Report of Findings and Recommendations on the Use and Management of Asbestos

February 10, 2003

Global Environment & Technology Foundation
7010 Little River Turnpike, Suite 460, Annandale, Virginia 22003

DRAFT REPORT OF FINDINGS AND RECOMMENDATIONS ON THE USE AND MANAGEMENT OF ASBESTOS

February 10, 2003

Section 3.0:
ISSUES IDENTIFIED

Several major categories of issues were identified in interviews prior to the stakeholder focus group meeting (See Appendix E for a summary of interview findings); others were identified during the focus group meeting (See Appendix F for a meeting summary). These categories then provided the framework for dialogue. The following discussion of issues, best practices, solutions, recommendations, and needs for additional research is based upon the views received. These views come from three major sources: the stakeholder focus group meeting and subsequent dialogue with participants and other technical and policy experts, prior and subsequent interviews, and research. There are certainly many additional issues concerning asbestos, however, which were not raised as particularly significant during this process.

For each major category, a brief background is provided, and the significant issues identified. Where additional research is needed to further define or address an issue, it is listed. (A compilation of research needs is contained in Appendix C.) Specific recommendations for actions are provided for many of the issues identified. In each section where recommendations are listed, they are listed in order of priority. Those having the highest priority are those identified by stakeholders as having the greatest impact for the resources expended, although no formal cost-benefit analysis was performed.

3.1 Asbestos in Buildings

Background: The 1984 EPA national survey of asbestos in buildings estimated 733,000 buildings with friable Asbestos Containing Materials (ACM). This study also estimated there is 2.7 billion square feet of exposed asbestos-containing floor tile in 1.526 million buildings. These estimates did not include schools, industrial facilities, and residences with fewer than 10 dwelling units. Most non-residential buildings are subject to the OSHA asbestos standards, the EPA asbestos NESHAP standard and various state regulations.

The OSHA asbestos standard requires building owners to presume that Thermal System Insulation (TSI) and surfacing ACM found in buildings constructed before 1981, and floor tile installed in buildings through 1981, are asbestos containing, unless demonstrated to be less than 1% asbestos through sampling. The rule does not permit an assumption to be made that a material does not contain asbestos in buildings constructed after 1980. This has led to some confusion among building owners regarding the need for labeling, training and inspections. The 1994 revision to the OSHA asbestos standards removed the term friable from the standard.

The EPA asbestos NESHAP standard categorizes asbestos-containing material according to its friability. Materials greater than 1% asbestos are Regulated Asbestos-Containing Materials (RACM) if they are (1) friable asbestos material; (2) category I non-friable ACM that has become friable; (3) category I non-friable ACM that will be or has been subjected to sanding, grinding, cutting, or abrading; or, (4) category II non-friable ACM that has a high probability of becoming or has become crumbled, pulverized, or reduced to powder by the forces expected to act on the material in the course of demolition or renovation operations.

Almost all states have regulations addressing asbestos. Many states have been approved by EPA to enforce the asbestos NESHAP in their states. In some states, the regulations are enforced at a local level. For example, California has separate air quality control districts, Florida has multiple districts, Allegany County, Pennsylvania enforces the regulations in the Pittsburgh area, and the cities of New York and Chicago have their own rules.

Elementary and secondary schools are covered by the EPA AHERA regulations, asbestos NESHAP regulations, OSHA asbestos standards, EPA Worker Protection Rule (some jurisdictions), and state asbestos regulations. These regulations provide a framework for the management of asbestos in school buildings. Even though the AHERA regulations do not apply to commercial, industrial, and other public buildings, many building owners and consultants look to AHERA as a guide when addressing asbestos in non-school buildings. This appears to have been largely successful for sophisticated office building owners, knowledgeable consultants, and some government entities. Industrial facilities, such as power plants and oil refineries, may find much of AHERA to be difficult to implement, even when looked at as a guideline. Since the AHERA regulations were designed for schools many of the procedures, such as the clearance protocol, does not work well in industrial settings.

The primary motivations for building owners to effectively manage asbestos in buildings are health, regulatory compliance, and financial considerations. The need to limit exposures and prevent future asbestos-related disease focuses on these considerations. The many regulations provide direction if understood and a "stick" if enforced. The financial considerations both detract from and promote proper management of asbestos in buildings. The cost of asbestos inspections, management programs, and response actions, with little tangible rewards is an incentive to consistently take the least costly approach. Concern over litigation, negative publicity, tenant complaints, and insurance issues may promote effective asbestos management.

