还参加此简报的还有Rand Corporation的Ross Anthony博士。
Doubleday上尉：下午好。
This is a special briefing with an individual who I think is well known to most of you. Dr. Bernard Rostker is the Under Secretary of the Army and also our Special Assistant to the Secretary and the Deputy Secretary for Gulf War Illnesses.
He is going to give an update on the Department's continuing efforts to investigate and to gain greater understanding of the illnesses which afflict so many of the individuals who served during the Gulf War.
He's brought with him part of his team of experts to help out with the briefing, but Dr. Rostker will start first and then turn it over to other experts for more on this, and then we'll be happy to answer some of your questions.
罗斯特克博士？
罗斯特克博士：谢谢迈克。
今天，我们发布了由我的办公室和兰德公司准备的案件叙述，该案件与我们签订了合同，以执行许多分析任务。我们正在发表两篇论文。第一篇关于尚未获得FDA批准CW/BW检测的药物使用的论文。这是有关科学文献的重要论文，因为它与海湾战争疾病有关，而这里的话题是枯萎的铀。
I'd like to spend a few moments talking about the cement factory case. This is the 14th case narrative describing the potential uses of chemical weapons during the war. This particular case narrative deals with a reported chemical incident in which two Marine Fox vehicles alarmed for a chemical agent. It's an important case because it's the first example where actual soil samples were taken and where Fox, at least one of the two Fox vehicle tapes have survived.
The results of the soil samples were analyzed within weeks of their being taken. They were analyzed here in the United States and they both showed no indications of chemical agents. They did show residuals from hydrocarbons and diesel fuel, and those are properties that could have caused the false alarm.
Unfortunately, when the samples arrived in the United States, it was noticed that they were no longer airtight, so it is possible that there was some evaporation of substance during its shipment. For that reason we can't be perfectly sure that there were no chemical agents at the time the samples were taken, but there certainly were no chemical agents when the samples were analyzed, there were no residuals or breakdown products from chemical agents.
两个福克斯汽车磁带被。他们have not been located in government archives, but one of the tapes was duplicated by the Fox vehicle driver. That tape has been analyzed by two independent laboratories and again, it shows no indication of chemical agents. The indications are consistent with the assays from the soil sample.
We made the judgment that it was definitely, the site was definitely not a chemical fueling site for mines because no chemical mines have been located, there's no indication that the Iraqis had chemical mines.
In terms of chemical agent we've made a determination that it is unlikely that there were chemical agents there. That's based upon the samples. We could not be totally sure because of the inability to preserve the samples in a pristine manner, in an airtight container, and the missing Fox tape. But all of the evidence that is available points to the conclusion that chemical agents were not present.
This is an important case because it also illustrates one of the main lessons I think to be learned from the Gulf. These findings were never communicated back to the Marines who made the initial detection. In fact upon their inquiry during the Gulf War period they were told they didn't have a need to know. That's very unfortunate, and we have been stressing with the Chemical Corps the importance of documenting all alarms, whether it's later determined to be false or not, and preserving all of the evidence and providing that feedback to those who were engaged in the possible detection of agents.
We found in a number of cases where this has not been done it's resulted in suspicions, it's resulted in reports that later have been determined not to be chemical agents, but it's important that we provide that follow-through and we'll continue to work with the Chemical Corps and the services to ensure the change in doctrine.
I'd like to introduce Dr. Ross Anthony from the Rand Corporation who will talk about these two papers which Rand is releasing today.
兰德一直在为我们进行许多分析研究。我认为可能最重要的是那些与对科学文献的审查有关的，这些文献与海湾中无法解释的疾病的一些可疑原因有关。众所周知，枯竭的铀一直是一个令人关注的问题，安东尼博士准备总结兰德的发现。这些报告ReportsReports可用，兰德或我的办公室都可以进一步询问兰德今天提出的发现。
Ross?
安东尼博士：谢谢你，罗斯特克博士。
我很高兴今天在这里释放兰德 - 对于那些不知道的人，兰德是一家非营利性研究所，致力于公共利益。今天，我们宣布Rostker博士已经表明的两份报告发布。ReportsReports
I am the principal investigator on all of the reports, and if you look on the second page of either report there is a whole list of the entire list of projects. As such, I'll try to summarize briefly the reports, but I am not the primary author on either report. If there are any other questions that need to be followed up on, I'd be glad to get you answers to those.
