Re: Gulf War Illness, Dr. Garth Nicolson, and Citizens with Toxin Induced Illness

[Guest guest]

-,

Thanks for clearing the news of Garth Nicholson. I have not spoken

with him for over 7 years at my first initial exposure to GWS.

However I find it interesting that he has changed stances on the

cause. Whatever, he ascertains to be the first and intitial cause is

probably accurate or at least the closes anyone has come to solving

the mystery. I know his own daughter was the cause of the research.

I was not in Desert Storm, but was the spouse of a Desert Storm Vet.

I was exposed in my belief through clothing that I touched that a Lt.

had worn while on the front line. He was sick as well as were his

children. I do believe that many chemical and biological insults

compromise the immune as well as make it difficult if not impossible

to reverse some of the effects for the long term. It makes since that

too many or even a few toxic insults would cause many long term

health issues. It has been known for years that trauma causes health

effects, physical and mental. Much of that was discovered by subject

trauma of victims during war.

Thanks for printing the article that Dr. Nicholson wrote. I had not

seen it before now. Still if anyone wants more info, we have the link

to Capt. Joyce Riley at our website: http://ntmc0.tripod.com

Carroll-Bower, President, NATIONAL TOXIC MOLD COALITION AND

FOUNDATION

-- In , " Hotz " <ahotz@m...> wrote:

> One of the Sick Building list participants gave an explanation of

Gulf

> War Illness that had some misinformation. I'd like to set the

record

> straight.

>

> For 11+ years I've been looking at how toxic insults make the body

> more vulnerable to a wide variety of immulological and neurological

> problems. Dr. Garth Nicolson originally thought that mycoplasma

> fermentans was the triggering culprit in GWI, but slowly came round

to

> the idea that toxic insults were the main cause.

>

> Dr. Nicolson focused only on one component of GWI -- the mycoplasma

> component - for a long time. He offered treatment of the

mycoplasma

> component of GWI through broad spectrum antibiotics, such as

> doxycycline. GWI is much more complicated than than just Mycoplasma

> infection. Dr. Nicolson has not participated in offering other

> treatments that have been helpful to vets such as detoxification,

> change of toxic environment to clean environment; stirict avoidance

of

> synthetic chemicals; use of nutritional supplements, etc. I became

> acquainted with Dr. Nicolson during my participation on a Gulf War

> Illness forum, and had multiple exchanges with him.

>

> Mycoplasma fermentans -- like many other bacteria and viruses,

> actually lives peaceably in most of our bodies and does not become a

> threat until the immune system gets knocked down --and then it can

> become very serious. People with AIDS for example, often die of

> Mycoplasma infection, but if it wasn't for them having AIDS -- they

> would not have succumbed. Mycoplasma is the co-factor in these AIDS

> deaths, not a prime cause. It's like if a person gets hit by a car

> and dies 3 days later of kidney failure in hospital -- it is much

too

> simplistic to say he died of kidney failure. To get the whole

picture

> you have to know that the body was hurt by something else which

> compromised the body's ability to function properly.

>

> Toxic insults that result in chronic illnesses are a huge problem in

> this country. Most of you in this group focus almost exclusively on

> mold, but may or may not know that if you have a normal household,

> with normal off-the-shelf cleaning and pest control products, that

> there are a wide variety of neurotoxic chemicals in your own home

that

> contribute greatly to your illnesses. Even your own clothing comes

> new from the store with a large number of intentional contaminants

> that will not easily wash out. Many people in the civilian

community

> have chronic illnesses exactly the same as Gulf War Illness, that

were

> triggered by pesticides, solvents, carpeting, drugs, toxic

adhesives,

> food additives, surfactants, waxes, coatings and building

materials.

>

> The paper below was written by Dr. Garth Nicholson in January of

2002

> and shows his change of position on Gulf War Illness. He now thinks

> that the initial trigger is from toxic insults. By the way --

> chemical nerve agents such as Soman, Tabun and Sarin --all war nerve

> gasses, (Sarin was part of the nerve gas supplies blown up by our

> military personnel)-- all of these are all made from organophosphate

> chemicals. Over 600 pesticide products that for decades we used in

> our homes, on our pets, and for mosquito control -- ALSO contain

> organophosphates… and many people (and pets) in the civilian

> population have been made chronically ill by low level, chronic

> exposures to these products. My husband and I both have the chronic

> illness just like GWI from exposure to inon -- an organophophate

> pesticide.

>

> Dr. Lipsey also has plenty of experience with people who

have

> been made permanently ill by pesticides such as inon and Dursban

> -- and several people that I know in the Chemical Injury Information

> Network have used his services. Gulf War veterans are a good study

> group for what is occurring in the civilian population. There are

> many lessons to be learned here -- if only there was strong

leadership

> to get us out of the traps we've set for ourselves.

>

> But let's be realistic. The chemical/pharmaceutical companies crush

> any attempt to get to the truth or attempts to publicize it.

> Chem/pharm's influence in congress and at the top levels of

government

> is legendary. Many industrial hygienists are afraid of chem/pharm.

