MINISTRY OF DEFENCE Final

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Final

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 4669

Helpline

0800

169

4495

Fax

020 7305 4166

Final

Our Reference:

D/GVIU/7/1/8/2

Date:

27 November 2003

MINUTES OF THE THIRTEENTH DEPLETED URANIUM SCREENING

PROGRAMME OVERSIGHT BOARD MEETING ON 20

NOVEMBER 03

Present:

Board:

Observers:

Professor David Coggon

Surg. Cdre Nick Baldock

Mr Ron Brown

Mr Ivor Connolly

Maj Gen (Retd.) R P Craig

Dr George Etherington

Mr Jim Glennon

Professor Malcolm Hooper

Dr Gordon Paterson

Dr Margaret Spittle

Professor Brian Spratt

(Mr Charles Williams

Air Cdre Simon Dougherty

Wg Cdr Charlie Wilcock

Mr Alan Duncan

Miss Rosie Wane

MRC

INM

DRPS

NGV&FA

RBL

NRPB

NGV&FA

GVA

BRC

GVIU

DMSD

HJA

GVIU

Chair

Secretary)

Apologies:

Dr Chris Busby

Dr Muir Gray

Dr Gideon Henderson

Mr Neville Higham

Dr Len Levy

Dr David Lewis

LLRC

NSC

Ox Uni

HSE

MRC IEH

INM

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Item Discussion

and

Decisions Actions

(Action date)

Introduction

a) The chairman opened the meeting. He stated that the main items of business

would be the laboratory analysis contracts, arrangements for the healthcare

function, the normative values study, the advisory factsheets, and the test

questionnaire.

b) Mr Glennon had requested a closed session of the Board from which

observers would be excluded. The chairman said that public sector

committees of this kind usually conducted their business quite openly. He

asked permission for a closed session from the members present. It was

agreed that non-members would be asked to leave at the end of the

advertised agenda.

c) The chairman noted that Mr Brown had circulated an email about the results

to date of the Op TELIC biological monitoring, which might have

implications for DUOB business. Surg. Cdre. Baldock reminded the

meeting that Dr Busby had responded to Mr Brown’s message with the

request that the Board make no firm decisions on the subject until he was

able to attend. Professor Coggon ruled that the biological monitoring results

must nonetheless be discussed.

d) The chairman apologised to the Board for any delays on his part in

completing actions or replying to requests for information. He was dealing

with DUOB affairs in addition to his main employment, and thus having to

prioritise use of his time.

Minutes of last meeting

The chairman asked for sub-headings to be numbered using Roman

numerals. Mr Brown requested the addition of some explanatory text to four

sections where he had been quoted.

Action 13.1 Secretary to finalise and circulate minutes of 12

DUOB

Secretary

(completed

21.11.03)

Matters arising from last meeting

i. Discrepancy in pilot study reports

The secretary reported that he had been unable to identify any discrepancy.

It was agreed that this action had been overtaken by events and could be

closed.

ii. Meeting with the Under Secretary of State for Defence

The chairman reported that on November 17

he had met the Minister, who

was pleased with the work of the Oversight Board and keen for the main

retrospective testing programme to start. Professor Hooper asked whether

the chairman had raised Dr Busby’s point, namely that he thought it

unacceptable that the DUOB’s remit was not being extended to the second

Gulf war. Professor Coggon said he had, and the matter was to be kept

under review with an open mind. Mr Glennon pointed out that meant the

answer was still no. The chairman confirmed this.

iii. Post-TELIC urinary uranium study

Professor Coggon reported that a draft protocol for the study was now in

existence and had been circulated to the Board. Professor Hooper said he

was uneasy about three members of the DUOB collaborating with

P f

h d

ib d

lt t t th M D I

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Professor Wessely, whom he described as a consultant to the MoD. In reply

to a query from Mr Brown, Professor Hooper said that Professor Wessely

had described himself as such in a television interview. Mr Brown and

General Craig said that MoD was funding some studies by Professor

Wessely, but that was not the same thing. The chairman said that the post-

TELIC study could be discussed in more detail later.

iv. Autopsy information

The chairman said that enquiries had been made in the USA via the GVIU

liaison officer in Washington DC, Colonel White. There appeared to have

been no relevant American autopsies. There was however one published

paper reporting analysis for DU of a Canadian bone sample, which had

shown a negative result. Professor Hooper said that there had also been one

positive finding of DU from Canada. Mr Brown said that it was unclear

whether the study in question had included control data, and the finding was

at best speculative. Professor Hooper objected to what he felt was an

unwarranted attempt to belittle data from other researchers.

