Whenever a new toxic material is introduced into the biosphere, it must be studied thoroughly with respect to: 1) The nature of the hazard; 2) The pathways to humans including the portal of entry into the human body; and 3) The host response.

My paper will deal primarily with the portal of entry into the human body and the expected host response. While uranium and depleted uranium wastes are not new toxins, the ceramic aerosol of DU produced in military activity is relatively new to civilian science.

THE HAZARD:
Uranium occurs naturally in about 3 ppm in rock in the earth crust. It is the decay product of plutonium, which was present in the beginning of our planet. Uranium occurs in rock formations with other radioactive elements, namely radium, thorium, lead, bismuth and polonium. One element in the decay chain, radon, is a gas with a short half-life. If there is no escape fissure in the rock, its decay products will remain as radioactive solids within the rock. Otherwise, they will be deposited on the ground as the radon gas travels in air, near the earth and in the direction of the wind, during its 3.8 day physical half life. In ordinary soil, unaffected by uranium mining and milling, one would expect to find more radioactive lead, bismuth and polonium than uranium.

In the process of uranium mining and milling, natural uranium is separated from the other radioactive elements (which are left as waste ore at the mine, and mill tailings at the mill). Uranium leaves the uranium processing facility as a yellow cake, technically triuranium octaoxide, U₃ O₈. Yellow cake involves a chemical change only, and the uranium in the molecule has the same isotopic composition as uranium in the natural environment. Compared with natural uranium in its natural state in soil or rock, yellow cake is about three hundred thousand times more concentrated.

In the normal course of events in the nuclear age, the yellow cake is sent to an enrichment plant, where it is converted into uranium hexa-fluoride, UF₆, and submitted either to centrifuge or gaseous diffusion technology to produce an enriched uranium, in which the U 235 isotope is more concentrated. The waste called depleted uranium or DU, from this process of enrichment for commercial nuclear fuel is generally about seven times in volume the enriched uranium product. There is an even greater amount of waste uranium when the enrichment is for nuclear weapons or nuclear research reactors.

Depleted uranium is the largest category of radioactive waste, next to the radioactive ore and tailings left at the mine and mill. Being more concentrated it is more radioactive. In general, natural uranium consists of 99.3% uranium 238 and 0.7% uranium 235; while depleted uranium consists of 99.7% uranium 238 and 0.3% or less uranium 235. Their chemical properties are the same. The depleted uranium waste from enrichment is reduced to uranium tetrafluoride and then reduced again to depleted uranium metal. In 1995, after the Gulf War, the USEPI (US army Environmental Policy Institute) required that the U 235 content of depleted uranium be less than 0.3%. It is this waste metal that the military is now using to replace tungsten and lead in military ordnance.

In some cases, I understand that the US, instead of sending freshly milled yellowcake to the enrichment plant, sent uranium recovered by reprocessing of spent nuclear fuel rods at Hanford. This would have produced waste, depleted uranium, contaminated with small amounts of plutonium and neptunium, and perhaps fission products.

Although it is often said that depleted uranium is only 40% as radioactive as natural uranium, this only holds true for natural uranium, which has been chemically purified and concentrated. Depleted uranium is some thousand times more radioactive than natural uranium in its natural state in soil and rock. A licensed and trained technician, experienced in the handling of radioactive material, is required before this waste product is released to a user.

SPECIAL COMPLICATION WITH RADIOACTIVE MATERIAL EXPOSED TO HIGH TEMPERATURES:
With the dropping of the nuclear bombs on Hiroshima and Nagasaki, the complication of physical change in materials subjected to a high temperature fire was introduced. This same problem occurred with the Wind-scale fire, the Three Mile Island and Chernobyl explosions. We now must deal with the friction fire that occurs when a DU weapon impacts a hardened target. In this case, temperatures may exceed 3.000 degrees Centigrade, beyond the melting point of uranium. The aerosol created under the temperature and pressure conditions is a ceramic. It is very insoluble in body fluid.

The internal dose received by the populations of Hiroshima and Nagasaki has never been used as a basis of radiation exposure research, and no information on the health effects of internal contamination with ceramic radioactive particulates has been released to the public. (I do not know whether or not the military researchers calculated it.) The problem of internal contamination of atomic bomb survivors has not been openly discussed in professional circles. Basically the published atomic bomb research contains data on external exposure of a healthy survivor population. The research excluded internal exposure to ceramic radioactive particulates.

