British Asbestos Newsletter
BRITISH ASBESTOS NEWSLETTER
PO Box 93, Stanmore HA7 4GR, England
Tel: 020 8958 3887. Fax: 020 8958 9424
Jerome Consultants
Issue 40: Autumn 2000
George Wragg: A Remembrance
George Wragg, author of The Asbestos Time Bomb, died in the Austin Hospital,
Melbourne, Australia on March 13th, 2000. After service in the Royal Navy,
George emigrated to Australia where he worked as a fitter and turner for
the State Electricity Commission in the infamous Latrobe Valley. His experience
with asbestos was up close and personal: "power stations were virtual
mountains of asbestos, and the larger the units the larger the quantities
of asbestos in all its forms." As a union health and safety representative,
a shop steward, secretary of the Gippsland Trades and Labour Council and
member of the SECV Joint Management-Union Asbestos Task Force, George
continued his efforts to improve working conditions in the power industry,
assist former colleagues who were dying from asbestos-related diseases
and publicize asbestos issues. According to George: "A succession of governments
from 1945 to 1978 bear the greatest responsibility for failing to adopt
and enforce measures which could have protected workers from the dangers
of asbestos." In the draft of his new book: Legacy of Evil, written in
the last year of his life, George describes the demolition by explosives
of three heavily contaminated power stations in the late 1990s. It seems
the then conservative state government and its private contractors had
a budget and timetable to keep. The clouds of dust, resulting from these
ill-conceived and dangerous practices, further contaminated the residential
areas of Yallourn North, Morwell, Newborough, and Moe, the town where
George and his family lived. His enthusiasm and commitment will be sorely
missed.
Mesothelioma
Recent data confirm the continuation of a European mesothelioma "epidemic,"
as first revealed in a 1999 paper by J Peto, A Decarli et al in The British
Journal of Cancer. UK statistics show an overall increase in mesothelioma
deaths of nearly 300% in twenty years: from 393 in 1978 to 1527 in 1998.
In Denmark "a further increase in the number of mesothelioma cases can
be expected, and the effect of regulating the environmental exposure to
asbestos cannot be expected within the next 10-15 years," according to
the authors of Incidence Rates of Malignant Mesothelioma in Denmark and
Predicted Future Numbers of Cases Among Men [Scand. J. Work Environ. Health
2000 April]. In the paper: Future Trends in Mortality of French Men from
Mesothelioma, researchers predict that between 1997 and 2050, the national
mesothelioma death-toll will exceed 44,000 [Occup. Environ. Med. 2000
July]. This Autumn, a team of fifteen scientists from Italy, Spain and
Switzerland published epidemiological evidence that: "living within 2000
m(etres) of an asbestos mine or works such as asbestos cement plants,
asbestos textiles, shipyards, or brake factories, entailed an almost 12-fold
increase in risk (of pleural mesothelioma)" in the paper: Multicentric
Study on Malignant Pleural Mesothelioma and Non-occupational Exposure
to Asbestos [Brit. J. Cancer 2000 83 (1)]. Another important conclusion
they reached was that: "low-dose exposure to asbestos at home or in the
general environment carries a measurable risk of malignant pleural mesotheliomaÉour
results suggest that non-occupational exposure to relatively low-doses
of asbestos is a hazard that may contribute to the burden of mesothelioma
over the next few decades."
Government reports documenting the scale of the UKÕs mesothelioma problem
make disturbing reading. Health and Safety Statistics 1999/2000 (HSE Stats),
Mesothelioma Area Statistics: County Districts in Great Britain part 1
(1976-1992) and part 2 (1986-1995) and Mesothelioma Occupation Statistics
confirm that those at highest risk (bearing in mind that workers in asbestos
manufacturing did not constitute an identifiable occupational group in
these analyses) include: "metal plate workers (including shipyard workers),
and vehicle body builders (including rail vehicles); both of these occupations
had rates over six times the average. Plumbers and gas fitters had a rate
over four times the average and carpenters had a rate over three times
the average." Other trades showing elevated proportional mortality rates
were: electricians, construction workers, managers in construction, plasterers,
builders and handymen, steel erectors, painters and decorators and scaffolders.
