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DRAFT MINISTRY OF DEFENCE DRAFT
Page 1
DRAFT
Gulf Veterans’ Illnesses Unit
MINISTRY OF DEFENCE
Room 6/03, St Christopher House, Southwark Street,
London, SE1 OTD
Telephone
Direct dial
020 7305 4644
Helpline
0800 169 4495
Fax
020 7305 2374
DRAFT
Our Reference:
D/GVIU/7/1/8/2
Date:
18
th
February 2002
These minutes are published in draft form and are subject to confirmation at the next Board.
MINUTES OF THE THIRD DEPLETED URANIUM SCREENING PROGRAMME OVERSIGHT
BOARD ON 28
th
JANUARY 2002
Present:
Board:
Observers:
Professor David Coggon
Mr Ron Brown
Dr Chris Busby
Dr Peter van Calsteren
Mr Ivor Connolly
Mr Ray Bristow
Miss Frances Fry
Miss Beverley Green
Dr David Lewis
Dr Gordon Paterson
Professor Brian Spratt
Mr Shaun Emery
Surg Cdr Stuart Allison
Mr Alan Duncan
Mr Neville Higham
Mrs Brigid Rodgers
Mr Mark Newman
Mrs Janie Walker
DRPS
LLRC
OU
NGV&FA
NGV&FA
NRPB
RBL
INM
BRC
RS
GVIU
SGD
HJA
HSE
GVIU
GVIU
GVIU
Chair
Secretary
Apologies:
Surg. Cdre Nick Baldock
Professor Nick Day
Prof Ian Gilmore
Dr Muir Gray
Dr Len Levy
Prof Malcolm Hooper
Dr Hilary Walker
INM
IPH
RBL
NSC
MRC IEH
GVA
DH

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Item Discussion
and
Decisions Actions
(Action date)
1.
Introduction
a) New attenders were welcomed and introduced.
b) The Chairman re-iterated the point that discussions and comments made
at the OB meetings are only to be communicated to persons external to the
Board through the published minutes. Individual members should be free to
speak more generally about issues relating to DU, but should make it clear
that they are acting as an individual and not representing the OB. The
Chairman also re-iterated that any individual who was not content with any
aspect of the OB would be welcome to discuss the matter with him.
c) The Chairman stated that the main aims of this meeting were to:
• Provide an update on the pilot exercise to establish if a suitable
urine test is available for retrospective assessment of exposure
to DU
• Select the pilot study laboratories
• Clarify a number of issues regarding the pilot exercise protocol
2.
Minutes of last meeting
a) These were accepted as a true record of the meeting.
3.
Matters arising from last meeting
a) A full list of actions arising from previous meetings and their current
status is attached at Annex A to these minutes.
b) The ‘Definitions of Terms’ attached to the draft protocol were accepted
by the OB.
c) The Secretary gave an update on progress with the DUOB website. He
stated that web pages had been produced for this site and he was currently
awaiting the registration of the domain name before the site could be
launched. The address of the site will be www.duob.org.
d) The draft Terms Of Reference for the OB have been accepted by US of
S, Dr Moonie.
e) The Chairman stated that he had been in contact with the MRC to keep
them informed of DUOB activities. He had also talked with Professor Simon
Wessley of Kings College regarding the possibility of using the established
Kings College cohorts in future research incorporating DU exposure
assessment.
f) Brigid Rodgers stated that the MOD was prepared to fund a number of
regional centres for urine collections (Action 2.17) but the details had yet to
be discussed.
g) There was some discussion regarding George Etherington’s paper on the
practicability of taking autopsy samples for DU testing. There was general
agreement that this was not easy to achieve, particularly because of the need
to obtain consent from the next-of-kin soon after death. This would be

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difficult unless the procedure had previously been agreed by the prospective
donor. A possible way of achieving the required consent might be to provide
veterans who wished to participate with a card or information sheet that could
be given to his/her doctors, rather like the card that was used by organ donors.
h) Annex A and D of the Royal Society report Part 1 had been distributed
with the calling notice for this meeting. It was noted that these Annexes are
very technical and that they are summarised in the main body of the RS
report. The Chairman asked about the levels of DU that might be excreted in
urine following an acute exposure many years earlier. Brian Spratt responded
that an inhaled dose of 25mg DU as insoluble oxides should be detectable
after 10 years. Ron Brown stated that he had already seen some results of DU
testing in urine and that at the Society for Radiological Protection seminar
two weeks ago Neil Stradling of the NRPB had made a presentation on
excretion profiles. GVIU undertook to make the slides of this presentation
available.
