 cases, they actually still had, by X-ray, small metal fragments of shrapnel still in their bodies. And the questions from the physicians to us was: How small of a fragment do I need to go in there and dig out, which produces a lot of trauma to the patient, when in fact if you can tell me that, medically speaking, that shrapnel piece is so small, and even if it is depleted uranium, it's not going to present any toxicological problem for the patient, so forget it. And so that's really what we were looking at. And so the number has come down considerably. And as I said, I wasn't involved in that case cohort selection, but that's essentially how it was done.

SECRETARY JESSE BROWN: Thank you. Sir, if you give us your name, I'm going to ask the staff to get that report and make sure that you receive it. And I think, Dr. Russell, you gave a great summary of it. That's exactly how I recall the reading. Thank you so much. Ma'am, I'm going to ask you -- we have some great people in the back from the VA, and I would like for you to go back and talk to some of them. I want to make sure that we're properly responding to some of your concerns. Jim Vance is here. He is assistant director of the VA.

MRS. VIRGINIA HAZEN: Well, actually, I know some of those people. And one of them -- I didn't get on the registry, but I am going to see them again tomorrow and they're going to put me on the registry. That's what I was told. But if I'm not going on it, it wastes our time, it wastes our energy to go to these things when they don't get (inaudible) the protocol because of budgets cuts and everything else.

SECRETARY JESSE BROWN: Ma'am, please. Will you give us a chance to do it our way on this one? I would like for you to go back and talk to the assistant director here and these folks. There are a lot of people. Give us a chance to talk to you and see if we can figure out a way to help -- to be helpful and responsive to some of your

MRS. VIRGINIA HAZEN: Well, actually, you're the one to help, because you people have got to let people like us get on the registry. Dr. Hunt cannot help me tomorrow if we're not on the registry.

SECRETARY JESSE BROWN: Will you do us a favor and at least talk to some of the VA people?

MRS. VIRGINIA HAZEN: I have talked to them. SECRETARY JESSE BROWN: Well, here's the top guy right here.

MRS. VIRGINIA HAZEN: Believe me -- well, I have a formal report coming tomorrow. (Inaudible.)

SECRETARY JESSE BROWN: Okay.

MRS. VIRGINIA HAZEN: That's because I couldn't get an ultrasound and I couldn't get a CT scan. And the girl was very ugly about it, said she had too much work to do and they had done these before, so there. Well, the fact is, the liver was getting larger and I was getting this over here. I didn't know what was going on.

So the bottom line was, she says, "Well, budget cuts. I can't do all this work." The doctor had ordered it ASAP. I had to go all the way home to Walla Walla, over 400 miles, go to a doctor there, get some work done, find out that now I have an enlarged spleen. He said I needed a liver biopsy, which I had done last week. And because of budget cuts, I could not get that done. And that very girl who was so overworked has left the VA, I understand. And they did not put my formal -- they did not put my formal complaint in, as I asked them to do. So I've been --

SECRETARY JESSE BROWN: Well --

MRS. VIRGINIA HAZEN: No, you don't understand. I've been knocking my head against these doors for almost ten years, and I'm getting sicker every day.

SECRETARY JESSE BROWN: I would just like to make this observation. If a VA employee told you that you could not receive the care that you've earned and deserved, she should have been fired. She should have been asked to leave.

MRS. VIRGINIA HAZEN: Well, I went immediately to the-

SECRETARY JESSE BROWN: And I'm going to again ask you before you leave today -- we have a lot of wonderful folks here. Just give us a chance.

MRS. VIRGINIA HAZEN: I understand that. I realize that.

SECRETARY JESSE BROWN: Just give us a chance.

MRS. VIRGINIA HAZEN: I understand that. I realize that. But budgets are holding this up. They've been demonstrating in Walla Walla VA because of budget cuts. So you people have got to take care of that. They can't do that back there. And Dr. Hunt can't put me on the registry unless you guys say so.

SECRETARY JESSE BROWN: Thank you so much.

MRS. VIRGINIA HAZEN: So I can't get help.

SECRETARY JESSE BROWN: Dr. Vojdani.

(Discussion off the record.)

SECRETARY JESSE BROWN: While they're doing that, I'm going to ask -- so that we can move on, why don't we ask Ms. Lisa Spahr to come forward for her presentation.

MS. LISA SPAHR: Good evening, everyone, distinguished members of the Board, and guests. I'm very happy to be here tonight and to have this opportunity. I'm very thankful that the Board has meetings such as these so that we can share our concerns and our experiences together.

I'd like to say that we received the interim report August of this year, and the American Legion was very pleased with the interim report and we found the recommendations and the observations very well thought out and very thorough. And we appreciate all the work done.

I'm going to be pretty brief this evening. I have two messages that I'd like to send with you tonight, and both are regarding working relationships.

And the first is, I really can't say enough good things about the contact managers at the Office of the Special Assistant to Gulf War Illnesses. It's a team of individuals that handle a hot line, a 1-800 phone number. Anywhere in the world you can contact them and they'll assist you by putting you in touch with VSOs, military service organizations, and anyone else that might be able to help you, such as the Catholic Charities Fund or anything -- or anyone that might be able to help. So these folks have worked closely with the American Legion and others alike to assist veterans. And I think that that's really important, that we work together and remember that we're all working for the common interest of the veterans. So we would certainly like to see our relationship with them continue, flourish, in the many years to come. It's very important that we keep that group of individuals working and helping veterans.

And the second message tonight that I'd like to leave you with is regarding the Lessons Learned Directorate. And the interim report suggested that that directorate be rolled over into a Joint Staff (inaudible) similar to that. And for very good reason, I think; that service-wide implementation of Lessons Learned might be more effective if the Joint Staff oversees that. And I think that's an excellent point.

And our only concern of the American Legion is that Dr. Rostker's office has given a great deal of time and a great deal of effort to work closely with the veteran service organizations and the military service organizations. And he's pointed that out in the interim report.

This relationship I think fosters what Lessons Learned is all about. I think that you have to understand what's meant to be learned before you can implement any sort of lessons learned or changes. And I think that you get those from the veterans organizations, other interested parties, and from the (inaudible).

So I think that until we would have a close working relationship like we do with Dr. Rostker's team, with the Joint Staff, we would just be concerned that the Lessons Learned might not be as effective or might not be as -- for instance, a depleted uranium, if I can just give an example. There are a number of people in the veterans community that brought depleted uranium up to the level, I think, that it's come in the last few months. And I think that that came from individuals in the veterans community. And I think that it was addressed with Dr. Rostker's team possibly more effectively than it would have been by the Joint Staff, simply because there isn't a lot of collaboration there among the groups. There's not a lot of close working relationships going on.

So I'd simply like you to think about that, as you certainly are looking at possibly recommending that it be turned over to the Joint Staff. Just keep in mind that I think the working relationships among the organizations are going to be the key to providing better veteran and military service personnel alike better services and better policies. And with that said, again, I appreciate the opportunity to be here tonight and I'm very happy to share with other folks concerns and experiences that we might have. Thank you.

SECRETARY JESSE BROWN: Thank you. Do you have any questions? Thank you.

Dr. Vojdani.

(Discussion off the record.)

DR. ARISTO VOJDANI: Mr. Secretary, thank you very much for giving me the opportunity to be here. My name is Aristo Vojdani. My Ph.D. is in the field of microbiology and immunology. I did my post-doc studies at UCLA in the field of (inaudible) immunology. I'm an associate professor at Charles Drew School of Medicine and Science and also director of Immunosciences Laboratory, which is a private clinical immunology laboratory.

During the past ten years, we had the opportunity to examine more than 5,000 clinical specimens, blood samples, from patients who have had symptomatology which you heard before called chronic fatigue immune dysfunction syndrome, or fibromyalgia; these individuals that had history of exposure either to toxic chemicals or to viruses or the combination of the two, viruses and toxic chemicals.

