Counterpoint: Responding to inadequate critique of birth defects paper

Before responding to Haley's critique (1) of thethree papers recently published in the New EnglandJournal of Medicine (2-4), we would like to place ourresearch in perspective. We conducted an exploratorycomparison of the available medical data for two largecohorts to see if there was an association between GulfWar service and the risk of birth defects. As pointedout by Wegman et al., there is a "serious lack ofinformation about risk factors" (5, p. 704), and so ourstudy was conducted without specific environmentalexposure hypotheses. It was an initial, rather than afinal, evaluation of reproductive outcomes amongGulf War veterans.Haley goes into great detail about why he believesthe findings of our report are not valid, includingdeveloping and arguing a complex scenario of "giv-en," "if," and "then" statements. A review of Haley'sargument regarding the birth defects study is in order.The first "if statement ("The wartime exposures(e.g., chemical or biologic toxins) in deployed veter-ans caused both the symptoms of the Gulf War syn-drome and birth defects" (1, p. 320)) is offered with noconsideration for biologic plausibility or even specu-lation regarding which exposures might possibly causeboth a "Gulf War syndrome" and birth defects. Futureresearch efforts would benefit if Haley could offer ahypothesis regarding a Gulf War exposure that mightcause both a newly described chronic condition andpaternally mediated teratogenesis. We hope he will beforthcoming, particularly since the role of and mech-anism for male-mediated teratogenesis remain unclear.Haley's argument also has errors in logic. In this "ifstatement, he lists the "Gulf War syndrome" sepa-rately from birth defects, while in the following para-graph he redefines them as one and the same ("... birthdefects are part of the Gulf War syndrome ..." (1, p.320)), which forces the "if statement to be true. This