April 15, 1999

Dear Gulf War Veteran:

As one of more than 700,000 Americans who served in the Gulf War, you know that a number of veterans of the conflict have suffered health problems marked by a variety of unexplained symptoms. Although neither a cause nor a single underlying disease process has been identified, the Department of Veterans Affairs is dedicated to studying and treating these ailments.

Recently the VA identified groups of patients who may benefit from possible therapies. Now VA is leading a $20 million effort with the Department of Defense to conduct two separate major studies of possible treatments for the symptoms of the undiagnosed illnesses of Gulf War veterans.

If you are a veteran who meets the eligibility requirements, I encourage you to consider volunteering for one of these large-scale clinical trials as we seek ways to provide veterans with the best possible care and a high quality of life. To qualify to participate, veterans must have served in the Gulf War between August 1990 and August 1991 and must currently be suffering from at least two of three otherwise unexplained symptoms of a) fatigue, b) muscle and joint pain, and c) memory and thinking problems. The symptoms must have been present for more than six months.

One of the studies will test whether exercise and cognitive behavioral therapy (CBT)-separately or in combination-improve physical function. CBT teaches patients active techniques for reducing the severity of symptoms and is commonly used to enhance traditional treatments for many chronic conditions, including cancer, coronary artery disease, asthma, and a variety of conditions characterized by pain and fatigue. The 1,300 participants in the study will receive exercise training, CBT, a combination of the two treatments, or usual and customary care. All participants will receive care from specially designated clinics and will work with a single nurse specifically assigned to the study. If you would like to volunteer or learn more about this study, see the list on page 2 for the telephone number at the nearest participating medical center.

The second treatment trial, which will involve more than 400 volunteers, will test whether an antibiotic is effective in treating the illnesses reported by Gulf War veterans. One current theory is that infection with the microorganism Mycoplasma fermentans causes the symptoms veterans are reporting. Some veterans say that the antibiotic doxycycline helps to treat their conditions, but a large-scale scientific study is needed to properly test this therapy. Volunteers will receive doxycycline or an inactive placebo orally for 12 months. To participate in this study, veterans must also have been suffering for six months or more from at least two of the three symptoms of fatigue, muscle and joint pain, or memory and thinking problems. Additionally, a test must show that they have a Mycoplasma infection. To volunteer for this study or to learn more, see the list on page 3 for the telephone number of the nearest participating medical center.

These two studies offer the prospect of significantly advancing our knowledge of the illnesses affecting veterans and our ability to treat the related symptoms. If you are eligible, you may wish to consider helping your nation once more by volunteering for one of these studies and supporting our effort to enhance the care and health of the men and women who served in the Gulf War.

Sincerely yours,

John R. Feussner, M.D.
Chief Research and Development Officer
Department of Veterans Affairs