Wednesday, June 30, 2010

Study: Regional Gray Matter Density Changes in Brains of Patients With Irritable Bowel Syndrome

Written by Anthony Hardie

(91outcomes.com) – There are visible changes in the gray matter of the brain in patients with Irritable Bowel Syndrome – a presumptive condition for service-connection for veterans with service in the Gulf War – says a new study published this month in Gastroenterology, the official journal of the American Gastroenterology Institute.

Using advanced brain imaging technology, the study found that patients with IBS had common changes in their brains’, with widespread areas of decreased grey matter density.

The areas of the brain affected are involved in cognitive/evaluative functions.

Study subjects were divided between controls without IBS and various subgroups of IBS patients separated based on their  most significant IBS symptoms.

The abstract of the study is below.

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Background & Aims

Several studies have examined structural brain changes associated with chronic pain syndromes, including irritable bowel syndrome (IBS), but study sample sizes have been small and heterogeneous.

Methods

We used magnetic resonance imaging–based techniques, voxel-based morphometry, and cortical thickness analysis to examine brain anatomical differences in a relatively large, tightly screened sample of IBS patients (n = 55); we compared data with that from healthy persons (controls; n = 48).

Results

IBS was associated with decreased gray matter density (GMD) in widespread areas of the brain, including medial prefrontal and ventrolateral prefrontal cortex, posterior parietal cortex, ventral striatum, and thalamus. Compared with controls, we observed increased GMD in patients with IBS in the pregenual anterior cingulate cortex and the orbitofrontal cortex, as well as trends in the posterior insula/secondary somatosensory cortex, (para)hippocampus, and left dorsolateral prefrontal cortex. In accounting for anxiety and depression, we found that several of the regions involved in affective processing no longer differed between patients with IBS and controls, whereas the differences in prefrontal and posterior parietal cortices remained. The areas of decreased GMD associated with IBS were largely consistent across clinical subgroups, based on predominant bowel habit and pain predominance of symptoms. No overall or regional differences were observed in cortical thickness between patients with IBS and controls.

Conclusions

Changes in density of gray matter among regions involved in cognitive/evaluative functions are specifically observed in patients with IBS, whereas changes in other areas of the brain can be explained by levels of anxiety and depression.

Tuesday, June 29, 2010

In Changing the Culture at VA, a Top VA Official Leads from the Front

Next Gulf War Task Force Report, personally led by VA Sec. Shinseki’s Chief of Staff, is expected in August

Gulf War veteran and VA Chief of Staff John Gingrich

Written by Anthony Hardie

(91outcomes.com) - John Gingrich, a unit commander during the 1991 Gulf War, knows what Gulf War veterans suffering from Gulf War illnesses have been through because he knows them personally.

Showing his true colors during a public meeting today of the Congressionally chartered VA Research Advisory Committee on Gulf War Veterans’ Illnesses at the VA’s headquarters in Washington, DC, Gingrich spoke directly to Gulf War veterans in the room. 

“I’m committed to this issue both professionally and personally,” said Gingrich. Professionally, as he is leading the effort to drastically change how VA does nearly everything related to Gulf War veterans, and “personally, because I know people who served in the Gulf War, about 800 when you add up everyone who was attached to us,” he said.

Now the chief of staff for the U.S. Department of Veterans Affairs, Gingrich, a retired U.S. Army Colonel, serves directly under VA Secretary Eric Shinseki, who has publicly pledged to Gulf War veterans that he will “get this right,” with Gingrich leading the charge.

One of the veterans in the room was Jim Bunker, a former Army officer from Kansas who served under Gingrich during the 1991 Gulf War who is now the president of the National Gulf War Resource Center, gave Gingrich some advice. “Currently, the Social Security Administration allows for total disability for fibromyalgia alone,” advised Bunker, who is now totally disabled and one of the 250,000 veterans of the 1991 Gulf War suffering from chronic multisymptom illness, more commonly known as Gulf War Illness or Gulf War Syndrome.

And Gingrich listened to the scientists and veterans, taking notes and directing various staff members in the room to take immediate action.

Gingrich provided the advisory body and veterans in attendance with an update on the pending final report of the VA’s internal Gulf War Task Force, an ambitious effort led personally by Gingrich to restructure and revise nearly everything in the vast agency related to veterans of the 1991 Gulf War.

While the occasionally self-deprecating leader confessed, “We didn’t do the outreach as well, and learned a lot of lessons on how to do it next time,” there was excellent response to the VA’s initial outreach efforts on the report with 150 formal comments, 28 written responses, 300 comments through the special VA website set up to receive comments on the report, and 2,100 votes racking and stacking those comments.

In fact, “this brought back probably the largest amount of public comment we have received on any proposal,” said Gingrich.

Even still, he said there were lessons learned and that VA would do more in the future to ensure even greater public awareness and opportunities for stakeholders to provide their input to VA decisions affecting them.

Shinseki appears to have picked an unusually adept leader who has realized that the only way to effect the necessary change is to lead it personally and by influencing a culture shift within the agency. Setting an example for his subordinates on all those comments, Gingrich said, “I have read every single one of them, and I’ve started on my second time reading through them.”

Later, Bunker said that he knows Gingrich well, and that when he says something like that, to believe it.

But Gingrich kept things realistic. “I don’t want to give the illusion that we’re going to be able to incorporate every single suggestion. I don’t want to start writing [the entire first report] over, but we will be adding notes that ‘we will be addressing this issue and this issue’.”

Gingrich’s assurances were well received, particularly when he candidly said, “It is a first report.”

“It’s about how we’re going to provide the care and services to the veterans, how do we fix it and provide that care and services. Do we have all the answers? No. Do we feel we are on the guidepost to get the answers? Yes,” said Gingrich.

Gingrich also addressed the report on Gulf War veterans’ health released in April by the Institute of Medicine, part of the National Academies of Science. “I’m glad that there was a public statement that undiagnosed illnesses are real, and are not in the mind,” just as ill Gulf War veterans have been saying for years.   The report stated definitively that the chronic multisymptom illness experienced by 250,000 veterans of the 1991 Gulf War could not be attributed to any known psychiatric illness.

Gingrich also laid out the VA’s ambitious efforts on veterans claims and Secretary Shinseki’s plans to eliminate the current claims backlog by 2015.

Gingrich explained that in addition to simply reducing wait times, there are clear reasons driving the changes. “First, it gets them into the medical system. Second, while their claims will be backdated, this will help them get money to them as quickly as possible,” he said.

One of the “28” efforts, described by Gingrich, was an initiative to extend the time between medical review exams for veterans with approved claims to five years, from the current two years, “which made 77,000 veterans not have to go through a physical this year,” said Gingrich.

Questions from the advisory members and the public appeared to be taken seriously by Gingrich, who is leading the culture change from the front.

"I’m really encouraged to hear what you’re doing, and your willingness to hear what we’re saying,” said Joel Graves, of Lacey, Wa., a Gulf War veteran with Gulf War illness who serves on the advisory committee. “I’m really pleased you’re working through all this.”

The final report of the Task Force Gingrich personally leads is expected in August.

 

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ADDITIONAL INFO:  Full Biography, John Gingrich

Announced in March, VA Gulf War Steering Committee Launched

New scientific committee will coordinate efforts to help VA best manage Gulf War research efforts

(91outcomes.com) - The VA’s Gulf War Steering Committee, publicly announced by the VA in March, has officially been launched said Dr. Joel Kupersmith, Chief Research and Development Officer for the U.S. Department of Veterans Affairs, in a public meeting today at the VA headquarters in Washington, D.C.

According to the mission statement, provided during a meeting of the Congressionally chartered VA Research Advisory Committee on Gulf War Veterans’ Illnesses (RACGWVI), the VA’s new Gulf War Steering Committee advises on matters related to integration of the VA Gulf War research program into global Research & Development policies, procedures and activities; and conducts analyses and develops reports or other materials as necessary.

More specifically, the GWSC will provide advice to the VA Office of Research & Development (ORD) and make recommendations on the nature and scope of research and development sponsored and/or conducted by the Veterans Health Administration (VHA) in the following areas:

  1. The focus of research on the high priority health care needs of Gulf War Veterans;
  2. The balance of basic, applied, and outcomes research;
  3. The projects supported by the VA Gulf War research program;
  4. The appropriate mechanisms by which ORD can leverage its resources to enhance the research financial base;
  5. The rapid response to changing health care needs, while maintaining the stability of the research infrastructure; and
  6. The protection of human subjects of research.

GWSC consists of approximately 9 members, including the Chair, selected from or recommended by the VA’s National Research Advisory Council (NRAC) and the RACGWVI. Members are selected from knowledgeable VA and non-VA experts, and veterans’ community representatives with special qualifications and competence to deal effectively with Gulf War research and development issues in VA. In addition, the NRAC will have at least one Gulf War Veteran as a member to ensure an appropriate perspective on the health problems of this Veteran population.

Members will serve for overlapping one- or two-year terms of service and may be reappointed for one additional term. The Chair of the Committee will serve for a two-year term of service, which is also renewable one time.

The GWSC will meet about four times per year, either by teleconference or in person.  The GWSC reports through the NRAC, the RACGWVI, and the VA Undersecretary for Health.  In order to avoid duplication of effort, the GWSC is encouraged to review deliberations of other committees or entities, and may incorporate or otherwise use the results of deliberations of such entities.  

GULF WAR STEERING COMMITTEE MEMBERS

Appointed by the NRAC, the GWSC is chaired by Dr. L. Maximilian Buja, M.D., who is internationally recognized for his research in cardiovascular pathology. He is author of over 240 research articles, 150 book chapters and two books in his scientific field. Buja served as dean of the UT Medical School at Houston from 1996 to 2003. Dr. Buja holds the Distinguished Chair in Pathology and Laboratory Medicine. In 2000, he was named the H. Wayne Hightower Distinguished Professor in the Medical Sciences.