The symptomatologies are very much overlapping, but one thing we see in these patients is immune disorders, chronic fatigue immune dysfunction syndromes, immune disorders. And that's due to the fact that immune systems, while its system is very complicated and sophisticated -- for example, if we take the first line of defense, microphages, and we look at certain or single factor called interleukin 1, the hormone of the immune system produced by these microphages, you can see that, hat interleukin 1 communicates with the brain, with the tissue, striated muscle, smooth muscle, everywhere almost. So any abnormalities of microphages at the cellular level will affect other parts of the body.

Next slide, please. So chemicals which affect the immune system, we called them immunotoxicants. Immunotoxicants are the moderate dose levels, very low levels. Their primary target is the immune system. Their secondary target could be other organs, such as brain and endocrine system. Modifying factors such as stress, hormonal imbalances, social stressors can alter the immune function, and that includes natural (inaudible) cell activity, T-cell function, B-cell function, microphage function. These reflect all the function of the immune system. The results of altered immune function could be immuno-suppression and the results of immuno-suppression could be increased infection or cancer or altering immunity, meaning the body reacts against itself, and hypersensitivity, which is allergy.

Next slide. Indeed, we read many, many articles recently in the scientific literature, very respected scientific literature, such as this is the cover of Immunology Today, talking about adverse immune response to xenobiotics being toxic chemicals. And the next slide, you can see the title of the article is "Allergic and Altered Immune Reactions to Toxic Chemicals or Xenobiotics." So chemicals can cause allergic reactions, altered immunity, and hypersensitivity.

Next slide. Also, the technology has moved to the level that we look at the genetic fingerprints of individuals. For example, in this case, they're talking about prescriptions for disaster. One drug could be life-saving for certain individuals; for another person, could be a killer. So pyridostigmine bromide could be given to soldiers and some of them will not have any effect on them; a few of them will have significant effect.

Next. So therefore, you and I could be exposed exactly to the same amount of chemicals and our response will differ perhaps by a hundred-fold. This is taken from Scientific American. Again, whatever I'm bringing here, it's all from scientific journals.

Next slide. The director of the National Institute for Environmental Health Sciences, Dr. Ken Holden, in one of his the laboratories which he is associated with or working under him, they looked at the enzyme which is metabolizing benzene in our system. Benzene is a carcinogenic chemical. In ten different individuals, they found ten different levels of enzymes. Another meaning: If ten different individuals get exposed to benzene, some of them -- metabolites which they make is so much that may cause cancer; in other ones, the metabolites are a small amount and will not cause any cancer.

Next slide. Also, the issue of synergistic effect was mentioned before. Here from the Journal of Clinical Laboratory, Immunology, were two groups of mice. They gave them an allergin, a material causing allergy. Only 5 percent of the mice developed allergy, but when they exposed second group of the same kind of mice to exhaust diesel emission and then gave them the allergin, 60 percent of them developed allergies. So we should not forget the issue of synergistic effects.

Next. So we use immunotoxicological assessment. And immunotoxicological assessment, they are not done in every laboratories[sic]. They are very complicated.

Next slide. And in 1992/1993, I got involved with Gulf War syndrome, where our laboratory did 40 blood tests -- immunotoxicological panels on 45 soldiers who were ill at that time, and also 20 controls who did not go to Kuwait. But first we did under CBC, glucose, repeat liver enzyme, thyroid. And they call this part immunology. Very simple immunology; it's not complicated immunology. (Inaudible). This is what is done, I believe, in the majority of the hospitals and the soldiers. We did not find any significant differences between the two groups.

Later on, a year ago, we did the same tests on a hundred controls and a hundred soldiers, which I'm going to share with you today. Again, these tests were not different in two groups. So we move --

DR. VINH CAM: The hundred soldiers that you just redid, did that include the 45 original ones?

DR. ARISTO VOJDANI: Those are additional hundred. So I'm going to share with you the next slide.

This is the data that was on 1993, which was presented in front of U.S. Senate, where we found when we looked at T Helper/Suppressor -- these are equivalent to the accelerator in the car and suppressors are equivalent to the brake in the car. So when we look at sub-population of white blood cells, we found 51 percent of the patients were abnormal, only 20 percent of controls. This is the data from 1993. Natural killer selectivity, which are the first line of defense against cancer and viral infection, 54 percent abnormal versus 16 percent. Myelin basic protein antibodies alter immune disease against the brain, 53 percent versus 10 percent. And thyroid antibodies, 42/20, and tissue antibodies 35 and 5. Now I'm going to share with you the data. So that was what was done then. And my conclusion at that time from that pilot study -- I really need to read this for you because it's very important. What I concluded, that all these findings point towards a process that is neuro-immunologically mediated and is associated with reduced lymphocyte function on the one hand, and the production of auto-antibodies on the other. Since this is common pathway described in solvent exposure toxicity and chemical sensitivity, we strongly suspected involvement of one or more chemicals to which our soldiers were exposed during the Gulf War. Other factors which may be synergistic or superimposed, such as vaccines, bacterial infection, parasitic infection, and others, such as pyridostigmine bromide, should be explored in future research. That was in 1993. So we took this kind of -- we applied this kind of methodology, which by looking at the subpopulation of white blood cells, using one of (inaudible) antibodies and very (inaudible) assays, out of almost 100 persons, we found for that certain people of -- these are from 1999 data, a hundred soldiers who were sick. And, by the way, the blood samples came to our laboratory from different clinicians where they put diagnosis: Gulf War syndrome. And then so we compared those to the controls. And we found 40 percent versus 7 percent. You'll see these numbers -- I have to go through the slides very fast -- that always somewhere between 40 to 50 percent abnormal versus 7 to (inaudible) percent of the control.

DR. VINH CAM: How were controls chosen? Just sex and age match?

DR. ARISTO VOJDANI: Sex and age match. That's all we could do.

Next.

RADM ALAN STEINMAN: But they are Army personnel, right?

DR. ARISTO VOJDANI: These are not Army personnel; they're controls. Unfortunately, we did not have the Army personnel. Just healthy individuals of the same age. But we'll be glad in the future to have -- originally, in 1993, that was my condition to do that research -- by the way, I did it at no charge -- to have the right controls. We have control soldiers versus ill soldiers, but not in 1993. And this is the data distribution where, you know, because the colors are not shown, although very fast through the

- next slide, please. Then we looked at percent T-helper/suppressor ratios, that 35 percent versus 2 percent.

Next. And we look at some of these data, since this is colorful, we see that usually in the scientific literature, they take it and mix it together and say non-significant differences were found. But this is wrong to do it in this way. You have to look whether -- what is the percentage of helper/suppressor ratio lower than 1, and we found only 2 percent. And also, what is helper/suppressor ratio greater than 2.5, when we found almost 30-something percent of those were abnormal. So these individuals may develop auto-immune diseases because they have these immune activation. These individuals that have immuno-suppression, which is something very similar to immune system of AIDS patients, they have immuno-suppression. So then their T-cells are abnormal -- T-cells cooperate with B-cells. Also we looked at percent of B-cell. And the same thing: 46 percent versus 5 percent.

Next. So that was the -- and we found the numbers (inaudible) soldiers of the body are not normal in the soldiers in patients with Gulf War syndrome. Now we wanted to see whether they functioned properly, so we expose the lymphocytes from the patient as well as controls to the antigen, which is similar to a virus or a material getting into our systems, and we found that also their function was significantly abnormal. Fifty-one percent did not function well with those antigens, versus only 10 percent of the controls. And that's the distribution.

Next slide. That was the T-cell function. The B-cell function also was abnormal in 48 percent versus 9 percent.

