WRITTEN TESTIMONY OF 
Dr. Garth L. Nicolson
COMMITTEE ON VETERANS’ AFFAIRS
Subcommittee on Benefits
UNITED STATES HOUSE OF REPRESENTATIVES
July 16, 1998

Dr. Garth Nicolson is currently the Chief Scientific Officer and Research Professor at the Institute for Molecular Medicine in Huntington Beach, California.  He was formally the David Bruton Jr. Chair in Cancer Research and Professor at the University of Texas M. D. Anderson Cancer Center in Houston, and Professor of Internal Medicine and Professor of Pathology and Laboratory Medicine at the University of Texas Medical School at Houston.  He was also Adjunct Professor of Comparative Medicine at Texas A & M University.  Among the most cited scientists in the world, having published over 475 medical and scientific papers, edited 13 books, served on the Editorial Boards of 12 medical and scientific journals and currently serving as Editor of two (Clinical & Experimental Metastasis  and the Journal of Cellular Biochemistry), Professor Nicolson has active peer-reviewed research grants from the U.S. Army, National Cancer Institute, National Institutes of Health, American Cancer Society and the National Foundation for Cancer Research.  In 1998 he received the Stephen Paget Award from the Cancer Metastasis Research Society and the Albert Schweitzer Award in Lisbon, Portugal.

We have been engaged in studying Gulf War Illnesses (GWI) since 1993 as researchers but also as a family that has suffered from GWI.  Our step-daughter returned from service in Desert Storm in 1991 as a Crew Chief of a Blackhawk helicopter in the US Army's 101st Airborne Division (Air Assault) and developed the unusual, multiple signs and symptoms of GWI that prevented her from finishing pilot training.  Much of our information on the problems within the VA benefits system has come from this source as well as others.  Our entire family has suffered from GWI, but this is not unusual for Desert Storm veterans’ families as will be discussed below.

The most troubling problems that veterans of Desert Storm face in trying to find adequate care for their illnesses are obtaining appropriate diagnoses and then adequate treatments for their conditions.  Most of the emphasis in diagnosing and treating GWI within the military and VA has been on stress-related conditions, such as Post Traumatic Stress Disorder (PTSD) [1].  Since many patients do not fit this category, but cannot be diagnosed within existing ICD-9-coded diagnosis categories, they usually receive an ‘unknown illness’ diagnosis.  This, unfortunately, results in their receiving reduced disability assessments and reduced benefits.  It’s not that they are any less sick than their compatriots who have ICD-9 diagnoses used by the VA, they just don’t fit within the military’s or VA’s diagnosis systems.

Gulf War Illnesses (GWI) present as complex, multi-organ chronic signs and symptoms that overlap with other chronic illnesses like Chronic Fatigue Syndrome (CFS), Fibromyalgia Syndrome (FMS) and Multiple Chemical Sensitivity Syndrome (MCS).  These include chronic fatigue, headaches, memory loss, muscle pain, nausea, gastrointestinal problems, joint pain, lymph node pain, memory loss, chemical sensitivities and other signs and symptoms [2-4].  Often included in this complex clinical picture are increased sensitivities to various environmental agents and enhanced allergic responses.  Although these syndromes have been known for several years, until recently most patients with CFS, FMS and GWI have had few options for obtaining effective treatments.  This may have been due to the imprecise nature of their diagnoses, which are usually based on clinical observations rather than laboratory tests.  Unfortunately, within the VA system medical treatments appear to be more easily administered on the basis of laboratory tests than on clinical observations, and the lack of clear-cut laboratory results in GWI cases tends to lend support for psychological or psychiatric diagnoses  for complex chronic illness like GWI.

Since the signs and symptoms of FMS and CFS overlap with those found in GWI, we suggested that these are not a separate syndromes, they are all CFS-like disorders [3].  In the case of GWI, over 100,000 veterans of the Persian Gulf War in 1991, not including immediate family members, have been found to have this disorder.  According to one government study, GWI has spread to family members [5], and it is likely that it has also spread in the workplace.  The fact that many immediate family members have also presented with similar signs and symptoms indicates that diagnoses biased on PTSD may be a gross oversimplification of GWI [9].  The variable incubation time of GWI, ranging from months to years after presumed exposure, the cyclic nature of the relapsing fevers and other signs and symptoms, and the types of signs and symptoms are consistent with diseases caused by combinations of biological and/or chemical or radiological agent(s) (Figure 1) [8-10].  Although this US Senate committee  study was incomplete, investigators found after surveying approximately 1,200 GWI families that 77% of spouses and a majority of children born after the war had the signs and symptoms of GWI [5].  Although the official position of Department of Defense is that family members have not contracted GWI, this US Senate study indicates that at least a subset of GWI patients have a transmittable illness.  We can lend our support to the Senate study, as we have found GWI in Desert Storm veterans’ family members.  In fact, clinical tests reveal that GWI family members have the same chronic infections as the veterans.