Male mesothelioma deaths are concentrated in the regions around the ports
and dockyards. With 626 deaths in twenty-five years, Strathclyde is second
only to Greater London in the league table. Within Strathclyde, which
accounts for nearly 70% of Scottish mesothelioma mortality, the biggest
cluster of deaths (280) was from Glasgow. Included in the HSE Stats are
projections that "male mesothelioma deaths would be in the range of 1400
(reached around 2005) to 2100 (reached around 2020)." Table A2.38 records
1328 male mesothelioma deaths in 1998; using 1328 as a base figure and
factoring into the equation the overall upward trend, the long latency
period and improvements in diagnosis, the figure of 1400 appears to woefully
underestimate the situation. Hedging their bets, the HSE urges caution
in placing too much reliance on official predictions: "these projections
rest on a number of uncertain (and largely unverifiable) assumptions and
should be regarded as informed guesses rather than firm forecasts." Perhaps,
a more useful measure of the extent of the problem is feed-back from asbestos
victim support groups such as GlasgowÕs Clydeside Action on Asbestos,
where Phyllis Craig reports "there has been a substantial increase in
the number of mesothelioma clients we are seeing. Previously, these clients
tended to be in their 60s or 70s, these days they are in their mid 40s
to early 50s." John Flanagan, at the Merseyside Asbestos Victims Support
Group, says: "IÕm not surprised that HSE figures show the North West to
be one of the worst affected regions. Our records show a continuing rise
in the number of mesotheliomas being diagnosed locally particularly on
the Wirral Peninsula."
There is an epidemiological consensus: the incidence of mesothelioma
is increasing and will continue to do for the foreseeable future. Programs
to quantify, control, treat and possibly reduce the suffering caused by
asbestos have been initiated. In the UK, the aim of the National Case-Control
Study of Mesothelioma and Asbestos Exposure is to: "identify the occupations
and work practices conferring the highest risk of mesothelioma and in
particular to determine whether construction workers involved in renovation
and maintenance are still at risk of substantial asbestos exposure." The
three year study combines personal interviews with lung burden measurements.
During the initial twelve months, much of the groundwork has been laid:
ethical approval has been obtained from English and Scottish authorities,
a questionnaire has been developed, permission to access Scottish Morbidity
Records has been granted, a database of English chest physicians has been
compiled and the design and distribution of a computer program to all
health authorities has been completed. In an announcement in September,
2000, the Cancer Research Campaign was optimistic about clinical trials
at Newcastle General Hospital where doctors, using a new drug combination
of carboplatin and alimta, found measurable improvements in the conditions
of twenty-five mesothelioma patients. Attempts are being made to ensure
that Scottish patients are included during the next phase of these drug
trials. Current research at St. BartholomewÕs Hospital in London is focusing
on irinotecan, a new drug, in combination with cisplatin and mitomycin.
A pilot study (MESO-1) being run by the British Thoracic Society and the
Medical Research Council is recruiting patients for a program which will
compare the efficacy of three regimes: vinorelbine alone, mitomycin, vinblastine
plus cisplatin and active supportive care.
Interesting research is being done in Australia. Professor Bruce RobinsonÕs
team at the Sir Charles Gairdner Hospital in Perth continues to explore
the promise of gene therapy: "weÕve already got existing therapies like
surgery and chemotherapy. Why canÕt we combine these treatments with gene
therapyÉweÕve argued if gene therapy had a certain effect by itself what
about if you took out as much of the cancer as possible. Would gene therapy
be able to work even more effectivelyÉthis is indeed what happens." At
the University of Sydney, Dr Judith Black is working on a therapeutic
approach to control the progression of pleural mesothelioma; techniques
to measure levels of enzymes and cyberkines could allow doctors to diagnosis
the disease before symptoms develop thereby improving survival rates.
Also in Sydney, Dr Helen Wheeler a clinician at the Royal North Shore
Hospital, has been monitoring the effectiveness of thalidomide, which
can inhibit the growth of blood vessels in new tumors, in the treatment
of mesothelioma. Although it is early days, anecdotal evidence suggests
that the drug is beneficial for pain management and symptom relief: "In
a couple of patients it caused stablisation of their cancers and in one
patient it may have even caused tumour regressionÉWith the patients we
were treating, they didnÕt seem to be requiring near as many analgesics.
