GULF WAR ILLNESS

RESEARCH PROGRAM
(GWIRP CDMRP DOD)

MARCH 3, 2016, WASHINGTON, DC:

Institute of Medicine Panel: Evaluation of Research Management by DoD CDMRP

Anthony Hardie
Chair, Programmatic Panel, GWIRP CDMRP
Director, Veterans for Common Sense
DISCLAIMER: The views expressed in this presentation are those of the author and may
not reflect the official policy of the Department of the Army, Department of Defense, or
the U.S. Government.

About the TreatmentFocused

Gulf War Illness CDMRP

Gulf War Illness (GWI)

Overview

Scientific research . . . supports and further

substantiates . . . that Gulf War illness is a serious
physical disease, affecting at least 175,000 veterans of
the 1990-1991 Gulf War, that resulted from hazardous
exposures in the Gulf War theater.1 (p.1)

Symptoms typically include widespread pain, cognitive

difficulties, debilitating fatigue, gastrointestinal problems,
respiratory symptoms, sleep problems, chronic headache,
and other abnormalities not explained by established
medical diagnoses or standard laboratory tests; affects 2532% of the nearly 700,000 veterans of the 1991 Gulf War.2

SOURCES: (1) Research Advisory Committee on Gulf War Veterans' Illnesses (RAC), U.S. Department of
Veterans Affairs, Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations,
2009-2013. Washington, D.C.: U.S. Government Printing Office, May 2014. Retrieved Jan. 24, 2016,
www.va.gov/RAC-GWVI/RACReport2014Final.pdf
(2) Gulf War Illness Research Program (GWIRP), Congressionally Directed Medical Research Program, U.S
Department of Defense, Program Website. Retrieved Jan. 24, 2016, http://cdmrp.army.mil/gwirp.

Why is there a Gulf War Illness

CDMRP?

DoD and VA efforts had focused on stress,

psychological issues, and causation complexities.
No priority to find evidence-based treatments to
improve GWI veterans health and lives.
Federal efforts failed in nearly all regards, yielding no
identifiable quality of life improvements for affected
veterans
Extensive criticism of prior federal efforts by VSOs,
Congress, the media, and Gulf War veterans and their
advocates
Gulf War Illness CDMRP created by Congress in FY06,
in response to demonstrated need for a treatmentfocused GWI medical research program, outside of VA.

Congressional Intent
The FY08 National Defense Authorization Act (NDAA) conference
report directed the Secretary of the Army to utilize the authorized
funding to undertake research on Gulf War Illnesses. Conferees also
directed that activities under the Gulf War Illnesses program include:
Studies of treatments for the complex of symptoms known as Gulf War
Illness
No studies based on psychiatric illness and psychological stress as the
central cause
Competitive selection and peer review to identify research with the
highest technical merit and military value
Annual letters from the Senators and Representatives to the Defense
Appropriations Subcommittees provide similar guidance.

Gulf War Illness CDMRP Focus

The GWIRP focuses on funding innovative,
competitively peer-reviewed research to:
(1) provide a better understanding of the
pathobiology underlying GWI,
(2) identify objective markers (biomarkers)
for improved diagnosis, and
(3) to develop treatments for the complex of
GWI symptoms and their underlying causes.

GWIRP Emphasizes IOMs Two

Recommended GWI Case Definitions

SOURCE: p. 74, National Academies of Sciences, Engineering, and Medicine. 2016. Gulf
War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, 2016.
Washington, DC: The National Academies Press. http
://www.nap.edu/catalog/21840/gulf-war-and-health-volume-10-update-of-health-effects

Gulf War Illness CDMRP Overview

Vision: Improve the health and lives of veterans

who have Gulf War Illness.1
Mission: Fund innovative Gulf War Illness research to
identify effective treatments, improve definition and
diagnosis, and better understand pathobiology and
symptoms.1
Treatment-focused; Peer-Reviewed; Research is
competitively selected. 1
CDMRPs are specifically funded in each annual
Defense Appropriations Act; FY16, $20m.

