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Saturday, July 31, 2010

Witness Says ‘Cabal’ at VA

At a hearing last week, experts told Congress that VA staff was “intentionally delaying research and treatment for our veterans.”

Written by Nora Eisenberg

(Alternet.net) - Despite the recently announced intention by Secretary Eric Shinseki and his Chief of Staff, John Gingrich, to change the “culture” of VA, the agency is in the grips of a rogue bureaucracy that bypasses congressional oversight and sabotages veterans interests and health. This was the claim made by several speakers at last Tuesday's hearing of the House Committee on Veterans Affairs Subcommittee on Oversight and Investigations  to consider Gulf War illness and "Dissatisfied Veterans." Some 250,000 veterans of Desert Storm are disabled from the a multi-symptom, multi-system sickness associated with exposure to toxins during deployment. service. According to Paul Sullivan, Executive Director of the veterans advocacy group Veterans for Common Sense, “a cabal of VA staff” is “intentionally delaying research and treatment for our veterans.”

Anthony Hardie, another Gulf War veteran and advocate, testified that VA bureaucrats “simply disregard the oversight ...created specifically” by Congress to bypass the entrenched bureaucracy in VA and the Department of Defense, which are “at the root” of many of the problems facing Gulf War veterans. While Hardie said that bureaucratic end-runs of both congress and agency programs might be be a matter of old-timers resisting new ways, he did not rule out less benign explanations including officials “having their own agenda.” and undermining reform because of “wanting this Administration to fail.”

As a member of the Congressionally-mandated Research Advisory Committee (RAC), Hardie said he was surprised and disappointed by recent VA actions taken without appropriate consultation with RAC and the Institute of Medicine (IOM) committee charged with Gulf War research advisement. Last week, Hardie learned only from a press release published on a veterans advocacy site that VA would be funding specific research programs.

The projects, budgeted for a meager $2.8 million, pursued discredited approaches to Gulf War illness, promoting psychological causes and psychological remedies, even as both RAC and IOM have reported that VA and DOD's long-held stress theory of GWI is unfounded and that compelling data link the disease to toxic exposure. Moreover, Hardie said, the VA press release promulgated misinformation, claiming that "almost a quarter" of GW veterans suffer from Gulf War illness, when the IOM committee that works at their direction, has clearly stated that 35.9% or over a third of Gulf War veterans suffer from the multisymptom, multisystem disease.

Meanwhile, Hardie and most veteran panelists decried the fact that the most substantial and productive research in Gulf War illness, conducted by epidemiologist  Dr. Robert Haley at University of Texas Southwestern Medical Center, was suddenly and summarily de-funded last August. As early as 1994, in research the government would not fund and that Ross Perot stepped in to support, Haley had demonstrated through scans the distinct brain malformations in Gulf War illness sufferers consistent with neurotoxic exposure—and not wartime stress, a theory that VA continues to entertain in its recently announced research projects.

Veterans and other stakeholders were excluded from the Task Force charged with reforming Gulf War research and treatment as part of VA's overall reform, panelists complained, and in committees in which they were included, they were ignored. According to Gulf War veteran and Desert Storm Battle Registy director, Kirt Love, the short-lived (2008-9) Advisory Committee on Gulf War Veterans on which he served was an “ole boys club” interested in pleasing the chairman, a former DoD and VA assistant secretary turned lobbyist/adviser to companies contracting with the government. 

Secrecy, concealment, dis- and mis-information, inadequate and inaccurate record-keeping and outreach, misguided and redundant research. These and more continue to plaque VA, the Subcommittee heard, leaving profoundly ill Gulf War veterans without appropriate treatment or benefits a full 20 years after their service.

Last November, after two decades of VA obstruction and obfuscation, VCS filed Freedom of Information Act (FOIA) requests with VA to find out who “impeded” Gulf War illness research and the scale of their internal "sabotage."  Last month, having received no response, VCS filed a FOIA appeal to obtain particular documents that could disclose the perpetrators and the extent of their crime. 

Nora Eisenberg is the director of the City University of New York's fellowship program for emerging scholars. Her short stories, essays and reviews have appeared in such places as The Partisan Review, The Village Voice, The Los Angeles Times and Tikkun. She is the author of three highly acclaimed novels. Her most recent novel, When You Come Home (Curbstone, 2009), explores the the 1991 Gulf War and Gulf War illness.

Thursday, July 29, 2010

Testimony Provided to this week’s Congressional Hearing on Gulf War Illness

Hearings » Gulf War Illness: The Future for Dissatisfied Veterans

Statement of Anthony Hardie

Member, Research Advisory Committee on Gulf War Veterans' Illnesses; Gulf War Steering Committee, U.S. Department of Veterans Affairs; and Gulf War Illness Research Program Integration Panel, Congressionally Directed Medical Research Program, U.S. Department of Defense

Thank you to the Subcommittee for holding this third hearing in a very serious series seeking solutions on the Gulf War illness issues that have plagued so many thousands of Gulf War veterans for nearly 20 years.  As you already know, I am one of those 250,000 veterans affected by Gulf War illness issues.  I particularly thank Chairman Mitchell and Ranking Member Roe for your bipartisan, professional, committed leadership on this issue.

I also want to thank VA Secretary Eric Shinseki and VA Chief of Staff John Gingrich for their courageous, principled stance on championing issues related to Gulf War veterans.  As veterans themselves, we look to them with hopeful anticipation and continue to wish for their encouragement in achieving so many long-overdue and deeply needed goals on our behalf. 

From my own experience helping to lead one of the largest state veterans agencies in the country, I know that this leadership can sometimes mean battling those within your own organization, who can range from well-intentioned to apathetic to resistant to change to even those who think they know better than leadership and believe they and their ideas and ways of doing thing will be there long after the latest batch of appointees are gone.

But I also believe from my personal experiences and from meeting with VA leadership that their vision of culture change at VA can indeed be achieved.

Much of what needs to be said has been said already elsewhere, including in public comments to the current and former VA advisory committees, VA’s new, internal Gulf War Veterans’ Illnesses Task Force, and during the many Congressional hearings held over the last two decades on issues related to the health and well being of Gulf War veterans.

And, I continue to have faith in the new VA leadership, and I continue to believe that they will be effective on these issues as long as they keep them directed at the high level they are currently directed, right from the Office of the Secretary.

Instead, I want to take this opportunity to highlight just some key issues.

New National Research Project.  First, from my experience serving on various federal research advisory committees related to Gulf War veterans’ illnesses, it is clear that what is needed most urgently is fulfillment of the Institute of Medicine’s recommendation for a Manhattan Project style, nationally directed research program focused on finding and funding the best science to unlock the etiology of, and effective treatments for the toxin- and other environmental agent-induced illnesses of veterans of the 1991 Gulf War. And, as has been previously shown in other hearings and testimony, much of the hundreds of millions of dollars of previous research was misdirected, misspent, and made no difference in the health and lives of Gulf War veterans. Continuing to fund Gulf War illnesses research piece-meal, without a broader strategy, is inefficient and best and may well be ineffective at worst, leaving Gulf War veterans to continue to try to endure without effective treatments to improve our health and lives.  This large-scale research project most likely cannot be created without Congressional action.

New Kinds of Research.  Second, I have become convinced from my work with the brilliant scientists next to whom I have served on these various committees that the key to success lies in funding interdisciplinary, multi-focused, consortium-type research projects rather than funding one lone scientist testing a single theory.

Simplifying Gulf War illness claims.  Third, with regards to benefits, we as a nation can and must achieve better results with regards to the service-connected disability claims of veterans of the 1991 Gulf War.  VA must clarify, or Congress must enact legislation to clarify the current disability claims eligibility contained in 38 CFR 3.117.  Veterans with chronic multi-symptom illness should be rated for “chronic multi-symptom illness” as a single entity, not have to prove each individual symptom, ensure that each symptom subset is “undiagnosed,” and then be subjected to separate ratings for each symptom or set of symptoms.  

Correcting flaws in Gulf War presumptive rating schedule.  Fourth, in previous testimony and public submissions, I have provided details of highly problematic issues related to service connection for fibromyalgia, a presumptive condition for Gulf War veterans under 38 CFR 3.117 which is currently only allowable to a maximum of 40 percent when it should be allowable to 100 percent.  And, the symptoms of severe irritable bowel syndrome, a second presumptive condition for Gulf War veterans can be substantially or even totally disabling should not be limited to just 30 percent as it is currently under 38 CFR 3.117.  And, the diagnosis of fibromyalgia should not preclude service-connection for chronic fatigue syndrome (a third presumptive condition for Gulf War veterans that is allowable by itself up to a 100 percent rating, as it should be) as it currently does.  While I have already made specific recommendations to VA on these issues, implementing the change suggested in my third point, above, would be another way to alleviate these issues of overlap and unfairness.

VA Staff Accountability.  Finally, VA staff must be held accountable for implementing the changes called for by Gulf War veterans, the scientific community, Congress, and VA appointees.  Even still, the advisory committees on which I serve are not always consulted on issues within their purview, advised of decisions made independently by VA staff without advisory committee consent, or heeded in the sound recommendations they make.

These issues internal to VA and the U.S. Department of Defense have been at the root of many of the concerns of Gulf War veterans, and have surfaced repeatedly, including as recently as last week with the issuance of VA’s new press release on funding $2.8 million in new Gulf War health research.

As a member of VA's new Gulf War Steering Committee (GWSC) and the Congressionally-chartered VA Research Advisory Committee on Gulf War Veterans' Illnesses, I was surprised to learn of VA's newly funded research related to the health of Gulf War veterans, not from VA staff as a member of these committees, but from a writer from the Veterans Today news website who emailed me the news, which was most surprisingly issued in the form of a press release. 

As a member of these committees and a typical ill Gulf War veteran, I also find the nature of the studies funded to be of concern.  None appear to be related to treatments for exposures from among the nearly comprehensive list of potentially hazardous exposures detailed in the Persian Gulf War Veterans Act of 1998.

I find it extremely disappointing that not only were the two committees with oversight and advisory roles yet again not provided input or even advance notice of these decisions (yet again, same as always in the past), but even the news of these funding decisions was not provided by anyone at VA (and still has not been provided) to our members on the VA's GWSC and the VA's RACGWVI.        

As Congressional and VA leaders know, these committees have substantial, Congressionally- and VA-chartered responsibilities related to overseeing VA’s performance of research related to ill Gulf War veterans.  These “oversights”, if we generously call these serious issues by that name – imply  that VA officials at several levels and in several capacities within VA do not take seriously the oversight and advisory roles of these committees. 

