SPECIAL OVERSIGHT BOARD FOR DEPARTMENT OF DEFENSE
INVESTIGATIONS OF GULF WAR CHEMICAL
AND BIOLOGICAL INCIDENTS
Friday, October 27, 2000
1401 Wilson Boulevard, Suite 400
Senator Warren Rudman, Chairman
RADM Paul Busick
Dr. Vinh Cam, Ph.D.
LTG Marc Cisneros
RADM Alan Steinman
Captain Greg Gray, M.D., USN
Captain Craig Hyams, M.D., USN
Captain Randy Beardsworth, USCG
Bernard Rostker, Special Assistant to Deputy Secretary of Defense for Gulf War Illnesses
Sean O'Shea, Special Assistant to the Cabinet Secretary
COL Michael Abreu, USA
CDR Drue Barrett, USPHS
Mr. Jack Heller
C O N T E N T S
Opening remarks and introduction of board - Sen. Rudman
Millennium Cohort Study - CAPT Gray
OSAGWIMRMD Transition Update - Dr. Rostker
Comparison of Pre- and Post-Gulf War
Deployment Blood Sample Chemistries - CAPT Hyams
Deployment Blood Sample Chemistries - CAPT Hyams
Board Discussion and Final Remarks
P R O C E E D I N G S
SENATOR RUDMAN: I'll designate our fellow representative, Sean O'Shea from the Cabinet Affairs Office of the White House, to officially open our meeting.
MR. O'SHEA: Thank you, Senator. Welcome, everybody, and thanks to Mike and everybody for putting the meeting together. So with that, we'll turn it back over to the Senator.
SENATOR RUDMAN: Thank you very much. I guess when the Congress passed the law for these presidential advisory commissions, they didn't trust that the civilian chairman would know how to open a meeting.
SENATOR RUDMAN: So I guess they -- they may be right in some cases. But thank you, Sean.
This meeting is being held in accordance with the Federal Advisory Committee Act and announced, as required by law, in the Federal Register on Monday, October 16th. We will proceed according to the agenda.
With some relief, I will tell you this will be our final meeting prior to publication of our final report. Our report is due on December 20th. I'm working now to arrange a time to meet with Secretary Cohen, to present the report directly to him. I know that the President will receive a copy at the same time.
Secretary Cohen has a very demanding schedule in late December, traveling to overseas bases to bring holiday greetings to the forward deployed troops, and of course preparing for a transition to a new administration. We don't have a definite date, but as soon as we do have a schedule, I will publicly announce when that will be. I hope that every one of the board members could make that meeting.
In the next several days, each member of the board will receive a draft copy of the final report. And I hope that each member of the board will try to put whatever they're doing aside and devote some time to reading that. You of course have had the integral part of forming that final report, but it's important that each member look at it carefully, to see whether or not they concur with the findings therein.
As you know, we have recommended to DOD that the OSAGWI organization be downsized and refocused. The Secretary has accepted that recommendation. Under the leadership of Dr. Rostker, it's being implemented -- first, by directing that the organization become permanent; second, buy directing that the name of the organization be changed to include the functions of medical readiness and military deployments.
Dr. Rostker, let me say we appreciate your efforts, and we look forward to hearing how you are going to transition between the present organization and the future one, and how it's going to be integrated into the mission. And then at some point, I believe we'll hear from CPT Craig Hyams, a physician who is the head of the Infectious Disease Department at Naval Medical Research Center. He will discuss an interesting research initiative.
And finally, after our meeting is formally concluded, I would like to have the staff and board members remain so I might present to each of them a certificate of recognition for their outstanding service.
Before we proceed, we're going to have opening remarks from our board members. Dr. Cam, good morning.
DR. CAM: Good morning, sir.
SENATOR RUDMAN: Good to see you. I believe Jesse Brown is going to join us. But I just want to make a couple of comments, beyond these formal comments.
First and foremost, I want to publicly thank the members of this Special Oversight Board for very devoted service. This has not been an easy task. The atmosphere that we found that existed when we were created was most difficult. There has been a great deal of controversy surrounding this whole subject that predates Dr. Rostker's stewardship and goes back to the period right after the war.
But I just want to make this observation. When I spoke with the Secretary, and later the President, about what we were going to do -- if you read the charge very carefully that we get in our charter -- it was clear to me that first and foremost, this board was charged with ensuring that there was a high degree of public confidence that the work being done by OSAGWI was thorough, complete, fair, unbiased and thorough. In the words of the President, to leave no stone unturned.
I can say this morning that I believe that our oversight has reached the conclusion that that is true, that those missions have been accomplished. Certainly not with perfection; there is so much that is not known that we wish was known. But our function was never to -- although it was publicly misunderstood -- to ascertain what the root causes were. Our mission was to ensure that those charged with that responsibility were thorough, fair, unbiased. And I believe you have been, Dr. Rostker. No one will ever be totally happy with anything any part of government ever does. But I am satisfied, as a veteran, that our veterans' community is being well served.
Let me turn to -- I don't believe Secretary Brown is here yet. I will try to appeal to RADM Busick.
RADM BUSICK: Sir, I would concur with your comments. And I will expound on them in the closing comments.
SENATOR RUDMAN: Dr. Cam, anything you would like to say at this time?
DR. CAM: Yes. I'm very honored to serve on this board. And it has been a very gratifying experience.
LTG CISNEROS: Sir, I, too, would just like to quickly add that throughout this whole process, I have been specifically oriented to make sure that we operated with the integrity that was intended for us to operate here, and to listen to all the arguments. I just want to assure you that my view of this panel -- and I have no oar in the water to protect anybody; I'm completely independent, and I value my integrity. And I want to tell you that I've been honored to work with you, because I feel that your integrity is beyond reproach. And you have set the groundwork for this to have independence, and to have the moral courage to call it as it is, regardless of the shells that we're going to get. And I value that, and I think we have done that under your leadership. And I concur with the remark that you just made.
SENATOR RUDMAN: Appreciate it, General. And let me also say, before we get into the main body of work, that I am very, very grateful and indebted to Mike Naylon and the entire staff. They have done an amazingly good job. This has not been an easy exercise; they have been devoted, every one of the staff has been. And Mike, I just want to thank through you all of the staff for a job well done.
I'm sorry Secretary Brown is not here yet. I've got some remarks I want to address to him, and I will when he arrives.
Board member David Moore is unable to attend today's meeting, as he had a last-minute schedule conflict. Now, I believe CAPT Gray is here.
CAPT GRAY: Yes, sir. Well, good morning. What I'd like to do today, Mike has asked me to introduce a study that we think might help the situation when we have deployments in the future. If we can turn down the lights here? Can I have the next slide?
In 1992, when the Gulf War veterans started complaining of symptoms and diseases, the spectrum of that morbidity was quite broad. It ranged from everything from mortality, increased mortality, to things that were very subjective, such as symptoms. And because we had very little exposure data, and very little morbidity data, at least controlled data, it was very difficult to answer the questions. Next slide.
I probably don't need to tell this committee, but a tremendous amount of work has been done since that time to investigate the allegations of increased morbidity and mortality. And here you see some of the things that were done. By some estimates, the cost of this effort has exceeded $1 billion. Next slide.
At the Naval Health Research Center, where I'm a physician epidemiologist, we began to get involved about 1994, at the request of DOD Health Affairs, to establish some long-term studies to investigate some of these allegations. And we investigated in three different realms. One was a realm of symptoms, here on the left. In the middle, a realm of health care utilization, largely hospitalizations. And finally, reproductive outcomes. Next slide.
The studies range in size, and various different methods, and I won't get into the details. But I will tell you that we were quite productive in doing studies that met with favorable peer review in the literature. And I think we've helped to, along with other teams, helped to at least answer some of the different allegations. Next slide.
I'd like to look at some of those allegations, as depicted here in this slide. And that is, at the beginning of the information on the Gulf War, there was just tremendous spectrum of disease and mortalities thought to be associated. But I think now many investigators will say that most of the associated morbidity is over here on the left-hand side of the spectrum, in the symptom area. And there's still some questions about chronic diseases. But I think a lot of the studies, investigations, the registries, have helped us to shape the debate in this area. Next slide.
Under Dr. [Jack] Feussner's [Chief, Research Working Group] guidance, a number of things have been done to investigate illnesses in that area. And two of the most laudable, I think, were these clinical trials targeting not etiology of the pre-symptom reporting, or multi-symptom conditions, but trying to come up with effective therapies. And these studies are now in the data analysis phase -- still collecting some data, but largely we've stopped enrolling. And we're evaluating basically two empiric treatments to see if it makes the veterans feel better and function better. Next slide.
A number of different bodies have reviewed the situation, such as yourselves, and concluded that we need to do a better job of collecting data and measuring health in our forces in the future. And I'm sure you've heard a little -- at least a significant amount about the Force Health Protection Program. Next slide.
The concept is to follow our veterans from the time they enter service until well beyond they've left service, to document, to do all we can to protect them, provide health care for them, and to well document their various different interventions, deployments, et cetera. Next slide.
So, since the Gulf War, I think we can all agree that we've done a lot better job at documenting and cataloguing various things in electronic systems. We certainly are working on collecting better data with respect to exposures in deployment, vaccinations, ambulatory events, et cetera, et cetera. But the task is really to aggregate these and to be able to compare populations. Next slide.
In the Strom Thurmond Act in 1999, the Secretary of Defense was authorized to establish a center to do such aggregation of these various different databases. And in September of 1999, DOD Health Affairs, through a memorandum, established, actually, three centers with this concept in mind, to maintain some capability to analyze veterans in this way. Next slide.
At the Naval Health Research Center in San Diego, we were devoted, as the research center -- and the idea was to retain a repository of talented folks that could understand these databases and do studies. There's a similar center for clinical events at Walter Reed, and at the U.S. Army Center for Health Promotion and Prevention, a Medical Surveillance Center. Again, a lot of that center is devoted to collecting electronic surveillance for health events, often in the field. Next slide.
The thinking is, if we have these people -- it took so long for us to build up to this capability. If we keep these people in the government's service, we'll be able to answer new events or new allegations such as this one here by quickly studying the available data.
