Document 5k8YokMD2v7a8xgdOrY9d2Q6J
FILE NAME: M obil (MOB) DATE: 1973 Aug 23 DOC#: MOB008 DOCUMENT DESCRIPTION: M em o and Unpublished Internal Report
ifJtm Q r a n Jiu n frvm
"
4
T. . ALIEN, M. D. HW YORK. N. Y.
.13 Auditst 1973 Dt*
Dr. H.H. Gals API
Dr. Allan has asked rae to send the attached to you for youx information.
Joan DiGanci Dr. Alien's Secratary
i
r t A O O ^ 92
Mobil-Smith 000505
Merr.Q te File
As noted in a memorandum dated 11 July 1973, a meeting was arranged, following an invitation from Dr. Irving Selikoff, to meet with him at the Mt. Sinai Medical Center. Attending the meeting were:
Dr. Harry Hermann - Associate of Dr. Selikoff - MV
Dr. W. Nicholson - Associate of Dr. Selikoff - MY
Dr. N. Roberts
- Assoc. Medical Director, Exxon Corp.-NY
Dr. M. Goldman
- Ass't. Medical Director, Exxon Corp.-NY
Dr. H.A. Sinclaire- Assoc. Medical Director, Mobil-NY
Dr. T .E. Allen
-* Medical Director, .Mobil-NY
The purpose of the meeting was to present findings that Dr. Selikoff had made fallowing examination of a croup o f represented Mobil employees (Pauisborc Refinery) or. the request of the union at Pauisborc. In addition. Dr. Selikoff hoped that, on discussion of these findings, the group might be able to advise aim whether such findings might be considered typical and usual of an average refinery population.
The meeting lasted approximately two and one half hours and consisted principally of a presentation of asbestosis as an occupational illness, with major points of same being illustrated by x-rays, statistics, and data gathered or. the Mobil population examined. No list of examinees was given, and, at r.o time, was any data or x-ray identified by a specific name.
Initially, Dr. Selikoff gave a brief discussion of the disease, asbestosis. in this coverage, he covered the highlights of work being done here and ir, U.K. He mentioned historical work done in shipyards in USA and D.X.. He made it clear that, during the discussions, he would be talking in terms of ''insulators, brick workers, etc. in user companies," rather than in terns of "factory w o r k e r s ( w h e r e asbestos products, piping, etc. are made such as Johns Manville, etc.). In spite of this, he pointed out that if exposure to asbestos fibers in insulators was enough to produce malignancy, the great exposure normally experienced ir. factory employees was "excess exposure" as far as cancer was concerned. Graphically shown, this would be as follows:
Exposure (Yrs. s
Service)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___________ rACTORS WORKERS' exec sura
mmmmmm_
___________ _
Cancer production level
Tthaaed area represents -`was tec* area or exposure)
Dr. selikoff pointed cut that the typical x-ray findings in a case of asbestosis were:
1) General thickened pleura (the pleura is the thin, transparent covering of the lungs)
2) Pleural plaques (a concentration of thickening of the pleura in certain specific areas)
3) Reticular fibrosis (intensified marking throughout lung tissue , particularly in lower lung fields producing a
M8EA005793
Mobil-Smlth 000506
4) A shaggy appearance to the heart outline. 5) Blunting or even complete obliteration of the area
where the diaphragm touches the rib area.
It was emphasized that the above findings were typical of but not pathog nomonic (specifically distinctive or diagnostic) of asbestosis. These findings, along with an extensive work or exposure history, can be considered diagnostic. One does not necessarily need to have positive pulmonary function tests to clin.c h the diagnosis. The development of asbestosis need not produce death in any person sufficiently exposed, but, there is developed in cases of asbestosis susceptibility to lung cancer, and even to mesothelioma, a specific type of malignancy.
In regard to Mobil's employee group at Paulsboro, Dr. Selikoff stated he was requested by the "union" there to examine a group of represented employees. This group of employees was presented by the union to Dr. Selikoff who did not have a voice in the choice and he had no previous knowledge of the examinees' medical, work or social history. He stated emphatically that, as a result, the study was a biased one, but he could not state whether it was biased in favor of a sick, average or well croup. The only point or. which there was certainty was that all examinees had had at least 20 years of work in the refinery. On several occasions, the size of the examined group was stated to be 137, this is not quite accurate because only U S were examined. The remaining 19 were those employees who, at an earlier date, had been seen only for a chest x-ray and chest examination and, on whom, the union re quested the company x-rays be forwarded to Dr. Selikoff at his Pate rson, N.J. office.