Action 3.1 GVIU to distribute NRPB Presentation
i) There was also some discussion of the results of testing that had been
carried out by Durakovic and colleagues. GVIU undertook to seek permission
to distribute the slides from a Durakovic presentation to the Royal Society in
November 2001 which contained these results.
Action 3.2 GVIU to seek permission and distribute Durakovic presentation to
RS
j) Brian Spratt stated that part 2 of the Royal Society report is in press and
will be released on 11
th
March 2002. The Chairman asked if an advance copy
of the section relating to urine excretion could be made available to some
members of the OB. Brian Spratt said he would look into this.
Action 3.3 Brian Spratt to investigate if advance copies of urine excretion
section of RS report can be made available to members of the OB
Action 3.4 GVIU to distribute part 2 of RS report when available
k) The Chairman briefly described his meeting with Under Secretary of
State, Dr. Lewis Moonie, on 16 January 2002. He had explained the approach
being taken by the OB in setting up the testing programme and stressed that
the Board is aware of veterans’ concerns over the timescale. Dr Moonie was
content with the way things are proceeding.
Secretary
(15/2/02)
Secretary
(15/2/02)
Spratt
(15/2/02)
Secretary
(when
available)
4.
OB Additional Members
a) Dr Len Levy from the MRC Institute for Environment and Health has
been appointed to the Board to fill the toxicologist role.
b) The Secretary gave an update on the additional names that have been put
forward for the Radiation Medicine role on the board. Following discussions
about the nominations it was agreed that only one candidate had the required
clinical experience. GVIU undertook to contact the proposed nomination to
see if they were interested in joining the Board.
Action 3.5 GVIU to contact proposed specialist in radiation medicine
Secretary
(15/1/02)

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5.
Programme Plan
Update on pilot study laboratories
a)
Seven expressions of interest in carrying out the pilot exercise had
been received and evaluated by a subset of the OB. Copies of these were
handed out at the meeting along with a summary document. The Chairman
stressed that these documents were Commercial-in-Confidence and should
not be removed from the meeting room and, in particular, not circulated to
non-members.
b)
The Chairman stated that the aim of this discussion was to select from
the expressions of interest up to 6 laboratories that were judged most suitable
to carry out the pilot exercise. Ron Brown questioned the reason for this. The
Chairman replied that constraints were imposed by the amount of spiked
urine that the NEQAS laboratory could provide and by MOD funding.
Post meeting note: At the first DUOB meeting discussions indicated that 3 or 4
laboratories would be chosen for the pilot exercise. MOD funding had therefore
been sought for this number.
c)
Peter van Calsteren led a discussion on the merits of the 7 expressions
of interest. He had evaluated them on the basis of the relevant experience of
the laboratories, accreditation, publications in journals and the equipment to
be used. This led to a prolonged discussion which is not documented in these
minutes due to the Commercial-in-Confidence nature of the expressions of
interest.
d)
One expression of interest was considered technically much weaker
than the others, although it did propose a novel method that might be worth
investigating. After some further discussion, it was agreed to issue an
Invitation To Tender (ITT) to all 7 laboratories. If all 7 labs provided bids at
acceptable prices then, all other things being equal, the bid that had been
identified as the weakest technically would be eliminated.
e)
Gordon Paterson expressed a concern that some of the laboratories did
not have the accreditation that would be expected by, say, the NHS. David
Lewis pointed out such accreditation would only cover the basic functions of
the laboratory and would not necessarily reflect their ability to do specific
tests for DU exposure. The Chairman said that this was not such an important
issue for the pilot exercise and that the necessary QA procedures etc. would
be built into the contract for the main testing programme.
