New Research Findings: Chronic Health Symptoms Caused by Pesticide Exposure, Worse with Greater Exposure

Written by Anglico.

(Washington, DC - November 2, 2009) - Neurological symptoms are caused by exposure to pesticides and are made worse with certain kinds of pesticide exposure and duration of exposure, according to scientific research presented today in Washington, DC by Dr. Freya Kamel, staff scientist with the Chronic Disease Epidemiology Group of the National Institute of Environmental Health Sciences (NIEHS).

In the presentation before the Congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), entitled, "Chronic health effects from pesticides: results from the Agricultural Health Study," Dr. Kamel noted that scientific findings found early evidence of neurological dysfunction related to pesticide exposure--especially organophosphates--before the appearance of apparent clinical signs normally identified during a physician's neurological examinations.

Exposures during the 1991 Gulf War to high levels of highly concentrated forms of two organophosphate pesticides, DEET and permethrin, in conjunction with exposure to Pyridostigmine Bromide (PB), a nerve agent protective pill, were identified as causes of Gulf War Illness in a 2008 U.S. Government scientific report showing that Gulf War Illness is real.

Groups of neurological symptoms identified in Dr. Kamel's team's research included affect, cognition, autonomic and motor function, and vision.

Affect:

• Anxiety (52%)
• Irritability (37%)
• Depression (27%)

Cognition:

• Memory (24%)
• Concentration (20%)

Sensory:

• Numbness or paresthesia (27%)
• Poor night vision (12%)
• Blurred or double vision (10%)
• Changes in taste or smell (6%)

Motor:

• Twitches (17%)
• Weakness (15%)
• Poor Balance (12%)
• Tremor (11%)
• Difficulty Speaking (4%)

Autonomic:

• Nausea (27%)
• Loss of appetite (18%)
• Excessive sweating (17%)
• Fast heart rate (15%)

Other:

• Headache (68%)
• Fatigue (58)
• Insomnia (43%)
• Dizziness (28%)
• Loss of consciousness (2%)

According to Dr. Kamel, acute, high level pesticide poisoning has long been recognized as having severe acute symptoms and likely long-term issues resulting from those exposures.  However, this study was a cross-sectional study that began with 90,000 pesticide workers and their families and looked at chronic effects of long-term, lower-dose exposures to pesticides and had profound results.

The study, based on Phase I data, was restricted to applicators who completed a take-home questionnaire and collected symptom and exposure data at the same time, a potential study weakness.  However, the study also examined participants' exposure levels and to different types of varied widely, identified by Dr. Kamel as, "an advantage, because we were comparing those with high level exposures to those with low level exposures."

The results suggested that neurologic symptoms are associated with cumulative exposures--exposures over time that have added up--to moderate levels of organophosphate and organochlorine insecticides and suggested permanent residual damage caused by these exposures.  The cumulate lifetime use of insecticides is associated with increased risk of having greater than 10 of the measured symptoms in the prior year.

With regards to functional pesticide groups, negative health outcomes were linked primarily to insecticide and herbicide agents, and less so to fungicides and fumigants.  However, there was a strong association with fungicides and age-related macular degeneration (AMD), a leading cause of progressive blindness.

With regards to insecticide chemical groups, organophosphates were heavily linked to negative health outcomes, while organochlorines and carbamates were associated with negative health outcomes in about half the cases.  Pyrethroids, the last of the four insecticide chemical groups, was associated with negative health outcomes in about one-fifth to one-fourth of the cases.

DEET and permethrin, two pesticides used commonly at high concentrations by 1991 Gulf War troops, are organophosphates, as is Agent Orange, an herbicide used widely during the Vietnam War and linked to a host of serious, negative health outcomes among veterans of the Vietnam War and the indigenous Vietnamese population.

Parkinson's Disease, a neurodegenerative disease with early symptoms that include tremor, slow movement, and postural instability, along with soft voice and small handwriting, was also associated with pesticide exposures. 

Dr. Kamel's research focuses on environmental determinants of neurologic dysfunction and disease, in particular, neurodegenerative disease.

Kamel received a B.A. in mathematics from Brandeis University and a Ph.D. in biological sciences from SUNY-Binghamton. She did research in neuroendocrinology as a postdoctoral fellow at The Rockefeller University and then as an assistant professor at The Rockefeller University and the University of Wisconsin. She received an M.P.H. in epidemiology from the University of North Carolina at Chapel Hill. She joined the Epidemiology Branch at NIEHS in 1989, and currently serves as an epidemiologic consultant for the National Toxicology Program, an associate editor of the American Journal of Epidemiology, and a member of the editorial board of Environmental Health Perspectives.

Gulf War, other Veterans Eat Free this Veterans Day at Applebee's

Written by Anglico.

(91outcomes - November 4, 2009) - Gulf War and all other veterans and currently serving members of the U.S. Armed Forces eat free this Veteran's Day due to a special promotion by the Applebee's restaurant franchise.

Applebee's website includes details of the promotion that is being repeated this year after a reported success in 2008.

