Boston University and Veterans Advocate for Improved Care

 

Written by Lisa Chedekel, chedekel@bu.edu

(Boston, Mass. – Boston University) -- Some of the wounds of war are invisible to the untrained eye: traumatic brain injuries, post-traumatic stress disorder, and illnesses traced to chemical exposures, to name a few.

These injuries, which affect hundreds of thousands of veterans of the first Gulf War and the ongoing wars in Iraq and Afghanistan, have been compounded by delays and controversy in recognizing, treating and compensating the veterans who suffer from them, according to Boston University Law School and Boston University School of Public Health experts and veterans' advocates who spoke at the annual Pike Conference, Oct. 29, 2010 in Boston.

"The VA's come a long way in the last few years, but there is still a lot of work that needs to be done," said conference panelist Paul Sullivan, a Gulf War veteran who heads the non-profit advocacy group Veterans for Common Sense. "We need more research, more treatment options, more doctors and mental health professionals… We [also] need facts and figures about the wars."

Sullivan joined fellow veteran Anthony Hardie and a line-up of BU School of Public Health professors at the conference to discuss the continuing challenges in research and treatment for troops who served in the 1991 Gulf War, as well as those now returning from Iraq and Afghanistan.

Chief among those challenges has been a 20-year battle, waged by veterans of the Gulf War, to get recognition and treatment for a cluster of debilitating symptoms known as Gulf War illness. Two years ago, a scientific panel directed by Roberta White, the conference keynote speaker and chair of the BUSPH Environmental Health Department, issued a landmark report affirming that neurotoxic exposures are causally associated with Gulf War illness. The U.S. Department of Veterans Affairs has since agreed to re-examine the disability claims of Gulf War veterans.

"So much time was squandered," said Hardie, who serves on the scientific panel. He said he and other veterans were told for years, "'There's nothing wrong with you guys. It's all in your head.'"

He called White "one of our leading champions" in studying the causes of Gulf War illness.

BUSPH faculty members spoke of the need to ensure that the new generation of veterans receives prompt treatment for post-traumatic stress disorder [PTSD], traumatic brain injury, and mental-health problems.

Michael Grodin, professor of health law, bioethics & human rights at BUSPH and of family medicine and psychiatry at BU School of Medicine, said he was especially concerned about troops with PTSD and other mental-health problems being re-deployed multiple times into the war zone. He said that while there has been progress in understanding PTSD, "I think we need to utilize many treatment approaches."

George Annas, chair of health law, bioethics & human rights at BUSPH and a professor at the BU schools of law and medicine, noted that the military is grappling with an increase in the suicide rate among active-duty soldiers. Recently, the Army announced two major research project aimed at trying to understand risk factors and examine which suicide-prevention programs are successful.

"What intervention programs work? We don't know much about that," Annas said. "In this case, we're back where we were with the Gulf War syndrome, in 1992 -- we recognize there's a problem, and now we need to figure out what to do about it."

Leonard Glantz, a professor of health law, bioethics & human rights, said suicide prevention is difficult in both civilian and military life, and that identifying risk factors among soldiers is challenging because the number of suicide cases is relatively small.

Sullivan's group, which has battled for data from the U.S. Department of Veterans Affairs, calculates that the VA's Gulf War, Iraq and Afghanistan patient count will reach 1.5 million by the end of 2014. Data obtained by the group shows that as of June 30, 2010, the VA had treated 594,000 Iraq and Afghanistan veterans -- up 29,000 from the previous three months. Of those, 295,000 were diagnosed with at least one mental health condition.

Hardie encouraged BU researchers to apply for available federal funding to study effective treatments for injured veterans.  (http://cdmrp.army.mil)

"We've had a lot of success over 20 years," he said, "but 20 years is a long time to wait for health care."

Annas said BUSPH faculty members hope to continue working with veterans' advocacy groups on research and ethical issues.

Boston Univ. Study Adds More Evidence for Role of Pesticides, Pills in Gulf War Veterans' Illnesses

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com - Kansas City, Mo., Thursday, September 3, 2009) -- The early results of a new study of pesticide exposures and anti-nerve agent pills in veterans of the 1991 Gulf War provides additional evidence that their multiple exposures contributed to their continued, chronic ill health. The study, funded by the Gulf War Illness Research Program (GWIRP) of the Congressionally Directed Medical Research Program (CDMRP), was presented this week at the 2009 Military Health Research Forum in Kansas City, Missouri.

These early findings by Boston University epidemiologist Kimberly Sullivan, Ph.D. and her team of scientists are consistent with other similar studies of people chronically exposed to low doses of pesticides, which showed similar subtle effects on cognition and mood resulting from the exposures. The study's results are also consistent with major U.S. Government studies concluding that these types of pesticides could be among the contributing factors to some of the undiagnosed illnesses in veterans of the 1991 Gulf War.

The pesticides are in the same class of chemicals -- acetylcholinesterase (AcHE) inhibitors -- as the pyridostimine bromide (PB) anti-nerve agent pills taken by about 250,000 (DOD estimate) troops during the 1991 Gulf War. In all, 696,842 U.S. troops served during the war, with the federal government now acknowledging that approximately 175,000 to 210,000 or more remain ill with a unique form of chronic multi-symptom illness commonly known as Gulf War Illness (GWI) or Gulf War Syndrome.

