Sunday, October 4, 2009

DALLAS MORNING NEWS: Loss of funding threatens UT Southwestern's Gulf War illness research

Written by Scott K. Parks, The Dallas Morning News

(Dallas, Tex. - October 4, 2009) - The U.S. Department of Veterans Affairs' cancellation of a $75 million contract with UT Southwestern Medical Center could mean the end to the Dallas university's research into treatments and cures for Gulf War illnesses. 

UT Southwestern epidemiologist Robert Haley rejects the theory that Gulf War illnesses stem from post-traumatic stress - a psychiatric condition. 'Now, we know it's a real disease caused by chemical exposure,' he said. Veterans groups, UT Southwestern and their political supporters in Washington are working to restore VA funding for Haley's research - without it, he says, the chances of finding a treatment are low.

UT Southwestern epidemiologist Dr. Robert Haley told The Dallas Morning News that he and a team of 200 colleagues from eight universities are five years ahead of anyone else engaged in the painstaking research into why 200,000 healthy soldiers went to the Persian Gulf in 1990-91 and returned to civilian lives of chronic illness.

"Without the VA funding, discovery of a treatment is very low," Haley said.

ERICH SCHLEGEL/Special Contributor
ERICH SCHLEGEL/Special Contributor
Paul Sullivan, executive director of Veterans for Common Sense, got sick after serving in the Persian Gulf. He calls Dr. Haley's work essential.
The VA declined to comment on Haley's research. Instead, a spokesperson referred The News to an Aug. 26 news release announcing cancellation of the contract for "persistent noncompliance and numerous performance deficiencies."

Haley has been studying a small group of sick Gulf War veterans for 15 years. His findings show a range of persistent symptoms – chronic fatigue, chronic diarrhea, memory loss, joint pain, loss of muscle strength and persistent headaches – caused by battlefield exposure to pesticides and other chemicals.

The next step, supported by $15 million a year from the VA, was to be a large study of 2,000 Gulf War veterans. The results of that study would show whether chemical exposures harmed a significant number of veterans, Haley said.

A closer look at the body of research conducted by Haley and his colleagues shows possible ramifications beyond the health of Gulf War veterans. VA funding to support development of diagnostic tests and medical treatments for sick veterans might also have helped civilian homemakers, factory workers or farm workers who get mysterious illnesses after exposure to pesticides, Haley said.

"We are looking at unplowed ground," he said. "Nobody has ever looked at pesticide exposure and brain damage and chronic symptoms. People didn't believe this stuff was real, even in the civilian world, and it's never been looked at."

Benefits blocked

An estimated 700,000 veterans served in the Persian Gulf in 1990-91. Veterans groups had hoped Haley's work might break the gridlock preventing thousands of them from receiving disability benefits and medical care based on exposure to pesticides, nerve gas, oilfield fires or military-issued antidotes to nerve gas.
Paul Sullivan, 46, married and a father of two, served as an Army cavalry scout in the Persian Gulf. He came home with chronic lung ailments and has been working as a veterans' advocate for more than 15 years. He is considered a particularly credible critic of VA policies because he worked for the federal agency from 2000 to 2006.

"Dr. Haley's work is absolutely essential," said Sullivan, who serves as executive director of Veterans for Common Sense in Austin. "Now, with the VA's premature cancellation of the contract, time is being lost and that entire institutional knowledge at UT Southwestern is being lost."

Haley is convinced that many veterans suffered brain damage from exposure to organophosphates (sprayed pesticides or insect repellants worn like flea collars) and pyridostigmine bromide (nerve gas antidote). He rejects the theory that Gulf War illnesses stem from post-traumatic stress – a psychiatric condition.

"Originally, this [Gulf War illness] was signed, sealed and delivered as stress," Haley said. "Now, we know it's a real disease caused by chemical exposure. It's now the conventional wisdom."
But the VA, which has the power to grant or withhold disability payments, has not embraced that conclusion. Consequently, billions of dollars in monthly veterans' benefits could hang in the balance.

Relevance to vets

The U.S. House committee on veteran affairs held two hearings on the status of Gulf War illness research in 2009. Testimony showed that federal agencies spent $350 million on 345 projects related to health care needs of Gulf War veterans between 1992 and 2007.

But critics say those projects didn't focus on identifying causes and treatment of Gulf War illnesses.
Dr. Lea Steele, a leading expert on Gulf War illnesses at Kansas State University, testified that much of the research focused on stress and psychiatric conditions and had "little or no relevance to the health of Gulf War veterans."

By contrast, Haley's supporters say his slow, painstaking research on veteran brain diseases is precisely targeted at causes and treatments.

This year's House hearings clearly showed that the VA's scientific advisers are still divided about why so many Gulf War veterans suffer from one or more chronic symptoms.

