This is the html version of the file
G o o g l e automatically generates html versions of documents as we crawl the web.
To link to or bookmark this page, use the following url:

Google is not affiliated with the authors of this page nor responsible for its content.
These terms only appear in links pointing to this page: minutes9 pdf

Page 1
Gulf Veterans’ Illnesses Unit
Zone A, Floor 7, St Georges Court,
2-12 Bloomsbury Way,
London, WC1A 2SH
Telephone Direct dial
020 7305 4644
0800 169 4495
020 7305 4166
Our Reference:
April 2003
MARCH 2003
Professor David Coggon
Surg. Cdre Nick Baldock
Mr Ron Brown
Dr Chris Busby
Mr Ivor Connolly
Dr George Etherington
representing Miss Frances Fry
Mr Jim Glennon
Dr Muir Gray
Miss Beverley Green
Professor Malcolm Hooper
Dr David Lewis
Dr Gordon Paterson
Professor Brian Spratt
Mr Shaun Emery
Air Cdre Simon Dougherty
Mr Neville Higham
Mrs Brigid Rodgers
Miss Rosie Wane
Mrs Janie Walker
Wg Cdr Charlie Wilcock
Gideon Henderson
Mr Alan Duncan
Miss Frances Fry
Professor Ian Gilmore
Dr Len Levy
Dr Margaret Spittle
Dr Hilary Walker

Page 2
2 of 20
Discussion and Decisions
(Action date)
a) The Chairman welcomed board members to the meeting.
b) George Etherington stated that Frances Fry was taking early retirement and
would no longer be attending the DUOB. Dr Etherington had represented the
NRPB on a number of occasions in Frances’s absence and NRPB were happy
for him to be their representative on the DUOB. This was agreed by Board
Action 9.1. The Secretary undertook to seek approval from US of S for
George Etherington’s appointment to the DUOB.
c) The Chairman stated that Peter van Calsteren had resigned from the DUOB
due to a potential conflict of interests. Dr van Calsteren had asked for this
issue to be discussed at this meeting. The DUOB agreed that it had been
appropriate for Dr van Calsteren to resign from the Board in the
d) As a result of Dr. van Calsteren’s resignation, there was a need to fill a gap in
expertise on the OB. At the Chairman's suggestion, Dr. Gideon Henderson
from Oxford University had therefore been invited to attend this meeting as a
guest and possible future member of the Board. Dr Henderson introduced
himself as a lecturer in environmental earth sciences at University College,
Oxford. Dr Henderson pointed out that his department had links with
Professor Sir Keith O’Nions, the Chief Scientific Advisor (CSA) to the MOD.
Dr Henderson stated that CSA was a previous head of the Department of
Earth Sciences and still had a nominal role in the department. Dr Henderson
had worked with CSA in the past and had not bid for the main testing contract
because of this link. Jim Glennon asked if his department received any
funding from the MOD. Dr Henderson stated that he was unaware of any
MOD funding within his department and undertook to check this fact. He also
undertook to provide details of his background. A decision regarding Dr
Henderson’s membership of the DUOB would be taken outside of the
e) Chris Busby spoke briefly about a proposal he wished to bring to the table
regarding the recent deployment of troops to the Gulf. As this was not within
the Terms of Reference of the DUOB, it was agreed to discuss it later under
f) The Chairman noted that the Secretary had been drafting various documents
for the DUOB, but it was important that all members of the Board contribute
to the process by commenting on the drafts in timely fashion. At present,
comments on documents were generally received from only a core of 3 or 4
members. He asked that if a Board member had no comments on a document
then an email to this effect should be sent to the Secretary within the required
Minutes of Last Meeting
a) Minor changes to the minutes of the last meeting were agreed by all Board
Action 9.2. Secretary to amend minutes of 8
DUOB and circulate
b) Jim Glennon queried the meaning of paragraph 8e in the last minutes. It was
agreed that this paragraph was clear in that if a veteran requested a re-test this

