cerning sulfur mustard, the nerve agent VX, and the role of the genetic expression of cholinesterases in protecting against anticholinesterase nerve agents. Subsequently, DOD published a four-part broad agency announcement called BAA to amplify research on low-level chemical warfare nerve agent effects, as well as research on the health effects of other exposures including insecticides, the nerve agent prophylaxis pyridostigmine bromide, and stress. The BAA resulted in funding recommendations for 12 new projects valued at approximately $12 million and covering such exposures as sarin, pyridostigmine bromide, insecticides, psychological stress and heat stress, alone and in various combinations. In March 1997, the VA organized an international symposium in conjunction with the Society of Toxicology on the health effects of low-level exposure to chemical warfare nerve agents. Investigators from the United States and from Japan to Israel participated in that conference. More recently, the sarin terrorist attacks in Japan have provided an opportunity to study the health consequences of a real-time, clearly confirmed sarin exposure. A VA investigator has been collaborating with Japanese investigators who have conducted followup studies on exposed individuals. These study subjects experienced acute, but mild, symptoms arising from the Tokyo subway sarin attack of 1995. Investigators have studied psychological, neurobehavioral, and neurophysiological outcomes in these sub jects. Three papers subsequently have resulted from this research and have been published. These papers provide new insight into the effects of clinical exposure to sarin 6 to 8 months following an acute attack. In comparison with matched controls, the exposed subjects manifest subtle neurophysiological effects that show that sarin may cause effects on the brain that are sustained for some time following clinical recovery from acute effects. Second, although issues around the potential health impacts on our troops of potential low-level exposures to nerve agents are important, there are other health outcomes of concern as well. For example, the importance of musculoskeletal conditions among Gulf war veterans is clearly evident based on the prevalence of these conditions among veterans reporting to the VA and DOD registries and on results emerging from a number of research efforts. Because of the obvious importance of ensuring appropriate and effective treatment of Gulf war veterans' illness, the Department of Veterans Affairs, Office of Research and Development, formed a planning group charged with developing a program announcement inviting proposals within the VA system, or in collaboration with DOD, for multicentered trials for candidate treatments of clearly defined medical syndromes or illnesses among subgroups of Gulf war veterans. The program announcement was issued in January 1998. In addition, VA and DOD are proceeding with the planning of a joint VA-DOD multicenter treatment trial for chronic fatigue syndrome and fibromyalgia in Gulf war veterans. Third, both VA and DOD have undertaken new initiatives that are focused on neurobiology of stress and stress disorders. These new efforts include the following: VA and DOD have issued a re quest for intramural proposals valued at approximately $5 million for research on the neurobiology of stress, the neuroendocrine sequelae of stress, and immunologic consequences of stress. In June 1997, VA funded a multicenter study examining the effectiveness of a computerized battery of neuropsychological testing that could improve the accuracy of the diagnosis of PTSD by enabling the clinician to rule out organic central nervous system dysfunction. In July 1996, VA funded a new multicenter treatment trial investigating the efficacy of trauma-based group therapy in the treatment of post-traumatic stress disorder. Finally, VA has issued a program announcement in August 1997, requesting proposals for additional multicenter trials of PTSD treatment. Treatment methodologies sought include novel, nonpharmacological approaches to treatment, with special emphasis on targeted subpopulations such as women and Gulf war veterans. From 1994 to present, the Research Working Group has worked to coordinate and direct a diverse research portfolio consisting of 121 projects and a total cumulative investment of approximately $115 million. Of these 121 projects, 39 have been completed, 78 are ongoing, and 4 have been newly awarded and are awaiting startup. There are 14 identified research focus areas ranging from the effects of service in the Gulf war on the brain and nervous system to potential health consequences of low-level exposure to chemical warfare agents. Approximately one-third of the projects are epidemiological, one-third clinical, and one-third represent basic laboratory-based research. As the research programs of the Federal Government continue to provide more results, we will increase our understanding of Gulf war veterans' illnesses, which will, in turn, enhance our potential ability to diagnose and treat them. Mr. Chairman, I will conclude my testimony here and answer questions later. [The prepared