Friday, January 12, 2001 10:30 a.m. EST
(Also participating: Ron Fricker, Ph.D., RAND Senior Statistician; Ross Anthony, Ph.D., RAND Director; Gary Cecchine, Ph.D., and Bill Shaughnessy)
Quigley: Good morning, ladies and gentlemen. Today, Dr. Bernie Rostker, the special assistant for Gulf War illnesses, is here to release a series of documents that provide our latest information. It will be the last study released in this administration. This is on pesticides in the Gulf War.
Dr. Rostker, over to you, sir.
Rostker: Thank you, Admiral.
This is a study that we have been working on for some time. It deals with the use of pesticides during the Gulf War. And it is the study for the first time -- we did originally research with questionnaires to over 2,000 service members randomly selected to be representative of those in the Gulf, as well as interviews -- over 900 interviews with people who are involved in the pesticide business. This is a collaborative effort for a number of organizations -- the RAND Corporation, the EPA, and our own organization.
We have a slide presentation, and during that presentation, we'll ask the RAND Corporation to come up and brief on their portions of it. [Slides used in this briefing are on DefenseLINK at http://www.defenselink.mil/news/#SLIDES ].
Next slide, please.
The question, as often many ask, why look at pesticides? Well, pesticides was one of the major items that were of concern to our veterans. There were stories about flea and tick collars being used by our folks, there were stories about locally procured pesticides being used, and the possibility of misuse of pesticides by our troops, particularly those involved in the application of pesticides. And those became the focal point of much of what we did.
Next slide.
This complicated slide really shows the interaction between RAND and our organization and the EPA as we built towards a risk assessment. RAND was involved in a literature review, as they have done for us on a number of occasions, and then they carried out a large, randomly selected sample to better understand how pesticides were used in the Gulf. That information was integrated by our people, working with EPA, to develop a health-risk assessment. [The environmental exposure and health risk assessment report is on the Web at http://www.gulflink.osd.mil/retired/pest/ ].
And I think at this point -- who's going to -- come on up. And RAND will make a short presentation about the work that they did both in terms of a review of the medical literature, as well as the survey.
Fricker: Hi, I'm Ron Fricker.
Q: Could you spell your name, please?
Fricker: The last name is spelled F, as in Frank; R-I-C-K-E-R.
This is joint work at RAND. Sue Hosek was also a co-principal investigator. And as Dr. Rostker said, we were asked to do a survey, a random survey, of Gulf War veterans. OSAGWI [Office of the Special Assistant for Gulf War Illnesses] had done a great deal of research talking to preventive medicine personnel, pesticide applicators, and other personnel about specialized uses of pesticides, but little was known about how the average service member used pesticides, and that's who we surveyed.
We had really three key questions we wanted to answer: Which pesticides were used, who used them, and then in what quantities.
As Dr. Rostker said, we surveyed just over 2,000 veterans that we selected to be statistically representative of the U.S. service population that was on the ground in the Kuwaiti theater of operations between October of 1990 and July of 1991. I'm happy to say the veterans were very cooperative with this effort; 96 percent of the veterans that we contacted participated in the survey. Very few actually declined to participate with us. And they were extremely cooperative; they helped us in many ways.
We spent a lot of time designing the survey, actually in concert with talking with veterans to aid recall. As you can imagine, recalling pesticides, when this survey was fielded, that were eight or nine years in the past, was a difficult task for people to do. So we focused that survey to look at forms of pesticides; so was the pesticide a spray, a lotion, a liquid, et cetera. We also asked them about descriptive information. So whether it was a -- what the color of the pesticide was, what its use was, and what its smell was. And from that, we hoped to be able to identify the particular pesticides.
We also feel that a second smaller survey, about six weeks after the first, to a subset of the 2,005 people that we talked to, to assess how well their memories were stable over time. And in fact, they tended to be very stable.
So what did we find out? In general, the Army used pesticides the most, both the most widely and most frequently, followed by the Marines and the Navy, and then, finally, the Air Force used pesticides the least.
There's a lot of detail in our report.
[The report is available on the Web at http://www.gulflink.osd.mil/library/randrep/pesticides_survey/ ].