Professor Coggon observed that whatever the merits and limitations of the

Canadian data, it was clear that there were not enough results in this area for

useful conclusions to be drawn.

v. Draft advice on “negative” test results

Professor Coggon said that he had not yet completed the revised draft.

Action 13.2 Chairman to amend the draft advice on “negative” test results

vi. Kuwaiti cancer registry

The chairman said that he had received a reply to his enquiry, advising that

the best information available could be found in “Cancer Incidence in Five

Continents”, published by an agency of the World Health Organisation

(WHO). He had requested the latest volume from the British lending library,

but it would not be available for several months.

vii. Age data on Gulf war veterans

The secretary had just received the requested information from the Defence

Analytical Services Agency (DASA). He reported that the numbers of UK

Gulf 1 military personnel in the undermentioned age ranges on April 1

1991 were as follows:

40-44 1,968

45-49 752

50+ 262

viii.Healthcare provider

The chairman said that Dr Paterson had suggested a research group that

might take on this function, but he thought it was unlikely that an academic

group would be willing to provide the services required. Dr Paterson

explained that the group in question had carried out a study for the Scottish

Office involving the collection of urine samples. There had been no other

proposals from Board members. Professor Coggon felt that a group of NHS

Occupational Health (OH) departments might take on the work, in

conjunction with a central co-ordinating organisation. The DUOB itself

would probably have to nominate an advisory consultant.

ix. Main test isotope measurements

Professor Hooper asked whether the

236

U measurement would be retained.

Professor Coggon confirmed that it would, as agreed at the wash-up

meeting with the pilot study laboratories on September 22

. Mr Brown

commented that only one lab had been able to make the measurement well.

Mr Glennon felt that was unimportant, as long as it could be done. The

Chairman

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chairman said that the Board could decide exactly how to use the

236

aspect in the light of the pilot exercise findings.

x. Advisory consultant

Professor Hooper asked if two advisory experts could be considered:

Dr Busby and a medical specialist. The chairman said this could be

discussed later. Professor Spratt suggested that it would be wrong to offer

advice from a person not bound by medical ethics.

xi. Durakovic paper

The chairman noted that Dr Etherington had circulated a response to the

paper. It appeared that Dr Durakovic might have somewhat underestimated

the lung burden; though even allowing for this, the overall risk to health was

low according to conventional health physics. Dr Etherington added that

Dr Durakovic’s claims about the reliability of his method were consistent

with the findings of the extended pilot study overseen by the DUOB.

xii. NERC research

a) Professor Coggon asked if there were any messages from the DSTL DU

Workshop at Tidworth. Professor Spratt said there was nothing very

significant to the DUOB. Mr Connolly said there seemed to be a pool of

money available for research, and wondered whether the Board could tap

into it before it was all committed. Mr Brown explained that funds for the

MoD Corporate Research Programme (CRP) came from the budget of the

Chief Scientific Advisor, and were quite separate from the funds used by

GVIU. The chairman stressed that commitment of CRP funds would not

affect DUOB activities.

b) Dr Paterson expressed his appreciation for the Workshop, and especially for

what he considered an excellent summary presentation by Ron Brown.

Professor Spratt agreed that there had been some good talks, albeit mainly

of little relevance to the Board. Surg. Cdre. Baldock informed the meeting

that the classified second day of the Workshop had not involved DU health

issues. Mr Glennon thanked him for the report.

xiii. Biological

monitoring

update

a) Mr Brown reported that 181 tests had now been carried out. A small group

with shrapnel injuries were the only personnel whose urine showed

detectable levels of DU. The rest, even those claiming “level 1” exposure,

exhibited nothing abnormal. Around 800 bottles had been sent out, so more

tests were likely. Mr Glennon asked whether the samples were 24-hour

collections. Mr Brown said no, they were all spot (single void) samples.