Page 3
3 of 20
agreed that this paragraph was clear in that if a veteran requested a re-test this
would have to be considered on its individual merits. Gordon Paterson
suggested it would be wise to check the NHS situation. He stated that while
an NHS patient is entitled to a second opinion he was unsure if this extended
to a repeat of a laboratory test.
Action 9.3. Gordon Paterson to supply details on NHS re-test policy
Matters arising from last meeting
a) The Secretary confirmed he had distributed the following documents:
Final minutes of 7
Malcolm Hooper’s email regarding the DU questionnaire
Final SOR for extended pilot exercise
Target isotope ratios for the extended pilot study (to a subset of the
Schedule for putting the screening programme in place
Questionnaire to people having a test
b) Malcolm Hooper had received comments from the Chairman and Ron Brown.
The questionnaire is discussed in section 8 of these minutes.
Summary of pilot exercise
c) The Secretary stated that he had completed this action and the summary was
available on the DUOB website.
d) Brian Spratt had received advice from two sources indicating that there was
no need to add thymol to urine other than in exceptional circumstances. It was
agreed therefore that there was no need for the DUOB SORs to specify that
thymol be added to urine samples. Contracted laboratories would be
responsible for the health and safety aspects of dealing with the samples.
SOR for Main Contract
e) The Secretary stated that he was working on the next draft of the SOR for the
main contract for laboratory testing which would be circulated soon. He
stressed that some of this work was outside his area of expertise and he
needed as much help from Board members as possible.
Plan for Analysis of Pilot Study results
f) The Chairman had produced a draft plan for examining the pilot study results.
This is discussed under section 7.
Information for GPs etc.
g) The Chairman had produced new drafts of the information. This is discussed
under section 9.
DU Research
h) With regard to section 7b of the last minutes, the Chairman stated that he had
attended a meeting of the MRC Military Health Research Advisory Group

Page 4
4 of 20
(MHRAG) (a committee established to advise the MOD) at the end of
January. DU had been discussed at the meeting – the general view was that
this subject was not a research priority. The Chairman said that he had
pointed out that it was a priority for some veterans. Chris Busby expressed
concern that if the MRC was saying that DU research was not a priority then
funding would not be available for related epidemiological studies. The
Secretary pointed out that the MOD had stated that it would fund
epidemiological studies once the screening programme had been set up. The
Chairman said that in relation to this research, the MRC would not be asked
to comment on the priority of proposed studies, but on their validity.
i) Ivor Connolly stated that, in his view, research tended to look at a subject in
isolation and did not study the combined effects of a number of factors. The
Chairman said that he believed that Porton Down research was looking at
interactions between vaccines and NAPS. He suggested that if members had
reasons to suspect a toxic interaction between DU and other exposures in the
Gulf or Balkans, they could present their ideas to a future meeting of the
Post meeting note: The Vaccines Interactions Research Programme will
complete in December 2003
Update on Extended Pilot Exercise
a) The laboratory responsible for producing the spiking solution for the pilot
study had written a detailed report on this. Dr. Henderson stated that from a
brief look at the report the work appeared to have been done very carefully
and along sensible lines. Dr. Henderson expressed concern over two issues.
He asked if the fact that uranium could be diet dependent had been taken into
consideration. The Chairman replied that the uranium content and isotope
ratios of the unspiked urine samples would be checked. Dr. Henderson also
expressed concern over the laboratory’s ability accurately to measure a zero
U236 reading. Dr. Henderson undertook to have a more detailed read of the
paper and report back to the DUOB.
Action 9.4. Dr Gideon Henderson to report back to DUOB on the spiking
solution paper
Post meeting note: Dr. Henderson emailed the Secretary on 13
March stating
that the U236 issue
appeared to have been dealt with satisfactorily.
b) The Chairman commented that the report indicated that the spiking samples
had been produced correctly and that the go-ahead had been given for the
laboratory to distribute the spiking solution to the other laboratories. The
Secretary stated that he expected this to happen by the end of the week.
Post meeting note: The spiking solution was delivered to the laboratories on
c) Chris Busby asked about the problem of uranium absorption in the containers.
David Lewis stated he had carried out experiments in his laboratory which
indicated that this was not a problem in polyethylene bottles if the urine was
d) It had originally been intended that, once the three laboratories had produced
the spiked samples, they would be sent to Peter van Calsteren's laboratory,
where they would be re-labelled and distributed back to the other laboratories
for measurement. It was agreed that it would not be appropriate for Dr van
Calsteren to carry out this task following his resignation, and Gideon
Henderson was asked if there was a possibility of carrying out the task at his
laboratory. Dr Henderson stated that he saw no problem with this but needed

