points that is often missed is that we have an obligation also to healthy war veterans. I came back healthy. A lot of other veterans did, too. Nevertheless, we had a lot of questions about what happened to us when we were in the Gulf. I think as a Nation we owe it to even healthy veterans to be able to answer those questions. Mr. SHAYS. Thank you very much. Gentlemen, we appreciate your contribution to the work of this committee, and thank you for your service to your country. Our second panel is Dr. John H. Moxley III, managing director, North American Health Care Division, Korn/Ferry International; Dr. Manning Feinleib, professor of epidemiology, Bloomberg School of Public Health, John Hopkins University; and Mr. Steven Robinson, executive director, National Gulf War Resource Center, Inc. You might want to remain standing, and I'll swear you in. Moxley, Feinleib and Robinson. Thank you, gentlemen. Raise your right hands, please. First off, is there anyone accompanying you or responding? No. OK. [Witnesses sworn.] Mr. SHAYS. Note for the record that all three of our witnesses have responded in the affirmative. Thank you, gentlemen, for your patience. You have the opportunity to read a statement or submit a statement and make some comments. You have obviously heard the panel before you. So you might want to respond in what you've heard, which would be helpful. So we're going to start, just as you are there, and we'll start with you, Dr. Moxley. STATEMENTS OF DR. JOHN H. MOXLEY III, MANAGING DIRECTOR, NORTH AMERICAN HEALTH CARE DIVISION, KORN/ FERRY INTERNATIONAL; DR. MANNING FEINLEIB, PROFESSOR OF EPIDEMIOLOGY, BLOOMBERG SCHOOL OF PUBLIC HEALTH, JOHNS HOPKINS UNIVERSITY; AND STEVEN ROBINSON, EXECUTIVE DIRECTOR, NATIONAL GULF WAR RESOURCE CENTER, INC. Dr. MOXLEY. Yes, sir. Thank you. Mr. Chairman, members of the committee, as has been noted, I'm managing director of the North American Health Care Division of Korn/Ferry International. I'm here because I served as chair of the Committee on Strategies to Protect the Health of Deployed U.S. Forces of the Institute of Medicine. The Institute of Medicine is part, as you well know, of the National Academies chartered in 1863 to advise the government on matters of science and technology. We have submitted a written statement for your review and for the record. I shall not repeat that statement. What I intend to do in the next few minutes is to summarize the history of the need for a report, highlight a few of our findings and proposals and then close by attempting to convey to the committee the intensity that our committee felt about the need for progress in the protection of deployed forces. The immediate history of the committee stems from the concern of then Deputy Secretary of Defense John White that there was a need to learn from lessons of the Gulf war and develop a strategy to better protect the health of U.S. troops in future deployments. In consultations with the IOM, it was agreed that they would undertake the study. The first step was the development of four technical reports addressing, first, health risks during deployments; second, detection and tracking of exposures; third, physical protection and decontamination; and, fourth, health consequences and treatment and the importance of medical recordkeeping. All four of those reports were detailed, were released at the time of completion, and were excellent reports. The committee that I chaired was charged with attempting to synthesize the technical findings of the aforementioned reports and other information to form a final overarching policy report. Our report was completed over 2 years ago. One of the first and most surprising findings was that we were not alone. Between 1994 and 2000, the Department of Defense sought assistance from seven expert panels who generated 10 reports examining these issues. Although DOD had agreed with the large majority of the findings, we found that very few had been implemented at the field level. Many recommendations remained totally unimplemented. Our committee concluded that despite all the advice and apparent agreement with it, progress had been unacceptable. We also concluded that it was very difficult to improve upon the recommendations made multiple times since 1994. Hence, many of our recommendations are restatements of recommendations that had been made before but remained unimplemented. We continue to stand behind all of them. I'd now like to briefly summarize three areas of particular concern to the committee. First, it is vital that the location of units and individuals, together with activity information, be documented during deployments. The information is important for real-time command decisionmaking and essential for reconstructing deployments for epidemiological studies and the provision of post-deployment health care. Despite many previous painful lessons, adequate systems for recording and archiving the locations of deployed individuals are not in place. The technology exists. Troops can be tracked in real-time, and it is time to do it. Second, the Department of Defense must be candid and trusted by service members, their families and the American people. To achieve that end, they must be more proficient at understanding and using contemporary principles of risk assessment, risk management and risk communication. The following vignette from the Somalia deployment vividly makes the point. Problems arose when family members learned of fire fights from news media instead of from official sources of information in the chain of command. Distraught family members in the United States were calling deployed service members on cell phones, upsetting the service members and causing decreases in force effectiveness. Rather than trying to quash the situation with top-down orders, the commanders worked with the troops and family members and developed a system of phone trees to notify family members in near real-time of the status of their deployed loved ones after a conflict. 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 |