Dr. Rostker: Yesterday we delivered to the Deputy Secretary of Defense a report covering the first year of operations of my office which was from November 1996 through November of 1997. It was not a required report, but it seemed appropriate to take stock of where we were, what we were doing, what lessons we had learned, and where we were headed in the future.
The report covers a wide range of activities. I would highlight for you really the lessons learned for the future, which deal with developing and maintaining the credibility of the Department on issues like Gulf War illness, how to better account for what happened on the battlefield, and how to better protect our troops on the battlefield of the future.
I believe you've had an opportunity to see the report, and I'd be happy to answer any questions you might have.
Q: One of the things that struck me in reading over your analysis is that you were looking at the process and not so much pointing toward any conclusions whatsoever. I know that you feel that you're only a year into your process, but we are many years past the end of the war.
Can you help us with any conclusion-oriented comment as to where we are on the research?
A: I think in the beginning of the report I indicate that we are working very hard to answer the question of why so many of our veterans are sick, and we do not have an answer to that question. We have ruled out a great deal. Much more work remains to be done, but we do not have a specific answer to that question.
Even though the cause of Gulf War illness remains largely unexplained, the men and women who served in the Gulf want to and deserve to know what happened in the Gulf--were they exposed to anything that could have impacted on their health--and that is the unique responsibility of the Department of Defense to do that, and that has been our focus this last year and will continue to be the unique focus of my office.
You might think of last year as the year of the chemical incident. A great deal of work on Khamisiyah, on other chemical incidents reported in Kuwait, and we have certainly drawn conclusions about that.
Next year will be more focused on more general environmental problems, particularly the oil well fires, depleted uranium, and pesticides.
There is a complimentary program of medical research that goes into millions of dollars both here and at the VA, largely being carried out at universities throughout the United States, and they are looking at a whole range of potential causes with an emphasis, in last year's funded research, on the low level chemicals and the possibility of contamination from multiple sources. So we very much are working on what happened in the Gulf, and the medical community continues to work on the issues of what is the likelihood that illness would result from various exposures.
Q: You've lived, slept and breathed this now for a year. Do you feel with any great deal of confidence that you will ever be able to come up with an answer to what has caused this?
A: There are a lot of veterans out there. It was quite clear before we started, and our experience just reinforces this, that there is no Gulf War Syndrome, there is no single cause. The epidemiological patterns don't suggest that; the exposures don't suggest that. But there are, and we recognize veterans who are ill in ways we can't explain, and we have an obligation to, to the best of our ability, tell them what happened on the battlefield.
I've always stressed that it's not just for them, because if we can't explain what happened in the Gulf and we can't develop those lessons, then we're bound to relive them with future generations of soldiers. So the work we do on chemical exposures, on low level chem, on depleted uranium, on pesticides, on pyridostigmine bromide are very important to make sure that we get it right in the future. That may mean no change from what we're doing now, but that is not a foregone conclusion and that is why we are intensely looking at these issues.
Q: Do you have a better feel for how many veterans really are sick for reasons that you cannot explain? I know in your past reports you divvy it up, but you're always reluctant to give us a number because you say you don't know a number. How do we...
A: I have sort of a rough rule of thumb. We have somewhat over 100,000 veterans who have reported to the various health registries. Some ten percent of those report but don't even take their physicals. Some 80 percent of those who do take physicals end up with a diagnosis. So there is roughly 20 percent--that's a little higher in the VA population, a little lower in the active duty population--who have unexplained, in a sense, unexplained illnesses.
Q: Twenty percent of 100,000?
A: Twenty percent of about 80,000. And the VA carries a number of unexplained illnesses of about, if memory serves, something on the order of ten percent.
What I found interesting is when we visited the Czechs in Prague, they had done a report on their troops, intensely examining 155 out of about 200. About six of those had unexplained illnesses. If you do the math from 700,000 in the Gulf vice 200 in the Gulf, you'll come out with a number of about 20,000 -- not very unlike what we are seeing.
The vast majority of people who served in the Gulf are well, or if they are ill and have registered with us there is a known diagnosis. We're talking about a very small percentage, a few percentage points of those who served, and that's part of the difficulty in establishing a clear epidemiological pattern.
Q: Historically is that very few percentage points different than past wars, understanding that you don't have data that is nearly as precise?
A: We don't really have comparable sets of data to make that judgment.
Q: The report says by the end of next year you will have completed the investigations, chemical exposures, and can start to draw down your office. You mean you think by the end of this current year...
A: By next November, roughly, we should have completed and republished the chemical incidents. We will have completed the major environmental inquiries, and then I think we can start to draw down.
There is a very important residual function and it gets to the heart of the whole tone of this report, and that is working with the veterans and with our active duty service personnel who have concerns and we are the people who have to work with them in meeting their concerns. That's something that will continue in terms of an ongoing outreach program, ongoing program of keeping in contact with the veterans. But where we'll be able to draw down, I'm hopeful, is in the investigative services. That all depends upon how the analysis goes and whether there are further surprises that we can anticipate.
Q: I thought it was interesting you would make the point that after Agent Orange and POW/MIA, this was the third time that... Why do you think? Especially after Agent Orange, why was it so long before the military decided to take it seriously?