A couple of major points:
DEET, which is technically an insect repellant, was used most. Fifty percent of the population that was in the Gulf War used DEET insect repellants, median frequency of about 30 times a month.
Other pesticides, personal pesticides, were used much less frequently. The next greatest one was permethrin, which was used by about 6 percent of the population, with a median frequency of about 20 times per month.
About one-third of the population at any given point in time did not use pesticides. So precisely 38 percent of the population didn't use pesticides.
Two other pesticides you will hear about from another speaker: About 7 percent of the population used no-pest strips, used or observed no-pest strips, and about 12 percent of the population used or observed pesticides of the form pellets, crystals, or granules, which is typical of a type pesticide called fly bait. And you'll hear more about that from the next speaker.
We looked at the misuse of pesticides, and we're carefully defining "misuse" in our survey report to mean that people did not use a pesticide in accordance with the EPA-approved label in existence at the time of the Gulf War. Some of those instructions have changed over time.
The most obvious misuse of pesticides was the use of pet flea and tick collars, where we found that about 3 percent of the population, or about 13,000 people, actually wore a pet flea or tick collar either over their clothes over their shoes in general.
Other either intentional or unintentional misuse of pesticide, we found, were rare. However, we caveat that by saying people in general had a hard time remembering pesticides, so whether misuse was actually rare or whether we just couldn't see it is hard to tell.
However, looking across all the answers in the survey, we did not find any suspicions that widespread misuse of pesticides occurred.
We also looked at multiple exposures for people that used more than one pesticide at a time, and we found that 31 percent of the population used one or more pesticides -- used more than one - excuse me -- more than one pesticide, and 9 percent of the population used three or more. However, as I've said before, most of the population -- a third didn't use pesticides, and about another third only used one.
We found that the use of pesticides on the body was correlated with the use of pesticides in the field, and we also found a correlation, a positive correlation, between personal pesticides and pyridostigmine bromide -- PB -- pills, which was used for nerve -- to guard against nerve agents.
Q: What does a "positive association" mean?
Fricker: That means that people that tended to use more personal pesticides also may have used more either PB pills or field pesticides. So there was an association. Sort of the bottom line right there is that some people could have been exposed to more of all these things than others, is what we found.
However, that correlation could be the result of many things. It could be the result, first of all, just of location where front-line troops perhaps used more pesticides, because they were living in the desert, than rear echelon troops. It could have been the result of seasonality or people's predisposition to just use lots of pesticides. And we can't tell.
With that -- well, we have a report available. We also are going to put on the web the actual data set that we have deidentified to protect the respondent privacy. But it will be available to other researchers on the world wide web. And we also make the instrument -- the survey instrument available so other researchers can look at it.
With that I'll turn this over to Dr. Ross Anthony to talk about the Rand literature review.
Anthony: Thanks. Thanks, Ron.
I'm Ross Anthony. As you can see, I'm one of the authors on this study, The literature review as relates to pesticides. [This review is on the Web at http://www.gulflink.osd.mil/library/randrep/pesticides_paper/ ]. I want to point out that Dr. Gary Checchine is really the lead author of this report, and unfortunately he could not be here with us today.
Our objective goal in this study was to look at the scientific literature on its potential health effects as might affect the health of veterans of the Gulf War. I'd just like to point out that a literature review can do many things and can bring out a lot of information, but a few things it does not do is it is not going to look at exposure -- and you heard some information just a few minutes ago about exposure and you're going to hear some more when the OSAGWI folks talk. Nor did we try to calculate risk associated with the information we found in the literature review.
Specifically, Rand was asked to look at 12 active pesticide ingredients that Gulf War veterans were exposed to and that would be thought to be of importance by OSAGWI. There were five organophosphates, three carbamates, two pyrethroids, one organochlorine, and one repellent DEET.
What we did is we employed a professional librarian, searched all the literature bases to see if we could find whatever literature we might find everywhere. We came up with 7,000 peer-reviewed publications that we looked at; read many, if not -- not all of them but many of those. And there were over 500 references in the report.
Once the report was prepared, it was extensively peer-reviewed. And we had three peer-reviewers that were outside of the -- of our system and outside of DoD, actually university professors. And then it was extensively reviewed by the EPA and other government agencies.
