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1127 Organophosphates [LORDS] Organophosphates 1128 [THE COUNTESS OF MAR] health. Since then there has been progress and their acute effects are readily acknowledged. Many OPs have been removed from the market, while stringent instructions now apply to those that are still in use. But there is still no recognition of their chronic central and autonomic nervous system effects. Following close on the heels of the sheep farmers and other agricultural workers were some Gulf War veterans who reported very similar adverse health effects following medication with pyridostigmine bromide, a carbamate closely related to OPs, and exposure to OP nerve gas and pesticide sprays. Despite the fact that the US Research Advisory Committee on Gulf War Illnesses recently concluded that some 25 per cent of Gulf War veterans—25 per cent of more than 6,000 people—are suffering the effects of OP poisoning, the British Government persist in their denial that these same exposures have had any effect on our troops. More recently, airline pilots and crew have reported ill effects following exposure to cabin air contaminated by leaking engine oil that produces very toxic OPs when heated. In all these groups, scientific research has shown consistently that there may be a relationship between long-term, low-level exposure to organophosphates and the development of neurobehavioural problems. The first study of sheep farmers was in 1991, and the latest was published this year. As there have been very few reports of adverse reactions to OP sheep dips in recent years, it is fairly safe to assume that the problems are persistent. It is interesting that Dr Sarah Mackenzie Ross, who conducted the DEFRA-funded research entitled “Neuropsychological and Psychiatric Functioning in Sheep Farmers Exposed to Organophosphate Pesticides”, had to eliminate 60 per cent of possible subjects, all of whom were sheep farmers exposed to OPs, because they had other conditions. Among those eliminated were people with a history of acute exposure; those with a neurological condition such as Parkinson’s disease or multiple sclerosis; heart conditions and lung disease, all of which are associated with possible toxic causation. This means that those in whom she did find neuropsychiatric problems were likely to have been those who had the lowest exposure to OPs. When the Labour Party came into Government in 1997, Ministers from all the departments involved agreed that an interdepartmental group of high-level officials should be formed to report to Ministers on the continuing public debate over whether OPs damage human health. This was the Official Group on Organophosphates, also known as the Carden Committee, although I understand that Mr Carden has since retired. The group reported in 1998 and a number of its recommendations, including a research programme, were implemented, for which I am grateful. I understand that the group has met occasionally since then, the last time being 26 June 2007. As the minutes of its meetings are not published, we have no means of knowing the detail of their discussions. What is clear is that the science has moved on considerably since 1998. The Carden report gives at paragraph 2.2 a simple explanation of the manner in which inhibitors of acetylcholinesterase function, stating that: “In the case of most OPs and all medicinal and pesticidal anticholinesterase OP products the effect is either reversible or recoverable”. It also reminds us that some non-OPs are anticholinesterases and that they have similar toxicity to anticholinesterase OPs, to which I shall come later. There appears to be a genetic susceptibility to OP poisoning. It is recognised that cytochrome P450 enzymes, Paraoxonase-1 and butyrylcholinesterase play important parts in the detoxification of anticholinesterases. It has also been recognised for some time that there are flaws in the traditional methods of assessing exposure to OPs by measuring metabolites for specific OPs in the urine or measuring levels of red blood cell acetylcholinesterase. The scientific paper Identification and Characterisation of Biomarkers of Organophosphorus (OP) Exposure in Humans by Kim et al, 2009, details, “the development of rapid protocols for extraction of the target biomarker protein from a sample, digesting the enzyme and identifying the OP modified peptide by mass spectrometry”. The authors go on to state: “We feel these methods are optimal for filling the void of diagnosing and treating long-term exposures to several ubiquitous OPs”. In the UK, the Government have funded a few neuropsychological function studies and epidemiological studies of shepherds exposed to OPs. None of these has gone into the detail of the US research on sick Gulf veterans. The US neurocognitive studies found similar significantly poorer performance results on veterans who had been exposed to anticholinesterase chemicals to those conducted in the UK on shepherds. Six out of seven projects that evaluated brain structure and function using highly specialised equipment found significant differences between veterans with Gulf War illnesses and healthy controls, although they qualify their results by stating that additional research is needed. I could go on, and those interested in the detail will find it in the US RAC report of last November. In view of the fact that providing scientific proof has been a virtual impossibility for those who are suffering the effects of OPs, may I ask the Minister how many of the most recent developments have been accepted in the UK? I cannot express adequately the effect that the somewhat apathetic attitude of those who are responsible for ensuring our health and safety over the past 20 years has had. By failing to study individuals who report symptoms after more than a minute exposure to OPs in the initial stages and by failing to conduct longitudinal studies, they may well have exposed many sick people to at least a poor quality of life or at worst an early death. My own experience has taught me that there is an almost total lack of understanding of the life-threatening heart and lung function damage and of the effects of administering drugs that act on the acetylcholine system. The Health and Safety Executive’s leaflet MS17, Medical aspects of work-related exposures to organophosphates, warns of the effects of repeated absorption of small doses of OPs. However, I can find no warning to the medical profession of the effects of administering any of a wide range of drugs that may have a similar action. First-line drugs for bladder incontinence, asthmatic symptoms and
