Tuesday, December 2, 2014

Public Session Tomorrow: IOM Gulf War and Health Rewrite Committee

(91outcomes.com) - A new Institute of Medicine (IOM) committee to revise and update the IOM's 2010 Gulf War health review will hold its first meeting as a public session in Washington, DC tomorrow, Wednesday, December 3, 2014.

The IOM has convened the "Committee on Gulf War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War," under contract with the U.S. Department of Veterans Affairs (VA).

The committee will revise the IOM's 2010 "Gulf War and Health" report via a medical and scientific literature review, with a focus on neurological disorders, cancer, and chronic multi symptom illness in Gulf War veterans, with a 2014 IOM panel directed to be named "Gulf War illness".

Among the scheduled presenters are the new committee's chair, Dr. Deborah Cory-Slechta, two VA officials, and Dr. Roberta White, Scientific Director of the VA's Research Advisory Committee on Gulf War Veterans' Illnesses (RAC).

The IOM's 2010 "Gulf War and Health" report, which will be revised by this new committee, found:

Higher rates of symptoms among veterans of the 1991 Gulf War are “beyond dispute” (p. ix)
There is "sufficient evidence of an association" between deployment to the Gulf War and Gulf War illness (p. 210), which affects more than 250,000 veterans of the 1991 Gulf War (p. 262)
Gulf War illness "cannot be reliably ascribed to any known psychiatric disorder" (p. 109)
"Current evidence is inadequate to determine whether an association exists between multisymptom illness and any specific battlefield exposure or exposures." (p. x)
The causes of Gulf War illness are likely the "interplay between genetic and environmental factors" (p. 261)
"Veterans who continue to suffer from these discouraging symptoms deserve the very best that modern science and medicine can offer to delineate the true underlying cause of these symptoms in order to speed the development of effective treatments, cures, and, it is hoped, preventions. The committee suggests a path forward to accomplish these goals and we believe that, through a concerted national effort and rigorous scientific input, answers can likely be found." (p. x)

Several former members of the RAC have expressed concerns regarding the composition and direction of the new IOM committee, in a letter to IOM President Dr. Victor Dzau. A copy of their letter is here.

Gulf War veterans and others interested in attending the Dec. 3rd meeting may join by phone using the call-in number below.

Wednesday, December 3^rd1pm to 4pm EST1-866-528-2256Access Code: 9958550

Brief comments will be called for after the scheduled presentations. Gulf War veterans Anthony Hardie -- a former RAC member and director of Veterans for Common Sense, a national veterans advocacy organization -- and Denise Nichols -- a former U.S. Air Force Major and nurse and Vice President of the National Vietnam and Gulf War Coalition -- are scheduled to be in attendance and to make a presentation to the committee during the public comment period.

Highlights from the 2010 IOM report, and the new committee's statement of task, membership roster, and agenda for this session are below.

###

******************************

Highlights - IOM Gulf War and Health Vol 8 by Anthony Hardie

***************************************

INSTITUTE OF MEDICINE

COMMITTEE ON GULF WAR AND HEALTH, VOL. 10:

UPDATE OF HEALTH EFFECTS OF SERVING IN THE GULF WAR

Statement of Task

An ad hoc committee under the auspices of the Institute of Medicine (IOM) will comprehensively review, evaluate, and summarize the available scientific and medical literature regarding health effects in the 1990-1991 Gulf War veterans. The committee will pay particular attention to neurological disorders (e.g., Parkinson’s disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, and Migraines), cancer (especially brain cancer and lung cancer), and chronic multisystem illness. The proposed study will update earlier IOM reviews on Gulf War and Health, and this volume (Volume 10) will update the literature since the publication of the 2006 (Volume 4) and 2010 (Volume 8) Gulf War and Health reports.

A note to attendees

This meeting is being held to gather information to help the committee conduct its study. This committee will examine the information and material obtained during this, and other public meetings, in an effort to inform its work. Although opinions may be stated and lively discussion may ensue, no conclusions are being drawn at this time; no recommendations will be made. In fact, the committee will deliberate thoroughly before writing its draft report. Moreover, once the draft report is written, it must go through a rigorous review by experts who are anonymous to the committee, and the committee then must respond to this review with appropriate revisions that adequately satisfy the Academy's Report Review committee and the chair of the NRC before it is considered an NRC report. Therefore, observers who draw conclusions about the committee's work based on today's discussions will be doing so prematurely.
Furthermore, individual committee members often engage in discussion and questioning for the specific purpose of probing an issue and sharpening an argument. The comments of any given committee member may not necessarily reflect the position he or she may actually hold on the subject under discussion, to say nothing of that person's future position as it may evolve in the course of the project Any inference about an individual's position regarding findings or recommendations in the final report are therefore also premature.

