Defense Issues: Volume 12, Number 1-- Report to the President on Gulf War Illnesses
Mrs. Clinton. Thank you, and please be seated, and welcome to the White House. I am pleased to see all of you here today for the presentation of this report of the Presidential Advisory Committee on Gulf War Veterans Illnesses.
The work of this committee reflects the administration's commitment to finding answers for the thousands of brave men and women suffering from undiagnosed illnesses after serving in the Persian Gulf War. And it reflects the president's abiding commitment to being responsive to and responsible for our veterans and their families.
I know that there are numbers who are here of the commission, and I'd like them, if they would, to stand so that we could see all -- they're all standing. We appreciate very much the time and effort that went into this service. And I know firsthand how important and difficult your task has been.
Over the last four years, the president and I have received many heart-wrenching letters from Gulf War veterans and family members. Many veterans and their family members said they felt that their country had forgotten them. So in the fall of 1994, the president asked me to explore the issues surrounding the health needs of Gulf War veterans and to look into the federal government's efforts to address their concerns.
I met with officials from the Department of Defense, the Veterans Administration and the Department of Health and Human Services to determine if we were doing the very best we could to respond to our veterans' needs and to facilitate research into their illnesses.
I met with representatives of the American Legion and the Veterans of Foreign Wars, who shared their own observations and told me of their efforts to bring more serious national attention to these illnesses, and I visited with individual veterans, active duty soldiers and their families. At Walter Reed Hospital [Army Medical Center] and the Veterans Hospital here in Washington. I listened to veterans as they tried to describe to me what it was like to live day after day, year after year, not knowing why they had become sick.
I heard stories of hard-working men and women who could no longer keep steady jobs and support their families because of their illnesses. One veteran officer who had been diagnosed as 100 percent disabled told me about the healthy and active life he had led before his tour in the Persian Gulf and about his frustration in seeking effective treatments for his systems.
In February 1995, I reported to the president and the chief of staff on these findings and recommended some steps the administration could take in the future, including the creation of a blue ribbon panel to investigate these issues further. And I had the privilege of testifying at the first meeting of this committee in August 1995, and I've been following the work that has been done closely ever since.
So I'm particularly gratified to be here today, and I'm also gratified that our government is making progress and being responsive in taking affirmative steps to do all that can be done on behalf of our veterans and on behalf of future members of our forces who might be put in harm's way in the future.
I want to thank all who served for their persistent efforts on this committee and for considering thoroughly the diverse and strongly held opinions, theories, explanations and evidence about these illnesses. But I particularly want to thank Gulf War veterans and their families for taking the time to share their experiences with this committee. We could not have had a better chairperson of this presidential committee than the one who was persuaded to undertake this significant responsibility, and it's my pleasure now to introduce Dr. Joyce Lashof, who will tell us more about the committee's findings.
Lashof. Thank you very much, Mrs. Clinton, especially for your compassion and your interest in this important issue. And thank you, Mr. President, for your very courageous leadership for wanting to get to the bottom of this issue and the effort you've made to bring this committee about.
Mr. President, Secretary [of Health and Human Services Donna E.] Shalala, Secretary [of Veterans Affairs Jesse] Brown, Deputy Secretary [of Defense John P.] White and Deputy [CIA] Director [George J.] Tenet, on behalf of the advisory committee it is a pleasure for me to transmit to you this, our final report.
Over the past 16 months, we have conducted a broad analysis of issues related to health consequences of Gulf War service. Our efforts to address the complexities of Gulf War veterans' illnesses would not have been possible without the contributions of hundreds of Gulf War veterans and their families. They have served with distinction, and we thank them.
Our interim and final reports make several recommendations which we believe can improve the government's approach to addressing the health concerns of veterans who served in the gulf. In all areas save one, these suggestions are to fine-tune the government's programs on gulf health matters. Overall, the government has responded with a comprehensive series of measures to resolve questions about Gulf War veterans' illnesses.
Unfortunately, the positive nature of these efforts has been diminished by how the Department of Defense approached the possibility that U.S troops had been exposed to chemical weapons. It is essential now to move swiftly to resolving Gulf War veterans' principal remaining concern -- how many U.S troops were exposed to chemical warfare agents and to what degree.
