Asbestkonferencen 1964, Selikoff, og de forudgående og efterfølgende kontroverser

Transcription

1 Asbestkonferencen 1964, Selikoff, og de forudgående og efterfølgende kontroverser Philippe Grandjean Fulbright stipendiat på Selikoffs afdeling, Mount Sinai Hospital, NYC ( )

2

3 The brief history, in Selikoff s words The first case of death of asbestosis occurred in Dr. Montague Murray, a physician at the Channing Cross Hospital in London, saw a man who worked in an asbestos factory who was very short of breath, and a year later he suffocated and died. Seven years later the British parliament was planning to revise its workers compensation laws and called Dr. Murray for testimony. They asked him, Should we put asbestos on the list of things which could be compensable? and he said No. He said it did not make sense to burden that list because, he naively thought, now that we know asbestos causes disease, it is not going to occur any more. (Selikoff, 1984)

4

5 The Annual Report of Her Majesty's Women Inspectors (1898) In the majority of cases the evil is very insidious and the general symptoms produced by dust on the various respiratory organs are to the lay mind so similar to those produced by other causes that it is not always easy to trace the connection. The incessant "sore throat," the irritation of bronchial passages, the frequent "colds on the chest," and "hoarse voice" and "morning cough" from which girls employed in dusty processes suffer, are all symptoms which to casual observers might easily be accounted for in other ways.... The worker falls into ill health and sinks away out of sight in no sudden or sensational manner. H. Montague Murray soon described the first asbestos related death with detailed autopsy information on a33 year old asbestos worker

6 Nellie Kershaw died in 1924 at age 33 years, and the cause of death was given as: fibrosis of the lungs due to inhalation of mineral particles (Selikoff & Greenberg, 1991)

7 Two views of the company doctor Alice Hamilton: For a surgeon or physician to accept a position with a manufacturing company was to earn the contempt of his colleagues as a contract doctor. National Conference Board of Physicians in Industry (1922): To secure the maximum efficiency from the human machine, the industrial surgeon, virtually the human engineer, acts as the agent for stabilizing labor, thereby facilitating production and helping the worker to do a better day's work, prolong the years of his activity and increase his compensation.

8 The workers were not told It must be remembered that although these men have X ray evidence of asbestosis, they are working today and definitely are not disabled by asbestosis They have not been told of this diagnosis as long as the man is not disabled it is felt that he should not be told of his condition so that he can live and work in peace and the company can benefit from his many years of experience. Kenneth W. Smith, MD Medical Director, Johns Manville (Canada) Report to J M headquarters, 1949 (quoted from Paul Brodeur, The New Yorker, 1985)

9 The role of exposure assessment Virtually no exposure measurements were made before 1930 Industrial hygiene evolved into a branch of engineering, while medicine was left to the doctors Data were in the hands of industry Only the company doctors and industrial hygienists employed by industry were in a position to interpret what they saw and in possession of lines of communication to the industry However, these professionals did little or nothing in the face of ample warning General medical practitioners were unable to see the entire picture ACGIH set 5 mppcf as exposure limit in 1946 (on uncertain grounds) and it remained unchanged for 20 years

10 Evolution of knowledge on asbestos before UK Factory Inspector warns of harmful and evil effects of asbestos dust 1906 French factory report of 50 deaths in female asbestos textile workers 1911 UK Factory Department finds insufficient evidence to justify further actions 1918 US insurers refuse cover to asbestos workers due to injurious conditions 1927 Asbestosis defined as occupational disease (British Medical Journal) 1931 UK asbestos regulations and compensation scheme 1932 Asbestosis in UK guard dog 1938 Germany: Lung cancer is an occupational disease due to asbestos 1952 Seventh Saranac Symposium (proceedings withheld) 1955 Richard Doll: High lung cancer risk in UK asbestos workers 1959 Chris Wagner: Mesothelioma in RSA workers and the exposed public

11 Wilhem Hueper ( ) Industrial concerns are in general not particularly anxious to have the occurrence of occupational cancers among their employees or of environmental cancers among the consumers of their products made a matter of public records. Such publicity might reflect unfavorabl[y] upon their business activities, and oblige them to undertake extensive and expensive technical and sanitary measures in their production methods and in the types of products manufactured. There is, moreover, the distinct possibility of becoming involved in compensation suits with extravagant financial claims by the injured parties. It is, therefore, not an uncommon practice that some pressure is exerted by the parties financially interested in such matters to keep information on the occurrence of industrial cancer well under cover. (1943)

