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MINISTRY OF DEFENCE FINAL
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Gulf Veterans’ Illnesses Unit
MINISTRY OF DEFENCE
Zone A, Floor 7, St Georges Court,
2-12 Bloomsbury Way,
London, WC1A 2SH
Telephone
Direct dial
020 7305 4644
Helpline
0800 169 4495
Fax
020 7305 4166
FINAL
Our Reference:
D/GVIU/7/1/8/2
Date:
3rd July 2003
MINUTES OF THE TENTH DEPLETED URANIUM SCREENING
PROGRAMME OVERSIGHT BOARD MEETING ON 12
th
MAY 2003
Present:
Board:
Observers:
Professor David Coggon
Surg. Cdre Nick Baldock
Mr Ron Brown
Dr Chris Busby
Mr Ivor Connolly
Dr George Etherington
Mr Jim Glennon
Dr Muir Gray
Dr Gideon Henderson
Professor Malcolm Hooper
Dr David Lewis
Dr Gordon Paterson
Professor Brian Spratt
Mr Shaun Emery
Air Cdre Simon Dougherty
Mrs Brigid Rodgers
Wg Cdr Charlie Wilcock
MRC
INM
DRPS
LLRC
NGV&FA
NRPB
NGV&FA
NSC
Ox Uni
GVA
INM
BRC
RS
GVIU
DMSD
GVIU
DMSD
Chair
Secretary
Apologies:
Mr Alan Duncan
Professor Ian Gilmore
Mr Neville Higham
Dr Len Levy
Dr Margaret Spittle
Dr Hilary Walker
HJA
RBL
HSE
MRC IEH
MH
DH
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Item
Discussion and Decisions
Actions
(Action date)
1.
Introduction
a) The Chairman stated that George Etherington and Gideon Henderson had been
formally invited to join the DUOB by US of S, Dr Moonie.
b) The Chairman informed the DUOB that Beverley Green would no longer be
attending due to a change in job. A replacement would be nominated by the
British Legion. The Chairman undertook to write to Beverley Green to thank her
for her contribution to the Board.
Action 10.1. Chairman to write to Beverley Green
c) The Chairman drew attention to the fact that a decision of the DUOB had been
published on a website before the minutes documenting that decision had been
published. He reiterated that, while individual members were free to express their
own opinions publicly on matters relating to DU, they should not claim to speak
on behalf of the Board. The business of the DUOB should be reported through
official minutes and through the Chairman.
Chairman
(13/6/03)
2.
Minutes of Last Meeting
a) Minor changes to the minutes of the last meeting were agreed by all Board
members.
Action 10.2. Secretary to amend minutes of 9
th
DUOB and circulate
Secretary
(13/6/03)
3.
Matters arising from last meeting
Comments on Documents
a) The Secretary stated that he had received approximately 5 responses from
Board members to the draft Statements of Requirements (SORs) that he had
recently sent out. The Chairman reiterated that it would be helpful if DUOB
members would indicate a nil response if they had no comments to make.
b) A number of Board members indicated that they would prefer to receive a hard-
copy of documents sent out by the Secretary. The Secretary agreed to do this.
c) Jim Glennon asked if the MOD would provide renumeration for the paper he
used in printing out DUOB documents. The Secretary stated that he would send
out hard copies of documents as required.
Re-test Policy
d) The Secretary had circulated a paper by Gordon Paterson regarding the right to
a second opinion or re-test within the NHS. Gordon Paterson summarised the
report by stating that there was no legal right to a second opinion although there
was an unwritten understanding that a second opinion would not be unreasonably
withheld.
Re-labelling of Pilot Study Samples
e) The Secretary confirmed that this exercise had been carried out 7
th
April at
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Gideon Henderson’s laboratory in Oxford and had been witnessed by Ivor
Connolly and the Secretary.
Analysis of Pilot Exercise Results
f) The Chairman stated that no comments had been received on his proposed
method of analysing the pilot study reports.
Treatment of Samples
g) David Lewis reported that he had carried out some testing on urine samples that
had been frozen for 18 months and the creatinine levels had not altered
significantly.
h) David Lewis stated that it was standard to acidify urine samples to 1% HNO3.
i) There was a brief discussion about the cooling or freezing of urine samples
between collection and analysis. It was decided that procedures would be agreed
with the laboratories involved in the main contract.
Expressions of Interest in Main Testing Contract
j) The Secretary stated that Gideon Henderson and David Lewis had examined the
seven expressions of interest in the main testing contract. It was decided that all
seven organisations should be invited to tender for the main testing contract.