Sullivan's research team interviewed 298 pest control military personnel who served in the 1991 Gulf War, including physicians, entomologists, environmental science officers, preventive medicine specialists, field sanitation team members, military police, and other pest controllers. In total, 159 inviduals were recruited from among the group for neuropsychological examination during a four-year time period.

The study subjects were divided into four groups, depending upon which combination of exposures they had to low- and high-dose pesticides and PB pills. The group with both high pesticides and PB had significantly higher rates of reported health and mood symptoms, were significantly more likely to meet criteria for chronic multi-symptom illness (CMI), and performed significantly worse on psychomotor testing.

Prior to Sullivan's study, it was unknown whether the cohort of Gulf War pesticide applicators had lasting neuropyschological or health problems, and if so, whether their health issues might correspond to their level of AcHE exposures.

In November 2008, a definitive U.S. federal government report on Gulf War veterans' health released by the Congressionally-chartered Research Advisory Committee on Gulf War Veterans' Illnesses found that the combination of pesticides and PB used during the Gulf War were common factors in many Gulf War veterans and at least partially caused their resultant chronic multi-symptom illness. Several other toxic exposures, including sarin and cyclosarin nerve agent, microfine particulate matter from the hundreds of oil well fires lit by retreating Iraqi troops, and other Gulf War exposures could also not be ruled out as additional causes.

Promising Research on Gulf War Illness, other Deployment Health Issues Presented at Key Scientific Meeting

(KANSAS CITY, Mo., Sept. 1 /PRNewswire-USNewswire/ CDMRP Release) -- From Gulf War Illness to traumatic brain injury to post-traumatic stress disorder to suicide, veterans face some of the most pressing conditions confronting the health care system today. And today's troops fighting the wars in Iraq and Afghanistan return home with medical challenges often unique to members of the military.

Research to address these needs is underway, and the work of hundreds of investigators engaged in the effort is being showcased September 1-3 at the Military Health Research Forum in Kansas City. The Forum is a conference designed to bring together investigators funded by the Department of Defense Congressionally Directed Medical Research Programs as well as invited speakers, consumers, members of the military health care system and DOD policy makers to facilitate the exchange of information and the development of new collaborations, and learn about research advancements funded through the host programs.

Areas of research include Gulf War Illness, psychological health, neuroprotection, rehabilitation, substance abuse, family issues and many more.


To view the Multimedia News Release, go to: http://www.prnewswire.com/mnr/militaryhealth/39824/

Among the highlighted abstracts:

* New research on treating Gulf War Illness, a condition that affects approximately 25 percent of service men and women who served in the 1990-1991 Gulf War. [ Read more about cutting edge Gulf War Illness treatments research ]

* Treatment for, and prevention of traumatic brain injury. Often called the "signature injury" of the Iraqi war, TBI can lead to a range of symptoms including headache, confusion, behavior change, memory trouble, convulsions and others. Topics examined include brain tissue regeneration, driving problems after mild TBI and the use of biomarkers to determine the extent of TBI. [ Read more about brain injury disagnostic and treatment oriented research initiatives ]

* Innovative treatments for post-traumatic stress disorder (PTSD). Depending on the conflict in which they served, 10 to 30 percent of soldiers who have spent time in war zones experience the debilitating and life altering symptoms of PTSD. Topics examined include employing virtual environments and novel medicines to help military personnel diagnosed with PTSD and or/other co-morbidities, and the use of psychiatric service dogs to help troops manage the symptoms of PTSD. [Read more about groundbreaking PTSD research ]

* General military health, including potential treatments for spinal cord injury, nutrition's impact on cognitive performance in pilots and the effectiveness of a family based reintegration program. [Read more ]

About the Military Health Research Forum

The MHRF is a scientific conference for presenting research studies funded by the DOD CDMRP Peer-Reviewed Medical, Gulf War Illness, and Psychological Health and Traumatic Brain Injury Research Programs. Research supported by these programs addresses the healthcare needs of the Armed Forces and their families, veterans and the American public.

The MHRF brings together scientists, clinicians, consumer advocates, policymakers and the military to learn about research and product development advancements supported by the host programs. The conference includes invited presentations by noted scientists, educational sessions on topics of general interest and poster and symposium presentations by CDMRP-funded investigators across programs. The MHRF is designed to promote the exchange of ideas to facilitate research progress, the development of new partnerships and the translation of research findings into field-ready methods and products.

About the Congressionally Directed Medical Research Programs

In the early 1990s, the breast cancer advocacy community launched a grassroots effort to raise public awareness of the crucial need for increased funding of breast cancer research. Beginning in fiscal year 1992 (FY92), Congress appropriated $25 million for breast cancer research to be managed by the Department of Defense. The following year, Congress continued to respond to the advocacy movement and appropriated $210 million for breast cancer research, marking the beginning of the U.S. Army Medical Research and Materiel Command’s Congressionally Directed Medical Research Programs. The CDMRP represents a unique partnership among the public, Congress and the military. Because of continued and expanded advocacy efforts, the CDMRP has grown to encompass multiple targeted programs and has received more than $5.3 billion in total appropriations for all CDMRP programs from its inception in FY93 through FY09.