b) Mr Connolly asked about Mr Brown’s aim in making the report: was he

seeking approval or guidance from the DUOB? The chairman said that the

update was for information only. The results could be borne in mind when

advising participants in the retrospective test; and they would also inform

the normative values study. The Board might usefully consider whether a

full normative values study should be pursued if the results were likely to be

all negative. However, no decision was needed until the outcome of the

preliminary study was known.

c) Professor Spratt said that it was not possible reliably to extrapolate back

from 2003 to 1991. The two wars were different. Test firings of DU

munitions, because they are designed to be “worst case”, tend to cause

greater aerosolisation than occurs under real battlefield conditions. During

Op TELIC the targets were relatively soft and there appears to have been

little dispersion of DU dust.

d) Mr Glennon asked exactly how many tests had so far been positive for DU.

Mr Brown replied that he was not at liberty to say, other than “a small

number”. The chairman said he would expect that to mean fewer than ten.

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Since there had been so few DU shrapnel injuries, it might be possible to

identify individuals if the precise number were announced. Mr Glennon

enquired whether details of the biological monitoring tests would be given

to the Board. Mr Brown said that the data would certainly be published in

due course. The question was when, as the monitoring had no set end-date.

Mr Glennon said he would like to see all the available information straight

away.

e) Professor Hooper said that he wanted to have full details, such as the time of

day when the urine samples were taken and the volume collected.

Mr Brown questioned the relevance of this information, saying that only the

isotopic ratio was important. Professor Hooper said it had a bearing on the

kinetics. Mr Brown said that none of the personnel tested so far had shown a

urinary uranium concentration exceeding the “action level” defined by the

Royal Society.

f) Professor Hooper claimed there were indications of the use of munitions

made from natural, as opposed to depleted, uranium. Mr Brown stated

categorically that the UK did not use natural uranium weapons.

Mr Connolly wondered if the DUOB should review its previous advice on

biological monitoring. Mr Brown felt that a review was appropriate, since

new information was becoming available. The chairman said the Board

would take all information into account, noting its limitations; however, he

did not think the previous recommendations should be reviewed at this

stage. Professor Hooper asked whether any air monitoring had been done

during Op TELIC. Professor Spratt replied that air monitoring was carried

out at a few DU strike sites several weeks after the conflict.

xiv.

Inter-Parliamentary Gulf War Group (IPGWG)

a) Professor Hooper requested clarification of the chairman’s ‘disturbance’

reported in the minutes of the 12

meeting. Professor Coggon said it had not

been correct to state that no research into DU medical effects was planned.

Professor Hooper said he had not attended the IPGWP meeting in question.

The remarks attributed to him were based on his comments about the MRC

report. He had said the Board had “no plans for a coherent research

programme”. This was true, since nothing was yet in place.

b) Professor Coggon said there were plans for case-control studies and cross-

sectional surveys. No research was yet ongoing, but it was certainly

intended. Professor Hooper said he thought the significance of cytogenetic

tests was being played down by the Board. The chairman replied that

genetic damage was not a reliable marker of DU exposure, since it could

also be caused by other types of radiation such as x-rays; Dr Spittle

concurred. Professor Spratt said there might be a case for more research in

this area if the Doyle study on the reproductive health of Gulf war veterans

showed abnormalities. Professor Hooper felt that this UK study was flawed,

but strongly supported a critique by Doyle of the Cowan paper on birth

defects in US veterans and mentioned several other relevant papers.

Update on screening programme contracts

i. Main testing contracts

a) The secretary said that the cost of placing contracts with the three analytical

laboratories recommended by the DUOB would have exceeded the available

budget by around 70%. To proceed on this basis would have required fresh

financial authorisation within MoD, inevitably causing delay. The secretary

had therefore arranged for contracts to be let to two laboratories, giving an

initial capacity of 800 samples in total. He would seek additional funds to

contract with the third organisation (whose tender price was approximately

four times that of the least expensive laboratory) if the Board so required.

b) Mr Glennon and Mr Connolly asked how such a restriction could occur

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when the MoD was committed to supporting the DUOB. The secretary

explained that in its day to day management, the Ministry always operated

within defined budgets set at the beginning of the financial year. These had

to be based on forward estimates, and the actual requirements might prove

to be greater or less. If greater funding were needed, as in this case, it could

be requested; but firm contractual commitments could not be made until

budgetary authorisation was obtained.

