NOTE: UNEDITED DOCUMENT

PRESIDENTIAL ADVISORY COMMITTEE

ON GULF WAR VETERANS' ILLNESSES

+ + +

MEETING

+ + +

WEDNESDAY, NOVEMBER 13, 1996

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The Advisory Committee met in the

Ballroom

ANA Hotel

2401 M Street, N.W.

Washington, D.C.

at 9:00 a.m.,

Dr. Joyce C. Lashof, Committee

Chair, presiding.

PRESENT:

JOYCE C. LASHOF, M.D., Chair

JOHN BALDESCHWIELER, Ph.D.

ARTHUR L. CAPLAN, Ph.D.

MAJOR THOMAS P. CROSS

ADMIRAL DONALD CUSTIS, M.D. (Ret.)

DAVID M. HAMBURG, M.D.

MAJOR MARGUERITE KNOX, R.N.C., M.N.,

C.C.R.N.

PHILIP J. LANDRIGAN, M.D.

ELAINE L. LARSON, R.N., Ph.D.

ROLANDO RIOS

ANDREA KIDD TAYLOR, Dr.P.H.

ALSO PRESENT:

THE HONORABLE JOHN P. WHITE, Deputy Secretary,

Department of Defense

THE HONORABLE STEPHEN C. JOSEPH, Assistant

Secretary for Health Affairs, Department of

Defense

NORA SLATKIN, Executive Director, Central

Intelligence Agency

SYLVIA COPELAND

KELLEY BRIX

MARK BROWN

KOSEPH CASSELLS

CLIFFORD GABRIEL

HOLLY GWIN

KATHI HANNA

MICHAEL KOWALOK

JOHN LONGBRAKE

THOMAS MCDANIELS

ROBYN NISHIMI

JOAN PORTER

JAMES TURNER

C O N T E N T S

PAGE

Public Comment:

Dru Dosher 5

Dr. Thomas Tiedt 14

Major Matthew Wagner 24

Arguelio Martinez 30

Jeffrey Tack 37

Update on Activities Related to Chemical

and Biological Weapons

Nora Slatkin 47

John P. White 96

Discussion of Draft Report:

Introduction 159

Chapter 2 159

Chapter 3 240

Chapter 4 252

Executive Summary 283

Discussion of Recommendation for an Oversight

Body 287

Closing Remarks by Committee Members 292

1 P R O C E E D I N G S

2 (9:04 a.m.)

3 CHAIR LASHOF: Good morning, everyone.

4 Before we start the formal agenda, I just

5 want to make a brief statement. Many of you are aware

6 and I think many of you are here because an earlier

7 version of the Committee's final draft report was

8 leaked to people outside the review process, and I

9 want to express my displeasure and that of the other

10 Committee members that this has occurred.

11 This Committee was established at the

12 direction of the President. We have an obligation to

13 deliver the final report to him. To that end, the

14 Committee will deliver our product to him before the

15 end of December, as charged.

16 We will not compromise the integrity of

17 this process by distributing a current draft or any

18 future iterations in draft format. The final

19 published report will be fully available.

20 And with that as a general statement, let

21 me begin the meeting. First we will begin with the

22 public comment, as has been our method in all of our

23 meetings. We begin with public comment, and the first

24 commenter will be Mr. Dru Dosher -- oh, Ms. Dru

25 Dosher. Sorry.

1 We would appreciate it if you would keep

2 your comments to about five minutes.

3 MS. DOSHER: Yes, ma'am.

4 CHAIR LASHOF: And we'll have five minutes

5 for the Committee to ask questions.

6 MS. DOSHER: That's very hard for a woman,

7 but I would like to ask you all to please question me

8 thoroughly after this presentation because there's so

9 much more that should be in here that five minutes

10 didn't allow.

11 My name is Dru Dosher, and I'm a

12 thoroughbred horse breeder who resides in Marion

13 County, Florida. I'm a recognized civic and

14 charitable activist in my community.

15 It was at the latter capacity that I

16 encountered the Gulf War illness. The local newspaper

17 conducts a holiday program known as the "Community

18 with a Heart." I was awarded funds to purchase Army

19 surplus duffle bags to be used in a foster children's

20 program.

21 After trying for several months to

22 coordinate the purchases with a foster parent, I found

23 it necessary to make the trip alone if the project was

24 to proceed.

25 A letter from the General Services Manager

1 of the HRS, Florida Division, was issued to the

2 Federal Surplus Warehouse, and the purchases were

3 made, 10/23/95 I purchased 20 items, 19 duffle bags

4 and one poncho.

5 In the months prior to the trip I had

6 called to see if the items I wished to purchase were

7 stocked and was told my choices would be limited

8 because when servicemen knew they were coming to

9 surplus, they sometimes put their bayonets through

10 them in order to render them useless.

11 At that time, the action enraged me, but

12 then I came to see some logic. I now believe that the

13 vets did not wish possible contamination from whatever

14 source to pass on to any recipients of these goods.

15 What followed was a bizarre series of

16 events. I placed the purchases still in the large box

17 that contained them on my covered veranda next to

18 where my dog slept. The bags had a horrible smell and

19 had to be washed before the children's name and

20 guardian angel could be written in gold on the bag and

21 dispersed to the needy children.

22 The duties of my farm prevented me from

23 preparing the gifts, and the upcoming Presidency III

24 straw ballot was looming in my future November 16, 17,

25 and 18. I attended as a press credentialed, free

1 lance journalist.

2 Upon my return, the severe throat I had

3 been experiencing worsened, and the caretaker of the

4 farm said the dogs had backed off from eating. Their

5 skin was blackened under their golden coats, and they

6 were losing their hair. One young cat ran a 106.7

7 fever, and the vet said he had never seen anything

8 alive with a fever of that magnitude.

9 The coming months saw the animals

10 undergoing prednisone shots monthly, then twice

11 monthly with no response. Fevers remained, and the

12 hair loss was dramatic. Small blisters appeared on

13 their coat.

14 May 30th, my Theodore died when he bled to

15 death during the night. He was to be followed by --

16 he was to be followed by my Mr. Shady, who likewise

17 bled to death. The surviving dog, Uriah, has several

18 tumors, but he's still hanging in there. Mr. Shady

19 was a cat who was groomed by his devoted pal,

20 Theodore, daily and could be considered the carrier.

21 A fox terrier who was kennelled was never affected.

22 As for me, I received treatment in

23 December with medications I was later to find out

24 worsened my condition. For the next several months

25 specialists endeavored to treat my symptoms and were

1 unsuccessful.

2 I had the full range of systems listed on

3 the biomedical research letter from the M.D. Andersen

4 Cancer Center. After the medical directors who were

5 treating me saw no improvement, I was finally given a

6 referral to an infectious disease specialist under

7 whose care I remain.

8 I have been receiving 200 milligrams of

9 doxycycline for four months and am responding well.

10 Dr. Garth Nicholson recently expressed this opinion to

11 me. Having a doctor who investigates and treats the

12 disease is 50 percent of your battle won, which brings

13 me to the reason behind my appearance before this

14 Committee.

15 The cost of one month's supply of

16 doxycycline is $14.99, affordable by U.S. government

17 under any programs. Unchecked, this illness that by

18 medical professionals nationwide have said is

19 communicable could devastate in the near future

20 Medicare and Medicaid with the illnesses that it

21 produces.

22 I'm sure the Committee in prior hearing

23 has heard from sources that have told of the disease

24 spreading within families. I went from being

25 described as the indefatigable Dru Dosher to one that

1 could not find the strength to fasten a horse's halter

2 or give a rider a leg up. After doing errands in

3 town, I barely had the strength to drive the 12 miles

4 to the farm.

5 The illness changed my life, and it made

6 me aware of the men and women who served this country

7 when ordered to Saudi Arabia were made to endure. Who

8 developed it, who sold it to a profit to be used

9 against the citizens of this great country cannot and

10 must not be buried under rhetoric.

11 You, the Committee, treatment by medical

12 professionals must be encouraged, and the sale or

13 disposition of Gulf War equipment must be stopped. In

14 a recent interview with Billy Graham a writer asked

15 did he have any concerns about the future, and he said

16 biological warfare, and I say: behold the pale horse

17 whose rider is death. If this -- and I said horseman-

18 like -- the hoofbeats are resounding louder every day

19 this microplasma infection is left unchecked.

20 In closing I wish to thank my Florida

21 Thoroughbred Fillies, of which I am a proud member,

22 for making this trip possible to address the Committee

23 in the battle for the survival that's being waged.

24 You can either win it with your help or lose it with

25 help withheld.

1 Thank you.

2 CHAIR LASHOF: Thank you very much.

3 Are there questions that anyone has?

4 Do you want to remain at the podium for a

5 minute and see if there are any questions?

6 Elaine.

7 DR. LARSON: Ms. Dosher, I'm sorry for

8 your losses. Just for some clarification for us so

9 that we can be thorough on this, the bags and the

10 poncho that you got, do you know where they came from?

11 Did they come from the Gulf War?

12 MS. DOSHER: No. I tried checking in

13 Tallahassee. No one knows that, but let me impart

14 this to you. Two years ago, three years this spring,

15 we had what was known as the storm of the century.

16 There were tornadoes rampant in Marion County, and

17 they devastated communities in the Ocala National

18 Forest. In my capacity of being on the local Food

19 Bank Board, which we had just assembled, I carried

20 food out there to those people, and we had five days

21 of rain, and there was no place to prepare it, store

22 it, or anything else.

23 So I got the National Guard to bring out

24 tents and strike them, and I got a call from this lady

25 that said, "Ms. Dosher, thank you so much for it, but

1 we're still getting wet."

2 And I said, "What do you mean you're

3 getting wet?" These were tents to hold the tables for

4 the food service.

5 And she said, "Well, all the holes in the

6 tent."

7 So enraged, I called the National Guard

8 and said, "What did you send me tents out there with

9 holes in them for?"

10 And the man said, "Ma'am, I'm sorry. They

11 came from the Gulf War and some of those are shell

12 holes," and all I can worry about is that there was a

13 possible contamination out there. And we've had

14 deaths in Marion County from people that used camping

15 equipment and things like that that, quote, by Shan's

16 Hospital, University of Florida, unknown causes, one

17 a ten year old child, and that's why I think that this

18 surplus -- I was also -- can you believe it? -- going

19 to travel to Jacksonville at the naval base to finish

20 my purchases and also travel to Tallahassee because I

21 did not acquire that many.

22 But let me tell you something. I plan on

23 hitting every committee in the Capitol. I want 300

24 new bags for my program. I think I went through

25 enough with the surplus.

1 DR. LARSON: Okay. So the bags were used,

2 but you're not sure where they came from?

3 MS. DOSHER: Yes, not sure when.

4 DR. LARSON: Okay.

5 MS. DOSHER: But the fact that they were

6 stored for almost a month, and then when I began

7 washing them in January is when I got so very, very

8 ill. I literally couldn't stand. I did three at a

9 time in boiling hot water, Lestoil, soap powder, and

10 bleach, and then tried them in my dryer.

11 And of course, when I was later to find

12 out in the spring that the Gulf Veterans Association

13 says the first order is touch not anything that came

14 from the Gulf War because of children putting Daddy's

15 uniform on to parade when he came home and having come

16 down with the illness.

17 And I just can't begin to tell you how

18 marvelously I have responded in the four months of

19 doxycycline.

20 DR. LARSON: And then just let me ask you:

21 when you were treated at M.D. Andersen, what was --

22 MS. DOSHER: No, I wasn't treated at M.D.

23 Andersen.

24 DR. LARSON: Oh, I'm sorry.

25 MS. DOSHER: No, that's just -- I'm under

1 the care -- well, Dr. Nicholson is in contact with me,

2 but I'm under the care of an infectious disease

3 specialist in Marion County, Florida.

4 DR. LARSON: Okay, and what is your

5 diagnosis? Did you have some cultures taken for an

6 infectious --

7 MS. DOSHER: No, nobody has a blood test

8 to take this. They did blood work by the pages,

9 pages, and pages, but because it is a gene inhibitor,

10 there's no test here, and they were only testing

11 veterans in California at the time. Well, it wasn't

12 Andersen, but Dr. Nicholson is in Irvine, California,

13 now, and the Blood Bank just looks at you.

14 And, by the way, I asked for a CEA test,

15 which tells if there's any cancer or tumors, and my

16 Medicare didn't want to pay for it.

17 DR. LARSON: So just for clarification,

18 normally when you go to and are under the care of an

19 infectious disease physician, the first thing that she

20 or he does is to take some cultures. So --

21 MS. DOSHER: Yes. I was tested for

22 everything from Lyme disease.

23 DR. LARSON: Okay. You did have --

24 MS. DOSHER: Two laboratories, to make

25 sure to eliminate -- yes, to eliminate everything

1 else, and as I said, just a simple drug, 14.99 for 30

2 days' supply that would bring me from what I felt was

3 death's door. Unfortunately what I originally

4 received exacerbated my illness because they were

5 penicillins, and I kept getting worse instead of

6 getting better, and until I was on the right

7 program -- and I think you can see I'm a pretty lively

8 69 year old. So I have recovered sufficiently to be

9 able to handle my duties and things of that nature.

10 DR. LARSON: Okay. Thank you.

11 MS. DOSHER: And I'm sorry if I get

12 emotional about my animals, but it was devastating.

13 DR. LARSON: I understand.

14 MS. DOSHER: Especially watching their

15 death, the bleeding.

16 And I also had problems with that, but

17 very small. I said if I had an orifice I was losing

18 blood until -- but I also will tell you that I'm a

19 great prayer, and I think that's what got me through

20 till I got the specialist care.

21 Thank you.

22 CHAIR LASHOF: Thank you very much.

23 Dr. Thomas Tiedt.

24 DR. TIEDT: I apologize for having such a

25 difficult name. You did pronounce it correctly.

1 CHAIR LASHOF: Thank you.

2 DR. TIEDT: Thank you very much for this

3 opportunity to address the Committee.

4 A neuroscientist for 22 years, I'm

5 observing many statements being made in contradiction

6 to extensive scientific and clinical evidence. I urge

7 looking at Gulf War Syndrome from two directions.

8 First, list the pathophysiologies that

9 could cause each symptom. I believe you will find

10 Cholinergic Syndrome a common thread.

11 Second, compare the list of symptoms with

12 the list of side effects from any cholinesterase

13 inhibitor. I believe you will find a match.

14 All acetyl cholinesterase inhibitors cause

15 stunning, nerve and muscle degeneration within 30

16 minutes of just a single dose. Much is known about

17 this toxicity, including the subcellular mechanisms.

18 Analogous to the term "autoimmune," I use

19 the term "autopathology" to describe the harmful

20 consequences of too much neurotransmitter.

21 One look at the electron micrographs will

22 shock anyone. That not all the damage could be

23 reversible is obvious.

24 My team's research back in the '70s

25 appears to have inspired my university colleagues in

1 the Pentagon laboratories to explore PB, in

2 particular, pyridostigmine, in depth. These

3 laboratories published many detailed and highly

4 relevant studies prior to the Gulf War.

5 By 1984, the Pentagon knew PB was not a

6 protectant against sarin, eliminating any validity for

7 its uncontrolled and unmonitored use on 500,000

8 soldiers, representing the world's largest clinical

9 trial. There was no possible benefit to balance the

10 certain and substantial risk.

11 Seemingly contradictory, various

12 epidemiological studies have failed to reveal the

13 existence of Gulf War Syndrome. However, entry

14 criteria and causal assumptions are key to the

15 results, and apparent lack of epidemiological support

16 does not rule out an actual event.

17 Many vets were excluded from these

18 studies. The controls were not evaluated for

19 cholinergic drugs. The quality of data, I'm sure we

20 all know by now, about the Gulf War vets is poor at

21 best.

22 Also, it is incomplete to compare a group

23 of the healthiest and most resilient to the general

24 population or to an elderly population. Nevertheless,

25 one series of epidemiological studies called CCEP

1 shows a higher incidence of several disorders in Gulf

2 War vets. Presumably these results are the reason the

3 Pentagon abandoned its five-year denial of Gulf War

4 Syndrome last April. Now the Pentagon says only 20

5 percent of the cases are psychological.

6 The CDC has reported a higher incidence of

7 13 chronic symptoms among Gulf War vets. The

8 Institute of Medicine concluded at least a few CCEP

9 patients have developed illnesses that are directly

10 related to their Persian Gulf service.

11 The following research findings must be

12 considered, almost all of which was missed even in

13 last month's release of what looks to be a very

14 exhaustive review of Gulf War Syndrome from the IOM.

15 The collective message of hundreds of

16 relevant and unrefuted studies about nerve and muscle

17 toxicity.

18 Two, weeks after cessation of one week of

19 low dose PB treatment, behavioral changes not apparent

20 during treatment were revealed. This study will be

21 reported in just a few days here in Washington, D.C.,

22 at the annual Society for Neuroscience meetings.

23 A 1996 report showed that Gulf War

24 veterans displayed various objective signs of

25 neurotoxicity several years after the Gulf War. The

1 authors postulated a role for the well known PB

2 toxicity on nerves and muscles.

3 Half of the 500,000 soldiers taking PB

4 reported acute toxicity, that is, cholinergic crisis.

5 In view of the high dose and frequency of use, surely

6 even more soldiers actually experienced cholinergic

7 side effects. Just a five percent incidence of

8 chronic effect would explain thousands of cases of

9 Gulf War Syndrome.

10 Acetyl cholinesterase inhibition and the

11 neurotoxicity induced by PB, sarin, and DEET are

12 synergistic. This synergism can unmask unobservable

13 effects of these agents given alone.

14 PB does not protect against nerve gas. In

15 fact, PB pre-treatment worsens nerve gas toxicity.

16 Administering PB after nerve gas exposure is uniformly

17 contraindicated.

18 At sublethal dosage, PB is more toxic than

19 sarin, shown by the Pentagon research during the '80s.

20 A 1993 clinical report using electromyography

21 concluded PB toxicity was typical of acetyl

22 cholinesterase inhibitor toxicity.

23 PB also induces growth in hormone release,

24 cardiomyopathy, mitochondrial damage, developmental

25 toxicity, decreased ability to work in the heat,

1 increased plasma CPK, Parkinsonism, and permanent

2 effects on sexual differentiation, and brain

3 norpinepherine levels.

4 Increase of acetyl choline levels in the

5 brain as a role in schizophrenia and psychosis.

6 Furthermore, schizophrenics are more sensitive to PB's

7 effects to increase growth hormone release.

8 Cases of congenital myasthenia have been

9 associated with acetyl cholinesterase deficiency,

10 placental transfer of PB, and lengthening of acetyl

11 choline receptor ion channel open time.

12 Concluded in many studies is that acetyl

13 cholinesterase inhibitor therapy has counterproductive

14 consequences in myasthenia gravis. The difference in

15 susceptibility to acetyl cholinesterase inhibitors

16 between normal individuals and myasthenia gravis

17 patients should not be overlooked. What is relatively

18 acceptable in myasthenia patients is very different

19 from what anyone would anticipate in healthy

20 individuals, especially when they are under stress, an

21 added risk factor for Cholinergic Syndrome.

22 The large body of evidence documenting

23 short and long-term effects of cholinergic crisis

24 forms part of a larger research field called

25 "excitotoxicity." Many and diverse studies implicate

1 excotitoxins in neurodegenerative diseases.

2 Recent reports show that excitotoxicity

3 causes DNA damage. Incidentally, enough excitotoxic

4 destruction of central cholinergic synapses would lead

5 to Alzheimer or ALS-type symptoms, memory loss and

6 confusion. Enough chronic cell damage might

7 predispose to autoimmune problems.

8 We need to be careful about tinkering with

9 neurotransmitters.

10 Deletions of mitochondrial DNA are

11 associated with myopathy. Organophosphates are well

12 known for producing nerve degeneration. This effect

13 does not involve acetyl cholinesterase inhibitor

14 toxicity, has a delayed onset following a single

15 exposure, and has been responsible for devastating

16 epidemics of neurotoxic injury.

17 A 1993 report showed extensive nerve and

18 muscle toxicity without symptoms of acute toxicity

19 from an organophosphate. These clinical findings were

20 attributed to the well known toxic effects of acetyl

21 cholinesterase inhibitors.

22 In summary, it appears compelling that

23 there is a strong correlation of Gulf War Syndrome

24 with Cholinergic Syndrome or cholinergic crisis and

25 organophosphate induced toxicity. There can be no

1 doubt that acetyl cholinesterase inhibitors played at

2 least some role and caused at least some toxicity to

3 our troops.

4 Unfortunately, Gulf War Syndrome is not an

5 easy disease. It's probably a multi-faceted disease

6 with multiple causes, but other diseases do not get so

7 mistreated for not having a single cause. Other

8 causal factors should be evaluated, although I know of

9 no other explanation with as much relevant and

10 mainstream data or that can explain as many cases.

11 Thank you very much.

12 CHAIR LASHOF: Thank you.

13 Are there questions for Dr. Tiedt from the

14 Committee?

15 (No response.)

16 CHAIR LASHOF: I would like to request --

17 you state in your testimony -- refer to a number of

18 studies and give the date of the study. Could you

19 please supply the Committee with the references to

20 where those studies are published?

21 DR. TIEDT: Sure. On a number of

22 occasions I have supplied to the Committee a

23 bibliography of these studies, particularly January

24 17th in response to a White House call to my home.

25 CHAIR LASHOF: Okay.

1 DR. TIEDT: Added studies have occurred

2 since that time, and I will be very glad to do that.

3 CHAIR LASHOF: Okay. Thank you.

4 MAJOR CROSS: Doctor, can you explain a

5 little bit about your background and why you have an

6 interest in this?

7 DR. TIEDT: I have an interest because I

8 published what unfortunately might be the most

9 definitive study on acetyl cholinesterase inhibitor

10 toxicity back in the '70s. Frankly, I was watching

11 television in May of 1994, and I was shocked off my

12 couch when I watched almost analogous to the cigarette

13 CEOs, when the Pentagon, FDA, and NIH stood up and

14 raised their right hand and actually said to the

15 public and to Senator Rockefeller's committee that PB

16 has no known toxicity.

17 Well, hundreds of millions of dollars have

18 been spent on that. And for government officials to

19 get up and say it doesn't exist and just take, you

20 know, that magic slate that kids use I think is very,

21 very improper, and so I've been involved every since.

22 Someone has to speak out about the

23 science. It is improper, you know, that the American

24 public has spent about $1 billion on relevant

25 research, and even the Institute of Medicine's report

1 last month, which is, I think, a very exhaustive

2 document, it doesn't even scratch the surface.

3 None of the studies I outlined for you

4 today, which represent hundreds of studies, were in

5 that report in the bibliography. If we don't use the

6 research that we do, why do we do it? You know,

7 eventually the public is going to stop funding this

8 gravy train for scientists. We must stop that.

9 CHAIR LASHOF: Where are you based now?

10 What is your research activity at this time?

11 DR. TIEDT: I'm not involved directly in

12 research. I left academic research in 1978. I then

13 went to the pharmaceutical industry, which gives me

14 some insight to the records that probably exist about

15 all of these chemicals in the actual drug companies,

16 and these days I'm working on writing a book about

17 things like this, actually about a larger subject

18 called "white collar crime."

19 CHAIR LASHOF: I see. Okay. Thank you

20 very much. We appreciate it.

21 Any other questions?

22 (No response.)

23 CHAIR LASHOF: Thank you.

24 DR. TIEDT: Thank you.

25 CHAIR LASHOF: Arguelio Martinez.

1 Arguelio Martinez is not here.

2 We'll go to Jeffrey. Jeffrey Tack,

3 Jeffrey Tack here?

4 (No response.)

5 CHAIR LASHOF: Okay. We'll try again. We

6 did receive a call that he'd be here at 9:30. It's

7 9:28.

8 Matthew Wagner.

9 MAJOR WAGNER: Ladies and gentlemen of the

10 Presidential Advisory Committee and staff, veterans,

11 and fellow Service members, my name is Matthew Wagner.

12 I am a Major in the Marine Corps Reserve, currently on

13 active duty.

14 I am here today not in an official

15 capacity, but representing myself and my fellow

16 veterans. In the interest of time I will read my pre-

17 written statement without additional comment.

18 The information presented in recent news

19 reports has dealt mainly with the exposure of Army

20 personnel to chemical weapons in Southern Iraq. I am

21 grateful that this information has been found,

22 released to the public, and personnel notified.

23 However, I believe it is my duty to draw

24 attention to the many Gulf War veterans experiencing

25 numerous medical problems of unknown origin. They

1 served all over the Persian Gulf, Iraq, Kuwait, Saudi

2 Arabia, the northern waters of the Gulf, and other

3 areas.

4 I was trained as a helicopter pilot,

5 flying for over eight years and close to 1,000 hours

6 before receiving orders to Washington, D.C. I was in

7 Saudi Arabia from August 20th, 1990, to March 17th,

8 1991, and while there I worked on the Aircraft Group

9 staff and at the squadron level. I flew helicopters

10 in theater and received an air medal, along with most

11 of the other squadron pilots.

12 I have recently been diagnosed with a

13 sleeping disorder and been found unfit for duty.

14 After almost 14 years of active duty, I will be unable

15 to continue serving in the Marine Corps, active or

16 reserve. It is possible an occasional symptom related

17 to this disorder may have been observed by my wife

18 prior to the Gulf, but over the last three to five

19 years those around me have noticed related symptoms at

20 an ever increasing rate.

21 This resulted in my finally questioning

22 the military medical doctors about it. I'm sure you

23 know the stereotype of the man who won't ask for

24 directions or go to the doctor.

25 After numerous tests, even being repeated

1 at my request, the diagnosis was clear. I had been

2 diagnosed with idiopathic hypersomnia, a disease

3 related to narcolepsy. This disease is normally

4 discovered in the late teens and 20s. I am 40 years

5 old.

6 The first word of the diagnosis is

7 idiopathic, which means of unknown cause or origin.

8 How many times have we heard that lately?

9 I am now on prescribed medication, which

10 I will have to continue for the rest of my life. I

11 will never fly aircraft again in the military or as a

12 civilian. There are numerous other consequences to

13 this disease, as well, that will greatly affect future

14 employment.

15 However, I am here today not just for

16 myself, but for all the Marines, sailors, soldiers,

17 airmen, and civilians that are medically affected by

18 their service to our country in the Gulf. Over the

19 last couple of years I have met and observed fellow

20 Marines and other Gulf War veterans with numerous

21 medical problems. These people were in multiple areas

22 of the Gulf performing widely different functions.

23 Their medical problems have included respiratory and

24 gastrointestinal problems, blotches of hair loss, body

25 temperature irregularities, problems with walking,

1 infertility, Lou Gehrig's disease, sleeping disorders,

2 memory loss, fatigue, and overall regressive health.

3 This is not an exhaustive list. In much

4 of the Gulf War Syndrome research, many of these

5 symptoms seem to be related to brain and central

6 nervous system irregularities.

7 I am grateful for the effort the Services

8 are putting forth into the review of health related

9 information from the Gulf. Yet in addition to any

10 findings that have or will result, I add an

11 observation.

12 It is well known that the Iraqis possessed

13 chemical weapons even at the smaller unit level. This

14 means that chemical weapons were all over the

15 battlefield, both in Iraq and Kuwait. We bombed the

16 battlefield for over 40 days during the air and ground

17 wars. Chemical weapons must have been blown up during

18 this period. This in and of itself would have

19 resulted in contamination of much, if not all, of the

20 battlefield and surrounding areas on numerous

21 occasions.

22 I am aware of some of the research that

23 has been presented to this Committee, especially

24 through its initial report. I am encouraged by this

25 first phase of medical studies. Nevertheless, I

1 believe it is essential that more emphasis be put on

2 the study of low level exposures and the varying

3 symptoms and diseases that can be provoked by such.

4 This includes not only chemical weapons,

5 but regular spraying of tent camps where people lived

6 and worked with pesticide sprays like malathion;

7 prolonged exposure to oil well fire, smoke, and

8 residue; numerous vaccines; anti-chemical exposure

9 pills; and other environmental factors.

10 The syndrome research to date has been

11 aggressive, but due to the short duration and newness

12 of the research into low level exposure specifically,

13 much more needs to be done. It is essential that the

14 Presidential Advisory Committee on Gulf War Veterans'

15 Illnesses and its support staff continue to monitor,

16 control, and oversee the research efforts.

17 I believe creating a new committee or

18 panel would significantly delay the research. This

19 Committee has over a year of corporate knowledge and

20 an already in-place work system and staff, but either

21 way, it is necessary for an independent panel to

22 maintain this Committee's functions.

23 I call on the President to continue this

24 Committee or its equivalent and on the Congress to

25 support the efforts to find the true causes of these

1 illnesses. It is imperative that this be done for all

2 of the suffering veterans, and it is morally necessary

3 so that we can prevent these maladies from continuing

4 to Service members in the future.

5 And I add this warning. Let us not be too

6 quick to label, categorize, or put these diseases,

7 symptoms, and possible causes into a neat, diagnostic

8 box and close the lid on them. If we do this, we may

9 never know the complete answer to this Gulf War

10 Syndrome. It is imperative that this be done for our

11 veterans and their families who have voluntarily and

12 faithfully served our country.

13 Thank you for your time and attention.

14 Semper fideles.

15 CHAIR LASHOF: Thank you very much, Mr.

16 Wagner.

17 Are there any questions the Committee has?

18 Marguerite.

19 MAJOR KNOX: Yes. I'm interested in

20 knowing what you know about chemicals that were

21 located in both Iraq and Kuwait. You mentioned that

22 in your testimony. Can you speak to that issue?

23 MAJOR WAGNER: I don't have any specific

24 knowledge of any documentation or anything specific to

25 that, but have heard on numerous occasions, and I

1 believe, if I remember correctly, in our training

2 prior to going over and in the initial stages of

3 waiting for the kickoff of the war, so to speak, that

4 we were told these things in our briefings and

5 training prior.

6 MAJOR KNOX: Okay. Did you keep a diary

7 while you were there? Do you have any record of that?

8 MAJOR WAGNER: I don't know specifically

9 if I would have that record. I did write some letters

10 and, you know, that type of thing on a regular basis.

11 MAJOR KNOX: Thank you.

12 CHAIR LASHOF: Any further questions?

13 (No response.)

14 CHAIR LASHOF: If not, thank you again.

15 MAJOR WAGNER: Thank you.

16 CHAIR LASHOF: Has Mr. Arguelio Martinez

17 arrived? Good. Please come forward.

18 MR. MARTINEZ: Good morning. I thank you

19 for the opportunity to talk to the Committee.

20 My name is Arguelio Martinez. I'm staff

21 sergeant with the National Guard from Pennsylvania.

22 I was deployed to serve in the Persian

23 Gulf under Operation Desert Shield and Desert Storm

24 later on from January to May of 1991, and while in the

25 Gulf, I became sick, bleeding through the nose and

1 coughing up blood and fevers and skin rashes.

2 Upon my return, I was discharged from the

3 active duty and went back to the National Guard. I

4 worked as a civilian for the National Guard since

5 1983, and upon my return I've been hospitalized about

6 15 to 20 times since my return. My spleen has been

7 removed, developed sleeping disorders, blood

8 conditions of unknown etiology, nonspecific hepatitis,

9 skin rashes, fevers of unknown origin.

10 Back in 1993, the VA declared me unfit to

11 work. So I could not return to work with the National

12 Guard. They placed me on leave without pay.

13 In 1995, the National Guard conducted an

14 investigation, and they determined that all my medical

15 conditions were related to my service in the Gulf.

16 They began to pay incapacitation pay, which is very

17 unreliable, sporadic. Sometimes it goes six months

18 without paying.

19 I've been to the Gulf War Research Center

20 in Washington, D.C., to Walter Reed a couple of times.

21 My experience with going to the Research

22 Center at D.C. VA, see, I was supposed to go there for

23 heavy metals testing, which they canceled. They did

24 more of the same, and the discharge diagnosis was

25 Persian Gulf Syndrome, but not related to my service,

1 non-service connected.

2 My last three discharge summaries from VAs

3 have been Persian Gulf Syndrome, not related to the

4 Service. I'm still in the National Guard. National

5 Guard refuses to discharge me. I've been on

6 incapacitation pay for almost four years now. I do

7 not earn any retirement points or anything, and again

8 it's sporadic at best, the pay.

9 My experience with going to Walter Reed

10 through the Persian Gulf Illness Center and then to

11 the Department of Defense Comprehensive Evaluation

12 program, it was frustrating. My welcome there by the

13 doctor was, "We don't think that there is anything

14 wrong with you guys. We didn't have any chemical

15 attacks. We used anti-nerve agent pills all the time,

16 and people don't get sick because of that."

17 And I was there for about a month, and

18 then after about 20 days, they send me home. And then

19 they have me driving from Pennsylvania to Walter Reed

20 a couple of times a week, sometimes to find out that

21 the appointments have been canceled or that they've

22 been postponed or rescheduled.

23 So I became tired of it. I was not being

24 paid per diem. So I called the clinic and told them

25 that I felt that their program was a joke, that I was

1 no longer going to attend.

2 What prompted me to contact the Persian

3 Gulf Committee was that I found out that there is --

4 that I have eight accounts at the Armed Forces

5 Institute of Forensics and Pathology, and I'm not

6 supposed to know about it. When my spleen was removed

7 back in '94, it was sent to a private lab in New

8 Jersey, and then from there they issued a pathology

9 report, very light I'd call it. It was nonspecific,

10 but then from there my spleen disappeared. It was

11 lost, according to them, and I found out that my

12 spleen is at the Armed Forces Institute of Forensics

13 and Pathology, and I'm not supposed to know about it.

14 If the government has nothing to hide, why

15 be so secret? I mean instead of telling me, "Your

16 spleen is at this place and we'll give you a report,"

17 report, you know, they have eight accounts, like I

18 said, bone marrow, lymph nodes, spleen, liver tissue.

19 I've been -- like I said, I've been in the

20 hospital so many times, and the quest is -- I went to

21 fight for a war, and then I come back to fight another

22 war against the government.

23 CHAIR LASHOF: Are there questions that

24 anyone -- Rolando.

25 MR. RIOS: Mr. Martinez, you said that you

1 got sick when you were over there.

2 MR. MARTINEZ: Yes.

3 MR. RIOS: And you had a nosebleed?

4 MR. MARTINEZ: Yes.

5 MR. RIOS: Was this after a specific

6 combat incident of some sort?

7 MR. MARTINEZ: I'm not sure. I'm not

8 sure. We had so many Scud missile attacks that were

9 intercepted overhead of us by the Patriots, and then

10 we moved from there after one of the missiles landed

11 in Khobar Towers. So I don't know.

12 MR. RIOS: Have you applied for any

13 disability ratings?

14 MR. MARTINEZ: Yes.

15 MR. RIOS: What is it?

16 MR. MARTINEZ: Well, I guess what the VA

17 is doing, they're supposed to be paying compensation

18 for undiagnosed illness, but I guess what they're

19 doing is giving it a diagnosis and then saying it's

20 not related to the service.

21 Yes, I applied for disability back in '92.

22 They find me 80 percent disabled.

23 MR. RIOS: But they actually told you that

24 it was not related to the Gulf War?

25 MR. MARTINEZ: No. They keep sending my

1 records from one place to another.

2 MR. RIOS: Okay.

3 DR. LARSON: So just to clarify a little

4 bit more, you've been diagnosed with Persian Gulf

5 Syndrome not related to being in the Persian Gulf.

6 MR. MARTINEZ: Yes. I have the discharge

7 summaries with me.

8 DR. LARSON: Okay. That doesn't make

9 sense. Okay. We need to check on that because that's

10 outrageous. You can't have Persian Gulf Syndrome if

11 you weren't in the Persian Gulf and if it wasn't

12 related.

13 MR. MARTINEZ: Yes.

14 DR. LARSON: And you are on 80 percent

15 disability, but you said that your pay has been

16 sporadic?

17 MR. MARTINEZ: Well, I get -- the only

18 thing I can count on is what the VA is giving me. The

19 National Guard also pays incapacitation pay, but

20 that's the one that is -- and the 80 percent is only

21 about $1,000 a month.

22 DR. LARSON: Okay. So you do get the 80

23 percent from the VA?

24 MR. MARTINEZ: The VA, yes.

25 DR. LARSON: But the sporadic part has

1 been from the National Guard.

2 MR. MARTINEZ: Correct.

3 DR. LARSON: Okay. Thanks.

4 CHAIR LASHOF: Other questions?

5 Marguerite.

6 MAJOR KNOX: Were you ever officially

7 diagnosed with leishmaniasis?

8 MR. MARTINEZ: No. I've been tested, but

9 since they don't have a reliable test, I've been told

10 that even if it comes back negative it doesn't mean

11 that you don't have it.

12 I had about eight bone marrow biopsies,

13 and three swollen lymph nodes, and a liver biopsy, and

14 a spleen removed.

15 CHAIR LASHOF: Dr. Custis.

16 DR. CUSTIS: Just a point of

17 clarification. As far as I know, the VA provides

18 compensation only for service connected disability.

19 Any other source of income or of payment is for

20 pensions for veterans who are indigent. I submit that

21 if you're receiving compensation it is for a service

22 connected disability, is it not?

23 MR. MARTINEZ: Yes. They are paying me

24 compensation for what is called idiopathic

25 thrombocytopenia, which means it's a low platelet

1 count. They don't know what's causing it, and they

2 lost my spleen because that showed right after my

3 return from the Gulf. Now they're not paying for

4 respiratory problems or liver disease even though

5 Walter Reed is saying it's related to the my service,

6 but the VA is not paying for that.

7 CHAIR LASHOF: Any other questions?

8 (No response.)

9 CHAIR LASHOF: If not, thank you very

10 much.

11 I believe Mr. Jeffrey Tack is here now.

12 Mr. Jeffrey Tack. We'll wait a few minutes. He is

13 outside, and he's in a wheelchair, and they're trying

14 to arrange to get him into the room, I believe.

15 (Pause in proceedings.)

16 MR. TACK: Okay. I'd like to say hello.

17 My name's Jeff Tack. I just got here.

18 Basically I don't have a whole lot to talk

19 about as far as the technical aspects. You guys have

20 been over that a million times. I'll just touch on a

21 few things briefly.

22 Twenty-eight years old. I was in First

23 Armored Division, 470th Armor. I went to the Persian

24 Gulf, and when I returned, I was diagnosed with ALS,

25 which is also known as Lou Gehrig's disease. It's a

1 pretty rare disease. There's only about 20,000

2 Americans with the disease. About 5,000 new cases

3 occur in the United States each year.

4 ALS is a difficult disease to diagnose.

5 There are no specific tests to determine ALS. It's a

6 rule-out disease. They do a number of tests on you,

7 and if they can't determine why you're sick and all

8 the pieces seem to fit, they put it under ALS.

