frontline: last battle of the gulf war: interviews: Dr. Robert Haley

Note: See reference at the end of this interview to read the studies by Dr. Haley, as well as the published scientific criticism about them.

Q: Dr Haley, are you today convinced there is a real Gulf War Syndrome?

A: In the 24th Navy Mobile Construction Battalion that we studied, there are 30 syndromes, they are very strong and they are due to neurological damage and they are strongly associated with combinations of organic phosphate chemical exposures. That's just undeniable. Now, there's a very good scientific question: is that finding going to be generalizable to the larger group of veterans who served in the war, and that's what our next research project is about.

Q: Tell me how you got involved with this issue.

A: I'm an epidemiologist. I spent 10 years at the CDC. Been here on the faculty now for almost 15 years. I was busily working on a number of epidemiologic projects including hepatitis C and some other fascinating new epidemics.

And one day we got a call from Ross Perot who lives here in Dallas and he came by the University here and said "I've been travelling around as usual talking to veterans groups and lately I've been getting an experience that is unusual. Groups of veterans will come up after one of my talks or will come and visit me here at my office and their wives or their company commanders will point to this fellow and say 'Look, before the war this guy was a strong, tough, can do person, and now look at this poor fellow, how sick he is and this change right after the war. And no-one's doing anything about it and they're telling him it's due to stress and he -- that just isn't in character for this fellow' and he says this has been happening all over. I don't know if this is real, but if it is, we need to -- we need an independent study and if you guys at this university will enter into such a study I will be happy to help defray the costs."

So we went into a 50/50 partnership where we provided the faculty time for nothing, and he chipped in and covered the out-of-pocket expenses. We started the study and actually I was very skeptical of this idea. I thought this was stress too. And I was collaborating with a toxicologist who had an inkling this might be a toxic problem, so we had that hypothesis --

Q: As an epidemiologist you know that these kinds of anecdotal pieces of evidence, they sound compelling but they often don't pan out.

A: Yes. Very frequently an epidemiologist is confronted with people who think they've been involved in an epidemic. Two or three cases of Hodgkin's disease at a high school reunion for example, and people say That's just too coincidental. But in fact most of these turn out to be not epidemics, just natural occurrences, things that would have occurred anyway, and that's what we thought the Gulf War Syndrome was, just illnesses that would have occurred. So we went into it really to disprove the syndrome. But then as we actually started studying it, at each stage the data just shouted out to us that this looked real.

Q: As an epidemiological problem this is really very hard isn't it ? You don't have a clear case definition for Gulf War Syndrome even today, you have dozens of possible risk factors and you don't have any good way of assessing which vets were exposed to which risk factors, and how big were the exposures they received. So what made you think this was an attackable problem?

A: Very good question. This is clearly the most complex epidemic investigation, epidemic problem that I've seen in my career, and I think it's the hottest thing that's happened in this half of the century. The reason for it is, not what you saw -- not the issues of risk factors and measurement of risk factors, that's not the problem.

The problem is the definition of the disease. Most diseases, Legionnaires' Disease, Toxic Shock Syndrome, AIDS, the big classic epidemics so far in recent time, the disease has been obvious and so you talk to half a dozen people who have it, and you write down a case definition and you study a population and divide them into the ones who meet the case definition, the cases, and those who don't, the controls, and you're off doing the study. You give the cases a questionnaire to have them write down what their exposures have been, for example in AIDS they would write down, they would tell you about their sexual behaviors; Legionnaires' Disease they would tell you about where they were in the Stratford Hotel in Philadelphia, and you gather self-reported risk factors.

In an epidemic investigation you almost then find the cause because an epidemic is unique in that the effects, the degree of association of risk factors with the disease is so strong that even with self-reported risk factors, you always find it. So the problem here is not measurement of risk factors, you can do that with self reports very satisfactorily. The problem was the case definition. All through 1994 and up through 1996 really nobody else would sit down and write down a case definition.

So what we did, we did a survey in order to devise a case definition from the data. We, in fact let me step back, when we teach the students about epidemiology there is a little saying, we say The first thing you do in an epidemic investigation is you examine half a dozen of the cases in an epidemic and then you write down a case definition. And if you can't do that then you devise a case definition because failure to develop a case definition means that you are doomed, you are -- it's a foregone conclusion that you will not find anything in an epidemic. That's just the way it is.

And so it was quite feasible to sit down and write down eight or ten symptoms that many of these people had in common, and so this is a case definition. Let's do a provisional study to see if that pays off. Well, nobody did that. Everybody said Well, these symptoms we've seen before and therefore we're reluctant to write down a case definition.... Now the reason I think they were reluctant to write down a case definition is to write down a case definition may have a political implication and that it may indicate that somebody has accepted this as a disease and to do that would have all kinds of political ramifications, so it was never done, and that's why the investigation never went forward.