Indeed, the message from these actions is that VA staff can and will simply disregard the oversight and advisory committees created specifically, in part, to help prevent the range of problematic issues described in this letter.   This appears to be in direct contravention to the culture change and policy changes advocated by Sec. Shinseki and VA Chief of Staff John Gingrich.

Additionally, I found at least one statement of fact in the VA's press release that is cause for substantial concern. 

·    Number of Gulf War veterans with Gulf War Illnesses Downplayed.  The VA press release says, "In the years since they returned, nearly a quarter of these Veterans have experienced chronic symptoms....known collectively as “Gulf War Veterans’ illnesses."  This statement contradicts the VA-contracted Institute of Medicine Volume 8 study on Gulf War Veterans' health, released in April 2010, and cited later in the press release, which states the number of veterans at 250,000 -- at 35.9 percent, this number is substantially higher than VA's claim in the release of, "nearly a quarter".  For many years, VA has downplayed the severity of Gulf War veterans' serious and disabling illnesses, and this latest instance is unacceptable and should be corrected immediately in the online version of this press release.

But most importantly of all, the substance of the three studies is deeply concerning.  Instead of focusing on known Gulf War toxic exposures (as shown in the list in the Persian Gulf War Veterans Act of 1998) and ameliorating the range of health effects known to be associated with those exposures, instead, one of the three VA studies is still, after 20 years of criticism for this kind of focus, focused on stress and psycho-social adaptation to disability without treating the underlying physical health conditions (“mindfulness-based stress reduction”).  To put it simply, of course mindfulness training provides some small bit of health to people in their personal adaptation to conditions of pain and disability and no new, expensive study is needed to show that – but   most importantly this adaptation has absolutely no bearing on the underlying and all too real physical health of the 35.9 percent of Gulf War veterans still suffering from Gulf War illnesses.    To portray this stress management study as somehow providing meaningful treatment to veterans is deeply disappointing, disingenuous, and a disgrace to all 250,000 Gulf War veterans still suffering from very real physical illness related to their toxic exposures.

Similarly, a second of the three announced studies is about exercise to alleviate pain in Gulf War veterans.  Again, this area has been excessively studied by VA, DoD, and the scientific community, and even non-scientist health writers regularly note that exercise helps people with fibromyalgia and chronic pain, but worsen the fatigue and others symptoms in people suffering from chronic fatigue.   Gulf War veterans hardly need a new, expensive study to tell them more about what is already known.

The third of the three VA announced studies is an animal study conducted over four years to assess the efficacy of drugs with anti-depressant, anti-oxidant, and anti-inflammatory properties.   At the end of those four years, presumably it will take some time to publish the results, after which, if success is found, new multi-year studies to study the efficacy of the treatments in humans will be required.  It is incomprehensible why, after 20 years of waiting, these treatments are not being tried in ill Gulf War veterans directly rather than in study design that will require more studies thereafter before treatments ever reach the Gulf War veterans who need them.  Even if this study of anti-depressants turns out to be effective, instead, this study will take years before any potential benefit can pave the way for yet another study, meaning many more years of waiting by the 35.9 percentof Gulf War veterans still suffering from Gulf War illnesses. 

In addition to the fact that adaptations to disability purporting to be “treatment” have already been excessively studied by VA and DoD over the last 20 years at costs ranging into the millions of dollars, to put it simply, after so many years of VA missteps, these latest missteps by VA are simply unacceptable, as I am sure Sec. Shinseki and you would agree.    Most importantly, these kinds of missteps are fully preventable if the oversight and advisory bodies cited above are actively engaged by VA staff and their recommendations heeded.  But again, these committees were not only not consulted; they still haven’t even been informed of these decisions made without their input on issues directly within their purview.

All these issues suggest that despite all the expressed good intentions, staff inside VA continue through their actions – whether intentional or not – to undermine these efforts.  Perhaps they want to do things the way they’ve always done them, perhaps they believe that what they’re doing is “right,” perhaps they want this Administration to fail, perhaps they have their own agendas, or perhaps they just don’t get it. 

In any case, given all of these facts and circumstances, on behalf of my fellow Gulf War veterans, I gave the following specific questions to VA leadership – questions I believe any reasonable person would have given the circumstances:

  1. What specific corrective steps are being taken immediately by VA leadership to ensure that the stated oversight and advisory roles of the GWSC and RACGWVI are respected and followed by VA staff at all levels? These bodies cannot perform their intended functions when they are completely bypassed by VA staff.
  1. When will VA begin a treatment-focused research program -- as called for in the more than a decade-old Persian Gulf War Veterans Act of 1998 -- that is based on alleviating the known health effects associated with the known toxic exposures of the 1991 Gulf War?  VA officials note in this press release, “The IOM report noted that the illnesses seen in Gulf War Veterans cannot be ascribed to any psychiatric disorder and likely result from genetic and environmental factors,” yet not one of these new expensive new studies focuses on environmental or genetic factors that caused 250,000 Gulf War veterans’ illnesses.
  1. When will VA correct the factual error in the press release?  Again, in one place in VA’s press release VA cites the number of the 696,842 Gulf War veterans still suffering from Gulf War illnesses as “nearly a quarter,” when the Institute of Medicine, contracted by VA, shows this number to be  far, far higher -- at least 250,000, or 35.9 percent.   That’s one-third again higher than “nearly a quarter”.  More broadly, this latest instance of downplaying the severity of Gulf War illness appears to be indicative of a continuing, long term trend within VA.
  1. When will VA provide the rewritten press release to every member of the two VA committees that have oversight over Gulf War veterans’ health issues?  (GWSC and RACGWVI)

For the last year, I have been using my leadership role to reassure my fellow ill Gulf War veterans – including through the Gulf War health news website I publish, 91outcomes.com, which has had more than 25,000 readers in the mere 16 months since it was created -- that change is coming, and that VA has a new focus and a dramatic culture shift that will almost certainly lead to effective treatments for Gulf War veterans’ toxin-induced disabilities. 

For most of us, like any other disabled veteran, all most of us has ever wanted is our health restored to a state as close as possible to its pre-war state.  Science tells us that may very well be possible, that effective remedies are within our reach – but the choices made in selecting these three studies do not reflect the direction that the scientists tell us should be the way forward.

VA’s serious factual, procedural, and research-focus errors have shaken my growing trust in the new VA.  But, I look to VA leadership to take immediate, good-faith steps to remedy these serious issues.  And, I remain optimistic that VA Secretary Eric Shinseki and VA Chief of Staff John Gingrich can find ways to effectively cause VA staff to conform to their stated vision of the “culture change” desperately needed by the at least 35.9 percent of Gulf War veterans still suffering from the life-long effects of their Gulf War toxic exposures – a vision that so many of us out here share with great hope and expectation. 

If ever there was leadership that can indeed get this right, I believe it is them, aided by the able, committed, and professional leaders in Congress including you on this committee.  Please, don’t let us down now when the end is finally in sight.

Again, thank you for holding today’s hearing, for all that you have done for all veterans, and all that you continue to do.

Tuesday, July 27, 2010

Congressional Hearing on Gulf War Illness Shows the Way Forward

“Big Science,” Continued collaboration between stakeholders and VA, and VA leaders holding VA staff accountable are required

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) - This morning’s Congressional oversight hearing on Gulf War illness issues was a mix of old and new, but for the first time in history painted a picture of the way forward to which all sides seemed to agree.

As in the past, Gulf War veteran leaders like Paul Sullivan of the advocacy group Veterans for Common Sense (www.veteransforcommonsense.org) minced no words in highlighting the long history of missteps and concerns that poignantly reminding the Committee members that there still are no meaningful changes in health care and benefits for Gulf War veterans with Gulf War illness.

However, the veteran leaders testifying today were particularly articulate and lucid, including Don Overton, Executive Director of Veterans of Modern Warfare (www.vmwusa.org), a protege organization of Vietnam Veterans of America (www.vva.org). 

And, while the three veterans organization representatives’ frustration was still visible at times, all outright anger was replaced with a steady flow of detailed lists of specific recommendations.  Even the American Legion, criticized by Gulf War veterans in the 1990’s for echoing the “official” government position that nothing was wrong with Gulf War veterans except “stress,” was actively engaged in advocating for Gulf War veterans.

Conspiracy theories were also noticeably absent, replaced by constructive, concrete solutions in both their oral comments – limited to just five minutes each – as well as their full written statements, which could be up to a dozen or so pages long.

But what was new was that no one – from veterans to scientists to VA officials to Congressional members – no one was questioning the reality of Gulf War illness.  There was overt acknowledgement of the credibility of the findings of the Institute of Medicine, which, after reviewing more than 1,000 studies, including reviewing 400 very closely, found chronic multi-symptom illness is associated with Gulf War service, affects at least 250,000 of the Gulf War’s 697,000 veterans, and cannot be attributed to any known psychiatric or psychological condition.

And what was also new was the clear focus of all involved in solving the host of issues surrounding Gulf War illness.  Among those issues discussed were benefits, claims, evidence-based treatments in Gulf War veterans’ health care, outreach, and prevention.

Charles Cragin, chair of the VA Advisory Committee on Gulf War Veterans that concluded its work last year, noted that VA’s data on Gulf War veterans is confused due to problems in VA’s Gulf War database. 

“If you don’t have good data, you can’t make good decisions,” said Cragin during the hearing.  Responding to a question from one of the Congressional members, Cragin said none of his committee’s recommendations have yet been implemented, though VA has included “most” of them in its final, upcoming first report of its internal Gulf War Task Force.

Dr. Stephen Hauser, the medical doctor and acclaimed researcher who chaired the most recent Institute of Medicine panel on Gulf War illness research, made the way forward plain. 

VA’s current research plans are a good way to fund “creative” research from individual researchers interested in the issue, sais Hauser. 

However, to succeed, “Big Science” is required, said Hauser, suggesting that good models of the kind of “top down directed” research needed to be effective for Gulf War illness would be the national effort to eradicate polio or government research efforts to identify causes of, and treatments for HIV/AIDS. 

Jim Binns, chair of the Congressionally chartered VA Research Advisory Committee on Gulf War Veterans’ Illnesses (www1.va.gov/rac-gwvi), told the Congressional members that despite apparent progress, VA staff are still funding research focused on “stress,” as shown in last week’s VA announcement of $2.8 million for research widely criticized by Gulf War veterans.  Binns also noted that VA is finding few takers interested in applying for research funding, an outcome he attributed to years of government denial of the reality and seriousness of Gulf War illness.

