Subject: Organophosphate (Nerve Gas) Sheep Dips and the Hen "test" and the Blood/Brain "Barrier".
Date: Fri, 23 Mar 2001 07:23:38 -0500
From: Stephen Tvedten <steve@getipm.com>
Organization: Get Set Inc. (www.getipm.com)
To: Paul Helliker <phelliker@cdpr.ca.gov>
Director, State of
California, Department of Pesticide Regulation
cc: Christine Whitman whitman.christine@epa.gov
Dear Mr. Helliker, I thought you might find the following article of interest:
The UKOPRP
Organophosphate Sheep Dips
12th February 1998.
Parliamentary Briefing Jubilee Room House of Commons - 11am
Chairman: Paul Tyler MP
Introduction: Paul Tyler MP
My involvement in this issue began when a member of my
constituency appeared to be suffering from organophosphate poisoning. I felt it
essential to set up this committee. I thought at the time it would only take
about six months to investigate these problems; six years later the group has
certainly grown tremendously. However it is still as necessary now as it was
then.
We have been helped greatly by a number of people who have
become involved, including Dr Ian Gibson MP and the Countess of Mar. This
meeting today however is primarily for the members of both houses so that they
can be briefed on this issues and in turn brief their constituents. Obviously
there are members of the press, farmers themselves and other interested persons
present today, but 1 hope you will forgive the fact that the primary purpose of
this meeting is to give MPs a chance to discuss the, problems.
We are lucky to have a panel of speakers here today. First
Professor Andrew Watterson, of De Montfort University Centre for Occupational
Health, is going to talk to us. Then on my left we have Dr Goran Jamal, who
since the last briefing has been involved as an expert medical legal witness in
a number of legal cases all over the world. On my far right we have Dr Bob
Davies, consultant psychiatrist who has had a wealth of experience and knowledge
about organophosphates, and to my right is Elizabeth Sigmund of the
Organophosphate Information Network, who has been the driving force behind all
of us.
Firstly I must make a personal comment. The longer
Ministers and manufacturers delay in making a decision to withdraw these
chemicals, the more formidable the case will build up on negligence. Equally the
longer people don’t take any action, the greater the increase in the eventual
claims for compensation. People are going to realise that the knowledge to do
something about these chemicals was there but nothing was done about it. The
manufacturers have very deep pockets, but the Chancellor keeps telling us that
in the Treasury the coffers are empty, so if a claim against them wins, it is we
the tax payers that have to foot the bill.
It is for this reason why I am dedicated to bringing these
issues to the forefront and getting these chemicals withdrawn as soon as
possible.
(Paul Tyler then introduced Professor Watterson.)
Professor Watterson:
In the audience we have a number of people present who have
been exposed, farmers and others, and also many who know an awful lot about
organophosphates.
I am looking at this from the point of view of occupational
health and safety. From the health and safety aspect, failure to protect against
these chemicals means failure to prevent exposure as well as failure to deal
properly with problem when exposures happen. It was a major failure.
[Professor Watterson then showed several slides on an
overhead projector]
First overhead: The Messing Occupational Health Circle.
This explains the circular argument which allows
researchers to ignore the evidence. This explanation is only a partial one.
Second overhead. Workers dipping sheep
This overhead shows how workers are exposed. Here are a
group of farmers dipping sheep and you can see that there is little or no
personal protective equipment (PPE). This is just off the front cover of a
journal, it is a scene, that is repeated all over the country.
Third overhead: List of organophosphate adverse events
This overhead shows a list of the officially reported
adverse events after organophosphate exposure in a certain period (starting June
1991). As you can see, records are entered of people who have developed symptoms
after using organophosphates, but they were wearing personal protection
equipment, varying in the amount but some quite substantial equipment. The final
decision as to whether this was a likely result of organophosphate exposure is
positive. You can see that the word "likely" has been entered. This
shows that it has been known for some time that wearing of personal protective
equipment does not necessarily prevent you from being exposed to
organophosphates.
Fourth overhead: Health & Safety Executive -
Strategy for Occupational Health
This overhead shows a publication which is 'hot off the
press'. It shows that it is difficult to predict accurately what the future
health concerns are going to be. They say here that ten years ago it would have
been difficult to recognise the potential for problems such as BSE, occupational
back injuries, E coli etc. Unless I have been asleep for the last ten years, I
know that ten years ago, and even twenty years ago people were saying that there
were problems with these. These concerns when voiced are simply not being
listened to.
Fifth overhead: Bradford Hill
An epidemiologist called Bradford Hill gave this statement,
a summary of which is "all scientific work is incomplete and is liable to
be upset. Just because we have scientific knowledge, this does not confer a
freedom to ignore possibility that knowledge may have to change".
In this audience today there are many people who can report
events that should be, giving us warnings. Ten, twenty even thirty years ago
farmers were reporting these "sentinel events".
