VIEWS: 5 PAGES: 17 POSTED ON: 11/7/2009
INDEPENDENT PUBLIC INQUIRY INTO GULF WAR ILLNESSES MINUTES OF PROCEEDINGS held at 1 The Abbey Garden, London SW1P 3SE on Thursday 23 September 2004 DAY TEN Lord Lloyd of Berwick, in the Chair Dr Norman Jones Sir Michael Davies (From the Shorthand Notes of: W B GURNEY & SONS LLP Hope House 45 Great Peter Street LONDON SW1P 3LT) 2 PROFESSOR DAVID COGGON, Called 1. THE CHAIRMAN: Can I say first of all that we are very grateful to you for coming. I think you are definitely our last witness. I say definitely but it is hard always to say that because, you never know, somebody else may turn up. Could you perhaps start by giving your name and address for the purposes of the shorthand writer? A. Professor David Coggon. My office address is MRC Environmental Epidemiology Unit, Southampton General Hospital, and that is Southampton SO16 6YD. 2. THE CHAIRMAN: How long have you been in that post? at that MRC unit since 1980. I became a Professor in 1997 I think. A. I have been working 3. THE CHAIRMAN: Yes, I follow. I do not know whether you have produced for us a paper, I am not sure that you have. A. No, I have not. 4. THE CHAIRMAN: Will you in a sense explain why you are with us? A. Yes. I contacted your Secretariat at the suggestion of Major General Craig who is a member of the Depleted Uranium Oversight Board who said that he thought it would be helpful if I came to speak to you. I have not come with any special message that I want to bring to you. It might be more helpful at this stage if I told you what my background is and the ways in which I have been involved and allow you to ask questions, although one I area that you may want to go into particularly is what the Depleted Uranium Oversight Board has been doing and what is happening in terms of testing for depleted uranium. I am happy to answer questions insofar as I can on other matters. Just to explain where I am coming from. I am a medically qualified epidemiologist. My clinical training is in occupational medicine. My research interests are the epidemiology of occupational and environmental causes of disease and within that I have a particular interest in the health effects of chemicals and the health effects of physical activities and other aspects of work on musculo-skeletal illness. I have been involved in relation to Gulf War matters firstly through membership of the successive committees at the Medical Research Council which were responsible for selecting proposals for research on Gulf War Illness and more recently as Chairman of the Depleted Uranium Oversight Board which is the independent Committee that was charged with overseeing the development of the retrospective testing programme for exposure to depleted uranium in the Gulf War and the Balkans. 5. THE CHAIRMAN: I suspect we will want to hear you on both aspects of that, both on the early days of the Medical Research Council advice to the MoD as to what research should be carried out - I think that is important - but also obviously we want to hear you on the present position on depleted uranium testing. Which will you take first? A. It is probably easier to take the depleted uranium testing first. What I do not want to do is to waste your time by duplicating information that you already have so it would be helpful for me to know where you would like me to start. THE CHAIRMAN: What we have got is the massive report from the Royal Society from which, as you know, there is a smaller version which is more readily understandable by the likes of me. I think that is our most updated view on depleted uranium but we also have with us, as you know, Professor Schott from Germany. I have forgotten for the moment your university. PROFESSOR SCHOTT: My name? Schott. 3 THE CHAIRMAN: Yes but from which university? PROFESSOR SCHOTT: The Free University. I am retired 6. THE CHAIRMAN: Who has made a particular study and given us the benefit of his advice on this issue of depleted uranium. Incidentally, you know Dr Norman Jones, I suspect? A. Yes I am a Fellow of the College but I spend more time in the field of occupational medicine. 7. THE CHAIRMAN: And I should also have introduced Sir Michael Davies. A. Perhaps I should start by saying I think that the Royal Society reports are of the highest scientific quality and they represent when written at the time the state of the art in terms of reviewing the potential risks from exposure to depleted uranium through its military use. I concur with the conclusions that were reached in the two volumes of the reports, particularly where they attempt to assess the sorts of exposures that one might predict to have occurred through military use and the implications that those exposures would have for health risks in terms of risk both of cancer from ionising radiation and risk of toxicity, particularly to the kidney. I also think that the report did a good job in trying to identify where the uncertainties are. It is very important when we are evaluating scientific evidence not only to say where the balance of evidence lies but what the uncertainties are and how great those uncertainties might be. One of the uncertainties which was identified in the report was the level of exposure which soldiers and others might have incurred. You could make a best estimate on a theoretical basis but there was uncertainty about that. The best way to test that, and again I think it was identified in the report, would be if you had a situation where DU was being used in a military conflict and you could go in at fairly short notice afterwards and assess what exposures people had received by biological monitoring so you could do urine tests at that stage. It is easier to do it at that stage because the nature of the excretion and the metabolic handling of depleted uranium is that it comes up more rapidly through the body initially and then the excretion tails off so if you wait years later then what is being excreted is at a much lower level. That is actually being done now in relation to the recent conflict in Iraq and Professor Simon Wessely, who I think has been to give evidence to you, is leading a study --8. THE CHAIRMAN: This is in relation to the second Iraq War? A. Yes, which as part of that research - and it is only a small part of the research that he is doing - he is going to collect biological samples, urine samples from a sample of Iraq veterans to look at depleted uranium exposure. But that does not directly help veterans from Gulf War I and I think it was three or probably four years ago now, I cannot remember the exact date, the Minister in Parliament undertook to provide a screening programme for veterans who were concerned about possibly exposure to depleted uranium and that is how our Board came into being. There was an initial consultation exercise I think really to explore exactly what form a screening programme might take and on the basis of that it was concluded, I think quite sensibly, that it would not really be sensible to screen for disease in people in the way that you might do a cervical cancer screening programme or a breast cancer screening programme. The situation did not really meet the criteria that one would normally expect to be fulfilled for screening for a disease, and there are well-established criteria that have to be met in that situation, but we thought that it would be useful perhaps to some veterans if we could give them an indication of what exposure, if any, they might have had to depleted uranium during the Gulf War or if they were exposed more recently in Yugoslavia. 