VA Chief of Staff John Gingrich, who testified on behalf of the VA (www.va.gov/gulfwar), was given the last word, beginning with his own poignant testimony detailing his close experiences with Gulf War illness issues.  His experiences as a Gulf War combat officer included hearing countless chemical alarms sound during the war that never went off during training, having concerns about the NAPP pills taken by Gulf War troops that made them sick, and witnessing one of his soldiers become inexplicably seriously ill during the war – ill enough to have to be medically evacuated.

While Congressional members of the committee were explicitly respectful of Gingrich’s own Gulf War service and his readily apparent commitment to Gulf War and other veterans’ issues,  they also were sharp in their comments and questioning of the capacity of VA’s large organization in being able to bring about the kinds of changes called for by Gulf War veterans. 

Their pointed questions and observations ranged from the adequacy of funding and staffing (VA always has enough, according to whomever is testifying on behalf of VA), to voicing constituent concerns about whether real change will be felt by Gulf War veterans within the next year with regards to disability claims, improvement in health, and recognition of meaningful research.

Gingrich made it clear that he understands why Gulf War veterans are “dissatisfied” with VA, attributing it to a loss of trust that he pledged VA must, can, and will regain.

However, during questioning, Charles Cragin noted that his experience inside VA showed him that there are some VA staff who refuse to participate except if they can do things “their own way.” 

“An inordinate amount of time,” must be spent keeping VA staff on track, said Cragin, further highlighting veterans’ and Congressional members’ concerns.

While many more excellent points were made by the veteran, advisory committee chairs, and Congressional members than can be covered in this article, perhaps Jim Binns said it best.

“It is important to close on a positive note.  Twenty years into this battle, the objective is finally in sight.  It is time for leaders and resources adequate to accomplish the mission.  It is within reach.  It is a matter of choice.”

“Twenty years into this battle, the objective is finally in sight.  It is time for leaders and resources adequate to accomplish the mission.  It is within reach.  It is a matter of choice.”  -Jim Binns, Chair, RACGWVI

 

------------------------------

FOR MORE INFORMATION

  • The written submissions of each panelist can be reviewed on the website of the U.S. House Committee on Veterans’ Affairs
  • The full hearing can also be viewed as a webcast.

Today’s Congressional Hearing Raises Questions of VA Career Staff Commitment to Gulf War Veterans, VA Appointees

The U.S. House of Representatives Committee on Veterans Affairs subcommittee on Oversight and Investigations is holding a hearing on Gulf War illness at 10 EDT today (Tuesday, July 27, 2010).  

Click on the link below for the live webcast of the hearing.

Webcast link

 

Opening Statements

 

Witness Testimonies

 

Panel 1

Panel 2

  • The Honorable Charles L. Cragin, Chairman, Advisory Committee on Gulf War Veterans, U.S. Department of Veterans Affairs
  • Stephen L. Hauser, M.D., Professor and Chair of Neurology, University of California, San Francisco, School of Medicine, and, Chair, Committee on Gulf War and Health: Health Effects of Serving in the Gul War, Update 2009, Board on the Health of Selection Populations, Institute of Medicine, The National Academies
  • James H. Binns, Chairman, Research Advisory Committee on Gulf War Veterans' Illinesses

Panel 3

  • John R. Gingrich, Chief of Staff, U.S. Department of Veterans Affairs
  • Accompanied By:
  • Victoria Cassano, M.D., MPH, Director, Radiation and Physical Exposures Service, Acting Director, Environmental Agents Service, Office of Public Health and Environmental Hazards, Veterans Health Administration, U.S. Department of Veterans Affairs
  • Joel Kupersmith, M.D., Chief Research and Development Officer, Office of Research and Development, Veterans Health Administration, U.S. Department of Veterans Affairs
  • Bradley Mayes, Director, Compensation and Pension Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs

Panel 4:  Submissions for the Record

Letter to COSVA John Gingrich

VA Appointees, Gulf War Veterans Deserve to be Better Served by VA Career Staff

July 22, 2010

Dear Mr. Gingrich,

First, I want to thank you for your courageous, principled stance on championing issues related to Gulf War veterans.  As one of us, we look to you with hopeful anticipation and continue to wish for your encouragement in achieving so many long-overdue and deeply needed goals on our behalf.  From my own experience helping to lead one of the largest state veterans agencies in the country, I know that this leadership can sometimes mean battling those within your own organization, who can range from well-intentioned to apathetic to resistant to change to even those who think they know better than leadership and believe they and their ideas and ways of doing thing will be there long after the latest batch of appointees are gone.

But I also believe from my personal experiences and from meeting with you that your vision of culture change at VA can indeed be achieved – even if it might mean some rocky times like those in which we now find ourselves with the issuance of VA’s  new press release on Gulf War health research.

As a member of VA's new Gulf War Steering Committee (GWSC) and the Congressionally-chartered VA Research Advisory Committee on Gulf War Veterans' Illnesses, I was surprised to learn this week of VA's newly funded research related to the health of Gulf War veterans.

I was also deeply disappointed at how I learned this news, not from VA staff as a member of these committees, but from a writer from Veterans Today who emailed me the news, which was most surprisingly issued in the form of a press release. 

As a member of these committees and a typical ill Gulf War veteran, I also find the nature of the studies funded to be of concern.  None appear to be related to treatments for exposures from among the nearly comprehensive list of potentially hazardous exposures detailed in the Persian Gulf War Veterans Act of 1998.

I find it extremely disappointing that not only were the two committees with oversight and advisory roles yet again not provided input or even advance notice of these decisions (yet again, same as always in the past), but even the news of these funding decisions was not provided by anyone at VA (and still has not been provided) to our members on the VA's GWSC and the VA's RACGWVI.       

As you know, these committees have substantial, Congressionally- and VA-chartered responsibilities related to overseeing VA’s performance of research related to ill Gulf War veterans.  These “oversights”, if we generously call these serious issues by that name – imply  that VA officials at several levels and in several capacities within VA do not take seriously the oversight and advisory roles of these committees. 

Indeed, the message from these actions is that VA staff can and will simply disregard the oversight and advisory committees created specifically, in part, to help prevent the range of problematic issues described in this letter.   This appears to be in direct contravention to the culture change and policy changes advocated by Sec. Shinseki and yourself.

Additionally, was at least one statement of fact in the VA's press release that is cause for substantial concern.

  • Number of Gulf War veterans with Gulf War Illnesses Downplayed.  The VA press release says, "In the years since they returned, nearly a quarter of these Veterans have experienced chronic symptoms....known collectively as “Gulf War Veterans’ illnesses."  This statement contradicts the VA-contracted Institute of Medicine Volume 8 study on Gulf War Veterans' health, released in April 2010, and cited later in the press release, which states the number of veterans at 250,000 -- at 35.9 percent, this number is substantially higher than VA's claim in the release of, "nearly a quarter".  For many years, VA has downplayed the severity of Gulf War veterans' serious and disabling illnesses, and this latest instance is unacceptable and should be corrected immediately in the online version of this press release.

But most importantly of all, the substance of the three studies is deeply concerning.  Instead of focusing on known Gulf War toxic exposures (there’s a nice list in the Persian Gulf War Veterans Act of 1998) and ameliorating the range of health effects known to be associated with those exposures, instead, one of the three VA studies is still, after 20 years of criticism for this kind of focus, focused on stress and psycho-social adaptation to disability without treating the underlying physical health conditions (“mindfulness-based stress reduction”).  To put it simply, of course mindfulness training provides some small bit of health to people in their personal adaptation to conditions of pain and disability and no new, expensive study is needed to show that – but   most importantly this adaptation has absolutely no bearing on the underlying and all too real physical health of the 35.9 percent of Gulf War veterans still suffering from Gulf War illnesses.    To portray this stress management study as somehow providing meaningful treatment to veterans is deeply disappointing, disingenuous, and a disgrace to all 250,000 Gulf War veterans still suffering from very real physical illness related to their toxic exposures.
Similarly, a second of the three announced studies is about exercise to alleviate pain in Gulf War veterans.  Again, this area has been excessively studied by VA, DoD, and the scientific community, and even non-scientist health writers regularly note that exercise helps people with fibromyalgia and chronic pain, but worsen the fatigue and others symptoms in people suffering from chronic fatigue.   Gulf War veterans hardly need a new, expensive study to tell them more about what is already known.

The third of the three VA announced studies is an animal study conducted over four years to assess the efficacy of drugs with anti-depressant, anti-oxidant, and anti-inflammatory properties.   At the end of those four years, presumably it will take some time to publish the results, after which, if success is found, new multi-year studies to study the efficacy of the treatments in humans will be required.  It is incomprehensible why, after 20 years of waiting, these treatments are not being tried in ill Gulf War veterans directly rather than in study design that will require more studies thereafter before treatments ever reach the Gulf War veterans who need them.  Even if  this study of anti-depressants turns out to be effective, instead, this study will take years before any potential benefit can pave the way for yet another study, meaning many more years of waiting by the 35.9 percent of Gulf War veterans still suffering from Gulf War illnesses. 
In addition to the fact that adaptations to disability purporting to be “treatment” have already been excessively studied by VA and DoD over the last 20 years at costs ranging into the millions of dollars, to put it simply, after so many years of VA missteps, these latest missteps by VA are simply unacceptable, as I am sure Sec. Shinseki and you would agree.    Most importantly, these kinds of missteps are fully preventable if the oversight and advisory bodies cited above are actively engaged by VA staff and their recommendations heeded.  But again, these committees were not only not consulted, they still haven’t even been informed of these decisions made without their input on issues directly within their purview.

All these issues suggest that despite all the expressed good intentions, staff inside VA continue through their actions – whether intentional or not – to undermine these efforts.  Perhaps they want this Administration to fail, perhaps they have their own agendas, or perhaps they just don’t get it. 
In any case, given all of these facts and circumstances, on behalf of my fellow Gulf War veterans, here are my specific questions for VA leadership – questions I believe any reasonable person would have given the circumstances:

1.  What specific corrective steps are being taken immediately by VA leadership to ensure that the stated oversight and advisory roles of the GWSC and RACGWVI are respected and followed by VA staff at all levels?  These bodies cannot perform their intended functions when they are completely bypassed by VA staff.

