Veterans Affairs Committee on March 26th, 2013

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

Yes, I appreciate that.

You said that there are really two groups. There are those who have been exposed to DU through the lungs, through an air exposure, and there are the other veterans who have been exposed to DU who have embedded fragments in their bodies.

I guess what you've concluded is that even though veterans have had fragments of DU in their bodies—and correct me if I'm wrong—even with those fragments in their bodies, they have had no ill health effects attributed to DU. Is that correct?

[Dr. Melissa McDiarmid]

That's a little more straightforward than we would put it, because one of the things I make the point about in our papers is that it's not normal to pee out uranium, so that is an abnormal finding.

We have turned over pretty much every rock looking for big outcomes that might have been expected from a uranium exposure and we don't see them. Most of our patients' sequelae from exposure have to do with traumatic injury from being hit in these tanks and other vehicles.

We have done some other very, I'd guess you'd say, sophisticated testing that kind of goes to the next level of organ function. For example, in the kidney, we didn't see any abnormalities in the typical kidney measures that your doctor would get on you at an annual physical. We don't see any signals of abnormality there, but we're looking at the next level of detail to make sure we don't miss anything.

[Bob Zimmer, Conservative, Prince George—Peace River, BC]

We really want to get to the bottom of it, too. The reason we did this study is we want to see if veterans are really experiencing ill health effects from DU. That's the bottom line for us. What we've seen, and I guess what you could conclude, is that DU effects on veterans' health just aren't there.

I guess what you referred to earlier was that we still see veterans who have health problems. I just want to ask you, would it not be accurate to move DU off the page essentially and deal with what's affecting veterans' health, as opposed to DU, because it hasn't been found to cause any negative health effects?

[Dr. Melissa McDiarmid]

I guess what I would say as a clinician who has to face patients who have these questions is, we believe here that we have been following the patients with the highest uranium exposures. We can document it. We can still document it 20 years later. Just as a quick sidebar for members who might be wondering why the heck we haven't taken all the uranium out of our patients, it's because the surgeons think it's too dangerous to do so.

We have had to monitor these veterans of ours who were exposed, prospectively here now for 20 years, and watch them carefully. I think most people would agree that veterans in this group certainly are candidates for most likely being the most highly exposed people we can follow. We are happy that we have not seen any what we would call uranium-related health effects, with the exception of the excretion of abnormally high uraniums in their urine with the isotopic signature, the proof that it's depleted.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you very much.

[Dr. Melissa McDiarmid]

Let me say one thing. If not off the page, I think it should be lower on the list of what we look for, because what we worry about is, if we focus only on depleted uranium, we might miss what's truly causing the veteran's problem.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you, Dr. McDiarmid. We greatly appreciate that.

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

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chairman.

Doctor, we've heard evidence before this committee that you have something in the United States called the concept of presumptive disease, which either lowers or eliminates the evidentiary onus on a veteran to establish a connection between their military service and certain diseases. Given that it doesn't exist here and you have it there, I wonder if you could tell us a little bit more about presumptive causation.

[Dr. Melissa McDiarmid]

Happily, sir, I am not an expert on that. I served on a couple of committees about it. I don't want to represent what I know about it; I'm not the expert. There's a whole separate group of benefits experts in our VA who run that. We're very separate from it; we're on the medical side.

[Sean Casey, Liberal, Charlottetown, PE]

I'd like to ask you, then, about a French study that was published in 2010 by Guseva Canu. The title is “Uranium carcinogenicity in humans might depend on the physical and chemical nature of uranium and its isotopic composition: results from pilot epidemiological study of French nuclear workers”, published in Cancer Causes & Control.

Are you familiar with that study, Doctor?

[Dr. Melissa McDiarmid]

I've heard of it.

[Sean Casey, Liberal, Charlottetown, PE]

If you've heard of it, I take it that you don't have an in-depth familiarity sufficient to answer questions on it. Would that be fair to say?

[Dr. Melissa McDiarmid]

Yes, sir. I thought this was going to be all of you asking me what I thought of the report you prepared, so I didn't review all of the literature on uranium, although I have in the past.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Doctor. I have no further questions.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you, Mr. Casey.

We now move on to Mr. O'Toole, for five minutes.

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

Thank you, Mr. Chair.

Thank you, Dr. McDiarmid, for taking the time and for your continued work with U.S. veterans.

I have a couple of questions. First, you described the Canadian report as complete and well described. In your opinion, having worked in the area, do you believe the committee canvassed fully the leading relevant research from around the world?

[Dr. Melissa McDiarmid]

Yes, I think that would be fair to say.

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

The odd time there's a reference to a report here, or an Italian court case, or isolated references from within the area of depleted uranium. but from their list of references, they seem to have canvassed what is generally accepted as the leading work on DU, and some just on uranium itself.

[Dr. Melissa McDiarmid]

Yes. It's typical for reviews like this to have certain criteria for the quality of a study that would or would not be included in a review. This would be the standard approach for any systematic review of the evidence; for example, it is what would be done at the International Agency for Research on Cancer, if they were reviewing a cancer endpoint. They have to look at the quality of the studies, and sometimes studies are included or excluded based on some kind of flaw in them.

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

Yes, and there is some reference to that in this review.

Speaking for a second about your Baltimore cohort, are they all considered level one, people who have had direct contact or contact with fragments with DU? Is that correct, that it's level one exposure?

[Dr. Melissa McDiarmid]

That's correct.

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

In your work with the cohort, has there been any statistically significant incidence of impact on fertility?

[Dr. Melissa McDiarmid]

No.

We don't specifically measure fertility; we measure pregnancy outcomes and take a history by the veterans' partners. This is not squeaky clean reproductive epidemiology; it can't be done, because a number of these folks have had several partners. But whenever we see the patients biennially, we have their partner complete a form to characterize what the reproductive history has been.

What we go by is that we've had, I think, 60 births of children from our cohort post-deployment.

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

That's very helpful. That examination of reproduction, in the way you track it through pregnancy outcomes and dealing with partners, has raised no red flags. Is that fair to say?

[Dr. Melissa McDiarmid]

Yes, it is.