4 9. THE CHAIRMAN: When was the screening programme announced? Have you got a date? A. I have not got a date here. I can find out for you. 10. THE CHAIRMAN: It was about 2000? A. It was about three or four years ago and I can certainly find out for you. Actually our Committee was set up in September 2001 so the announcement that there was going to be a screening programme would have been some time before that, so 2000 or 2001, something like that. 11. THE CHAIRMAN: I follow. A. There was a broad consensus among the scientific community at that time that the best method to test for retrospective --- did I say it was agreed at that stage that you could not screen for disease but you could test retrospectively for exposure to depleted uranium? It was agreed at that stage that the best method for testing would be through the measurement of uranium isotopes in urine, and the theory behind this is explained in the Royal Society report, but essentially it is expected that the main exposure for most veterans, other than those who have shrapnel wounds, is likely to come from inhalation of fine particles of insoluble uranium oxide dusts (well, largely insoluble, some of them are soluble but a large proportion are insoluble). The insoluble dusts that are inhaled are taken in the lung and handled like any other insoluble fine dust so they get taken up and can get transported through the lymphatics, through the lymph nodes into the lung. They are expected to remain in the lung a long time and just gradually be dissolved away and as they get dissolved and the uranium goes into a soluble form it gets distributed through the body in a way that soluble uranium solutions do anyway and a large part of it is excreted in the urine. It is excreted alongside the uranium that we all excrete anyway because all of us are exposed to uranium in our everyday lives principally through what we eat and drink. The uranium that we eat and drink, unless there is something very peculiar happening, is natural uranium which differs from depleted uranium in its isotope composition. Is this something that you are familiar with? 12. THE CHAIRMAN: No but you are explaining it very clearly, if I may say so. Some of it is familiar to us but not all of it. A. I do not want to waste your time. 13. THE CHAIRMAN: Please carry on exactly as you are. A. Uranium, like almost all elements, can exist in a number of different isotopic forms. Chemically they behave in the same way but they differ in the number of neutrons in the nucleus of the atom and that means that their physical properties, for example their density and also their radioactivity, is sometimes different one from another. Most uranium is in the form of the isotope uranium 238, but there are other isotopes. The next most common one is uranium 235. Uranium 235 is the more radioactive of those two isotopes and when you want to use uranium as a nuclear fuel you enrich it and you treat it in order to increase the proportion of uranium 235, the more radioactive component, because that is what is needed in order to use it as a fuel. What is left over when you do that process is depleted uranium which has relatively less of the uranium 235 in comparison with uranium 238. Overall, uranium is actually not particularly radioactive. Everybody knows that uranium is radioactive, it is common knowledge, but actually it is not particular radioactive, and that is reflected in the long half life for the isotopes and that is something that causes confusion in the media. I have certainly seen some reports that suggest that if something has a long half life that means it is going to be around for a long time and therefore it must be a really big problem. But actually a long half life means it is not decaying so quickly so you are not getting so much radiation from it at a given time. That is where the depleted uranium comes from and there are a number of uses to which it is being put that really derive from its unusual physical properties. It is a very dense metal, it is almost twice as dense as lead so it has been used for engineering purposes, for 5 example as counter weights for rudders and things like that, it has been used in aircraft engineering, but it has also been used militarily. The advantages of depleted uranium penetraters are first of all they are extremely dense and their activity depends on the kinetic energy that they carry. Also they spontaneously combust when they strike an armoured target and that causes mayhem inside for the poor people who are affected. That is where the dust comes from that people are exposed to. If some depleted uranium is being excreted in urine, along with natural uranium, that manifests as a perturbation in the ratio of uranium 235 to 238. 14. THE CHAIRMAN: Sorry, say that again? A. If depleted uranium is being excreted in the urine, together with the natural uranium that we excrete anyway, that will manifest as a perturbation in the ratio of the two isotopes, uranium 235 and 238, so you will have relatively less uranium 235 as compared with 238 if you made a comparison with somebody who was just excreting natural uranium. So the tests that we have been developing look for perturbation of the isotope ratio in the urine. The techniques that are used to do this (and you use a mass spectroscopic technique) have really been developed initially in geology, mainly for studying rocks, so they crush up rocks, dissolve them in acid, get them into accrete (?) solution and then analyse them to look at the isotope composition of metals such as uranium. By doing that you can tell things about the dates of the rocks and where they came from. I am not a geologist so I do not know the detail, but that is where the techniques have been developed. When we came to look at this there was really very little experience anywhere in the world of trying to apply these sorts of techniques to biological media such as urine, which of course do not behave necessarily exactly the same as accrete (?) samples, and so our initial task was really to see whether a test could be developed that was sufficiently sensitive and sufficiently accurate to detect perturbation of the isotope ratio in urine from meaningful exposures to depleted uranium that might have occurred 14 or 15 years ago. 15. THE CHAIRMAN: That is the point where I am really beginning to lose you. One would have guessed that all the 238, as it were, would have been excreted years ago. A. It is depleted uranium. Depleted uranium is just uranium with a slightly different isotope ratio. As I explained, a substantial part of the exposure is likely to be highly insoluble uranium oxides and because these are highly insoluble they stick around in the body for a long time and only slowly get dissolved away. Even now somebody who inhaled insoluble uranium oxides 15 years ago would be still excreting some of that depleted uranium and they will go on excreting it into the future. 16. THE CHAIRMAN: Forever? A. Until they die. How much is coming out gradually decays, so initially you get quite a lot coming out in the urine, it goes down over time but the rate at which it goes down goes down more slowly as you get longer in the future. 