Please visit www.cdmrpcures.org/press for updates on the Military Health Research Forum.

BU TODAY: One in Four Gulf War Vets Suffers Gulf War Illness

Medical breakthroughs: BU experts own the science for landmark report

By Caleb Daniloff

Roberta White, a neuropsychologist and chair of environmental health at the School of Public Health, has been studying Gulf War syndrome in U.S. military veterans since 1991. Photo by Frank Curran

Medical stories transcend all boundaries because all of us — rich or poor, old or young, Mayflower descendant or recent arrival — hope for good health, and need care sooner or later. This week, we revisit some of our intriguing medical reports from the past school year; the insights and breakthroughs they reveal could well shape our lives going forward.

Effectively debunking years of government denials, Gulf War veterans suffering a host of neurological problems scored a huge victory last fall in their struggle to legitimize their medical claims — thanks in part to public health experts at BU.

Comprising leading scientists, medical experts, and military veterans, a congressionally mandated panel charged with shaping federal health research related to the 1991 Middle East conflict has concluded that Gulf War syndrome is a real medical condition and that it afflicts at least one in four of the 697,000 U.S. veterans who fought in Iraq, Kuwait, and Saudi Arabia. The landmark report, presented in November 2008 by the Research Advisory Committee on Gulf War Veterans’ Illnesses to Secretary of Veterans Affairs James Peake, calls on Congress to appropriate $60 million for treatment of Gulf War vets.

“Veterans of the first Gulf War have been plagued by symptoms of ill health, including fatigue, problems with thinking, skin lesions, and gastrointestinal upset, since their return 17 years ago,” says Roberta White, the committee’s scientific director and chair of the department of environmental health at BU’s School of Public Health. “Despite their persistence and severity, these symptoms have often led to no diagnosis in a substantial portion of the war’s veterans.”

The 450-page report, which was prepared under the leadership of Lea Steele, the committee's former scientific director, and released under White, brings together for the first time the full range of scientific research and government investigations on Gulf War illness. The report found that the condition fundamentally differs from stress-related syndromes seen after other wars and states that scientific evidence “leaves no question that Gulf War illness is a real condition.”

The report lays the blame for several health problems on the troops’ exposure to toxins, primarily in two self-inflicted contexts. In anticipation of a chemical attack, the drug pyridostigmine bromide was given to hundreds of thousands of troops. And to battle desert insects, living and dining areas, as well as tents and uniforms, were sprayed with pesticides.

The report also suggests that the U.S. demolition of an Iraqi munitions dump may have exposed 100,000 troops to nerve gas stored at the facility. Gulf War veterans have shown significantly higher rates of amyotrophic lateral sclerosis, a neurodegenerative disease also known as Lou Gehrig’s disease, than veterans of other wars. And troops that were stationed downwind from the demolitions have died from brain cancer at twice the rate of other Gulf War veterans.

For almost two decades, the government and the military have downplayed veterans’ complaints, often referring to it as another form of post-traumatic stress disorder (PTSD). For its report, the research committee evaluated hundreds of studies of Gulf War veterans, extensive research in other human populations, studies on toxic exposures in animals, and government investigations related to exposures in the Gulf War.

“The illness is probably controversial because it’s symptom-based and most veterans don’t have a common medical diagnosis that fits all of their symptoms,” White says. “It may also be controversial because people feel that it’s obvious that war is stressful and therefore stress must be causing the health symptoms, even though this has never been proven. In fact, it’s been discounted in quite a few studies.”

White has been studying Gulf War illnesses since 1993 and served as research director of one of the three initial VA-funded centers on Gulf War illness. Since the early 1990s the U.S. Department of Defense and Department of Veterans Affairs, among other federal entities, have funded SPH studies of Gulf War veterans and the effects of exposure to low-level sarin, pesticides, and pyridostigmine bromide.

The Research Advisory Committee on Gulf War Veterans’ Illnesses has been based at BU since last year.

Caleb Daniloff can be reached cdanilof@bu.edu.

This story originally ran December 3, 2008.

Treatments may be ready for Gulf War Illness Treatment Trials

Written by Anthony Hardie, 91outcomes

(Boston, Mass. - June 29, 2009) Treatments for Gulf War Illness (GWI) may already be available and ready for testing in treatment trials, said Dr. Keith Kelley during a presentation today in Boston before the federal Research Advisory Committee on Gulf War Weterans' Illnesses.

Kelley is Professor of Immunophysiology in the Integrative Immunology and Behavior Program and Neuroscience Program and the Department of Animal Sciences at the University of Illinois at Urbana-Champaign.

During his presentation, entitled, The role of neuroinflammation in chronic illness, Dr. Kelley explained what it actually means "to be sick" from a scientific perspective, which includes increased temperature, decreased social and physical activity, and other effects, and noted that many of these correlate with key aspects of the current definition of Gulf War Illness, including affected learning and memory, mood changes, and unrelenting fatigue.