The promotion is good only on Vetereran's Day, which this year is on Wednesday, November 11, 2009.

For currently serving military servicemembers need only show their military identification card or a current leave and earnings statement (LES).  For veterans, a retired military identification card, veterans service organization membership card, or even a picture in uniform while serving.  Federal VA health enrollment identification cards should also be accepted.

VA Announces Creation of a 'Holistic', Internal Gulf War Veterans Task Force

Written by Anglico, 91outcomes Publisher/Editor.

(Washington, DC - November 3, 2009) - The U.S. Department of Veterans Affairs has created a “holistic” internal task force related to meeting the needs of veterans of the 1991 Gulf War, according to VA Chief of Staff John Gingrich, who chairs the task force.

In a public briefing today before the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses, Gingrich noted the failings of the VA with regards to Gulf War and other veterans.  “Gulf War veterans’ perceptions of VA is that it is bureaucratic, slow to respond, has uncaring staff, is dysfunctional, has poor databases, and is failing veterans,” said Gingrich, but in announcing the creation of the task force said, “We are trying to get it right.”

According to Gingrich, the goal of the internal VA task force on 1991 Gulf War veterans, which is already up and running, is to, “conduct a comprehensive review of all VA programs and services that serve this cohort of veterans.”

He said the task force’s charge is to challenge all assumptions and identify gaps in services and opportunities to better serve this veteran cohort.   He expects results-oriented recommendations to decisively advance VA’s efforts to address 1991 Gulf War veterans’ needs, with the desired end state being a coherent, comprehensive and facts-based action plan which considers and integrates appropriate viewpoints from stakeholders, subject matter experts, and advisory committees on Gulf War veterans.

The announcement that the task force had been created seemed to echo the comments earlier this year by VA Secretary Eric “Ric” Shinseki , who told the nation’s veterans In a series of speeches before the nation’s veterans service organizations between July and September 2009, “We are asking why, 40 years after agent orange was last used in Vietnam, this secretary is still adjudicating claims for service-connected disabilities related to it.  And why, 20 years after Desert Storm, we are still debating the debilitating effects of whatever causes Gulf War Illness.  Left to our present processes, 20 or 40 years from now, some future secretary could be adjudicating service-connected disabilities from our ongoing conflicts.  We must do better, and we will.”

In a military career spanning 30 years, Gingrich served in a variety of command and staff positions including commander of a U.S. Army Field Artillery Battalion in Operation Desert Storm. 
Appointed in January 200 as Chief of Staff, he works closely with the Secretary and Deputy Secretary in managing day-to-day operations of the federal government’s second-largest Cabinet department, with some 286,000 employees in VA medical centers, clinics, benefits offices and national cemeteries throughout the country. 

TASK FORCE SCOPE

According to the VA, the new 1991 Gulf War veteran task force’s efforts will include:

• Defining all key areas of review
• Consulting key experts and relevant stakeholders and reports.
• Capturing the issues, data, as wells as program and performance info to inform decisions.
• Looking holistically at issues and opportunities to advocate for the veteran.
• Identifiying as a priority effect, initiatives that enhance identification and Treatment of this cohort’s undiagnosed and unexplained illnesses.

TASK FORCE ACTION PLAN

The VA's 1991 Gulf War veteran task force action plan has several components, all due January 31, 2010 according to Gingrich, including the following:
 

DATA SHARING:   The task force will prepare a white paper on data sharing between VA and DOD.

OUTREACH:  The task force will prepare a white paper with the goals of leveraging lessons learned to reconnect to this cohort.  The white paper will address the creation of a new VA campaign to conduct outreach to 1991 Gulf War veterans to learn more about the best ways of communicating with them, including what these veterans want to know.  VA will conduct a literature review and other background info about what makes this cohort unique demographically and what sources of information these veterans use to educate themselves on issues of importance to them, and is conducting national calls.

BENEFITS:    To date among the 696,842 veterans of the 1991 Gulf War, VA has processed 250,897 claims, with 220,541 awarded service-connected disability compensation, including  15,181 approved for one or more undiagnosed illnesses.  

• Benefits Access Goal: expand outreach and education to Gulf War veterans.

• Benefits Claims Adjudication Goal: Timely presumption of service-connected disability.  The task force will identify how VA will look for higher rates of illnesses among deployed versus non-deployed veterans of the 1991 Gulf War, establish population–based connections between specific military deployment and long-term health effects through prospective studies initiated prior to and immediately post-deployment.    The  current process requires a review of all existing science.  Meanwhile, veterans’ perceptions are that the current process detached from their concerns and experiences, so the goal is to shorten the claims adjudication timeline while still employing appropriate scientific evidence. 

CLINICAL CARE:  Provide holistic care for Gulf War veterans that addresses the whole veteran.  One possibility would be to apply the existing VA post-deployment integrated care model developed and used for veterans of the current wars in Iraq and Afghanistan.  The model is of a post-deployment health clinic that includes primary care, social work, and mental health.  Additional services include those of the suicide prevention coordinator, pain clinic, compensation and pension, polytrauma, orthopedics, dental, women’s health, and rehabilitative medicine and prosthetics.