17. THE CHAIRMAN: I can see that if there is some depleted uranium in the urine now there must be some explanation for that, and then a natural explanation would be that it happened 15 years ago, but what I am saying is if there is no depleted uranium in the urine I cannot believe that that is proof the other way round. A. What you have to rely upon is the scientific research looking at the way in which uranium oxides are handled in the body and how quickly they are metabolised. This is not my particular area of science but there are members of the Board who are experts in this area and we have had advice particularly from the National Radiological Protection Board in relation to this matter. If you look in the Royal 6 Society report I think it is probably in an annex to it that you will get an indication of the way in which the thinking works. But you can apply what are called pharmaco-kinetic models to assess and predict how chemicals will be handled when they get into the body. This is not just done for uranium but it is done for all sorts of chemicals that are of interest perhaps because of their potential toxicity. It is done for drugs as well. If you have an intake of a chemical into the body, it goes to a particular part of the body, it may then be metabolised in some way. It may move to other parts of the body and eventually it may be excreted in one form or another by different routes. Sometimes we excrete things in the breath, sometimes in the urine, sometimes through the bile and into the bowel. You can collect information about the rates at which the different processes involved in that occur and by putting them all together in a mathematical way you can predict what the fate of a given dose of the chemical would be, so how much would be still around so many years after or so many days or even it might only be a few hours, it depends on the chemical, what happens to it, how long does it stick around, which parts of the body is in it, how quickly is it coming out. 18. THE CHAIRMAN: This is work which you say was started in about 2000? It was announced --- A. Our work started in 2001. 19. THE CHAIRMAN: What stage have you now got to then? A. The stage that we have now reached is that we had a test method which we have tested out to assess its sensitivity and its repeatability. We initially identified three laboratories that were capable of carrying out the test to the standard that was necessary and contracts have been let with two of those laboratories to provide testing for our main testing programme. So we have done quite a lot of preliminary work in which we have taken samples of urine and spiked them with natural and with depleted uranium and then asked the laboratories to do measurements on them without knowing what the content of the sample was to see how well one laboratory agrees with another and also how well they agree with what could be predicted given what had been put into the urine sample. 20. THE CHAIRMAN: In the four years which have passed or three years which have passed since you started, have any veterans had their urine tested? A. So we did that first and then the next step --21. THE CHAIRMAN: They have? A. Yes. 22. THE CHAIRMAN: How many? A. 32. So the next step was to pilot the method for carrying out a test in practice, so for collecting samples from veterans, for providing them to the laboratory, for getting the results back, and for handling those results when they came. 23. THE CHAIRMAN: Can you explain what the results of the tests on the 32 were? A. Yes, it now should be published on our web site. Of the 32 who were tested in none of them was there any indication of exposure to depleted uranium. 24. THE CHAIRMAN: Have you also said that there should have been if they had been exposed to depleted uranium? A. Any bio-chemical test has a limit of detection. In other words, there are levels below which you cannot be sure that the test will show positive. From our preliminary work we are confident that the test is capable of detecting exposures that occurred 15 years ago at the level that would be sufficient to cause a material risk to health according to mainstream medical opinion, so the sort of analyses that you see in the Royal Society report, the sort of exposures that the Royal Society are saying, “These are the sorts of exposures to ionising radiation, exposure of the kidney to uranium metal at which one might 7 start to see a material risk to health or a material impact on health.” This test that we have is sufficiently sensitive to be able to detect those sorts of exposures even if they occurred 15 years ago. It will not detect all exposures. If somebody had a tiny exposure much lower than that 15 years ago then we could not be sure that it showed up. There are some scientists, including some members of our Board, who do not accept the consensus opinion on the relationship of health risk to given exposures to uranium. They suggest that the risks may be higher even from very, very low exposures, and we have to acknowledge that as an uncertainty. My own view at the moment is that what they have is a theory but precious little empirical evidence to support their theory. The way in which science works is that it moves on if people develop hypotheses and they test those hypotheses and produce evidence to support them. So we always have to be open to the possibility that our current thinking is not correct and it could be improved but you do not change your current thinking until you have evidence to justify a change, and at the moment the mainstream view, as expressed by the Royal Society but also other international bodies like the International Commission on Radiological Protection, is that these are the sorts of risks of health effects that you might expect from a set exposure to uranium and depleted uranium and our test, even allowing for the uncertainties in the pharmaco-kinetic models, should be capable of detecting exposures to levels where adverse effects might occur. 25. THE CHAIRMAN: What is proposed now? You have been looking at 32 over the last three years or so. What is proposed now? A. We only got to the stage of being able to do that earlier this year, and having successfully completed that pilot testing today we are announcing in the press the start of the main testing programme. 26. THE CHAIRMAN: I think we have read it in the press already. I thought I read it in The Times. A. It is in The Times. There is an advert in the Sun. I did not get contacted by any of the other papers yesterday so I do not know if any of the others carried the story. 27. THE CHAIRMAN: The Times carried the story this morning. that. A. Yes, I have seen 28. THE CHAIRMAN: That is accurate, is it? A. It is accurate in its main message. Like most press articles it has a number of inaccuracies. It is a little bit inaccurate where it talks about what has been done previously in terms of attempts at this sort of testing. The true picture is that there have been a number of scientific papers published in which investigators have attempted to assess exposure to depleted uranium retrospectively and the results have been published. However, the authors of those papers have not published data on the sensitivity and the accuracy of their methods and I think there are doubts about whether the methods are sufficiently valid to give credence to the results from at least some of those tests. Ours, as far as I am aware, is the first example in which somebody has actually tried to assess how reliable the testing would be. 29. THE CHAIRMAN: Retrospectively. How many people are you going to then test? What is your plan? How long will it take? A. Well, the plan is that of those who are eligible to be tested - and I can give you the eligibility criteria if you need them, it is probably easier to give them to you in writing - which includes all the veterans of the Gulf War conflict and also the veterans of the Yugoslav campaign after the time when depleted uranium was used there, should be able to have a test. The difficulty at the moment is that we have absolutely no idea what the demand will be so we have had to try to take a sensible line in the first place with flexibility built in so that if necessary we can scale up if we get a very big 8 demand. On the other hand, if we find that there is very little demand then we do not waste taxpayers‟ money providing a very complex testing programme that nobody wants. 