Relationship of Stress to Chronic Illnesses, Including GWI, CFS and FMS

Patients with CFS, FMS and GWI often have cognitive problems, such as short term memory loss, problems concentrating and other psychological problems.   In fact, psychologists or psychiatrists who examine CFS, FMS or GWI patients usually find psychological or psychiatric problems in these patients and decide in the absence of contrary laboratory findings that these conditions are somatoform disorders.  That means that these practitioners decide that the illnesses are caused solely or predominantly  by psychological or psychiatric problems, not organic or medical problems that can be treated with medicines or treatments that are not specific for the Central Nervous System.  Stress is often mentioned as an important factor or the important factor in these disorders.  As mentioned above, GWI patients are often diagnosed with Post Traumatic Stress Disorder (PTSD) in VA and military hospitals.  The evidence that physicians have offered as proof that stress or PTSD is the source of most GWI sickness is the assumption that most veterans must have suffered from stress by virtue of the stressful environment in which they found themselves during the Gulf War [6].  In fact, most veterans themselves do not feel that stress-related diagnoses are an accurate portrayal of their illnesses.  Testimony to the US House of Representatives Committee on Government Reform and Oversight studying the origins of GWI refutes the notion that stress is the major cause of GWI [6].  The General Accounting Office (GAO) after studying government and civilian data on the subject concluded that while stress can induce some physical illness, the statement that stress is the causes of GWI has not been established [7].

Of course, stress can exacerbate chronic illnesses and suppress immune systems.  But most military personnel that we interviewed, including highly disciplined US Special Forces and Navy SEALS, indicated that the Gulf War was not a particularly stressful war, and they strongly disagreed that stress was the origin of their illnesses [8].  However, in the absence of physical or laboratory tests that can identify possible origins of GWI or FMS and CFS, many military and VA physicians accept that stress is the cause of these chronic illnesses.  It was only recently that other causes have been seriously considered, including chemical and biological exposures (Figure 1).

Chronic Illnesses Caused by Environmental (Chemical/Biological) Exposures

We have assumed that chemical and biological exposures occurred during the Gulf War, and many civilian patients may have also been exposed to chemical and biological substances that could be the underlying cause of their illnesses [9].  The complex signs and symptoms found in CFS, FMS and GWI, the variable incubation time, ranging from months to years after presumed exposure, the cyclic nature of the relapsing fevers and other signs and symptoms, and the types of signs and symptoms are consistent with diseases caused by combinations of biological and/or chemical or radiological agent(s) (Figure 1) [7-10].  In at least some of the GWI may be due to system-wide or systemic chronic infections and/or chemical insults that can penetrate various tissues and organs, including the Central and Peripheral Nervous Systems [9, 10].  When such infections occur, they can cause the complex signs and symptoms seen in CFS, FMS and GWI, including immune dysfunction.  Changes in environmental responses as well as increased titers to various endogenous viruses that are commonly found to be expressed in these patients have been seen in CFS, FMS and GWI.  If infectious agents are involved, few can produce the complex chronic signs and symptoms found in CFS, FMS and GWI patients.  One type of airborne infection that has received renewed interest of late as an important element in these disorders is represented by the class Mollicutes [11].  These microorganisms, principally mycoplasmas and other rather primitive bacteria, although not well known agents in causing disease, are now considered important emerging pathogens in causing chronic diseases and may also be important cofactors in some illnesses, including AIDS [11]. 