CLINICAL TRAINING:  This is a Gulf War Veterans’ Illnesses action plan item, which the task force will provide recommendations to enhance.  The review process will include content review, a field clinician focus group survey, development of design and modularization, a restructuring and rewriting of the current clinician guide, testing the new guide, and making the new clinician guide available on VA Intranet in April or May 2010.    

COMMUNICATION & TIMELINESS:  Tracking the health of veteran over time is important for providing timely info about the relationship of past exposures and health.  There is an identified need to establish surveillance studies, which the task force will address in its recommendations.

VA's Cancelled Gulf War Illness Research Was Even More Promising that Previously Known, Early Studies Show

Written by Anglico, 91outcomes Publisher/Editor. 

(Washington, DC - November 2, 2009) - Stunning new findings related to 1991 Gulf War Illness chemical exposures and potential treatments were revealed in a presentation today by Dr. Robert Haley, director of the $75 million Gulf War Illness research funding program at the University of Texas-Southwestern in Dallas, Tex. that was discontinued by the federal VA due to a contract dispute. 

Dr. Haley's studies, comprising more than 200 researchers at six universities, had developed an animal model of Gulf War chemical exposures, determined their effects on brain functions, and were making initial strides in unlocking treatments for the brain damage caused by the Gulf War chemical exposures. His research also revealed serious health consequences for one Gulf War chemical previously thought to be safe.

Three Gulf War chemicals were selected for study study in order to determine their effects on brain function, including:

• Chlorpyrifos (CP), a pesticide highly used in the Gulf War including in flea collars worn by many Gulf War troops to ward away biting sand fleas. 
• Pyridostigmine Bromide (PB), a pill taken by about 250,000 Gulf War troops to help sustain life after exposure to soman nerve agent, a key chemical warfare agent in the Iraqi chemical warfare arsenal at the time. PB has been implicated in a number of scientific studies as causally linked to the chronic multi-symptom illness, commonly known as Gulf War Illness, which affects between one-fourth and one-third of the 697,000 veterans of the 1991 Gulf War. 
• DFP, a good surrogate for Sarin, a potent chemical warfare nerve agent released in March 1991 at Khamisiyah, Iraq by U.S. demolitions teams, shortly after the war's conclusion. The U.S. Department of Defense contacted about 100,000 in the mid-1990s to notify them that they had been exposed to low-levels of sarin and cyclosarin nerve agents and possibly mustard gas when a"pl ume" lasting for three days following the detonations drifted over and exposed U.S. Gulf War troops. While the two letters sent to troops by DoD downplayed the risks of the exposures, numerous scientific studies have shown that rates of chronic multi-symptom illness, brain cancer, and other serious health effects are much higher among the Khamisiyah group than in other deployed Gulf War veterans.

Mouse Model

The first phase of the studies was to develop a mouse model of the effects of exposure to Gulf War chemicals on the brains of the laboratory mice. The mouse model study was conducted by providing laboratory mice with repeated low-dose exposures to Gulf War chemicals such that it was followed by the appearance of brain dysfunction lasting at least three months. The goal was to work out what was the exposure "recipe" that cuases delaysd, chronic changes in the laboratory mice. Once determined, the model would then be validated, and treatments would be developed.

According to Dr. Haley's presentation, that work has been successful in several areas.

One of the intermediate goals was to establish the brain penetration of a range of doses of the Gulf War chemicals, and that was accomplished. It was already known that CP and Sarin (DFP) readily crossed into the brain and caused damage. However, one of the study's surprising findings was that about 10 percent of the dose of PB--a drug used currently and for many decades in the treatment of myasthenia gravis, a neurodegenerative condition that results in extreme muscle weakness and failure--crosses into the brain. Until now, it had been believed that PB did not cross the blood-brain barrier. 

ALS 

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's Disease, has been shown to have occurred at excessively high rates among Gulf War veterans and at far younger ages than is normally seen. The studies revealed that PB reduces the number of neurons in key areas of the brain, and that the PB and CP Gulf War chemicals were linked to ALS in the mouse models.

The findings suggest that CP exposures led to damage to the mitochondria in the cells, making individuals more susceptible to a highly problematic cycle of oxidative stress that may result in serious or even fatal neurological diseases, including ALS. 

Brain Cancer 

The studies revealed that PB stimulated negative effects in the brain more so than CP or sarin (DFP), and led to the development of a factor that leads to brain cancer.

Brain cancer in Gulf War veterans has been shown to exist at at least twice the rate of non-deployed Gulf War era troops, but there has been no explanation before now for what might be the causative factors.

The studies demonstrated that there is an initial, dramatic neuroinflammatory response in the mice, and that it diminishes over time. However, at the stage at which the studies were terminated by VA, it was unable to be determined what the effects of that final state might be, including whether it might still be capable of producing symptoms. 

