Subject: Gulf War Illness Update
This activity preceeds the regular DoD Press Briefing. Also participating in are Dr. Stephen Joseph, assistant secretary of Defense for Health Affairs, Dr. Bernard Rostker, special assistant for Gulf War Illnesses, and Mr. Kenneth H. Bacon, ASD(PA).
Mr. Bacon: Good afternoon. We have a three part briefing today, a team. First, Deputy Secretary of Defense John White will begin with a statement and take several questions, then he has to go. At that point he'll turn it over to Dr. Stephen Joseph, the Assistant Secretary for Health Affairs, and Dr. Bernard Rostker who is running the Persian Gulf Illness effort here, Special Assistant to the Deputy Secretary on this. They will stay as long as you want to take your questions.
Dr. White, it's over to you.
Dr. White: Good afternoon.
The final report of the Presidential Advisory Committee on Gulf War Veterans Illnesses contains many useful and helpful recommendations regarding the government's responses to illnesses being experienced by veterans of the Gulf War. The Department of Defense welcomes these proposals. We are going to study them carefully, and in conjunction with Health and Human Services and Veterans Affairs we will evaluate them, and we will respond to each and every recommendation in a report we will provide to the President within 60 days. But let me say, [in] our at least brief and cursory review of these recommendations, we do not find anything significant in there that we either are not doing or do not intend to do, and we will have more details later.
The Advisory Committee has played a useful and important role in our efforts to ensure that those who need medical care are receiving it -- our first priority; that we have thoroughly investigated possible chemical and biological warfare agent exposures; that our research efforts into potential causes of Gulf War illnesses are broad-ranging and properly focused; that we develop more effective health programs for our people involved in future deployments; and that we are pursuing the President's directive to explore every angle of this problem.
We in the Department take this issue very seriously. Fundamentally, it's an issue of force protection and it goes to the heart of our commitment and responsibility to the brave men and women who risk their lives for our country. Our commitment is to provide them with the best possible protection from disease and illness, the best possible treatment should they become ill, and the appropriate care and compensation should those illnesses become chronic. We do not shirk from this responsibility.
Last year I announced a change in the Department's efforts with respect to this issue as we expanded and intensified our program. I established the Office of the Special Assistant of Gulf War Illnesses, reporting directly to me, and enlarged the effort. That office is now fully established and it has an increased level of effort of some ten-fold from what we were doing before. The results of that effort are now becoming apparent and we can talk some more about that this afternoon. We will continue to vigorously pursue our efforts in terms of all of the issues around this subject.
In particular, we will continue to explore all aspects of possible exposure of our troops to chemical agents. Since last spring when we first realized that American forces had been in the presence of Iraqi chemical munitions at Khamisiyah, a weapons storage site destroyed by American forces after the war, and that exposure was possible, this Department, in cooperation with the CIA and other agencies, has conducted extensive investigations. We are reaching out to more than 20,000 service personnel who may have been in the vicinity of Khamisiyah at the time of the possible release of chemical agent. We will continue our efforts to learn all we can about this incident, and to investigate any similar incidents that are identified. We will spare no resource in this effort.
Finally, as I said in testimony last April, the Department welcomes outside oversight and advice concerning our efforts. Last year I announced our agreement to engage the National Academy of Sciences and the Institute of Medicine in a wide- ranging program to assist us in all aspects of our Gulf War illnesses investigation and other parts of our program, as well as deal with issues of future deployments. In addition, we think the President's committee can continue to play a role that will be very constructive in oversight of our activities. They will, as you know, according to the President's decision this morning, be extended for some nine months. Part of that extension, in our understanding, is that they will participate with us in an outside oversight role of our program and particularly the incident investigation program.
Our commitment to our service personnel and our veterans, and our commitment to as complete an understanding as possible of any illnesses they experience is total, and we will continue our efforts in this vein.
We will, as I said, provide you with more detail, as much as you want here today, but let me, if I may, stop and take any questions you may have.
Q: What do you think about the study's conclusion -- given your experience so far with it -- what do you think about the study's conclusion that stress was the likely cause of much of this?
A: I'm going to defer the stress issue, which is really a medical issue, to Dr. Joseph. We will address that, though.
I think it is important to look carefully at the conclusions of this committee. They worked long and hard. They're eminent experts. I think we'll go through this in some detail later.
Q: Secretary White, how do you respond, even acknowledging what you've just said, how do you respond to the blistering criticism that's occurred since this report came out today? And in particular, from Senator Arlen Specter who says there's a cover-up involved at the Pentagon. And also from Senator Rockefeller who says that the Pentagon and the military leaders in it show massive indifference to the issue?
