Gulf War illness researchers wary about new approach
Former and current members of a national committee that studies the health of Gulf War veterans say they fear that one of the nation's most esteemed medical advisory associations is pursuing a course that could lead to inappropriate treatment for 250,000 veterans.
The crux of the matter is the question of what causes Gulf War illness, a chronic multisymptom illness suffered by U.S. troops who deployed to Kuwait and Iraq in 1990 and 1991.
Some say the cause is related to psychiatric issues. Others say it is linked to environmental exposures.
The Department of Veterans Affairs contracted the Institute of Medicine to review available research on Gulf War illness and issue a report on the matter. The report is expected to help lay the groundwork for future treatments and benefits for veterans who suffer from Gulf War illness.
The VA previously estimated that 250,000 veterans have the illness.
Five former and current members of the VA's Research Advisory Committee on Gulf War Veterans' Illnesses said recent research clearly shows that Gulf War illness is associated with a variety of toxic exposures during the war.
They stated in a letter to the president of the Institute of Medicine that the institute's newly assembled committee, which will oversee the research and report, is "grossly imbalanced" to favor 1990s-era thinking that Gulf War veterans have no special health problems.
"Reviving this discredited fiction will cause veterans' doctors to prescribe inappropriate psychiatric medications, and will misdirect research to find effective treatments down blind alleys — an unconscionable breach of the duty owed to veterans and expected of the Institute of Medicine," they wrote in the letter dated Nov. 28.
The motivation to tilt the committee's lineup is to hold down the cost of VA benefits and wait times for VA claims, the group says. The group is led by Phoenix resident James H. Binns, a former Department of Defense policy official who served on the VA's Gulf War illness research committee for 12 years.
Three other former members, plus current member and University of California-San Diego medicine professor Beatrice Golomb, also signed the letter questioning the new committee's objectivity.
The Washington-based Institute of Medicine is an independent, non-profit organization that provides advice to policy makers and the public.
In their letter, Binns and his colleagues urged institute President Victor Dzau to investigate the new committee's membership and to take corrective action.
"The most effective and rapid approach is for the (Institute of Medicine) to handle this itself. If it does not, however, we will work with veterans' organizations to show Congress the need to conduct an investigation and enact legislative solutions," they wrote.
Dzau did not respond to requests for comment.
Institute spokeswoman Jennifer Walsh said institute executives are aware of the letter. She noted that the committee's membership is subject to change.
"Careful steps are taken to convene a committee that has an appropriate range of expertise for the statement of task and a balance of perspectives," she stated in an e-mail to The Arizona Republic.
"As with all IOM committees, a committee is not finally approved until a thorough balance and conflict-of-interest discussion is held at the first committee meeting and any issues raised in that discussion or by the public are investigated and addressed."
Its first meeting is set for today in Washington.
The Institute of Medicine committee's 16 members will be charged with reviewing, evaluating and summarizing available scientific literature on the health effects of the war, according to a meeting notice.
The group's report will be issued after thorough deliberation and peer review, according to the notice.
No timeline for the process was provided.
Half of the new Institute of Medicine committee's members are predisposed toward the position that Gulf War illness is associated with post-traumatic stress disorder and other psychiatric factors, as opposed to physical reasons, according to Binns and his colleagues. Binns and his group based their analysis on a review of publicly available work by the committee members, they said.
The other Institute of Medicine committee members are neutral, they said.
"Given that the committee is charged with producing a consensus report, it is wholly foreseeable that its conclusions will end up between the group predisposed to 1990s fictions and those who are neutral but unfamiliar with the subject," Binns and his colleagues wrote.
The new committee threatens to reverse the institute's previous findings on Gulf War illness, according to the group.
A similar panel concluded in 2009 that it "is likely that Gulf War illness results from an interplay of genetic and environmental factors" and that it "cannot be reliably ascribed to any known psychiatric disorder."
Binns and his colleagues cite troops' exposure to toxicants from oil-well fires, low-level chemical weapons and anti-nerve-gas pills on the battlefield under skies that were blackened by smoke.
"I genuinely hope that Dr. Dzau will investigate this internally and will solve it internally," Binns said in an interview.
Veterans organizations and members of Congress are monitoring the matter.
Rick Weidman, executive director of policy and government for the Vietnam Veterans of America, said some members of the Institute of Medicine committee are on record that Gulf War veterans are not really sick.
"Some of the people are of a similar mind that it's all hysterical, and therefore we shouldn't even waste our time looking for a physiological cause. That's not the kind of scientist who should be put on the Institute of Medicine panel," he said.
U.S. Rep. Kyrsten Sinema, D-Ariz., who follows VA matters closely, said Institute of Medicine executives should put the best interests of veterans first.
"The Institute of Medicine's process should be fair, transparent, and based on sound science," she said in an e-mail.
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Paul Giblin is a Pulitzer Prize-winning reporter covering government policies and efficiency, and how they affect consumers of government.
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