Lt. Gen. Vesser's Briefing on Gulf War Illness
Lt. Gen. Vesser: As you know, Dr. Rostker has been named Under Secretary of the Army, but he will retain his role as special assistant for Gulf War illnesses. He has asked me to come here today to share three firsts for us, at least for our organization in our investigations.
We have just completed our second environmental exposure report on oil well fires. The first is that this is the first paper we have done that contains health risk assessments for those who participated in campaigns after Saddam Hussein had destroyed over 600 oil wells in Kuwait, burned a billion barrels of oil during the nine months they were alight, including millions of meters of natural gas. You'll recall that an international consortium of oil well fighters went. The estimate was it would take three years to put out these fires; it took nine months, because they did a good job using ad hoc measures such as sea water and many techniques. Of course, they were the people who were most acutely exposed, so we got an initial look thanks to an early study that was done on the health of the fire fighters who were there for all nine months. Many of them were breathing this because they did not often use, as the study showed, breathing apparatus. The net effect of that study which was published at the time was that they appeared to be suffering no ill health or diseases from their exposure. But the larger question is what about our troops? And, I can tell you that with one exception, our health assessments show that there is unlikely to be long or short term health effects from these exposures. This doesn't mean that people didn't have difficulty breathing as they were covered with this slime. I felt dirty just looking at this desolate area and oil well lakes that are still there seven years after last year when Dr. Roster and I were there.
But let's go to the facts. Right after the war, in addition to the oil well fire specialists, roughly 20 environmental health teams went to the locations you see marked here in red to collect data, to see exactly what had been released, to take air and soil samples. In addition, we had the U.S. Army environmental hygiene agency do a study that was the first risk exposure assessment based on a congressional law. And they used modeling techniques at the time that looked at where these plumes went through the period of time. They made some assumptions. They assumed that all our troops were exposed to all nine months of contaminants because information was lacking about where troops were located. It was precise in exactly when they arrived. Their findings, which were published in 1994, first with respect to standards was to say the type of risk assessment conducted, because of a desire to protect public health, inherently overstates risks to health. We're using those same standards as we discuss our risk assessment today, so let me elaborate.
Basically, the environmental, the EPA's standards takes account of young children and old people who are most susceptible to these sorts of contaminants, so as are most of our troops were young people in good health, the risks of applying such standards to their health are overstated. The other judgment made, though, considering this, was that the risks to health from exposure to the smoke in the background, air contaminants in the Persian Gulf are likely to be extremely small.
That was then. What's changed since then? Since then, we've got better models to determine where the pollutants and the contaminants from these fires may have gone. We do know that the oil well fires burned hot and the contaminants went above what's called the mixing layer, unlike the material that was released at Khamisiyah, so it went up to high altitude. We've got better locations for troops as a result of calling in Army operations officers who could help us find where units were. More importantly, they could tell us when units changed locations, so now we actually have times and precise locations so we can estimate what units were exposed to.
In addition, and I've got another sample of a plume up here. This plume is much more precise in terms of saying where the material went. In other words, it's like moving from analog to digital TV. You've got a lot more dots. We've got roughly 16 times the resolution with a model that is used in 1998 for where this stuff went that we had with the one that was used in 1994.
Now, we can do profiles month by month. The exposure is in the dosage. The dosage depends on how long you were under the area where the contaminants were. This is a contour type profile that shows that the orange portion had -- troop units there had approximately 24 days exposure to contaminants during the month of February. Ones out here in the light green had only five minutes. The good news is that a lot of this material went out over the Gulf. The bad news for the sailors was there were shoveling a lot of this stuff overboard.
Now let's talk about some of the contaminants. What we've tried to do in the papers, you'll see, talk about two different types of things, the things that are associated with the oil well fires and the more general pollutants in the area. We tried to separate them into those things that cause cancer, carcinogens and things causing non-cancer type diseases. That is, cardiopulmonary diseases, renal or kidney diseases, reproductive diseases, neurological diseases that are caused by certain toxic substances. So we're talking about two different kinds of substances. Benzene is a substance that causes both. Toluene is not. Ethylbenzene has a potential to cause both. Zilene (?) does not. This chart just shows something that was pointed out at the time that is important to grasp. That the exposure in Kuwait during the oil well fires that the military hospital at Camp Doha and at Dhahran in Saudi Arabia, to many of these substances was lower than it was in Houston, Philadelphia, Phoenix or Los Angeles during this same period of time.