They stopped losing weight and they felt much better within a couple of
days of taking the drug."
The Proceedings of an International Expert Meeting on New Advances in
Radiology and Screening of Asbestos-Related Disease, published by the
Finnish Institute of Occupational Health, contains papers updating the
Helsinki criteria for individual attribution, analysing epidemiological
trends, proposing screening and surveillance schemes for exposed workers
and discussing new techniques for early diagnosis of lung cancer. Conclusions
reached in Espoo, Finland this year include: "At present, there are no
clear health benefits from screening for mesothelioma because of the lack
of adequate treatments and interventions. However, lung cancer screening
directed at asbestos-exposed cohorts may provide important information
leading to earlier identification of mesotheliomas (e.g. through the evaluation
of small pleural effusions detected by CT) and potentially improved outcomes
depending on the introduction of new treatment modalities. By analogy
with other cancers, one might suspect that innovative therapies for mesothelioma
are more likely to be effective for early-stage minimal-bulk tumours than
for advanced mesothelioma."
For many years, information available to one set of professionals has
remained virtually unknown to others; e.g. social workers did not know
how or if mesothelioma clients could claim compensation from former employers
or the government. Patients remained unaware of the existence of drug
trials; the wife of one mesothelioma patient used the internet to find
out about a clinical trial which has helped prolong her husbandÕs survival
by two years and ten months. In the bad old days, geography and subject
constraints constituted unbreachable barriers to the flow of information.
For this reason, efforts to create a public dialogue on mesothelioma issues
are good news. Clydeside Action on Asbestos, which held an extremely successful
conference four years ago, has set a provisional date of 13 February,
2001 for a mesothelioma conference at which current treatment options
and clinical trials will be discussed by leading UK experts. Information
can be obtained from Phyllis Craig at: 0141 552 8852. The inaugural meeting
of the British Mesothelioma Interest Group (BMIG) will be held in Leicester
on 22 February, 2001. The program will include clinical and scientific
research presentations and open discussions "on the roles of current and
future treatment modalities, with particular emphasis on possible trial
protocols." While the BMIG website is being designed, more information
can be obtained from Linda Hollis at: LHollis@uhl.trent.nhs.uk
Protracted latency periods, inaccurate diagnoses, multiple employers
and the destruction of crucial documentation often frustrate attempts
by asbestos victims to obtain compensation. A recent judicial ruling which
significantly increases litigation required and concomitant costs is already
adversely effecting pleural disease plaintiffs. With the abolition of
legal aid for personal injury cases, the higher costs make it more difficult
to obtain after-the-event insurance without which lawsuits in England
and Wales will not proceed. These developments stem from the Court of
Appeal verdict in Holtby v Brigham & Cowan (Hull) Ltd. on April 6, 2000.
Mr Holtby, a marine fitter, alleged that occupational exposure to asbestos
over a forty year period caused him to contract asbestosis. Finding that
the exposure was periodic and not continual, the Court estimated the number
of exposure years as twenty-four, of which twelve occurred during employment
by the defendant. The issue of causation was paramount; if asbestosis
was caused by cumulative exposure, was the negligent employer liable for
all the damages or only an appropriate proportion? Upholding the High
Court ruling, the Court of Appeal agreed that Brigham & Cowan had been
negligent and in breach of statutory duty; liability was assessed at 75%
of the damages awarded. In the majority judgment, Lord Justice Stuart-Smith
wrote: "the onus of proving causation is on the claimant; it does not
shift to the defendantÉ the defendant is liable only to the extent of
that contributionÉ. the court must do the best it can to achieve justice,
not only to the claimant but the defendant, and among defendants." The
ramifications of the innocent/guilty dust concept for indivisible injuries
such as mesothelioma while not considered by Stuart-Smith were addressed
by Lord Justice Clark, in the minority opinion: "where the claimant proves
that two employers have made a material contribution to his condition,
he is entitled to judgment in full against each, leaving them to contest
issues of contribution between them. That would certainly be the case
where the injury was truly indivisible, so that each material contribution
to the same damage, as in a case of damage caused by, say, a collision."
