Presidential Advisory Committee on Gulf War Veterans' Illnesses
APPENDIX G - FINDINGS OF THE ADVISORY COMMITTEE'S INTERIM
- DOD's Persian Gulf Medical Registry Hotline and VA's Persian
Gulf Helpline effectively educate callers about the availability
of the CCEP and the Persian Gulf Health Registry, respectively.
Both telephone systems adequately refer callers to points of contact
at medical treatment facilities.
- DOD's GulfLINK offers a user friendly, accessible resource
that deposits information pertinent to Gulf War veterans' illnesses
in a central location.
- Since GulfLINK contains contradictory intelligence reports,
the net effect of posting these declassified documents on GulfLINK
could be to confuse rather than enlighten the interested public.
Without a better system for organizing and presenting information,
persons using the resource could gain false impressions or misunderstand
- Although mailings such as the memorandum from Secretary Perry
and Chairman Shalikashvili can be expensive, they are a reasonable
method of getting information to the concerned population.
- VA's On-line service and World Wide Web home page provide
computer users with a widely accessible Gulf War veterans' illness
education and referral resource.
- VA's print PSA gives readers useful information on Gulf War
veterans' illnesses. VA's broadcast PSAs, which publicize the
Helpline number but do not mention illness or potential illness
as a reason to call, need improvement.
- VA's use of the term "priority care" in reference
to Gulf War veterans' eligibility for health care creates false
expectations among a significant portion of its clientele.
- Public and congressional concern for the health of Gulf War
veterans has been evident since the world witnessed the 1991 oil
well fires on television. DOD did not set up hotlines or sites
at medical treatment facilities to provide information and medical
referral services to Gulf War veterans until 1994, a significant
delay in response time.
- VA's Helpline started late in comparison with its other efforts
to address the issue of Gulf War veterans' illnesses. It was established
two years after the initiation of the Persian Gulf Health Registry
and one year following the passing of Public Law 103-210, which
initiated "priority care" services. VA had conducted
some outreach in tandem with the establishment of the Health Registry,
but its Persian Gulf Review newsletter was sent only to
those already participating in the Health Registry.
MEDICAL AND CLINICAL ISSUES
- No uniformity existed among the services in their predeployment
or demobilization policies and procedures at the time of Operations
Desert Shield/Desert Storm.
- There is little evidence that quality control procedures were
employed to ensure that existing policies were actually carried
out during deployment or demobilization.
- DOD's policies and procedures were not adequate in all cases
to prevent members with preexisting conditions from deploying
or to identify health problems extant at the time of demobilization,
and these conditions could have contributed to some current health
- FDA and DOD undertook an urgent and orderly course of action
under the circumstances to devise a means to address the real
threat of chemical and biological warfare in the Gulf War.
- FDA has not been proactive in addressing public comments on
the interim final rule or in devising better long-term methods
for governing military use of drugs, vaccines, devices, and antibiotics
intended for chemical and biological warfare defense.
- When a waiver of informed consent is granted, the government
has a strong obligation to conduct long-term followup of military
personnel who receive investigational products.
- DOD did not keep adequate records on who received anthrax
and BT vaccines and PB in the Gulf War theater. There is little
possibility now of developing reliable data about which or how
many persons received those products.
- DOD and VA admit to problems with missing or lost medical
records, but neither system appears to place a priority on correcting
- DOD's rationale for the requirement that records of vaccinations
be kept secret was not well understood. This requirement confused
and complicated recordkeeping procedures and hindered systematic
followup of health issues.
- The issue of accurate medical and vaccination records is central
to the concerns of many ill veterans, and the absence of records
has been suggested by some as evidence that the government is
engaging in a cover-up of its own predeployment practices.
- Despite the unique features of the Gulf War, it should be
possible using epidemiologic approaches to determine whether Gulf
War veterans have more or less mortality, symptoms, or diseases
than an appropriately chosen comparison population.
- Most of the studies examined by the Committee appear to be
well-designed and appropriate to answer questions about mortality,
symptoms, or diseases.
- Some studies currently underway or planned at best will add
little information to other better designed studies and could
provide misleading information, leading to false conclusions.
- External scientific review of the major epidemiologic studies
has ranged from nonexistent, to one-time review of protocols,
to standing scientific advisory panels which have an ongoing role
in the design and execution of the studies. Ongoing external review
has proved beneficial to several of the studies.
- Public advisory committees might improve communications with
the veterans asked to participate in epidemiologic studies.
- A single coordinating body with an overarching perspective
is needed to monitor whether priorities are being established,
whether outstanding research questions are being adequately addressed,
whether individual studies will contribute to the overall effort,
and the extent to which the studies are responsive to recommendations
from external reviewers.
- Sharing a subset of basic questions on demographics, symptoms,
and exposures across large surveys of Gulf War veterans and controls
could provide information useful for comparisons across the studies
and better understanding of differences in the study populations.
- There is little exposure data available for Gulf War veterans
about many key risk factors. As a consequence, it will be more
difficult to link adverse health outcomes detected by epidemiologic
studies to some specific exposures or risk factors.
- The Persian Gulf Registry of Unit Locations data from DOD
will be important for investigating questions about Gulf War veterans'
health issues, but it will not be a substitute for missing exposure
data for many risk factors.
CHEMICAL AND BIOLOGICAL WEAPONS
- Although much was known at the time of the Gulf War, UNSCOM's
work provides a more definitive picture of Iraq's CBW capability
and doctrine, revealing advanced capabilities and underscoring
the considerable uncertainty regarding Iraq's intentions to use
CBW agents against American and coalition troops.
- The U.S. government's decision to reexamine the records of
the Gulf War for evidence of exposure to CBW agents is prudent
in light of the health concerns of veterans and the findings from
UNSCOM's investigations. The Committee intends to monitor the
investigations of PGIT and CIA.
- DOD is taking reasonable steps to improve battlefield CW agent
detection capability by developing equipment that will detect
mustard agent and that will not sound false alarms in response
to common battlefield interferents.
- The inability to provide real-time detection of BW agents
constitutes a serious deficiency in the U.S. chemical and biological
- The ability to monitor low-levels of CW agents would improve
the health care surveillance of U.S. troops.