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Sick Building Syndrome and Chemical Sensitivity
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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 David Bruton Jr. Chair in Cancer
Research and Professor at the University of Texas M. D. Anderson 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 Stephen 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 Coxiella 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 Reed 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 Reed AMC by MG
Leslie 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 Cooperative 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, Coxiella, 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, Coxiella, 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. William 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.
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20. Nicolson, G.L. and Nicolson, N.L. Doxycycline treatment and Desert
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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 &
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24. Nicolson, G.L. and Nicolson, N.L. The eight myths of Operation
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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
Institute for Molecular Medicine Website
Gulf War Vet's