Page 5
5 of 20
laboratory. Dr Henderson stated that he saw no problem with this but needed
to check a few details before he could commit to it.
Post meeting note: Dr Henderson confirmed by email on 13/3 that it would be
possible to re-label the samples at his laboratory.
Action 9.5. Secretary to arrange the re-labelling exercise with the relevant
e) Gideon Henderson asked if all the laboratories were using the same
containers for the final spiked samples. The Secretary confirmed that this was
specified in the contract and had been brought up in discussions with the 3
laboratories. He undertook to check this. Gideon Henderson also stated that it
was necessary to check how the laboratories intended to label the containers.
The Secretary also agreed to check this.
Action 9.6. Secretary to check on sample containers
Action 9.7 Secretary to check on sample labels
Analysis of pilot study results
f) The Chairman had produced a short plan of how the pilot exercise results
could be analysed (Attached at Annex A). He talked through this paper,
stating that Item 7 (checking that discrepancies between laboratories and in
comparison to expected values are within the quoted ranges of error for each
laboratory) would p robably be the most difficult for him. The DUOB were
asked to comment on this paper within two weeks.
Action 9.8. DUOB members to comment on analysis of pilot exercise results
Draft SOR for Normative Value Study
a) This SOR had been distributed prior to the meeting but did not include
comments received since that time. The Chairman stated that there were 4
main reasons for the normative value study:
To establish the range of urinary uranium excretion and isotope
ratios in the general population
To explore potential determinants of variation between individuals
such as place of residence and occupation
To examine how uranium excretion varies throughout the day
To establish how repeatable results are from one day to another
b) A number of issues were discussed, particularly with regard to factors that
might be associated with variation in uranium excretion. These included:
Residence near to the coast
Residence near to nuclear facilities etc.
c) The Chairman undertook to produce the next draft of the Statement of
Action 9.9. Chairman to produce fourth draft of Statement of Requirement
for Normative Value Study.
d) The Secretary stated that this was a small contract and did not need to be
advertised. A contractor had been suggested for this study at a previous

Page 6
6 of 20
meeting. The Secretary stated that he had been in preliminary discussions
with this organisation.
Draft Advertisement for Health Provider Contract
a) The Secretary stated that the activities leading up to placing the Health
Provider Contract now formed the critical path for the screening programme.
This advertisement needed to be placed as soon as possible to ensure that no
further delay occurred in the programme. [There had been no point in
advertising this previously as Invitations To Tender for the Health Provider
Contract would be issued in parallel to the main testing contract once it was
established that a suitable test was available].
b) Minor alterations to the advertisement were agreed.
Post meeting note: The revised advert was circulated by email following this
meeting and a few minor comments received. The final version was sent to MOD
Contracts Branch on 14/3/03.
Main Testing Contract
a) The Chairman sought to clarify a number of issues with regard to the main
testing contract.
Number of Laboratories for Main testing Contract
b) It was agreed that, if possible, 3 laboratories should be involved in the main
testing programme as this provided scope for interlaboratory comparison and
also provided back-up if one of the laboratories dropped out.
c) Ivor Connolly asked why the main testing contract had been advertised to
laboratories other than those taking part in the current pilot exercise as this
seemed to be delaying the programme. The Chairman explained that, because
of the uncertainty over the existence of a suitable test, the initial requirement
had been advertised for a pilot study to examine a number of techniques.
There would have been no point placing a contract for the main testing
programme at that stage. Because of the value of the main testing contract,
European Union rules required that the main testing contract be advertised in
the Official Journal of the European Community. This had elicited 7
expressions of interest in carrying out the main testing contract. However
many laboratories were asked to tender for the contract, these would all have
a set time to answer the ITT and would be considered at the same time. Hence
there would be no additional delay to the programme from inclusion of
laboratories other than those carrying out the pilot study.
Treatment of Sample
d) It was agreed that the laboratories involved in the main testing programme
would be responsible for organising the measurement of creatinine. It was
also agreed that acidification of urine samples should take place in the
laboratories rather than at the point of collection. No decision was reached on
whether the samples needed to be refrigerated. David Lewis undertook to
advise on these issues.
Post meeting note: The SOR for the Health Provider Contract will specify that the
samples must be delivered to the laboratories within 5 days of sample collection.
Consideration of creatinine measurements, acidification and refrigeration must be
made with this period in mind.