While there is currently a lack of treatments for Gulf War Illness, Dr. Kelley said he believes that the current neuroinflammation hypothesis of Gulf War Illness is worth testing because FDA-approved drugs to reduce neuroinflammation from pre-clinical animal studies are available. According to Dr. Kelley, neuroinflammation reduces appetite, motivation, increases exhaustive fatigue and sensitivity to pain, causes deficits in learning and memory, and induces depressive-like behaviors.

Dr. Kelley suggested that potential treatments that would be valuable to study with regards to the neuroinflammatory model of Gulf War Illness may include:

• Antibiotics
• New drugs for fibromyalgia
• Botanicals
• HMG-CoA reductase inhibitors
• Diet--soluable fiber (which increases Interleukin-1 (IL-1) expression in the brain)
• IDo Inhibitors now in Phase I clinical trials
• Exercise

According to Dr. Kelley's biography, his research interests include proinflammatory cytokines and hormones in the brain and in cancer and muscle cells:

"For the past 30 years, our laboratory has been involved in defining reciprocal systems of communication between the immune and central nervous systems. We currently are interested in defining receptor signaling pathways that occur following activation of receptors for both proinflammatory cytokines and growth factors in the brain and the periphery and the role of inflammation in mental health disorders. For the former, we have discovered the existence of intracellular crosstalk between receptors for proinflammatory cytokines (TNFalpha, IL-1beta) and hormones (IGF-I) in a variety of cells. This interaction reduces the ability of growth factor receptors to function in the presence of very low concentrations of proinflammatory cytokines.

"The result is that the biological response of cells to a growth factor, whether it is the proliferation of cancer cells or the differentiation of muscle progenitor cells, is reduced in the presence of proinflammatory cytokines. Collectively, these data show that the biological properties of a classical hormonal growth factor receptor are directly regulated by proinflammatory cytokines from the immune system. For the second major emphasis in our laboratory, major research projects are aimed at determining the actions of proinflammatory cytokine receptors that are involved in sickness behavior, depressive-like behavior and memory. Brain inflammation causes symptoms of sickness that are usually associated with microbial infections, which is likely to make an important contribution to the comorbid behavioral and psychological disturbances that occur in the elderly.

"We have shown that IL-1beta and TNFalpha serve as communication molecules between the immune and central nervous systems. In contrast, anti-inflammatory cytokines in the brain, such as IL-10 and IGF-I, reduce behavioral symptoms of sickness following infection. We now are exploring the influence of aging on development of depressive-like behaviors in mice because one in five individuals over the age of 65 suffer from depressive disorders. This is more than twice the prevalence found in the general population.

"A likely mechanism for the increased prevalence of depressive disorders during aging is a reduction in the synthesis of serotonin, a key neurotransmitter in the regulation of mood, caused by proinflammatory cytokines acting in the brain. This action is mediated by immune-induced activation of the tryptophan-degrading enzyme, indoleamine 2,3 dioxygenase (IDO). This process decreases the bioavailability of tryptophan for the synthesis of serotonin.

"We are measuring IDO enzymatic activity, tryptophan and its metabolism (serotonin, 5-HIAA, kynurenine) in discrete brain regions of aged mice given either LPS or BCG. The major health impact of our research is directed at cognitive function, affect and muscle wasting in AIDS, cancer and aging."

Immune System in Ill Gulf War Veterans "Remodeled", Research Shows

Written by Anthony Hardie, 91outcomes

(Boston, Mass. - June 29, 2009) Research findings show immune system "remodeling" in blood and saliva samples of ill Gulf War veterans, including clear abnormalities in their immune system function and response and neuroendocrine balance, said Dr. Gordon Broderick of the University of Alberta in a presentation today in Boston before the federal Research Advisory Committee on Gulf War Veterans' Illnesses.

Using highly detailed data and analyses, the study found that GWI subjects can be distinguished from healthy veterans (and from CFS) by their neuroendocrine-immune status, and that differences can be amplified by studying response to exercise by looking for diagnostic features and illness processes.

At the intracellular level, Interleukin-5 (IL-5), Tumor Necrosis Factor-alpha (TNFa), and IFN were substantially elevated, as was Interleukin-6 (IL-6) plasma in vivo. The level of cytokines as a broad sectrum response -- which are a marker of inflammation in the body -- is greatly increased in Gulf War veterans with GWI with relation to key immune system markers following exercise .

GWI subjects are distinct in their immune response to excercise, and most significant at rest. The findings note that cytokines in combination and across time are are entirely distinct between the GWI and control groups, leading to an ability to precisely identify those suffering from GWI using their immune system markers found in the blood.

At the cellular level of Gulf War veterans with GWI, the research found that their immune system does respond to an exercise challenge, but its response is significantly more diffuse and
disorganized than the immune response among healthy study controls.

The research suggests that the team may have developed a working model for diagnosing Gulf War illness through neuroendocrine-immune system markers in ill Gulf War veterans' blood and saliva. Dr. Broderick believes that his research will help lead to treatments for Gulf War veterans suffering from Gulf War Illness.

