Testimony of
Dr Goran A. Jamal, MB ChB MD PhD FRCP
Consultant Physician and Senior Lecturer
Imperial College School of Medicine, London University and
West London Regional Neurosciences Centre
before
the Subcommittee on National Security, Veteran's Affairs and
International Relations Committee on Government Reform, US
House of Representatives
LONG VERSION (FOR SUBMISSION)
Mr Chairman and Members of the Subcommittee I am pleased to be here
today to discuss
the involvement of myself and my research team with studies on the
Gulf War Syndrome (GWS)
and related subjects. I should perhaps begin by stating something
about my background and the reason of my involvement and interest in
GWS. I am a neurologist holding the position of Consultant in the
British NHS and Senior Clinical Lecturer at Imperial College of
London University and Glasgow University since 1988. In addition to
my very busy NHS clinical duties,
I head an active research team at IC including PhD students. I have
written two theses and more 145 original publications on the various
aspects of neurology particularly in relation to assessment and
characterisation of neurological injuries and their potential for
regeneration. We have introduced some new innovative techniques for
assessment with international recognition.
In 1992 we performed some research fundcdd by the Joseph Rowentree
Charitable Trust conceming the possible long-term effects of
supposedly safe Otganophosphate (QP) compounds. The results became
available towards the end of 1993 and caused us to be concerned and so
we informed the British MAFF and HSE and invited them to discuss the
findings. In October
1993 we received a top joint scientific team from 3 Bntish Ministries
of MAFF, DoH and Health
& Safety. They were equally concerned about the findings and
passed them to the relevant Government Committee the Veterinary
Products Committee (VPC). We were invited to a
special meeting in October 1993 following which it decided to advise
the formation of a special subcommittee top study OP effects. The
Government of the day took on the advice and formed
the Medical & Scientific Panel (MSP) with representations from
the three Government departments concerned in February 1994. I was
invited to serve on it by the Minister responsible and I agreed to
signing the non disclosure clauses of the Medicines Act of 1968.
Throughout my membership of the committee I was concerned about the
quality of advice given to ministers.
In the meantime my expert advice was sought in some British and
international legal cases for
OP related neurological damage. However, on the first opportunity
that the MSP committee became aware of my involvement in the middle
of 1996, they sought to enforce a new code of conduct which would
have effectively prevented me from providing expert advice to the
courts. They were uncompromising and I was left with no alternative
but to resign from the committee, which I did in December 1996. As a
result of the media publicity surrounding my resignation
with the subsequent highlighting of the faults in the system of
provision of impartial and unbiased scientific advice to responsible
ministers and the secrecy and closed-shop style surrounrling
such a system, I was given the 1997 Annual award of the Freedom of
Information Campaign
of Britain.
In January 1997 I gave evidence as the main expert to an Australian
Court and two months later to a court in Hong Kong. The former was in
relation to long lasting neurological damage in 4 sheep shearer and
the latter was in relation to an American citizen who was suing for
damages against Ciba Geigy the manufacturer of diaziuon which was
implicated in both court cases. Both judges preferred my evidence on
the alternatives and in the latter case Ciba Geigy lost more
than 37 million dollars in damages and costs.
In 1995 we were selected from amongst 12 major regional neuroscience
centers by a joint
scientific committee of 3 ministries to conduct extensive research on
possible long term effects of
OP compounds and were funded 0.5 million US$ 0.75 million). This work
was completed in
1999 concluding the existence of a definite link to neurological
damage following which we wrote
a three volume extensive report about the subject. As a result of our
findings the UK Government changed its policy and forced the OP
manufacturers to alter the design of the concentrate material
containers and introduce special training certificate for those who
handle these compounds.
In May 1997 the Labour Party won the general election and within a
few weeks of the appointment of the new minister Jack Cunningham I
received an invitation to go and meet him
and his deputy Jeff Rooker to discuss their concerns about the
circumstances of my resignation from the MSP in December 1996. After
listening to the story supported by documentations in
the presence of senior civil servants, they were appalled by the
events and wished to re-instate me on the advisory committee to which
I agreed with extreme reluctance. However, despite their attempts
over many months they discovered that they were unable to reinstate
me against the wishes of the cammittee chairman. A few months later I
was nominatad by the Royal College to join the committee and that was
turned down with no explanation. It is perhaps pertinent to state
that many members of the committee declared direct or indirect
interest as dictated by the rules. In the last two years alone we
have published 5 major papers on the subject in addition to a large
three volume report to the UK Government. We are currently involved
in a large study jointly with The London School for Hygiene and
Tropical Medicine to study the health effects of OP compounds on
sheep dippers.