SOURCE: Gulf War Illness Research Program (GWIRP), Congressionally Directed Medical
Research Program, U.S Department of Defense, Program Website. Retrieved Jan. 24, 2016,
http://cdmrp.army.mil/gwirp.
1

GWIRP Appropriations & Awards

GWIRP Appropriation

FY06
$5M

FY08
$10M

FY09
$8M

FY10
$8M

FY11
$8M

FY12
$10M

FY13
$20M

FY14
$20M

10

4
6

Number of funded awards

Award Mechanism

Translational/
Clinical

More Mature
Idea

Early
Idea

Exploratory Hypothesis Development Award

Idea Award
New Investigator Award
Investigator-Initiated Research Award

2
6

Investigator-Initiated Research Expansion Award

Innovative Treatment Evaluation Award

Clinical Trial Award
Consortium Development Award
Consortium Awards
Total Awards (Pre-applications)

3
8 (81) 12 (113) 9 (43) 13 (82) 8 (57)

2
6 (83) 16 (87) 21(112)

GWIRP Portfolio
Congressional
Appropriations

FY06, FY08FY14

$89M

= 93 Awards

Funded Topic Areas

CLINICAL
BIOMARKERS
TREATMENT
STUDIES
17
Awards
20 awards, $15,383,916

CLINICAL TREATMENTS
25 Awards

CONSORTIUM 2 Awards
POPULATION-BASED STUDIES
5 Awards

EXPOSURE ANIMAL MODEL DEVELOPMENT

6 Awards
GENETICS/GENOMICS DISCOVERY
PATHOBIOLOGY 5 Awards
PATHOBIOLOGY19 awards, $13,510,179
30 Awards
30 Awards

GWI CDMRP Program Cycle

January 2015

May 2015

March 2016
August 2015

January 2016
September 2015
*As needed

October 2015

Pre-Application Review Adds Value

Removes non-competitive proposals

early
Reduces waste:
Investigators submitting clearly non-

competitive pre-proposals dont expend

needless effort developing a full proposal
that stands no chance of getting funded
Reduces costs, time expended,
administrative burden, etc.

VA vs. GWI CMDRP Awards, Funding

VA

GWIRP-CDMRP

# of New
Proposals
# of New
Funded with
Proposal
this FYs
Funded this appropriated
FY
funding

Amount of
the
Appropria New Appropriation
tion made Made during this FY
for this FY (for future year)

During
this FY

VA Funding
Expended
this FY

2011

$5.54 m

8 (CY2012)

$8 m

$10m (for FY12)

2012

$6.72 m

6 (CY2013)

$10 m

$20m (for FY13)

2013

$7.94 m

16 (CY2014)

$10 m

$20m (for FY14)

2014

$9.73 m

$20 m

$20m (for FY15)

2015

$11.63 m

$20 m

$20m (for FY16)

2016

TBD

TBD

21 (CY2015)
TBA
(CY2016)
TBD
(CY2017)

$20 m

TBD (for FY17)

Avoiding Duplication of
Effort

No GWI Research Program at NIH or elsewhere in the federal

government
In recent years, VA has been funding treatment-focused
research for Gulf War Illness; includes symptomatic treatment
testing (7 RCTs as of Sep. 2015), animal models of exposure
leading to treatment development, etc.
Active, ongoing, substantive VA-GWIRP engagement:
VA ,Gulf War Illness program manager participates in Vision Setting,

Programmatic Panel meetings:

Formal presentation of VA GW Research Portfolio, Strategy, etc.
Active, ongoing interaction between VA and GWIRP
Active in PP discussions of funding overlapping or duplicative proposals
or aims
VA staff serves as voting member of External Advisory Boards
overseeing GWIRP Consortia

GWIRP Priority Areas

Improve understanding
of pathobiology and
symptoms

Improve definition and

diagnosis

Identification of effective
treatments

Gulf War Illness CDMRP Portfolio

~1/3 of Funded Studies are Testing treatments

Some are symptomatic-focused
Some are mechanistically informed/informing
~2/3 of Funded Studies are Mechanism Focused
Identifying treatment targets
Identifying biomarkers
Improving diagnosis
Improving definition
Improving understanding of the underlying
pathobiology

Most GWIRP-funded studies are active and

remain in the pipeline

Carlos Maldonado, Ph.D.