A: I haven't heard what you've just quoted, but I will tell you, there has not been a cover-up. There is not a cover- up. We can't find a cover-up. We still have investigations going on with IGs and others to find out more information, all the information we can get. We have no evidence of a cover-up now or in the past. If anybody does, we would welcome that information.
Q: Dr. White, there have been published reports of late, including a rather long, thought-provoking piece in the Washington Post last week, all coming to the conclusion that the nerve gas sarin and others -- low level or what have you -- were not the causes of the so-called Gulf War syndrome. Do you and your team seem to be moving in that direction?
A: Again, I would defer somewhat to Dr. Joseph on this. Let me just say that we continue to search for the reason why people are sick, and they are. That's of vital concern to us. We don't know why. The committee, as you have indicated and as they said clearly in their report, don't know why either. So we are continuing to assume, first of all, we know that people are sick. Secondly, we know they were in the Gulf, and therefore we're continuing to search for explanations to that illness. We haven't left anything out in that search.
Q: It's one thing to say we don't know why and are searching, but it's another thing to dismiss or rule out certain things. Are you close to ruling out nerve gas as a probable cause for Gulf War syndrome or any major illnesses that took place...
A: No, we're not. First of all, we haven't found any syndrome. Secondly, we're not close to ruling out... Our investigation continues with respect to the possible exposures to nerve gas, including at Khamisiyah, and in that regard, we have to presume going in that there was such exposure until we can develop enough evidence to the contrary.
Q: Why did you use the words useful and helpful? Aren't those rather bland, bureaucratic terms?
A: Useful and helpful for what?
Q: Useful and helpful is the way you described this Presidential Commission, and you referred to it as a committee.
A: It is a committee. I think technically it's not a commission, it's a committee.
Q: Why was it only useful and helpful? Very bland terms.
A: I didn't mean that inference. I didn't mean the inference with respect to the committee. I think the committee's done a lot. The report is extensive, has a lot of recommendations in it, it's very helpful to us that it has those recommendations. As I said earlier, we are in agreement with what's there and we think it's done a very, very good job and has been an important contributor.
Q: Do you have a sense of how long you can continue to study this issue before you can say either we're not going to find an answer or this is an answer? We've had a multitude of studies already in years of work.
A: No, I don't know. I assume that our investigation will go on for quite some time. Is quite some time months? At least. We are continuing to deal with this issue. It has many, many dimensions. It isn't just the investigation. It's a very large clinical effort. It's a very extensive research effort. Those research efforts will go on, I think, for years. Therefore, I think we will be dealing with the issue for a long time to come.
Q: Were you surprised by anything the committee had to say, or is this old stuff?
A: I was not surprised by it because we've been in close discussion with this committee over its complete existence. I've testified before the committee. They come and cooperate with us and we with them on the program. So from our point of view, it was not a surprise.
Q: Have you any reading so far (inaudible) of one single new factor...
A: I have not read the report completely... carefully. I've scanned it. But the answer is no.
Q: This committee was set up, at least in part, because of the hubbub among veterans activist groups and so on, and statements by senators. Looking back on it, with hindsight, can you think of anything that the DoD sees differently now to prevent this public relations fiasco?
A: I think in general, we early on did not focus enough on the investigative part of this effort. We did a lot of research. We did most, and most importantly, on illness, caring for our people. But I think we clearly did not do enough on investigation, and in that sense, Khamisiyah was a watershed.
Let me also say, back to an earlier question, I think also early on we did not have adequate lines of communications. One of the valuable contributions of this committee has been the fact that it has these public hearings and has heard a lot from veterans, which I think has been helpful to us. We now have a much more aggressive program in that regard. The committee criticizes us for not having as good a risk communications effort as we should. I think that's a fair criticism in the past. I think we've corrected that.
Q: Earlier today in the driveway of the White House one veterans group representative after another walked up to the microphone and continued to hammer the Defense Department -- we don't trust the Defense Department, they said, we don't... And still, you have this tremendous barrier of resentment among the groups that basically have served this Department. How do you rebuild those ties?
A: Dr. Rostker can go through it in more detail, but we have now had a whole series of meetings with the representatives of those groups. We have told them everything that we're doing. We're reaching out for them generally. We're using them to communicate with veterans, and we're trying to build a set of trust, a feeling of openness that clearly we haven't had. We're going to continue to try to do that.
Q: Dr. White, have you been asked to stay on, and will you?
A: Let me deal with this subject. I'll come back.
Q: Why did it take such a long time before you started dealing with this?
A: It depends on what "this" is. If the question is people ill from the Gulf, it didn't take a long time. As I said earlier...