We actually have engaged in two kind of separate categories of reports. One is the scientific review of the literature which depleted uranium fits into that category and I'll talk about that second. There are eight of those reports. Then there are a set of other reports on other issues, more policy oriented. The first report which we'll talk about is the military use of drugs not yet approved by the FDA for CW/BW defense. That report by Dr. Dick Rettig reviews in essence the history around the relationship between the FDA and the Department of Defense when the Gulf War began to, in essence, allow for the use of, in this case, two specific investigational new drugs -- PB and the BotTox vaccine.
There was an interim rule that was approved allowing for the waiver of informed consent so that those products could be used during the Gulf War. But frankly, that regulation, once the war was finalized, lay dormant for some time. There was a lot of discussion back and forth which the report goes into in great detail. Finally, in 1997 another rule was, at least a publication of a rule for comment was put out to finalize the rule. The discussion was reactivated.
Frankly, the whole discussion revolves around who has the authority to order the use of these drugs. Is it the FDA under the Food, Drug and Cosmetic Act? Or does the preeminent power lie with the President of the United States as the Commander in Chief of the military?
实际上，该问题是在去年所谓的伯德修正案中最终确定或至少由国会决定的。如果您在第97页的文本中查看，则有一个有关该文章的后录。现在，美国总统拥有当局。但是，该机构在第98页上列出了许多条件，包括书面命令，以提出获得该同意的理由，包括做其他事情不可行，这是不可行的，这是不违反的成员的最大利益，这是为了国家安全的利益。
尽管该法律已经通过，但在法规中尚未正式化，因此我们认为这份报告非常及时，并提供了很多信息和历史意义，以帮助人们提供有关这些问题的信息。乐动冠军
The second report's on depleted uranium, and I'm listed as a fourth author there. I'm an economist, as Dr. Rostker indicated. But as we started to look at the issues around depleted uranium, it quickly became apparent that there were two primary areas of concern. One of the radiological effects of uranium; and secondly are the toxicological effects. So we at Rand decided that we needed to get expert help and assistance in putting together this report and went out to find some experts that were recognized, but also who had not, in addition to being recognized, had not written extensively in the area so that they were thought to be biased on one side of the equation or the other.
Naomi Harley is the radiology expert, and Dr. Ernest Fooks is the toxicological expert. You'll find at the end of the report on page 119 there's a short biographical sketch of each one if you're interested.
除此之外，我们认为以医生的形式获得医学专业知识很重要，因此Lee Hillborn博士也是作者。他是兰德（Rand）的长期研究员，他还是加州大学洛杉矶分校（UCLA）的医生，负责UCLA医疗中心的质量。
Arlene Hudson did much of the research, while I, as the fourth author, primarily pulled together reports, made sure that all the parts were consistent. Oftentimes there were small differences, and we wanted to be sure that we had a report that represented all of the scientific literature.
What we did is we tried to review in an impartial way the scientific literature as relates to depleted uranium and come up with whatever conclusions seemed appropriate.
首先，我可能会表明，关于枯萎的铀的文献并不是很棒，但是关于自然和富集的铀的文献确实非常多产，这很重要，因为在天然铀的毒理学作用的情况下，它与枯萎的铀完全相同由于它们的化学特征。
On the other hand, in the case of the radiological effects, you find out that natural uranium is 40 percent less radioactive than depleted uranium, so any conclusions that you can draw on natural uranium, say of a negative nature, can be applied equally well to depleted uranium.
Having said that, let me briefly outline the structure of the report, and then I'll try to summarize quite briefly the conclusions, and I'd recommend the entire study to you for further details.
What we did is we looked at the radiological and toxicological effects by the various routes of exposure. And in this case there's external exposure; and secondly there's internal exposure. In the internal exposure category you actually have either ingested, inhaled, or embedded fragment exposure. The report deals with all of those cases, and also takes a look at a few other issues like the effects on reproduction, for instance, also.
Let me try to summarize the conclusions briefly and quickly, and I'll read at least one of them from the text so I'm sure I quote the authors accurately.
In the case of external exposure, really we're only looking at the radiological effects. We don't really have any toxicological effects to look at. You find that the primary particles emitted by depleted uranium are alpha particles. They do not penetrate the skin. And all of the studies indicate that they really have not been found to be a negative health problem.