Mitochondrial Effects 

Another of the studies was to show the toxic effects of Gulf War chemicals on the brain's neurons, the brain's building blocks. The study revealed early levels of damage, but was terminated by VA before it could reveal whether there was in fact damage to the cells and the powerhouse of the cells, mitochondria. If this damage was taking place, it was intended for the study to determine if the mitochondrial damage could potentially be treated by Coenzyme Q10, a substance produced naturally by the body and critical for the proper functioning of the cells.

"We are now at the point where we could be conducting studies that could help stop the neurological damage in ill Gulf War veterans where it is, or possibly even begin to reverse it," said Dr. Haley. 

What Next? 

"We are now at the point where we could be conducting studies that could help stop the neurological damage in ill Gulf War veterans where it is, or possibly even begin to reverse it," says Dr. Haley.

Yet, VA officials in the new administration do not seem willing to reverse the termination of the contract that funded Dr. Haley and his roughly 200 colleagues engaged on what can only be termed a massive effort aimed at successfully unlocking the chemical causes of, and treatments for Gulf War illness.

"I never believed that PB was part of this," said Dr. Haley. "I always believed it was sarin, sarin, sarin, possibly with the addition of chlorypyrifos or some other organophosphate [pesticide]. However, the evidence is clear and undeniable -- PB is a dangerous chemical."

One ill Gulf War veteran member of the committee, Anthony Hardie of Madison, Wis., stated his personal frustation with the VA's decision to cancel Dr. Haley's contract. "I have heard from Gulf War veterans across the country who are equally angry at the VA's crass decision to cancel your promising research program," he said.  "I hope that people [in the VA] know how wrong this decision was," he said.

Another Gulf War veteran member of the Committee, Marguerite Knox, from Columbia, S. Car., questioned if PB may still be carried currently by U.S. troops in the event of exposure to sarin or other nerve agents.

New Research Findings Link Gulf War Veterans' Neuropsychological Dysfunction with Gulf War Exposures

Written by Anglico.

(Washington, DC - November 2, 2009) - In a presentation today before the Congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), Dr. Roberta White, the committee's scientific director, presented scientific research linking Gulf War hazardous exposures and health outcomes in individuals exposed to neurotoxicants.

Neurotoxicants, a class of chemicals that includes pesticides and chemical warfare agents, were common hazardous exposures during the 1991 Gulf War linked to Gulf War veterans' illnesses and described in depth in a 2008 U.S. Government report that found that Gulf War Illness is a real neurological condition affecting between one-fourth and one-third of the 697,000 U.S. veterans of the 1991 Gulf War.

Dr. White, a neuropsychologist and chair of environmental health at the Boston University School of Public Health, presented scientific research that linked the Gulf War exposures to neuropsychological dysfunction.

According to Dr. White's research, individuals exposed to neurotoxicants such as the pesticides and low-level chemical warfare agent exposures of those serving in the 1991 Gulf War, "can have abnormal or within normal range [of neuropsychological testing] results but still have critical functional issues in daily life, especially with people who were high functioning [before their Gulf War exposures].

Dr. White noted that that this meant that those exposed had neuropsychological dysfunction, rather than the neuropsychological deficit that most current neuropsychological testing is designed to measure.

The research studies found that the cluster of neuropsychological dysfunction symptoms among Gulf War veterans included:

• Mood changes/fatigue
• Motor dysfunction
• Visual-constructional deficits
• Visual memory/learning retrieval issues
• Attention/executive working memory issues

It was noted that language function was generally intact.

"Some also have Parkinsonian symptoms," added Dr. White.  However, they do not respond to dopaminergic replacement, a standard Parkinson's disease treatment, "so this is not [typical] Parkinson's Disease."

One of the veterans in attendance, former U.S. Air Force Major and flight nurse Denise Nichols of Denver, Col., noted that most Gulf War veterans were high functioning before their exposures. 

Anthony Hardie, an ill Gulf War veteran member of the RAC from Madison, Wis. agreed, commenting that, "most Gulf War troops were at least high school graduates, as compared to today's military, where in 2008, only about four in five new enlistees in the U.S. Army were high school graduates."

Hardie also recommended that VA begin using its new Traumatic Brain Injury (TBI) compensation criteria for Gulf War veterans with this neuropsychological dysfunction.
 

Several ill Gulf War veterans in attendance agreed that the dysfunction identified by Dr. White's research mirrored their own experiences and those of other ill Gulf War veterans they know.

Third Congressional Hearing on Gulf War Illness Research Postponed

Written by Anglico, 91outcomes Publisher/Editor.


(Washington, DC - November 2, 2009) - The Congressional hearing on recommendations for future directions of Gulf War veterans' illnesses health research, originally scheduled for this Wednesday, November 4, has been postponed.

The hearing will be rescheduled at a future date.

Two previous hearings in the series have been held by the House Veterans' Affairs Subcommittee on Oversight and Investigations, which have highlighted significant issues with VA and Department of Defense Gulf War illnesses research conducted to date.