Q: ...came out only this summer after nearly five years.
A: Numbers for what?
Q: Twenty thousand...
A: No, no. Let me finish. Think about... One issue is, are people sick? That's the first and most important issue. We've had a broad clinical program for care. What are the causes for those illnesses? We've had an extensive, both clinical and research effort with respect to that.
As I said earlier, the place where I think we did not do well enough was on this issue of the investigation of possible exposure. That gets us to Khamisiyah and to the realization from Khamisiyah that there was or may have been such exposure. I've said before in testimony and down here, we think that was a watershed, and it has extensively focused our efforts in that area, in addition to the other parts of the program.
Q: The report also criticizes the Pentagon for intransigently refusing to conduct an investigation, or fund an investigation into the effects of low level exposures to chemical warfare agents until late this last year. Do you accept that criticism? And why didn't you?
A: I accept the criticism that we should have been quicker to get onto it, yes. The reason we didn't, again, was because our focus was in these other areas. That turned out to not be adequate. Therefore, we've expanded that focus.
Most of what I have read in this report is in the context of what we didn't do before. We accept those criticisms. When I testified in November before the committee, I said, we hear you. We're making very extensive changes. We've reorganized. We've put massively more money and effort and skill into this simply because we hadn't done enough, particularly in the investigative area.
Thank you very much. As to the question of my own tenure here, I have talked with Senator Cohen and, assuming that Senator Cohen is confirmed, he has asked me and I have agreed to stay on for some transition into the future. We don't know each other well enough yet to know whether that's something that will, or how long that will be. But we have so far in the efforts of getting him into the Department and getting him ready for his confirmation, from my point of view and I think from his, developed a good relationship, so we see the team as going forward.
Q: Good relationship and the body chemistry is good. So are you prepared to stay on if asked?
Dr. Joseph: Good afternoon. I'm Steve Joseph, the Assistant Secretary for Health Affairs. I have a short statement and then Bernie Rostker has a short statement. I think we'd best both give our statements and then answer questions together, turning one to the other.
Let me first take the opportunity to acknowledge the hard work of the Presidential Advisory Committee and especially its chair, Dr. Joyce Lashoff. As one who has been laboring for the past three years to find the answers to the medical questions related to the Gulf War, I understand well the difficulty of the task. The committee has asked the tough questions and made a number of constructive criticisms and recommendations. None of this has been easy. A number of lessons have had to be learned by us all. A number of changes have been needed and made in how we protect our people. The results of their efforts and ours will be a better understanding of the illnesses facing our Gulf War veterans, a better way of caring for our troops, and a better strategy for protecting our troops in the future.
One of the most trying issues for the committee, as well as for ourselves, is the basic question of whether or not the illnesses experienced by troops serving in the Gulf War were the result of some specific and unusual exposure related to that service. The committee, consistent with groups like the Institute of Medicine, and consistent with our own work, has concluded that, "Current scientific evidence does not support a causal link between the symptoms and illnesses reported today by Gulf War veterans and exposures while in the Gulf region to the following environmental factors assessed by the committee: pesticides, chemical warfare agents, biological warfare agents, vaccines, pyridostigmine, infectious diseases, depleted uranium, oil well fires and smoke, and petroleum products."
This is a very important finding and one on which the committee deliberated long and hard. But this finding, as important as it is in buttressing the best current scientific knowledge, does not and should not end our search for answers. There may still be small groups of Gulf War veterans that may have illnesses related to exposures during the Gulf War. There is still more for us to learn about possible medical effects of low level exposures to chemical and biological warfare agents. There is more for us to learn about the possible synergistic effects of pyridostigmine bromide with other risk factors. There's more for us to learn about the body's response to stress and how to manage that stress. There are still more epidemiologic studies which may shed light on these illnesses.
Let me assure both the committee and the Gulf War veterans that we will continue to search through our clinical investigation and research efforts.
I appreciate the committee's acknowledgment that "The clinical evaluation programs of the Department of Defense and VA are excellent for the diagnosis of Gulf War veterans' illnesses." Clearly our physicians, nurses, and clinical and administrative support staff have demonstrated their deep commitment to taking care of our own. I am especially grateful to and proud of our dedicated clinical staff.
I applaud the committee's focus on the relationship between stress and physical symptoms. In my view, as I've said to this group before, it would be a great disservice to our Gulf War veterans to brush aside this perspective. This area of stress and its relation to illness is just as legitimate, just as important, and just as worthy of our concern and support as are the more traditional hazards of deployment in combat.