Interestingly, as chronic illnesses such as GWI (and in some cases CFS and FMS) progress, there are a number of accompanying clinical problems, particularly autoimmune problems.   These  include in some patients the signs and symptoms of Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS or Lew Gehrig’s Disease), Lupus, Graves’ Disease, Arthritis and other complex autoimmune diseases.   Such usually rare autoimmune responses are  consistent with certain chronic infections, such as mycoplasmal infections that penetrate into nerve cells, synovial cells and other cell types.  It is proposed that these autoimmune signs and symptoms are caused when intracellular pathogens, such as mycoplasmas, escape from cellular compartments and stimulate the host’s immune system.   Microorganisms like mycoplasmas can incorporate into their own structures pieces of host cell membranes that contain important host membrane antigens that can trigger autoimmune responses or their surface antigens may be similar to normal cell surface antigens.  Thus patients with such infections may be responding to microorganism  antigens as well as their own membrane antigens, producing unusual autoimmune signs and symptoms in the organs where the infectious agents are located.

Microorganisms as Important Agents or Cofactors in CFS, FMS and GWI

Most microorganisms like mycoplasmas are not considered as important human pathogens, but some species, such as M. fermentans, M. penetrans, M. pneumoniae, M. genitalium, M. pirum  and M. hominis, among others, have been closely associated with various human diseases [11].  Do these agents cause CFS, FMS or GWI?  Not necessarily on their own, but they appear to be important in causing the major signs and symptoms or the morbidity seen in patients with chronic illnesses [12].  If such microorganisms can cause chronic illnesses, is there any evidence for mycoplasmal infections in CFS, FMS or GWI patients?  In a majority of FMS, CFS and GWI patients examined we and others, principally Dr. Daryl See of the University of California College of Medicine, Irvine, are finding strong evidence for mycoplasmal blood infections that can explain much if not most of their chronic signs and symptoms [13].  In our studies on GWI, we have found mycoplasmal infections in the blood of about one-half of patients (91/200), and these patients were found to have predominantly one infectious species of mycoplasma, M. fermentans [14, 15].  Moreover, in over one-half of the 150 civilians with CFS, FMS or arthritis that we have examined we are finding a variety of pathogenic mycoplasma species, such as those listed above, in their white blood cell fractions [13].  The tests that we use to identify mycoplasmal infections, polymerase chain reaction and nucleoprotein gene tracking [14, 15], are very sensitive and highly specific for mycoplasmas.  These tests are a dramatic improvement over the relatively insensitive serum antibody tests that are currently used to assay for systemic mycoplasmal infections.  We recently received a Department of Defense contract to train scientists and physicians to perform these tests, including the training of staff from the Armed Forces Institute of Pathology and Walter Reed Army Medical Center in Washington DC.

Possible Origins of GWI, CFS and FMS 

Our hypothesis (Figure 1) is that most GWI is not caused by stress, although it can be exacerbated by stress.  It is primarily caused by multiple exposures to environmental, chemical, radiological and/or biological agents that cause chronic multisystem signs and symptoms that for the most part can be diagnosed as existing diseases [2, 3, 10].  We have been particularly interested in veterans with GWI whose family members are now also sick with similar signs and symptoms, suggesting that many GWI patients owe their illness due to biological not solely chemical or radiological exposures.  Illnesses caused by chemical or radiological exposures should not be transmitted to family members.  Unfortunately, GWI in immediate family members is still officially being denied by the DoD and Veterans' Affairs (DVA).  Although some family members could have developed their illnesses by contact with war souvenirs, packs or uniforms, only biological causes of GWI can account for the overwhelming fraction of family members contracting the same illness in this important subset of GWI patients.  Our research into GWI and the laboratory tests for GWI-associated pathogens that we developedwere done completely without compensation or funding from the US Government.  Since the Institute for Molecular Medicine is a nonprofit private research institute dedicated to discovering new diagnostic and therapeutic solutions for chronic human diseases, we do not charge veterans or their family members for our assistance and services.  We do, however, solicit donations for our services.  We are also assisting Desert Storm veterans from other Coalition countries that have GWI casualties.

The DoD previously claimed from their clinical evaluation program that Gulf War veterans do not show higher rates of health problems than the US population as a whole.  They failed to mention, however, that all personnel that served in the Gulf received health clearances before they were deployed, and yet many returned with illnesses or later developed illnesses that cannot be explained.  Four National Guard and Air Force Reserve units were studied by the Center for Disease Control (CDC) in Atlanta for evidence of chronic health problems associated with deployment to the Persian Gulf, and it is clear from this CDC study that the Persian Gulf deployed soldiers have much higher frequencies (from 2.5-times to 13.5-times higher) of chronic health problems (> 6 months duration) than those who were not deployed to the Persian Gulf Theater of Operations [16].  