Page 7
7 of 20
Action 9.10. David Lewis to advise on creatinine measurements, acidification
and refrigeration of samples
Splitting of Samples
e) It was agreed that there was no need to split the samples for security
purposes. If a repeat test was required, the veteran could provide a second
f) Samples might, however, need to be split for the purpose of Quality Control,
with analysis of the same sample by two or more laboratories.
Quality Control
g) Quality Control would be achieved by analysing some of the samples in
duplicate and by providing spiked samples as in the pilot exercise.
h) It was agreed that once contracts were let for the main testing programme it
would be a good idea to get the contracted laboratories together to discuss
how a Quality Control programme could be carried out.
Assessment of Expressions of Interest in Main Testing Contract
i) The Secretary reminded the Board that the main testing programme had been
advertised last year, prior to the results from the first pilot study. Seven
organisations had expressed an interest in bidding for the main testing
contract. The Secretary stated that he now wanted expert input on which
organisations should be invited to tender. Gideon Henderson and David
Lewis were tasked with looking at the Expressions of Interest, and advising
on this.
Action 9.11. Gideon Henderson and David Lewis to review the expressions of
interest for the main testing contract
a) A revised draft of the questionnaire by Malcolm Hooper had been distributed
to the DUOB prior to this meeting. There was considerable discussion about
the purpose of the questionnaire, particularly with regard to whether and how
it should be used for research purposes. Beverley Green pointed out that it
had previously been agreed by the DUOB that the questionnaire would be
used primarily for clinical purposes and not to generate data for research.
Chris Busby argued that any data obtained could be used for hypotheses
generation. The Chairman stated that data linking DU exposure to health
were likely to be biased as the scheme was voluntary. This would make
meaningful interpretation virtually impossible.
b) There was a great deal of discussion about whether a question should be
included asking if the veteran had cancer. The Chairman argued that an open
question asking about any illnesses that the veteran was worried about would
be more useful for clinical purposes. Beverley Green stated that under the
Data Protection Act it was necessary to have a reason for collecting specific
data i.e. it is not allowed to ask for information without having a specific
purpose for those data.
c) Gordon Paterson pointed out that the Factsheet supplied to the veteran would
detail the alleged health risks of DU and most likely prompt the veteran to
consider cancers etc. in answering an open question. Chris Busby argued that
an open question would not generate information on where the cancers

Page 8
8 of 20
appeared. Brian Spratt asked if this was something that could be picked up
when the veteran visited the Health Provider and handed in the questionnaire.
David Lewis asked if a cancer question could be considered leading and
might generate unnecessary fear.
d) Chris Busby asked for a vote on whether an explicit question about whether
the veteran had cancer should be included. Four people voted for the question
and seven voted against with one abstention. It was therefore agreed that the
cancer question would not be included in the questionnaire
e) There were further comments on the questionnaire as follows:
The question about alcohol consumption should be removed – but
smoking left in
Acronyms should be expressed in full
The occupation of the veteran should be considered carefully as
many service personnel perform tasks outside of their designated
The layout of the questionnaire must be further considered
Possible inclusion of earlier residential history
f) Beverley Green expressed the view that the question relating to satisfaction
with the MOD Medical Assessment Programme was not relevant. Malcolm
Hooper explained that he was trying to collect evidence that would support or
disprove the feeling among veterans of his acquaintance that the published
figure of 95% satisfaction with the MAP was incorrect.
Post meeting note: The MAP satisfaction questionnaire is given to the veteran at
the beginning of the visit and generally filled out while the veteran is waiting for
blood tests etc. At no point does a member of the MAP staff sit with the veteran or
prompt answers. The anonymous questionnaire is placed into a box when the
veteran leaves and the forms are examined and the statistics updated
approximately every two months.
Information to Veterans/GPs
a) Muir Gray stated that he had done some work regarding the information that
should be supplied to veterans and their GPs. He distributed the papers
attached at Annex B.
b) Muir Gray recommended that the advice to veterans and GPs be combined
into a single piece of information.
c) Muir Gray also recommended that the work produced on this so far should be
passed to an organisation with experience in the preparation of resources for
clinicians and ‘patients’. His paper briefly discussed three organisations that
could carry out the task. The chosen organisation would take the information
that had already been produced, develop it using focus groups and then
supply the tested resources. The DUOB agreed with this approach and Muir
Gray undertook to prepare a report based on his discussions with the three
Action 9.12. Muir Gray to produce report on his discussion with the three
d) Muir Gray suggested that two members of the DUOB should be nominated to
help with the production of the information. Muir Gray and Gordon Paterson were
nominated by the Board