The committee is pained by the atmosphere of government mistrust that now surrounds every aspect of Gulf War veterans' illnesses because of these concerns. It is regrettable, but also understandable.
Our investigation of DoD's efforts related to chemical and biological weapons led us to conclude the department's early efforts were superficial and lacked credibility. DoD's failure to seriously investigate these issues also adversely affected decisions related to funding research on health effects of low-level exposure to chemical warfare agents. DoD was intransigent originally in refusing to fund such research until late this year. This has done a disservice to the veterans and the public.
But the committee recognizes that in November 1996, DoD announced it was expanding its investigation and research related to low-level chemical warfare agent exposure. We hope these initiatives can begin to restore confidence in DoD's investigation on chemical agent incidents.
But moving beyond the specific, albeit important, topic, it is important to reiterate that many veterans clearly are experiencing health difficulties connected to their service in the gulf.
First and foremost, it is vital that the government continue to provide the excellent clinical care for these veterans. Next, we must try to find why they are sick. Based on existing scientific data, none of the individual environmental Gulf War risk factors commonly suspected appears to be the cause. And while the government finds that stress is -- while the committee finds that stress is likely to be an important contributing factor to Gulf War veterans' illnesses, the story is by no means complete.
Veterans, their physicians and policy makers clearly stand to benefit greatly from the comprehensive range of ongoing research. We believe a continued commitment to long-term studies is important. Some health effects such as cancer would not be expected to appear until a decade or more after the end of the Gulf War.
Additionally, the committee recommends new research in three areas: the long-term health effects of low-level exposure to chemical warfare agents; the synergistic effect of pyridostigmine bromide with other Gulf War risk factors; and the most physical response to stress.
However, veterans and their families will realize maximum benefits from such research only through a thoughtful, inclusive dialogue between veterans and the departments. In light of current public skepticism, the committee strongly believes that a sustained risk communication effort is the only way to repair public trust.
The volunteers who served in defense of our national interest deserve complete and accurate information about the risks they faced, and I am sure that we will be able to provide it to them.
The committee also felt there were lessons to be learned about health matters based on Gulf War experience. We believe the government can avoid many future postconflict health concerns through better communication, better data and better services, and we make recommendations in all these areas.
In closing, I would like to re-emphasize that in many important and, in some places, unprecedented ways, the nation has begun to pay its debt to the 697,000 men and women who served in Operation Desert Shield-Desert Storm. We were impressed with the research the government had already initiated to understand the nature and causes of the illnesses so many veterans suffer from. The committee hopes the same degree of commitment will be applied to the issues still outstanding.
Finally, the committee gratefully acknowledges the significant time and effort that individuals within and outside government devoted to our effort. We also have been fortunate to have a talented and dedicated staff. On their behalf and on behalf of my fellow committee members, I thank you for your leadership in addressing Gulf War veterans' health concerns and for providing us with the unique opportunity to contribute to this vitally important issue .
President Clinton. Thank you very much to Dr. Lashof and the members of the Presidential Advisory Committee on Gulf War Illnesses: Secretary White, Secretary Brown, Secretary Shalala, Deputy Director Tenet. I'd like to say a special word of thanks to Dr. Jack Gibbons [assostant to the president for science and director of the Office of Science and Technology Policy] for the work that he did on this. I thank Sen. [John D.] Rockefeller [IV], Sen. [Arlen] Specter, Congressman Lane Evans for their interest and their pursuit of this issue, and all the representatives from the military and veterans organizations who are here.
I am pleased to accept this report. I thank Dr. Lashof and the committee for their extremely thorough and dedicated work for 18 months now. I pledge to you and to all the veterans of this country, we will now match your efforts with our action.
Six years ago, hundreds of thousands of Americans defended our vital interest in the Persian Gulf. They faced a dangerous enemy, harsh conditions, lengthy isolation from their families. And they went to victory for our country with lightening speed. When they came home, for reasons that we still don't fully understand, thousands of them became ill. They served their country with courage and skill and strength, and they must now know that they can rely upon us. And we must not, and will not, let them down.
Three years ago, I asked the secretaries of defense, health and human services and veterans affairs to form the Persian Gulf Veterans Coordinating Board to strengthen our efforts to care for our veterans and find the causes of their illnesses. I signed landmark legislation that pays disability benefits to Gulf War veterans with undiagnosed illnesses. DoD and VA established toll-free lines and medical evaluation programs.