Figure 1. Multiple exposures (chemical, radiological, biological) or multifactorial causes may have resulted in GWI in susceptible individuals (modified from reference 9).

The Responses of the DoD and DVA to GWI

In response to our published studies and formal lectures at the DoD (in 1994 and 1996) and DVA (in 1995), Dr. Steven Joseph, then Assistant Secretary of Defense for Health Affairs, and Dr. Kenneth Kizer, Undersecretary for Health, DVA, stated in letters to various members of Congress and to the press that this type of infection is commonly found, not dangerous and not even a human pathogen, and our results have not been duplicated by other laboratories.  These statements could not be further from the truth.  The Uniformed Services University of the Health Sciences, the US military's medical school, has been teaching its medical students for years that this type of infection, although uncommon in the US population, is very dangerous and can progress to system-wide organ failure and death [17].  In addition, the Armed Forces Institute of Pathology (AFIP) has been publishing for years that this type of infection can result in death in nonhuman primates [18] and in man [17].  The AFIP has also suggested treating patients with this type of infection with doxycycline [19], which is one of the antibiotics that we have recommended [20, 21].  Then why has the DVA issued guidelines stating that GWI patients should not be treated with antibiotics like doxycycline, even though in a significant number of patients it has been shown to be beneficial [14, 15]?  In response to the comments that our tests have not been duplicated,  certified diagnostic clinical laboratories, Immunosciences Laboratories of  CA and Medical Diagnostic Laboratories of NJ and have been conducting diagnostic tests on mycoplasmal infections in blood of GWI and CFS patients, and they are obtaining essentially the same results as we have found.  Thus our results have been replicated by certified commercial laboratories.  The DoD and DVA have also stated that we have not cooperated with them or the CDC in studying this problem.  This is not true.  We have done everything possible to cooperate with the DoD, DVA and CDC on this problem, and we even published a letter in the Washington Post on 25 January 1997 indicating that we have done everything possible to cooperate with government agencies on GWI issues.  We formally invited DoD and DVA scientists and physicians to the Institute for Molecular Medicine to learn our diagnostic procedures on 23 December 1996 at a meeting convened at Walter Reed Army Medical Center by Major General Leslie Burger at the request of Congressman Norman Dicks (D-WA).  We have been and are fully prepared to share our data and procedures with government scientists and physicians.  Although government laboratories can test for mycoplasmal infections and have been conducting their own examination of mycoplasmal infections in GWI patients, they are using relatively insensitive, outdated antibody tests or conventional molecular biological tests, and we would not expect them to detect the infection by these procedures.  To correct this situation we received a small training contract from the DoD to train DoD scientists in our new techniques, and the training was completed on January 30, 1998.

Successful Treatment of GWI using Private Funds

In GWI patients that tested positive for mycoplasmal infections in their blood, we have found that this type of infection can be successfully treated with multiple courses of specific antibiotics, such as doxycycline, ciprofloxacin, azithromycin, clarithromycin or minocycline [13-15, 20-21], along with other nutritional recommendations.   Multiple treatment cycles are required, and patients relapse often after the first few cycles, but subsequent relapses are milder and most patients eventually recover [14, 15].  In contrast, in nondeployed, healthy adults the incidence of mycoplasma-positive tests were <6% [15].  We found that 87 mycoplasma-positive GWI patients on antibiotic therapy relapsed within weeks after the first 6-week cycle of therapy, but 69/87 recovered after up to six cycles of therapy and 18/87 are still undergoing therapy.  GWI patients who recovered from their illness after several (3-7) 6-week cycles of antibiotic therapy were retested for mycoplasmal infection and were found to have reverted to a mycoplasma-negative phenotype [14, 15].  We hypothesize that the therapy takes a long time because of the microorganisms  involved are slow-growing and are localized deep inside cells in tissues, where it is more difficult to achieve proper antibiotic therapeutic concentrations.   As stated above, multiple cycles of therapy result in eventual recovery in a high percentage of mycoplasma-positive GWI patients.  Although anti-inflammatory drugs can alleviate some of the signs and symptoms of GWI, the signs and symptoms appear to quickly return after discontinuing drug use.  If the effect was due to an anti-inflammatory action of the antibiotics, then the antibiotics would have to be continuously applied and they would be expected to eliminate only some of the signs and symptoms of GWI.  In addition, not all antibiotics, even those that have anti-inflammatory effects, appear to work.  Only the types of antibiotics that are known to be effective against mycoplasmas are effective; most have no effect at all on the signs and symptoms of GWI/CFS/FMS, and some antibiotics make the condition worse.  Thus the antibiotic therapy does not appear to be a placebo effect, because only a few types of antibiotics are effective and some, like penicillin, make the condition worse.  We also believe that this type of infection is immune-suppressing and can lead to other opportunistic infections by viruses and other microorganisms or increases in endogenous virus titers.  The percentage of mycoplasma-positive GWI patients overall is likely to be lower than found in our studies (~45%).  This is reasonable, since GWI patients that have come to us for assistance are probably more advanced patients (with more progressed disease) than the average GWI patient.  Although we have been criticized for not conducting double-blinded, controlled clinical studies on large numbers of patients, such studies are quite labor intensive and expensive, and all of our studies were conducted without any government support or help whatsoever.  Although our studies do not involve controlled patient populations, such as all veterans that served in a single unit compared to similar numbers of nondeployed personnel from the same unit, such controlled populations can only be studied only with the help and financial assistance of the DoD and DVA.  Recently the DVA has agreed to initiate a controlled clinical trial (CSP#475) involving 18 VA institutions that will test the usefulness of antibiotic treatment of GWI patients.  This clinical trial is based completely on our research and publications on the diagnosis and treatment of chronic infections in GWI patients [10, 13-15].