Canadian Gulf War Veteran Expresses Concern on behalf of Fellow Canadian Gulf War Veterans 'Who Are Also Ill'

Written by Anglico, 91outcomes Publisher/Editor.

(Washington, DC - November 2, 2009) - Traveling on her own to speak before a federal U.S. committee hearing of the Research Advisory Committee on Gulf War Veterans' Illnesses (RAC) in Washington, DC, Louise Richard, a Canadian Gulf War veteran from Ottawa, Ontario, Canada, expressed concern for her fellow Gulf War veterans.

"We're ill too, and we deserve answers, too, but for some reason the Canadian Government has utterly failed us."

Richard stated that she was informed by Canada's Surgeon General that, "there are too few of you to worry about."

Richard expressed gratitude for the RAC's work, and work be U.S. veterans advocates, including Denise Nichols of Denver, Colo.

Study Finds Subtle Declines in Motor Speed, Sustained Attention in Gulf War Veterans

Written by Anglico, 91outcomes Publisher/Editor.

(Washington, DC - November 2, 2009) - In a public presentation today before the federal Research Advisory Committee on Gulf War Veterans' Illnesses by Dr. Rosemary Toomey, science has found that Gulf War deployment is associated with subtle declines of motor speed and sustained attention.  The evidence further suggested that the toxicant exposures influence these functions, and that symptoms of depression also influence attention.

Shortly after the end of the 1991 Gulf War, many U.S. Gulf War veterans reported cognitive issues that they believed to be related to their Gulf War service.  The cognitive issues could not be related to physical brain injury or known disease processes.

The study found scientific evidence that 1991 Gulf War toxicant exposures led to impaired motor speed and deficits in sustained attention.

The presentation, entitled, "Neuropsychological functioning in the VA National Health Survey of Gulf War Veterans," included the results of the National Health Survey of Gulf War veterans and their families, which was coordinated through Chicago's Hines VA Medical Center. 

Khamisiyah exposure was also found to be related to decreased motor speed.

It was noted that self-reported exposure variables did not explain the symptoms. 

Toomey is an Assistant Professor of Psychology in the Harvard Medical School Department Psychiatry, and an active researcher with the Psychology Department at Boston University, the Harvard Institute of Psychiatric Epidemiology and Genetics, and the Boston VA Medical Center Research Service. 

Laser Acupuncture May Help Alleviate Symptoms in Ill Gulf War Veterans, Mayo Clinic Study Suggests

Written by Anglico, 91outcomes Publisher/Editor. 

(Washington, DC - November 2, 2009) - In a public presentation today before the Congressionally chartered federal Research Advisory Committee on Gulf War Veterans' Illnesses, which oversees the federal government's scientific research efforts across the federal government, Dr. Peter Dorsher of the Jacksonville, Fla. Mayo Clinic provided a novel assesment of how fibromyalgia works, and scientific evidence for a potential treatment, laser acupuncture.

His study assumes that the conditions associated with fibromyalgia result from an imbalance or instability of the autonomic nervous system, the body's command center than includes breathing, heartrate, perpiration, digestion, and other "automatic" bodily functiong.  The conditions related to fibromyalgia include migraines, irritable bowel syndrome, insterstitial cystitis, endometriosis, idiopathic urethritis, chronic prostatitis, and temporomandibular joint pain (TMJ).

His findings noted that satisfactory, well-tolerated treatments for fibromyalgia and chronic fatigue syndrome have been sparse to date.  He noted some similarities between fibromyalgia, a presumptive condition for veterans of the 1991 Gulf War, and Gulf War Illness.

His successful study findings testing laser acupuncture in people with fibromyalgia suggest that this stimulation of the autonomic nervous system offers a potential way to reduce the symptoms and thereby improve the quality of life for veterans with Gulf War Illness as well. 

He also noted that the treatment is pain-free, and essentially risk free, and may result in restoring the autonomic nervous system to its original balance.

One of the Gulf War veterans in the audience supported the concept of acupuncture in relieving some Gulf War Illness neurological symptoms, stating that after her Gulf War service, she had numbness and loss of feeling in her arms and legs that was restored after five months of (non-laser) acupuncture.

Gulf War Veteran Killed by Police After Calling VA Suicide Hotline

Posted at the Salisbury Post 

(Salisbury, N.C. - October 27, 2009) - This is the text of District Attorney Bill Kenerly's statement saying that no criminal charges would be filed against Officer Preston Gene Houpe in the shooting death of Christopher Dupree Kluttz.

"At approximately 4:30 a.m. on February 6, 2009, Christopher Dupree Kluttz died at his residence as the result of multiple gunshot wounds to the chest and abdomen. On duty Spencer Police Officer Preston Gene Houpe fired the fatal shots. The Spencer Police Department and the District Attorney's office requested that the State Bureau of Investigation investigate Mr. Kluttz's death. I have reviewed the S.B.I. investigation and have concluded the evidence indicates that Officer Houpe did not violate the criminal law as it relates to the use of deadly force.