I am especially grateful to the first lady, who took this matter to heart and first brought it to my attention quite a long while ago now. I thank her for reaching out to the veterans and for making sure that their voices would be heard.
To date, we have provided Gulf War veterans with more than 80,000 free medical exams. We've approved more than 26,000 disability claims. HHS, DoD and the Veterans Department have sponsored more than 70 research projects to identify the possible causes of the illnesses. But early on, it became clear that answers were not emerging fast enough.
Hillary and I shared the frustration and concerns of many veterans and their families. We realized the issues were so complex they demanded a more comprehensive effort. That is why, in May of 1995, I asked some of our nation's best doctors and scientists, as well as Gulf War veterans themselves, to form a presidential advisory committee that could provide an open and thorough and independent review of the government's response to veterans' health concerns and the causes of their ailments.
Since that time, we have made some real progress. The Department of Defense with the CIA launched a review of more than 5 million pages of Gulf War documents, declassifying some 23,000 pages of materials and putting them on the Internet. Through this effort, we discovered important information concerning the possible exposure of our troops to chemical agents in the wake of our destruction of an arms depot in southern Iraq.
The committee made clear, and the Defense Department agrees, that this new information demands a new approach, focusing on what happened not only during, but after, the war and what it could mean for our troops. Based on the committee's guidance, the Department of Defense has restructured and intensified its efforts, increasing tenfold its investigating teams, tracking down and talking to veterans who may have been exposed to chemical agents and devoting millions of dollars to research on the possible effects of low-level chemical exposure.
I'm determined that this investigation will be comprehensive and credible. We haven't ended the suffering; we don't have all the answers; and I won't be satisfied until we have done everything humanly possible to find them.
That's why I welcome this committee's report and its suggestions on how to make our commitment even stronger. I also take seriously the concern regarding DoD's investigation of possible chemical exposure. I'm determined to act swiftly on these findings not only to help the veterans who are sick, but to apply the lessons of this experience to the future.
I've asked the secretaries of defense, health and human service, and veterans affairs to report to me in 60 days with concrete, specific action plans for implementing these recommendations. And I am directing Secretary [of Defense]-designate [William S.] Cohen, when confirmed by the Senate [confirmed, Jan. 22], to make this a top priority of the Defense Department.
I'm also announcing two other immediate initiatives First, I've asked this committee to stay in business for nine more months to provide independent, expert oversight of DoD's efforts to investigate chemical exposure and also to monitor the governmentwide response to the broader recommendations.
The committee's persistent public effort has helped to bring much new information to light, and I have instructed them to fulfill their oversight role with the same intensity, resolve and vigor they have brought to their work so far. Dr. Lashof has agreed to continue, and I trust the other committee members will as well.
Second, I'm accepting Secretary Brown's proposal to reconsider the regulation that Gulf War veterans with undiagnosed illnesses must prove their disabilities emerged within two years of their return in order to be eligible for benefits. Experience has shown that many disabled veterans have their claims denied because they fall outside the two-year time frame. I've asked Secretary Brown to report back to me in 60 days with a view toward extending that limit.
And we will do whatever we can and whatever it takes to research Gulf War illnesses as thoroughly as possible. Every credible possibility must be fully explored, including low-level chemical exposure and combat stress.
I know that Congress shares our deep concern, and let me again thank Sen. Specter, Sen. Rockefeller and Congressman Evans for being here. Caring for our veterans is not a partisan issue, it is a national obligation, and I thank them for the approach that they have taken.
As we continue to investigate Gulf War illnesses, let me again take this opportunity to urge the Congress to ratify the Chemical Weapons Convention, which would make it harder for rogue states to acquire chemical weapons in the future and protect the soldiers of the United States and our allies in the future.
This report is not the end of the road, anymore than it is the beginning. We have a lot of hard work that's been done and we have made some progress, but the task is far from over. The committee's assessment gives me confidence that we are on the right track, but we have much yet to learn and much to do.