c) Mr Williams said he had been anxious to ensure that at least some analytical

capacity would be available to the Board before the end of calendar year

2003. He was conscious that the start of the testing programme had already

slipped considerably. Mr Glennon said he felt it was premature to have

laboratories on standby when the rest of the practical arrangements were not

yet in place. Mr Connolly said that at a meeting of his organisation, veterans

had expressed concern about the laboratory that had tendered the lowest

price, because of its links with the nuclear industry.

d) The chairman said that the DUOB had two options. It could declare the

interim position unsatisfactory and demand contracts with three

laboratories, though this would be difficult to justify on scientific grounds

alone; or it could accept what had been done, begin the testing, and make a

case for a third lab only if a problem arose such as high demand. He felt that

the latter course was better since it minimised delay.

e) Mr Connolly said that it was hard on the third laboratory to be denied a

contract after its good work and co-operation in the pilot studies. The

chairman said the lab had put a very high price on its services. Mr Connolly

said he would be concerned if all samples were analysed by the lowest-

priced lab. Professor Coggon assured him that the initial samples (those

collected in the proposed pilot exercise) would all be split and tested by

both laboratories until the Board had gained confidence in the consistency

of the measurements. Mr Brown expressed concern on hearing that the third

laboratory intended to use new equipment and temporary staff for the main

study, as this meant the laboratory was not following the pilot study

procedures. Professor Spratt said that the labs had an incentive to work

diligently, as their reputations were at stake.

f) Mr Glennon was unhappy at what he saw as the selective nature of the pilot

testing being put forward. He said that a free and open test had been

promised. Dr Paterson said that the pilot exercise had been proposed only

because of the lack of contractors willing to take on the original healthcare

provider role. It was designed to ensure that something would be achieved,

rather than nothing; the Board had to start somewhere. A pilot exercise in a

single geographical area would allow other Occupational Health (OH)

departments to gain confidence in the practicality of the procedures.

g) The chairman said that the Board must decide whether to go ahead with two

laboratories, or not. The secretary reminded members that sample splitting

would be carried out routinely throughout the test programme as part of the

Quality Assurance. In reply to a query from Mr Connolly, the chairman said

that the samples would have to be split by the laboratories themselves in

order to maintain security and avoid the risk of contamination. Mr Glennon

said that the programme should not proceed without the third lab, since

otherwise analytical capacity would be too limited. Other Board members

raised no objection, however, and the chairman ruled that the majority

decision was to accept two laboratories for the time being.

ii. Heathcare provider

a) The chairman said that the main issue was the proposed pilot exercise. This

would involve approximately 30 veterans in a single region of the UK. They

would be supplied with containers, written guidance and questionnaires for

self-completion. They would be invited to a clinic to hand over a 24-hour

ll ti

At th

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urine collection and provide a spot urine sample. At the same time they

would hand in their questionnaires for review of completeness by clinic

staff, who would provide any further guidance required. By this means the

Board could get a feel for the workability or otherwise of the procedures,

the appropriateness of the questionnaire, and the quality of the courier

service; it would also discover how well the analytical laboratories agreed,

and get an indication of the prevalence of detectable DU (with implications

for the advice to be given) and of the reliability of data from spot as

compared with 24 hour samples. In short, the exercise would provide useful

information, and at least some of the waiting veterans would get their

results.

b) Mr Connolly expressed concern about the quality and accuracy of the

sample splitting. Professor Coggon said that this had been carried out

satisfactorily during the pilot studies. The Board could stipulate exactly how

it wanted the splitting done. Mr Glennon wondered if the pilot exercise

might entail compromise in relation to the security of the urine samples.

Professor Coggon said it would make no difference: tamper-evident seals

and coded labelling would still be used. If any problem arose, it would soon

be apparent as the split samples would give different results.

c) Professor Hooper said he supported a pilot exercise, but did not think

London would be the best location. In many respects the capital was unique.