Potential Sources of Exposures That Could Have Caused GWI

We consider it quite likely that many of the Desert Storm veterans suffering from the GWI signs and symptoms may have been exposed to chemical/biological toxins (exogenous or endogenous sources of these agents) containing slowly proliferating microorganisms, such as pathogenic mycoplasmas and quite possibly other bacteria and viruses, and such infections, although not usually fatal, can produce various chronic signs and symptoms long after exposure.  This would account for the illnesses being passed to immediate family members.  The DoD has maintained that Iraqi offensive Chemical and Biological Weapons (CBW) were not released during or after the Gulf War, but over 14,000 Chemical Weapons alarms sounded during but not before the conflict and we did not have detection equipment forward deployed to be able to determine whether Biological Weapons were present.  The Iraqi armed forces were operating under Soviet War Doctrine, which stresses offensive use of combinations of Chemical and Biological Weapons together with conventional weapons.  Evidence presented to Congress [6] indicated that it was extremely likely that Chemical Weapons were released during and certainly after the conflict when bunkers containing CBW were destroyed.  Although chemical and/or radiological exposure(s) can result in somewhat similar signs and symptoms to those found in GWI, this does not explain the apparent contagious nature of GWI and the delayed appearance of similar signs and symptoms in immediate family members.  Fortunately, the types of slow-growing, chronic infections found in GWI patients can be diagnosed and successfully treated with multiple cycles of specific antibiotics.  

There were several potential sources of chronic biological agents in the Persian Gulf Theater [9, 22].  First, deployed soldiers were given multiple inoculations, in some cases with experimental vaccines in unproved immunization schemes, such as vaccines that were given all at once instead of using an appropriate schedule of inoculations over months or years.  Multiple vaccinations given simultaneously can result in immunosuppression and leave an individual susceptible to opportunistic infections.  Some of these experimental vaccines could also have been contaminated with small amounts of slow-growing microorganisms.  Next, the Iraqis were known to have extensive stockpiles of Biological Weapons and the potential to deliver these weapons offensively, at short range in modified Italian-made biological sprayers that deliver Biological Weapons onto the sand to create exclusionary zones or 'biological minefields' and at long range in modified SCUD-B (SS-1) missiles with 'airburst' warheads or sprayers carried by aircraft.  As mentioned above, many of the storage and factory facilities where Chemical and Biological Weapons were stored were destroyed immediately up to, during and after the Desert Storm ground offensive, releasing plumes containing these agents high in the atmosphere where they could be carried downwind ('blow-back' exposures) to our lines.  These and other possible mechanisms of potential exposure must be carefully examined, not categorically dismissed by DoD personnel in Washington DC with little first-hand knowledge of the conditions on the ground [22].  A number of possible reasons exist that could explain why the DoD and DVA deny that our forces were exposed to CBW agents during the Gulf War, but this does not rationalize the poor responses to GWI casualties [22].