30. THE CHAIRMAN: Everybody will be eligible. How are you going to choose those you actually test? Are you going to wait for them to volunteer? A. The situation is that we are advertising the availability and then those who wish to be tested first of all must contact the Gulf Veterans Unit, or whatever it is now called at MoD, who will assess whether or not they meet the eligibility criteria. 31. THE CHAIRMAN: What are the eligibility criteria, that they were in the Gulf? A. I can read it out for you if you want. They have to have been either in the Persian Gulf area between 1 August 1990 and 31 July 1991 or in the former Republic of Yugoslavia on or after 5 August 1994, either one of those, and they have to have done that either as members of the UK armed forces or civilian employees of the UK Ministry of Defence or civilians working under the control of the UK Ministry of Defence or civilians employed by NGOs such as some of the aid organisations. 32. THE CHAIRMAN: So eligibility simply depends on whether they were there, not on whether they complained of any illness? A. Absolutely, it is just about being there. There is no plan at the moment for prioritisation of applications and we are waiting to see what the demand is. Clearly if we had an enormous demand (and there is only limited laboratory capacity to carry out this sort of work) there would have to be some prioritisation of the order in which people were tested, and then we would have to look to see whether we needed to apply anything other than a simple first come first served. At the moment it will operate on the basis of „first come first served‟. 33. THE CHAIRMAN: Surely there is no reason to assume that people who are not ill are going to come and be tested? A. I think there is because certainly there has been research conducted by Simon Wessely and colleagues asking veterans whether if a test were available they would like to be tested and a substantial proportion say that they would like to be tested. Of course that does not necessarily mean that they would be true to their word when the situation arose. We often say we would like to do something when we are asked in a theoretical way in a questionnaire and then when it comes to the crunch it is too much hassle and we do not bother. I think there is good reason to believe that some people would want to be tested even though they are not ill. From a scientific point of view that would be entirely rational because in terms of the health risks from depleted uranium (if you accept the mainstream and medical scientific view) those that you would be concerned about are not short-term effects that cause illness that make you ill now, they are long-term risks of diseases like cancer. Some people might be unfortunate enough to have cancer at the moment but in general the main concern would be: “Am I at increased risk of cancer in ten or 20 years' time?”, so it would be perfectly rational for somebody to want to have a test even though they are asymptomatic at the moment. 34. THE CHAIRMAN: Can I ask you one last question on the DU side of it because I must hand over to Dr Jones. What really is the purpose of all this? Is it to try and satisfy the Ministry of Defence that DU is safe so that they can continue to use depleted uranium tipped shells, or is it actually to help Gulf veterans prove their case against DU if they have to prove it? A. I did not set up the programme. I was asked to oversee the development. The promise was made by the relevant Minister at that time in the House --- 9 35. THE CHAIRMAN: Who was that? either. THE CHAIRMAN: It does not matter. A. I cannot remember who it was at that time 36. A SPEAKER: Was it John Reid? A. It may have been but you would have to check elsewhere and you would really have to ask the Minister why he did it. I cannot speak for his motives. I can give you my view as to what I think the value of the testing programme is. There are some people I think who are worried about depleted uranium and some of those may be helped by knowing what their exposure has been. Some of them may not be. If somebody is convinced that their health has been put at risk by exposure to depleted uranium and they have a test and as it happens the test turns out to show no evidence of exposure, then they may not want to believe the test, they might want to say that it has been fixed in some way or that they do not trust it. I cannot do anything about that. All I can do is provide a test that I think is scientifically valid. There may be some people who would like to be tested for that reason. As a side effect it will actually tell us something about the sorts of exposures that might have occurred in a situation where depleted uranium was being used for military purposes. How much information it will give us about that will depend on the numbers who come forward for testing and how representative they are of the different exposure scenarios that might have occurred. The prime purpose is to provide information to individual veterans who want to know about their exposure. It is not being set up as a research project. It is not to collect information for research purposes. We have been very clear all the way through and I have had to remind some of my members on a number of occasions that that is why we are doing it. It is there to serve individual veterans, it is not there to collect information, but some of the information that emerges may be of use for research or it may tell us something more generic and we are asking for permission from veterans who take part to use their data anonymously for that sort of purpose. It will be limited in what it can tell us. It will not tell us about whether depleted uranium is causing health effects or not and that is because of the way in which people are self-selected to come forward. It is not epidemiologically designed to do that, but if we find that there are significant numbers with detectable exposure to depleted uranium, it may enable us to identify the sorts of activities in the Gulf and in the Balkans that were often associated with exposure. For example, it might be that we find that there are a few people where we find exposure to depleted uranium and all of them were involved in entering vehicles that had been struck by depleted uranium munitions or potentially struck and you did not see any exposure to depleted uranium in people who stayed away from the battle field and you did not see any exposure to depleted uranium in people who were in military hospitals. That is a theoretical scenario but that could be quite useful in terms of telling us where the exposure occurs. At the moment we have theoretical predictions but we do not have hard empirical evidence. The test that has been developed could also be applied for research purposes but that would be a separate exercise. 