Dr. Selikoff handed out six sheets showing in graph form some of the findings resulting from his examination of the 118 employees. (It should be noted that the examinations were done by a team of 9 people from Mt. Sinai Medical Center who, with the aid of mobile x-ray unit, completed these examinations during one week-end.) After the charts were handed out, discussion was so continuous that it was not possible to examine these charts thoroughly. Constant re ferences were made to the charts, however, during the discussion.
On the days following the conference, when the undersigned was able to thoroughly review these charts, it wa* evident that there were many errors in calculation, ' as well as some ambiguity is reporting the population studied and the results found in same- A call was made to Dr. Selikoff's office and some corrections were offered via the phone, and others were made by sending revised charts to replace those ia question.
Attached are copies of the revised tables issued to us at the meeting. Table vr was not given at the meeting. It was included in a later mailing to the under signed. General comments on the tables, which are self-explanatory, include the. following.
It will be immediately obvious from Table I that the medical review was not restricted to "active" employees as was first thought. We are told by Dr. Selikoffs office that the breakdown of the 137 examinees is as
Mobil-Smith 000507
hBfcA00579<t
follows :
annuitants "active" employees "active" employees
13 105 (full medical review)
19 (partial medical review)
The 19 employees listed above were employees (no annuitants) who were seen at an earlier cate by Dr. Selikoff and on whom only a chest examination and a chest x-ray were done. This was the group of employees on whom the union requested their company x-rays to be sent to Dr. Selikoff.
we are not aware in which group, i.e. service, the 13 annuitants fall. We can assume they may be in the 30-39 and 40-49 because it is in this group that ages in excess of normal retirement age are listed. It is possible that some might be in the first service category, 20-29 yrs., if they re tired at an ace younger than 65 years.
The remaining tables are self-explainatory but indicate, among other things, that
1) none of the cases in this series showing classic signs of asbestosis are "serious" cases. There is no doubt that, in x-ray films shown to us (soma taken in the mobile unit - some previously in the group of 19) there are some x-ray signs indicative of asbestosis. Unfortunately, w* were not given the names of the patients represented in the x-rays shown as samples. Dr. Selikoff feels, from his long experience, that x-rays alone (if not correlated with pulmonary function tests, etc.) tend to "unread" the time picture of asbestosis.
2) Clinical findings such as bronchitis and positive x-ray findings and pulmonary function tests are higher in "smokers" than "non'smokers" and higher in "ex smokers" than in the group which has no smoking history.
3) A high percentage of this group axe "no hisotry of smoking" (28%) and "ex smokers" (39%) making a total group of
"nan smokers" - 67%.
4) The study is unique in on* aspect. With th* expected exposure of this group of employees to firebrick, there is no indication of silicosis. Firebrick is about 35 quartz in composition.
We are not prepared, at this time, to dispute or confirm Table VX_ It is interesting to note that cancer of the lung in this group studied is recorded as 0.8%, The national average of cancer of the lung (males) is 3+%.
Probably the most revealing and appropriate chart is Table VTI. This shows that of all tie categories of workers represented in the study, that of the insulators, masons and bricklayers (13), 81% show positive signs of both pleural and pirsnchymal involvement of asbestos exposure. This is markedly
MBfcAOO 5795
Mobil-Smith 000508
higher than the findings'in all other occupations represented. Again, it was staced by Dr. Sclikoff that although asbestosis is unquestionably established as a diagnosis, these do not represent presently "serious" cases.
Attached with the statistical tables is a copy of the recording fora used in the analysis of x-rays of patients whose occupation might make them liable to pneumoconioses (chronic fibrous reaction in the lungs to the inhalation of any type of dustl such as asbestos,iron dust, cloth fibers, and silica, it should be noticed that this form and its legend is the official classification established by the I.L.O., and generally accepted as a classification by most pulmonary and occupational health specialists.
Dr. Selikoff feels that, in an ideal program of preventive health,, workers with. 20 years or more exposure in jobs involving insulating materials, fire brick. and masonary cement, chest x-rays should be done every three months. He also thinks many other preventive procedures to protect their respiratory systems should be instituted. Thus, he advocates the administration of flu vaccine each year for such a group. Above all, he urges ail workers to stop smoking.
