frontline: last battle of the gulf war:interviews: Dr. Stephen Joseph

Q: Can you talk about the media and how they covered the story from this time.

A: I think it varies. I think you had different segments if you will of the media. You had, I think, a group in the media that were looking for sensational aspects of -- what could be more sensational than this? U.S. Soldiers Gassed in the Gulf, or, Mystery Illness Strikes Down American Military After the War, or whatever. And there was a good deal of sensationalism. I think there was some rather cynical self interest in some of the media approach.

I think the media in general did a very poor job, both the print and the electronic media, did a very poor job of covering what the medical facts and what the scientific realities were. There was a kind of period where there was the Disease of the Month. Anything that some Congressman could think up as might be a cause of mystery illness would be in the headlines or on the videotape as, The Cause of a Mystery Illness. There was not the kind of coverage you would expect had you had science reporters. The story from the beginning was not done by science reporters, or medical reporters. I think that's a very important fact. It was treated as a political story rather than a scientific or medical story. I think perhaps that's inevitable, but that's what happened.

Q: Take something like the Life Magazine piece, what kinds of things do you think as a public health officer when you see that?

A: I think the Life Magazine piece was both a charade and very cynically done. We knew that a piece was in preparation. We talked to the people at Life Magazine, told them what the scientific data showed, told them that within a week or two of their proposed publication that there would be a scientific journal article in the most prestigious medical journal in the country that showed there was no evidence for congenital defects, asked them if not to delay publication until the scientific article came out, to balance their story with the information that was there. They went ahead and published in the most sensationalistic way anyway. I think they did a great disservice to not only the people who served in the Gulf, but to their families. I think they scared a lot of people. There was no basis, no scientific factual basis for their story. It was just a cover and a headline and I think represents the worst kind of journalism.

Q: What was the antidote to this kind of journalism though? Where was the other side being heard?

A: I don't think the other side was heard well and for that perhaps you can criticize all of us, including the medical people. It was a difficult message to get out. It was, as I've said, complex, it was not particularly palatable, and there was some uncertainty to it. That's hard to portray as a message against the kind of single-minded certainty of a sensationalistic easy answer. In addition, messages from the government and messages from the Department of Defense don't often have a great deal of credibility. I think, on any given day, all other things being equal, John or Jane Q Citizen is going to believe the worst rather than the more balanced account.

This is an enormous, this is probably the most significant public health problem of our time, i.e., how you convey complicated probabilistic information in a way that is acceptable and understandable by the public. I don't think we did a particularly good job with this. I'm not trying to put the blame on the side of the receiving public. It's not an area where public health does a pretty good job in general. You can look at AIDS, you can look at Legionnaires', you can look at any of the environmental threats to health, and you see the same thing again and again. We need to learn to get much better at this, both in terms of conveying scientific information and in marketing the information in a palatable way. But in this case, in the Gulf War issue, it was not at all successful.

Q: The DOD emerged from the Gulf War victorious....but then seemed to lose their credibility so quickly and so totally. What do you think contributed to that?

A: I think there's plenty of blame to go around. I think in part it rests on the clumsiness with which the government, and the DOD in particular, tried to convey, first of all concern, which needed to be conveyed. And second of all, what the data was showing. I think part of the blame rests on those who continued to whip up the issue. I think there were certainly those in the media. There were pseudo scientists. There were individual members of Congress who just would dredge up the most fantastic hypotheses and explanations without, absolutely without a shred of what I would call acceptable scientific rationale behind them, and throw them out there and blow them up in headlines and in video footage of GIs in gas masks. If I have seen once I have seen 50 times that same segment of soldiers in MOPP gear, in chemical protective gear, entering a slit trench, and it's always shown in absolutely no context. Just whenever there's a Gulf War issue you'll see that same piece of footage.

So there were those in the media. There were those who had axes to grind for their own scientific research, and I think, most regrettably, there were individual Congressmen, members of Congress, who just kept blowing this thing up, I think created a great deal of anxiety, and also made it much harder to get the message out. And then there were the vets. These people, the 20,000, 60,000, whatever number you want to use. They were hurting. They were ill. They were worried about it. They were anxious about what the future of their health was. And they also wanted answers, as we all do. They wanted answers that were most acceptable to them. They wanted medical labels. I'm the same way. When I have something that hurts I want a medical label on it and hopefully I want a direct and complete therapy that will cure that symptom. And in this case, especially with this most important combination of psychological stressors and physical symptoms, this was a message that was not, and is not today, palatable to the vets. They don't want to hear that. You have to understand that.