f)
There was some discussion regarding the size of the urine samples that
would be required. Ray Bristow said that when he went to the US for testing
by Dr Durakovic he gave a 72 hour sample which removed some of the
problems of daily variation. The Chairman pointed out that there was a
balance to be struck between accuracy and practicalities, and large volumes
of urine were difficult to obtain, store and transport. Ray Bristow stated that
anything less than 24 hour samples would not be acceptable to members of
the NGV&FA. The Chairman pointed out that one of the aims of the pilot
exercise was to establish what size of sample would be required for an
accurate test and that each lab would receive large samples (probably 1 litre)
and smaller samples (probably 100 ml) for this purpose. It was generally
agreed that it would be wise to wait for the results of the pilot exercise.

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g)
Brian Spratt asked if the Canadian laboratory involved in the
Durakovic testing had been contacted about the pilot exercise. The Secretary
confirmed that they had been contacted but had not responded with an
expression of interest.
h)
The Chairman pointed out that he was indirectly linked professionally
(although not financially) to an organisations involved in one of the
expressions of interest, and asked if the OB had any objections to his
participation in the selection process. No objections were raised.
Update on laboratory to supply spiked samples
i) At the last meeting, the National External Quality Assurance Schemes
(NEQAS) laboratory at the University Of Surrey was identified as the
preferred supplier of the spiked samples. The Chairman had visited this
laboratory along with David Lewis, Peter van Calsteren and the Secretary on
18
th
December 2001. It was agreed that NEQAS would be suitable for
carrying out the task with supervision by an appropriate Board member. Peter
van Calsteren agreed to supervise the NEQAS work.
j) The Secretary gave an update on the status of the NEQAS contract. The
quote for the work had been received and approved. The contract was
expected to be placed in the next two days.
Post meeting note: NEQAS contract placed on 30/1/02.
k) Ivor Connolly asked if NEQAS could produce the samples to fit in with
the DU pilot study timescales. The Chairman confirmed that this was the
case.
l) The Chairman asked for the Board’s thanks to David Lewis and Peter
van Calsteren to be minuted for their efforts in this area.
Pilot Study Protocol
m) There was extensive discussion regarding the spiking regime, particularly
with regard to the size of the samples and the uranium isotope ratios and
concentrations in the urine. The Chairman stated that members of the OB
should not discuss this outside the meeting in case the credibility of the pilot
exercise was compromised. It was agreed that the spiking regime should be
finalised between David Lewis, Peter van Calsteren, Malcolm Hooper and
NEQAS.
n) Ray Bristow expressed concern that the standards used to spike the
samples would not be representative of the DU contained in weapons. David
Lewis confirmed that the standards used would be ‘pure’ DU standards and
that to create, and gain accreditation for, standards that exactly represented
the DU used in weapons would add excessive time and cost to the programme
without increasing its scientific rigour. Peter van Calsteren stated that other
elements, such as Plutonium, would not affect the analyses, which would look
at the
235
U/
238
U ratio.
o) There was some discussion regarding the supply of aqueous samples to
the pilot study laboratories. It was generally agreed that these would be useful
should there be a problem with the analyses of urine samples, to establish
whether the problem lay with the testing of urine specifically, or whether it
was a problem with the method more generally.

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p) David Lewis mentioned that NEQAS had contacted him to see if his
laboratory would carry out checks on the spiking agents prior to the actual
spiking of the samples and asked the members of the OB if they had any
problem with this as he was a MOD employee. Ivor Connolly expressed the
view that some veterans might be concerned about the MOD using this to
introduce delays into the programme. David Lewis clarified his position as a
board member and stressed his desire to ensure that veterans are tested
correctly. The proposed testing would not be expected to introduce any
delays. It was agreed that David Lewis’s laboratory should make the checks
required by NEQAS.
q) Gordon Paterson asked if the final details of the spiking regime could be
circulated to OB members as soon as they were finalised. He also expressed
the view that some urine samples should be held in reserve in case unforeseen
problems arose.