> When they do their inspections and analyses --they most often

> completely ignore, or trivialize chemical contamination because they

> don't want to anger industry. Industry is where most of their

> paychecks come from. Industrial hygienists have no trouble finding

> mold however, because mold is " natural " and easy to blame -- without

> fear of retribution. In fact the mold diagnosis is good for

> chem/pharm which most often profits because it then sells the

customer

> more toxic chemicals to " kill " the mold and further contaminate

their

> homes.

>

> The following is Dr. Nicolson's well documented testimony to

Congress

> saying that toxic insults came first in Gulf War Illness.

>

> One additional comment. The fact that some family Gulf War vet's

> family members became ill when they returned from the Gulf has been

> documented. What has been poorly characterized however, is that the

> gear that the vets brought home with them were highly contaminated

> with pesticides and other toxic substances. Pyrethroid pesticides

> were impregnated into the vet's uniforms and you cannot wash the

stuff

> out. This stuff constantly off-gasses into the indoor environment

and

> cross-contaminates other clothes when washed together. Depleted

> uranium dust and souveniers were brought home by some of the vets.

> The semen of vets often burned their wives. It also contaminated

> them. The burning semen was a very interesting problem because men

> who have been poisoned by organophosphate and other pesticides in

the

> civilian population -- they and their wives also complained of

burning

> semen -- my husband and I included.

>

> Our bodies are not capable of being repeatedly assaulted with toxic

> synthetic chemicals in our homes, clothing, lawns and workplaces--

but

> every year thousands of new synthetic chemicals are added to the

> marketplace and are imbedded into everything we buy. We were not

> designed by God to detoxify these chemicals -- they are very, very

> different from toxins found in the natural environment. Synthetic

> chemicals can store in our blood, our fat and our brains for

decades.

> All of our bodies are contaminated -- not one of us is clean. Many

of

> them -- like the recently discovered chemicals in Teflon -- remain

in

> the environment and in our bodies forever. Have any of us really

> thought about the depth of the implications --for this type of

> contamination?

>

> Citizens in our society have learned very little from Gulf War

> Illness, partly because the Department of Defense, the Department of

> Veterans Affairs, and the Chemical/Pharmaceutical industry have

> covered up the truth. Our corporate press does not do investigative

> reporting in this realm… or if they report it, it is a footnote and

> almost never hear of again. Note how many chem/pharm ads there are

on

> TV news channels these days and you might guess why.

>

> And our doctors in this country -- the doctors that you and I see--

> are not trained to recognize toxin induced illness. The reason for

> this is because they get most of their information on how to

diagnose

> and treat disease from chem/pharm and chem/pharm interests.

>

> Here is Dr. Garth Nicholson's paper:

>

> Best Wishes,

> Hotz

> *************************************

>

> WRITTEN TESTIMONY OF Dr. Garth L. Nicolson

>

> COMMITTEE ON GOVERNMENT REFORM

>

> Subcommittee on National Security, Veterans' Affairs and

International

> Relations

>

> UNITED STATES HOUSE OF REPRESENTATIVES

>

> January 24, 2002

>

----------------------------------------------------------------------

> ------

> Dr. Garth Nicolson is currently the President, Chief Scientific

> Officer and Research Professor at the Institute for Molecular

Medicine

> in Huntington Beach, California. He was formally the Bruton

Jr.

> Chair in Cancer Research, Professor and Chairman at the University

of

> Texas M. D. Cancer Center in Houston, and Professor of

> Internal Medicine and Professor of Pathology and Laboratory Medicine

> at the University of Texas Medical School at Houston. He was also

> Adjunct Professor of Comparative Medicine at Texas A & M University.

> Among the most cited scientists in the world, having published over

> 520 medical and scientific papers, edited 14 books, served on the

> Editorial Boards of 20 medical and scientific journals, including

the

> Journal of Chronic Fatigue Syndrome, and currently serving as Editor

> of two (Clinical & Experimental Metastasis and the Journal of

Cellular

> Biochemistry), Professor Nicolson has held numerous peer-reviewed

> research grants. He is a recipient of the Burroughs Wellcome Medal

of

> the Royal Society of Medicine, Paget Award of the Metastasis

> Research Society and the U. S. National Cancer Institute Outstanding

> Investigator Award.

>

>

----------------------------------------------------------------------

> ----------

>

> It is now over a decade since the Persian Gulf War, but over 100,000

> U. S. veterans still suffer from various illnesses attributed to

their

> service [1-4]. Although some Gulf War Illnesses (GWI) patients have

> unique signs and symptoms [5], most do not have some new syndrome

> (Gulf War Syndrome) [6]. These illnesses are more properly called

> GWI, and we believe that they are due to accumulated toxic insults

> that cause chronic illnesses with relatively nonspecific signs and

> symptoms [1-4,7].