I don't have time to go into great detail about what we're doing at the Naval Health Research Center, but these are the active projects for FY '01. We are designated as the DOD's -- to maintain the DOD's birth defect registry. So we actually capture data on that to answer reproductive questions. We're evaluating anthrax vaccine morbidity associated with hospitalizations and reproductive outcomes. We're collaborating with CAPT Hyams in a good assessment program, trying to get better baseline data on the cases that come in. And we're looking at the aggregations, in collaboration with the VA and the CEC and others, looking at aggregating all the various health registry data from the Gulf War veterans. Next slide.
Well, largely, I'm here to tell you about what we've done as a result of this report, "Measuring Health," from the Institute of Medicine, that was released in November 1999. It called for a large prospective cohort study of Gulf War veterans. And it mentions specifically a number of different populations: non-deployed veterans of the Gulf War era, Gulf War veterans, other deployed veterans to other conflicts, and the U.S. general population. Next slide.
They also recommended some specific core data to collect, and some things to target: death and the duration of life, impairment, functional status, health perceptions and opportunities. Next slide.
So under the encouragement of Dr. Feussner and others, we were challenged to respond to this Institute of Medicine report. And after a series of meetings, we developed a strategy to adopt many of these recommendations. Next slide.
We thought that we would take this opportunity to really build an effective cohort study that would for the first time be able to allow us to follow people prospectively, and to have these people available to answer future questions. Next slide.
And the reason is, at any one time in the service, as you're well aware, we have a tremendous number of people that are deployed. So we need to be able to quickly capture that data and conduct analyses. It's really hard to do ad hoc-sort of analyses retrospectively. Next slide.
We recommended, in a series of meetings, that the VA, that we respond to IOM's report by extending the national survey of Persian Gulf War veterans, and also doing the millennium cohort study, which is a totally new venture. Next slide.
The goal of those studies would be to determine how the health of veteran cohorts changed over time. Next slide. Just briefly, because of the large populations involved, we would have to restrict these studies to postal surveys and telephone surveys because of all the costs of trying to get an intensive, person-to-person-type evaluations. We recommended that we use similar instruments in the various cohorts, and that we do periodic sampling of the cohorts, and that we make the core data available to other researchers in the future, such that they might add additional studies, add-on studies, to get at specific questions that we can't anticipate right now. Next slide.
I mentioned some of the new data sources I showed you in the slide. We want to make sure that we, for the populations we identify, that we collect those data, and that we have them aggregated and linked to the core data, so that we can answer questions. Next slide.
So a number of organizations over the period of the last year or so have developed the Millennium Cohort Study. This has involved uniformed services, U.S. Army Research Institute for Environmental Medicine, DOD Health Affairs, and University of Washington-Seattle ERIC to be a lead for the study. Next slide.
We aggregated some of the best epidemiologic minds in designing these prospective Gulf War studies, a very distinguished scientific panel. But we thought it wise to bring in veterans' service organization representatives to get their input as well. We had a two-day meeting where we presented our initial design, and they helped us by critiquing that and making very good suggestions. Next slide.
In the Millennium Cohort Study, our primary objective is to compare the adjusted risk for development of common clinic-diagnosed diseases, such as asthma, diabetes, hypertension, coronary artery disease, between the cohorts. Other outcomes, secondary objectives: looking at a wellness, health wellness survey, SF-36, and to compare prime MD scores, which is a mental health diagnostic standardized instrument. Next slide.
The study in a nutshell is a probability-based cross-sectional postal survey of 100,000, or 3.2 percent sample as of October 1st this month. And the idea is to follow them prospectively at three-year intervals with serial surveys through the year 2022. We plan to add to the cohorts in 2004 and 2007 of 20,000 new accessions, with the idea that this might be further adopted in further out-years through various different things that we're doing now, such as the pre-assessment profile. But we'd always have a database of veterans to follow through time. Next slide.
Pictorially, here is how we show it. We follow the 2001 cohort that many of years, this 21 years, and the 2004 a little bit shorter. But it's a very ambitious project, the largest of its kind ever in military populations, and one of the largest prospective cohort studies ever attempted in any population. Next slide.
We wrestled with, and our advisors certainly helped us, with how to collect data, who to sample. And we followed this sort of algorithm -- and I won't get too much down in the weeds -- but the bottom line is, we would like to take 70,000 non-deployed veterans and 30,000 recently deployed veterans, and follow them through time. We would include components from the active duty forces, the reserves -- and over sample women as well as the reserves, so we can have enough of a sample size to make some determinations. Next slide.
The idea is down the road to pick -- if we have questions about outcome, we would be able through this technique to control for the various different risk factors for the outcome -- such as deployment in Kosovo, or Southwest Asia, gender, having a tendency before deployment, or race, ethnicity, enlisted/officer, et cetera -- such that we could determine uniquely how much probability or how much variance was contributed by deployment itself.
SENATOR RUDMAN: Captain, I don't understand that chart. Could you explain that, please? I don't understand -- I don't understand the mathematics, or the numbers. Just explain that, so we know what we're looking at? If I don't understand, I expect there are a few others who might not.
CAPT GRAY: Okay. For instance, in this statistical analysis, we would say that the risk ratio for deployment to Bosnia for, let's say, hospitalization with coronary artery disease is 22 percent greater than somebody who is not deployed, controlling for all those other covariants.
So basically this is a way to handle the various different things, statistically, that happen to our forces. Vaccinations, race/ethnicity, socioeconomic -- all these things that we think affect health outcomes, but we want to get -- really what we're looking at is the impact of deployments and military-specific exposures.
RADM STEINMAN: Is this a theoretical -- that's just a theoretical chart? Or are those actual numbers?
CAPT GRAY: This is just an example of what we might do. And it follows -- it follows -- we haven't actually collected any data in the study. But it follows the examples from some of our published reports already; this is exactly how we got first involved in it.
SENATOR RUDMAN: All right.
CAPT GRAY: Next slide.
The core data is really minimal. We think the survey will take 30 minutes. I have some examples -- maybe you could pass those out. But basically we're using standardized instruments as you see here; instruments that other research teams have developed and validated to collect these various different outcomes. These are MARKSYS or in optical scanning format, so that we could handle the volume. We would have to go out to 256,000 people to get the target of the 100,000, we think costs a tremendous amount of work.
SENATOR RUDMAN: Let me ask you a question, Captain. You know the fact that over the next few years, statistics indicate that a very high percentage of Americans are going to have computers and have Internet access. Why would you not give people the option to do this form over the Internet, and have it handled through your own servers, and be able to compile the information more efficiently and probably less expensively?
CAPT GRAY: Senator, we've done exactly that.
SENATOR RUDMAN: You have?
CAPT GRAY: Let me show you -- next slide. Well, actually, it's a couple slides down.
SENATOR RUDMAN: Actually he gave me that question and -- (laughter.)
CAPT GRAY: We anticipated that. What we're doing in addition to the survey data is linking available electronic data to these people such that we could quickly respond to questions, that's the plan. I won't get into a lot of detail. But these are the databases we know that are available now. And of course, as we get better and better at collecting data on our military personnel, we'll have more opportunities to upgrade data. Next slide.
The strategy to maximize participation is shown here in a synopsis. We're following traditional Dillman techniques. It means four postcard mailings, serial surveys -- you probably get this in your home. But it's the best strategy to get high participation, which is what we need to convince scientists in the peer review process that our data are valid and accurate. We will have a computer-assisted sampling of non-respondents. And the bottom line is, this is state of the art for this type of work. Next slide.
Here is our answer to Senator Rudman's question. We have a site right now -- actually, we have multiple sites, for when people misspell this. But basically we have a site where in the first postcard mailing, and throughout the serial mailings, they will have opportunity to fill out the surveys online, to keep us informed online of their addresses -- and we think this will greatly reduce the cost.
And interestingly enough, in our first, we did something called focus groups. We've had four of those, and various different service members. Today's service members are more willing to give information via the Internet than they are to complete surveys. Just sort of surprised us. But this is a new technology. It requires special protection of information. And there are quite a few hurdles for us to get over in order to get permission to do this sort of data collection.
SENATOR RUDMAN: That's interesting, Captain. On that point, there's some recent studies that indicate -- and it probably has a lot to do with the age group and the young people in this population, who tend to be the veterans as well within that group -- they would far prefer to work at a computer, and do all sorts of market survey, political polling data, far more apt to respond than either by telephone or with a form. So I think there's a lesson there, or certainly a strong suggestion.
CAPT GRAY: Well, the good thing about this is it saves us quite a bit of money. And not only for the forms, but also in processing them. So we're very pleased that that looks like a -- yes? Dr. Cam?
DR. CAM: Is the risk communication part of this that somebody else will take the job to explain the objective and the results?
CAPT GRAY: Yes. In order for them to complete the survey, our institutional review board is requiring online informed consent. And it's quite extensive, the hoops we have to go through. But they get a very good background of what's involved and why we're doing this study, how long they're thought to be participating. It's all spelled out very clearly to them.
We don't have a risk management person; I think Dr. Rostker's group is a good one for that. But we're just trying to do the science.
We think, in the sample size estimates, that we will have some answers in a relatively short period of time -- three to ten years for some of the chronic diseases; three to six years for some of the secondary objectives. So we're not going to have to wait twenty-some years to find this useful. Next slide.
Here's where we are with this study. We began, challenged by Dr. Feussner, in January. We developed a protocol that was sent out for external peer review, that scored well on the external peer review. We had our scientific steering committee in June. We met with veterans' service organizations, who have endorsed the study -- we hope that this body would also endorse the study in a formal way. And we've put those endorsement letters on the web site, or will.
We're now in the final stages of an institutional review board setting, and we hope to release the pilot study to about 3,000 service persons in November. And the first big mailings to the 256,000, we hope, in January. Next slide.
Our oversight is extensive. We've been funded by DUSD(S&T), and from DOD Health Affairs. We have various different oversight annual reviews by the various different bodies. And we have a scientific steering and advisory committee, particularly at the research working group of the Military and Veterans' Health Coordinating Board looks at our work very closely. Next slide.
So that's about it. I would ask if the committee would consider endorsing this study. It would be helpful to us, we think. And our biggest problem is that we're very light with respect to uniformed or government employees. Most of all these folks are contractors, and we're trying to resolve some of those issues. But I think Dr. Cam has seen this before; we need to -- in a 21-year study, we really need some people that are long-term team players. And we probably need to consider options for achieving those sorts of goals with GS workers.