37. THE CHAIRMAN: I have two other short questions. Obviously you have taken account of any research that has been going on in the United States, have you? What is your position? A. Yes, we have liaison with the groups in the United States that are doing work in this area and I think on this they are a bit behind us. 38. THE CHAIRMAN: We have had, as you probably know, evidence from the United States on depleted uranium. I was just wondering whether you were abreast of all that. You must be? A. I try to keep abreast of what they are doing in terms of testing. I have not 10 regularly and systematically kept up-to-date with everything that is being published about depleted uranium and health effects from the United States. 39. THE CHAIRMAN: When are you going to get your first results that are going to be of any use? A. The laboratories have asked that we allow for three months from collection of samples for them to produce their results. They may be able to do it quicker than that in some cases but that is the sort of timescale that is realistic. This is not like a routine biochemical test that you get in hospital. It is really state-of-the-art science and it takes time to get these tests to run properly and you cannot do it with a very high throughput. So it will be some months again before the next batch of veterans start to get their results back and we are trying to make sure that people are aware of that when they come forward for testing so that they are not disappointed that they do not get things straightaway. It will not affect the accuracy of the tests and if people have to wait months or even a year or so to get tested that will not mean that they cannot get the results at the end of the day. It is not something that has to be done now in order to be picked up. There has been misinformation about that as well going around. THE CHAIRMAN: We are very grateful to you for an extremely clear and interesting explanation of it all, having said which I will hand over to Dr Jones. 40. DR JONES: First of all, how were the 32 that have already been tested selected? A. They were selected from a group of individuals who had spontaneously and voluntarily enquired about the test before it was advertised and said that they would be interested in being tested. Some were identified through veterans‟ associations, I think some through the Royal British Legion. MAJOR GENERAL CRAIG: Yes, the bulk of them were from the Gulf Veterans‟ Association of the Royal British Legion, some were civilians who had come forward and some were from St John‟s and the Red Cross. In fact, the National Gulf Veterans‟ Association had no volunteers in that pilot study at all. 41. THE CHAIRMAN: Yes, thank you. A. So they were self-selected, they were volunteers, and also they had to be reasonably close to one of the two centres we were using for collection of samples which were in London and in Glasgow for that, so they are not necessarily representative in any way of all the people who might be eligible for testing. For that reason when I say that none of the 32 showed any evidence of exposure to depleted uranium that should not be taken as an indication that we are not going to find exposure to depleted uranium when larger numbers come forward for testing. If it becomes clear fairly rapidly that when you do test large numbers of people you do not find evidence of depleted uranium my expectation is that interest in being tested will dwindle away because people will either interpret this as “nobody has got important exposure so it is not worth being tested” or “I do not believe the test so I am not going to bother to go through with being tested”. Either way I suspect that there will not be a lot of interest if the word gets round that everybody is testing negative. On the other hand, if we found that ten or 20 per cent of people are showing evidence of exposure to depleted uranium I think there might well be quite lot of interest in people coming forward. It is very difficult for us to predict at the moment and we are trying to balance between not wasting taxpayers‟ money yet providing the sort of service that veterans deserve and want. 42. DR JONES: The next question really touches on a bigger issue which I will come to in a moment. Would I be right in thinking that those 32 who were self-selected had some 11 particular reason for thinking they might have been exposed? A. I guess you would not ask to be tested if you did not think there was a possibility but the individual grounds of suspicion may have been very different from one person to another and I am not aware they were all in the sort of situation that you or I would regard as being at high risk of higher exposure. 43. DR JONES: A moment or two ago you stood my slightly simplistic world on its head. I had thought that it might be quite possible to predict which people, which personnel were most at risk of exposure by their occupational histories during the conflict whereas a couple of minutes ago you were rather taking the reverse view that you might be able to approach through the findings of urinary excretion of depleted uranium who might have been most at risk. A. You can predict and the Royal Society have tried do that and the MoD and the military more recently have actually applied a scale of exposure probabilities in deciding how to manage biological monitoring for military personnel in Iraq. But there is going to be benefit from testing out the theory empirically and certainly there are some veterans who believe that they may have been exposed in situations where mainstream scientific opinion would not count it as being very likely they were exposed, and we need to find out for those people I think because they are concerned. 44. DR JONES: Probably implicit in your answers is the answer to the next question. I suppose you have no information about the sort of numbers or the percentage of deployed personnel who according to current concepts might have been seriously at risk of exposure? A. I cannot give you a number. 45. DR JONES: You quoted personnel who actually went into Iraqi vehicles which had been destroyed by DU-containing weaponry. A. My impression from reading the Royal Society report is that it would have been a tiny minority that would have been at risk of the very high exposures but I cannot give you chapter and verse on that. 46. DR JONES: Fair enough. Have you thought ahead to what will be told to veterans in this new programme who do test positive? A. Yes, it is something that we have thought about at great length. It is quite difficult because there is a range of scientific opinion on our Board and we need to try to represent in a meaningful way the range of opinion. One of the challenges is that a lot of people like to be given fairly clear advice from somebody they trust when they go to see a doctor or get a medical opinion, but on the other hand some people like to know what the uncertainties are, and it is how do you balance what one person needs and what another person needs. We have agreed a form of wording for the advice that we will give to people where there is no indication of exposure to depleted uranium and essentially that says that there is no evidence from your test that you were exposed to depleted uranium. This is the amount of total uranium you are excreting daily (and for most of them that will be within the expected range for the general population) and mainstream medical and