FY16 GWIRP Programmatic Panel

Department of Veterans Affairs

K. Jeffrey Myers, M.D.U.S.

Department of Veterans Affairs

Marni Silverman, Ph.D.

Henry M. Jackson Foundation for the Uniformed Services University of the Health Sciences

Andrea White, Ph.D.

University of Utah

David K. Winnett, Jr., Captain USMC Retired

Veterans for Common Sense

CAPT Mark Lyles, D.M.D., Ph.D.

United States Naval War College

Fiona Crawford, Ph.D.

Roskamp Institute

Gulf War Illness

CDMRP:
Emerging Results

GWIRP Treatment Findings

Coenzyme Q10 (CoQ10) found to reduce pain, fatigue, cognitive and certain
other symptoms in veterans with GWI

FY06 IIRA Dr. Beatrice Golomb, University of San Diego ( GW060036)

Published in 2014 Neural Computation 26(11): 2594-2651

Acupuncture may improve some GWI symptoms, including pain, fatigue, sleep
quality, and cognitive symptoms

FY08 CTA Dr. Lisa Conboy, New England School of Acupuncture ( GW080059)
Published in 2012 Contemp Clin Trials 33(3):557-562

Carnosine found to increase cognitive function and reduce gastrointestinal

symptoms in veterans with GWI

FY06 IIRA Dr. James Baraniuk, Georgetown University ( GW060044)

Published in 2013 Glob J Health Sci 5(3):69-81

Xylitol- and saline-based nasal irrigation may mitigate respiratory (chronic

rhinosinusitis) and fatigue symptoms in GWI

FY10 ITEA Dr. David Rabago, University of Madison, WI (GW100054)

Published in 2015 Contemp Clin Trials 41:219-226

GWIRP Mechanistic Findings

Low-dose sarin nerve agent exposure

a key 1991 Gulf War and OIF exposure
-- produces long term changes in brain
neurochemistry of mice (Morris,
GW060050), destroying an earlier myth
that only high-level exposures that
cause acute symptoms lead to potential
chronic health effects. Low-dose sarin
was one of multiple Gulf War exposures.

GWIRP Mechanistic Findings

2015

The stress hormone corticosterone exacerbates

the neuroinflammatory response following a
single dose of a sarin surrogate, in essence
negatively priming" the immune system of mice
exposed to a sarin surrogate. S. Lasley, Univ. of
Illinois & J. OCallaghan, CDC NIOSH, Published in
2015, J Neurochem 133(5):708-21 (GW080150)
Epigenetic alterations in the hippocampus of rats
exposed to GW chemicals and stress persist one
year later. L. Pierce, Tripler Army Medical Center, HI,
Published in 2015, FASEB J 29:814.6 (GW120033)

GWIRP Mechanistic Findings

Neuroimmune changes found in veterans with GWI

following exercise have provided new objective
evidence for GWI patients complaints of failure to
recover following exercise and new directions for
treatment pathways. (Klimas, GW080152) (Yet VA/DOD
still recommending non evidence-based exercise as a GWI treatment.
-VA/DOD Chronic Multisymptom Illness Clinical Practice Guideline, 2014)

Molecular modeling of the bodys control system

in GWI patients, based on a myriad of biological
samples (Broderick, GW093042) is now incorporated
into a larger consortium study to try to reset these
dysfunctions. (Morris, GW120045)

GWIRP Mechanistic Findings

Gulf War chemicals have been found to damage

mitochondria, which generate cellular energy but
when disrupted produce GWI symptoms. (Golomb,
GW093063, GW120071, GW130106; Shoffner,
GW080138). A related treatment, CoQ10, has been
shown to be effective in helping reduce symptoms.
(Golomb, GW060036).
Veterans affected by GWI show prolonged postexercise recovery of phosphocreatine, consistent
with a role for mitochondrial dysfunction. FY12 IIRA
Dr. Beatrice Golomb, University of San Diego. Published
in 2014 PLoS One 9(3):e92887