2.  When will VA begin a treatment-focused research program -- as called for in the more than a decade-old Persian Gulf War Veterans Act of 1998 -- that is based on alleviating the known health effects associated with the known toxic exposures of the 1991 Gulf War?  VA officials note in this press release, “The IOM report noted that the illnesses seen in Gulf War Veterans cannot be ascribed to any psychiatric disorder and likely result from genetic and environmental factors,” yet not one of these new expensive new studies focuses on environmental or genetic factors that caused 250,000 Gulf War veterans’ illnesses.

3.  When will VA correct the factual error in the press release?  Again, in one place in VA’s press release VA cites the number of the 696,842 Gulf War veterans still suffering from Gulf War illnesses as “nearly a quarter,” when the Institute of Medicine, contracted by VA, shows this number to be  far, far higher -- at least 250,000, or 35.9 percent.   That’s one-third again higher than “nearly a quarter”.

4.  When will VA provide the rewritten press release to every member of the two VA committees that have oversight over Gulf War veterans’ health issues?  (GWSC and RACGWVI)

For the last year, I have been using my leadership role to reassure my fellow ill Gulf War veterans – including through the Gulf War health news website I publish, 91outcomes.com, which has had more than 25,000 readers in the mere 16 months since it was created -- that change is coming, and that VA has a new focus and a dramatic culture shift that will almost certainly lead to effective treatments for Gulf War veterans’ toxin-induced disabilities.  For most of us, like any other disabled veteran, all most of us has ever wanted is our health restored to a state as close as possible to its pre-war state.  Science tells us that may very well be possible, that effective remedies are within our reach – but the choices made in selecting these three studies do not reflect the direction that the scientists tell us should be the way forward.

VA’s serious factual, procedural, and research-focus errors have rocked my growing trust in the new VA, trust that can only be regained by VA leadership taking immediate, good-faith steps to remedy these serious issues. 

Should that not take place, as might be expected of any reasonable person, then I will be left only to fervently hope that those participating in next week's Congressional oversight hearing on Gulf War veterans' illnesses will make known as widely as possible all of these serious issues – and in a public oversight forum attended by Congressional leaders, national media, and powerful representatives of the Gulf War veterans’ community. 

But, I assume that both of us hope that won’t be necessary.  I remain optimistic that Secretary Shinseki and you can find ways to effectively cause VA staff to conform to your vision of the “culture change” desperately needed by the at least 35.9 percent of Gulf War veterans still suffering from the life-long effects of their Gulf War toxic exposures – a vision that so many of us out here share with great hope and expectation. 

If ever there was leadership that can indeed get this right, I believe it is both of you.  Please, don’t let us down now.

Again, thank you for all that you have done for all of us

With utmost sincerity,

Anthony Hardie
Madison, Wis.

Saturday, July 24, 2010

VA Fast Letter to Claims Staff To Clarify “Medically Unexplained Chronic Multisystem Illness” for Gulf War Claims

Comp & Pen Director calls IBS, FM, CFS “examples” of medically unexplained chronic multisymptom illnesses, not “exclusive list”

U.S. Department of Veterans Affairs

July 21, 2010                                                                  

Director (00/21)                                                             

In Reply Refer To:  211AAll   

Regional Offices and Centers                                Fast Letter 10-26VA

SUBJ:  Revisions to 38 C.F.R. § 3.317 to clarify the Meaning of “Medically Unexplained Chronic Multisystem Illness” Related to Gulf War and Southwest Asia Service

Purpose

This letter provides information on a regulatory change being developed by VA to clarify the  meaning of a diagnosed “medically unexplained chronic multisymptom illness” for disability claims based on Gulf War and Southwest Asia service.   

Background

VA has statutory authority under 38 U.S.C. § 1117 to compensate Veterans for qualifying chronic disabilities resulting from Gulf War and Southwest Asia service when the disability is an “undiagnosed illness” or a diagnosed “medically unexplained chronic multisymptom illness.”  Section 1117 provides the following as examples of qualifying diagnosed multisymptom illnesses:  chronic fatigue syndrome, irritable bowel syndrome, and fibromyalgia.  However, the regulatory language of section 3.317 implementing the statute suggests that these three diagnosed illnesses are an exclusive listing, rather than just examples. 

Regulatory Change

VA is revising § 3.317 to clarify that the three listed diagnosed multisymptom illnesses are not exclusive, but rather are examples that can serve to inform VA medical examiners and adjudicators of the general types of medically unexplained chronic multisymptom illnesses that may qualify for service connection under the § 1117 authority.  

Questions

Submit questions concerning this fast letter to your Veterans Service Officer (VSO).

Bradley G. Mayes 

Director

Compensation and Pension Service

Friday, July 23, 2010

Gulf War Hearing Next Week

GW Task Force’s first final report, heavily criticized VA “stress” research, press release expected to be discussed

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) – The oversight and investigations subcommittee of the U.S. House Committee on Veterans’ Affairs is slated to hold a hearing next week that is expected to include both favorably received and intensely criticized recent VA actions related to Gulf War illness issues.

The hearing, inexplicably entitled, “Gulf War Illness: The Future for Dissatisfied Veterans,” will be held at 10:00 a.m. on Tuesday, July 27, 2010 in the House Veterans’ Affairs Committee hearing room on Capitol Hill.  The hearing is third in a multi-year series that has helped VA to reshape its healt, benefits, and outreach efforts related to Gulf War illnesses.

A recent Institute of Medicine report found that 250,000 veterans of the 1991 Gulf War – more than one-third – continue to suffer from what the IOM termed chronic multisymptom illness (CMI), more commonly known as Gulf War Syndrome or Gulf War Illness. 

The IOM also found that rates of PTSD and other psychiatric conditions were much lower than CMI rates in Gulf War veterans, and emphatically stated that the multisymptom illness prevalent in Gulf War veterans could not be attributed to a psychiatric cause, providing further vindication for the hundreds of thousands of Gulf War veterans who have been suffering from debilitating physical conditions for nearly 20 years.

Last August, U.S. Department of Veterans Affairs (VA) Secretary Eric Shinseki launched a comprehensive internal task force on Gulf War veterans’ illness issues, chaired by VA Chief of Staff John Gingrich, himself a Gulf War veteran. 

Earlier this year, VA’s internal Task Force not only released its initial draft report to the public  -- unusual for an internal government task force -- but also allowed and requested public comments.  

The transparency measures, on an issue that has drawn frustration and hostility for years from ill Gulf War veterans, were well received by the Gulf War veteran community.  The measures, from a federal agency previously known more for stonewalling and denial on Gulf War illness issues, renewed hope in many quarters that real change aimed at genuinely providing new improvements in the health and lives of Gulf War veterans is finally on its way.

However, a VA press release this week announcing funding for three Gulf War studies, including one focused on alleviating “stress,” has outraged leaders of several veterans organizations and had a severe, negative impact on that growing good will. 

Gulf War veteran leaders have called on the VA to correct a statement in the press release significantly low-balling the number of ill Gulf War veterans and to fix serious procedural violations by VA staff, who entirely bypassed the new VA Gulf War Steering Committee (GWSC) and Research Advisory Committee on Gulf War Veterans’ Illnesses (RACGWVI) in making the inappropriate funding decisions.

While the panelists testifying at the hearing have not yet been officially announced, representatives of Veterans of Modern Warfare (www.vmwusa.com) and Veterans for Common Sense (www.veteransforcommonsense.org) are among those who have been requested to testify.

A final copy of the VA task force’s first report is expected just prior to the upcoming Congressional hearing.

More information on the hearing can be found here:  http://veterans.house.gov/hearings/hearing.aspx?NewsID=601.

Thursday, July 22, 2010

AIR FORCE TIMES: Troops have higher rates of some cancers, says study

 

Written by Kelly Kennedy - Staff writer, military Times group

(Air Force Times) -  After looking at 10 years’ worth of cancer data, researchers at the Armed Forces Health Surveillance Center found that service members tend to have higher rates of melanoma, brain, non-Hodgkin lymphoma, breast, prostate and testicular cancers than civilians.

They also found interesting differences across the services. Airmen are more likely to suffer skin cancer than other service members, for example, while sailors are the most likely to have lung cancer. Coast Guardsmen have the highest rates of testicular cancer, while Marines tend to the have the lowest cancer rates overall.

Military researchers say the rates have remained stable — though the incidence rate of these particular kinds of cancer has increased from 51 per 100,000 troops in 2000, to 57.5 per 100,000 in 2006, and then back down to 54.5 per 100,000 in 2009.

“There were no clear trends of increasing or decreasing incidence of specific [cancer] sites or overall” cancer rates, the report states. “In general, the strongest demographic correlate of increased risk of a cancer was older age.”

That held true for all cancers except for cervical and testicular, the report states.

To conduct the study, researchers looked at how many times a service member had been seen for a diagnosis, whether a member had been treated with radiotherapy or chemotherapy, or whether a member’s medical code showed he had been diagnosed with a cancer. They found the lowest number of diagnoses from cancer over the past decade was in 2000, with 710. The highest rate came in 2006 with 802. There were 7,579 total diagnoses over the 10 years.

During those years, 904 service members died of cancer. The fewest deaths came in 2000 with 44; the most deaths came in 2005 with 125. Of those who died, 106 died of lung cancer, 101 died from brain or other nervous system cancers, and 92 died of colon cancer.

Researchers expected to see more cases related to tobacco smoking because 31 percent of service members smoke, compared to 20 percent of civilians. However, “lung cancer cases related to current tobacco smoking may not be clinically apparent until affected members leave active service,” researchers said.

The highest rates were for breast cancer. Service women ages 20 to 24 were diagnosed with breast cancer at a rate of 2.5 per 100,000, compared to civilians who were diagnosed at a rate of 1.5 per 100,000. Those numbers greatly increased for service women as they aged. Military women ages 35 to 39 were diagnosed at a rate of 77.3 per 100,000, compared to civilians who were diagnosed at a rate of 59.3 per 100,000.

Researchers explained that military personnel are younger and healthier than civilians, so one might think that the rates overall would be lower. However, the researchers reasoned, service members have unlimited access to health care, as well as required annual exams, so they may be diagnosed more frequently and at younger ages than civilians.

But that doesn’t completely explain disparities among the services, such as why Marines — who have access to the same health care as members of other branches — have significantly lower rates of these cancers than either their military peers or civilians.

