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Apologies for the cross posting however this is of importance to all.

Honer

WRITTEN TESTIMONY OF

Dr. Garth L. Nicolson

SPECIAL OVERSIGHT BOARD FOR DEPARTMENT OF DEFENSE INVESTIGATIONS

OF GULF WAR CHEMICAL AND BIOLOGICAL INCIDENTS

U. S. Senate Hart Office Building SH-216

November 19, 1998

_______________________________________________________________________

Dr. Garth Nicolson is currently the 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 and Professor 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 480 medical and scientific papers,

edited 13 books, served on the Editorial Boards of 12 medical and

scientific journals and currently serving as Editor of two (Clinical &

Experimental Metastasis and the Journal of Cellular Biochemistry),

Professor Nicolson has active peer-reviewed research grants from the

U.S. Army, National Cancer Institute, National Institutes of Health,

American Cancer Society and the National Foundation for Cancer

Research. In 1998 he received the Paget Award from the Cancer

Metastasis Research Society and the Albert Schweitzer Award in Lisbon,

Portugal.

_______________________________________________________________________

Gulf War Illnesses (GWI) have been proposed to be due to accumulated

toxic insults that can result in chronic illnesses with relatively

nonspecific or not unique signs and symptoms. For the most part,

patients do not appear to have some new syndrome; they can be best

described as patients with Chronic Fatigue Syndrome (CFS), Fibromyalgia

Syndrome (FMS) or Multiple Chemical Sensitivity Syndrome (MCS) [2]. The

‘official’ stance of the Department of Defense (DoD) appears to be that

‘battlefield stress’ was a major factor, but most nongovernment

researchers doubt that stress alone is a major cause of GWI [1, 3, 4],

and it certainly does not explain how some immediate family members can

present with the same signs and symptoms [2, 3, 5, 6]. GWI may be

better explained as the result of multiple toxic insults to our

soldiers, including those from chemical, radiological and biological

sources [3, 4]. We have worked exclusively on the biological or

infectious sources of patient morbidity (sickness) because whether these

were obtained as primary sources or secondary opportunistic infections,

they have to be identified and treated if patients are to recover from

GWI [6].

OBTAINING AN ADEQUATE DIAGNOSIS AND EFFECTIVE TREATMENTS FOR GWI

Many veterans of Operation Desert Storm face tremendous obstacles in

trying to obtain an adequate diagnosis for their illnesses and then

adequate care for their conditions. Up until recently, most of the

emphasis in diagnosing and treating GWI within the military and VA has

been on stress-related somatoform conditions, such as Post Traumatic

Stress Disorder (PTSD) [7]. Since many patients do not fit this

category, even with the ‘help’ of military and Veterans’ Administration

(VA) psychiatrists, and cannot be diagnosed within existing ICD-9-coded

diagnosis categories, they often receive a diagnosis of ‘unknown

illness.’ This, unfortunately, results in their receiving reduced

disability assessments, reduced benefits and essentially little or no

effective treatment for GWI. It’s not that they are any less sick than

their compatriots who have ICD-9 diagnoses used by the DoD and DVA, they

just don’t fit within the military’s or VA’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.

WHAT IS GWI AND HOW IS IT DIFFERENT FROM CIVILIAN CHRONIC ILLNESSES?

GWI present as complex, multi-organ 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 and other signs and symptoms [1-4].

Often included in this complex clinical picture are increased

sensitivities to various environmental agents and enhanced allergic

responses. Although CFS, FMS and now GWI have been known for years,

patients have had few options for obtaining effective treatments.

Unfortunately, within the DoD and VA medical systems treatments are more

easily ordered on the basis of laboratory tests than on clinical

observations, and the lack of clear-cut laboratory results in GWI cases

tends to lend support for psychiatric diagnoses.

Over 100,000 veterans of the Persian Gulf War have been entered into the

GWI registry. For the most part, this does not include immediately

family members. According to one government study, GWI has spread to

family members [5], and it is likely that it has also spread in the

workplace. Thus diagnoses biased on PTSD appear to be a gross

oversimplification of GWI [8]. Although the official position of the

DoD is that family members have not contracted GWI, a U. S. Senate

report [5] indicates that at least a subset of GWI patients have a

transmittable illness. In support of the Senate report, we have found

similar transmittable infections in Desert Storm veterans’ family

members. In fact, clinical tests reveal that GWI family members have

the same chronic infections that have been found in ~45% of the ill

veterans [9-11].

