IOM holds open meeting to discuss treatments for Gulf War illnesses

WASHINGTON, February 5, 2001 (GulfLINK) - Treating the multitude of undiagnosed illnesses experienced by some Gulf War veterans can be a daunting task. A committee of medical and scientific professionals assembled by the National Academy of Science's Institute of Medicine has been tasked to identify effective treatments for Gulf War veterans' health problems. In an open meeting held in Washington, D.C., in August 2000, the committee members heard from several healthcare professionals, medical researchers and Gulf War veterans on what treatments for their illnesses were effective or ineffective.

"We are here today to gather information to help the committee conduct its study," said Bernard Rosof, M.D., committee chairman. "The purpose of this project is to identify and describe methods of evaluating treatment effectiveness, regardless of disease and condition; to identify illnesses and conditions prevalent among Gulf War veterans, including medically unexplained physical symptoms and to identify valid models of treatment for such illnesses or identify new approaches, theories or research on management of patients with these conditions."

Rosof told those in attendance that the committee has drawn no conclusions, but that the information presented will help in writing their report.

Ten years ago, approximately 697,000 U. S. personnel and smaller numbers of British, French, Egyptian, Saudi Arabia, Syrian and several other national contingents were deployed to Southwest Asia to stop the invasion by Iraq. It wasn't until after the troops returned home following the Gulf War that some began to complain of diarrhea, pain, fatigue, sleep disturbance, headache, rash and many other problems. British and Canadian troops also report some similar symptoms.

A noted gastrointestinal specialist, Howard Spiro, M.D., spoke about the possibility that "irritable bowel syndrome" might be one of the leading causes for diarrhea among some Gulf War veterans. Spiro discussed his belief that irritable bowel syndrome typically starts during a person's teenage years. In his view, diarrheal conditions that begin later in life have probably been caused by such factors as infection or food poisoning, and may be perpetuated by stress. A diagnosis may be difficult to make in such cases. He also noted that doctors and patients often have different ways of approaching illnesses, both in making a diagnosis and in treatment. Doctors must care for the whole patient - mind, body and soul - when seeking to restore health.

Another speaker was Army Lt. Col. Charles Engel, M.D., of Walter Reed Army Medical Center, who advocated better assessment and management within the Defense Department and the Veterans Affairs' healthcare systems.

Engel also talked about the different perspectives of doctor and patient which can sometimes leave the patient dissatisfied with the healthcare system. He advocated a care-based approach. The physician and the patient should work together as a team to come up with solutions to the problems. Basically, he said, this entails managing the patient's care through cooperative action. He said he believes the patient needs to take some responsibility for feeling better by deciding on the outcome variables.

This care-based approach to veterans' treatment was reinforced by the reported experiences of Steven Hunt, M.D., and psychologist Ralph Richardson, Ph.D., who are from the Gulf War clinic at the Seattle VA Medical Center in Washington. Both doctors said it is necessary to find out from the veterans what they need to feel better. Veterans' beliefs and expectations will have an important impact on the outcome of their care.

In their Seattle clinic, the doctors developed a model for multiple unexplained physical symptoms. They said that while the doctors do not know what causes the symptoms, they do have a few opportunities for areas of intervention: treating factors which appear to have started the symptoms, or factors which to keep them present. Their model also recommends a shift from medical management to self-management, which allows the physician and the patient to share responsibility and also shifts the focus from cause to effect.

Following the medical presentations, committee members sought opinions about effective treatments from those Gulf War veterans who were in attendance. James Johnson and Michael Oldaker were two of 16 veterans who offered personal anecdotes on what kinds of treatment were working for them. Johnson, a retired Army veteran, said that he participated in the cognitive behavioral therapy and aerobic exercise treatment trial.

"While this has not cured me," said Johnson, "I have noticed a difference that it has made in several areas of my life. I now get along better with my family, neighbors and co-workers."

Johnson also told the committee that he diligently keeps up with the limited amount of aerobic exercise that he can handle.

Oldaker, who retired medically from the Marine Corps, gave a brief overview of which medications he considered effective in treating his blackouts and tremors, and which ones were ineffective. Oldaker said that the antibiotics provided to him were the most helpful.

At the end of the meeting, Dr. Rosof thanked everyone for attending and said that their comments were very helpful.

The National Academy of Sciences was created in 1863 by a congressional charter approved by President Abraham Lincoln. Under this charter, the National Academy of Engineering was established in 1964 and the Institute of Medicine in 1970.

All three organizations are private, non-profit, self-governing membership bodies, and all three share in the responsibility for advising the federal government, upon request and without fee, on questions of science and technology. The Institute of Medicine identifies concerns in medical care, research and education, and secures the services of members of appropriate professions to examine policy matters relating to public health. Although the Institute of Medicine is not a part of the formal structure of the National Research Council, its program is subject to approval by the Research Council's Governing Board and its reports are subject to the requirements of the Report Review Committee.

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