But at the same time you also have to recognize it as a position that makes it more difficult, both for them and for the rest of society. If we could only find a way to get all of us, not just those who are suffering from the symptoms, but the entire -- to accept that message, to understand that. When the Presidential Advisory Committee brought out this issue, as I think they were very correct to do, of the importance of psychological stress in this whole equation, they were shouted down. There was a program from the "Wisdom" of members of Congress and in the media. Why? Why is it so difficult to accept the message that, when you put young Americans, or anyone, in a situation that is uncomfortable, dangerous, and uncertain, that a number of those people come back from that situation with a combination of physical symptoms and psychological symptoms. I think we all know that. We look at ourselves in the mirror, everyone of us knows that and understands that in our lives. When you wake up in the morning and don't feel well and don't want to go to work because you have something unpleasant that's going to happen to you at work that day. You understand this combination of physical symptoms, whether it's sleeplessness or depression, or pains in your joints, or pains in your stomach, and what's going on in your psyche. So we all know this, but we can't face -- it's kind of the last taboo of being unable to face the truth about this. And it's very sad because, if there is an area where we need to do a better job of protecting our young people when they go in harm's way, and they will again, this is the area that we need to make progress on. And it's very difficult when we consciously blind ourselves from talking about it and facing it and understanding it.

Q: There's been quite a lot of messengers it seems to me in this story. There's been five blue ribbon panels, various studies. Pretty much all the messengers, present a fairly consistent message, I'm talking about the scientific messengers, and they've all tended to be treated the same way have they? Am I correct?

A: I think so. That's, but I think that's the nature of the issue. Let's talk about both sides of it. One is the consistency of the message. There's an old saying in medicine that says: When you hear hoofbeats in the street and you look out the window expect to see horses and not unicorns. As the data has piled up and piled up it's pretty clear that what we're look at are horses in this situation. There is no unicorn here. There is no mystery illness. That has been a consistent message in all the groups that have looked carefully and scientifically at this.

Another problem that we have as scientists and public health people however, is that we live by probabilities. And we are always reluctant, and for good reason, to say something is certain when we know that there's some degree, some small degree of uncertainty attached to it.

Now the rest of the world, the media and the public, and Congress, they live by certainties. They like to have things clearly black and white, yes or no, up or down. And we need to get better in my profession, we're not very good, at conveying those uncertainties to people. So when the scientist says, this was very clearly evident in the early days of the AIDS epidemic: "No, AIDS is only transmitted through these ways and not by those. 'Are you sure doctor?' Well, I'm almost certain, or it is highly probable." But I mean, how many times have you heard people like me say, "It's almost certain, or We're quite sure, or It's highly probable." Well when the public or the media hear that, what they hear is the uncertainty side, and they focus on that as an indication that this is not sure or not true or more than uncertain.

And of course, when people have reasons for wanting to hear the uncertainty, either because they can't face the reality of the psychological/physical symptoms combination, or because they want to make headlines the next day, then it's easy for them to discredit the argument.

Q: What about Congress. Congress has been very active on this issue haven't they? They've held a whole lot of hearings, dozens of hearings.

A: Congress has been enormously active on this issue, and I think they should be. This has been an issue that affects a significant number of people who served their country, directly. It's an issue that bears on very large questions of the government and the public and our military establishment. So this is an area where Congress should have been and has been very active. My concern is not with that. My concern has been with the way individual members have reacted to the issue, which is without a sense of responsibility to what the data shows, and what the data doesn't show.

Q: What's it been like appearing before them?

A: It's like -- it always is, appearing before them, you know, Congressional hearings are 90% theater and 10% a judicious examination of a situation. That really is no different in the Gulf War issue than it has been, for me at least, in any other setting.

Q: But how was it that you became identified for them as a bogeyman to go after? Why you?

A: Well I think I was the person who was doing something in the department. I think, particularly in 1994 and 1995, the department really allowed itself to see this as a medical issue and we did the best we could. I think we did good work. I think others have validated that we did good work, but it was only a part of the issue. It was the medical and clinical and scientific side of this. So I was the person that the department sent up to testify, and I went up there and said what I had to say. And if that drew fire, that's just the way it is.