The NRAC-appointd members of the Gulf War Steering Committee include:

Dr. Tilo Grosser, M.D. Dr. Tilo’s interests are in non-steroidal anti-inflammatory drugs (NSAIDs), which relieve pain, inflammation and fever by inhibiting the formation of bioactive prostanoids. Despite their efficacy in the relief of pain and inflammation, NSAIDs may be associated with gastrointestinal complications, including serious bleeds. Selectivity for COX-2 has been shown to reduce the incidence of these serious events, but is more likely to cause serious cardiovascular events than non-selective COX inhibition. Dr. Grosser is studying the mechanisms of these complications using genomics, proteomics, lipidomics approaches in model organisms and in proof-of-concept studies in healthy volunteers. One aim of this research is to identify approaches to the personalization of NSAID therapy.

Robert P. Kelch, MD. Dr. Kelch is Special Assistant to the President and the recently retired Executive Vice President for Medical Affairs at the University of Michigan. In this role, he led all three components of the University of Michigan Health System, including the Hospitals and Health Centers, the Medical School and the M-CARE managed care organization.

Dr. Loren D. Koller. Dr. Koller is an independent consultant and former professor and dean of the College of Veterinary Medicine at Oregon State University. His areas of expertise include pathology, toxicology, immunotoxicology, carcinogenesis, and risk assessment. He is a former member of the NRC Committee on Toxicology and has participated on several of its subcommittees, primarily those involved in risk assessment. Dr. Koller has served on the Institute of Medicine’s Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam and has been invited to serve on committees for the CDC, EPA, Homeland Security, the Agency for Toxic Substances and Disease Registry, and the U.S. Army. He is considered one of the founders of the field of immunotoxicology.

Richard P. Wenzel, MD, MSc. Dr. Richard P. Wenzel is Chairman, Department of Internal Medicine, Virginia Commonwealth University (VCU) and President, MCV Physicians Virginia Commonwealth University, The Practice Plan of the Health System. He previously was founder and director of the VCU Outcomes Research Institute and the Clinical Trials Institute. Dr. Wenzel holds an appointment as Professor, Department of Internal Medicine, VCU. His research interests include prevention and control of hospital-acquired infections, sepsis, Candida bloodstream infections, and policy development for quality of care of patients. Dr. Wenzel has been the recipient of numerous honors and awards, and he has very actively participated in the training of fellows. He was Lt. Commander in the U.S. Navy Reserve, from 1970-1972. He received an M.D. at Jefferson Medical College (Thomas Jefferson University) and M.Sc. (Epidemiology) London University, London School of Hygiene and Tropical Medicine.

The RACGWVI-appointed members of the Gulf War Steering Committee include:

Roberta White, PhD. Dr. White is Professor and Chair of the Department of Environmental Health at Boston University School of Public Health. She is a neuropsychologist with expertise in environmental and occupational epidemiology. Author of numerous scientific publications, her research interests include evaluation of chronic effects of exposure to neurotoxins, the use of imaging in behavioral toxicology, and gene-environment interactions that mediate the development of neurodegeneration following chronic exposures. Dr. White’s current research projects include evaluation of cognitive function in military personnel who worked as pesticide applicators in the Gulf War, cognitive and neuroimaging correlates of Gulf War service, effects of prenatal pesticide exposures in South African children, and effects of metal exposures in the Framingham Heart Study cohort. Dr. White is currently the Scientific Director for the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RACGWVI).

James P. O'Callaghan, PhD. Dr. O’Callaghan is Distinguished Consultant and Head of the Molecular Neurotoxicology Laboratory in the Toxicology and Molecular Biology Branch of the Health Effects Laboratory Division of the U.S. Centers for Disease Control and Prevention (CDC). Prior to joining CDC, Dr. O’Callaghan founded the molecular and cellular neurotoxicology program in the Neurotoxicology Division, U.S. Environmental Protection Agency in Research Triangle Park, North Carolina. He directs a research program dedicated to the discovery and implementation of biomarkers of neurotoxicity. Dr. O’Callaghan is an appointed member of the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RACGWVI).

Anthony Hardie. Mr. Hardie is the former Executive Assistant of the Wisconsin Department of Veterans Affairs, where he oversaw the agency’s external relations, including those with the state legislature, Congress, the media, stakeholders, and the public. He is a Gulf War and Somalia Veteran, and has worked extensively on policy issues related to post-deployment and Gulf War veterans’ illnesses, including service on several national boards and committees. He is a former Congressional staff member, a graduate of the University of Wisconsin, and the recipient of Wisconsin’s AMVETS Legislative Advocacy Award and Disabled American Veterans Department Distinguished Service Award, their highest annual state awards. Mr. Hardie is an appointed member of the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RACGWVI).

David C. Christiani, MD, MPH, MS. Dr. Christiani is Professor of Medicine, Director of the Harvard Education and Research Center for Occupational Safety and Health, and a Physician at Massachusetts General Hospital. Dr. Christiani’s major research interests are occupational, environmental and molecular epidemiology. He is studying the impact of exposures to various pollutants on health and the interactions between host factors (genetic and acquired susceptibility), and environmental exposures in producing acute and chronic diseases. This research is part of an emerging field known as molecular epidemiology. Dr. Christiani is active in developing new methods for assessing health effects after exposure to pollutants and has an interest in international occupational and environmental health studies.

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VA R&D contributed substantially to this report.

Monday, June 28, 2010

Study: Gulf War Chemicals cause Cognitive Dysfunction, may be treatable

By Anthony Hardie

Graphics: PB NAPP pills, implicated in Gulf War cognitive problems

(91outcomes.com) - During today’s meeting of the Congressionally chartered U.S. Department of Veterans Affairs Research Advisory Committee on Gulf War Veterans’ illnesses (RACGWVI), Dr. Fiona Crawford of the Roskamp Institute in Sarasota, Fla., presented her research findings that show

The presentation, entitled “Genomic and proteomic analysis of laboratory models of exposure to Gulf War agents,” described research conducted by Dr. Crawford and Dr. Michael Mullan of the Tampa VA Medical Center to assess the effects of pyridostigmine bromide (PB) nerve agent protective pills (NAPP) combined with pesticides used in the 1991 Gulf War.  They found that Gulf War chemicals cause cognitive dysfunction, one of the most commonly reported symptoms among the 250,000 veterans of the 1991 Gulf War suffering from Gulf War Illness.

An October 2009 Roskamp Institute study (Abdullah et al) analyzed the cellular responses to PB of neuronal cells, key to the function of the brain and nervous system.  Twenty-two different proteins were identified by mass spectrometry (MALDI-TOF MS) and a sophisticated analysis  was then used to determine the biological functions and pathways associated with the PB-responsive proteins.  This work provides great promise for the development of treatments.

Dr. Crawford noted that other work with the Roskamp Institute and Dr. Mullan has led to unique treatment possibilities for veterans with traumatic brain injury (TBI).  She hopes that the current work on GWI will lead to new proteomic-based treatments for veterans suffering from the disease.

Minneapolis scientist unlocks keys to diagnosing brain diseases; may lead to advances for Gulf War Illness

Written by Anthony Hardie

Graphic:  Sample of a Magneto-encephalography scan

(91outcomes.com) - During today’s meeting of the Congressionally chartered U.S. Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War Veterans’ illnesses (RACGWVI), Dr. Apostolos Georgeopolous of the Minneapolis VA Medical Center gave a presentation about new scientific technology that may provide a key to unlocking more of they mysteries of the effects of Gulf War Illness on the human brain. 

Georgopolous’ presentation, entitled, “Magneto-encephalography (MEG) patterns in neurological diseases,” provided an overview and stunning visual examples of his brain research.

In one example, one test (SNI) was “an externally cross-validated, bootstrap-based classification,” which provided excellent results. The test found a biomarker for PTSD, a disease that is associated with Gulf War service and is separate and distinct from Gulf War Illness (also known as chronic multisymptom illness), with a 96 percent sensitivity rate (and a 95% specificity rate). This shows what Dr. Georgeopoulos believes to be the best promise for a PTSD neuromarker that would help with both diagnosis and possibly treatment of this disease.

Dr. Georgeopoulos presented his research findings that showed another pattern for traumatic brain injury (TBI), and that the tests could determine in nearly all cases which patients have PTSD, which have TBI, which have both, and which have neither.

And, the tests have treatment outcomes, helping to show how the brain is affected, which may lead to treatments for neurological diseases like GWI/CMI.

He has researched other neurological diseases, each showing a distinct pattern, including schizophrenia, obsessive-compulsive disorder (OCD), Parkinson’s, and alcohol withdrawal, among others.

Significantly for Gulf War veterans, Dr. Georgeopoulos expects to have results for Gulf War Illness (GWI) by the end of the year.   As with the other diseases he has studied, Dr. Georgeopoulos expect the GWI/CMI results to probably look very different from other brain disease patterns including TBI and PTSD.

Graphic: Magneto-encephalography brain scanning machine

Dr. Georgeopoulos suggests that his research may have found a new basic science principle, which is that “fine-level synchronicity may be a fundamental aspect of cortical function that is differentially disrupted by different diseases and produces a differential disease signature for each disease.” In other words, his use of advanced scientific testing techniques produces a graphical pattern of the brain, and each pattern may be unique for neurological disease.

Dr. Floyd Bloom, past chairman of the American Association for the Advancement of Science (AAAS), former editor-in-chief of the journal Science, chairman of the Department of Neuropharmacology at the Scripps Research Institute in La Jolla, and a member of the National Academy of Sciences since 1977, praised and congratulated Georgeopolous and his team on their work.