Our involvement in GWS started around the middle of 1994 initially by
referring to us veterans and then by a fund award from the Joseph
Rowentree Fund to conduct studies on a relatively small group. We
completed this work and analysed the findings by February 1995,
written it
up and submitted the paper for publication. We found evidence of
neurological abnormalities
and markers of neurological dysfunction in a group of veterans
compared with an age and sex matched control group. We discussed the
possible potential causes and called for further neurological
research. We used sound methods which we used and extensively
published in
peer review journals.
We sent a copy of our findings to the MoD in May 1995 and welcomed
any discussion on the findings. We were visited in August 1995 by a
delegation headed by Wing Commander Dr Bill Cocker who was the head
of the Medical Assessment Program (formed in October 1993).
Despite their pre-visit scepticism they became very impressed and
concerned by the end of the
visit. Cocker expressed the wish to refer to us at least some but
preferably all or of the veterans for proper neurological assessment
but he added that though he would strongly recommend this, the final
decision to do so lies with some superiors in MoD. I know as a matter
of fact that he kept pushing for this and for instigating
neurological research but without success. We requested funding from
the MoD to continue and expand our research but this was repeatedly
refused with no reasons given. Our joint input to an audit exercise
of the Royal College later on that year materialized in calling for
research on neurological and immunological aspects. The following
year, Bill Cocker, who was one of the most senior military physician
and perhaps most clinically experienced in the country, was
transferred to another post outside the UK away from the MAP.
In April 1996 out study was published in the Journal of Neurology,
Neurosurgery and Psychiatry
(the official Journal of those associations in UK) having passed
through the toughest scrutiny and scientific referencing of all my
other publication. This attracted huge national and international
media attention and the British Medical Association held a conference
on the subject on the day
of publication. This was then followed a month later by the
publication of an important study on neurological damage in
experimental animal model frorn Duke University in South Carolina by
Abou Donia and group which also attracted extensive media attention.
Only after then on 17th
June 1996 I was contacted by the MoD and was invited to meet with
their Gulf War Illnesses
team headed by Colonel John Graham. I met them on 2nd July 1996. I
was premised that as
much information as was allowable would be made available to us and
that we would receive support but none of those materialized. I was
provided with very limited amount of information
at the meeting, When I raised the question of the extent of the use
of OP, based on accounts from veterans, this was dismissed but on my
insistence I was promised that this would be investigated
and I would be informed of the outcome. I kcpt pushing for this
information through a parliamentary question. In October 1996 the
then Minister of Armed Forces, Nicholas Soames conceded that the
Country and Parliament were mislead and that OP was used in the Gulf
more extensively than thought and announced an investigation into the
subject. It was later conceded that even some unlicensed OP compounds
were used. It is ironic that not only before but even after such
announcement and while we were heavily involved in research on the
long term health effects of OP compounds on behalf and through
funding of three other Government Departments, the MoD have never
sought our advice about this.
Around Mid 1996 the MoD set up a Gulf War Illness Research Committee
(GWIRC) under the auspices of the Medical Research Council (MRC). The
membership was secretive and was only disclosed following a
parliamentary question in the House of Lords asked by my friend the
Countess of Mar. It was made largely of people not involved in
examination of veterans and it included several members of the
already existing MSP on organophosphates.
In January 1997 Dr Haley's work was published. This was high quality
research in several
papers which confirmed and shed further light on the nature anrl
extent of the neurological damage. Dr Haley's group have published
several more high quality papers since then on the subject. There is,
however, much more work needed to be done to determine the extent and
nature of the neurological abnormalities and characterise them. We
did not and still do not get any support in the UK to conduct such
further studies.
In June 1995 the then shadow Defence Secretary Dr David Clark raised the matter of our study's findings with the then Defence Secretary Malcolm Rifkind. He replied on 27th June 1995 stating "The general cogency and significance of the research would, of course, be increased if it were to appear in an article in an accepted medical journal after the normal procedures of referencing and peer review". When the Shadow Defence Secretary wrote back to the Minister after publication of our research, he received a written reply from the then Defence Secretary Michael Portillo dated 27th February 1997 which indicated that his department was not interested in "causal research" of the type advocated by Dr Jamal and that his "Department's view of Dr Jamal's work has not changed" without providing any clarification.
In addition to repeated requests on every available opportunity for funding, we have made several formally written and detailed proposals for research. These could he summarised as follows.
Our submission for funding to the MoD throughout 1995 and early 1996 was acknowledged by the Minister Earl Howe who replied to a direct question to the House on 8th May 1996 "We had to reject a request from Dr Jamal for assistance with further research because we had not at that stage decided what areas of research to pursue".
In August 1995 I was approached and visited by Professor Peter
Spencer of Oregon University in Portland for discussion on writing a
joint proposal for US DoD on a bi- national study. This included our
team and three other teams from the US. We prepared a carefully
integrated, hypothesis driven and detailed proposal. It required a
letter of support from the British MoD.
