Examination of Witnesses (Questions 160
- 179)
WEDNESDAY 15 DECEMBER 1999
MR SHAUN
RUSLING, DR
DOUG ROKKE,
MR TONY
DUFF, PROFESSOR
MALCOLM HOOPER,
MR JOHN
DENNIS AND
DR HARI
SHARMA
160. Is that coming?
(Professor Hooper) Lots of things are coming but this
is nine or ten years down the road.
161. Let's stick to the management audit and
what your views are.
(Dr Rokke) There is something that we need to go back
to that is extremely important. One of the things we seem to have
forgotten is that despite numerous requests a complete characterisation
of all the exposures in the battlefield has still not been provided.
During the Gulf War I had the responsibility for the threat briefing
to the theatre command staff on Third Med Com on what was going
on. Those documents are still classified to the best of my knowledge.
I have asked Dr Rostker numerous times to release those to the
MoD, the VA and to MAP and they still have refused to do that.
It is extremely difficult for any physician to put together a
proper physiological assessment programme if they do not know
what the actual exposures were. I wish today that I could give
you that but all I have is my memory from eight years ago. Again
the battlefield known exposures were an extremely complex situation
not only from the chemical and biological stuff that was present
but from the pesticides used. The pesticides were bought on the
open market and used in theatre. They were all known things. The
whole thing comes back to the same thing, how can the MoD or how
can the Medical Assessment Programme across the street, or how
can the VA provide proper physiological assessments if they still
today do not know what all the exposures were and the US Department
of Defense as of still today refuses to release that information
which was thoroughly and completely available in which myself
and my staff did brief the theatre command staff to include the
British. To me that is the key point this thing is bouncing down
to. If you do not know, how can you do it?
162. On management?
(Professor Hooper) They said themselves, in the BMJ
paper that came out that the Programme was not designed as a research
tool. Why not? What are they trying to find out? The clinical
diagnoses were made by 17 different consultants, your point about
co-ordination. Two different disease classifications were used
and both differ from the United States' classification. So you
have got no basis for comparisons to be made. No denominator comparator
group was available. The psychiatric assessment was abandoned
half way through the programme. So where are you? There was inaccurate
follow-up in one in five psychiatric cases. Then they say, "Nor
do we have all the results of the psychiatric assessments that
we advised should take place." This is them telling us what
they have got wrong. These are not my words; these are their words.
So I think the clinical audit is going to be very interesting
as well. It was all about a failure of communications, a break
down in continuity and that sort of thing which came out of that
audit. That is what it means.
(Mr Duff) The previous clinical audit, which I think
was in 1995, was damning in certain areas and liberal in others
but at the end of the day they said, "This had to get better
or else", and I am just wondering based on what comes across
my desk and probably my colleagues' desk as well whether or not
that is going to be case.
Chairman: Did you ask about what they
can do to restore faith?
Laura Moffatt
163. Scrap it basically.
(Mr Duff) I come back to the initial point. They can
drag people in, as you are doing here, and find out what the problems
are and address them. At the end of the day there is a public
meeting, a gathering like this, or a conference happening in the
States and other parts of Europe every day and we just cannot
get to them all, but there is nothing happening here. If there
is something happening here we are organising it or yourselves
are organising it.
Chairman
164. What we have tried over the years by holding
regular hearings is to ensure they have to come before us and
explain what is being done. We have never ever said that we know
what the Gulf War Syndrome is. All we are anxious to find out
is that the MoD is seriously looking at it and seriously treating
it. That is our role.
(Mr Duff) They are making progress but at the end
of the day it is us that is making progress, it is not the MoD,
and there is a great fear here that we are going to overtake the
MoD in certain areas. Our organisation ourselves has got research
coming out in the early part of next year which will be very very
positive in nature.
165. Can you tell us about that?
(Mr Duff) I cannot.
166. You are as bad as the Ministry of Defence!
(Mr Duff) Alright, I put my hands up! Seriously, we
are a veterans' organisation primarily welfare based. What are
we doing getting involved in research? That should be done for
us.
Mr Colvin
167. But the Medical Assessment Programme has
seen 2,906 patients out of 53,000. So six per cent—
(Mr Duff) If we make it to 11 we get an epidemic.
168. A lot of those deployed must have been
ill for some reason or other. If I had been to the Gulf and I
was ill, whatever sort of illness, I would be off hot foot to
St Thomas's to find out if there was any connection between the
Gulf and what I was suffering from.
(Mr Duff) I do not think so.
169. What I do not understand is why only six
per cent of those that have been to the Gulf have been to the
Medical Assessment sessions at St Thomas's Hospital. Surely if
more had been then the clinical procedures they used might be
a bit better because they would have had more experience. 387
have died since they came back.
(Mr Duff) It is more than that.
(Mr Rusling) There are more than that.
170. So what is the reason for only six per
cent?
(Dr Rokke) I think I can answer that because speaking
to individuals in the northern part of your country before I left—
Mr Colvin: Come on, somebody raised the
question of transport. If you are ill and you think it is to do
with the Gulf you would be down there hot foot.