“This is one of the greatest demonstrations of diseased brains versus normal that I have ever seen,” said Bloom.

ALS outbreak among Gulf War veterans likely has common cause, says leading researcher

Written by Anthony Hardie

Graphic: What causes ALS?  Source: Huntsville Times

(91outcomes.com - June 28, 2010) - During today’s meeting of the Congressionally chartered U.S. Department of Veterans Affairs (VA) Research Advisory Committee on Gulf War Veterans’ illnesses (RACGWVI), Dr. Ronnie Horner of the University of Cincinnati  gave a presentation entitled, “Occurrence of ALS among Gulf War veterans,” which discussed what is known about the well-documented outbreak of ALS among veterans who served during the 1991 Gulf War that included both the deployed and the non-deployed.

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is an invariably deadly neurodegenerative disease, with an average lifespan of only two to five years from time of diagnosis to time of death.   ALS kills motor neurons, the large cells of the spinal cord, which send nerve fibers out to control the muscles.

The disease is typically associated with older age; ALS nearly always affects men over the age of 55.
And, there is some relation to genetics, with about ten percent of ALS patients having a family history of ALS.

Horner discussed several peer-reviewed medical journal articles including two of his own published about ALS, regarding the epidemic of ALS cased among veterans of the 1991 Gulf War.  Several factors that made the ALS among 1991 Gulf War veterans unique.

First, more than half of Gulf War veterans diagnosed with ALS were under age 25 and 98 percent under the age of 55 – a far different picture than that of ALS almost exclusively in men over age 55.
And, he found that there was shorter survival time for Gulf War deployed (40 months) versus non-deployed Gulf War era veterans (57 months).

As is typical for ALS, there was some familial effect among the Gulf War ALS cases, with three of 40 studied cases having a family history.

He noted that there were two peaks in the epidemic, one in 1991, and another in 1996, with about 48 cases among the deployed and 76 among the non-deployed, far, far higher than would be expected among healthy young military service members. It remains unclear why there were two different peaks in the outbreak, but Horner suggested that there may have been multiple causes, or that there may have been other factors.
 
Search for a Common Source or Common Time Point of Exposure

Horner’s research shows a two-fold higher risk of ALS among 1991 Gulf War veterans. The cause(s) remain uncertain; exposures immediately prior to or during deployment may be involved.

Horner noted that scientists have focused on several factors to find clues that may finally unlock the secrets of ALS.  Because of the timing of the outbreak, he said it is generally assumed that there is a common source or time point of exposure or exposures.

One study, conducted by Miranda et al, was a GIS analysis of “Hot Spots” with more cases of ALS. 
And, science has shown that another neurodegenerative disease that shares some common features with ALS -- multiple sclerosis (MS) – also saw a dramatic increase  after the 1991 Gulf War, this time in the Kuwaiti population who remained in Kuwait during the Gulf War.  The increase of this disease that affects primarily women affected irregularly large numbers of both among men and women, though more Kuwaiti women were affected than Kuwaiti men.

Another study cited by Horner (Weiskopf et al)  found a higher risk of ALS among people with any military service than civilians. The highest risk was service in the U.S. Army and U.S. Navy, but not the U.S. Air Force. There was also an increased risk associated with the number of wars during their military service, but no association with the number of total years of military service, suggesting that military service in an of itself is probably not the cause of the ALS, but instead it is something that happens during military service, especially during wartime.

Horner’s current hypothesis is that there was one common exposure during the Gulf War. The data shows an elevated risk associated with being exposed near, in both place and time, to the Khamisiyah demolition in March 1991, in which U.S. troops detonated large amounts of Iraqi munitions later learned to contain sarin and cyclosarin nerve agents and possibly mustard gas – a vessicant – and other chemical or biological warfare agents.

Among the theories of what may have caused the Gulf War ALS outbreak, Horner described the possibility of exposure to cyanobacteria that produce neurotoxic chemicals (BMAA, Cox et al), neurotoxicity of heavy metals in the desert soil (Capt. Mark Lyles, DMD, PhD), adjuvants in the anthrax vaccine (including Aluminum Hydroxide and Squalene), and/or head trauma.

Horner said that science has shown that head trauma has often been associated with ALS. And, increased blood lead levels are also associated with a greater risk of ALS.

Horner suggested that the Gulf War ALS outbreak could be multiple exposures to one agent, exposures to multiple agents, or a rapid time to a toxic dose.

The Future for ALS research

Horner posed the question of whether the pathology (progression/ development) of neurodegenerative conditions reflects a common mechanism to protect neurons, key cells in the brain?

Could there be a common mechanism to protect neurons?

Based on the science Horner says he believes that finding the answer to these questions – essentially, how to protect the brain’s neurons -- may provide life-changing or life-saving treatments for ALS and other neurodegenerative diseases.
 

ADDITIONAL INFORMATION:

  • Living with ALS (Huntsville Times)
  • The ALS Association
  • The ALS Association symbolizes the hopes of people everywhere that Amyotrophic Lateral Sclerosis will one day be a disease of the past – relegated to historical status, studied in medical textbooks, conquered by the dedication of thousands who have worked ceaselessly to understand and eradicate this perplexing killer.
    Until that day comes, The ALS Association relentlessly pursues its mission to help people living with ALS and to leave no stone unturned in search for the cure of the progressive neurodegenerative disease that took the life and name of Baseball Legend Lou Gehrig.
    As the only not-for-profit voluntary health agency dedicated solely to the fight against ALS, we direct the largest privately-funded research enterprise engaged to uncover the mystery of a disease that affects as many as 30,000 annually. With more than 5,600 people diagnosed each year – an average of 15 new cases each day – our mission is urgent. The search for answers knows no bounds.



























Medical College of Georgia research shows long-term damage from low-levels of Gulf War chemicals

Written by Anthony Hardie

(91outcomes.com) - During today’s meeting of the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ illnesses, Dr. Alvin V. Terry, Jr., Ph.D., gave a presentation entitled, “Organophosphate Exposure and Cognition: Novel Mechanisms of Neurotoxicity,” that covered his many years of research on the health effects of this class of chemicals.

Organophosphates (OPs) were first recognized as insecticides (pesticides) by German scientists in the 1930s. Their development as nerve agents came shortly thereafter.

During the 1991 Gulf War, OP pesticides were used to combat sand flies, fleas (including the unapproved but widely used flea collars), and other insects that carry diseases endemic to the region. [As an aside, the VA recently approved nine endemic diseases as presumptive for the purposes of service-connected disability claims.]

Gulf War troops were also exposed to varying levels of OP nerve agents following coalition air bombing of Iraqi chemical weapons production and storage facilities, and sarin and cyclosarin OPs (and probably mustard vesicant agent) as the result of the post-war demolition of Iraqi chemical warfare munitions at Khamisiyah, Iraq in early March 1991 that led to a plume containing the agents that drifted over troops in Iraq, Kuwait, and Saudi Arabia for at least a three-day period.

Health effects of OPs may be acute (close to the time of exposure) high-level exposures, or chronic and/or repeated low-level exposures.

The acute symptoms of exposure to high-levels of OPs have long been well understood are shown in Figure 1, below.

However, more recent studies have shown that even chronic or repeated low-level exposures are associated with anxiety, depression, psychotic symptoms, deficits in short-term memory, learning, attention, information processing, eye-hand coordination and reaction time, and other symptoms.

Terry’s published, peer-reviewed scientific research over many years on laboratory rodents has shown the scope and degree of OPs’ changes in and damage to neurons -- the functional cells of the brain -- and to axonal transport, part of the brain’s way of communicating.

Terry’s team found that exposure to OPs even at less than acute levels resulted in impairments in spatial learning, auditory startle response, and decreased brain proteins and axonal transport.

Terry’s team also found that there are differences between OPs, with low levels of pesticide-type OPs causing less damage than low levels of nerve agent OPs.  These findings are directly relevant to Gulf War illness research related to the chronic multi-symptom illness shown by a 2010 Institute of Medicine report to affect more than one-third (250,000) veterans of the 1991 Gulf War.

Terry is Professor of Pharmacology and Toxicology and Director of the Small Animal Behavior Core at the Medical College of Georgia.

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FIGURE 1:  SYMPTOMS OF ACUTE, HIGH-LEVEL OP EXPOSURE

Acute OP symptoms caused by Muscarinic (a neurotransmitter/brain chemical) stimulation (“DUMBBELS”)

  • Defecation
  • Urination
  • Miosis (constriction of the pupil in the eye)
  • Bradycardia (heart beating too slow)
  • Bronchospasm/Bronchorrhoea (excess production of mucus in the air passages of the lungs)
  • Emesis (vomiting)
  • Lacrimation (production, secretion, and shedding of tears)
  • Salivation (excess)

Acute OP symptoms caused by Nicotinic (another neurotransmitter/brain chemical) stimulation (“MATCH”)

  • Muscle weakness, fasciculations (spasming of small muscles)
  • Adrenal medulla activity increase
  • Tachycardia (heart beating too fast)
  • Cramping of skeletal muscle
  • Hypertension (high blood pressure)
Acute OP symptoms caused by Central receptor stimulation
  • Anxiety
  • Restlessness
  • Ataxia (gross lack of coordination of muscle movements)
  • Lethargy
  • Confusion
  • Coma
  • Seizure
  • Respiratory depression (hypoventilation,occurs when ventilation is inadequate)

Veterans with PTSD have visible brain degeneration

Written by Anthony Hardie

Image of Hippocampus, courtesy of Morphonix

(91outcomes.com) - During today’s meeting of the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ illnesses, Dr. Michael Weiner of the San Francisco VA Medical Center gave a presentation on his brain imaging research in veterans of the 1991 Gulf War that was unable to reproduce the work of Dr. Robert Haley that found brain changes in three distinct syndromes, but showed limited changes in the brain matter of veterans affected by two Gulf War diseases.