Now why is that? The oil well fires burned so hot, first of all, much of this material was lofted high. But in addition, much of the material was destroyed, so there were fewer contaminants left after the fire because the fire burned so hot.
One allegation that has been widely circulated was that Saddam Hussein actually had his forces put chemical warfare agent at the well heads before he blew them up to distribute the chemical warfare agent in the fires. We can find no evidence that that in fact happened. Further, we know that we incinerate as we meet our obligations under the chemical treaties to destroy our own nerve agents at 550 degree fires are used in incineration to destroy these materials. These fires were burning at about 800 degrees. So, we don't find that particular charge credible.
What comes out of all this is a series of computer models that bring all this information together. The samples that were taken right after the war, trying to come up with the fact that as most of the environmental agencies didn't deploy until March and the fires were burning ferociously from the ground war on, we have to go back and do a certain amount of reconstruction. Models project that. We have the operations officers on where the troops were located, the troop units. So we can now make very sophisticated estimates and CHPPM, the Army Center for Health Protection and Preventive Medicine, the follow-on to the Army environmental hygiene agency has given us some estimates.
First we have to learn how to read the chart. On the chart on non-cancer risk levels, that is for the diseases I indicated, it's this line across the top, 1.0. And what do we see? This chart shows that the least exposed units, the ones that were off in areas that maybe only got five days of exposure, compared to the most exposed, which may have had 60 or 90 or even more days' exposure are below the level that the EPA says is necessary for you to have a risk to your health for non-cancer type diseases. This segment over here shows exposure to all toxic contaminants that were identified through those samples. These involve industrial chemicals. Recall that other things were being manufactured and used in this area than just petro chemical industry. Vehicle exhaust, all the contaminants that were identified. Notice that a lot more people, of course, are exposed to those. But the range of these from least exposed to most exposed is still below the line. The bottom line, it's unlikely you're going to have higher risk to the diseases I talked about or the type diseases from being exposed to these toxic contaminants.
But now what about carcinogens? Is there a greater risk of cancer? This one's a little more difficult to read because first, there's the need to appreciate the standard. The standard, simply put, is if these agencies such as the EPA see that there is one excess cancer per million people, it triggers their interest. But they're unlikely to do anything until there's one cancer per 10,000 people. When I say do anything, I mean come up with a specific program to alleviate the situation. So what we have is a range that is an estimate that you've got to kind of project across the top. But once again, what we see is that with respect to oil well fires from the least exposed to the most exposed, well below the EPA standard of risk. Similarly for exposure to all carcinogens that were deemed present there.
You'll remember that I said with one exception, possible exception. Wait a minute.
Our second first is we have engaged the Rand Corporation to look at the medical literature and research it on a number of subjects. Every one of these contaminants, pollutants is described in great detail and its consequences for human health, at least, is known today by the medical profession in the paper that is available for you in the back of the room. They have also discovered that the possible exception was something that people were aware of at the time of the Gulf War. They noted that there were particulate levels. But Rand found that there's a possibility if you had a proclivity toward asthma, there's a likelihood that exposure to particulate levels that were present during this period could give you long term, could have long term consequences for your health. This is a hypothesis.
Let's just look at particulates. I would note while he's putting that up here that the Rand research is peered reviewed. They're an independent outfit, as you know. And we have asked them to look at a number of other things, but this is the first paper that they have published that we have released. I'm sorry, that they have released.
What this chart shows is that with respect to particulates, it's not just a Gulf War problem. This compares a period during 1991 when the oil well fires were burning at selected locations in Kuwait with 1994 when the winds continued to blow. The particulate composition, and these are very small pieces of grit, sand, soot, during the Gulf War oil well fires was about 20% soot, some of it covering small grains of sand. But the rest of it was essentially this small, gritty sand that could get down into the lungs. Now, a lot of soldiers who were coughing up black mucous are convinced that something bad happened to them because they were exposed to this. Dr. Kilpatrick, who is with me, would say no, no, that's a good thing. You coughed it up. It didn't get to your lungs. That stuff didn't get there. But what about these other particulates? This is work we still have to do. We've done two risk assessments, one on carcinogens and one on toxics that can cause the diseases I mentioned. We have yet to do the one on what effect these carcinogens are doing.
In addition to doing that study which is not due until August next year, CHPPM will be doing one on the connection between particulates like this of a small size and the potential for asthma. We can't do anything except make an observation. The observation I'll make is that in the United States, only 5 to 6% of the population has asthma. In Kuwait, 18% of population has asthma.
