WEDNESDAY 18 DECEMBER 2002

DR LEWIS MOONIE, MP, MS LIZ MCLOUGHLIN, CBE, AND MR ALAN BURNHAM

  100. I must say, I agree with the Minister. We are coming on to the Gulf War Syndrome, but I hope nobody thinks that one question exhausts our interest in this subject.
  (Dr Moonie) I am sure it will not!

  101. I think this Committee, in its previous incarnations, looked at Gulf War Syndrome and it is something which is ongoing in the press, although I understand the MoD do not recognise the use of the words "Gulf War Syndrome".
  (Dr Moonie) Indeed.

  102. You do recognise that there are certain conditions which have resulted from people's service in that part of the world. I do not want to talk about an individual case, but I also sat in the recent Pensions Appeal Tribunal case where the MoD were criticised for not using the words or the terminology of "Gulf War Syndrome". What are the practical difficulties of the MoD in actually adopting the use of the words "Gulf War Syndrome" and what research has been done on information which has been put forward to minimise any future possible condition or conditions which are recognised by the MoD resulting from people who have served in the Gulf?
  (Dr Moonie) Using the term "Gulf War Syndrome" is merely a description of a series of symptoms. It adds nothing whatsoever to the diagnosis, it adds nothing to the treatment and I can assure you it adds nothing to the benefits which are paid. The benefits are paid on the grounds of disability, on the grounds of illness and they are, therefore, paid on the grounds of what you are complaining of. One does not complain of Gulf War Syndrome, but one labels one's condition as Gulf War Syndrome. As somebody with some experience in the field, I have to say I have seen no evidence whatsoever, and that is backed up by every reputable study which has been done, no evidence that there is a single Gulf War Syndrome which can reasonably be labelled as such and, therefore, I believe that medically the term should not be used. However, let me stress that it makes no difference whatsoever to the benefits which people get. If people are disabled as a result of their service, then the benefits are paid and calling it "Gulf War Syndrome" will not add a penny to what they are paid. Having said that, you are quite right that something happened to people during their service in the Gulf. They expressed a wide variety of symptoms covering a wide number of effects to the body. What are we doing about it? Many things, some of which, I have to confess, I have set in train myself and there is a relatively tenuous medical basis, like the very detailed study on depleted uranium which we are still trying to bring in, despite the fact that the conditions bear no relation to any medical condition I could think of related to uranium poisoning, but the fact is due to the amount of concern which was expressed and the fact that we do use depleted uranium and will continue to use it makes it incumbent on us to take further action, so there is an underpinning there. On vaccinations, I can assure you that our Armed Forces are very much aware of the disapproval and displeasure which was expressed by Ministers of anybody who was in the Service without the appropriate vaccination or the appropriate treatments, in the case of malaria, for example. That has been made very manifest to them by myself and my colleagues, so the general preparations are going to be much better than they were. The record-keeping of people, just really knowing where they were and what they were doing, which in a war-fighting situation is so difficult to establish, will be done much better. It is still constrained by the fact that we do not have proper electronic records for people and that is a matter of great regret to me, so it is a spending priority which I would like to see advanced up our list. As to what we can actually do about the Syndrome itself, and perhaps I should not say that having just said what I have said, but it shows how easily, just as you did, Mr Jones, one slips into using the terminology, I do not know is the answer. I think that our psychological preparations for war get better with every action we take part in. I would like to see more prospective research done which is much more valuable in epidemiological terms in trying to identify the causes. At the end of the day we are well aware that there are things called "war syndromes" which have occurred throughout history and which have been well documented, but presently we have no means of preventing them. One particularly where the practice is much better than it was because of increased knowledge is in the general area of psychological management of people, although it is still very difficult and we still have no predictor to say, "This person will become psychologically disturbed as a result of the experience and this one will not". I think that is probably about as wide an answer as you would want on that.

  103. Are you satisfied that those individuals that are suffering from some sort of illness because of their service in the Gulf are actually receiving the pension or compensation that they are entitled to?
  (Dr Moonie) Of those who have claimed, yes, they have and I would encourage anybody who has not made a claim who feels ill to come forward and be assessed. There is no guarantee that they are going to be successful, but we have our own Gulf veterans' programme of medical assessments, and the Veterans Agency, which always stands ready to assess people. I am satisfied that those who have been able to show a link, however tenuous, with their service in the Gulf to the condition they are suffering is being paid the pension they are entitled to. I think there are over 1,300 of them.