The presentation, entitled, “Effects of Military Service on the Brain,” covered his years of research on the structural brain changes related to Alzheimer’s Disease (AD), Parkinson’s, Post-Traumatic Stress Disorder (PTSD), and the chronic multi-symptom illness (CMI) shown to affect more than one-third (250,000) veterans of the 1991 Gulf War.

Using sophisticated brain imaging equipment (MRI 1.5 Tesla and 4.0 Tesla), in particular, he found that Gulf War and other veterans suffering from PTSD have atrophy (shrinkage) in a key part of the brain, the hippocampus, which is involved in the complex processes of forming, sorting, and storing memories.  Short-term and working memory loss has been a primary symptom reported by ill veterans of the 1991 Gulf War, including those with and without PTSD.

Weiner’s team found that PTSD commonly co-occurs with GWI/CMI, atrophy of the hippocampus region of the brain (particularly in the CA3-dentate portion of the hippocampus, where stem cells reside), a reduced brain chemical (GABA), increased neuropsychological impairments, and increased risk for dementia.

Weiner made it clear that while about 30 percent of his study subjects exhibited symptoms of both PTSD and GWI/CMI, “it is clear that there is something else going on” with the veterans suffering from GWI/CMI.  This finding is consistent with a 2010 Institute of Medicine study that declared that the CMI affecting a very large number of veterans of the 1991 Gulf War could not be attributed to any known psychiatric illness.

Weiner’s work now includes further study, a new focus on treatments, and developing “personalized” indicators for optimum treatment response. He is also studying increased, associated risks of developing ALS, Parkinson’s and Alzheimer’s disease.

Weiner’s team is currently developing future research plans, including a new focus on treatments for Gulf War veterans afflicted by GWI/CMI.

Establishing "Disability" for Social Security Claimants with Fibromyalgia or Chronic Fatigue Syndrome

 

Editor’s Note:  Chronic Fatigue Syndrome and Fibromyalgia, a chronic pain condition, are presumptive conditions for VA service-connected disability purposes.  Veterans who receive VA service-connected disability compensation may also be able to receive Social Security benefits, as this article discusses.

Article provided by Jeffrey A. Rabin & Asoc.,  www.rabinsslaw.com

(24-7PressRelease) - Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For many people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow. For people suffering from conditions such as Fibromyalgia and Chronic Fatigue Syndrome, the requirements of the Social Security Act can become overwhelming. This article will explain and simplify in general terms the requirements of the Social Security disability program and describe the application and appeals process.

Two Different Programs - SSDI and SSI
There are two programs under the Social Security Act providing benefits for persons who are unable to work. The first is the Social Security Disability Insurance (SSDI) program found in Title II of the Social Security Act. The second is the Supplemental Security Income program contained in Title XVI of the Social Security Act. The medical test for both programs is identical. The differences are in the non-medical eligibility requirements.

Non-Medical Requirements
SSDI benefits are paid to totally disabled individuals who have worked and paid into the Social Security system with the FICA taxes that are deducted from paychecks. These FICA taxes are analogous to insurance premiums paid for automobile, homeowners or other private insurance. The FICA payments, which are matched by employers, buy coverage under the Social Security Retirement, Disability and Medicare programs. For SSDI, there are two requirements: a worker must have worked and paid FICA taxes for at least 40 quarters lifetime (10 years) and, also 20 quarters had to have been paid in during the ten years prior to the date of becoming totally disabled. For example, a 40 year-old Claimant who became disabled in 2003 would have had to have worked and paid FICA taxes for at least 10 years during his lifetime, and for at least 5 years between 1992 and 2002.

If approved for SSDI the Social Security Administration pays a monthly benefit based upon how much was earned and paid into the Social Security system. Benefits are also paid to dependent children who are under 16 years old, or who are under 18 years old and still in high school. Medicare eligibility begins twenty-nine months after the onset date of total disability.

The SSI program requires that an individual be totally disabled and "indigent." "Indigent" basically means that a single Claimant has little or no income and less than $2,000.00 in non-exempt assets. A home and furniture are not counted. One car is exempt. Bank accounts, IRAs, profit sharing plans, cash value life insurance and similar assets are all included in determining assets, even if penalties and taxes would be incurred if the asset were converted to cash. In addition, a spouse's assets and income are "deemed" to the disabled Claimant - this deeming rule wreaks havoc on many disabled persons, particularly the stay-at-home parent.

A disabled person receiving SSI will also be eligible for food stamps and a Medicaid card from the state.

The Social Security disability program is designed to pay benefits to claimants suffering from medical problems causing symptoms so severe that it becomes impossible to sustain function at any type of work. Issues of employability, job existence, insurability and location or desirability of alternative work will not be considered, although age and education are often important factors. The fact that a person can not do the work performed in the past is usually not determinative. This is a medical program that focuses upon medically proven symptoms and their impact on the ability to perform work activities.

Therefore, the focus in on function, not on diagnosis; SSA often admits that Claimants have medical problems and are "impaired," but denies that they are "totally disabled." The debate is over what the Claimant can "do" despite the medical problems.

The Social Security Administration's Regulations require determination of disability be based upon on "objective proof" of both the medical problem and of the severity of the symptoms. "Objective proof" means the findings contained in medical tests that are not dependent on the patient's subjective responses. A MRI, a cardiac treadmill test, an x-ray and a pulmonary function test are all "objective" tests. Asking a patient if she is in pain is "subjective." In Fibromyalgia and CFS claims, it is often difficult to objectively prove either the existence of the disease, or the severity of the symptoms. This has caused many claims based upon these conditions to be denied - especially at the first two levels of review.

The focus in all disability claims is upon the medical evidence, i.e. the treating physicians' clinical findings, office notes, reports, and medical test results. This evidence is primary and is often more important than the testimony of the Claimant. While a Claimant's description of the impact on daily activities, social functioning and concentration must be considered by SSA, the content of the medical documentation is the most important source of evidence in deciding the claim.

In Fibromyalgia claims the clinical notes and a report of the treating rheumatologist are most important. A 1996 decision by the Seventh Circuit Court of Appeals established that a rheumatologist is the primary source for proof of this disease. Office notes from the rheumatologist should consistently document the positive findings for the tender points which are diagnostic for this disease. In addition, the patient should be complaining at each office visit of the fatigue and pain that are consistent with this condition. A report that establishes that all other causes for the symptoms have been ruled out helps establish the existence of the disease.

Since the extent of fatigue and pain can not be measured, consistency of complaints in the various medical records will be important. The use of pain medications, even if just for trial periods is an important consideration in evaluating the severity of pain. Use of mild analgesics indicates less severe symptoms; prescription of stronger narcotics indicates that the treating specialist felt the pain problems more severe. Also, documentation by the physicians of concentration impairments, and the inability to perform routine daily activities such as housework, shopping, and social functioning, are also factors considered by Social Security Administration decision makers.

Chronic Fatigue Syndrome claims have been made clearer by the adoption of Social Security Ruling 99-2p. This Ruling finally acknowledges that CFS is a medically determinable impairment and describes the various findings that can establish the diagnosis. This Ruling is quite useful and can be found at the SSA's website, www.ssa.gov. Generally, the focus is on a longitudinal view of the medical evidence and the extent and nature of the treatment provided by the various physicians. The clinical findings and summaries of the patient's complaints in the office notes are critical in terms of establishing the existence of a medical impairment. As to whether the symptoms are totally disabling, SSA will consider the medical opinions, as well as the statements of the Claimant and third parties, as in any other disability claim.

Claimants who suffer from depression should also seek treatment from a mental health professional. Whether the depression is a symptom of the disease, or results from the significant impact on a Claimant's lifestyle, or is a separate disabling medical condition, the treatment notes and histories often lend credibility to the claim. However, SSA will generally not give significant weight to depression treated by a family doctor or social worker - emphasis will always be given to the records and reports of an M.D. psychiatrist or Ph.D. psychologist. Depression does not usually negate the existence of other underlying impairments but instead confirms the severity of their impact. On occasion, this diagnosis provides an alternative theory for an Administrative Law Judge who wishes to award benefits but will not approve a claim based on CFS or Fibromyalgia.

The Application Process
There are multiple levels of review of an application filed under the Social Security Act. In an effort to increase productivity, and decrease processing time, the Social Security Administration is testing different review models across the country. This article will describe the basic system which is still in place throughout most of the United States.

A claim is initiated by filing an application. This can be done over the telephone, on SSA's web site at www.ssa.gov (for SSDI claims only) or, preferably, in person at the local Social Security Administration District Office. The application will require a list of all of the jobs performed during the last 15 years, a list of all medical providers, a list of current medications, names and dates of all prior marriages and divorces, and a copy of the Claimant's birth certificate. Generally our practice is to recommend as much be done with Social Security face to face at the District Offices - this decreases the chance for errors. At the time of this writing, only SSDI claims can be filed over SSA's web site.

After the application is filed, the Social Security Administration will send the file to a Disability Determination Service (DDS) administered by that State. Each state has a contract with SSA to perform the first two levels of review. At the DDS the file will be assigned to an adjudicator who will be responsible for gathering medical documentation, getting any additional information from the Claimant, arranging for consultative examinations and obtaining medical and vocational opinions from the DDS's internal experts. A written decision is issued in about 90 days on average, although the time frame can vary widely. Historically only about 36% of claims are paid at this level.

