Former Members of VA Research Advisory Committee Charge VA of Reviving Pseudoscience to Reduce Claims Burden through Manipulation of Institute of Medicine

Dr. Victor J. Dzau, M.D. President

Institute of Medicine 500 Fifth St., NW Washington, DC 20001

Dear Dr. Dzau,

As former members of the VA Research Advisory Committee on Gulf War Veterans Illnesses, we are gravely concerned by the makeup of the committee that IOM staff has chosen for the upcoming review of Gulf War health literature. The membership is grossly imbalanced toward the 1990’s government position that Gulf War veterans have no special health problem — just what happens after every war, related to psychiatric issues, and not environmental exposures.

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.

Science has conclusively demonstrated that this government position has no scientific validity. Just four years ago, an IOM committee chaired by Dr. Stephen Hauser, former president of the American Neurological Association, reviewed the scientific literature and concluded that the chronic multisymptom illness suffered by an estimated 250,000 Gulf War veterans (over one-third of the 697,000 who deployed) is a physical illness associated with Gulf War service, a “diagnostic entity” that “cannot be reliably ascribed to any known psychiatric disorder,” and that “it is likely that Gulf War illness results from an interplay of genetic and environmental factors.”, pages 262, 210, 204, 109, 261

These conclusions reinforced the similar findings and recommendations of our former committee’s 452-page 2008 report. Our committee went further to identify the specific environmental exposures responsible, including pesticides, pyridostigmine bromide pills given to troops as a prophylaxis against nerve gas, and possibly low level nerve gas released by the destruction of Iraqi facilities, oil well fires, and multiple vaccinations. In April 2014, our committee published an update report which concluded that “[s]cientific research published since … 2008 … supports and further substantiates the conclusions of the 2008 report.”, page 5

Yet, as the attached analysis shows, fully half the individuals selected for the new committee are predisposed toward the discredited 1990’s government position, either because they promoted it themselves, or because they are professionally

November 28, 2014

oriented to view such problems as psychiatric and/or unrelated to environmental exposures. The rest of the committee are neutral figures with a background in other neurological conditions like Alzheimer’s disease and traumatic brain injuries. No member of the committee has been actively engaged in Gulf War health research in the past decade.

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 1990’s fictions and those who are neutral but unfamiliar with the subject. Compared to the 2010 IOM report, it will be a reversal toward the discredited 1990’s position.

For three years, VA has been engaged in a surreptitious campaign to revive the 1990’s government position. Since no scientific support for the position exists, VA staff has resorted to manipulating Gulf War research and reports. The Research Advisory Committee has documented this manipulation in forty-six pages of findings and recommendations in June 2012 and in a draft section of its April 2014 report which had to be removed because VA eliminated the committee’s oversight authority. GWVI/docs/Committee_Documents/CommitteeDocJune2012.pdf %20ExhibitBtestimony.pdf

In September, VA’s Director of Epidemiology, Dr. Robert Bossarte, and his staff presented findings of two new VA studies to the Research Advisory Committee. One showed that diagnoses given to Gulf War veterans in VA hospitals over a ten-year period were no different than those given to veterans of the same era who did not deploy. The other, a large survey, showed that rates of PTSD and depression were dramatically higher than previously reported by Gulf War veterans.

To an inexperienced observer, it might seem that the research on Gulf War veterans’ health was changing. However, Research Advisory Committee members quickly pointed out that Dr. Bossarte and his staff were not telling the whole story.

The diagnoses study presentation failed to mention that VA had no diagnostic code for Gulf War illness or chronic multisymptom illness, that VA doctors at this time were trained to consider the illness as psychosomatic, and that veterans who served during the period of greatest toxic exposures were inexplicably excluded from the study. Similarly, the survey presentation did not disclose that the survey was overweighted with mental health questions to the extent that the Committee had repeatedly recommended against sending it out, GWVI/docs/Committee_Documents/CommitteeDocJune2012.pdf, Appendix F, and that the survey’s principal investigator had testified to Congress that his superiors lied to then-VA Chief of Staff John Gingrich to induce him to release the survey. The

presentation did not mention that people suffering from chronic health problems often become depressed after 23 years, but it is not the cause of their illness.
Dr. Bossarte and his staff will be presenting to the new IOM committee on December 3. Very likely they will be presenting their new research findings. But no one on the IOM committee will know that they are not being told the whole story, because there are no members with the necessary background. Thus, misleading VA studies will be presented to an imbalanced IOM committee, which will include the findings in its new report, and science will be “revised”.