9 Unfortunately for me, it's very rare for

10 someone my age to be diagnosed with ALS. Fewer than

11 five percent of all cases of ALS begin before the age

12 of 30. Now, the reason for me to tell you this

13 information is since my medical discharge from the

14 military, I've contacted two other soldiers and a

15 widow of a Gulf War vet who was also diagnosed with

16 ALS, all of us under the age of 40, and I thought this

17 was a rather significant finding on my part just based

18 on calling people and word of mouth to find that there

19 was four of us all under the age of 40, which puts us

20 into the most rare category, all diagnosed with a

21 neuromuscular disease.

22 It's kind of like the Gulf War Syndrome.

23 They're not sure exactly what causes it, and to date

24 there is no cure.

25 Some of the things that I'd like to talk

1 about besides ALS is the fact that we Americans,

2 veterans, respected our country and its needs when the

3 country needed them, and since we came back, we've had

4 great difficulty in getting any -- making any headway.

5 It's been five years that they've had panels and

6 boards, and they've talked, and they've decided, and

7 they've tried to figure things out, and to me it seems

8 pretty clear.

9 We know who was involved. We know where.

10 We know when, and obviously there seems to be an awful

11 lot of information pointing to the fact that we are

12 sick. I mean you can look at all of us that have come

13 back and tell that. I'm not going to try and convince

14 you of that.

15 We feel that it's important, and I was

16 watching CNN this morning, and it took a little wind

17 out of my sails, and I was happy to hear it, that

18 President Clinton was giving us the support now that

19 we've been asking for for such a long time.

20 I think we've spent too much time trying

21 to determine who did what and where when we should be

22 trying to determine why we are sick and what can be

23 done to get us healthy. The government seems to be

24 spending an awful lot of money on the committees and

25 in lieu of spending the money on research to try and

1 find out what's wrong with us.

2 I know that I've also heard people talk

3 about the one reason why, the one link between all the

4 Gulf War vets. To me, and I was in the medical field

5 only as an EMT, it's fairly obvious. With all the

6 different chemicals, the oil well fires that we were

7 exposed to and being in different areas, we were

8 probably exposed to different chemicals, and that

9 would explain the differences in our health problems.

10 I think they should begin with researching

11 the vets to find out if it's not typical illness with

12 the possibilities of all of the things that we could

13 have been exposed to, and maybe look at nontraditional

14 causes of our illnesses.

15 And then just from some of the reading

16 that I have done over the years in trying to play the

17 scientist, which obviously I'm not, there's been

18 several things that I've found that seem to affect the

19 central nervous system. The PB tabs they've given,

20 typically an overdose, exhibit a lot of the same

21 symptoms -- excuse me -- that I have, such as muscle

22 vesiculations, cramping, nausea. Nerve agents can

23 cause muscle vesiculations, muscle twitching, nausea,

24 vomiting, headaches, and we know that some of the

25 enzymes or that the chemicals affect some of the

1 enzymes that affect the nervous system, and being that

2 the nervous system is one of the most sensitive and

3 important systems in our bodies, it is important to

4 look at the seriousness of this problem.

5 To me it seems to be a simple cause of

6 cause and effect. I was healthy before going to the

7 Gulf. I spent five months in the Gulf, and I returned

8 ill. Some of the symptoms that I exhibited when I

9 first got back were nausea, asthma-like symptoms,

10 night sweats, muscle cramping, and muscle twitching,

11 along with sores in my nose.

12 While I was in Saudi Arabia, we were part

13 of the group that cut up in between Baghdad and Kuwait

14 and then came down to fight the Republican Guard, and

15 then we camped out on the border of Kuwait under the

16 oil well fires before returning home.

17 The symptoms that I returned with are

18 listed as adverse reactions to use of the PB tabs and

19 the exposure to nerve agents. With the facts in mind,

20 it's not hard to hypothesize that agent or a

21 combination of these agents can cause the sickness in

22 a great many of the soldiers that returned from the

23 Gulf.

24 It has been proven that chemical agents

25 and PB tabs both attack the central nervous system,

1 and like I said, I'm not a scientist. I'm not a

2 researcher, and due to my limited resources, I can

3 only guess the answers to the unknown. But our

4 President and our country have virtually unlimited

5 resources, and it is our government's job to respect

6 our demands and achieve the answer to the what is

7 needed to conquer the illnesses that we suffer from.

8 We want and need the help, but no one is

9 listening to us, and like I said, the President seems

10 to have been listening to us. He has allocated some

11 funds for research, and he has allocated funds to help

12 the sick vets, but we need to push this further. We

13 want the President to stand up and be behind the vets

14 and show a support for the vets. And the groups that

15 are rather hesitant to look into what's wrong for fear

16 of adverse actions against them, the President needs

17 to stand up and say, "Yes, it is time to take action

18 and it is time to find out what is wrong with us."

19 And on the very last page I have this

20 picture. This is a picture that my four year old

21 daughter had drawn me while we were collecting all

22 this information and writing up our report. She came

23 to me and she said, "Daddy, this is your big heart,

24 and this is the answer to what's wrong with you."

25 So it's not -- it's not just affecting us.

1 It's affecting our families, and I think that this is

2 something that has to come out, and it has to be

3 looked at.

4 We have the resources here in this

5 country. We have some of the best scientists and some

6 of the best researchers, and I think that it's time

7 for action.

8 Thank you.

9 CHAIR LASHOF: Thank you very much, Mr.

10 Tack.

11 Are there questions any of the Committee

12 would like to address to Mr. Tack?

13 Marguerite.

14 MAJOR KNOX: Do you recall when you

15 initially took the PB tablets that you had severe

16 symptoms at the time?

17 MR. TACK: No, I hadn't noticed any

18 symptoms at the time. We all got together, and our PA

19 watched us take the first tabs, and we continued to

20 take them as he told us to, and I didn't actually

21 notice any symptoms until I got back, and I was laying

22 next to my wife, and she noticed that my arm was

23 twitching continuously.

24 And I went in, and I was told that it was

25 everything from post-traumatic stress to potassium

1 deficiency, and this was in '91, just coming back when

2 I noticed that, and then I wasn't diagnosed with ALS

3 until '95.

4 So, no, I don't recall any adverse effects

5 right away.

6 CHAIR LASHOF: Do you remember how much PB

7 you took or how many days you took it?

8 MR. TACK: No, ma'am, I don't recall.

9 CHAIR LASHOF: Elaine.

10 DR. LARSON: Mr. Tack, there's one thing

11 you said that I wish we could agree with, and that is

12 that we know what, where, and when happened. We're

13 sorting it out, but I think that's still some of the

14 challenges.

15 Are you getting the help you need now

16 financially? Are you on disability?

17 MR. TACK: Yes, I am.

18 One of the things that I had noticed, and

19 a lot of the articles that I've read, is that the

20 government wants to say with 100 percent certainty, no

21 doubt at all, that either, yes, we were or, yes, we

22 weren't. There doesn't seem to be a probability scale

23 there.

24 To me, when we went over there, we were

25 told that, you know, possible attacks were almost

1 certain to occur. The government took the steps to

2 give us the PB tabs to help try and prevent, you know,

3 death in the case of contact with a nerve agent, and

4 to me, if you look at all the information, all of the

5 alarms, all of the reports, all of the stuff that went

6 up, and if you look at that on a probability scale, I

7 would say that the probability is very high.

8 To negate a report because John Doe didn't

9 fill his name out at the bottom of the report, I

10 think, is a little overboard in looking for answers.

11 But, yes, I have received financial help.

12 I've been lucky.

13 CHAIR LASHOF: Thank you very much. I

14 know it's been an effort for you to come. We do

15 appreciate your appearing before the Committee.

16 Are there any other questions?

17 MAJOR CROSS: Mr. Tack, I really just

18 wanted to say I'm struck by you upbeat attitude, you

19 know, about your illness, and I'm glad you came forth

20 and, you know, told your story, and we are listening

21 to what the veterans have to say, and hopefully we'll

22 get to the bottom of this.

23 MR. TACK: Thank you.

24 Yes, I feel that it was important to me

25 when I found out that I had ALS and I started talking

1 with some of the other veterans that I've come in

2 contact with to find out that there was three others

3 also diagnosed with a neuromuscular disease with no

4 specific test to determine the disease.

5 Food for thought.

6 CHAIR LASHOF: Again, thank you very much.

7 MR. TACK: Thank you.

8 CHAIR LASHOF: This completes our public

9 testimony this morning. We will be taking written

10 testimony from additional people that we didn't have

11 time to hear from: Robert von Husen, Deborah

12 Ferguson, Tod Ensign, and Kevin Treiber, and we will

13 take written testimony from them, and I will reiterate

14 again that the Committee is always open to accepting

15 additional written testimony, and it will be given the

16 same consideration of any presentations.

17 With that, I'd like to move on to our

18 agenda, and we are planning to hear both from the

19 Central Intelligence Agency and from the Department of

20 Defense. We will being with the Central Intelligence

21 Agency. Nora Slatkin will present.

22 Move chairs around here a little bit.

23 If Nora Slatkin will come forward, we'll

24 proceed.

25 We know she's here, and I'm sure she'll be

1 in in just a minute.

2 (Pause in proceedings.)

3 CHAIR LASHOF: We're ready to resume.

4 Thank you for joining us. Let me turn the

5 mic over to Nora Slatkin, the Executive Director of

6 the Central Intelligence Agency.

7 MS. SLATKIN: Dr. Lashof and members of

8 the Committee, I really am quite pleased to appear

9 before you today to discuss CIA's efforts related to

10 reports of possible exposure of U.S. troops to

11 chemical agents in the Persian Gulf.

12 I have with me today Sylvia Copeland, who

13 runs our effort, who I know has testified before you

14 several times.

15 CHAIR LASHOF: Yes.

16 MS. SLATKIN: As you know, we strongly

17 belief that your Committee is making a very important

18 contribution to the public's understanding of this

19 issue, and as a result, we have given a very high

20 priority to all of your requests for our support. We

21 know how important this issue is to our Gulf War

22 veterans and that our intelligence may help.

23 Therefore, Director Deutch has made his

24 commitment clear and made it clear from the very

25 beginning that we should make public as much

1 information as possible.

2 I have provided you with a copy of my

3 transcript of the press conference that I did on

4 November 1st, and of course, the Central Intelligence

5 Agency through Sylvia has kept you informed of all of

6 our key analytic findings as they have occurred.

7 Today I'd like to briefly restate some of

8 the most recent findings and discuss the status of our

9 ongoing efforts to model the release of nerve agents

10 from the pit area, Khamisiyah, the expert review panel

11 that we've set up to review our modeling, our

12 declassification efforts, and finally, any future

13 plans that we have.

14 On the basis of a comprehensive review of

15 the intelligence that we have, we continue to conclude

16 that Iraq did not use chemical or biological weapons

17 during the Gulf War. Indeed, analysis and computer

18 modeling indicate that chemical agents released by

19 aerial bombing of chemical warfare facilities at

20 Muhammadiyat and at Al Muthanna, both located in

21 remote areas in northern Iraq, did not reach U.S.

22 troops in Saudi Arabia.

23 However, as you know, we have identified

24 potential fallout concerns in southern Iraq,

25 particularly at the rear area chemical weapons storage

1 bunker and pit area at the location known as Al

2 Khamisiyah.

3 In September 1995, we identified

4 Khamisiyah as a site where chemical agents may have

5 been released. We focused our investigation initially

6 on Bunker 73 and later learned that U.S. troops

7 conducted demolition activities at the site in March

8 1991.

9 The May 1996 UNSCOM inspection of Bunker

10 73 provided us evidence that confirmed our belief that

11 chemical munitions were present in the bunker when it

12 was destroyed.

13 We have published our findings, as well as

14 the modeling of the downwind hazard that could have

15 resulted from the demolition of chemical munitions in

16 Bunker 73. These results, as well as the results of

17 the modeling at Al Muhammadiyat and Al Muthanna, are

18 available on the Internet to everyone.

19 Our modeling work of the chemical release

20 at the Khamisiyah pit area is incomplete. As you

21 know, the modeling of this particular site poses far

22 more difficult challenges than the modeling of the

23 other sites.

24 For example, unlike the modeling that was

25 done in the Bunker 73 demolition, in the pit area

1 modeling we don't know the number or the date of the

2 demolition events, how many shells were destroyed, the

3 wind direction, and other critical determinants of the

4 dispersion of chemical agents.

5 Moreover, several of the important inputs

6 changed while we were undertaking this modeling

7 effort. I'd like to briefly go through each one of

8 these areas of uncertainty because it's very important

9 for you to understand why this is different than the

10 work we have done before and why we have taken a

11 little different course.

12 First and most significant, the exact date

13 and the number of the events are in doubt. We

14 believe, based on our review of the intelligence, that

15 the demolition occurred on the 10th of March and that

16 there may have been an additional demolition on the

17 12th of March.

18 In addition, we know that there were 13

19 stacks of rockets at the pit area before the

20 destruction activity occurred. However, according to

21 information we've gotten from the DOD investigators,

22 the number of stacks the soldiers claim to have

23 destroyed varies anywhere from three to nine.

24 Secondly, unlike the March 4th event where

25 we had a video, we have no verifiable ground truth

1 showing the wind patterns for either March 10th or

2 March 12th.

3 Third, unlike the bunker destruction, we

4 have no test results to indicate the percentage of

5 agent release and the rate of release for rockets

6 destroyed in the open, like the pit area. For Bunker

7 73 demolition, we were actually able to use the

8 results of earlier U.S. tests of the destruction of

9 artillery shells in bunkers in our modeling effort.

10 In this case we don't have comparable results.

11 Fourth, in the case of the pit area, a

12 larger amount of agent was released into the

13 atmosphere, and evaporation was slower. This further

14 complicated the modeling because weather conditions

15 varied over a longer dispersion period.

16 And finally, I want to say to you that the

17 pit event is of particular concern to us because of

18 the greater possibility of risk of exposure of U.S.

19 troops. In the other three releases, the remote

20 location of the event or the knowledge of a northerly

21 direction of wind suggests U.S. troops were not

22 exposed.

23 So because of the broad range of

24 uncertainties I've just gone through and because of

25 the importance of these modeling results of this

1 particular site to U.S. veterans, the Director of

2 Central Intelligence decided that we needed an expert

3 review group. He strongly believes we need to insure

4 that the technical results of this model are

5 unassailable.

6 The DOD will convene that group, and Dr.

7 White, I'm sure, will talk about that.

8 We think this group, drawn from the

9 scientific and technical community, will be able to

10 identify the strengths and the weaknesses of our

11 efforts and suggest modeling approaches and techniques

12 that will help us to better develop an understanding

13 of the events that Khamisiyah.

14 But we haven't sat idle through this time.

15 We've used this time leading up to the expert review

16 as an opportunity to try and refine some of the inputs

17 to our model and to try and decrease some of the

18 uncertainties to the best of our ability.

19 We've discovered the lack of weather data

20 -- excuse me. We've discussed the lack of weather

21 data with an expert group of weather modelers. They

22 have provided us some good ideas about how to obtain

23 new sources of weather data for this period of time.

24 We're currently trying to obtain that data.

25 Secondly, by working with the Defense

1 Department and researching additional intelligence

2 information, we are attempting to resolve the

3 uncertainties of the date and the number of rockets

4 that were destroyed in the pit area. Those are two

5 key input factors that we'd like to have a little more

6 information about.

7 At this point, as we continue our analysis

8 of all the intelligence, we are unaware of other

9 incidents involving possible chemical exposure to our

10 troops. That's at this point based on what we've

11 seen.

12 We know that the Department of Defense is

13 investigating other incidents of reported detections

14 from chemical agents, and we will provide any

15 intelligence that might be relevant to that.

16 We also continue to search for and

17 investigate any documents that may be relevant. So

18 we're not sitting dormant. We're continuing on the

19 Director's commitment to find out whatever we can and

20 to investigate and research all documents.

21 You asked me to talk about the Czech

22 detection, and with respect to the Czech detection,

23 beginning in 1993 we modeled at the request of the

24 Department of Defense a variety of release scenarios

25 to evaluate potential explanations for these

1 detections, but, frankly, based on all the work we

2 could do, we were unable to arrive at a reasonable

3 explanation for these detections.

4 We judge it quite likely that the Czechs

5 detected chemical agents as reported, but we have not

6 been able to help in pinpointing the source of those

7 detections. We are alert to any additional

8 information that would help us develop an explanation.

9 Finally, let me cover the question of

10 declassification, and frankly, as you know, it is a

11 subject that really the press conference was about.

12 As you know, all of the documents that

13 have been identified and been reviewed, classified or

14 unclassified, have been made available to you.

15 With respect to my decisions or the

16 Director's decisions to declassify additional

17 documents, we believe that we have made available to

18 the public all of the information relevant to the Gulf

19 War illness issue where we didn't have a concern about

20 sources and methods.

21 I'd like to summarize for you where we are

22 today. In 1995, the Defense Department established a

23 Web site on the Internet commonly known as GULFLINK.

24 That was designed to provide information on Gulf War

25 illnesses available to the public.

1 One element of the GULFLINK was devoted to

2 the results of DOD's declassification efforts, which

3 included 1,400 documents that people could access.

4 Anyone on the Internet could access.

5 The original DOD postings raised some

6 security concerns, and they were temporarily withdrawn

7 in February. We convened a community working group

8 from the CIA and the DIA to conduct a detailed

9 assessment of the contents of the documents. All but

10 369 were cleared by CIA for reposting by the end of

11 April.

12 On October 31st, all remaining documents

13 were reposted on GULFLINK.

14 In addition, two former agency employees

15 have claimed that I hold documents that contain

16 evidence that chemical weapons were used during the

17 Gulf War. Those documents have been released now on

18 the Internet. There's only one, I believe, that has

19 not yet been released of all those documents.

20 As you know, these documents were made

21 available to you --

22 CHAIR LASHOF: Yes.

23 MS. SLATKIN: -- before we released them,

24 and all the information had been released previously

25 as part of our overall declassification and as part of

1 our testimony in front of the PAC.

2 Even so, we decided that it was best for

3 everyone to have their opportunity to take a look at

4 these documents, and we decided to release the

5 individual documents. In this regard, we held nothing

6 back.

7 I want to close with two thoughts. First,

8 I want to emphasize to you that John Deutch, the

9 Director of Central Intelligence, his Deputy, George

10 Tennet, and I underscore our commitment, the

11 Director's commitment, to the American public to leave

12 no stone unturned. That has been our guidepost.

13 I want to also say to you that we know how

14 important this issue is, and we know that our

15 intelligence may help as it has in the past, and so

16 that commitment does not change.

17 Thank you very much.

18 CHAIR LASHOF: Thank you very much. I do

19 appreciate your testimony, and we do appreciate the

20 cooperation, and I will reiterate that we and our

21 staff have been able to look at all of these

22 documents.

23 I have just a couple of questions.

24 Concerning the ones that were withdrawn, you refer to

25 convening a community group. I guess I don't know

1 what a community group is, and you say all but 369

2 were cleared, but those have now been cleared and they

3 are back on, too.

4 How many in total were withdrawn, and can

5 you elaborate at all on the kinds of security issues

6 that led to your concern, and especially since they

7 had been on the Internet for a period of time? What

8 was the thinking that made you feel that you should

9 pull them off anyway, review them, and then put them

10 back on?

11 A clarification of that --

12 MS. SLATKIN: Sure.

13 CHAIR LASHOF: -- would be helpful to us,

14 and if you'd like Ms. Copeland to join you at the

15 table, I'm perfectly happy to ask her to do so again.

16 MS. SLATKIN: Okay, yes. That's fine.

17 Let me start. I may have to turn to

18 Sylvia for the actual numbers that were withdrawn, but

19 let me start with two thoughts.

20 When I say a community-wide group, it is

21 the intelligence community that I was talking about.

22 The issues were sources and methods. That's clearly

23 our legitimate responsibility, and the group was a

24 group that both Pat Hughes, the Director of DIA, and

25 I convened. We each had members of our respective

1 organizations on it, and their charter was to try and

2 go through as much as possible and find a way to put

3 as much back as possible.

4 The circumstance that I found myself in on

5 November 1st was not one of my choosing, frankly.

6 CHAIR LASHOF: That doesn't surprise me.

7 MS. SLATKIN: We were in a situation where

8 we had continued our effort to see how much more of

9 the 369 could be reposted. In the process, we were

10 informed that a publisher was reposting all of the

11 documents on the Internet.

12 At that point I had no choice. While I

13 have legitimate sources and methods responsibilities

14 and concern, my view was at that point I may as well

15 repost it all. Whether I like the circumstance or not

16 is another matter, but I think my legitimate

17 responsibility was to just repost it, and that's what

18 we did.

19 Now, originally there were 1,400

20 documents. How many did we take off?

21 MS. COPELAND: With about 1,400 --

22 MS. SLATKIN: Go ahead. Let's let Sylvia

23 provide the detail, please.

24 CHAIR LASHOF: Sure.

25 MS. COPELAND: DOD has exact figures

1 because they're the ones that run that site.

2 CHAIR LASHOF: Yes.

3 MS. COPELAND: It was about 1,400. We

4 went through the ones that we had concerns with. We

5 only withheld then 369 that we had concerns with.

6 CHAIR LASHOF: I see. Thank you.

7 MS. SLATKIN: And your question of what

8 the concerns were were sources and methods.

9 MAJOR CROSS: Sources of collection and

10 methods of collection?

11 MS. SLATKIN: Yes, sir. Yes, sir.

12 CHAIR LASHOF: Your concerns --

13 MS. SLATKIN: And that's all I was

14 interested in.

15 CHAIR LASHOF: Your concerns relating to

16 sources and methods, meaning you were concerned about

17 the accuracy of the source or revealing the source

18 or --

19 MS. SLATKIN: No. It's not a concern

20 about accuracy of the source. It's a concern about

21 providing some of the methodology that our analysts

22 use based on the collection techniques.

23 CHAIR LASHOF: That you'd just as soon not

24 have them --

25 MS. SLATKIN: Correct, correct.

1 CHAIR LASHOF: I mean intelligence does

2 have a reason for having secret intelligence.

3 MS. SLATKIN: But by not highlighting it,

4 which would have been a redaction effort rather than

5 a release, I don't feel like I have --

6 CHAIR LASHOF: Right.

7 MS. SLATKIN: -- shown a light on it.

8 CHAIR LASHOF: Okay. Fair enough.

9 DR. TAYLOR: So how many documents are not

10 posted now? Are all of them back on the Internet?

11 MS. SLATKIN: To the best of my knowledge,

12 all are back on the Internet on GULFLINK.

13 DR. TAYLOR: Except one, I thought you

14 said.

15 MS. SLATKIN: No. That's a different

16 issue.

17 DR. TAYLOR: Okay.

18 MS. SLATKIN: I addition to the 369, and

19 I should say to the best of my knowledge all of the

20 documents that we've reviewed and we've identified are

21 back on GULFLINK. That doesn't mean that there are

22 other documents that weren't originally posted that

23 aren't there.

24 With respect to the one that is not, it's

25 confusing, but there are two bins. There's the first

1 posting of GULFLINK, and that's the 1,400, and those

2 are back. There is then the allegations by two former

3 agency employees that I was hiding some information or

4 the agency was hiding some information. So that arose

5 to 58 documents.

6 We went back and checked the FOIA request.

7 We went back and checked any other request that might

8 be available as to how to identify those 58 documents,

9 which were above and beyond the 1,400 that were on the

10 Net.

11 There's only one of those 58 that we

12 haven't put back on, only one, and that was never out

13 there before, but we decided that the only way to

14 convince the public and convince everyone that we had

15 nothing to hide was to put it on out and let the

16 American people and you take a look, even though

17 you've seen them before, take a look and judge our

18 credibility.

19 CHAIR LASHOF: To clarify the Committee's

20 access, key staff have top security clearance. I have

21 top security clearance, and it's that key staff who

22 have looked at them, and I've discussed the documents

23 with them, and we're very well satisfied with your

24 position on these.

25 MS. SLATKIN: Thank you.

1 CHAIR LASHOF: Let me ask a couple more

2 questions about the modeling. I know they're tough,

3 and your efforts in the pit are the real problem at

4 this point.

5 The importance of the date and why that is

6 delaying you in doing the modeling, and what further

7 light can you shed for us on the problems in keeping

8 records so that we don't know when we demolish things

9 and we don't know what we demolished, and what

10 suggestions you have to improve our record keeping in

11 the future so you don't find yourself in this

12 position?

13 MS. SLATKIN: Two key factors occurred

14 while we were trying to complete the Khamisiyah pit

15 model. We obviously didn't have ground truth on the

16 weather, and that makes big differences you all know

17 better than I, but secondly, as we were coming to

18 closure, we were informed by the Defense Department

19 that they had found a particular log of a soldier who

20 cited a different date for the event.

21 And so it became extremely important that

22 we were able to not only determine the date, but the

23 date becomes extremely important for getting the

24 weather conditions right, and obviously the

25 variability of the numbers of rounds become even more

1 important.

2 So it was the combination of all those

3 events occurring as we were trying to complete the

4 activity that caused us to step back.

5 Now, we certainly could have, as some have

6 asked me. Why didn't you model the 10th, why didn't

7 you model the 12th, why didn't you do all of that?

8 And I think that you all know because of your

9 familiarity with the modeling that there's so much

10 variability in the results and the results are so

11 central to who you notify and how you deal with this

12 that the difference between knowing one date and then

13 having to do a series of assumptions caused us too

14 much uncertainty to give a real percentage of

15 credibility on the results.

16 That was our biggest problem. I think,

17 frankly, Dr. Lashof, that as we go through this

18 effort, as the government goes through this effort,

19 not just CIA, of trying to identify all the

20 information that we have, this is going to happen. So

21 I don't have any very good thoughts about how to

22 improve our record keeping.

23 I think what we really want to do and what

24 we really want the government to do is to dig into all

25 materials and come up with as much as we can to add

1 some certainty here.

2 CHAIR LASHOF: What's your best

3 guesstimate as to when you will be able to complete

4 this and how you're going to handle the fact that the

5 uncertainty may remain and you may not know the dates?

6 What do you do?

7 MS. SLATKIN: I think the expert review is

8 really critical to us. This expert panel of

9 scientists and technical people will take a careful

10 look at the modeling, at what else we might do to

11 lower the chance of uncertainty, how we could come to

12 terms on some of the uncertainty and some of the

13 things we may not know, and once we get the results of

14 that review, I think that will inform us a great deal

15 about how to proceed.

16 Now, all of you know that in major

17 analytical -- and this is second nature to all of you

18 -- in major analytical tasks that have a fair amount

19 of scientific uncertainty, you always want to reach

20 for some group of experts, not peers, but experts, to

21 give you a sense of where you might need some

22 additional help, and that's what this is about.

23 CHAIR LASHOF: Do you have a timetable for

24 them? I mean I know that's tough, and you don't pull

25 in experts and say, "We want an answer on date

1 certain," but do you have a range of what you think it

2 will take them to get back to you?

3 MS. SLATKIN: I believe the panel will

4 meet on the 18th and the 20th of November, through

5 November, and I believe I would ask you to ask Dr.

6 White this question to be confident in my answer, but

7 I believe he's expecting the results by mid-December.

8 CHAIR LASHOF: Very good. Thank you.

9 Further questions?

10 Rolando.

11 MR. RIOS: Yes, Ms. Slatkin. It's my

12 understanding that as early as 1990 the CIA had

13 information that the Iraqis had moved nuclear -- I

14 mean not nuclear -- chemical weapons to southern Iraq,

15 and then in 1991 we had the demolitions, and it isn't

16 until 1995 that the government now takes a position

17 that our troops may have been exposed to low levels of

18 chemical weapons.

19 Why has it taken so long to come out with

20 this information? There's a lot of suspicion that the

21 government was hiding something.

22 MS. SLATKIN: Let me try to respond to

23 that question because I think it's a very important

24 question, and I think it give you a sense of how the

25 intelligence community works on all problems, not just

1 this one.

2 We had a series of reports come in in '91.

3 We disseminated this report all over the government so

4 that people were aware of the information at the time

5 we got it.

6 At the time we got it, we took a careful

7 look at it and at other pieces of intelligence that

8 were coming in. Actually Sylvia's group did this, and

9 determined that there wasn't enough credible,

10 confirmatory information on this particular subject.

11 MR. RIOS: Can I hold you right there?

12 You said there was a report in 1991.

13 MS. SLATKIN: Yes.

14 MR. RIOS: What was the report?

15 MS. SLATKIN: Can I defer to Sylvia since

16 she's the one who got the report? And I'd like to

17 continue the response.

18 MS. COPELAND: The report was from an

19 UNSCOM inspection, and that particular report which

20 described munitions that were in piles, we were unsure

21 at that time whether the Iraqis had moved those

22 munitions in just prior to that inspection or whether

23 those munitions were present during the war.

24 That uncertainty and because the Iraqis

25 were moving munitions around at several sites, they

1 had lied about most of their capability. They had

2 denied a BW program and had denied most of their

3 chemical weapons. So they were setting up these

4 situations in several of the sites.

5 Since this site was not identified as a CW

6 storage site, the inspectors were very suspicious

7 about how they found these munitions and when and how

8 they got there. So at that particular time, there was

9 suspicion, and at that particular time our focus was

10 on identifying the Iraqi residual stockpile and

11 eliminating that.

12 So in that particular time in '91, we had

13 a different focus.

14 MS. SLATKIN: Then, as you know, the very

15 heroic story that arose in September of '95, one of

16 Sylvia's analysts, an individual named Larry Fox,

17 while he was at home doing the dishes, overheard on

18 the radio some testimony from veterans, and since we

19 had targeted Khamisiyah as something we wanted to look

20 at, he started to put the information that the veteran

21 was providing in testimony together with the

22 information we had, and that began a massive effort or

23 a large effort to try and identify all of this.

24 Then, of course, we got more information

25 once UNSCOM did its review of the site, and that

1 allowed us to pull the intelligence together and make

2 an analysis of that and go right to the Pentagon and

3 tell them what we had found.

4 So it's not a matter of hiding something.

5 I realize that's a complicated way to say that. When

6 we got the original report, we disseminated it

7 throughout the government. So people were aware of

8 that report.

9 We then, as Sylvia said -- our focus at

10 that time was trying to understand the residual

11 capability of the Iraqis. But we took a look at the

12 report. We tried to balance it against other evidence

13 that we had, and we were unable to make an analytic

14 judgment that this should be taken further at that

15 time, but we didn't forget about it, and I think

16 that's the point that I want to make clear.

17 MR. RIOS: In 1991 when you did that study

18 or that report, it was my understanding that you did

19 have some information that in 1990 some of the

20 chemical weapons had been moved to southern Iraq; is

21 that correct?

22 MS. COPELAND: There were reports that

23 they had been moved forward, but we hadn't identified

24 all the facilities. We had some like An Nasiriya,

25 which was southern, that we had identified, but

1 Khamisiyah was not on the list of facilities that we

2 had identified, and we didn't have necessarily

3 specific information on every site.

4 Our analysis at the time was that some had

5 moved forward.

6 MR. RIOS: All right. Now, the report

7 that was done in 1991, was it after the demolitions?

8 MS. COPELAND: That's correct. It was

9 when UNSCOM went into the site. It was after the

10 demolition, but the Iraqis had changed the look of the

11 site. They had put the munitions that were left that

12 had not been destroyed in three stacks, and so when

13 the UNSCOM inspectors came in, they found three stacks

14 of munitions that had obviously been moved, and now we

15 know in hindsight after putting the story together

16 that, in fact, they were moved from the pit area into

17 three stacks, but, again, that's part of the questions

18 that we have on how the demolition actually occurred

19 in that pit area and what day because there were some

20 munitions that were not destroyed. That's what UNSCOM

21 saw, and the Iraqis did move them and position them in

22 different places, and that was, again, what UNSCOM

23 saw, and therefore, their concern that these munitions

24 had been just put there, just moved in.

25 MR. RIOS: Do we know if any of these

1 chemical munitions were sold by U.S. companies to

2 Iraq?

3 MS. COPELAND: The chemical munitions that

4 were there was, in our analytic judgment, made by the

5 Iraqis, produced by them at the Al Muthanna, their

6 main production facility in northern Iraq.

7 CHAIR LASHOF: Other questions?

8 Marguerite.

9 MAJOR KNOX: Ms. Slatkin, I still have a

10 question about declassification, and I guess Mr.

11 Wagner can confirm that this has been an issue for me.

12 My question is twofold. I'm curious.

13 Does your agency, indeed, feel that sources and

14 methods are now in jeopardy since you've placed those

15 documents back on the GULFLINK?

16 And secondly, how many of those documents

17 originally came from the CIA?

18 MS. SLATKIN: Let me handle the first

19 question, and then I'll ask Sylvia to handle the

20 second.

21 We made a judgment, and frankly, the

22 professionals made the recommendation to me that my

23 Deputy Director for Intelligence, who has the

24 responsibility here, that while there were sources and

25 methods at risk, the greater value of providing this

1 information to the Gulf War veterans and to the public

2 outweighed the concerns over sources and methods.

3 Now, this was not an easy judgment for him

4 to make, but it was his judgment, and based on that

5 and based on the fact that someone else was going to

6 put them, we saw that there was no other rational

7 approach to the subject than to put them back up.

8 MS. COPELAND: There were out of the 369

9 a little over 100 that originated with CIA. I don't

10 know the exact number, but I do know it was over 100.

11 There were others though that we had

12 concerns with on the amount of information that was

13 out there. Others were not originated by us, but they

14 weren't originated by DOD either.

15 MAJOR KNOX: So where did they come from?

16 MS. COPELAND: Them came from other

17 intelligence services, other organizations that

18 control the information.

19 MS. SLATKIN: Other foreign governments.

20 MS. COPELAND: Other foreign governments.

21 CHAIR LASHOF: Phil.

22 DR. LANDRIGAN: Yes, Ms. Slatkin. A

23 couple of technical questions.

24 Clearly if any follow-up health studies

25 are going to be done on any veterans who might have

1 been exposed to chemical agents around Khamisiyah,

2 some things that we're going to need are -- and you

3 know this, of course -- are, first of all, what's the

4 total number exposed or at least a range of estimates,

5 and then secondly, will it be possibly to at least

6 semi-quantitatively to divide that total population up

7 into high, medium, low, or better yet, five or ten

8 gradations of exposure? So even if we don't know the

9 microgram per cubic meter levels of exposure, at least

10 we'll be able to stratify people and look for dose

11 response.

12 And so the question is: do you think

13 after the expert panel has convened and done its work

14 in the next couple of months that you'll be in a

15 position to provide those sorts of numbers?

16 MS. SLATKIN: As you know, that was our

17 original intent. That's what you've been briefed on

18 in the other three cases, in the modeling. That's

19 what we were hoping to get here.

20 It's my firm hope that we'll learn enough

21 from the expert review panel to make those judgments.

22 That's clearly our intent.

23 CHAIR LASHOF: Thank you.

24 Are there other questions?

25 Elaine.

1 DR. LARSON: I have three, I hope, quick

2 questions. One is related to the dates and the

3 modeling and the expert panel.

4 Now, obviously some scientific evidence is

5 more credible or more sure than others, but a date is

6 pretty sure. Now, if you're unsure of the date, it's

7 either because somebody didn't record it or you don't

8 believe what somebody recorded, and it seems to me the

9 DOD are the people that are supposed to record the

10 date, and yet the DOD now is convening the expert

11 review panel.

12 So I'd like some rationale for why that is

13 occurring. The DOD is convening this expert panel to

14 investigate modeling.

15 A second question. Clearly, the extent to

16 which you're aware of incidents is directly correlated

17 with the extent to which you look for incidents, with

18 the level of surveillance, and could you assure us

19 that your level of surveillance for other possible

20 incidents of exposure has been sufficiently high?

21 And then lastly, are you -- in San Antonio

22 we spent quite a bit of time talking about our own

23 detection procedures, some of which initially we were

24 told were highly unreliable, but we heard about some

25 very reliable detection methods and some alarms that

1 went off with very reliable detection, and we haven't

2 had a follow-up, at least a formal one, in this

3 Committee of at least, I think, 13 detection incidents

4 when equipment that was very highly reliable was used.

5 MS. SLATKIN: Dr. Larson, I'd like to

6 start with the second question because, frankly, I

7 need you to repeat the first one. I'm a little

8 unsure --

9 DR. LARSON: Sure.

10 MS. SLATKIN: -- which part you want me to

11 respond to.

12 DR. LARSON: Okay.

13 MS. SLATKIN: But let me start with your

14 second question, which is do I believe we have the

15 right level of resources on the surveillance piece.

16 And I think my answer to that question is,

17 yes, we have the right level of resources on the

18 surveillance piece. My greater worry originally, and

19 you know that when you first asked Sylvia to conduct

20 this modeling effort, she tried to say we don't have

21 the technical expertise, but then after you made it

22 clear that you really wanted someone independent, we

23 went out and did it, and we have no qualms about

24 having done it, and you know what we did. We went out

25 and contracted for it.

1 So Sylvia's role there was to oversee a

2 contractor. We didn't do the modeling in house

3 because we don't have resident in an intelligence

4 agency that kind of capability.

5 So in that regard, as far as the oversight

6 of the modeling, I feel confident that Sylvia has done

7 absolutely the best job she could, and frankly, the

8 Director and I applaud her. She's done a very good

9 job, given the circumstances she's in.

10 Secondly, on the level of resources on

11 looking for documents, I think it is unequivocal in

12 the CIA that John Deutch made it clear from the very

13 beginning this was important to him, and that he

14 wanted resources placed on this, to get work not only

15 on the looking for new pieces of information, but to

16 really force the declassification effort at a level

17 that wasn't occurring previously.

18 So as far as the resource commitment to

19 the surveillance piece, I believe, unless Sylvia has

20 a different view, that we have adequate resources on

21 this. We have committed to this. We understand the

22 importance of it, and we'll stay committed to it, and

23 if it requires more resources, I will provide those.

24 That's not a problem. You have my commitment to that.

25 On the level of resources on the review of

1 the contractor, as I said, I think that's there.

2 Now, we have a large number of people also

3 involved in the declassification effort. So our

4 effort is threefold: overseeing the contractor,

5 looking for new pieces of information, and we continue

6 to go through our records, our documents, other

7 governments' documents. The search is not over in the

8 CIA. We haven't stopped the search. We'll continue

9 to do that, and any time we find something new, we

10 will be the first ones to let you and the department

11 know that.

12 The third piece of declassification, we've

13 put a lot of people engaged in that effort. We've had

14 a lot of people engaged in the declassification

15 effort, and I believe the resources have been right.