As we do make progress, we will make our findings public. We will be open in how we view Gulf War illnesses and all their possible causes -- open to the veterans whose care is in our hands; open to the public looking to us for answers. I pledge to our veterans and to every American, we will not stop until we have done all we can to care for our Gulf War veterans to find out why they are sick and to help to make them healthy again.
Thank you very much.
Q. Mr. President, this has been studied to death. Do you believe that there is a Gulf War illness?
A. I believe that there are a lot of veterans who got sick as a result of their service in the gulf. And I believe it took experts to determine whether there is one or a deliberation of them in exactly what the cause and connection is. That has been apparent for some time. That's why the Congress agreed to support our efforts that for the first time paid disability payments for people with undiagnosed conditions. ...
I think that this committee has done a good job. I think -- I want to compliment the work that has been done in the last few months by John White of the Defense Department in facing up to the things which were not done before. No one has ever suggested that anybody intentionally imposed -- exposed American soldiers to these dangers, and there is nothing -- there is no reason that anyone in this government should ever do anything but just try to get to the truth and get it out and do what is right for the veterans.
And there are also -- I think we need to be a little humble about this. There are a lot of things that we still don't know. That's what Dr. Lashof said. And that's why these research projects are so very important.
And the final thing I'd like to say is we don't know all the answers here. You heard Dr. Lashof say that sometimes when people were exposed to substances that can cause cancer it may not be manifested for 10 years, which is why I want to thank Secretary Brown for urging that we stress the two-year rule. We have to -- we have to be vigilant about this. And my successor will be working on it. We will be monitoring this for a long time to come.
But we've got a process now the American people and the veterans and their families can have confidence in. We've got the appropriate commitment of personnel and money. And more important, we've got the appropriate commitment of the heart and mind. And I'm convinced now that we will do justice to this issue and to the people that have been affected by it.
Thank you, Mr. President.
Q. Dr. Lashof, just a few minutes ago, ... Sen. Specter said that they are going to be holding hearings on Thursday on the Hill, and he was talking about the possibility of a cover-up by the Pentagon. Do you agree with that assessment? Do you think that that's ... ?
A. We found no evidence of a cover-up in our work.
Q. Could we use another word? I mean, ... was the information adequately conveyed to the public about what they had found?
A. Let me put it this way: They were very slow, and the actual investigation for the possibility of exposure was, we say in the report, superficial and inadequate initially. I think now.
Q. Was it intentional or ... ?
A. We have no way of judging what their intentions were. We were critical of the lack of effort, and they now have made a commitment. But they can answer that, and I would turn that question to Paul Busick.
Q. Dr. Lashof, in the context of the Defense Science Board investigation of '94, which was presented as a thorough, exhaustive study of exposures, how do you rate that study compared to what you've found out?
A. Well, we obviously uncovered, and it was brought to light, the incident at Khamisiyah [Iraq] that apparently was not known at that time.
Q. Adm. Busick, would you be able to answer the first question?
A. Sure. I think that the Defense Department has acknowledged that it needs to do more and has moved very quickly recently to do more. I think that the secretary of defense has taken the allegations of a cover-up very seriously, and the deputy secretary of defense has instructed the secretary of the Army to launch an Army inspector general investigation into the incident at Khamisiyah.
Q. Admiral, why was the department so slow, though?
A. When we get the inspector general's investigation, then we will have more information about what to do, and we look forward to having that.
Q. Why was the initial investigation so slow? You obviously had had the experience of Agent Orange in Vietnam. There was a precedent for this. Why wasn't there a better effort made initially?
A. I think that the PAC report has stated that the Defense Department had two triggering events that they viewed as critical. One was whether the Iraqis presented or used offensive chemical weapons, and the second was whether there were acute symptoms.
Q. And what did they find?
A. Neither of those have been found to be the case, and that's in large part why there was no belief that there was a chemical event.
Q. Dr. Lashof, did your inquiry find any evidence of widespread exposure of American troops to chemical weapons, one? And two, do you have any chemical evidence to suggest that low-level exposure causes any of the symptoms that Gulf War veterans are now reporting?
A. The only evidence of exposure that we were able to find ... was the event at Khamisiyah. There are reports of other site-specific reading on M-254s and Fox vehicles that need to be further investigated. And that's why we've asked for further investigation of possible exposures. ... There are other reports of detections, but an actual source has only been identified in Khamisiyah.
