Ranch hand advisory committee

НазваниеRanch hand advisory committee
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Environmental Perspectives to write a review. He asked me on what subject I wanted to write on, and I wonder if it wouldn't be interesting to sort of write a review saying, "This is an example of what can be done in a well-organized, well-thought-out study, that certain things have been found" and almost kind of a puff piece sort of thing, but --

DR. STOTO: And the data are available on the web and more might be available on these samples and so on.

DR. HARRISON: I don't have to ask your permission to write something like that, but if anyone had a reason to think that it was not a good idea, I'd like to hear it.

DR. CAMACHO: We're writing to --

DR. HARRISON: We're talking about two things; letter to the Secretary of HHS --

DR. CAMACHO: Which brings this problem to the front --

DR. HARRISON: And suggests a possible --

DR. CAMACHO: Couple of alternatives.

DR. HARRISON:    way of approaching it, through the VA.

DR. CAMACHO: Okay, and that's one thing.

DR. FAVATA: How do we seek guidance? That's the other thing.

DR. HARRISON: No, that's all   

DR. FAVATA: That's it?

DR. HARRISON: Yes, so the VA and NAS will hopefully --

DR. STOTO: That letter has to be addressed to Secretary Thompson, for protocol reasons, but it probably should be copied to Secretary Principi, and that's the more important.

DR. GOUGH: Can you do that?

DR. HARRISON: Yes. Well, I can do that.

DR. CAMACHO: We do it and get yelled at later.


DR. HARRISON: Better to beg forgiveness than ask permission.

But also, as I said, letters will be copied to some of the interested parties; some of the VA organizations. And those letters will be --

DR. STOTO: And the cc's will be more important than the addressee, perhaps.

DR. HARRISON: Well, perhaps.

LTC BURNHAM: In this letter, we're also going to mention 2006. Right? Because that's connected.

DR. CAMACHO: That's our premise.

DR. HARRISON: In this letter we're not going to mention anything. Because --

LTC BURNHAM: "You'are."

DR. HARRISON: "We're" going to mention something. You'd get in trouble if you started mentioning this stuff.

LTC BURNHAM: That's our whole point, is that we want a disinterested -- because the Air Force's position is, we don't want to do research. Not in this room, but the big guys that drop bombs, they don't want to do research, they want out of this. And so, and since our financial cycle is five years, we really need --

VOICE: To talk about it now.

LTC BURNHAM: What's going to happen in '06 is    is CDC going to do this?

DR. HARRISON: Actually, that will bring up another interesting question, and that has to do with the timing of our next meeting. And I don't know how we're going to get to that. But I think we're settled for right now.

DR. MICHALEK: Can I just flick through the last couple slides?

DR. HARRISON: If you insist.


DR. MICHALEK: This is Section 8 of the law; I urge you to read that. The language is in there about VA, consulting with the National Academy about these kinds of issues. And here we are    we thought we'd be the next step just to get your opinion, and then I'm going to present an overview to the House Veterans Affairs Committee later this year, and perhaps by then we'll have something more to say.

DR. HARRISON: When is that scheduled?

DR. MICHALEK: It's not scheduled yet; the last time we made a presentation to them, they expressed the opinion that they'd like to hear an update from us every year. So maybe a month or two from now we might arrange another presentation, giving them an overview; and this would be part of the presentation.

DR. STOTO: Knowing that that's coming up, it ought to get people's attention to this letter.

DR. HARRISON: Well, yes. We were wondering if there was any advantage in us meeting just prior to that presentation.

MR. WEIDMAN: Joel, that meeting was a briefing for staff; it wasn't an open   .

DR. MICHALEK: That's right, it was just staff. A House briefing and separately a Senate.

DR. STOTO: I would just say in the letter to the Secretary of HHS that Joel is required to    Joel has been invited by the House committee to talk about next steps and so on.

DR. GOUGH: And he's asked us for advice.

DR. STOTO: Right.

DR. GOUGH: We need theirs.


- DR. GOUGH: This is just a timing thing, but when we get around to publicizing this, I think we should make a real effort to reach the professional clinical societies as well as the NIH, because I think we may miss people, just by going through the government.

You know, put notices in the newsletters that the data are available, bla-blah-blah.