I communicated with Mr B W J Pitts of the Chief Scientist Office of
the MoD. We had great difficulty in obtaining this and at the end we
were not provided with the kind of support
requested making it perhaps the only weak point of the application.
On 26th February 1996 Professor Spencer informed us of the decision
of decline for funding of the only bi-national
study submitted.The proposal was described as "good"
Following a call for research proposal by the newly appointed MRC
GWIRC we, in collaboration with the Institute of Occupational
Medicine OF Edinburgh, made a ioint application with detailed
proposals for research. We drew largely on our immense experience in
conducting the ongoing epidemiologicai and hospital based research
funded by 3 Govenment Departments
on the long term health effects of OP compounds. Shortly afterwards,
on July 16th 1996, we received a pre-typed kind of standard letter
of, 5 lines informing us of decline of funding. There was none of the
customary written explanation of refusal, nor any referee comments,
nor was there even an indication that it was sent for peer reviewing
all of which are standard procedures by the MRC. One of my senior
colleagues phoned asking for an explanation. He was told that our
"proposal was considered to be good and clear and we had a
strong team with appropriate skills" but no reason for refusal
was provided. When later on the chairman of the committee
Dr A McGreggor was asked about the matter he was quoted to state that
he "was not aware
that Dr Jamal has made an application for research to the
committee". I requested an explanation from the MoD directly but
I received a letter dated 23rd December 1996 from Colonel Graham of
the MoD (who attended the meetings of the committee as transpired
later) stating that he was "not in a position to comment"
copying his reply to the secretary of the committee. When, at a
later date the MRC was asked again about the proposal, it replied
that there was a request which was refused and that "verbal
feedback" was provided (Herald 15 January 1998).
In January 1998 and following communication with Dr Haley we prepared
another detailed proposal in two volumes for detailed animal and
human based comprehensive studies including neurological,
toxicological, autonomic, imaging and immunological examination. The proposal
was prepared by 15 senior academics from 5 universities across the
UK. We sent it to the Perot Foundation who had promised supportive
representation to the British MoD but so far the MoD support has not
been forthcoming.
We continue to do research on both programmes or OP and GWS but with
limited resources. The only source for this being the income from
Royalities from an equipment invented by myself
in the late eighties which I have donated entirely to our research
fund. We do most of the research work in our own time.
Our most recent paper on the subject is on the abnormalities of the
autonomic nervous system in GW veterans which I have in first draft
format and we hope it will be ready for publication soon. We used our
novel target orientated autonomic nervous system examination. This is
the part of the nervous system that autonomically (i.e. outside the
individual's control) regulates the functional conduct of all the
vital internal organs during rest, exercise and physical as well as
mental challenges. Its proper functioning is absolutely vital for the
well being of every individual. We comprehensively examined this
system in a cohort of GW veterans and found a unique pattern
of autonomic lesion which points to a possible underlying neurotoxic
cause. Our autonomic findings explain many of the incapacitating
symptoms that the veterans have such as fatigue, dizziness, nausea,
hot flushes and disturbances of sweating. Such symptoms have been
reported in our earlier studies as well as Dr Haley's and other studies.
We have also jointly examined with the Cyclotron Unit of the Hammersmith Unit in London two veterans using a carbon-11-labelled biomarker of neurotoxicity using advanced PET scanning and ligand binding. This method "is considerably more sensitive than traditional surveying imaging techniques". We found abnormalities in both subjects. In a report to me on the findings from the unit it is stated that it "revealed an abnormal pattern of ligand binding in the absence of abnormal MRI signals. The pathology shows a peculiar distribution in the pontine region and in certain areas of the thalamus. Such localisations seem consistent with the hypothesis that the peripheral neuropathic changes found in these patients are accompanied by, if not causally linked, with lesions in the central nervous system. The patterns found are unusual and have not been seen in any other patient studied so far". We need funding to pursue this further as we need to study larger numbers with this expensive technique. We think that the underlying cause of GWS is multi-factorial as mentioned in our first paper and today, more than 6 years afterwards, this still stands as the most likely explanation. In order to go forward we need to have bi- or multi- national studies combining mechanism and causative research carefully interlaced with proper epidemiological surveys. Such has been successfully applied in our studies of the long term effects of OP. We would very much welcome the opportunity to put our ideas into research and in close collaboration and liaison with Dr Haley and other groups in US both to reproduce their valuable work on a UK and European scene as well as to proceed further ahead. This is important not just to understand the illness of the veterans so that we find best ways to treat them but also to help in designing proper medical protection programmes based on best science against likely potential threats on the health of troops in the futute under similar circumstances.
Mr Chairman, this concludes my statement. I will be happy to answer any questions you or members of the subcommittee may have.
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