That's all I have.
SENATOR RUDMAN: Any questions? General?
LTG CISNEROS: On the peer review of the survey that you're doing -- just glancing through this real quickly, you know, a person who is thinking of coming into the military and answering some of the questions that I saw real quickly, might be concerned about the impact of this information -- what is it going to do to getting a security clearance? What are they going to do with it?
And in addition to peer review, have you all looked at it from the standpoint of a common-sense, of taking somebody who has no risk at all, to give you feedback about -- if you had to fill this out, would you have a propensity to flavor it, or not flavor it, how the questions were asked?
CAPT GRAY: General, you raise an excellent point. We've actually had extensive dialogue in the focus groups, I think about 30 individuals, and some of them have voiced significant reservations because of those concerns.
And what we've recently adopted is, in our cover letter we've explained to them that this study would never be used for other than research purposes, and specifically stipulate it would not go back to their command or be used for any sort of advancement or other issues.
LTG CISNEROS: And you think they're going to believe that?
CAPT GRAY: Well, it's the best we can do. And --
LTG CISNEROS: Because there's a lot of paranoia out there. And how do we deal with it? And I'm not being critical here, but when you ask for a name or whatever to identify --
CAPT GRAY: Yeah. We have to have personal identifiers to link to these other databases --
LTG CISNEROS: I understand. I understand. Our challenge is going to be to get a real solid database that we can have confidence that it is representing the --
CAPT GRAY: We hope that if this Board, and veterans' service organizations, endorse the study, that will help allay some of the concerns that the veterans have that they would be inappropriately used.
SENATOR RUDMAN: Well, there is a way to handle that, General, it seems to me. You raise an excellent point; you wouldn't want this to get set back by privacy concerns that people have. So I suppose you can handle it one of several ways, Captain.
You want to consider, number one -- and we might say something about this -- you could have a very tough regulation, with sanctions and penalties for disclosure, A. Or B, you might want to have Congress, as tagging on to one of the authorization bills, cover this, simply put in some privacy protection for that. I would prefer the former -- or the latter, if I were you. But Captain, these are some things that you can do.
Now, you still will have some non-believers. But at least that can give you something.
CAPT GRAY: Yes, sir.
SENATOR RUDMAN: Dr. Cam?
DR. CAM: I have a question about resources. What's the budget? How many people are doing this? How many full-time, how many contractors? Do you feel you have adequate resources to carry out your mission?
CAPT GRAY: We are programmed, we have $3 million board-funded that will get us through the first sampling and the first year of tracking. We have to track these people every year through their addresses. And we have program funding well into 2004, I believe, with promises that should this continue to serve well, we will be well funded in the future. The funding, in fact, is real healthy here, but it's DOD Health Affairs-type of funding.
With respect to the personnel, we have a pretty good staff, about ten on this team that are experienced. We've done surveys, now, in excess of 30,000 Gulf War veterans. So we're pretty adept at doing this. My concern is the -- most of those are contractors. We have just two uniformed folks on this. And with two weeks' notice, they can greatly disrupt our team.
So we're exploring ways to better institutionalize this study and our DOD center, through full-time government employees.
DR. CAM: And how is that being addressed? Because I have such a concern for it.
CAPT GRAY: Yes. The -- we have another medical corps officer from the Navy that's supposed to join our group. And through a memorandum establishing this center, the Air Force and the Army are supposed to send us other uniformed assets with epidemiologic backgrounds. But as yet, we have not received those due to a number of different reasons. But certainly those things -- having the additional uniformed officers at the DOD center would be a great asset to us, and I think are necessary.
In addition, we are planning to create some GS position, doctoral-level epidemiologist staff positions --
DR. CAM: Exactly. That would be helpful.
CAPT GRAY: Two of those. But we haven't gotten too far on that as yet.
DR. CAM: Yes, I would appreciate that you keep our board appraised on that effort. Thank you.
SENATOR RUDMAN: Admiral?
RADM STEINMAN: Captain, I compliment you on the presentation. I think this concept is an important one, and your study is a very important one. And had we had these data in 1994 going forward, we probably would be a lot further down the path of understanding Gulf War illnesses than we are now -- although even in this study, the potential exposures are, again, left to self-reported exposures, and the uncertainty that that brings. But still, reporting -- self-reported symptomatology and hospitalization data would be interesting.
I, for one, as a board member will recommend that we endorse this study, and will so put that in the final report.
CAPT GRAY: Thank you. We will -- I need to tell you that Jack Heller's group at USACHPPM is doing active surveillance and deployment. So we will be able to aggregate real exposure data linked with these. So we'll have better data, hard data, as well.
Thank you. Thank you very much.
SENATOR RUDMAN: I guess we can get the lights back on. Thank you very much, CAPT Gray. Dr. Rostker?
DR. ROSTKER: Sir. We are going to set up a slide projector. Let me just thank you, Senator, for your kind remarks, and say truly that the Department of Defense and Office of the Special Assistant will miss both you and the board. I think you've provided a very important function.
We have set out the task of, as we indicated, being as objective and as thorough as we possibly can. But we have always needed the critical review and feedback of organizations like yourself, the General Accounting Office, the Senate Special Investigative Unit, to take fresh eyes and to look at what we are doing. And we have valued that feedback, and it has made for a better product.
There has been, and there remains, a desire on the part of those who are extremely frustrated at the fact that we and others have not been able to come up with definitive answers to Gulf War illnesses, a desire for quick responses, quick determinations. We've been criticized, just recently, in Congress and the Senate, for not declaring a syndrome and getting on with it. We were criticized by members of the PAC for even questioning the reports of chemical exposures that were given in good faith by service members who served in the Gulf, and investigating them and in some cases -- even in a majority of cases -- raising questions about what they reported.
We did that because we felt our first and foremost requirement was to get to the truth; that we were not serving the veterans community, either today or for the future, if we took the easy path of declaring victory, of working towards placating conclusions that could not be demonstrated to be correct. Because it's only with the true information that we can correctly address the concern of today's veterans, and equally as important, take the right policy steps for the future.
And so sometimes the organization -- and I'm sure I can be accused of being a little stiff-necked on things. But it has been with only one goal. And that is to provide the best information that we are capable of providing to the veterans, to answer their questions as best we can, and to provide for the future the firmest base to make policy decisions, and to move on.
With that, I'm privileged to present our final briefing to the board. And we'll start by looking at the past, and our requirement to finish the work that you have directed us to bring to closure, look towards our vision, how we're organized, and then the initiatives for the future, in terms of the new organization. And then I'll tell you some of the things we are in the process of doing.
Over the next several weeks we intend to publish three major studies: a reassessment of Khamisiyah based upon the latest information from UNSCOM and from the CIA, in terms of what has been generally referred to as the source term -- what were the chemicals that were at Khamisiyah, that were detonated -- and revisions to the meteorological models and the meteorological data, as indicated by reviews by a number of scientific panels.
The Khamisiyah report will be accompanied by notification letters to those who were under the plume, as best we can understand the plume. We will be telling some people that based upon the latest information, we no longer believe they were under the plume. We will be telling other people that we now think they may have been under the plume. And we will be telling a third group that we continue to think they were under the plume. All in all, the number that we believe may have been exposed at Khamisiyah is approximately 100,000.
There has already been work done trying to link those people with reports of disease and the like. And that work, unfortunately, will have to be revised based upon the latest plume.
RADM BUSICK: And the -- excuse me. And the level of exposure based upon the revised reports?
DR. ROSTKER: The level of exposure is approximately the same. The area of first effects, where one would have felt something, is still an area of about eight kilometers by three kilometers. It is still an area where no chemical -- no people were, and no chemical alarms were set out. So the paradox of Khamisiyah, of how could we have a major event and no one heard it, or reported it, is still answered by the latest simulations.
We calculate to the general population limit -- that is, many, many times greater. And the difference in our reports are more precision in understanding where troop units were, and slightly different meteorological projections. You would recognize them as about the same, but small shifts of distance have an impact.
I would note interestingly, last week I went to Indiantown Gap to look at the MYSTIC units -- we used to call them RAID units -- these were civil units that would be dispatched to help state, local authorities if there was a release of chemicals. And they have their own computer simulations for real-time based upon weather. And -- but they don't calculate out to the general population limit; they calculate out to effectively the same first effects. We thought we were breaking ground by defining first effects, and we find here's a community that is using the same thing: where would people feel it? And that is an area that is somewhat larger than an area of lethality. And they make calculations similar to the kind of calculations we have made here.
DR. CAM: Excuse me, Dr. Rostker. What period did the plume cover?
DR. ROSTKER: The plume covers the same three-day period, the same basic event of the explosion and then a leaching of sarin and cyclosarin into the atmosphere as the vapors came out of the wood and came out of the soil. And we still see it as a three-day event to the general population limit.
DR. CAM: But only around Khamisiyah?
DR. ROSTKER: No. It's --
DR. CAM: It covered more sites?
DR. ROSTKER: About the same geographic distance as the original plumes. And it does extend several hundred kilometers.
RADM BUSICK: I think the question is different, though. I think the question is, are there different sites than Khamisiyah from which you were modeling something?
DR. CAM: Right.
RADM BUSICK: And I think the answer is no?
DR. ROSTKER: We did use the models to model the air campaigns, and possible releases from al-Muthanna and the other, because that was a question also. We used the best models and the best wind data we had. We had detailed, we calculated detailed weather data for the entire period of January, when we were doing the air campaign. So we extended these model sets to the air campaign, as well as using them for Khamisiyah.
RADM BUSICK: But nobody was exposed in those.
DR. ROSTKER: No Americans were exposed in either of these events. The CIA believes that the actual release at Khamisiyah was less than we originally projected two years ago. And that was calculated in according to the calculations.
LTG CISNEROS: A question on that, if I may, on the CIA report. I was really troubled at the hearing we had, where the CIA did a turnaround on that, and they also said that the reason their first report was much more massive is because they were pressured. And now they come with a revised one.
I remember the term he used: we were "pressured." And that really bothered me, because that added to the paranoia of a government cover-up. Are you saying now that the revised CIA report has the same coverage, exposure of the number of troops? Because I had the impression from him that it was much less than indicated.