statement of Dr. Feussner follows:] Statement of John R. Feussner, M.D. Chief Research and Development Officer Before the Subcommittee on Human Resources of the Research on Gulf War Veterans' Illnesses February 24, 1998 *** Mr. Chairman and members of the Subcommittee, thank you for this opportunity to discuss the status of the current and projected federal research program on Gulf War veterans' illnesses. I serve as the Department of Veterans Affairs' (VA) Chief Research and Development Officer and the Chairperson of the Research Working Group (RWG) of the Persian Gulf Veterans Coordinating Board. Today I will focus my presentation on the strategy and objectives of the RWG. First, I would like to provide some history of the RWG. The federal research effort on Gulf War veterans' illnesses involves scientists in federal, academic, and private institutions, in the United States and abroad, whose research is sponsored by VA, the Department of Defense (DoD), and the Department of Health and Human Services (HHS). Each department has distinct, though complementary, capabilities for conducting and sponsoring research on Gulf War veterans' health issues. In addition, each department has its own appropriations for extramural and intramural general biomedical research. The primary charge to the RWG is to assess the state and direction of research; identify gaps in factual knowledge and conceptual understanding; identify testable hypotheses; identify potential new research approaches; review research concepts as they are developed; collect and disseminate scientifically peer-reviewed research information; and ensure that appropriate peer review and oversight are applied to research conducted and sponsored by the federal government. The biomedical research programs in VA, DoD, and HHS have well established management structures for science policy formulation and the solicitation, scientific peer review, and funding of research projects. The coordination and management of this large research effort on Gulf War veterans' illnesses required the establishment of an overall research policy framework linking each Department's research management hierarchy. To provide this linkage, in 1993 VA, DOD, and HHS formed the "Persian Gulf Interagency Research Coordinating Council". By January 1994, when the Secretaries of VA, DOD, and HHS formed the Persian Gulf Veterans Coordinating Board (PGVCB), the Research Coordinating Council became the Research Working Group (RWG) operating under the auspices of the Coordinating Board. Because of the potential link between environmental factors and Gulf War veterans' illnesses, the Environmental Protection Agency was asked to be a member of the Research Working Group. An important function of the RWG is programmatic review and recommendation to funding agencies of research proposals that have been competitively peer reviewed. The RWG works collectively with VA, DoD, and HHS to elucidate agency-specific funding mechanisms to support research in those identified areas. For a specific research funding activity, the responsible funding agency works with and through the RWG to develop a targeted solicitation for research. Proposals that are submitted to the funding agency in response to a solicitation are scientifically peer-reviewed using agency-specific peer review programs (e.g., DoD/Department of the Army uses a contract with the American Institute of Biological Sciences). Abstracts of peer-reviewed proposals, written reviews of the peer-reviewers, and the scientific merit scores assigned by the peer-reviewers, are provided to a subcommittee of the RWG charged with providing secondary review of proposals for relevance. The information provided is redacted for personal and institutional identifiers so that programmatic review is anonymous. Relevance determinations are guided by programmatic needs articulated through the RWG process. In its secondary review the RWG may re-rank proposals based on relevance, but it will not recommend non-meritorious proposals for funding to any agency. The RWG continues to work diligently to foster the highest standards of competition and peer-review for all research on Gulf War veterans' illnesses. As an operational policy, the Research Working Group works through the line management authority each department maintains over its intramural scientists, scientific program managers (responsible for extramural research), and budgets. By drawing the three departments together, the RWG has been able to jointly develop a research strategy, jointly serve as a forum for researchers to present ideas and findings, and jointly respond to emerging research issues and problems. Through the priority setting processes carried on within the RWG, each department is able to independently develop approaches to addressing those priorities. These approaches are then returned to the RWG for joint discussion, resolution, and recommendations. The RWG has served as an umbrella under which the federal government has been able to respond to many research issues outside the context of the RWG's regular meetings. When emerging research issues arise within an individual department, the RWG is |