Information to Veterans/GPs
k) Muir Gray stated that he had been talking to three organisations with
experience in the preparation of resources for clinicians and ‘patients’. He had
eliminated one of these organisations and would prepare a paper on this topic
within three weeks. He believed that the work could be carried out by the end of
July.
Action 10.3. Muir Gray to provide paper on organisations to prepare
information for GPs etc.
l) Jim Glennon asked if the Gulf Veteran information pack that is currently
supplied to GPs took account of the Biological Monitoring policy. Brigid Rodgers
stated that the GP information pack would be reissued shortly and would take
account of the biological monitoring arrangements. The Chairman said that it
would be helpful if the DUOB could receive copies of the revised GP info pack.
Action 10.4. Secretary to distribute copies of the GP information pack (when
available).
Safety Instructions
m) The Secretary stated that the safety instructions issued to troops in the recent
gulf conflict had been placed on the MOD website and he had sent out the URL
by email. Some me mbers had had trouble opening this link. The Secretary
undertook to send hard-copies of the safety reports to the board.
Action 10.5. Secretary distribute safety instructions to DUOB.
Biological Half-life of Uranium
n) Malcolm Hooper provided extracts from the following papers on the above
topic:
Gray
(6/6/03)
Secretary
(when avail.)
Secretary
(13/6/03)
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• Durakovic: Internal Contamination with Uranium. Croatian Medicine J
1999;40:49-66
• Depleted Uranium Case Narrative
o) There was a brief discussion regarding these papers. George Etherington
undertook to provide a short note on them.
Action 10.6. George Etherington to provide a short paper on the solubility of
inhaled uranium and its effect on urine excretion
Military Health Research Advisory Group (MHRAG)
p) Malcolm Hooper asked for further clarification of the role and membership of
the MHRAG. The Secretary undertook to provide this information.
Action 10.7. Secretary to provide details on MHRAG.
Questionnaire
q) Malcolm Hooper circulated the latest drafts of his questionnaires for those
undergoing voluntary testing. The Chairman noted that these did not take account
of his suggestions which had been sent out by email. The Secretary undertook to
circulate the new drafts of the questionnaires along with the Chairman’s
suggestions.
Action 10.8. Secretary to circulate new draft of questionnaire and
Chairman’s comments.
Interactions
r) Malcolm Hooper took an action to provide any literature that exists regarding
the possible effects of interaction between DU and other material
Action 10.9. Malcolm Hooper to provide information on interactions
Etherington
(13/6/03)
Secretary
(20/6/03)
Secretary
(20/6/03)
Hooper
(20/6/03)
4.
Extended Pilot Exercise Results
a) The Chairman noted that one of the laboratories had measured the DU-D
(spiking solution) as having a concentration 30% different from that expected.
Gideon Henderson commented that, while it was important to establish the
reasons for this, it would not compromise the pilot study as the main comparison
was between the measurements obtained by the three laboratories for each urine
sample.
b) The Chairman said that one of the laboratories had been concerned about the
tight timescale attached to the pilot study. The Secretary responded that he had re-
assured the laboratory that, while the pilot exercise needed to be completed to
schedule if possible, getting the correct result was more important.
c) Chris Busby pointed out that he was unable to interpret the results that had been
sent out as there was no key relating the expected sample content to the code
number. The Secretary stated that he had deliberately not circulated the key at this
stage as the results from the laboratories were preliminary. The key would be
made available when all final reports had been received.
d) It was pointed out a possible discrepancy between two tables in one of the
laboratory reports. The Secretary undertook to check this.
Action 10.10. Secretary to check possible discrepancy in lab report
Secretary
(20/6/03)
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e) There was some discussion regarding the results of the spiked sample analysis.
The decision of the DUOB was that the results gave them sufficient confidence to
proceed with tenders for the main contract. The seven laboratories that had
expressed an interest in the main contract would be invited to tender once the
Statement of Requirement was complete. The results of the analysis for U236 did
not appear to be entirely reliable from the preliminary results, and at one
laboratory there appeared to have been a problem of U236 contamination. It was
agreed that the Statement of Requirement would be based principally on the
U238/U235 ratio and that the SOR would not specify an accuracy for U236
measurement.
Action 10.11. Secretary to proceed with main testing contract.
f) Jim Glennon asked what scope there would be for correcting any problems that
occurred once the main contracts were let. The Chairman pointed out that quality
procedures would be put in place as part of the contract. This would include
duplicating samples to ensure repeatability of results and also the testing of spiked
samples as in the pilot exercise. The Chairman stated that the SOR for the main
contract stipulated that the laboratories would establish QC procedures in
conjunction with the DUOB.
The subject of how the measured uranium level would relate to dose was
discussed. George Etherington undertook to produce a paper on this.