GWIRP Mechanistic
Findings

Gulf War chemicals led to persistent neuroinflammation and

neuropathological changes in an animal model of GWI.
The researchers were also able to identify novel biological
pathways, correlate the results with outcomes, and identify
potential treatment targets. (G. Ait-Ghezala, Roskamp
Institute, Sarasota, FL (GW100076)
Repeated exposures to Gulf War chemicals, at doses below
those associated with acute toxicity, result in persistent
alterations in axonal transport in the brain. A. Terry, Georgia
Regents Univ., GA, Published in 2015, Neurotoxicology 47:17-26
(GW110073)
Epigenetic alterations in the hippocampus of rats exposed to
GW chemicals and stress persist one year later. L. Pierce,
Tripler Army Medical Center, HI, Published in 2015, FASEB J
29:814.6 (GW120033)

Gulf War Illness CDMRP:

In-Process Studies

GWIRP Consortia: Broad, Interdisciplinary,

Inter-institutional collaborations
Understanding Gulf War Illness: An Integrative Modeling Approach Dr.
Mariana Morris, Nova Southeastern University (GW120045)
Characterization of multi-system dysfunction in mouse models of GWI using

validation and direction from computational biology

Integration of human and animal studies using computational modeling to identify
mediators and test putative therapeutics
Goal is to develop a translational model for rapid identification of targets and
prediction of effective therapeutic interventions

Brain-Immune Interactions as the Basis of Gulf War Illness

Dr. Kimberly Sullivan, Boston University (GW120037)

Brings together researchers from 5 sites

Series of clinical and preclinical studies to test for

chronic brain-immune activation and chronic
inflammation

Goal is to identify brain-immune pathways that can be

targeted for intervention

Some In-Progress GWIRP Treatment

Evaluations

Novel Anti-inflammatories (Younger, GW130015)

Inflammation reduction (Bach, GW130025).
Intranasal insulin (Golier, GW110054)
Methylphenidate plus a GWI-Specific Nutrient Formula
(Kaiser, GW130047)
Mifepristone (Golier, GW060048)
Monosodium Luminol (Shetty, GW130037)
Naltrexone and Dextromethorphan (Meggs, GW080064)
Nasal Irrigation for Chronic Rhinosinusitis and Fatigue
(Rabago, GW100054)
Polyphenol Preparations (Pasinetti, GW130070)

GWIRP Alternative Therapies

Acupressure (Lin, GW110019)

Acupuncture treatment protocol development
(Conboy, GW130028)
Cognitive therapy for improvement of sleep quality
(Nakamura, GW100068)
Portable vestibular stimulator (Serrador,
GW130093)
Probiotic for bowel symptoms (Tuteja, GW093043)
Yoga for pain management (Bayley, GW130022)

Treatment Trials Awarded in 2015

(FY14 Funds)

D-cycloserine (Dr. Rosemary Toomey, Boston University)

Vagus Nerve Stimulation (Dr. Benjamin Natelson, Beth Israel Medical

Center, NY)

Anti-inflammatory compound Anatabine (Dr. Fiona Crawford, Roskamp

Institute)

Low FODMAP (carbohydrate) diet (Dr. Ashok Tuteja, Western Institute

for Biomedical Research)

Liposomal Glutathione and Curcumin (Dr. Nancy Klimas, South Florida

Veterans Affairs Foundation for Research and Education, Inc.* / Dr. Richard
Deth, Nova Sotheastern)

Mitochondrial cocktail (Dr. Beatrice Golomb, University of San Diego)

*within the VA healthcare system

Gulf War Illness CDMRP:

What Makes it Unique?

What Makes GWIRP

Unique?

Treatment-focused a model for other environmental injuries

and Toxic Wounds.
Unique in the federal government.
GWIRP/CDMRP funds any qualified researcher; VA funds only
VA-employees
Includes Consumer (patient advocate) reviewers, who offer
focus, urgency, and impact insight. GWIRP: 1991 Gulf War
veteran living with Gulf War Illness
Special emphasis on interdisciplinary and inter-institutional
research collaborations to better solve complex issues than
single researchers working alone.
GWIRP is relatively small by federal research funding standards.