Now let's talk about our third first. Those of you who heard our earlier accounts of our chemical warfare agent investigations know that we are talking about investigation of a single incident. For the first time, we have looked at a unit and its performance over 42 days, during which it made, initially, a number of artillery raids up to the border. Then once the war started, the 11th Marines provided artillery support for the 1st Marine Division as over a four day period, they attacked during the ground war to seize the area around Kuwait city.
Why this particular unit? Because it had so many alarms. Eighteen alarms or reports of alarms that caused actions to be taken over the period of 42 days. This caused us to try and appreciate why so many alarms. You have to remember that artillery and an artillery regiment like this has more communications than the standard infantry or light armored vehicle unit because they have to reach out and support other units. Radio ricochet coming up one of these many channels could give them access to reports of chemical warfare agent coming in which could cause them to take action. In addition, the way the artillery operates is they have to provide continuous fire for infantry and armor units advancing. What this usually means is that one part of an artillery battalion or battery will stay in place to provide fire while another element moves forward and leap frogs. What does this mean? It means they're sitting ducks if there's a report of chemical warfare agent. They can't move out of the way from where the report is coming from. They have to sit there, conduct their mission, which means they have to go into protective gear.
The other thing that is interesting about this and is related to the oil wells is that we know that only 30 to 50 oil wells were blown up between roughly the middle of January until the ground war began. Then, during the period of the ground war, roughly another 500 plus were destroyed. What did this mean for the 11th Marines? It means the first oil field they went through had some smoke in it and some oil and a lot of hydrocarbons, but as they approached the Al Bergen (?) oil field, there were many more blown up, just about all the wells in the field. What we've tried to do chronologically here is show when their alarms took place so that we can characterize it. We show here the months of January 1991, February 1991. Notice that there are no alarms from the end of January until the ground war began even though artillery raids were being conducted. But what we've tried to do is break out the four days. You'll note that the 25th of February and the 26th of February when they were in the oil fields where most of the wells had been blown up, there are many more alarms. Why? Well, simply put, our alarms were susceptible to any hydrocarbon substance, including oil well fire smoke or oil itself that gave what were called false positives. What we did, our investigators did, was look at all of these incidents as they always do, looking at documentation and also at interviewing everybody we could find who could shed light on why so many alarms. What can you tell us about alarms at specific times to put together an account of what happened? What they found was the command was very conscientious about training.
However, the 11th Marines, like many other units, were joined by elements from the 10th Marines, 12th Marines and the 14th Marines to augment them so that would have sufficient artillery to perform the mission. It was a five battalion outfit, mostly towed 155 millimeter Howitzers. They had two self-propelled batteries. But the reserve units and a few of the others arrived late and didn't get the same amount of training on the use of detectors or in the protective means that everybody else had had. The leadership was very conscientious. Their attitude was, when in doubt, mask. And consequently, the first day of the air war, the second day of the air war when they had incoming 122 millimeter rockets in their area and later artillery, they went ahead and didn't take any chances that it might or might not be chemical warfare agent. Remember, everybody was very alert to this as a threat during the Gulf War. They masked, the alarm went off.
When they went up on an artillery raid here on the 20th and 21st, it was a different matter. Then, there was incoming artillery, but with it came some smells which were detected and which caused individuals having masked as a result and also having given the alarm to go into higher protective from MOPP up to MOPP 4. Later, of course, they used the 256 kit, didn't find any indication that they had, in fact, been exposed to chemical agent.
These are three indications of what happened during this period. We could go through each and every one of these cases. I'm not going to do that. What I'm going to do is let you ask any questions you have to ask. I will say to you that the bottom line is considering the oil fields they were attacking through and the false inference considering that some of their chemical detection equipment was experimental. One was a device called Rascal, the XM or experimental detection device 21, which was so faulty that it was directed to be put away. It was meant to detect chemical substances at a distance. But when you consider this, when you consider that in many of these instances, there was no means by which the Iraqis could have delivered chemical warfare agent, that is, there's no record of artillery. Through the entire period, there were no casualties or injuries treated within the unit that were characterized or identified as being from exposure to a chemical warfare agent. That our investigators made the determination after investigating each one of these and putting things in the context as I just described as it is unlikely that elements of the 11th Marines were exposed to a chemical warfare agent.
At this point, I would say to you, three firsts. One, the first health risk assessment. Secondly, our release of the first Rand paper on review of the medical literature that has a significant finding about the possibility that particulates may contribute to some long term health effects for those with a potential to have asthma. And finally, a first on looking at a unit over a period of time, advancing over a 160 miles under fire to accomplish a mission, which they did very successfully. But each of these cases is more complicated and more difficult than some of the other assessments we've done in the past. That is why we look to you, the media, as well as to the veterans for any help you can give us in terms of gaining more information so that we can give better answers to those veterans who want them.