DR. ROSTKER: We take the number from the CIA. My organization did the meteorological work. And the only pressure that we felt was a pressure on time that the PAC placed upon us, because they had indicated that they would make a finding that it was a massive release, and that literally millions of people should be notified. We were confident that we could do the Dugway tests and accomplish the work we did, and make that public. It did not have the degree of peer review that it got after it was made public, and reviewed by outside organizations.
The meteorological work was revised by my group under no pressure. And we took the latest CIA estimate. So I'm not in a position to talk to the CIA's conclusions --
LTG CISNEROS: No, no, I didn't intend to -- I didn't imply any pressure on you. But I had the impression when we heard that, that therefore the revised plume -- now that the CIA is coming back and said, our first one, we were pressured to worst-case it, coming in here. I had the impression when they briefed us, Dr. Rostker, that the exposure with their revision was much less.
And the comment you just made, RADM Busick, a while ago, I just want to clarify in my mind. You said we still had the same amount of people exposed?
DR. ROSTKER: Exactly. For example, one of the things that was different was that the CIA now told us that some of the chemicals were cyclosarin rather than sarin. And that has a more lethal effect. COL Abreu can maybe fill more in. He's the one who actually pushed all the --
COL ABREU: Sir, to answer your question, the hazard area is about -- roughly, as Dr. Rostker said, about the same size and encompasses the same population. The reason for that, yes, indeed, the source term that the CIA provided us is less than what was used in the 1997 model. However, in 1997 we had no toxicity data for the chemical warfare agent cyclosarin.
Since then, with the help of people at Aberdeen Arsenal, we now have toxicity data for cyclosarin, which is about three times more toxic than sarin. So the decrease in the amount of agent that was present and released is countered by the fact that the hazard area is slightly more toxic. And so it's counterbalanced, and that's why the hazard area encompasses about the same amount.
In 1997, since we did not have the data, we assumed uniform toxicity of sarin, because the data was not present.
LTG CISNEROS: I guess if I -- just a final comment, if I may. But this is an important point to me. Overseeing all of this, all our efforts -- including us individually, and you, Dr. Rostker, and all of this -- is by the paranoia of a conspiracy of the government to cover up. And we get this initial report, which contradicted completely what the military had said. The CIA, as I recall it graphically, the military said it's this, the CIA says it's this.
Immediately that triggered off the paranoia about government conspiracy cover-up. And I remember that clearly. The advocacy groups said, this is proof of a government cover-up. And then subsequently the CIA comes, and my impression was, well, listen, we were pressured to have said that; it really was this. And I said, you know, you can't get the horse back in the barn. That's how I perceived the issue. And that bothered me.
And I remember telling that agent when he testified, I said, you know, that bothers me what you said about being pressured to make a report, because this is a very sensitive thing. And how do you satisfy the conspiracy theorists on that?
COL ABREU: I worked with the CIA intensely on all of this. The only pressure we in any way felt was from the PAC on the issue of time. And so this did not go through the levels of peer review that it should have gone through.
I can tell you that we in DOD were talking about the 82nd, and then we were reprising the numbers. And then there was a number, 20,000, floating around. And the day we made the announcement, there was speculation; CBS thought they had a scoop that we were going to say 30,000. And we actually blew them away when we said there was 100,000 exposed. No one thought that we would be coming with a number that large.
The number was what it was. And my staff is used to hearing me say, it is what it is. I mean, there is no good number or bad number. There's just the best number we can have, or we can provide. And that's what we've done, now, twice.
It turns out there's about 30,000 people who we think we will send letters that will say, you were not under the plume, as best we can tell. And there will be about 30,000, it turns out, that we will say we think you may -- now, and I'm being very careful to say, we think. These are simulation models after the fact. They're the best that scientists in and out of the government, that academicians that advise us think are reasonable ways that intelligent people thinking about the problem can bring the tools of science to bear. Is this ground truth? Hell, no. It's the best we can do.
SENATOR RUDMAN: Why don't you go ahead?
DR. ROSTKER: Okay. We will be republishing the depleted uranium paper. And in this paper we will be correcting some information. We will be presenting other information we have now, further results from the VA's monitoring of veterans in Baltimore.
An issue was raised within elements of the Army, between CHPPM and the arsenals on the interpretation of some results based upon a failed sensor, a sensor that was inside a tank hit with a depleted uranium round. This sensor was destroyed when the round penetrated the tank compartment. And we have ordered a re-firing of that test, and that will occur in the next several weeks, at a cost of several million dollars.
There was no question about the downwind sensors, and so for those who were not immediately within the tank, if they had survived the event, what was their immediate exposure to depleted uranium? That's the question. There's no question about people outside of the tank, downwind from the tanks.
This would be a second interim report. And I'm sure that we'll gain comments, and we will contemplate moving to a final third report at some date in the future -- unfortunately, without the oversight of the Board. I wish we had that oversight.
And finally, we will be bringing to fruition a very extensive study of pesticides, including surveys of people in the Gulf, trying to understand how pesticides were used. This will be important in terms of informing our forces about hygiene measures, as it pertains to the application of pesticides. There's no smoking gun here. We have not been able to relate it to any outbreak of disease. But it will be an important addition to the information concerning the use and misuse of pesticides.
We have -- we're in the process of releasing two reports in which we have changed our assessment. We released yesterday the Fisher Mustard case report, in which we move from a declaration of "likely" to a declaration of "indeterminate."
A word, if I might say, about these words, "likely" and "indeterminate." It was always my desire, and it still is, not to use these words -- to lay the facts out before the American people, before our veterans, and let them draw whatever conclusions that they want to draw. We were requested on numerous occasions, and did agree, to try to characterize these in shorthand. And we developed the five-point scale, and there has been much discussion about how objective the points are, and where things fall. I think that's really unfortunate. The issue is not what we call it; the issue is the information that we present to veterans, and veterans have to make up their mind.
There is no compensation difference between "likely" and "indeterminate." There is no meaning to the words, outside of what is in the mind of the beholder. And I would encourage everyone to read the case narratives, and not get hung up on words like "likely" or "indeterminate." I'll discuss the Fisher case in a moment.
Similarly, in the Czech-French, there was an early determination that the equipment, particularly of the Czechs, was credible, did not false-alarm. There is now substantial evidence that says -- as similar to our equipment -- that the Czech equipment is prone to false alarms. And we brought that into the debate.
A little bit more on the Fisher case -- this was a very early case. And I must say, in retrospect, we did not do a thorough job of independently analyzing. We did a credible job of collecting the impressions of others and presenting it in a concise format. But when others, particularly the Senate Investigative Unit or the General Accounting Office, challenged some of the popular notions about this case, the case started to come apart.
And they asked us to reassess the case, and we did that through additional interviews, through additional fieldwork. And things that we thought were factual at the time reported, generally understood to be factual, turned out to have less precision to them. For example, there was an assertion that there was a positive urine sample in-theater. And we tracked down the corpsman who these statements were attributed to. They could not remember the urine sample, but remembered hearing about the urine sample.
Dr. Dunn tells us he knows of only one urine sample that he took, which was sealed and sent to the States. And when it was processed in the States, it was negative for the byproducts of mustard. So that important piece of confirmatory evidence turns out to have been lacking, and upon further review it could not be found -- or in this case, was found to not corroborate the story.
We still have the diagnosis of a competent and qualified physician, who believes that these blisters were certainly consistent with ones you would have expected to see from mustard. And we take that as important first-hand information. But all in all, given the items here -- and I'm not going to go through each one of these -- we have revised our conclusion to call this case indeterminate.
LTG CISNEROS: Is urinalysis a very dependable method of determining mustard exposure?
DR. ROSTKER: There should have been some chemicals that are byproducts of the exposure in the urine. This is a standard test. It broke down.
We also had -- this wasn't the only thing. We also had samples of his uniform, his flak jacket, which did not test positive in the States. There was a thought at the time that this might have been a bunker that stored chemical weapons, mustard, during the Iran-Iraq War, except we later learned that this bunker was built during the occupation of Kuwait in 1991, and did not exist during the Iran-Iraq War. No chemical weapons were found in the bunker, or in the vicinity, by any of the U.S. troops or SGT Fisher himself. So we have no explanation why a sample of mustard would be on a doorjamb in a bunker that did not contain mustard rounds.
And so an explanation which in retrospect looks a little ad hoc-ey, does not, again, support this. So ultimately we don't know. We're not asking SGT Fisher for his medal back. We just don't know. But it is not as clear to us as it was earlier, in recounting what turns out to have been the popular view of the story.
In terms of the French-Czech detections, the French were very forthcoming last year. They provided us with a letter, which clearly stated that they now believe that the tests, the detections, were false. I also led a team -- GEN Vesser, Dee Dodson was part of the team -- and we went to the French chemical school, and actually looked at their equipment, and got a better feel for its characteristics and the like. But they now believe, and have said so formally in writing, that they did not have a positive detection.
There has also been further tests of the Czech equipment. And one cannot be as certain as we first were led to believe that this equipment would not false-alarm.
Since last April, at the direction of the Board we have released a number of documents, either in final form, in closeout where the board directed that we bring an inquiry to fruition, or in a few cases republication, where further public comment seemed necessary.
And what we have done is, with the concurrence with the Board, published -- and the Board has reviewed in its final form after it's published and indicated whether we have met all of their concerns -- I've been told that the first three on this list, the board staff has indicated that they concur with the publication of those. The bottom two are reports that we just released yesterday.
The next slide shows the reports that are still in our pipeline. Some of these reports have taken more work, in dialogue with the Board and Board staff, than originally anticipated. In some cases, because we have been on a drawdown, we've lost staff and we've had to reassign staff to concentrate, to regain a critical mass. And in a few cases, we've had to reassign staff because of important continuing inquiries. And we'll talk about one, Project SHAD, which the new organization has taken on -- has nothing to do with the Gulf War; has to do with concerns that people have with chemical and biological tests in the 1960s. But it carries the same kind of inquiries that are necessary, and we've had to divert staff to examine that situation.
Let me shift to the new organization --
RADM BUSICK: Let me digress before you do that. I think that the Board's staff has reached the conclusion that we should support the three reports -- the oil well fire, the an-Nasiriyah, and the cement factory. But we as a Board have yet to --
DR. ROSTKER: Yes, I understand that. That's why I was careful to say the staff.
RADM BUSICK: Okay.
DR. ROSTKER: I believe they've submitted to you, and we are waiting for the dialogue.