"Christopher Dupree Kluttz was a former Spencer Police Officer and a disabled veteran of Desert Storm. He lived alone at his residence in Spencer. During the early morning of February 6, 2009, Mr. Kluttz called the National Suicide Hotline, where the call taker noted that he was apparently intoxicated. At 1:55 a.m. the Veterans Administration telephoned Rowan County Communications and requested that the Spencer Police Department contact Mr. Kluttz at his residence in Spencer to investigate his welfare.

"Officer Preston Gene Houpe was the patrol officer on duty when the Veterans Administration request was received by the Spencer Police Department. Officer Houpe responded to Mr. Kluttz's residence at approximately 2:03 a.m. He entered the residence and spoke with Mr. Kluttz. Officer Houpe assessed Mr. Kluttz to be safe and left the residence at approximately 2:37 a.m. At that time Officer Houpe returned to his regularly assigned duties.

"In the course of his patrol duties Officer Houpe drove his marked Spencer Police vehicle past Mr. Kluttz's residence again at approximately 4:00 a.m. Officer Houpe stated that, as he approached the Kluttz residence in his vehicle, he saw Mr. Kluttz on the front porch of his house. Mr. Kluttz was cursing and speaking loudly, and Officer Houpe told him to "calm down". Officer Houpe followed Mr. Kluttz into the residence as Mr. Kluttz continued to curse. Inside the residence Officer Houpe talked with Mr. Kluttz, at one point suggesting that Mr. Kluttz place a telephone call to a friend. About 4:28 a.m. Mr. Kluttz placed this call. During the telephone conversation the friend heard Mr. Kluttz tell Officer Houpe to get out of his house. Mr. Kluttz then gave the telephone to Officer Houpe, who told the friend to call Mr. Kluttz's parents. The friend called Mr. Kluttz's father at approximately 4:30 a.m. and informed him of the situation. His father left his residence in route to the residence of Christopher Kluttz.

"While still in Mr. Kluttz's residence and before Mr. Kluttz's father arrived, Officer Houpe called for "routine" backup. This request was made in response to Mr. Kluttz's belligerent comments, including a threat to shoot the Officer. Officer Houpe relates that, at this point, Mr. Kluttz entered the kitchen of his residence, was heard to open a drawer, and returned armed with a butcher-type knife. Officer Houpe requested "urgent" backup, and during this call Officer Houpe can be heard to shout, "Drop the É" (inaudible, possibly "gun"). As Mr. Kluttz threatened Officer Houpe and approached him with the knife, Officer Houpe fired three shots, fatally injuring Christopher Dupree Kluttz. During an additional request for "urgent" assistance Officer Houpe can be heard telling Mr. Kluttz to "stay down". Officers of the Salisbury and Spencer Police Departments, Rowan County Deputies, and Emergency Medical personnel responded immediately and found Officer Houpe in the residence, and Mr. Kluttz deceased.

"Christopher Dupree Kluttz was found lying in the doorway that connects the dining room to the kitchen of his residence. A large chrome-bladed knife with a black plastic handle was lying on the dining room floor about four feet from Mr. Kluttz. Three .40 caliber cartridge casings were found in the dining room, and three .40 caliber bullets were recovered from Mr. Kluttz's body. The casings were fired in Officer Houpe's issue weapon; however, the recovered bullets were too distorted for a conclusive match to his pistol. A kitchen drawer and the chrome-bladed knife were examined for latent fingerprints; however, there were no identifiable latent prints noted or developed on either item. The medical examiner did not find either gun powder soot or stippling in connection with Mr. Kluttz's wounds.

"The death of Christopher Dupree Kluttz, a former police officer and veteran, is particularly unsettling and unfortunate. However, after reviewing this very thorough investigation, I have determined that no criminal charges will be filed against Officer Preston Gene Houpe for the shooting death of Christopher Dupree Kluttz."

Another Gulf War Veteran Dead: "He Was Sick When he Came Home from Kuwait"

Written by Bill Bell, Whittier Daily News.

(Whittier, Calif. - October 23, 2009) - Those closest to him called him "Skeeter." 

A strapping, healthy 6-foot water polo player in high school, Clinton Marvin Hammitt Jr. enlisted in the U.S. Marine Corps right after graduating from Pioneer High School in 1987. 

In 1990, Skeeter was deployed to the Gulf War, called Desert Storm, and was discharged in 1991. 

Hammitt worked his way up from a restaurant job at the former El Patio on Greenleaf Avenue to becoming the owner of Steel Press Printing, which did most of the printing for the city of Whittier and its Police Department, said his sister, Renee Hammitt Mendoza. 

Then on Aug. 20, he died at the age of 40. 

"He was sick when he came home from Kuwait," said Renee, one of his five older sisters. Even now, there is no definite diagnosis of the cause of his death, said Renee. 

She said Veterans Hospital doctors worked on his blood disorder over the years and kept Hammitt and his family advised of their progress on a weekly basis. 