Many of the veterans had misgivings about the big London hospitals. It

would also be useful to trial the test procedures provincially.

d) The chairman said he had suggested London for practical reasons. He had

had some contact with the OH department at St. Thomas’ hospital, which

was well established and experienced. Much of the population of southern

England could reach St. Thomas’ by public transport within one hour. The

chairman asked for alternative suggestions, but warned of delays if there

were a need to repeat the initial approach.

e) Dr Paterson noted that a great many veterans were resident in the west of

Scotland, and said he had a contact in an NHS OH service there. Professor

Coggon said the capacity existed to run two pilot exercises concurrently.

Dr Paterson said that in that case he proposed using London plus a second

region outside southeast England. Professor Hooper said this was a good

way forward and would address the anxieties of the veterans. Dr Paterson

felt there would be no problem in hospitals taking on the work at the level

proposed, because handling 30 or so samples would be a minimal addition

to what was part of their normal routine.

f) The chairman pointed out that a list of names and addresses was required so

that veterans in the chosen regions could be contacted. He said that the pilot

exercises would be run in the London and Glasgow areas, and asked for

assistance from the NGV&FA. In addition, the secretary should examine the

list of veterans who had already contacted GVIU to ask about the test.

General Craig said that the Royal British Legion would also like to put

forward nominations.

Action 13.3 NGV&FA members and General Craig to assist the secretary in

drawing up a list of potential test participants in the London and Glasgow

areas

g) The chairman said that a health advisory mechanism had to be set up for the

pilot exercises. Dr Spittle had offered her assistance and was willing to take

calls on a helpline if necessary, so long as the numbers were small.

Dr Spittle’s expertise lay in radiation medicine rather than heavy metal

toxicology. Mr Glennon said he would prefer the advisor not to be a

member of the DUOB. The chairman said such a restriction would create

considerable difficulty, as the UK had very few specialists in that field.

Secretary

Mr Connolly

Gen Craig

Mr Glennon

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h) Professor Hooper asked how the suggested arrangement would work.

Professor Coggon replied that people whose test results were negative

would receive written advice from the Board, which he thought should

initially review all results. The DUOB would decide on the interpretation of

“questionable” cases, and participants would be offered follow-up via the

helpline if needed. The review process would probably make the feeding

back of results a little slower than in the main testing programme.

i) Professor Hooper said he was happy for Dr Spittle to take on the role. He

did not consider membership of the DUOB a relevant factor. Professor

Coggon pointed out that participants would be free to discuss their results

with Dr Busby or anyone else if they wished. Professor Hooper said that the

division of opinion on the Board with regard to the health risks of DU

exposure must be made clear to veterans. The chairman confirmed that this

would be done.

j) Mr Connolly asked if review of individual results by the Board might raise

legal issues. Professor Coggon said that no names would be seen – only

anonymous data.

k) Dr Paterson said that the advance information on the test should name Dr

Spittle in her full professional capacity. Dr Spittle said it was important to

have an agreed response for particular levels of DU. The Board must not

give mixed messages. The chairman said it would speak with one voice but

state that there were two opinions.

l) Mr Brown felt that one of the two analytical laboratories lacked experience

with urine samples and ought to be guided on what was ‘normal’. The

chairman thought that was not essential at this stage; results from the

normative values study were not a prerequisite. Professor Hooper agreed.

m) The chairman wondered whom the Board should approach for the central

healthcare role: overall co-ordination, handling of appointments, and the

transport of samples. He asked the secretary to make enquiries.

Action 13.4 Secretary to research potential co-ordination contractors with

assistance from the chairman

n) The chairman referred to the question of an “independent third party” that

had been raised by Dr Busby. He said that he saw no problem in lodging a

third copy of the test results with such a party, provided that individual

consent was obtained and all statistical analysis of results was carried out

through the Board. It was agreed that further discussion would be deferred

until Dr Busby was present.

iii. Civilian normative values study

a) The chairman recalled that the initial proposal received from the normative

values contractor had been complex and excessively expensive. The work

was now being approached in two stages. The first stage would be a

preliminary study based at a single hospital in Edinburgh, where each

participating patient would be asked to give both a combined 24-hour urine

sample and a series of individual spot samples collected over a second

24-hour period. The results obtained would define how well a spot sample

could serve as a proxy for a 24-hour sample and how much variation is

caused by the time of day of voids. With that information, the Board could

decide whether to proceed to the full civilian normative values study; and if

so, whether its logistics could be simplified.