Issues Remaining: Many issues were raised through the interviews and meetings about asbestos in buildings. Some issues are addressed in other sections of this report. The list of issues below is not exhaustive but appeared to be significant based upon the views of several stakeholders.

1. The quality of work performed by people conducting response actions and managing asbestos in buildings may have declined during the past decade. This may not be universal across the country, or consistent by the types of facilities involved. Reasons expressed have included less frequent enforcement of existing regulations; quality of training for asbestos workers, consultants and regulatory personnel; misunderstanding of existing regulations; and, conflicts among federal regulations and state regulations.
2. The EPA and OSHA regulations are quite lengthy and attempt to address most asbestos issues in buildings. The agencies have issued dozens of letters interpreting various requirements. This approach is seen by some as confusing and inconsistent and may serve as a barrier to employing innovative approaches to managing asbestos and developing new technical solutions. The EPA AHERA regulations (for schools) and numerous state regulations make asbestos management options even less flexible in schools.
3. The high cost of liability insurance and the quality of coverage provided to building owners, contractors and consultants may significantly influence asbestos management decisions. Financing acquisitions of commercial and industrial facilities may also affect asbestos management decisions. These influences need to be better understood to determine whether government policy clarification is warranted.
4. The last comprehensive EPA guidance document for asbestos in buildings, the "purple book," was issued in 1985. This pre-dates the EPA AHERA regulations for schools, and the latest revisions to the OSHA and EPA asbestos NESHAP standards. The 1990 EPA guidance document for asbestos operations and maintenance (O&M) programs is not entirely consistent with existing regulations.
5. Attitudes about asbestos in buildings are wide-ranging and often inconsistent. The heightened concern about asbestos in the 1980s may have led to some premature asbestos removal projects. The perceived complacency about asbestos in the 1990s may have resulted in less effective asbestos management programs. According to a number of stakeholders, mixed messages in the media from regulatory agencies may have also affected how asbestos in buildings has been managed during the past decade.
6. There is a misconception that asbestos products are no longer permitted to be sold in the U.S. A number of products may continue to be produced with commercially-added asbestos, although most manufacturers have substituted non-asbestos alternatives. For example, building products, roofing cements, gaskets and packings with asbestos are available in the U.S. This issue is further discussed in section 3.2.
7. The application of risk assessment techniques to the management of asbestos in buildings was raised as a remaining issue. One subpart to this issue appears to be perceived risks versus actual risks from in-place ACM. Another appears to be potential risks or exposures from in-place ACM verses current risks or exposures.

Recommended Solutions: For each issue raised there could be many solutions. The solutions recommended below are those that could be implemented in the near term. These ideas have emerged from stakeholder input; they are also ones that may best employ education, outreach and/or oversight to achieve results.

1. The EPA should update the "purple book" guidance document to make it the premier technical resource for managing asbestos in buildings and facilities. The revised document should be consistent with current federal regulations and good practices. The "purple book" was released in 1985. Up-to-date information will facilitate voluntary compliance with existing regulations, reducing asbestos exposure among contractors working on buildings.
2. Regulatory agencies should encourage voluntary compliance with existing regulations and good practices for managing asbestos in buildings and conducting response actions. This may be accomplished through a series of asbestos awareness seminars directed at the regulated community (building owners, contractors and consultants). The seminars should be sponsored by EPA and OSHA, and hosted by the resident state asbestos authority. Joint sponsorship would be extremely valuable. Such seminars should be held in conjunction with national or regional meetings of professional/trade associations such as the Environmental Information Association (EIA) to encourage participation by the target audience. Voluntary compliance will increase worker and building occupant safety, reduce asbestos exposure, and decrease costs associated with liability.
3. The EPA in conjunction with the Consumer Product Safety Commission (CPSC) should revise and update the Asbestos in Homes guidance document. This would help address the gap that currently exists in regulations affecting residential buildings.
4. Federal and state agencies should provide additional training to their personnel responsible for asbestos. These personnel would be better equipped to provide guidance and assistance to the regulated community. These agencies should use these personnel to increase enforcement of existing regulations. Federal agencies could be tasked to ensure that this training is supported by consistent messages from those agencies.
5. Federal and state agencies should communicate among themselves before issuing communiqués to the public. This may reduce confusion among building owners and others attempting to comply with regulations. A web-based electronic distribution mechanism for such information should be established to assure rapid communication.

