ANNUAL REPORT TO CONGRESS Federally Sponsored Research on Gulf War Veterans’ Illnesses for 2002 April 2004 Deployment Health Working Group Research Subcommittee Annual Report to Congress – 2002 Research on Gulf War Veterans’ Illnesses DEPLOYMENT HEALTH WORKING GROUP RESEARCH SUBCOMMITTEE MEMBERS Department of Veterans Affairs: Kelley Ann Brix, M.D., M.P.H. (VA Co-Chair) Bradley Doebbeling, M.D., M.H.S.A. K. Craig Hyams, M.D., M.P.H. Roberta White, Ph.D. Department of Defense: Bart Kuhn (DOD Co-Chair) Salvatore Cirone, D.V.M. Karl Friedl, Ph.D., Col, USA Carol Linden, Ph.D. Department of Health and Human Services: Drue Barrett, Ph.D., CDR, USPHS ii TABLE OF CONTENTS EXECUTIVE SUMMARY ...................................................................................................... 1 I. INTRODUCTION .......................................................................................................... 1 II. RESEARCH RESULTS IN 2002..................................................................................... 1 III. RESEARCH FUNDING TRENDS................................................................................. 5 IV. NEW RESEARCH PROJECTS AND INITIATIVES....................................................... 5 V. RESEARCH PRIORITIES............................................................................................. 7 I. INTRODUCTION............................................................................................................... 8 II. RESEARCH RESULTS IN 2002.......................................................................................... 8 A. Symptoms and General Health Status.............................................................................. 8 B. Brain and Nervous System Function .............................................................................. 26 C. Diagnosis.................................................................................................................... 33 D. Immune Function ........................................................................................................ 33 E. Prevention .................................................................................................................. 34 F. Environmental Toxicology (Includes Oil Well Fire Smoke) ............................................... 44 G. Depleted Uranium ....................................................................................................... 46 H. Chemical Weapons...................................................................................................... 48 I. Pyridostigmine Bromide................................................................................................ 53 J. Interactions of Exposures.............................................................................................. 54 III. RESEARCH FUNDING TRENDS.................................................................................... 62 A. Overview.................................................................................................................... 62 B. Research Funding........................................................................................................ 63 C. Diversity of Research Approaches............................................................................ 65 IV. NEW RESEARCH PROJECTS AND INITIATIVES......................................................... 66 IV.A. NEW RESEARCH PROJECTS ................................................................................ 66 IV.B. 2002 UPDATE OF KEY RESEARCH PROJECTS AND INITIATIVES ........................ 69 V. RESEARCH PRIORITIES............................................................................................... 73 A. RESEARCH PRIORITIES FOR 1995 ........................................................................... 73 B. RESEARCH PRIORITIES FOR 1996 ........................................................................... 74 C. RESEARCH PRIORITIES FOR 1998 ........................................................................... 77 iii VI. REFERENCES.............................................................................................................. 80 APPENDIX A FEDERALLY FUNDED RESEARCH ROJECTS…………………………93 A. A1 PROJECT INDEX BY DEPARTMENT…………………………………………………..95 B. A2 PROJECT LIST BY RESEARCH FOCUS AREAS..………………………………113 C. A3 PROJECT FUNDING…….