Veterans Affairs Committee on March 26th, 2013

[The Vice-Chair, NDP, Peter Stoffer]

Ladies and gentlemen, mesdames et messieurs, we're ready to start.

Today the Standing Committee on Veterans Affairs for the Parliament of Canada is very pleased, through video conferencing, to meet and discuss with Melissa McDiarmid, medical director of the depleted uranium program for the Toxic Embedded Fragment Surveillance Center. That's quite a business card.

Ms. McDiarmid, it's an honour to talk with you today, and we look forward to your presentation. We want to thank you in advance on behalf of our chairperson, Greg Kerr, who can't be with us. From all members of our committee, we thank you very much for your time and your information. We know you're extremely busy down there in the great city of Baltimore, Maryland, so we thank you very much.

Please go right ahead.

[Dr. Melissa McDiarmid, Medical Director, Depleted Uranium Program, Toxic Embedded Fragment Surveillance Center, U.S. Department of Veterans Affairs]

Thank you very much for the invitation. I have short introduction so your members might know what my background is, and then I'd be happy to answer any questions you might have for me.

My name is Dr. Melissa McDiarmid. I'm a physician with training and specialization in internal medicine, occupational medicine, and clinical toxicology. Since 1997 I've been the medical director of the U.S. Department of Veterans Affairs' surveillance program for Gulf War veterans exposed to depleted uranium. As you mentioned, I've also inherited another responsibility, which is to direct a surveillance program for veterans who are victims of IED injuries and have toxic-embedded fragments in their bodies.

Our team here has completed nine biennial surveillance assessments of a group of 84 Gulf War I and OIF veterans who have been exposed to depleted uranium, and we've extensively published our findings. In February of last year, the Scientific Advisory Committee on Veterans' Health, convened by your Minister of Veterans Affairs, requested a briefing about our work here in Baltimore, which I provided at that time. I received a few follow-up e-mail requests for clarification of the original briefing.

About a month ago, I received a request to provide my comments about the scientific advisory committee's report entitled, “Depleted Uranium and Canadian Veterans: A Review of Potential Exposure and Health Effects”. Here's the punchline: overall, I agree with the findings of your committee. I believe their review of the evidence was complete and well described. As well, I agree with your final point, that there are many veterans suffering from persistent symptoms following deployment which, though unlikely to be linked to DU exposure, nevertheless can and should be effectively treated by your veterans health system.

I'd be happy to answer any specific questions your members have of me.

[The Vice-Chair, NDP, Peter Stoffer]

Yes, perhaps you have something further to add in your testimony, or we can go straight to questions, whichever you prefer.

[Dr. Melissa McDiarmid]

Let's go ahead to questions.

[The Vice-Chair, NDP, Peter Stoffer]

Okay, the format is five-minute rounds. You'll notice there may be some questions in French, and there will be a slight delay when you hear it in English. By the way, I should ask:

Do you speak French?

[Dr. Melissa McDiarmid]

Not since high school; we don't use French a lot here. We use Spanish, and I also study Italian, io studio italiano.

[The Vice-Chair, NDP, Peter Stoffer]

On a personal note, is that an Illinois accent?

[Dr. Melissa McDiarmid]

You have a very good ear, sir. I grew up in Clarendon Hills, Illinois, but I moved to Baltimore when I was nine.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Very good. Thank you very much.

We'll now proceed to questions with Carol Hughes, please, for five minutes.

Welcome, Carol.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Thank you, Mr. Chair.

Thank you, Dr. McDiarmid. I will get straight to my questions.

Can you please tell us about the depleted uranium follow-up program for those who were “on, in or near vehicles hit with friendly fire; entering or near burning vehicles; near fires involving DU munitions; or salvaging damaged vehicles”?

What is your approach when it comes to health care?

[Dr. Melissa McDiarmid]

Your description is pretty much what we call the exposure scenario for the group in our first mission program which was to perform surveillance on Gulf War I. Since the recent conflicts we've inherited another four patients from OIF who were exposed to depleted uranium because they were on or in a vehicle that was hit with depleted uranium rounds, or they were in a tank which had depleted uranium armour that sustained a through and through exposure with a penetrator.

Do you need me to slow down?

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

No, you're doing fine.

[Dr. Melissa McDiarmid]

Since the early 1990s we have invited veterans, who come to Baltimore every other year, for a three day in-patient assessment. It is basically a complete medical history and physical exam, as well as quite detailed laboratory testing that focuses on what are the known target organs of uranium in the body. We have performed these surveillance exams nine times. In fact, we are preparing in two weeks to welcome our veteran patients back to Baltimore for the 10th surveillance round of assessments.