12 Irving J. Selikoff 1953: Selikoff started his medical clinic in Paterson, NJ 1961: Mortality among Unarco asbestos workers appeared overwhelming 1962: In collaboration with two local unions found excess mortality in 632 exposed workers 1967: Study expanded to 17,800 exposed workers 1982: Unarco declared bankrupcy

13 Selikoff and Labor Asbestos companies would not allow Selikoff inside (and neither would the Navy shipyards) The unions had no objections Their records (including the funeral insurance) were better than industry s records Union leaders do not inherit the leadership from their fathers, but are selected from the ranks Selikoff s conclusion: Scientists should work with the workers

14 Status by 1964 (1988) Through the period before 1964, private enterprise successfully retained control over conditions in the workplace. Even the compensation system was designed to insulate employers from tort liability, offering workers little if anything in return. Despite the overt manipulation of data and interference with the work of insistent Jeremiahs such as Hueper, it is not clear what a scientist could have done without the cooperation of industry. Hueper did sound a warning, but without result. There was no federal authority to regulate the work place, and even staunch reformers such as Alice Hamilton depended completely on persuasion and rational argument rather than government coercion. The concern of industry was primarily over compensation costs, not fear that it would be required to institute costly preventive measures. It was not a lack of moral fiber on the part of scientists and engineers but a lack of social controls that allowed private interests to meet their own needs at the expense of the health of workers, consumers, and the general public.

15 Evolution of knowledge on asbestos before UK Factory Inspector warns of harmful and evil effects of asbestos dust 1906 French factory report of 50 deaths in female asbestos textile workers 1911 UK Factory Department finds insufficient evidence to justify further actions 1918 US insurers refuse cover to asbestos workers due to injurious conditions 1927 Asbestosis defined as occupational disease (British Medical Journal) 1931 UK asbestos regulations and compensation scheme 1938 Germany: Lung cancer is an occupational disease due to asbestos 1955 Richard Doll: high lung cancer risk in UK asbestos workers 1959 Chris Wagner: Mesothelioma in workers and the exposed public 1964 More than 700 articles in the worldwide medical literature detailing the hazards of asbestos exposure

16

17

18

19 NYAS conference (1964) The Asbestos Textile Institute requested that the NYAS exert caution in the public disclosure of infrmation about the connection between asbestos and mesothelioma (request refused) For the first time, scientists from all over the world assembled to compare notes and present their findings Mesothelioma and other adverse effects were reported in a variety of asbestos exposed workers Adverse effects also in bystanders and relatives The importance of latency Lack of compensation and social support

20

21

22 Epikrise: En 59 årig mand indlagdes i juli 1971 på Mt. Sinai Hospital med skarp, svær smerte i højre del af brystkassen, øges ved dyb indånding. Tidligere nålebiopsi havde vist mesoteliom, og der udførtes partiel pleurectomi. Pt. havde derefter været næsten symptomfri i et halvt år. Smerterne var nu kommet igen med hoste og dyspnø og vægttab på ca. 25 kg. Der foretoges igen pleurectomi, og kemoterapi igangsattes. Patienten afgik ved døden året efter. Arbejdsanamnese: Pt. begyndte som lærling på et københavnsk skibsværft som 15 årig (1927), og som metalarbejder var han udsat for hvid asbest i ca. fem år. Derefter gik han på teknisk skole og blev udlært maskinist. Ingen klar eksponering for asbest sidenhen.

23 Conclusions in light of the 1964 conference The culpability of the asbestos industry in its failure to provide timely warning to the users of its products entangled reputable scientists in a web of deceit and manipulation that was only partly engineered by clever corporate manipulators. Much of it was a consequence of the social forces that produced the industrial health specialist in the first half of the twentieth century. David Ozonoff (1988)

24 Selikoff s asbestos lessons What we are doing is collecting information, but so far we are only counting the bodies (1978) It has become clear that, just as in the 1890s, scientific research is necessary for the identification of causes of disease. But the simple gathering of data is only one part of the process. Utilization of the information is also required. Regulatory measures are needed, often of considerable complexity (1984) Never forget that the numbers in your tables are human destinies, although the tears have been wiped away (advice to young colleagues)

25 Paul Brodeur: Annals of Law The asbestos industry on trial

26 Last letter from Selikoff (1991) In other words: We must learn from the past and share with our successors