Veterans Affairs Committee on March 26th, 2013

[Erin O'Toole, Conservative, Durham, ON]

One of the peer reviewers of the Canadian study, Dr. Nicholas Priest, in reply to questions about the final conclusion of the report, stated that, and I'm referring now to chronic multi-symptom disease, “Why we have this problem I don't know, but I'm convinced it's not related to depleted uranium.” That's in relation to chronic multi-symptom disease. Would you care to comment on his statement?

[Dr. Melissa McDiarmid]

It's a little out of context for me to comment because I didn't hear everything that he said at the time. Just let me reflect with all of you that our country, too, has gone through this wicket of folks returning from deployments with multi-symptom problems for 20 years at least. I know from our first Gulf War group returning 20 years ago there were something like 700,000 people, but please don't hold me to the numbers. Maybe your assistants can find the original papers.

When people were offered an assessment exam, a high number of people with unexplained or multi-system illnesses had an explanation. Very few had anything to do with depleted uranium. This question has been asked and answered, maybe not to the satisfaction of all veterans, but we've also had to face this and look at it.

There have been a large number of other candidate explanations for the suffering that our veterans were experiencing when they came home. This goes back to my comment before about always being careful not to focus on one explanation for fear we miss the other ones sitting right in our midst.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you, Dr. McDiarmid.

We will now move on to Madame Papillon, for five minutes please.

[Annick Papillon, NDP, Québec, QC]

Thank you very much.

I would like to thank you for being here today.

I particularly enjoyed hearing that, in your country, as soon as veterans think they have been affected by something, for example, if they think they have been exposed to depleted uranium, whether they have been or not, they can be tested. You mentioned a urine test.

I imagine that you are someone who believes that when veterans think they have been affected by a physical or psychological health problem, regardless of whether the potential cause is known, they must obtain the appropriate care. Is that right?

[Dr. Melissa McDiarmid]

I think that's the disposition of our Department of Veterans Affairs here.

[Annick Papillon, NDP, Québec, QC]

Excellent.

You also recognize that a problem like Gulf War syndrome leads to pensions, disability benefits and health care. Is that correct?

[Dr. Melissa McDiarmid]

This is where I'm not the expert with what kinds of benefits are given to veterans with specifically what you call Gulf War syndrome. I think we use different language for that, but I know we're talking about the multi-system illnesses that people have experienced. There is a pathway for veterans like that to apply for benefits. That is true. Whether they're all granted, those decisions are made on a case-by-case basis.

[Annick Papillon, NDP, Québec, QC]

The first American veterans who suffered from Gulf War syndrome had problems with their credibility initially. That was the case for a number of people who have testified over the course of this study.

Do these veterans need to prove why they need health care?

[Dr. Melissa McDiarmid]

Do you mean before they were deployed?

[Annick Papillon, NDP, Québec, QC]

Do they have to prove that their health problems are related to the fact that they served in the military?

[Dr. Melissa McDiarmid]

Again, we're getting into the system of disability. I can tell you that there was a post-deployment exam offered to any Gulf War veteran—we call it Gulf War I, the 1991 conflict—and there was an assessment made of them. From the little I know of disability benefit determinations, certainly their pre-deployment condition, risk factors, and a number of typical factors, such as family history, would probably be assessed by, again, a completely separate group of disability physician experts in the VA. It's a separate silo that does that.

[Annick Papillon, NDP, Québec, QC]

Okay.

Do they have to prove the cause of their health problems? How does it work when they want to get health care?

[Dr. Melissa McDiarmid]

I'm not an expert on this.

[Annick Papillon, NDP, Québec, QC]

Okay.

Would you recommend that the committee do research on Gulf War syndrome, in particular? What medical research done in the United States could the committee use as inspiration?

[Dr. Melissa McDiarmid]

I guess I would suggest that your assistants and content experts review the extensive medical literature that's been produced as a result of the U.S. experience, so that you don't have to reinvent the wheel. As I said before, it's more likely than not that an explanation and a medical cause can be identified for the types of symptoms and health concerns that a veteran presents with. If they have a comprehensive health assessment accessible to them, it can be determined.

I think in a country your size, with the population number you would have in your cohorts, it would be hard to see a signal of a problem from an epidemiologic perspective that wasn't seen in the U.S., which had larger populations at risk.

[Annick Papillon, NDP, Québec, QC]

Can you talk briefly about the—

[The Vice-Chair, NDP, Peter Stoffer]

No, Ms. Papillon, sorry. We're way over our time.

We move on to Mr. Hayes, please, for five minutes.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you, Mr. Chair.

Dr. McDiarmid, did anything in the study surprise you? Were the results what you would have expected?

[Dr. Melissa McDiarmid]

I think so, yes.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Do you agree that the results of the study, they're not new, but they agree with the conclusions of other expert bodies in Europe and the United States, including research on the U.S. friendly fire cohort? Is that a fair statement?

[Dr. Melissa McDiarmid]

I think for the most part, yes.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you.

Do you agree that the study appropriately assesses all Canadian and international research in reaching its conclusions?

[Dr. Melissa McDiarmid]

I think they did a very fair review. We spoke a little earlier in the hearing about the quality of the evidence they reviewed that might have then set up a system where they held certain papers in higher regard than others because those studies were performed with more academic rigour.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Is there anything in the study that you felt missed the mark? Is there anything you thought should have been included that wasn't?

[Dr. Melissa McDiarmid]

There was nothing I thought that should have been included that wasn't, nothing missing the mark.

I do think that in their extensive review of some of the Gulf War I deployment epidemiology, they didn't make it clear that those studies were not proxies or depleted uranium exposure; rather, they were studies of the effect of deployment itself and all of the unmeasured exposures that occur with deployment. I think that point could have been made more clearly.

However, what that does is it really dilutes the reason the committee had asked them to review this. In other words, if there were findings in these generic Gulf War deployment studies, which there were not, it still wouldn't have helped the committee know whether it was DU related or not. That was one thing I would have made more clear to the reader.

Nonetheless, I think it was important for your committee to see that a lot of these questions have been asked and answered academically already.