Chairman
171. Shall we start with Dr Rokke and work our
way down.
(Dr Rokke) What happened in the United States, and
this is the same thing, is first off this is not only veterans,
this is civilians. We had a lot of civilians who were exposed
and are now sick and have been absolutely left out. When I spoke
to an individual in the northern part of your country before I
left the other day, the individual is sick. I knew he had exposures
because I was there and I know he was exposed, there is no doubt
whatsoever. The individual expressed the opinion to me, "When
I go for medical care all they tell me is that it is in my head,
that I am nuts", and the individual is physiologically sick
from known chemical, biological and radiological exposures. So
when the individual goes in for medical care and all they say
is, "All I am going to do is an assessment for stress",
after a while the individual says, "Why should I go back?
I don't get mycoplasina from walking down the street thinking
micro, micro, micro. I don't get DU from walking down the street
thinking DU. I do not get chemical exposure from thinking about
this." These individuals have been physiologically sick and
when the individual goes in and they say, "We are just going
to test you for stress," or, "This is what is causing
it," the individual gets so frustrated that he just walks
away. There is this fundamental philosophy that they deny the
exposures, therefore they are only testing for stress and the
individual is saying, "Wait a minute. I am not nuts. Mycroplasm
got into me because Saddam Hussein bought it from a Texas firm
in the United States, weaponised it and deliberately released
it."
Mr Colvin
172. I do not think you can claim against the
Ministry of Defence for stress. Hell's bells, when you join the
Army you expect to be put under stress.
(Dr Rokke) Absolutely, but that is what is happening.
That is why there is only a handful in the US because they are
frustrated.
(Mr Duff) To go on from that that is a question of
overstretch really. At the end of the day there is a lot less
of us in the Armed Forces doing a lot more. Certainly before I
left I was doing a lot more foreign tours than I did when I started.
It kept on going. To go back to your original point, if you were
sat where I am looking at a possible genetic insult, looking at
a possible neurological insult and half a dozen other insults,
you would get a bit worried about this and say, "Have I got
any confidence in what is being offered to me?" "No."
"Can I go somewhere else?" "No". "So
what do I do about it?" "I do the best I can. I make
do. I get through this as best I can." Just to put another
analogy on the table, this is exactly the same as voter apathy.
At the end of the day we are all concerned about what happens
in this country on various issues but if we are to believe recent
elections we do not all trot off to the polling station and put
our votes in. There are a lot of reasons why this does not happen
but it is wrong to assume just because the Medical Assessment
Programme has only seen 2,000 that that is the extent of problem.
It is not. There is a larger problem buried beneath the surface
and unfortunately for all the good things the MoD has done the
bad things are the ones that are remembered and that is what is
keeping people under.
(Mr Rusling) It is quite clear to any serving soldier
that if they went forward with their illnesses to the Medical
Assessment Programme that is their career finished and that is
a fact. I get people ringing up all the time from Germany and
the United Kingdom on our help line and they are explaining genuine
fears. We have guys going sick on a daily basis who are just seeing
the medic, not getting as far as a doctor and they are being sent
back to the unit and not getting medical treatment. They are not
even bothering to refer them to the Medical Assessment Programme
now. Having said that, the matter that was mentioned a moment
ago about how we could get away from the problem about the Ministry
of Defence Medical Assessment Programme and what we need, what
we need is an independent medical programme and investigation
into Gulf War illness, we need to take it away from the Ministry
of Defence who are far more concerned with the possibility of
being responsible for our illness and possible litigation. That
is not our issue. The issue is our health and our care and we
are not getting it, Mr George.
(Dr Sharma) May I say something?
Chairman
173. Of course, Dr Sharma.
(Dr Sharma) I got involved with the problem of Gulf
war syndrome some 18 months ago and stress had been mentioned
time and again as the causative agent for the syndrome; and I
kept reminding them that there have been wars for the last 500
or 2,000 or 3,000 years. To my mind, the Gulf War was probably
the least stressful war for the coalition forces. Perhaps it was
stressful for the Iraqis but not for the coalition forces. Probably
World War One was the most stressful war when veterans stayed
in the trenches and at times had to face bayonets and things of
that sort. So the comparison can be made for the last six or seven
years.[4]
We have just heard that the illness is worse than stress. Now
we are coming out with the causative acts. I have come to the
conclusion that we must not consider one causative agent in isolation.
We should not have separate compartments for each causative agent.
We should consider the overall picture and that can be done by
MAP having experts in all related areas to investigate this problem
in depth. Three facts are known. Number one, I think it has been
accepted in the United States and it has been accepted in the
UK that the veterans are sick, they need treatment, they need
care. Number two, we have the means for testing for exposure levels
to the causative agents. I have asked over and over again for
information from various agencies, I get no figures with respect
to exposures to causative agents. There have been several causative
agents and they have been exposed. Number three, we ought to find
out the extent of exposure to causative agents.