>

> Over the last few years researchers have published much higher

> prevalence rates of GWI in deployed than in non-deployed forces

> [8-10]. Case control studies of Gulf War veterans showed higher

> symptom prevalence in deployed than in non-deployed personnel from

the

> same units [9,10]. For certain signs and symptoms, this difference

> was dramatic (for example, the rate of diarrhea in the deployed

group

> was over 13-times greater than in the non-deployed group [9]).

Steele

> [10] showed that in three studies, Gulf War-deployed forces had

excess

> rates of GWI symptom patterns, indicating beyond a doubt that GWI

is a

> major problem that needs to be adequately addressed.

>

> Ten Years Later -- Obtaining an Adequate Diagnosis of GWI

>

> For years the Departments of Defense (DoD) and Veterans' affairs

(DVA)

> promoted the notion that Post-Traumatic Stress Disorder (PTSD) was a

> major factor in GWI [11]. Most researchers doubt that stress is a

> major cause of GWI [1-5,7], and it certainly does not explain how

some

> immediate family members presented after the war with the same signs

> and symptoms [2,3,12]. Even psychiatrists who have studied GWI do

not

> believe that GWI is explainable as PTSD [13]. Researchers find that

> GWI cases differ from PTSD, depression, somatoform disorder and

> malingering [7,14]. Although most GWI patients do not appear to

have

> PTSD, they are often paced in this diagnosis category by DoD and DVA

> physicians. GWI can be diagnosed within ICD-10-coded diagnosis

> categories, such as fatiguing illness (G93.3), but they often

receive

> a diagnosis of `unknown illness.' This, unfortunately, results in

> their receiving reduced disability assessments and benefits and

> essentially little or no effective treatments. It's not that they

are

> any less sick than their compatriots with ICD-10 diagnoses, they

just

> don't fit within the military's or DVA's diagnosis systems. In

> addition, many active-duty members of the Armed Forces are hesitant

to

> admit that they have GWI, because they feel strongly that it will

hurt

> their careers or result in their being medically discharged. They

> have good reason to fear this, because many officers that we have

> assisted eventually retired or resigned their commissions because of

> imposed limits to their careers [15].

>

> Psychiatrists often decide in the absence of contrary laboratory

> findings that GWI is a somatoform disorder caused by stress, instead

> of organic or medical problems that can be treated with medicines or

> treatments not used for PTSD or other somatoform disorders. The

> evidence that psychiatrists have offered as proof that stress or

PTSD

> is the source of most GWI is the assumption that most veterans must

> have suffered from stress by virtue of the stressful environment in

> which they found themselves during the Gulf War [15]. However, most

> veterans do not feel that stress-related diagnoses are an accurate

> portrayal of their illnesses. Testimony to the House Committee on

> Government Reform and Oversight questions the notion that stress is

> the major cause of GWI [16], and the General Accounting Office

>

> (GAO) has concluded that while stress can induce some physical

> illness, it is not established as the major cause of GWI [17].

Stress

> can exacerbate chronic illnesses and suppress immune systems, but

most

> military personnel that we interviewed indicated that the Gulf War

was

> not a particularly stressful war, and they strongly disagreed that

> stress was the origin of their illnesses [18]. However, in the

> absence of physical or laboratory tests that can identify possible

> origins of GWI, many DoD and VA physicians accept that stress is the

> cause. It has been argued that the arthralgias, fatigue, memory

loss,

> rashes and diarrhea found in GWI patients are nonspecific and often

> lack a physical cause [19], but this conclusion may simply be the

> result of inadequate workup and lack of availability of routine

tests

> that could define the underlying organic etiologies for these

> conditions [7].

>

> It has also been claimed that there are no unique illnesses

associated

> with deployment to the Gulf War--similar clusters of illness (albeit

> at lower rates) can be found in non-Gulf War veterans deployed to

> Bosnia [8]. Such epidemiological analyses have been criticized on

the

> basis of self-reporting and self-selection [19], and the veterans

> under study may not be representative [8]. These criticisms

> notwithstanding, it remains important to characterize signs and

> symptoms and identify exposures, if possible, of Gulf War veterans

in

> order to find effective treatments for specific subsets of GWI

> patients. We have been trying for years to get the DoD to

acknowledge

> that different exposures can result in quite different illnesses,

even

> though signs and symptoms profiles may overlap.

>

> How Does GWI Differ from Other Chronic Fatiguing Illnesses?

>

> GWI patients can have 20-40 or more chronic signs and symptoms,

> including chronic fatigue, headaches, memory loss, muscle pain,

> nausea, gastrointestinal problems, joint pain, lymph node pain,

memory

> loss, increased chemical sensitivities, among others [1-5]. Often

> included in this complex clinical picture are increased

sensitivities

> to various environmental agents and enhanced allergic responses.

> Civilian patients with similar signs and symptoms are usually

> diagnosed with Chronic Fatigue Syndrome (CFS), Fibromyalgia Syndrome

> (FMS) or Multiple Chemical Sensitivity Syndrome (MCS) [2,3,7].

> Although clear-cut laboratory tests on GWI, CFS and FMS are not yet

> available, some tests that have been used in recent years for GWI

are

> not consistent with a psychiatric origin for GWI [20-25].