scientific opinion is that the test is capable of detecting exposures that would cause any significant risk to health but there is some disagreement on this and further research is continuing. I can give you the exact wording if you would like to see that. The next level up will be people who show some evidence of excretion of depleted uranium but when you do the calculations, even though they show evidence of excretion of depleted uranium, the dose that you calculate they might have received 15 years ago, assuming it was as long as that, is really at the level where you would not expect adverse effects. We have got a provisional wording to use in that situation but really we want to wait and see exactly what the scenario is and we will find our way in the first place with a few real cases when they come along and agree how we are going to approach them and out of that will evolve a more generic approach to the situation. Going 12 beyond that, if we get some individuals who have evidence of even higher levels of excretions of depleted uranium then we will treat them on an ad hoc basis. As part of setting up the programme we are in the process of securing the services of a senior consultant physician with experience in occupational and environmental medicine to act as a medical adviser to those people who have been tested and who would like to know more about what their tests mean and we are just in the process of finalising the arrangements for that and then he will need to be briefed by the Board and ask us questions so we are all clear about what our thinking is in relation to interpretation of results. It was a little bit difficult again because some veterans were very anxious not to have advice being given by anybody who had connections either with the military or the MoD or the nuclear industry and that rules out most of the doctors in this country who have any expertise in this area. I think we have found a very good person to do it and I hope he is going to accept. 47. DR JONES: Obviously a lot of thought has been given to that. One last question: you mentioned a minority of scientists, including some members of the Board, who thought that the risks from low exposure might be higher than conventional wisdom would suggest at the moment. A. Yes. 48. DR JONES: What reasons do they advance for their belief? A. You would do better to ask them and probably have. Chris Busby is the man to ask. Has he been to give evidence? 49. DR JONES: No. A. And Malcolm Hooper might be able to explain it to you. My understanding is that it relates to the fact that the radiation that you get from uranium 235 is alpha radiation. These are relatively large sub-atomic particles with high energy but they do not go very far so they can cause a lot of damage to the tissue that they hit but they do not get very far into the tissue. The theory I think relates to the fact that if you have an alpha remitter that is fixed in one place and which is an insoluble particle, then the cells immediately adjacent to it are going to get more than one hit and they may get more than one hit in fairly rapid succession. He is theorising on the consequences of that, I think, but it would be wrong for me to try to go into it in more detail because it is not my field and you would be better to ask a radiobiologist about it. I think there are others who have seen the theory and have reasons for doubting that it would have a big impact on risk. Ultimately, of course, as in any area of science, if you have a hypothesis then the onus is on you to go out and test it and what we need is empirical evidence before or against it. I do not think mainstream opinion is going to shift unless there is good evidence that it is wrong at the moment. 50. SIR MICHAEL DAVIES: Professor Coggon, could I ask you what the veterans have to do to be tested. You said that 32 lived close to Glasgow or London. A. Not too far away. 51. SIR MICHAEL DAVIES: Do the others all have to go to the laboratories or do they go to their GPs? A. No, we are setting up a panel of clinics to which veterans can go to deliver urine samples. The exact process is that they contact the Veterans Unit at MoD who check their eligibility. That is the limit of their role. If somebody is eligible the MoD will then pass the contact details of that individual to a separate contractor who has been engaged to oversee and co-ordinate the whole testing programme, and that is a company that is based in Redditch. Their main business is providing occupational health services to large organisations across the country, but they are very well geared up to this sort of co-ordination exercise. They will then identify one of the clinics that we have contracted that would be 13 most convenient for the person to attend. At the moment we have four clinics and a fifth just in the process of being finalised and we are looking for more, but we did not want to delay the onset of the programmes while we waited to get more and more. It has been long enough getting it going without that. Most of them are NHS occupational health departments based in NHS hospitals but the latest one is a private company. We are not fussed which it is as long as they can do the job properly and it is convenient for the veterans in travel arrangements and things like that. Having identified a clinic the co-ordinating centre then write to the veteran and send them, first of all, a questionnaire asking them to fill that in and bring it with them when they come to the clinic and, secondly, providing them with a bottle to collect a 24-hour urine sample with instructions how to collect that sample and they get advice sheets as well. There is a contact number and if they want further information they can come back with queries. They collect the 24-hour sample just before they come to the clinic, they come to the clinic with that and the questionnaire. At the clinic someone receives the sample, seals it in a tamper-proof bag in the presence of the veteran having labelled it and numbered it, takes the questionnaire, checks that it is completed and asks questions if there are any bits that are not clear, offers to provide the veteran with a copy of their questionnaire as well if they want to keep it for their own records, and then holds the questionnaire and the urine sample in the bag, and then within four days of collection the urine sample is sent to one of the two laboratories that is carrying out the analyses and the questionnaire is sent to the co-ordinator in Redditch. 52. THE CHAIRMAN: So we have got two laboratories, we have got a co-ordinator and how many clinics? A. Four going up to five and we hope going beyond that. We have also got a medical adviser. We had hoped that we would find somebody who would do the whole lot but when we put it out to tender nobody came forward. We tried encouraging people to come forward and nobody was interested so we have had to go the long way round and organise it ourselves, but that is life. 53. THE CHAIRMAN: This is the programme which has in fact been announced today, as least insofar as I have read about it in The Times for which the MoD is providing how much money? A. I asked this the other day because the Board has not been involved in the financial decisions. The way it has worked is when tenders have come we have been asked to assess the quality of the tender from a scientific and practical point of view and then the budgetary decisions are taken within MoD. My understanding is that the cost of the exercise at present with the sort of commitment that has been made (which is for up to 500 tests over the next year plus all the development work) will be I think probably between half a million and £1 million, but again I am not speaking officially on that and if you really want to know what it costs then you need to ask the Minister and he will find out from MoD. I should say that the members of the Board do not get paid for their services. They are in the same position that you are. I think some who do not have other jobs have the option of being paid but those of us who are in other jobs do not get paid for serving on the Board. 