RELATIONSHIP OF STRESS TO CHRONIC ILLNESSES

Patients with CFS, FMS and GWI often have cognitive problems, such as

short term memory loss, problems concentrating and other psychological

problems. Psychiatrists often decide in the absence of contrary

laboratory findings that these conditions are caused by somatoform

disorders, such as by stress, instead of organic or medical problems

that can be treated with medicines or treatments that are not specific

for the Central Nervous System. The evidence that physicians 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 [2-4]. However, most veterans do not feel that stress-related

diagnoses are an accurate portrayal of their illnesses, and testimony

to the House Committee on Government Reform and Oversight questions the

notion that stress is the major cause of GWI [8], 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 [12].

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. However, in the absence of

physical or laboratory tests that can identify possible origins of GWI

or FMS and CFS, many military and VA physicians accept that stress is

the cause of these chronic illnesses.

CHRONIC ILLNESSES AND CHEMICAL AND/OR BIOLOGICAL EXPOSURES

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 initial cause of their illnesses

[3]. 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) [3]. System-wide or

systemic chemical insults and/or chronic infections that can penetrate

various tissues and organs, including the Central and Peripheral Nervous

Systems, may be important in GWI [9-11]. 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. If

infectious agents are involved, few can produce the complex chronic

signs and symptoms found in these patients. One type of airborne

infection that has received renewed interest of late as an important

element in these disorders is mycoplasmal infections [13]. 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 [13,

14].

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),

Lupus, Graves’ Disease, Arthritis and other complex autoimmune diseases

Mycoplasmal infections can penetrate into nerve cells, synovial cells

and other cell types. 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.

Figure 1. Multiple exposures (chemical, radiological, biological) or

multifactorial causes may have resulted in GWI in susceptible

individuals. Chemical exposures alone could also be responsible for

Multiple Chemical Sensitivity Syndrome (MCS) or Organophosphate-Induced

Delayed Neurotoxicity (OPIDN) (from Reference 3).

MICROORGANISMS AS IMPORTANT AGENTS OR COFACTORS IN CHRONIC DISEASES

Some species of mycoplasmas, such as M. fermentans, M. penetrans, M.

pneumoniae, M. genitalium, M. pirum and M. hominis, among others, have

been closely associated with various human diseases [13, 14]. In

addition, chronic infections caused by Brucella or iella can also

cause similar signs and symptoms. Do these agents cause or are

cofactors in CFS, FMS or GWI? They can certainly be important in

causing morbidity seen in patients with chronic illnesses [14]. If so,

is there any evidence for mycoplasmal infections in CFS, FMS or GWI

patients? In a majority of FMS, CFS and GWI patients examined we [9-11]

and others, principally Dr. Daryl See of the University of California

College of Medicine, Irvine, and a commercial laboratory in Los Angeles

[15] have documented mycoplasmal blood infections that can explain much

of the chronic signs and symptoms seen in GWI [9-11]. In our studies on

GWI, we have found mycoplasmal infections in the blood of about one-half

of patients (91/200), and these patients were found to have

predominantly one infectious species of mycoplasma, M. fermentans [9,

10], compared to ~60% of mycoplasma-positive civilians with CFS, FMS or

Rheumatoid Arthritis, where several different pathogenic mycoplasma

species have been found [11, 16]. The tests that we use to identify

infections, Forensic Polymerase Chain Reaction [11, 16] and

Nucleoprotein Gene Tracking [9-11], are very sensitive and highly

specific tests compared to the relatively insensitive antibody tests

that are currently used to assay for systemic mycoplasmal infections.

We recently received a DoD contract to train scientists and physicians

to perform these tests, including the training of staff from the Armed

Forces Institute of Pathology and Walter Army AMC.