3.2 Asbestos in New Products

Asbestos was commercially added to more than 3,000 products historically. Asbestos has been removed or substituted for in all but a small number of products today. In 2001, the U.S. Geological Survey (USGS) stated approximately 13,100 metric tons of asbestos was used in the United States. Most of the asbestos was imported from Canada. One asbestos mine in California continues to produce asbestos, primarily, if not exclusively, for export.

The USGS estimated the major manufacturing uses in the U.S. are (as of 1999) asphaltic roofing compounds (9,000 tons), gaskets (2,300 tons), and friction products, such as brake linings and clutch facings (600 tons). These are shown in Figure 3.1, left. Asbestos-containing products may be imported to the U.S. What products are imported with commercially-added asbestos has not been systematically investigated. Manufacturing organizations have indicated that brake products are likely to be phased out in the U.S. over the next few years.

Substitutes for asbestos in products are available for almost all uses. The health risks for some substitutes are controversial. Many private entities and government agencies have established policies that prohibit the purchase or use of products with commercial added asbestos. A.A. Hodgson’s book, Alternative to Asbestos - the Pros and Cons (1989) and other similar publications provide listings of some available alternatives. None of these sources appears to be exhaustive.

On July 12, 1989 the EPA promulgated the Asbestos Ban and Phase Out Rule under authority of the Toxic Substances Control Act (TSCA). Under this rule certain asbestos-containing products were scheduled to be banned at staged intervals over a 7 year period. The U.S. Circuit Court of Appeals vacated most of the rule and remanded it to the EPA in October 1991. The court left intact the portion of the rule that regulates products that were not being manufactured, produced, or imported when the rule was published on July 12, 1989.

The six asbestos-containing product categories still subject to the rule are corrugated paper, rollboard, commercial paper, specialty paper, flooring felt, and any other new uses of asbestos. Actions by the EPA in the 1970s had previously eliminated the application of friable spray-applied fireproofing and surface treatments, as well as friable thermal system insulations, such as pipe and boiler insulation. The CPSC issued rules prohibiting the sale of consumer patching compounds and fireplace emberizing agents. The U.S. Food and Drug Administration (FDA) has prohibited asbestos from use in some drugs, cosmetics and foodstuffs.

The following commercial product categories are no longer subject to the EPA rule and it appears permissible that they be manufactured, imported and sold in the U.S.:

TABLE 3.1: Asbestos-Containing Products Allowed in the U.S.

The following products were never a part of the ban and phase-out rule:

• acetylene cylinders
• arc chutes
• asbestos diaphragms
• battery separators
• high-grade electrical paper
• missile liners
• packings (valves, seals, and other uses)
• reinforced plastic
• sealant tape
• specialty industrial gaskets
• textile products

Over thirty countries have issued bans on all forms of asbestos (see Appendix G). The European Commission banned the 5 forms of amphibole asbestos from the European Union in 1991. Chrysotile asbestos was banned from 14 categories of product at that time. On July 27, 1999 Annex I of Directive 76/769/EEC extended the ban on chrysotile in asbestos cement products, friction products seals, gaskets, and various specialty uses.

The Directive requires member states to implement the ban by January 1, 2005. An exception is made for using chrysotile asbestos in diaphragms used in chlorine plants for electrolysis, for which no substitute is available. This use is permitted until at least 2008. The European Commission directive does not apply to substances used for research or analysis, and special military uses. The ban does not apply to asbestos that is not intentionally added to products. The ban does not require in-place asbestos-containing products to be removed until the end of their service life.

In 2002, Senator Patty Murray of Washington introduced legislation titled, The Ban Asbestos in America Act of 2002. This bill, S. 2641, would require the EPA to issue regulations prohibiting the manufacture, processing, importation and distribution of asbestos-containing products. The bill also contained provisions for a public education campaign, research on asbestos diseases, a national mesothelioma registry, evaluation of products unintentionally contaminated with asbestos, and establish a blue ribbon panel on asbestos and non-regulated fibers. No action was taken on this legislation during 2002. The bill would need to be re-introduced in the current (or future) Senate session to be considered.

The current OSHA asbestos standard requires products used in the workplace to be labeled if greater than 1% asbestos, and likely to result in exposures above the permissible exposure limits during their foreseeable use. The OSHA Hazard Communications standard requires materials used in the workplace having greater than 0.1% of any known human carcinogen to be labeled. Material Safety Data Sheets (MSDS) are required to be made available to employers from manufacturers upon request. This information must be accessible to employees, or their representatives.