Page 9
9 of 20
a) The Secretary pointed out that the schedule for implementing the screening
programme was very tight, particularly with regard to the Health Provider
Contract. He also pointed out that if the next meeting was scheduled for May
then the SORs for the three contracts (main testing programme, Health
Provider and normative value study would need to be discussed and agreed
ex-committee. He again stressed that he would need the Board's co-operation
to achieve this.
DU Background and Scientific Issues
a) David Lewis had recently visited a number of organisations in the US on
behalf of the Chairman. He provided a brief of his activities in the US,
attached at Annex C.
Date of next meeting
a) The date for the next meeting was set for 12
May 2003.
a) Malcolm Hooper presented a proposal by Chris Busby (who had to leave the
meeting early). The main points of the proposal were that:
1) British soldiers engaged in operations in southern Iraq should be
given respirators or masks capable of stopping particles down to 0.1
2) British soldiers should be adequately and fully warned of the
dangers from DU particles
3) That British Forces should be made aware that following any
conflict they could ask for urine tests and be included in the testing
programme being carried out under the direction of the DUOB
b) The Chairman pointed out that points 1 and 2 were outside the terms of
reference of the DUOB. However, Brigid Rodgers gave a brief summary of
the instructions that have been given to British troops:
General health and safety instructions for UK troops, which cover
encounters with DU, are incorporated in the Mounting Instructions for
the operation which have been passed to the units involved
Safety instructions, covering all aspects of the hazard management of
DU munitions in theatre, have also been issued by the Permanent Joint
Headquarters (PJHQ) through the operational chain of command to all
units and formations deployed in the Joint Area of Operations
Specific instructions and training packages exist for Explosive Ordnance
Disposal (EOD), Royal Armoured Corps (RAC) and support personnel,
those most likely to come into contact with DU munitions or dust.
Radiation monitoring equipment has also been provided to some EOD
Brigid Rodgers stated that these safety instructions would soon be made
available to the members of the DUOB
c) With regard to point 3 of Chris Busby’s proposal Brigid Rodgers pointed out
that the MOD Biological Monitoring policy (
Issues/Health and Safety/Depleted Uranium) had been discussed at the last
DUOB meeting. Under this policy post-deployment monitoring would take
place on return from the area of operations. Levels 1 and 2, according to the
definitions used by the Royal Society, would be encouraged to receive testing

Page 10
10 of 20
definitions used by the Royal Society, would be encouraged to receive testing
and Level 3 (which includes all personnel who have operated in a theatre
where DU has been used) would be offered a test on a voluntary basis. These
personnel would be tested with a less sensitive assay than that being explored
by the DUOB to assess exposures after an interval of up to 13 years.
d) In addition to this Brigid Rodgers provided further information about a
suggestion made at the last DUOB meeting regarding pre-deployment testing
of troops heading to the Gulf area. This would not be carried out for a number
of reasons (discussed at the last meeting). However, a normative value study
of military personnel was being planned – this would be carried out in
addition to the normative value study of the general population being planned
by the DUOB. The subjects of the study would be military personnel in the
UK and Germany and would be representative of those currently deployed to
the Gulf area.
e) Charlie Wilcock (Defence Medical Services Department) reiterated that all
those deployed to the Gulf would be eligible for a post-deployment test
should DU be used. Returning troops would be given an information card
stating that DU had been used and how to apply for a test. He also explained
that it was considered impractical to take samples from those already
deployed in the region due to the activities being carried out. Also the DU
pilot exercise had already demonstrated the ease with which contamination of
samples can occur and this would be a much worse problem in the middle of
the desert.
f) Gordon Paterson expressed the view that, from an epidemiological point of
view the normative value study appeared to be sound and that it was not
necessary for pre- and post-deployment testing to be carried out on the same
personnel. Malcolm Hooper reiterated his view that the biological half-life of
soluble uranium was 36 hours and that by the time personnel returned from
the Gulf the uranium in their bodies would be much reduced. Ron Brown
stated that he had seen no evidence of this timescale and asked Malcolm
Hooper to provide his source of information about this. Brain Spratt stated
that he was confident that DU would be easily detectable for up to a year
following exposure.
Action 9.13. Malcolm Hooper to provide information regarding biological
half-life of soluble uranium.
g) Ivor Connolly expressed the view that the DUOB should recommend to the
MOD what tests should be carried out in the Gulf and when the troops
returned home. The Chairman pointed out that this was outside the terms of
reference for the DUOB.
Post meeting note: As the subject of the terms of reference of the DUOB was
mentioned a number of time during this meeting, a copy of the TOR is attached at
Annex D
All members
All observers
Devolved Health Administrations

Page 11
11 of 20
Annex A -Plan of Analysis for Extension to Pilot Exercise
Compare results for spiking solution – between laboratories and with expected
2. Determine best estimate for uranium concentration and isotope ratios of
spiking solution.
Compare results for unspiked urines – between laboratories, and within
laboratories according to sample size.
4. Determine best estimates for uranium concentration, isotope ratios, and
“concentrations” of natural and depleted uranium in the three unspiked
samples of urine. (n.b. we do not expect to find any evidence of depleted or
enriched uranium in these samples.)
Compare results (total uranium concentration, isotope ratios, and
“concentrations” of natural and depleted uranium) for spiked urines – between
laboratories, within laboratories according to sample size, and with expected
values based on the best estimates determined previously for the spiking
solution and unspiked urines.
For each laboratory and sample size, compare the results for spiked samples
with those expected from the unspiked sample and the composition of spiking
solution as measured by that laboratory.
Check whether the discrepancies between laboratories and in comparison with
expected values are within the quoted ranges of error for each laboratory.

