Saturday, November 3, 2012

Gulf War Veterans' Lung Cancer Risk and Gov't Failures

A six-month long news team investigation into lung cancer in Gulf War veterans was finally completed and aired this week in Indiana.  

The investigative team's story asks this incisive rhetorical question:

"So if doctors, the VA, and the military all know veterans from the Gulf War are at higher risk: Why isn't DOD notifying those at higher risk and why isn't the VA screening them aggressively?"

VA and DoD have known for years about higher risks of lung cancer, and other cancers, among Gulf War veterans.  Yet, that knowledge has translated into absolutely nothing in terms of DoD or VA health care screenings for affected veterans.

One of those affected veterans is Colonel Mark Smith, a Gulf War and OIF veteran with advanced lung cancer, featured in the story below.  He attributes his lung cancer to heavy exposure to the burning oil well fires lit by retreating Iraqi forces in February 1991.  

A presentation by the National Gulf War Resource Center at its annual conference in Las Vegas in 1999, attended by VA and DoD officials, presented evidence from dozens of documents received under the Freedom of Information Act showing that federal officials were aware that microfine (< 2.5u) particulates from Kuwaiti burning oil well fires exceeded safe health limits by hundreds of times, and that long term health effects included lung disease and lung cancer.  

Some 1991 Gulf War troops were also exposed to Iraqi chemical warfare agents, including following air bombing and demolitions of Iraqi chemical munitions during and following the war.  Those officially recognized include sarin, cyclosarin, and mustard gas, a known carcinogen.  

VA and Congress have received recommendations from multiple sources on the need for appropriate screening for those at greater risk for lung cancer, including detailed reports from highly reputable health and veterans advocacy organizations.   Among these is the entire section on lung cancer and veterans in the annual "Independent Budget" coauthored by a long list of veterans service organizations (VSOs).   

And, in repeated reports to the Secretary of Veterans Affairs (VA), the Congressionally chartered  Research Advisory Committee on Gulf War Veterans' Illnesses (RAC) has recommended health monitoring for cancers, including lung cancer.  In particular, the 2008 RAC report cited findings by the Institute of Medicine (IOM) that lung cancer is associated with combustion byproducts.  The report, as well as more recent reports and recommendations by the RAC, have detailed serious concerns with VA's lack of adequate medical surveillance related to cancer and other serious diseases.  

These and other reports, recommendations, and research are provided at the end of the news story, below.  More information can also be found here on 91outcomes by searching on "lung cancer," including an April 2012 post, "Higher Rates of Lung Cancer Among Gulf War, Other Veterans; Immediate Medical Research Funding Availability through CDMRP."  

Yet DoD and VA officials and bureaucrats to date have failed to act to implement lung cancer risk assessments among Gulf War veterans and screening for those deemed at risk, leading to one of many ongoing advocacy missions for the VSO's and health advocacy organizations like the Lung Cancer Alliance in Washington, DC.  

As an affected Gulf War veteran myself, one whose lung issues began in the Kuwait in 1991 and have never subsided, I can personally attest to years of battles within the VA healthcare system to get appropriate diagnostic testing and care.  Finally in 2009 -- after 15 years of fruitless battles with VA -- private healthcare paid for by expensive private health insurance included a bronchoscopy that provided obvious visible evidence of serious chronic inflammation, consistent with my two decades of lung symptoms -- and a new avenue for treatment.  For veterans like me -- with a long, well documented history of debilitating respiratory issues that began on a particular day in Kuwait in 1991 -- VA has done and continues to do nothing proactive to reach out or to provide anything other than grossly inadequate healthcare related to these Gulf War related lung issues.  

Other veterans besides Gulf War veterans with oil well fire and chemical warfare agent exposures could also be at risk for negative lung outcomes, potentially including those already suffering following exposures to hexavalent chromium exposure at Qarmat Ali and to burn pits in Iraq, Afghanistan, and elsewhere.  

It is high time that ranking officials at VA take action and implement the clearly articulated recommendations of the Lung Cancer Alliance, the Independent Budget VSO's, the RAC, and medical researchers, implement risk assessments for Gulf War (and other potentially at risk veterans), and conduct regular screening for those at higher risk for lung and other cancers.  