Issues Remaining: A number of issues were raised through interviews and meetings about asbestos in new products. The list of issues below is not exhaustive but appeared to represent the major issues discussed by the group.

1. The extent to which products currently on the market contain commercially-added asbestos is not clearly defined. Which products contain asbestos and which do not is often not clearly disclosed on the product labels. It is also unclear the degree of hazard, or risk, posed by some products on the market with commercially-added asbestos. Put another way, the presence of asbestos in products needs to be understood, but it may be that in certain products, the asbestos presents no meaningful risk.
2. The definition of an asbestos-containing material under the EPA regulations is a material having greater than 1 percent asbestos. When this definition was established by EPA, it was rare that manufacturers would add less than this amount to a product. The analytical methods did not permit a reliable measurement of less than 1 percent asbestos. An issue remains whether 1 percent is an appropriate definition of an asbestos material with commercially-added asbestos. A related issue is the percentage of naturally occurring asbestos not intentionally added to the product.
3. Interviews, meetings, and field visits to workplaces and home improvement stores found products with asbestos as an ingredient. The word "asbestos" was not used on the label. Rather, the terms "Canadian Mineral Fiber" or "Chrysotile" were used. The issue is whether such labeling practices are misleading to consumers or employers wishing not to purchase products with commercially-added asbestos.
4. Which federal agencies have jurisdiction over the monitoring of asbestos in products is unclear. Each of the following federal agencies has some jurisdiction:

TABLE 3.2: Agencies Responsible for Monitoring and Controlling Asbestos

Agency	Area of Responsibility
U.S. Environmental Protection Agency	products (TSCA), emissions, buildings
Occupational Safety and Health Administration	workplace products
U.S. Department of Transportation	shipping
Food and Drug Administration	asbestos in foods, drugs and cosmetics
Mine Safety and Health Administration	asbestos products (during mining)
U.S. Consumer Product Safety Commission	asbestos in consumer products
U.S. Department of Commerce	import/export, with EPA
U.S. Customs Service	importation of products, with CPSC

The many federal agencies with sometimes overlapping jurisdictions may have resulted in a piecemeal approach to regulating asbestos in products.

5. The EPA asbestos NESHAP regulations require building owners or operators to inspect buildings for asbestos prior to certain renovations and all demolitions. If asbestos products were no longer available for use in buildings the EPA could establish a firm date after which building owners could assume asbestos products are not present. Economically, building owners would not need to hire accredited building inspectors to sample and analyze building materials in newly constructed buildings and facilities.

Recommended Solutions: Several recommended solutions to issues raised about commercially-added asbestos in new products are described below.

1. As one option, an outright legislative ban on the production, manufacture, distribution and importation of products with commercially-added asbestos could be considered. We cannot conclude that a ban is the only effective approach but rather that the process of reviewing information concerning the ban will be useful in assessing next steps. Such legislation would eliminate remaining products by a specified date, and installation of those products by a later date. Jurisdictional issues could be addressed in congressional legislation that might not be achievable by individual agency rule-makings. Exceptions to such a ban may be necessary for a small number of applications for which substitutes may not be available, and for research purposes. Stakeholders at the focus group meeting did not universally support this option. Many stakeholders indicated that implementing regulations, and perhaps the enabling legislation itself, would likely be challenged in the courts.
2. A uniform labeling requirement for all products with commercially-added asbestos should be established through rule making. Labels should include the word asbestos and be a specified minimum size. The EPA would likely be the lead agency for such a rule making, but would need to coordinate its efforts with other agencies having jurisdiction over products with commercially-added asbestos. This option would need to be implemented with the following recommendation as well.
3. A coordinated effort to educate consumers, employers and building owners about products with commercially-added asbestos may be successful. Such a program would assist the target audience to make an informed decision about which products are legally available with commercially-added asbestos. This education and outreach effort would be performed by EPA, OSHA and CPSC. These agencies would need to perform research into which products actually have commercially-added asbestos, which do not, and which are to be phased out voluntarily by manufacturers.

3.3 Naturally Occurring Asbestos as a Product Contaminant

Background: Naturally-occurring minerals known collectively as "asbestos" are occasionally found as an unintended contaminant in some products. Depending on the nature and use of the products, asbestos exposures to workers, consumers and others can occur. The amphibole forms of asbestos known as tremolite and actinolite are perhaps the most common asbestos contaminants. Asbestos contamination may be often found in metamorphic rock with high magnesium content.