RADM BUSICK: Yes.
DR. ROSTKER: The new organization, and the new organization is called Gulf War Illnesses, Medical Readiness and Military Deployment. I think it's interesting here that when we submitted this originally, the name really was Medical Readiness and Military Deployments. And there was some consideration that we continue to highlight the Gulf War illnesses so that their veterans would not believe that we'd lost faith and written it off. And we were quite pleased to continue the emphasis on Gulf War formally in the title of the new organization.
We have been spending a fair amount of time, commensurate with trying to get the previous work done, to understand what kind of role we could play for the future, and how we would interact with the rest of the institution in DOD, as well as the veterans community inside the government, as well as military and service organizations and veterans' services organizations. Yes, ma'am?
DR. CAM: May I ask a question?
DR. ROSTKER: Of course.
DR. CAM: Going back to the previous slides, I just have a practical question for you. How can your organization help with the issues that I mentioned before with CAPT Gray, in terms of resources? And the other point is about working with Gulf War veterans. Are you going to have some kind of a mechanism to bring in the Gulf War veterans, in terms of having input into research recommendations and things like that?
DR. ROSTKER: Remember --
DR. CAM: I think that's important, that they are in the room.
DR. ROSTKER: Yes. The Department of Defense has a shared responsibility here with the Department of Veterans' Affairs and the Department of Health and Human Services. And one of the things that has also been made permanent is the move from the Gulf War Veterans Coordinating Board to a Veterans Coordinating Board, in which the three departments and the three Secretaries chair.
And so we have a -- as part of that, there is a, or will be, a veterans advisory group that will be able to particularly input to the issue of medical research. Remember, I've had relatively little to do with medical research. That's been a function both of Health Affairs, but primarily a function of the Gulf War Veterans Coordinating Board, and the research coordinating board. And Dr. Feussner is here; he's done an outstanding job, Jack, of bringing the communities together.
I think you'll find that most of the dollars that were actually expended came through the Defense budget. But we coordinated that as a community.
DR. CAM: Yes. But that's different from what Dr. Barrett did last year at the CDC. That was a great conference. But it was a one-shot deal.
DR. ROSTKER: Well, the coordinating board is charged with the continuing -- they're not going away. And they have a major function in risk communication. For example, when we did the Khamisiyah letters, we coordinated it through the agencies and used the facility of the coordinating board as the vehicle, to make sure that we were meeting the appropriate risk communications standards.
In terms of the individual things, I think I can be helpful to Dr. Gray, as we've tried to be in the past, in ensuring his budgets are reasonably supported. And I think I can do that with either my special assistant add-on or my Under Secretary's hat. It's very useful, sometimes, to have many, many hats.
SENATOR RUDMAN: Yes. Go ahead.
DR. ROSTKER: The next slide has the vision of the organization. And we struggled with this. We think it's important that we are able to provide information to those who are concerned about their health, so they can make informed decisions; that we can do this by developing and disseminating relevant information, and do it in a timely fashion; and that we must incorporate our lessons learned from the Gulf War and from other experiences.
The next chart is the current revised organization. We're about a third of where we were at our max. And it is a flexible organization -- you'll see it is dominated by contractors. And we did that so we could both expand and contract as needed.
The government civilian positions are being permanentized [sic.] We had temporary authority for hiring, and we're almost completed with the hiring, permanent hiring of the government civilians.
The organization will have a career Chief of Staff. It will eventually have a single Special Assistant, as we transition. And then we'll have either career military or a civilian in charge of each of the major operating directorates, with our management information system and database being maintained by contractors.
Our strategy is to be an organization that can facilitate, can integrate, and can communicate. And we -- next slide, please? -- we expect to do that by building off of our experience in the Gulf. The operable words here are "greater sensitivity," to be "proactive," to be "responsive," and to be concerned with "managing risk management."
Now, the next set of slides are slides that we have used in our opening discussions with the CINCs. I am convinced that the only way we will improve the way we collect data, the way we handle the false alarms on the battlefield, the way we can interact with our troops, is to make the CINCs part of the solution. I am not in favor of writing Washington regulations to be put on the backs of our divisions. I know what will happen to them.
So we sent out a briefing, where the purpose of the briefing was to scare the CINCs. And let me show you how we intend to do that.
We want to show them how -- in the worst of terms, how the service members perceive the Gulf, in this case in terms of false alarms, and what the reality was. And the message to the CINCs are, if you want to live in the world of perceptions, then continue to do what we have been doing. If you want to live in the world of realities, then you have to take actions to make sure that your soldiers understand the realities of what's going on. So you have to educate them, you have to collect the data and make reports to them. You have to be a resource for them, as they have experiences on the battlefield that you have to help them interpret.
And so we're doing this in terms of false alarms. We've talked to the CINCs about missing records, and their responsibility for record keeping. We talked about their responsibility for, as it says, leadership -- you need to talk to people, tell them about the events.
There's a lot of sense that technology is the solution, that with global position satellites and personal information carriers and medical dog tags, that we can have all information about everything on the battlefield, and that will make Dr. Gray's life much easier. I think we're dealing with soldiers, and I don't think we'll ever get to that point. We have flirted, ourselves, with the notion of, couldn't we have a little GPS receiver, and it would record where everybody was on the battlefield? I don't think it passes the test of reality, in terms of what a soldier would be willing to put up with.
So short of these technological solutions, I think the way we have to go is working with the CINCs to develop procedures which are reasonable, not onerous, and will get the information that we need to a reasonable degree.
The issue here is leadership at the highest. We need to convince the chain of command, from the top down, that they have a central role in this risk management; that caring for your troops is not just in the warfighting sense, or in the physical sense, but it is also in the sense of providing them all of the information that is necessary for them to have confidence as to what has happened on the battlefield.
And so over the next several months, we are on line -- GEN Vesser's already been to PACCOM, and we'll be going to Europe and Korea. And some of us will also go down to CENTCOM to work with GEN Franks.
I think -- I've asked Steve to start planning for a video that would clearly represent this -- that we could use across the commands -- represent this issue of the realities from the Gulf War versus, or the perceptions versus the realities, and how do we ensure we can talk about realities, not continue to talk about perceptions? Next slide.
The key to all of this is communications. And we will be keeping our web site, expanding it, but keeping it open for veterans, keeping a hotline open for those who are concerned about the Gulf War, as well as any other deployment. Our interactive e-mail continues. We do a monthly roundtable with the VSOs and the MSOs, veterans' service organizations and military service organizations.
We are moving from the town hall schedule that we had to a schedule of providing information to professional organizations and fairs, rather than the massive outreach. We just don't have the manpower at this point to sustain the kind of quality job we have done in the town hall meetings. And so we're going to pull back somewhat in this area to be more a resource for other organizations.
DR. CAM: So Dr. Rostker, you do information fairs outside the base, not at the base?
DR. ROSTKER: It would be with the American Legion, with AUSA. It would be at their conventions.
DR. CAM: Oh, okay. I see.
DR. ROSTKER: We'd go to state conventions, national conventions. But we will not be sending a team of ten or 12 or 15 to a base for the kind of saturation that we have done over the last year.
In total we've done -- 32 town hall meetings?
SENATOR RUDMAN: We have seen a substantial attendance decline at these meetings, have we not?
DR. ROSTKER: We have. But I must tell you that we still get 100 people, and sometimes it's like deja vu all over again -- it's people who are not familiar with what we do. And we provide them a function by being able to say, you know, we are aware of that. But that's covered in a case narrative; would you read the case narrative? Clearly someone we had not gotten to. But there is a limit to how far you can go. And we're talking about, when we do it, with pre-visits and the time we spend there, several -- many man-years of effort by -- we were doing this once a month -- probably 15 people involved for each time we went out. It was well worth it, but very, very time-consuming.
SENATOR RUDMAN: Oh, I think this is now the way to go.
DR. ROSTKER: Almost as if it had been designed, the new organization was able to fill in immediately to take on concerns that veterans have expressed about Project SHAD, a set of biological and chemical tests that were done in 1964. This has been floating around the Department. I will tell you, a comprehensive job of reporting to the American people has not been accomplished. The Department of Veterans' Affairs asked the Department to provide additional information. Because of the way the request came in, it was given to the Army, the Army assigned a major or a lieutenant colonel. One of the things they did was call us and say, here, can you help us? How do we get information out of the Navy?
Once this came to my attention, I called the Army in and we all agreed that the place to put this inquiry was in the Special Assistant's office. And, for example, earlier this week I signed out a memo to the Under Secretary of the Army and the Under Secretary of the Navy asking for immediate declassification of all Project SHAD documents, and to pull it to the top of the queue, not move it in the normal bureaucratic queue.
We know how to do this. We know how to deal with veterans groups. It is a logical function, and I'm glad we are here with our experience. And hopefully we will do the kind of thorough job that I believe we have done in the Gulf War on this issue. I'm sure there are other issues that the organization will be in a position to respond to, without having to reinvent the methods of response every time a new issue comes up.
And so in summary, we have not given up on our veterans. I know our research has not. We continue to inquire, we continue to publish, so that everyone can have the best information possible about what happened in the Gulf. We have to be in a position to deal with these non-traditional kinds of issues. And the creation of the new organization, I believe, was the right response. I believe the best thing we can do is work with the CINCs and make them part of our solution. If we have a Washington solution without it having reality in the foxholes and on the deck-plates, then we will not have been successful. And we look forward to working with the other elements of the federal community, the VA and the Department of Health and Human Services, as well as our veterans' organizations, to accomplish our common goal.
Thank you very much, sir.
SENATOR RUDMAN: Thank you very much, Dr. Rostker. Questions from the panel?
RADM STEINMAN: I just -- I don't have a question, Dr. Rostker. I just have some comments I'd like to make.
First, I want to compliment you personally for your efforts and that of your staff in what I find is a thorough investigation and results for the issue of Gulf War illnesses. It's been about two and a half years since I think you've been immersed in the process of holding public hearings and reviewing every paper, every published study on Gulf War illnesses, hearing testimony and interviewing the Gulf War veterans, scientists who have looked into this issue such as Dr. Haley and others. And based on all of that, I can honestly state that in my opinion you and your staff have done a highly commendable job of investigating Gulf War illnesses.