Dr. Broderick's current research on Gulf War Illness is funded by the U.S. Department of Defense Congressionally Directed Medical Research Program.

RAC ready to meet tomorrow: Treatments for Gulf War Illnesses Top the Agenda

Written by Anthony Hardie, 91outcomes

(Boston, Mass. - June 28, 2009) Doctors and researchers from Harvard, the University of Illinois at Urbana-Champaign, the International Brain Research Foundation, and the Miami, Minneapolis and Boston VA Medical Centers are among the presenters for tomorrow's meetings of the the Congressionally chartered federal Research Advisory Committee on Gulf War Veterans' Illnesses (RAC).

The RAC's members, scientists and doctors, Gulf War veterans, and members of the public will hear two days of key presentations and discussions beginning tomorrow morning, June 29th, at 8:00 a.m., on the campus of the Boston University School of Public Health in Boston, Mass.

The RAC has a full agenda focused on treatments for Gulf War Illness, fibromyalgia, brain injury, lung function and disease following exposure to burning Kuwait oil well fires, and other Gulf War veterans' illnesses.

According to the U.S. Department of Veterans Affairs (VA), between 175,000 and 210,000 Gulf War veterans, out of a total of 696,842 troops who served in the 1991 Gulf War. are afflicted by chronic multi-symptom illness, commonly known as Gulf War Illness or Gulf War Syndrome.

91outcomes will be posting live from the RAC meetings, which have never before received comprehensive news coverage. Coverage will include overviews of the presentations and breaking news, live as it happens.

Florida Doctoral Program Enrollees to Research Gulf War Syndrome

By Tampa Bay Business Journal

Roskamp Institute announced the first enrollment of students in its three-year Ph.D. program through which students will conduct full-time laboratory research with direct mentoring from internationally-recognized scientists.

Roskamp, an affiliated research center of the United Kingdom’s Open University, recently was granted a license from the Commission for Independent Education within the Florida Department of Education to begin this program.

The doctoral students will work side-by-side with scientists, perform hands-on, laboratory-based research and gain the practical knowledge necessary to succeed in their area of research, and emerge as fully operational professionals, said Michael Mullan, director of Roskamp, in a release.

Roskamp enrolled three students in its Ph.D. program, the release said. The first class of students in the program will pursue dissertation research on Gulf War syndrome, traumatic brain injury and Alzheimer’s disease.

Roskamp is a not-for-profit research institute located in Sarasota that is dedicated to understanding the causes of, and finding cures for, neuropsychiatric and neurodegenerative disorders with an emphasis on Alzheimer’s disease.

DoD Congressionally Directed Medical Research Programs (CDMRP) -- FY09 Gulf War Illness Research Program -- Clinical Trial Research Awards

Synopsis:

Through the FY09 Gulf War Illness Research Program (GWIRP), the Department of Defense's Congressionally Directed Medical Research Programs (CDMRP) solicits applications for the Investigator-Initiated Research Award.

The Investigator-Initiated Research Award contains the following key mechanism elements:

• Supports new ideas in basic and clinical developmental research focusing on GWI.
• Preliminary data are not required, and if provided, do not necessarily have to come from the GWI research field.
• Clinical trials are not allowed under this mechanism.

Deadlines:

Jun. 17, 2009 (REQUIRED pre-application - letter of intent);

Sep. 9, 2009 (invited full application).

The official announcement and description of this opportunity may be found on the funding agency's website:
http://cdmrp.army.mil/funding/gwirp.htm

Areas of Interest:

The Investigator-Initiated Research Award supports research focusing on the complex of symptoms known as Gulf War Illness, improving its diagnosis, and better understanding its pathobiology. It is intended to encourage basic or clinical developmental research aimed at identification of objective measures to distinguish ill from healthy veterans (e.g., biomarkers), or elucidate potential treatment targets for GWI. Studies that characterize chronic effects of neurotoxic exposures encountered during the Gulf War (and at comparable dosage) are also acceptable.

The GWIRP also seeks proposals that can contribute to improved diagnostic testing for GWI and/or improved understanding of its pathobiology. Particular areas of interest include research on objective indicators of biological processes or abnormalities in GWI associated with these areas:

• Central nervous system structure and function
• Central neuroinflammatory processes
• Neuroendocrine measures
• Autonomic nervous system function
• Immune parameters
• Indicators of chronic infection
• Gastrointestinal complaints/symptoms
• Genetic, genomic, proteomic, or metabolic characteristics

The Investigator-Initiated Research Award is designed to promote new ideas in Gulf War Illness research. Proposals are not required to include preliminary data; however, preliminary data may be used to support the objectives of a proposal. This data does not necessarily have to come from the GWI research field. Proposals not supported by preliminary data should be based on a sound scientific rationale and may reflect clinical observations or seek to evaluate in GWI discoveries made in relation to other chronic multi-symptom illnesses. Using either approach, however, the focus should be clearly on ill Gulf War veterans. It is the responsibility of the PI to clearly and explicitly articulate the project’s potential impact on GWI.