Chain of Custody for Urine Samples in the main testing programme
r) The Secretary introduced his Chain of Custody paper which had been
distributed prior to the meeting.
s) Ron Brown asked if tamper-evident containers were available for 24 hour
urine samples. David Lewis stated that he did not believe this would be a
problem.
t) Chris Busby asked what was known about the absorption of uranium
onto storage containers etc. Peter van Calsteren stated that this problem was
well recognised, and that appropriate plastic containers are available.
u) There was some discussion regarding the logistics of taking large
samples if they turned out to be necessary. The Chairman stated that he
envisaged the donors being given a large container and collecting the sample
at home rather than staying at a hospital for 24 hours. Gordon Paterson noted
that there are now sophisticated ways of carrying samples to a collection
point i.e. by the use of specially-designed holdalls. He also pointed out that
there are contractors who have experience in the bulk distribution/collection
of sample containers.
v) Ivor Connolly expressed concern over the splitting of samples if this
were required. It was agreed that there was little point in veterans taking their
own sample away with them as the testing could always be repeated if results
were doubted. In this respect, the situation was different from a test, say, of
blood alcohol concentration, where the timing of sample collection was
critical.
w) Chris Busby expressed concern that analyses might under-estimate the
level of DU excreted because DU particles excreted by the kidney were not
completely dissolved. Peter van Calsteren pointed out that the samples would
be acidified in nitric acid and did not see this as a problem.
x) Ron Brown asked if the Chain of Custody paper needed expanding. The
Chairman stated that the paper was a good starting point and would be refined
in the future once the results of the pilot exercise had been examined.
6.
Timescales
a) The Secretary gave an update on the pilot exercise timescales. He stated
that the ITTs would be issued to the 7 laboratories by mid-February, once the
Statement of Requirement had been finalised. Following this, ECC
regulations require that the laboratories should have 40 days to reply. This

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means that the bids will come back in at the end of March. Ivor Connolly
expressed concern that the ITTs were being issued 2 weeks later than had
previously been envisaged. The Secretary stated that he believed the
programme was still on track because a month had been allowed for the
assessment of the bids and two months for the actual pilot studies to take
place, both of which were probably over-generous.
b) The Secretary asked for clarification of the purpose of the Protocol as
compared to the Statement Of Requirement. The general agreement was that
the protocol details how the entire pilot exercise is to be carried out and is
effectively an agreement between the OB and NEQAS. The SOR will be the
instructions to the pilot study laboratories stating what they actually have to
do and will, effectively, be one part of the protocol. It was agreed that the
contracted laboratories should be given a chance to comment on the protocol
before it is finalised, particularly with regard to the arrangements for
handling, storing and transporting samples. If necessary, a meeting could be
arranged for this purpose.
c) The Chairman confirmed that it was still the intention that the pilot
exercise would take place in May. In parallel with this, thought would have to
be given to the advertisement and design of the contract for the main testing
programme. The Secretary agreed to produce a paper on the requirements for
this contract.
Action 3.6 GVIU to produce paper on requirements for main testing
programme contract
Secretary
(15/3/02)
7.
DU Background & Scientific Issues
a) Chris Busby questioned the interpretation of a recent study by the Italian
Commission of Experts into tumour cases among military personnel who had
served in the Balkans and, in particular, the response from US of S to
Caroline Lucas MEP on the subject. Ray Bristow voiced the opinion that if a
map of where DU was fired in Kosovo was examined it would be apparent
that a large number of DU attacks occurred in the Italian sector. The
Chairman said he was interested in this and would like to receive further
information, but that it was not mainstream OB business.
b) Gordon Paterson enquired about the process of setting up
epidemiological studies. The Chairman suggested that any assessment of
research should be carried out by the MRC, and that it should not be the
function of the OB to set up the research programme, although it should have
input to the assessment of proposals.
Post meeting note: GVIU have now written to the MRC for assistance in
establishing epidemiological studies to explore possible health effects of DU, if
and when a reliable method of retrospective exposure assessment becomes
available.
c) Ray Bristow expressed concern that the results of the studies might be
kept secret from veterans. The Chairman stated that the results would not be
secret from the veterans. As with any medical investigation, any veteran who
was tested as part of an epidemiological study would be told of the result if he
or she wished to know it. In addition, the results of the epidemiological study
would be published in the open scientific literature.