But again, as the committee recommends, more needs to be done, and we will do it. As the committee suggests, we need to do more in the areas of mental and reproductive health, and we will do so. We need to tackle the issues of stress, its prevention and management and treatment of its consequences, and we are. We need to be prepared to launch evaluation and care more quickly after a deployment, and we are already doing so. We need to continue caring for our Gulf War veterans, whatever causes their illnesses, and we will.
The committee has also been very clear on how we need to better protect our people in future deployments. We strongly agree, and have already in Bosnia, put into place a number of changes that will do just that.
Before going to war or major operations other than war, health evaluations and collection of serum samples help us know our troops are ready and provide a baseline health status for post-deployment comparison. We are working on better ways to protect our troops from the full range of hazards in theater, including chemical and biological agents. We are strengthening our basic public health measures against environmental hazards. We have implemented better medical record systems and are working to refine them further with a feasible goal of a soldier-carried, computer-based medical dog tag. We have put into place our deployment and post-deployment surveillance system to help identify health problems which we can either prevent or treat more quickly.
Though difficult for us all, there is the proverbial silver lining with respect to the Gulf War experience. It has to do with the future. The lessons learned from the Gulf War make us better able to protect our people, better able to listen to and dialogue with our troops, better able to understand the causes of their illnesses, better able to prevent illness and injury, and better able to diagnose and treat what we cannot prevent.
Dr. Rostker: Good afternoon. I'm Bernie Rostker, the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses.
First, I would like to express my personal appreciation and admiration for the outstanding job done by the President's Advisory Committee since they were established by President Clinton on May 26, 1995. And for the extremely valuable document that the President released today. The thoughtful and comprehensive final report will not only well serve those most concerned with Gulf War illnesses -- Gulf War veterans and their families -- but also this Department as we continue our efforts to ensure that veterans of the Gulf War are appropriately cared for, to do everything possible to understand and explain Gulf War illnesses, and to put into place those military doctrines, personnel, and medical policies and procedures and equipment which will minimize any future problems from exposure to biological or chemical agents or other environmental hazards.
You will note that the committee made reference to the fact that, and I quote, "In November the DoD announced it was expanding its efforts relative to low level CW agent exposure. These initiatives, combined with independent and vigorous oversight, could begin to restore public confidence in the government's investigations of possible incidents of CW agent exposure."
The revamped investigatory office is in place and has substantially changed the way we do business. I would like to take a few moments to highlight some of these changes.
The new Office of Special Assistant reports directly to the Deputy Secretary of Defense. It contains the investigators and analysts necessary to explore a full review of currently known exposures and the authority to search out and pursue any new incidents. In addition, we have added functionality in areas not previously covered to initiate a proactive, risk communication program with two-way communication efforts as suggested by the PAC. Last month we hosted the veteran service organizations for a demonstration of chemical alarms and protective gear, and brought to the Pentagon for their examination -- and I may say your examination -- a Fox vehicle so that the VSOs could better understand the discussions before Congress and in the press on the issue of CW detections.
We put into place last month new procedures to engage those who call our telephone hotlines. Today, when a veteran calls our telephone hotline and reports an incident, he or she is called back by a trained interviewer within four days. In fact the mean is 4.2 days and a mode of two days, so most of the people we try to get back to in two days.
These people are thoroughly debriefed. This call-back interview often takes over 30 minutes and provides a single point of contact between my office and the reporting veteran for future contacts with the veterans so we can provide him or her with the information necessary to monitor the progress of our investigations. Shortly we will revamp the Gulf Link Homepage on the World Wide Web to include a weekly posting of what is new in our office, and a two-way E-mail communication that we will use to keep the veterans informed. These are but a few of the extensive changes we have made in the Gulf War illness program here at Defense.
We agree with the PAC, and I quote that, "The initiatives, combined with independent vigorous oversight, could begin to restore public confidence in the government." We are also working with the National Academy of Sciences to provide the appropriate independent, vigorous oversight and look forward also to working with the PAC in their newly expanded role.
Q: Mr. Rostker, could you bring us up to date on your investigation and where it stands into the missing NBC logs kept by Central Command?
Dr. Rostker: I put a tiger team on that, including a trained legal investigator as well as the staff. I hope to be able to make a more complete report to you within the next two weeks. I would like to also emphasize that the existing logs, the 26 pages that have already been posted on Gulf Link, are extremely valuable and provide a great deal of insight into the reports that they contain, and we'll be highlighting those entries in the log also.
Q: Is there any indication, since you're well into this, that any of those missing pages contain any information dealing with what happened at Khamisiyah?