DR. HARRISON: Well, that's why I asked Joel yesterday how the web site had been managed and whether the website had been submitted to the search engines, because if you're in academic medicine like I am, you're sniffing around everywhere you find to see if you can find some money.

DR. GOUGH: But the first key word should be money.


DR. HARRISON: You know, every now and then I put something like "diabetes" into Google, you know, to see what comes up. There's got to be some way to raise the   .

DR. MICHALEK: I agree.

DR. HARRISON: Okay. Anything else --

MR. WEIDMAN: One of the ways is, I don't know whether Joel can do it or not, but it is not unusual for the veterans organizations to have, in the veterans websites, to have hotlinks back and forth.

DR. MICHALEK: We have hot links to your website from ours.

MR. WEIDMAN: To our website, right. Do you have them to them all?

DR. MICHALEK: The major ones; to VFW, yours, and   .

DR. STOTO: I think that's helpful, but it's really the non-veterans community that might have a lot more ideas about what to do about this.

DR. HARRISON: Do you know what would make a lot of sense, Joel, what I've suggested that we might also consider doing? And that is, what would you think of the idea of sending a letter to the, the way the American Diabetes Association is organized, there is a nonprofessional head and there's a professional head. It's kind of    I'm never quite sure exactly how it works.

What if we send a similar kind of toned letter, saying that these are important findings that have been made, the committee feels that they represent new information about the possible etiology of Type 2 diabetes, and we would like to invite an ADA representative to the next meeting of the Advisory Committee, as a spectator, and we would like your ideas about how this work might be brought forward.

Did you ever read Eric Hoffer's The True Believer? These are true believers. And if you tell them that there's something new about diabetes, a whole horde is going to come sniffing down here. And they've got research funds. You actually might wind up, with the ADA, trying to develop a line of support for this.

DR. FAVATA: Not to diminish the importance of the finding of diabetes, but wouldn't we be guiding the future research that way, toward that path in and of itself?

DR. HARRISON: Yes, absolutely.

DR. FAVATA: But then in doing so, are we excluding some other important research?

DR. HARRISON: There are not that many true believers around.

DR. GOUGH: Well, FASEB must have a lot of true believers.

DR. CAMACHO: I don't think we're narrowing things, though. We're searching for widest possible announcement power here, and advice here.

DR. STOTO: You know there are a couple things you can do here. One is you can focus on the outcomes where there is some interest, like diabetes. Or you can focus on the exposure to dioxin and their environmental health and occupational health, groups that have been interested in that.

DR. HARRISON: Does one diminish the other?

DR. STOTO: No. I think you can do both of those; and the third one, I would say, is epidemiologists who are interested in doing, analyzing long term studies.

DR. HARRISON: Your point about this being a long term study and the study of aging, I think those are excellent points.

DR. STOTO: Gerontologists make a fourth one.

DR. HARRISON: Those are excellent points.

There's no closure on that, though. We've already decided what we're going to do. The letter is going to HHS with copies to everybody   

DR. STOTO: I guess I would maybe not promote the other ones at this moment, because there's so much up in the air about what might be available. Even what's available now is valuable, but we may only have, you know, may want to go out to these groups one time and maybe want to get a bit of sense --

DR. HARRISON: That's fine with me. So for right now, our response to the question of disposition is a letter indicating that an urgent need to make decisions on this, and that's it. That's our response.

DR. GOUGH: And our suggestions about the procedure, VA through --

DR. HARRISON: Yes, all that's already included.

Okay? Questions?

Anything else?

- DR. HARRISON: Let's try and finish what we were supposed to be doing.

Paul, at each cycle there have been findings that generated hypothesis that then either got strengthened as each new cycle came up or may have even fallen by the wayside, as it didn't hold up. A suggestion was made that there should be essentially a chart, not in the blue book, necessarily, but in helping us work on this, that has all of the hypotheses from Cycle 1, 2, 3, forward, sort of like a timeline saying "this was a hypothesis, it's still active, it's not active, it was dropped after Cycle 4," and so on.

Can we get you to just say that you agree that that's a good idea?

DR. CAMACHO: Sure. It's a good idea. Hey.

DR. HARRISON: Let's see.

Did you have any GI review comments to make? It was acceptable.

DR. CAMACHO: Yes, plus I told you, I'm better off in other areas.

DR. HARRISON: Okay, for the psychological question, we needed your comments, and I needed to tell you that questions were also raised    I'll tell you in a second.

