Dr. Robert Haley, shown here reviewing brain scans of Gulf War veterans, has been studying the illness for 28 years. Credit: UT Southwestern

No one knew what was going on. It was the early 1990s, and soldiers were getting sick. They reported memory problems, brain fog, headaches, fatigue, fever and pain. The symptoms were varied, the cause unknown. The sick men and women had one thing in common: service during the Gulf War.

Lisa Doggett

Was this bizarre constellation of ailments even a real disease? The government said no.

Enter Ross Perot, the Dallas billionaire and onetime presidential candidate, who had a passion for helping veterans and was frustrated with the government’s response. He asked doctors at the University of Texas Southwestern Medical Center to investigate.

One of them was Dr. Robert Haley, an internist and epidemiologist. After 10 years with the U.S. Centers for Disease Control and Prevention, Haley served as chief of epidemiology and preventive medicine at UT Southwestern. He had credentials, contacts and an insatiable curiosity.

With funding from Perot, Haley and his colleagues put hundreds of Gulf War veterans through a battery of tests and questionnaires. They developed a case definition of what would become known as Gulf War illness and designed a case-control study to hunt for a cause.

Eventually they found one: low-level exposure to sarin nerve gas, a chemical weapon released from Iraqi storage facilities when they were bombed.

“One [veteran] couldn’t remember his wife’s name,” Haley recalls. Others were struggling with cognitive and physical challenges and facing skeptical doctors, while the government denied that nerve-gas exposures had occurred.

In 1997, Haley published his first three papers on the subject. “I presented [my research] to a room full of reporters, all holding microphones in my face,” he said. “We were contradicting the government.” It took more than a decade for the government to finally admit to the reality of Gulf War illness, which affected an estimated 100,000 to 150,000 of the 700,000 Gulf War veterans.

Haley has continued to study the condition. In his latest paper, released in Environmental Health Perspectives this week, he put another piece of the puzzle in place. He and his team discovered that a gene, paraoxonase-1 (PON1), produces an enzyme that destroys sarin gas in the blood and protects against low levels of exposure. People who have a lower-functioning form of the PON1 gene are much more likely to develop Gulf War illness.

“We are now able to make a causative determination from the gene-environment interaction,” Haley said. He’s hopeful his research will offer insight into how to test for and treat the condition.

Campaign Against Coal

In 2007, another problem caught Haley’s attention. Power companies had proposed up to 19 new coal-fired plants in Texas. A notorious source of air pollution, coal was already making people sick. One study estimated Texas power plants contributed to 33,000 asthma attacks and 1,160 premature deaths annually — more deaths than from drunk driving or murder.

Haley’s headstrong sister-in-law, environmental activist Margie Haley, convinced him doctors could help.

Haley, then president of the Dallas County Medical Society, connected with Tom “Smitty” Smith, then director of Public Citizen’s Texas office and a leader in the push for clean energy, who agreed physicians could play a powerful role in the fight against coal.

“We didn’t know if the Dallas County Medical Society would support this — [it had] a lot of conservative doctors,” Haley said. But, with help from the society’s CEO, Michael Darrouzet, he surveyed physicians and was astonished when 96% said the society should address coal pollution.

Haley campaigned to stop the new coal plants and clean up or close old ones. He wrote opinion pieces. A delegate to the Texas Medical Association, he lobbied to pass the TMA’s first policy statement on clean air. Ultimately,plans for most of the new plants were scrapped.

“Robert understands the key role physicians have in shaping public opinion, and that their voices and medical research can be transformative in shaping policy,” Smith said. “His mentorship has led to a decade of studies on health impacts of air pollution by Texas scientists and scholars.”

West Nile and Climate Change

In 2012, Haley’s attention shifted to an even more controversial topic: climate change.

“As the coal work was winding down, we had a big West Nile outbreak … the largest epidemic ever in Dallas,” he said. Almost 400 people got sick in the Dallas area with the virus, and 19 died. Haley was surprised, since cases had been rare in the preceding years. Why did it happen?

Working with the Dallas County Health Department, Haley discovered an important connection between the number of hard-freeze days each winter and West Nile. Because a freeze reduces a mosquito’s ability to survive, a milder winter meant more cases.

Struck by this finding, Haley read everything he could about global warming. He became convinced that climate change was “proven beyond anything we’ve ever proven in medicine.” 

Haley started talking to colleagues. “I would bring it up at lunch,” he said. “Everyone had strong opinions, but no one had any idea what the evidence was.” He summarized climate studies in a PowerPoint and presented it to a group of internists from across the state. “They loved it. Nobody said anything negative — even the conservative doctors.”

Encouraged, Haley shared his talk with a wide range of physicians, medical students and the lay public, with Federal Reserve officials, even oil and gas executives. His audiences were impressed. “When you show them the evidence, people come away [thinking], ‘Oh my God that’s frightening.’… [I] don’t embarrass people or bring out political stuff – when they see it, they are free to make up their mind.”

“He has a keen ability to recognize how politically charged the subject of climate change is in Texas,” said Karen Batory, vice president of population health and medical education at the TMA, who has worked with Haley for more than a decade. He “listen[s] to windows of opportunity to advance the latest research, demonstrate the negative health consequences for patients and make tangible and credible recommendations.”

“We’ve got 10 years,” Haley said, until we reach a tipping point. “Think about your grandchildren [who] are going to live to see this happen. It’s not going to be pretty. It’s going to be horrible.”

Commitment from the federal government — with cooperation from the private sector – is key, Haley said. “All the great achievements of our country are when the federal government got behind it,” he said. “The problem is special interests and elected leaders are getting in the way.”

Nonetheless, Haley isn’t giving up. “I kind of thrive on setbacks,” he said.

Lisa Doggett, senior medical director of HGS AxisPoint Health, is a columnist for Public Health Watch. The views expressed in her column do not necessarily reflect the official policy or position of HGS AxisPoint Health or Public Health Watch.