16 Now, if I had it all to do again, and I

17 might --

18 CHAIR LASHOF: Let's hope not.

19 MS. SLATKIN: -- I might make sure that

20 people weren't working as many hours as they were

21 working by beefing up the staff a little bit. I think

22 they've all suffered from a little bit of overtime,

23 that maybe some more people might have helped.

24 But it's been made very clear to the

25 Deputy Director of Intelligence that these are our

1 priorities, and he should let us know if he needs

2 more. So you have my commitment on that.

3 Your first question, I'm not sure what you

4 want me to --

5 DR. LARSON: And my last question also.

6 Specifically, the detections that were known to be

7 alarms from highly reliable equipment that we had. In

8 other words, we're focusing on one or two sites, and

9 then the first question was the modeling expert review

10 group is being convened by DOD, and my question is:

11 why did you pick that group to convene that expert

12 review group?

13 MS. SLATKIN: That's a fair question and,

14 I think, a very important one. When the Director

15 decided, based on our recommendation, that an expert

16 panel be convened, he felt the most important thing

17 was to have technical expertise in its support.

18 Now, we know that, and we've been clear

19 about the fact that, we don't have that technical

20 expertise resident in the Central Intelligence Agency.

21 It's resident in a lot of other places in this

22 government, as you know, the Department of Defense

23 being one place, but other places, NOAA and the like.

24 So it was clear that to get an expert

25 panel stood up and done well -- and, by the way, we're

1 going to participate fully in this. Sylvia is going

2 to be a frequent, and Sylvia's modeler, a frequent

3 participant in its activities -- but it was clear to

4 get it done right and get it done with technical

5 expertise underpinning it that we needed to go to

6 another place, and that's why DOD.

7 There's no hiding the ball here. It's

8 getting it done right. I think this expert review

9 group is key to our confidence and anyone's confidence

10 in the modeling results. That's what our intent is.

11 And if you don't mind, I'd like to defer

12 to Sylvia on the detection.

13 MS. COPELAND: As we went through all of

14 our intelligence to look at any evidence of use, I

15 mean, we first started there, and we didn't find any

16 evidence of use. Now, particular detections that DOD

17 -- remember they're the ones that go through the logs

18 and look at it -- as they bring those detections

19 forward to us, we look for any evidence of

20 intelligence, but we haven't had any luck at finding

21 anything that would shed light on the source of those

22 detections.

23 I know that they're going to continue to

24 look into some of the incidents, and as they do and

25 provide us information because we've worked together

1 on this, we'll continue to look at the intelligence to

2 see if there's any information that can shed light on

3 those detections, but we haven't identified any to

4 date.

5 MS. SLATKIN: I'm going to add something

6 to what Sylvia said. I don't want to leave the

7 impression that this is a passive effort by the

8 Central Intelligence Agency who sits back and waits to

9 be fed information.

10 First, there's a very active engagement

11 with the current Persian Gulf investigative team.

12 Secondly, we continue to look for this

13 information. We're alert to what we need, and we go

14 out and try and see what we can find.

15 So it's not as though we're sitting back

16 waiting for someone to hand feed us. We have an

17 active posture.

18 Now, what the yields remains to be seen,

19 but we have an active collection posture in that

20 regard.

21 CHAIR LASHOF: Art.

22 DR. CAPLAN: I just want to follow up

23 first on this issue of the detections, and I

24 understand what you're saying about looking for

25 source, but with the Czech detections, Fox vehicle

1 detections, M-256 kit detections, other alarm

2 detections, a regime that's known to have now stored

3 these chemical weapons out there, I fear that what's

4 getting lost is the issue of "well, we don't know

5 exactly why the detections took place" versus "are

6 these reliable measures that can be trusted by

7 competent people that something was there."

8 So I understand the need to pursue the

9 point about what set it off, but can we say that we

10 have confirmed detections from other places of some

11 sort of chemical presence besides the pit and the

12 Khamisiyah dump? Are you willing to say "unexplained

13 but evidence of" or how far are you willing to go

14 here?

15 MS. COPELAND: We don't have any other

16 event like Khamisiyah currently right now that we're

17 working on. That doesn't mean that we won't identify

18 anyone as we continue to look and search and work with

19 the investigative team, but right now we have no

20 active investigation going on.

21 DR. CAPLAN: But the Czechs say, "We have

22 chemical weapon detection," and you say what?

23 MS. COPELAND: We looked into the Czech

24 detections, and when we look at the site that they

25 detected it and then we try to discern where that

1 source could have come from on that particular date,

2 we've looked at that, and we cannot identify any

3 source that would have caused those detections through

4 the information that we have available today.

5 MS. SLATKIN: But in addition, what we say

6 is that we've looked at their testing regime and we

7 judge that the way they did this and we judge that the

8 detection was probably a valid one. We're not arguing

9 that fact. We're just telling you that we can't

10 pinpoint the source.

11 DR. CAPLAN: I understand.

12 MS. SLATKIN: The point is clear. We're

13 saying we have no reason to doubt this. It's unclear,

14 as you pointed out, what the source of it is.

15 DR. CAPLAN: And would it be fair to say,

16 too, that that's the same judgment you bring to the

17 Fox vehicle detections that we've heard about here?

18 MS. COPELAND: I don't as an intelligence

19 officer look at U.S. equipment and judge their

20 validity. DOD does that. We look at foreign

21 intelligence equipment and we'll judge their validity.

22 DR. CAPLAN: There's a great opportunity

23 for a joke there, but I'll let that go.

24 (Laughter.)

25 DR. CAPLAN: This may be the last time I

1 get to get this question answered. So I'm going to

2 try it one more time.

3 Assuming CIA does not believe that there

4 was any use in battle of chemical and biological

5 weapons and that we know we've got a storage area

6 where things were that were chemical and that was

7 demolished on some day with some effect, do you

8 believe that there was no other deployment of chemical

9 or biological weapons by smaller units in the theater

10 of operations before and during the Gulf conflict?

11 MS. SLATKIN: Let me take shot at that,

12 and then we'll give Sylvia the chance to make any

13 corrections.

14 We have done a thorough review of all the

15 evidence that we hold. This is an analytical judgment

16 about what evidence we have so far. Our view is, as

17 I said in my statement, we continue to conclude that

18 there was no use during the war by the Iraqis.

19 But we also have made it very clear, as we

20 have with Khamisiyah, which is frankly a watershed

21 event, that we have analysis and we have evidence that

22 something occurred there, but that something was done

23 by U.S. troops.

24 So based on all of our analysis of the

25 intelligence that we have, that's our conclusion so

1 far.

2 MS. COPELAND: Right.

3 MS. SLATKIN: Would you agree?

4 MS. COPELAND: I agree. I mean, we've

5 identified two facilities that we know for sure had

6 chemical agents during the war, An Nasiriya and

7 Khamisiyah, the agents removed from An Nasiriya to

8 Khamisiyah. We haven't identified any other facility.

9 Would I say categorically there are none?

10 Of course not.

11 MS. SLATKIN: No, no.

12 MS. COPELAND: You know, we're continuing

13 to look, and all I can say is these are the ones that

14 we've identified to date.

15 DR. CAPLAN: I'll put maybe a somewhat

16 nastier twist on it and say it seems to me UNSCOM

17 identified Khamisiyah. The question that I'm pressing

18 you on is not whether there are storage dumps, but

19 whether there was deployment in the field to other

20 small units carrying chemical or biological weapons.

21 MS. COPELAND: Our judgment at the time

22 was there were those sorts of deployments. We never

23 identified exactly where they were, and we still

24 haven't identified exactly where they were, and now

25 when we review all the information, we don't think it

1 was as extensive as we thought it was during the war.

2 So we've revised our wartime estimate.

3 Really the bottom line is those are the

4 only two facilities that we've identified, and then

5 they were consolidated into the one at Khamisiyah.

6 We've identified no other forward deployment.

7 MS. SLATKIN: And I want to underscore one

8 point that Sylvia made because I think it's important,

9 and I think it really goes to the heart of your

10 question.

11 We're not equivocating here. We're trying

12 to say that based on what we've done so far, on the

13 evidence we have so far, this is our conclusion, but

14 our effort continues. It's not going to stop, and we

15 have no reason to not provide that information as soon

16 as we get it, just like occurred in Khamisiyah, and

17 we're committed to doing that.

18 DR. TAYLOR: You mentioned earlier, and

19 this was maybe back at previous testimony several

20 months ago, that you could not identify chemical

21 munitions from other munitions. So that brings back

22 to the question that Art just asked. Then you said

23 that you're still investigating.

24 So we still cannot be definitive that

25 there were no chemical weapons used by Iraqi soldiers.

1 MS. COPELAND: From all the evidence that

2 we've looked at, we do not believe that chemical

3 weapons were used. We had --

4 DR. TAYLOR: But if you could not identify

5 munitions, you could not break down which ones were

6 and which ones aren't, then that doesn't add up to me.

7 MS. COPELAND: We have information that we

8 get from a variety of sources. From that -- it's not

9 just identifying exactly where they are and what type

10 of color coding they have on them. It's information

11 that talks about use, that talks about other source of

12 events, and we put this all together.

13 From the information that we have

14 available, we've identified no use. What we've

15 identified --

16 DR. TAYLOR: They just stored them, and

17 they transported them from place to place?

18 MS. COPELAND: They stored them, and they

19 put some at the front and did not use them to our

20 knowledge today.

21 DR. TAYLOR: Okay.

22 MS. SLATKIN: I think there could always

23 be another Khamisiyah event. I don't think we can say

24 there's nothing more there until we have other

25 evidence, but we can certainly tell you that today

1 based on a review of all the intelligence, those are

2 our analytic conclusion.

3 CHAIR LASHOF: Yes, Elaine.

4 DR. LARSON: Well, you can see our dilemma

5 because what you have testified today is in direct

6 opposition to what was testified to us on the first

7 meeting we had, which was that -- not from you -- but

8 that there was no, absolutely no evidence of use of

9 chemical agents in the Gulf.

10 Now, whether or not this has anything to

11 do with Gulf War illness, it probably doesn't, but it

12 just causes us to ask questions, and we had a whole

13 meeting on risk communication. It causes a high level

14 of distrust, and that's why I asked you about why the

15 expert review being done by DOD when the problem now

16 is a problem of public and vets' distrust, and whether

17 or not there was any problem or any causal link

18 between chemical warfare and veterans' symptoms, which

19 we don't see any evidence of.

20 There's a big perceptual problem here.

21 MS. SLATKIN: I understand that, ma'am,

22 quite well. Our dilemma --

23 MAJOR CROSS: And let me just follow up on

24 that, if I may --

25 MS. SLATKIN: Yes.

1 MAJOR CROSS: -- because actually she

2 jumped in front of me. I was going to ask the same

3 thing, but I'm glad she did.

4 (Laughter.)

5 MAJOR CROSS: If the panel is not

6 independent and conducting an independent review, the

7 perception by the veterans out there is going to be,

8 "This is another event of some sort of cover-up," and

9 I'm not suggesting there is one, but I'm just saying

10 that the perception is going to be out there on the

11 table.

12 DR. LARSON: Otherwise we're wasting the

13 government's resources by having all of us as

14 volunteers spend our time and spend the government's

15 money and money that could be done for other things

16 and your time and money in ongoing investigations we

17 know very well that you could work forever and never

18 disprove something. That's the nature of scientific

19 investigation.

20 So, you know, we're doing a lot of effort

21 to disprove something which may not be disprovable,

22 and perhaps we are focusing the resources in ways that

23 are not as useful as it could be.

24 MS. SLATKIN: Our dilemma on the expert

25 review panel was to get it technically right. I think

1 I have described to you all the reasons why this is

2 different than the others, all the reasons why this is

3 more, in some ways, critical to get it right, because

4 the results really do bear on the veterans, and

5 getting it wrong wouldn't help anyone.

6 So the expert review is critical. Now, no

7 one is going to look at whether our result -- the

8 expert review panel isn't convened to look at the end.

9 It's convened to look at the modeling effort, convened

10 to look at how to reduce the uncertainties in the

11 input factors, convened to give us some help and give

12 everyone some help.

13 So this is an independent review group.

14 It's not the Department of Defense reviewing our

15 model. It's an independent group that's reviewing our

16 model.

17 CHAIR LASHOF: Just to clarify, Department

18 of Defense's role in this is really to provide the

19 technical staff support that you don't have, but that

20 you and your group, as well as DOD, will be involved,

21 but the expert panel in that sense is independent and

22 will be done in the open with Sunshine and all the

23 rest; is that correct?

24 MS. SLATKIN: Yes, ma'am, and I would ask

25 you to confirm that with Dr. White.

1 CHAIR LASHOF: I'm sure we will.

2 Can I ask you one more questions, and then

3 I will go to John. Dr. White is waiting, but I think

4 it's important we explore all of this.

5 What do the Czechs say about their

6 detection? What do they think it was due to?

7 MS. SLATKIN: Actually that's an excellent

8 question. There was a recent visit by a DOD team of

9 which we had a member. No, I'm sorry. The recent one

10 we did not have a member, and so there is some new

11 information about that. I'm not sure that we know

12 the --

13 MS. COPELAND: Right. You need to ask Dr.

14 White that question because DOD did send a team over

15 recently to talk to the Czechs.

16 CHAIR LASHOF: I see, but CIA doesn't have

17 intelligence from Czech intelligence. It's DOD.

18 Okay. I'll ask them.

19 MS. COPELAND: Yes, we were part of a team

20 that went in '93, I believe it was. We did determine

21 at that time the Czechs said it was credible. We

22 agreed with their techniques and said it was credible.

23 They had no, you know, theories. One time one person

24 said, "Well, maybe it came from the explosions or the

25 bombings," but they weren't really sure either. So

1 they had a lot of hypothetical things, but had no real

2 evidence of anything either.

3 CHAIR LASHOF: Okay. Fine. Thank you.

4 Other questions?

5 John.

6 DR. BALDESCHWIELER: I'd like to ask in

7 the absence of a sophisticated model, is it possible

8 to set some useful boundary conditions, that is, for

9 example, some upper bounds on release and exposure

10 from the pit incident?

11 MS. SLATKIN: That was exactly what we

12 were trying to do, model sort of the worst case and

13 model the most limited case, and then set some

14 parameters within some standard deviations to give

15 people a sense that we don't have enough actual

16 history from five years ago to replicate it. So we

17 were using the model to try and come up with a way to

18 describe it, and that's what we were intent on doing.

19 As I said, when those two factors, two

20 important input factors changed, and that was did we

21 have the right date, but more importantly, we didn't

22 have any sense of the wind condition, and so that

23 particular item put so much uncertainty because, as

24 you know, if the high winds are reacting differently

25 than we thought, we would have a very different

1 direction and a very different azimuth, and that

2 matters when you think it's blowing southerly.

3 So our original intent was to create some

4 parameters and create a worst case based on number of

5 rockets and all of the input elements and then create

6 a lesser case and try and define with use of standard

7 deviation what our ranges were.

8 But then the wind factors changed our

9 ability to do that.

10 CHAIR LASHOF: Tom?

11 MAJOR CROSS: Ms. Slatkin, one other

12 question I have. The two former analysts, what's the

13 basis of their complaint? You know, why are they

14 coming public today?

15 MS. SLATKIN: Sir, I don't know their

16 motives. I can answer you directly about what their

17 allegations are, and there are three, and they're very

18 clear. Their first allegation is that the CIA has

19 hidden or has continued to hide evidence of the

20 exposure of U.S. forces to chemical weapons during the

21 war.

22 The second allegation is that their

23 careers at the CIA were effectively destroyed because

24 of their insistence on pursuing this inquiry, an

25 inquiry which senior agency officials, they contend,

1 sought to hinder.

2 And their third allegation is that the

3 agency's employees sought to discount what they said

4 and would not review honestly the evidence that they

5 presented.

6 They also make the same allegations about

7 DOD. Now, these are very serious allegations from our

8 perspective, and ones that deserve to be investigated

9 fully. Our Inspector General is the right person to

10 do that because he has access to all agency documents,

11 regardless of the classification level, and the

12 Director has charged him with responding clearly to

13 those three allegations.

14 Now, as I said on November 1st, I don't

15 personally believe that there are people in my agency

16 who would knowingly withhold information that could

17 provide something of benefit to the men and women who

18 deployed to the Persian Gulf, knowingly withhold

19 information that could benefit United States soldiers,

20 but this is such a serious allegation, and it goes to

21 the core of our credibility as an institution and the

22 core of our integrity, that it was an easy decision to

23 ask the Inspector General to undertake all this.

24 We will await his findings. He is an

25 independent, statutorily determined individual that

1 works for the Congress. He reports to the Congress

2 and tells us. He is independent. We will await his

3 findings, and if he finds anything here, we will

4 proceed to act upon it as we have in other cases.

5 CHAIR LASHOF: Thank you very much for

6 clarifying that. Let me just ask one more aspect of

7 that.

8 Is there a timetable for the work of the

9 Inspector General as to when you think he would be

10 able to thoroughly investigate each of these

11 allegations and report?

12 MS. SLATKIN: The Director's letter to Mr.

13 Hitz says, "I request you initiate an immediate

14 inquiry to determine if the allegations are true. I

15 request that you insure that adequate resources are

16 dedicated in order to contend with an expeditious

17 investigation."

18 I don't have a date from the Inspector

19 General, but he understands the importance of this,

20 and he understands where it sits in the Director's

21 priorities.

22 CHAIR LASHOF: Fine. Thank you very much.

23 One more question, Elaine?

24 DR. LARSON: Your response was very

25 carefully thought through and you said that no one

1 that you personally knew of would knowingly withhold

2 information that could benefit vets, and there's

3 nothing wrong with withholding information that could

4 be dangerous to security. That's your job, et cetera,

5 but it probably would help credibility if you just

6 said that, that there are things that we are

7 withholding.

8 In other words, the way it was crafted was

9 so careful that I'm back to the public credibility

10 issue again, and I'm not trying to be confrontational,

11 but I'm raising issues that I'm hearing, and if I'm

12 hearing them, other people are hearing them.

13 I have no doubt about the extent of our

14 investigation, and I'm very comfortable with what

15 information this Committee has been given, but I am

16 hearing what I think other people are hearing, and

17 that is a very carefully limited, crafted statement.

18 MS. SLATKIN: Well, I always try and be

19 careful about what I say, and I always try to say what

20 I mean. Let me restate it because I didn't say what

21 you said.

22 I said from my own personal perspective

23 there's not one person in the Central Intelligence

24 Agency who would purposely, knowingly and purposely,

25 withhold information that would benefit United States

1 men and women in the Armed Forces.

2 PARTICIPANT: Dr. Lashof, may I respond

3 publicly to that?

4 CHAIR LASHOF: No, not at this time.

5 MS. SLATKIN: That is my view. I didn't

6 say there's no one that I know. I said there's --

7 this goes to the core of the integrity.

8 Now, I'm going to disagree with something

9 you said, ma'am. We have sources and methods

10 concerns, but that doesn't stop our communication with

11 the Department of Defense on any issue, nor has it

12 stopped our communication with you about any issue.

13 Now, there may be limits to what you

14 release publicly because of sources and methods

15 concerns, but that doesn't limit in any way or

16 constrain our dealing with other members of the

17 bureaucracy, other members of the government. That's

18 very clear.

19 So it wasn't -- I was careful, but I

20 didn't craft it. I happen to believe it.

21 CHAIR LASHOF: Are there any -- Rolando?

22 MR. RIOS: Just one more comment, Ms.

23 Slatkin. I'll just tell you that from what I assume

24 the resources that CIA has and what I've seen over the

25 past year and a half, it's very difficult for me to

1 believe that the information that leads us to conclude

2 that there's a high possibility that our troops were

3 exposed to low levels of chemical weapons or

4 exposures; it's very difficult for me to believe that

5 somebody in the government didn't know about it and

6 covered it up. It's very difficult for me to believe

7 that. I just want you to know that.

8 CHAIR LASHOF: Others?

9 (No response.)

10 CHAIR LASHOF: Thank you very much. I

11 think you've been very helpful and very forthcoming.

12 MS. SLATKIN: Thank you very much. I

13 appreciate the opportunity.

14 CHAIR LASHOF: Deputy Secretary John

15 White, we're ready to hear from you.

16 Mr. White, welcome. Sorry to keep you

17 waiting, but the Committee had lots of questions for

18 CIA, and I'm sure they will for you, too, and we do

19 appreciate your coming before us today.

20 DR. WHITE: Thank you. It's nice to have

21 the opportunity. Would you like me to start?

22 CHAIR LASHOF: You may proceed, please.

23 DR. WHITE: Thank you.

24 I would ask, if I may, that we put my

25 statement in the record, but I would like to make some

1 comments, if I may.

2 CHAIR LASHOF: Certainly.

3 DR. WHITE: Since I have this opportunity

4 and it's important.

5 First, I want to commend the Committee for

6 what you are doing. I think you play an important

7 role. You do so in terms of educating the public with

8 respect to the illnesses, with respect to what the

9 government is doing, what we're not doing with respect

10 to that, and also the causes.

11 You have been of great assistance to us,

12 and I will identify some of that specifically in terms

13 of the investigations, in terms of our approaches to

14 understanding Gulf War illnesses, and also in terms of

15 our preparations for future deployments.

16 So I look forward to your final report,

17 and I would pledge to you that what we will do at

18 least at the Department of Defense is put together a

19 formal process. That formal process will take the

20 report, evaluate it, identify every one of your

21 recommendations, assess those recommendations, either

22 implement them or explain why we wouldn't implement

23 them, and we will publish those results.

24 And let me say because I've been through

25 this before with other important reports in critical

1 areas that from my point of view, the presumption is

2 on the side of the recommendation. The issue is not

3 so much whether the exact recommendation is what we

4 ought to do. It's whether it's a good idea, whether

5 what you have told us makes sense, whether it's a

6 change that we ought to make.

7 Otherwise you get a situation where the

8 bureaucracy can say this rule and that rule doesn't

9 allow us to do exactly what they said. So I will

10 assure you that that will be the spirit in which we

11 will address your recommendations, and I anticipate we

12 will be able to be very forthcoming.

13 The President, as you know, on Veterans

14 Day said, and I quote, "I want to assure all of you

15 that we will leave no stone unturned in our efforts to

16 investigate these cases and to provide our Gulf War

17 veterans with the medical care they need. There are

18 mysteries still answered (sic)" --

19 CHAIR LASHOF: Unanswered.

20 DR. WHITE: -- "and we must do more."

21 I want to assure the Committee and the

22 American people and, most importantly, the people who

23 fought in the Gulf War that it is the department's

24 commitment to make sure that we do everything possible

25 to deal with this problem. We take that

1 responsibility very, very seriously. It's one of my

2 highest priorities. I work on this subject

3 personally.

4 Our approach to the problem has to be far

5 reaching, it has to be inclusive, and it has to be

6 comprehensive. As the President said, we cannot leave

7 a stone unturned.

8 Obviously our primary obligation is, first

9 and foremost, to the people who fought in the war and

10 particularly those who are ill, but in addition to

11 that, we have other focus that we need to deal with.

12 We, of course, as you know, have funded

13 extensive supporting research in this area, medical

14 research, clinical efforts, and so on.

15 Secondly, we are asking veterans of the

16 war what they know and what experience they have that

17 will help us.

18 And thirdly, we have a major investigative

19 effort to find out what happened operationally on the

20 ground and what happened with respect to particular

21 incidents or events in that regard.

22 In addition, our effort has to be not only

23 remedial; it has to be preventive in the future. We

24 have to look to the future and make sure that we learn

25 from these events.

100

1 As you know, our initial focus in this

2 regard was on the health of veterans of the conflict,

3 reaching out to them, taking care of them and their

4 families, improving their clinical evaluation

5 procedures, conducting medical research, et cetera.

6 We also did and are doing extensive

7 outreach. We do this in cooperation with the

8 Veteran's Administration, and while we have focused on

9 this, we think we have to also have a major effort on

10 the events that occurred during the war.

11 In '95, we began an extensive effort to

12 review relevant intelligence and operational documents

13 relating to the war, to investigate specific

14 incidents, to declassify information. So far some

15 23,000 pages of documents have been declassified.

16 Those operations are going smoothly, and I believe

17 they are on schedule. By the end of the year, I

18 expect we will have reviewed some 5.2 million pages of

19 operational and intelligence documents.

20 The effort here is to identify information

21 about any incidents that may shed light on the causes

22 of illnesses. Over the next year, we will shift and

23 put more of our focus on these operational matters,

24 more energy into reconstruction of what actually

25 happened. This is an emphasis that has been proposed

101

1 by this Committee, and we think it's good advice.

2 There is one important issue that has

3 dominated our focus on these concerns recently, and

4 that, of course, is Khamisiyah in southern Iraq.

5 Working with the CIA, our investigative teams have

6 learned that the U.S. forces participated in

7 demolition operations that blew up a bunker, so-called

8 Bunker 73, that contained chemical munitions. I

9 should underline that this was an event that occurred

10 after the war was over.

11 Khamisiyah was a large, conventional

12 ammunition storage site, and the U.S. forces

13 conducting these operations were not aware at the time

14 of the presence of chemical weapons. It was not until

15 the U.N., so-called UNSCOM, returned to Khamisiyah in

16 May of this year to inspect the destroyed bunker

17 visually that we were able to say with confidence that

18 chemical munitions had been in the bunker at the time

19 of the demolition.

20 Another important discovery this year

21 concerned the second demolition at Khamisiyah. Here,

22 again, because of the UNSCOM visit and discussions

23 with the Iraqis, we learned that U.S. forces blew up

24 120 millimeter rockets in an open area called "the

25 pit." It contained these rockets, and they were there

102

1 during the initial visit by UNSCOM, but it was not

2 until this year that we realized that U.S. forces

3 actually destroyed some of those rockets.

4 These are significant findings. They mean

5 that we have on two separate occasions believe there

6 are nerve agents that may have been released, May 4th

7 when Bunker 73 was destroyed, and again we believe May

8 10th -- there's a little question about the date --

9 with the pit operation.

10 At this time we have no direct evidence of

11 exposure to chemical agents as part of the Khamisiyah

12 demolitions, but given the amount of agent that may

13 have been present, we must presume that there was some

14 exposure, even if that exposure was at levels too low

15 to detect.

16 Therefore, we are continuing to

17 investigate these matters intensively. We are

18 contacting individuals who actually conducted these

19 demolitions and issued them. We have reached some 600

20 so far by telephone. We have sent certified letters

21 to the others.

22 In the process of doing this, we have

23 expanded our investigation to all people who were

24 there between the dates of March 4th and March 15th to

25 50 kilometers around Khamisiyah. We believe this

103

1 period covers the appropriate time when these events

2 occurred, and we believe that 50 kilometers is safe

3 because it exceeds the likely zone of potential acute

4 effects under worst case scenarios by 100 percent.

5 As a result, we're sending surveys to

6 these individuals, some 20,800 people, to learn more

7 about Khamisiyah and whether or not people are

8 suffering illness who were in that area.

9 In addition, I have ordered the Army

10 Inspector General to provide me with an independent

11 assessment of all of the events that went on at

12 Khamisiyah. I can assure you that it will be thorough

13 and complete and will be available.

14 In addition to that, I have asked the

15 Special Assistant to the Secretary of Defense for

16 Intelligence Oversight to provide me with a report

17 that explains why intelligence documents that were

18 provided to us in 1991 did not resurface until 1995

19 and what happened to those documents. Why were they

20 not found and why were they not utilized?

21 This is a particular responsibility of

22 this office. They, in fact, provide us with regular

23 reports designed to look at intelligence operations

24 inside the department.

25 I believe as a result of these efforts we

104

1 will get a comprehensive review and picture of what

2 went on at Khamisiyah, but I want to share with you

3 the significance of Khamisiyah, which is much broader

4 than that.

5 I regard Khamisiyah as a watershed. It

6 reinforces our need and focus to move from the

7 clinical effort, which must continue, but increase the

8 effort in terms of what actually occurred in the Gulf.

9 An event of the magnitude of Khamisiyah

10 has another effect. It has been dominating our

11 resources, and as a result of that, the people charged

12 with this investigation have been doing it at the

13 expense of what they ought to be doing regarding other

14 incidents that occurred during the war.

15 Khamisiyah is important, but it is not the

16 only incident that is important, and therefore, I

17 think we need to do more. As a consequence, I've

18 ordered a reassessment of our total program to see

19 whether or not we're behaving appropriately. I've

20 asked Dr. Bernard Rostker, who is here today, the

21 Assistant Secretary of the Navy for Manpower and

22 Reserve Affairs, to lead that assessment.

23 Let me give you the reasons why I think

24 it's important. First of all, the one I just

25 discussed, the overall magnitude of our program. This

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1 is not an issue that ought to be constrained by

2 budgets. This is an issue that ought to be run down

3 wherever possible to make sure that we have all the

4 information we need.

5 Secondly, I became concerned about the

6 focus of our effort and whether it was broad enough.

7 That is to say we need, of course, to increase the

8 operational aspects, but even further, I wanted to

9 make sure that we were looking broadly, thinking

10 openly, and following information wherever it may

11 lead.

12 My own view is that one of the reasons we

13 have given some people the appearance of hiding

14 information, which is not true, is that we have

15 thought too narrowly. We've used paradigms that are

16 too rigid and restrictive, and as a consequence, when

17 new information shows up, we have difficulty

18 assimilating that information and putting it into our

19 concept of what went on, and that causes us problems.

20 As a consequence of that, I think we need

21 to think much more broadly and imaginatively.

22 Thirdly, I wanted to be absolutely certain

23 that those who served in the Gulf War knew that we

24 were reaching out to them, that we had real two-way

25 communications, that we had an effective risk

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1 communication program, a program that has always been

2 important in this regard, but is getting more

3 important as our effort expands, and as the

4 information that comes out of the research efforts and

5 other activities, your activities, for example, grow,

6 it will become even more important.

7 I know the Committee has expressed

8 concerns in this area. I share those concerns, and I

9 think you will see corrective actions which are now

10 underway.

11 Finally, I wanted to get the word better

12 to the public, and again, we have not done well

13 enough, and we have engaged some independent, outside

14 consultants to help us with this communication process

15 so that we can do a better job, and there, too, I

16 think you will see that, in fact, we will improve our

17 efforts in general communications.

18 When I ordered this reassessment, there

19 was a set of other things that I did that I want to go

20 through very briefly. First of all, I mentioned the

21 Army IG report with respect to Khamisiyah and the

22 report of the Assistant to the Secretary for

23 Intelligence oversight in the same regard. These, of

24 course, are important.

25 In addition to that, we've asked the

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1 Institute for Defense Analyses to put together an

2 independent expert panel that would look at ways that

3 advanced modeling techniques can assist us in this

4 regard. That panel of 12 people has convened, and I

5 expect a progress report from them in mid-December.

6 Fourth, the DOD has asked the National

7 Academy of Sciences to convene an expert committee.

8 We use the Academy on a whole set of issues, and

9 including on the issues with respect to Gulf War

10 illnesses, both the Academy in general and the

11 Institute of Medicine. We want to strengthen that

12 relationship. We want them to assist us in our

13 ongoing investigation. We want them to help us

14 understand the implications of sending forces to

15 unfamiliar environments more generally.

16 The issue here is one of protecting the

17 health of our military people during employments,

18 learning from the Gulf War, and making sure we do

19 better in the future.

20 As you well know, the Academy brings both

21 extensive expertise and open, objective assessment to

22 its projects. The Academy has agreed to assist us,

23 and while the agreement is not complete, we have the

24 general outlines and an agreement in principle.

25 Basically we would see them working in two

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1 broad areas. The first would be a panel that would

2 examine, critique, and generally oversee the expanding

3 operations incident investigation program that I've

4 discussed here this morning. So they would be part of

5 that team in the sense of looking at everything we do,

6 talking to the investigators in terms of what they're

7 doing, getting periodic reports in terms of what's

8 happening, guide us with respect to research and

9 search techniques and strategies, and then, of course,

10 doing critiques and helping us in making that public.

11 I would also hope, and they've agreed,

12 that they would provide a certain ombudsman effort

13 here in case people have other information that they

14 feel is not getting to us. They can get it to them,

15 and we make sure we have that openness as well.

16 I gave a press conference yesterday, and

17 unfortunately at least in some of the papers, I think

18 in this regard they did not report completely what was

19 said. Specifically, The New York Times talked about

20 our concern with how we ought to do such an

21 investigation, but did not talk about the other part

22 of the response to the question which had to do with

23 the outside review, and let me read that to you. This

24 is from the transcript of yesterday's press meeting

25 where I was asked:

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1 "How do you respond to the suggestion in

2 the draft report of the Presidential Commission the

3 department should not investigate itself in regard to

4 Khamisiyah or any of these health effects and it

5 should be left to an independent body?"

6 Answer: "I am not going to respond to a

7 draft report, but let me address the question of the

8 investigation, which is the fundamental question.

9 This is a big, complicated issue. We are looking at

10 an operation that took hundreds of thousands of

11 people. There are literally millions of pages of

12 documents. It is operationally complicated. We think

13 that the Department of Defense is effectively the only

14 place you can do that in an effective way in a

15 relatively short period of time.

16 "Then the issue becomes one of oversight.

17 We would welcome and are exploring ways to identify

18 and establish public, outside, objective, not related

19 to the Department of Defense oversight efforts."

20 That's something I think we ought to talk

21 some more about this morning. It's important to us.

22 I believe it's important to you, and we think that

23 while we have a major responsibility in this regard,

24 we have to make sure that whatever we do has the

25 credibility and the oversight to make sure that we're

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1 doing it well, and we need devices for conducting this

2 effort.

3 The second panel that we would have with

4 the Academy would look at all other aspects of the

5 program regarding Gulf War veterans' illnesses and

6 future unfamiliar environments. It, of course, would

7 use as part of its efforts information gathered from

8 the first panel.

9 Now, let me spend a few moments on the

10 specifics of the new actions we're taking that I've

11 alluded to here this morning.

12 First of all, specifically, I've ordered

13 a significant expansion in both the personnel and

14 resources devoted to this issue. We stood up a new

15 organization. Dr. Rostker has been named as the

16 Special Assistant to the Deputy Secretary for Gulf War

17 Veterans' Illness. He will report directly to me.

18 We've also done a substantial increase in

19 the level of effort. We will increase the people

20 working on the review of operations incidents by more

21 than ten times.

22 In addition to that, we've engaged

23 contractors providing for added capabilities with

24 respect to hot lines and will soon have over 100

25 researchers and investigators committed to this

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1 effort.

2 We will also continue to expand the

3 medical research and clinical programs. We've

4 allocated $27 million overall for scientific research

5 in this area this year. That's over double last

6 year's budget. We're doing that in terms of -- and we

7 have a comprehensive clinical evaluation program which

8 you are familiar with.

9 We are also continuing to cooperate with

10 our International Coalition partners, most recently

11 with the United Kingdom and the Czech Republic. We

12 are sharing information and analysis both ways.

13 I hope that you can see from the scope and

14 magnitude of the initiatives that I've just outlined

15 that DOD is fully committed to investigating

16 thoroughly all matters possibly related to Gulf War

17 veterans' illnesses, and that we are committed to

18 making the results of those investigations and the

19 manner in which we have conducted them completely open

20 and available for public scrutiny.

21 We welcome public discussion of these

22 issues and constructive criticisms and suggestions

23 regarding our efforts.

24 In addition, we are open to additional

25 suggestions regarding the outside oversight of our

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1 efforts to insure objectivity, thoroughness, and

2 credibility.

3 This is a broad based effort to take care

4 of our people, to research thoroughly causes of

5 illnesses, to investigate and understand the events

6 that occurred during and after the Gulf War, and to

7 plan for future deployments to unfamiliar

8 environments. It is based on our fundamental

9 commitment to our men and women in uniform.

10 These valiant people defend our country

11 around the world every day. They are flying airplanes

12 in Iraq. They are in Bosnia. They helped restore

13 order and democracy in Haiti, and they are guarding

14 the border in Korea.

15 We ask them to take these commitments and

16 to do so without question, to serve wherever our

17 national leadership asks them to serve. We owe it to

18 our people to protect them before, after, and during

19 deployments. This is a fundamental and unshakable

20 commitment of our government. Force protection is at

21 the core of DOD's compact with its people. This is a

22 very important issue before us because it goes to the

23 heart of our credibility as an institution. It goes

24 to the issue of what happens when we send young people

25 into combat, and consequently we are dedicated to

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1 conducting a thorough, open, and complete program.

2 If I may make a personal comment, my son

3 served as a Marine Corps platoon commander nine months

4 in the Gulf, through to the end and in the taking if

5 Kuwait City. This is not an abstract issue. This is

6 an issue about real people who have problems, and we

7 must address those issues comprehensively and make

8 sure that we have done everything that we can to

9 answer these questions.

10 If I may, let me end by again thanking the

11 Committee for your assistance. I expect that you see

12 many of your ideas in the changes that we've outlined

13 here today, and well you should. Your efforts have

14 been a real catalyst.

15 Thank you, and I would be pleased to try

16 to answer your questions.

17 CHAIR LASHOF: Thank you very much, Dr.

18 White.

19 Let me throw it open to the Committee for

20 questions.

21 Dr. Hamburg.

22 DR. HAMBURG: Thank you very much, Dr.

23 White.

24 I think I've got a dead mic here. Thank

25 you. Am I on the air now?

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1 CHAIR LASHOF: No.

2 DR. HAMBURG: Try again. We're pushing

3 all over the place, but nothing's happening.

4 PARTICIPANTS: They're all out.

5 CHAIR LASHOF: Gee, mine's working.

6 (Laughter.)

7 CHAIR LASHOF: I guess I'll just take over

8 here. Can we find out about the mics or shall I move

9 mine around, I guess?

10 DR. HAMBURG: I can just shout. Shall I

11 shout?

12 CHAIR LASHOF: No, because they're trying

13 to record. David, do you want to come take my seat

14 and then proceed?

15 DR. HAMBURG: Thank you, Dr. Lashof. It's

16 a great sacrifice.

17 I think this is extremely helpful.

18 Reference was made earlier by one of my colleagues to

19 where we were in the first meeting of this Committee,

20 and I have to say in listening to you, Dr. White,

21 we've come a long way since that first meeting. I get

22 a sense that these recent changes are very

23 constructive, and to the extent they've been

24 stimulated by the work of this Committee, we, of

25 course, are gratified.

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1 The sense of willingness to learn from the

2 experience, the sense of facing hard facts and

3 reorganizing, remobilizing even in light of those

4 facts is very gratifying.

5 I want to specify four points and make

6 sure that I'm clear about them. The advantages of the

7 recent moves you describe seem to me, first of all, to

8 pull the management of this enterprise up to the very

9 top level of the Department of Defense.

10 Second, add substantial additional staff

11 to have the talent and capability and people to do the

12 job.