Sixth overhead: Christer Hogstedt, Swedish Occupational
Physician
Christer Hogstedt, Swedish Occupation Physician, said that
you should listen to sentinel events. Back in 1957, toxicologists and physicians
were saying that if we were going to get rid of DDT (an organochlorine) what
were we going to do about protecting people from organophosphates such as
diazinon, which were being promoted as a replacement?
This is a problem that the World Health Organisation also
warned about in 1958 Dated recommendations put forward by them included a strong
recommendation to avoid skin contact.
None of this fits with the Ministry of Agriculture,
Fisheries and Food (MAFF) advice during that period.
It wasn’t just the toxic effects on humans that were the
concerns. In 1960 veterinary surgeons were worried about adverse effects of
organophosphate sheep dips in sheep.
(Reference paper by Barnett 1961)
We should have concerns about releasing toxic substances
such as organophosphates into what is basically primitive technology in the farm
situation. In the late 1960's Bamett and colleagues were warning about the use
of personal protection equipment. Little was known about this, and it was a
"blind spot". There was no proper link between the agrochemical
manufacturers and the PPE manufacturers, and because of this there was no
liaison about what PPE was sufficient.
During the 1960’s and 1970’s there were continued
concerns about the safety of OPs. Geoffrey Rose once said "have not
noticed" is not the same as "isn’t there". Toxicology
literature reveals a great lack of research into safety. Epidemiological studies
were not properly done. The only real research into this issue that was carried
out appears to have been relating to the actual manufacture of the OPs and was
instigated because of concerns over factory safety. However, you must not allow
what happens on a farm to happen in a factory.
Emphasis in these safety studies was always on the acute
hazards, not the long term chronic effects. These are largely un-researched.
Some of us were asking the health and safety executive what
the result would be if we mixed phenols and diazinon? There were concerns over
the safety of these two products together.
We were told that it was okay. We now know otherwise. We
should have been adopting a precautionary approach. We failed on risk
assessment. In Occupational Health and Safety, you don’t need to dot every
"I" and cross every "i".
You don’t need that level of proof. We need to set
tighter standards, but there are perennial problems with data collection.
Data comes from agrochemical manufacturers and is subject
to their own screening first. Failures with personal protective equipment were
not fully researched, and did not keep up with new technology. If using very
toxic substances you can never be sure.
We should open these systems up - the type of research
being done and the results coming in were never clear. We need to involve more
people outside the industry in checking the results. The evidence from what we
have seen over the last thirty to forty years should have led to stricter
controls.
Dr Goran Jamal - Institute of Neurological Science,
Southern General Hospital, Glasgow.
I will not talk about the science of this neurological
syndrome as we have very little time. I wanted to tell you that there is a paper
coming out in a very prestigious journal very shortly, and to save time I would
ask anyone that wants copies of this to sign their name on a list that will be
passed around.
I have reviewed in that paper over 164 major publications
on organophosphate adverse effects from 1964 onwards. I have particularly
addressed the corner stone that the authorities have been relying upon - I have
demolished this, which is the hen test, the main toxicological test of
organophosphates.
I can assure you there are also a number of very high
quality publications in press at the moment, not just our team but in the United
States and elsewhere in the UK, and these will be coming out towards the end of
the year.
I can say with absolutely no hesitation that these products
are unsafe.
Many of you will be aware that I resigned from the Medical
and Scientific Panel. The reason for this was that two years after my
appointment to that committee advising three government departments
(Environmental, MOD and MAFF) a code of conduct was introduced which prevented
me from acting as a medical legal witness on issues of organophosphate safety.
Since December 1996 I have been involved in four major
legal cases. There was a six month hearing in Hong Kong of the Phillips case, a
case against Ciba Geigy and others. The cost to the Defendants was tens of
millions of pounds. The plaintiff received an award of over £2m. I was the only
expert neurophysiological witness for the plaintiff in that case. The defendants
had twenty-one expert witnesses, including four Professors of Neurology, three
of whom were from London and a team from the John Hopkins University, Baltimore,
USA. They also fielded five teams of QCs. I was in the witness box and cross
examined for 8 days. The costs to Ciba Geigy alone for this case was £37 m.
This gives you an idea of the fierce and hotly debated way these cases are run.
There was also a case of three sheep shearers in Australia.
I appeared as an expert witness for this case, and they were awarded substantial
damages.
The third case was that of Hill in London [significant
finding in this case was that it was the first time that a court in this country
had found that there was long term damage after organophosphate use].
The most recent case was that of Mr Shepherd who worked at
an agricultural college and was dipping sheep. Three of the expert witnesses at
that case are at this table [Jamal, Dr Davies, Dr Watterson]. The college
realised that they were going to lose the case and it was settled out of court.
So therefore there have been a string of four legal cases,
three of which have been debated openly in court. They have all been won. What
more do the authorities need before something is done? This is a vindication of
why I resigned from the committee. It goes right to the core of the issue.