Disciplinary Category:
Medical - Basic Science; Medical - Clinical Science; Medical - Translational.

Applicant Type:

All individuals, regardless of ethnicity, nationality, or citizenship status, may apply as long as they are employed by, or affiliated with, an eligible institution. Eligible applicants for the Investigator-Initiated Research Award are independent investigators at all academic levels).

Award Amount:
The maximum funding for the award is $600,000 for direct costs. The maximum period of perfornance is three years.
Numerical value: $600,000

Funding Agency Contact:
Department of Defense
US Army Medical Research and Materiel Command, Commander
ATTN: MCMR-ZB-C (OC05-PA)
1077 Patchel Street (Building 1077)
Fort Detrick MD 21702-5024
Phone: 301-619-7079
Fax: 301-619-7792
Email: cdmrp.pa@det.amedd.army.mil

Deadlines:
Deadline: 6/17/2009

ARMY NEWS SERVICE ARTICLE: Researchers narrow Gulf War Syndrome causes

May 26, 2009

By Kyle Hodges

WASHINGTON (Army News Service, May 27, 2009) -- Research completed and analyzed over the past year has narrowed the underlying causes of Gulf War Syndrome to three factors.

For 18 years, researchers struggled to pinpoint the causes of Gulf War Syndrome and its wide-ranging symptoms. Then last year, a group of researchers under the U.S. Army Medical Research and Materiel Command and the Congressionally Directed Medical Research Program narrowed the primary causes to three: chemical nerve agents, pesticides, and the use of Pyridostigmine Bromide pills.

A report titled Gulf War Illness and the Health of Gulf War Veterans was released by the Department of Veteran's Affairs in November 2008, consolidating all research on the syndrome to date.

"There is definitely something different that has happened to servicemembers during the Gulf War as opposed to what is happening to Soldiers now," said retired Col. Melissa Forsythe, program manager of the Congressionally Directed Medical Research Program.

"Today's Soldiers don't exhibit any of the same symptoms," Forsythe said. "We're talking about the same geographical region. So what happened to these servicemembers in 1990-91 that's not happening now? That's really the central question."

Chemical nerve agents, PB, and many of the pesticides to which Gulf War veterans were exposed belong to a class of chemicals called Acetylcholinesterase inhibitors.

These chemicals inactivate the enzyme Acetylcholinesterase, which is essential for breaking down the neurotransmitter chemical acetylcholine - a chemical which affects numerous bodily functions, according to the report.

Forsythe believes a mixture of the three items above in combination with vaccines given to Gulf War servicemembers can't be ruled out as a possible cause for Gulf War Syndrome.

The acute symptoms of excess exposure to Acetylcholinesterase inhibitors results in increased salivation and respiratory secretions, nausea, abdominal cramping, diarrhea, excess sweating, increased heart rate, and blood pressure.

Other side effects can include muscle twitching, cramps, weakness, tremors, paralysis, fatigue, mental confusion, headache, poor concentration, and general weakness. At sufficient doses, exposure to Acetylcholinesterase inhibiting chemicals can result in respiratory arrest and death.

Many of these side effects coincide with those of GWS.

Typically, Gulf War veterans exhibit a number of symptoms including chronic headaches, widespread diffused pain that moves to different parts of the body, fatigue, gastrointestinal problems, cognitive difficulties, skin rashes, and respiratory problems, said Forsythe.

Because of the wide range of symptoms, a diagnosis of GWS could be likened to finding a needle in a haystack, Forsythe said. There is no one test that will yield a definitive diagnosis for this illness that affects 25-32 percent of Gulf War veterans, she said, adding that the only way to diagnose the disease is to eliminate all other diseases with similar symptoms.

Today's GWS research focuses primarily on diagnosis and treatment rather than a single cure.

Studies focusing on the physical differences between ill and healthy Gulf War veterans may make a diagnosis easier and provide a much needed legitimacy to the illness.

"At first, servicemembers were told that the illness was all in their heads. So now, it's very validating for those servicemembers to see that there are real physical differences between themselves and the Gulf War Veterans that are not ill," said Forsythe.

Other GWS studies by the CDMRP include: research looking into the over-the-counter herbal supplement Co-enzyme Q10; the drug methylpristine, which may help with cognitive problems; and plans to look at self medications that Gulf War veterans have used and whether or not those were effective. Acupuncture is also being looked at for possible funding.

Currently, the only relief for GWS sufferers is to prescribe treatments for their individual symptoms, said Forsythe.

Unfortunately, record keeping practices during the Gulf War were not equal to today's standards, said Forsythe. Records on the use of Pyridostigmine Bromide and pesticides in theatre are virtually nonexistent.

PB had been approved, since 1955, for treatment of myasthenia gravis, a muscular disease. During the Gulf War, PB was not licensed for protection against chemical nerve agents by the U.S. Food and Drug Administration, but it was authorized by the FDA to be released to Soldiers in combat as an "investigational new drug" as a nerve agent pretreatment.

PB is now FDA approved as an effective pretreatment exclusively for the nerve agent soman and it is still issued to Soldiers for that purpose.

