Epidemiological studies
66. A major complaint from veterans when our predecessors
inquired into this matter in 1994-95 was the failure of the MoD
to set up a full epidemiological study. Our predecessors commented—
We are appalled that it has
taken two years since the establishment of the Medical Assessment
Programme—over four years since the end of the Gulf War—for
MoD even to contemplate compiling the data necessary to facilitate
a full epidemiological study.[162]
Assessing the numbers affected by Gulf War illnesses
has proved difficult. According to MoD figures, 53,462 Forces
personnel have been identified as taking part in Operation Granby
or being deployed in a Gulf region state between 1 September
1990 and 30 June 1991.[163]
The MAP has been in operation for six years and has seen 2,934
patients in that time,[164]
which represents just over five per cent of all UK Gulf veterans.
67. The MoD has provided us with figures on the number
and the causes of deaths for veterans who served in the Gulf and
are recorded as having died between 1 April 1991 and 31 August
1999. Of the 413 people who have died, causes of death are indicated
in 387 cases. In the remaining 26 cases the MoD does not have
sufficient information to classify the cause of death.[165]
| Cause of death[166]
| No. of deaths
|
| Infectious and parasitic diseases
| 3 |
| Neoplasms (new or abnormal growth of tissue)
| 56 |
| Mental disorders | 7
|
| Diseases of the nervous system and sense organs
| 6 |
| Diseases of the circulatory system
| 48 |
| Diseases of the respiratory system
| 4 |
| Diseases of the digestive system
| 5 |
| Signs, symptoms and ill-defined conditions
| 2 |
| External causes of injury and poisoning (including traffic accidents, other accidents and suicide)
| 256 |
| TOTAL | 387
|
The head of the Gulf Veterans' Illnesses Unit at
the MoD told us that a 'crude, non-standardised estimate' of deaths
in the general population aged 16 to 62 in the same period of
time would be 479 deaths.[167]
These figures, although interesting, do not assist in assessing
the relative health of Gulf veterans without comparable figures
for the general population.
68. The usual means of assessing prevalence of illness
is by epidemiological study. This involves large population comparisons,
seeking to identify whether there is a greater or lesser prevalence
of certain diseases in a targeted group as compared with the population
as a whole. One such study, looking at whether service in the
Gulf is associated with increased illness in UK veterans, is being
conducted at King's College School of Medicine with funding from
the United States Department of Defense. The results of the first
phase of the study were published in The Lancet in January
1999 and concluded that UK Gulf veterans report up to three times
more ill health than other comparable groups.[168]
This study was based on questionnaires and self-reporting, not
on physical examinations.
69. Two MoD-funded large-scale epidemiological studies
are under way. The first, headed by Professor Cherry at the University
of Manchester, is attempting to determine whether Gulf veterans
are experiencing greater illhealth than Service personnel
who did not take part in the conflict; to identify possible exposures
and predisposing factors associated with any distinctive pattern
of symptoms which may be found; and to ascertain whether there
is an increased incidence of mortality or cancer amongst Gulf
veterans. These studies have now been submitted for peer review
and the mortality paper has been accepted for publication.[169]
Professor Hooper told us—
I think Nicola Cherry's questionnaire
particularly was quite seriously flawed.[170]
The Gulf Veterans' Association commented on the pilot
study for this research but received no response to its comments.[171]
70. The second study, headed by Dr Doyle of the London
School of Hygiene and Tropical Medicine, is examining the reproductive
health of Gulf veterans and the health of their children, based
on a study population of 50,000. The results of this study will
not be available until well into 2000.[172]
The view of the Secretary of the Gulf Veterans' Association was—
As far as the Pat Doyle study
is concerned, we supported that 110 per cent. She is never going
to report though, that is the problem, because her study needs
everybody to get involved and unfortunately that is not going
to happen with the best intention in the world, and I just hope
that when she settles on a percentage that she can report on,
I hope it is in the higher end of the scale and not the lower
because she really will have some fundamental things to say, but
she is just not getting the level of support that she needs in
order to complete the work.[173]
A further study is taking place at King's College,
London, to investigate whether symptoms such as fatigue, weakness
and muscle pain experienced by some veterans might be due to disturbance
of nerve or muscle function. This study is expected to report
later this year.[174]
Future research
71. We look forward to seeing the results of these
studies as soon as possible and hope that their findings will
make a valid contribution to understanding the nature and extent
of the problem. But we believe that further research is necessary,
and that it should be of the same high standard and detailed nature
which has characterised the research into possible causes of veterans'
illnesses discussed above.
72. The United States Institute of Medicine noted
in September 1999 that no systematic evaluation had been done
to determine whether or how veterans' health status was changing
in the US.[175]
The US General Accounting Office recently recommended that steps
be implemented to compile data on the number of Gulf War veterans
with unexplained illnesses, the treatments they are receiving
and the success of those treatments.[176]
We believe it is vital that similar research studies are undertaken
in the United Kingdom. We recommend that the government take
advice, as a matter of urgency, from the Medical Research Council
to enable systematic and detailed research to be conducted into
the number of veterans with unexplained illnesses, the nature
of the symptoms, and the way the illnesses are progressing. It
is not sufficient for these studies to be based solely on questionnaires;
a representative proportion of veterans should be seen by clinicians.
Veterans and their associations should be asked for their views
on the form the studies should take and their co-operation with
them actively sought. The outcome of this research should enable
us to have well-founded evidence of the morbidity and mortality
amongst Gulf veterans to measure against comparable groups in
the general population.
73. Lessons will need to be learned from the handling
of Gulf veterans' illnesses. In any future conflict there may
be claims of new syndromes and new illnesses. The Ministry of
Defence should look at what resources would be needed to monitor
the long-term health of veterans of future conflicts and what
might constitute sources of independent scientific advice. We
suggest that the new Chief Scientific Adviser be encouraged to
review the past scientific advice given to the Ministry on Gulf
War illnesses and to draw lessons from this for the future.
162 Eleventh Report, Session 1994-95, op cit,
para 28 Back
163 Ev
p 88 Back
164 Ev
p 88; HC Deb., 17 March 2000, cc 343-344w Back
165 Ev
p 88 Back
166 For
a more detailed breakdown of cause of death, see Ev p 91 Back
167 QQ
8-9 Back
168 The
Lancet, Vol 353, 16 January
1999, pp 169-178 Back
169 Ev
p 89; HL Deb., 10 April 2000, c WA8 Back
170 Q
195 Back
171 QQ
202-204 Back
172 Ev
p 89 Back
173 Q
205 Back
174 Ev
p 89 Back
175 Institute
of Medicine, Gulf War Veterans: Measuring Health, September
1999, pp 3 and 35 Back
176 General
Accounting Office, Gulf War Illnesses: Management Actions Needed
to Answer Basic Research Questions, January 2000, p 20 Back