Q: In many ways this is a battle in the public mind, or in the Congressional, the media mind, between stress as an explanation, or part of the explanation, and chemicals. Talk about why so many people seem to be so ready to believe that, of all the things that might have caused this phenomena, chemicals was the one.

A: Well chemical agents are mysterious, they're frightening, they're threatening, as well they should be. In my own view the biological and chemical threat in the military threat of the future. And in a sort of perverse way there's a positive aspect to the Gulf War illnesses controversy about this, because it has focused people's attention and people's interest, inside the Pentagon and in the country in general on this issue. That's not entirely a bad thing. But it's because the chemical threat is so focused, frightening, and unknown, that I think people have grasped upon it, to the exclusion of what the, on the medical side, what the evidence shows. It also became involved in issues of government conspiracy, of silence, hiding data, not protecting our people, and the rest. And of course, that's very appealing. It's got a lot of shock value in the media and it has a great appeal politically. It's a way to point a finger at a villain.

Q: Do you think the Department of Defense was too quick to dismiss chemical weapons from the point of view of exposure? That part of the problem they got into later was that they just were too dismissive of this as a possibility.

A: It's hard for me to say. I will say, and I have tremendous admiration for the senior military people I worked with in the Pentagon. I came there as someone without a military background and I have tremendous admiration for their intellect and for their commitment. So I'm not coming from a sort of military bashing position on this. But it is clear that the department in general and the military leadership in particular, did not want, early on, to see this issue as an important issue for them in a kind of public and policy sense. They wanted to see it as a medical issue. And we, the medical folks, were willing to pick up the ball and run with it because we felt that was a responsibility that we had, to take care of our people and understand what was going on. So we did that and they were content to let us do that.

Q: The problem is, from a medical issue, is you're kind of dependent on them for information about exposure aren't you?

A: That's what I was about to say. I don't have a clear judgment, a clear understanding of how the operational intelligence and military information, we're really it all lay, and how vigorous the pursuit of those issues was in the rest of the department. It's hard for me to say. There was not a great deal of open communication between those areas. We kind of did what we were able to do and needed to do.

Q: You needed certain information to assess this as a risk factor, didn't you?

A: Yes and no. Remember what I said, we began with the patients. We began with the clinical physical and laboratory examination of patients to see where that would lead us. We could do that to a very significant extent without a lot of risk and exposure information because it would lead us back there, if it did, which, in truth it did not. But we did work very much on our own on this one.

Q: The issue in 1996 became an issue about exposure -- became a very important one.

A: With Khamisiyah?

Q: With Khamisiyah right. Now, talk a bit about that. You'd been communicating your message, an unpopular message, for several years before Congress and the media and so forth. Part of the message is that chemical weapons don't seem to be indicated, partly because of clinical effects, but we don't seem to have much data of confirmed exposures anyway. And suddenly this thing comes out. How did you find out about it?

A: I found out about it through the process that surfaced it within the department. It would be an understatement to say that I was surprised. It would be an understatement to say that I was embarrassed for the department and for ourselves. This, the Khamisiyah issue just destroyed any credibility the Department had, it -- I'll tell you what it did for us on the medical side, immediately that this came out, we went back and looked at all our clinical -- I mean, there's the best example of what a bombshell, no pun intended, this was.

We then went back and looked at all the clinical data we had amassed, in ignorance of Khamisiyah to see if there was anything either geographically or temporally or symptomatically from the Khamisiyah experience that might change how we looked at, how we interpreted the data. In fact I went back to the National Academy of Sciences Group, the Institute of Medicine Group, and I said to them: Look, we asked you to review our clinical findings and our clinical process, which they had been very supportive of, and very positive about. We asked you to do that in ignorance of Khamisiyah, and in ignorance of an awareness that there well might have been actual chemical exposure. Go back now and look at our process and our data again, with the other hat on. That now we know there's a probability, a significant probability that there was some exposure, to some level, significant or not, of a chemical agent. Look at it again and tell us if we should do something different. Indeed they did not. They looked at it but they didn't really see that the Khamisiyah revelation invalidated anything we'd done. But it threw everything into further uncertainty, and caused total loss of public credibility.