Among those who have been involved with trying to assist the Gulf War Veterans, only Dr. Doug Rokke, Health Physicist, and Dr. Asaf Durakovic, Nuclear Medicine, have been potentially privy to classified military information on radiation exposure. There are a number of other persons who have written chapters in Military Radiobiology [Ref. 1], the military textbook, who have not yet offered to help. Dr. Durakovic wrote the Chapter on internal contamination. [Ref. 2]

While I have FBI clearance for reading the military radiobiology materials, since I have served as a consultant to the US Nuclear Regulatory Commission, but have no direct access to the military data base. I, together with other competent researchers who are willing to assist the people exposed to DU, must build up the knowledge from civilian sources and experience. Hence, we need to collect a database of DU exposed persons in order to understand and document the whole picture of health damage. This is essential if we are to communicate the problems to civilian legislators or judges.

The Rand Report [Ref. 3] depended heavily on civilian experience, especially with uranium mining and milling. While they quoted military manuals, they failed to discover the text book(s) called Military Radiobiology. For many reasons theirs was an inappropriate choice of research documents. The second source of information was that recently produced by the US National Academy of Science [Ref. 4]. It is much more professionally done. You will notice, however, that it made frequent use of the terms inadequate and insufficient evidence to conclude whether or not there would be health damage. They castigated the military for withholding vitally needed information, and while their references are more extensive than those of the RAND Report, they also failed to consult Military Radiobiology. This withholding of health information on the part of the military is a historical problem dating back to the 1950's, and it distorts our understanding even today, for example through the IAEA lead in reporting on the Chernobyl disaster and the concurrent silencing of the World Health Organization. [Ref. 5] Radiation has been declared a physics problem rather than a medical problem.

PATHWAYS TO HUMANS:
While natural uranium does contaminate the food web and drinking water of humans to some extent, its portal into the body is by way of the gastro-intestinal tract. This human digestive system is very effective against uranium. About 99% of the ingested uranium is excreted in feces within 24 hours. In the case of airborne uranium dust, which occurs in a mine or mill or in the vicinity of the tailing piles, small particles, less than 10 microns in diameter, can be inhaled. Although much of the information on inhaled depleted uranium has been based on the inhalation of dust in the uranium mine or mill, most occupationally inhaled uranium dust particles are of such aerodynamic form that only 1 to 5% penetrated into the lungs. Most was deposited in the upper respiratory tract and diverted into the gastro-intestinal tract. It is generally accepted that radon gas and its decay products, lead, bismuth and polonium, and not uranium, are the main cause of lung cancer in uranium miners.

On the other hand, Uranium subjected to melting and aerosol formation is of different aerodynamic form than the dust in a mine. Only about 75% of the inhaled aerosol is expected to be diverted to the gastro-intestinal tract. The 25% of inhaled ceramic and non-ceramic aerosol uranium, which remains in the lungs, has no exit except through the lung - blood barrier or into the lymph system. The lung is like a bag with no exit portal, such as we find in the rectum. If eventually the uranium in the lung dissolves in body fluid, it can be carried into the blood and circulated within the body. If it cannot be dissolved, it may be ground into very fine particles by the lung motion and eventually carried by monocytes [phagocytes] into the thoracic lymph nodes and the body's lymph system. [Ref.1]

After a uranium air contamination event it is important to do feces analysis for uranium within 48 hours of the exposure. This is obviously not a good test for the Gulf War Veterans some 8 or 9 years after their exposure in the Gulf War. However, had the governments been alert to the human dimensions of this exposure, they should have done testing immediately or at least taken specimens for later analysis. Civilians and Peacekeepers serving later in the contaminated area are less at risk than those exposed to an impact event, because the particles will not be airborne unless disturbed mechanically or by wind, and what is inhaled will be largely diverted into the stomach. There will be exceptions, and some particles can still become trapped in the lungs of an unsuspecting person.

Contact with depleted uranium metal will continue to be a hazard long after the war is over, especially for children and souvenir hunters. Children in Iraq have been seen playing with the radioactive debris left by the warriors.

The Textbook «Military Radiobiology» strongly recommends prevention as the medical response to airborne uranium: A self-contained breathing apparatus, gas mask, or at least fine-particulate mask should be used whenever airborne alpha radiation is present.