b) Professor Hooper asked how many patients would be involved. The

secretary replied that the plan was for twenty five. Professor Hooper said he

was content for the work to proceed. The chairman pointed out that there

was provision in the study protocol for patients to be asked follow-up

questions if the need arose. Mr Glennon enquired about the isotopic ratio

measurements Professor Coggon said that the

238

235

U ratio would be

Secretary

Chairman

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measurements. Professor Coggon said that the

238

235

U ratio would be

recorded, but the

238

236

U ratio could be added if required. Mr Glennon

wanted it included.

c) General Craig wondered about the risk of impaired renal function,

expressing concern that hospital in-patients on medication might have

altered levels of creatinine excretion. Professor Coggon said that such

variation should not affect the uranium isotope ratios, though it could alter

the overall uranium excretion. General Craig suggested the use of mental

health patients, but this was considered too difficult. He said that creatinine

levels were elevated for at least three days after surgery. Mr Brown advised

that patients fitted with catheters should be excluded from the study, as the

plastic tube material could influence the test result. The chairman undertook

to convey this instruction to the contractor. Dr Paterson asked for all

correspondence with the contractor on technical matters to be copied to the

Board. The secretary reported that placement of a contract for the normative

values preliminary study was underway.

Action 13.5 Chairman to warn contractor against use of catheters

Action 13.6 Secretary to copy any technical correspondence to the Board

Chairman

(completed

21.11.03)

Secretary

Information to veterans and GPs

The chairman asked Dr Spittle, who had to leave the meeting early, for her

comments on the factsheets as redrafted by the contractor and the latest

draft of the test questionnaire. Dr Spittle felt that a question should be asked

specifically about pregnancy, since it was not an illness. Professor Coggon

thought this was not essential because there was an existing question on any

children’s health problems.

i. Depleted

Uranium

Factsheet

a) The chairman said that the contractor had apparently believed the aim of the

factsheets was to encourage the highest possible participation in the testing

programme, and this was not the case. Professor Hooper noted that the

statement DU is “40% less radioactive” than natural uranium is true only for

α-particle emissions. If all emissions were considered, DU had 88% of the

radioactivity of the natural material. Dr Etherington explained that the

phrase “40% less radioactive” referred only to the activity of uranium

isotopes present in DU. Mr Brown objected to use of the phrase “natural

uranium” in the factsheet on the grounds that it has a very specific meaning

which was not intended.

b) The secretary was asked to consult Dr Levy about the toxicity of tungsten.

Action 13.7 Secretary to enquire about the toxicity of tungsten

c) There was a discussion about the list of sources of further information on

the factsheet. Professor Hooper and Mr Glennon wanted Dr Busby’s Low

Level Radiation Campaign (LLRC) website included, but the chairman was

opposed to this because of some of the site’s non-scientific content.

Professor Hooper felt it was important to have a non-orthodox view

available to veterans. The chairman suggested a separate heading for “other

views”.

d) The Board agreed a number of changes to the factsheet, which were to be

implemented by the secretary.

Action 13.8 Secretary to modify the DU factsheet as agreed

ii. Information for those seeking a test for DU

The Board discussed the question of “significant” exposure.

Secretary

(completed

28.11.03)

Secretary

(completed

25.11.03)

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Professor Hooper said he thought there was no effective threshold and that

all DU exposure was therefore significant for health. The chairman

disagreed, stating that there was a wealth of information on relevant health

outcomes. Professor Hooper insisted that a firm statement could not be

made. Mr Brown felt that the advice should be based on a consensus view,

but Professor Hooper pointed out that the majority opinion on the health

risks of low-level radioactive sources was in dispute.

b) There was some discussion of bone cancer. Professor Hooper claimed that

information on the subject was being suppressed, and said that statements

from the Board should not be categorical. Professor Spratt said that the

question of reassurance to participating veterans had to be considered.

