This medical branch of the National Academy of Sciences was by no means an illogical place for the MFUA's epidemiological methods, and Page found himself as comfortable there as he had been in the NRC.176

However, the IOM was as uncomfortable with the MFUA as the agency's other parental entities had been in its more than 40 years of existence. A site visit by two outside investigators to familiarize the IOM with the workings of the MFUA took place in 1989. Pronouncing themselves ''shocked" to learn that the Medical Follow-up Agency's very existence was in peril (although they admitted to being previously unaware of its existence themselves), the investigators called for "important changes" so that the agency might "continue, or even perhaps become again, the national resource it was intended to be." To quell the "interim'' feelings that they detected on the part of the staff (only about ten persons at that time), the investigators recommended that the MFUA fill the position of a permanent director as soon as possible, preferably with a physician or epidemiologist. They urged securing long-term core funding, subsequent staff growth, and computer upgrades and spoke of the need for the agency to reach out better to the scientific community and the VA.177

By 1990, the Medical Follow-up Agency was again pursuing an active mandate. The agency sponsored a conference on epidemiology in military and veteran populations, as a sort of sequel to the workshop held in 1988, even publishing the proceedings with Dr. Page as editor. Seventy people attended the conference, which was intended both to report on the work of the agency and to draw new investigators into its orbit. After two years of wrangling and arm twisting by Senator Alan Cranston (D-California) and other members of the Senate Committee on Veterans Affairs, some of it public, first the NIH and then the VA agreed to fund the core program of the MFUA. Page and his staff believed that the funding derived from these agencies was more than sufficient for planning activities as the MFUA continued to grow in size for the second time in its history.178

In 1990, CEVFUS met again to discuss the agency's program and discovered an abundant amount of research done under MFUA auspices. Staff reported on the completed POW questionnaire, which found depressive symptomatology in POWs at a level three to five times higher than expected in a comparable general population. A study of hepatitis B and liver cancer in World War II veterans discovered little incidence of liver cancer in the study group. Ongoing efforts featured an examination study of former POWs, two other hepatitis studies, the mineral oil adjuvant study, and a pilot study of World War II veteran death reporting. Studies that awaited funding included the HIV study, an examination of Korean hemorrhagic fever (see Box 15), a study of multiple sclerosis, three twin studies, and a follow-up of nuclear veterans. In addition, the committee heard discussions of the body build registry, posttraumatic stress disorder in World War II riflemen, Alzheimer's disease, and head injury.179



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