Radioactive material entering into the body through the gastro-intestinal tract can do damage to the lining of the tract. If some is absorbed, it is shunted into the hepatic portal and sent through the liver. In the liver it can be stored or removed and sent to the kidneys, or released into the blood system. Some ingested toxins are detoxified in the liver, but this cannot be said for uranium. Radioactive material, which enters the body through the lung, has no such protective screening.

While both the lungs and the gastro-intestinal tissue can be damaged by the passage of radioactive particulates, there is a greater concern for damage to the lungs when the uranium is in an insoluble form, since this radioactive material stays in the lungs for a very long period of time. We are talking about years rather than hours. There may be problems with intestinal damage at places where the intestinal material is temporarily held up, but generally the pollutant will move out in 24 to 48 hours.

Uranium can also affect the body by exposing the skin and by fragments which enter the body through friendly fire accidents. This subject is being followed and reported on by Dr. Melissa McDiarmid at the Veteran's Hospital in Baltimore, Maryland, USA [Ref. 6]. It will not be treated here.

BIOCHEMICAL BEHAVIOUR WITHIN THE BODY:
Uranium isotopes are a considerable hazard for accidental exposure through inhalation. [Ref. 1] The effects of uranium differ with its chemical form, its solubility, and its biological half-life in organs and in the whole body, the tissues of incorporation, and the physiological factors that determine its metabolic fate. Uranium is highly reactive chemically, and the various chemical compounds, which it forms, will have different physical and chemical properties. Its fate in the body will change with the solubility of these compounds, particle size, homeostasis, biological decorporation and method of elimination. Uranium is bound by all of the biochemical properties of the molecule in which it is incorporated, but it will also be continually emitting alpha particles into the surrounding tissue and exerting its toxic heavy metal effect.

Uranium hexafluoride and uranyl nitrate hexahydrate dissolve easily and are taken up from the lungs in a few days, excreted in the urine within days, and are the most likely to cause kidney damage early on after an exposure. For a long time the US Veteran Administration confused this property of soluble uranium with the long-term effects of DU experienced in the Gulf War exposure. They therefore wrongly stated that none of the veteran's medical problems could be attributed to DU unless there was damage to the kidneys. Kidney damage is not expected to occur with the nearly insoluble compounds because of the slow excretion through the kidney and urinary system. However, there may have been a soluble component of the inhaled DU, which caused kidney problems early on after the war.

The chemical form of the DU inhaled in the Gulf, Bosnia and Kosovo Wars was most probably a mixture of: uranium trioxide, which is likely to remain for a few weeks in the lung tissue and in the thoracic lymph nodes); and, two other more insoluble chemical forms - uranium dioxide and triuranium octaoxide, which are likely to remain for several years in the lungs and thoracic lymph nodes). According to Dr. John Gofman, some of this insoluble radioactive debris may remain in the lungs for the rest of a person's life.

The soluble fraction of uranium which passes the lung-blood barrier, is expected to form chemical complexes with the bicarbonate in plasma (47%), form chemical bonds with protein in plasma (32%), and bind to the red blood cells interfering with iron transport (20%). [Ref. 7] The low molecular weight uranyl-bicarbonate will pass most easily through the renal glomerulus, and if the pH is low will rather quickly be passed through the kidneys and excreted in urine. This is the first fraction release, which depending on its rate of passage may or may not have caused kidney damage in Veterans early on after the exposure.

If the pH of the kidney is high, small amounts of the uranyl bicarbonate can be retained within the walls of the kidney. It would increase localized radiation doses to the kidney.

Uranium bound to protein or to erythrocytes will not easily pass through the renal glomerulus, and will likely stay in the blood or lymph. Uranium can be incorporated into bone, although if it is in ceramic form this may not occur.

RADIOLOGICAL ACTIVITY WITHIN THE BODY:
Radiation induces the formation of reactive chemical products when it enters a biological system [Ref. 1] It can effect the water inside cells, converting it to free radicals which can form harmful peroxides which in turn cause damage to the cell and its membrane. The radiation can also directly impact DNA and large molecules, breaking the molecular bonds and fragmenting the genetic material, the cell membrane, and the enzymes that the cell needs for repair.

