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WHITE PAPER: IOM CMI Panel Membership Analysis.

WHITE PAPER: IOM CMI Panel Membership Analysis.

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Published by Anthony Hardie
MEMO: Membership of Institute of Medicine Committee to Establish A Case Definition for “Chronic Multisymptom Illness” (“CMI”) in 1990-1991 Gulf War Veterans. Submitted to the Meeting 1, June 26, 2013, Institute of Medicine (IOM) panel, "Development of a Case Definition for Chronic Multisymptom Illness" in 1990-91 Gulf War veterans.
MEMO: Membership of Institute of Medicine Committee to Establish A Case Definition for “Chronic Multisymptom Illness” (“CMI”) in 1990-1991 Gulf War Veterans. Submitted to the Meeting 1, June 26, 2013, Institute of Medicine (IOM) panel, "Development of a Case Definition for Chronic Multisymptom Illness" in 1990-91 Gulf War veterans.

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Published by: Anthony Hardie on Jun 30, 2013
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09/04/2013

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 AwhitepaperregardingtheIOMGulfWarIllness(“ChronicMultisymptomIllness”/”CMI”)panel.SubmittedfortherecordbyAnthonyHardie.
MEMO: Membership of Institute of Medicine Committee toEstablish A Case Definition for “Chronic MultisymptomIllness” (“CMI”) in 1990-1991 Gulf War Veterans
This memo reviews the membership of the recently-appointed IOM Gulf War casedefinition committee.(http://www8.nationalacademies.org/cp/CommitteeView.aspx?key=49546).It is followed by memos reviewing the previous IOM Gulf War committee (the 2013treatment report committee) and the IOM Board on the Health of Select Populations,which oversees Gulf War reports. Membership on IOM committees related to Gulf War veterans’ health is heavily weighted toward positions favored by government officials inthe 1990’s and early 2000’s, but now scientifically discredited, including the view thatGulf War multisymptom illness is due to stress or other pychiatric problems.
A. Scientific Background to the Case Definition Committee
In many cases, members have previous associations regarding views on this illness thatthey bring to the committee. As background, these respective views will be brieflysummarized. These views fall into two broad categories: 1) views reflecting currentscience and 2) views reflecting positions from the 1990’s that have been discredited bycurrent science.The current scientific understanding of Gulf War chronic multisymptom illness isreflected in the two recent comprehensive reports on the subject, the 2008 report of theResearch Advisory Committee on Gulf War Veterans Illnesses (RACGWVI), and the2010 Gulf War and Health (Vol. 8) report of the Institute of Medicine. In its 2008 report,“Gulf War Illness and the Health of Gulf War Veterans,” the RACGWVI found that Gulf War illness is real, that it affects at least one-fourth of US Gulf War veterans, that it is notthe result of combat or other stressors (noting that rates of PTSD are low in Gulf War veterans), and that it is the result of toxic exposures during the war.http://www.va.gov/RAC-GWVI/docs/Committee_Documents/GWIandHealthofGWVeterans_RAC-GWVIReport_2008.pdf (pages 1-2).The 2010 IOM Gulf War and Health Report (Vol. 8), “Update of Health Effects of Serving in the Gulf War,” made similar findings, concluding that the illness (which ittermed “chronic multisymptom illness”) is a “diagnostic entity,” affects more than250,000 Gulf War veterans, is associated with service in the war, “cannot be reliablyascribed to any known psychiatric disorder,” and that “Gulf War illness likely resultsfrom an interplay of genetic and environmental factors.” The one significant difference is
 