The information included in the report is not only the information on the health effects as it might relate to veterans, but we also included information on physical and chemical properties of the pesticides and their recommended uses. That was partly to aid in the other studies going on, but partly to provide as much information as possible to veterans, which is one of the goals and objectives of all of these studies.
Well, now we focused primarily on the long-term chronic health effects of the reported pesticides. At the time that we did these studies, there were no reports of acute pesticide poisoning in the Gulf that we were aware of. I think you're going to hear from the later speaker that they've since uncovered one. But clearly, the issue that we wanted to look most at were the long-term chronic effects. We also compared our results with the symptoms that you saw in Gulf War veterans so that we could get some ideas if there was a relationship there.
We found the results really kind of fit into two categories. First, we found that for four of the pesticides studied -- lindane, DEET, permethrin, and d-Phenothrin, that there really were no long-term effects in the scientific literature. Therefore, we felt that they were really not -- we could pretty much rule them out as something that might cause long-term chronic effects. There is some small literature as relates to lindane on some effects that might be considered chronic; however, those studies in general are hard to interpret because usually they are occupational studies that have many chemicals mixed in when there is an exposure that takes place.
The next set of results really deal with a whole set of chemicals that are all known as acetylcholinesterase inhibitors, and both the organophosphates and the carbamates fit into that class of chemicals. Acetylcholinesterase is critical to regulating nerve signaling, and we find that acetylcholinesterase inhibitors do present in the literature chronic symptoms that have been reported by some Gulf War veterans. That is to say, let me put that a little bit better, acetylcholinesterase, the literature, if you're exposed to that, you do find that you can find symptoms similar to those you see in Gulf War veterans -- fatigue, muscle and joint pain, headaches, cognitive problems and sleep disruptions. Further, we note that there is a reported biological role of acetylcholinesterase in the symptoms that provide some plausibility for the illness that we see in Gulf War veterans.
The literature is clear that enzymes that metabolize acetylcholinesterase inhibitors are important in mitigating these effects. Studies in animals and humans outside the Gulf War have also shown that individuals can differ in the activity or form of these enzymes and these individual differences are important in determining the health outcomes of exposure to acetylcholinesterase inhibitors.
Similarly, there is some limited evidence in the peer-reviewed literature that a difference in these enzymes exists between ill Gulf War veterans and health veterans. At least one study has found such similarities.
In combination with the biological plausibility of ACH's role in producing the symptoms discussed earlier, this suggests to us that the role of acetylcholinesterase inhibitors, particularly organophosphates and the carbamates, in producing these symptoms should be further investigated and cannot be rejected at this point.
These results, however, should be taken with some caution. There are other exposures to other compounds that are also acetylcholinesterase inhibitors that happened during the Gulf War, in particular to PB and nerve agents. There are other compounds that also could produce similar effects to these; for example, -- (word inaudible) -- solvents are one class of those. And interactions could also involved and need to be looked at. We did not actually look at interactions of these chemicals.
I would also point out the similarities in symptoms alone are insufficient to draw conclusions and that we should look at these with some caution.
Finally, the bottom line, we found is based on the scientific literature, but a potential role for some pesticides cannot be ruled out in the undiagnosed illnesses of some Gulf War veterans.
Rostker: With those two pieces of information, and with the extensive interviews in our own shop, we proceeded in the development of the risk health assessment. As I indicated, this was done in conjunction with the Environmental Protection Agency. The report was then coordinated throughout the federal government.
Here are the basic findings:
As Ross indicated, we cannot rule out the possibility of that overdoses of pesticide, pesticide poisoning, occurred during the Gulf. We were able to identify -- by scrutinizing the in-house, the in-patient hospital records, we were able to identify a single soldier who was hospitalized for pesticide poisoning. And it is generally understood in the medical community that long-term effects will come only after there is an acute event, and so we have only been able to identify a single acute event.
The issue of whether or not you can have long-term poisoning without an acute event has been studied mainly in migrant workers. I'm aware of some work in Israel that they talked to us about when we visited them. But that was a repeated exposure for workers who were working with pesticides over an extended period of time, and it is unlikely that our soldiers were involved with pesticides even during the Gulf at levels and in frequencies that would meet that. But there is very little research done on chronic exposures where there is no acute event.