INADEQUATE RESPONSES OF THE DOD AND DVA TO GWI

Has the DoD responded to the published studies on microorganism

infections in GWI patients? They did award us with a small training

grant to teach the techniques to DoD and non-DoD scientists, but in

general, the response has been inadequate and mainly denial that what we

and others have found is important in GWI, even though the majority of

patients diagnosed with chronic infections and treated with antibiotic

protocols developed by us recover from their illness. In response to

our publications and formal lectures at the DoD (in 1994 and 1996) and

DVA (in 1995), the DoD stated in letters to various members of Congress

and to the press that this type of infection is commonly found, not

dangerous and not even a human pathogen, and our results have not been

duplicated by other laboratories. These statements could not be further

from the truth. The Uniformed Services University of the Health

Sciences has been teaching its medical students for years that this type

of infection is very dangerous and can progress to system-wide organ

failure and death [17]. 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 [18] and in man

[17]. The AFIP has also suggested treating patients with this type of

infection with doxycycline [19], which is one of the antibiotics that we

have recommended [9-11, 20-22]. Then why did the DVA issue guidelines

stating that GWI patients should not be treated with antibiotics like

doxycycline, even though in a significant number of patients it has been

shown to be beneficial [9, 10]? In response to the comments that our

tests have not been duplicated, certified diagnostic clinical

laboratories, Immunosciences Laboratories of CA [15] and Medical

Diagnostic Laboratories of NJ have been conducting diagnostic tests on

mycoplasmal infections in blood of GWI and CFS patients, and they are

obtaining similar results. Thus our results have been replicated by

certified commercial laboratories and published in the medical

literature. The DoD and DVA have also stated that we have not

cooperated with them or the CDC in studying this problem. This is 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. We formally invited 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 by MG

Burger at the request of Congressman Norman Dicks (D-WA). We

have been and are fully prepared to share our data and procedures with

government scientists and physicians. Although government laboratories

can test for mycoplasmal infections and have been conducting their own

examination of mycoplasmal infections in GWI patients, they are using

relatively insensitive, outdated antibody tests or conventional

molecular biological tests, and we would not expect them to detect the

infection by these procedures. To correct this situation we received a

small training contract from the DoD to train DoD scientists in our new

techniques, and the training was completed on January 30, 1998.

Recently the DVA has recognized the value of our work and will initiate

on 1 January 1999 VA ative Clinical Trial #475, a diagnostic and

treatment trial that focuses on mycoplasmal infections in GWI and their

treatment with doxycycline using essentially a regimen that we published

in 1995 [20].

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 [9-11, 20-22], 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 [9, 10]. In contrast, in

nondeployed, healthy adults the incidence of mycoplasma-positive tests

were ~6% [11]. We found that 87 mycoplasma-positive GWI patients on

antibiotic therapy relapsed within weeks after the first 6-week cycle of

therapy, but 69/87 recovered after up to six cycles of therapy and 18/87

are still undergoing therapy. 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 [9, 10]. We hypothesize that 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. As stated above, multiple cycles of therapy result in

eventual recovery in a high percentage of mycoplasma-positive GWI

patients. Although anti-inflammatory drugs can alleviate some of the

signs and symptoms of GWI, the signs and symptoms appear to 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 on the

signs and symptoms of GWI/CFS/FMS/RA, 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. The percentage of

mycoplasma-positive GWI patients overall is likely to be somewhat lower

than found in our studies (~45%). 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.

Although we have been criticized for not conducting double-blinded,

controlled clinical studies on large numbers of patients, such studies

are quite labor intensive and very expensive, and all of our studies

were conducted without any government support or help whatsoever.

Although our studies do not involve controlled patient populations, such

as all veterans that served in a single unit compared to similar numbers

of nondeployed personnel from the same unit, such controlled populations

can only be studied only with the help and financial assistance of the

DoD and DVA. Recently the DVA has initiated a controlled clinical trial

(CSP #475) involving 18 VA medical institutions 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 [9,

10, 20-22].

WHAT HAS THE DOD STATED ABOUT OUR PROCEDURES AND RESULTS?

The recent comments of Mr. Bernard Rostker, Special Assistant to the

Deputy Secretary of Defense for Gulf War Illnesses and more recently

Assistant Secretary of the Army, at the 17th ‘Town Hall’ meeting on Gulf

War Illnesses at Camp Pendleton on 23 September 1998 indicate that the

DoD is still trying to bury the issue of infectious diseases and GWI.