Dr. selikoff was most professional in his conduct during this session. At no time did he mention the company's name and only, as identification of location of the worker studied, was the name Paulsboro used. furthermore, he feels tha` the union is unaware of '99% of the great work done by the company medical department." "They only see and talk about the bad things hen they happen." He cited a common union complaint that "our men naturally are sick breathing i: that contaminated air at the refinery every working cay." Ha quickly referred again to Table V showing that chronic bronchitis, if the union complaint had merit, would be appearing in all represented employees, when actually his statistics show it occurs primarily and credominaely in the "smokers."
He urged consideration of a joint management - union study of the asbestos, workers (those who have been exposed curing their work life) in at least five refineries, among which, should be included the "best" (as far as modern, but not recent construction) and the "worse." Thus assumes more than one company would be so involved. The whole research project should be jointly sponsored developed and each side totally aware of the progress from planning through completion stages.
Such a study can be done by any one of many agencies. There is no doubt that it could be done by the federal government - through the agency of NIOSH. If done by them, he feels it would be a fair, well done and complete study. However, NIOSH could and would probably look at such a project only once and not on a continuing basis, and this type of study needs at least a 20-30 year followwup since this can be the "incubation" period of asbestosis.
Th.a study could be done completely by any outside agency, such as an academic group or a private research group.' Needless to say, choice of the group would have to be mutually agreeable.
m b EA005796
Mobil-Smith 000509
the ideal project, in Dr. Selikoff's odnion, is one planned with, guided and supervised by capable outside experts, but with all the examinations, x-rays, lab. work done by the company inolant medical department. He feels this is the only source of ongoing interested medical supervision available to the men. He does feel that,-in Paulsboro's case, it may well take a gigantic effort to get the union and management to mutually trust each other in such an undertalcing. He does not feel that it is impossible, and he feels every effort should be made to accomplish this coal. Again, he pointed out that, in the general male population of tire USA, there is a 3-4% death rate due to lung cancer. Admittedly, there aremultiple etiological factors in development of lung cancer. However, if and when lung cancer occurs in a company worker ex posed to such materials as asbestos, the first and most obvious conclusion is that this is due to a carcinogenic material in the work environment. This is difficult to combat, and admittedly, can be unfair to managements. Research and careful clinical follow-up can establish data that could remove the haziness as to responsibility in all such cases.
In summation, Dr. Selikoff presented findings to the group in a most pro fessional and non spectacular fashion. He admitted repeatedly the group studied is an ideal one in many respects. A more ideal study, jointly sponsored by management and union, should be undertaken. Mobil is not the only petroleum company with this problem (cases in Texaco were cited). Dr. Selikoff did not pretend to be an expert on refinery health since he has never had an opportunity to visit a refinery. No commitment was made to him as to follow up to his presentation or suggestions After the close of the meeting, Dr. Selikoff was asked if he would explain his relationship to either OCAW or independent unions in the petroleum industry. He answered that he has no contract with OCAW or any union. OCAW and indeoencer. unions have and do request the Mt. Sinai Medical School - Department of En vironmental Medicine to do projects for them as indicated in this study of some Pauisboro employees. He emphasized his commitment is not unilateral, and both the school and he, as an individual, are free at any time to consider research or consultant capacities with any agency, management, union or government.
HtJ * 0 0 5 7 9 7
Mobil-Smith 000510
M8E.A00 57 98
M o b il-S m ith 000511
Table l
Age dlstribut Ion of 137 refinery workers, by years since first exposure
Years since first c:;|)onnn>
Length of exposure Number (years)
Age range
Average
20-20
20-29
66
41-65
50.0
30-30
30-39 13
05
48-70
1
81 .