在内部暴露的情况下，让我首先处理毒理学影响。在摄入或吸入的暴露中发生的情况，最终的一些颗粒或枯竭的铀到达血液，研究发现最重要或目标器官是肾脏。因此，我们感兴趣的是，作为最大程度受到影响的器官，肾脏可能会发生什么影响。我们在研究文献中发现，尽管在很高的水平上，任何重金属都会对肾脏产生影响，但我们没有发现海湾战争中可能的接触水平，但文献中有任何后果从毒理学的角度来看。
On the radiology side, actually the findings were similar. At the levels we see in the Gulf War we did not find that the radiology would have any real effect.
I'd like to read one quote that I think puts both of those in context a bit, and explains why in fact you do find that. I'm reading from page 18 of the summary of the text. "Although any increase in radiation to the human body can be calculated to be harmful from extrapolation from higher levels, there are no peer-reviewed published reports of detectable increases of cancer or other negative health effects from radiation exposure to inhaled or ingested natural uranium at levels far exceeding those in the Gulf War. This is mainly because the body is very effective at eliminating ingested and inhaled natural uranium and because the low radioactivity per unit mass of natural and depleted uranium means that the mass of uranium needed for significant internal exposure is virtually impossible to obtain."
这样做的原因是，身体在摄入或吸入的东西方面非常有效并摆脱它，因此实际上您需要的水平或您需要吸入或摄入的金额才能获得毒性剂量真的很高。
Now let me turn to the final category which is embedded fragments. And the case of the Gulf War is the first time we've really seen evidence or had evidence to research of embedded fragments. There's an ongoing program right now at the Baltimore VA Medical Center to look at 33 people that have been identified as being in vehicles that were struck by depleted uranium munitions, and I believe 17 of those people actually have embedded fragments.
他们have been studied quite extensively by Dr. Melissa McDiarmid and her team, and if we look at them as the most exposed group we find that they do have elevated urine uranium levels, and that there are some other tests that she cannot fully explain, and that these people do have some significant health effects as a result of their wounds. But when one looks at the actual effects of depleted uranium, one finds that there is neither toxicological or radiological negative health effects that she's been able to identify.
因此，考虑到这一点，我们相信并在我们的报告中得出结论，我们认为研究应该继续在这个问题上，尤其是在嵌入式片段问题的情况下。主要是因为这是一个新领域。我们不知道那里的一切都知道，我们认为研究应该继续进行。同样，这是退伍军人的真正关注点，如果实际上还有其他研究会增加问题的其他研究，我们不应该留下任何坚定的石头。
That pretty much summarizes what I have to say. I'd be glad to take any questions, and I know that Dr. Rostker wants to indicate a bit about some of the follow-up training programs that they're doing at OSAGWI.
问：我对铀有一个问题。从本质上讲，这本质上是否认为枯竭的铀是这种海湾战争综合征的潜在原因？这就是退伍军人团体代表，他对此表示了简短的说法。
Dr. Anthony: It means, and I'm going to stick to our charge. I want you to understand what my charge is. My charge is to look at the scientific literature, and we're combining that, at least Dr. Rostker's office is combining that with what actually happened in the Gulf War, and you have to bring those two pieces of evidence together. Sometimes one outweighs the other one. But at the levels of exposure that I'm aware of, and unless there's something that I'm not aware of, the scientific literatures does not find that there is a negative health effect. You can draw the inferences that you wish to, but that is in fact what the scientific literature has indicated.
Dr. Rostker: We had a statement that has been reviewed by the President's Special Oversight Board, it's on page 10 of our original case narrative, and let me read you that one sentence. "Based on data developed to date, the Office of the Special Assistant believes that while DU can pose a chemical toxicity and radiological hazard under specific conditions, the available evidence does not support claims that DU caused or is causing the undiagnosed illnesses some Gulf War veterans are experiencing." So that is the position we've taken.
Q: That's on the report...
Dr. Rostker: Page ten of this report.
安东尼博士:我可能会增加,在某种意义上你houldn't be surprised by the findings in the Rand report. They are consistent with every other group's that I'm aware of, whether it's the Institute of Medicine, the British have put out a recent report, and a number of other groups have reached similar conclusions.