Next slide. We'll go through these next slides, please. And then we look at natural killer cytotoxic activity. These are, as I said, the first line of defense against viral- infected cells and cancer cells. This is the natural killer cell attacking a tumor cell; and the tumor cell is the Brown and the natural killer cells are attacking the tumor. If these natural killer cells have the right (inaudible), they will release their enzyme material, destroy the membrane of the tumor (inaudible), and the natural killer cells can recirculate and kill another set of tumor cells. When we look at the soldiers, we found 47 percent of them did not have the good natural killer cell selectivity. That means they could not kill tumor cells in culture, and meaning they do not have, really, the right cytoplasm and so forth and whatever is needed in order to kill tumor cells. So from this, we know that chemicals can cause either immunologic suppression or altered immunity or hypersensitivity. Overall, we can call that immune dysregulation.

Next. So therefore, it was quite important to see whether or not these patients, they have any signs of altered-immune disease where the body reacts against itself.

Next. So also in the scientific literature, very well documented in relation several drugs and medications where medication could cause auto-immune disease.

Next. So one of the cells of the body which are extremely sensitive to toxic chemicals, and if toxic chemicals penetrate or manage to go through blood, brain barrier, they can bind to the nerve cells and there will be some immune reaction, like a PacMan. Those T-cells will attack the nerve cells and the nerve cells now damaged completely; they can not communicate with the neighboring cells; therefore, the kind of memory loss and so forth we see in our soldiers. So when we looked at antibodies against myelin sheath, we found to be highly abnormal in soldiers, in 36 percent versus 4 percent of the controls.

Next. We looked at tissue antibodies also, such as striated muscle, smooth muscle; 37 percent versus 9 percent. Then we looked at markers of inflammation. When we have -- when we encounter infection, such as bacterial or virus, we make antibodies against all bacteria or viruses. Then antigen plus antibody form new complexes. If liver function is good, they will be able to get rid of those immune complexes. If not, those immune complexes can go to the kidney, can go to the joint, cause arthritis or lupus, or some other diseases called auto- immune diseases. Therefore, we looked at the level of immune complexes and we found 52 percent of them have highly elevated immune complexes versus 14 percent of controls.

Next. So what we see here is some kind of immunologic dysregulation. So when the immune system is not working properly, then the infectious agents, whether from outside of the body or those who already are within our system, can get reactivated.

Next. And therefore, we looked at Epstein-Barr virus. As you know, Epstein-Barr virus was mentioned as one of the causes of chronic fatigue syndrome and then after that, after a few years, they mentioned cytomegalovirus, herpes type C. And so we have many, many cause of chronic fatigue syndrome, but so far they don't know what really causes chronic fatigue syndrome. We found 56 percent versus 12 percent. And by the way, similar findings were published in Journal of Military Medicine in 1994, where they found evidence of activation of Epstein-Barr virus.

So the next slides you will see the same results in relation to cytomegalovirus, Herpes 1, Herpes 2, and -- next slide Varicella zoster, 55 percent versus 6 percent. Herpes type 6, which after four, five years ago, they found that it was the cause of chronic fatigue syndrome. There we find that in 49 percent of the soldiers versus 7 percent of controls, highly elevated antibodies.

And then we did also an environmental mold. And I have an article with me right there from a scientific journal where they show toxins of environmental molds, such as aspergillus, and other environmental molds, can cause immune dysfunction and many, many other abnormalities. So we found 52 percent versus 14 percent have antibodies against aspergillus and other molds, which will be shown in additional slides. Again, 58 percent and 12 percent and this is (inaudible). These aren't just environmental molds. When we go to a building which we smell some kind of moldy smell, that's those are environmental molds. Then the issue of mycoplasma I'm sure you heard about involvement of mycoplasma. Mycoplasma has been accused to be one of the organisms as a cause of Gulf War syndrome.

We did complete -- handled a thousand blood samples from the soldiers. And I'm going to show you the data. The data in relation to -- mycoplasma, when enters into the cell, stays inside. It's called intracellular microorganism. And that's due to the fact that when -- under normal condition, when the bacteria goes into the cells' cytoplasm or microphage, they have some kind of -- they create some kind of bag around it where the enzymes unite with that bag and release into -- inside that bag, destroying the bacteria and the bacteria is going elsewhere. But somehow mycoplasma manages to stay there almost forever. Where the immune system is weakened, it can become activated and divide and attack the immune system.

So -- next. So therefore, we have to take blood using DNA technology, collect the blood, isolate the DNA, amplify the DNA next slide -- and use specific fingerprints of mycoplasma or other microorganisms we are looking for and then identify it. And this method is thousand-fold more sensitive than serology. That's why I mentioned before, thousand-fold more sensitive than serology. And if it's positive, we consider it and then we confirm with other (inaudible) is mycoplasma. Not only we can say the patient is (inaudible) how many copies, whether it's strongly positive or not strongly positive.

Next. So here, the data. First of all, we show evidence of mycoplasma genus in 15 percent of controls, without having any symptomatology of chronic fatigue and fibromyalgia. That by itself really is a question right there: How come they have this organism but they do not have symptomatology? Fifty-two percent of patient with chronic fatigue syndrome, 54 percent with fibromyalgia -- and it's hard to read 40 percent of patient with rheumatoid arthritis. And these are the Gulf War syndrome, 55 percent. What we can see here, really, patients with Gulf War syndrome are no different than patients with rheumatoid arthritis, they're no different from fibromyalgia, they're not different from chronic fatigue syndrome. So therefore, can we claim mycoplasma is the cause of illness? No, we cannot.

Next. And then we look at subspecies of mycoplasma -- fermentans, hominis -- the same conclusion; that really chronic fatigue, fibromyalgia, rheumatoid arthritis, and Gulf War syndrome, they have similar percentage of subspecies of mycoplasma. All these are published in scientific journals and articles are available to you. So, however, is it good to have these mycoplasma in our blood? No, definitely not. Here is an example of electromicroscopy; one of the soldiers where we see mycoplasma is attacking the helper cells, same helper cells I was talking about before. And if mycoplasma enters inside the helper cells, that will change the characteristics of the behavior of these lymphocytes and they become dysregulated. They will make different type of cytoplasm and so forth. So therefore, we have to treat these patients with some kind of doxycycline, minocycline, whatever, in order to get rid of these organisms from their blood.

Next. So this type of organism could cause cell communication failures, and cell communication failures can lead to immune disorder. And that's from Journal of Science.

Next. So to summarize my presentation to you, what is really the cause of Gulf War syndrome? What is the Agent X which can affect the cells involved in the immune system microphagias and so forth?

With that thinking, I'm going to summarize my talk to you and conclude with the last slide, which is after this one. So based -- I would like to summarize and conclude that basic laboratory testing, such as CBC chemistry, T3, T4, TSH, RF, and others are not sufficient for diagnosis of Gulf War syndrome.

More advanced laboratory tests, including lymphocyte sub-population analysis, T-cell function, B-cell function, natural killer selectivity, myelin and other tissue-specific antibodies, and immune complexes are needed for a more thorough documentation of the immune disorders found in the ill soldiers. Antibody detection, as mentioned before, such as serology techniques alone with DNA technology, should be applied for detection of primary or secondary causative agents of Gulf War syndrome.

Evidence of herpes family virus reactivation, mycoplasma infection, and the environmental molds detection in the blood of ill soldiers indicate involvement of these agents in Gulf War syndrome. Whether directly or indirectly, we don't know. This similar viral reactivation, mycoplasma infection and other environmental agents have been demonstrated in patients with chemical exposure, chronic fatigue syndrome, fibromyalgia syndrome, and rheumatoid arthritis. These factors do not appear to be etiologic agents but cofactors in Gulf War syndrome. Gulf War syndrome is due to multifactorial etiology.

As we discuss in the Journal of Internal Medicine, Volume 245, Page 409 through 412, 1999, the title of that article was "A Single Etiologic Agent may Not be Feasible in Chronic Fatigue Syndrome Patients," this theory could be applied to Gulf War syndrome, as well.

Next slide. So this is really one of the most important slides. And if it's possible to focus in, and that's really the summary of so while we are looking for the X-factor, this is what I believe happened to our soldiers.