According to the comments of Mr. Rostker as related by two participants

(S. and L. Dudley of San Diego, CA) in their TV interview after the

meeting, “Dr. Shyh-Ching Lo, Armed Forces pathologist, is going to

publish that he was not able to reproduce Nicolson’s results and that

Nicolson was not cooperating in terms of not obtaining those results in

the medical community and in fact was hampering it.” This is not the

truth. In fact, two commercial laboratories that we assisted in setting

up similar clinical tests, one in California and one in New Jersey, have

confirmed our mycoplasma results in Gulf War Illness patients. It seems

that only the AFIP cannot apparently repeat the results, which is why we

were awarded a small contract to train them in January of this year.

They have never submitted their data for peer-review, even after several

years. We have published our data [9-11, 20-22], and we have also

published that blood for analysis must be at refrigerator temperatures

and prepared very quickly in order to prevent mycoplasma deterioration

[11]. GWI patients have told me (and Dr. Lo even admitted to this to

patients) that the AFIP does not store blood properly, and we claim that

they do not do the tests properly, which could be why the DoD has never

obtained accurate data on mycoplasmal infections in GWI patients.

The DoD pronouncements on the lack of chronic infections (Mycoplasma,

Brucella, iella, etc.) in GWI and CFS patients flies in the face of

published data from university and nongovernmental laboratories. Mr.

Rostker stated that “the DoD/VA had initiated a program with Dr.

Nicolson to train labs on his testing techniques but were unable to get

Dr. Nicolson to send blood samples as he promised to do and were unable

to identify the techniques he used and were unable to find the

mycoplasma in the blood.” These are complete distortions and untruths.

The laboratories involved in these studies are using blood from NIH not

my laboratory, and these laboratories can and have been detecting

mycoplasmal infections using the techniques that we taught them. Why

would high officials use untruths and distortions in an effort to cast

nongovernmental scientists in an unfavorable light. Was this done to

cover up a completely inadequate government response to GWI? And why

are they still going to such great lengths to cover this up more than 8

years after Dessert Storm? We have been able to help thousands of GWI

patients after years of suffering obtain a diagnosis and treatment and

recover from their illnesses, and these same patients were not even

given a diagnoses or effective treatments by DoD or VA medical

facilities. If we are wrong, then why are our patients doing better

than the DoD/VA patients with GWI? Why then is the DVA willing to

allocate more than $12,000,000 to conduct a cooperative clinical trial

based entirely on our diagnosis and treatment protocol for treating

mycoplasmal infections?

POTENTIAL SOURCES OF EXPOSURES THAT COULD HAVE CAUSED GWI

We consider it quite likely that many of the Desert Storm veterans

suffering from the GWI signs and symptoms may have been exposed to

chemical/biological toxins (exogenous or endogenous sources of these

agents) containing slowly proliferating microorganisms (Mycoplasma,

Brucella, iella, etc.), and such infections, although not usually

fatal, can produce various chronic signs and symptoms long after

exposure. This would account for the illnesses being passed to

immediate family members. The DoD has maintained that Iraqi offensive

Chemical and Biological Weapons (CBW) were not released during or after

the Gulf War, but over 14,000 Chemical Weapons alarms sounded during but

not before the conflict and we did not have detection equipment forward

deployed to be able to determine whether Biological Weapons were

present. The Iraqi armed forces were operating under Soviet War

Doctrine, which stresses offensive use of combinations of Chemical and

Biological Weapons together with conventional weapons [23]. Evidence

presented to Congress [8] indicated that it was extremely likely that

Chemical Weapons were released during and certainly after the conflict

when bunkers containing CBW were destroyed. Although chemical and/or

radiological exposure(s) can result in somewhat similar signs and

symptoms to those found in GWI, this does not explain the apparent

contagious nature of GWI and the delayed appearance of similar signs and

symptoms in immediate family members. Fortunately, the types of

slow-growing, chronic infections found in a subset of GWI patients can

be diagnosed and successfully treated using our published protocols

[9-11, 20-22].

