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No Pat Answers to Persian Gulf Illnesses

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Nov. 4, 1996 – Medical researchers continue to pursue answers to what causes socalled Persian Gulf illnesses, according to Dr. Stephen Joseph, assistant secretary of defense for health affairs.

The military's top doctor said some answers may come from the ongoing clinical evaluations of Gulf War veterans DoD and the Department of Veterans Affairs began conducting in 1994. He also lauded the recent expansion of DoD's investigation of the illnesses, which includes review and declassification of operational and intelligence documents that may shed new light on the issue.

"We now have the opportunity to get into the operational and intelligence history of the Persian Gulf War," Joseph said. "That's important in light of Khamisiyah." Joseph was referring to recent revelations that American soldiers destroyed Iraqi chemical weapons in March 1991 at a storage complex in Khamisiyah, Iraq. "We had been saying for three years that to our best current knowledge, there was no evidence of an exposure. All of a sudden we found out that isn't true. So it will be very helpful to have a more direct focus into operational and intelligence information."

Deputy Secretary of Defense John White heads the expanded investigation. On Oct. 2, he appointed Bernard Rostker, assistant secretary of the Navy for manpower and reserve affairs, to head a Persian Gulf illness action team. That team will reassess investigations of intelligence and operations incidents, document review, clinical evaluations and DoDsponsored medical research. Joseph's department is most concerned with the latter two activities, and he said some of those efforts are beginning to produce information.

The November New England Journal of Medicine published the results of a major study on hospitalizations, Joseph said. That study compares hospitalization rates of Gulf War veterans with those of sameera veterans who did not deploy. "It's one of a series of studies that looks at public health, reproductive health and all the other health issues related to the concerns of Persian Gulf veterans," he said. "That series of studies began in early 1994 and they're close to completion. A lot of very important data will come out of that."

Joseph has seen a steady increase in funding for research into Persian Gulf illnesses, but he said such research takes years to complete. Research into the effects of lowlevel exposure to chemical weapons began this year, he added. Although basic information about the effects of chemical weapons is known, he said, there isn't much scientific information about the longterm effects of lowlevel exposure. "That's why we need that research, but everybody has to understand it's not going to yield answers next month. It will take a couple of years."

The discovery of sarin, a highly toxic nerve agent, at Khamisiyah probably won't alter the way DoD conducts its clinical evaluations, Joseph said. "From the beginning, we built into the evaluation all the things you would think of to look at nerve and muscle function. Now that we know it's likely some troops were exposed to sarin at some level, would we do anything differently? I don't think so, but we've asked the Institute of Medicine to look at it."

The Institute of Medicine, a federal agency under the auspices of the National Academy of Sciences, previously reviewed and lauded clinical protocols established for the evaluation of Persian Gulf veterans.

"Now that we have evidence of possible exposure, we're asking them to look at our protocols again and tell us if they think we should do anything differently," Joseph said.

Meanwhile, DoD announced Oct. 22 that it would mail letters to more than 20,000 Gulf War veterans who may have been exposed to sarin and urge those with health problems to come in for evaluations. While the mailings will take several weeks to complete, Joseph said calls to the hot line are pouring in at double the rate of the previous high. "We're certainly tapping into a lot of concern," he said.

In early December, DoD will begin mailing a survey to the same group of veterans, asking for their recollections of where they were, what they observed, if they have related health problems and what unit they were with while in the Persian Gulf during that period.

"I can tell you right now, however, we don't know how many of the 20,000 people were affected by lowlevel chemicals," Joseph said. "The question is, are there any? And if any, how many?"

Meantime, Joseph said, any Gulf War veteran or family member who has a health concern or problem should go to a DoD or VA medical facility for help. "Come in and let us take care of it, and in taking care of it, better understand what went on in the Persian Gulf."

He also urged people to be wary of unsubstantiated reports about Persian Gulf illnesses. "Some issues you have to work at for a long time. It takes discipline and forbearance. This is one of those situations.

"I don't think that's an answer that any of us want, but that is the answer."

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