The motivation behind VA’s manipulation of science is clear: to hold down benefits costs and claims wait times. In April, Military Times reported that VA Undersecretary for Benefits Allison Hickey was concerned that even using the term “Gulf War illness” “might imply a causal link between service in the Gulf and poor health which could necessitate legislation for disability compensation for veterans who served in the Gulf.” -VA-official-questions-use-term-Gulf-War-illness-

She also recently testified to Congress that VA would meet its 2015 claims processing target of 125 days unless she had to add a quarter million new claims to her inventory overnight, as happened in 2010 when Agent Orange coverage was expanded: “That will kill us.” system-review-of-vas-transformation-progress [1:38:50 mark]

While VA says that it provides care and benefits to veterans suffering from Gulf War illness under the category “undiagnosed illnesses,” illness.asp, the reality is otherwise. A 2014 VA report to Congress revealed that only 11,216 Gulf War-related claims have been approved, while 80 percent are denied., page 7. VA’s September 2014 press release that “nearly 800,000 Gulf War era Veterans are receiving compensation benefits for service-connected issues” is grossly misleading. mcdonald.html VA counts every veteran in the area from 1990 to the present as “Gulf War era,” not just those who served in 1990-91.

We are appalled that the government has been able to influence the workings of the Institute of Medicine, the most revered institution in American medical science, to further its shameful campaign to manipulate science to deny veterans care and benefits. Regrettably, however, we are not surprised, as this has been more common than not where Gulf War veterans’ health has been concerned. For example:

1. For fourteen years, in response to a law passed by Congress in 1998, VA has ordered and the IOM has prepared reports on the health effects of thirty-three toxic substances to which Gulf War veterans were exposed. The law repeatedly specified

that the reports must consider studies in both humans and in animals. For fourteen years, however, these IOM reports have considered only human studies. To do this, VA and the IOM not only have had to disregard the law; they also had to manipulate the standard established in the IOM reports on Agent Orange, inserting the word “human” in the standard. As a result, since most research studies of toxic substances are necessarily done in animals, these IOM Gulf War reports have never found sufficient evidence of an association between these substances and Gulf War veterans’ health problems. In turn, VA has never recognized any toxic exposure as a reason for granting these ill veterans care and benefits.

2. The most egregious of these IOM Gulf War reports was the Updated Literature Review of Sarin, in which animal studies were not considered even though new animal studies were the only reason that then-Secretary Principi ordered the report. The outcome of the report was predetermined before the VA-IOM contract was ever signed, by understandings between VA and IOM staff discussed in a cover letter from the then executive director of the IOM to the then head of the VA Environmental Agents Service. testimony/james-h-binns-0

3. The Research Advisory Committee recommended in 2008 that these IOM reports be redone in accordance with the law. GWVI/docs/Committee_Documents/GWIandHealthofGWVeterans_RAC- GWVIReport_2008.pdf, pages 53-55, 57. However, they have not been redone. Worse, the manipulated standard is now being employed in VA-ordered IOM studies of the health of post-9/11 veterans. The 2011 IOM report on the long-term health effects of burn pits used to incinerate waste in Iraq and Afghanistan used the manipulated Gulf War standard (limited to human studies), not the Agent Orange standard. As a consequence, the IOM burn pits committee found “inadequate/insufficient evidence of an association between exposure to combustion products and cancer, respiratory disease, circulatory disease, neurologic disease, and adverse reproductive and developmental outcomes.”

4. In 2006, the IOM did a general Gulf War literature review for VA, similar to the current task. Most of the report was a straightforward summary of the research, but IOM’s press release and press conference focused on one conclusion that echoed the familiar government theme that there is “no unique Gulf War syndrome.” Technically, this only means that others have similar symptoms, but the press release and conference spun the message to imply that Gulf War veterans have no major health problem. health_care/t/study-gulf-war-syndrome-doesnt-exist/#.VHLDjUuBNH8

5. The 2013 IOM treatments report was a recent glaring example of VA and IOM collaboration to disregard the law and promote the 1990’s government position. A 2010 law required VA to contract with the IOM for a comprehensive review of the

best treatments for ill Gulf War veterans by a group of doctors experienced in treating Gulf War veterans “diagnosed with chronic multisymptom illness or another health condition related to chemical and environmental exposures that may have occurred during [their] service.”