53.4 81
40-4 9
10-47 36-39
12
59-GC
4
64-70
63. 1 68.2
M8EA005799
Mobil-Smith 000512
Tabla II
Work Activities of 137 Production and Maintenance Employees
Type of Work
Active
"Clean Work"
10
(Docks, Case-Can, Auto Shop)
"Dusty" Production Work
5
(Bead Plant, Filter Dept,)
Fume Exposure
23
(All other production units)
Mixed Fumes and Dust
6
"Clean" Maintenance
21
(Carpenters, Machinists, Electricians,
etc, )
High Asbestos Exposure
13
(Insulators, Masons, and Bricklayers)
Other Maintenance
41
(Pipefitters, 'Welders, and
Boilermakers)
Retirees 1
7 2 3
Totals
124
13
MBEA00580Q
Mobil-Smith 000513
*>
X-ray changes
Length of exposure
(yosrs)
Numbor of
Persona
parenchymal
1
2
Pleural (only)
Total pleural changes
Total changes Parcnchymnl
and/or pleural
No changes
20-29
66
30-30
06*
>40
16
Total
136*
IS
2
28% 3%
20
2
36$ 4$
0
1
57% 0%
10 15%
3 5%
0
47
5
34?. 4%
13 10$
15 23%
3 57.
3 19*
21 15%
30 46*
25 45%
10 62*
65 48%
35 54%
31 56%
6 `38%
72 52%
* A X - r a y o i ons in d i v id u a l was u n s a t i s f a c t o r y anil c o u ld not be read
MB6.A00 5801
Mobil-Smith 000514
T;!lo ill
Pulmonary fu n c t io n nbtiorm/Jitie.s in r e la tio n to X-rny changes ami smoteIn "
llcstriction 1
Smokers Ex-smolcers Non-smokers Total
Parenchymal
and/or pleural
' changes
7
3
Number of
11%
9%
persona 65
3
5%
16 253
Obstruction Smokers Ex-smokers Non-smokers V :> t.' l
11
17%
9 14%
0
20
'll'.,
Ko changes
2
2
Number of
parsons 71 3% 3%
2
6
3%
97c
8 11%
5
7%
3
4%
227
2 CE m > o o v-n Oo o rv)
Mobil-Smith 000515
Table IV
Smoking Habits
length o exposure (years)
20-20
Muaber l f
Workers
cs
Smoller
1
22 34%
30-30
5G
19 34%
40+
16
4 25%
Ex-smokera
Non-smokers
23 30%
21 37%
10 52%
20 31%
16 29%
2 13%
Totnl
45
137
|
33%
r.4 39%
36 28%
MB fcAOO 5803
Mobil-Smith 000516
Table V Prevalence oi Chronic Bronchitis
Length oi exposure (years)
Humber of
| Persons
20-29
65
30-39
56
40+
iG
Total
137
Smokers
Ex-Stackers
9
4
11
3
1
1
21
3
Jion-Sm alters
Total
16 3 25% 1 15
277. 2 0
12.5 33 4
24
70SSOGV3flW
Mobil-Smith 000517
i
Table VI
H is to r y oi p revio u s ca sse r i a 113 r e i i s e r y workers
Cancer
fturbar
|
oi cases
Skia
2 1.6%
Bladder Colon
2 1.6% I
1 0 ST>
Abdcaiaal
1 0 S|9
Lung
1 0 .2 %
Total
T
6%
MBEAOO 5805
Mobil-Smith 000518
'tM
.y. jy.'JlSj&jfY/iftrt-iS.?.;>,,
. T u-Vu
X~ray ilosults of iloilnory Productio. ,iud Maintenance! Employons
Negative
ypo o t Work
0/0 0/1
'Clean Work" (Docks,
nse-Can, Auto Shop
&
4
lust (Dead Plant, 'liter Dopt.)
1
3
urnes (All other reduction units)
8
0
U x o d punas and lust
1
3
'Clean''aaintenanca
Carpenters, llnoh In
st, Electricians,
tc.)
` .
6
&
thcr maintenance
Pipefitters, Welders,
><ul -Oollornnkara)
11
11
nsulators, Masons,
nd Bricklayers
3
1
Pooitivo
1/0
1/1
1/2
2/1
2/2
Ploural
1
1
fi
&
1
1
1
' 1
1
1
3
7
4
6
3
8
2
1
1
4
1
2
% Positive IB
1 20 47 33
52
4G 81 '
overall
48
MB&A005806
Mobil-Smith 000519
J R O N M E N T A L S C I E N C E S L A R O . 'I A '. A vJ.
r SINAI SCH O O L OF MEDICINE OF THE CITY UNIVERSITY OF NEW YORK
{JlllilllCt' . - -- Kcr.naroh (itoo|> -
eat;
X lllflCdililF
cnu
MfcA00580/
Mobil-Smith 000520
.'A, CII CO !, r( e*