13 Third, focus on really critical issues,

14 and I take it, I believe, I understand that means a

15 sustained effort to the extent that becomes necessary,

16 that it's not just an acute response or transient

17 response.

18 I also understand you to say you're open

19 to, indeed, seeking independent oversight of the

20 highest quality mainly through the National Academy of

21 Sciences, but conceivably through one or two other

22 bodies as well.

23 And finally, I understand you to say that

24 you're going to set up a formal process to respond

25 systematically and thoroughly to the recommendations

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1 of this Committee.

2 There are two things I would ask. Have I

3 misunderstood any of that? And then would you say a

4 little more, in any case, about how you envision this

5 process by which you would respond to the

6 recommendations of this Committee?

7 DR. WHITE: You have all of it exactly

8 right, Dr. Hamburg. I would only make one --

9 CHAIR LASHOF: Press your mic now.

10 DR. WHITE: I'm sorry. You have it

11 exactly right. Let me make one additional comment,

12 and that is with -- or a couple of comments. One is

13 with respect to the staff. What I've talked about is

14 the staff that we will add to do this effort, but

15 we've also gone back and re-energized the Service

16 staffs, particularly the Army, which has been very

17 helpful in this, so that as we expand our staff the

18 total number of people involved in the process goes up

19 by some multiple of that.

20 So we add 100. The Army has got to add

21 some amount over 100 in order to make sure they do

22 that, and they're committed to doing that. I've

23 talked to the Secretary, and I've talked to the Chief

24 about these subjects. So that's very important.

25 Secondly, to underline something you said

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1 which I did not say, but is correct, and that is, yes,

2 we do not see this as a temporary phenomenon. We see

3 this as something that's long term. We don't know how

4 long this is going to take. So we're into it for the

5 long haul.

6 With respect to the report, if I may, let

7 me begin with an analogy, having just been through two

8 major efforts of this regard, one of them that we did

9 with the Commission on Roles and Missions of the Armed

10 Forces, which I chaired, and one of them that had to

11 do with the Khobar Towers bombing in Saudi Arabia in

12 which General Downing provided an independent sense of

13 what we ought to do. I'll do the first one because

14 it's a bit more long term, although they both follow

15 the same model.

16 What we did with these is we put together

17 a team. That team was a team of action officers in

18 OSD and sometimes identified in the Joint Staff. We

19 put on top of that team an advisory group. In these

20 cases the advisory group is normally the Under

21 Secretaries of the Services, the Vice Chiefs from the

22 Services, the Vice Chairman of the Joint Chiefs of

23 Staff, and senior Deputy Under Secretaries from the

24 Office of the Secretary.

25 We then put together a book that

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1 identifies all of the recommendations, and we sit and

2 we parse out those recommendations to specific

3 individual teams. They then have to give us the

4 following answers:

5 Yes, do it immediately.

6 Yes, but we can't do it immediately.

7 We've got some work to do, and we'll do it by date X,

8 some date certain.

9 Three, we're not sure whether we can do it

10 or should do it or not. So we have a study team, and

11 we'll be back to you.

12 And, four, we don't think it's a good

13 idea.

14 We then have regular meetings of the

15 oversight, and we go through the reports of each of

16 these efforts, and as a result of that, then I make

17 formal decisions which are written, directed back to

18 whoever the affected part of the department is, as to

19 what our recommendations are.

20 And then in addition to that, we produce

21 a periodic update, a report, that's public that says,

22 "Here's where we are. Here's what we've done."

23 In the case of the Roles and Mission

24 Commission, which we've been at now for about 18

25 months, we're just about done with that, except for

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1 some long-term issues, which are outstanding, and we

2 will have implemented about somewhere around 75

3 percent of all of their recommendations, and their

4 recommendations, depending on how you count through

5 the report, are about 130 recommendations. So it's

6 quite extensive.

7 So I would envision that same thing here,

8 and as I said earlier, my guidance has been don't tell

9 me why the words in the recommendation don't allow you

10 to do X, Y, or Z. You tell me if it's a good idea,

11 and if it's a good idea, tell me how we're going to

12 implement the idea because you all have obvious

13 difficulty. You don't live in our institution. You

14 may not get the words just right, but that isn't your

15 responsibility. That's ours.

16 DR. HAMBURG: Thank you very much. That's

17 exceedingly helpful.

18 I'll give back the chair now.

19 CHAIR LASHOF: Rolando.

20 I think all of the mics are now working.

21 MR. RIOS: They are.

22 Mr. White, you said that one of the

23 aspects that you're going to be looking into is to

24 find out why it took from 1991 to 1995 to get these

25 intelligence documents on the issue of the locations

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1 of these chemical munitions. So does that mean that

2 one of the results of this particular investigation

3 could be that there was some kind of cover-up?

4 DR. WHITE: Could be, yes, because I told

5 them to just look thoroughly at the whole

6 investigation and give us an investigative answer.

7 This is a responsibility of this office,

8 and they give us regular reports on various incidents,

9 and some of those incidents are incidents of

10 malfeasance or cover-up or misbehavior or whatever,

11 yes. They have that power, yes.

12 MR. RIOS: It's good to hear that.

13 The other thing is do you know whether or

14 not any of the chemical munitions that were in the

15 country at the time in the possession of the Iraqis

16 were munitions that U.S. companies sold to them?

17 DR. WHITE: No, sir, I do not. We can

18 check on that. I have had extensive investigations on

19 what we know about the Iraqi chemical program, but I

20 don't know that. I'd have to check.

21 MR. RIOS: Thank you.

22 CHAIR LASHOF: I'm sorry.

23 DR. CAPLAN: I'd like to ask you basically

24 three questions. One starts with the commitment to

25 force protection and lessons from these events for the

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1 future.

2 One of the things that we've tried to

3 stress, I think, in our hearings and talking with

4 representatives from Department of Defense is the

5 importance of really laying in thorough and adequate

6 health evaluations pre- and post-deployment, and if

7 we're going to understand what happens in new

8 environments in an age of technological war, it seems

9 crucial that we have good indices of what people's

10 health status is before they leave, where they go,

11 what they're exposed to, and what happens when they

12 come back.

13 One of the things that disturbed me a

14 little in listening to a commitment to make that

15 happen is that I'm not sure that kind of zeal has been

16 in place yet with respect to Bosnia and deployment in

17 Iraq again, and I'd just like your comment on what

18 have we done, so to speak, in recent deployments that

19 have taken place since the Gulf that would indicate

20 that kind of commitment to getting this health

21 information in place.

22 DR. WHITE: If I may, I think I would --

23 CHAIR LASHOF: Your mic.

24 DR. WHITE: I'd like to call on Dr.

25 Joseph, who is here, who is the Assistant Secretary

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1 for Health Affairs, but I know with respect to Bosnia

2 we have an extensive program because I've been briefed

3 on that program, and I've been to Bosnia. I've talked

4 to people in the field. That tries to deal with just

5 these issues. They are very important issues, and we

6 have such a program.

7 We are also doing work -- I mentioned the

8 Academy -- we're also doing work in terms of the

9 longer term in this regard, which I think will be

10 important.

11 The question of zeal, I can only assure

12 you that we're committed to do this. We're going to

13 set up standards. We're going to monitor. The only

14 way you get things done in a large bureaucracy is to

15 put down the marker and monitor it and make sure it

16 gets done. We will do that.

17 Dr. Joseph, do you want to add to that?

18 DR. JOSEPH: About two years ago, perhaps

19 two and a half years ago, even as the early work on

20 the comprehensive evaluation program was beginning and

21 as this issue was rising to more prominence, we began

22 as one of the lessons learned from the Gulf a

23 comprehensive review of pre-, during, and post-

24 deployment health activities, and that led to what is

25 really a rather comprehensive overhaul of department

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1 policy in that light.

2 Joint Endeavor, the Bosnia deployment came

3 along before that policy was enacted formally, and I

4 think I briefed the Committee that what we did is we

5 took the guts of that policy and implemented it as

6 they went off for Joint Endeavor before we would have

7 the policy finally cooked.

8 I think there are very large changes in

9 the during deployment and after deployment efforts in

10 that regard, and again, I think the Committee's been

11 briefed fully on that. If you haven't we can do that.

12 The one place that did not come up, I

13 think, to scratch on that, and I don't think this was

14 a matter of zeal, was our ability to do a more

15 thorough pre-deployment health assessment. The

16 exigency of the situation and where we were at the

17 time prevented that.

18 We are well aware of that, and in the

19 final policy which will now result that will be fully

20 covered.

21 The one area -- and, again, I think I've

22 said this to the Committee before. If I'm repeating

23 myself, excuse me -- that I think still represents the

24 critical link in all that we do pre-deployment in

25 terms of assessment, during deployment in terms of

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1 both environmental, public health, and clinical

2 assessments and oversight, and the post-deployment

3 health assessments, which, by the way, are going on

4 very intensively for those troops that are now pulling

5 out of Joint Endeavor; the one missing link is the

6 ability to have a practical, field deployable, medical

7 record, and we are in process of developing hopefully

8 in the next year or so a device that will allow a

9 read, write, indestructible, chip sized, dog tag-like

10 device.

11 That's the key to all of this because

12 unless you really can follow the soldier all the way

13 through the process and read and write at every

14 appropriate point what occurs, you can't link pre-,

15 during, and post-deployment together sufficiently.

16 DR. TAYLOR: How soon do you think that

17 kind of technology will be available? You said that

18 you've started.

19 DR. JOSEPH: The demonstration efforts are

20 currently going on at Fort Gordon, actually going on

21 as we speak, as a matter of fact, on that particular

22 piece of technology. It's tied in with our overall

23 telemedicine efforts, which have made a big difference

24 in Bosnia in terms of having visibility into the

25 situation and the individual soldier.

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1 You know, one always hesitates to know

2 when technology is going to work and when it'll be

3 here, but I think our expectations are within the next

4 year or two ready for deployment.

5 You just can't put a 100-page hard copy

6 medical record in the knapsack and expect to really do

7 anything with it.

8 CHAIR LASHOF: Quite agreed.

9 Don. Check your mic, Don, please.

10 DR. CUSTIS: Is the technology you

11 describe a part of the CPR program or independent of

12 it?

13 DR. JOSEPH: Dr. Custis, CPR program, it's

14 related to all our efforts in telemedicine. This

15 would then link into our ability to run the whole

16 stream of clinical information, deployed or non-

17 deployed.

18 CHAIR LASHOF: Art.

19 DR. JOSEPH: It's a software problem, not

20 a hardware problem.

21 DR. CAPLAN: Another question I wanted to

22 ask you is one I raised earlier when folks were here

23 from the CIA. As we have heard testimony about our

24 capability to detect chemical weapons, biological

25 weapons on the battlefield, one of the things that I

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1 think has concerned this Committee greatly is the

2 adequacy of our detection technology, the ability also

3 to interpret what we pick up from what we put out in

4 the field.

5 Well, I'd like to just have your comments

6 about what we can do to make sure that people out in

7 the field and the veterans who are out there and

8 report to us various chemical detections, things they

9 saw, are going to be able to properly evaluate and

10 weigh those. Are we making efforts to improve that

11 technology? Where are we with this?

12 DR. WHITE: We do have a technology

13 program in that regard. These are difficult issues,

14 but we do have such a program. We are trying to

15 improve this technology.

16 As you recognize, much of the technology

17 that was used in the Gulf has all kinds of problems

18 with it. You know, that has to be improved, and we

19 have the technology program to do that, and I can

20 provide the details if you would like for the record.

21 DR. CAPLAN: Yes, actually later I would

22 like to --

23 DR. WHITE: Absolutely.

24 DR. CAPLAN: Last question. One of the

25 things that troubles me is that we see, and I'm

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1 grateful to see, the activities that are now

2 commencing to muster manpower and expertise to do

3 better modeling. I understand, and you said it

4 yourself, that the Khamisiyah event was a watershed.

5 We've said this morning that chemicals are obviously

6 not the only thing that comes into play, and this

7 committee has been struggling with the fact that it's

8 not clear what the connection is between low level

9 chemical exposure and Gulf War illness.

10 I'm just troubled that the effort in some

11 sense is three, four years after a lot of veterans

12 complained about illness, and I'd just like you to

13 comment if you would why, not just why did it take a

14 long time for the documents, the reports about

15 chemical exposure to come up the line, but as I've sat

16 here and listened the veterans come to our various

17 meetings, they've been complaining for a long time

18 about being ill and asking for that systematic

19 investigation at the level I think we're now starting

20 to get it. Why the gap?

21 DR. WHITE: I obviously in going through

22 what I've just described to you raised in my own mind

23 and with a lot of people the same question. Let me

24 try to give you the answer that I've come to at least

25 at this stage.

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1 We do take this seriously. We did take

2 this seriously, I think, as I said in my comments, but

3 we tended to focus it too narrowly on the Gulf

4 veterans and illness, and because of that we did some

5 things well on the clinical side and the research

6 side. We did not do enough on the operations side.

7 That, I think, is our fault in terms of thinking

8 through the issue.

9 Now, I don't want to denigrate all the

10 work that's been done. We do a lot of work. This is

11 already a big program, but it is not big enough, but

12 more importantly, it's not broad enough.

13 So the only answer I can give you is that

14 as we have learned more about this subject, we have

15 increasingly expanded our effort and looked elsewhere.

16 It is a bigger problem than I thought we started with,

17 and I think because the conventional wisdom to start

18 with was that there was no use, that, in fact, people

19 started with the wrong mind set in terms of what was

20 going on.

21 That's the best I can do, and as I say,

22 the only thing I can do about it or we can do about it

23 obviously is try to fix it.

24 CHAIR LASHOF: John.

25 DR. BALDESCHWIELER: One of the major

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1 findings of the Committee is that stress, and in

2 particular the physiological effects of stress, is

3 likely to be a major contributing factor to the range

4 of illnesses that have been reported. I wonder if you

5 have some specific thoughts as to how to proceed with

6 this.

7 DR. WHITE: Steve, would you like to?

8 DR. JOSEPH: That thought, of course, was

9 echoed by the Institute of Medicine, and when they

10 reviewed our CCEP, they pointed out that they felt we

11 should pay more attention to stress and psychosomatic

12 and psychological issues as we went further, and it

13 also is a prominent feature of the CCEP itself and its

14 discussion.

15 I think that that issue, and perhaps here

16 is a place where the Committee can help us, has been

17 made more difficult by a kind of either/or, or black

18 and white or yes or no attitude on the part of many,

19 perhaps not least in the media. I remember back in

20 the early days of the clinical program in early '94,

21 as we began to look at these issues of stress and its

22 relationship to symptoms and illnesses in some

23 patients, what would come back is, "Oh, the department

24 is saying it's all in their heads," or, "Oh, they're

25 telling me I'm not really sick."

130

1 And there has been a kind of false, I

2 think, in all our understandings, false view that to

3 the extent that we talk about stress and psychological

4 elements as an important part, not as an explanation,

5 but as an important part of this issue, that somehow

6 we collectively are downplaying it or pushing it

7 aside.

8 To me, perhaps the greatest or one of the

9 greatest tragedies in this whole affair has been that

10 we risk missing an important opportunity. This really

11 is an opportunity for us as a society to be mature

12 enough to understand that stress related illness and

13 stress related symptoms are as valid, as important, as

14 real, and as worthy of effort as any other kind of

15 symptoms and any other kind of illness.

16 I think we have, to date, been unable,

17 both ourselves working in the department and also all

18 others who have spoken on this issue, to make it clear

19 that that is not a rejection of the other hypotheses,

20 probabilities, and realities of symptoms and

21 illnesses, and I for one would welcome any help that

22 the Committee can provide either in your report and

23 rhetoric or in your suggestions for further action by

24 which we can make that very important step.

25 That is possibly the most important single

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1 statement that may come out of this in terms of the

2 future of deployments, particularly in an unusual

3 circumstance.

4 CHAIR LASHOF: Let me just make one

5 further statement on that to clarify, I think, some of

6 our thinking in this regard, and I think it's

7 important to say that when we look at stress, we're

8 looking at stress as the cause of physiologic disease,

9 not stress as related only to psychological, and I

10 think part of the problem we have is always coupling

11 stress and psychology or stress and psychological.

12 One of the things we have real concerns

13 about is that there has not been adequate research

14 around the physiologic impact of stress and stress

15 relation to organic disease. The whole field of

16 psychoneuroimmunology is a relatively new field in its

17 infancy and needs and deserves much more research,

18 much more funding directed to understanding the total

19 impact of stress on the physiology of the body, and I

20 think that's important for us to stress, important for

21 you to stress, and important for us to look at in the

22 research, and we will do so in our report.

23 DR. JOSEPH: I would agree with that

24 entirely.

25 CHAIR LASHOF: I will ask for further

132

1 questions. I just wanted to clarify that.

2 Let me then come back to you, Dr. White.

3 You've given us a fair description of your strong

4 efforts, and Dr. Hamburg reviewed many of those. As

5 I go down the list of groups that you've got working

6 on this, I need to get a better understanding of how

7 they're all going to be integrated and who does what

8 where.

9 We have a Persian Gulf investigating team.

10 You have a Persian Gulf senior level oversight panel.

11 We have a Persian Gulf focal group. I mean different

12 documents talk about different ones. Whether they're

13 all going to come into one or what I don't know --

14 Persian Gulf action team. We now have the role of the

15 Army Inspector General in this. We have various peer

16 review panels, and then you're talking about tasking

17 the Institute of Medicine and the National Academy of

18 Sciences with activities.

19 How is all of this going to be

20 coordinated, relate? How do we get an integrated

21 approach to all of this?

22 DR. WHITE: Well, let me make a couple of

23 comments first and then specifically address your

24 question.

25 Some of these issues, such as asking the

133

1 IG to do something, takes us down a different track

2 institutionally with different laws and different

3 protections and so on and back up to the Congress

4 since the activities of the IGs are rightly protected

5 from any involvement on the part of management.

6 So they will come back to us as full

7 reports, and that's as it should be.

8 CHAIR LASHOF: Let me stop you right there

9 a minute. Could you just, therefore, detail as to

10 what things specifically the Inspector General is

11 going to be asked to look at once more for us?

12 DR. WHITE: The Inspector -- I will have

13 to provide you with a document --

14 CHAIR LASHOF: Okay.

15 DR. WHITE: -- but from memory the

16 question was: tell me everything that went on with

17 respect to Khamisiyah in detail from the Inspector

18 General, and then we normally, and I'm sure we did

19 here, put in a follow-on so that it isn't precluded,

20 and any other relevant information that may be

21 appropriate.

22 But I will provide you with the letter

23 that I sent to the Secretary of the Army.

24 Now, with respect to the larger question

25 of integration, what we have done is by the device of

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1 a special -- we have a new organization. We have a

2 Special Assistant who reports to me. So there is a

3 direct reporting relationship of Dr. Rostker to me.

4 Then underneath that, he has a set of

5 organizations, and we'll provide you with this. Just

6 reading from left to right, public affairs and

7 veterans outreach, congressional outreach, but most

8 importantly, investigation and analysis and special

9 situation and response.

10 So we have put together a major team of

11 people, both employees of the department and

12 contractors, and we've put together an organization

13 under his leadership designed specifically to look at

14 questions of incident investigation.

15 Then beyond that we have the medical and

16 benefits part, which is conducted by Dr. Joseph.

17 So where we have a standard DOD

18 organizational structure to deal with it, medicine and

19 health, we do it through that, and then it reports up

20 directly. If we need something that is not natural to

21 the organization, does not currently exist, which was

22 true with respect to investigation and analysis where

23 we have had a small investigative team, then we stand

24 that up separately. We do that in the Office of the

25 Secretary. We put funds and people in that. Dr.

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1 Rostker has direct management responsibility, and then

2 that reports through him to me.

3 Now, that's how we will get the

4 integration.

5 One last point, if I may. We also have

6 that sits with me a steering committee which is made

7 up of very senior people in the department, again, so

8 that they not only hear what's going on, but also can

9 bring back any other related information that comes

10 from other situations, other programs, or whatever,

11 and that's made up of the full array, again, as I

12 described earlier of Under Secretaries, the Vice

13 Chairmen, and so on.

14 CHAIR LASHOF: Thank you.

15 Let me then go to some of the other

16 questions that came up with the CIA. In regard to the

17 Czech detection, everyone says it's credible.

18 Everybody says we don't know what set it off. Do you

19 have information as to what the Czechs believe

20 happened?

21 DR. WHITE: I think we have recent

22 information because we sent one of our experts to talk

23 to the Czechs, and he's back. I have not talked to

24 him, but I would be happy to give the report, have him

25 get in touch with you and give you --

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1 CHAIR LASHOF: Well, I think if he could

2 submit a written report to us --

3 DR. WHITE: Fine.

4 CHAIR LASHOF: -- that would be helpful.

5 I must admit I read something that he said in the

6 newspaper, and it didn't make much sense to me, but

7 that doesn't surprise me.

8 DR. WHITE: Right. No, we will send you

9 a report.

10 CHAIR LASHOF: Now, I also wanted to ask

11 you if you would further elaborate on the role of the

12 National Academy of Sciences and the Institute of

13 Medicine, whether you've fully developed what you want

14 them to do, whether you've developed a task

15 presentation or not.

16 DR. WHITE: Yes. I sent them a letter.

17 It's got a whole set of tasks on it. I think your

18 staff has that letter. It details those tasks.

19 CHAIR LASHOF: Okay. It came in last

20 night. So I haven't had a chance to see it yet.

21 Okay, fine.

22 DR. WHITE: But let me, if I may. The

23 point is we need to do a set of activities and break

24 them in different ways, but my focus has been in one

25 sense on this issue of operation incidents and how

137

1 they would oversee that, help us in that regard

2 provide outside, objective advice and reporting in

3 terms of how we're doing.

4 The second part has to do with making sure

5 all the other activities with respect to health, the

6 clinical protocols, et cetera, is done properly, and

7 utilized in terms of future environments, back to the

8 questions that were raised earlier.

9 It's a three-year program, at least starts

10 for three years. It could go longer. It's

11 multimillion dollars. I don't remember the number,

12 but it's several million dollars as we've tasked it,

13 as we've identified it so far, but we're not through

14 with the tasks yet.

15 CHAIR LASHOF: Okay. Thank you. We'll

16 review that carefully.

17 Yes, Andrea.

18 DR. TAYLOR: Given in the past that there

19 has been an appearance that DOD has not been up front

20 with providing information, how can you insure in the

21 future that the veterans will be adequately provided

22 with information that they want or that information

23 will be forthcoming on a routine basis?

24 DR. WHITE: I think there are a number of

25 things that we have to do that we've started doing.

138

1 The most important one is to make sure that we have

2 much better two-way communications. Much of what we

3 have done is one-way. Here's a hotline; please call

4 us. That's inadequate.

5 More broadly, we have engaged experts in

6 terms of a larger risk communications program, which

7 we have not done well enough, and that program is just

8 ongoing, and we're just going to have to review that

9 and assess it as we go along and, again, get outside

10 reviews, and we've asked the Academy to help us in

11 that regard as well.

12 Thirdly, we've met with the major veterans

13 and Service organizations. I met with them last week,

14 told them what we were doing, asked for their

15 assistance, which they said they would provide,

16 because they are very good, incredible communicators

17 to veterans. So we're doing that as well.

18 CHAIR LASHOF: Other questions?

19 Yes, Art. Oh, I'm sorry. Let me go to

20 Tom first. Go ahead, Tom.

21 MAJOR CROSS: Mr. White, I know we touched

22 on it earlier, but I just want to be reassured. Can

23 we reassure -- in forward looking of the Services, can

24 we be assured that you're going to look at better

25 detector equipment, better protective clothing for our

139

1 military in the future? You know, is that going to be

2 looked at? Can we get some money in the budget to

3 make sure that happens?

4 DR. WHITE: The answer is absolutely yes,

5 but let me give you a more extensive answer, if I may.

6 We have convened recently, and I chair, a counter-

7 proliferation program review. These each take an hour

8 to two hours, again, with a large group of senior

9 officials and military officers, and we have been

10 working our way case by case through doctrine of the

11 Joint Staff. We've had briefings from every one of

12 the Services in terms of their programs. We think

13 they're not as good as they need to be.

14 This is not just equipment. This is

15 training, exercises, and so on.

16 We've had briefings from the Joint Staff

17 and two of the commands, specifically the Pacific

18 Command and the Central Command, with respect to what

19 their programs are.

20 You see, there is an issue here where the

21 Service has the responsibility for training and

22 equipping the force. The CINC has responsibility for

23 utilizing the force. You want the Service to do the

24 unit training. You want the CINC to do the joint

25 training, and so you have to make sure you're doing

140

1 both, and you're doing it with all of the troops and

2 with their commanders, which are two different

3 functions.

4 So we're doing that effort as well. So

5 that will be technology training, doctrine,

6 procedures, and so on, and we will keep at this until

7 we're satisfied that, in fact, we now have an ongoing

8 institutional program.

9 The problem we have generally is that

10 while we do quite well particularly at small unit

11 levels, although it varies across the Services, we

12 don't do as well when it gets complicated, when it

13 gets up to a higher level. That we have to improve.

14 CHAIR LASHOF: Art?

15 DR. CAPLAN: It's actually a follow-up a

16 little bit from Tom's question. I wanted to make a

17 comment. One of the things, I think, that we were

18 frustrated by with Department of Defense was the hope

19 that we would be able to or you would be able to use

20 and tell us using unit locator information and other

21 modes of tracking where troops were, who was exposed

22 to what where, when, and as you know, the litany of

23 causes that this Committee has heard that might be

24 involved in the illness ranging from stress to fleas

25 to dust to oil fires to depleted uranium to -- I

141

1 sometimes play a Trivial Pursuit kind of contest:

2 name the 20 things that might have made people sick in

3 the Gulf. It's a long list.

4 It turned out that the unit locator

5 information, the ability to cross-correlate who was

6 where, even to the point of what date did the pit get

7 blown up at Khamisiyah, is not there, and I

8 understand. I'm not naive about big organizations and

9 record keeping and all the joys of doing that, but I

10 think it's going to take a mind shift in the

11 Department of Defense to make people understand that

12 in modern technological warfare, if you're going to

13 know where your casualties are, you're going to have

14 to really get in there with pen and pencil and

15 computer to get that information so that you can track

16 the after effects of technological warfare.

17 And I'm hoping that not only will it be in

18 the chemical weapons detection and monitoring areas,

19 but also in these areas of record keeping and tracking

20 and location, and so my comment is I'm looking for

21 just a stated commitment that this is going to happen,

22 too.

23 DR. WHITE: Let me make two statements.

24 First of all, the statement that, yes, it will happen

25 and we are committed to doing that in the future, some

142

1 of which Dr. Joseph touched on earlier.

2 And, secondly, I went back and talked

3 again to the senior leadership of the Army, who is the

4 principal focus in terms of our incident

5 investigation, to make sure they reinforced and re-

6 communicated the fact that we must learn where this

7 is. It's not enough to say that that's where the unit

8 is but we don't know where the people are. We have to

9 have that information.

10 I talked very recently with the Vice Chief

11 General Griffith about this, and he assured me that he

12 is putting actions underway to make sure that they do

13 reinvigorate those programs.

14 DR. CAPLAN: The other comment I was going

15 to make to you, and since you solicited advice, I'll

16 give a two cent bit of advice about oversight. I

17 think many of the veterans that I've heard, some that

18 have talked to me, would say they'd like to see some

19 oversight to veterans groups as part of who you report

20 to directly. I think that's prudent. I don't know

21 what the structure is for that.

22 And I think you have some expertise and

23 knowledge that's built up in the staff of this

24 Committee, and as far as oversight goes, that might

25 well be tapped for some structure of accountability.

143

1 DR. WHITE: Those are very good comments.

2 As I mentioned, I did meet with the veterans groups.

3 We're going to have to do that on a regular basis,

4 although we do deal with them on a number of issues,

5 and we'd be happy to use your expertise and the

6 expertise of your staff to help us in this regard.

7 CHAIR LASHOF: Further questions?

8 Let me come back to one about part of the

9 openness and communications business. The DOD's

10 declassification efforts and getting things up on the

11 GULFLINK, how far along is it? Are there many more

12 documents to go? Are we expecting more things to come

13 up on the GULFLINK? Are we getting to the end of that

14 process?

15 I mean, who can read it all?

16 DR. WHITE: Well, that's another question.

17 Let me give you an answer, but let me also say I think

18 we ought to give you a written answer about the

19 scanning techniques and the specific schedule, which

20 obviously I don't have in my head, because there are

21 some new things that they are doing in terms of key

22 word searching, and so on, which I think will help in

23 this dilemma, and it's not just health. It's

24 operational, and as we learn more, we get those key

25 words. I think that's very important.

144

1 Secondly, if we take operational data,

2 there's a long way to go. As I said to you, we'll

3 have five million-some documents by the end of the

4 year, but there are many, many more than that. So we

5 have to figure out what kind of search techniques

6 we're going to use.

7 With respect to the intelligence

8 documents, we think we are largely done with that in

9 terms of the department. I personally asked the

10 Director of the Defense Intelligence Agency the other

11 day to go back and examine this issue of intelligence

12 documents in the Department of Defense that relate to

13 this issue and give me his personal assurance of where

14 we are, and if we don't have anymore, I want General

15 Hughes' personal assurance that that's the case, and

16 he's assured me he will do that.

17 CHAIR LASHOF: Okay. It's noted that last

18 October we were told that the operations records would

19 be completed by December of this year.

20 DR. WHITE: The December, I think, has

21 slipped to December.

22 CHAIR LASHOF: December of this year.

23 DR. WHITE: December.

24 CHAIR LASHOF: Yes.

25 DR. WHITE: But I will not say that

145

1 they -- I'll have to go back and check. I don't want

2 to say today that they will be, quote, completed.

3 CHAIR LASHOF: Let me go back to the

4 investigations of the kits, the 256 kits, and the Fox

5 reconnaissance, and you know, whether there's another

6 Khamisiyah out there or not. Clearly that's one of

7 your priorities --

8 DR. WHITE: Yes.

9 CHAIR LASHOF: -- and one of the things

10 that they're going to look at, and you've added a lot

11 of new people, and it's in that area, I gather, that

12 some of them will be concentrated.

13 DR. WHITE: Most of them.

14 CHAIR LASHOF: And that you will be

15 looking at every one of those reports that come up.

16 DR. WHITE: Absolutely.

17 CHAIR LASHOF: Okay.

18 DR. WHITE: Yes. That's how --

19 CHAIR LASHOF: I just wanted that

20 reassurance.

21 DR. WHITE: Yes, sir. Yes, ma'am. That's

22 basically how we sized much of this new organization

23 in terms of those incidents and other incidents we

24 don't know about. That's why I said if we have to

25 expand it, we'll expand it some more.

146

1 CHAIR LASHOF: Do you have a timetable by

2 which you expect them to have been able to track down

3 each of those 256 and Fox? I know that's tough.

4 DR. WHITE: I don't yet.

5 CHAIR LASHOF: A ball park?

6 DR. WHITE: They're just forming up. So

7 I'll have to get back to you, but I will do it in the

8 next couple of weeks because we have to have a

9 schedule. Otherwise we won't know.

10 CHAIR LASHOF: Sure. Good. Thank you.

11 Phil.

12 DR. LANDRIGAN: Secretary White, a couple

13 of questions about the various committees that you're

14 putting into place. I certainly join with Dr. Hamburg

15 in saying I think it's a fine idea to get the

16 Institute of Medicine and the National Academy

17 involved in an oversight role.

18 Let me offer the suggestion that in your

19 discussions with the leadership of the NAS and the IOM

20 that you might propose to them the notion that they

21 put on the committees either some members of this

22 group to provide first some continuity -- I'm not

23 volunteering, but would you consider that?

24 CHAIR LASHOF: Yes, volunteer yourself,

25 please, not us.

147

1 (Laughter.)

2 DR. LANDRIGAN: But consider that at least

3 as a possibility.

4 And another related notion is that they

5 consider -- well, let me say frequently when they put

6 those committees together only a core of the members

7 are actually members of the NAS or the IOM.

8 Oftentimes much of the committee, as you know, is

9 comprised of people who are not members, and that when

10 they reach out and put those committees together, that

11 they think about putting a couple of folks from the

12 veterans groups on the committee. That would be a

13 nice way of maintaining the momentum towards good

14 openness.

15 DR. WHITE: Those are both good ideas.

16 With respect to the first, I've already made that

17 suggestion to Dr. Shine and Dr. Alberts some time ago.

18 And the second is a good idea. I hadn't

19 thought about it, but I will make that suggestion to

20 them.

21 Obviously, as you know, at the end of the

22 day, they have to decide who they're going to put on

23 these groups.

24 DR. LANDRIGAN: Then in relation to the

25 first committee, the committee that's going to be

148

1 working over the next couple of months to try to

2 further decipher the Khamisiyah episode, could you

3 tell us a bit about the disciplines and the

4 affiliations of the people that are going to be on

5 that committee?

6 And might I offer the suggestion that you

7 consider including in that group somebody with

8 training in epidemiology? The reason I make that

9 particular suggestion is that it would seem to me that

10 ultimately the findings from that committee, the

11 modeling and the specification of the populations at

12 risk, and so on, may need to form the basis for some

13 follow-up health studies, and so it might be a good

14 idea of have somebody on that committee who will be

15 able to translate meteorological data and so on into

16 demographic data that can form the grist for the

17 epidemiologic mill.

18 DR. WHITE: Absolutely. Let me say --

19 CHAIR LASHOF: Your mic.

20 DR. WHITE: -- the 110 people inside, that

21 is, who are on our group, inside the department

22 effort, that's a mix of about 60 investigators, and

23 the others are health and statistician and other

24 experts, and then on top of that, we, of course, have

25 this oversight which I mentioned with the Academy, and

149

1 we in the letter identified a whole set of

2 specialties, including the one that you just

3 mentioned, that we thought would be valuable in this

4 regard.

5 Steve, would you like o add to that?

6 DR. JOSEPH: The Committee knows that

7 there have been already two IOM committees who have

8 been looking at the PGI issues, one, the broader

9 committee, looking at research, and one a narrower

10 committee that we specifically asked to oversee and

11 comment upon the CCEP.

12 Immediately that we learned about the

13 watershed event at Khamisiyah. I wrote to Dr. Shine,

14 the President of the IOM, and we had already been

15 negotiating with them a continuation of that CCEP

16 oversight group at the IOM, and I said to him, "You've

17 looked at the CCEP efforts. You've been quite

18 positive about them, but that was in a context where

19 both we and you felt that there was no persuasive

20 evidence of exposure to chemical agents."

21 Now with Khamisiyah clearly that

22 presumption, that former presumption, comes into

23 question and we have to presume, as I think has been

24 said here this morning, that there may well have been

25 some significant level of exposure, and so I asked the

150

1 IOM committee to relook at their review of the CCEP

2 and tell us whether we should be doing anything

3 different or we should go back and reanalyze

4 differently the entire CCEP based on that change in

5 presumption.

6 That group is going to meet in the next

7 several weeks, and I'm sure we'd be happy or they

8 would be happy to share with the Committee as you get

9 into your final stages any further thoughts that they

10 have in that changed environment.

11 CHAIR LASHOF: We're rapidly getting into

12 our final stages. As you know, this is our last

13 public meeting. Our report is due to the President at

14 the end of December. We need to go to press in mid-

15 December.

16 But with that, are there other questions

17 or comments for Dr. White?

18 Well, I'll throw one last one in. In

19 relation to the Academy and working with the Institute

20 of Medicine for the broader, not the one that Steve

21 just talked about, but the overall investigation of

22 all the rest of this, the issue of openness and

23 everything and Sunshine is clearly key. As you know,

24 this Committee has worked very hard to make everything

25 completely open and in Sunshine.

151

1 IOM doesn't hold things in secret

2 particularly, but it isn't organized or usually set up

3 to do every committee meeting as an open, Sunshine,

4 public comment, et cetera. Have you discussed that

5 issue with them and how they may or may not change

6 their policy or what would be done to assure that

7 whatever is done in that work does get that kind of

8 openness?

9 DR. WHITE: Yes, I have discussed that

10 with them. We haven't gotten into the details yet,

11 but as they responded and as you recognize, that's not

12 their mode of operation, and I've told them how

13 important it is in this regard, particularly with

14 certain elements of this, for instance, the incidence

15 investigation, and we're just going to have to work

16 through that and make sure we're satisfied that that's

17 provided.

18 And we may have to have some additional

19 oversight if that doesn't even appear to be as open as

20 it ought to be. So we do intend to do that, yes.

21 CHAIR LASHOF: Very good. Thank you very

22 much.

23 There are -- yes, Tom. Go ahead.

24 MAJOR CROSS: Mr. White, we don't have to

25 look very far and see we do have sick veterans who are

152

1 here today. What's your interaction, your

2 department's interaction with the VA in terms of

3 helping them through their illness? And there may not

4 be any interaction, but I just want to get your

5 comments on it.

6 DR. WHITE: Let me turn to Steve, but let

7 me first say I've met with the Administrator of VA and

8 with his Deputy on this issue more than once. We have

9 made sure and pledged that we will be committed to

10 sharing all of the information and coordinating. It's

11 particularly true on the outreach programs.

12 One of the concerns I have, if I may, is

13 that we talk in a shorthanded way about veterans, but

14 what we really mean is people who served in the Gulf.

15 Those are active duty people, they're Reserve people,

16 they're retired Reserve people, and then there are

17 people who have left the Service.

18 All of those different categories fall

19 under some different rules and get their care

20 sometimes from different places. So we have to

21 continue to remind ourselves that that's true, that

22 there is not just one or two categories here, and

23 we're working hard to make sure we do that.

24 The particular concern I have is with the

25 Reserve community because I think they have not been

153

1 or we have not put as much focus on that as we should

2 have.

3 Steve.

4 DR. JOSEPH: As the Committee has heard

5 both from the DOD and the VA, both the respective

6 clinical programs and the research programs are very

7 tightly bound together. They really were developed

8 jointly. The research oversight is truly joint, et

9 cetera.

10 So at that level I think there really is

11 very close connection between the two agencies. Where

12 I think -- you raised a new idea in my head with your

13 question. I think in our -- let me say one other

14 thing. And in the entry to the clinical programs,

15 through the hotlines, there always has been from the

16 beginning the ability of the prospective patient to go

17 in either direction.

18 Where I think we have not done well is in

19 our discussions and interactions with Gulf War

20 veterans with symptoms and illnesses across the

21 agencies. We have tended to. DOD will talk to our

22 beneficiaries, quote, unquote, and VA will talk to

23 their beneficiaries, which your question raises in my

24 mind. I think it may be something very useful.

25 Perhaps we should explore with VA joint

154

1 fora in which we can talk to veterans, whether they

2 are active duty or Reserve, or whether they are

3 veterans no longer connected with the military. We

4 have not done that to date.