54. SIR MICHAEL DAVIES: My second question is that you have told us it could be three months to do the test, so how many tests can each laboratory handle at any one time because if you are expecting a lot of well veterans there are 53,000 potentially out there? What is the throughput of these tests? A. The two laboratories differ. One of them is capable of working to a higher throughput but the testing is slightly less accurate and sensitive. The other has a more sensitive, more accurate test but is it less geared up to routine work and cannot promise quite the same throughput. What we have at the moment is capacity to test 500 people which is what we are aiming for over the first year. We also have to build into the laboratory work not only the testing of individuals but some of the samples will be analysed in duplicate because we need to check that they are maintaining their performance 14 and there will also be some further spiked samples that are put into the system without the laboratories being told which they are, again to give quality assurance, so there is some extra work they have to do in addition to the actual testing of individual veterans but that is how it is at the moment. If we find that there is enormous demand and it is going to be into the thousands then we will look to scale it up and if necessary that will mean purchasing additional laboratory equipment and paying for additional staff and that is something that MoD would then have to find the money to pay for. But we need to see what the demand is going to be. I do not think it would be sensible to try to cater for very large capacity at this stage without knowing what people want. 55. THE CHAIRMAN: We are very grateful to you, Professor Coggon, for that part of what you have told us which was extremely interesting and valuable. Do you think we could briefly turn to the other aspect which is the question of epidemiological studies because, as I understand it, the Ministry of Defence was really taking advice from the Medical Research Council as to what studies should be done and how to approach the problem of Gulf War Illnesses. How well does your memory go back to 1993 and 1994? A. I am afraid I do not think I could remember any detail from that time. 56. THE CHAIRMAN: Although you were you part of the Medical Research Council team? A. I was a member of the committee that was responsible for assessing bids to do research in this area, the committee which actually oversaw the commissioning of the research that was done by Macfarlane and Nicola Cherry and colleagues in Manchester at that time and also the work that was done at the London School of Hygiene and Tropical Medicine, Pat Doyle and others. Simon Wessely‟s study was already in progress being funded from the United States at that stage but we also kept abreast of what he was doing as well. 57. THE CHAIRMAN: The problem, if I could just interrupt, is this: we know that when the Gulf War Veterans‟ Association was formed one of the very first things they did was to press for a proper epidemiological research into what had been going on A. Yes. 58. THE CHAIRMAN: But the answer which they got from the MoD, as I understand it, given in the House of Commons in December 1994 was that “in the absence of any confirmed scientific evidence that there is a health problem resulting from Gulf service, I do not believe that there are any grounds at present for such an inquiry” That answer was considered by the House of Commons Defence Select Committee and their comment on that was that they were appalled that it had taken four years and even then no full epidemiological study had been set up. And in practice we know that Simon Wessely had to go to the United States for funding and no proper study was set up in England until December 1996. As you are an epidemiologist, what I think I am anxious to find out is would it not have been possible for a survey to have been started, as the Gulf War Veterans‟ Association asked, very much earlier than 1996? A. It certainly would have been possible to do the study much earlier than that and of course studies are being done now much earlier in relation to the recent conflict in Iraq, so in terms of is it a practical possibility, yes, of course it is. On what sort of studies you could do early, of course not all studies would be appropriate to do at an early stage. For example, there is little point in trying to do a study of mortality or cancer incidence one year after people have been exposed because it is not long enough time to accrue cases. On the other hand, studies looking at possible acute, short-term health effects, that is very much the time you want to do it and if you delay it then it is going to be much harder to get the information that you want because you are asking people to remember things. So in terms of when is the best time to do epidemiological studies and when is it possible, yes, you can do 15 studies early on. I was not involved in the decision making at that stage. My involvement was once the MoD had said to the MRC: “We want to support some studies on Gulf War Illness; can you help us in selecting studies for funding?” I think in generic terms one can see that in a situation like this where the question is being asked should you fund research in this area, it is really a judgment as to whether the research is going to be useful or not and whether it justifies the costs. 59. THE CHAIRMAN: That is really the point of my question because I think the MoD will say or have said that the reason why epidemiological studies were not carried out earlier was that the MRC advised against it. A. I am not aware of that. 60. THE CHAIRMAN: We need to find out whether that is the case. A. I am not aware of that. I think what the MRC might have been asked about was were there scientific reasons to suspect that people were at risk of disease because of the sort of exposures that they had there. There are two reasons why you do research. One is because you suspect that people have been exposed to a serious hazardous disease, and you want to know whether there is an increased risk and what the nature of that risk is. Another reason you do it is people are worried about things and they want answers to questions. Even if there is not a very strong scientific suspicion of a problem, the fact that people are worried may be a reason for doing a study. It is the sort of thing we encounter sometimes where you have a cluster of cancers in a workforce or in a village and people are worried is there something going on. When you are deciding whether you should do research, part of the decision is based upon what the level of scientific suspicion of a problem is but also part of the decision is based on how much concern and anxiety there is. It seems very clear from the way in which the MoD has acted following the Iraq War where they have commissioned research at a much earlier stage, I would guess, and I cannot speak for the MoD, they would say in retrospect they wished they had commissioned research earlier after the first Gulf War, but we all learn from our experience, do we not? THE CHAIRMAN: Thank you very much. Did you want to ask anything on that? 61. DR JONES: Very briefly. The MRC committee to which you refer is the one chaired by Catherine Beckham? A. There was certainly one that was chaired by her. There was another one that was chaired by Alan MacGregor I think. There was a sub-committee that I was on as well. There was a main committee and then more recently they have been replaced by a new Military Health Research Advisory Group. 