Instead, VA contracted for a literature review of treatments for all “populations with a similar constellation of symptoms,” and the IOM appointed a committee with no experience in treating Gulf War veterans but extensive experience in psychiatric and psychosomatic medicine — though the 2010 IOM report had just concluded that the illness “cannot be ascribed to any known psychiatric disorder.” Analysis ns%2C%20ExhibitBtestimony.pdf Membership-

The individuals selected to give background briefings to the committee were largely familiar advocates for the 1990’s position, who told the committee the problem was psychiatric. GWVI/docs/Committee_Documents/CommitteeDocJune2012.pdf, pages 24-30. Half the illnesses whose therapies were reviewed were psychiatric. The report revived 1990’s themes that that “[t]hroughout modern history, many soldiers returning from combat have experienced postcombat illnesses. . . that cannot now be attributed to any diagnosable pathophysiologic entity or disease,” and that “[c]linicians should approach [chronic multisymptom illness] with ‘a person- centered model of care . . . that helps patients understand that the word psychosomatic is not pejorative.’” %20ExhibitBtestimony.pdf

6. The person who identified the individuals to be invited to brief the treatment committee was the chief scientist of the VA Office of Public Health, according to Congressional testimony by a senior VA epidemiologist who worked for him.

7. One of the psychiatric-oriented briefers was a member of the IOM Board on the Health of Select Populations, the IOM board that oversees veterans’ studies. Dr. Kurt Kroenke, an Army doctor and psychiatric-oriented Gulf War researcher in the 1990’s, is a leading figure in somatic medicine. He co-chaired the “Conceptual Issues in Somatoform and Similar Disorders” project that laid the groundwork for the controversial expansion of the definition of somatoform disorders in the recently revised Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association. He has co- authored publications with two members of the IOM treatment committee and two members of the new IOM committee that begins work December 3.

8. Two other members of the IOM Board of the Health of Select Populations were also leading proponents of the government position on Gulf War health in the 1990’s. Dr. Francis Murphy held the position equivalent to chief scientist in VA’s Office of Public Health, and Dr. Greg Gray was a Navy doctor who published numerous papers in 1996-2001 that dismissed the idea that Gulf War veterans have any special health problems. Conversely, as of June 2013, no one on the IOM Board of the Health of Select Populations represented current scientific understanding of Gulf War illness. CMI-Panel-Membership-Analysis. It is currently undisclosed who serves on this board, as its membership has been removed from the IOM website, although the membership of all other IOM boards continues to be listed.

In summary, there has been a long-term corrupt relationship between the government and the Institute of Medicine to deny the true state of Gulf War veterans’ health, of which the makeup of the new committee is only the latest example.

We are confident that neither you nor VA Secretary McDonald, as newcomers to Washington and to your respective institutions, is aware of this problem. At one point, none of us would have believed it possible either. But it is a cancer that threatens to destroy the integrity and reputations of both organizations. And it makes a mockery of the mission of the IOM “to provide unbiased and authoritative advice to decision makers and the public.”

We urge you to conduct a thorough investigation of this problem and to fix it. The most effective and rapid approach is for the IOM 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.

As part of putting IOM on solid ground going forward, we urge you to replace the eight provisional members predisposed to the government’s scientifically discredited 1990’s position with individuals representing current scientific knowledge of Gulf War research and the health effects of neurotoxic exposures. We also urge you to replace those members of the Board on the Health of Select Populations identified with this position, with individuals representing current scientific knowledge regarding veterans’ health and environmental exposures.


James Binns
Former Chairman, Research Advisory Committee on Gulf War Veterans Illnesses

Beatrice A. Golomb, MD, PhD
Professor of Medicine, University of California San Diego
Current Member, Research Advisory Committee; former Committee Scientific Director

Rev. Joel C. Graves, DMin,
CPT U.S. Army (Ret.)
Former Member, Research Advisory Committee

Marguerite L. Knox, MN, ARNP-FNP/ACNP
COL, South Carolina Army National Guard Former Member, Research Advisory Committee

William J. Meggs, MD, PhD
Professor and Chief, Division of Toxicology, Brody School of Medicine, East Carolina University
Former Member, Research Advisory Committee

cc: Institute of Medicine Council

Analysis of the Provisional Committee Membership

The provisional committee is grossly imbalanced in favor of the 1990’s government position that Gulf War veterans have no special health problem—just what happens after every war, related to psychiatric issues, and not environmental exposures. The following committee members are predisposed toward this position, either because they personally supported it, or because they are professionally oriented to view these kinds of health problems as psychiatric and unrelated to environmental exposures.