Action 10.12. George Etherington to produce a paper on relationship between
dose and measured level of DU.
g) It was agreed that the Chairman, Gideon Henderson and David Lewis would
write a summary paper to collate findings from the pilot study once all the final
reports had been received. This paper would summarise the whole pilot exercise
and results and would be published on the web. It was agreed that a meeting of the
pilot exercise laboratories should be held to discuss the results but there was
concern that there might be difficulties with this due to sensitivities regarding their
bids for the main contract. Malcolm Hooper asked about the differences in
methods used by the laboratories and noted that one laboratory did not seem to
have the same accuracy as the other laboratories. This will be covered in the pilot
study report.
Post meeting note: MOD Contracts Branch advise that there are no problems with
holding a ‘wash-up’ meeting with the laboratories as long as the discussions only
concern the pilot exercise.
Action 10.13. Produce a final report on the pilot exercise
h) Jim Glennon expressed concern that results of one of the laboratories did not
appear to be as good as for the others. He asked if this laboratory should be
allowed to tender for the main contract. The secretary explained that the main
contract was a separate requirement from the pilot study and had been advertised
separately. The seven organisations who had expressed an interest in the contract
had all been assessed (by David Lewis and Gideon Henderson) as suitable to bid
for the contract. The decision about which laboratories would get the main
contract would be taken by the DUOB based on the responses to the Invitation to
Tender.
i) The Chairman pointed out that the results of the pilot exercise were confidential
and should not be discussed outside of the DUOB.
Secretary
(ASAP)
Etherington
(20/6/03)
Chairman,
Lewis,
Henderson
(ASAP)
5.
Draft Statement of Requirement for Main Testing Contract
a) Draft 11 of this Statement of Requirement was discussed. A large number of
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minor amendments were recorded by the Secretary and would be incorporated
into the next draft.
b) There was some discussion regarding whom the anonymised results of the
voluntary testing should be sent to. It was agreed that results should be distributed
to GVIU, the Chairman of the DUOB and an independent third party (to be
decided). The subsequent handling of such data was also discussed. The Chairman
stated that any publication resulting from the analysis of such data should go
through the DUOB.
c) There was also discussion regarding Section 7 of the SOR which deals with the
Method of Analysis. Gideon Henderson and David Lewis undertook to aid the
Secretary in redrafting this section.
Action 10.14. Gideon Henderson and David Lewis to aid in redrafting Section
7 of Main Contract SOR.
Action 10.15. Secretary to redraft SOR for Main Contract
Lewis,
Henderson
(30/5/03)
Secretary
(30/5/03)
6.
Statement of Requirement for Health Provider Contract
a) Minor changes to this SOR were agreed and noted by the Secretary.
Action 10.16. Secretary to revise SOR for Health Provider contract
b) The Secretary stated that only two expressions of interest in this contract had
been received following advertisement of the requirement. MOD contracts branch
was trying to contact other organisations who could carry out this work.
Secretary
(13/6/03)
7.
SOR for Normative Value Study
a) Minor amendments to this SOR were agreed and noted by the Secretary
Action 10.17. Secretary to revise SOR for Normative Value Study and
commence contract action.
Secretary
(30/5/03)
8.
Information to Veterans/GPs
a) This was covered by Muir Gray under Matters Arising.
9.
Timescales
a) The Secretary stated that all contracts could now proceed as soon as the SORs
were finished. This should mean that the main testing contract would be placed at
the end of August. As before, the Health Provider contract remained the rate-
limiting step.
10.
DU Background and Scientific Issues
a) A paper from Gordon Paterson on Disease Registers was circulated.
b) Chris Busby mentioned the Committee Examining Radiation Risks from
Internal Emitters (CERRIE) of which he is a member. DU has been suggested as a
topic for discussion by CERRIE and Chris Busby believed there was a potential
advantage in communicating with this committee with regard to the interpretation
of the DU test results. Chris Busby asked if the Chairman would write to CERRIE
to facilitate communication with the DUOB.
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Action 10.18. Chairman to write to CERRIE
Chairman
(13/6/03)
11.
Date of next meeting
a) The date for the next meeting was set for 1
st
July 2003.
12.