To your second question of low-level exposure and is this the cause of the illness, we have no clinical evidence now of long-term health effects from high-level exposures from times when people are ill. The research on long-term effects from low-level is not really available at this point.
In my view, it would be unlikely to see results from low level when we don't see long-term effects from high-level exposure. But we believe that research needs to be done around this, and there are, and we suggest in the committee report, that there are two populations that could be looked at. One is the Japanese in the subway who were exposed, and the other are the pesticide applicators who often are exposed for long times to very low levels. And we think these could be investigated and that question put to rest.
Q. Just to follow up that, if I might, given the uncertainty about whether any more than one chemical alarm went off at Khamisiyah, do you regard the exposure at Khamisiyah as a case of potential exposure or actual exposure?
A. I think we feel that -- we know that there were weapons that contained chemical agents at Khamisiyah that were exploded. Therefore, we have to assume that there was exposure to the troops from that release from those weapons that were destroyed at Khamisiyah.
Q. Even if chemical alarms didn't go off?
A. I was going to say, I thought there was a chemical alarm that went off there and one positive detection. We'll get back -- I can get this. They have to research that, and they can get back to you with further detail.
Q. You've termed so far today the Pentagon's response to this problem as being inadequate, superficial, incredible, intransigent, various other adjectives. Yet your conclusion is that they will be able to do the follow-up with a tenfold investigative staff. Isn't there a dichotomy there?
A. I do not believe there is a dichotomy. In fact, I'm glad you asked the question about that. We feel it's very essential that the follow-up be done and that it be done under very strong oversight with a public view of it. The committee's work, actually, on this issue I think has been misrepresented. I have held back from reporting on the mischaracterizations until our work was finally completed, but let me point out that I think it's unfortunate that our deliberations have been cast in the light that suggests that we have backed off from any suggestion of an independent investigation.
At the committee's September meeting, the staff briefed us on its investigations on the exposure half of the chemical and biological weapons issue. In the transcript of that meeting, the staff reported -- and I will quote from that transcript because I'd like this to be on the record correctly because it has been misrepresented: "The Department of Defense has assets that cannot be replaced in pursuing those investigations. DoD has to play a critical role in investigating possible exposures. And credible review cannot be accomplished internally by the Department of Defense, however. To be credible amongst veterans and the American public in general, there is a need for outside, independent oversight review and involvement." Now, that was the quote from our September meeting.
At the November meeting, the committee met to review and complete the recommendation process. For the recommendation in question, our discussion at the November meeting centered around adding language to provide greater context and depth to the recommendation -- adding language to the report, that is. And I'm aware that many people portrayed this discussion as a re-evaluation of staff's recommendation. As the record clearly shows, however, this is just not true. Our position has been clear from the outset, and our final recommendation reflects that position. The investigation must be done by DoD, but it must be done under very vigorous and extensive oversight. And I think that the president's action today to extend the committee fully meets the intent and the spirit of that recommendation, and we intend to be vigorous in our oversight of this.
Q. Adm. Busick, the veterans groups have been on record as saying that in the case of the missing logs and missing records, that there is an issue, potentially criminal issue, of chain of custody, whether they are missing or whether they do exist but have been misplaced. What's the current situation with that?
A. I think the Department of Defense has started the investigation to reconstruct what's occurred. I know that the Department of Defense has launched an inspector general investigation into the events surrounding Khamisiyah, and that will include the look at logs.
Q. Doctor, this study seems to focus mostly on stress, and in the three that you all list early on about what you've found you can't find any casual link between the illnesses and these types of pesticides and chemicals and the like. What caused the stress?
A. Going to war is a stressful situation and having alarms going off around you, the oil well fires, the general conditions under which people were living and working. All of these add stress, and different people are going to react to stress differently, and different degrees of stress have different effects on individuals.
Q. Could you see this as any different than any other type of wartime scenario?
A. Well, we see effects of stress in any war; that is correct. Whether it's more or less, we have no data on that, one way or the other.
Q. You seemed careful in the previous session to say that you found no causal link between any individual factor and the veterans illnesses.
A. That's correct.
Q. Does that leave the door open to synergistic effects, particularly between stress and, for instance, various chemical agents or even the PB [pyridostigmine bromide] pills?