I also want to state for the public record, and the benefit of our veterans' service organizations and the press, that all my dealings in the last two and a half years with yourself, your organization, and other agencies in the Defense Department, I've found, as LTG Cisneros has found, no evidence of any kind of cover-up or attempt to obfuscate. In contrast, I found really only a sincere effort to get the facts out, to let the facts fall where they may, and get that information to the veterans and the public.
That's not to say we haven't had disagreements on issues. And you're well aware of those. But I think those disagreements have been down in the weeds and in details. And I think our macro analysis, I think that you've done a pretty good job of laying the facts on the table and investigating these issues.
SENATOR RUDMAN: Thank you very much. Dr. Cam?
DR. CAM: I have a question and a comment. I would like to know the status of the declassification of the MITRE report?
SENATOR RUDMAN: The declassification of the MITRE report?
DR. CAM: And my other comment is, I really wish you luck for the follow-on organization, which we supported. We would like to have, if it's possible, like, a schedule of what you are planning to achieve, like in a year or two years, of the lessons learned. You know, I'm more interested in the practical aspect of the program.
DR. ROSTKER: It's my understanding -- I've not been involved, and I don't believe my organization has been at all involved, in the declassification of the MITRE report.
SENATOR RUDMAN: We'll try to get an answer to Dr. Cam from the appropriate people.
DR. CAM: Yes, right.
SENATOR RUDMAN: If you're interested, we will attempt to get an answer as to if and when --
DR. CAM: When, right.
SENATOR RUDMAN: Any questions at all? Admiral? Okay, thank you very much, Bernie. Appreciate it. Thank you very much. General? CAPT Hyams?
CAPT HYAMS: Earlier you got to hear from Greg, and now you're going to hear from Craig, briefly present the understanding we have dealing with the possibility that our troops were exposed to chemical agents during the Gulf War.
SENATOR RUDMAN: You've got a presentation of about, what, 15 minutes, I understand?
CAPT HYAMS: Less than that, sir.
SENATOR RUDMAN: All right.
CAPT HYAMS: It will be quite quick. I'm the head of the Epidemiology Division at the Naval Medical Research Center here in Silver Spring, Maryland. And I've done some work on Gulf War health issues, along with Greg and other people. I'm probably most noted for being the lead author on the article that showed that we have seen similar unexplained illnesses going back to the Civil War, up to the present.
I will say this, I was deployed to the Gulf in late August 1990, and I helped establish the Navy Forward Laboratory in al-Jubayl. There's been some comments made over the years that we didn't do much surveillance during the Gulf War deployment. Actually, as far as infectious disease risks go, we did an enormous amount of surveillance. We conducted a lot of epidemiologic surveys, and we had a sophisticated diagnostic laboratory that evaluated our troops and biological samples, and -- of dead animals and different things for infectious disease risk.
All that information has come out. I think it's helped in some ways to understand some of the health threats for our troops during this wartime performance.
Are there some questions?
A PARTICIPANT: Obviously, technology will catch up with us.
A PARTICIPANT: Okay, here we go.
CAPT HYAMS: Let me -- I'll talk about something else, then.
Our laboratory, I think we were able to collect a lot of data on infectious disease risks during the war. But in some ways, we may have exacerbated some problems.
One of the first questions we were asked when I got to Saudi Arabia in late August 1990 was about the dead animals. This was an issue that arose months before the war began; a lot of people don't realize that. If you were a soldier or an airman who came into the Gulf in January or February of 1991 and saw these dead animals for the first time, you wouldn't have known that they had been there when the deployment began, many months before anything had happened.
And we were approached by entomologists at that time, the people who do the spraying, the pesticide spraying because of the arthropod pests, what they should do about these dead animals. And we recommended that they heavily spray piles of dead animals because they are potential sources of vector-borne diseases, potential breeding grounds. And they did that. And this may explain some of the reports that later arose about the possibility, about the dead flies and insects and stuff on these piles of dead animals, and that this may have been due to chemical weapons exposure. That just shows you how something innocent and potentially useful gets changed around because of a lack of information during one of these really critical periods, these wartime periods, when there's a lot of misinformation and confusion.
LTG CISNEROS: Let me make a comment. It's germane to that point you just made, as to what chemicals were used as part of the vector control, if you will. My understanding was that a lot of the local contracting officers went and bought some commercially available insecticides and pesticides that were banned in the United States, like Skeet, I think, was one of them.
CAPT HYAMS: Yes, I went into town, actually, with them on several occasions when they did that. There were some limited supplies purchased for different things. But for the most part, they used FDA-approved pesticides that they brought over from the United States.
LTG CISNEROS: They did?
CAPT HYAMS: We bought a few things in town. But I never saw any massive purchase of unapproved substances of any kind.
LTG CISNEROS: During the Gulf War event?
CAPT HYAMS: Right. I mean, I didn't see everything that was purchased. But my experience was not that there was wholesale purchase of non-FDA-approved pesticides. I saw nothing like that.
LTG CISNEROS: I have the impression that there was a lot of it, and some of the units went out and bought -- you know, to kill flies or something. A lot of them had Skeet. In fact, we got a briefing on the wide use of Skeet. That's not correct?
DR. ROSTKER: It was Snip, I think, sir. And we actually brought some back from Saudi Arabia on our trip, and we had it assessed in terms of its volatility and toxicity. And it was one of many false -- things that was used, for example, widely around food. But we found that it was not at all volatile. It is licensed outside of the United States, but it is not licensed inside the United States. So we tried to follow that lead --
LTG CISNEROS: Yes. Yes, we had talked about it one time. And somebody -- if I recall correctly, Dr. Rostker -- they were going to check to see the purchasing, how much of it was done, to see -- of that one which would be banned in the United States.
DR. ROSTKER: It's part of the pesticide paper that we will publish in July.
LTG CISNEROS: Yeah. Thank you.
CAPT HYAMS: Okay. This is a proposed study that will involve DOD personnel -- myself, CAPT Malone, and CAPT Trump -- actually collecting these biological samples. Dr. Heller is with us today; he's in charge of the geographic information system. And then a group of really distinguished researchers at the CDC, who developed unique toxicological assay methods. And then Dr. Murphy from the VA. So it's a wide group that would be involved in this study, if we do it.
The objectives of the study are to determine whether a cohort of U.S. ground troops deployed to Saudi Arabia and Kuwait was exposed during the Gulf War to selected chemical substances that have been hypothesized to cause long-term health problems among veterans. Another objective is to begin to evaluate new biomonitoring/biomarker methods and models that may lead to the development of simple and effective procedures to assess military personnel for exposure to toxic agents in future wartime deployments. And then a final objective is to establish a linked database and serum bank for future analysis of adverse exposures during the Gulf War as new tests and hypotheses are developed. This will become more clear as I go through the slides.
Now, let me talk about the population. When I was in the Persian Gulf, we were doing a lot of surveys over there amongst our troops for infectious disease risk. One of the things we couldn't do is, we couldn't do longitudinal analysis very well. We could do cross-sectional surveys amongst troops when they were in one location. It was hard to follow them up later -- I mean, things were breaking very quickly when we were over there, and obviously when the war began. These troops move forward, and really, you know, it's not a period of time to do surveys.
So I got back to a friend of mine, CAPT Malone, in the United States, who I had done surveys with in the past. And what he did is, he identified a group of Marine Corps personnel who were scheduled to deploy to the Persian Gulf.
So he identified this group of Marine Corps personnel who were scheduled to go to Saudi Arabia in December of 1990. And we got a protocol together over the telephone, and we got approval for the protocol. And what CPT Malone did is, he and CPT Trump, is he administered a self-completed survey questionnaire to these troops within three days before they flew directly to Saudi Arabia. He also collected a venous blood sample from all these personnel, and when it was spun down we saved the serum samples, the sera from these samples. This was really patterned off of studies being done before the war amongst Navy personnel. So he did this for 1,000 Marine Corps personnel that went to the Persian Gulf.
During their wartime deployment, ninety-seven -- they were deployed to northern Saudi Arabia -- 97 percent of them also went into Kuwait. Only about one percent really traveled into Iraq during this period of time.
They returned to the United States in May 1991, after a mean deployment of 131 days. And we were ready for them. We wanted this longitudinal database, this longitudinal, this over-time sample of a group of military personnel. So within two days of their return, we were able to administer a post-deployment health questionnaire asking about their health status during the time that they were in Saudi Arabia and Kuwait. And we were able to -- and this is very important -- obtain a second venous blood sample from approximately 900 of the original 1,000 in this group. These serum samples were frozen down and stored at -70 degrees.
So we have -- this is a very unique population. We have biological samples from the time of the wartime deployment -- just before they left, just after they came back. We also have a fairly complete history of their health status while they were in the Persian Gulf. It's a unique sample. Next slide, please?
I'll just mention some of the things that were reported on their questionnaire. Approximately 60 percent reported at least one episode of acute diarrhea -- keep in mind, we're infectious disease doctors; this is where our thinking was centered. This was an area we knew would be at risk for many infectious diseases. And so, I mean, that's what we were looking for, that's what we were training for. So a lot of our questions were directed towards infectious disease risk.
About a quarter of them had transient cough or sore throat -- we were they were worried about the sand exposure, the blowing sand. Thirty-four percent complained of rhinorrhea -- that's, again, because of blowing sand. Twelve percent complained of fever, with 22 individuals who complained of fever without GI or respiratory complaints. The reason we collected this data is we were very interested in seeing whether or not sand fly fever was affecting our troops -- not just diarrheal disease, not just common respiratory complaints, by sand fly fever.
Sand fly fever had been a huge problem for allied troops stationed in this area during World War II. And we were quite worried that this would cause a decrement in our combat effectiveness if we started seeing sand fly fever. So we were on the lookout for that particular infectious disease. And two percent were briefly unable to carry out their routine duties due to health problems.
If you look at these statistics and compare it with troops during Operation Desert Shield before the war began, with the surveys we did at that period of time, we find almost the same percentages of upper respiratory complaints, diarrheal disease and fever. There's nothing that we could see that was unusual about this group compared to the pre-war period. Upon return, this cohort appeared healthy, just like almost all of the Gulf War veterans.
We did a number of studies using the questionnaire data and the biological samples. We published two studies where we evaluated viral infections, arboviral infections like sand fly fever, Congo-Crimean hemorrhagic fever and a number of other types of infections you would see over there. We also looked at rickettsial infections. We published our data; we didn't find a single case of sand fly fever in this study and several other studies we've conducted.