There were several potential sources of chronic biological agents in the

Persian Gulf Theater [9, 23]. First, deployed soldiers were given

multiple inoculations, in some cases with experimental vaccines in

unproved immunization schemes, such as vaccines that were given all at

once instead of using an appropriate schedule of inoculations over

months or years. Multiple vaccinations given simultaneously can result

in immunosuppression and leave an individual susceptible to

opportunistic infections. Some of these experimental vaccines could

also have been contaminated with small amounts of slow-growing

microorganisms. In fact, some of the vaccine lots to be sent to the

Gulf were removed because of “microorganism contamination.” Next, the

Iraqis were known to have extensive stockpiles of Biological Weapons and

the potential to deliver these weapons offensively, at short range in

modified Italian-made biological sprayers that deliver Biological

Weapons onto the sand to create exclusionary zones or 'biological

minefields' and at long range in modified SCUD-B (SS-1) missiles with

'airburst' warheads or sprayers carried by aircraft. As mentioned

above, many of the storage and factory facilities where CBW were stored

were destroyed immediately up to, during and after the Desert Storm

ground offensive, releasing plumes containing these agents high in the

atmosphere where they could be carried downwind ('blow-back' exposures)

to our lines. These and other possible mechanisms of potential exposure

must be carefully examined, not categorically dismissed by DoD personnel

in Washington DC with little first-hand knowledge of the conditions on

the ground. A number of possible reasons exist that could explain why

the DoD and DVA deny that our forces were exposed to CBW agents during

the Gulf War, but this does not rationalize the poor responses to GWI

casualties [23].

CONCLUSIONS AND SUGGESTIONS

It seems counterproductive to continue the contentious battle over

whether or not our forces were exposed to toxic agents in the Gulf

Theater of Operations and whether or not they have chronic infections in

their blood. I firmly believe that it is now time to diagnose and treat

the casualties irrespective of how politically painful the truth may be.

Our lack of an adequate response to GWI may dictate how our weaknesses

are assessed and exploited in any future conflict [24]. Therefore, we

need to act. I have the following suggestions:

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

from the 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.

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.

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.

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

recently sought protection under the ‘Federal Whistle Blower’s Act’

after he exposed such misappropriation of funds at the CDC. It is

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

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.

5. Senior DoD and DVA 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 how many veterans and civilians have died and how many

have become sick because of an inadequate response to this health

crisis.

References Cited

1. Murray-Leisure, K., s, M.O., Sees, J., Suguitan, E., Zangwill,

B., Bagheri, S., Brinser, E., Kimber, R., Kurban, R. Greene, W.H.

Mucocutaneous-Intestinal-Rheumatic Desert Syndrome (MIRDS). Definition,

histopathology, incubation period, clinical course and association with

desert sand exposure. Intern. J. Med. 1997; 1: 47-72.

2. Nicolson, G.L. and Nicolson, N.L. Chronic Fatigue Illness and

Operation Desert Storm. J. Occup. Environ. Med. 1996; 38: 14-16.

3. Nicolson, G.L., Nasralla, M, Hier, J. and Nicolson, N.L. Gulf War

Illnesses: role of chemical, radiological and biological exposures. In:

War and Health, H. Tapanainen, ed., Helinsiki, in press, 1998.

4. Nicolson, G.L., Hyman, E., Korényi-Both, A., , D.A, Nicolson,

N.L., Rea, W., Urnovitz, H. Progress on Persian Gulf War Illnesses:

reality and hypotheses. Intern. J. Occup. Med. Tox. 1995; 4: 365-370.

5. U. S. Congress, Senate Committee on Banking, Housing and Urban

Affairs, U. S. chemical and biological warfare-related dual use exports

to Iraq and their possible impact on the health consequences of the

Persian Gulf War , 103rd Congress, 2nd Session, Report May 25, 1994.

6. Nicolson, G.L. Chronic infections as a common etiology for many

patients with Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Gulf

War Illnesses. Intern. J. Med. 1998; 1: 42-46.

7. NIH Technology Assessment Workshop Panel. The Persian Gulf

Experience and Health. J. Amer. Med. Assoc. (JAMA) 1994; 272: 391-396.

8. U. S. Congress, House Committee on Government Reform and Oversight,

Gulf War veterans’: DOD continue to resist strong evidence linking toxic

causes to chronic health effects, 105th Congress, 1st Session, Report

105-388, 1997.

9. Nicolson, G.L. and Nicolson, N.L. Diagnosis and treatment of

mycoplasmal infections in Gulf War Illness-CFIDS patients. Intern. J.

Occup. Med. Immunol. Tox. 1996; 5: 69-78.

