Written by Chris Harding, Gulf War veteran, in response to written statements (by Jim Bunker) on the 2014 RAC Report
Larger Studies[Jim
Bunker]
Jim Bunker Quote: That is because neither the primary report
nor the executive summary recommended that the Secretary of the Department of
Veterans Affairs conduct any kind of follow-up research in regards to the pilot
studies cited within the report. While the CDMRP has conducted over 50
different research studies, the report does not comprehensively incorporate
that activity into a single follow-on study. I believe the RAC should ask the
Secretary to conduct such a larger study to move research and treatment forward.[1,
Jim Bunker;Page 1]
Personally, I would like to see more suggestions of larger
trials too. The RAC did have a section in the 2008 report titled “Research
Priorities and Recommendations.”[5] In fact, most of the RAC suggestions listed
on page 16[5] appear to have been done by independent researchers such as Dr.
Haley, Dr. Golomb, Dr Baraniuk, etc. Even Veterans Affairs has done some
studies that turned out to be fruitful.
In truth, 1991 Gulf War illness is complex, and the reason
we ill 1991 Gulf War veterans have seen success is because of the diverse pilot
studies. With that said, I personally believe many of the recent studies from
Dr. Baraniuk on Central Nervous System (CNS) damage, Dr. Haley on autonomic
nervous system damage, Dr. Golomb on mitochondria damage, etc should be
considered for larger studies. Interestingly, the Veterans Affairs could have
made this decision themselves, but the VA seems to have decided to do small
pilot studies to verify independent research results[6;7]. As an example, the
VA appears to be verifying Dr. Haley’s and Dr. Baraniuk’s results[Quote, 6;7].
As such, the Veterans Affairs decided to do pilot studies instead of large
trials.
RAC 2008 Report Quote: "Recommended research includes
studies that expand on existing biological findings in Gulf War
veterans—comprehensive research on brain structure and function, autonomic
function, neuroendocrine and immune alterations, and processes associated with
biological vulnerability to neurotoxicants—as well as studies that investigate
neuroinflammatory processes and utilize genomic and related technologies to
identify biological characteristics of Gulf War illness. Additional research
priority areas include studies that characterize effects of neurotoxic
exposures associated with Gulf War illness, and epidemiologic studies to assess
rates of neurological diseases in Gulf War veterans."[5, Page 16 and 17]
A few examples: Dr. Baraniuk's studies on Central Nervous
System damage (brain structure and function); Dr. Haley's studies on autonomic
nervous system dysfunction (autonomic function) that was mostly verified by a
VA pilot study on autonomic dysfunction[6]; Dr. Golomb's studies on
mitochondria and associated toxic effects of our environmental exposures on
mitochondria; etc. In fact, all researchers considered the toxic effects of our
environmental exposures.
Personally, I realize that peer-repeated studies strengthens
the science. As such, it might not be time for larger trials yet, but,
logically, one can assume that larger studies is the next step in the process,
which is not the hard part. The hard part is the actual research, and many
current and past RAC members have benefited ill 1991 Gulf War veterans.
Sadly, I also believe RAC members might be a little
disgruntled with the institutional corruption at the Veterans Affairs. For this
reason, I think the RAC put the responsibility for determining future trials
into the Veterans Affairs corner[Quote, 2]. Still, I have no personal
information to verify the latter. If true, the RAC and the VA are responsible.
RAC Quote: “Center- and consortium based treatment research
efforts can capitalize on multi-disciplinary expertise and multi-pronged
approaches to treatment targets and pre-clinical trials. The CDMRP treatment
consortia are an important step in developing integrated treatments for ill
Gulf War veterans as an initial assessment of treatment safety and efficacy in
Phase I/II trials. Since CDMRP has limited capacity to fund larger clinical
trials, validation studies through the VA Cooperative Studies Program (CSP) or
similar large, multi-site, government sponsored programs are necessary to
provide validation of the safety and efficacy outcomes identified in initial
Phase I/II trials. When a pilot treatment study funded by VA or CDMRP shows
promising results and is judged to have scientific merit, VA should follow up
with a larger trial or other systematic assessment of the treatment’s potential
benefits.”[2, Executive Summary, Page 14]
The above paragraph appears three times in the most Recent
RAC report[2], and Jim Bunker actually refers to it later in his letter when he
mentions page 79.
As an example of a suggested need for more studies that will
lead to a potentially larger study, I believe the above quote covers the
following[2, Page 25]. Still more suggestions would have been beneficial.
RAC Quote: “As described in the 2008 Committee report, only
limited research has been conducted to determine cancer rates in Gulf War
veterans. As of 2008, information from two studies provided no evidence of
significantly increased cancer morbidity among Gulf War veterans (Macfarlane et
al., 2003; McCauley et al., 2002). However, preliminary data from one pilot
study indicated a significant proportional excess of testicular cancer and
non-Hodgkin’s lymphoma among deployed Persian Gulf War veterans, identified in
specific state cancer registries (Levine et al., 2005).”[2]
Report Falls
Short[Jim Bunker]
Jim Bunker Quote: “This Report also falls short by not
giving the Secretary advice or tools to request funding for much-needed
research into diagnosis and treatment of Gulf War Veterans”[1, Jim Bunker, Page
1]
As mentioned before, it is my opinion that the diverse
research and pilot studies are needed to properly map potential causes of our
symptoms. As an example, mitochondria damage and Central Nervous System (CNS)
damage can cause chronic fatigue like symptoms, and each dysfunction might be
interrelated. If only CNS research would have been done, the dysfunctional
mitochondria would not have been discovered. As such, potential treatments for
CNS damage might not have proved to reduce all fatigue symptoms. In turn, more
pilot studies would have been needed anyhow. Also, the 2008 report accurately
recommended studies that have turned out to be significant in 1991 Gulf War
Illnesses. In the recent RAC report, May 2014, the RAC suggests the VA now start
considering the pilot studies that stemmed from the 2008 report, which were
fruitful, and consider larger trials.