GWIRP Military
Relevance
According

to a 2014 update report of the Congressionally-mandated Research Advisory

Committee on Gulf War Veterans Illnesses (RAC), Scientific research [since 2008] . . .
supports and further substantiates . . . that Gulf War illness is a serious physical disease,
affecting at least 175,000 veterans of the 1990-1991 Gulf War, that resulted from
hazardous exposures in the Gulf War theater.
Studies reviewed in the report found an elevated incidence of Lou Gehrigs disease (ALS)
among Gulf War veterans as well as significantly elevated rates of death due to brain
cancer among those who were most exposed to the release of nerve gas by the
destruction of the Khamisiyah Iraqi arms depot.
In addition to improving the health of Gulf War veterans, important discoveries made by the
Gulf War Illness CDMRP may also help protect current and future American service
members who are at risk of similar toxic exposures.

SOURCES: (1) Research Advisory Committee on Gulf War Veterans' Illnesses, Gulf War Illness and the Health
of Gulf War Veterans: Research Update and Recommendations, 2009-2013, p. 1. U.S. Government Printing
Office, Washington, D.C., 2014. (2) RAC, pp. 23-25. (3) RAC, pp. 23-26. (4) RAC, pp. 1; 4; 5; 13; 78; 83. And:
Institute of Medicine, N. R. C., 2010. Gulf War and Health: Volume 8 - Health Effects of Serving in the Gulf War.
The National Academies Press, Washington, DC, pp. 10; 260-64.

Support for the Gulf

War Illness CDMRP

Gulf War Illness CDMRP Scientific Support

Veterans who continue to suffer from these

discouraging symptoms deserve the very best
that modern science and medicine can offer to
delineate the true underlying cause of these
symptoms in order to speed the development
of effective treatments, cures, and, it is hoped,
preventions. The committee suggests a path
forward to accomplish these goals and we
believe that, through a concerted national effort
and rigorous scientific input, answers can likely
be found. IOM Gulf War & Health Vol. 8, 2010 (p. x)

SOURCE: Institute of Medicine. Gulf War and Health, Volume 8: Update of Health Effects of Serving in the
Gulf War. Washington, DC: The National Academies Press; 2010.

Gulf War Illness CDMRP Scientific

Support

Scientific research .... supports and further substantiates .... that Gulf War
illness is a serious physical disease, affecting at least 175,000 veterans of
the 1990-1991 Gulf War, that resulted from hazardous exposures in the Gulf
War theater.(7)p.1
Symptoms typically include some combination of widespread pain,
headache, persistent problems with memory and thinking, fatigue, breathing
problems, stomach and intestinal symptoms, and skin abnormalities.(7)p.2
Gulf War veterans who were most exposed to the release of nerve gas by
the destruction of the Khamisiyah Iraqi arms depot have significantly
elevated rates of death due to brain cancer (7)p.2 ...elevated rates of ALS
(Lou Gehrigs Disease) (7)p.2... and there are concerns for the health of this
vulnerable population as time progresses. (7)p.2
Important progress has been made... However, much work remains to be
done. (7)p.1
Congress should maintain its funding to support the effective treatmentoriented [GWIRP]. (7)p.14

SOURCE: (7) Research Advisory Committee on Gulf War Veterans Illnesses (RAC). ulf War Illness and the Health of
Gulf War Veterans: Research Update and Recommendations, 2009-2013. Washington, D.C.: U.S. Government Printing
Office; April 2014.

Gulf War Illness CDMRP Supporters

Supported by: American Legion; AMVETS; Association of the U.S.

Navy (AUSN); Burnpits360; Disabled American Veterans (DAV);
Lung Cancer Alliance; National Gulf War Resource Center
(NGWRC); National Vietnam & Gulf War Coalition; Paralyzed
Veterans of America (PVA); Sergeant Sullivan Center; Toxic Wounds
Task Force; Veterans for Common Sense (VCS); Veterans of Foreign
Wars (VFW); Vietnam Veterans of America (VVA).
The FY15 Independent Budget Veterans Service Organizations
(IBVSOs, composed of AMVETS, DAV, PVA, VFW, and 53 other
organizations that serve veterans) stated that the Gulf War Illness
CDMRP, has made great strides in the short time it has been
operating.5 (pp. 126-27)
Strong support from GWI CDMRP Patient Advocates (Consumer
Reviewers)
SOURCE: The Independent Budget for the Department of Veterans Affairs: Fiscal Year 2015.
http://www.independentbudget.org/2015/IB_2015.pdf. Accessed February 26, 2015.

