Monday, December 15, 2014

Congress Grants Strong Continuation for Gulf War Illness Treatment Research Program

(91outcomes.com) - The $1.1 trillion federal appropriations package that finally hurdled Congress last weekend included a measure of relief for the roughly one-third of veterans of the 1991 Gulf War suffering from Gulf War Illness.  


The massive bill funds almost the entire federal government of the next year.   Among its many provision, the life of the treatment-focused, Congressionally directed, "Peer Reviewed Gulf War Illness Research" program (GWIRP) is extended for another year through Fiscal Year 2015 and is funded at the same $20 million level as the last two fiscal years.

The Gulf War Illness Research Program -- part of the Congressionally Directed Medical Research Programs (CDMRP) -- has been praised by veterans and researchers alike.  It directs its efforts to, "improve the health and lives of veterans who have Gulf War Illness."  The program's stated mission is to, "fund innovative Gulf War Illness research to identify effective treatments, improve definition and diagnosis, and better understand pathobiology and symptoms." 

 
As a Congressionally directed program, the Gulf War Illness Research Program must be specifically funded by Congress each year or it does not continue.  


Other CDMRP programs funded this year and of potential interest to Gulf War veterans include ALS ($7.5 million, same as FY14), MS ($5 million, same as FY14), traumatic brain injury (TBI) and psychological health ($125 million, an increase from $80 million in FY14), various cancers, and a new therapeutic service dog training program ($3 million).


Medical research into burn pit exposure is included for the first time under the Peer Reviewed Medical Research Program (PRMRP), which was funded at $247.5 million (up from $200 million in FY14).  Among the 41 conditions authorized under the program are also acupuncture, integrative medicine, metals toxicology, mitochondrial disease, rheumatoid arthritis, and sleep disorders.  


The effort to secure this funding is led by Gulf War veterans, advocates, and Congressional allies.  In the U.S. House of Representatives, key supporters included co-leads outgoing House Veterans' Affairs Committee (HVAC) Ranking Member Rep. Mike Michaud (D-ME) and Rep. Phil Roe (R-TN), and important supporters including HVAC Chair Rep. Jeff Miller (R-FL), HVAC Subcommittee Chair Rep. Mike Coffman (R-Colo.) and Ranking Member Rep. Ann Kirkpatrick (D-AZ), and newly appointed HVAC Ranking Member Rep. Corrine Brown (D-FL). 


In the U.S. Senate, co-leads U.S. Sen. Tammy Baldwin (D-WI) and Sen. Jay Rockefeller (D-WV), and Senate Veterans' Affairs Committee (SVAC) Chair Sen. Bernie Sanders (I-VT) were among the supporters.  

The bill passed the House on Thursday, December 11, and the Senate on Sunday, December 14, 2014.  The President is expected to sign it into law.  

******


Research Program  FY15 Funding (in $ millions) 


Alcohol/Substance Abuse Disorders 
 4.000
ALS   7.500
Alzheimers  12.000

Autism
 6.000
Bone Marrow Failure Disease  3.200
Breast Cancer  120.000

Cancer (NOTE 1)
 50.000
Duchenne Muscular Dystrophy  3.200
Epilepsy  7.500

Gulf War Illness

20.000
Lung Cancer  10.500
Medical (NOTE 2)  247.500

Multiple Sclerosis

5.000
Orthopedic  30.000
Ovarian Cancer  20.000

Prostate Cancer

80.000
Spinal Cord  30.000
Reconstructive Transplant  15.000

Traumatic Brain Injury and Psychological Health


125.000
Tuberous Sclerosis Complex  6.000
Vision  10.000

Global HIV/AIDS

8.000
HIV/AIDS program increase
12.900
Joint Warfighter  50.000

Orthotics and Prosthetics Outcomes
 10.000
Restore Core Research Funding Reduction  179.815
Therapeutic Service Dog Training Program  3.000

TOTAL:
=======
 1,076.115


NOTES:
*NOTE 1 - Cancer:  The Peer Reviewed Cancer Research Program (PRCRP), funded at $50 million for FY15, includes the following cancers:

  • Colorectal cancer
  • Genetic Cancer research
  • kidney cancer
  • listeria vaccine for cancer
  • liver cancer
  • melanoma and other skin cancers
  • mesothelioma
  • myeloproliferative disorders
  • neuroblastoma
  • pancreatic cancer
  • stomach cancer
*NOTE 2 - Medical: The Peer Reviewed Medical Research Program (PRMRP), funded at $247.5 million for FY15, includes the following conditions:
  • acupuncture
  • acute lung injury
  • advanced prosthetics
  • arthritis
  • burn pit exposure
  • cardiovascular health
  • chronic migraine and post-traumatic headache
  • congenital heart disease
  • Dengue
  • diabetes
  • DNAvaccine technology for postexposure prophylaxis
  • dystonia
  • focal segmental glomerulosclerosis
  • food allergies
  • Fragile X syndrome
  • healthcare-acquired infection reduction
  • hepatitis B 
  • hereditary angioedema
  • hydrocephalus
  • inflammatory bowel disease
  • integrative medicine
  • interstitial cystitis
  • lupus
  • malaria
  • metals toxicology
  • mitochondrial disease
  • nanomaterials for bone regeneration
  • osteoarthritis
  • pancreatitis
  • pathogen-inactivated dried plasma
  • polycystic kidney disease
  • post-traumatic osteoarthritis
  • psychotropic medications
  • pulmonary fibrosis
  • respiratory health
  • rheumatoid arthritis
  • scleroderma
  • sleep disorders
  • tinnitus
  • vascular malformations
  • women’s heart disease