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Q: Can you talk about the media and how they covered the story from this time.

A: I think it varies. I think you had different segments if you will of the media. You had, I think, a group in the media that were looking for sensational aspects of -- what could be more sensational than this? U.S. Soldiers Gassed in the Gulf, or, Mystery Illness Strikes Down American Military After the War, or whatever. And there was a good deal of sensationalism. I think there was some rather cynical self interest in some of the media approach.

I think the media in general did a very poor job, both the print and the electronic media, did a very poor job of covering what the medical facts and what the scientific realities were. There was a kind of period where there was the Disease of the Month. Anything that some Congressman could think up as might be a cause of mystery illness would be in the headlines or on the videotape as, The Cause of a Mystery Illness. There was not the kind of coverage you would expect had you had science reporters. The story from the beginning was not done by science reporters, or medical reporters. I think that's a very important fact. It was treated as a political story rather than a scientific or medical story. I think perhaps that's inevitable, but that's what happened.

Q: Take something like the Life Magazine piece, what kinds of things do you think as a public health officer when you see that?

A: I think the Life Magazine piece was both a charade and very cynically done. We knew that a piece was in preparation. We talked to the people at Life Magazine, told them what the scientific data showed, told them that within a week or two of their proposed publication that there would be a scientific journal article in the most prestigious medical journal in the country that showed there was no evidence for congenital defects, asked them if not to delay publication until the scientific article came out, to balance their story with the information that was there. They went ahead and published in the most sensationalistic way anyway. I think they did a great disservice to not only the people who served in the Gulf, but to their families. I think they scared a lot of people. There was no basis, no scientific factual basis for their story. It was just a cover and a headline and I think represents the worst kind of journalism.

Q: What was the antidote to this kind of journalism though? Where was the other side being heard?

A: I don't think the other side was heard well and for that perhaps you can criticize all of us, including the medical people. It was a difficult message to get out. It was, as I've said, complex, it was not particularly palatable, and there was some uncertainty to it. That's hard to portray as a message against the kind of single-minded certainty of a sensationalistic easy answer. In addition, messages from the government and messages from the Department of Defense don't often have a great deal of credibility. I think, on any given day, all other things being equal, John or Jane Q Citizen is going to believe the worst rather than the more balanced account.

This is an enormous, this is probably the most significant public health problem of our time, i.e., how you convey complicated probabilistic information in a way that is acceptable and understandable by the public. I don't think we did a particularly good job with this. I'm not trying to put the blame on the side of the receiving public. It's not an area where public health does a pretty good job in general. You can look at AIDS, you can look at Legionnaires', you can look at any of the environmental threats to health, and you see the same thing again and again. We need to learn to get much better at this, both in terms of conveying scientific information and in marketing the information in a palatable way. But in this case, in the Gulf War issue, it was not at all successful.

Q: The DOD emerged from the Gulf War victorious....but then seemed to lose their credibility so quickly and so totally. What do you think contributed to that?

A: I think there's plenty of blame to go around. I think in part it rests on the clumsiness with which the government, and the DOD in particular, tried to convey, first of all concern, which needed to be conveyed. And second of all, what the data was showing. I think part of the blame rests on those who continued to whip up the issue. I think there were certainly those in the media. There were pseudo scientists. There were individual members of Congress who just would dredge up the most fantastic hypotheses and explanations without, absolutely without a shred of what I would call acceptable scientific rationale behind them, and throw them out there and blow them up in headlines and in video footage of GIs in gas masks. If I have seen once I have seen 50 times that same segment of soldiers in MOPP gear, in chemical protective gear, entering a slit trench, and it's always shown in absolutely no context. Just whenever there's a Gulf War issue you'll see that same piece of footage.

So there were those in the media. There were those who had axes to grind for their own scientific research, and I think, most regrettably, there were individual Congressmen, members of Congress, who just kept blowing this thing up, I think created a great deal of anxiety, and also made it much harder to get the message out. And then there were the vets. These people, the 20,000, 60,000, whatever number you want to use. They were hurting. They were ill. They were worried about it. They were anxious about what the future of their health was. And they also wanted answers, as we all do. They wanted answers that were most acceptable to them. They wanted medical labels. I'm the same way. When I have something that hurts I want a medical label on it and hopefully I want a direct and complete therapy that will cure that symptom. And in this case, especially with this most important combination of psychological stressors and physical symptoms, this was a message that was not, and is not today, palatable to the vets. They don't want to hear that. You have to understand that.