***********************************************

Committee Roster

Deborah Cory-Slechta, PhD (Chair)

Department of Environmental Medicine

School of Medicine and Dentistry

University of Rochester

Robert H. Brown, Jr., MD

Chair and Professor of Neurology

University of Massachusetts Medical School

Alberto Caban-Martinez, DO, PhD

University of Miami Health System

Ellen A. Eisen, ScD

School of Public Health

University of California, Berkeley

Javier Escobar, MD

University of Medicine and Dentistry of New Jersey

Scott Fishman, MD

UC Davis Medical Group

Mary Fox, PhD

Bloomberg School of Public Health

Johns Hopkins University

Nancy Fugate-Woods, PhD

School of Nursing

University of Washington

Herman Gibb, PhD

Gibb Epidemiology Consulting, LLC

Clifford Jack, MD

Professor of Radiology, Diagnostic Radiology

Mayo Clinic

Howard Kipen, MD, PhD

Clinical Research and Occupational Medicine Division

UMDNJ - Robert Wood Johnson Medical School

Kenneth W. Kizer, MD

University of California Davis

School of Medicine

Betty Irene Moore School of Nursing

Institute for Population Health Improvement

UC Davis Health System

Joel Kramer, PsyD

University of California, San Francisco

Francine Laden, PhD

Harvard School of Public Health

James M. Noble, MD

Columbia University Medical Center

Anbesaw Selassie, DrPH

Department of Public Health Sciences

Medical University of South Carolina

********************************************

Gulf War and Health Vol. 10: Update 2014

December 3-4, 2014, Meeting 1

National Academies Building, Room 125

2101 Constitution Ave., NW

PUBLIC SESSION AGENDA

1:00–1:10 Welcome and Introductions

Deborah Cory-Slechta, Ph.D., Committee Chair

1:10–2:00 Charge to the Committee and discussion

R. Loren Erickson, M.D., Dr.PH – Director, Pre-9/11 Era Environmental Health Program, Department of Veterans Affairs

2:00–3:00 Update on VA longitudinal study

Robert Bossarte, Ph.D., Director, Epidemiology Program, Department of Veterans Affairs

3:00–3:15 Research Advisory Committee on Gulf War Veterans’ Illnesses

Roberta White, Scientific Director, RAC

3:15–4:00 Open microphone for public comments

Limited to approximately 10 minutes per person

4:00 Open Session Ends

Monday, November 10, 2014

CDMRP: Neuroinflammation in Gulf War Illness

SOURCE: Congressionally Directed Medical Research Program (CDMRP), U.S. Army Medical Research and Materiel Command, U.S. Department of Defense. Published Nov. 10, 2014

http://cdmrp.army.mil/gwirp/research_highlights/14Lasley_OCallaghan_highlight.shtml

ARCHIVED ARTICLE:

Enhanced Neuroinflammation in Gulf War Illness

Share on facebook Share on twitter Share on pinterest_share

Posted November 10, 2014

Steve Lasley, Ph.D., University of Illinois College of Medicine at Peoria
James O'Callaghan, Ph.D., Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health

Gulf War Illness (GWI) is a multi-symptom disorder with features characteristic of "sickness" behavior including cognitive impairment, fatigue, depression, sleep disruption, muscle and joint pain, and gastrointestinal and dermatological problems.

Typically, sickness behavior is the normal manifestation of an inflammatory response to infection or injury and one that resolves with restoration of homeostasis. In GWI such symptoms persist, and research suggests this may be due to heightened and chronic inflammation of the nervous system following a mild toxic exposure to any of a number of neurotoxic compounds.

In work supported by a Fiscal Year 2008 Gulf War Illness Research Program (GWIRP) Investigator-Initiated Research Award, Dr. Steve Lasley at the University of Illinois College of Medicine at Peoria, along with collaborator Dr. James O'Callaghan at the Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health, set out to characterize chronic neuroinflammation using an animal model of GWI. To produce the initial elevated level of inflammation in mice, Drs. Lasley and O'Callaghan and their teams gave animals low doses of an acetylcholinesterase inhibitor called diisopropyl fluorophosphate (DFP). In these experiments this chemical was used as a nerve gas surrogate: At higher doses it can cause neuronal damage by abolishing the normal signal transmission at connections involving one type of nerves. This results in excess nerve firing, possibly leading to seizures and nerve system damage due to overstimulation.