Gulf War Illness CDMRP

Congressional Support

Very strong, bipartisan, bicameral

Congressional support.
FY16: 70 co-signers included House
Veterans Affairs Committee Chair,
Ranking Member, 5 Subcommittee
Chairs/Ranking Members, Key Senators
Last funding increase doubling GWIRP
funding was supported unanimously on
House floor vote.

Conclusion

Thank you!
Questions?
More information:
CDMRP: http://cdmrp.army.mil
CDMRP-GWIRP: http://cdmrp.army.mil/GWIRP
VCS: veteransforcommonsense.org

Additional
Information

Gulf War Illness CDMRP:

Patient Advocate
Consumer Reviewers

What is vs. What Could

Be
Health care harms patients too
frequently and routinely fails to deliver
its potential benefits. Indeed, between
the health care that we now have and
the health care that we could have lies
not just a gap, but a chasm.
IOM committee on a 21st Century
healthcare system

IOM Panel on 21st Century

Healthcare System

The IOM committee on Shaping the Future for Health for the
21st century (Publication: Crossing The Quality Chasm: A
New Health System For The 21st Century, 2001) formulated
a set of ten simple rules, or general principles, to inform
efforts to redesign the health system.
To help in achieving these improvement aims, the committee
deemed that it would be neither useful nor possible to specify
a blueprint for 21st-century health care delivery systems.
Imagination abounds at all levels, and all promising routes for
innovation should be encouraged.
At the same time, the committee formulated a set of 10
simple rules, or general principles, to inform efforts to
redesign the health system.
These rules are:

Aims for the 21st-Century Health Care System

The IOM committee on Shaping the Future for Health for the 21 st
century (Publication: Crossing The Quality Chasm: A New Health
System For The 21st Century, 2001)
The committee proposed 6 aims for improvement to address key
dimensions in which todays health care system functions at far lower
levels than it can and should.
A health care system that achieved major gains in these six
dimensions would be far better at meeting patient needs. Patients
would experience care that was safer, more reliable, more responsive,
more integrated, and more available.
Patients could count on receiving the full array of preventive, acute,
and chronic services from which they are likely to benefit. Such a
system would also be better for clinicians and others who would
experience the satisfaction of providing care that was more reliable,
more responsive to patients, and more coordinated than is the case
today.

Core Aims for Health

Care:
Safe: avoiding injuries to patients from the care that is intended

to help them.
Effective: providing services based on scientific knowledge to
all who could benefit, and refraining from providing services to
those not likely to benefit.
Patient-centered: providing care that is respectful of and
responsive to individual patient preferences, needs, and values,
and ensuring that patient values guide all clinical decisions.
Timely: reducing waits and sometimes harmful delays for both
those who receive and those who give care.
Efficient: avoiding waste, including waste of equipment,
supplies, ideas, and energy.
Equitable: providing care that does not vary in quality because
of personal characteristics such as gender, ethnicity, geographic
location, and socioeconomic status

21st Century Healthcare System

Rules

1. Care is based on continuous healing relationships. Patients should

receive care whenever they need it and in many forms, not just face-toface visits. This implies that the health care system must be responsive at
all times, and access to care should be provided over the Internet, by
telephone, and by other means in addition to in-person visits.
2. Care is customized according to patient needs and values. The
system should be designed to meet the most common types of needs, but
should have the capability to respond to individual patient choices and
preferences.
3. The patient is the source of control. Patients should be given the
necessary information and opportunity to exercise the degree of control
they choose over health care decisions that affect them. The system
should be able to accommodate differences in patient preferences and
encourage shared decision making.
4. Knowledge is shared and information flows freely. Patients should
have unfettered access to their own medical information and to clinical
knowledge. Clinicians and patients should communicate effectively and
share information.