……………………………………………………135 iv EXECUTIVE SUMMARY 2002; Unwin, et al., 2002; Higgins, et al., 2002; Hull, et al., 2002; Smith, et al., 2002b; I. INTRODUCTION Richardson, et al., 2002; Voelker, et al., 2002; Wolfe, et al., 2002; Jones, et al., 2002) These The Secretary of Veterans Affairs is required by publications included the results of studies Section 707 of Public Law 102-585 as amended conducted at five Federally-funded research by Section 104 of Public Law 105-368, to submit centers in San Diego, Portland, Oregon, Iowa to the Senate and House Veterans’ Affairs City, Boston, and London, UK. Each of the Committees an annual report on the results, publications included data on hundreds to status, and priorities of research activities related thousands of individuals. Six of these studies to the health consequences of military service in were population-based, which means that the the Gulf War. The Research Subcommittee of results of these studies may have implications for the interagency Deployment Health Working the overall population of 697,000 Gulf War Group (DHWG) prepared this 2002 Annual veterans. (McCauley, et al., 2002a; Kang, et al., Report to Congress, which is the ninth report on 2002; Unwin, et al., 2002; Higgins, et al., 2002; research and research activities. (PGVCB, Hull, et al., 2002; Voelker, et al., 2002) 1995a; 1996a; 1997; 1998a; 1999a; 2001; MVHCB, 2001a; 2002; DHWG, 2003) The The objective of the first study was to compare DHWG tracks all Federally-funded research the rates of self-reported symptoms among projects related to Gulf War veterans’ illnesses. veterans who deployed to the Gulf War (Gulf War Seabees), veterans who deployed to another This Annual Report is divided into five sections. foreign country (Seabees deployed elsewhere), Section I is an introduction. Section II highlights and veterans who did not leave the U.S. (non­ and summarizes research progress since the last deployed Seabees). The Seabees were active- Annual Report. Section III is an analysis of the duty and Reserve personnel who served in seven Federal Government’s portfolio of research on Naval Mobile Construction Battalions. (Gray, et Gulf War veterans’ illnesses. Section IV al., 2002b) highlights significant new research projects and initiatives since the last Annual Report. Section The objectives of the second and third study V discusses priorities established for future were linked, and were based on an investigation research in 1995, 1996, and 1998, and highlights of three groups of veterans: 653 Gulf War the progress made to date. veterans who had deployed within 50 km of Khamisiyah, Iraq in March 1991; 610 Gulf War II. RESEARCH RESULTS IN 2002 veterans who were distant from Khamisiyah; and 516 non-deployed veterans. The objectives of In 2002, several research studies have yielded the second study were to examine the results that provide new and expanded relationships between possible low-level information on the health problems of Gulf War exposure to organophosphate nerve agents and veterans. Section II provides brief summaries of subsequent health effects, including medical research projects for which results were diagnoses, hospitalizations, and disability. published from January 2002 to December 2002. (McCauley, et al., 2002b) The objectives of the As in previous Annual Reports, the research third study were to determine if a unique pattern reports summarized in Section II are grouped of symptoms was present in veterans located according to ten focus areas: symptoms and near Khamisiyah; and if so, to determine if the general health status, brain and nervous system pattern differed from that of veterans located function, diagnosis, immune function, farther away from Khamisiyah, or from that of prevention, environmental toxicology, depleted non-deployed veterans. (Shapiro, et al., 2002) uranium, chemical weapons, pyridostigmine bromide, and interactions of exposures. The objective of the fourth study was to use factor analysis to determine if patterns of 1. Symptoms and General Health Status: reported symptoms were similar in Gulf War veterans, compared to patterns of reported Thirteen large studies published in 2002 focused symptoms in non-deployed veterans, based on on symptoms and general health. (Gray, et al., data from the VA National Health Survey. 2002b; McCauley, et al., 2002a; McCauley, et (Kang, et al., 2002) al., 2002b; Shapiro, et al., 2002; Kang, et al., 1 The objective of the fifth study was to examine among 1,290 members of the Fort Devens, the clinical characteristics of Gulf War veterans Massachusetts cohort. (Wolfe, et al., 2002) with chronic fatigue syndrome (CFS), compared to healthy Gulf War veterans. (McCauley, et al., The objectives of the thirteenth study were to 2002a) determine if post-combat syndromes have existed after modern wars and what their The objectives of the sixth, seventh, and eighth relationships were to each other, based on British studies were linked, and were based on an medical records from the Boer War to World investigation of three groups of British veterans: War II. (Jones, et al., 2002) Gulf War veterans, Bosnia veterans,