The widely reported misuse of flea and tick collars was corroborated in the study, but less widely used than we might have thought from the anecdotal information. During the Gulf War, troops took those collars with them. Some of them wrote home asking for more collars to be sent. In our exchanges and in our commissaries, signs went up that indicated these were not for human use. And the survey suggests that the actual use was less than what might have been expected. The use, however, while creating local burns and dermatological reactions, was not indicated as pesticide poisoning. It's not a volatile pesticide as some of the other pesticides were.
An area that somewhat surprised us was pest strips. We found widespread use of pest strips. And in the intervening years since the Gulf War, the EPA has recommended a lesser use of pest strips. The use there was one pest strip for a tent of about 1,000 cubic feet of air, and today they would say that a half a pest strip would be appropriate for that amount. And we have examples not only of one pest strip going up in that volume, but if one's good, two must be better, and three could even -- should even be better than that. So it's quite clear that we overused them.
This is an area of concern because the pest strip is designed to be volatile in the air and give out vapor. However, even at those levels, while they're above EPA recommendations, we did not see acute pesticide poisoning.
Finally, flea bait. There are a number of products, which are available around the world, which are used often in kitchens, which attract fleas -- flies and then the flies eat the bait and die. We actually purchased some of that material in Saudi Arabia, brought it back here, had it analyzed for potency, and what we discovered is that it is also not a very volatile substance. It doesn't give off vapors. And while it was used -- and again, by anecdotal accounts, misused -- again, this is unlikely to be the source of pesticide poisoning in our troops, and the scrutiny of the inpatient records that we have been able to retrieve, again, only shows a single incident of hospitalization.
This, by the way, was a soldier who went into a warehouse with leaking pesticides and was overcome by the vapors from the pesticides in an enclosed area in this warehouse. He was released after one day, and we have followed up and interviewed him, and he has no long-term symptoms or complaints that can be related back to his exposure in pesticides.
I think that's the last slide.
We started this work very much at the request of Admiral Zumwalt. Admiral Zumwalt was very concerned about pesticides, and as Ross Anthony has indicated, and you put some of the characteristic complaints of veterans against the known reactions that people can have from pesticide poisoning, there is a correlation.
Our work, however, in terms of both interview work and survey work, indicates that it is unlikely that we reached those levels of toxicity with our troops. We certainly do not have in any of our work indications of widespread or even limited pesticide poisoning, with the one exception of the soldier who was overcome in a warehouse. And the individual assessments of misuse suggests that that misuse was -- while regrettable, was not at a level sufficient to have resulted in adverse reactions.
In the previous chart, I did miss the people who were applying pesticides. We did find that our training in terms of the folks who were tasked with applying the pesticides was not fully adequate, and that's an area that we can concentrate in in the future.
Q: By applying them, do you mean putting them on people, or what do you mean?
Rostker: Spraying. It was often an additional duty. Somebody would come by and say, "You're our pesticide sprayer for today." And adequate safeguards were not necessarily taken.
Q: Personal protection, you mean?
Rostker: Personal protection. Masks, gloves and the like. And one would be concerned that people who were working with pesticides for a period of time might become over-exposed, but we did not see that in the health records, or in the interviews it did not correlate with reported health status today.
As often occurs in this, we do not have sufficient evidence to fully rule it out. Research continues, particularly research on the cross-effects of pesticides and pyridostigmine bromine. Some of these pesticides, organophosphates, work on the nervous system. PB is not an organophosphate, but it does have relationship to the nervous system. And we are trying to better understand the relationship of the whole range of pesticides and PB as we look towards the future.
The last bullet really talks to the benefit. One of the unique and wonderful things that occurred in the Gulf War was a reduction in diseases that historically are the major killers of soldiers. If you go back to World War I, even World War II, infectious diseases were a major contributor to military casualties. And that's why we used pesticides so extensively in the Gulf, because of a whole range of insect-carrying diseases that could have affected our people. And basically, the campaign for pesticides was effective. It could have been done with more attention to detail in terms of the hygiene, but it was effective in forestalling disease, insect-borne diseases. And at least in terms of acute pesticide reactions, the only one we can document, from in-house -- some 28,000 in-patient records, was as a result of over-exposure in a storage situation.
I'll be happy to take questions.