DR. GOUGH: I can't find it now.

DR. HARRISON: What are you looking for?

DR. GOUGH: Psychological.

DR. HARRISON: It's right after Neurological.

DR. CAMACHO: How about a number?

DR. GRUBBS: 3644.

DR. HARRISON: And there's a specific question, Paul, and that is: short-term memory has been said to be one of the affected variables, and the question was raised, if there weren't better or additional tests of short-term memory, that ought to be considered for inclusion in this cycle.

DR. GOUGH: In addition to the Wexler.

DR. CAMACHO: That's the kind of thing you'd have to look up. We need a decision now, right?

DR. HARRISON: No; in fact if you'd be more comfortable talking with a colleague or looking something up and giving Bill a call, that would be perfectly all right.

DR. CAMACHO: What's my timeline?

DR. MICHALEK: A month.

DR. CAMACHO: Fine. So that's from 3644 to --

DR. HARRISON: Well, analysis of psychological data. Do you have any other comments to make about that? That was one of your review areas. If you don't, then that's fine.

DR. CAMACHO: Let me get to you within the month.

DR. HARRISON: Joel, that drinks per day thing, is it a covariate in every section?


DR. HARRISON: I just saw it again in Psychological here. What you've agreed is that you're going to normalize that back to the more detailed way of expressing the drinking, right?

DR. MICHALEK: I think we are interested in both current drinking --

DR. HARRISON: Right. Drinks per day and drink-years.

DR. MICHALEK:    and drink history, both. In looking at this data.

DR. HARRISON: I'm just checking one more time. Instead of just whether they had a drink yesterday --

DR. MICHALEK: Oh, you want the average in the last 12 days?

DR. HARRISON: Number of drinks per day during the two weeks prior to the physical exam.

DR. MICHALEK: Right. I'll put that in.

DR. STOTO: It's there now.

DR. HARRISON: Mike, if you remember what happened was, that in the GI section he had changed it to just "current drinking, yes or no."

DR. STOTO: But in this section it's drinks per day.

DR. HARRISON: Yes, but we had discussed, and I'm just reiterating is that everywhere where drinking is analyzed, we want it analyzed at this more precise level; and then if he wants to simplify it for an editor or for a reviewer, that's a different thing.

DR. HARRISON: Anything else, Paul, on your psychology?

DR. FAVATA: You wanted to ask Paul about the last issue on general and the adjustment for hostility.

DR. HARRISON: Oh, yes.

Speaking of hostility, Paul    the discussion we got into is that    they started off with separating the subjects into type A and type B personalities. They did a psychological test that included jobs. Most of these people, and how they reacted in their jobs, most of these people are now retired and they're getting irritated at being asked irrelevant questions.

So they had changed it to, instead of type A and type B personalities to just an expression of whether or not the person was hostile.

DR. MICHALEK: Or a quantitative measure of hostility.

DR. FAVATA: Was that for the reason of bearing out on the cardiovascular? But why choose hostility? Why not choose anxiety? I'm not saying that either of them should be chosen. Why adjust it for anything? You have a measure of hostility on your psych testing.

DR. MICHALEK: It's possible, all we need to do is take a hostility scale off of the    Is there a hostility scale on the SCL90?

DR. GRUBBS: Yes, there is.

DR. FAVATA: Yes, that's included in that.

DR. MICHALEK: Then maybe that's the answer. The hostility idea was expressed at the last committee meeting. I wrote it down.

DR. FAVATA: I remember that discussion, and I think that I was the one that was reviewing it, and I don't remember hostility being suggested, but what is the need for the assessment of one's perception of their health? How is that important?

DR. MICHALEK: I'm not sure that's    that's an item of discussion. I can't justify the use of that covariate through any knowledge base of my own. It would have to be someone like you or someone else to advocate that. I'm no advocate for that.

DR. HARRISON: You really were using that in terms of selecting comparisons. You wanted comparisons that matched in every way, and including    I thought as part of the selection they had to feel as good as the Ranch Handers.

DR. MICHALEK: True, they had to have the same perception of health or approximately the same as the guy that refused to come, that's true. But that's not the purpose of the hostility or personality type.

DR. HARRISON: No. Everything is getting mixed together here.

DR. STOTO: General health is a dependent variable, is it not, under --
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