Stress is one of the major factors in here. Stress, warfare agents, pyridostigmine bromide, vaccine, organophosphates, pesticides, insect repellant, electromagnetic radiation, polycyclic aromatic hydrocarbons from oil well fires, diesel exhaust, and airborne particles, every one of these -- even sand we can add to this, because I read an article just last week that sand by itself, if it's inhaled, could cause immune disorder in certain individuals.

So let's take some of these factors, one or all of them together. A hundred people get exposed to them. Eighty percent who do not have genes which makes them sensitive to these factors do not have immune abnormalities and they will stay in perfect health. Twenty percent who get exposed to any of these or other combination, if they have genes which makes them sensitive to these, they get immune dysregulation. And then the viruses which I was mentioning -- EBV, CMV, Herpes 1, Herpes 2, Herpes 6, mycoplasma and others -- become reactivated. Reactivation of those can cause further decline in the immune system or immune function in the patients, then, with chronic fatigue immune dysfunction syndrome. So that's really the summary now. Are we going to wait to find what is the agent X? I think again, I'm going to mention that we may waste our time. I'm not saying this is not important. This is important probably for the future, wars and so forth.

For immediate treatment of our soldiers, we know some of these factors in combination or by themselves played very important role. And also, we know that patients are having chronic fatigue immune dysfunction syndrome, immune abnormalities, and so forth. Therefore, treatments immediately should be designed for corrections of all these immune abnormalities we find in our soldiers, and we should not wait until we find the X-factor.

And also, if we look at the other diseases anyway, almost every chronic illness in the field of medicine right now display symptoms without knowing the cause. We don't know what's the cause of rheumatoid arthritis, but patients get treated for rheumatoid arthritis. The same thing for our soldiers: I think they should get treated immediately without knowing what the agent is. Thank you.

SECRETARY JESSE BROWN: Doctor, I have to tell you, that was a fine, fine presentation. That was outstanding. And I'm going to ask the staff to -- I want to ask the staff to make sure that we get a summary of that so we can pass that on to Dr. Rostker and his group

DR. ARISTO VOJDANI: Mr. Kaplan has a complete copy of my presentation.

SECRETARY JESSE BROWN: We should also make sure that the VA --

DR. ARISTO VOJDANI: I sent it to you by Federal Express last week.

SECRETARY JESSE BROWN: Can we have a copy of your slide presentation?

DR. ARISTO VOJDANI: Definitely.

SECRETARY JESSE BROWN: Dr. Cam?

DR. VINH CAM: Yes, I have -- I started having five questions, but now I have six questions for you. The first one, a month ago for patients, did you observe the differential response when you've used (inaudible)? In this slide, you did talk about (inaudible). That's the first one.

DR. ARISTO VOJDANI: Let me answer one by one. I don't have a good memory as you. First of all, if I take another hundred patients exposed to toxic chemicals and put them side by side, the results will be exactly the same.

DR. VINH CAM: So there is a same way to plan like this?

DR. ARISTO VOJDANI: We don't have a fingerprint which is unique to the soldiers. There is laboratory overlap. Similar to the symptomatology overlap, we have laboratory overlap between chronic fatigue syndrome and fibromyalgia and Gulf War syndrome. Yes, we get about half of those abnormalities, like 50 percent of those were abnormal (inaudible) and half of them were higher than 100, meaning that they were overactive, and half of them were underactive, below 75.

DR. VINH CAM: You don't know what that means?

DR. ARISTO VOJDANI: Some they have immuno-suppression and some they have -- so therefore, if we mix the data together, they will not have statistical difference. But that's why you have to separate between immuno-suppression and immune activation.

DR. VINH CAM: Okay. One of your slides was really striking. I mean, you had really immuno-deficiency, and then the response was more than doubled. Now, is that process irreversible?

And the next question which kinds of ties into that, did you or do you know any clinicians that conducted like a very pilot experiment; you know, take those patients, give them some kind of treatment, and redid the same tests? And did you observe improvement in their response?

DR. ARISTO VOJDANI: First of all, we knew about chemical-induced immuno-suppression many, many years ago, when I did my post-doc study at UCLA. At that time, we're talking about chemical-induced immune dysfunction and immuno-suppression, way before people knew about HIV in immunosuppression. We have seen some patients when they get treated with biological response modifiers, and, you know, such as antioxidants, such as --

DR. VINH CAM: Interferon?

DR. ARISTO VOJDANI: -- interferon, interleukin 2, and many others, where you can increase the helper/suppressor ratio from 0.7 to 1.2 by a long systematic process. It takes about six months to a year potentially for treatment.

DR. VINH CAM: My next one: Did you do any study with PB to see whether there was some kind of impaired --

DR. ARISTO VOJDANI: I did not do PB. It's amazing that exactly after my presentation, (inaudible) PB, one of the TV stations came to me and said, "Have you done any studies? How did you know that pyridostigmine bromide was one of the causes?" I said, really, that was just an intelligent guess, where -- because I'm so much familiar with toxicological chemical exposure and laboratory testing, when you give certain type of chemical which may be more toxic to some individuals and develop some kind of abnormalities but the others do not, and that was really intelligent guess. I did not do any studies of it.

DR. VINH CAM: The next one: You know, your (inaudible) where you have all the stresses and you put stress at the top. And this is a difficult question I'm asking. Do you think of stress being the primary factor and everything follows, or it's the other way around? You get some kind of immune --

DR. ARISTO VOJDANI: Thank you. Every one of us is influenced by our own research and thinking and so forth. In 1983, I did a very simple experiment. At that time, I was exposing mice, different strains, to (inaudible), which is a very carcinogenic chemical. And the mice were developing tumor after three months; depends on strain, genetics, and disabilities.

We took one group of mice. We put them under stress and don't ask me how. At that time, really, there wasn't any review Board and so forth. And we put them under stress and then we gave them the chemicals. The mice ended up -- for example, in 90 days, developed tumor of this size (indicating); in 30 days developed tumor of almost this (indicating), ten times bigger. So that by itself shows the synergistic effect. And stress is a major factor in cancer and immune disorders. That's why I put it on top.

DR. VINH CAM: Okay. My last point: I understand you have once offered to help the VA do the training. Is this offer still open? Because a lot of officials from the VA out here suggest you reiterate your offer again.

DR. ARISTO VOJDANI: I'll send you a copy of this, and in certain pages is -- my offer is still there where I (inaudible) since these techniques or these tests are sophisticated and the VA personnel do not know how to perform them, I will be very happy to go to the VA hospital and train them in order to be able to do this type of testing in our soldiers. If they are not ready, I'll be very happy to do them at the agent cost, not for profit; just to help our soldiers. That's documented in 1993.

DR. VINH CAM: And I want to mention, Doctor, that you have helped a lot of Gulf War patients. I acknowledge that. That's really good. And thanks a lot for your interesting presentation.

DR. ARISTO VOJDANI: Thank you.

RADM ALAN STEINMAN: Just a couple questions. On your last slide, you had the X-factor plus all the potential stressors that lead to immune dysregulation, dysfunction, in about 20 percent of the patients. Why do you even get an X-factor? It seems that the (inaudible).

DR. ARISTO VOJDANI: I absolutely agree with you. Again, to be careful, I put that X-factor. To me, the X-factors are in here.

DR. VINH CAM: The 20 percent?

DR. ARISTO VOJDANI: That's why I said we're wasting our time to look for X-factors. The X-factors are in that box already.

RADM ALAN STEINMAN: And that leads to -- your last point was don't waste your time looking for the X-factor; you have all these other stressors that you could develop on your own. But then you said focus on treatment. What would the treatment be to repair the --

DR. ARISTO VOJDANI: Well, really I'm not qualified. I'm a Ph.D., as you know. (Inaudible) I believe the treatment should be for correction of the immune disorders. There are certain treatment for immune activation and there are certain treatment for immunologic suppressions. And there are many members of American Academy of Environmental Medicine or other associations who know how to treat these type of abnormalities. I think we should consult those associations and learn about treatment.

