WASHINGTON, April 6, 1998 (GulfLINK)� "It is important to speak with our veterans. It gives us a sense of reality," said Bernard Rostker, special assistant for Gulf War illnesses during a meeting he hosted with United Kingdom members of Parliament on February 24, 1998.

The delegation members, who serve on the House of Commons Select Defense Committee, visited the United States on a four-day fact-finding mission related to national defense and Gulf War illnesses issues. They met with U.S. intergovernmental representatives, including Rostker, to gather information on how the U.S. is caring for their Gulf War veterans and to learn from the U.S. investigative experience. In addition to Rostker, representatives from the National Security Council, Joint Chiefs of Staff, Office of the Secretary of Defense, Office of the Army Surgeon General and Department of Veterans Affairs briefed the delegation.

The information exchange was a continuation of the U.S and United Kingdom collaborative efforts to clearly understand what happened during the Gulf War and what is causing the

illnesses some veterans are experiencing. The discussion ranged from an overview of the organization and function of the office of the Special Assistant to current DoD initiatives to protect service members from medical hazards associated with military service to research results on Gulf War veterans� health.

Rostker said that DoD�s initial response to the issue of possible Gulf War exposures in the United States was medical. When a team of 12 DoD health affairs professionals were tasked to oversee the effort in 1992, the operational aspects of the Gulf War were given less importance, he explained. At the direction of then Deputy Secretary of Defense John White, Rostker organized a new office in November 1996 that now focuses strongly on veteran outreach, investigation and analysis as well as force medical protection issues.

"Today, we are asking veterans about their experiences in the Gulf, trying to learn from them what went on. Our emphasis is on [ investigating ] incidents in the Gulf, the exposure that may have occurred from those incidents, and the implications of such incidents," Rostker said.

Rostker emphasized that the process used by his team is based on an investigative methodology and the U.N. protocol for chemical weapons verification. In 1997, Rostker�s office released four information papers and nine case narratives that focused on investigations of suspected chemical incidents. Another 15 cases dealing with chemical, biological or environmental issues are in various stages of preparation and review.

Patrick Williams, lead analyst on the depleted uranium investigative and analysis team, briefed the audience on the investigation into the potential hazards associated with the use of depleted uranium during the Gulf War. Williams said that depleted uranium munitions and protective armor during the Gulf War gave U.S. forces a tremendous operational advantage and significantly contributed to U.S. victory. Called the "silver bullet," depleted uranium 120mm sabot rounds (M829) allowed U.S. tankers to engage the Iraqis with unprecedented range and effect. Depleted uranium�s metallurgical properties make it ideal for use in armor-piercing kinetic energy munitions and protective armor packages, It is viewed predominately as a heavy metal hazard and low-level radiation hazard, Williams said.

"Veterans are concerned that battlefield depleted uranium contamination may be linked to Gulf War illnesses due to chemical and radiological toxicity," said Williams. "Our investigation is aimed at establishing what depleted uranium exposure scenarios and incidents occurred, and then assessing their potential medical significance," he explained.

Williams provided an in-depth briefing and outlined actions DoD is taking to identify and, to the degree possible, quantify the various exposure scenarios and incidents.

Frances Murphy, MD, MPH, director of Gulf War health programs for the Department of Veterans Affairs provided a briefing on VA�s programs. To respond to veterans who were most severely effected by depleted uranium exposures during the Gulf War, the VA established the specialized medical surveillance program in 1992 at the Baltimore VA Medical Center. Currently, 33 individuals are being evaluated, including 16 that have or had depleted uranium fragments embedded in their bodies. Preliminary results of specialized examinations completed in 1993 showed that while participants with retained fragments were excreting uranium in their urine, no kidney damage could be detected.

"At this time, it appears that only those veterans who have retained depleted uranium fragments have increased levels of uranium above the occupational exposure levels. They are not showing evidence of kidney toxicity at this point," said Murphy.

Turning to broader activities with which the Department of Veterans Affairs is involved, Murphy spoke of the coordinated VA, DoD and Department of Health and Human Services Federal research program. Currently, there are more than 100 research studies underway to investigate the health consequences of Gulf War service.

She also noted that results of the first phase of the VA National Survey of Persian Gulf Veterans postal questionnaire are expected this year. The survey�conducted in three phases� is designed to determine the prevalence of symptoms and illnesses among a random sampling of Gulf veterans across the nation. Phase I surveyed the health of 30,000 randomly selected veterans from the Gulf war era, 15,000 deployed and 15,000 non-deployed veterans. Phase II consisted of a telephone interview of 8,000 non-respondents from Phase I to determine if there are any response difference between those veterans who participated or did not participate in the study. Copies of medical records will also be collected in Phase II. In Phase III, the 2,000 randomly selected veterans, along with their family members, will be invited to participate in a comprehensive physical examination protocol.

"The findings will be important because no previous studies have determined if Gulf War veterans, or their families, suffer from higher rates of illnesses when compared to those who were not deployed, or the general population," said Murphy.

The British delegation was also interested in key aspects of DoD initiatives to overcome some of the health care challenges experienced during and after the Gulf War. Rear Adm. Michael L. Cowan, deputy director for medical readiness, Joint Chiefs of Staff J-4, presented the Chairman of the Joint Chiefs of Staff�s Joint Vision 2010, Focused Logistics and Force Medical Protection - a concept for protecting servicemembers and their families.