Using this procedure, the researchers found that exposure to a single dose of DFP that did not produce overt signs of toxicity in the animals did result in inflammation in the brain, which was measured by monitoring inflammatory cytokine levels and microglial activation. Furthermore, the observed neuroinflammatory response was exacerbated when animals were given the stress hormone corticosterone (CORT) prior to DFP exposure. This was an unexpected finding because CORT is generally thought to be an immunosuppressive hormone secreted by the body to prevent damage from the body's own inflammatory responses. Instead of reducing the initial neuroinflammatory response to DFP, prior exposure to CORT was found to "prime" the immune system of DFP-treated animals to mount an exaggerated response. This phenomenon could also be produced after brief CORT exposure using another inflammogen called lipopolysaccharide. Giving mice occasional doses of CORT over time (as a person might naturally experience in a war theater as a result of day-to-day stresses) was found to maintain this pro-inflammatory state for 180 days, which is the approximate human equivalent of 20 years.

Dr. O'Callaghan further discovered that the tetracycline-like antibiotic minocycline was able to reduce both DFP-induced and CORT-enhanced neuroinflammation. Minocycline is a U.S. Food and Drug Administration-approved antibiotic that is known to exert immune suppressive, anti-inflammatory effects in addition to its antibiotic properties. Furthermore, minocycline is also known to cross the blood-brain barrier, allowing it to suppress inflammation in the brain. These characteristics, along with the findings by Dr. O'Callaghan, suggest that minocycline may be an effective treatment option for veterans suffering from GWI. The GWIRP is supporting continuation of research on the immune system priming by CORT and possible treatments using minocycline through Gulf War Illness Consortium grants to Boston and Nova Southeastern Universities, which are expected to conduct human treatment trials.

Links:

Public and Technical Abstracts: Neuroinflammatory Pathobiology in Gulf War Illness: Characterization with an Animal Model

Friday, November 7, 2014

NY TIMES: "More Than 600 Reported Chemical Exposure in Iraq, Pentagon Acknowledges"

SOURCE: New York Times, C.J. Chivers reporting, Nov. 6, 2014

http://www.nytimes.com/2014/11/07/world/middleeast/-more-than-600-reported-chemical-weapons-exposure-in-iraq-pentagon-acknowledges.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0

ARCHIVED ARTICLE:

More Than 600 Reported Chemical Exposure in Iraq, Pentagon Acknowledges

By C. J. CHIVERSNOV. 6, 2014

More than 600 American service members since 2003 have reported to military medical staff members that they believe they were exposed to chemical warfare agents in Iraq, but the Pentagon failed to recognize the scope of the reported cases or offer adequate tracking and treatment to those who may have been injured, defense officials say.

The Pentagon’s disclosure abruptly changed the scale and potential costs of the United States’ encounters with abandoned chemical weapons during the occupation of Iraq, episodes the military had for more than a decade kept from view.

This previously untold chapter of the occupation became public after an investigation by The New York Times revealed last month that while troops did not find an active weapons of mass destruction program, they did encounter degraded chemical weapons from the 1980s that had been hidden in caches or used in makeshift bombs.

The Times initially disclosed 17 cases of American service members who were injured by sarin or sulfur mustard agent. And since the report was published last month, more service members have come forward, pushing the number who were exposed to chemical agents to more than 25. But an internal review of Pentagon records ordered by Defense Secretary Chuck Hagel has now uncovered that hundreds of troops told the military they believe they were exposed, officials said.

The new and larger tally of potential cases suggests that there were more encounters with chemical weapons than the United States has acknowledged and that other people — including foreign soldiers, private contractors and Iraqi troops and civilians — may also have been at risk.

Having not acted for years on that data, the Pentagon says it will now expand outreach to veterans. One first step, officials said, includes a toll-free national telephone hotline for service members and veterans to report potential exposures and seek medical evaluation or care.

Phillip Carter, who leads veterans programs at the Center for a New American Security, called the Pentagon’s failure to organize and follow up on the information “a stunning oversight.” Paul Rieckhoff, founder and executive director of Iraq and Afghanistan Veterans of America, said the military must restore trust by sharing information.

“We need total transparency and absolute candor,” Mr. Rieckhoff said, and noted the military’s poor record in releasing information about its use in Vietnam of Agent Orange, a chemical defoliant linked to an array of health problems, and in sharing data about troops’ presumed chemical exposures and other medical and environmental risks during and soon after the 1991 Persian Gulf war.

Military officers said the previously unacknowledged data was discovered when, at Mr. Hagel’s prodding, the Army’s Public Health Command examined its collection of standardized medical-history surveys, known as post-deployment health assessments, which troops filled out as they completed combat tours.

The assessments included the following question: “Do you think you were exposed to any chemical, biological and radiological warfare agents during this deployment?” For those who answered Yes, the forms provided a block for a brief narrative explanation.

Col. Jerome Buller, a spokesman for the Army surgeon general, said Thursday that the review showed that 629 people answered yes to that question and also filled in the block with information indicating chemical agent exposure.