我们认为这是一个有用的文档，因为它将所有信息都在一个地方提取，并试图以一种对退伍军人和科学界可以接受的方式提出，但这并不是，从本质上讲，它与我们以前的见解并不矛盾。
问：您能告诉我们更多有关33个人带有嵌入式碎片的人吗？
Dr. Anthony: What would you like to know?
Q: Who are they, where do they come from? Is it listed in here?
Dr. Anthony: It's not. There is a small... We've primarily dealt with the published peer-reviewed literature, and although we have included that information because it's obviously quite important, but there has not been much of a published record so far, so all the results, although we did give the VA an opportunity to review this so they were sure we quoted them correctly, I think you have to keep in mind that anything that's in this publication actually is preliminary and subject, of course, to the changes that they find.
我没有花很多时间这样做，但是我认为还有其他一些，也许Kilpatrick博士或Daxon博士更熟悉那里发生的事情，如果您愿意，可以为您提供更多具体的信息。
Q: Yeah. Who are these 33?
罗斯特克博士：这33位是涉及友好消防事件的士兵。
Q: Do you have a list of their names?
Rostker博士：我们当然会这样做，但是由于隐私考虑，它没有可用。
Q: What's the privacy considerations? Have they asked they not be identified?
Dr. Rostker: Under the law, they constitute a requirement that we not make that information available. You're welcome to contact the VA in Baltimore. They're the ones who are running the study. If they want to make those names available...
Q: Did you make them available to the Rand Corporation?
Rostker博士:没有。他们审查,采访了博士。McDiarmid and have talked about her findings. They have not discussed individual medical cases with Dr. McDiarmid. That would not have been appropriate.
Q: Do you have a list of these incidents where it happened?
Dr. Rostker: The incidents are in this case narrative. They constitute the tier one incidents. We've extended the medical program to all tier one soldiers and all those engaged in cleanup that would have been exposed, those are tier two. They have all been... We've attempted to notify every one of them. Most of them have been notified and some group of them have gone to local VA or DoD hospitals to participate in the medical screening. That screening program continues. Dr. McDiarmid, completely independent of the Department of Defense, is the prime investigator. We've done everything we can to support her investigations.
Q: Seventeen of these 33 have...
Dr. Rostker: Embedded fragments. These are very small fragments that are too small to be removed surgically.
Q: But they're radioactive?
Rostker博士：它们被枯竭，尿液中有17个铀数量升高。
We can provide more information, and let me get one of the experts.
Col. Daxon: This is really a good news story because it's something that the Army basically initiated on its own to try to follow these veterans up. It was identified in theater that this follow-up should take place, and the Office of Surgeon General started the follow-up.
We basically transferred the program to the Department of Veterans Affairs. I really don't know the timeframe, but I can get it. So that they would follow them.
逻辑的一部分是退伍军人事务部将在我们很多人完成后成为我们很多人的家，因此我们希望这种连续的护理。另一部分是巴尔的摩的人们非常好。
Q: The 17 have radioactive particles in their bodies now?
Col. Daxon: As do we all, but yes, they have embedded fragments.
Q: I mean they have a little more than I do, I think.
上校Daxon:是的,先生。
Q: What are these levels? Is it in this report?
上校Daxon:是的,先生。这是。
问：您是说这不是有害的吗？这是结论吗？
Col. Daxon: The direct conclusion that we got from the folks at the Baltimore VA, is that right now we should use standard surgical removal procedures for removing fragments, which means in terms of balancing the risks of surgery versus the risk -- which is really what you're talking about -- of allowing these fragments to remain, at this point in time the risks are comparable to lead, steel, and other shrapnels in the body.
问：这17个，您是否权衡过这些决定，发现您无法手术删除这些碎片？
Col. Daxon: Absolutely. The first time I heard about this my initial response was take it out. But when you see the X-rays, and it's not just one, but it's like a shotgun shell. I showed this to a surgeon. His first response was, well, take it out. I showed him the X-ray. He said oh, now I understand. Maybe you could get that one, maybe you couldn't get that one. But each one of these, there's one individual where we counted anywhere from 10 to 20 fragments that range from very small to something maybe half the size of a pinkie. Each one of them is a separate surgical operation, to the point where if you tried to take them out, the individual would lose probably the use of his leg.