"As a result of the Gulf War, many veterans lost faith in our medical system. We have completely reconfigured how we respond. We are being proactive in identifying, avoiding, and managing risks. When we put forces in the battlefield, we should not subject them to risks we can do something about," said Cowan.

He described the many issues driving changes in force medical protection today - a national military strategy that is now global in reach, technology advancement that will render massive battlefield logistics unnecessary, and a revolution in health care trends that has created a proactive focus on health rather than illnesses.

Cowan explained that the current medical system had been built up piecemeal over time.

"We need to think of the soldier as we do our weapons systems � which are maintained on a regularly scheduled basis. At each point in a person�s career, their health must be evaluated and managed," he said.

The DoD is developing doctrine and policy for this approach and proactively changing the infrastructure for record keeping, medical and environmental surveillance, and pre-deployment and post-deployment blood and serum sample collection.

"We are finishing in 1998 and fielding in 1999, a medical personal information carrier that carries a person�s medical history encrypted on it," Rostker added, emphasizing one of the biggest advances made by DoD since the Gulf War. The device will store an individual�s medical status and history and ensure the ability to retrieve important health data.

"We learned a number of lessons from the Gulf War. We�ve made changes. We need to measure risks, do the right thing and stay focused on putting a healthy soldier in the battlefield," said Cowen as he summed up DoD�s revolution in medical affairs.

Brig. Gen. John Parker, assistant surgeon general for force protection, amplified this view when he presented an overview of DoD�s plans to systematically vaccinate U.S. military personnel against the biological warfare agent anthrax. He called anthrax a transnational, transglobal threat that is 99 percent lethal to unprotected individuals.

"One of the lessons learned from the Gulf is that people want to know what the risks are when they are given a vaccine. We are going about things differently now to re-establish our credibility. Through risk communication, every sailor, soldier, airman and Marine must be told what we know about a vaccine," Parker said.

Throughout the session, questions from the British delegation flowed freely. One member asked if it were far from the mark to label the health symptoms of Gulf War veterans a syndrome.

"The list of symptoms don�t seem to cluster around a single organ system or single characteristic set of signs and symptoms," Murphy explained. "They span a whole range of diagnosable medical conditions. While it is clear that Gulf War veterans are suffering from real illnesses, there doesn�t appear to be a solitary, unique syndrome."

"What the cause may be still remains a mystery," Rostker said. He explained that the investigation thus far has found no causal relationship from incidents or exposures.

"Our best estimate after Khamisiyah[ demolition ] was that nerve agent exposure was widespread, but low-level," Rostker said, referring to the analysis indicating that no U.S. units were close enough to the demolition to experience any noticeable health effects at the time of the event.

"We see no clustering of health problems around the Khamisiyah exposures. We looked at the medical experience of our coalition partners. In Dharhan and Kuwait no one has reported an increase in health effects other than asthma. Egypt reported nothing. We also looked at rates of individuals using the VA Registry and DoD Comprehensive Clinical Evaluation Program � we found no correlation. We will look harder at pesticide issues this year. We are aware of your interest in the effects of organophosphates," Rostker told the British delegation.

"My office produced an Annual Report this year which summarizes the thoughts I�d like to leave with you," said Rostker, as he closed the proceedings and restated the progress of his three-prong DoD mission.

"First, we are building trust and confidence in DoD. We have made a concerted effort in our investigation to better account for what happened on the battlefield. Second, we have to better protect our people on the battlefield and we are working on doctrine and equipment to get that right. Third, we need to establish and sustain viable risk communications. The standard we work under today is full disclosure. Proactive outreach provides people with the answers they need," said Rostker.

At the conclusion of the meeting, the United Kingdom officials expressed hope of continued coordination with the U.S. investigation . Using sources and data from each country�s investigations, the U.S. and the United Kingdom jointly released the Kuwaiti Girls� School case narrative on March 19, 1998.

• A depleted uranium medical surveillance program was established at the Department of Veterans Affairs Medical Center in Baltimore in 1992 to provide medical follow-up. Currently 33 veterans are enrolled, including 16 that had or have depleted uranium fragments embedded in their bodies. DoD continues to locate and interview personnel who may have been exposed to identify personnel for medical follow-up.
• The Armed Forces Radiobiology Research Institute is conducting depleted uranium-related medical research in animals to expand knowledge of the effects of internalized depleted uranium.
• The U.S. Surgeon General�s Office and the Department of Veterans Affairs are jointly developing a new medical follow-up protocol focused on notifying and testing those exposed to depleted uranium in fratricide incidents.
• The Department of Defense has also increased its emphasis on soldier and leader awareness of the hazards associated with battlefield depleted uranium use and contamination. A new training package was developed in 1997. The Deputy Secretary of Defense endorsed the package and directed Service chiefs to implement depleted uranium training into the general military training program.
• The Army Center for Health Promotion and Preventive Medicine is developing dose and risk assessment theoretical models for all identified exposure scenarios.
• RAND is completing a comprehensive review of the existing body of medical and scientific literature concerning the known health effects of depleted uranium.
• DoD will publish their findings this spring as an interim case narrative.