62. DR JONES: And the sub-committee you were on, the remit was what? A. I think it was overseeing the epidemiological studies. I would have to go back through the papers. I was on lots of committees over the time. It was certainly looking at the studies being done in Manchester, the studies being done at the London School and also keeping an eye on Simon Wessely‟s studies. 63. THE CHAIRMAN: That was all much later, was it not, that was not until 1996, 1997, 1998. A. Probably, I really cannot remember. 64. THE CHAIRMAN: I am more interested in what was going on in 1990. cannot speak to that. A. I THE CHAIRMAN: We happen to have with us another great expert on the subject of depleted uranium and I am just wondering, Professor Coggon, if you would like to take a seat. 16 Maybe he has got nothing to add to what he has already told us but he has listened to what you have said I am sure with as much interest as we have and he may have some comments. The Witness Withdrew PROFESSOR ALBRECHT SCHOTT, Re-Called 65. THE CHAIRMAN: Professor Schott, we are very glad to see you here again. Would you like to come and sit on the chair. You will have heard obviously what Professor Coggon has been doing these last three or four years. Do you have any comments on what he has told us which would be of use? A. Yes, I have some comments. My evidence and my two supplementary evidences already give some answers to what colleague Coggon did tell us. His comments and his evidence was for you interesting; for me it was very basic. You know that we are asking for the new evidence and the evidence that is necessary to find out what happens in the inner metabolism of a cell is being researched. There is some knowledge but except my short evidence some time ago it is not evidenced here and is not evidenced by colleague Coggon. It was very basic. It was the first step of the DU information that is necessary for an independent public inquiry and this has to be the very beginning and now many steps have to follow if this evidence wants to prove that it - excuse me - fulfils his self-selected task. This is the matter. Of course my task is deeper inside what is going on when the DU enters our bodies and therefore I am preparing this DU review for you and for others. I can tell you parts of that now but it is not finished. If you have DU in your body DU in the periodic system is a high number so it has the ability to have five oxidation steps - two, three, four, five, six. They are all different in their chemical toxicity. Then they have the possibility for complexation, the oxidation stages, the so-called speciation, and there is very basic research by Professor Dahmer (?) and I gave you his address and he has papers about that. The second point is the binding form. If you have this uranium two, three, four, five, six, I only speak about four and six, these are most stable oxidation steps of this uranium. It can be in a positive charged ion and it can be part of a negative charged ion. It can complex with phosphate, with carbonate in the cell. That means in the body of the human, in the animal and in the plant. They all have of course different toxicities. There is not one chemical uranium individual. There are in the meantime at least a dozen - two, three, four, five, six, cardnium, anion, complexation to carbonate and to phosphate - and, and, and - in the cell. We have to look to the uranium in the living cell in the cellular metabolism if we want to find out what is the toxicity, what is the cause of the DU part of the Gulf War Illness, and so these are the things we handle and if we test uranium in the urine we make a very, very basic step. 66. THE CHAIRMAN: Yes, I think I follow that. it is not much. A. This is good but you understand 67. THE CHAIRMAN: What surprised me I think about Professor Coggon‟s evidence and I am sure it did not surprise you but perhaps you can confirm it - that it is possible to tell 15 years after the event from analysing a veteran‟s urine now what he may have been exposed to 15 years ago. As a layman one would have guessed - and I put this to Professor Coggon and he answered it - that by now any depleted uranium would long since have gone, have disappeared in the urine, but now in your words do you confirm what Professor Coggon has said about that? A. I confirm many of the comments of Professor Coggon of course and I also confirm that it is possible to get information about what happened 15 years ago despite the fact it is 15 years delayed. 17 68. THE CHAIRMAN: He will be very glad to hear you say that! A. But --- 69. THE CHAIRMAN: It still surprised me but there we are. A. --- But if you want to get real insight into what happens, you must go further. You will remember that I organised chromosome aberration tests and if you look for the urine you are still in the mineral state and if you look to the chromosome breaks in the cell you are in the living body, you are in the living cell and on the information you get 15 years ago you have first of all to make the chromosome aberration test --70. THE CHAIRMAN: We have got that part of your evidence well in mind. A. I spoke about that in my comments and my comments on the evidence of Major General Craig. I gave you this information about the abilities of uranium. The reason is to tell you what about your handling of the complexity of that. These are different toxicities and the radiological toxicity adds to that and if you look to the uranium you have to look to all these different specimens, and there is already scientific evidence about that. THE CHAIRMAN: Well, I think you have certainly answered the question I wanted to ask you. I do not know whether Professor Coggon wants to add anything himself as a result. PROFESSOR COGGON: I think it helps for you to know where we agree. It is correct that what we are developing is a test for exposure and, as I have said earlier, there is a mainstream view about how that translates into health risks. There are uncertainties about that and clearly if you want to try to resolve those uncertainties then you need to do studies in which you look at the relationship between exposure and the health outcomes that you are concerned about. If you have a test that works then you have a way of assessing people‟s exposure. You can then put that alongside information on health outcomes, whether it is chromosome aberrations or other aspects of toxicity that worry you, and then you can start to do research that will help to resolve those uncertainties. THE CHAIRMAN: Well, thank you again very much for your help. I think that is all the evidence we are going to listen to today. Thank you again, Professor Schott, and so we will rise. The Witness Withdrew _____ 18
"PROFESSOR DAVID COGGON_ Called"