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8.
A.O.B.
a) The Chairman asked David Lewis if he would write a short paper on
evaluating the relative performance of laboratories [This will come out of the
protocol work] and explaining some of the statistical jargon for a lay reader.
Action 3.7. David Lewis to produce paper on how laboratories can be judged
against each other.
b) There was further discussion regarding the work of Dr Durakovic. Ray
Bristow stated that Dr Durakovic should be invited to speak to the OB. Brian
Spratt pointed out the lack of controls in the Durakovic work. The Secretary
stated that MOD were very keen to talk to Dr Durakovic and that GVIU had
just written to Dr Durakovic inviting him to come over to discuss his work.
The Chairman stated that it would probably be better if we had some results
of our own before we invited Durakovic to talk to the OB. The Chairman
asked if the McDiarmid et al paper ‘Surveillance of Depleted Uranium
Exposed Gulf War Veterans: Health Effects Observed in an Enlarged
“Friendly Fire” Cohort’ could be circulated to the board.
Action 3.8. GVIU to circulate the McDiarmid paper
c) There was some discussion about whether other tests, particularly blood
tests for lymphoma, myeloma etc, should be carried out at the same time as
the urine testing. The Chairman stated that this was not appropriate and that it
was necessary to first look at the primary indicator of DU exposure i.e. the
urine test for uranium isotopes. A possible future study that could then be
carried out would be to relate the exposure to DU to early biological effects.
d) Gordon Paterson expressed the view that, whatever test was carried out,
it was very important that the method of presenting the results to veterans was
correct.
Lewis
(15/3/02)
Secretary
(15/2/02)
9.
Date of next meeting
a) The date of the next meeting is currently set for 28
th
March 2002 at 09:45 and it
will be held at the Royal British Legion HQ on Pall Mall. A decision as to
whether this date needs to change will be made nearer the time, particularly as it
very close to the expected return date for the pilot exercise tenders.
Distribution:
All members
All observers
Devolved Health Administrations

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ANNEX A - DUOB Action List
Action Date
placed
Action
Date
Detail Owner Comments
1.1
27/9/01
16/11/01
‘Definitions of Terms’ appendix to be
drafted and circulated for comment
Lewis/
Calsteren COMPLETE – Definitions attached
to draft protocol distributed at 2
nd
meeting
1.2
27/9/01
16/11/01
Nominations for toxicologist and radiation
medicine experts to be sent to GVIU
All OB
Members
COMPLETE – See actions 2.2, 2,3
1.3
27/9/01
26/10/01
CVs and declarations of interest to be sent
to GVIU
All OB
Members
Still awaiting Hooper (short), Levy
and Gilmore
1.4
27/9/01
12/10/01
Secretary to establish if payments can be
made for Board members to attend
meeting
Secretary COMPLETE – Payments will be
considered on an individual basis.
Written justification must be
forwarded by Board member to
GVIU for consideration.
1.5
27/9/01
12/10/01
Secretary to create a claim form for
expenses
Secretary COMPLETE - Form distributed on
23/10/01
1.6
27/9/01
26/10/01
Secretary to distribute a copy of the press
release to board members
Secretary COMPLETE – Press release
distributed on 23/10/01
1.7
27/9/01
Ongoing
Board members to write to GVIU with
suggestions for further background reading
All OB
Members
Ongoing
1.8
27/9/01
26/10/01
GVIU to obtain permission and distribute
responses to the 2
nd
consultation paper to
Board Members
Secretary COMPLETE – distributed by email
on 13/11/01
1.9
27/9/01
26/10/01
GVIU to distribute list of email addresses
Secretary COMPLETE – Distributed on
23/10/01
1.10
27/9/01
26/10/01
Board members to suggest suitable
laboratories to GVIU
ALL OB
Members
COMPLETE – 30/11/01
1.11
27/9/01
26/10/01
Secretary to arrange for invitation to
express an interest in the ‘pilot study’ to be
advertised in the relevant journals
Secretary COMPLETE - Advert in MOD
Contracts Bulletin on 21/11 and
OJEC on 13/11/01
1.12
27/9/01
16/11/01
Produce and circulate draft protocol prior
to next meeting
Lewis/
Calsteren
COMPLETE – 30/11/01
2.1
30/11/01
4/1/02
GVIU to send TOR to Minister for
comment
Secretary COMPLETE - Sent on 11/1/02.