A: I think if you go back to the PAC [Presidential Advisory Committee on Gulf War Veterans' Illnesses] reports and to the medical side of this, a great deal was learned from Agent Orange and a great deal was put in place very quickly. The initial health registries were within months of the analysis. But the response we had was very much on the medical side, and where the controversy has occurred is in making an accounting for what went on in the battlefield.
One of the things I highlight in the report is a statement in what was a classified report. Now it's declassified and on GulfLINK, on Marine Corps NBC defense in Southwest Asia -- nuclear/biological/chemical. The author was a Captain David Manley, and he makes the point that many Marines thought they had encountered chemical agents. That his findings were, and I quote, "No indications that the Iraqis tactically employed agents against Marines." Then here's the important part. "However, there are too many stated encounters to categorically dismiss the presence of agents and chemical agent munitions in the Marine Corps sector." It's the "categorically dismiss" that we were into big time. The pieces didn't fit together. We didn't have all of the facts, but we were quite sure.
What we have been about this last year is the exact opposite of categorically dismissing. We have taken the major claims extremely seriously and we have investigated them. Those are covered, again, in this report in two sections. Instead of dealing with the individual case narratives I've summarized it in terms of Khamisiyah, and importantly, in terms of operations in Kuwait. Operations in Kuwait are probably the most controversial because we had a whole group of folks testifying before Congress that they thought they were exposed here or there or the others. We very systematically have traced the Marine operations from the breach through Al Jaber up through the Orchard. We've looked at other sites within Kuwait. We have become the true experts on what went on. Looking at all the information. Not just "I think I saw something," but all of the information.
While I wouldn't say never, our strong indication in the analysis is it is unlikely there were chemical releases in Kuwait with the exception for the Fisher case which is technically not in Kuwait, and the fallout obviously from Khamisiyah. But there are not just explanations, but a ring of the operations looking for collateral damage, taking into account the Fox vehicles and what we know about it, what we knew about a dirty battlefield now and the issues of contamination. We're very sure that there were no chemicals there. We don't have every piece of information in the locker, we don't have all of the tapes from the Fox vehicles, and that's why we've said it's unlikely. But the clear indications are that there were no other chemical releases in Kuwait.
Subject to continued analysis of cases, that we have not done. That's an important part of not making categorical dismissals.
Q: You said there's no cause that you've found yet. You said you can rule out some things. List the things you can rule out now.
A: I think in terms of the wide exposure, there are people who are ill who at this point we do not believe were exposed to any chemicals, even at low levels. There are people who are ill who were exposed, but there are many, many more people who from Khamisiyah were exposed and are not ill. So we continue to press forward on the low level chem. It's an important area to understand, but right now we see no correlation between patterns of illness and the exposures from Khamisiyah, and we don't see other exposures for any other epidemiological work. That would be a major issue.
We still have to go with things like pyridostigmine bromide, DU, pesticides. That's what's coming up this year.
Q: Have you found any correlation between where these 20 percent of 80,000 were deployed?
A: The definitive work... The docs will tell you that the CCEP and the VA registries are not adequate research tools, they're self-selected, they have all of the problems that one has from those databases to generalize. The VA is engaged in a much more scientifically developed, large-scale survey, and we'll have better answers when that work is completed.
Q: But right now, it seems to be a random factor.
A: You'll remember in the case of Khamisiyah, we had the responses from the 20,000 people who were within 50 kilometers of Khamisiyah, and there were no correlations to those under the plume or not under the plume.
Q: But all the 20 percent were deployed in the Gulf.
A: We're talking about people who were deployed, yes.
Q: You mentioned the Czechs before. What other countries are you working with, and do those countries have the same percentage of problems with their veterans?
A: We have in the last six months visited the Czech Republic, France, England, Kuwait, Saudi Arabia, Egypt, Israel. The Brits have a problem. It parallels us and we do a lot of work with them. In fact there will be a case narrative that will come out on the Girls' School Case -- that may have meaning to you. It will be a joint product between ourselves and the Ministry of Defense in Britain.
The French I believe have been cooperative. They do not have the problem. They are very eager to understand why we have the problem, because as they have said to us, "There but for the grace of God go we." But they have not reported the problem.
Q: Did their troops take pyridostigmine bromide?
A: Yes, they did. There had been discussions that they had not. We were able to confirm, in fact, when they... They didn't get an order to take it, but when they went to collect it they clearly had troops that had taken it, and one of the senior colonels that we dealt with in France said, "Oh, PB. Very good. I took it every day." (Laughter) So, there was firsthand support.
The Kuwaitis' report concerns for oil well fires, particularly fallout in asthma, and our research in the Rand paper that we will produce, will be published in the near term, will also support the notion that there were particulates registered that would indicate intensified asthma and breathing problems. That's what the Kuwaitis reported to us.
We had an excellent visit with the Saudis and they had an invitation for us to go back and do some health records screening with their indigenous population. We were interested in whether they had seen any changes in health status since the war. The head of the medical services for the Saudi National Guard has offered to allow us to come back and we're in the process of putting that together.
The Egyptians had a contingency and reported no illness. We had a full review with them. So it is somewhat spotty.
Press: Thank you.