Chairman
174. Can I ask a really dumb question. Can you
treat something successfully if you do not know the cause of it,
because I have the overwhelming impression that the view is we
will never find out what the cause is, therefore is it not far
better to try and deal with the medical response rather than the
research into the cause?
(Professor Hooper) I think you are under an obligation
to explore the cause. That is the first step and then you can
treat. There are treatments that work. We know people who have
been treated for Gulf War Illness in this country and the United
States. People have gone to Bill Rea Dallas. Chairman, you know
about the case of Robert Lake who went out in a wheelchair and
walked back.
175. I remember him coming in here in a wheelchair.
(Professor Hooper) Sergeant Hale's story is on the
Net, supported by his GP and he was given, on Garth Nicholson's
recommendation, a repeat cycle of antibiotic treatment. He is
out of his wheelchair and is functional at a much higher level.
He would not say he is 100 per cent but he is certainly 80 or
90 per cent. Dr Jean Munro in this country treated a Gulf vet
and in three weeks from being unable to walk upstairs he was out
running again. These things have happened but we have not learned
from them. It is not true to say we cannot treat. We can treat.
I think what is required is a most careful assessment using techniques
which are not routine, things like SPECT scans, things like prolactin
stimulation tests which are used routinely in ME and CSF. These
tests are around. There are new tests being developed. Why are
we not looking at paraoxonase in the way that Haley is doing?
Haley has set the pace in this along with Nicholson. These are
all techniques that we have and can be used.
(Mr Dennis) Apart from treatment there is a debt of
honour to explain to Gulf vets why they are as they are.
176. Perhaps I am wrong but it really began
to make sense to me for the first time will we be at this for
the next 20, 30 or 40 years finding out what the cause is? I wondered
whether some point of time is going to come, it will not be now,
when we will concede defeat.
(Mr Duff) If that is the case, what is the assistance
we are getting now? One of the bees in my bonnet is the fact that
when we go off and look for these things, and quite rightly too,
we are not giving any assistance to people now. There is an argument
to be treated in a special way. I do not like to have us thought
as special in that term but you have got to give us the tools
to live a decent life and that is not happening. Whilst that is
not an issue for the MoD it is certainly an issue for the Government.
The way that this is structured at the moment is that if you have
your leg amputated or you lose an arm, that is great, we can deal
with that. But if you have an illness or a disability that takes
over your life they are falling down in pretty serious areas.
Of course, with the mass of welfare reform legislation that is
going through this Parliament and the one further north, I just
wonder where I am going to be in six months' time.
(Mr Rusling) Mr Chairman, when a serviceman goes to
war for his country he has the right to expect should he be ill
or injured he will get proper care and medical attention. Again,
Mr Chairman, this is not the case. It does not surprise me that
recruitment to our Armed Forces is dropping so significantly.
Guys are getting out faster than they are getting in. If I had
the opportunity again I would think twice in hindsight. Obviously
we are all better off with hindsight but that is the case and
that is what is happening.
(Professor Hooper) Could I pick up your question about
causes. I think this is a red herring that is used and I am beginning
to feel it is being used deliberately to obscure things. There
is no single cause. I nearly brought a pack of cards and handed
them round and said, "Have one of these." The vaccines
were a major factor, we know that, we have got evidence for that.
We can do more work to check that out and the experiments can
be set up. PB, organophosphates, nerve agent exposure—that
is the Cholinergic Triple Whammy. Cholinergic `wipe-out' is a
term that is used for ME-CFS. We have got these relationships
and so we are looking at multi-symptom, multi-organ, multi-insult
injuries to people and the response is going to vary depending
on genetic composition, as Haley suggested with paraoxonose, and
some people are more susceptible than others. It is going to vary
in terms of immune disease responses that people make and we know
that from our research into rheumatoid arthritis where certain
genetic definitions are applicable to people with it. We have
got the information, it is a case of pulling it together and doing
some lateral thinking. To do that we have got to get the scientists
and the medics together and we also need the troops, we need the
facts, we need what Dr Rokke is saying about evidence of exposures.
We cannot have a persistent denial that these things did not happen.
Chairman: We have mentioned depleted
uranium on several occasions and Jamie Cann will pursue some aspects
of that.
Mr Cann
177. Thank you, Chairman. We have got a memorandum
from the MoD that a draft protocol for DU testing was passed to
veterans' representatives on 1st November for comment. Have you
responded to that MoD request for comment?
(Mr Rusling) We have broken off contact with the Ministry
of Defence, Mr Cann.
178. Do you feel that is wise?
(Mr Duff) We have responded and we were not happy
with the protocol. We were very, very unhappy with the majority
of what was said and put down and we have addressed those issues
briefly yesterday and we have agreed to rewrite certain areas
and put that to the MoD.
Chairman
179. Will you send us a copy?
(Mr Duff) Yes, absolutely.
4 Note by witness: so a comparison with the
level of stress experienced by veterans in the two wars and morbidity
in the two sets of veterans is apt. In this way we can determine
the effect of stress as a causative agent (for their illnesses). Back
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