Damage to the membrane increases cell fluidity and permeability, leaving it vulnerable to viral and bacterial invasion. The process can cause the release of an inflammation cascade, or important biochemical mediators, which induce chronic problems. It can kill cells, or induce subtle changes in the cellular physiology of those cells that survive. This damage can in turn sensitise the organism to other insults. When cell membrane permeability is increased, there may be invasion by micobacteria and infections of various kinds can develop.

The most talked about effect, namely cancer, is most likely not the most frequent effect which is an increase in bio-feedback mistakes due to the breakage and disruption of molecules, a characteristic of the ageing process.

MEDICAL TREATMENT:
Major categories of injury include the haemopoietic, gastrointestinal, and neurovascular syndromes. There is no realistic hope in managing injuries in the neurovascular system. [Ref. 1]

Bone marrow cells and circulating blood cell damage leads to opportunistic infections, often from micobacteria, which require anti-microbial and immuno-modulating techniques. It may be possible to enhance marrow repair.

Restoration of body fluid and electrolyte balance is important.

To rid the body of the uranium contamination, chelation therapy may be undertaken with professional supervision. It is important not to deplete the body of needed minerals, and also not to overload the kidneys by precipitating uranium too rapidly. [Ref. 8]

CURRENT EPIDEMIOLOGICAL DATA:
The Hannan Chuo Hospital in Osaka, Japan has in its catchment area more than a thousand survivors of the Hiroshima and Nagasaki atomic bomb (called Hibakusha). [Ref. 9] In 1985 they undertook a study of the chronic health problems of the Hibakusha, then having average of 59.5 years, against the expected ill health for person 60 years and over, based on The Basic National Life Survey, 1986, prepared by the Japanese Ministry of Health and Welfare. This research was done in the civilian sector and the Radiation Effects Research Foundation, the holders of atomic bomb research database, denied the researchers information on the atomic bomb exposure of each person in their study.

They divided the Hibakusha into two groups, namely those who had immediate acute symptoms of radiation sickness in 1945 (presumed to have the greatest dose) and those who were known to have been exposed but were without acute radiation symptoms. This study generally speaks to the long-term disability suffered by those who experienced the atomic bomb. The entries in the table are the results of dividing the incidence rate in the exposed group with the incidence rate in the general population.

In 1995, a study was undertaken in Belarus, the country that received the heaviest fallout from the Chernobyl reactor disaster. The study compared the health problems of the following populations: the more than 60,000 Belarus liquidators who received the highest doses while working directly in the contaminated area in the years 1986 to 1987; the more than 1.5 million Belarus citizens who had to be evacuated because of the contaminated land; and the population in general. They found marked differences in health, reported as ratios between the rate in the exposed groups and the rate in the general Belarus population. [Ref. 10]

The Liquidators, who were 30 to 35 years old at the time of the disaster, experienced higher rates of diabetes mellitus (twice the rate in the general population); serious mental disorders; diseases of the central nervous system and sense organs (including cataracts); higher incidences of cardiovascular diseases (including hypertension), i.e ischemia, stenocardia, cerebrovascular, endarteritis and thrombocystis. [Taken from an English translation of the Russian].

Most significant among the respiratory diseases are: chronic pharyngitis, nasopharyngitis, sinusitis, diseases of the tonsils, pneumonia, and bronchitis. In 1995, 76 out of 10,000 liquidators were recognized as disabled. In the evacuated population of Belarus, 32.5 per 10,000 were recognized as disabled. The percentage with diseases in the evacuee population has increased with time:

Among the public exposed, there was a significant growth in the incidence of major diseases, especially diseases of the digestive system, urogenital system, nervous system, endocrine system, and diseases of the ear, throat, and nose in both adults and children.

COMPENSATION AND LEGAL ACTION:
Because historically radiation epidemiology, especially when important to the military, has not been in the hands of civilian medical researchers, it will be necessary to build up a data base which can reveal the particular illnesses which are caused by inhalation of ceramic and non-ceramic DU. Findings can be strengthened by comparison with findings for Chernobyl and the Atomic Bomb survivors in Osaka.

We have no way at present to make an assumption that just because DU is present in urine it is the cause of a veteran's illnesses. This is the serious flaw in Dr. Durokavic's approach. He is assuming that the nuclear chemistry which would allow us to determine the original dose to the lungs, and the causal connection between exposure and health effects have been determined. This may be true in military classified documents, but it is not true in the civilian sector. Parliamentarians, judges, veteran administration officials and others in decision-making positions rely on and generally have access only to information in the civilian society. We need either to get hold of the secret military documents (if they exist) or to generate detailed studies of our own.