It is true that there are health risks associated with the screening procedures, including radiation from CT scans, that must be weighed by health care providers.  But failure to notify veterans at risk, failure to implement plans for risk assessment, and failure to do the sorts of health screening recommended for those at higher risk are all signs of unmistakable DoD and VA failure -- the kind of failure to which Gulf War veterans have grown all too accustomed over the last two decades.  

Special thanks to investigative reporter Karen Hensel for her exceptional work on this expose, and to all involved at WISH-TV8.  It was a privilege to assist you in your investigation.  



Veterans not told of lung cancer risk

Updated: Friday, 02 Nov 2012, 10:51 PM EDT
Published : Friday, 02 Nov 2012, 10:27 PM EDT

INDIANAPOLIS (WISH) - An I-Team 8 investigation is already prompting congressional action in Washington D.C. In a six-month long investigation, I-Team 8 uncovered information raising more questions than answers about government accountability to American troops.
I-Team 8’s investigation began with a U.S. Marine in Indianapolis. The investigation is now centered in Washington D.C. as we question top commanders, Veterans Affairs and congressional leaders about the deadly cancer predicted 20 years ago in what some called "The Black Lung Tour."
Colonel Mark Smith is a fighter.
"I kill freakin' terrorists. That ain't hard. It's what I was born to do. These people kill cancer,” Smith said.
He is a battalion commander — a U.S. Marine.
In 2004 he led 1,200 Marines into one of the fiercest battles of Iraq, the battle of Fallujah. Looking at pictures of the Marines his battalion lost, he says, "I cried like a baby every time we lost one of our outstanding Marines in combat."
Many in central Indiana came to know Mark, also an Indiana State Trooper, his wife and daughters through letters home from Iraq that were featured on WISH-TV.
But in those letters years ago, his real battle was just beginning.
"The morning I got up, I had a bizarre pain in my calf," Smith recalled.
At a commanders conference in New Orleans, he was about to take his morning run.
"Being athletic you automatically think strain, sprain, overtraining," he said.
The pain persisted. Doctors found a blood clot in his leg, so they ordered a CT scan.
It was lung cancer.
"The only thing I heard in that room that night was in my own mind, planning my funeral," Smith said.
24-Hour News 8 cameras have spent months documenting how a Marine commander, always prepared, battles cancer.
"This is just something I was completely and utterly unprepared for,” Smith said. “The Marine Corps steels you."
Smith admitted it was hard to get into the car to go for his first double dose of chemotherapy and radiation.
"It's really hard because everything from the time you are diagnosed is about finding 'the new normal,’” he said.
Chemotherapy and radiation became his "new normal."
Leaving his first day of treatment, Smith describes it as "awesome" then lifts his shirt to show the box outlined in marker on his chest to show the area doctors will hit with radiation. Day after day he undergoes both radiation and chemo — long, hard, grueling treatments.
He sits with an IV in his arm for chemotherapy, holding a book and saying, "This is just the Marine Corps way."
The Marine Battlebook is replaced by Mark's Cancer Battlebook. He fights fatigue and nausea as a Marine — through martial arts, the treadmill and swimming.
Sitting on his couch at home, Smith explains where the cancer may have originated.
"My personal belief is Desert Storm," he said.
His team of doctors points to Desert Storm as a possible source for the cancer. When asked if there could be any connection between Smith's lung cancer and his time served in the Gulf War, Dr. Peter Garrett says, "He certainly had exposure."
In 1991 Smith deployed with the 3/24 Marines to Saudi Arabia — "Camp Coyote."
"Prior to the ground war — starting when the Iraqis torched some of the oil wells — we were in a significant path of the smoke from one of those oil fires for a very long time,” he said. “Four to six weeks."
His pictures tell the story.
"At high noon the sky had a blackish blue hue to it. We would routinely, constantly blow our nose and have nothing but black in the Kleenex. It wasn't uncommon to be standing there and another instructor go like this (wipes his nose) to let you know you had black gunk coming out of your nose,” Smith said.
Young and bulletproof, they joked it would kill them one day.