Each person who answered the questionnaire would have received a medical consultation at the end of their combat tour, Colonel Buller said.

Why the military did not take further steps — including compiling the data as it accumulated over more than a decade, tracking veterans with related medical complaints, or circulating warnings about risks to soldiers and to the Department of Veterans Affairs — remained unclear.

Before post-deployment assessments were reviewed, Colonel Buller said, the Public Health Command had already expanded its search for potential victims and intended to examine the medical records of all troops assigned to units that the Army has belatedly acknowledged handled or were attacked with chemical weapons.

These include three Army explosive ordnance disposal companies and B Company, First Battalion, 14th Infantry, he said.

Veterans said this unit list was incomplete and would inevitably grow as the military accounted for other high-risk troops, including those on route-clearance duties in areas where chemical roadside bombs were repeatedly found, or chemical warfare troops who served in so-called technical escort units, which were assigned to collect and analyze the old chemical weapons.

Nonetheless, the new data has prompted the Public Health Command to take further steps, Colonel Buller said.

These will include identifying all veterans who reported a possible chemical exposure, gathering their medical records, contacting them for a structured interview and perhaps inviting them for a medical exam.

He said the Department of Defense had also revived a telephone line, 1-800-497-6261, for veterans to notify the Pentagon that they may have been exposed. The phone line, he said, had previously been used for veterans reporting Gulf War-related illnesses.

Immediate reactions among exposed service members and veterans’ advocates mixed cautious appreciation with skepticism.

“It’s too little, too late,” said Jordan Zoeller, a former Army sergeant who served in a platoon that was exposed to sulfur mustard agent as soldiers destroyed buried chemical artillery shells near Taji in 2008.

Mr. Zoeller was medically retired after developing a series of health problems, including asthma and psoriasis. He said his breathing trouble began within weeks of the chemical episode, though he is not sure its onset was related to mustard agent because the Army denied that he had been exposed and did not examine his claims.

A portion of the 114 chemical projectiles discovered in December 2006, awaiting disposal on Forward Operating Base Brassfield-Mora. One of them leaked mustard agent onto the forearm of a Navy explosive ordnance disposal technician.CreditThe New York Times

“No one ever believed me,” he said. “They were like, ‘Oh, that never happened._ ”

He said at one point after he returned to the States and coughed up blood and lost consciousness, a regimental surgeon agreed to look into the episode. Nothing came of it, he said.

Another veteran, a Navy explosive ordnance disposal technician who remains on active duty, said he was burned on the left forearm in December 2006 when handling 114 American-designed M110 mustard shells at a bomb-makers’ weapons cache near Samarra.

He said that after the mustard agent splashed on his arm he quickly rinsed it away by squirting it repeatedly with solution from IV bags. The mustard agent still caused a long patch of redness that took weeks to heal and left scarring, he said.

The sailor, who asked that his name be withheld, said when he sought treatment at Forward Operating Base Brassfield-Mora, the Army doctor was not interested.

An officer in the unit to which he was assigned — a battalion from the 505th Parachute Infantry Regiment, he said — issued what he called “a gag order” that forbade him to discuss that he had found chemical shells.

The sailor’s post-deployment health survey, which he provided to The Times, shows he reported the exposure again as he left Iraq in late 2007.

The attending caregiver did not recommend further care, but noted the previous order prohibiting mention of the incident. The patient, he wrote, “was instructed not to discuss due to mission classification.”

Cmdr. Ryan Perry, a Navy spokesman, said that the sailor had discussed the exposure with the Navy in recent days and that any previous order of silence was unacceptable.

“We in no way condone the silencing of any of our service members,” he said, “and are greatly encouraged that this sailor took the step of reaching out to the Navy so we can get him the medical attention he needs.”

While exposure to nerve or blister agents can carry long-term health risks, veterans, medical officers and exposure victims said that it was impossible to analyze the new data immediately and predict how many troops who reported exposure would have suffered medical problems. They said it could also be difficult to establish how closely medical complaints might be linked to exposure.

They noted that many of the troops’ encounters with chemical agents could have been brief and minimal, as that of a turret gunner in a vehicle passing briefly through an area where a chemical shell had been used in a makeshift bomb.

Moreover, not all chemical agents were alike. The nerve agents found in Iraq after the United States invaded in 2003 were much less potent than when manufactured decades ago, according to people involved in many of the chemical weapons recoveries in Iraq. Iraqi mustard agents tended to be of higher quality and far more stable, they said.

Nonetheless, Mr. Carter and Mr. Rieckhoff said that the latest number was probably understated, and that the military should not rely on people who reported chemical weapons exposures to determine the scope of the problem.

It should look deeper, Mr. Carter said, at symptoms, such as troops who reported rashes, breathing difficulties or tremors.