Pesticides are still used in theater, however, only a handful of those pesticides linked to GWS in the report are still in the Department of Defense's pest control inventory.

"Research is not necessarily fast, but is our best route in terms of helping people," said Forsythe. We know that people are out there suffering and they're trying to find their own remedies for symptoms. So our program, being focused on improving the diagnosis and treatments, is trying to get at the two prongs that can best serve those veterans who are ill."

Research Shows Elevated Disease Rates in Gulf War Veterans

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- Recent news stories highlighted a 2005 study by Dr. Han Kang that showed significantly increased rates of unexplained multi-symptom illness among deployed veterans of the 1991 Gulf War.

However, several other studies by Dr. Kang and other researchers have also had significant findings for 1991 Gulf War veterans, including the following (follow the links for the cited study):

• Elevated rates of testicular cancer
• Increased deaths due to Brain cancer;
• Increased rates of Chronic Multisymptom Illness (CMI);
• Increased rates of Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's Disease);
  
• Experiencing Clusters of neurological symptoms;
• Increased rates of Chronic Fatigue Syndrome (CFS);
• 6 subgroups among those with Fatigue Syndrome (FS): fatigue, pain, infectious, gastrointestinal, respiratory, and neurologic/mood/fatigue
• Increased rates of post-war hospitalization;
• Increased rates of depression and anxiety;
• Increased rates of death by motor vehicle accident.
  

Additionally, another important 2005 study by Dr. Kang and her research team had findings that "contradict the prevailing notion that perceived exposure to chemical warfare agents should be considered an important cause of morbidity [illness and disease] among Gulf War veterans."

Veterans of the 1991 Gulf War have been too ill, and for too long already. Effective treatments for the underlying illness have yet to be found or implemented.

Change is needed -- desperately.

VA Official Recycles Testimony While Nothing Changes at VA for ill Gulf War Veterans

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- In a stunning discovery reported here at 91outcomes first, Dr. Lawrence Deyton, Chief Public Health and Environmental Hazards Officer in the Veterans Health Administration of the U.S. Department of Veterans Affairs (VA) recycled large portions of his Congressional testimony this week from testimony he gave to Congress nearly two years ago, on July 26, 2007.

This week's May 19th, 2009 hearing was a critical review by the powerful House Veterans' Affairs Committtee's Subcommittee on Oversight and Investigations, entitled Gulf War Illness Research: Is Enough Being Done?

Despite appearing with two other highly paid VA bureaucrats -- including Mark Brown, who not surprisingly also appeared with Deyton at the July 2007 Congressional hearing -- no one at VA apparently wanted to bother with writing much new for Deyton's testimony except filler justification on VA's traditional and by law reliance on the Institute of Medicine "for independent and credible reviews."

Whole paragraphs from the 2007 testimony were recyled into Deyton's testimony on Tuesday.

From countless veterans' accounts, there are literally thousands of employees within VA dedicated to the VA's mission of serving those have borne the battle and their loved ones, particularly at the VA medical centers and clinics across the country.

Yet, it is no wonder that VA health care providers have no new treatments to offer the 175,000 to 210,000 ill Gulf War veterans when the the callous indifference of VA officials in Washington like Lawrence Deyton can't even find new words to describe his work unit's lack of new findings that might help these ill veterans.

Ironically, one of the new statments in the closing comments of Deyton's testimony this week was, "VA is an evolving organization that operates in a rapidly changing environment."

Apparently that didn't apply to his own testimony, indicative of the lack of change of his work unit during the last two decades, which is still without treatments, answers, or information for ill Gulf War veterans, their health care providers, and their families.

Change is needed -- Desperately.

MAY 19TH CONGRESSIONAL HEARING -- Little Change Yet for Ill Gulf War Veterans, Federal Officials

Written by Anthony Hardie, 91outcomes

(91outcomes.blogspot.com) -- Army veteran Paul Sullivan of San Antonio, Texas gave perhaps the clearest answer to the question posed by Tuesday’s Congressional hearing, Gulf War Illness Research: Is Enough Being Done?

“As an ill Gulf War veteran who has worked on this issue for 17 years both inside and outside government, the answer is no,” testified Sullivan, Executive Director of Veterans for Common Sense, former Executive Director and co-founder of the National Gulf War Resource Center, and a former VA employee in VA's Data Management Office.

“In the past, we have seen service-related illnesses ignored, misunderstood, or swept under the rug,” said Subcommittee Chairman Harry Mitchell (D-Ariz.) in his opening statement.

Rick Weidman, a Vietnam veteran and Government Relations Director for Vietnam Veterans of America (VVA), added: “In regard to Gulf War Illness, VA has known the basic outline as to what was wrong with up to 200, 000 of those who served in the Gulf for a decade. Yet they continue to drag their feet in addressing the justifiable compensation requests of these veterans, and to give them the runaround on medical care.”

Weidman, a longstanding veterans’ advocate, continued in his testimony, “One has to ask, what is wrong with this institution (VA) that it would treat the men and women who are literally its very reason for existing in such a high-handed and disrespectful manner, even in the face of consistent scientific advice and good judgment?”