If denied, the second step is the filing of a Request for Reconsideration at the SSA District Office. A Claimant is allowed 60 days from the date of the initial denial to file this appeal, although there is usually little to gain by waiting. The Request for Reconsideration is also processed by the state DDS. Historically only about 17% of claims are approved at this level and SSA is testing elimination of this step.

The third level of review, for those claims denied at Reconsideration, is the hearing before the Administrative Law Judge (ALJ). These are informal administrative hearings held before independent judges who hear testimony, review the medical records and issue written decisions. While progress had been made in reducing the backlog in setting hearing dates, the delays have been increasing once more. Time frames vary widely across the nation, many hearing offices now take at least twelve months from the date the Request for Hearing is filed to set a hearing date.

The hearing is critical to the review process because it is the only time that a Claimant has the opportunity to see, and talk to, the decision maker. Up until this time all decisions are based upon paper, i.e. medical reports and written questionnaires. This is the only time in the process where the decision maker gets to see and question the Claimant. That face to face observation is critical and in this author's experience is one of the factors causing ALJs to reverse many reconsideration denials.

While all Social Security cases first focus on medical proof, the testimony at an administrative law judge hearing may tip the scale in favor of a sympathetic and credible Claimant. It is important that a Claimant fully explain the limitations and the effects of the disease on their daily activities. Testimony, which is consistent with the medical evidence and credible, can persuade a Social Security judge to award benefits in a claim based upon Fibromyalgia or CFS.

The final two steps in the review process are the Appeals Council, and if unsuccessful, the United States District Court. These reviews are primarily based upon the medical evidence and testimony from the ALJ hearing. Since there is no additional testimony, and very little additional medical evidence can be supplied, these two levels of review are helpful in only a small percentage of claims. The backlog at the Appeals Council is now almost two years.

NOTE: SSA has begun testing different application processes in different parts of the nation. Some Claimants will not have a reconsideration stage; some will not have Appeals Council review. All Claimants will have an opportunity for an Administrative Law Judge hearing.

Representation
This Social Security disability application and appeals process was designed so that Claimants are not required to obtain representation. However, people with representation have much higher success rates. Familiarity with SSA's Regulations, Rulings, the federal caselaw interpreting the Act, and with SSA's internal guidelines called the POMS and HALLEX, help guide preparation of a claim. Representatives do not have to be licensed attorneys and there are paralegals and other non-attorneys who do provide representation.

This author's strong preference is to become involved in a claim as early in the process as possible. The earlier a Claimant understands the issues in her particular situation, and the earlier the review of the existing available medical proof, the greater the chance the assistance will be granted at some point in the process. In addition, care needs to be exercised in the completion of many of the early questionnaires sent by the DDS adjudicators - many answers on these forms end up being twisted and serving as the basis for denials by adjudicators and ALJs.

Almost all attorneys who focus in this area of the law will agree to representation on a contingency fee basis - that means that fees are only awarded in the event of a favorable outcome. In addition, the Social Security Administration always retains the right to review attorney fees.

Conclusion
Many claims for SSDI and SSI benefits are approved for persons with Fibromyalgia and Chronic Fatigue Syndrome. Claimants must have the support of their treating specialists - especially the rheumatologist and/or pain specialist and must maintain good communication regarding their symptoms and limitations.

If depression has become an issue then treatment with either a Ph.D. psychologist or M.D. psychiatrist is important. The earlier a Claimant obtains experienced representation the greater the chance for success, and the less stressful the battle through the various levels of appeal and review. Perseverance will prevail and disabled persons can obtain this much needed assistance.

Nothing in this article is intended to be specific legal advice or to create an actual or implied attorney-client relationship. This article has been a brief summary of the basic law and persons seeking benefits should contact experienced representatives for advice upon which they can rely. Hopefully, however, this brief analysis will provide some insight into the disability system.

Federal Gulf War Illness Research Advisory Cmte. to Meet Monday, Tuesday in DC

(91outcomes.com) - The Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RACGWVI) is set to meet for two days, beginning Monday, June 28, at the federal VA’s central office in Washington, DC.  

Among the expected highlights are the unveiling of the final first report of the VA’s internal Gulf War Task Force, a presentation about the new Gulf War Steering Committee (GWSC) on internal VA research related to Gulf War veterans’ health issues, and scientific research presentations providing additional evidence linking 1991 Gulf War toxic exposures to long-term, negative health outcomes.

Another highlight will be an update on the Department of Defense’s Gulf War Illness Research Program (GWIRP) - part of the Congressionally Directed Medical Research Program (CDMRP) - by CDMRP director, U.S. Navy Captain Melissa Kaime.

Dr. Michael Weiner of the San Francisco VA Medical Center will be giving a presentation entitled, “Effects of military service on the brain.”  Earlier this year, VA officials revealed that approximately $11 million in funds from the cancelled contract with Dr. Robert Haley of the University of Texas-Southwestern had been awarded to Dr. Weiner for the purchase of a state of the art brain imaging machine.

Also slated to be discussed is the Institute of Medicine Report on Gulf War and Health, released on April 9, 2010, which found associations between deployment to the 1990 - 1991 Gulf War and specific health problems including chronic multisymptom illness (CMI).  CMI is popularly known as Gulf War Illness or Gulf War Syndrome. 

The RACGWVI meetings are open to the public and will be held in the Sonny Montgomery Conference Room on the second floor of the VA headquarters at 810 Vermont Avenue, N.W.  

The next meeting of the RACGWVI is scheduled for early November in Boston, Mass. 

This week’s agenda is as follows:

Monday, June 28, 2010

8:00 – 8:30 Informal gathering, coffee

8:30 – 8:35 Welcome, introductory remarks by Mr. Jim Binns, Chairman, Res Adv Cmte Gulf War Illnesses

8:35 – 9:30 Case report: long-term cognitive sequelae of sarin exposure, by COL Jonathan Newmark, Joint Program Executive Office for Chemical/Biological Defense, Department of Defense

9:30 – 10:15 Effects of military service on the brain, by Dr. Michael Weiner, San Francisco VA Medical Center

10:15 – 10:30 Break

0:30 – 11:15 Organophosphate exposure and cognition: Novel mechanisms of neurotoxicity, by Dr. Alvin Terry,  Medical College of Georgia

11:15 – 12:00 Neural Stem cell dysfunction and its implications on memory and mood in a rat model of Gulf-War illness, by Dr. Ashok Shetty, Durham VA Medical Center

12:00 – 12:45 Proteomic analysis of cellular response to Biological warfare agents and cognitive function in animal models, by Dr. Michael Mullan, Tampa VA Medical Center, and Dr. Fiona Crawford, Roskamp Institute

12:45 - 1:45 Lunch

1:45 - 2:30 ALS rates in Gulf War veterans, by Dr. Ronnie Horner, University of Cincinnati

2:30 – 3:15 Magneto-encephalography (MEG) patterns in neurological diseases, by Dr. Apostolos Georgopoulos, Minneapolis VA Medical Center

3:15 – 3:30 Break

3:30 - 4:30 Committee Discussion: VA Gulf War Task Force Report, led by Mr. Jim Binns, Chairman, and Dr. Kimberly Sullivan, Res Adv Cmte Gulf War Illnesses

4:30 – 5:00 Public comment 

Tuesday, June 29, 2010

8:00 – 8:30 Informal gathering, coffee

8:30 – 9:15 CDMRP Gulf War program update, by CAPT Melissa Kaime (USN), Congressionally Directed Medical Research Program

9:15 –9:45 VA Gulf War Task Force Report, by Mr. John Gingrich
Chief of Staff, Dept. of Veterans Affairs

9:45 – 10:30 VA Gulf War research program, Dr. Joel Kupersmith
development, Chief Research and Development Officer, Dept. of Veterans Affairs

10:30 – 11:15 Federal Advisory Committee Ethics Training, Mr. Jonathan Gurland, VA

11:15 – 11:30 Break

11:30 – 12:00 Update of VA Gulf War research: RFAs, by Dr. William Goldberg, VA Office of Research and Development

12:00 – 12:45 Committee discussion: Institute of Medicine (IOM) Gulf War report, led by Mr. Jim Binns, Chairman, and Dr. Lea Steele, Res. Advisory Cmte Gulf War Illnesses

12:45 – 1:15 Public comment

1:15 Adjourn

Monday, June 21, 2010

Gulf War Steering Committee Members Named

(91outcomes.com) -- The members of the VA’s new Gulf War Steering Committee have been named.  As planned, they include five members of (or appointed by) the VA’s National Research Advisory Committee (NRAC), which encompasses all of VA’s medical research, and four members of (of appointed by) the VA’s Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI).

One of the GWSC’s RAC members – me – is the panel’s representative Gulf War veteran with GWI.

VA officials created the GWSC based on an action item in the internal VA Task Force on Gulf War Veterans’ Illnesses and the recommendation of the RAC-GWVI. 

The new panel will hold its first meeting via teleconference tomorrow, June 22, 2011. 

-----------

GULF WAR STEERING COMMITTEE MEMBERS:

Chair

L. Maximilian Buja, M.D.

Dr. L. Maximilian Buja is internationally recognized for his research in cardiovascular pathology. He is author of over 240 research articles, 150 book chapters and two books in his scientific field. Buja served as dean of the UT Medical School at Houston from 1996 to 2003. Dr. Buja holds the Distinguished Chair in Pathology and Laboratory Medicine. In 2000, he was named the H. Wayne Hightower Distinguished Professor in the Medical Sciences.