The hen test is the corner stone of the policy of the
authorities. It is used to check the neurotoxicity of the organophosphate.
However there are very big question marks over the scientific accuracy of the
hen test.
The main symptoms of organophosphate long term damage are
excessive fatigue, sensory disturbance, dizziness, disturbance of higher
cerebral function, problems with memory, with cognitive functions, being able to
carry out tasks such as mathematics and how to deal with life generally. How can
you relate these effects to hens? Is the hen going to say "my leg is
sore"? It is obviously totally unacceptable. I can quote from one senior
adviser to the Government, Dr Timothy Mars, who himself said "the
hen test does not detect neurotoxicity as well as you might think".
My view on licensing is that it is fundamentally wrong. In
human medicine, an adverse effect to a drug is reported. But you have the
intervention of a doctor between the manufacturers and the patients. There is no
exposure to the rest of the population, and you have a defined population who
were at risk.
In these veterinary medicines, exposure is to everyone.
Organophosphates are used extremely widely, even in the home there are cans of
insecticide. Often it is difficult to find out if they contain organophosphates,
you have to look at the small print on the label.
All data regarding toxicity comes from the chemical
companies direct. There is no independent data given to the veterinary products
committee VPC) who are responsible for licensing.
All this data is highly secret, if you are not on the
committee you don’t have access to the safety data. When I was on the
committee I was able to access it, but not now.
This should all be open, after all we are not talking about
nuclear weapons or national security.
Professor Abou-Donia (Duke University, North Carolina)
completely shot down the data on which one product was licensed [referring to
his testimony in the Hill case].
We need people like him on the committee, the balance of
representation on these committees is totally wrong. Some hold shares in the
companies - the excuse for this is that they are knowledgeable about
manufacturing processes.
Once this committee is reorganised, it must be given the
power to enable it to revoke a license. At the moment, a chemical company can
take the committee to court if it revokes a license. This is an £8,000m
industry - so it will not stand idle. One problem is that under both governments
the committee has lacked the power to revoke licences. If the Veterinary
Products Committee needs to take this action, they should be able to carry it
through.
The question which was posed about safety should not be to
the level of "scientific proof" it should be more like the proof
required in a court of law i.e. "it is more likely, than not".
To prove something scientifically, you need 95-99%
confidence. The best epidemiological studies can never reach this level of
proof.
On the issue of chronic low level damage, we have twelve
studies. Ten show an association and two do not. This therefore roughly equates
to 80%. We have already exceeded the requirements of a court of law, which
requires 51%.
There is some very new tantalising research regarding
toxicology of these products. The paper released by the Israel Science
Foundation was a very high quality piece of work, and probably-one of the best
scientific papers I have seen in my entire career. This looked at the
blood/brain barrier, which is a shield between the circulation of the blood and
the central nervous system and brain. It is supposed to protect the brain from
toxins, viruses etc. We used to believe that it was stable like a brick wall.
However these researchers, working in the context of Gulf
War Syndrome, have shown that when you expose an individual to stress (such as
physical, heat or emotional) the barrier is reduced and the gate opens so that
substances can cross over 100 times more easily into the central nervous system.
Farmers will tell you that sheep dipping is very tiring and
stressful. You are fatigued, it is hot and hard physical work.
Their blood brain barrier is open so that toxins such as
organophosphates can cross ever. What may be safe for me and you becomes 100
times less safe for them.
This research done in Israel is torpedoing the present
knowledge.
Paul Tyler:
In our meetings with Ministers we would very often come up
against the limited range of skilled advice available. Ministers are dependent
upon their advisers. It is a little bit like an analogy of game keepers, the
game keeper can be sitting around a table with everyone advising him who are all
poachers. We are advised by part time poachers, retired poachers etc. This is
particularly evident in these cases. That is why it is so disastrous that people
like Dr Jamal are not available to the committee any longer.
Dr Robert Davies - Consultant Psychiatrist, Taunton
Somerset: It seems likely that in the next few days, British Forces
will be going to Iraq to deprive Saddam Hussein of his weapons of OP nerve
agent. Nerve agents are very many times more toxic (probably 100 times) than
organophosphate sheep dip. Their main mechanism of action is that they donate an
alkyl phosphate group and knock out protein. OPs can be used to count how many
free hydroxyl groups there are on a particular chemical molecules.
The only difference between organophosphates and nerve
gases is a question of extent. Following on from that we must accept that they
cause long term damage. This damage tends not to be lethal (although there are
exceptions) but it is chronic and long lasting.
Next month there will be a programme on Channel 4 which
documents the after effects of organophosphate nerve agents in Kurdistan. This
is a shocking programme detailing as it does a catalogue of horrors. It will
give us a flavour of what may be lying in store for us, because of our use of
organophosphates.
The mechanism of toxicity is critical to this issue. All
toxicity books concentrate on the effect of acetylcholinesterase.