Dr. Roberta White, Ph.D., who has been researching Gulf War veterans’ illnesses since 1993, stated for the record that her team found not only low rates of PTSD among ill veterans, but also “systematic relationships,” between, “self-reported exposures to pesticides and to nerve gas agents and health complaints in specific body systems.” This early research was later validated by other research efforts.

White’s team also found decreased white matter in the brains of ill Gulf War veterans, cognitive and neuropsychological deficits not explained by psychiatric diagnoses, and that ill Gulf War veterans’ health complaints remained stable and without improvement over time – no surprise to ill Gulf War veterans. White is the current scientific director of the Congressionally chartered Federal Research Advisory Committee on Gulf War Veterans’ Illnesses.

Army veteran Jim Bunker of Topeka, Kan., courageously told the Congressional investigators in his halting voice of his current Gulf War illness symptoms, which are typical for literally tens of thousands Gulf War veterans:

• Numbness, weakness, and/or tingling in arms and legs
  
  
• Headaches
  
  
• Cognitive dysfunction
  
  
• Gastric reflux disease
  
  
• Fibromyalgia
  
  
• Mouth sores and skin peeling from roof of mouth
  
  
• Skin rashes
  
  
• Sinusitis
  
  

Later in the hearing, when federal agency officials implied there was nothing wrong with Gulf War veterans, one Congressman pointedly asked, “What about Bunker?” Bunker had become a visible symbol of what has been and continues to be wrong with between 175,000 and 210,000 veterans from among the 696,842 who served in the 1991 Gulf War.

Meanwhile, a CIA official testified regarding the 1991 Gulf War theater of operations chemical agent releases known to the agency. He failed to mention incidents known to the Pentagon or described by veterans to Congress in Congressional hearings over the past two decades, relying purely on what CIA “knew”. He showed little knowledge of ground conditions, during which chemical alarms – when used – continuously went off.

 

He failed to mention chemical agent releases and exposures known to veterans and some within the Pentagon at the time that occurred in al Jubayl and Ra’s al-Mishab, chemical minefields in southeastern Kuwait, blister agent releases that caused the rapid Iraqi evacuation of a unit’s bunker complex in north-eastern Kuwait, and countless others like the incident Bunker described that personally affected him.

VA, predictably, recycled old testimony from a previous Congressional hearing, suggesting that VA has done everything possible to help Gulf War veterans, who do not suffer from a “unique illness.” Predictably, Dr. Lawrence Deyton stated that VA would wait until 2010 for an Institute of Medicine (IOM) review of the November 2008 report of the Research Advisory Committee (RAC) on Gulf War Veterans’ Illnesses.

The RAC’s findings were covered in detail by Dr. Lea Steele, Ph.D., of the University of Kansas, who passionately and compassionately presented the report’s findings during the Hearing.

Steele echoed the report’s findings in her prepared testimony:

Oddly, in his testimony the Department of Defense official claimed credit for funding recent research years focused on treatments for ill Gulf War veterans – an irony given DoD’s enduring opposition to the funding as DoD officials have reportedly made clear to House Defense Appropriations staffers.

Due to powerful support from Gulf War veterans' advocates, Congress has provided annual funding to DoD anyway, and it falls under the well-run Congressionally Directed Medical Research Program (CDMRP) based at Ft. Detrick, Maryland. The Congressional funding has been provided with clear instructions to DoD on its possible uses, with requirements to focus on treatments and prohibitions against more unneeded DoD research on stress and psychological causes for ill Gulf War veterans’ all too real array of symptom clusters.

In short, veterans and science are in full agreement that the Gulf War’s veritable toxic soup made between 175,000 and 210,000 Gulf War veterans ill with chronic, multi-symptom illness, that their illnesses have not improved over time, and that effective treatments still do not exist – in large part due to long-term failures by the federal agencies charged with caring for ensuring the well-being of these veterans.

And the federal response? CIA officials are still blindly and wrongly claiming there were few or no chemical releases that reached Gulf War troops, DoD officials are overly proud of the “lessons learned” from the Gulf War while Gulf War veterans continue to suffer, and the same low-level VA officials providing the same recycled testimony are still implying or outright stating that everything that could be done for Gulf War veterans was and is being done.

Tell that to Jim Bunker as he, like tens of thousands of other ill Gulf War veterans, struggles with walking, sleeping, and communicating.

All might be well safe with the Beltway in the Land of Washington. But all is certainly not well for the 175,000 to 210,000 Gulf War veterans who still continue to suffer the lingering, untreated outcomes of their Gulf War service.

Change is needed – desperately.

[Watch the Hearing via Multimedia Link now]

“A renewed federal research commitment is needed to identify effective treatments for Gulf War illness, improve understanding of this condition, and address other priority Gulf War health issues. Adequate funding and appropriate program management is required to achieve the critical objectives of improving the health of Gulf War veterans and preventing similar problems in future deployments. As noted by the Committee this is a national obligation, made especially urgent by the many years that Gulf War veterans have waited for answers and assistance.”