The issue of asbestos contamination in products has surfaced repeatedly during the past 25 years. Incidences of asbestos contamination in talc, vermiculite, play sand, crayons, and art supplies have arisen. Educational efforts by the EPA and CPSC, along with voluntary efforts by some manufacturers have traditionally been relied upon to address each incident. Manufacturers have generally employed alternate materials whenever concerns arose regarding the safety of a product. The perception of risk among consumers, rather than regulatory action, was the major motivator in many of these cases.

In recent years, much attention has focused on the vermiculite-mining district near Libby, Montana. Concern has also been expressed about exposures to users of products consisting of vermiculite from this location. The Libby vermiculite deposits have been reported to be significantly contaminated with asbestiform amphiboles closely resembling tremolite and actinolite.

The mineral names for the Libby minerals are winchite and richterite, which are not listed by regulatory agencies as forms of asbestos. The differences between these mineral forms and the listed tremolite and actinolite forms are minor. Some workers who mined and milled the Libby vermiculite appear to have developed the same asbestos-related diseases as workers exposed to the listed forms of asbestos.

The EPA, CPSC, USGS, and ATSDR are conducting studies to determine exposures from Libby vermiculite products, and the resultant health effects.

The Libby vermiculite deposit was originally exploited as an asbestos deposit. In this sense, the Libby vermiculite deposit is unique, and not likely to be representative of vermiculite deposits in the U.S., or elsewhere.

The issue of asbestos contamination in mining and quarrying operations is not limited to just vermiculite and talc. The Mine Safety and Health Administration (MSHA) is currently revising their asbestos standard. The current MSHA standard of 2 f/cc is expected to be reduced to match the current OSHA standard of 0.1 f/cc. The dusty nature of mining operations and the non-specific nature of the air sampling method currently used to measure worker exposures has prompted MSHA to consider transmission electron microscopy (TEM) as the analytical method of choice.

Interviews with some representatives of the mining and quarrying industries indicate efforts are being made to avoid deposits and seams likely to have substantial quantities of asbestos. Knowledge of the geology of the area, visual inspections of the working face, and sample analyses are used to avoid encountering significant asbestos deposits.

Issues Remaining: The following issues related to naturally occurring asbestos as a contaminant were identified during the asbestos strategy process. The list below is not exhaustive.

1. How should mining concerns, product manufacturers, distributors, and users respond to the issue of natural asbestos in products as unintentional contaminants? As a closely related issue, how should regulators respond to the same concern?
2. Producers of vermiculite and vermiculite products expressed concern that all vermiculite has been tainted due to the publicity surrounding the Libby vermiculite. It is noted that vermiculite from the Libby deposit has not been mined for approximately 10 years. Since these deposits appear not to be equally risky, an effective way of communicating on this topic appears essential.
3. What information should be provided to homeowners who may have Libby vermiculite as insulation in their homes?
4. Does the existing PLM analytical method for measuring asbestos in bulk materials, and the commercial laboratories performing these analyses provide reliable results for measuring asbestos as a natural contaminant at the 1 percent level, or below?

Recommended Solutions: The following possible initial solutions were considered as means to address some of the issues raised.

1. Reduction of naturally occurring asbestos in products could be achieved by a program set up by a consortium of mining concerns to develop a sampling and analytical protocol to analyze bulk materials at the mining stage for chrysotile and all asbestiform amphibole forms of asbestos. Oversight of such a program may be provided by EPA and MSHA, with technical assistance by NIOSH and NIST. This program would assist the mining and quarrying industry in avoiding unwanted asbestos in their product. The program would provide a degree of assurance to users of these raw materials that they are not contaminated with asbestos.
2. The Libby vermiculite situation should be considered an important lesson, but not be treated as a typical case. The definition of "asbestos" should be clarified to include all asbestiform amphiboles, in addition to currently regulated amphiboles and chrysotile. An evaluation by EPA, OSHA and MSHA will be needed to determine procedurally how this should be accomplished, and what consequences such a clarification might have, if any, on other industries. This definition would enable federal agencies to reduce the risk of exposure from minerals such as winchite and richterite.
3. A labeling provision should be considered for products having naturally occurring asbestos as a contaminant. Existing regulations may be sufficient for products found to contain more than 1 percent asbestos. A label may be appropriate for products containing greater than 0.1 percent asbestos by volume, if feasible. Products consistently found to contain asbestos at a level below 0.1 percent through a testing program may be exempt from labeling, or have a label with different wording.