There are many more effects. They are capable of-deranging
the mechanism of the reaction:
Phosphorylation � dephosphorylation which
is fundamental in brain function, genetic action and other physiological
functions.
I conducted a literature search, to see what studies had
been done on the effects of organophosphate on anything other than
acetylcholinesterase.
This is limited, there has been some work done on a number
of other neurotransmitters and enzymes affected by organophosphates. Work in
Russia found second messenger systems’ are disordered (which affect the way
the brain communicates with itself).
I have two colleagues who are with me today, Dr Ahmed and
Dr Ted Frier. We have worked together on a paper which is now being submitted
for publication.
I started seeing patients who fell ill after sheep dipping.
They had a remarkably similar cluster of symptoms involving higher mental
functions and muscle functions, mood changes, acute periods of
depression/anxiety, memory impairment and disorders of language function. They
also had alcohol intolerance (a very small amount of alcohol produces very
severe symptoms), their sense of smell is heightened and their ability to
sustain activity is markedly decreased.
They are also exquisitely sensitive to even small traces of
organophosphate chemical and other chemicals.
We published a description of this "neuropsychiatric
syndrome". We then conducted two postal questionnaire surveys. Farmers were
selected randomly from Yellow Pages. They were then sent a questionnaire which
asked very detailed questions about exposures to organophosphates and health
problems.
There were a significant number who had not been exposed in
the ten years prior to the questionnaire being sent out, and we were able to use
their results in comparison.
What we found was an enormous statistical significance.
There was a huge difference between the groups exposed to the organophosphates
and those who had not.
Therefore two groups demographically equivalent, aged more
or less the same, occupation the same, were compared. The only difference
between the two groups was the organophosphate exposure. There were chronic ill
health problems in the group exposed.
The second survey we did involved individuals who had
already made some link with their health problems to organophosphate exposure.
The majority were sheep farmers, but also there was a reasonable number who were
exposed by other means, including Gulf War veterans, delivery drivers and MAFF
inspectors. They all had identical profiles.
This gave us fairly compelling evidence that
organophosphate exposure and chronic ill health are causally related. The most
disabling chronic health problems are mood destabilisation (with devastating
results on the family); impulsive suicidal thoughts (research in Spain has shown
that the suicide rate in some areas of high organophosphate usage is twice as
much as the normal background rate); cognitive function disturbance and
difficulty in sustaining muscular activity. This latter aspect is totally
disabling when your principle job (as a farmer) is hard manual work.
Our final results from farmers in Cornwall and West Devon
were able to give a prevalence rating for this disorder. We found it to be
around 10% of exposed individuals develop the neuropsychiatric disorders l have
described.
I am not saying that this work is the same as Dr Jamal's -
it may be an entirely different mechanism of damage to that described by Dr
Jamal. There is no reason why peripheral neuropathy would affect mood. Also
other systems in the body are severely affected. I am not able to comment fully
on other’s work, but certainly there are researchers who are finding that bone
and heart are also heavily affected. Therefore the level of damage done to
the human body by organophosphates is much higher than previously supposed.
In the issue of Gulf War Illness, British troops were known
to have been exposed to diazinon, sprayed all around them as an insecticide.
French troops also in the Gulf War used synthetic pyrethroids instead to clear
bugs. There have been no cases of Gulf War Illness in French troops. There are
cases of Post Traumatic Stress Disorder (PTSD) in both groups and this is
related to their experiences. But the French troops did not suffer the same
chronic ill health as British and American troops.
A moratorium should be declared on the use of all
organophosphates until an accurate assessment is made of toxicity and the
mechanism of damage.
We have no treatment at all for this damage done, and a
priority is therefore to investigate the mechanism of damage more fully so that
we can develop a treatment.
Paul Tyler MP: In the last Parliament one of the
scandals was the way in which the MOD failed to give protection and advice to
the soldiers in the Gulf. When we were trying to investigate this, we were all
given misleading advice.
The case in respect of Gulf War Illness is still unproven -
but the fact is that the advice given to the users was not even as basic as that
given to the sheep farmers (and that is basic).
The advisory leaflet MS17 which gives information about
usage of organophosphates and safety requirements, including the use of personal
protective equipment, was not available to Gulf soldiers.
Elizabeth Sigmund: I would like to first of all
thank Paul Tyler who has been such an enormous help and has stood with us
dealing with this problem since we received the very first anecdotal reports of
the types of damage being caused by these chemicals. We also had the help of one
local general practitioner and one local Ministry official who had to help
anonymously. We now have a data base of over 600 people who have had a clear
history of exposure. We do not include in that data base anyone without this
clear exposure history. We produce a free newsletter quarterly and try to advise
on where people can get help and which specialists are interested in this type
of work.
There is no doubt that the effect on the family is complete
devastating. It is very upsetting when you see big, strong independent farmers
who are crying with despair.