The most recent information was that Hammitt's disorder most likely was something called TTP (thrombolic thrombocytopenic purpura), a blood disorder that could be related to parasites, oil well fires or nerve gas, but possibly could also be unrelated. 

"Skeeter was handsome, funny, had a million friends and turned out to be an outstanding businessman," Renee said. 

Hammitt was born Feb. 27, 1969, in Montebello to Clinton Marvin Sr. and Helen Hammitt. The family moved to the unincorporated west side of Whittier where Skeeter attended Phelan Elementary school and Katherine Edwards middle school prior to Pioneer High. 

He was cremated and interred with military honors at Riverside National Cemetery. 

Besides his parents and sister, Renee, he also leaves a 7-year-old son, and his other sisters, Joy Hammitt of Cedar Creek, Utah, Lynne Nay of Los Angeles, Denise Hammitt of Wilmington and Julie Arredondo, and 12 nieces and nephews.

newsbybell@aol.com

Last of Three Congressional Hearings on Gulf War Illness Scheduled

(91outcomes - October 23, 2009) - The U.S. House Veterans' Affairs Subcommittee on Oversight and Investigations, chaired by Rep. Mitchell (D-Ariz.) will hold a Subcommittee Hearing titled "Gulf War Illness: Where Do We Go From Here?"

The hearing will be held on Capitol Hill in Washington, DC, in Room 334 of the Cannon House Office Building.

CYPRESS BIOSCIENCE: Low-Dose Savella Helps Chronic Pain

Editor's Note:  Fibromyalgia, a condition characterised by chronic widespread pain common in Gulf War veterans, is one of three presumptive conditions for VA service-connection for veterans of the 1991 Gulf War.  The other two are Irritable Bowel Syndrome (IBS) and Chronic Fatigue Syndrome (CFS).


Cypress Bioscience Press Release.

(New York and San Diego - October 17, 2009) - Forest Laboratories, Inc. (NYSE: FRX) and Cypress Bioscience, Inc. (NASDAQ: CYPB) today announced that Savella® (milnacipran HCI) 100 mg/day (50 mg twice daily) demonstrated statistically significant and clinically meaningful concurrent improvements in pain, patient global assessment, and physical function, according to results from a large-scale, Phase III clinical trial that will be presented on Tuesday, October 20, 2009, at the American College of Rheumatology Annual Meeting in Philadelphia, PA. 100 mg/day is the recommended dose of Savella. Savella is a selective serotonin and norepinephrine dual reuptake inhibitor (SNRI) that was approved by the U.S. Food and Drug Administration (FDA) earlier this year for the management of fibromyalgia.

Fibromyalgia is a chronic condition characterized by widespread pain and decreased physical function, afflicting as many as six million people in the United States. The study showed statistically significant and clinically meaningful concurrent improvements in pain, patient global assessment, and physical function, among patients receiving Savella treatment of 100 mg/day, as compared to a placebo treatment group, when measured by patient-reported outcomes assessed in composite responder analyses. These results at the 100 mg/day dose are consistent with those of previous clinical trials that have demonstrated the safety and efficacy of Savella at doses of 100 mg/day and 200 mg/day.

"Fibromyalgia is a common, chronic pain disorder that can be associated with an array of debilitating symptoms, so it is important that treatments manage the multiple symptoms of fibromyalgia and improve function," said lead investigator, Lesley M. Arnold, MD, Professor of Psychiatry, University of Cincinnati College of Medicine.

Study Details

 
This Phase III, double-blind, placebo-controlled trial of 1,025 fibromyalgia patients was designed to further evaluate the efficacy and tolerability of Savella 100 mg/day. Patients were randomized to receive Savella 100 mg/day (n=516) or placebo (n=509) and underwent four to six weeks of flexible dose escalation, followed by 12 weeks of stable-dose treatment followed by a two-week randomized, double-blind discontinuation phase.
 

This study, like other phase III fibromyalgia studies of Savella used a composite responder analysis as the primary endpoint. This endpoint required individual patients to demonstrate concurrent and clinically meaningful improvements in multiple domains using validated measures, including pain (visual analog scale), patient global assessment (patient global impression of change), and physical function (Short Form-36 Physical Component Summary).
 

In this study a greater proportion of patients in the Savella treatment arm (100 mg/day) as compared with placebo treatment, at 3 months, experienced at least a 30% reduction in pain from baseline and also rated themselves as "very much improved" or "much improved" based on the patient global assessment. In addition, a greater proportion of patients treated with Savella as compared with placebo treatment met the criteria for a treatment response as measured by concurrent improvements in pain, patient global assessment, and physical function. Some patients who rated themselves as globally "much" or "very much" improved experienced a decrease in pain as early as week 1 of treatment with a stable dose of Savella that persisted throughout the study.
 

“These data confirm the benefits of Savella in managing fibromyalgia,” said Dr. Marco Taglietti, President of Forest Research Institute. “Patients receiving Savella showed simultaneous improvements on multiple measures of fibromyalgia, including pain, patient global assessment, and physical function.”