5 CHAIR LASHOF: Which suggests to me

6 another aspect of this is the risk communication as

7 well --

8 DR. JOSEPH: Yes.

9 CHAIR LASHOF: -- needs to be coordinated

10 between DOD and --

11 DR. WHITE: Absolutely, and we started to

12 do that.

13 CHAIR LASHOF: That's really important.

14 DR. WHITE: That's right, and we also, I

15 understand, have also reached out to HHS because they

16 have particular expertise in similar issues. So we're

17 working with them as well.

18 CHAIR LASHOF: Very good. If there are no

19 further questions, let me thank you again, Dr. White,

20 Dr. Joseph, Ms. Slatkin for staying through this

21 session and for being here this morning.

22 We'll adjourn for lunch. The Committee

23 will resume at 1:30, and we will be discussing our

24 draft report and final report.

25 (Whereupon, at 12:28 p.m., the Advisory

155

1 Committee was recessed for lunch, to

2 reconvene at 1:30 p.m., the same day.)

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1 AFTERNOON SESSION

2 (1:35 p.m.)

3 CHAIR LASHOF: Well, I thought it was a

4 fascinating morning, and I think we've made a lot of

5 progress, and now our job is to give staff input on

6 this draft that we have in front of us, and the game

7 plan is that after today staff will take these

8 comments, the comments they've gotten from outside

9 reviewers that have not yet been incorporated, and

10 come up with one more, hopefully the final, draft

11 which will be sent out to all of us just before

12 Thanksgiving. So with turkey you can read it, with

13 requests that you get back your comments on that draft

14 to staff by?

15 We don't know. It'll say in the letter,

16 and we'll probably give you a week, and from that,

17 that will be the final work for the staff to pull

18 together, get it to GPO by mid-December and into the

19 President's hands by our deadline of December 31st,

20 and hopefully we'll beat that deadline by a few days

21 anyway.

22 What I thought we'd do in trying to go

23 through this, I did meet with staff yesterday and did

24 review a lot of the comments from the outside

25 reviewers that have been incorporated and some that

157

1 have not. Those that staff felt were important and

2 appropriate they included, and those that they felt

3 less comfortable, they didn't.

4 The overall ones that I think I just want

5 to highlight are the fact that the various veterans

6 groups, of course, did receive copies of the draft and

7 did send comments. Overall I could summarize those,

8 and Holly can correct me if I'm wrong or leave

9 something out.

10 Positive about many of the things that we

11 say need to be done; unhappy that we haven't found a

12 cause of the illness; unhappy that we put so much

13 emphasis on stress as a major factor. They wanted us

14 to drop our doing that, and I don't think we can, and

15 I think that's about it.

16 Do you want to say a little more about the

17 review process and what comments came in, Holly?

18 MS. GWIN: We did send the report out for

19 expert review, as well as to the VSOs, and then each

20 of the departments had an opportunity to review the

21 October 31st draft, as well, and we have incorporated

22 many useful technical edits in the draft that you

23 have.

24 I just add to the sort of summary of the

25 VSO comments that they were also urging us uniformly

158

1 not to make the conclusion that other risk factors

2 don't cause the current symptoms. Where our language

3 says it's unlikely, they would prefer that we leave

4 that job to the people who are conducting the

5 research.

6 CHAIR LASHOF: And I guess the one other

7 thing that we got material in late yesterday has to do

8 with the biological plausibility of congenital

9 defects, and Kathy is still looking at that. She's

10 not here, and we're going to have to dig into that

11 further because it came in late yesterday, and it was

12 fairly extensive and isn't completely in sync with

13 other scientific expert comments we got. So we'll be

14 looking further into that and digging into it before

15 we finalize it.

16 So I just highlight that's something

17 you'll want to look for when you get the next draft

18 that will deal with that.

19 Okay, and with that I think the process

20 I'd like to use is sort of go section by section, and

21 I'm not going to read it aloud. I'm not going to go

22 through all the findings as we go. I hope that all of

23 you have been through and are prepared to question and

24 make suggestions where you feel they should be.

25 The thing you were handed this morning has

159

1 to do with the executive summary, and I'll come back

2 to that at the end of how we're structuring that.

3 So as it's organized now, it's by

4 chapters. We've had some discussion whether it will

5 be the form of Part I, Part II, and Part III rather

6 than chapters, but that's a technical thing I don't

7 think we all need to worry about. I'll leave it to

8 our crafts people.

9 So starting with the introduction, has

10 anybody noted anything that they find any problems

11 with in the introduction? To me it was a fine

12 introduction.

13 Hearing none, we will move to the Chapter

14 2, the government response. This is, you know, very

15 much the heart of the document that goes through most

16 of the controversial issues, I think, doesn't it, more

17 or less, plus or minus?

18 So go ahead. Right, David.

19 DR. HAMBURG: I think overall this chapter

20 and, indeed, the whole document is very well done and

21 not too far from closure. The big news is what we

22 heard this morning. It isn't the first time we heard

23 it, but it's the first time we've heard some of the

24 things, but there's been a trend very recently to some

25 major changes in the government's response, and I

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1 think we have to take account of that.

2 I'll offer some provisional wording in

3 Chapter 2, page 2, Lines 3 to 7, where it starts with

4 "regrettably DOD." I'd leave "regrettably DOD," but

5 I would change that to "did not act." I'd put it in

6 the past tense. "Regrettably DOD did not act in good

7 faith in this regard. However, DOD has announced

8 constructive plans to revamp its investigatory and

9 research programs related to low level chemical

10 warfare agent exposure. The Committee believes those

11 efforts, including independent, high quality

12 oversight, could restore DOD's credibility," something

13 like that.

14 I'm not saying that's the ideal wording,

15 but at least it's wording in the direction I think we

16 need to go in order to recognize what is, in fact, a

17 kind of seachange in the response of DOD.

18 CHAIR LASHOF: Yes, I think this is

19 probably the most important issue for us, is how you

20 feel about the presentation this morning and what

21 we're going to say in this regard.

22 So let me just really, I think, almost

23 poll us and go straight through and ask each of us to

24 comment on that. We might as well just start with

25 you, Phil, and sticking just to the -- we could

161

1 discuss it in general and then decide what wording we

2 would like to see here. It also comes up again later

3 in this chapter, and then in the final recommendation.

4 So maybe we should just comment on what you think

5 about this area.

6 DR. LANDRIGAN: Well, first of all, I'll

7 say that I like the direction in which they're going.

8 I think that that's all to the good and probably we

9 can take some justifiable credit for having stimulated

10 that, and all to the good. Success has many parents.

11 I'm not sure that the particular structure

12 that they've come up with is the best way to get where

13 they themselves want to go, and I'm not saying this so

14 much to criticize them, but rather to see if we can

15 work with them to help them tune up their design.

16 At one time this morning we heard that

17 this committee that's to be formed in the next month

18 or two is an independent committee, and then later it

19 seemed to be a DOD committee with some CIA input. I

20 wonder if they could pull together that committee, but

21 instead of having it be headquartered in DOD, try a

22 different locus. I don't know. The Office of Science

23 and Technology Policy is just something that pops into

24 my mind. I don't propose it as more than an option,

25 but is there some way that basically the same experts

162

1 could be convened because I realize the expertise has

2 to come from the operating agencies, but under a

3 different leadership I think would actually help DOD

4 because it would get the job done, but at the same

5 time get the monkey off their back and increase

6 credibility.

7 And in a lot of ways I think the

8 composition and structure and the organization of that

9 first committee is much more important than whatever

10 follows at the IOM or the NAS, which will be slower

11 and after the fact. The template will have been laid

12 down by the findings of this first committee, and the

13 IOM and/or the NAS, if they accept the task -- and I

14 guess they haven't accepted it yet -- would basically

15 be in the position of having to comment upon what's

16 already done. So the first document takes on great

17 importance.

18 CHAIR LASHOF: I think we need to kind of

19 clarify what committees we're talking about. I mean

20 they're going to have a committee to oversee and react

21 to our recommendations internally, and I don't have

22 any problem with that. They've put together a whole

23 new investigative team to go after Khamisiyah and all

24 the other investigations, the 2-56, and that's an

25 internal staff team.

163

1 And then?

2 DR. LANDRIGAN: I was talking about the

3 committee of 12 experts that Secretary White said were

4 about to be convened or had just been convened, and

5 that we understood from the CIA testimony would have

6 its report out by the middle of December. That's the

7 committee.

8 MS. GWIN: That's on modeling.

9 CHAIR LASHOF: That's just modeling.

10 MS. GWIN: That's the peer or the expert

11 review of the modeling of the downwind footprint for

12 the pit at Khamisiyah.

13 DR. LANDRIGAN: Yes, that's precisely what

14 I'm talking about because, I mean, I understand that

15 whatever happened at Khamisiyah can't possibly account

16 for a major portion of the disease in the 700,000

17 veterans, but yet it's critically important now that

18 we've opened the lid on that pit that it be properly

19 followed up.

20 I'm just worried about the credibility of

21 DOD doing the follow-up. They should staff the

22 follow-up, but I wonder if the leadership should be

23 situated elsewhere.

24 CHAIR LASHOF: Okay.

25 DR. TAYLOR: Well, is that separate

164

1 from -- he mentioned in his testimony that he's asked

2 the National Academy of Sciences to convene an expert

3 committee to advise us on an overall approach to Gulf

4 War veterans' illnesses.

5 DR. LANDRIGAN: I'm confused because --

6 CHAIR LASHOF: There's two different ones

7 here.

8 DR. LANDRIGAN: -- I thought there were two

9 committees over at the Academy --

10 CHAIR LASHOF: Already.

11 DR. LANDRIGAN: -- in the Academy complex,

12 one to give a second opinion, if you will, on the

13 findings of the Khamisiyah modeling committee and the

14 other one to have a broader charge; is that correct?

15 CHAIR LASHOF: No, no. Go to his

16 testimony. Do you have his testimony in front of you?

17 Page 11 on his testimony, he has, "Third, we have

18 asked the Institute for Defense Analysis to convene an

19 expert panel to advise us on the ability of applying

20 advanced modeling techniques to the problems of

21 understanding possible dispersion of chemical agents

22 as a result of the demolition activities at

23 Khamisiyah."

24 And those are 12 experts that have been

25 convened that he expects a progress report by mid-

165

1 December, and that's a really technical, scientific

2 panel just on modeling and specifically the modeling

3 relating to the pit at Khamisiyah, as I understand.

4 Is that right, Jim? Is that your understanding?

5 MR. TURNER: Yes. The pit is a starting

6 off spot on it, but it is unclear the extent to which

7 that expert panel will also be rendering advice that

8 would apply to the modeling efforts that have already

9 been completed at Muhammadiyat and Al Muthanna and the

10 Bunker 73.

11 So it is, I think, a broader than just the

12 pit modeling review that is going on. It's an effort

13 to try to marshall the best available techniques to

14 model the various releases that have been documented.

15 CHAIR LASHOF: But it is limited just to

16 that.

17 MR. TURNER: And it is within DOD. I

18 think that Dr. Landrigan is correct about that is

19 convened through the auspices of the Defense

20 Department.

21 CHAIR LASHOF: But that was the one I

22 asked him if I understood it, that the panel itself is

23 outside -- it's an expert scientific panel drawn from

24 the scientific community outside DOD, but staffed by

25 DOD staff; is that correct?

166

1 MS. GWIN: It's at the Institute for

2 Defense Analysis, which is a defense contractor. I

3 mean they do a lot of their work for DOD.

4 CHAIR LASHOF: Okay. So I'm not sure

5 that's relevant at this point. It's something to

6 consider further on.

7 The next one, fourth, was, "The department

8 has asked the National Academy of Sciences to convene

9 an expert committee to advise us on our overall

10 approach to Gulf War illness and to recommend any

11 needed changes to that approach."

12 To tell you the truth, what bothers me

13 about that one is I thought that's what we've been

14 doing for a year and a half.

15 But then he goes on and say he intends to

16 continue to strengthen that relationship not only to

17 help us in the ongoing investigation, but to help us

18 understand the implications of sending forces, and so

19 on, and goes on to "further," and I think the rest of

20 that issue, protecting the health and so on, is all to

21 the good.

22 But go ahead. Let's continue down around

23 the table on it.

24 DR. LANDRIGAN: Could I just say to wrap

25 it up, Joyce --

167

1 CHAIR LASHOF: Yes, please.

2 DR. LANDRIGAN: -- if I may, I thought

3 that what Steve Joseph said at the end of the morning

4 was just very good. I mean I thought his talking

5 about plans for incorporating some of these lessons in

6 the future was right on. So I think that's all to the

7 positive.

8 CHAIR LASHOF: Take a look at the top of

9 page 12, too, on the testimony. He says the Academy

10 agreed it's not yet complete. "The idea is for them

11 to work on two broad efforts. One would be a panel,"

12 and I think this was the one you were thinking about,

13 "panel or panels that would closely examine, critique,

14 and generally oversee the operations incident

15 investigating program." I mean that's the wording for

16 the investigating possible other release, and that, I

17 think, is the one we may want to talk about further.

18 "Review the thoroughness of the process,"

19 and of course, their assessment would be public. In

20 addition, they would play ombudsman, and this is the

21 one I asked him about, what kind of an open process,

22 and they're still talking about that because that's

23 not IOM's usual.

24 Actually this is the part we'll get to in

25 the recommendations, but we might as well discuss it

168

1 here. Here we're talking about whether we want to add

2 anything to the statement, whether we want to accept

3 what David had suggested, that we change "regrettably

4 DOD has not acted" to "did not act in good faith in

5 this regard," and then add something that says that we

6 believe that they are now taking seriously these

7 issues and have laid out plans to move ahead in that

8 regard, and that this could restore their credibility,

9 and that they would do it openly and independently,

10 and that that could restore -- independent oversight

11 could restore their credibility, and whether we want

12 to add something to that effect here and then later

13 deal with how we deal with the recommendation about

14 the independent.

15 Don? We'll just run down the whole table,

16 I think, on this one. It's the heart of our problem.

17 DR. CUSTIS: Well, I think that we

18 certainly should make reference to what they're now

19 doing, commend what they're now doing. I think I'd be

20 inclined to stop with what Dave has to say there and

21 not get into a critique of their plans. I think they

22 ought to be given a chance to do their thing.

23 I would also be careful not to say

24 anything in the way of comment on their future plans

25 that would in any way require us to change what we

169

1 have to say in the body of the report about their past

2 behavior.

3 And I am also constrained to say something

4 else.

5 CHAIR LASHOF: Don't feel constrained.

6 DR. CUSTIS: I think Steve Joseph's

7 description of the technology that's coming for record

8 keeping in the future is all well and good, but you

9 know, I doubt very much that record keeping in the

10 environment of war when all hell is breaking loose

11 will ever be that easy.

12 CHAIR LASHOF: Okay.

13 DR. CUSTIS: I would subscribe to Dave's

14 phraseology and let it go at that.

15 CHAIR LASHOF: Marguerite.

16 MAJOR KNOX: Well, I guess I'm not that

17 polite. I think I like this sentence because I think

18 it makes the shoe fit where DOD has been, and I do

19 think that what Secretary White said today was very

20 encouraging, and I hope that that will come to pass.

21 However, I do know that last August when

22 we commenced on this mission the same kind of things

23 were said, and it has not come to fruition. So I'm

24 more hesitant.

25 CHAIR LASHOF: How do you feel about

170

1 adding any language here that takes any recognition?

2 Well, think about it. Let's run on through the table.

3 MAJOR KNOX: I would just like to see

4 their actions speak for themselves.

5 PARTICIPANT: And that this stay the same?

6 MAJOR KNOX: Yes, that's my opinion.

7 CHAIR LASHOF: David has spoken unless you

8 want to make some more comments now. Otherwise we can

9 come back to it.

10 Rolando?

11 MR. RIOS: I would say that if you're

12 going to say anything about their efforts now it

13 should be said in a more neutral sense, that it

14 appears that they're trying now, and then I would

15 agree with Marguerite. I would also urge that there

16 be some call for an independent review either here

17 initially and also in the body because we think that's

18 important.

19 CHAIR LASHOF: Yes, I think we'll come to

20 that further on. Okay.

21 DR. TAYLOR: And I guess I tend to agree

22 with Rolando and Marguerite that the language -- we're

23 stating based on what has happened to this point. The

24 Department of Defense is reacting to what they

25 received earlier. So it's good that they're finally

171

1 getting on board and stating what they're going to do,

2 but that did not happen in the past, and we have to be

3 very careful with what we say now.

4 And we could say we salute their efforts

5 and hopefully this will move forward, but changing it

6 say that they are now acting in good faith --

7 CHAIR LASHOF: Well, yes. I heard the

8 language from David. We weren't going --

9 DR. TAYLOR: He said "did not act in good

10 faith."

11 CHAIR LASHOF: "Did not act in good

12 faith." And you prefer saying "has not acted in good

13 faith." I guess that's a nuance.

14 We don't know whether they're going to act

15 in good faith in the future.

16 DR. TAYLOR: We don't know, right.

17 CHAIR LASHOF: They clearly did not act in

18 good faith, and so I would have leaned toward "did not

19 act in good faith," and then we could make the wording

20 that follows that a little more ambiguous, but my fear

21 is that if we stick with the wording here, it ignores

22 what we heard this morning, and we're sort of

23 outdated, and that they can then say, "Well, that

24 draft was in October before they heard us. We've now

25 done this, and that takes care of it all."

172

1 I almost think we strengthen our hand to

2 take some cognizance of the fact that they have

3 presented some plans, and we're not saying outright we

4 know that solves everything and, therefore, it's all

5 great, but that it has the potential.

6 DR. TAYLOR: Okay, all right.

7 CHAIR LASHOF: Or it could, you know, the

8 wording "could" or "has the potential" or some sense

9 that we recognize --

10 DR. TAYLOR: Recognize it could lead to

11 something.

12 CHAIR LASHOF: -- that they are doing

13 something.

14 DR. TAYLOR: Okay.

15 CHAIR LASHOF: And that we can be hopeful

16 maybe.

17 DR. TAYLOR: Okay.

18 CHAIR LASHOF: I don't know whether you

19 want to hope or have potential.

20 DR. TAYLOR: I'm easily influenced.

21 CHAIR LASHOF: Maybe we could let staff --

22 DR. TAYLOR: I'll go with that.

23 CHAIR LASHOF: -- play with that language.

24 DR. TAYLOR: That's okay.

25 CHAIR LASHOF: I don't know.

173

1 Let me go to Tom.

2 MAJOR CROSS: I'm going to make the

3 presumption that veterans this morning heard some good

4 news. I want to firmly believe that. So, you know,

5 I'll agree with Don Custis that let's give DOD the

6 chance. They've started a new initiative to rethink

7 some issues that we've been talking about for some

8 time. Let's give them a chance to do that.

9 And I'm not convinced that we're in any

10 position at this point to look at the make-up and

11 comment on that. Unfortunately we're not going to be

12 around to comment on it, and I wish we would, but

13 let's give them the benefit of the doubt that the

14 initiatives will bear some fruit in the end.

15 CHAIR LASHOF: Elaine.

16 DR. LARSON: We're only on page 2 of the

17 document. So I --

18 CHAIR LASHOF: Right, but I think it's the

19 heart.

20 DR. LARSON: Right.

21 CHAIR LASHOF: I think we can go to other

22 stuff after.

23 DR. LARSON: No, I agree, but what I was

24 going to say is I'm comfortable with changing the verb

25 to say, "DOD did not act in good faith in this

174

1 regard," but I don't think we need to go into our

2 recommendation or our further conclusion.

3 CHAIR LASHOF: Yes. No, we'll come to

4 that later.

5 DR. LARSON: If we wanted to say something

6 additional, we could say, "Regrettably, DOD did not

7 act in good faith in this regard, and the department,

8 therefore, lost credibility," or just leave it as it

9 is, but I don't think we need more than that here on

10 page 2.

11 CHAIR LASHOF: Okay. Art.

12 PARTICIPANT: Could we hear Dave Hamburg's

13 --

14 CHAIR LASHOF: Do you want to hear his

15 wording again? Sure.

16 Dave.

17 DR. HAMBURG: Maybe I should charge for

18 reading it again.

19 (Laughter.)

20 DR. HAMBURG: "Regrettably, DOD did not

21 act in good faith in this regard. However, DOD has

22 announced constructive plans to revamp its

23 investigatory and research programs related to low

24 level chemical warfare agent exposure. The Committee

25 believes these efforts, including independent, high

175

1 quality oversight, could restore DOD's credibility."

2 Let me just add that what I'm really

3 trying to get at is to reinforce something. I mean,

4 in effect, as I heard it they're doing what we asked

5 them to do, belatedly, but it seems to me at a very

6 high level and a very strong commitment, and I want to

7 reinforce that.

8 Since we were very critical when they were

9 acting badly, I want to say this is much better, and

10 I may not have the right language, but it seems to me

11 to walk away from this without a reinforcement would

12 be in a way irresponsible.

13 CHAIR LASHOF: Art.

14 DR. CAPLAN: Well, I think my attitude is

15 that we should encourage them to follow through on

16 their rhetoric. They haven't done anything. They've

17 talked about what they plan to do, and I think we

18 should not just reinforce it, but we should phrase it

19 in such a way that they're held accountable to it, and

20 my suggestion might be to split that discussion off

21 from where this page 2 of the report is. Maybe it

22 belongs a few sentences, a few paragraphs, or a couple

23 of chapters later. I'm not sure.

24 But we do want to lay the history in. It

25 doesn't make sense about many of the things we have to

176

1 say later if we don't stress the fact that there was

2 failure. So I don't want to make it impossible for

3 them to recover, but I think we have to lay the

4 foundation form any of the things that happened, why

5 the vets feel frustrated, and so on; then maybe not in

6 the immediate sense -- I'm not sure -- but somewhere

7 in the report absolutely say that they've begun to

8 make steps toward rectifying this, and that that's the

9 only way they are going to restore their credibility

10 on this, is to follow through on that, on those early

11 plans.

12 CHAIR LASHOF: Okay. John.

13 DR. BALDESCHWIELER: I think what we heard

14 this morning was as constructive and forthcoming as we

15 could hope for, and I guess I would be in favor of

16 encouraging DOD to continue to define their own

17 approach.

18 In his testimony, White, I think, really

19 discussed three advisory groups and at a sort of sense

20 of decreasing specificity. For example, in the first

21 of these, the panel to help with the modeling effort,

22 it seems to me that's a very well defined problem.

23 You can pick the experts. Putting them into the

24 Institute for Defense Analysis strikes me as a

25 feasible way to do it. It seems to me that's well

177

1 defined, and they should go ahead and do it.

2 The second of these is basically the

3 investigation of other chemical incident reports, and

4 it seems to me that, again -- it's reasonably clear

5 what you have to do. There's a huge stack of material

6 to go through, operations reports and all kinds of

7 things, and it seems to me having an Academy oversight

8 panel and an internal defense working group strikes

9 me, again, as a reasonable approach to that.

10 There's a diminishing returns issue here,

11 which I think is significant. That is, it seems to me

12 the probability of finding anything additional of

13 major significance is very low, and you know, you

14 don't want to define a make work project that will go

15 on indefinitely.

16 But I think, again, their approach to that

17 strikes me as pretty well on target.

18 The third panel, which would advise on the

19 broader issues of Gulf War illness and preparation for

20 future incidents is, I think, undefined, and I'd be in

21 favor of letting them come up with a proposal for

22 that. I mean, the Academy of Sciences strikes me as

23 a potentially good organization to help with that, but

24 I don't think that's at this point well enough defined

25 for us to comment.

178

1 CHAIR LASHOF: Okay. Okay.

2 DR. TAYLOR: So I guess -- Joyce, could I

3 say just one more thing?

4 CHAIR LASHOF: Sure, sure.

5 DR. TAYLOR: I guess the biggest thing for

6 this particular sentence on page 2, the only thing

7 that I hear is that we say we change the verb. DOD

8 did not act in good faith in this regard.

9 The other comments that David has made

10 should be somewhere else, but possibly not in this.

11 DR. HAMBURG: It could be later, yes.

12 DR. TAYLOR: It could be later in the

13 report.

14 CHAIR LASHOF: Okay. Well, why don't

15 we -- we'll revisit this as we go.

16 DR. TAYLOR: Okay.

17 CHAIR LASHOF: And by the end of the day

18 we'll have figured out what we want to say in the

19 different parts, but this is a good start to that

20 discussion. We have a sense.

21 Okay. Anything else in the next couple of

22 pages? We go to the outreach, and there's a long

23 discussion about that outreach and how it worked and

24 didn't work, and it's all background. We get into

25 this communication.

179

1 If I'm going too fast for anybody, yell,

2 and I know we want to go to the reception, but we want

3 to be thorough.

4 We heard about risk communication this

5 morning. They seem to have gotten a lesson there

6 because the risk communication we had real problems

7 with, and they seem to have recognized that and do

8 sound like they're going to do something about it, and

9 I think that was a good section here.

10 Anybody have any problem with that?

11 Okay. Moving right along, we get to the

12 findings on those red pages that you can't read in

13 this light, and it didn't succeed a great deal in

14 preventing somebody from getting a copy of this, but

15 I applaud staff for their efforts to see that we did

16 not have draft reports floating around, and this red

17 paper does the trick. It's very hard to read.

18 I would suggest that as we flip through

19 these or at least afterwards that eventually you might

20 want to check which you think are the most important

21 findings and most important recommendations to be

22 included in the executive summary. It's unlikely that

23 we're going to just list every finding or every

24 recommendation in the executive summary. We'll get

25 back to that, but I just wanted to let you begin

180

1 thinking as you're flipping through, that you might

2 want to think about how you want to pick out which

3 ones you think are most important.

4 Okay. Then we go into the access to care

5 issues, and I think there's a good discussion of that

6 and the clinical evaluation. We have all of the staff

7 sitting there waiting for you to ask them questions or

8 challenge them on what they've written here.

9 Okay. A typo on page 2-31. I'm up to

10 findings regarding medical and clinical issues on page

11 2-34. Anybody?

12 DR. CAPLAN: I've got something there.

13 CHAIR LASHOF: Anything before that? Yes?

14 DR. CAPLAN: No, just on medical/clinical.

15 CHAIR LASHOF: Okay. Go ahead.

16 DR. CAPLAN: Just on the medical and

17 clinical issues it says, "We found" --

18 CHAIR LASHOF: Could you tell the page and

19 line?

20 DR. CAPLAN: Line 12. I'm on 2-19, Line

21 12. "We found DOD's policies and procedures were not

22 adequate in all cases to prevent Service members with

23 preexisting conditions from being deployed."

24 Actually, I think what we found was that

25 not only were they not adequate in all cases. They

181

1 weren't adequate in any cases. I'd like to see this

2 tougher. This is a hobby horse I've been riding

3 around a lot today, but I think this predeployment

4 physical, prehealth assessment stuff was inadequate to

5 detect anything from anybody as far as I could hear in

6 terms of deployment, and so I'd like to see this

7 toughened, or I'm wondering why it's not tougher,

8 staff.

9 MS. GWIN: Can I --

10 DR. CAPLAN: Since you want me to talk to

11 them.

12 CHAIR LASHOF: Yes, please.

13 MS. GWIN: This actually is a repeat

14 verbatim what was published in the interim report.

15 So --

16 CHAIR LASHOF: Which you accepted that.

17 MS. GWIN: So this is what we felt could

18 be justified at that time and is repeated for the

19 Committee's consideration here.

20 DR. BALDESCHWIELER: On Line 13, why not

21 take out "in all cases"?

22 On Line 13, why not just strike "in all

23 cases"? I think that strengthens it without being too

24 categorical.

25 MS. GWIN: Well, some people were

182

1 screened.

2 DR. BALDESCHWIELER: Yes, that's right.

3 We're not adequate to prevent Service members with --

4 CHAIR LASHOF: Oh, but it --

5 MS. GWIN: Some Service members with

6 preexisting conditions were not deployed because of

7 those preexisting conditions.

8 DR. CAPLAN: No, no. You just mean that

9 they weren't adequate. Even though they picked up

10 some, they weren't adequate.

11 MS. GWIN: Just take out the phrase "in

12 all cases"?

13 CHAIR LASHOF: Well, I think there is a

14 difference almost. It's in perception of how you're

15 reading the phrase "in all cases." If you drop it,

16 the implication is that they didn't pick up anything

17 in anybody.

18 DR. CAPLAN: No, no, no.

19 CHAIR LASHOF: I think that's the concern.

20 If you don't think it reads that way --

21 DR. LARSON: Inadequate is different than

22 ineffective. I mean inadequate is --

23 PARTICIPANT: Not adequate.

24 DR. CAPLAN: Get some, miss some.

25 DR. LANDRIGAN: You could say not adequate

183

1 to prevent certain Service members.

2 CHAIR LASHOF: Not adequate to prevent

3 some Service members with preexisting conditions?

4 DR. CAPLAN: That's okay.

5 CHAIR LASHOF: Not adequate to prevent

6 some.

7 MS. GWIN: Okay.

8 CHAIR LASHOF: Okay.

9 MAJOR CROSS: Change "adequate" to

10 "thorough"? We're not thorough enough?

11 PARTICIPANT: No, adequate.

12 CHAIR LASHOF: That's okay. Okay. All

13 right. I was actually up to page 2-34. Does anybody

14 have anything in between 2-19 and 2-34?

15 (Laughter.)

16 CHAIR LASHOF: I don't have anything on 2-

17 34 either. It was just that's the speed at which I

18 had flipped.

19 Were there anything other in

20 clinical/medical because the next big issue is

21 research.

22 Yes, David.

23 DR. HAMBURG: Although it's a title on 2-

24 32, the title "Prevention of Combat Related Stress,"

25 I think it would be more accurate to say "Prevention

184

1 of Combat Related Stress Reactions," as it does on the

2 next page.

3 MS. GWIN: Okay.

4 CHAIR LASHOF: Related stress reactions,

5 okay, fine. Yes.

6 DR. CAPLAN: Just on 2-22.

7 CHAIR LASHOF: Two, twenty-two.

8 DR. CAPLAN: This is the FDA response to

9 the biological. Have we got any more recent news

10 about what FDA, Joan, is thinking of doing about the

11 interim rule since last we met?

12 DR. PORTER: They have indicated that they

13 prefer language that doesn't say they're moving toward

14 finalization of the interim rule, but that they are

15 proposing to solicit public comment on perhaps a

16 series of options that would incorporate some of the

17 substance of the public rule, and that could be a

18 range of options.

19 So they are addressing it, but they may

20 not be moving directly to finalize that rule that has

21 been issued as an interim final rule.

22 DR. CAPLAN: Yes, I'm not sure that

23 finalizing that rule is a good idea, and I like better

24 this newer line of approach that they're going to

25 take, some more comment and think about their options

185

1 here. So maybe that could be --

2 MS. GWIN: Adjusted.

3 DR. CAPLAN: -- adjusted.

4 CHAIR LASHOF: Okay. Joan will take care

5 of that.

6 DR. LARSON: Do we have a recommendation

7 related to -- I mean we have a finding. Where is the

8 recommendation related to that?

9 CHAIR LASHOF: It's later. We'll get

10 to -- the recommendations are sort of at the end.

11 Let's proceed and we'll get to them, and I'll be sure

12 we stop and look at that one.

13 The next, we were still trying to get to

14 the findings regarding medical and clinical issues.

15 Does anybody else have anything prior to getting to 2-

16 34?

17 And then I was flipping through those and

18 getting to the ones dealing with research.

19 DR. LARSON: My question is we don't have

20 a recommendation. We have a finding about the concern

21 on 2-34 about the FDA moving slowly, et cetera. We do

22 not have a recommendation about that.

23 MS. GWIN: If you go to page 2-68, Line

24 27.

25 DR. LARSON: What is it, 2-68?

186

1 MS. GWIN: Line 27.

2 CHAIR LASHOF: We're going to come to the

3 recommendations later. So --

4 DR. LARSON: All right. Thank you.

5 CHAIR LASHOF: -- you know, the background

6 and findings all come first, and then we have all of

7 the recommendations.

8 DR. LARSON: Right, but there were

9 recommendations on 2-36, and it wasn't there. I was

10 looking for them in the same section where --

11 CHAIR LASHOF: Well, is there a

12 recommendation on 2-36?

13 MS. GWIN: Those are findings.

14 DR. LARSON: Oh, it says, "The Committee

15 made the following recommendations following its

16 preliminary analysis."

17 MS. GWIN: It's repeating the

18 recommendations that we made in the interim report.

19 DR. LARSON: Right. I understand.

20 MS. GWIN: And the interim report

21 recommendations are just used to introduce each

22 section, and the new recommendations do not appear

23 until the end of the chapter.

24 DR. LARSON: Okay. Thank you.

25 CHAIR LASHOF: If you have a problem with

187

1 this structure, we can discuss that.

2 DR. TAYLOR: That's a problem, I believe.

3 That has to be distinguished because when I first read

4 it, I said -- I thought I was reading recommendations

5 for this report. Then I noticed that they were in a

6 separate section.

7 MS. GWIN: It's confusing.

8 DR. TAYLOR: So it's kind of confusing.

9 I think when this is done again, if you're going to

10 have findings first then the recommendations, then

11 reference should be made that during the interim

12 report recommendations were made, dah, dah, dah, dah,

13 or something so that we'll know the distinction

14 because that was one of the things I found when I read

15 it.

16 CHAIR LASHOF: I think it says that

17 somewhere early.

18 DR. TAYLOR: Does it? But it doesn't

19 state it direct.

20 CHAIR LASHOF: I think it may be need to

21 be structured --

22 DR. TAYLOR: The structure of it is a

23 little bit complicated and hard to understand.

24 CHAIR LASHOF: Okay. Okay. I'm up to

25 page 2-45.

188

1 DR. TAYLOR: I am, too.

2 CHAIR LASHOF: Anybody there?

3 DR. TAYLOR: I am.

4 CHAIR LASHOF: If I get that one this

5 late, boy, I'm really having trouble, but I have made

6 a note to myself. We're talking here about low level

7 effects of warfare agent exposure, and we on Lines 16

8 to 20 talk about projects that have been funded, and

9 if I get it right, as of this morning we heard some

10 more money and new stuff that would need to be added

11 here; is that correct?

12 MS. GWIN: I think they're saying now that

13 they're committing $15 million. We'll have to check

14 the testimony and update the text.

15 CHAIR LASHOF: The text. Okay. That's

16 all I wanted to highlight, that we needed to update

17 that based on the newest testimony.

18 DR. CAPLAN: On that, it may be in here

19 and I think it is. I just forgot sort of where it is,

20 but right in this section do we want to say something

21 about interactive effects, aside from the low level?

22 PARTICIPANT: Synergistic?

23 DR. CAPLAN: Yes, synergistic. That's

24 better. Synergistic or --

25 CHAIR LASHOF: Yes, we probably should.

189

1 DR. TAYLOR: That comes somewhere later

2 though.

3 DR. CAPLAN: I think it does, but it

4 may --

5 MS. GWIN: We talk about that in Chapter

6 4 under the risk factors.

7 CHAIR LASHOF: Ah, yes.

8 MS. GWIN: But we can add it here, as

9 well.

10 CHAIR LASHOF: Okay. Anything else in

11 here, a few pages, 2-48, 2-49?

12 We have as a discussion of all the things

13 and the Czech and so forth -- we're going to get

14 hopefully more information from them on what the

15 Czechs now think or what the Czechs told DOD, right?

16 MS. GWIN: They said they would send us a

17 written report on that.

18 CHAIR LASHOF: Yes. I would assume we'll

19 incorporate something from that here. Would that be

20 where we would do it?

21 MS. GWIN: It depends on what it says.

22 CHAIR LASHOF: Yes, Holly.

23 (Laughter.)

24 CHAIR LASHOF: Mark and Holly will decide.

25 I suspect that when you send us the next draft, which

190

1 should be the final, you should send us a highlighted

2 sheet or --

3 MS. GWIN: Yes, we'll do a closeout memo

4 that shows you where the changes are.

5 CHAIR LASHOF: The changes are.

6 PARTICIPANT: Will it be in red?

7 MS. GWIN: Oh, yes, every page, all red.

8 CHAIR LASHOF: A little blue and gold

9 thrown in.

10 MS. GWIN: It will be red.

11 CHAIR LASHOF: Okay, and then we get the

12 search for evidence, and we discuss this, and again,

13 I guess this is another spot where we'll need updating

14 based on what CIA and DOD had to tell us this morning.

15 Yes, sure, Rolando.

16 MR. RIOS: I'll ask the staff. Did the

17 issue of whether or not any of these chemical weapons

18 were sold to the Iraqis by American companies -- did

19 that issue ever come up in any of your investigations?

20 DR. JOELLENBECK: We didn't consider that

21 a primary element of our investigation. We looked at

22 all of the intelligence records and operational

23 records that were available to us, but that was not a

24 primary emphasis of our investigation.

25 MR. RIOS: The reason I ask those

191

1 questions is because I'm concerned that maybe if there

2 was a cover-up, if there's any relationship between

3 the cover-up and whoever these companies were. Who

4 are they? If they did sell them these weapons, is

5 there any continued relationship between them and the

6 government? You know, those kinds of questions.

7 That's why I asked.

8 DR. BALDESCHWIELER: I think the common

9 wisdom on the subject is that there was technology

10 transfer from German and Swiss companies on the

11 techniques for manufacturing these highly toxic

12 materials and also sale of process equipment and

13 technology.

14 It's my impression that the literal

15 synthesis of the agent and loading them into weapons

16 and so forth was all done in Iraqi facilities. I

17 think the German government has, in fact, moved

18 against some of their firms that were implicated in

19 this.

20 MR. RIOS: No American firms?

21 DR. BALDESCHWIELER: I have not heard of

22 that.

23 PARTICIPANT: But is it relevant?

24 CHAIR LASHOF: Well, I was going to say I

25 think the problem is that I don't think that's

192

1 relevant to the charter and our charge of the

2 Committee, which is really to look into the illness,

3 not where did they get their weapons from and how did

4 they get them and so on.

5 So I think it's an interesting subject and

6 another committee, but not us.

7 MR. RIOS: I was just wondering.

8 CHAIR LASHOF: Okay.

9 MR. RIOS: The reason I was asking about

10 it is I'm concerned about whether or not there is some

11 connection between those companies and the lack of the

12 information coming out. Do you know what I'm saying?

13 Exposure. Once you get into the issue of exposure,

14 that's the only reason I was asking.

15 CHAIR LASHOF: I see. Okay. All right.

16 Shall we move along?

17 We then have this discussion of PGIT, and

18 a discussion of enhancing public access to information

19 and the GULFLINK material, and I guess we may end up

20 having to update some of that, but I'm not sure.