Dr. Rostker: Let me sort of get ahead of myself just a moment here. If you have an image of a log as being a big book that people wrote in, and I think that's what most people have an image of a log, that doesn't appear to be correct.
What we've learned is that the log itself is a computer hard drive. It was kept on a Japanese laptop, and the issue is what's happened to the laptop and why certain pages were kept in hard copy, in paper copy. That's the essence of the investigation. The interface between hard copy and the computer hard disk, just as you have laptops, what happened to it and the like. I think it's going to be a very interesting story, but we have some depositions to take and we will take depositions, and I think we're shooting to be back within the next two weeks to have a more complete picture.
Q: You don't think the laptop ended up on some school kid's desk in Tampa, do you? (Laughter)
Dr. Rostker: No. The laptops apparently ended up back in Tampa, but they were not given to the same people who had the laptops. We're trying to confirm that. So a person was handed in a laptop and was given back a laptop, but it wasn't his own laptop. So it appears that we have hard drives that were given back to people who had no idea what was on the hard drive.
I'm trying to be responsive, but we need to understand that in excruciating detail.
Q: Can you say if the hard drives were erased...
Dr. Rostker: Certainly some hard drives were erased. But again, if you'll let me come back to you in a couple of weeks we will have the full time line and custodies and I think be able to tell the story. But the one thing that is very clear, and if you look at the logs that are posted, these are not handwritten logs, these were generated by a computer program in a spreadsheet. That interface between what's on our hard drives and what's in the paper is an important consideration.
Q: You sound confident you'll be able to reconstitute these logs.
Dr. Rostker: No. I'm not confident at all that we can reconstitute the logs. What I'm saying is, I am confident that any mental image that there was a stack of paper in a notebook that people recorded, and why would pages be randomly taken out of a notebook, doesn't quite fit what we are learning. I want to come back with a complete picture...
Q: But are you saying also that there is a possibility that some important information has been shoved into 'computer land' ether and that it will never be...
Dr. Rostker: I think that's clear across the entire spectrum of record retrieval. No question about that.
Q: A question for both you and Dr. Joseph, if we may focus on this issue of stress just for a moment.
If we take Desert Storm we know there were stresses with heat, with sand, with uncertainty. Then you go back to the rigors of war and what used to be called shell shock as early as World War I. The fact is, when you go into combat, you can get killed. That makes you sit up and pay attention. How do you deal with that kind of stress, other than giving somebody Prozac before they go into combat? What do you do about that?
Dr. Joseph: Let me answer your question in two parts, really. The first part is really just a reaffirmation of what you said. I think the Advisory Committee played a very important service by focusing this, that there is a history of... Whether it's called shell shock, PTSD, soldiers' heart, neurasthenia, etc., of stress-related physical symptoms in the context of the extreme stresses of combat or deployment in adverse circumstances. So this is not new. It should not be unexpected. I think we've been saying for some time that it is not unexpected.
There are important ways both to prevent, early diagnose, and to treat. We have talked before about the combat stress teams that accompanied the deployment to Bosnia, and whose job it is to be alert both on a unit level and an individual level for signs of stress and environmental factors that might accentuate stress, and to offer support to commanders as well as to the health people in those circumstances.
Second, although maybe not less in importance, is the self awareness and the preparation of both the individual soldier and the chain of command to these issues. Again, you've heard me say before and I tried to say today, it's important that we begin to recognize the validity, the importance, the legitimacy of the whole spectrum of stress-related conditions including the physical symptoms, but not just the physical symptoms.
Q: These veterans are so resistant to this analysis. They hate this analysis.
Dr. Joseph: I think our veterans are a reflection of our entire society. I believe the first time I was up here two years ago on this issue I talked about that, and how it was important for us, and I think a responsibility, if I may, that you have as well as we have, to mature ourselves as a society to where we understand both the legitimacy and the importance of this area. I don't think the veterans are reflecting anything different, really, than the general society would reflect in this area.
Q: Which is what?
Dr. Joseph: Which is that this is somehow less than legitimate, that someone who has physical symptoms on the basis of psychological causation or stress-related physical symptoms, is somehow less ill or less worthy of concern. That's just not true. We are not yet mature enough as a society to really accept that. I think that's what's going on here.
Q: ...analogous perhaps?
Dr. Joseph: Are you saying that some may believe its (inaudible). We clearly know that's not true.
Q: No, I'm saying about the discussion on the concern or the antagonism, if you will.
Dr. Joseph: Not real or the doctor told me it was all in my head, or somehow not worthy of support or medical care or compensation or whatever. We've got to get over that. My own view is that this may be the most important thing... I sort of believe it will be the most important thing to come out of this whole Gulf War Illness' business.