RADM ALAN STEINMAN: So if your thesis is correct, then the current VA protocol on treating mycoplasma fermentans with doxycycline should lead to no result because it's only treating --

DR. ARISTO VOJDANI: First of all, because I was just a month ago (inaudible) by Department of Defense along with University of Washington, the only clinical laboratory who recognized the technology to be good enough to be studying 720 soldiers, to evaluate effectiveness of doxycycline. We have to wait, really, as you know, but I will not be surprised to come to the same conclusion that they did.

RADM ALAN STEINMAN: I think the trial needs to be done because the anecdotal cases (inaudible) has been a factor.

DR. ARISTO VOJDANI: Absolutely. Because this was a double-blind study (inaudible).

SECRETARY JESSE BROWN: I have one question and then I'd like to open this up to our guests here. Mike Kiser from the DAV talked about the application from the VA regulation, which basically says -- this is for conversation purposes. And Jim, if I'm wrong, please correct me. But I think the regulation reads something like this: That if you served in the Persian Gulf and you are now manifesting residuals that are outlined -- and there are like 13 to 17 of them -- and they are not diagnosed, then service connection can be applied. Which also means that if they can be diagnosed, then service connection would not be applied. You stated that some of these immune deficiencies can trigger things like arthritis, which is a diagnosed condition.

DR. ARISTO VOJDANI: Yes.

SECRETARY JESSE BROWN: But it appears to me, from a lay standpoint, what you're also saying is that they can be indirectly related to the so-called Persian Gulf syndrome.

DR. ARISTO VOJDANI: Yes. And with that -- I would like to add I don't understand why we cannot make diagnosis of Gulf War syndrome, because many doctors are already doing that, and make the insurance companies to accept Gulf War syndrome as an illness, including Medicare.

SECRETARY JESSE BROWN: Well, the VA treats it, for adjudication purposes, as a symptom, because historically the regulation says in order to receive compensation, it has to be a disease. And some of the symptoms, such as headaches, muscle pain, joint pain, those are more symptoms as opposed to a disease and, therefore, under the old regulation, they didn't qualify. But based upon the new policy that went into effect about three years ago, the VA has now service-connected those conditions. But at the same time -- getting back to what the

problem is -- is that if some of these problems end up being diagnosable, then the veteran cannot receive compensation for it. But here you are saying that some of these problems here, such as stress, the warfare agents, PB, and so forth, can cause or trigger conditions that are diagnosable, such as arthritis and that kind of thing. Is that correct?

DR. ARISTO VOJDANI: I didn't say that. I didn't say that, no. What I said is that (inaudible) cause immune abnormalities which similar immune abnormalities also found in patient with arthritis, which is immune activation, or immuno- suppression, which is found in patients such as AIDS or HIV. But they are not typical enough to call them arthritis or other illness because when you do -- in order to have arthritis, according to the College of Medical Pathology and Rheumatology, you have to have certain parameters to define arthritis. You have to have joint pain, rheumatoid factor, and many, many other these are atypical diseases. They will not fit in the box of arthritis. They will not fit in another box. So these are unique group of abnormalities which are special to Gulf War syndrome, chronic fatigue syndrome, and fibromyalgia.

SECRETARY JESSE BROWN: I got it. Are there any questions that the audience would like to ask Dr. Russell or Dr. Vojdani at all?

UNIDENTIFIED SPEAKER: Yes, sir. To follow up on what you said there, Mr. Secretary, when I see younger guys that were in the Gulf, even 26, 27 years old, the degenerative arthritis seems to be the prevalent one. Not just the young guys, but anybody you talk to. You name it -- say arthritis and they say, yeah, degenerative arthritis. Does that fall in that category?

DR. ARISTO VOJDANI: Well, they have symptoms similar to arthritis, but when you do further study, they do not fit to have the classical arthritis. Therefore, these are unique type of diseases.

UNIDENTIFIED SPEAKER: What I'm saying is, under the diagnosis from VA, everybody has a claim for degenerative arthritis, whether he's 27 or 47. That's one of these claims that's been adjudicated for degenerative arthritis.

SECRETARY JESSE BROWN: Under the rules, the VA can service-connect degenerative arthritis under two regulations. One, if the condition is shown concurrent with his or her active duty or developed to a 10 percent or more disabling within the first year of discharge.

Did I get that right? Is that correct? So under those circumstances, service connection can be applied. But what I'm talking about, and the doctor explained it to me, is that we're talking about a guy that's been out of the service for, let's say, six years, he served in the Persian Gulf, and he now feels that his joint pain is secondary to his service in the Persian Gulf and he goes into a VA hospital and they diagnose it as arthritis.

And what you just explained to me is that the VA's current interpretation will be correct because the guy does not have degenerative arthritis. He has something that looks like it. But on the other hand, a good service officer will argue that that is still consistent with the regulations governing the Persian Gulf. (Inaudible) help me out on that.

MR. MARSHALL BOYD: You're absolutely right, Mr. Secretary, regarding service connection on a direct basis. Where we come up against it under 38 CFR 3.317, that regulation, is that it has to be undiagnosed. Since the point has been made many times now, it has to actually be undiagnosed. So if the diagnostic criteria for arthritis are met, the VA or another physician diagnosis arthritis, we can't, under 3.317, grant service connection for that condition. We might be able to do it on a direct basis or on a secondary basis, but not under 3.317. And that point is made by Mr. Kiser and several other people.

SECRETARY JESSE BROWN: Thank you. Do we have any other -- yes, sir.

UNIDENTIFIED SPEAKER: Doctor, you mentioned that you had done some studies injecting allergins into mice and you had further exposed them to engine exhaust. Did you do any studies with vaccinations?

DR. ARISTO VOJDANI: That wasn't my study. That was published in Journal of Medical Pathology and Immunology, a slide taken from that. And I presented it for showing the synergistic effects of chemicals. And we have many, many publications similar to that.

UNIDENTIFIED SPEAKER: Have you done anything with the vaccinations?

DR. ARISTO VOJDANI: No, I didn't.

SECRETARY JESSE BROWN: Any other questions, ma'am? Ma'am, do you have any other questions?

UNIDENTIFIED SPEAKER: No, that's all.

SECRETARY JESSE BROWN: Sir, do you have a question? Do we have anyone else here? Yes, sir.

MR. HARDY AWADJIE: This one is probably directed to the VA, but I can also, I guess, put this before the panel. It was mentioned that -- first of all, let me say that we went to Kuwait -- Saudi Arabia because Kuwait had a problem. And most people volunteered to make this trip. You mentioned that in order for veterans to receive compensation, this has to be an illness or has to be a disease.

I was discharged from the military -- medical discharge from the military March of this year due to just unexplained illness; went before the military Board, medical Board, and voted for -- from this Gulf War illness thing due to joint pain, and eventually it led up to knee surgery. I ended up getting discharged with a 10-percent disability from the military. I feel like I'm dying a slow death here. And I sympathize with this lady when she got emotional. I had to hold back the tears here. I feel right now that my illness has seriously ruined my life and it's getting to the point where it's ruining my marriage.

I tried to hold on as best as I could in the military, because when I joined the military, I decided I was going to stay in the military for as long as Uncle Sam would have me stay. And I think that that proves true when I got my walking papers in March of this year.

Since November of 1991, I've been on this emotional roller coaster; joint pains, body aches, I'm talking extreme fatigue, my skin hurts on a daily basis. I can't even afford to go to a doctor because if I take off work, that's money I'm taking away from supporting my family. I've been getting a letter almost every three, four weeks from the VA stating that my claim is being processed; they're backed up, but I will eventually hear from them. But I guess the question I have is, if the vets are not going to get compensated until this is labeled as a disease, why am I getting these letters?

SECRETARY JESSE BROWN: First of all, that's not what we said here. What we said, under the classic rules and regulations, the VA grants service connection for diseases. There is one exception basically, and that is the Persian Gulf, where they grant service connection for symptoms.