Q: How many case narratives have you released now as part of this -- these two that you released today make how many?
A: I believe we at a total of 14 case narratives on the chemical warfare agent investigations, two environmental exposure reports and four technical papers.
Q: Have any of these shown any link between the various undiagnosed illnesses reported by some Gulf War veterans and the activities in the Gulf?
A: Well, let me say to you that we've been trying to do three things. The first thing is identify the hazards on the battlefield. The case narratives have been the major vehicle and the environmental exposure reports, through which we've been doing that. VA doctors, DoD doctors, through the CCEP and the VA registries, have worked to compile a list of the illnesses that Gulf War veterans have. Those are two separate and distinct efforts. The bridge that we're trying to use to link them is the research effort which the Department and HHS and the VA are trying to do research in about 121 separate areas, the cost of $115 million dollars so far, to make the link you're talking about. So far, a specific link from a specific hazard to a particular illness today or symptom has not been identified. Yet, you know, it's very clear that if you breathed in these fumes during the oil well fires, people had difficulty breathing and they had shortness of breath. That's one of the continuing chronic symptoms that many Gulf War veterans complain of.
Q: Maybe I should follow that up. Let's try it this way. The level of hydrocarbons, emitted hydrocarbons, (inaudible) in Kuwait would be (inaudible) let's say somebody's driving down the freeway, an hour a day back and forth, stop and go traffic, quite a concentration of exhaust emissions there. Can you equate those two? Would it be more dangerous to drive our freeways or more dangerous to have been in that battlefield?
A: I used to arouse some of my audiences who came from New Jersey by saying that it probably was no worse than driving up 95 in the days -- in early days. But I have an environmental specialist with me, Bill Shaughnessy. Bill, would you care to tackle that one? And I apologize to anybody from New Jersey whom I might have offended.
(End of tape 1)
Mr. Shaughenessy: (Start of tape) and I think this gets to your point. I make a direct comparison between the VOC levels that were observed during the monitoring studies in Kuwait and levels that were seen on the New Jersey Turnpike. No, we didn't do that.
Q: You want the one that shows Philadelphia?
A: Yes, I do. Those, I think, probably better answer your question. Those compounds are VOCs, the benzenes, the ethylbenzenes, toluenes and so on. And you can see -- keep going.
Lt. Gen. Vesser: The one that had Houston, Phoenix, Philadelphia.
Mr. Shaughenessy: These are monthly averages taken during the same time frame that compare the levels of Kuwait and various cities in the United States. And these are VOCs here. In addition to VOCs, we had pHs, semi-volatiles, some of the criteria pollutants also were measured. There was probably 60 or 70 different contaminants that were measured during the period of those 20 organizations that Gen. Vesser referred to that were taken. And so we have a great deal of information on individual contaminants.
Q: It is an over statement or over simplification to say that in many ways, the risk would have been similar or greater breathing the air in, according to this chart, to Phoenix or Los Angeles as it was breathing the fumes from these oil fires?
A: We're not looking at risk here. We're looking at contaminant levels. Risk is something entirely differently.
Q: In theory, the exposure level -- if there is a risk, it's dictated by the exposure level. It wouldn't --
A: In the diagram of the chart we showed previously, those levels were below levels that the EPA would consider to be caution levels or action levels, if you will. The ranges for the carcinogenic compounds and also for the non-cancer causing agents. The levels that were determined or estimated risk levels were below those action levels as determined by EPA.
Q: Basically, then, driving on a freeway is being exposed to a higher level?
Lt. Gen. Vesser: Not all freeways, just on some.
Q: It seems to be one of the more credible hypotheses about Gulf War Syndrome people have made is that stress plus some environmental exposure of some kind does more than just the environmental exposure or the stress, that there is some kind of synergistic --
Mr. Shaughenessy: The synergistic effect.
Q: Did anything in your research look at that?
A: We did not look at synergistic effects. We looked at multiple pathways of exposure to humans, dermal interlation and ingestion. But we did not look at the synergistic.
Q: Do you buy that --
A: That is the direction that we can go into in the future as far as future investigations.
Q: A lot of people, when they look at things like sick buildings and whatever, in industrial exposure, that seems to be what they look at, the combination --
A: We're trying to focus on the causes that appear to be the most likely or have received the most attention as kind of a first run at this. The first tier investigations for environmental included depleted uranium, the oil well fires and pesticides. There will be others that will follow on. And in all likelihood, we may be looking at some of the synergistic effects down the road, but at this point in time, we have not.