21 MS. GWIN: We have updated based on DOD

22 and CIA review the number of documents that were

23 withheld from the GULFLINK and the date that they were

24 reposted in this draft.

25 CHAIR LASHOF: Okay, good. Okay. We then

193

1 bring us to coordinating efforts and implementation of

2 external reviews, and we then come on page 2-66 to a

3 summary, and then we come to recommendations, and

4 these recommendations all to go back to all the

5 different areas that we covered, and I guess one of

6 the structural problems -- and let me ask Holly to

7 just say a few words about why she has structured it

8 so that the recommendations come as a group here

9 rather than being broken out in the different sections

10 along the way.

11 MS. GWIN: It was a judgment about how

12 people would read this. I figured there would be one

13 group of readers who would want to get straight to the

14 bottom line, and they would like to find a group of

15 recommendations to see what are my action items here

16 and what am I going to do with them.

17 But I did feel like if you were more

18 interested in the detail and the Committee's

19 justification for coming up with some of these

20 recommendation, e.g., our findings, that it was too

21 long a chapter to ask you to wait to the very end to

22 find all of the findings as well; that it was more

23 useful to the reader to find those interspersed with

24 each topic.

25 As we got through outreach, you got to our

194

1 bottom line about what we're really concluding, and

2 then -- but everything about the action items, the

3 recommendations waits till the end.

4 CHAIR LASHOF: How did people feel about

5 reading it? Did that work for them? Of course, we're

6 trying to read every word, and Holly's trying to look

7 ahead at the average reader who's going to get this

8 afterwards, and that makes it different.

9 MAJOR CROSS: I like the idea we kind of

10 broached on earlier. Instead of any change in chapter

11 format, breaking it down into three parts maybe or

12 something similar to that. Part I is an executive

13 summary for those folks that just get to the point.

14 Chapter 2 would be maybe recent information that's

15 come to light. Chapter 3 is just all of the minutia

16 background that, you know, we've accumulated in a

17 year's period. That might make it simpler.

18 MS. GWIN: What do you mean, "minutia

19 background"?

20 (Laughter.)

21 CHAIR LASHOF: Go on. I mean that's all

22 that's here. Why don't we walk through the

23 recommendation area.

24 MAJOR CROSS: More background than

25 minutia.

195

1 CHAIR LASHOF: Yes.

2 DR. LANDRIGAN: Could I offer a stylistic

3 suggestion that maybe would help?

4 CHAIR LASHOF: Sure.

5 DR. LANDRIGAN: Maybe as you go through

6 Chapter 2 and, I suppose, in subsequent chapters as

7 well, each time when you offer findings on a

8 particular point, you could just put a little sentence

9 in italics in the section on findings that

10 recommendations that flow from these findings are

11 listed on page X.

12 MS. GWIN: Okay.

13 DR. LANDRIGAN: And then --

14 CHAIR LASHOF: Then all of the

15 recommendations go at the end, but you know which

16 recommendations go with which findings.

17 DR. TAYLOR: That's good.

18 CHAIR LASHOF: I think that would be

19 helpful.

20 DR. LARSON: My main concern was having

21 the recommendations separate from the findings, but if

22 we do that, that should work. That was one problem.

23 The other is where you repeat the interim

24 recommendations. Maybe there's a way to box those or

25 something from the interim report. I don't know.

196

1 MS. GWIN: Okay. I understand the

2 confusion that it's creating, and we'll work on that

3 for the next draft.

4 DR. LARSON: Great.

5 CHAIR LASHOF: Good. Okay.

6 DR. LARSON: One specific comment on page

7 2-68, the recommendation starting in Line 27 about the

8 FDA. I wonder if there is something more we can say

9 about just soliciting public comment.

10 Now, this is a problem with FDA in a

11 variety of areas where there are tentative final

12 monographs and tentative tentative monographs and, you

13 know, interim final rules and interim interim rules,

14 and they never get resolved, it seems.

15 I'd like to make that stronger. It seemed

16 to me that when we heard testimony from the FDA, it

17 was pretty hard to sort out even if you had several

18 million dollars to spend how you would -- what would

19 be satisfactory to the FDA for answering these

20 questions, and their answer was, "Well, just send us

21 a proposal and then we'll tell you if it's

22 satisfactory."

23 And is there a stronger recommendation we

24 can make about that? I don't know how to word it,

25 but --

197

1 DR. CAPLAN: I had a comment about that,

2 too, although I don't think it's in the spirit of what

3 Elaine is asking for because it goes back in the "talk

4 some more" stage, but I thought maybe for this issue

5 with research in the military, research on the

6 soldiers, aside from just public comment, what they

7 need to do is have a sustained inquiry. I don't know

8 if that's a two-day meeting or a retreat or a couple

9 of meetings over time, but I'd like to see them

10 finally once and for all since World War II get this

11 issue seriously addressed.

12 I understand what you're saying about

13 don't just send us comments and we'll do it ad hoc and

14 we'll all figure it out. They have never really made

15 a sustained effort to take on this tough question

16 about how to do research in the military, and I'm not

17 sure if comments coming in over the transom is going

18 to do it.

19 MS. GWIN: I would just say to that we

20 haven't really prepared the background analysis that

21 would support --

22 DR. CAPLAN: Support it?

23 MS. GWIN: -- a recommendation like that.

24 DR. LARSON: Well, what do you mean? I

25 mean, we heard testimony where we asked the FDA what

198

1 it would take to resolve these issues, and they said,

2 "We don't know." So maybe they're unresolvable, in

3 which case asking for public comment isn't going to

4 help.

5 MS. GWIN: Okay. We heard testimony from

6 Dr. Lee in September that laid out they're considering

7 how to move forward with an approval process for these

8 prophylactic types of drugs. At the same time they're

9 looking at whether the interim rule should address

10 both military and civilian use of these types of

11 prophylactics, but all of the background that appears

12 in our report is specific to these CBW prophylactic

13 drugs, preventive measures.

14 What I was saying we haven't done a

15 background analysis to support is this broader

16 recommendation that FDA needs a larger, more sustained

17 effort on the issue of research on military personnel.

18 CHAIR LASHOF: Could we possibly fudge

19 that a little in the sense that we say "solicit

20 comment on the interim final rule," but then we say

21 what are the things that they need to address, and we

22 had made the case that at least the only prophylactic

23 was this, but since it really is tied to the fact that

24 they haven't looked well at the problem of

25 investigational drugs in the military -- granted we

199

1 haven't talked about that specifically -- but if we

2 could word this more around that because that the

3 interim final rule raises a number of complex issues

4 that have applicability, that we recommend that they

5 convene a group or have a conference or do a thorough

6 assessment of this, looking at all of these issues

7 rather than just asking for public comment. Would

8 that be feasible in your mind or am I making myself

9 completely unclear?

10 MS. GWIN: Joan, do you want to say

11 anything?

12 DR. PORTER: I want to make sure that I

13 understand more precisely which part of the

14 recommendations we're talking about on 2-68. I think

15 we're really mixing up two issues here.

16 CHAIR LASHOF: You're probably right.

17 DR. PORTER: And sometimes they can be

18 mixed up and sometimes they should be separated. I'd

19 like to ask if Art is suggesting that we have a

20 conference on the ethical issues surrounding waiver of

21 informed consent in military exigencies. That's one

22 possibility I hear.

23 The other issue that we seem to be talking

24 about is the issue of how do you get to an approval

25 process for drugs and biologics for which human

200

1 testing is not ethical, and I believe that the FDA has

2 taken steps in late October in having a meeting of

3 their FDA Vaccine Advisory Committee to look at

4 botulinum toxoid -- toxin -- excuse me -- toxoid

5 vaccines and what it would take to move, what kinds of

6 scientific evidence would have to be mustered to move

7 to an approval process.

8 So I think they are moving in that

9 direction and having public fora to discuss those

10 types of issues, but I have not seen any particular

11 public discussion on this more discrete issue of

12 waiver of informed consent.

13 DR. CAPLAN: Yes, it's the form that

14 interests me, and in fact, I think from my point of

15 view they can as a regulatory agency set out

16 procedures as to how they want to respond when they

17 have less evidence or can't move certain

18 investigational things through.

19 I'm not as worried about the public

20 comment. I mean there can be reaction and dispute and

21 so on, but the former question, when do you waive

22 informed consent, how do you notify, how do you follow

23 up, what do you owe, whether it's just a case study of

24 PB or anthrax vaccine that triggers it, they still

25 have not -- not that they haven't -- no one has had a

201

1 sustained look-see at this.

2 So that seems to me to still be here, and

3 if we just say, "Well, send your comments to us," I --

4 DR. PORTER: It would seem that adjusting

5 that recommendation to say public comment and open

6 discussion, open public discussion, you want to narrow

7 the method by which they have public input. Is that

8 the idea?

9 DR. LARSON: I'd like to see it go a step

10 further than that. It's not just having a forum, but

11 it's moving in a timely manner to set out procedures

12 and policies that would provide some direction. I

13 mean it's not just having discussions, but it's giving

14 some guidance.

15 It seems to me, in all fairness to the

16 military, what could they do without additional

17 guidance on what information is needed and how to

18 proceed? So I think saying solicit public comment and

19 have open forums is too weak. It should also be moved

20 in a timely manner or maybe even more specific, to set

21 out or to delineate --

22 DR. CAPLAN: Or convene an advisory -- I

23 mean we've got advisory panels spinning out so there

24 will be no unemployment in the nation with all of our

25 advisory panel recommendations, but we could get one

202

1 here, even so far as to say convene it and do it

2 publicly.

3 DR. LARSON: My point is that they could

4 solicit public comment for the next six years, and it

5 would be still --

6 DR. CAPLAN: Yes, it would be no place.

7 DR. LARSON: -- not resolve the issue of

8 concern.

9 DR. CAPLAN: Exactly.

10 CHAIR LASHOF: Okay. Why don't we leave

11 this to Joan and Holly to take another crack at

12 tightening up things in this area? Is that enough

13 guidance or not?

14 MS. GWIN: Acting in a timely manner is

15 strong enough for you? You're not interested

16 particularly in setting a deadline?

17 DR. LARSON: I was just trying to say what

18 my concern was, that it's more than getting public

19 comment. It's doing something about it, and I

20 don't -- you can work on that.

21 CHAIR LASHOF: Okay. You'll work on it.

22 We've got it.

23 Okay. Anything else, recommendations, in

24 this area? Then we come to the recommendations of the

25 research. We have a research working group, and then

203

1 I think the research -- does anybody have anymore

2 recommendations or any concerns about any of the

3 recommendations on research before we move to chemo.

4 and biological weapons again?

5 If not, let us take a good, hard look at

6 the ones on chemical and biological weapons.

7 Yes, John.

8 DR. BALDESCHWIELER: I agree with the tone

9 of the recommendations. I think, however, that you're

10 getting into some of the nuts and bolts of how one

11 literally does a plume analysis, a plume modeling, and

12 I'd be more comfortable by leaving some of the details

13 out.

14 For example, in the first diamond if you

15 were to stop with the following, "where objective,

16 unrebutted evidence suggests the release of chemical

17 warfare agents in the vicinity of U.S. troops, every

18 effort should be made to identify the source of the

19 agent and to model the downwind footprint of the

20 potential distribution of the agent," period.

21 It seems to me that suggesting the

22 specific choice of exposure level is in a sense

23 anticipating what a good modeling effort will do

24 because there are several different choices for

25 exposure levels.

204

1 And it seems to me also there are a number

2 of other choices one has to make in the modeling

3 study, the decay lifetime of the agent itself, the

4 fluid mechanics, b the amount of material that's

5 destroyed in the fire or explosion, and so it seems to

6 me a lot of those things have to be part of the

7 modeling study itself.

8 I make this same comment on the second

9 diamond where you say, "When a downwind footprint is

10 established, a conservative presumptive exposure area

11 should be defined that reflects the uncertainties of

12 the modeling effort." I would put a period there

13 rather than telling the reader just how to define a

14 conservative view of the plume because it seems to me

15 there will be cases where you don't want to do what's

16 suggested here.

17 CHAIR LASHOF: Mark, do you want to

18 comment?

19 DR. BROWN: Well, in principle, of course,

20 I agree with you. You'd want to use the best data

21 that you had available, but I'm sure you remember that

22 there's a history behind these specific

23 recommendations.

24 DR. BALDESCHWIELER: Sure, absolutely.

25 DR. BROWN: In the case of the general

205

1 population exposure limits, the idea behind

2 recommending those, that relatively very low exposure

3 level was that initially, as you recall, PGIT and

4 Department of Defense was very reluctant. They wanted

5 to use an exposure level that would have involved

6 acute effects, which is manyfold higher.

7 The point is by selecting, you know,

8 obviously you bias the results depending on the types

9 of parameters that you choose, and we're trying to be

10 specific int his recommendation to pick the most

11 conservative estimates rather than the least

12 conservative.

13 DR. BALDESCHWIELER: No, and I agree. I

14 think when you say "choose the most conservative

15 possible approach," that's sufficient because there

16 might be other exposure levels. There's an

17 occupational exposure level, and we --

18 DR. BROWN: This is the lowest. We

19 hunted.

20 DR. BALDESCHWIELER: Yes, and we heard,

21 you know, another approach to achieve the same result

22 this morning, which was to make the most conservative

23 estimate and then, you know, increase the radius by a

24 factor of two, which increases the exposure area life

25 by a factor of four.

206

1 And so it seems to me that I think the

2 general principle is sufficient here without putting

3 in one choice of a few of the factors.

4 CHAIR LASHOF: Well, may I suggest, John,

5 trying to get at both your concern, but Mark's concern

6 that they not set it so high, that it's so narrow and

7 since that's where they started and part of our whole

8 problem was if they weren't acutely ill, they weren't

9 exposed, was what we've worked hard over a year to get

10 them beyond, to say something rather than defining the

11 specific one, but the potential distribution of the

12 agent at the most conservative feasible level or

13 something like that, and it would be important to err

14 on the side of conservative or lowest level.

15 DR. TAYLOR: Right, because my problem is

16 if you just leave it at distribution of the agent,

17 then you have the same problem that Mark is referring

18 to.

19 CHAIR LASHOF: If we didn't have a history

20 of what they had done.

21 DR. BALDESCHWIELER: It's in the second

22 diamond when he says, "When a downwind footprint is

23 established, a conservative presumptive exposure area

24 should be defined." It seems to me that really covers

25 what we want them to do without telling them exactly

207

1 the choice of the parameters.

2 DR. BROWN: Well, but --

3 PARTICIPANT: That's just the area.

4 DR. BROWN: -- I guess the thing is that

5 there's a history. I guess "conservative" means

6 different things to different people, and I think PGIT

7 was in their own minds making, for instance, a good

8 faith effort when they were using the criteria. I

9 think that they would have said that they were using

10 a conservative estimate at the time.

11 I don't know. I guess it boils down to

12 how prescriptive you feel we need to be when we say

13 "conservative."

14 CHAIR LASHOF: And the second one is

15 talking about the footprint, the size of it, what

16 area. Well, I guess they both are. What is the

17 difference between Diamond 1 and Diamond 2 in terms of

18 the conservative presumptive exposure versus the

19 potential distribution?

20 MS. GWIN: The first diamond tells you

21 what level of exposure you should be concerned about.

22 The second diamond says how you should expand the

23 modeling effort to establish a cautious exposure zone.

24 It suggests you take the footprint resulting from the

25 model and expand it as a circle.

208

1 So it's what level you use and then how

2 far you expand the exposure.

3 CHAIR LASHOF: Yes.

4 DR. BALDESCHWIELER: I think it's a little

5 different, Holly. I think the first one says that you

6 should try to identify the source of the agent and you

7 should do a model.

8 MS. GWIN: That creates a footprint.

9 DR. BALDESCHWIELER: Yes, and the second

10 one says that it should be a conservative model, and

11 I think those are both the right messages, but that

12 you shouldn't clutter it with some of the nuts and

13 bolts but not all the nuts and bolts.

14 CHAIR LASHOF: No, but I think Holly's

15 right though, John, that in the first one you're

16 saying to identify the source of the agent and to

17 model the downward footprint.

18 DR. BALDESCHWIELER: Exactly.

19 CHAIR LASHOF: Of the potential

20 distribution of the agent, and it talks about the

21 exposure level, and I think you could say there at a

22 lowest feasible or some other language that's broader

23 than just saying the general population exposure

24 level, although he says, "Or lower threshold if

25 available."

209

1 The lowest available threshold, maybe you

2 should say "distribution of the agent at the lowest

3 available threshold."

4 DR. BALDESCHWIELER: Well, that has

5 trouble, too, because --

6 CHAIR LASHOF: That's awful.

7 DR. BALDESCHWIELER: -- that's zero, and

8 you can't --

9 CHAIR LASHOF: Yes.

10 DR. BALDESCHWIELER: So the footprint

11 covers the --

12 CHAIR LASHOF: But then the next one says

13 given that exposure, given that you've taken some

14 exposure level, then how big an area do you cover.

15 DR. BALDESCHWIELER: Well, no, no. The

16 exposure level defines the area.

17 DR. BROWN: The exposure level defines the

18 area, and this exposure number was picked for a very

19 specific reason. It's numbers developed by the

20 Department of Defense itself for protection of the

21 general population. I'm sure that there are lower

22 numbers generated by other groups that have an

23 interest and concerns about chemical exposures, for

24 instance, but this one was generated by the relevant

25 agency for protection of the most vulnerable segment

210

1 of our population. So it seemed appropriate to use

2 it, to choose it as the most conservative, specified

3 as the most conservative number.

4 DR. LARSON: John, what's the down side of

5 keeping it the way it is?

6 DR. BALDESCHWIELER: It's just that you've

7 chosen one or two parameters in a very complex model,

8 and they all interact, and so, you know, if I were a

9 modeler, I would not like to have that constraint.

10 DR. BROWN: Well, maybe we can try and --

11 I mean, I see your point. You could say the most

12 conservative wind numbers, too. We can work on this,

13 I think.

14 DR. NISHIMI: But I would like to get the

15 Committee's sense, and I wasn't going to interject,

16 but you know, I can't help myself sometimes.

17 I think the staff needs to get a clear

18 sense of how the Committee feels about being this

19 prescriptive because these are two very key issues.

20 I mean, I agree with you, John, that there are many

21 elements of the models, but the two key factors are

22 the exposure level and then the area, and it is

23 staff's concern that the threshold that PGIT and the

24 Department of Defense have used in the past has either

25 been nonexistent or a moving target, and so I really

211

1 do think it is important for the Committee to, you

2 know, make a judgment here, prescriptive/not

3 prescriptive.

4 DR. LARSON: Well, one alternative would

5 be to just acknowledge what John just said, that there

6 are a number of parameters, but that the modeling

7 should include at least the following, something like

8 that.

9 CHAIR LASHOF: I think, in other words --

10 let me see --

11 DR. BALDESCHWIELER: Yes, I agree

12 completely.

13 CHAIR LASHOF: Would you buy that?

14 DR. BALDESCHWIELER: I agree completely

15 with the spirit of the recommendations, and my only

16 quibble here is that it, I think, is counterproductive

17 to define, you know, one or two of the detailed

18 parameters in the recommendations.

19 DR. BROWN: Well, what about Dr. Larson's

20 suggestion that we just acknowledge that there are

21 many parameters, but that we're calling out these

22 parameters to be prescriptive? Is that --

23 DR. BALDESCHWIELER: I would suggest

24 giving it a try.

25 CHAIR LASHOF: Okay. Give it a try.

212

1 Bounce it off with John and --

2 DR. NISHIMI: So let me just clarify here

3 then. We'll acknowledge that there are many other

4 parameters and that we are calling specific attention

5 to two of these. We are prescribing specific

6 parameters at minimum, and we'll work with that kind

7 of language. Is that where we're sort of at now and

8 then run it by?

9 DR. BALDESCHWIELER: That's too much. I'm

10 not sure we're smart enough to do just what you said.

11 DR. TAYLOR: Well, then make a suggestion.

12 DR. BALDESCHWIELER: What I would suggest

13 is a period after "agent" and crossing out the rest of

14 the --

15 CHAIR LASHOF: Yes, but I think the rest

16 of us aren't quite comfortable being that

17 unprescriptive to DOD given the past history of how

18 they've handled this. So we want to be a little more

19 prescriptive than just stopping and saying should

20 identify the source and model an agent, period. We

21 need a little more.

22 Andrea, do you have other wording you

23 would like?

24 DR. TAYLOR: Phil does.

25 CHAIR LASHOF: Phil.

213

1 DR. LANDRIGAN: This is more of a question

2 than a comment. Within the footprint that they'll

3 create, I presume they must have the technology to

4 indicate gradations of concentration within that

5 footprint or is it all or none?

6 MS. GWIN: Yes, the CIA has actually

7 published that for Bunker 73, a gradation all the way

8 out to the general population exposure level back to

9 lethal.

10 DR. BROWN: That defines a series of

11 contours and for the lower exposure level you get a

12 larger --

13 DR. LANDRIGAN: Some of isopleths?

14 DR. BROWN: Yes.

15 DR. LANDRIGAN: Okay. That's obviously

16 important if they go on to do health studies.

17 DR. BROWN: And maybe that's the route to

18 a constructive approach here, that one should define

19 a series isopleths, of contours relating to different

20 exposure levels.

21 CHAIR LASHOF: Okay. All right. That

22 would do it. Is that okay, Mark? Do you get enough

23 guidance that you think you can work something out

24 with John?

25 DR. BROWN: I think I understand the sense

214

1 of this now.

2 DR. NISHIMI: I understand the sense, but

3 I really would like to know are we going with some

4 level -- contours is general, again, and I really need

5 the Committee to come to closure here on this issue of

6 actually specifying at either a minimum or include

7 this notion of general population exposure level.

8 DR. LANDRIGAN: The suggestion they do it

9 by contours still doesn't get at the issue of where's

10 the outermost contour.

11 DR. NISHIMI: That's correct, and I really

12 would like the Committee to struggle with this.

13 DR. BALDESCHWIELER: To do a successful

14 model, you have to understand how long the agent stays

15 around and the rate at which it would be based, and

16 that depends on the conditions of sunlight and

17 moisture, and so there are all kinds of things in

18 these models.

19 DR. LARSON: I think we should be

20 prescriptive and explicit about certain minimum

21 levels.

22 DR. BALDESCHWIELER: Well, I think the

23 first sentence of the second diamond is beautiful. It

24 says, "The area should be defined that reflects the

25 uncertainties in the modeling effort." That's exactly

215

1 what we want, isn't it?

2 DR. NISHIMI: But one person's

3 uncertainty, John, is another person's certainty, and

4 the sense of the staff is, and a little bit of the

5 Committee and that's why I'm pressing here, is that

6 some level of, you know, lower threshold needs to be

7 explicitly stated by the Committee because the history

8 has been a moving target.

9 DR. LANDRIGAN: Could I add something

10 here?

11 CHAIR LASHOF: Sure.

12 DR. LANDRIGAN: You have to remember that

13 there's a third dimension here, and that's time. I

14 guess it's the third. At least it's the second, and

15 the concentration that existed in the first hour after

16 the detonation is almost certainly not that that

17 existed six hours later, which was probably different

18 from that that existed 24, 40 hours after that, and

19 then finally one presumes that it gets down to nil.

20 And if you approach this working backwards

21 from the perspective of an epidemiologic study, what

22 you'd really want to know for a particular veteran or

23 a particular platoon, say, is you'd really want to

24 know the time integrated exposure, which of course is

25 the product of the -- it's the summed product of the

216

1 concentrations at a particular point over a particular

2 period of time. That's assuming that the soldier

3 doesn't move.

4 So that when you really get -- I don't

5 think we want to get into this in here at all, but

6 when you really get down to it, what you want is a

7 family of maps that represent different slices of

8 time, and within each map you want isopleths, and then

9 there remains the question that Robyn has raised. Do

10 you specify the outer margin, the final limit down to

11 which you want them to carry the analysis?

12 CHAIR LASHOF: What if one kind of --

13 well, go ahead, Jim. See if you can try something.

14 DR. CASSELLS: This recommendation, as I

15 see it, does not prescribe the totality of the

16 modeling efforts that should be made. What it does is

17 lay out what you look at in assessing the extent of

18 possible exposure. It codifies, if you will, the

19 approaches that have been taken to date by the CIA and

20 the Department of Defense to do worst case analyses of

21 the various releases.

22 This is not an effort to say this is the

23 only way you analyze it, this is the only set of

24 contours that you draw, but when you are presented

25 with a release scenario, this is the methodology that

217

1 staff believes is the appropriate one to assess the

2 extent of possible exposure.

3 DR. CAPLAN: What about changing one word

4 in here from "should model the downwind footprint of

5 the agent" instead of "at the general population

6 exposure level" to "including the general population

7 exposure level"?

8 CHAIR LASHOF: No.

9 DR. CASSELLS: That's fine.

10 DR. CAPLAN: Because that gets you --

11 DR. CASSELLS: I do not think that that

12 changes -- I mean Dr. Landrigan's comments about the

13 time and concentration components are exactly

14 accurate, and that is what the models that generate --

15 DR. LANDRIGAN: You think that level of

16 detail sounds absurd, but, in fact, that's precisely

17 what we had to do when I was in the Public Health

18 Service when we did time integrated exposure models

19 relating cumulative dose of benzene in workers to the

20 ultimate risk of their developing leukemia, and it was

21 about a four-year effort. It's not trivial, of

22 course.

23 DR. CASSELLS: Yes, and I understand that,

24 and I think this thing is drafted now to allow, you

25 know, those kinds of more in depth analyses as

218

1 information is developed about particular sites.

2 But when you're presented with an exposure

3 release scenario, these are the conservative, prudent

4 approaches that the Committee in its work with both of

5 these agencies has been presented.

6 CHAIR LASHOF: Would either or any of you

7 be satisfied if this went something like, "In the

8 models, the most conservative approach would be taken

9 to the various parameters," you know?

10 DR. NISHIMI: I think you really have to

11 go prescriptive/not prescriptive.

12 CHAIR LASHOF: Okay.

13 DR. NISHIMI: I think the notion the

14 government should adhere, you know, should include at

15 minimum. I mean I think we can acknowledge this sort

16 of range of other parameters, but I really would like,

17 like I said, some --

18 DR. TAYLOR: So if you say at minimum

19 general population exposure level or lower threshold,

20 doesn't that take care of it all, John? And that's

21 more prescriptive, right? That sounds fine.

22 DR. BROWN: It works for me.

23 CHAIR LASHOF: Will it work for you, John?

24 DR. LANDRIGAN: I mean, to borrow language

25 from another field, suggest that they use best

219

1 available technology to model exposures over time down

2 to the lowest limit of detection.

3 DR. BALDESCHWIELER: Well, lowest limit of

4 detection is another set of problems.

5 DR. BROWN: That would be quite -- I mean,

6 the limit of detection with the available equipment

7 was much higher than this.

8 Well, you can't tell them to do it lower

9 than the best equipment.

10 DR. BALDESCHWIELER: You know, what you

11 said here is quite good, and one has models with lots

12 of uncertainties, and it seems to me one should have,

13 you know, a conservative -- use the conservative

14 outcomes for --

15 CHAIR LASHOF: Go ahead, Mark. One more

16 try.

17 DR. BROWN: Just to recap the idea, I

18 agree with you completely in principle, but this

19 particular situation has a history that it struck many

20 of us that requires this kind of prescriptive language

21 to avoid using assumptions which would shrink the

22 footprint to something much, much smaller than what --

23 and as Jim pointed out, this has a history. It's been

24 used. This is the approach -- as Jim pointed out,

25 this is in a sense just sort of vetting what the CIA

220

1 has done with its modeling as being a reasonable first

2 shot.

3 It doesn't preclude the possibility of

4 doing better modeling with the best available data,

5 integrating exposure, for instance, to figure out --

6 CHAIR LASHOF: Let me suggest that I get

7 the sense that most of the Committee who are not

8 experts in this area -- you who are discussing it are

9 the experts -- do feel that we need some level of

10 prescription just because of the history, and, Mark,

11 make another crack at trying to get that in a way and

12 bounce it off both John and Andrea and Phil and see if

13 the four of you even if it takes a conference call can

14 come up with something or fax some wording around that

15 would give us some degree of prescription, but satisfy

16 some of your concerns. Okay?

17 DR. BROWN: We can pay for the call.

18 CHAIR LASHOF: Pardon?

19 DR. BROWN: We can cover the call.

20 CHAIR LASHOF: Okay. Thanks.

21 Anything else on page 2-71 on

22 recommendations?

23 Yes, go ahead.

24 DR. TAYLOR: I don't want us to leave the

25 last one. We had talked about this earlier

221

1 regarding --

2 CHAIR LASHOF: The bottom one. That's

3 right.

4 DR. TAYLOR: The bottom one.

5 CHAIR LASHOF: That's what I was looking

6 for.

7 DR. TAYLOR: Okay.

8 CHAIR LASHOF: Okay.

9 DR. TAYLOR: Where it says, "To insure the

10 credibility and thoroughness, any further

11 investigation of possible chemical or biological

12 warfare agent exposures during the Gulf War should be

13 conducted by a group independent of DOD."

14 CHAIR LASHOF: Okay. This brings us

15 exactly to where we were on the other discussion and

16 what we heard this morning. Does this require any

17 modification or does it stand as is?

18 MAJOR KNOX: Well, I think we had

19 mentioned before that maybe we would want this to be

20 in an open, public hearing. Would that be --

21 CHAIR LASHOF: Yes, adding a statement

22 that it must assure that all investigations be done in

23 the sunshine with open hearings and oversight

24 investigation or something about oversight

25 investigation and in the sunshine and openness, that

222

1 we have to add something more there.

2 MAJOR CROSS: In light of the new

3 initiatives that DOD mentioned this morning, I'd be

4 almost willing to scrap this recommendation. Just

5 rewrite it altogether.

6 DR. TAYLOR: I have a problem with that

7 because one is we've talked about these are

8 initiatives that DOD says they are starting. This has

9 not yet been done. So I believe that we still need

10 some sort of independent advisory group or group to

11 investigate possible chemical or biological warfare

12 agents that's separate from any governmental agency.

13 DR. CAPLAN: Why can't we go for something

14 like "should be conducted under the supervision of" or

15 "with accountability to a publicly" whatever the word

16 is, Sunshine or open body?

17 They told us why some of the investigation

18 is going to have to come from inside DOD.

19 DR. TAYLOR: Sure. We agree with that,

20 yes.

21 DR. CAPLAN: And then the question is:

22 who are they accountable to besides DOD? And it seems

23 to me we want some form of non-DOD based body to have

24 supervision over what they're doing. That's the

25 sentiment.

223

1 CHAIR LASHOF: What if we added something

2 to the sentence? Leave that sentence there, "should

3 be conducted by a group independent of DOD," but try

4 to write an explanatory sentence that would explain

5 what we mean by "conducted," like saying something

6 like we recognize that much of the investigative

7 legwork must be done by the agency, but to assure

8 credibility it must have oversight by an independent

9 body.

10 Do you think that would do it?

11 DR. LARSON: Why couldn't we just add to

12 the sentence "should be conducted with oversight by a

13 group independent of DOD"?

14 MS. GWIN: Okay. I think we can --

15 DR. LARSON: We have the sense of it.

16 MS. GWIN: We can craft a sentence that

17 recognizes the need for oversight and openness.

18 CHAIR LASHOF: Okay.

19 DR. LANDRIGAN: Given that the DOD

20 proposed a plan this morning, do we have to offer any

21 comment on that plan?

22 CHAIR LASHOF: That, I think, was the next

23 question I was going to ask. Do we leave it that it

24 should be open and oversight and conducted under the

25 aegis of or whatever language staff feels they can

224

1 work out that preserves the fact, but recognize that

2 DOD is going to have to do some of the legwork, that

3 it's got to be open, that we've got to have oversight

4 and accountability, and we feel strongly about that?

5 Do we need to comment upon their particular proposal

6 that it be via the Academy of Sciences and the

7 Institute of Medicine? Do we think that's the

8 appropriate body or do we want to leave that for the

9 President and DOD to figure that out?

10 DR. LARSON: I'd like to make a comment

11 about that, but I need to preface it by saying that I

12 am on the Governing Council of the Institute of

13 Medicine, and with that preface, I need to say that I

14 think that is an inappropriate place for the panel

15 that is proposed on page 12 of Dr. White's statement

16 where he says that this panel would oversee the

17 operations incident investigating program and play an

18 ombudsman role. That's not the role or the function

19 of the National Academy of Sciences or the IOM. It is

20 not an oversight group and should not be.

21 I believe we need one, but the IOM and the

22 Academy is not the place for it.

23 MS. GWIN: Would that kind of --

24 DR. LARSON: But I think we should say

25 something about that proposal.

225

1 MS. GWIN: -- statement fit better in the

2 background than in the recommendation itself?

3 DR. LARSON: Well, I'm not saying we need

4 to change this specific recommendation, but I do think

5 we need to make comment about the proposed plan this

6 morning, which it seems to me is inappropriate.

7 CHAIR LASHOF: And I guess what Holly is

8 saying is in the background, in the findings section

9 would be the place to discuss the fact, update the

10 background with a statement about DOD proposes to do

11 the following, concern as to whether the Institute of

12 Medicine or the Academy is an appropriate body for

13 such oversight or raise question about it or

14 something.

15 MS. GWIN: The text right now on page 2-59

16 just barely alludes to the fact that they've announced

17 some new organizational changes and that we don't

18 think these changes alone can restore DOD's

19 credibility on these issues.

20 We could include some detail.

21 CHAIR LASHOF: Let me come up with the

22 page.

23 MS. GWIN: Page 2-59.

24 CHAIR LASHOF: Page 2-59.

25 MS. GWIN: Lines 3 through 5.

226

1 CHAIR LASHOF: Three, okay.

2 MS. GWIN: Is a place where we could

3 insert some more detail about the testimony that Dr.

4 White provided today in terms of Dr. Rostker's new

5 work and Dr. Joseph's new role, and we could mention

6 the IOM, but what I would want to find out from you

7 now is whether you would want to comment specifically

8 on IOM is not the appropriate body to do this.

9 CHAIR LASHOF: Use your mic. Can't hear

10 you, Don.

11 DR. CUSTIS: It seems to me we're

12 anticipating what Ken Shine responded. It may well be

13 that he's modified the Institute's criteria.

14 DR. LARSON: All I'm saying is that I

15 think we agree that there needs to be some oversight

16 independent of DOD, and what I'm saying is the

17 function of the Institute of Medicine in their mission

18 -- I mean, I'm sure that Ken Shine will say this -- it

19 is not to be a political body or an oversight body for

20 supervising.

21 DR. CUSTIS: I think it's for Ken Shine to

22 say this.

23 DR. LARSON: Fine.

24 DR. CAPLAN: That may be, but I'd like to

25 go on record to say that I don't think the Institute

227

1 of Medicine is the appropriate place for this,

2 whatever the Institute of Medicine thinks, because I

3 think what we want staff to do is come up with not so

4 much the location as the features of accountability.

5 One is that there should be veterans'

6 input into how this investigation goes. The only way

7 they're going to be credible is if there are people

8 who have served, who are not in active duty, who can

9 come from the veterans organizations and be persuaded

10 that they've given it a thorough investigation, and

11 who better to act in the ombudsman role?

12 Second, I think there should be some

13 continuity from this group that we're sitting in to

14 their group, and I mentioned earlier that I thought

15 that might come through some of the staff, but I think

16 continuity is important.

17 If you give it to the IOM, it'll take them

18 a year to figure out what this investigation is.

19 They're not going to be able to hold to account to

20 anything. Our staff is in a little better position to

21 do that than almost anybody else I can think of.

22 And, third, it seems to me it should have

23 some lay accountability, that is, just citizens, maybe

24 not as big as our advisory group, but something like

25 that.

228

1 Part of this is a trust issue. It's not

2 just are they doing it right, but are they doing it

3 thoroughly? Can we hold them to account?

4 So I don't care who's got it, where it is.

5 I'm more interested in does it have these features.

6 does it have veterans' input? Does it have public

7 input? Does it have some continuity to us?

8 DR. NISHIMI: But I think it's important

9 for the Committee to consider that the Department of

10 Defense has come forward with some very specific

11 proposals, and that I would agree with Elaine that it

12 is within the realm for you to comment on the

13 suitability of those proposals, and so I guess the

14 staff would appreciate guidance on whether or not you

15 wish to do that vis-a-vis their proposal for CBW

16 investigations.

17 DR. LANDRIGAN: I think the statement on

18 page 2-59, Lines 4 and 5, I think it's too harsh,

19 where the short paragraph there says, "DOD has

20 recently announced some organizational changes related

21 to the department's work on Gulf War veterans. The

22 Committee doubts that these changes alone can restore

23 DOD's credibility."

24 I just think it takes away any degrees of

25 freedom that we have in later recommendations.

229

1 MAJOR KNOX: Maybe this would be a place

2 that we could insert Dr. Hamburg's comment that he

3 wanted to put in the very beginning in Chapter 2.

4 DR. BALDESCHWIELER: I think it's a

5 mistake to, once again, micromanage the details of the

6 DOD response, and I guess it's not clear to me that

7 the Academy is such a bad place. At least for years

8 there's been a committee of the Academy in the

9 National Research Council that's dealt with, for

10 example, the destruction of chemical weapons. It's

11 been a long-term committee. There's a lot of

12 expertise in that group. I think it has provided

13 effective oversight, you know, for a huge government

14 program.

15 DR. TAYLOR: I guess the biggest question

16 would be the Academy, it's my understanding, and IOM

17 is sponsored by the Department of Defense.

18 CHAIR LASHOF: No, no, no.

19 DR. TAYLOR: No?

20 CHAIR LASHOF: No, no, completely

21 independent.

22 DR. NISHIMI: The studies would be.

23 DR. TAYLOR: The studies would be.

24 CHAIR LASHOF: The study would be funded

25 and the Academy would get its money from a contract

230

1 with DOD, but the Academy and the Institute are

2 entirely separate.

3 I think -- let me join Elaine in this and

4 John in this discussion. I mean there are a number of

5 us on this Committee who are also on IOM. You are,

6 David is, Phil is, I am an emeritus member. I was on

7 the council, too.

8 In my experience, I have never seen IOM

9 take the responsibility for overseeing an actual

10 investigation like this, where we're asking DOD to

11 investigate all possible previously 2-56 and Fox and

12 very specific things we're asking them to investigate.

13 I mean we want it investigated, but they're saying

14 they really need to do that sort of thing. They have

15 the staff and the expertise, and we're saying but we

16 want it open, we want it accountable, and so on.

17 I've not in my history known IOM to do

18 that sort of thing. I think where IOM fits --

19 PARTICIPANT: Joyce, I have an historical

20 question.

21 CHAIR LASHOF: -- is in the broader -- is

22 that wrong? Good, David.