that the IOM report did not find the evidence sufficient to conclude which specificenvironmental exposures caused the illness.http://books.nap.edu/openbook.php?record_id=12835(pages 204, 262, 210, 109, 261)In the 1990’s and early 2000’s, the government theory of the illness reflected acombination of the following positions:
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These kinds of illnesses happen after every war.
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Gulf War veterans have no common disease, just an unrelated assortment of symptoms.
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Their symptoms are psychiatric in origin, reflecting battlefield stress or other  psychological concerns.These views have been discredited through the scientific research assembled in the 2008RACGWVI and 2010 IOM reports.
B. Committee Membership
The most striking characteristic of the group selected to be on this committee is how fewqualify as experts in the disease. Case definitions are typically developed by committeesof experts in the disease in question, using detailed data sources to ascertain objectivelywhich elements best characterize the disease. The VA Gulf War Strategic Research Plan just released called for a case definition to be developed in this well-accepted fashion:“The case definition should be developed by a consensus panel of experts in the field,using analytical results from a comprehensive evaluation of available data resources.”http://www.research.va.gov/resources/pubs/docs/GWResearch-StrategicPlan.pdf (page28)The original draft of the strategic plan, as it emerged from the scientific working groupsand before its doctoring by VA staff, was even clearer on this point. Assigning this vitaltask, which will influence all future Gulf War health research, to a committee largelywithout expertise in the illness, and directing them to carry out the task through aliterature review, is without precedent.The membership also does not appear to include anyone with prior experience indeveloping case definitions for other illnesses.
1. Only three members of the IOM committee appear to qualify as experts in theillness. Two of the three are associated with discredited viewpoints from the 1990’sand early 2000’s rather than current science.
 
Dr. Howard Kipen, MD,
has published and lectured on Gulf War Illness sincethe mid-1990’s, consistently supporting the views that all wars cause these kindsof health problems and that what caused the illness was not toxic exposures butthe psychological fear of those exposures. Eg, “Reported exposures, stressors, andlife events among Gulf War Registry Veterans, belief in CBW[chemical/biological warefare] exposure, and the experience of war stress andserious negative life events after the war, are important concomitants of Gulf War 
 
illness.” Military Deployment as a Risk Factor for Psychiatric Illness Among Gulf War and Era Veterans.
o
 
http://www.unc.edu/~ntbrewer/pubs/in%20press,%20fiedler,%20et%20al. pdf  
o
 
“The data we have don’t indicate there was anything about being exposedto a certain toxin that caused it. Those data say that just being there wasenough.”http://www.umdnj.edu/umcweb/marketing_and_communications/publications/umdnj_magazine/hstate/sprsm98/gulf1.html 
o
 
“Concerns . . . of a unique Gulf War syndrome, remind us that military personnel returning from wars have regularly described disablingsymptoms.”Clauw DJ, Engel CC, Aronowitz R, Jones DPhil E, KipenHM, Kroenke K, Ratzan S, Sharpe M, WesselyS. Unexplained Symptomsafter Terrorism and War: An Expert Consensus Statement. Journal of Occupational and Environmental Medicine 45(10):1040-8, 2003. 
o
 
Dr. Kipen was a reviewer of the 2005 IOM Gulf War (Vol. 3) report thatfound no association between selected environmental particulates, pollutants, and synthetic compounds and illnesses associated with Gulf War service.http://www.nap.edu/openbook.php?record_id=11180&page=R7 
o
 
Dr. Kipen was selected to present to, and review the report of, the 2006IOM Gulf War (Vol. 4) committee whose main finding was that there isno unique Gulf War syndrome. 
o
 
http://www.iom.edu/Activities/Veterans/GulfWarLitReview/2005-APR-20/Gulf-War-and-Health--Review-of-the-Medical-Literature--Meeting-Two--Agenda.aspx 
o
 
http://www.nap.edu/openbook.php?record_id=11729&page=R7 
o
 
http://www.washingtonpost.com/wp-dyn/content/article/2006/09/12/AR2006091201494.html 
 
Dr. Ron F. Teichman, MD,
until recently worked at the VA New Jersey War Related Illness and Injury Study Center as deputy head of risk communication.His publications also support the views that the psychological worry aboutenvironmental exposures is the problem for ill veterans, not the exposuresthemselves, and that these experiences are common in wars. Eg, "OEF/OIFveterans reported a high level of environmental exposures and concerns aboutenvironmental exposures. Greater reported environmental exposures (
β
= 0.13)and environmental exposure concerns (
β
= 0.39) were associated with a greater somatic symptom burden.” Environmental Exposure and Health of OperationEnduring Freedom/Operation Iraqi Freedom Veterans.
o
 
http://journals.lww.com/joem/Abstract/2012/06000/Environmental_Exposure_and_Health_of_Operation.3.aspx 
o
 
“Environmental exposure hazards during deployment to conflict are notnew. Concerns about these exposures are not new.” Health hazards of exposures during deployment to war.J Occup Environ Med.2012Jun;54(6):655-8. doi: 10.1097/JOM.0b013e318259bfd9http://www.ncbi.nlm.nih.gov/pubmed/22684316 

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