For example, the Air Force rate for malignant melanoma was 14.8 per 100,000, while the rate for Marines was 6.5 per 100,000. And sailors had almost double the rate of lung cancer as people from other services.

This was the first report to look cancer rates in all services. Another recent study conducted by K. Zhu at the U.S. Military Cancer Institute at Walter Reed Army Medical Center compared data from the Defense Department’s Automated Central Tumor Registry and from the National Cancer Institute from 1990 to 2005.

Zhu found that colorectal cancer in white troops, lung cancer in white and black male troops and white female troops, and cervical cancer in black female troops were significantly lower than similar civilian populations.

However, breast cancer and prostate cancer rates were significantly higher in both black and white troops than in civilians. Prostate cancer rates were also higher in military patients.

“Overall, these results suggest that cancer patterns may differ between military and nonmilitary populations,” Zhu wrote.

A second study of Air Force personnel, by G. Yamane, found that invasive cancers had “decreased significantly” from 1989 to 2002. Cancer rates for female airmen were about the same as civilian populations, and Air Force men had lower cancer rates. However, cervical, prostate and vulvar cancers were “significantly higher.”

And a third study, published in the Medical Surveillance Monthly Report in 2008, found that service members had lower rates of colorectal, lung and cervical cancers, and higher rates of prostate and breast cancers.

Wednesday, July 21, 2010

VA PRESS RELEASE: VA Approves $2.8M for Gulf War Illness Research

The following is a press release from the U.S. Department of Veterans Affairs (VA).

*****
SOURCE:  http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1925



clip_image002

FOR IMMEDIATE RELEASE

July 21, 2010

VA Approves $2.8M for Gulf War Illness Research
WASHINGTON – The Department of Veterans Affairs (VA) has approved $2.8 million to fund three new research projects that focus on testing or developing new treatments for illnesses affecting Veterans who served in the Gulf War 1990-1991. The research incorporates recommendations of the department’s Gulf War Veterans’ Illnesses Task Force.
“Reaching out to Gulf War Veterans is essential to the transformation of VA,” said Veterans Affairs Chief of Staff John R. Gingrich. “This research is a great opportunity to do something that will improve the care and services these Veterans have earned.”
About 697,000 men and women served in operations Desert Shield and Desert Storm from August 1990 to June 1991 during the Gulf War. In the years since they returned, nearly a quarter of these Veterans have experienced chronic symptoms such as fatigue, weakness, gastrointestinal problems, cognitive dysfunction, sleep disturbances, persistent headaches, skin rashes, respiratory conditions and mood changes. The symptoms are known collectively as “Gulf War Veterans’ illnesses.”
A recent report by the Institute of Medicine’s Committee on Gulf War and Health, “Health Effects of Serving in the Gulf War,” noted that chronic multi-symptom illnesses affect an estimated 250,000 Gulf War Veterans. Given the findings, VA is embarking on a national Gulf War Veterans’ illness research program to identify and adopt the most effective treatments for Veterans.
- More -
VA Gulf War Research 2/2/2
“Last February, we welcomed Secretary Shinseki’s decision to take a serious look at the disability claims of Gulf War Veterans,” said Clarence Hill, national commander of The American Legion. “Now that VA is following through with these important studies of Gulf War illness, which has plagued many of the 700,000 Gulf War Veterans for nearly 20 years, The American Legion believes these studies should provide a shared foundation for those Veterans who need to be cared for and compensated for their disabilities.”
The first $700,000 will be available Oct. 1, 2010, the beginning of fiscal year 2011.
The studies are expected to take between two to five years to complete, and include:
-- A five-year study to evaluate the impact of resistance exercise training (RET) in treating chronic musculoskeletal pain and associated symptoms in Gulf War Veterans. The study will evaluate the influence of RET on total physical activity, pain sensitivity and regulation, and brain white-matter tracts. Dane B. Cook, Ph.D., of VA’s William S. Middleton Memorial Veterans Hospital, Madison, Wis., will conduct it.
-- A four-year study on an animal model of Gulf War illnesses to assess the effectiveness of therapies to enhance mood and memory. The therapies are designed to increase generation of nerve cells in the hippocampus, improving cognitive function and reversing depressive and anxiety-like behaviors. One strategy will test treatment with anti-depressant medicine and a drug or dietary supplement having antioxidant and anti-inflammatory properties. The second strategy will test use of either an antidepressant or an
antioxidant/anti-inflammatory agent, combined with exercise. Ashok K. Shetty, Ph.D., of the Durham, N.C., VA Medical Center, will conduct it.
-- A two-year pilot study that will include randomized, controlled, eight-week trials of an intervention known as “mindfulness-based stress reduction,” compared with usual care. Assessments of Veterans will include symptom-based measures of pain, fatigue, and cognitive and physical function as well as objective measures of attention, concentration and memory. David J. Kearney, M.D., of the VA Puget Sound Health Care System, Seattle, Wash., will conduct it.
The IOM report noted that the illnesses seen in Gulf War Veterans cannot be ascribed to any psychiatric disorder and likely result from genetic and environmental factors, although the data are not strong enough to draw conclusions about specific causes.
















Monday, July 19, 2010

Health Effects of Depleted Uranium (DU): A review of Recent Research

Written by Anthony Hardie

(91outcomes.com) - The following is a review of select new scientific studies (2009, 2010) related to the health effects of Depleted Uranium (DU). This review is based on the abstracts of published studies publicly available on PubMed.gov, a service of the U.S. National Library of Medicine, which is part of the National Institutes of Health. This review is by no means intended to be perceived as comprehensive, nor does it take into account every single study published on DU during this time period. However, every attempt has been made to provide a balanced and careful review of each of the studies below. 

The studies examine the health effects associated with DU that has been embedded/implanted (such as shrapnel) in the body, ingested/swallowed and absorbed into the body, and inhaled into the upper and/or lower respiratory tracts/lungs. One study examines the health effects associated with DU exposure through wounds. None of the studies examines health effects related to skin contact with DU, DU particulate matter, or DU crystalline residue.

Taken together, these studies suggest that there are a number of negative health effects associated with exposure to DU.  The nature and severity of these health effects are dependent upon the type, duration, and magnitude of DU exposure, and, for aeresolized DU particulates, the size, composition, and timing of the DU particles inhaled.

First, some terms we’ll be using…

Depleted Uranium (DU). Uranium (U) is a naturally occurring heavy metal that has both radioactive properties caused by the decay of the uranium atom’s nucleus, and chemical properties as a heavy metal. DU is the by-product of the enrichment process, which extracts portions of naturally occurring uranium for nuclear fuel and weapons. DU is what’s left over after enrichment: a form of uranium that 40 percent less radioactive than naturally occurring uranium, but is chemically identical to naturally occurring uranium and other forms of uranium. In addition to a less radioactive form of uranium, the DU used in the U.S. military’s armor plates and munitions also contains trace levels of more radioactive transuranics (neptunium, plutonium, and americium) and fission products (technetium-99). DoD says the levels of these more radioactive transuranics and fission products are in minute quantities and result in” less than a one percent increase in the internal radiation dose. “ More detailed information on DU’s characteristics is available from DoD.

Oxidative Stress (OS). The human body is a careful balancing act. Too much or too little of one thing or another can lead to disastrous consequences. One of these countless balancing acts is with reactive oxygen species (ROS), chemically reactive oxygen-containing molecules most often created by the body as by-products of normal and essential metabolic reaction, and which are needed by the body for immune function and cell signaling. However, an imbalance causing too many ROS can be caused by many factors as results in an inability by the body to detoxify or to repair damage caused by excessive ROS. This resulting condition is called Oxidative Stress (OS), an imbalance that results in damage to one or more cells, tissues, or organs. OS has been found to play a key role in many disease processes.

…And now, on to the studies themselves.

U versus DU. An Italian government study found cytotoxic (cell-killing) and genetic effects at quite low concentrations of uranium (U). The impact was higher with exposures to natural uranium (U) than to DU. (A. Giovanetti et al, 2010)

A study from the University of Nebraska-Kearney (W. Briner et al, 2010) notes, “while depleted uranium is less radioactive than natural uranium, it still retains all the chemical toxicity associated with the original element. In large doses the kidney is the target organ for the acute chemical toxicity of this metal, producing potentially lethal tubular necrosis. In contrast, chronic low dose exposure to depleted uranium may not produce a clear and defined set of symptoms. Chronic low-dose, or subacute, exposure to depleted uranium alters the appearance of milestones in developing organisms. Adult animals that were exposed to depleted uranium during development display persistent alterations in behavior, even after cessation of depleted uranium exposure. Adult animals exposed to depleted uranium demonstrate altered behaviors and a variety of alterations to brain chemistry. Despite its reduced level of radioactivity evidence continues to accumulate that depleted uranium, if ingested, may pose a radiologic hazard.”

The results of a French government study, conducted by France’s Radioprotection and Nuclear Safety Institute, “illustrate that oxidative stress plays a key role in the mechanism of uranium neurotoxicity. They showed that chronic exposure to DU, but not enriched uranium, seems to induce an increase of several antioxidant agents in order to counteract,” the OS in the brain. According to the study authors, “these results demonstrate the importance of the double toxicity, chemical and radiological, of uranium.” (Lestaevel et al, 2009)

DU Genotoxity. Some substances have genotoxic properties – properties that make them harmful to the genetic information (DNA, RNA, chromosomes, etc.) in living creatures. There are three types of genotoxins: 1) Carcinogens (cancer-causing); 2) Mutagens (cause mutations); and, 3) Teratogens (birth-defect causing).