Mr Glennon said that the factsheets should not be about reassurance, but

rather about telling the truth as it was understood.

c) Dr Paterson said that the key point of the test was to establish whether a

given individual’s urinary uranium concentration was significantly different

from that expected in the general population. Mr Brown pointed out that

relatively high urinary uranium levels can arise from drinking some mineral

waters, so that by itself is not a sufficient indicator. The chairman said that

DU content was the key factor.

d) Professor Coggon undertook to modify the draft factsheet in accordance

with the Board’s deliberations. The secretary was asked to ascertain the

exact starting dates of the UK Balkan operations. Dr Paterson requested a

definitive statement from the MoD about whose tests it would pay for; and

that other NGO personnel could access the testing programme on the

understanding that they or their organisation would bear the cost of the test.

Action 13.9 Chairman to rewrite the “seeking a test” factsheet

Action 13.10 Secretary to ascertain Balkan operation dates

Action 13.11 Secretary to provide a definition of the MoD payment policy

e) Mr Brown pointed out that the test participants must be asked for their

permission if the results were to be sent to a third party; this was agreed.

The likelihood of compliance with a 24-hour urine collection regime was

discussed. General Craig said that it would be difficult to guarantee. It was

agreed that the factsheet would stress the importance of completing the

collection, but all samples would be analysed even if they were not

complete.

f) The secretary reported that the individual chiefly responsible for the revised

factsheets was no longer employed by the contractor, but had expressed a

personal professional interest in learning the response of the Board to her

work. He asked for permission to give her this information. The Board

assented and asked the secretary to convey its thanks.

Action 13.12 Secretary to convey the thanks of the DUOB to the factsheet

author

Chairman

(completed

25.11.03)

Secretary

(completed

27.11.03)

Questionnaire

a) The chairman said that he had designed the latest draft of the questionnaire

to be simple to complete; sections not relevant to an individual could simply

be passed over. The operation of the questionnaire could be tested in the

planned pilot exercise.

b) The Board considered the questionnaire under its existing page numbering

and agreed the following changes:

Page 1: Question on NHS number to be deleted.

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Page 2: Question on service start date to be deleted; dates to be recorded as

year and month only.

Page 3: Questions 6 and 7 to be deleted.

Pages 4 & 5: Question 8 to read “1990 or 1991”; question 13 to ask “to

which unit were you attached?” rather than “where were you based?”;

question 14 to include Doha and Thumrait in the list of military sites, and

to include Royal Marines; question 21 to read “assist or treat casualties”.

Page 6: The term “Balkans” to be used in place of “Bosnia/Kosovo”.

Page 7: “NGO” to be written in full (Non-Governmental Organisation).

Page 8: Question 45 to read “military or NGO”.

Page 9: Question 53 to be deleted; in question 54, the definition of “close”

to be “within 2 miles”.

c) General Craig said that most war pensioners suffered musculoskeletal

problems, so question 62 would provide no information about DU.

Mr Glennon felt the question was irrelevant. The chairman said it was

included for background understanding and awareness, which would be

useful when offering advice over the telephone.

d) Mr Glennon enquired about the purpose of question 64 (previous urine test

for DU). Professor Coggon said that too was background information that

would be useful to have in case of any discrepancy. Dr Paterson commented

that it would be of value only if the previous result were known as well.

Glennon expressed some concern about the security of copy

questionnaires. Dr Paterson said that a serial number must be printed on

each page to avoid the possibility of accidental mismatching during the

copying process.

e) Professor Coggon undertook to revise the draft questionnaire as agreed. He

said it would be piloted with the first groups of veterans tested and then

refined again if necessary before the main programme.

Action 13.13 Chairman to modify and reissue the draft questionnaire

Chairman

(completed

26.11.03)

Timescales

The chairman said that discussions with the OH departments and the setting

up of contractual arrangements with them would take several weeks. A list

of veterans to be invited to participate in the pilot exercises could be drawn

up concurrently.

DU background and scientific issues

There was no discussion of this agenda item.

Dates of next meetings

The secretary reported that provisional venue bookings had been made for January

and March 23

, as these were the dates on which the greatest number of

DUOB members had said they were available. It was agreed that the next two

meetings would be held on those days.

10.

Any other business

i. Post-TELIC

study

Professor Coggon had circulated a draft study protocol, and asked for Board

members who wished to do so to send him comments on it by email.

At this point the observers left the meeting, which then continued in members-only

session. The secretary departed also, and subsequent minutes were recorded by

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the chairman.

ii. Closed session

a) Mr Glennon reported that he had a number of issues he had been asked to

raise by the National Gulf Veterans and Families Association (NGV&FA).

