First, do no harm

Due to the lessons learned from the Gulf War, the 1997 Force Health Protection law and the DoD directive 6490.3 were implemented.

Our Gulf War veterans have faced a decades long battle to receive medical treatment related to service connected illness.

The greatest obstacle to arriving at a conclusion is due to the fact our troops did not have any baseline data to compare.

Meaning there were no exams and blood sampling collected before our troops were deployed to the Gulf in1991.

Here we have a situation where there are laws and mandates requiring our troops receive comprehensive medical and mental exams, including blood sampling pre and post deployment.

Our troops in Iraq did not receive the mandated evaluations and now we have soldiers who are sick and dying.

On August 5, 2003 the military sent a six person medical team to Iraq and Germany to evaluate the reasons for the illness and deaths. There has been no news coverage since that date related to the status of our troop or the investigation. Why?

There are federal regulations to protect human subjects and these 'rules' concern Good Clinical Practices (GCP) and the protections of human subjects under the Health and Human Services (HHS) guidelines.

However, the military subjects are exempt from these protections.

When Representative Shays of Connecticut, on March 25th asked Dr. William Winkenwerder, Assistant Secretary of Defense for Health Affairs, why the military did not perform the DoD directive exams and blood sampling pre and post deployment, Dr. Winkenwerder, said, "the law called for a medical examination, which is not synonymous with a physical examination."

The DoD directive 6490.3 -- policy 4.8 specifically states that the exam be 'comprehensive' and consistent.

The following list describes the medical criteria for a 'comprehensive' exam. The information is from a medical school residency program clinical competency exam. (see link at bottom of page)

Basic Clinical Skills (Criteria for Assessment)
The competent graduate is:
Capable of eliciting and documenting a medical history appropriate in scope to the clinical encounter.
Comprehensive physical exam to include:
Vital signs (blood pressure, pulse and respirations)
General appearance
Skin
Head
Eyes
Ears
Nose
Mouth and throat
Neck
Lymph nodes
Breasts
Thorax and lungs
Cardiovascular system
Abdomen
Back and extremities
Neurologic exam
Genitals
Rectum
Mental status exam: using four techniques to evaluate the patient's mental status - observation, casual conversation, obtaining psychiatric history, and formal testing - determine the following mental status assessments:
Appearance and attitude
Behavior
Affect/mood
Thought process
Thought content
Intellectual function
Judgment
Insight
Summary

The medical criteria for a comprehensive exam is basic to all fourth year medical students. Therefore, a practicing physician has no excuse for not knowing what a comprehensive exam entails.

You do not need a medical degree to be aware that our troops filling out a questionnaire is NOT by any measure, comparable to a 'comprehensive' exam.

The fact that Dr. Winkenwerder felt he was within the 'letter of the law' to substitute a questionnaire as comparable to the medical criteria of a comprehensive exam is cause for concern.

Is it unreasonable to expect that the physician in charge of our troops' health has the competency and awareness of the criteria expected of a fourth year medical resident?

Need we ask the good doctor if his oath covers the ethical practice of medicine or the legalese that results in not only the compromise of quality of care, but also sloppy science?

How many soldiers have been evaluated with a post deployment questionnaire and within what time frame? What is the established protocol for consistent surveillance?

It is imperative to have 'baseline' data on file in order to be able to establish a correlation with the post treatment/exposure samples.

And, it is essential to collect serum samples and data in a consistent manner and on a consistent basis at protocol established time intervals. That is good science.

It's not merely a matter of good science, it's common sense!

© March 2003

Office of Medical Education and Curricular Affairs, IU School of Medicine

Nurses United To Protect OUR Troops

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Please, take note the media is avoiding using the terms, 'Iraq and Middle East', instead the term used is 'Southwest Asia' -- do you recall that term Southeast Asia?

What better method can we 'Support Our Troops' than by protecting their health?
 
Contacting the Congress