A Chinese government study using rats fed levels of DU, ranging from none to high, found increased concentrations of uranium in the kidneys and ovaries and significant abnormalities in the sperm in those that had consumed the DU. Because these genotoxic changes to the DNA affected ovaries and sperm, the DNA changes were passed on to offspring, even for rats that had consumed only low doses of DU, with the most severe changes in the sperm found in the offspring of the rats exposed to DU, even at low levels. (Y. Hao, 2009)

Another French government study conducted by France’s Radioprotection and Nuclear Safety Institute showed that while enriched uranium has a higher genotoxic ability than DU to cause mutagenic structural changes and breakage in the chromosomes, the genotoxic, mutagenic ability of DU to cause an abnormal number of chromosomes, “remains high.” (C. Darolles, 2010)

A University of Belgrade study conducted on local individuals exposed to DU, and a control group of those not exposed to DU, found that individuals exposed to DU contamination from the war had cell and chromosome damage associated with their DU exposure. (S. Milacic, 2009)

A French study discussed in more detail below found that inhaled DU caused damage to the chromosomes in the cells lining the airways after just 48 hours. (C. La Certe, 2010)

DU Dose-Response. In one Italian government study, the negative effects of DU were observed in greater levels with greater exposures, but the dose-effect relationship was found to be non-linear, meaning not only the negative effects themselves increased with greater doses, but also the rate of negative effects increased with larger doses of the concentration of uranium. (A. Giovanetti, 2010)

Effects of Ingested (Swallowed) DU. A Norwegian University of Life Sciences study examining DU in Kuwait and Kosovo found that a majority of DU is readily absorbed into the body (bioaccessible) when ingested (swallowed). (Lind et al, 2009)

As noted above, a Chinese government study using rats fed levels of DU, ranging from none to high, found increased concentrations of uranium in the kidneys and ovaries and significant abnormalities in the sperm in those that had consumed the DU, and that those changes were passed on to offspring who then exhibited even more dramatic changes In their own reproductive systems. (Hao et al, 2009)

A French government Institute for Radiological Protection and Nuclear Safety study showed changes in rats in the liver’s modulation of cholesterol following ingestion (swallowing) of DU. The study’s authors noted that previous studies showed vitamin D and the brain’s cholesterol metabolisms were affected following chronic ingestion of DU. In this study, high, “chronic” (40 milligrams/liter every day for nine months) doses of DU were swallowed by the rats, and despite changes in the way cholesterol is metabolized, high cholesterol levels were still seen. Of particular note, one of the study’s results was a noted deficiency of a particular enzyme that breaks down cholesterol, leading to hypercholesterolaemia. (R. Racine et al, 2010) The enzyme found to be decreased by DU in this study normally, dramatically increases in the liver with age. (Norlin 2002)

Effects of Inhaled DU. A new study from the Wise Laboratory of Environmental and Genetic Toxicology in Maine found that DU caused cellular death in the cells lining the bronchial airways of human lungs, and caused damage to the chromosomes after just 48 hours. While the scope of the study wasn’t to determine whether DU causes lung cancer, the study results, indicate that if indeed DU does cause lung (specifically bronchial) cancer in humans, the DU, “is likely acting through a mechanism that involves DNA breaks after longer exposures.” (C. La Certe, 2010)

A second study published by the same group found even stronger evidence of the damage caused by DU to human lungs, showing that the cells lining the airways are “transformed by DU and exhibit significant chromosome instability consistent with” the growth of neoplasms -- abnormal growth of cells that, if large enough, are known as “tumors.” Neoplasms are of three types: non-malignant, pre-malignant, and malignant. (H. Xie et al, 2010)

A study by the Quebec-based Uranium Medical Research Center found that following exposure to inhaled DU, “biological samples show the presence of a synthetic mixture of natural uranium and DU.” . (M Valdes, 2009)

A Lovelace Respiratory Research Institute study, part of the U.S. government-led Capstone DU studies, found that inhaled aerosolized DU posed the greatest cancer risk to the lungs, with the lungs receiving nearly all (97%) of the risk posed by inhaled DU. However, even with a relatively long (two hour) exposure to the aerosolized DU, the cancer risk was found to be” 0.42%, low compared with the natural or background risk of 7.35%.” (Hahn et al, 2009)

Another Lovelace Capstone study modeled exposures for M1A1 Abrams tanks hit by DU rounds. The study estimated the greatest risk of inhaled DU exposures, at “a factor of 20” was shown in the case of a one minute exposure in an unventilated Abrams with a DU round perforating then tank’s DU armor, whereas the exposure was only “a factor of two” for a first-responder scenario. (Guilmette et al, 2009) Another Capstone study discussed the methods used to calculate the dose of the aerosolized DU exposures. (Miller et al, 2009)

Another Capstone study found that there was a substantial variability in how inhaled DU is absorbed, “which in part depended on the type of armor being impacted by the DU penetrator and the particle size fraction being tested.” The study further noted that, “although some trends were suggested, the variability noted leads to uncertainties in predicting the solubility of other DU-based aerosols.” (Guilmette and Cheng, 2009)

Variability of DU particle size, shape, solubility, and suspension in air. An earlier Capstone study analyzed the size and shape of DU after the impact of a DU penetrating round against an armored target. Notably, “A few samples seemed to contain small bits of nearly pure uranium metal, which were verified … to have a higher uranium content exceeding that expected for uranium oxides.” Different levels of solubility -- the ability of the DU to be absorbed into the body – were also found. (Krupka et al, 2009)

Another related Capstone study analyzed the size of DU particulate matter in relation to how long it stayed in the air after the impact of a DU round. The study found that the DU particulate matter ranged from “small” (between 0.2 and 1.2 micrometers) and “large” (between 2 and 15 micrometers), with the larger particles settling fairly quickly, while DU particulate matter 1 micrometer and smaller remaining suspended in the air two hours after impact. (Cheng et al, 2009). A related Capstone study found that the amount of uranium in the particulate matter varied with the size of the particulate, “typically with less uranium associated with the smaller particle sizes.” Furthermore, “the results demonstrate that the peak uranium concentration in the aerosol occurred in the first 10 s after perforation, and the concentration decreased in the Abrams tank shots to about 50% within one minute and to less than 2% after 30 minutes,” following impact of the DU penetrating round. (Parkhurst et al, 2009)

The USEPA classifies “inhalable coarse particles” as between 2.5 micrometers and 10 micrometers in diameter, while “Fine particles," such as those found in smoke and haze, are 2.5 micrometers and smaller (also known as PM2.5)(Source: USEPA)

Without regard for the radiologic or toxic properties of DU, according to the New York State Department of Health has this to say about microfine particulate matter in general:

Particles in the PM2.5 size range are able to travel deeply into the respiratory tract, reaching the lungs. Exposure to fine particles can cause short-term health effects such as eye, nose, throat and lung irritation, coughing, sneezing, runny nose and shortness of breath. Exposure to fine particles can also affect lung function and worsen medical conditions such as asthma and heart disease. Scientific studies have linked increases in daily PM2.5 exposure with increased respiratory and cardiovascular hospital admissions, emergency department visits and deaths. Studies also suggest that long term exposure to fine particulate matter may be associated with increased rates of chronic bronchitis, reduced lung function and increased mortality from lung cancer and heart disease. People with breathing and heart problems, children and the elderly may be particularly sensitive to PM2.5. (Source: NY Dept. of Health)

Effects of Implanted/Embedded DU. Urine testing of approximately 1,7000 U.S. veterans found three with evidence of DU in their urine; all three had embedded DU fragments. (CD Dorsey et al, 2009)

Further testing involved, “35 members of a larger cohort of 77 Gulf War I veterans who were victims of depleted uranium (DU) "friendly fire" during combat underwent a 3-day clinical assessment at the Baltimore Veterans Administration Medical Center (VAMC).” The study concluded that, “Sixteen years after first exposure, this cohort continues to excrete elevated concentrations of urine U as a function of DU shrapnel burden. Although subtle trends emerge in renal proximal tubular function and bone formation, the cohort exhibits few clinically significant U-related health effects.” (McDiarmid et al, 2009)

A Fudan University (China) study concluded that kidneys and bone are the primary reservoirs for uranium redistributed from DU fragments embedded in muscle, and “the accumulations in kidney, bone and many other tissues suggest the potential for unanticipated physiological consequences of chronic exposure to DU.” (G. Zhu et al, 2009)

The Fudan study also found that, “uranium concentrations increased with a close correlation to the implanted DU doses and duration of exposure, with a peak at 90 days post-implantation, after which followed by a decreasing period, but still maintained at a relatively high level even at 360 days post- implantation.” (G. Zhu et al, 2009)

Effects of Internally Injected DU. A Japanese National Institute of Radiological Sciences study found that high doses of DU in solution injected under the skin of rats acutely induced severe damage in the DU-injected sites and organs by chemical toxicity within a very short time after DU intake, including depositions of uranium in the liver, kidneys and femur just one hour after DU injection. Severe damage in the organs, including the kidney resulted. (Fukuda et al, 2009)

A second experiment conducted by the Japanese National Institute of Radiological Sciences sought to determine whether a chelating agent was useful in mitigating the damage caused by the high doses of injected DU in solution. The chelating agent worked well when it was administered shortly after the DU injections to cause the excretion of uranium in urine and feces and decreasing the concentrations of uranium in the kidneys and femur. (Fukuda et al, 2009)

Leukemia and DU. A U.S. Department of Defense, Armed Forces Radiobiology Research Institute (AFFRI) study of mice with leukemia induced by chronic internal exposure to DU found that non-genetic factors causing genes to behave (or "express themselves") differently are implicated in DU-induced leukemia. The study found evidence that a form of abnormal activity, called hypomethylation, in the DNA in the spleen was associated with both the chronic internal DU exposure and the onset of leukemia, a new link between DU and leukemia. (Miller et al, 2009)

According to the MIT’s Whitehead Institute for Biomedical research, hypomethylation is “a process that can cause chromosomes to become unstable,” by causing changes in the natural methylation process of the DNA. (Gaudet et al, 2003).

Hypercholesteraemia and DU. As noted above, one recent French study found that hypercholesteraemia as associated with ingested DU due to decreased levels of a key cholesterol-regulating enzyme. (R. Racine et al, 2010)

A major, multi-institutional study undertaken to determine the effects of a natural deficiency of the same enzyme in a particular kindred of Caucasian individuals of English and Celtic decent was found to be associated with a metabolic disorder, hyptertriglyceridemia (increased blood levels of triglycerides, a risk factor for coronary artery disease), and also appeared to be associated with increased risk of cholesterol gallstones. (Pullinger et al, 2002)

DU Exposure Testing. A study reporting the results of urine testing of approximately 1,700 U.S. veterans seeking DU urine testing, using a new and improved method, found only three with evidence of DU in their urine. All three had embedded DU fragments. Based on an underlying assumption that all DU in the body is continually excreted in small amounts in the urine, the study’s authors assert that, “these findings suggest that future DU-related health harm is unlikely in veterans without DU fragments.” (CD Dorsey et al, 2009)

A study by the Quebec-based Uranium Medical Research Center developed a linear model to estimate the lung burden of DU from measurements of DU in 24-h urine samples, years after inhalational exposure to aerosols of DU. This model takes into account the intracellular dissolution of the retained particles and the precipitation of a significant fraction of the dissolved DU as insoluble uranyl phosphates. (M Valdes, 2009)

A U.S. Army Center for Health Promotion and Preventive Medicine (USA CHPPM) Capstone study discussed its development of a test that determines the approximate severity of effect on the kidneys following DU exposure with 85 percent accuracy. The study asserted that, “The primary target for uranium toxicity is the kidney.” (Roszell et al, 2009)

Possible Treatments and Preventions. A group of fungal compounds, one of which might be effective in treating the toxic effects of the OS caused by DU, is currently being used clinically in China and Japan as potent immunological activators and has been shown to be effective in treating diseases like cancer, a range of microbial infections, hypercholesterolaemia (high blood cholesterol), and diabetes (Chen et al, 2007). These fungal compounds are called non-cellulosic beta-glucans and a new Iranian study suggests that one, fungal beta-1-3-D-glucan, as well as silymarin, a compound extracted from the Blessed Milk Thistle plant found worldwide, are drug treatment candidates for preventing against and detoxifying from DU’s OS effects (J. Pourahmad et al, 2010).