Q: Did you all use more pesticides in the Gulf, as compared to other conflicts? And was that because there are more pests in that area, or just because technology has increased and there's a lot more pesticides to use and so you had more of an opportunity?
Rostker: I don't know the answer to that question on either account. You have two interesting hypotheses about technology and disease. Flies were very prevalent, and we certainly had a hygiene program built around pesticides, particularly geared to the kind of fly-borne disease, Leishmaniasis and other diseases that we knew and we were concerned of.
This area was of great concern to the British during World War II, where insect-borne disease was a major problem. And we did not see that with almost 800,000 service members in the Gulf.
Q: Given all of what you've said, I take it that you're saying essentially that the use, and even the misuse of pesticides, probably cannot explain anything to do with Gulf War illness?
Rostker: We're not able to make a link epidemiologically, we're not able to make a link in relation to the exposures. When we started this, the first set of results that I got back were, "No problem, the people who put the pesticides on said they used it just according to the book, and there's no problem here." I said, that doesn't ring true. It certainly didn't ring true in flea and tick collars.
And so my own staff did extensive work, leading to hundreds, eventually 900 or so interviews. The problem with the interviews was we had no way of knowing whether they were representative of the entire theater, and that's why we asked RAND to put together a survey which was designed to be representative of the entire theater.
Difficult trying to put this picture together nine years afterwards. Encouraged at the high response rate, encouraged at the high recall rate in terms of recall bias, at the consistency of the results over time. It is the best picture we can put together today.
Q: Which of these pesticides had that ingredient? I think it was acetylcholinesterase --
Rostker: Organophosphates. The pest strip has organophosphates, am I correct in that? The tick and flea collars do not.
Staff: I think some of them do.
Rostker: Some of them do? Effectively --
Q: Well, what's the difference between the acetylcholinesterase and the organophosphates?
Rostker: Well, the acetylcholinesterase is the chemical that works on the nervous system.
Q: Right.
Rostker: The class of chemicals that disrupt that chemical are the organophosphates, and there are other chemicals that also work on the system.
We can have -- who wants to come up and -- which --
Anthony: Yeah, that's -- let me explain that -- (off mike).
Q: What I'm trying to figure out is that you've got these pesticides here from one column and then you have these active ingredients that could lead to Gulf War -- or could explain Gulf War illness-type symptoms, and I'm wondering --
Anthony: Fit them together?
Q: Yeah. How they're connected, yeah.
Anthony: Okay, there are a whole slew of pesticides, you know, that you can buy in the marketplace. For instance, Off!. Off! happens to have DEET in it, so there's lots of products that have one or more active ingredients in it, but you find a lot of the pesticides have the same active ingredient in it. For -- to use something you're more familiar with, both Tylenol and Advil both have acetaminophen in them. So that's the connection.
In terms of the acetylcholinesterase inhibitors, there are a bunch of things, chemicals, that all act that way. The organophosphates are in the class. All the carbamates are also in that class. And it also turns out that some other things that you're familiar with -- PB and sarin, for instance -- also have that kind of action on the body. They all inhibit this enzyme, acetylcholinesterase. And that's how they act on the body. So they all at least share that in common.
And I believe -- and now I'm going to turn it to the OSAGWI people. I believe there were -- how many total pesticides used in the Gulf? There was something like --
Staff: (off mike)
Anthony: -- sixty-four total pesticides, with how many active ingredients?
Staff: Thirty-five.
Anthony: With 35.
Q: And do you know a gross amount of -- is there a weight --
Staff: This is -- (off mike).
Shaughnessy: I'm Bill Shaughnessy. I was involved in --
(Cross talk.)
Staff: Come on, Bill. You've got to come up here.
Shaughnessy: I'm Bill Shaughnessy. I was involved in the development of the health risk assessment. We had identified 64 different pesticide products that were used during the Gulf War. And of that, there were 35 active ingredients. Of that 64, because it was such a large number to work with, we narrowed that down, through various screening processes, to a group that we considered to pose the greatest threat. And that involved -- that -- when we did that, we reduced the number from 64 down to 15 pesticides of concern, which contained 12 active ingredients. And that's what the RAND literature review is based on.