Legally, the VA must seek the opinion of a prestigious group of medical researchers on the Institute of Medicine (IOM) Committee on Gulf War and Health. The committee has reported that it cannot conclusively link toxic exposures to Gulf War illnesses.

On the other side of the ledger, another panel of prestigious scientists, the VA's Research Advisory Committee on Gulf War Veterans' Illnesses, reported in October 2008 that "a unique neurological illness has caused significant morbidity (25 percent) among Gulf War veterans, and this is 'causally' [the highest possible level of association] linked to nerve agent antidote and pesticides used in the 1991 Gulf War."

It's a bureaucratic stalemate.

Restoring funding

Veterans groups, UT Southwestern and their political supporters in Washington are working to restore VA funding. If successful, they hope the money will flow as a grant rather than a government contract, which comes with many more rules and regulations.

"You can imagine," Haley said, "if you have to go to the government every time you want to take a step, your job becomes a six- or seven-decade job, and everybody quits. Everybody's dead."

The VA announcement ending the contract came after repeated disputes between UT Southwestern and government contract managers. A scathing report from the VA inspector general in July accused Haley of violating all sorts of VA contract protocols.

UT Southwestern administrators admitted some mistakes in contract administration and said they tried to correct them, but the VA canceled the contract anyway.

Privately, UT supporters said some longtime VA administrators resent the federal budget earmark that dedicated research funds to UT Southwestern – legislation that prevented the VA from controlling where $75 million was going to be spent on research.

In the Sept. 11 edition of Science magazine, writer Eliot Marshall described the VA contract with Haley as "lavishly funded." The article quoted British psychiatrist Simon Wessely, a noted health researcher, as saying that Haley's work was worthwhile but that it's time to recognize that "we're not going to find the smoking gun that explains the cause of Gulf War illness."

Other critics allege that Haley and his team have spent too much time studying a group of 43 Navy Seabees, subjecting them to sophisticated brain imaging tests and genetic research. Haley chose the Seabees because they traveled all over the Persian Gulf, building things like bridges and runways in advance of troop movements.

If any group experienced all the wartime conditions in the Persian Gulf, it was the Seabees, he theorized.
Haley and his team believe their body of published research proves conclusively that the Seabee illnesses stem from toxic chemical exposures during the war. But his critics contend that research on such a small group proves nothing about the overall health of 700,000 men and women who served during the war.
Haley said the VA pulled the plug on his funding just as he was designing a study of 2,000 randomly selected Gulf War veterans – 1,000 sick and 1,000 healthy.

"The VA funding is the final step, the rifle shot, to prove this," Haley said. "Is what we found with the Seabees true of the whole of Gulf War veterans? And that is the final definitive question."

Genetic implications

If you've never heard of Dr. John F. Teiber, you've probably never heard of the PON1 gene.

In the late 1990s, Haley's research on the Seabees began to intersect with sophisticated genetic research into the sources of disease and illness.

Teiber is one of the world's foremost experts on PON1. He is a protégé of the late Dr. Bert N. La Du of the University of Michigan. Haley recruited Teiber to UT Southwestern after La Du's death.

PON1 produces an enzyme that protects the human body from chemical toxicity. Some people produce more of the enzyme than others.

In 1999, Haley and La Du published a scientific paper that compared PON levels in a group of sick Seabees with PON levels in a control group of healthy Seabees. The control group showed higher levels of the PON enzyme.

This explained why two Seabees worked side by side in the Persian Gulf and only one of them got sick after both suffered toxic chemical exposure, according to Haley.

But the PON1 discovery had wider ramifications.

Haley enlisted the aid of a UT Southwestern colleague to build a "gene therapy device" to boost PON1 levels in laboratory mice. Generally, those mice showed more immunity to the effects of toxic chemical exposure than the control-group mice not injected with the device. The university has submitted a patent application to the U.S. government to exploit the invention.

Theoretically, after obtaining the patent, the university could license the invention to a pharmaceutical firm that turns it into a vaccine against pesticide or other chemical exposures. Future soldiers could go into battle with higher PON levels to protect them against a range of chemical exposures.

Ordinary citizens worried about their exposure to pesticides or household chemicals some day might get a PON-boosting immunization.

"With this patent, should it be given and should a [pharmaceutical company] end up with a product, the genesis goes back to the Gulf War illness research," Haley said.

Meanwhile, Teiber and his colleagues continue to labor in his PON1 laboratory on the UT Southwestern campus, charting PON1 levels in 2,000 sick and healthy Gulf War veterans.

VA funding for this work is gone, but Haley said he has found other money to support Teiber's operation.
"We are making significant progress," Teiber said. "But we were counting on the VA funds to continue the research."

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