The Countess of Mar has also been a great help. She was
exposed to organophosphate herself, but thank God she was (although I wouldn’t
wish that on anybody) but she can understand so well because she has been in the
same situation.
It is very difficult for farmers to get the assistance they
need. The Health & Safety officers are not very helpful. Farmers find it
difficult to explain the full extent of the problem to the Health and Safety
Executive, to the MAFF and even to their own general practitioner because of the
effects of the organophosphate poisoning itself.
Now we have the recent six successful legal cases {there
are six because the case in Australia involved three individuals). Bob Shepherd,
the case against the Agricultural, College, settled out of court. The three
sheep shearers in Australia was successful, the Phillips case in Hong Kong, and
the first case in this country which was that of Mr Hill.
What is worrying about Mr Hill's case apart from the damage
that it did to him, was that the organophosphate was being sprayed on grain
stored in a grain silo. This was going to be used for human consumption. Even
organically grown wheat may be sprayed when it is stored or on its way to
processing.
There is a very high possibility of multiple exposures to
these chemicals. They are used so widely. There is also a possibility of genetic
damage with many children of, sheep farmers badly affected. This may be due to
damage being passed down to them by their fathers, or it may be due to their
proximity to the sheep dip or a mixture of both. It is difficult to say.
Headlice treatment exposes many children to
organophosphates. We should think especially of the exposure of a mother of a
large number of children, say four or five, which is not that uncommon nowadays.
She may be treating the children for headlice every few weeks.
The main absorption of malathion is through the skin, it is
applied to the hair and scalp and left on for hours and often overnight. It is
in direct contact with the skin for all this time, and yet toxicologists tell us
that the most common method of absorption of these chemicals is through the
skin. Doctors are told that malathion is safe, and this information is passed to
the parents.
There is so little information, and there is nowhere for
victims to go. It is almost like a science fiction story.
Many victims find it very difficult to get financial help.
Bob Shepherd was lucky in that he was able to obtain industrial injury benefit
because he was an employee this is the mad anomaly. If you look at the DSS
leaflet NI 2 it states that Industrial Injury Benefit is available only for
employees.
Section C (3) specifically relates to injuries caused by
exposure to organophosphates, and it lists farmers and growers in the list of
people most likely to be exposed. Farm workers and anybody else employed to work
on farms can claim this benefit, but farmers themselves are excluded. This is
not just a temporary benefit, this is a financial benefit that is given for life
because of severe incapacitating injuries.
Douglas Hogg said that this was jolly unfair and promised
to look into it. Unfortunately he then lost his seat and as far as I know
nothing more has been done.
If we go back to 1951, Lord Zuckermann was the Chief
Government Chemist at the time. He was asked by the MAFF to look at chemicals
and their effects. Lord Zuckermann recommended vital action regarding
organophosphates. He called for.
-
Accurate information given to doctors
-
Warnings to local doctors to be given before use of
organophosphates in the area
-
Weekly checks of acetylcholinesterase (AChE) blood
levels for workers involved with organophosphate chemicals
-
Urgent research to find safer chemicals to replace
organophosphates
This was right back in 1951 and these recommendations have
still not being fully implemented. There are a few lone voices who are trying to
push this issue forward.
Dr Brand, who is an MP, has confirmed that doctors are not
given accurate information, and are often not told that there can be long term
problems. The last document that was released relating to pesticide poisoning,
when looking at the issue of long term damage, stated:
"When these people who hold to the belief that they
have had .long term damage have tests done it is invariably found to be untrue
....
Statement by Department of Health Chief Medical Officer
This is a lie. Sufferers are in a trap, and it is a trap
that has been very carefully constructed.
If you look at the way farmers have to report serious
adverse events you can see what I mean. If a farmer has a reaction to
organophosphate, if he knows who to ask he will be given a form to report the
matter to the Veterinary Medicines Directorate (VMD). But because the farmers
are so ill they find it very difficult to fill in the form and get it back to
the right person.
A retired Welsh farmer who is present today at the back of
this room will tell you that getting through the battery of requirements of the
VMO just to report an adverse event was too difficult.
Even if he manages to get the report sent off, if he tries
to ring to see if it has been accepted as an adverse event he is told it is not
possible to give him information about that. He can get his local MP or general
practitioner to ring, and when they ask if this report has been accepted as an
adverse reaction to organophosphates, they are told that the VMD cannot give
them that information because it is a private matter for the VMD.
We must break the trap that these farmers are in, and we
must allow them to speak and to be listened to.
Miners have been Allowed to speak, and they are at last
being listened to.
The NFU have been dilatory in this respect. Five years ago,
the Chief Medical Adviser to the NFU said that if lawyers could give them good
cases of organophosphate poisoning they would take them up on behalf of the
farmers. This was done, lawyers put forward cases for the NFU to look at, but
they wouldn’t take them up.
(Comment from the floor - "they have been defending
cases instead! ")
Most of the farmers cannot get legal aid to fight a legal
case even if they have a low income. In many cases they are left without a job,
and because of the emotional strain and the illness itself, the marriages often
break up and they are left without a family too.
