Mr. TOWNS. Dr. Barrett. Ms. BARRETT. Thank you for the opportunity to review the Department of Health and Human Services involvement in the coordinated effort to address the health concerns of Gulf war veterans. As you indicated, I am Dr. Drue Barrett. I am Chief of the Veterans' Health Activity Working Group of the National Center for Environmental Health at the Centers for Disease Control and Prevention. I serve as CDC's liaison to the HHS on Gulf war issues, and I am a member of the Research Working Group of the Persian Gulf Veterans Coordinating Board. Through its membership in the Research Working Group, HHS has been involved in providing guidance and coordination for DOD, VA, and HHS research activities relating to Gulf war veterans. Specifically, this has included assessing the state and direction of research, review of Government research concepts as they are developed, identification of gaps in factual knowledge and conceptual understanding, and providing recommendations regarding research direction. When the input of experts on a specialized research topic is needed, HHS scientists who are not regular members of the Research Working Group have provided consultation and have participated on special subcommittees managed by the Research Working Group. Through participation on the Subcommittee for Project Funding Recommendations, HHS has provided input into the programmatic review and funding recommendations of the Research Working Group. The process that is involved is reviewed in my written testimony. HHS believes that the Research Working Group has developed an appropriate and scientifically rigorous agenda for addressing the health concerns of Gulf war veterans. This research agenda includes an important balance of clinical studies, epidemiologic investigations, and basic research. Now I would like to briefly review CDC's current research activities relating to Gulf war veterans and how these activities were selected and funded. In 1997, CDC developed a request for proposals which focused on two programmatic priority areas: one, research that enhanced the understanding of conditions and symptoms reported to be more prevalent among Gulf war veterans; and two, research that added to the scientific knowledge needed to develop a case definition of illness among Gulf war veterans. CDC convened a Special Emphasis Panel, known as SEP, composed of 17 experts from outside CDC to review and rate the scientific merit of the proposals received. In addition, a subcommittee of the Research Working Group reviewed proposal abstracts and SEP summary statements to determine the relevancy to the Federal research goals. Based on the results of the SEP and the Research Working Group reviews, two new studies were selected for funding. The Boston University School of Public Health will conduct a study examining "Cognitive Function and Symptom Patterns of Persian Gulf Veterans." Robert Wood Johnson Medical School will conduct a study comparing various case definitions for unexplained illness among Gulf war veterans. Specifics regarding these two studies are detailed in my written testimony. Besides these two new studies, CDC continues to work with the Iowa Department of Public Health and the University of Iowa to collect additional data to validate health outcomes reported by participants of the Iowa study. A followup study focusing on the selfreport of asthma symptoms will be conducted. The University of Iowa has also been funded by DOD to conduct additional validation studies on other health outcomes, including depression, cognitive dysfunction and multisystemic conditions. An interagency agreement is currently being developed that will enable CDC investigators to provide technical assistance to DOD and the University of Iowa for this study. Finally, HHS has developed a research strategy for addressing health effects of exposure to multiple chemicals. The principal goal for fiscal year 1998 is to develop a 5-year research plan. This will include joint sponsorship by CDC and the National Institute for Environmental Health Sciences of a consensus-building conference. In addition, HHS will augment funding for an existing NIH grant announcement calling for research projects on the health effects of chemical mixture exposures. Together with research sponsored by VA and DOD, HHS's past research efforts have added new or confirming information to the growing knowledge base managed by the Research Working Group. Our new research activities will continue to contribute to a better understanding of illnesses among Gulf war veterans and will assist in providing new information to guide the collaborative planning process of the Federal Government. HHS is proud to serve along with the other two principally responsible departments on the Persian Gulf Veterans' Coordinating Board. This board has provided a necessary forum for the exchange of information within the Government and for the development of interdepartmental relationships, which have fostered greater understanding and cooperation. We look forward to continuing collaboration of this type. That concludes my statement. Mr. TOWNS. Thank you very much, Dr. Barrett. Mr. Chairman, thank you for the opportunity to review with the Committee the Department of Health and Human Services' (HHS) involvement in the coordinated Federal effort to address the health concerns of Gulf War