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Note: See reference at the end of this interview to read the studies by Dr. Haley, as well as the published scientific criticism about them.

Q: Dr Haley, are you today convinced there is a real Gulf War Syndrome?

A: In the 24th Navy Mobile Construction Battalion that we studied, there are 30 syndromes, they are very strong and they are due to neurological damage and they are strongly associated with combinations of organic phosphate chemical exposures. That's just undeniable. Now, there's a very good scientific question: is that finding going to be generalizable to the larger group of veterans who served in the war, and that's what our next research project is about.

Q: Tell me how you got involved with this issue.

A: I'm an epidemiologist. I spent 10 years at the CDC. Been here on the faculty now for almost 15 years. I was busily working on a number of epidemiologic projects including hepatitis C and some other fascinating new epidemics.

And one day we got a call from Ross Perot who lives here in Dallas and he came by the University here and said "I've been travelling around as usual talking to veterans groups and lately I've been getting an experience that is unusual. Groups of veterans will come up after one of my talks or will come and visit me here at my office and their wives or their company commanders will point to this fellow and say 'Look, before the war this guy was a strong, tough, can do person, and now look at this poor fellow, how sick he is and this change right after the war. And no-one's doing anything about it and they're telling him it's due to stress and he -- that just isn't in character for this fellow' and he says this has been happening all over. I don't know if this is real, but if it is, we need to -- we need an independent study and if you guys at this university will enter into such a study I will be happy to help defray the costs."

So we went into a 50/50 partnership where we provided the faculty time for nothing, and he chipped in and covered the out-of-pocket expenses. We started the study and actually I was very skeptical of this idea. I thought this was stress too. And I was collaborating with a toxicologist who had an inkling this might be a toxic problem, so we had that hypothesis --

Q: As an epidemiologist you know that these kinds of anecdotal pieces of evidence, they sound compelling but they often don't pan out.

A: Yes. Very frequently an epidemiologist is confronted with people who think they've been involved in an epidemic. Two or three cases of Hodgkin's disease at a high school reunion for example, and people say That's just too coincidental. But in fact most of these turn out to be not epidemics, just natural occurrences, things that would have occurred anyway, and that's what we thought the Gulf War Syndrome was, just illnesses that would have occurred. So we went into it really to disprove the syndrome. But then as we actually started studying it, at each stage the data just shouted out to us that this looked real.

Q: As an epidemiological problem this is really very hard isn't it ? You don't have a clear case definition for Gulf War Syndrome even today, you have dozens of possible risk factors and you don't have any good way of assessing which vets were exposed to which risk factors, and how big were the exposures they received. So what made you think this was an attackable problem?

A: Very good question. This is clearly the most complex epidemic investigation, epidemic problem that I've seen in my career, and I think it's the hottest thing that's happened in this half of the century. The reason for it is, not what you saw -- not the issues of risk factors and measurement of risk factors, that's not the problem.

The problem is the definition of the disease. Most diseases, Legionnaires' Disease, Toxic Shock Syndrome, AIDS, the big classic epidemics so far in recent time, the disease has been obvious and so you talk to half a dozen people who have it, and you write down a case definition and you study a population and divide them into the ones who meet the case definition, the cases, and those who don't, the controls, and you're off doing the study. You give the cases a questionnaire to have them write down what their exposures have been, for example in AIDS they would write down, they would tell you about their sexual behaviors; Legionnaires' Disease they would tell you about where they were in the Stratford Hotel in Philadelphia, and you gather self-reported risk factors.

In an epidemic investigation you almost then find the cause because an epidemic is unique in that the effects, the degree of association of risk factors with the disease is so strong that even with self-reported risk factors, you always find it. So the problem here is not measurement of risk factors, you can do that with self reports very satisfactorily. The problem was the case definition. All through 1994 and up through 1996 really nobody else would sit down and write down a case definition.

So what we did, we did a survey in order to devise a case definition from the data. We, in fact let me step back, when we teach the students about epidemiology there is a little saying, we say The first thing you do in an epidemic investigation is you examine half a dozen of the cases in an epidemic and then you write down a case definition. And if you can't do that then you devise a case definition because failure to develop a case definition means that you are doomed, you are -- it's a foregone conclusion that you will not find anything in an epidemic. That's just the way it is.

And so it was quite feasible to sit down and write down eight or ten symptoms that many of these people had in common, and so this is a case definition. Let's do a provisional study to see if that pays off. Well, nobody did that. Everybody said Well, these symptoms we've seen before and therefore we're reluctant to write down a case definition.... Now the reason I think they were reluctant to write down a case definition is to write down a case definition may have a political implication and that it may indicate that somebody has accepted this as a disease and to do that would have all kinds of political ramifications, so it was never done, and that's why the investigation never went forward.

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