3.4 Regulations and Enforcement

Background: There are over 20 different asbestos rules and regulations at the federal level. At least 40 states have asbestos regulations mostly affecting asbestos in buildings and the qualifications of contractors and others who perform asbestos surveys and response actions. Additionally, many local government agencies (county and city) have promulgated rules affecting asbestos in buildings.

The major regulations affecting asbestos in buildings, the workplace, and products have been summarized elsewhere in this document and highlighted in Table B.1 of Appendix B. Many of the issues concerning regulations were described in sections 3.1, 3.2 and 3.3.

Interview and focus group participants made reference to various innovative approaches at the state and local level to support enforcement of asbestos regulations. Most of the approaches described focused on existing asbestos in buildings, response action practices, and contractor licensing or certification. Michigan funds its NESHAP enforcement activities through a surcharge of 1% on asbestos removal fees. Wisconsin reported an increase in NESHAP notification compliance through an outreach program to fire departments. Maine has developed a "one-stop shop" for asbestos issues within its Department of Environmental Protection. Georgia has demonstrated increased compliance with its asbestos regulations through its STAR program, working cooperatively with the regulated community. Several states in the Southwest employ a simple worksheet that must be completed and submitted along with building permits. This information alerts the building inspectors and the building owner of the need to survey their buildings for asbestos before they begin a renovation or demolition project.

Issues Remaining:

1. Building owners, contractors, consultants, and others often are not knowledgeable of the applicable federal, state and local regulations governing asbestos in buildings, response actions, and disposal.
2. Existing federal, state and local regulations are often not regularly enforced. Possible reasons include insufficient staffing, funding, and training among the existing staff.
3. Some regulations may benefit by clarifications and revisions. Many stakeholders appear wary of re-opening rule-makings that might allow special interests to weaken some provisions.

Recommended Solutions: Most proposed solutions affecting asbestos regulations are addressed in sections 3.1 — 3.3. Several additional proposed solutions are offered below.

1. The EPA and OSHA should focus on more predictable enforcement of existing regulations, which may be more beneficial than committing scarce resources to new rule-making efforts. Consistent interpretations and streamlining across agencies will lead to increased compliance and potential reduced liability for businesses.
2. Training providers under the EPA model accreditation plan (MAP) and corresponding state plans should be audited with sufficient frequency to assure the training is provided, tests are conducted, records maintained, and certificates issued. The EPA should update the model training curricula. Updating the training will make the curricula consistent with existing regulations and increase worker safety. The updated versions should cover the revised OSHA asbestos standards, revised EPA asbestos NESHAP, EPA Worker Protection Rule, new respirator designations/regulations, and other topics. The training providers should also be permitted to vary the course content in refresher courses. Auditing training providers will also increase worker safety and the effectiveness of abatement efforts. Reducing the incidence of training fraud will provide greater security to building occupants and owners. Partnership will provide better coordination among federal and state agencies.
3. A summary document of federal asbestos regulations should be prepared. This would be a valuable resource for the regulated community and the regulators. The document would be prepared by EPA and OSHA with input from the other federal agencies with asbestos regulations.
4. A companion summary document of state asbestos regulation summaries would also be a valuable education tool. This document should be developed by the National Conference of State Legislatures (NCSL). The NCSL has developed such documents in past years, but these are now no longer accurate.
5. The EPA should partner with one or more local organizations such as the Environmental Information Association (EIA), state agencies, local building code inspectors, fire departments, and other groups to inform stakeholders and to encourage voluntary compliance with both federal and local regulations. Similar efforts with these groups have been successful recently.

3.5 Medical/Health Issues

Background: The early evolution of the health effects related to exposure is summarized in Appendix B. There continue to be inconsistent perceptions among the public about the health effects associated with asbestos. Frequently references are made in the lay press to "asbestos disease," rather than the recognition of several different health effects associated with asbestos exposure. While it is beyond the scope of this study to address technical risk assessment issues, comments from participants stressed that more precision and clarity of information is needed with risk assessment issues.

