Veterans Affairs Committee on March 26th, 2013

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

That being said, do you feel that the body of international and Canadian research reaches a conclusive determination, or are there conflicting results?

[Dr. Melissa McDiarmid]

“Conclusive” sounds like something a lawyer would say, and I'm a clinician and I take care of patients. Does that mean we shut the door on a veteran who still feels there's a problem that is related to DU? These kinds of reviews will never satisfy some people. I think what it can do is do the best we can to say we have really turned over every rock and found there is not evidence that for the majority, the large populations exposed, depleted uranium is the candidate explanation for their symptoms. I think that's a fair thing to say.

For a veteran who would still feel frustrated by this outcome, I would say to them, “Let's make sure we haven't missed something else.”

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

Thank you.

Thank you, Mr. Chair.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you, Mr. Hayes, very much.

We move on to Mr. Lobb, please.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you very much, Mr. Chair.

I thank our guests here today.

Dr. McDiarmid, this is just to build off what Mr. Hayes asked you in his last question. When we're talking about what the study indicates and what, it appears, are the majority of the experts' conclusions, is it fair to say, without a shadow of a doubt, that the majority of the experts feel that depleted uranium is really not the explanation or the causation of their ailments?

[Dr. Melissa McDiarmid]

I think that would be fair to say.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay.

There's another point I wanted to run by you. We've had service people appear before our committee and indicate to us that there's this equivalent majority of experts who feel that depleted uranium is the causal explanation.

Is this something that you've come across in your years of experience, that there's almost a 50% cohort who believe this is the cause?

[Dr. Melissa McDiarmid]

No. There are some people who don't agree with what the primary findings are, but I've never heard 50% to be attached to that opinion. I think it's a minority opinion.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay, thanks.

I appreciate that, because certainly among the group of peers that you would associate yourself with, through, I'm sure, international conferences and really trying to become experts on the topic, you would have come across this so-called 50% opposing viewpoint. So I do appreciate the fact that you're indicating that this isn't the case and it's quite likely a very small minority.

Do you have any idea, other than maybe the obvious reasons, why some veterans I'm sure in the U.S. and Canada are so focused on depleted uranium as being the cause?

[Dr. Melissa McDiarmid]

Well, I would say in our country depleted uranium is not exactly at the top of the list anymore. When people are sick, not even just after a deployment, people start racking their brains to come up with an explanation for why they don't feel right. As a clinician who's done this for 35 years, what I see in the human condition is people start making a list of stuff that could possibly have been the reason, and they go through a process of eliminating the candidates on that list. I'm just talking in general; I'm not even talking about veterans right now. But something that people have less experience with, let alone something that might be radioactive, are all the kinds of issues that people who are experts in health risk communication have identified as things that would be worrisome to anybody. Also, in a climate of suspicion, it makes it hard for people to believe that something that sounds as exotic as depleted uranium is not why they're suffering.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Okay.

Probably there's just one last question, for time. Could you tell us if there's an international association that you work with, to the point that you mentioned, almost a way to brainstorm or work on best practices, to triage some of these perceived ailments? Is there a world body that basically works to eliminate some of the causes of these veterans' ailments?

[Dr. Melissa McDiarmid]

Do you mean from an information point of view, or do you mean how to assist them medically?

[Ben Lobb, Conservative, Huron—Bruce, ON]

I would think both, the best practices of knowledge and the best practices of treatment.

[Dr. Melissa McDiarmid]

I don't think there's an international organization. I can tell you that the people who take care of their veterans in our allied countries know each other, maybe not personally. For example, the British will be in touch with us on occasion, and the Italians, when they first had some concerns. Then when they redid their literature, they found out there were some problems in their original reviews, The Italians have had a couple of meetings. We've been invited to collaborate or have briefings with your medical experts in the past. It's sort of informal like that.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thank you.

[The Vice-Chair, NDP, Peter Stoffer]

Thank you, Mr. Lobb.

We'll now move on to Ms. Mathyssen, for four minutes, please.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much, Mr. Chair.