The first concerned the involvement of three members of the Board (the

chairman, Professor Spratt, and Dr Etherington) in the study to be carried

out in collaboration with Professor Simon Wessely on DU exposures among

Operation TELIC military personnel. Professor Wessely was perceived by

the Association as not being “on the side of veterans”; and members of the

Association felt that Board members should not be involved in the study,

particularly since it was not under the direct control of the DUOB.

b) In response the chairman pointed out that the DUOB did have involvement

in the study to the extent that it had been invited to comment on the draft

protocol, and any suggestions would be taken into account when the

protocol was finalised. The fact that three members of the Board were

taking the leading role in designing the study helped ensure that the thinking

of the DUOB was properly taken on board. However, the DUOB did not

have ultimate responsibility for the work, and it was recognised that the

Board could not be considered to have “authorised” the investigation.

c) Professor Spratt said that he had spent much of the previous two years

trying to persuade the MoD of the need to collect better information about

the patterns and determinants of exposure to DU when DU weapons are

used in military conflicts; and that it was important to capitalise on the

opportunity to obtain data in an appropriate time window.

Surg. Cdre. Baldock added that in his view the input from DUOB members

should improve the quality of the study and enhance its credibility.

General Craig agreed, asking who else had the expertise to conduct the

study. Dr Paterson noted that there was a perception that health problems

related to Gulf War 1 had not been taken seriously early enough. In his

view, it was to the credit of MoD that it now wanted to act quickly.

Professor Hooper said that there was nevertheless concern that members of

the Board would be “tainted by association”.

d) The chairman pointed out that unlike Gulf War 1, Operation TELIC was not

of immediate concern to the NGV&FA. Therefore there was no obvious

case for its being closely involved in the study. However, it was recognised

that the NGV&FA representatives on the DUOB did have a contribution to

make, along with other Board members, and the mechanism was in place to

achieve this. Professor Hooper agreed that it was important from a scientific

point of view to carry out the study at an early stage, but nonetheless

remained concerned about what some members of the Board considered

secrecy in its development. Dr Paterson said he was sure that relevant issues

would be brought to the attention of the DUOB, and the chairman

confirmed that this was the case.

e) Mr Glennon said that a second issue of concern was the chairman’s

apparent wish to push for the use of spot urine samples rather than 24 hour

collections. The chairman responded that if they were shown to provide

scientifically valid information, the use of spot samples would be to the

advantage of all concerned, including the veterans being tested. There was

no question of substituting spot samples for 24-hour collections unless there

was good scientific evidence that this was justified. In order that a properly

informed decision could be made, it was proposed to collect information on

the comparison of results from spot and 24-hour samples as part of the pilot

testing of veterans, and also in the civilian normative values study.

f) Mr Glennon said that a third issue for the veterans was the need to ensure

that measurements of

236

U were made. The chairman responded that whilst

he did not think there was a strong scientific rationale for measuring

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the marginal cost of doing so was relatively small and it could be done if

that was what the veterans wished.

g) Mr Glennon then asked about the position of the DUOB in relation to

testing for chromosome aberrations. The chairman said he did not believe

that chromosome aberrations provided a specific index of exposure to DU;

but that if urine testing indicated a significant prevalence of exposure to DU

among veterans, a scientific study of the relationship between chromosome

aberrations and DU exposure would be useful and something the Board

could actively promote. Other members of the Board agreed, pointing out

that chromosome aberrations might also arise from exposure to diagnostic

x-rays. It was agreed that this topic would be an agenda item for the next

DUOB meeting.

h) Finally, Mr Glennon asked for clarification on the proposed paper reporting

the results of the pilot study of laboratory methods. Professor Spratt said the

pilot study had been a valuable piece of work, and it was important to share

its findings with the wider scientific community. The chairman added that

this was not only so that others could learn from the work, but also because

it was possible that someone might draw attention to previously

unrecognised limitations in it. The chairman assured Mr Glennon that the

paper would simply report what was done, and would not be used in support

of other aspects of the DU testing programme that were not addressed in the

study. He said it was unlikely that anything would appear in print for at least

a year.

Distribution:

All members

All observers