Members

Tilo Grosser, MD

Dr. Grosser interests are in non-steroidal anti-inflammatory drugs (NSAIDs), which relieve pain, inflammation and fever by inhibiting the formation of bioactive prostanoids. Despite their efficacy in the relief of pain and inflammation, NSAIDs may be associated with gastrointestinal complications, including serious bleeds. Selectivity for COX-2 has been shown to reduce the incidence of these serious events, but is more likely to cause serious cardiovascular events than non-selective COX inhibition. Dr. Grosser is studying the mechanisms of these complications using genomics, proteomics, lipidomics approaches in model organisms and in proof-of-concept studies in healthy volunteers. One aim of this research is to identify approaches to the personalization of NSAID therapy.

Robert P. Kelch, MD

Dr. Kelch is Special Assistant to the President and the recently retired Executive Vice President for Medical Affairs at the University of Michigan. In this role, he led all three components of the University of Michigan Health System, including the Hospitals and Health Centers, the Medical School and the M-CARE managed care organization.

Dr. Loren D. Koller

Loren D. Koller is an independent consultant and former professor and dean of the College of Veterinary Medicine at Oregon State University. His areas of expertise include pathology, toxicology, immunotoxicology, carcinogenesis, and risk assessment. He is a former member of the NRC Committee on Toxicology and has participated on several of its subcommittees, primarily those involved in risk assessment. Dr. Koller has served on the Institute of Medicine’s Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam and has been invited to serve on committees for the CDC, EPA, Homeland Security, the Agency for Toxic Substances and Disease Registry, and the U.S. Army. He is considered one of the founders of the field of immunotoxicology.

Richard P. Wenzel, MD, MSc

Dr. Richard P. Wenzel is Chairman, Department of Internal Medicine, Virginia Commonwealth University (VCU) and President, MCV Physicians Virginia Commonwealth University, The Practice Plan of the Health System. He previously was founder and director of the VCU Outcomes Research Institute and the Clinical Trials Institute. Dr. Wenzel holds an appointment as Professor, Department of Internal Medicine, VCU. His research interests include prevention and control of hospital-acquired infections, sepsis, Candida bloodstream infections, and policy development for quality of care of patients. Dr. Wenzel has been the recipient of numerous honors and awards, and he has very actively participated in the training of fellows. He was Lt. Commander in the U.S. Navy Reserve, from 1970-1972. He received an M.D. at Jefferson Medical College (Thomas Jefferson University) and M.Sc. (Epidemiology) London University, London School of Hygiene and Tropical Medicine.

Roberta White, PhD

Dr. White is Professor and Chair of the Department of Environmental Health at Boston University School of Public Health. She is a neuropsychologist with expertise in environmental and occupational epidemiology. Author of numerous scientific publications, her research interests include evaluation of chronic effects of exposure to neurotoxins, the use of imaging in behavioral toxicology, and gene-environment interactions that mediate the development of neurodegeneration following chronic exposures. Dr. White’s current research projects include evaluation of cognitive function in military personnel who worked as pesticide applicators in the Gulf War, cognitive and neuroimaging correlates of Gulf War service, effects of prenatal pesticide exposures in South African children, and effects of metal exposures in the Framingham Heart Study cohort. Dr. White is currently the Scientific Director for the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RACGWVI).

James P. O'Callaghan, PhD

Dr. O’Callaghan is Distinguished Consultant and Head of the Molecular Neurotoxicology Laboratory in the Toxicology and Molecular Biology Branch of the Health Effects Laboratory Division of the U.S. Centers for Disease Control and Prevention (CDC). Prior to joining CDC, Dr. O’Callaghan founded the molecular and cellular neurotoxicology program in the Neurotoxicology Division, U.S. Environmental Protection Agency in Research Triangle Park, North Carolina. He directs a research program dedicated to the discovery and implementation of biomarkers of neurotoxicity. Dr. O’Callaghan is an appointed member of the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RACGWVI).

Anthony Hardie

Mr. Hardie is the former Executive Assistant of the Wisconsin Department of Veterans Affairs, where he oversaw the agency’s external relations, including those with the state legislature, Congress, the media, stakeholders, and the public. He is a Gulf War and Somalia veteran, and has worked extensively on policy issues related to post-deployment and Gulf War veterans’ illnesses, including service on several national boards and committees. He is a former Congressional staff member, a graduate of the University of Wisconsin, and the recipient of Wisconsin’s AMVETS Legislative Advocacy Award and Disabled American Veterans Department Distinguished Service Award, their highest annual state awards. Mr. Hardie is an appointed member of the VA Research Advisory Committee on Gulf War Veterans' Illnesses (RAC-GWVI) and the Congressionally Directed Medical Research Program (CDMRP) Gulf War Illness Research Program.

David C. Christiani, MD, MPH, MS

Dr. Christiani is Professor of Medicine, Director of the Harvard Education and Research Center for Occupational Safety and Health, and a Physician at Massachusetts General Hospital. Dr. Christiani’s major research interests are occupational, environmental and molecular epidemiology. He is studying the impact of exposures to various pollutants on health and the interactions between host factors (genetic and acquired susceptibility), and environmental exposures in producing acute and chronic diseases. This research is part of an emerging field known as molecular epidemiology. Dr. Christiani is active in developing new methods for assessing health effects after exposure to pollutants and has an interest in international occupational and environmental health studies.

Friday, June 18, 2010

Congressional Hearing on Gulf War Illness Issues Scheduled for July

Written by Anthony Hardie, 91outcomes.com Publisher/Editor

(91outcomes.com) – The U.S. House subcommittee on veterans affairs oversight and investigations has announced its third and final hearing of a three-part series on Gulf War illness issues. 

The hearing, entitled, “Gulf War Illness: The Future for Dissatisfied Veterans,” will be held at 10:00 a.m. on Tuesday, July 27, 2010 in the House Veterans’ Affairs Committee hearing room on Capitol Hill .

A recent Institute of Medicine report found that 250,000 veterans of the 1991 Gulf War – more than one-third – continue to suffer from what the IOM termed chronic multisymptom illness (CMI), more commonly known as Gulf War Syndrome or Gulf War Illness. 

The IOM also found that rates of PTSD and other psychiatric conditions were much lower than CMI rates in Gulf War veterans, and emphatically stated that the multisymptom illness prevalent in Gulf War veterans could not be attributed to a psychiatric cause, providing further vindication for the hundreds of thousands of Gulf War veterans who have been suffering from debilitating physical conditions for nearly 20 years.

Last August, U.S. Department of Veterans Affairs (VA) Secretary Eric Shinseki launched a comprehensive internal task force on Gulf War veterans’ illness issues, chaired by VA Chief of Staff John Gingrich, himself a Gulf War veteran. 

Earlier this year, VA’s internal Task Force not only released its initial draft report to the public  -- unusual for an internal government task force -- but also allowed and requested public comments.  

The transparency measures, on an issue that has drawn frustration and hostility for years from ill Gulf War veterans, were well received by the Gulf War veteran community.  The measures, from a federal agency previously known more for stonewalling and denial on Gulf War illness issues, renewed hope in many quarters that real change aimed at genuinely providing new improvements in the health and lives of Gulf War veterans is finally on its way.

A final copy of the VA task force’s report is expected just prior to the upcoming Congressional hearing.

More information on the hearing can be found here:  http://veterans.house.gov/hearings/hearing.aspx?NewsID=601.

Tuesday, June 15, 2010

Letter from VA Chief of Staff John Gingrich

RE:  Gulf War Task Force Draft Written Report Public Comment submissions

Dear contributor,

Thank you for commenting on the Department of Veterans Affairs’ Gulf War Veterans’ Illnesses Task Force draft report. Your insights, issues and ideas are not only important to VA but to every Veteran who served in the Gulf. VA is committed to improving its transparency and public engagement in finding innovative solutions to these long standing issues. We recognize that VA must actively engage our Veterans to ensure that misconceptions are addressed and that stakeholders and Veterans are empowered and thus part of the solution in ensuring that VA is the best it can be.

This is our first initiative where we have solicited public feedback on policy proposals utilizing both the Federal Register and a public comment driven New Media messaging board. The responses have been historic. Never before has VA received so many public comments on a proposed rule, regulation, or policy in such a short period of time. We thank you for your responsiveness.

VA is reviewing all comments and recommendations related to the draft findings and conclusions. Once the review is completed an updated version of the report will be drafted. The Secretary will be made aware of your recommendations, and the other issues presented before publishing our report in late July. VA does not consider this a final report and will continue to work with Gulf War Veterans and their families as we move forward and begin the 2011 Task Force Report.

Having commanded troops during the Gulf War, and then knowing that some of these brave men and women have fallen to mysterious illnesses has been both a frustrating and saddening experience. Some of your shared personal stories have been particularly compelling as well as enlightening to me and our team.

We now have an opportunity to do something about this situation, and with this Task Force I know that we will greatly improve the care and services Veterans have earned in service to our country. Also, a special thanks is extended to the Veteran Service Organizations who not only commented on the report but actively spread the word to Veterans about this draft written report.

I would also like to take this opportunity to encourage you to attend the Gulf War Veterans Reunion in Dallas, Texas this coming summer. This event will be hosted by the National Gulf War Resource Center (NGWRC) and will provide an opportunity to gather, fellowship and share information. I will be there with my team to discuss the latest efforts VA is making on behalf of Gulf War Veterans. For further information on this event, please visit the URL noted below: http://www.ngwrc.org/2010/2010%20reunion.htm.