Q: And those active ingredients were --
Shaughnessy: Organophosphates, carbamates, pyrethroids. We had one organochlorine, which was lindane, in that group, and the one repellant, which was DEET.
Q: And in terms of the percentages of people who used those, do you have a breakdown on that? I mean, what --
Shaughnessy: We know basically, for example, for the pest applicators, there were roughly between 3,500 and 4,500 veterans that were involved in that particular process. That included MPs as well, who were involved in the delousing operations. There was about 200 MPs.
And then there was approximately -- based on the RAND survey, there were approximately 30,500 who had some exposure to the pest strips.
Q: Could you say that again? The last part?
Q: Could you repeat that?
Shaughnessy: Through the RAND survey, we were able to find out that there was approximately 30,500 troops who were involved in these pest strips.
Q: And the previous statistic was 3,500, 4,000 involved with --
Shaughnessy: Pesticide application, that's correct.
Q: Dr. Rostker, I know it's not the subject of this briefing, but given the growing concern among America's NATO allies about the use of depleted uranium munitions, and given the fact that your office has dealt with this issue for some time now, could you just tell us whether there is any reason for concern about possible health effects from exposure to depleted uranium munitions that are left on the battlefield in Yugoslavia?
Rostker: We don't believe so. And we have extensive research and review of research by the Gulf War Office over the last four years. And I've stood here on many occasions to review it with you, and I'd like to give you the highlights again.
One of the RAND literature reviews was on depleted uranium. And broadly speaking, they reviewed the literature on depleted uranium, which is limited; the much more extensive literature on natural uranium, which is more radioactive and shares with depleted uranium the same characteristics for heavy metal toxicity. They did not find a plausible link. That work was scrutinized by Senator Rudman's Presidential Advisory Committee, by the original PAC, by the General Accounting Office. There were subsequent reports on toxicity by the Department of Health and Human Services. And then, finally, late last year, the Institutes of Medicine, charged by the Congress to effectively do what RAND had been doing for us -- review the literature -- reported on their first four potential risk factors, one of them being depleted uranium. In their review of depleted uranium, they went further in ruling things out than they did in anything else -- PB, vaccinations -- and I'm missing one other.
Staff: Low levels of sarin.
Rostker: Low levels of sarin.
The only thing they were prepared to rule out was the impact of depleted uranium on lung cancers and on renal disease from heavy metal toxicity.
Now, why is lung cancer the suspect here? Because when a depleted uranium round hits, it will vaporize, it will create a great deal of heat, fragments break off and little pieces break off and it will eventually create a uranium oxide, which can be ingested, particularly by breathing it.
And the argument was made that if you breathe it, it could lodge in the lung and create lung cancers. A review of a half-century of work with more radioactive substances in mining situations demonstrates that's not the case, and they opine to that.
The major concern that doctors, environmentalists will talk about in terms of depleted uranium, as they will with lead and tungsten, is heavy-metal toxicity. And heavy metals, in the case of depleted uranium, is thought to collect in the kidneys, and so you look for kidney failures. And at very, very high dosage of contamination, kidneys will fail, but at the dosages we saw in the Gulf -- and these are dosages that are likely to be higher than you saw in Kosovo -- there is no indication of renal failure.
We have the unfortunate circumstance from the Gulf of a number of soldiers who were exposed to depleted uranium, either directly in friendly fire situations, where their vehicles were hit by depleted uranium shells, or in cleaning up those vehicles and providing aid to the people who were in the vehicles when they were hit. The Department of Veterans Affairs have been monitoring the health status of some 33 veterans who we know were exposed to depleted uranium.
Sixteen of those veterans to this day still have small depleted uranium fragments in their bodies. The veterans who do not have fragments in the bodies do not have any excess radiation counts, and there is no cancers or renal disease malfunction. Now, these are people who are ill and are hurting, some of them because of surviving friendly fire incidences, but not because of exposure to depleted uranium. Of the 16 soldiers who have depleted uranium fragments, they continue to have elevated levels of uranium in their urine, and they've experienced no renal failure or lung cancers.
We are well aware of the issue of contamination. We have monitored the soil in Kuwait, and at its most contaminated level, it is at a level that the EPA would allow us to return to general use without any cleanup. And that's where all of the tanks, all of the vehicles hit with depleted uranium are stored in the desert and where rain runoff, the collection pools for runoff are and a concentration has built up there over the 10 years. But that concentration is just slightly above background. It's my understanding that the UN team also found that there was little above background.