A Vanderbilt University Medical Center study found that “DU causes toxicity in a dose-dependent manner,” meaning greater or less DU leads to greater or less toxicity. The study also found that metallothioneins (MTs), which are small proteins that have numerous functions such as metal sequestration, transport, and detoxification, are protective against DU exposure. (GC Jiang et al, 2009)

As noted in the Japanese National Institute of Radiological Sciences study, above, a particular chelating agent was useful in mitigating the damage caused by the high doses of injected DU in solution when it was administered shortly after the DU injections. (Fukuda et al, 2009)

Sunday, July 18, 2010

OPINION: DU’s Hazards are Real

The Science Shows Hazards Associated with DU

Opinion-Editorial, Written by Anthony Hardie

As always, I welcome your comments.  The article I promised earlier, summarizing the scientific articles below, is coming in the next few hours, as fast as I can write it.

First, I believe in a continuum of beliefs on the issue. On the far end of the spectrum is the message of the charlatans like Rokke and Durakovic and Riley, who make it sound like DU is absolutely deadly and an integral part of some global genocidal conspiracy.  On the other end of the spectrum is the message of the most adamant DU proponents, who make it sound like DU is utterly harmless to humans, animals, or the environment in all its forms and in all circumstances.  I believe that DU's hazards are somewhere in between those two ends.

My beliefs are based on the current science related to DU, with which I've been privileged to become somewhat acquainted over the years, including in my roles on a couple governmental research bodies.   And, as the science evolves, so undoubtedly will my beliefs.

As you may know, there's a growing body of scientific evidence, including a number of DoD-funded studies, which show replicable health effects of DU in various settings, particularly DU that is inhaled or ingested.  And, since they're scientists rather than self-serving charlatans, their studies are published in reputable scientific journals for peer review rather than broadcast on talk radio, and that scientific writing rarely makes it into the popular press. 
DU's hazards are known, as you may know, as a result of its toxicity as a heavy metal.   And, there's a good body of scientific evidence that shows that even the relatively low-level radioactive properties of DU can cause damage to cells and DNA in very close proximity to DU, such as in the lungs, implanted DU (i.e. shrapnel), and so on.

Notably, there's even been a change at DoD as research results have shown the hazards of DU dust/particulate matter, especially on equipment or in buildings hit by DU rounds.  The result is common task training at the lowest skill level for enlisted soldiers.  See:  031-503-1017 Respond to Depleted Uranium/Low level Radioactive Materials (DULLRAM) Hazards (Skill Level 1):  http://www.armystudyguide.com/content/SMCT_CTT_Tasks/Skill_Level_1/0315031017-sl1-respond-to.shtml  

This seems to imply that a balance has been found between the known hazards of DU particulate matter and the recognized and substantial utility of DU in both protective armaments and offensive weapons.

For the Gulf War, some troops (not nearly enough to account for IOM's 250,000 Gulf War veterans with chronic multisymptom illness) were exposed to DU particulate matter suspended in air in equipment (tanks, etc.) and buildings shortly after hit they were hit by DU rounds.  Still others (also relatively small numbers) were exposed when entering and re-aeresolizing the DU particulate matter by kicking it up.  And, some number of troops (and possibly locals) were exposed to burning DU smoke and particulate matter at the Camp Doha fire, though that particulate matter may have had different physical properties.

In case you haven't been tracking the medical and scientific journals, below are a handful of scientific journal citations.  I pulled them as I found them to give you a sample and a sense of the findings  -- others, including the scientists on the VA Research Advisory Committee on Gulf War Veterans' Illnesses, have done a much better job of reviewing and collating this sort of research.  And, if you're already well acquainted with this body of research, please forgive me.  Again, the articles below are just a small sample of what's out there. If you're not acquainted (and forgive me again if you are), PubMed is an excellent source for these sorts of journal abstracts.

Meanwhile, it appears from follow-on conversations that the battle to prevent Rokke from speaking is still ongoing.  I hope Jim Bunker survives the current coup attempt from Rokke's unwitting supporters on the NGWRC board.   Gulf War veterans need NGWRC to survive – and remain credible – in order to continue the important advocacy work in Washington, DC and beyond.