Thank you, Dr. McDiarmid. We appreciate very much your expertise. We are hoping that you can shed some light because we have heard some contradictory things from witnesses, particularly from the veterans who have been so impacted with regard to negative health outcomes.

One of the things I wanted to ask you about was non-Hodgkin's lymphoma. We had a veteran last week who is dying from this form of cancer, and he talked about a Royal Society report he said cited that the greatest exposure to radiation resulting from DU was inhaled depleted uranium particles.

You have talked about embedded uranium with regard to shrapnel. Have you looked at all at the possibility that there was exposure through inhalation that would have perhaps caused this cancer for a number of victims?

[Dr. Melissa McDiarmid]

That's a very good question, and I'm glad you asked it so I can clarify. All of our cohort had inhalation exposure at what we call time zero, at the time of impact. That just makes sense.

With the advance of science in the 20 years since the exposure took place, we have imaging techniques that have allowed us to look at pulmonary lymph nodes, which is where some of the particulate that was inhaled might have been deposited or be hanging out. Although the vast majority of a burden of inhalation would be eliminated over time, it has been something that I have wanted to rule out, that there wasn't something sequestered in pulmonary lymph nodes. That's a good question.

When we did that we didn't see any hot spots in the pulmonary lymph nodes. Again, I hope that you folks and others who have read our papers would agree that if you are the subject of an impact and an inhalation of an explosion with DU, you are the most highly exposed population. We don't have any non-Hodgkin's lymphomas in our cohort.

Again, on the radiation issue, non-Hodgkin's lymphoma has been linked to radiation exposure generally, but remember in the beginning of the hearing I mentioned that we really believe the primary toxicity of our veterans from exposure to depleted uranium is its chemical nature, not radiological.

Having said that, the inhalation of a radioactive particle would be the thing we'd want to watch for as a radiation risk, and maybe this goes to segue about the other elements of your committee's report and review. It's not just a review of the health outcomes that was done by your expert panel. It was the review of the exposure likelihood, the exposure opportunities. I hope your committee now looks at that as carefully as the review of the health outcomes, because if you don't have exposure, then even if there were health outcomes, they can't be attributed to depleted uranium.

[The Vice-Chair, NDP, Peter Stoffer]

Very quickly, Ms. Mathyssen.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

We talked about the Gulf War syndrome, the multi-symptom disease that many veterans return with. I wonder if U.S. troops were vaccinated. Were they exposed to toxins like a number of chemicals connected with pesticides? Is it your understanding that there was also that element in their deployment exposure?

[Dr. Melissa McDiarmid]

Yes. We had hearings on this side of the border on that. Yes, Madam.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Is it possible—

[The Vice-Chair, NDP, Peter Stoffer]

I'm sorry, Ms. Mathyssen, I apologize but the time is up.

We'll now move on to Ms. Adams, for four minutes, please.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thank you, Dr. McDiarmid, for joining us today.

As you're very well aware, we had struck an independent review body of different scientific experts here in Canada to review the existing literature surrounding depleted uranium. That report was peer reviewed, and we've been very fortunate to have some of those scientists join us here during our committee hearings. We've also had scientists who were independent of this process come to share their viewpoints with us, as well as veterans, but we're particularly fortunate to have you as someone who has studied veterans who have DU fragments, so thank you very much for joining us today.

I have a quick question about the conclusions of your research and then I'd like to turn to the conclusions of the report.

In your research you studied just under 1,800 urine samples, and of those, only three showed any evidence of depleted uranium.

[Dr. Melissa McDiarmid]

Right. This is a good chance for me to fill the committee in, because they're probably saying 84 and 1,300. We have two different big missions for DU. The first is the detailed surveillance of the 84 who were on or in a vehicle when it was hit; the other is that mail-in urine surveillance program that I talked about. We now have more than 3,000 of those urine uraniums measured, with a history questionnaire that goes with it that asks about circumstances of possible depleted uranium exposure. So, yes, you're right.

We found out the three people who were identified in the mail-in surveillance were on or in a vehicle when it was hit. They were people that DOD wasn't able to find when they were first looking for the original cohort of the 84. So because of this large—