Q: ...preparation of the soldier. I don't want to get into a long discourse here, but how do you prepare somebody for combat? There really is no preparation.
Dr. Joseph: I'm not really... There are a lot of people in this building who are a lot more qualified than I to speak about that. But there are things about unit cohesion, there are things about the soldiers' awareness of the physical and other kind of environment that he or she is going into.
Remember, a lot of stressors in the Gulf were in addition to the combat kind of stressors that you're talking about -- the fear of death, the fear of whatever. A lot of the stressors in the Gulf were related to the very, very austere and lonely, and inhospitable physical environment that the troops were in. You can prepare people for that. Unit cohesion and self-assurance are ways to deal with it, and an early recognition of symptoms or increased levels of stress by either buddies or unit commanders or line commanders or medical personnel are ways that you deal with it.
The most important thing is being straight and frank and open about being able to discuss it.
Q: Does either one of you have any better information to day as to why the UN's report on Khamisiyah filed in the fall of 1991 did not surface until early this year? At least wasn't flagged by somebody as relevant?
Dr. Rostker: I have personally talked to the two critical players here. The DIA analyst who saw the original report, discounted it. It was not credible in his eyes because the UN was led to the spot by the Iraqis.
I've also personally talked to the CIA analyst who uncovered it again. I've asked him what brought him to that report, and the answer was President Clinton's initiative to reexamine this, which in Defense was the initiatives that Secretary Deutch put underway, but the same thing was true at the CIA, and he was assigned to go back over, once again, the files and came across the UN report, found it interesting. But he didn't know what to do with it until he could get the right American unit associated with the demolitions at Khamisiyah. There is an interesting interaction with the public and the news broadcaster...
Q: Was it clear from the report that these were American units?
Dr. Rostker: No. Apparently the report was not clear, and it's only with... It is clear it was Khamisiyah, but it was only with tying it to a unit that the pieces start to fall into play. Once they fall into play and the UN goes back, the notification to the public last June comes in very rapid order.
I think one of the things we will try to do is, for your edification, is to put together a living time line. When I say a living time line, bring in here for a round table discussion the actual people who were the critical players in these various times, and let you talk to them.
Q: ...access to this information?
Dr. Rostker: I don't know that answer in terms of where it was in the intel databases.
Q: Is he still working?
Dr. Rostker: Yes. He's still working for DIA and the CIA...
Q: Did he get promoted?
Dr. Rostker: I don't know the answer to that question, but I would say that he made an honest judgment based on the facts at hand, and I think we have to respect that judgment. But I think that there are people who actually did that and we can set up, will set up a forum that you can talk to the critical players.
I would also point out that the exact question you're asking is the charter to Walt Yako in terms of what was known in the intelligence stream and what was done with it, so that we have a totally independent and separate effort that we'll be reporting out later this spring to answer exactly that. Where was it, and why did it take so long, were there other people who could have found it, and the like. But I can tell you that it was found and it was, as the pieces fell together it was expedited and brought forward in as quick a fashion as we possibly could.
Q: The CIA weather/cloud model is inconclusive so far. Do you expect that to firm up? And do you expect that 20,000 figure could change?
Dr. Rostker: We expect that in late January or early February, that IDA will come back with further analysis based upon their initial work and assessment. I have no idea what will happen in that case. We will revise the number according to what that analysis says. I should also say that we received last Friday final approval from OMB to promulgate the questionnaire to the 20,000 that were in the 50-kilometer range, and that questionnaire will go out later this week or next week. Hopefully by the end of the month we will also have some indications of whether there were other occurrences that the 20,000 found or report to us, and whether they were sick, whether they heard alarms, and the like. So I think we'll get a much more robust picture as we go forward, including the final report from IDA on the plume analysis.
Dr. Joseph: Let me say a word about the clinical side of that. We've had a very robust response back into the clinical evaluation program from people who were notified as part of the 20,000 effort. Only a small number of those have actually come very far through the clinical evaluation process. I would guess that it would be perhaps three to six months before we really had a large amount of data with which we could say the people who came in for clinical evaluation because of being in some geographic proximity to Khamisiyah are different in some way or just exactly the same or whatever, to all the people in the clinical evaluation program.
So far with the various probes -- and these are probes -- of going back into CCP and finding out how many people were in there in the original 20,000 who later we found out were near Khamisiyah, we can get to the bottom line quickly. No differences, no indicators of any significant illness that one would relate to chemical agent exposure, etc. We just don't find anything that pops up above the horizon. But it is early days. We'll see what we get from the response to Khamisiyah.