Savella was generally well tolerated in the study. The most common treatment emergent adverse events observed during the placebo-controlled trial included nausea, headache, constipation, hot flush, dizziness, insomnia, hyperhidrosis, palpitations, fatigue, tachycardia, and hypertension. The majority of adverse reactions reported were mild to moderate in nature.

 

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About Savella

 
Savella was approved by the FDA on January 14, 2009, for the management of fibromyalgia, a chronic condition characterized by widespread pain and decreased physical function that afflicts as many as six million people in the United States. Savella is a dual-reuptake inhibitor that, in vitro, preferentially blocks the reuptake of norepinephrine with higher potency than for serotonin, two neurotransmitters thought to a play a central role in the symptoms of fibromyalgia. Savella is marketed by Forest and its licensor, Cypress Bioscience. Pierre Fabre, who originally developed and sells milnacipran outside the U.S., licensed the rights for North America to Cypress Bioscience.

Please visit www.savella.com for safety and other information.

For more information about Cypress, please visit the Company's website at www.cypressbio.com.

To learn more about the Pierre Fabre group, visit www.pierre-fabre.com.

DECISION RESOURCES: Cymbalta and Lyrica Most Prescribed for Fibromyalgia, but Neither as First Line

Cymbalta Is the Agent Most Likely to Lose Patient Share to Savella Over the Next Two Years, According to a New Report from Decision Resources

Patient-Flow Models Will Need to Take Into Account That the Highest Percentage of Patients Take Lyrica Before Adding or Switching to Cymbalta

Decision Resources Press Release

(Waltham, Mass. - October 21, 2009) - Decision Resources, one of the world’s leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that although the majority of surveyed U.S. physicians prescribe Eli Lilly’s Cymbalta and Pfizer’s Lyrica for the treatment of fibromyalgia, neither agent has the majority of its uses in the first line. In the case of Cymbalta, surveyed rheumatologists report that 37 percent of their prescriptions for the drug are in the first line; in the case of Lyrica, 32 percent of prescriptions for the drug are in the first line.

“None of the fibromyalgia agents we surveyed physicians about has the majority of its uses in the first line. Surveyed rheumatologists told us that similar percentages of their prescriptions for amitriptyline and cyclobenzaprine are in the first line compared with their prescriptions for Lyrica or Cymbalta, likely because amitriptyline and cyclobenzaprine have a long history of use in the treatment of fibromyalgia (albeit off-label) and are available as inexpensive generics,” stated Andrea Buurma, analyst at Decision Resources.

The new Treatment Algorithms in Fibromyalgia report also finds that Cymbalta is the agent most likely to lose patient share to Forest Laboratories/Cypress Bioscience’s Savella by 2011. Savella was recently launched into the fibromyalgia drug market in April 2009. However, Cymbalta is currently the only agent that is approved for both fibromyalgia and depression and therefore it will continue to be surveyed physicians’ drug of choice for fibromyalgia patients with comorbid depression.

By combining patient-level claims data with physician survey data, this report can be used to build patient-flow models and analyze the assumptions driving these models. Patient-level claims data show that more patients turning to Cymbalta as a second-line or later therapy are prescribed the drug after Lyrica than vice versa. These data suggest that Cymbalta is positioned behind Lyrica; a likely scenario given Cymbalta was approved for fibromyalgia one year following Lyrica’s approval.

About Treatment Algorithm Insight Series

Decision Resources combines in-depth primary research with the most extensive claims-based longitudinal patient-level data from IMS Lifelink: Health Plans Claims database to provide exceptional insight into physicians' prescribing trends and the factors that drive therapy product choice, from diagnosis through multiple courses of treatment, for a specific disease.

About Decision Resources

Decision Resources (www.DecisionResources.com) is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

MEDSCAPE: Veterans with PTSD Twice as Likely to Die After Surgery

Editor's Note:  Roughly 10% of Gulf War veterans from the 1991 Gulf War have been diagnosed with PTSD, compared to at least one-third of veterans of the current Iraq War.

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Written by Medscape.

(Medscape - October 17, 2009) -  In continuing coverage, Medscape (10/17, Kelly) reported, "The first study to examine the effects of posttraumatic stress disorder (PTSD) on mortality after surgery shows that veterans with PTSD are twice as likely to die following surgery as their counterparts without PTSD." 

The study, which "found a startling 25% increase in 1-year mortality, even if surgery occurred years after the patients completed military service," was "presented October 17 at the American Society of Anesthesiologists 2009 Annual Meeting by lead author Marek Brzezinski, MD, PhD, from the San Francisco Veterans Affairs Medical Center and the University of California–San Francisco." 

The "San Francisco research group is currently conducting a prospective epidemiological study looking at the effects of PTSD on perioperative outcomes that builds on the current study. They are also preparing a study to examine the potential protective effects of medical therapy in patients with PTSD undergoing surgery in an attempt to identify a potential solution."