But at the same time you also have to recognize it as a position that makes it more difficult, both for them and for the rest of society. If we could only find a way to get all of us, not just those who are suffering from the symptoms, but the entire -- to accept that message, to understand that. When the Presidential Advisory Committee brought out this issue, as I think they were very correct to do, of the importance of psychological stress in this whole equation, they were shouted down. There was a program from the "Wisdom" of members of Congress and in the media. Why? Why is it so difficult to accept the message that, when you put young Americans, or anyone, in a situation that is uncomfortable, dangerous, and uncertain, that a number of those people come back from that situation with a combination of physical symptoms and psychological symptoms. I think we all know that. We look at ourselves in the mirror, everyone of us knows that and understands that in our lives. When you wake up in the morning and don't feel well and don't want to go to work because you have something unpleasant that's going to happen to you at work that day. You understand this combination of physical symptoms, whether it's sleeplessness or depression, or pains in your joints, or pains in your stomach, and what's going on in your psyche. So we all know this, but we can't face -- it's kind of the last taboo of being unable to face the truth about this. And it's very sad because, if there is an area where we need to do a better job of protecting our young people when they go in harm's way, and they will again, this is the area that we need to make progress on. And it's very difficult when we consciously blind ourselves from talking about it and facing it and understanding it.

Q: There's been quite a lot of messengers it seems to me in this story. There's been five blue ribbon panels, various studies. Pretty much all the messengers, present a fairly consistent message, I'm talking about the scientific messengers, and they've all tended to be treated the same way have they? Am I correct?

A: I think so. That's, but I think that's the nature of the issue. Let's talk about both sides of it. One is the consistency of the message. There's an old saying in medicine that says: When you hear hoofbeats in the street and you look out the window expect to see horses and not unicorns. As the data has piled up and piled up it's pretty clear that what we're look at are horses in this situation. There is no unicorn here. There is no mystery illness. That has been a consistent message in all the groups that have looked carefully and scientifically at this.

Another problem that we have as scientists and public health people however, is that we live by probabilities. And we are always reluctant, and for good reason, to say something is certain when we know that there's some degree, some small degree of uncertainty attached to it.

Now the rest of the world, the media and the public, and Congress, they live by certainties. They like to have things clearly black and white, yes or no, up or down. And we need to get better in my profession, we're not very good, at conveying those uncertainties to people. So when the scientist says, this was very clearly evident in the early days of the AIDS epidemic: "No, AIDS is only transmitted through these ways and not by those. 'Are you sure doctor?' Well, I'm almost certain, or it is highly probable." But I mean, how many times have you heard people like me say, "It's almost certain, or We're quite sure, or It's highly probable." Well when the public or the media hear that, what they hear is the uncertainty side, and they focus on that as an indication that this is not sure or not true or more than uncertain.

And of course, when people have reasons for wanting to hear the uncertainty, either because they can't face the reality of the psychological/physical symptoms combination, or because they want to make headlines the next day, then it's easy for them to discredit the argument.

Q: What about Congress. Congress has been very active on this issue haven't they? They've held a whole lot of hearings, dozens of hearings.

A: Congress has been enormously active on this issue, and I think they should be. This has been an issue that affects a significant number of people who served their country, directly. It's an issue that bears on very large questions of the government and the public and our military establishment. So this is an area where Congress should have been and has been very active. My concern is not with that. My concern has been with the way individual members have reacted to the issue, which is without a sense of responsibility to what the data shows, and what the data doesn't show.

Q: What's it been like appearing before them?

A: It's like -- it always is, appearing before them, you know, Congressional hearings are 90% theater and 10% a judicious examination of a situation. That really is no different in the Gulf War issue than it has been, for me at least, in any other setting.

Q: But how was it that you became identified for them as a bogeyman to go after? Why you?

A: Well I think I was the person who was doing something in the department. I think, particularly in 1994 and 1995, the department really allowed itself to see this as a medical issue and we did the best we could. I think we did good work. I think others have validated that we did good work, but it was only a part of the issue. It was the medical and clinical and scientific side of this. So I was the person that the department sent up to testify, and I went up there and said what I had to say. And if that drew fire, that's just the way it is.

