The point is that DOD cannot suppress the Information Age. It must find effective means to embrace it.

Finally, medically unexplained symptoms are symptoms that are not clinically explained by a medical etiology, but necessitate the use of the health care system. They are increasingly recognized as prevalent among civilian populations and are associated with high levels of distress and functional impairment. In the military, they have been observed following deployments as far back as the Civil War.

Clinicians and other persons must recognize that medically unexplained symptoms are just that. There are no current explanations for them. Communicating the limits of modern medicine, coupled with the compassionate approach, is essential to management. There's also very good evidence that early intervention leads to better results.

The committee's overriding concern was that everything consistent with mission accomplishment was done to protect the health and lives of U.S. service members who are knowingly placed in harm's way. The committee understood that the changes would be costly and inflict the pain of organizational change. The Department of Defense, however, has in our opinion an obligation to avoid unnecessary disease, injury, disability and death as it pursues the accomplishment of its missions. Not to fulfill that obligation would be simply unconscionable.

Thank you for the opportunity to testify, and I'll be pleased to answer any questions the committee might have.

[The prepared statement of Dr. Moxley follows:]

PROTECTING THOSE WHO SERVE: STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES

Statement of

John H. Moxley III, M.D.

Chairman of the Committee on Strategies to Protect the Health of Deployed U.S. Forces Institute of Medicine and

Managing Director, North American Health Care Division, Korn/Ferry International

before the

Subcommittee on National Security, Emerging Threats, and International Relations Committee on Government Reform

U.S. House of Representatives

March 25, 2003

Good morning, Mr. Chairman and members of the Committee. My name is John

Moxley. I am Managing Director of the North American Health Care Division of

Kom/Ferry International and served as chair of the Committee on Strategies to Protect the

Health of Deployed U.S. Forces of the Institute of Medicine (IOM). The Institute of Medicine is part of the National Academies, chartered by Congress in 1863 to advise the government on matters of science and technology.

The report from which I provide testimony today was the end result of a large study initiated in 1997 in response to a request from Deputy Secretary of Defense John White. Secretary White met with the leadership of the National Research Council and Institute of Medicine to explore the idea of a proactive effort to learn from lessons of the Gulf War and other deployments to develop a strategy to better protect the health of U.S. troops in future deployments. A set of four technical reports addressing 1) assessment of health risks during deployments in hostile environments 2) technologies and methods for detection and tracking of exposures to a subset of harmful agents, 3) physical protection and decontamination, and 4) medical protection, health consequences and treatment, and medical record keeping were completed in the fall of 1999. In the study's final year, the Institute of Medicine committee that I chaired was formed and used those reports as well as additional information gathering to inform a final over-arching policy report, entitled, Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces. This report was completed in the fall of 2000.

The 670,000 service members deployed in 1990-1991 to Southwest Asia for Operations Desert Shield and Desert Storm (the Gulf War) were different from the troops

deployed in previous similar operations: they were more ethnically diverse, there were more women and more parents, and more activated members of the Reserves and National Guard were removed from civilian jobs. The overwhelming victory that they achieved in the Gulf War were shadowed by subsequent concerns about the long-term health status of those who served. Various constituencies, including a significant number of veterans, speculated that unidentified risk factors led to chronic, medically unexplained illnesses, and these constituencies challenged the depth of the military's commitment to protect the health of deployed troops.

Recognizing the seriousness of these concerns, the U.S. Department of Defense (DoD) sought assistance over the past decade from numerous expert panels to examine these issues. Although DoD generally concurred in the findings of these committees, at the time of this IOM study few concrete changes had been made at the field level. The most important recommendations remained unimplemented, despite the compelling rationale for urgent action. A Presidential Review Directive for the National Science and Technology Council to develop an interagency plan to address health preparedness for future deployments led to a 1998 report titled A National Obligation. Like earlier reports, it outlined a comprehensive program that could be used to meet that obligation, but there was little progress toward implementation of the program. The Medical Readiness Division, J-4, of the Joint Staff released a capstone document, Force Health Protection, which also describes a commendable vision for protecting deploying forces (The Joint Staff, Medical Readiness Division, 2000). The committee feared that the vision outlined in that report would meet the same fate as the other reports. I hope that Dr.

Winkenwerder will have enlightened us on this point in his presentation today.

The Committee on Strategies to Protect the Health of Deployed U.S. Forces concluded that the implementation of both the expert panels' recommendations and government-developed plans was unacceptable. As of the time of the report release, medical encounters in theater were still not necessarily recorded in individuals' medical records, and the locations of service members during deployments were still not documented or archived for future use. In addition, environmental and medical hazards were not yet well integrated in the information provided to commanders. The committee believed that a major reason for this lack of progress was the fact that no single authority within DoD had been assigned responsibility for the implementation of the recommendations and plans. The committee believed, because of the complexity of the tasks involved and the overlapping areas of responsibility involved, that the single authority must rest within the Office of the Secretary of Defense.

The committee was charged with advising DoD on a strategy to protect the health of deployed U.S. forces. The committee concluded that immediate action must be taken to accelerate implementation of these plans to demonstrate the importance that should be placed on protecting the health and well-being of service members. Our report described the challenges and recommended a strategy to better protect the health of deployed forces in the future. Many of the recommendations are restatements of recommendations that had been made before, recommendations that had not been implemented. The committee was very concerned that further delay could result in unnecessary risks to service members and could jeopardize the accomplishment of future missions. The committee