Questions from floor
Paul Tyler MP explained that there were a number of MPs
here from all over the country, including Northern Ireland, West Wales and
Scotland, because this was essentially a Parliamentary briefing for MPs.
Therefore, although there is a lot of interest and many people here, the first
questions are mainly for MPs please.
Countess of Mar, House of Lords: I have a
question down for Monday asking for a complete ban on the sale and manufacturer
of organophosphates. I have had an indication that the line that wi11 be taken
is that organophosphates are safe. I have two questions to ask the panel of
speakers, and these are relating to research being done.
Firstly can we have any further information on the MRC
funded research in conjunction with Newcastle, which is new medical research
into the effects of organophosphates, and secondly can anybody give me any
information about the galanthamine trial.
Dr Goran Jamal: Acetylcholinesterase plus neuropathy
target esterase together form less than 20% of the enzymes and proteins that
organophosphates inhibit and destroy in the central nervous system.
We think more research should be done on the remaining 80%.
They must have a function. They may be the underlying cause of the damage we see
after organophosphate exposure. Now that research into these aspects is started
to be done.
Even the effect of acetytcholinesterase, which we thought
was depressed for only a few hours or a few days, has been shown to be much
further reaching than that. Refer to the work of the Professor Peter Blain at
Newcastle and also work done at Porton Down and Southampton. Studies here have
been using very small amounts of sarin given to thirty volunteers who are then
followed up for 30 months (although it is surprising how they can persuade
volunteers to take part in this study).
It is often argued that there has to be a severe acute
effect to be able to produce chronic long lasting damage. We now know this is
not true. Most of the people studied had a mild acute reaction to the sarin, in
some cases this simply consisted of constricted pupils.
However, more detailed tests showed that there was a
decreased level of acetylcholinesterase it the junction between the nerves and
the muscles 30 months after the exposure.
This explains the sensitivity at reexposure that many
suffers report. Because synapses have been affected in this way, they are primed
to be super sensitive to further exposure.
In 1992, Dr Martin Johnstone, ex Porton Down and MRC, said
that he believed a number of other enzymes could be damaged by organophosphates.
He said that if it was not for the fact he was at the point of retirement and if
he had the funding, he would be looking more closely at these other enzymes.
This demonstrates that one of the Chief Government
Scientists knew that there was a problem with the wider effects of
organophosphates, and that this had not been adequately researched.
Dr Robert Davies: Detoxification of organophosphates
relys upon enzymes such as paroxonase, which releases alkyl groups. There are
also a wide variety of other enzymes involved.
Most agricultural organophosphates are thions, in that they
have a large sulphur atom which prevents them inhibiting acetylcholinesterase.
However in the liver, cytochrome P450 system oxidises
thions which then allows these chemicals to inhibit acetylcholinesterase. Low
paroxonase activity and a high thion oxidation leads to a highly vulnerable
individual.
On the question of galanthamine, evidence is not fully
available. It is an experimental, drug used as a cholinesterase inhibitor.
Reports are that the drug is being used in treatment of chronic fatigue
syndrome, although the rational for this escapes me.
Shire Pharmaceuticals is one company who is involved in the
manufacture of this drug.
The CDC (Centre for Disease Control) cites
acetylcholinesterase inhibitors as causative agents of this type of illness.
Unless you sign the Doctrine of Signatures (treating like with like) it would
seem to be entirely the wrong treatment. I cannot comment any more, on this
drug, although I am told that it is very different from organophosphates. I know
that procycladine depresses levels of acetylcholine and this gives a
"buzz", whereas elevated levels of acetylcholine leads to depression.
This may be the mechanism involved.
Professor Andrew Watterson: Another thing that
should be mentioned is immunotoxicity of organophosphates. This has been in
literature recently, and has a bearing on the development of other diseases such
as cancers after organophosphate exposures. Carcinogenicity of organophosphates
is definitely being under researched.
In the United States, the environmental impact of toxins on
children is only just starting to be researched. Fenskey [unsure of spelling],
an Occupational Hygienist, looked at, toddlers in ordinary household situations,
and found that they were exposed to organophosphates widely. Mark Robson at
Ruttgers found organophosphates in children's toys.
Jaeger [unsure of spelling] from Shell said 25 years ago
that acetylcholinesterase inhibition will not tell you what is really going on
in the body in response to organophosphates.
The Chairman Paul Tyler MP asked for further questions from
members because of the shortness of time.
Teresa Gorman MP: The panel describe the
effects on people. What I am very interested in is are there any demonstrable
effects on animals? Also, what effects can this have on young people, and in
particular is there any link between exposures to organophosphates and new
variant CJD.
(This question was referred to Dr. lan Gibsen MP) There
will obviously be an opportunity for answers to be given to these questions on
Monday. Regarding cancers I would like to know details and information on
cancers occurring after organophosphate exposures.