Lt. Gen. Vesser: There's more to come on this issue. We have research that would indicate already that this may -- yeah. There's more research to come. We have indications already from some research that's been done and has been published, at least results have been reported in the press, that would indicate not with respect to these exposures, but with respect to some other things, stress may play a role. We have additional research under way and additional work yet to come on the subject you raised.
QLet me ask another big picture question. Which is, I asked you about whether you've been able to make a link yet. You said that that's what all this is about, this research is about. But is there to date any credible, valid, scientific research that establishes that service members who served in the Gulf are suffering these various ailments at higher rates than people in the general population or veterans who didn't serve in the Gulf or some valid comparison group? Have we established that, in fact, Gulf War veterans are sicker than those who didn't go?
A: I will let Dr. Kilpatrick, who is here with me, answer that one.
Dr. Kilpatrick: I think your question comes very close to the heart of what this is all about is defining sicker. Very clearly, we know that those who served in the Gulf War have a higher rate of reporting symptoms than those who did not. The comparison to the general population has not been done just because as a different cohorts and to try to get to that data is harder because it doesn't exist within DoD's reach. The British and the Canadians are seeing the same thing in their individuals who served in the Gulf as far as reporting symptoms at a higher rate than those who did not serve in the Gulf. But those are symptoms that you see in an outpatient setting. We take a look at being hospitalized, the rate of any other disease processes that end in death. There is no difference in those who served in the Gulf and those who didn't. So it's a stratification I think that's important to take a look at.
Q: The time line on the reporting of symptoms, in some schools of medicine, psychological effect that people get illnesses by hearing that other people have had it. Have the incidents, of reported incidents of symptoms, increased over time and is there any connection between the publicity over those?
A: We know that for both the VA registry and the CCEP registry for people voluntarily come in to have examinations done, that there has always been a bolus of people coming in after any major media announcement, Khamisiyah being one of the critical ones. I think those individuals also got letters that they were possible exposed to low levels of nerve agents and we saw an increase of people coming in there. The British say that their rate of people coming in to be seen is about six months' delayed from when the American press releases any announcement. I think that one of the issues that we need to understand also is that the symptoms that the individuals have are not the kind of symptoms that necessarily at onset, keep you from doing your job. And so that there's that delay in seeking health care that may not be related to the length of time the individual has the symptom. A mild headache for two or three days won't send you to the doctor, but a mild headache for a month may send you to a doctor. And so I think that those are some issues that we need to take a look at and make sure we're not leaning the other direction in saying because of the delay in reporting symptoms, there's no validity to the symptoms.
Q: Just to get back to my original question, I take it from what you said that at this point, you can't with any degree of certainty say the Gulf War veterans are, in fact, sicker than those who didn't serve in the Gulf.
A: We really don't have the data to be able to look at that. That is underway in the VA national survey where they have done a mail-out questionnaire to 15,000 who were in the Gulf and 15,000 who were not. They have done the second phase which is the telephone follow up with 2,000 in each group. And they are now initiating a thousand in each of those two groups to come in with their family members for fairly extensive physical examinations, which will also include pulmonary evaluation, which would relate back to the oil well fire issue. And I think that as that study is done, we'll have a much better idea. There are other studies going on, for example, in Iowa, where they are looking at Gulf War veterans and looking at measuring their health. They've done a questionnaire and now they're doing the physical examination part. So I think these studies are underway and they will certainly shed more light on this issue. And I think the hard issue is are people more ill, what is the measurement we used to figure that out.
Lt. Gen. Vesser: I would say that one thing that I would bring to your attention is our outreach program. We are concerned, of course, that not everyone who has symptoms is going to seek medical attention or examination, especially active duty personnel who may think that it is career threatening as they seek to finish a career in the military to go and get examination or treatment. We have completed some additional townhalls to active duty bases at both Camp Pendleton and Camp LeJeune. In addition, as part of our outreach program, we are carrying the word that we have a new outreach number that will let veterans get in touch with us and get help in getting their medical records. Do you have that number, Bob? I think that the outreach program is valuable in encouraging people and their chains of command to help individuals who need medical evaluation get it. Because our experience is that 80% of the illnesses we were talking about which physicians have identified can be treated once identified. And it's getting people with these symptoms, especially those doing -- on active duty in so that they can become again, fully productive members of the force.
Q: Thank you very much.
A: Good to be here with you today.