-Anthony

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Int J Environ Res Public Health. 2010 Jan;7(1):303-13. Epub 2010 Jan 25.
The toxicity of depleted uranium.
Briner W.
Department of Psychology, University of Nebraska at Kearney, Kearney, NE 68818, USA. brinerw@unk.edu
Abstract
Depleted uranium (DU) is an emerging environmental pollutant that is introduced into the environment primarily by military activity. While depleted uranium is less radioactive than natural uranium, it still retains all the chemical toxicity associated with the original element. In large doses the kidney is the target organ for the acute chemical toxicity of this metal, producing potentially lethal tubular necrosis. In contrast, chronic low dose exposure to depleted uranium may not produce a clear and defined set of symptoms. Chronic low-dose, or subacute, exposure to depleted uranium alters the appearance of milestones in developing organisms. Adult animals that were exposed to depleted uranium during development display persistent alterations in behavior, even after cessation of depleted uranium exposure. Adult animals exposed to depleted uranium demonstrate altered behaviors and a variety of alterations to brain chemistry. Despite its reduced level of radioactivity evidence continues to accumulate that depleted uranium, if ingested, may pose a radiologic hazard. The current state of knowledge concerning DU is discussed.
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Biochimie. 2009 Oct;91(10):1328-30. Epub 2009 Mar 24.
DNA methylation during depleted uranium-induced leukemia.
Miller AC, Stewart M, Rivas R.
Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University, Bethesda, MD 20889-5603, USA. millera@afrri.usuhs.mil
Abstract
OBJECTIVES: The radioactive heavy metal depleted uranium (DU) is used in kinetic-energy penetrators in military applications. The objective of this study was to determine involvement of DNA methylation in DU-induced leukemia. METHODS: Methylation was measured by direct analysis of 5-methylcytosine content of spleen DNA in DU leukemic mice. RESULTS: Spleen hypomethylation occurred during DU-induced leukemogenesis (chronic internal DU exposure). Aberrant gene transcription was also detected. CONCLUSIONS: Epigenetic mechanisms are implicated in DU-induced leukemia. These data are evidence of aberrant DNA hypomethylation being associated with DU leukemogenesis.
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Mutat Res. 2010 Mar 29;697(1-2):33-7. Epub 2010 Feb 19.
Particulate depleted uranium is cytotoxic and clastogenic to human lung epithelial cells.
LaCerte C, Xie H, Aboueissa AM, Wise JP Sr.
Wise Laboratory of Environmental and Genetic Toxicology, University of Southern Maine, 96 Falmouth St., PO Box 9300, Portland.
Abstract
Depleted uranium (DU) is commonly used in military applications and consequently exposure to soldiers and non-combatants is potentially frequent and widespread. DU is suspected to be a carcinogen, potentially affecting the bronchial cells of the lung. Few studies have considered DU in human bronchial cells. Accordingly, we determined the cytotoxicity and clastogenicity of particulate DU in human bronchial epithelial cells (BEP2D cells). DU-induced concentration-dependent cytotoxicity in human bronchial epithelial cells, and was not clastogenic after 24h but induced chromosomal aberrations after 48h. These data indicate that if DU is a human bronchial carcinogen, it is likely acting through a mechanism that involves DNA breaks after longer exposures. Copyright 2010 Elsevier B.V. All rights reserved.
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Toxicol Lett. 2010 Feb 15;192(3):337-48. Epub 2009 Nov 13.
Different genotoxic profiles between depleted and enriched uranium.
Darolles C, Broggio D, Feugier A, Frelon S, Dublineau I, De Meo M, Petitot F.
Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire de Radiotoxicologie Expérimentale IRSN/DRPH/SRBE/LRTOX, Pierrelatte, France.
Abstract
Uranium is an alpha-particle-emitting heavy metal. Its genotoxicity results from both its chemical and its radiological properties that vary with its isotopic composition (12% enriched uranium in (235)U (EU) has a specific activity 20 times higher than 0.3% depleted uranium in (235)U (DU)). The influence of the isotopic composition of uranium on its genotoxic profile (clastogenic/aneugenic) has never been described. The present study evaluated genotoxic profile of uranium with the cytokinesis-block micronucleus centromere assay. C3H10T1/2 mouse embryo fibroblasts were contaminated with either DU or EU at different concentrations (5 microM, 50 microM and 500 microM). Cells received low doses ranging from 0.3 microGy to 760.5 microGy. The frequency of binucleated cells with one micronucleus increased with increasing concentrations of both DU and EU in the same way. EU induced more centromere-negative micronuclei and nucleoplasmic bridges than DU. A correlation between these two clastogenic markers and ionizing radiation doses was observed. Finally, this study showed that the genotoxic profile of uranium depends on its isotopic composition. DU and EU are low and high clastogens, respectively. However, DU aneugenic effects remain high. Thus, there is a need to study the potential role of aneugenic effects of DU in carcinogenic risk assessment linked to uranium internal exposure. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
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J Toxicol Environ Health B Crit Rev. 2009 Aug;12(7):525-39.
Toxicity studies on depleted uranium in primary rat cortical neurons and in Caenorhabditis elegans: what have we learned?
Aschner M, Jiang GC.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. michael.aschner@vanderbilt.edu
Abstract
Depleted uranium (DU) is the major by-product of the uranium enrichment process for its more radioactive isotopes, retaining approximately 60% of its natural radioactivity. Given its properties as a pyrophoric and dense metal, it has been extensively used in armor and ammunitions. Questions have been raised regarding the possible neurotoxic effects of DU in humans based on follow-up studies in Gulf War veterans, where a decrease in neurocognitive behavior in a small population was noted. Additional studies in rodents indicated that DU readily traverses the blood-brain barrier, accumulates in specific brain regions, and results in increased oxidative stress, altered electrophysiological profiles, and sensorimotor deficits. This review summarizes the toxic potential of DU with emphasis on studies on thiol metabolite levels, high-energy phosphate levels, and isoprostane levels in primary rat cortical neurons. Studies in Caenorhabditis elegans detail the role of metallothioneins, small thiol-rich proteins, in protecting against DU exposure. In addition, recent studies also demonstrate that only one of the two forms, metallothionein-1, is important in the accumulation of uranium in worms.
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Chem Res Toxicol. 2010 Feb 15;23(2):373-8.
Depleted uranium induces neoplastic transformation in human lung epithelial cells.
Xie H, LaCerte C, Thompson WD, Wise JP Sr.
Wise Laboratory of Environmental and Genetic Toxicology, Maine Center for Toxicology and Environmental Health, Department of Applied Medical Sciences, University of Southern Maine, 96 Falmouth Street, P.O. Box 9300, Portland, Maine 04104-9300, USA.
Abstract
Depleted uranium (DU) is commonly used in military armor and munitions, and thus, exposure of soldiers and noncombatants is frequent and widespread. Previous studies have shown that DU has both chemical and radiological toxicity and that the primary route of exposure of DU to humans is through inhalation and ingestion. However, there is limited research information on the potential carcinogenicity of DU in human bronchial cells. Accordingly, we determined the neoplastic transforming ability of particulate DU to human bronchial epithelial cells (BEP2D). We observed the loss of contact inhibition and anchorage independent growth in cells exposed to DU after 24 h. We also characterized these DU-induced transformed cell lines and found that 40% of the cell lines exhibit alterations in plating efficiency and no significant changes in the cytotoxic response to DU. Cytogenetic analyses showed that 53% of the DU-transformed cell lines possess a hypodiploid phenotype. These data indicate that human bronchial cells are transformed by DU and exhibit significant chromosome instability consistent with a neoplastic phenotype.
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J Radiat Res (Tokyo). 2009 May;50(3):183-92.
Accumulation and distribution of uranium in rats after implantation with depleted uranium fragments.
Zhu G, Tan M, Li Y, Xiang X, Hu H, Zhao S.
Institute of Radiation Medicine, Fudan University. Zhugy@shmu.edu.cn
Abstract
PURPOSE: The aim of our study was to clarify the accumulation and distribution of uranium in depleted uranium (DU) implanted rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were surgically implanted in gastrocnemius muscle with DU fragments at 3 dose levels (low, medium and high), and biologically inert tantalum (Ta) fragments were used as controls. At 1 day and 7, 30, 90, 180 and 360 days after implantation, the rats were euthanized and tissue samples including serum and urine were collected to analyze the uranium levels by inductively coupled plasma-mass spectrometry (ICP-MS). RESULTS: At all time points, uranium levels in all the DU implanted groups were higher than that in Ta control group, and uranium concentrations in kidney and bone were significantly greater than that in other tissues. Otherwise, uranium concentrations increased with a close correlation to the implanted DU doses and duration of exposure, with a peak at 90 days post-implantation, after which followed by a decreasing period, but still maintained at a relatively high level even at 360 days post- implantation. The uranium concentrations in bone were 6.92 +/- 0.97 microg U/g, 16.35 +/- 1.67 microg U/g and 21.64 +/- 3.68 microg U/g in the low-, medium- and high-dose group animals, while values in kidney tissues were 10.66 +/- 1.10 microg U/g, 14.06 +/- 1.28 microg U/g and 17.79 +/- 2.87 microg U/g, respectively, at 360 days post-implantation. CONCLUSION: It was concluded that kidney and bone are the primary reservoirs for uranium redistributed from intramuscularly embedded fragments, and the accumulations in kidney, bone and many other tissues suggest the potential for unanticipated physiological consequences of chronic exposure to DU.
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Health Phys. 2009 Apr;96(4):483-92.
Acute toxicity of subcutaneously administered depleted uranium and the effects of CBMIDA in the simulated wounds of rats.
Fukuda S, Ikeda M, Nakamura M, Yan X, Xie Y.
Research Center for Radiation Emergency Medicine, National Institute of Radiological Sciences, Chiba 263-8555, Japan. s_fukuda@nirs.go.jp
Abstract
We examined the acute toxicity of depleted uranium (DU) after subcutaneous injection as a simulated wound model (experiment I), and the effects of a chelating agent, catechol-3,6-bis(methyleiminodiacetic acid) (CBMIDA), on the removal and damages caused by uranium by local treatment for wounds in rats (experiment II). Experiment I: To examine the initial behavior and toxicity of uranium of different chemical forms, male Wistar rats were subcutaneously injected with 4 and 16 mg kg-1 DU in a solution of pH 1 and 7. The rats were killed 1, 3, 6, and 24 h after DU injection. The DU (pH 1) injection site on the skin was altered markedly by acid burn, and the chemical action of uranium compared with that of DU (pH 7). After the injection of 4 mg kg-1 DU (pH 1), about 60% of the uranium was retained 1-3 h at the injected sites and then decreased to 16% at 24 h. However, the concentration of uranium in the injected site after 16 mg kg-1 DU (pH 1) injection did not change significantly. Urinary excretion rates of uranium (pH 1) increased in a time-independent manner after the injection. Depositions of uranium in the liver, kidneys and femur were found at 1 h after DU injection, and the results of serum and urinary examinations indicated that severe damage in the organs, including the kidney, was induced. The results of the DU (pH 7) were useful for estimating the chemical toxicity of uranium. Experiment II: The effects of CBMIDA by local treatment for wounds with DU were examined. CBMIDA (480 mg kg-1) was infused into the DU-injected site 0, 10, 30, 60, 120 min, and 24 h after the subcutaneous injection of 4 mg kg-1 DU (pH 1 and 7). The uranium at the injected sites decreased to 4-17% of that at 24 h in the DU (pH 1) group without CBMIDA treatment in experiment I, when it was administered within 120 min after DU injection. In addition, CBMIDA had excellent efficacy in excreting the uranium in urine and feces and decreasing the concentrations of uranium in the kidneys and femur. However, there were no distinct effects of CBMIDA for DU (pH 7). In conclusion, the results indicated that the subcutaneous injected uranium acutely induced severe damage in the DU-injected sites and organs by chemical toxicity within a very short time after DU intake, despite the chemical forms of uranium used, and the local treatment of CBMIDA for wounds contaminated with DU was effective in decreasing the acute toxicity of uranium if carried out within 120 min after DU administration.
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Health Phys. 2009 Mar;96(3):292-305.
Physicochemical characterization of Capstone depleted uranium aerosols IV: in vitro solubility analysis.
Guilmette RA, Cheng YS.
Lovelace Respiratory Research Institute, Albuquerque, NM 87108, USA. rguilmette@lrri.org
Abstract
As part of the Capstone Depleted Uranium (DU) Aerosol Study, the solubility of selected aerosol samples was measured using an accepted in vitro dissolution test system. This static system was employed along with a SUF (synthetic ultrafiltrate) solvent, which is designed to mimic the physiological chemistry of extracellular fluid. Using sequentially obtained solvent samples, the dissolution behavior over a 46-d test period was evaluated by fitting the measurement data to two- or three-component negative exponential functions. These functions were then compared with Type M and S absorption taken from the International Commission on Radiological Protection Publication 66 Human Respiratory Tract Model. The results indicated that there was a substantial variability in solubility of the aerosols, which in part depended on the type of armor being impacted by the DU penetrator and the particle size fraction being tested. Although some trends were suggested, the variability noted leads to uncertainties in predicting the solubility of other DU-based aerosols. Nevertheless, these data provide a useful experimental basis for modeling the intake-dose relationships for inhaled DU aerosols arising from penetrator impact on armored vehicles.
PMID: 19204487 [PubMed - indexed for MEDLINE]
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Toxicology. 2009 Apr 5;258(1):1-9. Epub 2008 Dec 31.
Different pattern of brain pro-/anti-oxidant activity between depleted and enriched uranium in chronically exposed rats.
Lestaevel P, Romero E, Dhieux B, Ben Soussan H, Berradi H, Dublineau I, Voisin P, Gourmelon P.
Institut de Radioprotection et de Sûreté Nucléaire, Direction de la RadioProtection de l'Homme, Service de Radiobiologie et d'Epidémiologie, Laboratoire de RadioToxicologie Expérimentale. IRSN, Cedex, France. philippe.lestaevel@irsn.fr
Abstract
Uranium is not only a heavy metal but also an alpha particle emitter. The main toxicity of uranium is expected to be due to chemiotoxicity rather than to radiotoxicity. Some studies have demonstrated that uranium induced some neurological disturbances, but without clear explanations. A possible mechanism of this neurotoxicity could be the oxidative stress induced by reactive oxygen species imbalance. The aim of the present study was to determine whether a chronic ingestion of uranium induced anti-oxidative defence mechanisms in the brain of rats. Rats received depleted (DU) or 4% enriched (EU) uranyl nitrate in the drinking water at 2mg(-1)kg(-1)day(-1) for 9 months. Cerebral cortex analyses were made by measuring mRNA and protein levels and enzymatic activities. Lipid peroxidation, an oxidative stress marker, was significantly enhanced after EU exposure, but not after DU. The gene expression or activity of the main antioxidant enzymes, i.e. superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), increased significantly after chronic exposure to DU. On the contrary, oral EU administration induced a decrease of these antioxidant enzymes. The NO-ergic pathway was almost not perturbed by DU or EU exposure. Finally, DU exposure increased significantly the transporters (Divalent-Metal-Transporter1; DMT1), the storage molecule (ferritin) and the ferroxidase enzyme (ceruloplasmin), but not EU. These results illustrate that oxidative stress plays a key role in the mechanism of uranium neurotoxicity. They showed that chronic exposure to DU, but not EU, seems to induce an increase of several antioxidant agents in order to counteract the oxidative stress. Finally, these results demonstrate the importance of the double toxicity, chemical and radiological, of uranium.