问：我对辐射的理解是它积累在体内。
Col. Daxon: Absolutely.
问：没有消除。那么这些碎片是否正在进行积累过程？
Col. Daxon: By accumulation, is the dose increasing with time? Yes, it is. And that's being considered in the decision to remove it all.
The thing to remember, I need to correct one thing, depleted uranium is 40 percent less radioactive than the natural uranium you all have in your bodies right now. That gets factored into dose equations and we basically include that as part of the risk of allowing these fragments to remain.
问：您能否对这17个投影毒理学影响？
Col. Daxon: No, I can't project it, which is part of the reason that we're following it. Based on the stuff that's been in the past, the level that they're excreting in their urine are such that we don't anticipate any effects on the kidney, and that in fact has been seen so far for this particular population, and we don't anticipate any radiological... I shouldn't say that, but the risks, the radiological risks are within acceptable ranges at this point.
Q: What would be threatened initially by even these low levels? The lymph nodes or...
Col. Daxon: Low level of radiation or the chemical part?
Q: What part of their bodies are...
Col. Daxon: The kidneys. Chemical toxicity is the primary thing we're talking about.
安东尼博士：他们会随着时间的流逝而溶解并在体内循环并部分排泄，但是肾脏是最容易受到影响的部分。
Col. Daxon: And there are some very specific tests that can be done to determine. What we found is the kidney is exceptionally robust, even with occupational exposure for very, very high levels, much higher than we have right now, the kidney has basically recovered.
Q: What's the prognosis on the 17 men?
Col. Daxon: I really can't answer that. Dr. McDiarmid can. But right now I believe it's pretty good.
Dr. Rostker: In terms of radiation, these are men who survived a very traumatic event, being their vehicles were hit with depleted uranium rounds. They are, frankly, lucky to be alive. These are extremely lethal weapon systems which have given us a tremendous advantage on the battlefield. So the soldiers we're talking about here have first and foremost battle injuries that are not directly related to uranium per se, but are related to their vehicles being brought under fire.
In terms of the radiation, there are no impacts to date. We continue to monitor them. Dr. McDiarmid continues to monitor them and we support that.
但是我要指出的是，这些是那些在友好的火灾或发生火灾事件中的人。海湾中的大量部队不在那种事件中。
问:33我们说阿布t are the most intensely affected by DU.
Dr. Rostker: That's correct.
Q: Then you have a body of mechanics, welders...
Dr. Rostker: Right.
Q: What are the total population...
安东尼博士：我只想添加另一件快速的东西。现在，已经有与人类研究不同的动物研究，试图重复嵌入动物的碎片以查看，以试图测量您提到的一些毒理学或放射学效应。在级别上，如果您尝试...再次进行这些比较有点困难，但是在到目前为止测试的水平上，直到您获得非常非常高剂量的情况下，似乎没有真正的高负面影响。
问：您现在为DU的总人口是多少？在您的数字中，参与其中的人数吗？
Dr. Rostker: I'm just looking for the table. It goes to the issue of the various bands or tiers. It's several hundred involved in either the friendly fire incidences or the cleanup, and it's some place in this report. I just can't put my... Each one of those people have been notified, or we've attempted to notify but we've not been successful in every case, but multiple phone calls, letters. They've been invited to come in to take a urine, 24 hour urine test to see if there's an elevated urine, and then with the appropriate follow-up.
我还要补充一下海湾战争中的任何士兵都担心枯萎的铀，我们欢迎他们参加测试。它对所有人都开放，因此我们不包括任何人。
Q: But that's sort of a key figure to journalists, is how many people are involved here.
Dr. Rostker: It's in here someplace. We can search for it now or after.
问：另外，如果不在这里，如果您可以将其详细说明。显然，在体内拥有它的人受到最严重的影响。
Dr. Rostker: Correct.
Q: The people who are on the outside of it... So we should be able to have a statistical picture...
Dr. Rostker: We do. On page 23, for example, this is a list of all of the Army units, type of vehicles, the incidences, and that's the 113 who are on tier one.
Page eight... This page here, Pat, is the various levels, the numbers involved, what we believe the exposure duration was. And we are looking at calling in the tier one and most of the tier two people.