Conclusions and Suggestions

Seven years after the Gulf War, it seems counterproductive to continue the contentious battle over whether or not our forces were exposed to toxic agents in the Gulf.  It is time to put this war behind us, and treat the casualties and claims appropriately.  We previously stated that “the lack of response to possible CBW use during the Persian Gulf War has actually increased our risk and future vulnerability to CBW attack.  Aggressor countries and terrorists groups may have concluded that the US and UK are vulnerable to CBW, because they may assume from the Gulf War that we will not acknowledge CBW use and we will not treat our casualties.  Thus a very bad precedent has been set by our policies during the Gulf War.  Unfortunately, the steps that we take to health crises such as GWI/CFS/FM may dictate how our weaknesses are assessed and exploited in the future” [23].

Finally, the following suggestions are advanced to the Subcommittee:

1. Benefits and claims from the Persian Gulf War must be expanded to include immediate family members who have suffered and who continue to suffer because of veterans’ illnesses that were transmitted to family members after the war.  Denial that this has occurred has only angered veterans and their families and created a serious public health problem, including contamination of our blood supply.

2. Serious consideration must be made to overhaul the ICD-9-coded diagnosis system used by the VA to determine illnesses.  The categories in this system have not kept pace with new medical discoveries in the diagnosis and treatment of chronic illnesses.  This has resulted in large numbers of patients from the Gulf War with ‘undiagnosed’ illnesses who cannot obtain treatment or benefits for their medical conditions.

3. The efforts at denying claims and benefits by giving small, partial % disabilities due to PTSD should not be continued in patients that have organic (medical) causes for their illnesses.  

4. Research efforts must be increased in the area of chronic illnesses.  Traditionally this area has not received much attention or financial support.  It is estimated that over 3% of the adult US population suffers from chronic illnesses, such as those mentioned in this report; however, there are few federal dollars available for research on the diagnosis and treatment of chronic illnesses.

References Cited

 1. NIH Technology Assessment Workshop Panel. The Persian Gulf Experience and Health. J. Amer. Med. Assoc. (JAMA) 1994; 272: 391-396.

 2. Murray-Leisure, K., Daniels, M.O., Sees, J., Suguitan, E., Zangwill, B., Bagheri, S., Brinser, E., Kimber, R., Kurban, R. Greene, W.H. Mucocutaneous-Intestinal-Rheumatic Desert Syndrome (MIRDS). Definition, histopathology, incubation period, clinical course and association with desert sand exposure.  Intern. J. Med.  1997; 1: 47-72.

 3. Nicolson, G.L. and Nicolson, N.L.  Chronic Fatigue Illness and Operation Desert Storm.  J. Occup. Environ. Med.  1996; 38: 14-16.

 4.  Nicolson, G.L., Hyman, E., Korényi-Both, A., Lopez, D.A, Nicolson, N.L., Rea, W., Urnovitz, H.  Progress on Persian Gulf War Illnesses: reality and hypotheses.   Intern. J. Occup. Med. Tox.  1995; 4: 365-370.

 5. US Congress, Senate Committee on Banking, Housing and Urban Affairs, U. S. chemical and biological warfare-related dual use exports to Iraq and their possible impact on the health consequences of the Persian Gulf War , 103rd Congress, 2nd Session, Report May 25, 1994.

 6. US Congress, House Committee on Government Reform and Oversight, Gulf War veterans’: DOD continue to resist strong evidence linking toxic causes to chronic health effects, 105th Congress, 1st Session, Report 105-388, 1997.

 7. US General Accounting Office, Gulf War Illnesses: improved monitoring of clinical progress and reexamination of research emphasis are needed.  Report GAO/SNIAD-97-163, 1997.

 8. Nicolson, G.L. and Nicolson, N.L. Chronic Fatigue Illnesses Associated with Service in Operation Desert Storm.  Were Biological Weapons Used Against our Forces in the Gulf War?  Townsend Lett. Doctors  1996; 156: 42-48.

 9. Nicolson, G.L., Nasralla, M, Hier, J. and Nicolson, N.L. Gulf War Illnesses: role of chemical, radiological and biological exposures. In: War and Health, H. Tapanainen, ed., Helinsiki, in press, 1998.

10. Nicolson, G.L. Chronic infections as a common etiology for many patients with Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Gulf War Illnesses. Intern. J. Med. 1998; 1: 42-46.