Do I have that right? So it sounds like to me if everything that you said is all forward -- and I have no doubt about your comments -- it sounds like to me you have a good case. And what I'd like for you to do is -- we have some people here. Not only am I going to ask them to -- they used to work for me. They don't anymore, but they're good folks.

I'm going to ask them to talk with you about two things. Number one, is to expedite your case; and number two, to talk to you to make sure it's well grounded, that we didn't miss anything in the initial 526. Give us a shot at that, will you? And I'll get your name, because I want to follow up on this.

MR. HARDY AWADJIE: Can I make one quick comment?

SECRETARY JESSE BROWN: Absolutely.

MR. HARDY AWADJIE: The very first time when I complained of these illnesses was when I was in the theater of operation. These pills that they talked about, we were including the (inaudible). Straight out of basic training (inaudible) we had no choice (inaudible) including the vaccine that they were talking about earlier. The first time I experienced my illness was when I was in Saudi Arabia; went into the hospital, and I was -- I was told that my symptoms could be due to stress. So I was sent to a psychiatrist. Something I don't admit to people, but I think I'm going to tonight. It came to a point in time where I was sick and tired of being on antidepressants, because that's -- that's all the doctors were telling me. The next time I complained about this, I was tested for STDs.

The third time I complained about it again, I was sent back to see a psychiatrist. And the very first time when I came back from Saudi Arabia and came to Madigan, went to see internal medicine, I'm not sure how many of these vials of blood can be taken out of you at one time, but when I sat down, this medic put about 16 of these little vials on the table next to me and then he said, "I'll be right back." He went in and brought some smelling salts. And I asked him what it was for. And he told me, "Well, I've never taken this much blood out of anybody before. This is just in case you pass out."

This has been the case -- my case since 1991. Every day I feel like I get worse. Many times we see the elderly walking and at that slow pace. I've never been an elderly. I feel like I'm a hundred years old many, many mornings. Many mornings I wake up and I feel like I ran 25 miles overnight. My joints ache. Many mornings on my way to work, I end up talking to myself. Many mornings I cry. I can't go to work. It hurts. But I have to because I have a family to support. And like everybody else that spoke this evening and recommended something to you, I'll do the same thing, too: Please, by all means, do the best you can to help those ailing Gulf War vets.

Most people thought this stuff was all in our mind. That's what the doctors kept telling me. That's why they've been prescribing antidepressants for me, but I got tired of being on antidepressants because I feel like antidepressants were only masking my illnesses.

By all means, do all that you can to help us. There's no way -- people have waited from Vietnam for years before some kind of compensation was handed to them. And for most of those people, it was way, way too late. Please.

SECRETARY JESSE BROWN: Well said. Now, we're going to help you. Okay. We have someone over in the corner.

UNIDENTIFIED SPEAKER: Yes, I have a question for Dr. Vojdani. You showed us a lot of slides having to do with immunological changes that you observed in people in your study; is that correct?

DR. ARISTO VOJDANI: Yes.

UNIDENTIFIED SPEAKER: Okay. And you proposed a model of that that could involve stress and then various toxicants. Is it also possible that the immunological changes could be caused by a single bacterial or infectious agent that hasn't been identified or isn't on that list?

DR. ARISTO VOJDANI: I think indirectly in my presentation, that was shown, yes. For example, if you have mycoplasma -- just mycoplasma by itself could change the immune function, the immune system completely. So, yes, you can have stress or no stress. Just having a single infectious agent in the body can make all -- some of those immunological changes.

UNIDENTIFIED SPEAKER: Just one other question. Are you familiar with PANDAS?

DR. ARISTO VOJDANI: No, I'm not.

UNIDENTIFIED SPEAKER: It's -- if I can remember. It's really an involved anagram. It's Pediatric Auto-immune Neuropsychological -- Neuropsychiatric Disorders Associated with Stress.

The reason I bring that up is because I know the number of veterans who a lot of times don't seem to be impaired or very impaired themselves or have had mild illnesses, who have had children who have symptoms that are kind of consistent with that.

DR. ARISTO VOJDANI: Again, don't forget that, really, the scientific literature, lots of infectious agents, their structure is similar to human tissue. For example, Herpes Type 6 or 7 or 8; multiple sclerosis is described as due to some of these viruses because of the similarity between certain compartment of the virus with human brain tissue. So therefore, yes, a single infectious agent could cause all of the symptomatology you are describing.

UNIDENTIFIED SPEAKER: Thank you.

SECRETARY JESSE BROWN: Thank you very, very much. Oh, we have one more for you, Doctor.

UNIDENTIFIED SPEAKER: Yes. My situation is a little bit different. I went to Saudi and when I came back -- I had allergic reactions while I was in Saudi and when I returned. Then I had muscle aches and pains, memory loss, fatigue, a lot of those things. And when I went to some doctors initially, they said, "It's the aging process. You're just getting older. It's expected. It's the way you live, your duty," etcetera. Environmental kind of things.

And so I, like the gentleman over there, thought that it was fact; the doctors were telling me what was true. And then I started to hear that there were so many people who have the Gulf War syndrome. And I started to try to convince myself that I didn't have those problems. And I tried to see if they could go away, mind over matter, thinking that most of the people were being told it's all in their mind, then I would control my mind to make it not matter. That didn't work. And so I didn't register until last year. I registered here at Madigan because now I'm working here at Madigan. And I registered and they did some tests on me and they were nonconclusive and they don't identify me as having Gulf War syndrome. They're saying that most of the things I have were preexisting conditions; basically I was born with it and it gets worse as you get older.

So I'm getting older. I'm 45 years old. But I also went to Gulf War. And I think for many of the problems that I have, it may or may not be related to. I don't know. But just by the simple fact that people are telling me it may be a preexisting condition that we can't prove or disprove and you are getting older, then I pretty much have to contend with the problems. I guess I'm questioning in my mind as to whether or not this is actually right, you know, the real thing. But many of the things that you put on that slide -- on those slides this evening, I can relate to. I've been there. I've seen it. I've felt it. I've experienced it. I'm living with it. I don't know if I have the syndrome. I don't know if I have anything to do with it or not. From what I understand, the registry is not identified to help find a cure; it's to help get you enrolled so that collectively we'll find a solution and be able to address it and find a way to fix it. But we're not going to get treatment by enrolling, being registered. I'm not going to argue that. I don't know exactly the policy, because as I said, I haven't been following it because I didn't register until this year. I'm going to retire in about six months and I don't know if I'm going to have enough time between now and then to get registered, put on record, to say that I do or do not have a problem and then get identified by VA to say I have a problem within two years from discharge and be eligible for any kind of compensation.

Which I'm not really looking for. I'm not trying to get anything out of the government. I just want to find an answer to what my problem is. And if there is a solution or a treatment, that I be afforded that opportunity.

SECRETARY JESSE BROWN: I thank you. Let me just answer that, Doctor. Number one, you're on the right track. Let me suggest to you: Continue the complaint so that it's documented in your service record. That's what the VA will evaluate. Number two, don't worry too much about the so-called preexistence, because the VA, under their own rules and regulations, they can grant service connection for preexisting conditions that were aggravated beyond (inaudible.) Did I get that right?

UNIDENTIFIED SPEAKER: Sure.

SECRETARY JESSE BROWN: And thirdly, what I would like -- you say you're going to be discharged when?

UNIDENTIFIED SPEAKER: Six months.

SECRETARY JESSE BROWN: Do we still have that old 526E?

UNIDENTIFIED SPEAKER: Here at Fort Lewis, the Seattle regional office has piloted and invented a pre-separation program. We can take an application from an active-duty person within six months of separation. If you're going to separate -- the gentleman over there at the door is going to come talk to you right now and get all the details. We can take the claim, rate the claim based on military medical records, whatever is available, and we can do that before you get out.