>

> Chronic Illnesses and Chemical Exposures

>

> It has been documented that chemical and biological exposures

occurred

> during the Gulf War, and many civilian patients may have been

exposed

> to chemical and biological substances that could be the underlying

> causes of their illnesses [1-3,7]. The variable incubation times,

> ranging from months to years after presumed exposure, the cyclic

> nature of the relapsing fevers and other signs and symptoms, and the

> types of signs and symptoms of GWI are consistent with diseases

caused

> by combinations of biological and/or chemical or radiological agents

> (Figure 1) [1,7].

>

> Gulf War veterans were exposed to a variety of chemicals, including

> insecticides, such as the insect repellent N,N-dimethyl-m-toluamide,

> the insecticide permethrin and other organophosphates, fumes and

smoke

> from burning oil wells, the anti-nerve agent pyridostigmine bromide,

> solvents used to clean equipment and a variety of other chemicals

> [1,2,7]. This also includes in some cases, possible exposures to

low

> levels of Chemical Warfare (CW) agents. Some CW exposure may have

> occurred because of destruction of CW stores in factories and

storage

> bunkers during and after the war as well as possible offensive use

of

> CW agents [27]. Although some former DoD physicians feel that there

> was no credible evidence for CW exposure [19], many veterans have

been

> notified by the DoD of possible CW exposures.

>

> Figure 1. Hypothesis on how multiple toxic exposures, including

> multiple vaccines (2), chemical (3), radiological and biological (4)

> exposures, may have resulted in GWI in predisposed, susceptible

> individuals (1) [modified from Nicolson et al.(7)].

>

>

----------------------------------------------------------------------

> ---------

>

> Exposures to mixtures of toxic chemicals can result in chronic

> illnesses, even if the exposures were at low-levels [20,21,28,29].

> Such exposures can cause a wide variety of signs and symptoms,

> including chronic neurotoxicity and immune suppression.

Combinations

> of pyridostigmine bromide, N,N-dimethyl-m-toluamide and permethrin

> produce neurotoxicity, diarrhea, salivation, shortness of breath,

> locomotor dysfunctions, tremors, and other impairments in healthy

> adult hens [28]. Although low levels of individual organophosphate

> chemicals may not cause signs and symptoms in exposed, non-deployed

> civilian workers [30], this does not negate a causal role of

multiple

> chemical exposures in causing chronic illnesses such as GWI.

> Organophosphate-Induced Delayed Neurotoxicity (OPIDN) [31] is an

> example of chronic illness that may be caused by multiple, low level

> chemical exposures (Figure 1). Multiple Chemical Sensitivity

> Syndrome (MCS) has

> also been proposed to result from multiple low level chemical

> exposures [32]. These syndromes can present with many of the signs

> and symptoms found in GWI patients, and many GWI cases may

eventually

> be explained by complex chemical exposures.

>

> In chemically exposed GWI patients, memory loss, headaches,

cognitive

> problems, severe depression, loss of concentration, vision and

balance

> problems and chemical sensitivities, among others, typify the types

of

> signs and symptoms characteristic of organophosphate exposures.

> Arguments have been advanced by former military physicians that such

> exposures do not explain GWI, or that they may only be useful for a

> small subset of GWI patients [19]. These arguments for the most

part

> are based on the effects of single agent exposures, not the

multiple,

> complex exposures that were encountered by Gulf War veterans [33].

> The onset of signs and symptoms of GWI for most patients was between

> six months and two years or more after the end of the war. Such

slow

> onset of clinical signs and symptoms in chemically exposed

individuals

> is not unusual for OPIDN [34]. Since low-level exposure to

> organophosphates was common in U.S. veterans, the appearance of

> delayed, chronic signs and symptoms similar to OPIDN could have been

> caused by multiple low-level exposures to pesticides, nerve agents,

> anti-nerve agents and/or other organophosphates, especially in

certain

> subsets of GWI patients.

>

> Radiological Exposures and GWI

>

> Depleted uranium (DU) was used extensively in the Gulf War, and it

> remains an important battlefield contaminant. When a DU penetrator

> hits an armored target, it ignites, and between 10% and 70% of the

> shell aerosolizes, forming uranium oxide particles [35]. The

> particles that form are usually small (less than 5 µm in diameter)

and

> due to their high density settle quickly onto vehicles, bunkers and

> the surrounding sand, where they can be easily inhaled, ingested or

> re-aerosolized. Following contamination, DU can be found in the

lungs

> and regional lymph nodes, kidney and bone. Additionally, the Armed

> Forces Radiological Research Institute (AFRRI) found DU in blood,

> liver, spleen and brain of rats injected with DU pellets [36].

> Studies on DU carriage should be initiated as soon as possible to

> determine the prevalence of contamination, and extent of body stores

> of uranium and other radioactive heavy metals. Procedures have been

> developed for analysis of DU metal fragments [37] and DU in urine

> [38]. However, urine testing does not detect uranium in all body

> sites [36]. So far, analysis of DU-contaminated Gulf War veterans

has

> not shown them to have severe signs and symptoms of GWI [38], but

few

> Gulf War veterans have been studied for DU contamination.