A. I think it does leave that door open. We do recommend further research specifically on the synergistic effects between pyridostigmine bromide and pesticides. You are correct that we say stress is a contributing factor and we don't know what other factors it could relate with. We really have a lot of epidemiologic research ongoing, and until that research is completed, we're not going to be able to answer some of the questions you're now -- you and the vets, appropriately, and we are asking.
Q. Doctor, do you come away from this study thinking that the U.S military force structure should somehow be altered so that the Guard and Reserves aren't relied upon so heavily in wartime performance?
A. That's not an issue that was in the realm of our committee to consider.
Q. Doctor, much was made a few months ago of a claim by two former CIA analysts that documents that they had examined demonstrated beyond doubt Iraqi use of chemical weapons and a CIA cover-up. Are you satisfied you got those documents from the CIA, and did they show any evidence of Iraqi chemical use during the war?
A. We reviewed those documents and do not see that they present any evidence that the Iraqis used [chemical] weapons during the war.
Q. Did we use any?
Busick. Can I follow up on that? Again, the director of central intelligence found that the accusation, the allegations that there was a cover-up on CIA,were important, and they have also launched an inspector general investigation into that issue.
Q. Dr. Lashof, can you address the issue of why Dr. Jonathan Tucker was dismissed, I guess over a year ago -- a member, a researcher on the committee?
A. I'm aware of the circumstances concerning his departure, and I will not discuss personnel matters. I know that the staff acted appropriately in that.
Q. Do you think that has damaged your credibility at all, dismissing one of your top researchers? He's now saying that there was disagreements among himself and some of the members I think on the research ... .
A. I think our report on that stands as a good record. We've obviously dealt very heavily into this area. We have an excellent investigator who has taken on that area and done an excellent job, and I think -- look at the report.
Q. Just a very basic kind of technical question, but are you, at this point, aware -- do you feel that you are aware -- of every single chemical that people in that region may have been exposed to, as opposed to how these chemicals may have worked together? In other words, is there any factor, any chemical factor, that you feel you do not know existed there that might have been used?
A. Well, it's always hard to know something that you don't know. I believe we know everything that's been issued to them. We know everything that you could logically think about. If there's something that's illogical, unknown out there, I don't know how anyone knows what they don't know. But there's obviously no evidence that anyone has information that they're keeping from us. We certainly know everything that's been issued. We know what oil well fires burned. We know what diesel fuel was used. We went into this extensively.
Q. Do you have fixed in your mind a population that shares these multiple symptoms? How many active duty, how many veterans?
A. No, the only data -- we do in the report review briefly the data from the comprehensive clinical evaluation protocol of the Department of Defense, and then the VA has a registry, and we give a table that shows what percentage had symptoms of ill-defined conditions and PTSD [posttraumatic stress disorder] and so forth.
Q. What do you have fixed in your mind as the population who are complaining or have some illness as a result of this? What is it?
A. You mean, how many, numbers? The only numbers we have are the numbers who have gone in for examinations. And until we have the epidemiologic studies, we don't know what percentage that represents, whether it represents who has been ill or not. We've got to await those studies.
Q. Dr. Lashof, do you think that nine more months of operations by your committee will produce a definitive conclusion as to what's behind these illnesses?
A. I think we'll be able to elucidate a great deal more. I don't think a definitive solution will be known in nine months. It depends really on what the results of the major studies that are ongoing now show as to how far we can go in nine months. They may open up avenues that are new that will need further exploration. They may give us answers. I really couldn't speculate.
A. I think the objective on the part of the administration here is to get to credibility in terms of process. One of the major factors that we wanted the PAC to stay on for was to address the issue of the process that the Department of Defense is using to get to the answers that we need, in terms of investigations into low-level chemicals and those kinds of issues. If we can get to a credible process that has been independently verified, then we'll be a long way down the road toward the answers that we need to get at. That's the objective.
Published for internal information use by the American Forces Information Service, a field activity of the Office of the Assistant Secretary of Defense (Public Affairs), Washington, D.C Parenthetical entries are speaker/author notes; bracketed entries are editorial notes This material is in the public domain and may be reprinted without permission Defense Issues is available on the Internet via the World Wide Web at http://www.defenselink.mil/speeches/index.html.