SECRETARY JESSE BROWN: All right. That's what it's all about. Working together. We have Denise -- my good friend Denise Nichols wants to share her observations with us.

(Discussion off the record.)

MS. DENISE NICHOLS: Thank you, Mr. Brown, and each of you honorable men and women for being here (inaudible). The charter of the commission was reviewed earlier, the two principal roles that you all were here under. I'd like to point out that under one of those roles that you had was to review possible detections of and exposures to chemical or biological warfare agents and environmental and other factors that may have contributed to the Gulf War illnesses.

We've gone a long ways since '93, since the first hearings on Capitol Hill. But we came out of the PAC with a recommendation that an independent body look at this. We ended up, yes, with a compromise politically, that we have the Oversight Board. We still feel like the process could be somewhat better. We're happy with how things are going pretty well with the Oversight Board and the interim report, although we still feel that there's -- the process is still driven by the DoD. The DoD -- we feel a loss of trust still with the DoD. We understand and we even spoke of the need to have the DoD involved in this process as we go along because they do have to rebuild that trust to continue our national security. But we are still having problems with that. We're still looking for (inaudible) to be more independent or to have another group be more independent.

So we're progressing, I guess, if we have a scorecard, with the interim report coming out. It's getting there. It's very trying for the veterans to live through this because the war was in '91, although it's continued on. So we've been asking for help for nine years. So there's a lot of frustration, a lot of mistrust. Our belief systems have been affected. It's almost like being raped by your own country.

Some of us keep trying. We keep holding in there with you all. A lot of people have been dropping off along the way. We're very concerned about that. We're very concerned about that trust and rebuilding that. Not a whole lot of (inaudible) is being made on that. And my concern is we don't want to lose a lot more to suicide.

So I want to bring up where we've come from and a kind of grading system with where we are, and very politely and with respect to the work that's being done. But the PAC defined when they turned in their report that investigations to date were superficial and likely to provide credible answers to the veterans and the public's questions. We're improving, but we're not totally there yet. We still have contention on a lot of items, (inaudible) being one of them. I'll have a few suggestions here to add to that. I've made notes as we've gone through and altered my testimony.

Let's see. Where do I want to go here? We still have concern about Mr. Rostker having sufficient time to devote. And this is a big issue with Gulf War veterans. He's still second in command with the Army, the Secretary. And so we're still wondering if we're getting the total commitment that we need. And the vets need to see that, that we have total commitment by the people that are put on boards and commissions. And I think there's been some concern with the former Senator Rudman. I mean, he's got other commissions. We're very concerned that people devote their time and let's get to the bottom of this.

So we have concerns with Admiral Zumwalt being out. We wish him to recover quickly, but do we need to supplement the Presidential Oversight Board? Do we get to get more help staff- wise so we can get through these things in a timely manner? That is our concern as veterans.

We feel that the anthrax vaccine or all vaccines I'm not talking about just anthrax vaccine, but all vaccines need to be under that other factor; that is, under the charter. And that has not been really done fairly. I have mentioned up on The Hill and in other testimony that we need -- on the registry, we need to identify people that got vaccines here in the States and yet did not deploy and that are sick. Now, they may have had other contact with exposed equipment or with providing care for people coming back from the Gulf. But we need a registry for those people because it might, you know, help us sort this out. I agree with Dr. Ari Vojdani and always have since we met at NIH in '94, wherever we met. During our paths, we've crossed several times. But the veterans have always said it was multiple exposures, and it's multiple symptoms and multiple exposures. So I agree fully with him. But I'm very concerned on the vaccine issue, because we have too many vets that I've talked to that don't -- they weren't deployed. And that's what this lady has brought up, not being able to get on the registry because they weren't in the Persian Gulf theater of operation. Now, we may need to code them differently, but we need those people. We need to study and see if they're coming out the same way as we are. The people that have taken the vaccine and are having reactions on the current force, we need to include those and see if there's something there.

Our active-duty forces are speaking up. Our pilots are leaving because of that. That's a lot of training money that the taxpayers paid. And it's not being recorded that they're leaving because of that reason, because the military won't let them report it that way. Okay?

So we have a problem, and the true communication with the leadership is not being heard. And I'm trying to be a logical, thought-provoking person here to say we need to look at those vaccines under other factors, pull in our active duty that got shots, that got sick, because we've had several of them go into the hospital with reactions. And we need to do some of these leading-edge research to see if it falls under there. Then we need to pull back and have a moratorium for a while and rethink this as scientists and medical people and give better input into our leadership of our active-duty forces, because for certain, we do not want to repeat any errors that were made, no matter if they weren't recognized as errors and they were done. In wartime, you make the best decisions you can at that time and you move forward. And I think that's what's happened with the Gulf War, is we made the best decisions at the time with the vaccines, the pills, you know, although there was a lot of research there that makes us rethink it. But we have sick people; they need to be cared for. We have active-duty troops that are refusing vaccine. And I don't think you can separate them and keep them separate issues.

So my thought is we need a different roster, a registry for these people. We need to get them with some of these researchers right now, get answers for that. Because we as veterans were proud of serving and would want to -- we want to help solve the problem, too. Okay? It's our lives that have been affected so much, and we will be a part of this. As you know, I've said that before.

But in your interim report, there was only very limited remarks on the vaccines. And it clearly said something about other factors. The RAND study was a review basically of the legality of informed consent. It didn't do any research on long- term effects or what was there or anything like that. So it's been very limited coverage on the vaccines. And we have not seen any plan to include the vaccines in that study. And we need to because we are continuing on with a mandatory anthrax vaccine program.

I have looked at it. If I was still active duty, I might refuse to take it, too, sir, and I was a nurse. And we have a lot of medical people that when you start giving them the shots, they're going to do like the pilots are. They're going to be out the door. Okay? So we need to look at that other factor, other charter, and recommend some studies on plan on vaccines. GAO has identified that on The Hill. There has been eight hearings I believe now with Congressman Shays' committee and with Burton's committee and the Armed Services Personnel Committee subcommittee under Congressman Buyer. There is a lot of attention being paid to this. It started with the Gulf War. We got vaccines, other things, and we need to include that in your plan to oversee the DoD. I'd like you to really put that down into the plan. And Rostker and OSAGWI and everybody over at DoD should be involved. And I've detailed all that about the vaccine in the written materials, so I'm not going to go over that because it can be easily ready, and I've summarized it well.

I will say that the oversight that we're having here on this project and the questions that come up in every hearing make me think that we need an oversight committee on VA care and claims problems that have been surfacing with the Gulf War vets. This isn't really under your charter. You've got the expertise and have helped greatly in bringing in the VA people. But that's a big problem, and I think that we need a committee to deal with that and go to the community like you all have or like the PAC has, to deal with those problems to give back the recommendations of how to correct them.

I think that we need triage in the VA system. We have some Gulf War vets that are very, very ill, and we need emergency care for them and emergency supplementation for those families. If it's not direct, then maybe we need some personal waivers or something, because we have to fulfill the need for the vets. And one of the examples I'll use is (inaudible), but a POW from the Vietnam War, Colonel Ted Guy, who died five months ago. He had a cancer and they put in an emergency claim for Agent Orange-related. It didn't get worked. Here we had a man who served our country; almost the ultimate price of death on the battlefield, several years in the Hanoi Hilton, and he died. And he put in a claim through the VA and we didn't come through for him.

I think that kind of is an example that we have to keep in mind. We need a triaging system just like we had in combat, and we need to find a way to solve these problems so the vets don't walk away feeling betrayed. We have vets of the Gulf War that the (inaudible) was set up was to provide care for them. They come into the VA and before they put a claim in -- they may still be active reservists and they're going to the VA because they have symptoms of Gulf War syndrome, and they get a bill. I don't think that's what the sense of the Congress was, and we have to go fight those (inaudible) when they crop up across the nation. We have problems with the antibiotics. Whether they believe in it or not, it's unequal. When you have the research study -- and for example -- I'll use Denver as an example. Denver is not part of the research study. So if we have vets in Colorado that wanted to participate in that study, they can't. And that's not right. That's saying there's not availability of research in an area. And all vets should have equal access to their research studies and to the benefit that it may help them. So we need to look at that. We need veteran input to research priorities. The press asked me tonight, "What would you see as research priorities?"