21st Century Healthcare System

Rules
5. Decision making is evidence-based. Patients should receive care based on

the best available scientific knowledge. Care should not vary illogically from
clinician to clinician or from place to place.
6. Safety is a system property. Patients should be safe from injury caused by
the care system. Reducing risk and ensuring safety require greater attention to
systems that help prevent and mitigate errors.
7. Transparency is necessary. The system should make available to patients
and their families information that enables them to make informed decisions
when selecting a health plan, hospital, or clinical practice, or when choosing
among alternative treatments. This should include information describing the
systems performance on safety, evidence-based practice, and patient
satisfaction.
8. Needs are anticipated. The system should anticipate patient needs, rather
than simply react to events.
9. Waste is continuously decreased. The system should not waste re- sources
or patient time.
10. Cooperation among clinicians is a priority. Clinicians and institutions
should actively collaborate and communicate to ensure an appropriate exchange
of information and coordination of care.

Consumer Reviewers:
Why?
Why does the CDMRP include Consumer Reviewers on their scientific
peer review panels?

Participation of consumers leads to an expanded perspective by both

scientists and consumers.
Consumers keep the needs of the consumer community at the forefront of
scientific discussions and scientists are reminded of the human dimension
of the disease.
There is improved understanding of the benefits and burdens imposed
upon patients participating in research studies.
Consumers bring back hope for a cure, better treatment, or quality of life
for those living with their disease/injury/condition generated by their
participation and understanding of the focus of the research that might be
funded.
This results in increased awareness by consumers of the importance of
research and a stronger relationship between the scientific community and
the consumer community.

Congress on Consumer
Reviewers
The inclusion of patient advocates in the
CDMRP peer review has been a highly
regarded addition to the process, and the
Committee believes that these voices
provide a valuable contribution.
SOURCE: Senate Report 113-211 - DEPARTMENT OF DEFENSE
APPROPRIATIONS BILL, 2015; July 17, 2014. (S. Rpt. 113-211, p. 254) URL:
https://www.congress.gov/congressional-report/113/senate-report/211

Consumers:

Few Gulf-War related organizations

Each consumer brings individual
viewpoint based on individual health and
healthcare delivery experiences

CDMRP Consumer Reviewer

Evaluation Criteria

IOM CDMRP Panel:

Congressional Intent

Congressional Direction, 2014

In order to build on this collaboration, the Committee directs the
Department to contract with the Institute of Medicine [IOM] to
evaluate the Congressionally Directed Medical Research
Program [CDMRP] and provide a report to the congressional
defense committees not later than 12 months after enactment of
this act. The report should include an evaluation of the CDMRP
two-tiered peer review process, its coordination of research
priorities with NIH, and recommendations for how the process can
be improved. The Committee notes that the peer review system
used in the CDMRP is the recommendation of a 1993 IOM report
and was modeled after the NIH system. The inclusion of patient
advocates in the CDMRP peer review has been a highly regarded
addition to the process, and the Committee believes that these
voices provide a valuable contribution.
SOURCE: Senate Report 113-211 - DEPARTMENT OF DEFENSE APPROPRIATIONS BILL, 2015; July 17,
2014. (S. Rpt. 113-211, p. 254) URL: https://www.congress.gov/congressional-report/113/senate-report/211

Congressional Direction, 2014

Congressional Direction, 2015

Last year, the Committee directed the Department to
contract with the Institute of Medicine to evaluate the
Congressionally Directed Medical Research Program and
provide a report to the congressional defense committees
within 12 months. This report will include an evaluation of
the Congressionally Directed Medical Research Program's
two-tiered peer review process, its coordination of research
priorities with NIH and recommendations for how the
process can be improved. The Committee looks forward to
receiving this report in its efforts to continue to ensure that
Government investments in medical research are
maximized.
SOURCE: Senate Report 114-63 - DEPARTMENT OF DEFENSE APPROPRIATIONS BILL, 2016; June 11, 2015. (S.
Rpt. 114-63, p. 202) URL: https://www.congress.gov/congressional-report/114th-congress/senate-report/63/1

Congressional Direction, 2015

National Academies Inscription