Christopher Gill: Like Teresa Gorman, I am also
interested. in possible effects on animals, particularly on cattle and the
possible link with 8SE, Do the panel have any information about this link?
Elizabeth Sigmund: There has been a lot of
discussion about this aspect. One person who is very interested in this is a
very senior retired veterinary officer, Mr Fowler. I myself have two rooms full
of documentation and papers that show that sheep are not particularly
susceptible. There are of course variations according to breeds. Sheep are sent
to slaughter fairly soon after dipping, and so in these cases there wouldn’t
be enough time for the full symptoms to show.
Regarding BSE, organophosphates are of course used
extensively on sheep, and it is in sheep that this type of illness first started
in the form of scrapie. Now we have BSE in cattle. However the situation is not
at all clear, because we have had vast use of; organophosphates in some
countries, where despite the high amounts used they have no instance of BSE.
Therefore there must be some doubt over this possible connection.
Dr Goran Jamal: Organophosphate effects are species
specific - this is quite obvious - and it is why we use the hens test to examine
toxicology of organophosphates in humans. It was felt that hens have the closest
response to the physiological response of humans. Regarding the link with BSE -
I am cautious. More work is being done at the moment relating to the blood brain
barrier. That Israeli group is also looking to see if a viral agent can cross
the blood brain barrier by an increased order of magnitude under stress in the
same way that toxins can increase 100 times more easily when the subject is
stressed.
As a prion is similar to a virus, we should consider its
transmission too. Certainly there are teratogenic effects and genotoxic effects.
The study referred to, in Norway, was, carried out on a quarter of a million
pupils and showed an increased risk of cancers in the children.
Paul Tyler: I am a total non-scientist and I am
coming from that angle. We know from our constituents, and from our own
instincts, that BSE became an epidemic in the way that it did because of an
increased susceptibility of some sort. It seems almost inconceivable that
organophosphates would not make cattle more susceptible.
Countess of Mar. There is some anecdotal evidence,
although I must stress it is anecdotal only, that farmers treating cattle with
organophosphates noted that light coloured Fresians that were affected collapsed
and died very rapidly. Genetic susceptibility in cattle is also quoted in
Timothy Mar’s book Toxicology of Organophosphates and Carbamates.
Bob Smith: One speaker mentioned French troops being
able to use synthetic products to control insects in the Gulf War. Does that
mean that there are alternatives to organophosphates?
Dr Peter Brand MP (Isle of Wight): There are indeed
a whole series of other pesticides that can be used. I’m very concerned at the
poor standard of post marketing surveillance on organophosphate used on animals
and people. At an adjourned debate, the Minister promised something like a
Yellow Card warning system, as we have with medicines, so that every slight
adverse effect is recorded.
Second issue is that there is a tremendous amount of
experience and expertise in the VMD but it is not used properly.
Dr Robert Davies: Regarding the effects on animals,
there are many anecdotal reports; of the effects of flea treatments in
domesticated animals causing severe behavioural problems, although these have
not been reported as occurring in sheep to the same extent. Perhaps this is a
case of those animals who lead "emotionally rich lives" suffer more
severely from behavioural problems after organophosphate exposure than those
leading "emotionally dull lives" such as sheep.
Professor Andrew Watterson: Synthetic pyrethroids
are an acceptable alternative to organophosphate sheep dips. However there are
serious concerns about these chemicals as a cause of water pollution. >From
the Occupational Health and Environmental Health point of view, they could be
seen as hazardous. We should be looking more fully at an integrated pest control
to minimise the use of any of these chemicals.
The chemical input to sheep farming on organic farms is
different because they very often do use synthetic pyrethroids, and are
therefore not fully organic but do avoid organophosphates. Also there is
considerable research going on into injectables that we could use to control
sheep scab. As regards reporting of cases, Goran has 600 cases, but the Health
and Safety Executive says only a dozen or so are affected.
Dr Goran Jamal: I can confirm that the
French troops in the Gulf War did use synthetic pyrethroids. I have visited
France myself and met the medical officer in charge of the troops who went out
to the Gulf The French did not use pyridostigmine bromide, and not even very
much synthetic pyrethroids were used. With my hand on my heart, I can say that
French troops were not exposed to risks in the same way that UK troops were.
However there are two problems with synthetic pyrethroids:
-
They stay in the environment longer.
-
Studies in Duke University North Carolina have shown
that synthetic pyrethroids alone are safe to use up to a certain level, but
when used in combination with other chemicals previously safe levels become
unsafe. This is a very important factor.
Farmers use a wide variety of chemicals. We need to
radically rethink how we assess the risk of using these chemicals. In a lab the
risk is assessed when chemicals are used on their own in laboratory controlled
conditions. It is obviously going to be altered when used on farms.