We also evaluated these samples for Norwalk virus infection, which causes vomiting, and for Shigella infection, which causes diarrhea, as you know, and confirmed many of our previous findings about the fact that our troops were at high risk of impairing infections. This is a well-characterized cohort of veterans, and we've done a number of studies on them. It's out there in the peer-reviewed literature.
Now, this is something new. Within about the last 12 to 18 months, the CDC has developed some rather unique capabilities for assaying, for potential chemical agents that our troops may have been exposed to. And some of the tests they have developed can be duplicated in other centers. But as far as this total package of chemicals that they can -- the chemical agents they can assay for us, this is very unique to the CDC.
They are now able to assay sera -- they were able to assay other types of biological samples in the past -- but they are now able to assay sera for certain chemical warfare nerve agents, including sarin, cyclosarin, soman and a few others. They are also able to assay sera for organophosphate pesticides, for sulfur mustard, for chlorinated pesticides like lindane, and for vanadium. Vanadium is very interesting, because the Kuwaiti crude oil apparently has this metal in the crude. And so if you find someone who was stationed over there with vanadium in their system, it's an indication of smoke exposure. Next slide.
Okay, this just gives you the sort of techniques they have used. And these are really, really new. In fact, just a year ago, or 18 months ago, we couldn't have assayed for most of these chemical agents. So the CDC is progressing very rapidly in their capabilities.
DR. ROSTKER: How long will these markers stay?
CAPT HYAMS: That's very interesting. The CDC is confident that if the troops were exposed toward the end of the deployment and towards the end of the war, that they probably still have detectable levels. If they were exposed towards the beginning of the deployment, then probably not. But the tests are so new -- and there's a limited amount of normative data, there's a limited amount of data in other populations -- that, I mean, they're not totally positive about that. But that's their feeling right now. The tests they did would probably only show exposure towards the end of the deployment. Next slide.
What we're proposing is that we take the pre- and post-deployment survey data, and we link it to Jack Heller's geographic information system, so we have a much clearer idea about where the troops were during their wartime deployments. We link it to the combined clinical registries to see whether or not -- what kind of health problems the veterans had after the war, and the hospitalization records for the same reason.
We then will test a randomly selected batch of 100 matched pairs of samples blindly for each of the five major categories of chemical agents. And depending on what we find -- if we find any evidence between pre- and post-samples; if we find a rise in levels of these chemicals between the two samples, that they may have been exposed to one of these chemical agents -- then we will test a larger number of our samples, to get a better idea about what the extent of exposure was and who may have been affected. Next slide.
We also will place a set of paired serum samples from members of this cohort, along with a linked database, at the CDC and the DOD. We're not going to use all the serum samples, and so we're going to establish a serum bank and a linked database so that as new tests are developed -- and we see things are developing fairly rapidly here -- or a new hypothesis arises, we'll have this asset to go back to, to further tests. Next slide, please.
Okay, and this is the last item. I need to talk about some of the research limitations. We're dealing with a relatively small sample size here. We only have about 900 individuals, with a limited exposure -- it was northern Saudi Arabia and Kuwait City. So we really don't have a randomized sample of the entire Gulf War population to draw from. So, if this group was exposed, or if it happened not to be exposed, we'd get an erroneous idea about what the risk was for other Gulf War veterans, maybe a certain selection bias.
It's very interesting. When we collected these samples, I mean, they were clearly collected for the purposes of evaluating our troops for their health risk during this wartime deployment. But being infectious disease doctors, we only asked for consent to test for infectious disease agents. And we may be able to go back to these samples and test them for virtually any infection if we develop a test, someday, for viscerotropic leishmaniasis. We weren't thinking of chemical agents; we didn't put that on the consent form.
And it's just almost 100 percent probability we would have to go back and get re-consent from the 900 Marine Corps personnel in order to test their samples now for these chemical agents. And as we know in the past, it's hard to contact the Gulf War veterans. And I think the best efforts so far have reached, what, 50 percent or something like that, when we've tried to contact them? Fifty or sixty -- Dr. Heller may know about that.
So I'm not sure we can find all these veterans to test, and that could introduce a certain amount of selection bias in our testing.
Okay, we've already discussed the possible loss of detectable level of chemical agents, if they were exposed early on in their deployment. And then we have a certain novelty of the test methods. I mean, the CDC is the only group which really has all these tests. And we don't have a lot of data now in other populations -- there is some data; we don't have a lot of data -- showing exactly what these levels of chemical agents should be.
Let me say something about funding. We've applied for funding from both the BAA and DHRP proposal. I'm not here today to ask for funding, and I'm not here to ask for an endorsement of the study. The staff asked me to present this study; I mean, it's germane to the work you're doing. But also, I think it shows there are biological samples from this wartime deployment. It also shows you that there are new tests being developed that will help us out in the future, if our troops are potentially exposed to some of these chemical agents. I think that's worthwhile, to discuss that in the meeting today.
I want to also say that I think this proposed study demonstrates the importance of peer review and independent assessment of research proposals. We actually applied for funding for this research study over a year ago the first time, and were turned down. However, we got a lot of useful recommendations on how to focus the study and improve it. We've also been able to develop assay methods that will allow us to test for a wider range of potential chemical exposures. We have a better proposal now than we had a year ago. And a lot of that is due to the peer review process. Not only does it help you select the best proposals, but it helps the proposals that look favorable, it helps you improve those research studies. So I think this is a good example of why the peer review process is so necessary.
And then another outstanding issue is locating veterans for re-consent, I've already mentioned that. We have an alpha roster from OSAGWI that would be helpful. We can do announcements to the DOD, VA, and American Legion web sites if we conduct this study. And certainly we're going to have to prepare to answer veterans' questions if we start re-contacting them about the possibility of testing their serum for chemical agents. And they're going to have a lot of questions about that.
So that's all.
SENATOR RUDMAN: Thank you, Captain. Do you have any questions at all? Admiral?
RADM STEINMAN: I guess three. First, probably an easy one. Depleted uranium, is it possible to test for that?
CAPT HYAMS: My understanding is no. Jack, do you want to say something about that?
DR. HELLER: I don't believe they can do it, but we still have our 11th ACR work. We're working out a protocol and methods for smaller volumes. We have our good, clean uranium from -- excuse me, our urines from the 11th ACR that will also put proposals into that work. And whether that gets funded or not, we've still got to try to take that out of our program so we can do that.
RADM STEINMAN: And that may be a year or two?
CAPT HYAMS: Sometime in the future, sure.
SENATOR RUDMAN: Maybe there will be an opportunity to --
RADM STEINMAN: Second, second is more of a comment. Here you have before and after serum samples, pre- and post-deployment, clearly. And if you find interesting chemical findings in your post-deployment samples, it would support some of the Board's concerns about proposed DOD post-deployment screening of troops that's going to rely on HIV samples, sometimes as much as one or two years after deployment. The concern we had originally, when we heard that plan, was the loss of ability to detect changes that might occur in later serum. So it would call into question whether DOD might have to revise its post-deployment sampling if you come up with some interesting findings in your post-deployment screen.
And the third had nothing to do with --
CAPT HYAMS: There's another issue here, too. Serum is not always adequate for certain assays that you want to do. We have been over this over and over again. Sometimes you need whole blood; sometimes you need white cells. Sometimes urine may be a better sample. All of these things, you know, add to the complexity of obtaining biological samples and trying to use them to determine whether your troops have been exposed to something.
And so I think on a routine basis it would be hard to collect all of these different types of samples, on a routine basis. If you collect them just before and after deployment, I think you could take a subset, if you have time, and you sort of have an idea about what your exposures might be, then that might be worthwhile. If we had a lot of troops deployed to that area, and it looks like we're going to have to end up going to a conflict, you might want to take a subset like we did here, perhaps larger than this, but still rely on our serum bank for further studies.
I mean, our serum repository has been very useful for, like, determining what the risk are troops are at for Hepatitis C. I've been involved in that study. But for, like, the chemical agents and the techniques we have now, it would have been better if we'd had samples just before and after deployment. For, like, mycoplasma infection, serum samples really aren't very worthwhile, because they're all free of white cells, so they're not useful.
So all I'm trying to say is it's very complex what you do. Sometimes you're going to have to be a little flexible and innovative, depending on what the situation's like.
RADM STEINMAN: Well, there's no question it would be a sampling and storage nightmare, if we were to do everybody. Post-deployment immediately might be done. But it was just an observation.
And the last thing is a question to do with you personally, it has nothing to do with this study, but some of your previous work. You have probably one of the experts on the post-war illnesses that have occurred in every war we've been in since at least the Civil War, that we know of. And it seems to me, in looking at the symptoms of illnesses that fall into the category of the Gulf War, at least undiagnosed Gulf War illnesses, as far as possible etiologies of that -- we all know all the interest has been focused, and all the money and the research has been on potential toxic exposures. Three other ones might be the fact that Gulf War illnesses have the same symptoms as most commonly found in the general population, civilian and military; two, they somewhat match the signs and symptoms of chronic fatigue syndrome, fibromyalgia, multiple sensitivity; and third, they seem to match the same kinds of symptoms and illnesses that veterans have had in all these other wars. So my question to you is, given your background and research in that post-war illness issue, do you think it's likely that in this war, that at least some veterans would fall into that category of the post-war illnesses that you have found in other wars?
CAPT HYAMS: I think that's definitely true. I mean, their symptomatology is very similar with the symptomatology we saw in veterans after the Civil War, and after World War I and after World War II. I don't think there's any doubt, to me at least, that one could assume some similar phenomena here, that we're dealing with postwar phenomena, a post-war syndrome of some kind. As to its cause, I don't know what to say. I mean, that's why we're all here, you know, to a certain extent.
What's happened after previous wars, very interesting -- the best example is World War I. Effort syndrome, or neurocirculatory asthenia, or soldier's heart, is probably the most similar to what we're dealing with now. It had a very similar symptomatology, there were a lot of debates after the war as to what its cause was. Poison gas actually was one of the potential causes of effort syndrome, and it was put on the table. There was a lot of debate about whether it was a psychological condition, or whether infectious diseases -- I mean, almost everything we're dealing with now were thought of as being potential causes of effort syndrome.