And we'll be happy to take any data they have and assess it. If our conclusions in any way are countered by new data, we'll be happy to analyze it and bring that to you. But we have extensively worked with, tested, monitored depleted uranium and soldiers who have been involved with depleted uranium, and we do not see a health risk. And depleted uranium is a licensed substance, licensed by the Nuclear Regulatory Commission, and we have a responsibility under that license to provide certain safeguards in terms of handling and the like, and we abide by our license requirements.
Q: As the Pentagon point man on this subject, have you had any discussions with any of -- representatives of America's European allies about this?
Rostker: Well, I haven't personally, but I -- besides the British, which we have an ongoing and very detailed set of discussions, and I would include the French also, but not in the contemporary era of Kosovo. But I do have two officers who are in Europe right now and have been briefing the NATO ministers this week and will be on Monday briefing the NATO surgeons. And then at the request of the State Department, they're staying and briefing a number of foreign governments.
So the material that we have is fully available to our European allies. I would also say it's fully available to the American people. It's available on GulfLink, our award-winning home page, and if you go to gulflink.osd.mil, you can find all of the reports I'm talking about and draw your own conclusions.
Q: Have you also followed or monitored the health of soldiers who were involved in clean-ups of -
Rostker: Yes.
Q: You have?
Rostker: Yes.
Q: And there has been no change in their health status?
Rostker: No, not at all. We, in fact, at the request of the Department of Veterans Affairs, entered into a program in which we notified over 200 veterans who were not in the initial surveys, but were involved in clean-up operations, what we call Level 1 exposures, and they've come in for health assessments. I think one or two of them were actually found to have depleted uranium fragments from the friendly fire incidents that we had not caught earlier. But depleted uranium will move out of the body very quickly, and this is really an area where the science has been very helpful, and it suggests that there is not a problem here.
And we're happy to share that science with our NATO allies, and if additional work is called for, we're happy to do it. For example, literally as we speak, we continue to do depleted uranium firings because -- at Aberdeen -- while we know the down-wind implications of a depleted uranium round hitting a tank and how much is thrown up, it turns out we did not have good readings for the tank compartment itself because the projectile entering the tank compartment destroyed the sensors. And so we have gone back and are in the middle of refiring those with hardened sensors so we can find out what the immediate effect of the depleted uranium is within the confined cavity of a tank or in a Bradley Fighting Vehicle. And we're doing that with depleted uranium, protected tanks and tanks that are not protected by depleted uranium. But down-wind characteristics are well understood and, again, are available for scientific scrutiny.
Q: Is that -- do you mean to test the effects from the depleted uranium armor or from projectiles?
ROSTKER: Both. Well, there's a different reaction or a different amount of release if a depleted uranium round is hitting a conventional tank versus hitting a tank protected with depleted uranium. If it's hitting a conventional tank, what basically happens is the round passes right through the tank. It has enough kinetic energy, it's heavy enough to not only enter the compartment of the tank, but pass completely through the tank, and largely intact. If it hits a tank protected by depleted uranium, then there is actually more shattering of the projectile and a potential release of fragments from the depleted uranium armor.
But, you know, your reaction is exactly right. Can you imagine a round that has so much power that it will enter a tank and still have enough power to go through it and keep going? And that's what happened in the Gulf War.
Q: It's their air conditioning system, eh?
Rostker: It sure makes a nasty day, and it is a very important weapon for us and it is very important in protection. All of our modern M-1 tanks have depleted uranium shielding. That variety of tanks -- the Iraqis never penetrated the tank compartment of an American tank protected by depleted uranium.
Q: And DU does penetrate the M-1 tanks? DU can --
Rostker: DU can penetrate a tank protected by DU. It depends upon the angle and some other things, but it is -- it can be a problem and, increasingly, countries around the world are securing depleted uranium rounds.
Q: Has there been, you know, aside from these Gulf War cases, have there been another efforts to track or monitor the health or do studies of the health of soldiers who've worked with depleted uranium, either in environmental cleanup, as part of their training, or for -- or using it in, you know, by firing rounds and that kind of thing?