veterans and our corresponding research activities in this area. I am Dr. Drue Barrett, Chief of the Veterans' Health Activity Working Group in the Division of Environmental Hazards and Health Effects, National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention (CDC). I serve as CDC's liaison to HHS on Gulf War issues and I am a member of the Research Working Group of the Persian Gulf Veterans Coordinating Board. NCEH has been designated as the lead Center at CDC for addressing Gulf War veterans' health concerns, however other Centers within CDC have also been involved in this effort, including the National Center for Infectious Diseases, and the National Institute of Occupational Safety and Health (NIOSH). Besides CDC, other agencies within HHS have also contributed to addressing the health concerns of Gulf War veterans, including the National Institutes of Health (NIH) and the Agency for Toxic Substances and Disease Registry (ATSDR). Coordination of Federal Research Efforts: There has been HHS representation on the Research Working Group since its inception. In addition to CDC, the Office of the Secretary and NIH are represented. Through its membership, HHS has been involved in providing guidance and coordination for the Department of Defense (DoD), the Department of Veterans Affairs (VA), and HHS research activities relating to Gulf War veterans. Specifically, this has included assessing the state and direction of research, review of government research concepts as they are developed, identification of gaps in factual knowledge and conceptual understanding, and providing recommendations regarding research direction. When the input of experts on a specialized research topic is needed, HHS scientists who are not regular members of the Research Working Group have provided consultation on specific projects and have participated on special subcommittees managed by the Research Working Group. Examples of this include the involvement of a CDC scientist with particular expertise in chemical warfare agents on a subcommittee addressing low level nerve agent exposure health effects, involvement of CDC, NIH, and Food and Drug Administration scientists with expertise in parasitic diseases on a subcommittee regarding serological testing for detection of leishmania infection, and consultation of CDC and NIH infectious diseases experts on mycoplasma infection issues. NIOSH and ATSDR have also been involved in providing consultation to the Persian Gulf Veterans Coordinating Board on health risk communication issues. Through participation on the Subcommittee for Project Funding Recommendations, HHS has provided input into the programmatic review and funding recommendations of the Research Working Group. Specifically, this has involved a process where DoD, VA, and HHS representatives review abstracts of peer-reviewed proposals along with written reviews of the peer-reviewers and their scientific merit scores. The submitting investigator's names and institutions are removed form these abstracts and peer reviews in order to minimize any potential bias. The Subcommittee is charged with reviewing this information in order to rate the proposals for relevance to the programmatic needs as outlined in the Research Working Plan. This process was used to rate the relevance of proposals submitted in response to recent DoD Broad Area Announcements and to a CDC program announcement. Only proposals that receive scientifically meritorious ratings through the peer review process are recommended for funding. The Research Working Group also serves as a forum for research data exchange among the three departments and among federally funded investigators. This includes the maintenance of a research database on all VA, DoD, and HHS research activities. VA, DoD, and HHS share in the responsibility for tracking research projects and updating the research database, which is maintained at the VA Office of Research and Development. The Research Working Group also sponsors an annual investigators meeting where new research results are shared. HHS participates on the planning subcommittee for this effort. CDC Gulf War Research Activities: Now I would like to review CDC's research activities relating to Gulf War veterans, with a special focus on our current activities and how these activities were selected and funded. Our involvement in this research effort began not long after the cessation of hostilities when in May 1991 researchers from NCEH and several other Federal agencies conducted cross-sectional surveys of workers in Kuwait City and of firefighters in the oil fields in October 1991. Since this initial research effort, CDC has continued to contribute to our understanding of the health effects of military service in the Gulf War through a variety of studies. Besides studies on the health effects of exposure to oil well fire smoke, CDC researchers have conducted studies addressing the prevalence of birth defects among Gulf War veterans, and have completed two large epidemiologic studies documenting the prevalence of symptoms and conditions among Gulf War veterans in comparison to Gulf War era controls, the Iowa and Pennsylvania Air National Guard studies. Our involvement in the Gulf War research effort has been initiated through a variety of mechanisms. For example, the Iowa study was conducted in response to a Congressional request |