They had a lot of special committees, and boards like this that evaluated this. They had registries, and examined large numbers of veterans at specialized health care centers, like at Walter Reed. They did almost everything that we are doing now. And it was a huge controversy at the time. Actually, their unexplained syndrome, effort syndrome after World War I, was the third-leading cause of disability determination in World War I troops.
They never did figure it out. There was a huge debate. At the beginning, they thought it was, you know, like poison gas or something like that. With time, they didn't find its etiology. And after ten, 20, 30 years, you know, the consensus was it was a psychological condition, because they didn't find any other cause for it.
And we simply may end up in that situation here. We don't find the etiology of it, people ten or 20 years from now may decide it's a psychological condition. I don't think that's necessarily correct, but that's been the history of these syndromes in the past.
SENATOR RUDMAN: Dr. Cam, do you have a question?
DR. CAM: Yes. Do you have a timetable for your research, when you think you would get off with the project, and what the --
CAPT HYAMS: Well, actually, we'll hear about the funding in the next eight weeks.
DR. CAM: Oh, okay.
CAPT HYAMS: And then, you know, we can start the analysis probably in February or March.
DR. CAM: So it's a couple of years from now?
CAPT HYAMS: No, no --
DR. CAM: I mean, in terms of the findings?
CAPT HYAMS: No. We'd be back in 12 months.
DR. CAM: Oh, okay.
SENATOR RUDMAN: Admiral?
RADM BUSICK: Just a couple of comments. First of all, contrary to popular opinion about DOD and its response to the veterans, this shows that there was a thoughtful effort early on, I think, to what might be occurring, and to find some rational way to take a look at that. And that's really commendatory, and I'm really glad that we got this briefing today.
Secondly, you made a comment about peer review works. And there is some controversy currently over the Department of Defense's decisions to fund some research outside of the Research Working Group process. And I would make a comment, having been a player at the time, to make the point that the reason for that, from my perspective, was to try to get that research into the peer review process, so we would have a publicly defensible process through which to accept or reject the findings of the research being done.
Sometimes, I think, policy makers have to make decisions outside of that standard scientific rigor process, simply to get that thing corralled and into the process so we can corral all of you scientists to say, this guy's doing work that either cuts the mustard or it doesn't.
CAPT HYAMS: Let me say this a different way. As a researcher for 20 years now, somehow the larger scientific community gets the idea that we're not following a process, we're not doing this in such a way that selects for the best research, it's really going to stigmatize or taint all of Gulf War research. And our findings are not going to be taken as seriously, particularly negative findings. I think it's very important, technically, that we follow the routine process for selecting and verifying and improving the research. In this area, you know, it should be done like all the other areas about medical research.
RADM BUSICK: And I would make this personal observation, that is, like the CINCs, you haven't really recognized yet, or maybe you're only beginning to recognize, that they have some different sets of responsibilities in terms of warfighting than they used to think they had. Sometimes you have to make decisions outside of the standard scientific process because you have other reasons for doing that. And the objective is to get that stuff into the scientific process in a way that -- so it can stand on its own merits or not. That's the point.
And the last point I would make is, while I would recognize that 900 individuals is not a very large sample size, it's a hell of a lot more than 41.
SENATOR RUDMAN: Dr. Cam?
DR. CAM: Yes, as a follow-up to the peer review process, I just want to know your personal feeling. Do you really feel it's better off to take this Gulf War research and put it into really academic, scientific establishment, like the NIH? At least, so then we take the politics out of it, and focus on the solid long-term research.
CAPT HYAMS: Well, I'm not sure you take the politics out of it. I mean, you take the DOD out of it to a certain extent. But as a uniformed researcher, it's hard for me to imagine doing research in this area without having people like me contributing -- people with firsthand experience, people who understand how operations take place, people who -- you know, who can make the sort of context that outside researchers need to do research on a military population.
What do you say, Greg? Can you imagine turning the bulk of this over to the civilian researchers?
DR. CAM: May I ask -- I didn't mean removing people like you out of the loop. I mean, you should be a significant part of that. But the review process, you know, how to select topics and grants and funding -- because one time, we were talking about recommending research for the NIH, you know. And in that context -- it's a mechanism.
CAPT HYAMS: Oh, okay.
DR. CAM: But not removing people like you out of the research loop altogether.
RADM BUSICK: But in fact, doesn't the Research Working Group reach out to those kinds of organizations to do a series of topics? I mean --
A PARTICIPANT: Yes. Each service is a full partner, and the various researchers from the CDC, so --
RADM BUSICK: So it is not as if DOD, in and of itself, decides which ones to fund or not. They actually have a Research Working Group, who draws from people outside of DOD to make recommendations to them as to which ones to fund, through the Research Working Group, or a subset of the MVHCB
SENATOR RUDMAN: Well, in fact, Dr. Cam, as we all know, the -- and I take your point. But the overwhelming amount of research has been done on grants, after peer review, funded by DOD but done outside of DOD.
RADM BUSICK: And recommended by individuals who are not associated with DOD.
SENATOR RUDMAN: Correct. Any other questions at all for CPT -- Captain, thank you very much. We can turn those lights back on. Very good.
That closes the agenda we have for today. And before I ask for any closing remarks by members of the panel, we had a Federal Register notification of this meeting, and everybody knew we were going to have it. And we had no other requests for anyone to appear before the board, or comment before the board. And since this is our last public session, if there is anyone in the room who would like to address a comment to the panel of some brief nature, you would be welcome to do so.
Do you have -- would you like to come up here, then, and identify yourself?
CDR. BARRETT: I just want to make a quick comment. My name is Drue Barrett from the CDC. And I think this addresses a comment that RADM Steinman made. CDC is in the process of developing what they call a rapid tox assessment, and they are working with people at DOD in order to go in and very quickly do an assessment of what people may have been exposed to. They have a battery of about 150 different things that they can assess, so if there are specific events that occur, where there may be a concern that troops have been exposed to potential agents, they could go in very quickly and get an answer with a 48-hour turnaround time. So I think there have been discussions with DOD on how to implement this.
MR. HELLER: Well -- my name's Jack Heller. I'm from the U.S. Army Center for Health Promotion and Preventive Medicine at Aberdeen, as Craig mentioned. In fact, we have an ongoing relationship now with the people at CDC. And again, we have a grant proposal in where we actually want to get the CDC personnel new methods on a future, not-too-distant deployment, either to Southwest Asia or Bosnia, where we will actually be doing pre-, during-, and post-deployment screening for particular toxic substances to which our troops may be exposed, in conjunction with our environmental sampling and the new personal sampling that Marine Corps Systems Command is developing. So it would be a three-pronged approach to that.
SENATOR RUDMAN: Thank you. Appreciate your comment. Is there anyone else in the room? Anyone from any of the veterans' organizations? Any individual? We've tried to maintain open meetings since the inception, and this will be no exception. So, is there anyone else?
Well, if not, I would ask if any of the members of the panel have any remarks to make before I ask CAPT Beardsworth to officially adjourn.
RADM BUSICK: I was honored to be asked by the President to serve as the senior director for the Gulf War illnesses on this issue. I was gratified to work with individuals within the government who I thought brought extraordinary dedication to try and solve this issue, contrary to the real public perception on where we were and what we were doing.
I was privileged to participate in the selection of all of you to be on this Board --
SENATOR RUDMAN: We'll never forgive you, Admiral.
RADM BUSICK: And I guess I'm doubly honored to act as the replacement for one of my personal heroes, ADM Zumwalt, who passed away, and also to, with respect to what you just said, work with you, Senator.
I would echo your comments and Dr. Steinman's comments that it has consistently been my observation that Dr. Rostker has scrupulously carried out the President's directive to leave no stone unturned, has stood with a great amount of moral courage to do what appeared right based upon facts, not upon the popular opinion. And I would really echo the commendations of you, Dr. Rostker, for having served the veterans community quite well, despite the perception of what might be going on. So thank you.
SENATOR RUDMAN: Admiral?
RADM STEINMAN: No further.
SENATOR RUDMAN: No, we're not [Audience member signaled her desire to speak]-- I gave everybody a chance. And you did not take the chance. We're now in closing statements. The protocol does allow no more comments. If you wish to address them to me afterwards, fine. But I gave everybody two chances, and you're a little late.
Do you have anything here, General? Any closing remarks?
LTG CISNEROS: Again, the one thing that stands out for me, Senator, is that I hope that as a result of this, that our impact is substantial. I realize that hindsight is not as good as foresight. But hindsight is better than no sight at all. That we convey about looking back in hindsight the deployment to this was teeming with reports of possible unseen enemy hazards, like biological and chemical, and that we would have addressed those a little bit better, and anticipated the paranoia, or the perception of this. I don't think we did a very good job of that. I hope that we learn from that, that we have a team of people, an organization -- I hope this organization will be able to do that.
And as we do the risk assessment, as I indicated, that we have elements out there that will have credibility with the troops, to chase down these things -- like, a dead camel, it must be because of chemical warfare; might have been just an insecticide or vector control -- to have credibility with the troops. Otherwise we will continue to have these problems in this new era of environmental awareness, more so than in the past.
SENATOR RUDMAN: Thank you very much, General. Again, I want to express -- Dr. Cam?
DR. CAM: I'm very honored to serve on this board. I want to thank the veterans community and all the government agencies who have worked with me on this issue. And also thanks to the White House for having nominated me on this.
It was a very interesting and rewarding experience for me. It is a very complex issue, and I believe that as a result of our board, there's much greater involvement with everybody on this issue.
I have a special request for Dr. Rostker. After my term ends, I no longer get these documents. But I would very much appreciate you put me on your mailing list as an outreach to the public, so that I could learn about all the good things that will come out from the follow-on organization.
DR. ROSTKER: As a political appointee, I may have to put myself on that list.
SENATOR RUDMAN: You never know, Dr. Rostker. You never know. Again, to the staff and the commission, thank you very much. You've been very easy to use.
And I'm going to now ask CAPT Beardsworth to adjourn, and then we will take the staff and members back to our conference room, where I want to present them with some certificates from -- on my behalf, and then a certificate from the President.
CAPT BEARDSWORTH: I'll take the opportunity of having the last word to thank you, Senator, for your work. And I adjourn the meeting.
(Whereupon, the hearing was adjourned.)
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