Page 12
12 of 20
The National Screening Committee wishes to commission, on behalf of the Depleted
Uranium Oversight Board, the appraisal of draft information sheets for clinicians and
patients. The outputs that would be expected from the project would be:
a general practitioner information sheet which had been tested with focus groups
of general practitioners for readability and usefulness; the general practitioners
would also be asked how much of the information being given to people being
tested they wished to see;
a question and answer sheet for those offered the test which had been piloted and
evaluated with a focus group of veterans; it would be assumed that this would be
made available for two levels of readability using a standard process for assessing
a report describing the process that had been undertaken in the preparation of
these resources, together with any additional recommendations the team carrying
out the development project wished to make.
Time scale
The time scale would be determined by the Ministry of Defence but testing should not
start until the Depleted Uranium Oversight Board was satisfied that they had valid and
useful resources for both clinicians and patients to accompany the testing process.
J A Muir Gray, CBE, DSc, MD, FRCP, FRCPSGlas
Programme Director – UK National Screening Committee

Page 13
13 of 20
The National Screening Committee undertook to help the DUOB with the quality
assurance of information prepared for clinicians and veterans because of their
experience in developing resources to ensure that people offered tests made an
informed choice about whether or not they accepted the test.
A draft letter to general practitioners has been prepared with a depleted uranium fact
sheet. In addition a question and answer sheet has been prepared for those seeking a
test for depleted uranium.
The issues
In preparing material of this sort there are a number of issues that need to be
considered. Two that are of particular importance are:
1. Should there be material specifically written for clinicians and for members of the
public, or should the same material be available to all with members of the public
also having access to the same content in a simpler style? At present the proposal
is that general practitioners receive a fact sheet with those who are seeking a test
for depleted uranium being offered a question and answer sheet. Some healthcare
professionals prefer question and answer as a means of assimilating unfamiliar
knowledge and some healthcare professionals would probably prefer the question
and answer format although this does not cover all of the issues covered by the
fact sheet.
2. Similarly there are some facts on the fact sheet which are not contained in the
question and answer sheet and some people offered testing would probably like
this fact sheet linked to the question and answer sheet. It is also possible that
some veterans will want more information than healthcare professionals are
offered because exposure to depleted uranium is perceived by them as a risk of
very high significance, whereas the healthcare professional, particularly if he or
she does not understand all the issues involved, may not see it as such a serious
Testing of the draft materials
It is proposed that the services of a centre with the tools, experience and credibility in
the preparation of resources for clinicians and patients be obtained to test the
resources that have been prepared and address the two questions set out above. This
would be done by developing focus groups of veterans and clinicians and discussing
with them both the questions raised above and any questions that may be raised by the
DUOB, and then appraising the individual documents.
Document appraisal will be carried out using standardised techniques such as the
DISCERN instrument. This has been validated as a means of appraising patient

Page 14
14 of 20
information and covers not only the clarity of the English but also the strength of the
evidence base. Furthermore, the people who carry out this appraisal have experience
of developing patient information materials for a range of groups and could advise on
the need for one level or more than one level of resource to be made available.
The process of procurement
Three organisations have been invited to express an interest in carrying out this work.
They are widely regarded as the leaders in the field both nationally and internationally
and are independent organisations. All organisations have received grants from the
Department of Health in the past but they are charities and would certainly not see
themselves as part of government. All three have a mission to ensure that patients and
members of the public are adequately informed about the choices they face.
Using the specification attached as an appendix, one of the three organisations
described briefly below will be asked to carry out the work.
It is recommended that the DUOB nominate two people to help in the selection
process and sit on a small project board that could be consulted during the course of
the project if necessary.
[Information on individual organisations removed – Secretary]

Page 15
15 of 20
Annex C – David Lewis Brief on US Visit
1. Introduction.
1.1 MOD members visited the USA between 24
and 26
February to discuss
issues surrounding depleted uranium exposure in US Gulf war veterans. This
included visits to a number of US Armed Forces establishments where
depleted uranium (DU) analysis was being performed and offered the
opportunity to discuss analytical methods and instrumentation.
1.2 The following establishments were visited.
The Armed Forces Radiobiology Research Institute
The Armed Forces Institute of Pathology (AFIP)
The US Army Centre for Health Promotion and
Preventive Medicine (CHPPM)
The Veterans Assessment Medical Centre Baltimore
2.1 AFFRI is responsible for medical nuclear and radiological readiness
including; research and development, medical training and emergency
response procedures. AFFRI has been involved in the study of the health
effects of embedded uranium in animals as a model for uranium toxicity in
level 1 exposed veterans. This has involved the development of analytical
methods for the measurement of DU in urine and other biological fluids. Two
analytical methods were identified at the meeting between GVIU and AFFRI
a. ICPMS analysis. It was indicated that the AFFRI
laboratories were analysing DU in urine using a standard
Perkin Elmer Elan quadropole instrument. Samples
appeared to be pre-concentrated using an ion exchange
system before analysis. No details were obtained but the
use of ion exchange resins in this way is a standard
radiochemical procedure. An example would be the
Eichrom UTEVA resin. Unfortunately the planned
laboratory visit could not take place due to time
constraints so the performance of the method could not
be pursued, however level 1 exposure leads to excretion
of DU in µg/l quantities. A method developed for the
study of such high DU levels is unlikely to be suitable for
the ng/l levels expected in the DUOB retrospective study.