23 DR. HAMBURG: We're talking a lot of

24 foolishness here. In the first place, I really feel

25 we shouldn't micromanage. I think there ought to

231

1 be -- Art's approach of criteria is better, although

2 I don't entirely agree with the criteria he set

3 forward. I think they're too limited, but

4 nevertheless, if you say criteria and then there's an

5 attempt to find or modify or create an institution,

6 you know, we're talking about hypothetical ideals. If

7 not the Academy, what? Are you going to invent an

8 institution that would have anything like comparable

9 credibility?

10 Maybe you will, but as far as the

11 institution itself goes, there's enormous flexibility.

12 First of all, it's not just the IOM. It's the IOM and

13 the NRC, the National Research Council complex, which

14 does things like this, has for a long time, going back

15 to the effects of the bomb in Japan. There are all

16 kinds of activities.

17 Furthermore, the IOM itself is an evolving

18 institution. It does a lot of things now that it

19 didn't do 20 years ago, but if you take the whole

20 Academy complex, it could provide a lot of this, but

21 I don't see any reason for us to prescribe it or

22 certainly not to rule it out. It seems to be very

23 presumptuous of us to say that institution wouldn't

24 do.

25 Then what institution do you suggest?

232

1 We're talking about some hypothetical ideal. It's

2 very hard to meet all our criteria. Do you want the

3 DOD to create a new institution that would have

4 immense credibility? I don't. I mean, I think we

5 ought to try to set out some criteria and let them try

6 to work it out with the Academy. If that works, that

7 in my judgment would be the best option, but if it

8 doesn't work, let them find an alternative.

9 I haven't heard an alternative suggested.

10 What would it be? Maybe you could imagine that some

11 university or university consortium could do it. I

12 don't think you'd want to contract with private

13 industry to do it. Maybe in the present rage for

14 managed care you'd get a managed care institution to

15 do it.

16 So I think we're getting pretty airy here

17 about it, and I would rather take some criteria, let

18 the staff work out a reasonable statement of what

19 needs to be done, and then urge them to negotiate to

20 find a suitable institution to do it.

21 DR. LARSON: Fair enough, and I thought

22 that that's what the staff did in Section D. They

23 outlined six criteria, and I thought really that --

24 CHAIR LASHOF: Where are you?

25 DR. LARSON: I'm in Section D.

233

1 CHAIR LASHOF: Section D?

2 DR. LARSON: Yes, locus for follow-up.

3 CHAIR LASHOF: Oh, oh, that's for follow-

4 up, but that's for follow-up of our recommendations.

5 DR. LARSON: Oh, okay.

6 CHAIR LASHOF: This is just very specific,

7 investigation --

8 DR. LARSON: Just about the investigation.

9 CHAIR LASHOF: -- of chemical and

10 biological weapons.

11 DR. LARSON: Okay.

12 CHAIR LASHOF: And I agree, David, and I

13 appreciate -- what I was saying, that if we give

14 criteria and if we include the whole complex of the

15 Academy, then I would agree that there are examples of

16 where the Academy, the NRC, and the whole works has

17 done it, although I wasn't familiar of any time that

18 IOM per se had done this sort of thing, but --

19 DR. HAMBURG: That would be collaborating.

20 CHAIR LASHOF: Yes. Phil.

21 DR. LANDRIGAN: I was on a committee that

22 met very briefly that oversaw the Ranch Hands study

23 under Lynn Kirlan, an IOM committee.

24 PARTICIPANT: The ranch?

25 DR. LANDRIGAN: The Ranch Hands were the

234

1 people who applied Agent Orange in Vietnam, and we

2 convened. We had I think it was two meetings in the

3 space of a month, and we basically reviewed,

4 critiqued, and ultimately approved the Air Force

5 protocol for conducting that study.

6 CHAIR LASHOF: Yes, but that, again, was

7 critiquing and approving an epidemiologic study. Here

8 we're trying to say: are they really digging into all

9 the files? Have they looked at every 256 kit? Have

10 they looked at every Fox and are they doing that in

11 the open? Are they involving the veterans? Are they

12 convincing the world that they are looking for any

13 other possible Khamisiyah?

14 That's what we really want out of this,

15 isn't it?

16 DR. BALDESCHWIELER: And the NRC complex

17 certainly has the machinery to do this.

18 CHAIR LASHOF: Okay.

19 DR. BALDESCHWIELER: And have done it in

20 the past.

21 CHAIR LASHOF: Okay, all right.

22 DR. CAPLAN: Well, again, I don't care

23 where it goes. It seems to me the features are

24 accountability, credibility. I will say you can bring

25 all the scientific expertise to bear you want. You

235

1 can have it in the lobby of the National Academy of

2 Sciences every day. If there's no vet oversight, if

3 there's no public participation, if it's not done

4 somewhat in the open, I don't think that will assure,

5 sadly, but I don't think it will assure --

6 DR. HAMBURG: Let me respond to

7 stereotypes. The Academy has plenty of open hearings.

8 The IOM, indeed, pioneered in opening up many, many of

9 the activities. It doesn't mean that there are no

10 private meetings. I would urge that it's very

11 important to have some private meetings on technical

12 content, but certainly there's plenty of opportunity

13 for that.

14 Furthermore, all kinds of community

15 service organizations and others have been represented

16 on IOM and NRC committees.

17 DR. CAPLAN: Right. No, I know that,

18 David. I'm only saying we might urge these criteria,

19 and then how IOM or somebody else works it out with

20 them is fine with me. I just think those features

21 should be there.

22 CHAIR LASHOF: What I think I'm hearing is

23 that we should be silent on pro or con IOM, NRC, NAS;

24 that we recognize that DOD has the kind of sentence

25 before that we fit in here, that they've moved ahead

236

1 with having a number of proposals that we think can

2 restore credibility or have the potential to restore

3 credibility or any way we want to word that; but then

4 under the recommendations where we talk about

5 independent, we state something about they --

6 DR. TAYLOR: Should be conducted with

7 oversight.

8 CHAIR LASHOF: With oversight, with

9 openness, and so on, and then the question is how much

10 other detail do you want in that oversight

11 organization, and it's just that the oversight must

12 include veterans, et cetera, et cetera, or just leave

13 it that it's oversight that's open, that will have

14 credibility.

15 DR. TAYLOR: If you leave as with

16 oversight by a group independent of DOD, that should

17 be enough, shouldn't it?

18 CHAIR LASHOF: I'm asking.

19 DR. HAMBURG: Well, I don't think so

20 because it could be a private consulting firm. You

21 think of all the private consulting firms that DOD

22 deals with.

23 DR. TAYLOR: That's right.

24 DR. HAMBURG: I'm not saying -- I don't

25 want to denigrate the private consulting firms. Some

237

1 are very good, and some not so good, but that would

2 not be my idea of a credible oversight.

3 DR. TAYLOR: That's right.

4 DR. HAMBURG: So you need some kind of

5 criteria, as well.

6 CHAIR LASHOF: Okay. Criteria? The kinds

7 that Art put forward? Is there a sense that people

8 feel that we could ask staff to draft something here

9 that would include the chronic criteria and we're

10 silent on what group has that capability? We neither

11 applaud IOM nor criticize IOM or the Academy or

12 whatever.

13 DR. TAYLOR: That might be the best

14 approach.

15 DR. NISHIMI: And that's part of that

16 recommendation, is what we're talking about.

17 DR. TAYLOR: Right.

18 CHAIR LASHOF: Yes, yes. Is that where it

19 would go, people?

20 DR. TAYLOR: Yes.

21 MS. GWIN: The criteria?

22 CHAIR LASHOF: The criteria would be part

23 of the recommendation. Let's take a look at that one

24 once more because this is probably the most critical

25 and, I assure you, was the one that the TV cameras

238

1 wanted all the answers on right away, and I said I

2 didn't know where the Committee was going to be.

3 Two - seventy-one, 31 to 32, and the only

4 remaining question is whether they insert in the

5 sentence and modify the sentence or just add modifying

6 sentences following.

7 DR. TAYLOR: The insert was "with

8 oversight." "During the Gulf War should be conducted

9 with oversight by a group independent of DOD," and

10 then putting something about the criteria or selection

11 criteria for this group.

12 MS. GWIN: Okay. I think we can draft

13 that.

14 DR. TAYLOR: You've got it?

15 MS. GWIN: Yes.

16 CHAIR LASHOF: Okay, okay. Marguerite?

17 MAJOR KNOX: I just wanted to ask. Did we

18 agree that on page 2-59, Line 4 and 5, that that's

19 where we would, indeed, add David's comment about

20 Secretary White's efforts? I think that's a good

21 place to insert that.

22 CHAIR LASHOF: And that we would drop the

23 sentence that says the Committee doubts these changes

24 alone can restore DOD's credibility. We just drop

25 that sentence that Phil wanted us to do and put in

239

1 other language. Okay. Very good. That was clearly

2 the toughest issue for us today, I think.

3 Sixty-five, 66, okay, we're back to 66 on

4 the recommendations. We're back to 68, 69, was where

5 we stopped. Okay. We've gotten through.

6 Then we get to the research

7 recommendations. Any changes in any of the research

8 recommendations?

9 Okay. Seventy-one was where we were,

10 right. Now, the coordination. Let's take a look at

11 page 2-72. "The Presidential Review Directive shall

12 be issued to instruct the National Science and

13 Technology Council to develop an interagency plan," et

14 cetera.

15 Anybody have any problem with that one?

16 This is really directed just toward the issue of

17 health preparedness, readjustment, record keeping,

18 peacekeeping missions. Okay? Good.

19 Let us flip through the rest. They're

20 going to clean up this chart eventually, or maybe it

21 is cleaned up since the last look I took. Then we get

22 to Chapter 3, the nature of the illness to date, and

23 this is really a review of the data and review of the

24 mortality studies.

25 I should alert you that the mortality

240

1 study is being published, and there's a press release

2 out today. I guess it's going to appear in the

3 journal tomorrow or the next day, as well as one of

4 the -- the morbidity study? No. What was the other

5 study that came out?

6 DR. JOELLENBECK: The hospitalization

7 study.

8 CHAIR LASHOF: The hospitalization study.

9 Those two studies that we mentioned in here have now

10 hit the journals.

11 DR. BALDESCHWIELER: Can I raise a

12 question on page 3-9?

13 CHAIR LASHOF: Three-nine? Please.

14 DR. BALDESCHWIELER: On Line 12, the

15 report, 1,765 deaths occurred among Gulf War veterans

16 and 1,729 among Era veterans. The next line says that

17 these results indicate a statistically significant

18 higher number of deaths among the veterans. Can that

19 possibly be true, that that small differences is

20 statistically significant?

21 DR. LANDRIGAN: I read the paper. It hit

22 my desk yesterday, and this is an accurate rendition,

23 and there were -- I don't remember if it was a

24 statistically significant excess or not, but there was

25 clearly an excess among the veterans who served in the

241

1 Gulf, but then on deeper analysis, it turned out as

2 they say here that the excess was due to external

3 factors, which is jargon for injuries and accidents,

4 mostly automobile accidents.

5 DR. BALDESCHWIELER: Two questions. One,

6 can that possibly be a statistical significance?

7 CHAIR LASHOF: They said so.

8 DR. BALDESCHWIELER: I don't know if that

9 can possibly be right, 30 out of 1,700. It seems to

10 me -- pardon?

11 DR. LANDRIGAN: It depends entirely on the

12 variance.

13 DR. BALDESCHWIELER: Yes, and then the

14 next --

15 CHAIR LASHOF: I think they said it was in

16 the paper, didn't they? And they did in their

17 presentation feel that that was statistically

18 significant.

19 DR. BALDESCHWIELER: And the next line

20 says excess of deaths compared to Era veterans, a 15

21 percent increase. That's not 15 percent, the

22 difference between --

23 CHAIR LASHOF: No, that one isn't. The

24 excess deaths that were is due to external causes.

25 There was a 15 percent increase from external causes.

242

1 You see, what happened is that when you

2 broke down your deaths between natural causes and

3 illnesses and external causes, there were less than

4 expected of --

5 DR. BALDESCHWIELER: Well, I understand

6 that, but the sentence doesn't say that. It says,

7 "The excess of deaths compared to Era veterans," and

8 that's the difference between 1,765 and 1,729.

9 CHAIR LASHOF: Okay. They need to reword

10 that sentence to make the excess from the external

11 causes.

12 DR. BALDESCHWIELER: Is my arithmetic

13 still all right?

14 DR. JOELLENBECK: If I could just say --

15 CHAIR LASHOF: Please, Lois, yes.

16 DR. JOELLENBECK: -- the expectation is

17 that now that the -- this was based on what was

18 presented to us back in San Francisco, and now that

19 the paper is available, the thought would be that this

20 text would be replaced with what comes out of their

21 paper, and so maybe we could --

22 CHAIR LASHOF: Well, hold it, and we'll

23 use the abstract for the paper. I think it's worded

24 poorly here in the sense that as I understand it, it

25 was the excess of deaths from external causes

243

1 represented a 15 percent increase or something like

2 that.

3 DR. BALDESCHWIELER: Okay.

4 CHAIR LASHOF: But they'll reword it based

5 on the paper and how the paper presents it.

6 DR. BALDESCHWIELER: And then come over to

7 Line 2 on page 3-10, the 47 percent higher rate for

8 the women. I mean that -- that's a huge number, and

9 so I would like to know whether that has any

10 significance.

11 DR. JOELLENBECK: Again, that was a

12 reflection of with the external causes that was higher

13 in the women, but again, this whole paragraph would be

14 replaced with what's coming out of the paper to be

15 published tomorrow.

16 DR. BALDESCHWIELER: If that's the number

17 you're going to use, then it requires some explanation

18 beyond what you said. I mean, if it's 47 percent out

19 of a tiny number, that I could understand.

20 CHAIR LASHOF: Kelley.

21 DR. BRIX: Maybe I'm misinterpreting what

22 you're saying, but I think a little bit of your

23 confusion, John, is that these are just the numbers of

24 deaths, and what the excess is actually in rates.

25 What we don't have here is the denominators. So when

244

1 you have a 15 percent excess, to 15 percent excess in

2 the deaths divided by the total population that was

3 included in there, and that's not stated here, but

4 that's what that refers to; so that's why these

5 numbers are a little confusing to you.

6 DR. BALDESCHWIELER: It's got to be 36

7 divided 1,765.

8 DR. BRIX: No, no.

9 CHAIR LASHOF: Let's let staff rework it

10 with the paper and make sure the statistics and the

11 numbers are clear, and we'll bounce you back on it.

12 DR. BALDESCHWIELER: Tell us what the 47

13 percent means, and if it's not significant, then --

14 PARTICIPANT: It's going to be small

15 numbers.

16 DR. BALDESCHWIELER: Well, then it

17 shouldn't be in here.

18 DR. TAYLOR: Go back to the paper.

19 DR. LANDRIGAN: The standard practice is

20 to give both, give the actual number and the rate, and

21 then it takes care of the issue.

22 CHAIR LASHOF: Okay. For logistical

23 reasons we're going to take a five-minute break, and

24 then we'll come back and try to finish this up very

25 quickly.

245

1 (Whereupon, the foregoing matter went off

2 the record at 3:23 p.m. and went back on

3 the record at 3:32 p.m.)

4 CHAIR LASHOF: If the Committee will join

5 us here, I'm sorry to break into the press, but I'd

6 like the Committee.

7 I know we went through the interim report

8 in one hour. I didn't expect to do that with the

9 final report, but we do want to get through it today.

10 The last time I looked at a page, I seemed

11 to be -- should I be? -- about 3-14, 3-10, somewhere

12 in there. Yes, we were arguing over statistics on

13 page 9-310. Their studies are out, and we'll clean

14 that up.

15 Moving then through the rest of this area

16 as to the data, what we know and don't know about the

17 epidemiologic studies, then we get to the data on

18 stress related disorders.

19 MAJOR CROSS: Joyce, can I stop you?

20 CHAIR LASHOF: Sure, please do.

21 MAJOR CROSS: On page 3-11 and it goes for

22 a couple more pages, we talk about some of the

23 specific studies.

24 CHAIR LASHOF: Yes.

25 MAJOR CROSS: Is there any way we can get

246

1 kind of a closure on some of these, maybe to update it

2 one more time or maybe that's already been done?

3 Maybe you have been in contact with some of these

4 studies.

5 CHAIR LASHOF: Lois.

6 DR. JOELLENBECK: What we presented here

7 were studies that have pretty much come to closure.

8 There are ongoing studies where we are keeping in

9 touch with them, and there had been some hope that

10 some further results would be available for us to

11 include in the report.

12 The Iowa study, for example, it now looks

13 as though there won't be anything published for us to

14 include before we come to closure here, but the ones

15 that are presented in this section are ones where

16 there's unlikely to be further -- well, it varies

17 actually. It's where they've already presented some

18 results, and we provided those.

19 MAJOR CROSS: Okay. Do we say anything

20 about what you just said here, that there might --

21 more time is required or --

22 CHAIR LASHOF: That there are many other

23 studies ongoing and the results can be expected --

24 MAJOR CROSS: Right.

25 CHAIR LASHOF: -- in such-and-such dates.

247

1 I think that appeared earlier under the Chapter 2.

2 This is chapters on data that's current. You're

3 right. If somebody just wants to go to this chapter

4 and hasn't looked at the earlier, some reference might

5 just be given here in introducing these that data on

6 the following studies, which have been completed;

7 other studies as described in Chapter so-and-so are

8 ongoing, and we can expect results at such-and-such,

9 something like that.

10 Would that help? Would that do it for

11 you, Tom?

12 MAJOR CROSS: Sure.

13 CHAIR LASHOF: Good. Okay. Three, data

14 on stress is where we are now. I'll as David to take

15 a look at that again. I thought this was fairly well

16 done.

17 Then we have symptoms associated with

18 stress reported in clinical programs, and then we have

19 some epidemiologic studies of stress that are done,

20 okay, and then we have data on undiagnosed illnesses.

21 Any comments? Any additions, changes

22 anybody sees in any of those pages?

23 Okay. Then we go through starting on page

24 3-31 the comparison, symptom based, chronic fatigue,

25 illness among family members, so forth.

248

1 We then get into the material on

2 biological plausibility of birth defects, and as I

3 indicated before we did get some scientific reviews

4 done by some of the people who appear to be at the

5 cutting edge of some of the newer science in that

6 area, and we'll need to review this section and

7 probably have some -- may have some changes. So I

8 would say just hold that, and we'll highlight that to

9 you in the next draft.

10 Okay. So I'm flipping up to infectious

11 diseases, and I think staff have tried to keep on top

12 of an update, the latest on the microplasma or Dr.

13 Nicholson and whether he's agreed to have any samples

14 studied by CDC; is that correct? We're not getting

15 anywhere on that. Okay.

16 DR. CAPLAN: Joyce, can I add something on

17 3-47?

18 CHAIR LASHOF: Yes, sure.

19 DR. CAPLAN: Did you get there yet?

20 CHAIR LASHOF: Yes.

21 DR. CAPLAN: It's just on this Line 13 and

22 14 about Dr. Hyman and his research.

23 CHAIR LASHOF: Yes.

24 DR. CAPLAN: It says, "No research

25 approved by an Institutional Review Board has been

249

1 initiated on this hypothesis." That's true, but I

2 think what we were trying to say or staff might

3 reconsider that and say, "No research subjected to

4 peer review and Institutional Review Board."

5 I mean, the Institutional Review Board,

6 that's important. I'm not going to deny that, but I

7 think what we're trying to get at here is that his

8 particular research protocols have not gone through

9 the peer review and standard review by peers prior to

10 being conducted, that it was in some ways the peer

11 aspect, not the IRB aspect, that had to be noted.

12 DR. NISHIMI: I believe it's been peer

13 reviewed, Art.

14 DR. CAPLAN: Was it?

15 DR. NISHIMI: Yes.

16 DR. CAPLAN: But was it --

17 MS. GWIN: The hold-up on this study is

18 funding, which is contingent upon IRB approval.

19 DR. CAPLAN: So it's just the IRB?

20 DR. NISHIMI: That's correct.

21 DR. CAPLAN: Okay.

22 DR. NISHIMI: That is the hold-up, yes.

23 CHAIR LASHOF: I think we're silent on the

24 issue of whether it was peer reviewed.

25 DR. CAPLAN: No, no, I thought it was not

250

1 peer reviewed, too, but if it was, then okay.

2 CHAIR LASHOF: Well, I'm not sure it had

3 to be. That's the point.

4 DR. CAPLAN: So he can't get the thing

5 through the IRB still.

6 CHAIR LASHOF: Kelley?

7 DR. BRIX: Cliff, do you want to speak up

8 here?

9 MR. GABRIEL: I believe it was looked at

10 by AIBS, and whether it went through the full peer

11 review process, but they kicked it out because it

12 hadn't gone through the IRB approval process.

13 DR. CAPLAN: Okay.

14 MR. GABRIEL: So a body did look at it.

15 How far they got with it is another question.

16 CHAIR LASHOF: Yes. I mean, I think we

17 can be silent on that aspect of it.

18 DR. CAPLAN: Good.

19 CHAIR LASHOF: Okay. Summary. Yes,

20 Holly, did you have something?

21 MS. GWIN: No, they turned it off.

22 CHAIR LASHOF: I'm sorry. They turned it

23 off. Okay.

24 The findings then on this appear on page

25 3-48, and the recommendations appear on 3-49. Anybody

251

1 have any problems, additions, substitutions or what

2 have you?

3 DR. TAYLOR: I have a question.

4 CHAIR LASHOF: Sure.

5 DR. TAYLOR: Holly mentioned earlier that

6 there were some comments made regarding the statements

7 that we make in the findings not only regarding

8 reproductive effects, but others, where we say, "It is

9 unlikely that the exposures in the Gulf War theater

10 are responsible for the birth defects," and I know we

11 use this term quite a bit, unlikely that exposures to

12 chemical warfare.

13 Is there another terminology that persons

14 suggested we could use or did they want us not to

15 state that at all?

16 MS. GWIN: When I was summarizing the VSO

17 comments earlier, what I mean to convey was what they

18 objected to was us reaching any conclusions about the

19 contribution of the environmental risk factors to Gulf

20 War veterans' illnesses until all of the research was

21 done, and the impression is because they feel like

22 it's too early.

23 CHAIR LASHOF: That is relevant also to

24 Chapter 4 on the scientific analysis of Gulf War risk

25 factors. So let me just finish up on page 3-49 and

252

1 get into that.

2 DR. LANDRIGAN: Three - forty-eight,

3 Madame Chairman.

4 CHAIR LASHOF: Three - forty-eight, yes,

5 Phil.

6 DR. LANDRIGAN: The first bullet under

7 findings.

8 CHAIR LASHOF: Yes.

9 DR. LANDRIGAN: The current thinking is

10 not to call them accidents but injuries.

11 CHAIR LASHOF: Right.

12 MS. GWIN: Okay.

13 CHAIR LASHOF: Yes. Thank you for

14 catching that.

15 DR. LANDRIGAN: You might want to word

16 search the text prior.

17 CHAIR LASHOF: That's right.

18 Anything else on that page, 3-48? Any

19 other findings?

20 Now, recommendations on 3-49.

21 Okay. All right. That then does take us

22 to -- this all data. That takes us to Chapter 4, in

23 which we do go through all of the following risk

24 factors, and this is where your question is clearly

25 germane, Andrea.

253

1 How does the Committee feel?

2 DR. CAPLAN: I'd love to express my

3 feelings, but what was the question?

4 (Laughter.)

5 CHAIR LASHOF: The question is on many of

6 these we say we believe it is unlikely.

7 DR. TAYLOR: Right, and the research is

8 still being conducted.

9 CHAIR LASHOF: On some.

10 DR. TAYLOR: On some.

11 CHAIR LASHOF: Not on others.

12 DR. TAYLOR: Right.

13 CHAIR LASHOF: And the question is:

14 should we look at the use of the word "unlikely"

15 across the board? Are there specific ones that we

16 think we ought to relook at the word "unlikely" and

17 say something about further research or not?

18 MAJOR KNOX: Joyce.

19 CHAIR LASHOF: Yes.

20 MAJOR KNOX: On those that we say that

21 there are federally funded studies which may resolve

22 the uncertainties, could we say that maybe it's

23 indeterminate or it is uncertain at the time?

24 DR. TAYLOR: That might be a better term,

25 "uncertain" versus "unlikely."

254

1 MAJOR KNOX: Particularly with low level

2 exposures to chemicals.

3 CHAIR LASHOF: Why don't we pick them up

4 one by one because on some I'm willing to say that

5 where I think there is ongoing? On others, I think we

6 don't think further research is indicated, and there

7 isn't really further research going on. I think

8 that's correct.

9 DR. NISHIMI: Well, I think there's also

10 some cases where there is further research, I mean, in

11 almost all of these areas. So I think the Committee

12 is going to have to march through each one

13 individually.

14 CHAIR LASHOF: Yes. So let us march

15 through them. The first is pesticides.

16 MS. GWIN: The beginning of the section is

17 on exposures.

18 CHAIR LASHOF: Tell me where we should

19 really go to get to the heart of it.

20 MS. GWIN: You should go to page 4-14 if

21 you want to --

22 CHAIR LASHOF: Health effects.

23 MS. GWIN: -- go through health effects.

24 CHAIR LASHOF: Okay.

25 MS. GWIN: And the first are pesticides,

255

1 and the conclusion about pesticides begins on page 4-

2 21, Line 15.

3 CHAIR LASHOF: What do we conclude?

4 DR. LANDRIGAN: I think it's fine as

5 written.

6 CHAIR LASHOF: I concur. Does anyone have

7 a problem with the conclusion on pesticides?

8 DR. NISHIMI: Mark, is that research

9 ongoing? I mean I think we have to address, you know,

10 the -- you guys raised both hurdles here. So I think

11 you need to do it.

12 CHAIR LASHOF: Four - twenty-one.

13 DR. BROWN: There's some research on the

14 insect repellent DEET, and particularly in combination

15 with other agents, such as PB.

16 CHAIR LASHOF: In combination?

17 DR. BROWN: And I think the issue there is

18 the combination, I think.

19 CHAIR LASHOF: That was my thought, and do

20 we deal with that later in here, the combination?

21 MS. GWIN: It comes up in the section on

22 PB.

23 CHAIR LASHOF: Okay.

24 DR. NISHIMI: But there is no free

25 standing. I wanted to be very clear on this.

256

1 DR. BROWN: I believe that there's no

2 research specifically on the health effects of any

3 individual pesticides vis-…-vis --

4 DR. NISHIMI: Okay.

5 DR. BROWN: -- vis-…-vis Gulf War veterans'

6 health.

7 DR. NISHIMI: Okay.

8 DR. TAYLOR: So then this one --

9 DR. NISHIMI: Yes. That's why I am

10 raising this question quite specifically because if

11 you are going to make a matrix, I would like you to be

12 consistent.

13 DR. TAYLOR: Right.

14 CHAIR LASHOF: Right. Okay. Chemical

15 warfare agents.

16 MS. GWIN: The conclusion is on page 4-27,

17 beginning on Line 3.

18 CHAIR LASHOF: In red, 4-27, Line 3, what

19 do we conclude?

20 MAJOR KNOX: Joyce, on this one I would

21 like to say it is uncertain, I think, if you look at

22 Line 9 through 13.

23 The other thing I'm not clear about, it

24 says, "The Committee concludes it is unlikely the

25 health effects reported by Gulf War veterans today are

257

1 the result of exposure to organic phosphate or mustard

2 chemical warfare agents during the Gulf War." Would

3 that read clearer for this sentence to insert "the

4 result of acute exposure," followed by the next

5 sentence, which talks about low level?

6 And I think we need to look at these

7 terms, subclinical exposure, because really that's low

8 level exposure that may be causing subclinical

9 effects. What do you all think?

10 CHAIR LASHOF: We could, I think, almost

11 -- first we say the Committee concludes it's unlikely.

12 The next sentence says, "Ongoing or planned federally

13 funded studies focus specifically on subclinical

14 exposures and delayed neurotoxicity should eliminate

15 any uncertainty from this conclusion and/or identify

16 new directions for research."

17 Since we say that there is some

18 uncertainty in that sentence, certainly imply it if

19 we're going to have research that would eliminate any

20 uncertainty from this conclusion, then we could

21 almost --

22 DR. TAYLOR: I think removing the term

23 "unlikely" there or replacing it with "uncertain"

24 would flow by, particularly since we don't -- we are

25 uncertain about the health effects reported.

258

1 DR. LANDRIGAN: Are you proposing, Joyce,

2 to take out that sentence?

3 CHAIR LASHOF: Well, no. I was looking at

4 it and trying to figure out whether it needed to be

5 modified in any way rather than taking it out. First

6 I thought maybe I might take it out in view of the

7 last sentence, but the last sentence really says

8 "should eliminate any uncertainty from this

9 conclusion," which implies we're not certain about the

10 conclusion and, therefore, does indeed sort of modify

11 the sentence and, therefore, it could stand to me. I

12 don't know.

13 DR. NISHIMI: Do you want to modify it

14 with an introductory clause along the line of the

15 first sentence, "based on existing data" or something

16 like that?

17 PARTICIPANT: Yes.

18 DR. NISHIMI: I mean, it would make it

19 somewhat redundant, you know, a series of three,

20 but --

21 CHAIR LASHOF: Maybe "concludes" is not

22 the right word. "Based on the previous data, it

23 appears unlikely that," but, you know, further

24 research would remove any uncertainty because we're

25 really not able to reach a conclusion because there is

259

1 uncertainty and there is further research.

2 DR. NISHIMI: So qualify it with the

3 "based on existing data" --

4 CHAIR LASHOF: Yes.

5 DR. NISHIMI: -- and remove "conclude."

6 Okay. I think we know where to go with it.

7 CHAIR LASHOF: Okay. All right.

8 DR. LARSON: And change "subclinical" to

9 "low level."

10 CHAIR LASHOF: Okay. Is that all right?

11 Does anybody have a problem with that? Staff?

12 DR. BALDESCHWIELER: And you could even

13 clarify by saying "any remaining uncertainty."

14 CHAIR LASHOF: Okay, all right. "Any

15 remaining uncertainty."

16 DR. LARSON: I think that's much better.

17 CHAIR LASHOF: Okay. Biological warfare

18 agents.

19 MS. GWIN: The conclusion is on page 4-30,

20 Line 7.

21 CHAIR LASHOF: Four-thirty, Line 7. What

22 do we conclude?

23 I would like that one to stand myself. I

24 think that's pretty solid.

25 DR. NISHIMI: Again, the staff, Joan?

260

1 CHAIR LASHOF: Any ongoing research on

2 this area?

3 DR. NISHIMI: Mark?

4 CHAIR LASHOF: Anybody know of anybody

5 seriously looking at --

6 DR. BROWN: No.

7 CHAIR LASHOF: No? Okay.

8 DR. NISHIMI: So let's just clarify. In

9 the portfolio, no federally funded projects addressing

10 these two issues; is that correct?

11 DR. BROWN: As far as I know, yes. I'm

12 not aware of any projects that address those issues.

13 CHAIR LASHOF: Why don't we --

14 MS. GWIN: Portfolio on Gulf War

15 veterans' --

16 DR. NISHIMI: Right.

17 MS. GWIN: -- illnesses.

18 DR. NISHIMI: Correct. I'm sorry. Yes.

19 CHAIR LASHOF: I mean there might be

20 somebody out there somewhere.

21 MS. GWIN: Right. No, no, that's right.

22 DR. NISHIMI: The threshold is the

23 portfolio of federally funded research on Gulf War

24 veterans' illnesses.

25 DR. BROWN: We're talking about the

261

1 roughly 100 studies.

2 DR. NISHIMI: Correct. Okay.

3 MAJOR KNOX: Can I ask something on that?

4 CHAIR LASHOF: Sure, please.

5 MAJOR KNOX: This might be semantics, but

6 could we reverse those last two sentences, 9 through

7 11? "While the Committee concludes it is unlikely the

8 health effects reported today by Gulf War veterans are

9 the result . . . aflatoxin, however," and make -- just

10 reverse those two sentences?

11 CHAIR LASHOF: Yes, sure, right. Very

12 good idea. Okay.

13 Now we're up to anthrax and botulinum

14 toxoid vaccines. We've discussed the background on

15 that and the conclusion on that is page 4-34, Lines 6

16 through 8.

17 Any research on either of those issues,

18 botulinum toxin or anthrax vaccine?

19 DR. PORTER: Yes, there is research

20 ongoing on those two vaccines, but not necessarily in

21 relationship to Gulf War veterans' illnesses per se.

22 CHAIR LASHOF: What kind of research is

23 ongoing?

24 DR. PORTER: For example, there's research

25 to look at lowering the number of doses. There's

262

1 research looking at anthrax vaccine and botulinum

2 toxoid vaccine boosters in combination to see if there

3 are any problems associated with that.

4 CHAIR LASHOF: But there's no research

5 that would even suggest that they're looking at

6 anything that could cause illness rather than Gulf

7 War? I mean they're looking at how to improve the

8 efficacy when they're looking at boosters and how many

9 boosters and so on, and when you say they're looking

10 at the combination, they're looking whether it's safe

11 in terms of acute use of the vaccines.

12 In other words, is there any research that

13 is exploring the hypothesis that there might be long-

14 term chronic illness because of the vaccines?

15 DR. PORTER: There is a study that has

16 been initiated in DOD looking at multiple vaccinations

17 of military personnel over the course of many years,

18 and it's possible that data will come out of those

19 types of studies that would address the results of

20 exposure to multiple vaccine agents, but to say that

21 it's addressed at Gulf War illnesses per se I think is

22 a bit of a leap.

23 CHAIR LASHOF: Or to say that it was at

24 botulinum or anthrax per se.

25 DR. PORTER: Right. I don't think there's

263

1 any research --

2 CHAIR LASHOF: It's a whole mass of --

3 DR. PORTER: -- based on the theory that

4 these were causal factors for Gulf War veterans'

5 illnesses, but I think any research lends new

6 information that could possibly address questions that

7 people have.

8 CHAIR LASHOF: I'm satisfied that this

9 meets our criteria for unlikely. Does anybody feel

10 otherwise?

11 Okay. Pyridostigmine bromide, page 4-39,

12 Line -- what do we conclude? Line 5 through 10. Here

13 we clearly state, "Ongoing federally funded studies

14 should eliminate any uncertainty or identify new

15 directions particularly with regard to the synergistic

16 effects of PB and other risk factors."

17 I wonder if this one could be rewritten

18 some way to basically say that PB alone we consider

19 unlikely.

20 DR. CAPLAN: In fact, I was going to

21 suggest that we just say "exposure simply to PB."

22 CHAIR LASHOF: Yes.

23 PARTICIPANT: Right. That has to be

24 reworded, yes.

25 CHAIR LASHOF: As a result of exposure

264

1 simply to PB, just a "simply" in front of PB would do,

2 and then you say, "Ongoing studies should eliminate

3 uncertainty or identify."

4 Well, I think you should say, "Ongoing

5 federally . . . studies with regard to the synergistic

6 effects of PB and other risk factors are ongoing and

7 will enable us to draw conclusions about that

8 synergistic effect," or something like that. I think

9 that last sentence sort of needs to be reworked along

10 the line of our philosophy.

11 CHAIR LASHOF: Okay. Agree?

12 Phil.

13 DR. LANDRIGAN: I apologize for being out

14 sequence.

15 CHAIR LASHOF: Sure.

16 DR. LANDRIGAN: I'll explain later why I

17 had to run out of the room, but is it possible we

18 could come back to 4-27, to the section on CW?

19 CHAIR LASHOF: Sure.

20 DR. LANDRIGAN: I do apologize for

21 being --

22 CHAIR LASHOF: That's okay.

23 DR. LANDRIGAN: -- out of the loop on

24 this.

25 CHAIR LASHOF: Okay, and David, I think,

265

1 was out when we started this process. David, what

2 we're looking at is each one of the risk factors and

3 trying to decide whether we're keeping the language

4 "unlikely" or whether we feel it needs any

5 modification.

6 Phil, page what?

7 DR. LANDRIGAN: Four - twenty-seven.

8 Leaving the particular words aside for a moment --

9 CHAIR LASHOF: Yes.

10 DR. LANDRIGAN: -- I think the issue here,

11 the scientific issue with regard to delayed effects of

12 the agents is that basically not a whole lot of work

13 has been done here.

14 CHAIR LASHOF: Right.

15 DR. LANDRIGAN: You will recall that I had

16 a little dialogue with Dr. Joseph at an earlier

17 meeting.

18 CHAIR LASHOF: Right.

19 DR. LANDRIGAN: And I reminded him that

20 for a lot of neurologic or neurotoxic agents that

21 basically the way the science has progressed is that

22 initially there's been recognition of acute toxic

23 effects at fairly high levels of exposure and then a

24 follow-up study of groups with lower exposure has

25 dissected out chronic effects. It was true for lead.

266

1 It's been true for mercury. It's been true for

2 solvents. It's been true for certain pesticides.

3 And I know there has been some past effort

4 to look at delayed effects of these agents. There are

5 two NRC committees that are quoted. So it's not an

6 absolute void, but my sense is that there's,

7 relatively speaking, a dearth of information here.

8 So I think it may just be too strong a

9 sentence to say that it's unlikely. I think that it

10 might be better to say that the current state of our

11 knowledge doesn't permit us to know whether or not

12 there exists these effects and we applaud the fact

13 that further research is now ongoing.

14 I understand that research is ongoing at

15 the two centers that have been established with the

16 PGW money at Portland and Boston.

17 CHAIR LASHOF: We made some change in

18 that. We changed in the last sentence "subclinical"

19 to "low level," and we do end up saying "should

20 eliminate any uncertainty," and I thought we modified

21 something so as to indicate there was some

22 uncertainty. Would you give me the wording?

23 MS. GWIN: We decided to, I think, use a

24 prefatory clause that says, "Based on existing data,

25 it appears unlikely or uncertain that the health

267

1 effects reported by Gulf War veterans," and then the

2 rest stays the same.

3 DR. LANDRIGAN: You may very well be right

4 when all is said and done, but the trouble is that

5 there's so little information here that I feel

6 reluctant to craft that kind of a sentence even with

7 the "although" phrase.

8 CHAIR LASHOF: Would you like to provide

9 some other wording? The last sentence, of course,

10 points to the fact that there's ongoing research and

11 that that should eliminate uncertainty. If you want

12 to eliminate uncertainty, "should clarify this

13 situation" or "should" --

14 DR. LANDRIGAN: Yes, I can't think of any

15 research that ever eliminated all uncertainty.

16 CHAIR LASHOF: That's a point.

17 DR. TAYLOR: So maybe, Joyce, we don't say

18 that the Committee concludes even with the --

19 CHAIR LASHOF: I think we dropped

20 "conclude" and said "the Committee believes it's

21 unlikely."