这两个都将帮助我们理解其体内是否还有其他枯竭的铀碎片 - 这些人是围绕它工作的人 - 或者是否有其他手段诸如Intestion之类的残留铀，并以某种方式继续被污染。有人认为这是一个问题。
Q:...airborne uranium in these battlefield things? Is it brief, longer than we would think?
Col. Daxon: Brief.
Q: Seconds, minutes?
Col. Daxon: Yes, it sort of depends on the scenario, but the levels, we've actually measured levels around tanks during tests, and what we found for the airborne stuff is greater than 50 meters away from the vehicle the levels are just well below any of the standards in terms of allowable concentrations of uranium.
The stuff does settle out. You hear a lot of folks say that depleted uranium travels great distances, and that's true. Some of the particles are small, they do travel great distances. But there's not that much of it that makes it there. The majority of the stuff is relatively heavy and does settle relatively close to the vehicle. But after it's struck, or even in a fire. But the smaller particles can travel far, they can be detected, but they're not of concern. The amount, which is the focus of this, the amount of these particles, the number is so low that after 50 or so meters it's very hard to even detect.
Dr. Rostker: We have actually, in concern for force protection last year when we were sending troops, potentially sending large numbers of troops last January back into the Gulf, we had the environmental health people draw soil samples all over Kuwait in battle areas and the like, and only one area had samples shown above background. That was at the boneyard where all these vehicles were collected. They took a sample in the rain catchment areas where rainwater would have washed down. That sample was elevated, but at a level that was one-third that with which EPA would allow us to return the land to general use.
问：我的印象很明显，许多被击中的美国车辆都返回了这个国家。
Col. Daxon: Correct.
Q: So what are you looking at? Iraqi stuff?
Dr. Rostker: Yes, a lot of it.
这是一个很好的过渡到我们正在进行的项目给我mprove depleted uranium training. We do this not because we believe that there is a hazard here that is acute and imminent to our soldiers' health, but we have a requirement and a responsibility to the NRC and to our soldiers to provide them with the best awareness training we possibly can. My office has taken a lead in coordinating this across the Department of Defense. In the Army, for example, it is one of the soldier common tasks that every soldier must be trained on every year. We've included that in that regimen.
我们还修改了训练，以使保护措施与极低的危险水平一致。因此，几年前我们的培训进入MOPP装备的地方，这完全不适合危险水平。现在，培训谈论您是否要乘片刻坐下来找回东西，然后放上手巾；而且，如果您是正在清理车辆的工人之一，那么像您在绘画中使用的工业呼吸器是防止不必要的摄入的合适方法。但是就像我们的油漆一样，如果您要在没有的情况下进行绘画，您就不会立即期望生病，我们不会期望那会是正确的，但这是正确，安全的方法，我们致力于确保对我们的士兵进行培训。因此，我们付出了很大的努力来确保我们做正确的事。
问：我对毒品问题有疑问。在现实世界中，我猜我们将使用法规的新法律是设计的...批评太多，以至于士兵们没有对此计划进行过批评。它是否旨在确保士兵有机会获得知情同意，但最多...我认为您提到了国家安全。在最不寻常的情况下？或该政策是为了做什么？
Dr. Rostker: Let me say that in this regard I'm the historian. I'm talking about what happened in the Gulf. The issue you raise is actively under consideration by Health Affairs, and the White House and National Security Council, because the President is now explicitly named as the decision authority.
他们're working on a policy. I don't know the details of that. We can get you that information from Health Affairs if you'd like, but I really am not qualified to comment on that today.
Q: So the finding of the study that was critical of, well, a lot of ways the policy was carried out...
罗斯特克博士：这项研究确实是为了帮助我们了解发生了什么。有很多讨论。1990年和1991年参加活动的许多人不再在国防部，我们委托这项研究主要是为了了解发生了什么。
The study comes out at a time, in a timely fashion and we have made sure that those who are building the new policy at the NSC and here in DoD at Health Affairs have this and they've told us that this has been very helpful to help frame the debate and understand all of the issues. But I'm really not up to speed on where they are in the development of the policy.
Q: Can you tell me if there is any experimental drug being used now for say soldiers who are serving in the Gulf region or even around...
Dr. Rostker: I frankly have no idea one way or the other. It's not something that I deal with.
If there are no other questions, thank you very much.
http://www.defenselink.mil/news/Apr1999/t04191999_t0415gwi.html