According to Jim Wyatt, Mr. HoltbyÕs solicitor: "Many clients with pleural
disease have experienced exposure at several companies. Holtby means that
in cases where former employers are now untraceable or defunct, the surviving
defendants are only liable for a proportion of the damages. Claimants
are already receiving substantially less damages than previously." Leave
to appeal the Holtby judgment to the House of Lords is being sought. Defendants
have not been slow to appreciate the lee-way this ruling has given them.
Plaintiffs are once again faced with a causation nightmare; can they ever
prove conclusively whose fiber caused their mesothelioma? Fortunately
in Wix vs Wilton Cobley Ltd. and others, Judge Rudd sitting at the Southampton
County Court on May 12, 2000 agreed with Lord Justice Clark: "the effect
of mesothelioma is different to that of asbestosis, the one involving
physical damage, the other involving risk of mutationÉ For these reasons
I hold the third defendant to be one hundred per cent liable to the claimant."
Predictably, the Wix decision is being appealed.
The paper which first identified the continuing increase in mesothelioma
mortality in Britain included caveats about the as yet unquantifiable
risks experienced by asbestos removal workers: "Any contribution of asbestos
removal to the mesothelioma epidemic cannot yet be assessed. Asbestos
removal did not develop as a specialised industry until the 1980s, and
the latency is too short for these workers to have developed mesotheliomaÉ
the creation of the new, and initially inadequately regulated, industry
of asbestos removal may well have increased the burden of future occupational
asbestos disease." It is ironic that while some struggle to come to turns
with the enormous toll asbestos has taken, others still persist in underestimating
the severity of the situation. So, while the HSEÕs Epidemiology and Medical
Statistics Unit beavers away collecting and analysing asbestos-related
data, the HSEÕs Field Operations Directorate (FOD), responsible for inspecting
and enforcing regulations, exhibits a degree of complacency which is breath-taking:
"In only three of 939 visits to asbestos removal activities was dry stripping
an issue. In one of these cases the contractor was prosecuted. If this
level of response is sustained, our target of eliminating dry stripping
methods has all but been achieved." Someone who works in the asbestos
removal industry and who has asked to remain anonymous was surprised by
this finding saying: "In our experience, dry stripping remains the norm,
without a doubt." In an article published in The Academy, an asbestos
removal trade journal, Graham Gwilliam, a director of Asbestostrip Innovations,
writes: "It is accepted by many of these (HSE) inspectors that 50% of
all removal work is carried out dry. A senior member of the H.S.E has
given the figure of 60%. A very reliable source, close to the workforceÉ
states that a more realistic figure is 80%." The HSE is sending out mixed
messages; on the one hand they have adopted a high profile campaign to
"name and shame" those who fail to comply with occupational health and
safety regulations (Health and Safety Offences and Penalties; HSE website
at www.hse.gov.uk), on the other
they are claiming victory for a battle only just begun. The governmentÕs
failure to acknowledge the prevalence of inadequate controls and the continued
use of dangerous practices, such as dry-stripping, will ensure that the
mesothelioma tragedy will endure well into the twenty-first century.
News Round-up
Publications:
- The paperback book: Asbestos in Spain (El amianto en Espana) by
Angel C. Carcoba Alonso was published in May, 2000.
- Asbestos and Health, published by the World Health Organization
this year, recommends: prohibition of asbestos production and use,
minimization of fiber inhalation, proper disposal of waste, adoption
of safe working procedures, labelling of asbestos-containing products,
education and training of vulnerable workers. Evaluating previous
ILO and WHO studies and European Union Directives, the report states
that amosite, crocidolite and chrysotile cause asbestosis, lung cancer
and mesothelioma: "no threshold, below which no carcinogenic effect
will occur, has been identified."
- Proposals for amendments to The Control of Asbestos at Work regulations
1987; a new Approved Code of Practice; and a minor amendment to the
Health and Safety (Enforcing Authority) Regulations 1998 is an HSC
consultative document (CD159) which was circulated over the Summer
and early Autumn months. Employers must "take reasonable steps" to
manage risks properly. Methods for doing so include: recording the
presence of asbestos materials, monitoring their condition, assessing
the risks arising from location and age and ensuring that information
is accessible. A Trades Union Congress spokesman was critical: "We
believe that the proposals do not go far enoughÉ these (asbestos)
records must be made publicly available through deposit with local
authorities (as part of their land registry functions)." The TUC also
called for the labelling of asbestos materials and a phased approach
which would ensure that older premises are surveyed first. In its
submission, the Union of Construction, Allied Trades and Technicians
highlighted the danger of permitting a "visual examination of those
parts of the premises which are reasonably accessibleÉ You cannot
tell if something is asbestos by lookingÉ We do not believe the average
employer has the expertise to carry out the assessment themselves."