The official view is that there have only been 68 cases of
severe side effects since the beginning of the cases being reported. There are a
few points to make about this:
-
The same people who decide which cases are officially
reported are the same people who don’t believe that there is this damage
anyway.
-
It is decided on a very cavalier basis. None of the
cases are fully investigated and despite this a lot of them were not
officially recognised as adverse events.
-
There is a question about Dipper’s Flu. In the BMJ it
has been reported in the past that up to 30% of farmers report this illness
after sheep dipping. It is well known amongst farmers and even their general
practitioners. But when you look at the symptoms of Dippers Flu, you can see
quite clearly that this is a classic acute mild/moderate poisoning by
organophosphates.
The MS17 leaflets produced a detailed list of symptoms of
organophosphate poisoning and the leaflet also says that organophosphates can
penetrate personal protective equipment (PPE) and can cause damage. When the
Countess of Mar asked who the MS leaflets were designed for, the answer was that
it was never meant for doctors, it was meant for MPs. Then there was confusion,
and eventually they admitted that the MS17 was actually designed for factory
workers.
The Health and Safety Executive gave funds to the Institute
of Health, Birmingham to perform cognitive impairment study on sheep dippers.
The results showed that there was definite probability that organophosphates
were causing this. Although Professor Harrington, the author of a paper on this
study, did not have his work fully accepted here, his paper is now
internationally acclaimed.
The MS17 was also the document that was never drawn to the
attention of the MOD when troops were sent to the Gulf War, until it was too
late.
Miles Clark (Isle of Wight): I represent three
serious cases. We have tried to get an early day motion on this subject. Health
and Safety Executive and MAFF investigating anything is what the Police would
call " attending an incident". One case I know of was sprayed in his
back garden on 6th June, became acutely ill and had to be hospitalised.
Peter Brand called for an early day motion. Will you [to
Paul Tyler] be saying that acts relating to HSE are not sufficient. The Minister
said an inquiry had taken place, but this hasn’t happened.
Paul Tyler. I know an Early Day Motion will be
influential but the most effective way has to be through the Government. If we
have to wait for a private members bill it would be impossible.
Stephen Hodges, University of Sheffield: With
colleagues we have met with a number of difficulties in trying to undertake
research into this issue. I have established genetic tests, but was refused
funding by the MRC. Members should try to find out what has happened to MOD
money which was given to the MRC to fund research into this type of problem. Why
has it been ring-fenced?
Paul Tyler. We will try to find out more information
about that.
Peter Tyrer: I am an Animal Health Officer. Relating
to the earlier questions about effect on animals, we had reports of a lot of
problems with sheep who have been dipped in Coopers 2000 dip. They had terrible
side effects, coming out of dip like drunken sailors, often having to be lifted
out bodily and others simply jumping around up on their hind legs, completely
uncontrollable. If you asked MAFF for animal adverse event forms, you found that
nobody was aware that there were forms for adverse events in humans.
Steven Hodges, University of Sheffield Relating to the link
between organophosphates and BSE, the so called "Purdy theory after Mark
Purdy who brought it to the media attention. Professor Ebringher of King’s
College suggested that BSE is possibly immune mediated. Organophosphates could
be reducing the natural bacteria in the cattle which neutralises bacteria on
green offal. Green offal was previously well cooked, but when temperatures were
lowered in the rendering process, bacteria could survive. Because of the reduced
ability of the cattle to fight them, they could get a hold. This work should be
drawn to the attention of the committee.
Dr Robert Davies: This question is not just about
the organophosphate use in the UK. There is a onus of responsibility on the
British. Government because of its overseas aid. The General Accounting Office
(GAO) of the US say that we are in the UK are ahead of the states in research
into OP damage.
On March 16th it will be the tenth anniversary of the
gassing of the Kurds any agreement that our Government has entered into with
Saddam Hussein should include a provision for UN driven and protected research
on the aftermath of sarin gassing on the Kurds. We should not lose this
opportunity.
Paul Tyler MP: I would like to make one final point and
that is that we shall make sure that MPs are fully briefed for the next time
that we see Jack Cunningham. We know that he has raised this to the highest
priority. One advantage he has is his knowledge of the scientific background to
these cases.
Meeting ended at 1 pm. Notes taken by Kirsten Limb,
Dawbarns.
Well Mr. Helliker, I believe
that a moratorium should be declared on the use of all of your
"registered" POISONS until an accurate/unbiased assessment can be made
of their total toxicity and the mechanism(s) of damage.
To me the continued use of these dangerous POISONS is premeditated
murder. You decide what is an
"acceptable risk' and then you allow the "registered' POISONS to
legally go out kill and maim and sicken whoever "they" want. If a sniper sat on a bridge and killed one out of a million,
the sniper would be indicted for premeditated murder - even if the sniper did
not know the victim(s). When you
consider that there are many safe and far more effective alternatives --- the
continued use of your "registered" POISONS for profit is even more
heinous.
Respectfully,
Stephen L. Tvedten
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