The Committee's final report will include additional evaluation of the government's outreach efforts to Gulf War veterans, their families, and communities, including DOD's AFIS and AFRTS, the department's survey of active duty troops, and education and counseling provided by DOD during clinical evaluations. The Committee will examine VA's Persian Gulf Health Days, active duty preseparation briefings on Gulf War veterans illness issues provided through VA's Transition Assistance Program, special programs for women veterans, and outreach to Spanish speaking people. We will review suggestions received from veteran service organizations for improving outreach to Gulf War veterans.
The Committee will continue to review carefully the content of the departments' outreach message and whether its level of complexity makes it accessible for their audiences. We will investigate how the departments evaluate their own outreach components and programs. Without evidence to indicate how well outreach efforts reach the target population and how much this population actually learns about the relevant issues, claims of outreach program effectiveness are unsubstantiated.
The outreach programs of both departments have improved over the last two years. It remains important to highlight the lessons learned in implementing them in order to create a useful model of communication and outreach that would be responsive to veterans of future conflicts. The final report will explore this issue.
For the final report, the Committee intends to evaluate the quality of care provided to Gulf War veterans who enlist in VA's Persian Gulf Registry or DOD's CCEP. We will assess access to the treatment programs, the treatment protocols, the implementation of those protocols, and the attitudes of the health-care providers employed by the systems. In undertaking this evaluation, we will continue to receive public testimony, make site visits to VA and DOD medical facilities where the clinical evaluations are conducted, and interview veterans to assess their impressions of their access to care and their expectations from the registry protocols.
The Committee will conduct a review of clinical syndromes that might be similar to some of the undiagnosed illnesses among Gulf War veterans. We will assess the reproductive problems experienced by veterans and their families, including birth defects and decreased fertility. We also plan to examine the psychological sequelae of stress, which many previous advisory groups have identified as a high priority for the government's research program.
The activities of FDA and DOD related to the use of drugs and biologics intended to protect against CBW remain an area of considerable interest to the Committee. In particular, we plan to explore with FDA possible alternatives to the interim final rule to help ensure troops are protected against CBW. Some observers have suggested an approval standard that recognizes surrogate endpoints and other data indicative of efficacy for vaccines, drugs, devices, and antibiotics intended for CBW defense might be a more appropriate policy than a waiver of informed consent.
Previous advisory groups have made recommendations concerning health care for Gulf War veterans. For instance, the NIH panel ( 4 ) recommended that a coordinated VA and DOD hospital-based case assessment protocol be developed to provide uniformly thorough assessment, diagnosis, and treatment; we believe a coordinated clinical protocol is now in place. The NIH panel also stated that clinical treatment, absent a proven etiology, must be managed on a case-by-case basis according to the symptoms presented. The Committee will continue to monitor the adequacy of the government's response to that recommendation (i.e., the quality of medical care provided to ill Gulf War veterans) during the remainder of our work. The IOM ( 5 ) has been evaluating the CCEP since its inception, and we will follow DOD's response to IOM's continuing findings and recommendations with interest, but we will not try to duplicate its effort.
The Committee will continue its review of research related to Gulf War veterans' illnesses. In particular, we will focus on the smaller epidemiologic studies and toxicologic research protocols designed to assess specific risk factors. In reviewing research directed at Gulf War veterans' health issues, the Committee will attempt to evaluate the overall research effort, identifying areas where key research may be missing or where additional efforts to investigate or coordinate could improve the understanding of Gulf War veterans' illnesses. The Committee intends to monitor research awards resulting from recently issued requests for proposals in order to evaluate the performance of the Coordinating Board.
Another source of information about the exposures and risk factors of the Gulf War is DOD's approach to occupational safety and health evaluations. The Committee believes reviewing the process by which DOD assessed potential exposures and risk factors before the Gulf War and the data DOD accumulated to support its decisions will be important for both evaluating Gulf War exposure and risk factors and anticipating future health issues. Data from pesticide applicators, uranium miners and fabricators, and firefighters, for example, exist and can be brought to bear in considering hazards that U.S. troops faced in Southwest Asia. For this avenue of inquiry, the Committee intends to focus on the question: How did DOD evaluate known risk factors when it approved materials for use in the Gulf?
In the coming months, the Committee will shift its focus from questions involving Iraqi CBW capabilities and the detection systems deployed by U.S. forces in the Gulf, to those involving alleged incidents of exposure to CBW agents. In particular, the Committee plans to examine instances where there are allegations that U.S. personnel were directly exposed to CBW agents, and to review evidence relating to possible collateral exposures to such agents. In addition, we plan to examine questions surrounding possible low-level exposures to CBW agents, including their potential medical effects. As part of this effort, the Committee plans to monitor closely the progress of DOD and CIA in their renewed investigations of possible CBW exposures during the Gulf War. Finally, the Committee will continue its review of developments relating to Iraqi CBW capabilities and the detection systems deployed by U.S. forces in the Kuwaiti Theater of Operations.