>

> Other Environmental Exposures and GWI

>

> In addition to chemical exposures, soldiers were exposed to burning

> oil well fires and ruptured petroleum pipelines as well as fine,

> blowing sand. The small size of sand particles (much less than 0.1

mm)

> and the relatively constant winds in the region probably resulted in

> some sand inhalation. The presence of small sand particles deep in

the

> lungs can produce a pulmonary inflammatory disorder that can

progress

> to pneumonitis or Al-Eskan Disease [39]. Al-Eskan disease,

> characterized by reactive airways, usually presents as a pneumonitis

> that can eventually progress to pulmonary fibrosis, and possibly

> immunosuppression followed by opportunistic infections. Although it

> is doubtful that many GWI patients have Al-Eskan Disease, the

presence

> of silica-induced immune suppression in some soldiers could have

> contributed to persisting opportunistic infections in these

patients.

>

> Biological Exposures and GWI

>

> System-wide or systemic chemical insults and/or chronic infections

> that can penetrate various tissues and organs, including the Central

> and Peripheral Nervous Systems, are important in GWI [1-5,7]. When

> such infections occur, they can cause the complex signs and symptoms

> seen in CFS, FMS and GWI, including immune dysfunction. Changes in

> environmental responses as well as increased titers to various

> endogenous viruses that are commonly expressed in these patients

have

> been seen in CFS, FMS and GWI. Few infections can produce the

complex

> chronic signs and symptoms found in these patients; however, the

types

> of infection caused by Mycoplasma and Brucella species that have

been

> found in GWI patients, can cause complex problems found in GWI

> [reviews: 23,40,41]. These microorganisms are now considered

> important emerging pathogens in causing chronic diseases as well as

> being important cofactors in some illnesses, including AIDS and

other

> immune dysfunctional conditions [23,40,41].

>

> Evidence for infectious agents has been found in GWI patients' urine

> [4] and blood [12,26,42-44]. We [12,26,42,43] and others [44] have

> found that most of the signs and symptoms in a large subset of GWI

> patients can be explained by chronic pathogenic bacterial

infections,

> such as Mycoplasma and Brucella infections. In studies of over

1,500

> U. S. and British veterans with GWI, approximately 40-50% of GWI

> patients have PCR evidence of such infections, compared to 6-9% in

the

> non-deployed, healthy population [review: 23]. This has been

> confirmed in a large study of 1,600 veterans at over 30 DVA and DoD

> medical centers (VA ative Clinical Study Program #475, S.

Donta

> and C. Engel, statements at the NIH Chronic Fatigue Syndrome

> Coordinating Board, 2/00). Historically, mycoplasmal infections

were

> thought to produce relatively mild diseases limited to particular

> tissues or organs, such as urinary tract or respiratory system

> [23,40,41]. However, the mycoplasmas detected in GWI patients with

> molecular techniques are highly virulent, colonize a wide variety of

> organs and tissues, and are difficult to treat [23,45,46]. The

> mycoplasma most commonly detected in GWI, Mycoplasma fermentans

(found

> in >80% of those GWI patients positive for any mycoplasma), is found

> intracellularly. It is unlikely that this type of infection will

> result in a strong antibody response, which may explain the DoD's

lack

> of serologic evidence for these types of intracellular infections

> [47].

>

> When civilian patients with CSF or FMS were similarly examined for

> systemic mycoplasmal infections 50-60% of these patients were

> positive, indicating another link between these disorders and GWI

> [23]. In contrast to GWI, however, several species of mycoplasmas

> other than M. fermentans were found in higher percentages of CSF/ME

> and FMS patients and most had multiple infections [48,49].

>

> GWI can Spread to Immediate Family Members

>

> During the last year we have documented the spread of GWI infections

> to immediate family members [12]. According to one U. S. Senate

study

> [50], GWI has spread to family members, and it is likely that it has

> also spread in the workplace [18]. Although the official position

of

> the DoD/DVA is that family members have not contracted GWI, these

> studies [12,50] indicate that at least a subset of GWI patients

have a

> transmittable illness. Laboratory tests revealed that GWI family

> members have the same chronic infections [12] that have been found

in

> ~40% of the ill veterans [42-44]. We examined military families (149

> patients; 42 veterans, 40 spouses, 32 other relatives and 35

children)

> with at least one family complaint of

> illness) selected from a group of 110 veterans with GWI who tested

> positive (~41% overall) for mycoplasmal infections. Consistent with

> previous results, over 80% of GWI patients who were positive for

blood

> mycoplasmal infections had only one Mycoplasma species, M.

fermentans.