Q: On the so-called model, Bernie, do we know X number of troops, geographically, where they were in relation to Khamisiyah? And two, what are the prevailing winds in that part of the world? Southerly, southeast?
Dr. Rostker: The first question, we have a database constructed by the Army which has the location of unit command centers. They believe it's about 85 percent correct. The PAC correctly said this doesn't help us with people who may have been detailed one way or the other. That's one of the reasons for the questionnaire. The issue of the winds is fundamentally at the heart of the plume analysis, and how variable they were, it's not an issue of the prevailing winds, it's an issue of the winds that day and it's not just an issue of the ground winds, it's the winds aloft. It is a complicated process as IDA has reminded us.
Ken reminded me that the initial 1991 UN report talks about coalition forces and did not single out American forces specifically or specific units. That was part of the dilemma.
Mr. Bacon: I think it may be on Gulf Link now, but we'll check that out.
Q: Can we return just a moment to what Dr. Joseph was just saying so I understand you clearly, in your early findings of the people that you're beginning to correlate unit and time in this body of 20,000 people, you're seeing at this point no early clusters or types of illness or no higher incidents of illness? What is it that you're not seeing?
Dr. Joseph: Both are true. No higher reports rates of illness, no unusual patterns or clusters of illness. No unusual types of illness.
I've been standing here hesitating whether to try, because we never kind of get this right together, but it's this business of the 20,000. Your question kind of pushes me over the edge to do that.
What is the 20,000 that came up before? The 20,000 is our best outside, most inclusive guesstimate, furthest, largest estimate, of individuals who might have been exposed, taking the worst case scenarios that initially came up in the CIA model development. That figure uses distances that are twice what the advisory committee suggested that we use, so the 20,000 has no reality yet in the sense of there were 20,000 people exposed, to go back to your question. The 20,000 is kind of an outside limit safeguard sort of pushing the boundaries of reasonable assumption of what a worst case might be. We do not know at this point whether the actual number of American troops exposed at Khamisiyah was zero, 500, 750... I think the media has kind of gotten this, taken it the other side of the stick, which is that the numbers keep increasing. What actually has happened is that we've taken the largest figure we can to work inward from to make sure that we're not missing anything.
Dr. Rostker: And you also remember that we have company commanders from the 37th who to this day swear they don't believe there were chemical weapons at Khamisiyah. We have video, home video from the 37th that extends from the blast time through roughly 30 minutes, 28 to 30 minutes after the blast, and you'll see no alarms in those tapes. I'm sure you have those tapes. There are no alarms going off, people are not in mop gear. This is the bunker explosion, not the pit explosion.
So I've used the term before, it's a puzzle and we're trying to put the pieces together, but it remains a puzzle and there are inconsistent parts to that puzzle.
Q: What do we know?
Dr. Joseph: We know that in that time period, in the entire theater, there were no deaths in that area and no deaths anywhere in the theater that might in any way be ascribed to chemical agent. We know that from the medical and medics' recollections and statements, there were no increases in any kind of utilization of medical care, and certainly nothing that they recognized as that might be related to chemical agents. And as one of the docs said to me, the way doctors are, every one of us was looking for that first case. Every one of us over there wanted to be the first person to find... They didn't find it. We know, looking back at what we have in the CCP to date, we can find no higher registration or any unusual pattern of illnesses in people who were ascribed to the units. So everything we know here is on this side of the ledger. But can we say with confidence yet that the negative is proved? No. That's what I think both Bernie and I are trying to say. You have to keep looking.
Q: Can you clarify something you just said? "Everyone wanted to find it. Everyone wanted to be first." What timeframe are you speaking of?
Dr. Joseph: Through the entire war and the immediate post- war period. Our medical people were very well primed to look for chemical or biological casualties. There was great concern about that at the time, as you all remember. The medics were very alert. Perhaps I'm being a bit facetious, but that's what the doc said, and I can understand that as a physician. They were looking for that first case. They didn't find it.
Q: If I'm hearing you gentlemen correctly aren't you really, at least the two of you, saying more and more as you go through this you are at least having a tendency to rule out...
Dr. Joseph: In my profession rule out means something very specific. Rule out means you know there was not. Rule out means that you've proven the negative. What I think we're both trying to say, and what we always try to say in this discussion is it's a day to day matter of the balance of the weight of the evidence.
Clearly what I do agree with in your comment, is to date, to date, the enormous weight of the evidence is over on the side of there not having been chemical casualties. But can we rule that out? Absolutely not, for all sorts of important reasons. So we keep looking.