Minister has approved the TOR.
2.2
30/11/01
8/1/02
CVs for toxicologist to be sent to GVIU.
GVIU to forward to Minister
Secretary COMPLETE – Sent on 15/1/02
2.3
30/11/01
8/1/02
Suggestions for radiation medicine experts
to be sent to GVIU
All
COMPLETE
2.4
30/11/01
8/1/02
GVIU to consult Royal College of
Radiologists
Secretary COMPLETE – RCR
recommendation received on 24/1/02
2.5
30/11/01
12/12/01
GVIU to notify members of expressions of
interest
Secretary COMPLETE – emailed on 13/12/01
2.6
30/11/01
7/12/01
Draw up Statement Of Requirement for the
sample preparation
Van
Calsteren
COMPLETE – 1
st
draft discussed at
meeting with NEQAS on 18/12/01.
Will be revised in discussion between
LEWIS, van Calsteren and NEQAS
2.7
30/11/01
10/12/01
David Lewis to contact the preferred
supplier of spiked samples (and other
suppliers if required) to assess interest and
costs
Lewis
COMPLETE
2.8
30/11/01
13/12/01
Arrange meeting with supplier of spiked
samples
Lewis
COMPLETE – see 2.9 below

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2.9 30/11/01
20/12/01
Subgroup
to
visit
supplier
Coggon/
Lewis/
van C/
GVIU
COMPLETE – lab visited on
18/12/01
2.10
30/11/01
28/1/02
Nick Day to review protocol and proposed
statistical methods
Day
Ongoing – awaiting redraft of
protocol following discussions with
NEQAS
2.11
30/11/01
21/12/01
David Lewis to redraft protocol for pilot
study of analytical methods
Lewis
Ongoing- awaiting NEQAS contract
2.12
30/11/01
21/12/01
David Lewis to draft the SOR for the urine
testing in the pilot study, to be distributed
to the OB by 21/12/01
Lewis
COMPLETE – ITT sent to NEQAS
on 14/1/02
2.13
30/11/01
10/1/02
OB to comment on the SOR for urine
testing by 12.00, 10 Jan 02
All COMPLETE
2.14
30/11/01
28/1/02
Chairman to appraise MRC of the planned
timetable for the development of the
testing method
Chair
COMPLETE – Chairman talked to
Catherine Moody of MRC
2.15
30/11/01
21/1/02
Chairman to produce paper for next
meeting summarising the different types
of epidemiological study that might be
relevant
Chair
COMPLETE – Paper circulated on
11/1/02
2.16
30/11/01
21/1/02
GVIU to produce a paper on the options
for a chain of custody of urine samples
Secretary COMPLETE – Paper circulated on
25/1/02
2.17
30/11/01
28/1/02
GVIU to identify the position of MOD
funding of regional centres
Secretary COMPLETE – MOD will fund
regional centres but the details of this
need to be decided
2.18
30/11/01
28/1/02
NRPB to obtain advice on the feasibility of
testing for DU in tissue samples obtained
at autopsy
NRPB
COMPLETE – paper distributed on
18/1/02
2.19
30/11/01
14/1/01
GVIU to circulate Annexes A and D (on
the current ICRP models and Organ Doses
from intakes) from the Royal Society
report
Secretary COMPLETE – Circulated on
11/1/02
2.20
30/11/01
21/1/02
GVIU to provide Contracts Branch with
the draft protocol in time for ITT issue on
31 Jan 02
Secretary Ongoing – awaiting NEQAS contract
2.21
30/11/01
21/1/02
David Lewis/ van Calsteren to prepare a
paper on laboratory methods
Lewis/
van
Calsteren
Not possible within this timescale –
due to DL and PvC commitments
will be re-considered in the future
2.22
30/11/01
7/12/01
GVIU to arrange a meeting between
Chairman and US of S
Secretary COMPLETE – Chairman met with
US of S on 16/1/02