Also, most of the June, 2012, Congressionally Chartered
Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC) report covered
funding and misappropriation of funds leading to inadequate research. Most
advocates believe the VA retaliated against the release of the June 2012
report. Just read the first page of the report and the following quote.
2012 RAC Report Quote: “VA research officials continue to
misrepresent to the Secretary of Veterans Affairs and to Congress, in the
Annual Report(s) To Congress, the level of research dollars spent addressing
the health of Gulf War veterans. The true figures are vastly overstated by the
inclusion of funds spent on studies that have little or nothing to do with Gulf
War veterans. [Appendix C].”[3]
As previously mentioned, the June, 2012, RAC report is
expected as the reason for the gross charter changes that has lead the US House
Committee on Veterans Affairs to introduce legislation to make the RAC
independent once again.
Suggestion of Endoscopy
To Diagnose GERD[Jim Bunker]
Bunker Quote: “The study needs to be using an Endoscopy to
check for damage.”[1, Jim Bunker; Page 3]
After a brief review of the literature, I disagree that
endoscopy alone should be used to detect GERD. The diagnosis of GERD is
complicated and many procedures might be needed to give a definitive
diagnosis[8]. Also, many medical researchers state that the 24 hour pH study is
the most sensitive for detecting acid that will likely progress to severe
GERD[8;9].
Quote: “The pattern of esophageal acid exposure has been
shown to influence severity of the disease, which increases progressively from
postprandial to upright, supine and bipositional reflux (21).”[8]
Quote: ”Currently upper gastrointestinal endoscopy is the main
clinical tool for visualizing esophageal lesions. Since the majority of GERD
patients do not have endoscopic visible lesions other methods are required to
document the abnormal acid exposure in the distal esophagus. For many
clinicians ambulatory esophageal pH monitoring is the gold standard in
diagnosing GERD since it quantifies distal esophageal acid exposure and allows
the evaluation of the relationship between symptoms and acid reflux.”[9]
Medicine is complicated.
Gulf War Illness
Treatment Research Recommendations[Jim Bunker]
Above, I provided a Veteran’s Affairs quote that suggested a
larger study for autonomic dysfunction in 1991 Gulf War veterans[6], and I
personally believe that Dr. Baraniuk’s study on CNS damage, Dr. Haley’s study
on autonomic nervous system dysfunction, and Dr, Golomb’s study on
dysfunctional mitochondria should be considered for a larger study. As
mentioned several times, the Veterans Affairs have already done a pilot study
that verified some of Dr. Haley’s autonomic nervous system dysfunction[6].
References:
[1] Bunker, Jim. National Gulf war Resuorce Center. Jim Bunker Rebuttal to Congressionally Charter Research Advisory Committee on Gulf War Veterans Illnesses, Apr. 24, 2014. Available from: http://www.scribd.com/doc/
[2] Research Advisory Committee on Gulf War Veterans’
Illnesses. Gulf War Illness and the Health of Gulf War Veterans: Research
Update and Recommendations, 2009-2013: Updated Scientific Findings and
Recommendations, April 2014. bu.edu[online]. 2014. Available from: http://www.bu.edu/sph/files/2014/04/RAC2014.pdf
[3] Research Advisory Committee on Gulf War Veterans'
Illnesses. Research Advisory Committee on Gulf War Veterans' Illnesses Findings
and Recommendation, June 2012. va.gov[online]. 2012. Available from: http://www.va.gov/RAC-GWVI/docs/Committee_Documents/CommitteeDocJune2012.pdf
[4] US Department of Veterans Affairs. Charter of the
Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC).
scribd.com[online]. 2014. Available from: http://www.scribd.com/doc/150956464/Sixth-Revised-RAC-Charter-05-17-2013
[5] Research Advisory Committee on Gulf War Veterans'
Illnesses. Gulf War Illness and Health of Gulf War Veterans. Scientific
Findings and Recommendations, 2008. va.gov[online]. 2012. Available from: http://www.va.gov/RAC-GWVI/docs/Committee_Documents/GWIandHealthofGWVeterans_RAC-GWVIReport_2008.pdf
[6] li, M; Xu, C; Yo, W; Mahan, CM; Kang, HK; Sandbrink, F;
Zhai, P; Karasik, PA. Self-reported post-exertional fatigue in Gulf War
veterans:roles of autonomic testing, Jan 7, 2014. Front Neurosci[online]. 2014.
vol. 7(269). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882719/
PMCID: PMC3882719; doi: 10.3389/fnins.2013.00269
[7] WRIISC Advantage. NJ WRIISC focuses on Gulf War Veterans
in research, June 2013. drive.google.com[online]. 2013. Available from: https://docs.google.com/file/d/0B1JqJ6C1t6WHU2VpWHl2SGFYNW8/edit?usp=sharing
[8] Gorecki, P., MD. Surgical Treatment: Evidence-Based and
Problem-Oriented: Gastro-esophageal reflux disease (GERD), 2001. ncbi.nlm.nih.gov[online]. 2014. Available
from: http://www.ncbi.nlm.nih.gov/books/NBK6896/
[9] Tutuian, Radu. Update in the Diagnosis of
Gastroesophageal Reflux Disease. jgld.ro[online]. 2006. Available from: http://www.jgld.ro/2006/3/6.pdf
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