This latter would involve random selection of veterans and other DU exposed persons, and completion by each of an exposure history, a medical/environmental history, and a detailed medical examination [Ref. 11]. Ideally, exposure and dose information would be obtained by urine analysis, and supplemented by the exposure history. Urine analysis would need to be carefully done, and a selected number of participants would need to repeat the urine testing procedure at determined intervals so that an excretion rate can be obtained. This would allow us to determine the original exposure dose for all of the subjects. This project is extensive and would need to be funded. It might take two of three years since there are no easy or quick answers. There should also be a follow up team of physicians willing to develop appropriate chelating techniques for decontamination and other medical therapies for healing.[Ref. 8]

We had started a pilot program three years ago to determine which tests should be administered and how to interpret them when the British Veterans, who were not properly prepared for the needs of the study and who had unreal expectations, caused the study to be aborted. We also found that Dr. Durakovic felt no need for research documentation of harm caused by internal contamination with DU. He was merely assuming this, which might be all right in the military, but is not acceptable in the civilian forum. We have now lost a trusted researcher of top quality, Dr. Hari Sharma, and the use of one of the best laboratories with good equipment. We may be able to locate another. However, none of us are willing to do more without the support of the veterans.

By a carefully focussed design, a cost-effective approach could be made. However this would imply the need for co-operation in planning and execution. No one would benefit unless everyone benefited. It would necessarily be a group study, not one, which would provide evidence for a few chosen individuals. It would require patience and recognition of the legitimate needs and scientific integrity of the research personnel. While you can use the enclosed Diagnostic Protocol for your own medical care, if you want to affect the care of all veterans and the cessation of poisonous warfare, it will be necessary to release the findings of your medical examination (without name) to a legitimate research body.

1. Military Radiobiology, Edited by James Conklin and Richard Walker, Academic Press Inc. Orlando, Florida,1987 [ISBN 0-12-184050-6]

2. Internal Contamination with Medically Significant Radionuclides, by Asaf Durakovic. Chapter 13 in Military Radiobiology ibid.

3. A Review of the Scientific Literature as it Pertains to Gulf War Illnesses, by Naomi Harley et al., Volume 7: Depleted Uranium. National Defense Research Institute and Rand Corporation, Santa Monica California, 1999.

4. Gulf War and Health Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines. Prepublication Copy Embargoed to 7 September 2000. Institute of Medicine, US National Academy of Science.

5. Agreement between the International Atomic Energy Agency and the World Health Organization, approved by the Twelfth World Health Assembly on 28 May 1959 in Resolution WHA 12.40.

6. Health Effects of Depleted Uranium on Exposed Gulf War Veterans by Melissa Mc Diarmid et al. Environmental Research section A, Vol. 82, pages 168-180, 2000.

7. Complex Formation of Natural Uranium in Blood by S. Chevari and D. Likhner, in Medical Radiobiology (Moscow) Vol. 13 No. 8, pages 53-57, 1968.

8. The Parallel Radiation Injuries of the atomic bomb victims in Hiroshima and Nagasaki after 50 years and the Chernobyl Victims after 10 Years by Katsumi Furitsu, MD, et al, International Perspectives in Public Health Vol. 13, 2000.

9. Current State of Epidemiological Studies in Belarus about Chernobyl Survivors, by Vladimir P. Matsko, in Research Activities about the Radiological Consequences of the Chernobyl NPS Accident and Social Activities to Assist the Sufferers of the Accident, Edited by Imanaka T., Research Reactor Institute, Kyoto University, 1998.

10. Mechanisms of Detoxification and Procedures for Detoxification, by Jon B. Pangborn, Ph. D. Bionostics Inc., PO Box 111, 170 West Roosevelt Road, West Chicago IL 60185, USA. 1994.

11. Defining Chemical Injury: A Diagnostic Protocol and Profile of Chemically Injured Civilians, Industrial Workers and Gulf War Veterans, by G, Hauser, MD, P. Axelrod and S. Hauser. International Perspective in Public Health, Vol. 13, pages 1- 18, 2000.