###
















Sunday, December 7, 2014

IOM considers changes in Gulf War study

SOURCE:  Arizona Republic, Paul Giblin reporting, Dec. 7, 2014

http://www.azcentral.com/story/news/arizona/investigations/2014/12/06/medical-association-considers-changes-gulf-war-study/20038207/

ARCHIVED ARTICLE

Medical association considers changes in Gulf War study

 28 12LINKEDIN 1COMMENTMORE
Leaders of one of the nation's most esteemed medical-advisory associations are considering whether to alter the membership of a new committee assigned to scrutinize scientific studies on Gulf War illness.
"We are exploring options for expanding the committee," Institute of Medicine spokeswoman Jennifer Walsh said. "We plan to have the committee finalized by our next public session at the end of January."
The Institute of Medicine committee met for the first time in Washington, D.C., Wednesday, but its membership has yet to be formally approved.
The committee's lineup could have a profound effect on its eventual findings, according to Phoenix resident and Gulf War illness researcher James H. Binns.
The Department of Veterans Affairs commissioned the Institute of Medicine to conduct the review, and the committee's report is expected to help lay the foundation for future treatments and benefits for thousands of Gulf War veterans.
The VA previously determined approximately 250,000 U.S. troops who deployed to Kuwait and Iraq in 1990 and 1991 suffer from Gulf War illness, a collection of symptoms that often includes gastritis, irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia.
The committee's membership became a flashpoint when Binns, a former Department of Defense policy official, and four colleagues charged that the Institute of Medicine's new committee lacks a broad spectrum of perspectives.
The focal point of the matter is the question of what causes Gulf War illness: psychiatric triggers, such as post-traumatic stress disorder, or environmental triggers, such as exposure to toxins from chemical weapons and smoke from oil-well fires.
Eight of the 16 proposed members of the committee already are on record supporting the idea that Gulf War illness is caused by psychiatric triggers, according to an analysis by Binns and his colleagues, who are current or former members of a VA advisory committee on Gulf War illness.
The other eight members of the Institute of Medicine committee are neutral, according to their analysis.
"Conspicuously absent from the committee are any doctors or scientists who have studied Gulf War health in the past decade," they wrote to Institute of Medicine President Victor Dzau on Nov. 28.
The committee also lacks anyone who has studied or treated other groups, such as farmers, who have been subjected to neurotoxin exposures, or anyone who has studied the effects of Gulf War exposure on animals, they wrote.
Binns and his colleagues believe the toxic-exposure connection is well established by existing scientific research. They believe the psychiatric connection is tied to outdated theories intended to keep veterans off the VA's rolls, they wrote.
Institute of Medicine executives screen potential committee members to ensure balance, Walsh said.
"Committee members are expected to have points of view, and the National Academies attempt to balance these points of view on a committee and to include members on a committee with the specific expertise and experience needed to address the study's statement of task," she said in an email.
The Institute of Medicine is part of the National Academy of Sciences, which positions itself as a nonpartisan and independent adviser to government policymakers on scientific matters.
Binns' group, which is aligned with representatives of six veterans organizations, is prepared to bring the matter to members of Congress if the committee's membership remains unchanged, he said.
Phoenix resident Matthew Key said he and other Gulf War veterans are monitoring the matter closely.
Key, a former Navy corpsman who advanced with the Marines during the Gulf War invasion, is certain toxic exposures are the root of his medical ailments. He said he's losing function of his hands, knees and shoulders.
"Chemicals from over there are eating up all my joints," he said.
The makeup of the Institute of Medicine panel is concerning, Key, 46, said. "I sure hope they get somebody who's in for the vets," he said.

ON THE BEAT
Paul Giblin is a Pulitzer Prize-winning reporter covering government policies and efficiency, and how they affect consumers of government.
How to reach him
Phone: 602-444-8228
Twitter: @PaulGiblinAriz

Friday, December 5, 2014

AZ REPUBLIC: Gulf War illness researchers wary about IOM Gulf War Committee

SOURCE:  Arizona Republic, Dec. 2, 2014, Paul Giblin reporting

http://www.azcentral.com/story/news/arizona/investigations/2014/12/03/gulf-war-illness-researchers-wary-new-approach/19818277/

ARCHIVED ARTICLE:


Gulf War illness researchers wary about new approach


 39 23LINKEDIN 2COMMENTMORE
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.

MORE NEWS ON THE VA CRISIS


  • The doctor who launched the VA scandal
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  • 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.
    ON THE BEAT
    Paul Giblin is a Pulitzer Prize-winning reporter covering government policies and efficiency, and how they affect consumers of government.
    How to reach him
    paul.giblin@arizonarepublic.com
    Phone: 602-444-8228
    Twitter: @PaulGiblinAriz

    Tuesday, December 2, 2014

    Former RAC Members Express Concerns about New IOM Gulf War Committee




    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 3rd1pm 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.

    ###

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




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

    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