MOD Biological Monitoring Policy
a) Several members of the DUOB had emailed the secretariat asking for further
information about the implications of the biological monitoring policy. The
Chairman had advised that such requests should go to him. Brigid Rodgers
pointed out that members could also write to the MOD as private individuals.
b) The Chairman stated that according to the terms of reference, the DUOB had
been invited to comment on the development of MOD biological monitoring tests
He expressed surprise that recent press articles, highlighting the fact that all troops
returning from the recent Gulf Conflict would be offered a test for either total
uranium or uranium isotopes, as determined by the level of their presumed
exposure in theatre, were being interpreted as a new development. The DUOB had
been given sight of the MOD Biological Monitoring policy in August 02, then at
the meeting in October, and what had been announced was what the Chairman had
expected.
c) Brigid Rodgers reiterated the MOD policy that troops classified to exposure
levels 1 or 2 would be encouraged to undergo a test which would analyse for
uranium isotopes. Those classified as level 3 would be given information which
would enable them to decide if they wanted a voluntary test. The Level 3 test
would be for total uranium concentration, and would be followed by an isotope
test if the concentration showed a significantly high level. This had been set out in
the first public draft of the Biological Monitoring policy (Aug 02) and in all
subsequent versions.
d) Brigid Rodgers confirmed that 1.9 tonnes of DU had been used by the UK in
the recent Gulf conflict. No information on US usage had yet been received.
e) There was some debate about why the test being developed by the DUOB was
not being used for the biological monitoring. The Chairman explained that the test
for those returning from the recent Gulf conflict did not need to be as sensitive as
the retrospective test for veterans of the 90/91 Gulf conflict, since for a given level
of exposure, rates of excretion would be much higher. Ron Brown asked the
Board if anyone could give him a reason why a total uranium test, coupled with
the assumption that all uranium found was DU, was anything other than an
overestimate of intake and hence risk. None of those present answered this
question.
f) Brigid Rodgers stated that a system had been put in place to brief personnel on
these issues prior to deployment. Further guidance had been issued in theatre and
also appeared in the ‘Sandy Times’ newsletter in an effort to reinforce the
message. A ‘credit card’ was issued on departure from theatre advising troops that
they may apply for a test and how to go about it. [Copy attached to these minutes
at Annex A]. Consideration is being given to carrying out a survey post-operation
to assess the effectiveness of pre-deployment preparation procedures which could
include a question on the briefings. The mechanics of the survey had not yet been
determined.
g) Brigid Rodgers stated that a small number of UK troops had been identified
who may have received level 1 exposures to DU. The incidents of concern were
subject to Boards of Inquiry and the outcome of these must be awaited before the
circumstances could be confirmed. In the meantime the MOD was assuming that
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exposures could have been at this level, and those involved were being offered the
relevant test.
h) Some members asked for further details about the tests and which laboratories
would be carrying them out. Brigid Rodgers said they would not be giving details
on the laboratories at this stage but David Lewis could provide a brief on testing
that the Institute of Naval Medicine would be able to provide. Ron Brown
explained that the Approved Dosimetry Service at DRPS decided which
laboratory to use, that only a small numb er of tests had been carried out so far, and
that the location of testing was not yet being revealed.
i) Brigid Rodgers stated that the MOD would not be providing any detail about
individual results. The results of the biological monitoring would form part of
overall medical surveillance and would be subject to medical confidentiality.
However, grouped data would be published if a sufficient number of results were
obtained and consent was given.
j) There was discussion about which laboratories would be involved in the
biological monitoring testing. Brigid Rodgers stated that the laboratories would be
fully UK accredited for the work. The number of laboratories used would depend
on demand. MOD would prefer to use in-house testing but wished to use an
accredited laboratory. INM is UKAS accredited and was expected to gain
accreditation for its method in June 2003. Jim Glennon asked if there was conflict
of interest in INM carrying out the testing. Nick Baldock stated that it was merely
the case of an employer fulfilling a duty of care towards its employees. INM had
decades of experience in carrying out testing servicemen for lead and thallium.
k) The Chairman noted that the MOD did not appear to be very forthcoming with
regard to the testing that had already been carried out.
l) Ivor Connolly expressed his disappointment that the MOD would not be paying
for contractors to take the DU test.
m) Gordon Paterson stated his view that the MOD had been remarkably receptive
to comments made at the DUOB concerning the biological monitoring policy.
13.
A.O.B.
a) There was no other business.
Distribution:
All members
All observers
Devolved Health Administrations
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Annex A – Safety Instruction Credit Card
DU Information Card
F Med 1018
You have been deployed to a theatre where Depleted
Uranium (DU) munitions have been used.
DU is a weakly radioactive heavy metal, which has
the potential to cause ill health.
You may have been exposed to dust containing DU
during your deployment.
Further Information
You are eligible for a urine test to measure uranium.
If you wish to know more about having this test, you
should consult your unit medical officer on return to
your home base.
Your medical officer can provide information about
the health effects of DU.
Information is also available on the MOD web site:
www.mod.uk/issues/depleted_uranium/index.htm