> In healthy control subjects the incidence of mycoplasmal infection

was

> 7%, several mycoplasma species were found, and none were found to

have

> multiple mycoplasmal species (P<0.001). In 107 family members of

GWI

> patients with a positive test for mycoplasma, there were 57 patients

> (53%) that had essentially the same signs and symptoms as the

veterans

> and were diagnosed with CFS or FMS. Most of these patients also had

> mycoplasmal infections compared to non-symptomatic family members

> (P<0.001). The most common species found in CFS patients in the

same

> families as GWI patients was M. fermentans, the same infection found

> in the GWI patients. The most likely conclusion is that certain

> subsets of GWI can transmit their illness and airborne infections to

> immediate family members [12].

>

> As chronic illnesses like GWI (and in some cases CFS and FMS)

> progress, there are a number of accompanying clinical problems,

> particularly autoimmune signs/symptoms, such as those seen in

Multiple

> Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS or Lew Gehrig's

> Disease, see below), Lupus, Graves' Disease, Arthritis and other

> complex autoimmune diseases. Mycoplasmal infections can penetrate

into

> nerve cells, synovial cells and other cell types [40,41]. The

> autoimmune signs and symptoms can be caused when intracellular

> pathogens, such as mycoplasmas, escape from cellular

> compartments and stimulate the host's immune system.

Microorganisms

> like mycoplasmas can incorporate into their own structures pieces of

> host cell membranes that contain important host membrane antigens

that

> can trigger autoimmune responses or their surface antigens may be

> similar to normal cell surface antigens. Thus patients with such

> infections may have unusual autoimmune signs and symptoms.

>

> Involvement of Infections in Gulf War Veterans with ALS Amyotrophic

> Lateral Sclerosis (ALS) is an adult-onset, idiopathic, progressive

> degenerative disease affecting both central and peripheral motor

> neurons. Patients with ALS show gradual progressive weakness and

> paralysis of muscles due to destruction of upper motor neurons in

the

> motor cortex and lower motor neurons in the brain stem and spinal

> cord, ultimately resulting in death, usually by respiratory failure

> [51]. Gulf War veterans show at least twice the expected incidence

of

> ALS.

>

> We have recently investigated the presence of systemic mycoplasmal

> infections in the blood of Gulf War veterans and civilians with ALS

> [52]. Almost all ALS patients (~83%, including 100% of Gulf War

> veterans with ALS) showed evidence of Mycoplasma species in blood

> samples. All Gulf War veterans with ALS were positive for M.

> fermentans, except one that was positive for M. genitalium. In

> contrast, the 22/28 civilians with detectable mycoplasmal infections

> had M. fermentans (59%) as well as other Mycoplasama species in

their

> blood, and two of the civilian ALS patients had multiple mycoplasma

> species. Of the few control patients that were positive, only two

> patients (2.8%) were positive for M. fermentans (P<0.001). The

results

> support the suggestion that infectious agents may play a role in the

> pathogenesis and/or progression of ALS, or alternatively ALS

patients

> are extremely susceptible to systemic mycoplasmal infections [52].

In

> the GWI patients mycoplasmal infections may have increased their

> susceptibility to ALS, which may explain the recent VA studies

showing

> that there is an increased risk of ALS in Gulf War veterans.

>

> Successful Treatment of GWI Mycoplasmal Infections

>

> We have found that mycoplasmal infections in GWI, CFS, FMS and RA

can

> be successfully treated with multiple courses of specific

antibiotics,

> such as doxycycline, ciprofloxacin, azithromycin, clarithromycin or

> minocycline

> [45,46,53-55], along with other nutritional recommendations.

> Multiple treatment cycles are required, and patients relapse often

> after the first few cycles, but subsequent relapses are milder and

> most patients eventually recover [42,43]. GWI patients who

recovered

> from their illness after several (3-7) 6-week cycles of antibiotic

> therapy were retested for mycoplasmal infection and were found to

have

> reverted to a mycoplasma-negative phenotype [42,43]. The therapy

> takes a long time because of the microorganisms involved are

> slow-growing and are localized deep inside cells in tissues, where

it

> is more difficult to achieve proper antibiotic therapeutic

> concentrations. Although anti-inflammatory drugs can alleviate some

> of the signs and symptoms of GWI, they quickly return after

> discontinuing drug use. If the effect was due to an anti-

inflammatory

> action of the antibiotics, then the antibiotics would have to be

> continuously applied and they would be expected to eliminate only

some

> of the signs and symptoms of GWI. In addition, not all antibiotics,

> even those that have anti-inflammatory effects, appear to work.

Only

> the types of antibiotics that are known to be effective against

> mycoplasmas are effective; most have no effect at all, and some

> antibiotics make the condition worse. Thus the antibiotic therapy

> does not appear to be a placebo effect, because only a few types of

> antibiotics are effective and some, like penicillin, make the

> condition worse. We also believe that this type of infection is

> immune-suppressing and can lead to other opportunistic infections by

> viruses and other microorganisms or increases in endogenous virus

> titers. We have also found Brucella infections in GWI patients but

we

> have not examined enough patients to establish a prevalence rate

among

> veterans with GWI.