I-Team 8 discovered experts sounding the alarm as early as 1991 that deaths "from lung cancer...are expected to rise dramatically..." (Source: John Horgan, The Danger from Kuwait's Air Pollution: Smoke from Oil Fires Threatens Healthy, Scientific American October 1991)
And I-Team 8 uncovered documentation showing Gulf War veterans with a "higher rate" and "substantially higher risk" of lung cancer. (Source: The Congressionally Directed Medical Research Program )
"We've known for years that our veterans are being diagnosed and dying of lung cancer at higher rates than civilians," Admiral T. Joseph Lopez, USN (Ret) said. He's on record saying early "screening not only saves lives but money."
While Veterans Affairs has been urged to offer CT screenings for veterans at high risk for lung cancer so far, the VA has not implemented it — relying solely on the less efficient X-rays. Remember, it was civilian doctors who discovered stage 3b cancer in Smith with a CT Scan. So if doctors, the VA, and the military all know veterans from the Gulf War are at higher risk: Why isn't DOD notifying those at higher risk and why isn't the VA screening them aggressively?
Should Smith have been on a priority list to be screened each year? His medical records show after returning from the Gulf War in 1991 he was diagnosed with asthma. The records show an abnormality on his right upper lobe — the same spot now riddled with cancer. I-Team 8 showed those medical records to his current doctor, asking if there is a correlation.
"Could be but I couldn't tell you for sure there was," Dr. Garrett said.
When told Smith believes the cancer originates to his time served in Desert Storm Garrett replied, "Could be."
Even at the time, British scientists predicted a jump in lung cancer over the following 20 years. (Source: American University International Law Review "Environmental Terrorism: Lessons from the Oil Fires of Kuwait" 1991 Volume 10/Issue 1)
Dr. Garrett confirms it can take that long for the cancer to develop. Smith is right on target. So, if members of the military are coming back and there is a higher risk and higher rate of lung cancer that has been documented, are members of the military supposed to just wait for it to show up?
"Well, I think that is the role for the Department of Defense," Dr. Garrett said.
Smith wore his uniform for his final treatment — the same uniform that may have led to the cancer.
"One of his nurses said, ‘What is the occasion?’ He goes, 'Last treatment.' Then he said he just wanted to show respect,” Mark's daughter Nichole explained.
Respect for his Marines he still considers on his watch.
"I knew when he said that even though they are up in heaven, they were part of the team too,” Nichole said. “Part of him fought it (the cancer) because they didn't have the choice or the chance to fight something like that if it ever came up. I know a part of him did it for them and their families too."
Smith has spent a career fighting terrorists to protect American lives. Now his fight is for his own life.
"The prognosis is good,” he said through tears. “Chances are everything will work out. But if they don't, I worry about others."
Asked if he means his daughters he breaks down with emotion and simply says, "Yeah."
And other Marines. At risk. Dying. Unaware.
Through months of research and digging for answers, I-Team 8 uncovered a disturbing trend. We discovered documentation that governments of Kuwait, Saudi Arabia and the United States suppressed information and a "gag order" led to a scarcity of data. (Source: John Horgan "Why are Data Being Witheld? Scientific American, July 1991) (Source: William Booth, Washington Post June 25, 1991. Also, Daphne Bramham Black Death in the Gulf: Environmentalists Accue Governments of Playing Down Potential Dangers from Blazing Oil Wells, Vancouver Sun July 27, 1991 B1, B4, B6)
Indiana Congressman Marlin Stutzman, Indiana's only member on the House Veterans Affairs committee, is launching his own investigation.
"After hearing about this case, I am very concerned,” Stutzman said. “This is an issue that needs to be brought to the immediate attention of the VA and DOD. I know one thing, being proactive in regard to early detection is the best prevention for cancer. We also need to make sure high-risk soldiers and Marines are getting the appropriate notification so they can be screened in a timely fashion. I will be following this story very closely."

Research and resources:

1 comment:

Anonymous said...

Well done!