Although the proposed regulations stipulate that the employer must
carry out a suitable and sufficient assessment, they do not spell
out the qualifications needed to do so competently.
- Finding the Fatal Fibre: What To Do About Asbestos Where You Work
is a practical guide issued by the TUC which advocates that health
and safety representatives: "keep the workforce informed at all times;
make sure management identify asbestos, develop an action plan to
deal with it and stick to that plan; assume that walls, ceilings and
lagging contain asbestos unless certain they donÕt; and insist that
all work with asbestos complies with the Control of Asbestos at Work
and the Asbestos (Licensing) Regulations." The leaflet includes the
salient reminder: "people exposed to asbestos can reduce the risks
to their health by giving up smoking."
Meetings:
- A symposium on "Fibers and Health" will be on the agenda of The
Indian Association of Occupational Health Conference in New Delhi
between February 1-4, 2001.
- Handling Asbestos-Related Claims Conference, chaired by Alan Gore,
will be held in London on November 28, 2000.
- Scientists at The International Conference on Environmental and
Occupational Respiratory Disease in Lucknow, India (October 29-November
2, 2000), concluded: "evidence that exposure to asbestos fibres
is an extreme risk to health is overwhelming. The world community
should move to implement measures to rapidly bring down exposures
to this hazardous substance with an eventual target of zero exposure."
- The Problem of Asbestos was the subject of one of the sessions at
the three-day ECOHSE 2000 Symposium in Kaunas, Lithuania. On October
6, Mieczyslaw Foltyn, from the National Labor Inspectorate of Poland,
described the history of asbestos use, the effects of workplace exposures,
national health regulations and the experiences of labor inspectors
who found "a general unawareness of the harmfulness of asbestos and
of the ways to limit the related hazardsÉ work involving asbestos
creates not only occupational hazards to employees but frequently
public hazards as well." Viktoras Seskauskas, from the Institute of
Hygiene in Vilnius, Lithuania, called for "international co-operation
with the countries experienced in asbestos abatement, research and
quality management, public and specialist education" to establish
the scale of a problem aggravated by the continuing import of 4,000
tons of chrysotile every year.
The Global Asbestos Congress took place in Osasco, S?o Paulo, Brazil
from September 17-20, 2000. More than four hundred delegates from thirty-two
countries attended plenary sessions, workshops and round-tables, a photographic
exhibition, video screenings and a musical tribute to the asbestos victims.
Initiatives to emerge out of this landmark event include: the establishment
of a Global Asbestos Congress Virtual Network, the founding of a quarterly
Latin American journal on asbestos issues, an asbestos conference on South
American issues to be held in Buenos Aires in August, 2001, a new telephone
hotline for asbestos and other occupational illness victims in Japan,
discussions between Slovenian and Italian health and safety activists
on joint ventures, the launching of anti-asbestos campaigns in Malaysia
and India, cooperation on compensation issues between South American and
European lawyers and a possible consumer boycott of goods produced by
companies which deny compensation to asbestos victims. The conference
also prompted: the stunning declaration by the Mayor of Osasco that he
would encourage his city council to make Osasco one of the first cities
in Brazil to ban the use of asbestos, the announcement of a joint medical
initiative between the Mount Sinai Hospital in New York and the Osasco
Hospital, a statement signed by the trade unionists calling for an international
ban on asbestos, an offer from S?o PauloÕs House of Deputies to exhibit
a South African asbestos photographic exhibition during the period when
the stateÕs ban asbestos law will be discussed. A Congress CD with many
of the of plenary and poster presentations and extra-Congress submissions,
as approved by the CD editors, is being compiled. A notice will appear
on the IBAS website (www.ibasecretariat.org)
when the CD is available. Congress videos can be obtained from MFM Video
Imagem; for more information email A Meindl at mfm@mfm.com.br
Compiled by Laurie Kazan-Allen
Jerome Consultants
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