Dr. Kenneth Kizer, as VA Undersecretary for Health, 1994-1999, was the chief promulgator of this position, including this 1997 Congressional testimony: “The overall frequency of unexplained symptoms among Gulf War veterans appears to be about the same as in a general medical practice.”

Dr. Howard Kipen, a member of the VA Persian Gulf Expert Scientific Committee, 1993-1997, has published “Military deployment to the Gulf War as a risk factor for psychiatric illness among U.S. troops” (2005) and that “[c]oncerns . . . of a unique Gulf War syndrome, remind us that military personnel returning from wars have regularly described disabling symptoms” (co-authored with Dr. Kroenke). Unexplained Symptoms after Terrorism and War: An Expert Consensus Statement. Journal of Occupational and Environmental Medicine 45(10):1040-8, 2003

Dr. Herman Gibb runs a private consulting firm. The NIH terminated its contract with his previous firm, while he was president, on grounds that his firm was working for three chemical companies at the same time it was reviewing their chemicals for the government. dyn/content/article/2007/04/13/AR2007041301979.html

Dr. Nancy Woods is an expert on midlife and aging women’s health; her background relevant to Gulf War illness was as a member of the IOM committee that authored a 1996 report, “The Health Consequences of Service During the Persian Gulf War,” which concluded: “Men and women served side by side in conditions that increased the stresses of serving in these grim surroundings . . . Studies of Gulf War veterans suggest that these veterans suffer from a variety of recognized diseases, . . . not the existence of a new disease. ”

Dr. Javier Escobar is a professor of psychiatry at the Robert Wood Johnson Medical School, where his work “focuses on the somatic presentations of psychiatric disorders in primary care . . . as director of the ‘Medically Unexplained Physical Symptoms Research Center.’” With Dr. Kroenke he was a member of the “Conceptual Issues in Somatoform and Similar Disorders” project that laid the groundwork for the controversial expansion of the definition of

somatoform disorders in the recently revised Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, and was a member of the task force that wrote DSM-5. He was a member of the 2013 IOM treatment report committee.

Dr. Scott Fishman is board certified in psychiatry and pain medicine. His research includes a focus on “psychiatric issues of chronic illness and pain.”

Dr. Alberto Caban-Martinez studies musculoskeletal pain in workers related to their occupational risk factors.!about/c46c He has studied “The prevalence of Somatic Disfunctions in a Multi-Center Outpatient Osteopathic Medicine Clinic” and has published that “[c]onstruction workers struggle with a high prevalence of mental distress, and this is associated with their pain and injuries.” J Occup Environ Med 2013 Oct;55(10):1197-204

Dr. Deborah Cory-Slecta, the committee chair, has not done Gulf War health research herself but stated in 2013, in connection with service on another IOM Gulf War committee, that she does not believe Gulf War illness research has produced adequate data to show what caused the illness. definition-for-gulf-war-illness/ She also served on the 2003 IOM Gulf War committee that concluded there was insufficient evidence to show an association between any illness affecting Gulf War veterans and exposure to pesticides, applying the manipulated standard that excluded animal studies.

The other half of the committee are neutral, people who have not been engaged in Gulf War health research themselves, but who have a background in studying other neurological conditions and expertise in relevant subjects like neuroimaging, neuropsychology, and neuroepidemiology. They include Dr. Robert Brown, Dr. Ellen Eisen, Dr. Mary Fox, Dr. Clifford Jack, Dr. Joel Kramer, Dr. Francine Laden, Dr. James Noble, and Dr. Anbesaw Selassie.

Conspicuously absent from the committee are any doctors or scientists who have studied Gulf War health in the past decade, who have studied or treated other groups subjected to neurotoxic exposures like farmers or pesticide applicators, or who have studied the effects of Gulf War exposures in animals.

Read Original: LetterReIOMGulfWarCommMembership112814

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