Depending on the specific disease, a threshold may exist below which symptoms would not be expected. Some diseases exhibit a classic linear dose-response relationship, while others do not. The potency of one form of asbestos may be greater for one disease than another form. The issue of fiber dimensions, surface characteristics, and other physical properties continue to be studied and debated today. Individual susceptibility is also an issue when considering asbestos related diseases. It appears unlikely that many of the health issues will be resolved in the near term.

The risk of developing an asbestos related disease is also controversial in the scientific and medical communities. The risk is also inconsistently perceived by the public. At one extreme, some of the public perceive one asbestos fiber is sufficient to cause a fatal disease. While theoretically this appears possible, in reality such a risk is de minimus. At the other extreme are some who believe only massive long-term industrial exposures may result in disease.

In the U.S., regulatory agencies have always treated all the forms of asbestos (chrysotile and the amphiboles) the same. The American Conference of Governmental Industrial Hygienists (ACGIH) initially treated them the same for over 20 years, then issued more restrictive threshold limit values (TLVs) for the amphiboles, but reverted back to one TLV for all forms of asbestos in the 1990s. Most European countries treated all asbestos forms the same, then issued more restrictive requirements for the amphiboles, and now returned to treating them equally for regulatory purposes.

The background of medical and health issues would not be complete without mention of the effect litigation may have had on the scientific and medical literature. Recognition of this fact was evident in the Health Effects Institute Asbestos Research (HEI-AR) where that panel of experts felt it necessary to describe data as "litigation" and "non-litigation" data. On the positive side, litigation has provided financial support for many studies that otherwise may have not been performed. On the negative side, the financial support creates at a minimum the perception of bias by researchers, or may have prevented distribution of results not in the best interest of the research sponsor. Today, most reputable scientific and medical journals require disclosure of affiliations and funding prior to publication.

Issues Remaining: This Asbestos Strategies process was not designed to identify or evaluate the many issues relating to health effects, diagnosis and treatment of disease, and the epidemiology of asbestos-related diseases. However, several issues were raised that are described below.

1. The need for early recognition and diagnosis of asbestos related diseases was raised as an issue. This issue is not as simple as it may appear. There is controversy over the use of various tests to diagnose disease, such as using Computerized Axial Tomography (CAT) scans. The use of repeated chest x-rays for people with little asbestos exposure is controversial. The question of which branch of the medical profession is best equipped to recognize the asbestos-related diseases is not resolved.
2. The need for epidemiology studies of populations with "low-level" exposures to asbestos was raised as an issue. This would include additional studies of workers in the vicinity of others who worked with asbestos, family members of asbestos exposed workers, and persons with short-term high-dose exposures.
3. The need for a national mesothelioma registry was raised as necessary. Closely related was the issue of clarifying malignant mesothelioma in the International Classification of Disease (ICD).
4. The obvious issue of compensation for persons with asbestos-related diseases remains today, as it did 50 years ago. The mechanism of compensation, responsible parties, and the definition of fair compensation are all significant issues that are beyond the scope of this analysis and have been wrestled with in the courts and legislative bodies in the U.S. and worldwide.

Recommended Solutions: The following proposed solutions address only a fraction of the possible medical/health issues surrounding asbestos-related diseases.

1. A national mesothelioma registry is necessary to facilitate epidemiology studies evaluate the effects of asbestos exposure. Many countries and some states have established mesothelioma registries. The establishment of such a registry would likely be performed by the Centers for Disease Control (CDC) in conjunction with state public health departments.
2. There is a need for an inventory of significant health-related research to ensure that interested parties can access experts wherever they are located. The CDC should lead this effort. In conjunction with the mesothelioma registry, this would improve research and treatment of asbestos-related disease.
3. The relationship between fiber size and disease is being considered by the Agency for Toxic Substances and Disease Registry (ATSDR). This agency convened a panel of experts on October 29-30, 2002 to consider the health effects of asbestos and synthetic vitreous fibers: the influence of fiber length. These efforts should be supported and encouraged.

3.6 Risk Assessment and Analysis

Background: Risk assessments have been performed by the National Academy of Sciences (NAS), OSHA, CPSC, EPA and ATSDR over the years in support of regulatory activities or research. The risk assessment area is controversial. Much of the controversy may stem from uncertainties in the source data the assessments are based on. The long latency period between exposure and onset of disease makes linking exposure concentrations, frequency and duration to disease difficult.