11. Baseman, J.B. and Tully, J.G. Mycoplasmas: Sophisticated, reemerging, and burdened by their notoriety.  Emerg. Infect. Diseases  1997; 3: 21-32.

12. Cassell, G.H. and Cole, B.C.  Mycoplasmas as agents of human disease.  New Eng. J. Med.  1981; 304: 80-89.

13. Nicolson, G.L., Nasralla, M, Hier, J. and Nicolson, N.L. Diagnosis and treatment of chronic mycoplasmal infections in Fibromyalgia Syndrome and Chronic Fatigue Syndrome: relationship to Gulf War Illness. Biomed. Therapy  1998; in press.

14. Nicolson, G.L. and Nicolson, N.L.   Diagnosis and treatment of mycoplasmal infections in Gulf War Illness-CFIDS patients. Intern. J. Occup. Med. Immunol. Tox. 1996; 5: 69-78.

15. Nicolson, G.L., Nicolson, N.L. and Nasralla, M.  Mycoplasmal infections and Chronic Fatigue Illness (Gulf War Illness) associated with deployment to Operation Desert Storm.  Intern. J. Med. 1997; 1: 80-92.

16. Kizer, K.W., Joseph, S. and Rankin, J.T. Unexplained illness among Persian Gulf War vetrans in an Air National Guard unit: preliminary report--August 1990-March 1995.  Morb. Mort. Week. Rep.  1995; 44: 443-447.

17. Lo, S.-C., Dawson, M.S., Newton, P.B., Sonoda, A.A., Shih, W.-K., Engler, W.F., Wang, R.Y.-H. and Wear, D.J.  Association of the virus-like infectious agent originally reported in patients with ADIS with acute fatal disease in previously healthy non-AIDS patients.  Amer. J. Trop. Med. Hyg. 1989; 41: 364-376.

18. Lo, S.-C., Wear, D.J., Shih, W.-K., Wang, R.Y.-H., Newton, P.B. and Rodriguez, J.F. Fatal systemic infections of nonhuman primates by Mycoplasma fermentans (incognitus strain). Clin. Infect. Diseases  1993; 17(Suppl 1): S283-S288.

19. Lo, S.-C., Buchholz, C.L., Wear, D.J., Hohm, R.C. and Marty, A.M.  Histopathology and doxycycline treatment in a previously healthy non-AIDS patient systemically infected by Mycoplasma fermentans (incognitus strain).  Mod. Pathol.  1991; 6: 750-754.

20. Nicolson, G.L. and Nicolson, N.L.   Doxycycline treatment and Desert Storm.  J. Amer. Med. Assoc. (JAMA) 1995; 273: 618-619.

21. Nicolson, G.L. and Nicolson, N.L.  Mycoplasmal infections--Diagnosis and treatment of Gulf War Syndrome/CFIDS.  CFIDS Chronicle   1996; 9(3): 66-69.

22. Nicolson, G.L. and Nicolson, N.L.  Gulf War Illnesses: complex medical, scientific and political paradox.  Medicine Conflict & Survival  1998; 14: 156-165.

23. Nicolson, G.L. and Nicolson, N.L.  The eight myths of Operation Desert Storm and Gulf War Syndrome.  Medicine Conflict & Survival  1997; 13: 140-146.

Under penalty of perjury, I swear that the statements above are true and correct to the best of my knowledge, information and belief. 

Garth L. Nicolson
Chief Scientific Officer
The Institute for Molecular Medicine
  and
Professor of Internal Medicine

Address:
The Institute for Molecular Medicine
15162 Triton Lane
Huntington Beach, CA 92649

[Current Address: 16371 Gothard Street H, Huntington Beach, CA 82647]
Institute for Molecular Medicine Website: www.immed.org

Statement of Federal Support (all Federal grants and contracts):

US National Institutes of Health, National Cancer Institute, 5RO1-CA63045-03 - "Breast Cancer Metastasis-Associated Genes", Garth L. Nicolson, Principal Investigator, 5/1/94-4/30/98

US Army Medical Research and Development Command Grant  DAMD 17-94-J-4513 - "Breast Cancer Metastases: Prognosis and Monitoring" Garth L. Nicolson, Principal Investigator, 10/1/94-9/30/98

US Army Medical Research and Development Command Contract DAMD17-97-M-1452 “Detection of Myco-plasmal Infections in Gulf War Illness Patients" Garth L. Nicolson, Principal Investigator, 10/1/97-6/30/98