  104. I have heard a number of Gulf War veterans, including a member of my own family, raise this issue about the injections they have received and you have admitted on previous occasions and so has the MoD in evidence to our former Committee that there were not proper records kept about who was given what, on what occasions and what for. Some of the servicemen who have spoken to me and who have given evidence have claimed to have been injected on a number of occasions and were not told exactly what they were being given. Now, have the Ministry of Defence tried to replicate the circumstances in which those injections and inoculations were given for various reasons and has a proper detailed analysis of the possible effects of those injections which have been given in the time-frame given and in the physical circumstances of being in the Gulf? Some of these injections were actually given to people who were on the front line and within days of being given them, sometimes within hours, they were being "MEDVACed" out of the area because of the seriousness of the deterioration in their health. What evidence has the Ministry of Defence got which they have not put in the public domain to rebut the claim that many of these servicemen have made that their illness, the Syndrome, is as a direct result of the mismatch of inoculations they were given when they were there?
  (Dr Moonie) The epidemiological work which we have done, or we have not, but it has been done on our behalf, has failed to show a major link. There are very loose links with the actual receiving of vaccinations, but no direct clinical links whatsoever. I think that based, as I say, on the loose evidence that people complain of much the same symptoms, but to a greater degree, I think it is fair to say, when they were given a larger number of vaccinations, I think that is bad practice and it should be stopped and it has been stopped. We ensure now that people are given the correct vaccinations over the proper period and they are all up to date before they go out to active service. Having said that, most of the vaccinations which are being given have been used in clinical practice often for generations and the potential interactions between them are very well known. There is no a priori medical reason to suppose that giving many of them together would have some mysterious effect. Having said that, we are looking still at potential interactions to try and find out if there is something that we have overlooked and we will continue to carry out research where any reasonable hypothesis can be advanced as to why some can take place.

  105. How can it be reasonable to say that when the MoD have not been able to furnish details of what servicemen were given in the way of injections so that their reaction to it can be properly gauged, when the MoD themselves cannot give a straight answer to what Serjeant X was given two days after his arrival in the Gulf?
  (Dr Moonie) The fact that that cannot be given does not in any way justify the making of assumptions as to the effect on people's health. The fact is that when you have a situation where you are using products which are well known, whose effects are well known, whose interactions are well known, the fact is that when you are doing that it is reasonable to argue from the general case to the specific that if they do not have any effects anywhere else, they will not have any effects here. That is a reasonable assumption to make. I am not trying to defend the fact that we do not keep records. We should have kept proper records, and I will agree with you 100 per cent on that. However, it is unwarranted just to look for various mysteries in the fact that that was it, that they used depleted uranium, so that was it. There is no scientific basis whatsoever for saying that.

  106. I am sorry, but we are talking about fit young men who went to serve their country and within hours of having injections, they were so ill they had to be flown out of the area back to hospitals in the UK and in Germany. They have a perfect right to say, "Please tell me what it was you gave me and is it a fact that it is these injections which have mucked up the rest of my life?" They are perfectly entitled to an explanation.
  (Dr Moonie) I am not saying that there are no reactions to vaccinations; there are and they are very well documented and if any such cases occur, there will be a medical trail for them and we will see what the illnesses were. If you wish to give me details of the cases, we can follow them up. The fact is you are attempting to make a general argument from specific cases and frankly medically that is wrong.

  107. I am sorry, but—
  (Dr Moonie) This is wrong. I am a doctor. You are not.

  108. Are you saying that all of the evidence and the tests that you carry out are now in the public domain?
  (Dr Moonie) Not necessarily, no, but individual medical records are confidential.

  109. Not individuals.
  (Dr Moonie) I thought you were talking about an individual.

  110. You have now said you will make available through parliamentary questions any reasonable request for a former Service personnel's medical records. I am not asking that. Are you prepared to make available the results of all of the tests that the MoD have either commissioned or carried out themselves in respect of the possible effects of the various cocktails of injections which were given?
  (Dr Moonie) Absolutely. Everything which is done will be put in the public domain at the appropriate time. Yes, of course. I am not going to put it in before the research has actually been reported on.

  111. Can I ask then of all of the research which has been completed and has been made available to you as Minister, has that all been put in the public domain?
  (Dr Moonie) As far as I know, yes. I can think of nothing in terms of research which has been done which has not and if there is anything, then I will make sure that it is. I am pretty certain that there is nothing. The only thing which is not yet in the public domain is the research which is not yet completed.