10. Nicolson, G.L., Nicolson, N.L. and Nasralla, M. Mycoplasmal

infections and Chronic Fatigue Illness (Gulf War Illness) associated

with deployment to Operation Desert Storm. Intern. J. Med. 1997; 1:

80-92.

11. Nicolson, G.L., Nasralla, M, Hier, J. and Nicolson, N.L. Diagnosis

and treatment of chronic mycoplasmal infections in Fibromyalgia Syndrome

and Chronic Fatigue Syndrome: relationship to Gulf War Illness. Biomed.

Therapy 1998; 16: 266-271.

12. U. S. General Accounting Office, Gulf War Illnesses: improved

monitoring of clinical progress and reexamination of research emphasis

are needed. Report GAO/SNIAD-97-163, 1997.

13. Baseman, J.B. and Tully, J.G. Mycoplasmas: Sophisticated,

reemerging, and burdened by their notoriety. Emerg. Infect. Diseases

1997; 3: 21-32.

14. Cassell, G.H. and Cole, B.C. Mycoplasmas as agents of human

disease. New Eng. J. Med. 1981; 304: 80-89.

15. Choppa, P.C., Vojdani, A., Tagle, C., Andrin, R. and Magtoto, L.

Multiplex PCR for the detection of Mycoplasma fermentans, M. hominis and

M. penetrans in cell cultures and blood samples of patients with Chronic

Fatigue Syndrome. Mol. Cell Probes 1998; 12: 301-308.

16. Hier, J., Nasralla, M. and Nicolson, G.L. Detection of mycoplasmal

infections in blood of patients with rheumatoid arthritis. Brit. J.

Rheumatol. 1998; in press.

17. Lo, S.-C., Dawson, M.S., Newton, P.B., Sonoda, A.A., Shih, W.-K.,

Engler, W.F., Wang, R.Y.-H. and Wear, D.J. Association of the

virus-like infectious agent originally reported in patients with AIDS

with acute fatal disease in previously healthy non-AIDS patients. Amer.

J. Trop. Med. Hyg. 1989; 41: 364-376.

18. Lo, S.-C., Wear, D.J., Shih, W.-K., Wang, R.Y.-H., Newton, P.B. and

, J.F. Fatal systemic infections of nonhuman primates by

Mycoplasma fermentans (incognitus strain). Clin. Infect. Diseases 1993;

17(Suppl 1): S283-S288.

19. Lo, S.-C., Buchholz, C.L., Wear, D.J., Hohm, R.C. and Marty, A.M.

Histopathology and doxycycline treatment in a previously healthy

non-AIDS patient systemically infected by Mycoplasma fermentans

(incognitus strain). Mod. Pathol. 1991; 6: 750-754.

20. Nicolson, G.L. and Nicolson, N.L. Doxycycline treatment and Desert

Storm. J. Amer. Med. Assoc. (JAMA) 1995; 273: 618-619.

21. Nicolson, G.L. and Nicolson, N.L. Mycoplasmal infections--Diagnosis

and treatment of Gulf War Syndrome/CFIDS. CFIDS Chronicle 1996; 9(3):

66-69.

22. Nicolson, G.L. Considerations when undergoing treatment for chronic

infections found in Chronic Fatigue Syndrome, Fibromyalgia Syndrome and

Gulf War Illnesses. (Part 1). Antibiotics Recommended when indicated for

treatment of Gulf War Illness/CFIDS/FMS (Part 2). Intern. J. Med. 1998;

1: 115-117, 123-128.

23. Nicolson, G.L. and Nicolson, N.L. Gulf War Illnesses: complex

medical, scientific and political paradox. Medicine Conflict &

Survival 1998; 14: 156-165.

24. Nicolson, G.L. and Nicolson, N.L. The eight myths of Operation

Desert Storm and Gulf War Syndrome. Medicine Conflict & Survival 1997;

13: 140-146.

Under penalty of perjury, I swear that the statements above are true and

correct to the best of my knowledge, information and belief.

Garth L. Nicolson

Chief Scientific Officer

The Institute for Molecular Medicine

and

Professor of Internal Medicine

Address:

The Institute for Molecular Medicine

15162 Triton Lane

Huntington Beach, CA 92649

Tel (714) 903-2900 Fax (714) 379-2082

Institute for Molecular Medicine Website: www.immed.org