1129 Organophosphates [17 JUNE 2009] Organophosphates 1130 glaucoma are all in this group and the first two are, to my knowledge, also caused by OP damage to the autonomic system. Is the Minister able to say how much research has been conducted into the effects that drugs which act on the acetylcholine system have on patients who have reported illness following exposure to organophosphate pesticides? If he knows of none, does he agree that this is an important consideration for a large number of agricultural workers, Gulf War veterans and aircrew? Should this not be an urgent consideration? I have made a brief outline of some of the reasons why I believe that the Official Group on Organophosphates should reconvene. I have barely touched on recent developments in this field. I have asked that it should give the matter priority. I also ask that on this occasion it produces a report on the lines of its 1998 report. 7.41 pm Lord Rooker: My Lords, I support the noble Countess. Basically, the simple answer to her question should be yes. I am not going to go into all the background details because I am not as up-to-date as I was when I was one of the Ministers responsible in 1997-99 and then again from 2006-08 in one department, but the fact that this issue goes across departments is the central point that I wish to make. As the noble Countess has said, there has been progress. The lack of exposure today is a result of the work that has been done by the industry, pushed by our officials in the Veterinary Medicines Directorate, in producing better containers from which people could not by accident, irrespective of negligence, be contaminated. There is no question that this was a serious issue in the past. However, this means that no new people from farming are coming into the system for the doctors and the scientists to look at. As I say, the problem transcends that, but there has been stagnation. When we considered this problem in MAFF from very early on in 1997 and 1998, I had discussions with the then Minister, Jack Cunningham, who, with his background as a chemist, took it very seriously. We picked up from other departments that there were issues across government in regard to chemicals. Richard Carden—who, as the noble Countess said, has retired— would take some pleasure in seeing the Carden Committee reconvened. He was a first-class civil servant, in my experience, at MAFF and he chaired a large Whitehall committee which covered many more departments than one would imagine. Obviously, as I moved around Whitehall I did not keep up to date over the years. I regret that the committee’s deliberations have not been made public and I can see no good reason for that. In that period of time, we had probably three scientific advisers, and now we have a new Government Chief Scientific Adviser. This problem should be the first thing on Professor Bennington’s desk and he should look at it to see what the current situation is. There are grounds for considering it. I have never seen a satisfactory answer to the issue of the airline pilots and the doubts that have been raised about it. I do not want to be controversial but, if one looks at the big picture from the outside—at the nature of the doubts about organophosphates, at the issue of Factor VIII, dirty blood and blood products, and at the issue of Gulf War syndrome from the first Gulf War—one gets the impression of a natural reluctance of the centre to investigate when these issues arise and a pattern starts to be formed. That is the point that I want to make. In a way, the Carden Committee and what was put together could overcome and answer some of these issues. They go across Whitehall departments. I do not want the Government to be in the dock over them but a pattern has emerged over a period—there may be others of which I am unaware—that there is a reluctance to investigate. Why? “Oh, because there are no new cases; because of the issue of compensation; because the science is not quite clear”. Given what has happened in the United States in the first 100 days, if these matters were put to President Obama I can envisage some executive action coming forth. Not by overdoing the science or taking the scientists’ view, but by giving the issue a push, a spurt, to ensure that we can put it to bed. There is plenty of evidence—I do not think complete solutions will ever be found—from those who have been injured, if I can put it that way, in the farming industry, from those with Gulf War syndrome and from the issue of the fuel used in aircraft to ensure that the doubts about the use of organophosphates remain. These are matters worthy of investigation. In the way that it does, Whitehall did some joined-up thinking on this. There was genuine joined-up working in the way in which the Carden Committee was put together and worked. I pay tribute to that and I have no problem with it. I was on the receiving end over a 10-year period of delegations which included the noble Lord, Lord Taylor, and the noble Countess, Lady Mar. I said to officials on one occasion—I think it was in 2006 or early 2007—after the noble colleagues had left, “One day I will be a Back-Bencher and she is my model”. That is true. The noble Countess has shown great tenaciousness in pushing this issue—it is not a vested interest, although she has been affected in many ways—getting to grips with it and not accepting no for an answer. In this case, Whitehall and the Government reached out. I do not know whether it is time to call for Carden, who is well away into retirement—I shall not mention what part of the country he is in but I had a nice letter from him when I left government, so I know he keeps a watch on what is going on—but I hope the lawyers will not make the final decision; it is important that it is made on the grounds of science and health. The Government have a public responsibility and a duty of care in all these issues. In allowing products onto the market, however they are used, the Government have a duty of care. It may be that people will say, “We have solved all the problems” but, nevertheless, there are too many unanswered questions. It is probably time, given the Whitehall committee structure, genuinely to say to the noble Countess tonight that the answer to her question should be yes.
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