Q: In many ways this is a battle in the public mind, or in the Congressional, the media mind, between stress as an explanation, or part of the explanation, and chemicals. Talk about why so many people seem to be so ready to believe that, of all the things that might have caused this phenomena, chemicals was the one.

A: Well chemical agents are mysterious, they're frightening, they're threatening, as well they should be. In my own view the biological and chemical threat in the military threat of the future. And in a sort of perverse way there's a positive aspect to the Gulf War illnesses controversy about this, because it has focused people's attention and people's interest, inside the Pentagon and in the country in general on this issue. That's not entirely a bad thing. But it's because the chemical threat is so focused, frightening, and unknown, that I think people have grasped upon it, to the exclusion of what the, on the medical side, what the evidence shows. It also became involved in issues of government conspiracy, of silence, hiding data, not protecting our people, and the rest. And of course, that's very appealing. It's got a lot of shock value in the media and it has a great appeal politically. It's a way to point a finger at a villain.

Q: Do you think the Department of Defense was too quick to dismiss chemical weapons from the point of view of exposure? That part of the problem they got into later was that they just were too dismissive of this as a possibility.

A: It's hard for me to say. I will say, and I have tremendous admiration for the senior military people I worked with in the Pentagon. I came there as someone without a military background and I have tremendous admiration for their intellect and for their commitment. So I'm not coming from a sort of military bashing position on this. But it is clear that the department in general and the military leadership in particular, did not want, early on, to see this issue as an important issue for them in a kind of public and policy sense. They wanted to see it as a medical issue. And we, the medical folks, were willing to pick up the ball and run with it because we felt that was a responsibility that we had, to take care of our people and understand what was going on. So we did that and they were content to let us do that.

Q: The problem is, from a medical issue, is you're kind of dependent on them for information about exposure aren't you?

A: That's what I was about to say. I don't have a clear judgment, a clear understanding of how the operational intelligence and military information, we're really it all lay, and how vigorous the pursuit of those issues was in the rest of the department. It's hard for me to say. There was not a great deal of open communication between those areas. We kind of did what we were able to do and needed to do.

Q: You needed certain information to assess this as a risk factor, didn't you?

A: Yes and no. Remember what I said, we began with the patients. We began with the clinical physical and laboratory examination of patients to see where that would lead us. We could do that to a very significant extent without a lot of risk and exposure information because it would lead us back there, if it did, which, in truth it did not. But we did work very much on our own on this one.

Q: The issue in 1996 became an issue about exposure -- became a very important one.

A: With Khamisiyah?

Q: With Khamisiyah right. Now, talk a bit about that. You'd been communicating your message, an unpopular message, for several years before Congress and the media and so forth. Part of the message is that chemical weapons don't seem to be indicated, partly because of clinical effects, but we don't seem to have much data of confirmed exposures anyway. And suddenly this thing comes out. How did you find out about it?

A: I found out about it through the process that surfaced it within the department. It would be an understatement to say that I was surprised. It would be an understatement to say that I was embarrassed for the department and for ourselves. This, the Khamisiyah issue just destroyed any credibility the Department had, it -- I'll tell you what it did for us on the medical side, immediately that this came out, we went back and looked at all our clinical -- I mean, there's the best example of what a bombshell, no pun intended, this was.

We then went back and looked at all the clinical data we had amassed, in ignorance of Khamisiyah to see if there was anything either geographically or temporally or symptomatically from the Khamisiyah experience that might change how we looked at, how we interpreted the data. In fact I went back to the National Academy of Sciences Group, the Institute of Medicine Group, and I said to them: Look, we asked you to review our clinical findings and our clinical process, which they had been very supportive of, and very positive about. We asked you to do that in ignorance of Khamisiyah, and in ignorance of an awareness that there well might have been actual chemical exposure. Go back now and look at our process and our data again, with the other hat on. That now we know there's a probability, a significant probability that there was some exposure, to some level, significant or not, of a chemical agent. Look at it again and tell us if we should do something different. Indeed they did not. They looked at it but they didn't really see that the Khamisiyah revelation invalidated anything we'd done. But it threw everything into further uncertainty, and caused total loss of public credibility.

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