-Caveat Lector-

A Promise to Do Better Is Not Enough
By Patrick B. Pexton


Monday, January 12, 1998; Page A17
URL:
http://www.washingtonpost.com/wp-srv/WPlate/1998-01/12/009l-011298-idx.html
>From the Washington Post, Monday, January 12, 1998; Page A17
In a recent letter to the Food and Drug Administration, the Pentagon asked
for broad authority to distribute to U.S. civilians -- during or after a
domestic terrorism incident -- some of the same experimental drugs and
vaccines used on troops to unknown effect in the gulf war. In most cases
these are drugs, or uses of drugs and vaccines, that have never been tested
in a clinical trial for effectiveness or side effects and that are not at
present for sale commercially.
The Pentagon is seeking not only broad authority to give out these drugs
during terrorist emergencies but also to waive FDA rules meant to ensure the
safest use of experimental drugs: requirements such as keeping track of who
gets what drugs, proper labeling, monitoring of side effects and fully
informing patients of possible complications before they give their consent.

The FDA is concerned, because as it and the Presidential Advisory Committee
on Gulf War Illnesses recently documented, the Pentagon has a terrible
record in using such drugs and vaccines both in Desert Storm and more
recently in Bosnia.

Just before Desert Storm, the FDA allowed the Pentagon to give troops
several experimental drugs and vaccines not approved for commercial sale.
Among them were pyridostigmine bromide (PB), a drug believed to be effective
in fending off the effects of chemical and nerve agents; botulinum vaccine
and antitoxin medicine to combat biological weapons other than anthrax; and
anthrax post-exposure treatments. The FDA also allowed the Pentagon to waive
informed consent, in some cases making it mandatory that the troops take the
pills or vaccines without full knowledge of possible risks.

Early research suggests that the interaction of PB with wartime stress,
pesticides and other hazardous materials present in Desert Storm may be a
trigger for "gulf war illness." PB may have been taken by as many as 500,000
troops and botulinum vaccine by about 8,000, although some information still
is classified.

After the war, the FDA, in reviewing the Pentagon's compliance with the
minimal wartime conditions the agency had laid down, found that "deviations"
from the rules "pointed out an underlying inability for the Defense
Department to carry out its obligations" under the rules for handling
experimental substances. For example, only about half of the troops surveyed
by the Pentagon received required information about PB; no records were kept
of troops who had adverse reactions to the PB pills; and no notation in
permanent medical records was made of those who took botulinum vaccine,
making it impossible to study its long-term effects.

The Pentagon, chastised, promised the FDA it would do better next time.
Bosnia was that next time.

In Bosnia, the Army was authorized to dispense an experimental vaccine for
tick-borne encephalitis, a disease common in the Balkans. In its recent
review of that program, the FDA criticized the Pentagon for failing again to
document immunizations in soldiers' permanent medical records and for
touting the vaccine in handouts given to troops as "very safe and extremely
effective" when the FDA never authorized such glowing language. The FDA at
last is considering rescinding its permission for the Pentagon to use some
experimental drugs on troops in wartime without their consent.

The President's Committee on Gulf War Illnesses was even more critical of
the Pentagon's performance with unapproved drugs in the gulf war and Bosnia,
saying the Pentagon "currently is incapable" of handling such drugs, and
that its poor performance has hampered research into the causes of gulf war
illness.

Against this background, the head of defense health affairs boldly is
requesting from the FDA more authority to use some of these same substances
not only on troops but on civilians in case of domestic terrorism involving
chemical and biological weapons, with the same protocol waivers that the FDA
already has noted the Pentagon is incapable of honoring.

The Department of Defense, understandably and correctly, wants as much
flexibility as it can have during times of national emergency to protect
troops and civilians at home from these weapons of mass murder.

But if Americans are in imminent danger of dying by the thousands from
biological and chemical weapons at home, then the Pentagon and the White
House should do a better job leveling with the people and Congress about the
precise nature of the threat and how imminent it may be, and then begin a
debate on how far the Pentagon should go in injecting itself into civilian
emergency care.

The writer is a managing editor at Army Times Publishing Co.

© Copyright 1998 The Washington Post Company


Dave Hartley
http://www.Asheville-Computer.com
http://www.ioa.com/~davehart

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