The Northern Ireland Organophophorus Sufferers Association was formed two years ago. Sufferers in Northern Ireland were experiencing the same rejection by the medical profession as in the rest of the UK. GPs seemed to know nothing about OP poisoning. Specialists appeared to have little or no knowledge on the subject either. Patients were not being referred to the relevant people. Some patients were being shunted from department to department within the health service without being dealt with properly.
The Northern Ireland Organophosphorus Sufferers' Association (NIOPSA) brought the matter to the attention of the Northern Ireland Forum: the Agricultural Committee invited us to present evidence to them on two occasions. The press release announcing the publication of the Committee's report was headed 'Government drags its feet on organophosphates'.
The Chief Medical Officer, questioned in February 1998 by the Forum Committee, said 'I hope to have a team of experts put together in the next six to eight weeks, at which time people can be referred to it.' 'Our aim will be to provide a service which is up-front, accessible and known about by GPs.' 'We want to ensure that Northern Ireland facilities will be the best.'
However, after the six to eight week period, facilities were still not in place. The weeks became months. In October last year there was still no diagnostic centre. In response to a question by a Belfast Telegraph reporter over the delay, a DHSS spokesperson said ' We are finalising the arrangements for the establishment of a clinic for patients who are thought to be suffering chronic effects from organophosphates. The original concept of an assessment clinic has now been broadened to include full diagnostic facilities. This has required a comprehensive planning process for the procurement of diagnostic equipment and the training of specialist personnel. It is anticipated that the clinic will be opened in the very near future.'
The long-awaited Royal Colleges report:
Organophosphate sheep dip: clinical aspects of long-term, low-dose exposure [see Newsletter 2] appeared in November 1998, and we suspect that the DHSS was stalling until its publication.
Finally, on 22 January this year, the CMO issued a notification to all GPs regarding the arrangements. There was no reference to diagnostic facilities. There is no mention of 'diagnostic equipment' or 'specially trained personnel'. Instead, it is introduced as 'specialist assessment'. In addition, the Royal Colleges' report is cited as providing 'comprehensive advice'. As we suspected, the activities of the centre would hinge on the recommendations of this report.
Unfortunately, it is seriously flawed. The Royal Colleges' working party has taken a blinkered approach. There is no acknowledgment of NIOPSA's letter detailing the problems in Northern Ireland. There is no indication in the reference section of them having considered existing medical guidance note MS17, which details specifically the biological monitoring of workers exposed to OPs. This document was produced as long ago as 1981 by the Health and Safety Executive and it appears to be as elusive as it was in 1996, when Michael Meacher pointed out in his report Dangerous Dips that MS17 was not fully circulated to doctors, farmers, or even HSE field officers.
In a summary of existing facilities, the report states 'Existing clinical services for patients with symptoms associated with OP sheep-dip exposure are unsatisfactory. The patient's GP should in most cases be responsible for diagnosis and management, but specialist referral may be needed in some cases.'
It is unreasonable to throw responsibility for diagnosis into the lap of the GP. With no training and no specialist equipment, how can the GP provide a service. For other illnesses such as leukaemia, heart disease, multiple sclerosis, etc, specialists in these fields are called upon to provide diagnosis. The report makes the weak recommendation 'More in-service training for practitioners in rural areas could be helpful.' To do the job that the Royal Colleges expect of GPs, training would be vital.
The report states 'Attempts to measure airborne concentrations and skin contamination are, however, fraught with difficulties. More information is also needed on the compounds, the formulations and the solvent vehicles.' How can the Royal Colleges begin to compile a report on the aspects of exposure to sheep-dip if they do not have access to this information? Surely this ought to be a starting point. The Royal Colleges need to look at the matter again and get the relevant information from those who issued the product licenses, the Veterinary Medicines Directorate.
The matter of what exactly is in commercial OP products is a mystery. In 1986 the issue was raised in an EC report on Industrial Health and Safety. It states 'It must be remembered that commercial formulations of OP pesticides may not contain only a single compound but rather be a mixture of OPs. Besides deliberately added substances, commercial products may also contain production impurities, sometimes in remarkable concentrations. The biological behaviour and toxicity to humans of OP associations may be different from those of the single compounds because metabolic interactions may result in synergic effects'.
In other word, the toxic effect could be many times greater than anticipated.
MAFF has also raised the question of the purity of the dips. In MAFF news release no 28/92, relating to a review of sheep-dips, the need for further evaluation of the product is indicated, in particular the 'level of purity of the active ingredient', and the 'toxicity of other ingredients and solvents in the product formulations'. 'The companies concerned are being asked to provide additional data by the end of 1992'.
This confirms that those who issued licences for sheep-dip products did not know what they contained and that the toxic potential was an unknown factor.
The Royal Colleges' report does not answer these questions. The working party calls for more information on 'the compounds, their formulations and the solvent vehicles'. This information should have been supplied to MAFF by the end of 1992. Why was it not available to the Royal Colleges working party?
Copies of Ernie Patterson's unedited presentation are available from PAN UK.
[As published in PEX Newsletter No.4, September 1999]