Page 16
16 of 20
b. Colorimetric method. AFFRI have also developed a
patented colorimetric method for analysis of uranium in
urine. The method again uses ion exchange sample
concentration followed by a colour reaction with 2-(5-
Bromo-2-pyridylazo)-5-diethylaminophenol. The test kit is
hand held and is intended as a rapid field test for uranium
in environmental samples and biological fluids. The
current detection limit is 30µg/l although it is thought this
can be lowered to 3µg/l with further development. Again
this method, although adequate for its intended purpose
cannot be considered appropriate for retrospective
2.2 Conclusion. AFRRI methods are intended for the study of embedded
DU and field estimation of excretion immediately post exposure and are
comparable to the biological monitoring methods now to be employed by
3. AFIP.
3.1 AFIP is the US tri-service centre of expertise in pathology with a wide
ranging remit covering all areas of advanced pathology including toxicology,
infectious disease and environmental medicine. Included in this AFIP provides
the pathology expertise in the study of Gulf War illness symptoms, including
the determination of uranium concentration and isotope ratio in urine samples
from DU exposed veterans. AFIP, like AFRRI, has a direct interest in the
study of level 1 exposures and has carried out studies on the fate of DU
shrapnel in the body.
3.2 Interlaboratory comparisons. AFIP has been involved in an
interlaboratory comparison trial to assess the performance of the laboratories
involved in the analysis of DU in urine samples from Gulf War veterans.
3.3 DU analysis at AFIP. Uranium analysis and isotope ratio methods have
been developed by a group led by Dr John Ejnik, a lieutenant in the US Navy
Medical Corps. The methods for urine analysis involve the use of a Perkin
Elmer Elan DRCII ICPMS which is a quadropole instrument with an additional
reaction cell before the main mass filter. The use of the reaction cell allows
the removal of mass interferences thus giving lower instrument backgrounds
and lower detection limits. The instrument is used in its standard
configuration using platinum cones and a quartz spray chamber.
3.4 Total uranium. Samples are collected in polythene containers that have
had minimal pre-cleaning. The samples are then ashed in nitric acid, taken to
dryness and re-dissolved in 0.2% nitric acid. U233 is added as an internal
standard and the samples are then analysed by isotope dilution mass
spectrometry using the Elan ICPMS in normal mode. Results are ratioed to
creatinine allowing spot samples to be used.
3.5 Isotope ratio. The
U ratio is measured in urine samples but other
isotopes are omitted. Samples are again collected in polythene containers and

Page 17
17 of 20
are acidified with 5% nitric acid prior to analysis. Analysis is direct using the
Elan ICPMS in DRC mode. Several DRC reaction gases have been used
including oxygen which forms uranium oxides in the reaction cell and allows
measurement of the uranium at masses of 267 and 270. No tracer is used
and the analysis can be performed on a 15ml urine sample.
3.6 Method performance. Data was presented demonstrating that the
method could determine accurate 235/238 isotope ratios in samples
containing 3-5ng/l total uranium. No detection limit for total uranium was
given but it is assumed that it will be at least an order of magnitude lower, ie of
the order of 0.3ng/l.
3.7. Conclusion. The data presented for the DRC ICPMS analysis confirms
that this method would potentially be suitable for assessment of current DU
excretion by Gulf War veterans.
4.1 CHPPM is the US Army’s environmental and occupational health
organisation. Although based in Baltimore it is active worldwide. Militarily its
role is to ensure the health of US soldiers by both preventative measures and
by minimising exposure to environmental and toxicological hazards. CHPPM
has been involved in the characterisation of DU exposure pathways and the
development of awareness training for military personnel to minimise DU
exposure in future operational theatres.
4.2 DU analysis. CHPPM has investigated a wide range of analytical
methods to assess their suitability for determining DU in urine following
inhalation exposure and have concluded that ICPMS is the most appropriate.
The laboratory currently uses a Perkin Elmer 6000 quadropole ICPMS for
determination of total uranium with a detection limit of 1.8ng/l. Samples are
prepared for analysis by digestion with nitric acid and hydrogen peroxide and
diluted prior to analysis. U233 is used as a tracer and the analysis is carried
out by isotope dilution.
4.3 Sample storage. Studies are underway to fully evaluate sampling and
storage procedures but the use of polythene containers is likely with
preservation by acidification or freezing.
4.3 Isotope ratio. Current work is based around the use of preconcentration
techniques. Samples are separated using the Eichrom UTEVA resin and
analysed by ICPMS. Development work is still ongoing.
4.4 Conclusion. CHPPM is developing methods for prospective monitoring of
personnel in future operational theatres. This is focussed on the ability to
identify inhalation exposures and appears to be linked to acceptable radiation
exposure limits. As such the methods are comparable with MoD biological
monitoring methodology rather than the DUOB retrospective analysis.
5. VAMC.
5.1 The Baltimore VA Medical Center is described as the acute medical and
surgical care facility for veterans. It combines inpatient, outpatient and primary