Finally, please note that general information on the Department of Veterans Affairs’ benefits and services related to service in the Persian Gulf Theater may be found at www.publichealth.va.gov/exposures/gulfwar/ or the toll free helpline at: 1-800-749-8387

Personal regards,

John R. Gingrich

Chairman, Gulf War Veterans’ Illnesses Task Force

Wednesday, June 9, 2010

VA Announces New Task Force to Address IOM Report Recommendations

Written by Anthony Hardie

(91outcomes.com) - VA has formed a task force to address an April 9, 2010 Institute of Medicine (IOM) report on Gulf War Veterans’ illnesses that found associations between deployment to the 1990 - 1991 Gulf War and specific health problems. .  The new VA task force is reviewing the Institute of Medicine Report on Gulf War and Health and will make recommendations for VA action to VA Secretary Eric Shinseki.

The Persian Gulf War Veterans Act of 1998, enacted through the work of Gulf War veteran activists, directs VA to contract with IOM for the study of exposures and ailments potentially linked to service in 1991 Gulf War. 

VA’s review of IOM reports of new associations with wartime service generally result in expanded presumptions for service connected disability benefits and can result in new focuses in VA health care. 

In 2008, IOM began to review, evaluate, and summarize the literature on health outcomes noted in its 2006 report that seemed to appear at higher occurrence in Gulf War-deployed Veterans than non-deployed Gulf War Veterans. Also, IOM reviewed studies on cause-specific mortality in Gulf War Veterans and examined the literature to identify any emerging health outcomes.

In the April 2010 report, IOM found the following associations between deployment to the 1991 Gulf War and specific health outcomes:

  • Sufficient evidence of a causal relationship: PTSD, as might be expected from any combat experiences.  Rates of PTSD are much lower for veterans of the 1991 Gulf War than for other wars, and IOM found the percentage of Gulf War veterans with PTSD to be far lower than that with chronic multisymptom illness.
  • Sufficient evidence of an association:
    • Chronic Multisymptom illness (CMI).  IOM noted that this affects 250,000 veterans of the 1991 Gulf War and could not be attributed to any known psychiatric condition.  CMI is more popularly known as Gulf War Illness (GWI) or Gulf War Syndrome. 
    • Gastrointestinal symptoms consistent with functional gastrointestinal disorders such as irritable bowel disease (IBS)
    • Anxiety disorders and other psychiatric disorders. These disorders persist for at least 10 years.   It is well established that depression and anxiety are common in people with chronic illness.  A recent 91outcomes.com article showed that depression is often diagnosed before diagnosis of the real underlying disease.
    • Substance abuse, particularly alcohol abuse.
  • Limited/suggestive evidence of an association:
    • Fibromyalgia and chronic widespread pain
    • Amyotrophic lateral sclerosis (ALS).  ALS has been termed by involved scientists as a true “outbreak”, which peaked in 1995.  Scientists are monitoring whether there may be other future peaks.
    • Sexual difficulties
    • Death due to causes such as car accidents in the early years after deployment

Of the conditions found by IOM to be associated with 1991 Gulf War service, currently only fibromyalgia (FM) and irritable bowel syndrome (IBS) are presumptive for service-connected disability claims for veterans of the 1991 Gulf War.  While claims for chronic multi-symptom illness, called “undiagnosed or ill-defined illness” by VA, are also presumptive, VA has come under severe criticism for its high claims denial rates in this area. 

Another task force, chaired by VA Chief of Staff John Gingrich, is currently reviewing this and other related matters.

The report calls for a substantial commitment to improve identification and treatment of multisymptom illness in Gulf War veterans.

According to IOM, the path forward should include continued monitoring of Gulf War veterans and development of better medical care for those with persistent, unexplained symptoms.  IOM said that researchers should undertake studies comparing genetic variations and other differences in veterans experiencing multisymptom illness and asymptomatic veterans. 

According to IOM, it is likely that multisymptom illness results from the interactions between environmental exposures and genes, and genetics may predispose some individuals to illness, the committee noted.  IOM noted that there are sufficient numbers of veterans to conduct meaningful comparisons given that nearly 700,000 U.S. personnel were deployed to the region and more than 250,000 of them suffer from persistant, unexplained symptoms. 

IOM stated that a consortium involving the U.S. Department of Veterans Affairs, U.S. Department of Defense, and National Institutes of Health could coordinate this effort and contribute the necessary resources.

From the IOM:  About Us

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

The Institute of Medicine serves as adviser to the nation to improve health.

The IOM asks and answers the nation’s most pressing questions about health and health care. Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. Each year, more than 2,000 individuals, members, and nonmembers volunteer their time, knowledge, and expertise to advance the nation’s health through the work of the IOM.

Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While our expert, consensus committees are vital to our advisory role, the IOM also convenes a series of forums, roundtables, and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking.

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The U.S. Department of Veterans Affairs and the Institute of Medicine contributed to this story.

Tuesday, June 8, 2010

Gulf War Illness, ALS, Cancer and other Research Programs Seeking Consumer Reviewers

CDMRP logo

The Department of Defense, Congressionally Directed Medical Research Programs (CDMRP) is actively seeking military personnel, veterans, and/or family caregivers to serve as consumer* reviewers of scientific proposals to help determine the research that will be funded this year.

The CDMPR program was established to fund and manage research grants designed to address the prevention, diagnosis, treatment, and mitigation of these conditions, diseases and/or illnesses.

Consumers participate in the scientific peer review process as representatives of those living with the condition/disease/illness that has touched their lives. They provide a broad perspective of condition-related issues important to their community. They may be survivors who have been affected by the conditions, diseases and/or illnesses or family members caring for individuals with the condition/disease/illness.

Consumers who are not active duty military are nominated by their advocacy, outreach, support organization or treatment professional to participate in this important process. Consumers who are military personnel may apply directly.

If you are interested in learning more about this exciting opportunity call 301-360-2150, or email:

You can also check the CDMRP Web site at http://cdmrp.army.mil for additional information.

* Consumer definitions are program specific.

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FOR MORE INFORMATION:  http://cdmrp.army.mil/cwg/default.shtml

VCS to Attend 20th Anniversary Gulf War Conference in Dallas in August

Written by VCS

Health & Educational Fair for Veterans Who Served in Southwest Asia Since August 1990

(VeteransForCommonSense.org) - June 7, 2010 - The National Gulf War Resource Center (NGWRC) is pleased to announce its Health & Educational Fair for veterans who served in Southwest Asia.  This year's event is to be held in Dallas, Texas, Thursday August 5th through Sunday August 8, 2010.

You can see the agenda HERE. The featured Guest of Honor at the event will be Mr. H. Ross Perot, a distinguished American businessman, former Presidential Candidate, staunch supporter of the United States military and veterans' causes and a veteran himself. During the event Mr. Perot will be honored with the National Gulf War Resource Center’s 20th Anniversary Desert Storm Patriot Award.

Many thousands of veterans have been afflicted with an array of chronic illnesses directly resulting from their service.  Now with the Department of Veterans Affairs (VA) opening up those covered under gulf war illness to veterans of OEF and OIF, there will be a lot of information given out to help them.   Click HERE to register.

The VA’s Research Advisory Committee on Gulf War Illnesses announced in November 2008 that one in four veterans of the PGW suffer from chronic illness. In April of this year the Institute of Medicine (IOM) released their report that acknowledged a relationship between one's service in Southwest Asia and their multisymptom illnesses.

NGWRC and other veteran organizations continue to advocate on behalf of these veterans for treatment and disability compensation and to push for annual research funding that may one day lead to a cure.

Our four-day event will feature a number of distinguished speakers who will discuss ongoing research into Gulf War Illnesses (GWI) and other related topics, including Dr. Robert Haley from the University of Texas, Southwestern Medical Center. Dr. Haley and his colleagues have made great strides in epidemiologic, clinical and laboratory research on GWI since March of 1994.

The VA’s Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI) will be represented by the well known researcher Lea Steele, PhD. She will be covering the different research programs that have been completed.  Dr. Steele will also cover what research is going on and how imperative it is for veterans to take part.

The Department of Veterans Affair’s War Related Illness and Injury Study Clinic (WRIISC), on the request of the NGWRC, will present information to the veterans about their program.  The NGWRC has also set it up for them to visit the Dallas/ Fort Worth area VA and put on classes for the staff about gulf war illness.

All veterans are invited regardless of their periods of service. Details are available at http://www.ngwrc.org/2010/2010%20reunion.htm or by calling toll-free; (866) 531-7183

Monday, June 7, 2010

Army psychiatrists who supervised psychiatrist/Fort Hood shooter Nidal Hasan face charges for failing to take action

Ft. Hood Accused Shooter, U.S. Army Maj. Nidal Hasan

By Daniel Zwerdling, January 21, 2010

(NPR) - The Army has told some of the psychiatrists who supervised Fort Hood shooting suspect Nidal Hasan that it’s investigating them — and they could face punishments from letters of reprimand to court martial.

The Army said it’s going to decide if the doctors at Walter Reed “failed to take appropriate action” against Hasan and were “derelict” in their duties.

Evidence shows a lot of doctors were worried about Hasan — some for years. Evidence also shows that only one supervisor, Scott Moran, actively tried to kick Hasan out of the psychiatry program. Now sources involved in the investigation say Moran is one of the officers who’s in big trouble. Moran wouldn’t comment, but the sources say the supervisors under investigation are fairly low level officers like Moran, who is a major.

“They’re attacking the wrong target,” says Gary Myers, a lawyer who’s representing Col. Charles Engel, another psychiatrist whom Myers says is under investigation.

Engel was Hasan’s main supervisor in the fellowship program at the military’s medical school, the Uniformed Services University of the Health Sciences. Myers says the Army is trying to find scapegoats and that everybody knows officials in the nation’s intelligence agencies bear at least some responsibility for what happened at Fort Hood.