22 DR. TAYLOR: But we need to take that out,

23 too. I think there's some agreement or disagreement

24 among the Committee of whether it's unlikely the

25 health effects reported today are the results of --

268

1 unlikely -- maybe "uncertain" is a better term.

2 MR. RIOS: Phil, are you saying that the

3 information is not out there to reach a conclusion?

4 DR. TAYLOR: Right now it's not.

5 DR. LANDRIGAN: My concern is there's

6 really very little information out there and not

7 sufficient to reach a firm conclusion, yes. You're

8 correct. I agree with you.

9 MR. RIOS: Then why don't we say that?

10 DR. LANDRIGAN: I'm trying to put some

11 words together now that basically come down there.

12 DR. TAYLOR: Okay. That's good.

13 CHAIR LASHOF: All right. Why don't you

14 try crafting some words, and we'll come back to you

15 and see if we can get some? Otherwise we'll circulate

16 them in the next draft and comment on them.

17 Okay. That brings us to the endemic

18 infectious diseases, and what do we conclude is on

19 page 4-42, and I think that can stand. There's no

20 research that would affect that thing. I mean there

21 is further research on testing for leishmaniasis and

22 so on, but, you know, we say that caused some illness,

23 and we know the others.

24 PARTICIPANT: That's fine.

25 CHAIR LASHOF: Okay. Let us go to

269

1 depleted uranium, 4-45. Is there other work going on

2 on depleted uranium that should change our conclusion

3 or make us be less certain?

4 MR. KOWALOK: There are two animal studies

5 being conducted right now on the rat model looking for

6 the metabolic effects of imbedded metal, of DU metal,

7 and then there's a monitoring program at the VA for

8 veterans who have shrapnel within their body still.

9 Within that group of veterans, there has

10 not yet been seen kidney toxicity that one would

11 expect from exposure to DU.

12 CHAIR LASHOF: Okay.

13 MR. KOWALOK: So within the group that's

14 been most affected, you're not seeing effects.

15 CHAIR LASHOF: Does that meet our

16 threshold for leaving this stand as is? Okay. We'll

17 let that one stand.

18 Oil well fire smoke. We come to we're

19 reviewed the research on that, and we conclude on page

20 4-48. is there research on this ongoing?

21 DR. JOELLENBECK: Yes, there is. There's

22 one study in humans being carried out at Boston where

23 they're going to be looking at pulmonary effects and

24 then comparing that with location relative to the

25 plumes.

270

1 CHAIR LASHOF: Okay. How would we like to

2 modify? We could add a, "However, further research is

3 exploring possible pulmonary effects," which is

4 different than really the symptoms reported by Gulf

5 War veterans. We could still leave it that it's

6 unlikely to cause symptoms reported today, the major

7 symptoms maybe, the usual symptoms or the major

8 symptoms reported today by Gulf War veterans.

9 However, research is still ongoing to explore the

10 possibility of respiratory symptoms as a result.

11 Phil?

12 DR. LANDRIGAN: The other thing we have to

13 remember here is that other similar smoke to this has

14 been declared carcinogenic.

15 CHAIR LASHOF: Yes.

16 DR. LANDRIGAN: NIOSH has declared diesel

17 exhaust, for example, to be carcinogenic, and I think

18 the International Agency on Research on Cancer has

19 come to the same conclusion, and I realize diesel

20 exhaust and this smoke are not precisely identical,

21 but they share a lot of chemical constituents in

22 common, like polycyclic aromatic hydrocarbons.

23 So I think there has to be a nod in that

24 direction.

25 DR. BALDESCHWIELER: Yes, I would like to

271

1 reinforce that by taking a quick look back at the text

2 on page 4-10, and it seems to me one has to be careful

3 here not to defy common sense, and for example, on 4-

4 10, Line 10, it says the levels were lower -- did not

5 exceed those in urban air in a typical U.S. industrial

6 city, and you know, Los Angeles is not nearly as bad

7 as those black plumes.

8 I mean, so it seems to me there simply had

9 to be huge exposures to particulates, and that's, of

10 course, where the --

11 DR. JOELLENBECK: Well, we explored this

12 a great deal in Denver where both Dr. Jack Heller and

13 Dr. Mauderly came in and addressed the issues, both of

14 the levels of polycyclic aromatic hydrocarbons and

15 also of the particulates, and presented, I believe,

16 persuasively to the panel that those weren't at levels

17 that would be expected to cause the illnesses that

18 have been observed in the Gulf War veterans.

19 DR. TAYLOR: It was surprising, Joan, the

20 results that they had, but it was amazing that the

21 results indicated that the levels --

22 DR. BALDESCHWIELER: I guess my only

23 concern here is that what we say make common sense,

24 and I've commented before on this, and it just doesn't

25 seem to me to make sense. I wonder just what they

272

1 measured and how they measured it.

2 CHAIR LASHOF: Well, maybe what we want to

3 say is not based on research of human, animal, other

4 effects of exposure to air pollutants, but rather

5 based on the information concerned about the degree of

6 exposure because these pollutants are carcinogens and

7 there is data on particulates, a recent report by NRDC

8 on breath taking which compared cities around the

9 country and came out with those with small particulate

10 increases caused increased death rates, usually of

11 heart disease and lung disease in people chronically

12 ill, but so on.

13 DR. BALDESCHWIELER: I would urge you to

14 look at the last sentence on Line 18 on page 4-10

15 which says, "Although airborne contaminants were

16 detectable, they were low compared to current U.S.

17 occupational standards for these contaminants even

18 within the plume touchdown." I mean that doesn't make

19 sense.

20 DR. JOELLENBECK: That's what they were

21 able to measure with their industrial hygiene

22 equipment.

23 DR. BROWN: Well, first, I think there are

24 two issues. One is I think that the plume touchdowns

25 were short-lived, and you know, monitoring is time

273

1 averaged, and secondly, most of these pollutants were

2 lofted up high enough in the atmosphere to not be

3 within the breathing space of the people who were

4 there.

5 DR. BALDESCHWIELER: Well, I know, but it

6 says "even within the plume touchdown." So, you know,

7 I urge one to write this in a way that doesn't raise

8 obvious questions like this.

9 DR. JOELLENBECK: This was a risk factor

10 where, in contrast to some of the others, there was a

11 lot more data relevant to exposure and trying to

12 understand exposure, and they actually were able to

13 carry out a risk assessment where to the extent one is

14 able in a risk assessment, were able to estimate

15 potential cancers and found those to be well within

16 the range that EPA generally considers acceptable.

17 So, yes, there were known carcinogens in

18 the air. The comparison to U.S. cities is relevant in

19 that what they came up with as far as expected excess

20 cancers was in ranges that are not usually considered

21 unacceptable.

22 So going back --

23 DR. LANDRIGAN: Certainly not numbers of

24 cancers. It's way too early, but you mean levels of

25 carcinogens.

274

1 DR. JOELLENBECK: Well, yes, and excess

2 cancers that they would anticipate to the extent that

3 they ever can in a risk assessment.

4 CHAIR LASHOF: In a risk assessment.

5 DR. JOELLENBECK: Right.

6 CHAIR LASHOF: I guess your concern is

7 even within the plume touchdown phrase; is that

8 correct?

9 DR. BALDESCHWIELER: Yes. I mean it just

10 seems to defy common sense.

11 DR. TAYLOR: But this is their report of

12 what they found. They're describing their results.

13 DR. JOELLENBECK: One thing that might

14 help resolve this is what Dr. Landrigan mentioned.

15 The first part of this comment is about how likely or

16 unlikely you think it is that exposure to the smoke is

17 contributing to the Gulf War illnesses that have been

18 reported today. An additional sentence about

19 awareness of cancer risk in the smoke components would

20 be germane, although it's been addressed to the extent

21 that they have data available. It looks as though

22 these levels would not be expected to cause excess

23 cancers.

24 DR. LANDRIGAN: You could just say that,

25 and that's a fair statement. I mean if you've done

275

1 measurements and the levels are low, you can say,

2 well, some known carcinogens were there. The levels

3 were low. The risk of future cancer is not excess,

4 but the ongoing surveillance will pick up anything

5 that may occur in the year 2010.

6 DR. BROWN: And we do have a

7 recommendation on 5-54 or 4-54 that addresses that

8 issue, recognizing that there are a number of

9 carcinogens present, that an ongoing cancer mortality

10 should be done.

11 CHAIR LASHOF: Okay. Is that clear? Lois

12 knows where to go with it.

13 Petroleum -- is that all right now, John?

14 DR. BALDESCHWIELER: I don't object to the

15 recommendation. Just I think if one could modify the

16 statement in the text here to soften that a bit.

17 CHAIR LASHOF: Quote another sentence or

18 two from Heller's study.

19 MS. GWIN: Right.

20 CHAIR LASHOF: And we'll send you the

21 study, John. Send John the study.

22 Petroleum products, and the conclusion on

23 that is on page 4-51, Lines 11 through 14. We do

24 conclude about the risk. Certain subsets of Gulf War

25 may have experienced increased risk for health effects

276

1 from their occupational exposure. It's unlikely the

2 health effects reported by -- well, wait a minute.

3 DR. LANDRIGAN: That phrase "may have

4 experienced risks," do you mean that they have

5 experienced exposures that may predispose them to

6 future risks? Is that --

7 DR. JOELLENBECK: Yes. There is research

8 ongoing that would contribute to elucidating this.

9 None of it is specific at petroleum products, but

10 several studies include petroleum products in

11 questions that they're asking. One is a study of rats

12 exposed to various risk factors together, separately

13 and in combination, and there's research in Boston

14 that's looking at neurological effects, some of which

15 might potentially be caused by petroleum products.

16 So there is some relevant research

17 ongoing.

18 CHAIR LASHOF: Do you want to try to

19 recraft this conclusion based on research and saying

20 something more about -- if I understand what we say

21 here about the subsets of Service members may have

22 experienced increased risk, that's not clear. I think

23 may have experienced increased risk of what? I mean

24 you say for health effects. Late effects of certain

25 types, and then just --

277

1 DR. JOELLENBECK: Perhaps as in the other

2 risk factors there could be a sentence that says

3 ongoing federal studies should address any

4 uncertainties.

5 CHAIR LASHOF: Yes. Okay. Would that do

6 that one? Anybody have anything more on that?

7 Andrea?

8 Okay. Psychological and physiological

9 stress, we go through that in some detail, and I had

10 one suggestion again along the line of my thoughts

11 that I presented this morning of the importance of

12 stressing that we get physical symptoms from

13 psychological, from stress, and that it's not just

14 psychiatric.

15 I wondered what the advantage of the

16 sentence, " While some physicians consider these

17 illnesses to be primarily psychiatric in origin," what

18 that phrase adds to the rest of the sentence. "It's

19 significant evidence supports the likely" -- oh, I'm

20 sorry. I'm on page 4-53, Lines 10 through 12.

21 I would like to suggest, and, David, I'm

22 looking to you for advice on this one. I was wanting

23 to cross out the phrase, "while some physicians

24 consider illnesses to be primarily psychiatric in

25 origin." Strike that and begin that sentence with,

278

1 "Significant evidence supports the likelihood of a

2 physiological stress related origin of many of these

3 ailments." I would add "of many of these ailments,"

4 and strike the psychiatric aspect.

5 DR. HAMBURG: I think that's an

6 improvement. I think this section is generally well

7 done, but I think that definitely -- there's no need

8 to have that phrase in there.

9 CHAIR LASHOF: Okay. They didn't want us

10 obviously the veterans didn't want us to say anything

11 about stress causing illness, but I think we've got to

12 make the point that there is physiologic illnesses as

13 a result of stress, and it's incumbent upon us to help

14 get that message out.

15 DR. CASSELLS: And it can involve any

16 organ system.

17 CHAIR LASHOF: Pardon?

18 DR. CASSELLS: And it can involve any

19 organ system.

20 CHAIR LASHOF: Involve any organ system,

21 right. We can even add something to that if you want

22 to in the sentence to strengthen it.

23 DR. CASSELLS: It's in the earlier test.

24 CHAIR LASHOF: Okay. Yes, that's right.

25 We do in the text.

279

1 DR. HAMBURG: It's a little light on the

2 cardiovascular component. It does refer to

3 hypertension in Line 7, page 53. I can't read this

4 stuff, but anyway, I think we're talking about the

5 various systems that are responsive in human, and over

6 here on page 52, I'd put in a bit more about

7 cardiovascular responses.

8 MS. GWIN: Okay.

9 CHAIR LASHOF: I have some other change

10 that I can't read here on the page on Lines 1 and 2.

11 It says "can link" maybe, and I've changed it, but I

12 can't read my handwriting.

13 MS. GWIN: I know what you said. You

14 said --

15 CHAIR LASHOF: Oh, "recognize that."

16 MS. GWIN: "Physicians recognize," yes.

17 CHAIR LASHOF: "Physicians recognize that

18 physical and psychiatric diagnoses" would be better

19 than "may link."

20 Buy that, David?

21 DR. HAMBURG: Yes.

22 CHAIR LASHOF: Okay. All right. David,

23 if you have any other additions to that section, we're

24 more than happy.

25 That's the final, last sentence or last --

280

1 no, there's another page. The next page is

2 recommendations on -- well, we have a summary, and

3 then we have recommendations.

4 DR. TAYLOR: This will change a little

5 bit, I believe, where it says -- well, maybe -- not

6 necessarily, no. I think it's okay.

7 CHAIR LASHOF: I think those two

8 recommendations are --

9 DR. TAYLOR: Right. This is fine.

10 MAJOR KNOX: How about on Lines 4 through

11 6 on page 4-54? That sentence, "for most of the risk

12 factors evaluated the Committee has determined even in

13 the absence of exposure data" --

14 DR. TAYLOR: Right. That changed. I knew

15 it was something, yes.

16 MAJOR KNOX: Yes. Can we say that while

17 Gulf War veterans are clearly suffering health

18 effects, no single causative agent can be identified

19 with the health problems currently reported by Gulf

20 War veterans? Something that would not be so all

21 knowing perhaps.

22 DR. TAYLOR: I believe, yes.

23 CHAIR LASHOF: That's okay.

24 PARTICIPANT: Say that once more.

25 PARTICIPANT: Can you say that again?

281

1 MAJOR KNOX: While Gulf War veterans are

2 clearly suffering health effects, no single causative

3 agent can be associated with the health problems

4 identified currently reported by Gulf War veterans.

5 Maybe I didn't read that the same.

6 While Gulf War veterans are clearly

7 suffering health effects, no single causative agent

8 can be -- okay. Let me read it again.

9 While Gulf War veterans are clearly

10 suffering health effects, no single causative agent

11 can be identified with the health problems currently

12 reported by Gulf War veterans.

13 CHAIR LASHOF: Is that okay? Anybody have

14 any problem with that?

15 Okay, and the findings all look okay and

16 the recommendations look okay. Then let me come --

17 anything more on the body of the text?

18 Let me just say a word about the executive

19 summary, and then let us go to the final options that

20 we have to deal with.

21 DR. LARSON: Joyce, sorry.

22 CHAIR LASHOF: Yes.

23 DR. LARSON: Just on the last --

24 CHAIR LASHOF: Sure, Elaine.

25 DR. LARSON: -- recommendation on 4-54.

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1 CHAIR LASHOF: Yes.

2 DR. LARSON: "The entire federal research

3 portfolio should place greater emphasis on basic and

4 applied research on stress related disorders." Do we

5 want to say "on the physiologic effects of stress"?

6 CHAIR LASHOF: Well, you want to do both.

7 DR. HAMBURG: On the physiologic effects

8 of stress and stress disorders. I wouldn't take the

9 term out.

10 DR. LARSON: Okay.

11 DR. HAMBURG: Because physiologic

12 response, part of a normal adaptive response.

13 DR. LARSON: Right.

14 CHAIR LASHOF: Yes.

15 DR. HAMBURG: And you don't want to leave

16 out the disorders.

17 CHAIR LASHOF: So we'll add a phrase.

18 DR. LARSON: But if we just -- yes, if we

19 don't add that, then we've already diagnosed a stress

20 related disorder before we can study it.

21 DR. HAMBURG: Right.

22 CHAIR LASHOF: Okay. Good.

23 DR. HAMBURG: Add that phrase.

24 CHAIR LASHOF: Very good. Okay. What

25 we've given you is an outline of the approach that

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1 Holly wants to take to the executive summary. I'm

2 going to let her come on down and tell you what she's

3 trying to do there and ask you what she wants you to

4 do.

5 MS. GWIN: Okay. If you recall, for the

6 interim report we summarized our findings and then

7 listed each of our recommendations. I think that if

8 we try to list each of our recommendations this time

9 we'll wind up with an executive summary that's almost

10 as long as the report.

11 So what I'm proposing here is to focus in

12 the executive summary on the most forward looking of

13 the recommendations, to summarize our other more Gulf

14 War specific findings and recommendations, and then

15 group the recommendations that we have identified, as

16 possibly the mandate of the NSTC Committee that is one

17 of our recommendations, things they ought to work on

18 first in three categories, sort of open lines of

19 communication, better data, and comprehensive

20 services.

21 And I've picked out of the report I think

22 it's 12 here that I would propose to focus on. If you

23 all could before the end of next week look at this and

24 see whether the format is acceptable and whether you

25 would pick different recommendations to focus on or a

284

1 different approach entirely and get it back to me, you

2 know, no later than next Friday, it would be very

3 helpful.

4 And you will get it when the report comes

5 out to you in draft form again before Thanksgiving,

6 there will be an executive summary attached.

7 CHAIR LASHOF: Your goal is to make the

8 executive summary about how long, Holly? You've got

9 a target, I'm sure, in your mind.

10 MS. GWIN: I would like it to be no more

11 than seven or eight pages because it has to be short.

12 I mean it would be ideal if it could be four, which

13 was about what our one last time was, but we have too

14 many recommendations for that.

15 CHAIR LASHOF: Yes, we have too much to

16 say. I think we have too much to say.

17 I am afraid to make it too short because

18 that may be all people read, and I think we have a lot

19 to contribute, and I would like to see us summarize

20 some of the key findings and some of the work that the

21 federal government has done and some of their

22 proposals of what they want to do, as well as

23 obviously picking the key recommendations.

24 And whether you can get those summarized

25 in that short enough time so that if somebody doesn't

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1 look at anything except the executive summary, they

2 have some sense of the scope of the work of the

3 Committee and some sense of the breadth of the

4 findings and recommendations.

5 So that's my sort of philosophic approach.

6 I don't know what that adds up to in pages and so on.

7 I will try to go through and put check marks on pages

8 that I think have findings that I would like to be

9 sure are reflected somewhere in the summary, as well

10 as some of the recommendations, and try to get that to

11 you.

12 MS. GWIN: Okay.

13 CHAIR LASHOF: And if others have strong

14 feelings along that line, I would welcome their doing

15 that.

16 DR. LARSON: I'd really like to see the

17 recommendations in the executive summary. Now, I know

18 there's 40.

19 CHAIR LASHOF: Every one of them?

20 DR. LARSON: Yep. Somehow categorize. I

21 mean, where else are they going to be summarized?

22 MS. GWIN: Well, they're all in one -- you

23 know, they're not all in one list, but they are all

24 clumped at the end of each chapter so people can find

25 them that way when we eventually have a table of

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1 contents. So it's a matter of whether you want to

2 relist them all as your executive summary or whether

3 you want to use your executive summary to sort of

4 focus the message for the future.

5 CHAIR LASHOF: I think there's much to be

6 said for what Holly's trying to do of making this

7 executive summary a forward looking document, and if

8 we repeat all the recommendations, you may lose people

9 and you may lose the impact of some of the most

10 important things. So some of the recommendations are

11 terribly important. Some of them are very much really

12 clean up your house, do this, do this minor -- I mean

13 they're all important, but there are gradations of

14 importance in the recommendations, and if we list them

15 all and consider them all the same level you may lose

16 it.

17 DR. LARSON: Okay. Yes, I can buy that.

18 CHAIR LASHOF: But I do urge you to take

19 a look at all of them and think about those that you

20 really feel have got to be in that executive summary.

21 DR. LARSON: After our discussion today

22 clearly some of these aren't even the same anymore.

23 So --

24 CHAIR LASHOF: Yes, okay, all right. Then

25 let us go to this final recommendation that we asked

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1 staff to present options for us to discuss at this

2 meeting, and this is the fact that we've done all this

3 work; we're making all of these recommendations.

4 There are going to be some oversights around CBW.

5 John White tells us, you know, he'll set up a method

6 within his agency on how he'll evaluate the

7 recommendations. I know it's government policy on a

8 document like this to assign somebody over in I guess

9 it would be the Security Council or Domestic Council.

10 Someone over there is going to be given the job of

11 riding herd on the agencies to see whether they've

12 followed through on recommendations that come through

13 on a report.

14 The question is: do we feel there needs

15 to be, in view of the scope of some of our

16 recommendations, an ongoing body that would be charged

17 with making sure that the things we recommend are,

18 indeed, implemented or do we feel, you know, that's

19 the President's job and the Domestic Council or the

20 National Security Council or whoever is going to be

21 assigned this or it's the agency's job?

22 At the time I requested this, I must admit

23 I had the feeling that we needed an oversight body to

24 keep on top of it, and we were trying to figure out

25 who and what. Staff then looked at all of the

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1 possibilities, and as you see, they've listed the

2 Department and the agencies individually, the Persian

3 Gulf Coordinating Board, OSTP, Institute of Medicine,

4 VA expert committee, or the National Security Council.

5 Staff has come down with its chart of

6 pluses and so on, saying that really the Persian Gulf

7 Coordinating Board does represent all the agencies, is

8 the one that ought to be charged. They have the

9 ability, and they ought to keep on top of it, but to

10 be sure that something happens other than internal,

11 that they be required to report.

12 And staff is suggesting that they report

13 at 90 and 180 days after the Committee. It's not

14 clear as to who they report to, and it should be, oh,

15 posted on the GULFLINK, to the President and posted on

16 the GULFLINK and sent to congressional committees.

17 Some of it is going to be more ongoing to

18 me. I don't think even in 180 days they're going to

19 implement everything. I don't know.

20 Holly, do you want to talk further, and

21 then we'll throw it open and I'll stop.

22 MS. GWIN: There's no impression among the

23 staff that the Coordinating Board will cease to exist

24 after 180 days. I think it should be pretty clear

25 after that length of time, you know, which

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1 recommendations they've elected to implement and

2 whether they're making a good faith effort to

3 implement those, and then if anybody wants to say,

4 "Well, we disagree," or, "Okay. Everything that you

5 didn't implement has been overtaken by events anyway,"

6 it's there for them to exercise some judgment about.

7 We didn't think it made sense for them to

8 keep tracking our report indefinitely.

9 CHAIR LASHOF: Forever. Well, our report

10 is so good, I mean.

11 Let me open it for discussion.

12 DR. TAYLOR: You mentioned the Persian

13 Gulf Coordinating Board is the recommended body --

14 CHAIR LASHOF: Yes.

15 DR. TAYLOR: -- for, you know, basically

16 getting back or overseeing what happens at this point,

17 but I notice that the Office of Science and Technology

18 Policy had more pluses, except for the scientific and

19 administrative expertise. So were they considered

20 or is the other.

21 CHAIR LASHOF: Yes, one has three pluses

22 and one has four.

23 MS. GWIN: We didn't do an absolute adding

24 of pluses and minuses.

25 (Laughter.)

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1 DR. TAYLOR: I'm just wondering.

2 MS. GWIN: I think we came down on the

3 side that if you actively involve -- I mean the

4 Persian Gulf Veterans' Coordinating Board comprises

5 the Secretary of Defense, the Secretary of Health and

6 Human Services, and the Secretary of Veterans'

7 Affairs. They seemed like the best people, the people

8 the President is most likely to hold accountable for

9 whether this is successfully implemented, and that

10 that was the place to go.

11 DR. TAYLOR: Okay.

12 CHAIR LASHOF: I think so. I buy this.

13 I think that's a reasonable analysis, and I really

14 can't see as I look at the others that they're going

15 to be able to keep on as well, and as you say, those

16 three Secretaries are responsible to the President,

17 and if the President is going to take this report as

18 seriously as he appears by the press conferences and

19 statements, and he's mentioned us twice in the past

20 ten days as doing important work, I think he'll hold

21 their feet to the fire and will request ongoing

22 reports, and it'll be monitored by someone in the

23 White House there, from my knowledge of how that

24 works.

25 DR. LARSON: Just throwing it out --

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1 CHAIR LASHOF: Yes.

2 DR. LARSON: -- what would be the

3 disadvantages of having those investigations also be

4 using these same criteria and be overseen by it.

5 MS. GWIN: The primary objection I think

6 you would have to that would be it's back inside the

7 government. It's not inherently an open process

8 conducted in the sunshine.

9 CHAIR LASHOF: You mean the CBW

10 investigations --

11 DR. LARSON: Right, yes.

12 CHAIR LASHOF: -- and so on be done here?

13 DR. LARSON: Yes. There might be some of

14 those same objections to overseeing the

15 recommendations, but not really, I guess.

16 CHAIR LASHOF: Not really.

17 DR. LARSON: Okay.

18 CHAIR LASHOF: Okay. If not --

19 DR. LARSON: One other thought about the

20 design of the executive summary.

21 CHAIR LASHOF: Yes.

22 DR. LARSON: It might be nice to have it

23 according to our six mandates, seven mandates, you

24 know, the ones that are listed.

25 CHAIR LASHOF: Oh, the executive summary?

292

1 DR. LARSON: Yes, the executive summary,

2 listed highlighting. We were asked to look at seven

3 different aspects in our mandate, and it would seem to

4 me an appropriate way to summarize would be here's our

5 major recommendations and our future thinking in these

6 seven areas that we were asked to review.

7 MS. GWIN: I'll look at that.

8 CHAIR LASHOF: Holly will consider it.

9 She's a great writer.

10 If not, before you adjourn, let me just

11 thank the Committee for their hard work, and it

12 certainly has been a real pleasure to work with the

13 Committee, and I want to thank staff who have done a

14 tremendous job and Robyn and Holly and all of them.

15 It's been, I think, a fascinating 15 months.

16 And before we close, I do want to give any

17 of the Committee members an opportunity to make any

18 concluding remarks that they would like to make on the

19 record, off the record, or what have you, and then

20 I'll turn it over to Cliff to adjourn, and then we'll

21 socialize.

22 MS. GWIN: It's all on the record.

23 CHAIR LASHOF: It's all on the record.

24 Sorry. Everything you say is on the record. I forget

25 that. In fact, the cameras continue to go, and the

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1 tape recorder goes.

2 Okay. Any?

3 MAJOR KNOX: Well, I actually have a

4 couple of closing remarks that I wanted to make. It's

5 been an honor to have served on this Committee, and my

6 personal commitment to work on this Committee stems

7 from the fact that I do remain active in the Army

8 National Guard, and having served in the Gulf War with

9 the 251st Evacuation Hospital, stationed in Kinkala in

10 Military City, therefore, I do want to acknowledge

11 that it has been a challenge to develop an objective

12 perspective with my own personal subjective

13 experience.

14 My tenure career with the VA system has

15 also contributed to this mission and has enabled me to

16 scrutinize the services provided to Gulf War veterans.

17 With these affiliations the charges of this

18 appointment have at times been difficult.

19 We have attempted to objectively review and

20 evaluate the information provided by the staff,

21 government agencies, veterans, and interested parties.

22 As an active member of the South Carolina National

23 Guard and, therefore, part of the DOD, it has been

24 disheartening to see the leadership of DOD and the CIA

25 place the departments in the position where veracities

294

1 can be questioned.

2 However, I do want to commend Secretary

3 White for the future efforts that he put forth today

4 as our reputation can only be restored by

5 acknowledging our difficulties and deficiencies and

6 challenging ourselves to be supportive and open to the

7 concerns of Gulf War veterans' illnesses.

8 Lastly, as a professor teaching in a VA

9 facility, familiar with the impact of VA policies and

10 procedures on veterans' health care, I think it's

11 crucial that the delivery to both active duty soldiers

12 and veterans not be hindered by institutional

13 barriers. My wish is that DOD and the VA will

14 anticipate and act in good faith to provide care to

15 veterans who may develop health problems related to

16 their service in the Persian Gulf and in future

17 conflicts.

18 And I appreciate the opportunity to serve.

19 CHAIR LASHOF: Thank you very much,

20 Marguerite. Thank you very much, and it was a most

21 appropriate statement, and I'm glad, and it's been a

22 pleasure working with you.

23 David?

24 DR. HAMBURG: Since I'm sitting next to

25 Marguerite, let me try to follow her good example.

295

1 I, too, feel very grateful to have had

2 this opportunity. I, of course, thank the President

3 for giving us the chance to work on this very

4 important problem with full independence and the scope

5 to let the chips fall, to follow the evidence wherever

6 it might lead.

7 I think that the nation has really had

8 difficulty for decades, not just a few years, but for

9 decades in responding adequately to the problems of

10 veterans, and I think it has even a greater

11 significance in the Persian Gulf War, important as

12 that is.

13 It was a daunting task, and I feel very

14 grateful to you, Joyce, as the chair, and to the

15 staff, and we've had a terrific staff, and I'm really

16 quite amazed in how far we've been able to pursue so

17 many complex facets of this problem.

18 and working with the members of this

19 Committee has been a real pleasure, a very collegial,

20 searching, open-minded approach, and I think we've

21 ended up with a careful and systematic and thorough

22 effort to clarify the health related problems of the

23 Persian Gulf War.

24 I do want to say I think it's very hard to

25 understand all of the ramifications. There are so

296

1 many complexifying issues, the fog of war, the

2 complexity of the experiences during war, the

3 institutional inadequacies, the limitations of

4 existing knowledge about risk factors and health and

5 disease. I think particularly the staff has made an

6 extraordinary effort to sort out these ambiguities and

7 arrive at as reasonable a position as is possible to

8 do.

9 Over and above that, the scientific and

10 professional scrutiny, there was also a sense in this

11 whole experience of the courage and the risks and the

12 suffering and the coping with adversity on the part of

13 the veterans and their families, and I think those

14 memories will last for a long time.

15 I guess the central point of it all is

16 that it's essential for the nation to do what this

17 Committee has tried to do, and that is to take the

18 veterans seriously, to provide some compassionate

19 understanding of their suffering, and make every

20 effort humanly possible to improve their conditions

21 through research, education, patient care, and

22 prevention, and I think at least we've been able to

23 illuminate some path in those directions, foggy though

24 it may be. It may be the best that's possible to do

25 at the moment.

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1 But the final notion is I hope we've set

2 in motion a process that will continue not just about

3 the Persian Gulf War, but about the exposure of our

4 people to hazards over the long term, and that

5 whatever lessons we've learned from this might at

6 least have a stimulating effect on future deployments

7 and other high risk situations.

8 Thank you.

9 CHAIR LASHOF: Thank you, David.

10 Rolando.

11 MR. RIOS: Yes. I'd just like to say that

12 as a Vietnam Era veteran, as a disabled veteran, I

13 think that I have a first-hand knowledge of what the

14 impact is of government action. Many times we forget

15 that a government makes a decision, moves troops

16 around, gets involved in international affairs, and

17 once the action is over, government doesn't realize

18 what the implications of its actions are in that

19 people's lives are impacted for many, many years.

20 Here I am, 51. I was involved in Vietnam

21 in my mid-20s, and I'm still taking medication from

22 injuries sustained there. So that the inconvenience

23 that government imposes on individuals that serve our

24 country is sometimes overlooked, and government

25 doesn't realize what an impact it has on people's

298

1 lives.

2 Having seen what we saw today insofar as

3 what appears to be the reaction that the government is

4 taking now insofar as trying to get to the bottom of

5 what happened and what are the implications of its

6 actions, I feel that the work that we have done has

7 been good and positive. I feel very fortunate and

8 privileged to have served with the members of this

9 Committee, and I thank the President, thank the staff,

10 and, Ms. Lashof, I think you've done an excellent job.

11 CHAIR LASHOF: Thank you.

12 MR. RIOS: Thank you.

13 DR. TAYLOR: I'd like to say a few closing

14 comments as well.

15 I'd like to first thank the staff for the

16 excellent work that you've done, and without your

17 work, I guess we wouldn't have the report that we

18 have, and I think when we give our final report to the

19 President, we'll all be satisfied with what we've

20 presented based on your good work, and I commend you

21 for that.

22 I see a lot of parallels with the

23 workplace, the work that I do every day as an

24 industrial hygienist in occupational health, with

25 what's happened with the Gulf War veterans. In many

299

1 workplaces, it's not always easy to identify the

2 source or cause of an employee's health concerns or

3 the symptoms that they experience, and in many times

4 there may be multiple exposures to chemicals in the

5 workplace.

6 Also in the work environment, I think we

7 are trying to do a better job now, not the best, but

8 we're doing a better job of record keeping, employee

9 training and education, implementing better

10 environmental controls to reduce exposure, and

11 monitoring exposures.

12 As we continue to improve conditions of

13 workers, it is imperative that we do the same for the

14 men and women who serve our country. The threat of

15 being attacked or killed is stressful enough. It is

16 our government's obligation for persons who serve to

17 maintain and improve the record keeping system, and

18 we've talked about that; to adequately train and

19 inform servicemen of potential hazards and exposures;

20 and to insure that they are adequately protected.

21 Additional research that is currently

22 being conducted may provide answers. It may not, but

23 taking the lessons that we've learned and making

24 improvements is very important.

25 Again, I'd like to say that I appreciate

300

1 the fine job that you've done, and I've enjoyed

2 working on the Committee and serving with others, and

3 that hopefully some answers may be forthcoming.

4 Others may not, but we do have to take care of our men

5 and women who serve our country, and it is very

6 important that we continue to do the best job that we

7 can, that the government can, to insure good health

8 when they return.

9 CHAIR LASHOF: Thank you, Andrea.

10 I don't know if anybody else feels

11 obligated, but don't feel obligated, but if you want

12 to, I give everybody a chance.

13 Tom.

14 MAJOR CROSS: Yes, let me just take this

15 opportunity. Also being a Persian Gulf veteran and a

16 Marine, there's a term that we kick around. It's "we

17 take care of our own," but I think what I've seen here

18 is it's not only a Marine phrase. I think it's a

19 phrase that everybody on this Committee, both civilian

20 and military, takes to heart.

21 You know, we send folks out worldwide to

22 put forth a foreign policy, and when they do come

23 back, there is a commitment that the government

24 assumes to take care of those people, and in the end

25 it ultimately affects the patriotism of the American

301

1 populous.

2 So, you know, I think we've attempted to

3 do the best job that we can. I think at times the

4 schedule was trying to many of us, but I think we've

5 all prevailed, and I'd like to personally thank the

6 staff and Dr. Lashof. You've done a wonderful job.

7 And to my colleagues, thank you for your

8 support.

9 CHAIR LASHOF: Thank you, Tom.

10 Elaine.

11 DR. LARSON: It has been a humbling

12 experience for all of us, and we are very grateful for

13 the high level of professionalism of the staff, and I

14 think we've been a good balance for each other, people

15 who know or don't know and can sort of help each

16 other.

17 But mainly we've had the privilege and the

18 heartbreak of hearing from a number of our vets and

19 those who served in the Gulf across the country who

20 are suffering from a variety of serious illnesses,

21 some of which are clearly associated with their

22 experience in the Gulf, just as there has been similar

23 kinds of effects from other wars in the past.

24 The difference is that I think we've made

25 tremendous progress. We have more openness. We have

302

1 better surveillance. We have better science. In

2 previous wars, it was just sort of an accepted fact

3 that there were casualties and there was shell shock

4 and there were other things, and this time we have

5 been not only allowed the privilege, but given the

6 mandate to do everything we can to explore possible

7 causal associations.

8 Clearly we're never going to know all of

9 the reasons for some of the Gulf War illness, just as

10 we don't know all the causes of other kinds of

11 illness, as well, and I know it will never be possible

12 to disprove that there is no association between

13 exposures and Gulf symptoms.

14 But we've got to get on with the business

15 of aiding our veterans who are in need, and at the

16 same time continuing with open and objective vigilance

17 in investigation.

18 I do agree with one thing that Jeff Tack

19 said this morning, and that is that let's spend time

20 and resources not only deciding who did what and where

21 or even determining why vets are ill, but also let's

22 spend our time and resources providing them with the

23 care that they need.

24 My main hope is that, first of all,

25 obviously war is not good for your health and we ought

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1 to avoid it, but when it occurs, hopefully we can

2 learn that for the future we have been insufficiently

3 ready in the past and insufficiently responsive, and

4 we have had insufficient information, and I hope that

5 never happens again.

6 CHAIR LASHOF: Thank you, Elaine.

7 Robyn, do you have any final comments?

8 DR. NISHIMI: Sure. Just on behalf of the

9 staff, obviously we appreciate your kind words, and we

10 certainly have appreciated the opportunity to have

11 worked for you.

12 I would be remiss, however, if I didn't

13 draw your attention before we close to the truly

14 critical work that has been done and has occurred,

15 frankly, unbeknownst to you. You know Cliff Gabriel

16 is the person who opens our meetings and closes our

17 meetings.

18 MR. GABRIEL: I do.

19 DR. NISHIMI: Yes, and he does it well.

20 I think you also should know that Cliff's

21 efforts in many ways, large and small, since he came

22 on board have been absolutely essential to the staff's

23 work and to the Committee's work. He has always been

24 fully supportive. He has always been fully supportive

25 of our interests and very protective of this

304

1 Committee's independence, and he has served this

2 Committee well and the President with singular

3 distinction.

4 CHAIR LASHOF: Thank you very much, Robyn.

5 And, Cliff, thank you. Yes, you've been

6 the silent partner, and we know you're over there in

7 OSTP, and you have made a difference, and we

8 appreciate it.

9 Again, once more, let me just thank all

10 Committee members, all of the staff, and commend

11 everyone for the work we've done. I think we've made

12 some accomplishments. I think we've made a

13 difference, and that's what really makes it

14 worthwhile, to know that our 15 months may, indeed,

15 did, indeed, make a difference. I think that was

16 clear this morning.

17 So with that, Cliff, we'll let you close

18 the meeting.

19 MR. GABRIEL: I don't think you need to

20 hear any additional thank you's. There have been

21 quite a few, but actually one group that wasn't

22 mentioned, I think, that needs to come up now is the

23 active involvement by the agencies, and for the most

24 part I've been impressed with the level of commitment

25 that they've shown this Committee, and I think that

305

1 was a very telling and important part of making this

2 whole process a success.

3 So with that thank you, you know, I thank

4 the staff, and we're adjourned.

5 (Whereupon, at 4:48 p.m., the Advisory

6 Committee meeting was concluded.)