Page 18
18 of 20
care services and also carries out research into medical issues, including
depleted uranium exposure studies led by Dr McDiarmid.
5.2 VAMC is involved in two separate studies which are of interest.
a. A cohort study of 39 exposed veterans most of whom are
carrying DU shrapnel. Most of these individuals are
excreting background levels of uranium.
b. A mail-in study consisting of 450 individuals who provided
24 hour urine samples by post. Data was presented
showing that the great majority of samples gave uranium
levels of less than 0.05ng/g.creatinine. Judging from the
data shown the average uranium excretion was about
10ng/l. This is especially notable as the sample
containers used are high density polythene which are
issued uncleaned. This strongly suggests contamination
was not a problem in this study. Samples for this study
are stored frozen and acidified prior to analysis by AFIP.
5.3 Normal levels. Dr McDiarmid discussed the availability or normal data for
uranium excretion and identified the following ranges and values
a. The US national study carried out by CDC – geometric
mean urine concentration, 10ng/l.
b. ICRP urine uranium dietary limit – 365ng/l
c. ICRP maximum background uranium in urine – 15ng/l.
d. DoE occupational decision level for nuclear plant workers
– 800ng/l
e. VAMC cut off level, below which isotope ratios are not
measured, 100ng/g.creatinine.
6. Overall conclusions.
6.1 The following points should be noted.
a. Of the three US methods the AFIP method using DRC
ICPMS has the lowest detection limit and can measure
isotope ratios at uranium concentrations of a few ng/l.
This is directly comparable with the levels expected in the
DUOB retrospective study.

Page 19
19 of 20
b. Creatinine measurements are recommended for all
samples to allow spot urine samples to be used.
c. Polythene containers are universal and only minimal pre-
cleaning is used.
Dr D Lewis
10 Mar 03

Page 20
20 of 20
1. The purpose of the Depleted Uranium Oversight Board is to:
a. Oversee and co-ordinate the process of letting the contracts, and undertaking testing, for uranium
isotopes in urine to assess historical exposure to DU.
b. Act as a Project Board, to direct, endorse and oversee the work of the MOD Project Manager who
(1) Develop a draft Statement of Requirement for a DU sampling protocol, a
chain of custody for samples and a quality control protocol for endorsement
by the Board.
(2) Invite proposals for testing.
(3) Prepare an assessment of proposals received.
(4) Manage a pilot study to demonstrate the performance, precision, accuracy and
validity of the method, including the techniques for collecting, splitting,
storing, transporting and analysing samples.
c. If satisfactory methods of testing can be established, agree proposals for one or more
epidemiological studies using those methods, to determine the distribution and determinants of
excretion of uranium isotopes in urine, and to explore the relation of historical exposure to DU to
possible biological and health effects.
d. If satisfactory methods of testing can be established, agree arrangements for testing additional
individuals who are not part of the epidemiological studies. These will include the arrangements
for the involvement and briefing of GPs, and procedures for any accompanying medical
e. Monitor progress of the testing, including auditing and quality assurance of the data.
f. Ensure that the findings of the testing and research are appropriately promulgated.
g. Report to the Under-Secretary of State for Defence and Minister for Veterans’ Affairs, on
progress issues and concerns.
2. The Oversight Board will explore and advise on other possible methods of historical exposure
3. The Oversight Board will be invited to comment on:
a. The development of biological monitoring tests to be used by MOD for future operations
where DU is used.
b. Proposed epidemiological studies to examine possible ill-health effects of service in the
Possible arrangements for a Veterans’ Assessment Centre