The details of this have been extensively published, and we can get some of our reprints to your— [Technical difficulty]

[The Vice-Chair, NDP, Peter Stoffer]

Dr. McDiarmid, can you hear me?

Unfortunately, Dr. McDiarmid, the gremlins are at work here so we'll have to pause for a second.

[Dr. Melissa McDiarmid]

How much did you miss? I'm all done.

[The Vice-Chair, NDP, Peter Stoffer]

Your last three or four sentences actually.

[Dr. Melissa McDiarmid]

I was letting your members know that we have extensively published on the depleted uranium surveillance program, including the details of what the assessments contain and we'd be happy to get those publications to your members if that would be helpful.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you.

[Carol Hughes, NDP, Algoma—Manitoulin—Kapuskasing, ON]

Are all the veterans required to share their problems with you individually? Do you determine what their health problems are or what the causes of those problems are as they describe them to you?

[Dr. Melissa McDiarmid]

That's a very good question. It allows me to distinguish between the two different pathways for veterans to get tested for depleted uranium exposure.

I just told you about the first pathway, which is the one that's perhaps most visible to our veterans community. We had documentation from the 1991 war of several friendly fire events that pinpointed the first population of veterans and active duty service members who needed to be followed up on. We were able to match the names of the service members to the vehicles we knew were hit. We actually went and looked for these people. We did active surveillance, and DOD was a key partner in this.

However, we have a large number of concerned and worried veterans who come back from deployment and want to be assured they were not exposed. Although they were not in a friendly fire incident, they may have been what they consider to be too close to a burning tank that may or may not have had DU armament. They might have had another exposure to something due to inhalation. They want to rule out that they might have been exposed.

We have devised a method to measure depleted uranium in urine, which is the best way to measure it. We can do this by mail. Any veteran who has any concern at all, and they don't even have to have been deployed, we will test their urine uranium in a 24-hour urine collection. These kits are made available to all of our hospitals and community-based outpatient clinics. The veteran can go to their primary care provider and request this.

We have the details of the testing all worked out. As you might imagine, since we're measuring something kind of unusual, like uranium, we can differentiate by the isotopic count whether the uranium we measure in the patient's urine is from natural deposits. We all have natural uranium in our urine. We can tell the difference between depleted and natural uranium in the urine uranium sample.

We've also done studies to determine what type of container we can safely use in these mailing projects so that the container neither contributes to the uranium count nor binds the uranium that might be present in the sample. In other words, we've tried to eliminate all the possible explanations for an erroneous result.

The veteran sends the kit back to us in Baltimore—

[The Vice-Chair, NDP, Peter Stoffer]

I'm sorry, Dr. McDiarmid, but we're running against the clock and I'd like to get to further questions. Quite possibly someone will ask a question to further that.

Thank you very much, Dr. McDiarmid.

[Dr. Melissa McDiarmid]

Okay, great.

[The Vice-Chair, NDP, Peter Stoffer]

We now move on to Mr. Zimmer, please, for five minutes.

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

Thank you, Dr. McDiarmid, for appearing before us today. Also, my thanks to the veterans in the room who have served our country, and also to veterans possibly in your room who have served your country. They're much appreciated. We all appreciate their service.

I want to refer to your research titled, "The Gulf War Depleted Uranium Cohort at 20 years: Bioassay Results and Novel Approaches to Fragment Surveillance”. Your conclusion states:

No urine U measure with a 'depleted' isotopic signature has been detected in U.S. veterans without a history of retained DU embedded fragments from previous injury. These findings suggest that future DU-related health harm is unlikely in veterans without DU fragments.

Could you elaborate on these findings? You've been doing that already, but perhaps you could speak to that specifically.

[Dr. Melissa McDiarmid]

As I mentioned earlier, we can tell the difference between natural uranium and depleted uranium by what's called the isotopic signature, which is a fancy way of saying we can tell the difference through physical and chemical means. That's important to veterans, because they want to know, yes or no, were they exposed to depleted uranium.

However, the health implications of uranium exposure do not depend on the isotopic signature. What determines that, your health outcome, is the burden of total uranium in the body. We have determined that most of the risk is through the uranium's chemical effects as a heavy metal, as opposed to its radioactive effects.

I'll stop there for fear of saying too much and burning up your time. If there's something specific you want me to clarify, I will.