Read entire article:  http://www.npr.org/templates/story/story.php?storyId=122778372

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Military Doctors Worried Hasan Was 'Psychotic,' Capable of Killing Fellow Soldiers

Published November 12, 2009

(FoxNews.com) - U.S. military doctors overseeing Nidal Malik Hasan's medical training were concerned he was "psychotic" and possibly capable of killing other American soldiers, before the Army major allegedly went on a deadly shooting rampage at Fort Hood, Texas.

Psychiatrists and medical officials at Walter Reed Army Medical Center held a series of meetings beginning in the Spring of 2008 to discuss serious concerns about his work and behavior, National Public Radio reported.

One of the questions they asked: Was Hasan psychotic?

"Put it this way," one official told NPR. "Everybody felt that if you were deployed to Iraq or Afghanistan, you would not want Nidal Hasan in your foxhole."

One official who participated in the discussions reportedly told others he was worried that if Hasan was deployed to Iraq or Afghanistan, he might leak covert military information to Islamic extremists, NPR reported.Another official "wondered aloud" to colleagues whether Hasan might be capable of killing fellow soldiers in the same way a Muslim sergeant in 2003 had set off grenades at a base in Kuwait, killing two and wounding 14, the radio network reported.

The officials who discussed Hasan's status were unaware — as some top Walter Reed hospital officials were — that intelligence agencies had been tracking Hasan's e-mails to a radical imam since December 2008, NPR said.

Officials considered kicking Hasan out of the program but chose not to partly because firing a doctor is a "cumbersome and lengthy" process that involves hearings and potential legal conflict, sources told NPR.

Officials also believed they lacked solid evidence that Hasan was unstable and were concerned they could be accused of discriminating against him because of his Islamic identity or views.

The concerns about Hasan's performance and religious views were shared with other military officials considering his assignment after he finished his medical training, and the consensus was to send the 39-year-old psychiatrist to Fort Hood, an official told the Associated Press.

Hasan was characterized in the meetings as a mediocre student and lazy worker, a matter of concern among the doctors and staff at Walter Reed and the Uniformed Services University of the Health Sciences, a military medical school in Bethesda, Maryland, an official told The Associated Press.

Fort Hood, one of the country's largest military installations, was considered the best assignment for Hasan because other doctors could handle the workload if he continued to perform poorly and his superiors could document any continued behavior problems, the official said.

Sharon Willis, a spokeswoman for the Uniformed Services University, referred questions Wednesday about Hasan to his lawyer. The attorney, John Galligan of Belton, Texas, did not immediately return a telephone call seeking comment.

The revelations about the concerns that Hasan's superiors had before sending him to Fort Hood come amid a growing debate over what warning signs the military and law enforcement officials might have missed before last week's massacre.

A joint terrorism task force overseen by the FBI learned late last year of Hasan's repeated contact with a radical Muslim cleric who encouraged Muslims to kill U.S. troops in Iraq. The FBI said in a statement late Wednesday that the task force did not refer early information about Hasan to superiors because it concluded he wasn't linked to terrorism.

The doctors and staff who discussed concerns about Hasan had several group conversations about him that started in early 2008 during regular monthly meetings and ended as he was finishing a fellowship in disaster and preventive psychology this summer, the official familiar with the discussions said.

They saw no signs of mental problems, no risk factors that would predict violent behavior. And the group discussed other factors that suggested Hasan would continue to thrive in the military, factors that mitigated their concerns, the official said.

According to the official, records reviewed by Hasan's superiors described nearly 20 years of military service, including nearly eight years as an enlisted soldier; completion of three rigorous medical school programs, albeit as a student the group characterized in their discussions as mediocre; his resilience after the deaths of his parents early in his medical education, and an otherwise polite and gentle nature when not discussing religion.

The Army has said it has no record of enlisted service for Hasan, instead noting that his military service began when he started the medical school program in 1997.

The official said the group became increasingly concerned about Hasan's religious views after he completed two research projects that took a decidedly religious tone — one at the end of his residency at Walter Reed that advocated allowing Muslim soldiers to be released as conscientious objectors instead of fighting in wars against other Muslims, and the other as he pursued his master's degree in public health that discussed religious conflicts for Muslim U.S. soldiers.

Some in the group shared their experiences with Hasan, all telling similar stories about repeated instances when he made religion an issue.

Officials involved at various times in the meetings about Hasan included John Bradley, Walter Reed's chief of psychiatry; Scott Moran, Walter Reed's psychiatric residency program director; Robert Ursano, chairman of the Uniformed Services University's psychiatry department; Charles Engel, the university's assistant chair of psychiatry, and David Benedek, an associate professor of psychiatry at the university.

Those officials either declined to comment or did not return telephone calls and e-mails seeking comment Wednesday.

Meanwhile, the Pentagon has found no evidence that Hasan formally sought release from the Army as a conscientious objector or for any other reason, two senior military officials told The Associated Press. Family members have said he wanted to get out of the Army and had sought legal advice, suggesting that Hasan's anxiety as a Muslim over his pending deployment overseas might have been a factor in the deadly rampage.

Hasan had complained privately to colleagues that he was harassed for his religion and that he wanted to get out of the Army. But there is no record of Hasan filing a complaint with his chain of command regarding any harassment he may have suffered for being Muslim or any record of him formally seeking release from the military, the officials told the AP.

The officials spoke on condition of anonymity because the case is under investigation.

Another Army official, Lt. Col. George Wright, said Wednesday that Hasan likely would have had to commit to another year in the military when he was transferred to Fort Hood earlier this summer. It is common for an officer to incur a one-year service extension when they receive a transfer to another post.

The Associated Press contributed to this report.

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January 21, 2010 Thursday

DEPARTMENT DEFENSE BRIEFING

NATIONAL PUBLIC RADIO "MORNING EDITION" REPORT;
SUBJECT: "ARMY DOCTORS COULD FACE DISCIPLINE IN FORT HOOD CASE" REPORTERS: RENEE MONTAGNE, DANIEL ZWERDLING

NATIONAL PUBLIC RADIO "MORNING EDITION" REPORT SUBJECT: "ARMY DOCTORS COULD FACE DISCIPLINE IN FORT HOOD CASE" REPORTERS: RENEE MONTAGNE, DANIEL ZWERDLING TIME: 7:15 A.M. EST DATE: THURSDAY, JANUARY 21, 2010

MS. MONTAGNE: Returning to the story of Nadal Hasan, the U.S. Army major charged in last year's Fort Hood shooting. NPR has learned the Army has told some of the psychiatrists supervising Hasan at Walter Reed Hospital that it's investigating them and they may face punishment. The Army said it will decide whether the doctors, quote, "failed to take appropriate action against Hasan and were derelict in their duties."

One name on the list of supervisors is a surprise as NPR's Daniel Zwerdling reports.

MR. ZWERDLING: The evidence shows that a lot of doctors were worried about Nadal Hasan for years. The evidence also shows that only one supervisor actively tried to kick Hasan out of the psychiatry program, his name is Scott Moran. So here's the surprise. Sources involved in the investigation say that Scott Moran is one of the officers who is now in big trouble.

Moran wouldn't comment, but the sources tell NPR that all the supervisors under investigation are fairly low level officers like Moran. He's a major.

GARY MYERS: They're attacking the wrong target.

MR. ZWERDLING: Gary Myers is a lawyer who is representing another psychiatrist whom he acknowledges is under investigation. His client is Colonel Charles Engel. Engel was Hasan's main supervisor in the fellowship program at the military's medical school. Meyers says the Army is trying to find scapegoats. He says everybody knows by now that officials in the nation's intelligence agencies bear at least some responsibility for what happened at Fort Hood.

MR. MEYERS: The notion that that it is attributable to lower level physicians who were also mentors strikes me as being a bullet fired high and to the right.

MR. ZWERDLING: A spokesman for the Army said they won't confirm or deny that they've notified any officers that they're under investigation. As you might remember, NPR reported troubling details about Hasan's medical career back in November. We reported that right after Scott Moran took over the psychiatrist residents program back in March 2007, he reviewed Hasan's record and he told colleagues they should get rid of him. Moran wrote a memo to the powerful credentials committee. The memo denounced Hasan for a pattern of poor judgment and a lack of professionalism. But sources and documents confirm that higher ups told Moran to back off. They said going after Hasan might cause legal hassles.

Next, Hasan went to a fellowship at the military's medical university and documents show that supervisors there got upset, too. Some of Hasan's supervisors were concerned that Hasan seemed to have extremist Islamist beliefs. Hasan seemed obsessed with a Muslim American soldier who killed fellow troops in Kuwait. Some supervisors even wondered out loud, could Nadal Hasan be psychotic?

Sources say the Army is investigating Charles Engel because he knew about those concerns, yet he allegedly didn't take tough enough action. Those same sources say the Army is investigating another psychiatrist named Colonel John Bradley for the same reason. Bradley has been running the psychiatry department at Walter Reed and colleagues say both men kept telling them, we're running training programs here, we're supposed to help people like Hasan try to improve. And sources say when they got on his back, Hasan occasionally did better work.

The investigation of Scott Moran is more puzzling since documents suggest that he's the only one who actively tried to go after Hasan. Documents show that Moran did sign paperwork later that recommended Hasan for promotion, but that was after higher ups rebuffed him. So far, there's no sign that the Army is investigating those higher ups.

NPR tried to reach Moran, Bradley and Engel for comments. None of them responded. Sources say the Army has notified several other mid-level officers that they're being investigated, too. The Army won't confirm those details either.

Daniel Zwerdling, NPR News.

January 21, 2010

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COL Charles Engel, M.D., M.P.H., mentioned in the press accounts above, currently serves on the Congressionally Directed Medical Research Program’s (CDMRP) Gulf War Illness Research Program (GWIRPFY2010 Integration Panel.