  112. If you will elaborate on what you said earlier, we would like to know what action has been taken and preparations made for the current developments, if you would not mind, in some detail.
  (Dr Moonie) I would be happy to do that.

  113. We are still smarting after the last deployment and we want to make sure that as far as possible nothing happens
  (Dr Moonie) Absolutely. What I can assure you, in addition to what I have said, is in general medical terms I think things are much better organised than they were.

  114. Again, if I might say, could we have a further assurance, even though you have had a report apparently saying that there is no such thing as Gulf War Syndrome, that this is not going to affect any existing programmes or any funding that the research will need?
  (Dr Moonie) I am happy to give you a categorical guarantee that any reasonable line of research, and I suspect some few unreasonable ones as well, will be followed up. I want to get to the bottom of this as much as anybody. I will insist always that any statements which are made or any descriptions which are made are based on rigorous medical evidence. I think that is reasonable. I can give you an absolute assurance. Suggest reasonable lines of inquiry and we will put our hands in our pockets and we will fund them.

  Chairman: Thank you. We will return later on in this session to the theme. Thank you, Minister. Now to asbestos-related diseases. Mr Hancock.

  115. Thank you, Chairman. If I could draw your attention first, Minister, to the fact that you asked me to give you the names of people in the Gulf. I submitted a case study of 20-odd servicemen suffering asbestos-related illnesses, in some instances death. That was over 12 months ago and the MoD still have not replied to that very comprehensive case study on each of those individuals from right around the country ranging from an admiral down to an able seaman. Sadly, the admiral, who was one of the better case studies, subsequently died and did not get a response from the MoD and I am still awaiting one. I am a little surprised, to say the least, that I have not had that. If you would bear that in mind. The Government believes that the law should not be changed to allow service personnel to claim compensation for illnesses resulting from service before 1987 because, you say, "there is no logical point at which to draw a line..." and you go on to suggest that examples of unfairness and injustice would be difficult to clarify. What exactly does that mean and would it?
  (Dr Moonie) With regard to your first point on the cases, I am not sure whether it is because of length of time or the fact that there is currently a case under appeal as regards asbestos and that is the reason why a reply has not been sent to you. I will make sure that is looked into. With regard to the general principles of retrospection it is difficult to draw a line. I do not like to use the word "retrospection" again, I am sure it raises people's hackles.

  116. Or expectations.
  (Dr Moonie) Shall I give you a general answer. It is very easy to look back with the hindsight of modern medical knowledge and say "Something wrong happened to me 30 or 40 years ago". Something wrong did happen to the people 30 or 40 years ago, but the fact is 30 or 40 years ago we were unaware of the reasons for certain conditions occurring. One should not apply the knowledge of today to the problems of yesterday, you have to look at them. That is one of the reasons why we are having such difficulty in looking at what happened at Porton Down because standards 40 or 50 years ago were very different from those there are today. It is a generally accepted thing in medical practice that if the current standards are applied then there is no negligence involved in the case. We have looked at this very closely because with modern knowledge it is well-known that asbestosis, and particularly mesothelioma, is related to asbestos and literally nothing else. I knew people in Scotland in clinical practice who made it their life's work studying this particular tumour. That does not alter the fact that the law pre-1987 was as it stood then, Crown Immunity applied, and a general decision has been taken across Government that no retrospection will be allowed and the law will not be changed.

  117. And yet the Government made exceptions in this respect, did they not, with regard to miners. They accepted that miners suffering from illnesses which were related to working in the coal industry would be given blanket compensation.
  (Dr Moonie) Paid for out of the surplus in the Miners' Fund, I have to say.

  Mr Jones: That is not totally true. There is also a cut-off date.

  118. I am interested to know what claims other than asbestos-related diseases the Government is concerned might raise substantial numbers if the abolition of Section 10 of the Crown Proceedings Act were made retrospective? How much thought has been put into this? I cannot think of too many other examples.
  (Dr Moonie) There are not many quite as florid as the relationship between asbestos ingestion and mesothelioma, which is the main issue I suspect. The general one of psychological problems is the other large number of cases still subject to various actions in courts and not something I can talk about in detail. That is the other obvious large group and, again, one where modern practice has changed and is being applied to past experience. That is the obvious other one. I can think of no great other numbers, no.

  119. Does your colleague wish to add anything?
  (Ms McLoughlin) All I was going to add, although it is probably blindingly obvious to everybody else bar me, is to make the point that there is a difference, of course, between compensating for an impairment and as far as I know there is no reason at all why people should not claim for a war pension.