>

> The true percentage of mycoplasma-positive GWI patients overall is

> likely to be somewhat lower than found in our studies (41-45%)

> [12,42,43] and those published by others (~50%) [44]. This is

> reasonable, since GWI patients that have come to us for assistance

are

> probably more advanced patients (with more progressed disease) than

> the average patient. Our diagnostic results have been confirmed in

a

> large study DVA/DoD study (~40% positive for mycoplasmal infections,

> VA ative Clinical Study Program #475). This DVA study is a

> controlled clinical trial that will test the usefulness of

antibiotic

> treatment of mycoplasma-positive GWI patients. This clinical trial

is

> based completely on our research and publications on the diagnosis

and

> treatment of chronic infections in GWI patients [42,43,53-55]. This

> clinical trial is complete but the treatment results have not yet

been

> analyzed. There is a major concern that the DoD/DVA will not be

> forthcoming about this trial.

>

> Vaccines Given During Deployment and GWI

>

> A possible source for immune disturbances and chronic infections

found

> in GWI patients is the multiple vaccines that were administered

close

> together around the time of deployment to the Gulf War. Unwin et

al.

> [8] and Cherry et al. [56] found a strong association between GWI

and

> the multiple vaccines that were administered to British Gulf War

> veterans. Unwin et al. [8] and Goss Gilroy [57] also noted an

> association specifically with anthrax vaccine and GWI symptoms in

> British and Canadian veterans. Steele [10] found a three-fold

> increased incidence of GWI in nondeployed veterans from Kansas who

had

> been vaccinated in preparation for deployment, compared to

> non-deployed, non-vaccinated veterans. Finally, Mahan et al. [58]

> found a two-fold increased incidence of GWI symptoms in U.S.

veterans

> who recalled they had received anthrax vaccinations at the time of

the

> Gulf War, versus those who thought they had not. These studies

> associate GWI with the multiple vaccines given during deployment,

and

> they may explain the high prevalence rates of chronic infections in

> GWI patients [59,60].

>

> GWI signs and symptoms have developed in Armed Forces personnel who

> recently received the anthrax vaccine. On some military bases this

> has resulted in chronic illnesses in as many as 7-10% of personnel

> receiving the vaccine [60]. The chronic signs and symptoms

associated

> with anthrax vaccination are similar, if not identical, to those

found

> in GWI patients, suggesting that at least some of the chronic

> illnesses suffered by veterans of the Gulf War were caused by

military

> vaccines [59,60]. Undetectable microorganism contaminants in

vaccines

> could have resulted in illness, and may have been more likely to do

so

> in those with compromised immune systems. This could include

> individuals with DU or chemical exposures, or personnel who received

> multiple vaccines in a short period of time. Since contamination

with

> mycoplasmas has been found in commercial vaccines [61], the vaccines

> used in the Gulf War should be considered as a possible source of

the

> chronic infections found in GWI. Some of these vaccines, such as

the

> filtered, cold-stored anthrax vaccine are prime suspects in GWI,

> because they could be easily contaminated with mycoplasmal

infections

> and other microorganisms [62].

>

> Inadequate Responses of the DoD and DVA to GWI

>

> In general, the response of the DoD and DVA to the GWI problem has

> been inadequate, and it continues to be inadequate. The response

> started with denial that there were illnesses associated with

service

> in the Gulf War; it has continued with denial that what we

(biological

> exposures) and others (chemical exposures) have found in GWI

patients

> are important in the diagnosis and treatment of GWI, and it

continues

> today with the denial that military vaccines could be a major source

> of GWI. For example, in response to our publications and formal

> lectures at the DoD (1994 and 1996) and DVA (1995), the DoD stated

in

> letters to various members of Congress and to the press that M.

> fermentans infections are commonly found, not dangerous and not

even a

> human pathogen, and our results have not been duplicated by other

> laboratories. These statements were completely false. The

Uniformed

> Services University of the Health Sciences taught its medical

students

> for years that this type of infection is very dangerous and can

> progress to system-wide organ failure and death [63]. In addition,

> the Armed Forces Institute of Pathology (AFIP) has been publishing

for

> years that this type of infection can result in death in nonhuman

> primates [64] and in man [65]. The AFIP has also suggested treating

> patients with this type of infection with doxycycline [66], which is

> one of the antibiotics that we have recommended [53-55].

> Interestingly, DoD pathologist Dr. Shih-Ching Lo holds the U. S.

> Patent on M. fermentans ( " Pathogenic Mycoplasma " [67]), and this may

be

> the real reason that in their original response to our work on M.

> fermentans infections in GWI, the DoD/DVA issued guidelines stating

> that GWI patients should not be treated with antibiotics like

> doxycycline, even though in a significant number of patients it had

> been shown to be beneficial. The DoD and DVA have also stated that

we

> have not cooperated with them or the CDC in studying this problem.