Rostker: Yeah. As I said, in terms of cleanup in the Gulf, but I'm not aware of any other studies, epidemiological studies. What we have relied on is workers in the nuclear industry; people who have been involved in processing depleted uranium, people who were in the industrial part of it, and there are studies that have been reviewed that deal with long-term health effects of uranium miners and those who are involved in fabrication.
Q: And is there any data on U.S. troops who have served in the Balkans, you know, with regard to leukemia, regardless of what the source is?
Rostker: I don't know of any, but I would tell you that, given the time frame for Kosovo, it would make medical history if you had an exposure of any kind and leukemia resulting that quickly. Now, one of the things we do know, there was an article in --
Q: But it has that been checked, I mean --
Rostker: Yeah, I mean, we know --
Q: No, I mean have there been any leukemia cases?
Rostker: Not that I know of. But I would tell you that there was an article today about the Italians -- (to staff) -- was it today, today's Early Bird? --
Staff: Yes.
Rostker: -- the Italians using benzene as a solvent for cleaning their rifles. Benzene is a known carcinogenic with a particular link to leukemia. And so there are alternative explanations.
But cancers do not develop, even leukemia, in the periods of time we are talking about here. And there is no indication, from 50 years of research and monitoring of people working with natural uranium, which is more radioactive than depleted uranium, that would associate it with leukemia. The issue that has been suggested is lung cancers. There's no indication of that, and the IOM, again, in their review ruled that out, and it's the only thing -- that and renal were the only thing that the IOM went so far as saying that they would say is not likely to have a relationship.
Q: Just back to today's report for a moment. This is the latest in what's been a long series of reports, during the time you've been here, that have examined some aspect of a potential cause for Gulf War illness and essentially found that it's not likely. When are we going to hear what might be a likely cause for these Gulf illnesses? And 10 years after the Gulf War, why aren't there better answers for veterans who are sick?
Rostker: I don't manufacture answers, I assess hypotheses. What we have done is to take issues of concern to the veterans, and have subject that to scrutiny as best we can nine years after the fact, in terms of what happened, what were likely exposures, what does science tell us about the relationship between the item of concern and the issue of health. And I have to sit back and let the science talk for itself.
Q: Well, what does -- as you prepare to leave -- I take it you're leaving this office with the change of administration.
Rostker: I am.
Q: So as you prepare to leave, and as you look back on all of these reports and all of the science that you've reviewed, what -- can you encapsulate for us what does the science tell us at this point about --
Rostker: We know that there are veterans who are sick. Our first priority has to be to the care of those veterans today. We know that there has been speculation on a number of causes. And we have been able to rule out some of these causes, sometimes more definitively than others in terms of ruling it out, but we certainly have not been able to make an association.
I believe that is an important service to veterans. I can tell you from doing 30 town hall meetings that veterans have come up to me and said, "Thank God somebody's listening. I had a concern, I didn't know, and now you've put my mind to rest by providing me with this information." I would like very much to be able to say here is a smoking gun and, by the way, and here is the cure that goes with that smoking gun." But I can't manufacture answers. I can only do the inquiries as best that we can and as objectively as we can. And I think that is what we have done.
Q: Is it your personal view, then, that there is no Gulf War syndrome per se?
Rostker: I have not been able to identify a smoking gun in terms of a single cause. I know there are people who served in the Gulf that are ill. I can't tell you whether they would have been ill if they did not serve in the Gulf. I can tell you that those who served in the Gulf are more likely to have symptoms, have complaints. But on a -- consistently on objective standards of birth defects, of hospitalizations, of time lost on the job, we don't see a difference between the Gulf War population and the control populations, those who did not serve in the Gulf.
I don't know why people are sick. I hope we've given them some relief in examining some of the potential causes, and helping them, informing them of what happened in the Gulf and what science tells us. And I know we have to continue to treat those who are ill. We have a -- we are still under a presumptive period that if we can't provide an explanation, there is a presumption that that illness was caused by service in the Gulf. I completely support that. And we will continue to try to take the lessons of the Gulf and apply them to ongoing deployments like the issue we've talked about here on depleted uranium and Kosovo and future deployments.
Q: Okay, thank you.
Rostker: Thank you very much.
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