Dr. Rostker: Let me go to the other side and review for you the UN found shells with plastic linings indicating chemicals. The Iraqis, who have proven to be somewhat reliable, talked about those shells leaking and that's why some of them were taken to the pit. The UN did find shells with sarin, very diluted sarin by the time they got there -- it wasn't stabilized, but we don't know the intensity or the purity of the sarin at the time, did find it in the pit.
Q: I'm not asking you to say there were no chemical weapons there. What I'm asking is, the evidence to date, I think Dr. Joseph in a sense answered it, the evidence to date, it seems clearly shows that chemical or exposure to any kind of level -- low, high, medium level of nerve agents or others, is not a prime cause of an illness that has affected X number of Gulf War veterans.
Dr. Joseph: That's what brings us five years later to the famous issue of low level chemical exposure. Because the current best scientific understanding -- not mine, but the scientific understanding -- is that if you do not have adequate exposure to give you acute symptoms, that you will not have later on in time chronic symptoms of illness. But that best scientific understanding is not based on an awful lot of data and research, and that's the other reason why we have to keep looking, to see if indeed there might be something in that hypothesis. That's a kind of rule-out situation, and as John White said, it's going to be a couple of years before there's really a definitive understanding of that.
Dr. Rostker: Steve talked about doctors being primed to find it if it was possibly there. We have another group that was primed, and that was our chemical corps of officers. It would have really made their day, certainly bureaucratically, for the rest of their lives if we had found sarin.
I would refer you back to those very interesting 36 pages that are posted on the Internet. I think you will find case after case where there is an initial observation, and then they come back two or three lines later in the log and they say whoops, didn't test out -- including some of the more famous cases that have been the subject of congressional testimony. You can make those connections, and in almost every single case when it got to the lab it didn't test out, or the same people who called them in turned around a day later and said whoops, when we fully investigated it wasn't what we thought it was in the first place.
Dr. Rostker: That's the UN and not covered, obviously, in the CENTCOM 36 pages.
Q: It may be that the 36 pages you just referred to answer this, but the Persian Gulf investigative team has always been looking at not only the -- leaving aside the Khamisiyah incident -- a universe of other possible detections. You have a cluster on (inaudible), then you have three dozen or whatever.
Have you laid out on the Internet, I haven't found it in the mass of material, have you laid out on the Internet the evidence, or what information you have about those other incidents that the team regarded as sufficiently well corroborated to be worth further investigation? If not, will you do so?
Dr. Rostker: That's part of an ongoing investigation. It is not laid out that way. What we have put on the Internet is just the documents that have been declassified. But we are certainly internally organized. That consumes me in terms of making sure we've completed our investigations and the like, and I think will be the subject of further and continuing dialogue with us.
Q: I'm not quite sure what the reluctance is to lay out... You've laid out so much material. I'm not quite sure what the reluctance is, which is now several months old, to lay out any of the details -- dates, locations and so on -- about those other incidents you're looking at.
Dr. Rostker: I think we've made available to the press the...
Dr. Rostker: We'll make it available to you. We have given the other incidents out...
Q: Is there any study about how stress might affect family members? Like a lot of the wives of the veterans suffer as well from things, or the children that have been born after the veterans returned? Is there any study in previous wars that stress might have affected the family as well, or...
Dr. Joseph: I'll sort of take the same tack John White did. When you say a lot of wives and the children, it's impossible to answer that question. It's not a lot of wives. Clearly, stress and its consequences, psychological pressures and their consequences, physical as well as emotional, clearly have the ability to impact other family members. We all know that absolutely in our daily lives. So the answer to that question is obviously, yes.
If you're asking the question might stress and physical symptoms in the battlefield be somehow transmitted to the new... That's a theory of biology that I've never heard before, and I doubt...
Q: Is there any explanation why family members are sick as well?
Dr. Joseph: Which family members being sick are you... We really don't know...
Q: Wives and the children...
Dr. Joseph: That's what I'm saying to you. That's an easy statement to make, but I'm not aware of clear cases of illness in family members or offspring that one might reasonably medically ascribe to the exposure of the parent in the Gulf.
Q: Mississippi has from the 18 newborn children after...
Dr. Joseph: No, they don't. No, they don't. There have been now a good number of studies, a large number of studies on the reproductive outcomes and the offspring of people who served in the Gulf and didn't serve in the Gulf. There is, I'm quite sure of this, there is no evidence at all to date of a different rate of congenital malformations or a different rate of illnesses in offspring. You see this popping up again and again in the popular press and elsewhere, but there just is no scientific basis for it. And I can't conceive of what one would be in specific relationship to your comments about stress. But could stress affect family members? I think we all know that that's true. Thank you.