Much of the risk assessment exposure data was generated during asbestos mining, milling and product manufacturing. Most of this exposure data during the 1930s through the 1960s were generated using the impinger technique or the thermal precipitator. These methods expressed exposures in millions of particles per cubic foot of air (mppcf). In the late 1960s the method of choice changed to measuring fibers visible by the optical microscope with concentrations expressed as fibers per cubic centimeter (f/cc). These early exposure measurement techniques assumed all particles, or all fibers were asbestos. In some workplaces most were likely asbestos, in other workplaces, most were likely not asbestos.

Since the onset of disease among asbestos exposed populations often occurs 30 years to 40 years later it is difficult to estimate the exposure(s) responsible for the disease. Since there are multiple diseases associated with asbestos exposure, and for lung cancer a recognized positive synergistic effect with cigarette smoking exists, the uncertainties are compounded.

The degree of risk posed by a substance is always a controversial subject. With substances such as asbestos, factual variables such as the specific form of the material and exposure pathways can vary widely, and oversimplification of risk characterization can be problematic. For example, if it is assumed that any increase in exposure represents some increase in risk, should all exposures be eliminated? Since there is some low exposure in the outside air, should only additional exposure be eliminated? Is there some increased exposure, and corresponding increase in disease that is considered "acceptable?"

The term "risk assessment" has been used when discussing the management of asbestos in buildings and in considering asbestos in products. Often it is used, perhaps erroneously, interchangeably with "exposure assessment" or "hazard assessment." Exposure assessments are performed to measure airborne concentrations of asbestos. Hazard assessments look at current exposures and the potential for future exposures. Building owners use this information to develop asbestos management plans to reduce or minimize actual exposures, and hence to reduce or minimize actual risk.

The foregoing is a brief synopsis that only begins to suggest the range of risk assessment issues relevant to asbestos. Studies of this subject are on-going worldwide and will likely continue for decades to come. Areas of research were listed in section 3.1 and 3.5 that are necessary to further define the risks associated with exposure to asbestos, particularly low-level exposures.

Issues Remaining: There are numerous issues surrounding risk assessments for asbestos. One identified during this process was the public’s perception of exposure and risk.

Recommended Solutions:

1. The EPA is currently reviewing the need to revise its risk assessment methodology for asbestos. The agency is currently convening a panel of experts to consider whether this methodology can be used to support decisions about asbestos contaminated sites. This panel is scheduled to meet during February 25-27, 2003 in San Francisco, California. Such efforts should be encouraged and supported.
2. The EPA and OSHA should employ education and outreach to provide reliable risk communication to the regulated community and the public. Following the World Trade Center attacks federal agencies may have underestimated the risks out of concern to control the public’s perceived risk. A backlash followed inside and outside some agencies, which may have overstated the risks.

3.7 Analytical Issues

Background: For at least 75 years there have been issues relating to how best to measure asbestos in bulk materials, soils, dust, water and air. The methods of analysis have evolved and many have become regulatory requirements.

Polarized light microscopy (PLM) is commonly used to measure asbestos in bulk materials. It is inexpensive (about $10 per analysis in commercial laboratories) and a quality assurance program administered by NIST is in place. The method can identify asbestos in bulk materials down to 1 percent reliability. False negative results (i.e., not finding the asbestos) are common in some bulk materials when the asbestos is very small or concealed in a matrix, such as floor tile or roofing tar. Transmission electron microscopy (TEM) has gained wider acceptance to confirm or deny the presence of asbestos in bulk materials at a cost of about $50-75 per sample, but getting reliable quantitative data from this technique has been questioned.

Air samples are generally collected on a filter and analyzed by phase contrast microscopy (PCM) or TEM. The PCM method is inexpensive (about $15.00 per analysis) but does not distinguish asbestos from other fibers. PCM also only looks at bundles of fibers longer than 5 micrometers in length since the optical microscope cannot resolve, or "see," individual fibrils of chrysotile asbestos for example. TEM only counts asbestos fibers and has the ability to detect all sizes of fibers. TEM remains more expensive than PCM, but its cost has come down markedly over the past 15 years from about $500 per sample to $100 per sample today.

Recommended Solutions: Many of the technical issues surrounding sampling and analytical issues are addressed as they arise by professional associations such as ASTM and AIHA; and federal agencies such as EPA, NIOSH, OSHA (Salt Lake City, Utah laboratory), and NIST (NABLAP program).

1. Federal agencies should continue to actively participate and support the efforts of professional associations in the development, revision, and quality assurance practices relating to sampling and analytical methods for asbestos