Number one, we have family members that have developed illnesses that parallel what the veteran has. We need to find out what's going out in those families, in the highest order. If we brought something back, a biological or whatever, that's been transmitted to the family, that should be number one because it's going beyond the veteran. So that should be a number one research study.

Number two would be the reproductive problems that are occurring and involvement of reproductive organs, for research monies. We need to expand Dr. Haley's neurological findings and have that available.

I was very unhappy at the federally sponsored research conference when one of the VA people -- and I was shocked when they did this -- after so much funds were spent on that research and there was so much excitement to, Let's see if we can go out and find this enzyme and this brainstem damage. And basically the VA said, "It's just research and we can't do it at the VA." That's not an appropriate answer, as far as I'm concerned. We've gone too far in pushing medical science to find answers, to say, well, when a project is done, that we can't do it anymore. Find a way to implement it at the local VAs. There's a lot of things that we need to look at, but that is -- and it has been above and beyond the scope of your charter. So I'm recommending that -- and I'm surprised it wasn't in your interim report -- identifying that as a problem from your Oversight Board and passing it up to the White House and seeing if we can start something to get the care and treatment started. We have FEMA that goes out and does that for disaster victims, but yet our vets have to wait nine years? Something's not right here. It's terribly wrong. Because we went to war nine years ago and we've been saying we need immediate, urgent attention this.

Well, we're getting research funds, but that doesn't really help the vet. What helps the vet is for you to listen. And, you know, if the vet brings in independent testing, to say, "Whoa, where did you get this from?" Dr. Ari Vojdani, I've been tested by him. I took in my lab results and I said, "Here, this is real." Okay? I got hard proof now," to the doctor. And I was offered psych drugs. And I said this is getting really frustrating, you know. I'm not asking for psych drugs. I'm not asking for pain pills. I'll keep going, but I want to find a way to get those values on the herpes viruses back down, try to get holistic balance back in my body. And I don't get any help from the VA. So that's what the vet is looking for. And it never was really about money, except that if you can't work, you need that assistance. And if you were used to a two-income family and you've got one and now your wife or your spouse is getting ill, too, or your little daughter is ill and wasn't before and they can't figure out what's going on, that's the priorities. And I thank you for listening to me. And I did divert from my testimony because I always come to the meeting and try to summarize at the end to bring it home to you. Thank you very much.

SECRETARY JESSE BROWN: You're very good. Thank you so very, very much, and good seeing you again. We appreciate your comments and observations. And I would like at this time to thank all of the presenters. Also thank the Fort Lewis's facility, the veterans that are here. And I'm going to ask just one additional time if there are any other people here who would like to make any comments, just raise your hand.

Dr. Vojdani?

DR. ARISTO VOJDANI: The issue of vaccination really is a very sensitive issue. It happened that last week I was in a medical convention, and not far from here, Coeur d'Alene, Idaho, where international scientists from England, Australia, United States, they shared some concern about vaccination of children. And I know -- I have three children and almost grandchildren and all of you have also children, probably. The recommendation for the future is not to give three or four antigens at the same time; to give one at a time. Because what happens really to children who develop autism, for example, which is claimed to be partly induced by the vaccines, is when the immune system is not mature enough and you overload it with all these bacterial antigens, that child is going to end up with some kind of immune disorder or with some kind of disease. So therefore, I want you to take with you home, please, if you -- I'm not saying do not immunize. I would not dare. Immunize, but one at a time.

In adults, if you want a model of arthritis, take a little bit of bacteria and inject it into a rat or a rabbit, and the rabbit will develop in three months arthritis due to just simple injection of bacterial antigens. What is a vaccine? Vaccine is a bacterial antigen. So what I'm trying to say is that if we give those bacterial antigens to all individuals, to say these individuals are equal, the end result will be 20 percent of them will develop disease, 80 percent, again, according to that formula. I believe there should be some kind of screening prior to that. If they have perfect immune system, immunize them. If they have immune activation, if you immunize them, they will develop some kind of auto-immune disease in the future. Thank you.

SECRETARY JESSE BROWN: Sir?

EDWARD NOBLE: I'd like to thank everyone on the panel for hearing me out. I thank everyone else for being here. I'm not very diplomatic. I'm a Marine. My name is Ed Noble. I was part of Task Force Ripper, which was a lead element in -- I don't know -- mine fields and in oil fields up in Kuwait City. We've got a statement for you and I've got a few questions also.

I was asked to give testimony today because I suffer from continuing health problems due to my service in the Gulf War. Over two years ago, I gave testimony in a hearing that was videotaped and supposed to be taken back to Washington, D.C., to be used in Senate investigations pertaining to the health problems of Gulf War veterans and their possible causes. In that testimony, I told what I believe to be a chemical or biological delivery site we encountered during combat operations in the Awop (phonetic) oil fields. That's located in southeast Kuwait.

I was never contacted about this incident again, never. I testified that Marines from the 1-5 were made to sleep in their gas mask one night during the air war. I testified in detail on how surveillance and target acquisition Marines encountered dead sheep and camels in our area of operation, with no visible signs of how they died. Once again, I never heard anything more about these incidents.

Since 1991, I've been involved in an ongoing battle with the Department of Defense and the VA system. At every turn, I have met with resistance and sometimes outright fraud, which I can outline to you after the meeting if you'd like. I was given two investigational new drugs that I know of in the Gulf: pyridostigmine bromide and botulism vaccination. I strongly believe that these investigational new drugs may play some part in the decline of my health. I was not given any information at all on pyridostigmine bromide and was not given a choice of whether or not to take nerve agent pills. On top of that, I was responsible for ensuring that my team members took the pyridostigmine bromide tablets.

I believe that's a violation of our rights under the Declaration of Helsinki. The reason I believe that is that I got that information out of Senate report 103-97. That's about all I have to say in my statement, but I do have a few questions. I realize I might not get the answers to them now. I'd just like you to consider them, if you can't answer, please.

My first question: I'd like to know when the veterans can anticipate the release of the RAND report on vaccines and their relationship to Gulf War illness.

Secondly, I'd like to know why this Task Force Ripper unit history is still not available when we're talking this is eight years later. For Mr. Kaplan, I would like to know why did the White House liaison change their phone number and cut off all contact with me and my advocate in 1996 and '97.

My final question -- like I said, I'm not very diplomatic -- I'd like to know who made the money from pyridostigmine bromide tablets that were distributed to the troops.

My last comment: I guess we want to talk about lessons learned, I think the most important lesson that we can learn from any of this is that you're not going to get anybody that's going to join an armed forces that's not going to stand behind their people. The first thing we're taught as Marines and noncommissioned officers is that you're accountable for your troops. If your troops aren't eating, you don't eat. They get fed first. You take care of them first. The problem is, people keep hearing about this over and over again on how the Department of Defense or the military isn't taking care of their people. We're not going to be able to get the kind of quality individuals that we need to keep our security. I'm a little nervous, but that's about it. That's all I have.

SECRETARY JESSE BROWN: You don't sound nervous to me. We obviously can't answer those questions now, but we will get your name and address and you can rest assured that you will hear from us.

EDWARD NOBLE: Thank you very much.

SECRETARY JESSE BROWN: With that, I'm going to ask if there are any final comments from the members of the Board. At this point, I'd like to ask Mr. Kaplan to come forth as the representative from the White House and close the meeting.

MR. ROGER KAPLAN: Would you like to do it?

CAPT BRIAN PETERMAN: I'll do it. I'd like to thank the Board for their participation tonight and everybody that was here, and I declare the meeting closed.

(Proceedings recessed at 10:11 p.m.)