> This is also not true. We have done everything possible to

cooperate

> with the DoD, DVA and CDC on this problem, and we even published a

> letter in the Washington Post on 25 January 1997 indicating that we

> have done everything possible to cooperate with government agencies

on

> GWI issues, including inviting DoD and DVA scientists and physicians

> to the Institute for Molecular Medicine to learn our diagnostic

> procedures on 23 December 1996 at a meeting convened at Walter

> AMC. We have been and are fully prepared to share our data and

> procedures with government scientists and physicians. The DVA has

> responded with the establishment of VA ative Clinical Study

> Program #475, but many Gulf War Referral Centers at VA Medical

Centers

> continue to be hostile to non-psychiatric treatment of GWI. The DoD

> and DVA continue to deny that family members of Gulf War veterans

> could contract the illness or that there could be an infectious

basis

> to GWI.

>

> DoD/DVA Scorecard on GWI from Previous Testimony

>

> In my previous testimony to the U. S. Congress in 1998 [15,18], some

> suggestions were made to correct for the apparent lack of

appropriate

> response to GWI and the chronic infections found in GWI patients.

It

> seems appropriate to go back and revisit these suggestions to see if

> any of these were taken seriously or corrected independently

(Updates

> in italics).

>

> 1. We must stop the denial that immediate family members do not have

> GWI or illnesses from the Gulf War. Denial that this has occurred

has

> only angered veterans and their families and created a serious

public

> health problem, including spread of the illness to the civilian

> population and contamination of our blood supply. This item has

still

> not been taken seriously by the DoD. The DVA has initiated a study

to

> see if veterans' family members have increased illnesses; however,

> they have decided to group GWI patients together independent of the

> possible origins of their illness. Since veterans who have their

> illness primarily due to chemical or environmental exposures that

are

> not transmittable will be grouped with veterans who have

transmittable

> chronic infections, it is unlikely that studying family members of

> both groups together will yield significant data. Whether

intentional

> or not, this DVA study has apparently been designed to fail.

> Potential problems with the nation's blood and organ tissue supply

due

> to contamination by chronic infections in GWI and CFS patients are

> considered significant [68,69], but no U.S. government agency has

> apparently taken this seriously.

>

> 2. The ICD-9-coded diagnosis system used by the DoD and DVA to

> determine illness diagnosis must be overhauled. The categories in

> this system have not kept pace with new medical discoveries in the

> diagnosis and treatment of chronic illnesses. This has resulted in

> large numbers of patients from the Gulf War with `undiagnosed'

> illnesses who cannot obtain treatment or benefits for their medical

> conditions. The DoD and DVA should be using the ICD-10 diagnosis

> system where a category exists for chronic fatiguing illnesses.

> Apparently little progress in this area has been made by the DoD or

> DVA.

>

> 3. Denying claims and benefits by assigning partial disabilities due

> to PTSD should not be continued in patients that have organic

> (medical) causes for their illnesses. For example, patients with

> chronic infections that can take up to or over a year to

successfully

> treat should be allowed benefits. The DVA has recently shown some

> flexibility in this area. For example, Gulf War veterans with ALS

> will receive disability without having to prove that their disease

was

> deployment-related. Similarly, GWI

> patients with M. fermentans infections (and also their symptomatic

> family members with the same infection) should receive disabilities.

> Thus far there has been no attempt to extend disability to

> GWI-associated infectious diseases. Instead of waiting for years or

> decades for the research to catch up to the problem, the DoD and DVA

> should simply accept that many of the chronic illnesses found in

Gulf

> War veterans are deployment related and deserving of treatment and

> compensation.

>

> 4. Research efforts must be increased in the area of chronic

> illnesses. Unfortunately, federal funding for such illnesses is

often

> rebudgeted or funds removed. For example, Dr. Reeves of the

> CDC in Atlanta sought protection under the `Federal Whistle Blower's

> Act' after he exposed misappropriation of funds allocated for CFS at

> the CDC. It is estimated

> that over 3% of the adult U.S. population suffers from chronic

> fatiguing illnesses similar to GWI, yet there are few federal

dollars

> available for research on the diagnosis and treatment of these

chronic

> illnesses, even though each year Congress allocates such funds.

There

> has been some progress at NIH on this issue, but in general little

has

> changed. The DoD and DVA have spent most of the hundreds of

millions

> of dollars allocated for GWI research on psychiatric research. Most

> of these funds have been spent on studies that have had negligible

> effect on veterans' health.

>

> 5. Past and present senior DoD and DVA administrative personnel must

> be held accountable for the utter mismanagement of the entire GWI

> problem. This has been especially apparent in the continuing denial

> that chronic infections could play a role in GWI and the denial that

> immediate family members could have contracted their illnesses from

> veterans with GWI. This has resulted in sick spouses and children

> being turned away from DoD and DVA facilities without diagnoses or

> treatments. The responsibility for these civilians must ultimately

be

> borne by the DoD and DVA. I believe that it is now accountability

> time. The files must be opened so the American public has a better

> idea as to how many veterans and civilians have died from illness

> associated with service in the Gulf War and how many have become

sick

> because of an inadequate response to this health crisis.

> Unfortunately, little or no progress has been made on these items

for

> the last decade or more, and the situation has not changed

> significantly since my last testimony in 1998.

>

> References and Notes

>

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