Document 6R0QgYN9vMgpKe3v9RZmryXLm

| & V It S I K A ( 1 To pin insight into corporate activities regarding the identification ofoccupational caidnopos earlier in thii ceotury, tita actkaia of one in dustry, the adbertas industry, wen reviewed THs btany, concert wfth many at to tncsiea, ijmamA- jf? IBM --- - * - -* (MLIiMfiMmpManOBi industries daring dds tine. (4m / Pubic Heath. 1991:81:791-00* UK.Vrf.a.N*t The Silence: The Asbestos Industry and Early Occupational Cance Research--A Case Study David E. Lilienfeld, MD, MPH, MS Engin If in ox gores someone that they die, then the ox shall be lulled, and his flesh shall not be eaten; but the owner of the ox will not be liable. But if the ox has given indications of goring persons, and his owner was so informed, and the ax was not kept in and he killed someone; the ox shall be IbBed and his owner also shall be killed. Exodus 22: 28-29 The Industrial Revolution brought with it widespread occupational exposures to pathogenic agents, such as sflica and lead. Recent legislative initiatives in the United States have greatly reduced such expo sures. However, in the absence of major enforcement efforts, the effectiveness of this legislation depends on corporate cooperation and compliance. Many of the corporations whce products cause occu pational diseases sponsored the initial de velopment of that etxtogic knowledge.1'* Recent legal actions by some members of the asbestos industry have disclosed doc uments describing the development and subsequent suppression of data concern ing the hazards of asbestos. Members of both the insurance industry and the aca demic medical community participated in such activities which permeated the as bestos industry. This paper describes the develop ment of these actions and how the concern with asbestosis which had developed first, was extended to cancer. It discusses the industry's growth, the development of coocems about asbestosis, and the forma tion of a research program tc counter thrm. When these studies found that as bestos was a carcinogen, this information was suppressed. The ensuing cover-up, effected through industry association and research compacts, resulted in thousands of deaths.74 The Asbestos Industry, 1850-1927 The attributes of asbestos, s silicate, that fostered its widespread use have been known for at least two milknta.* Yet it was the unique confluence of the Industrial Revolution, innovations in building construction, and the ccooomic growth in the United States that led to its wide spread use during the pSRenm^nrau^ lation was needed for efficient energy use to maximize engine power.10 Resistance to both heat degradation and combustion was desirable. Asbestos was such a ma terial. The asbestos industry developed as a response to this need for insulation. It grew in tandem with the post-Gvil War development of heavy industry. During the late 1800s, many in the industry thought that I asbestos Celts oouid limit engine heat loss, then asbestos roofing felts might similariy limit building heat loss. Asbestos became a construction material. Rapid growth of the industry was not without serious consequences.u In the 1920s, for example, the medical community recognized a fibrobc hiag cotxhtion, similar to sifioosis, that resulted horn asbestos exposure.*'13 The Hazard Suggested In the late 1800k and early 1900s, the hazards of occupational silica exposure were recognized, and the widespread na ture of such exposures became appar ent. >3Tbey were made clear in a landmark 1917 report by a young Public Health Ser vice (PHS) physician, Anthony Joseph Lanza.14 After entering the PHS in 1907, Lanza was detailed to the Foit Suntan, New Mexico, Marine Hospital Tubercu losis Sanatorium. He left that assignment with an interest in pulmonary medicine and the dmical skills to pursue it. In 1914, Lanza was appointed as the Chief Surgeon to the Bureau of Mines. He was assigned to the Joplin, Missouri, lead and zinc mining areas "to investigate and report oo the prevalence, causes, and methods of control of pulmonary diseases among miner*"1* A scries of investiga tions followed that quickly established him as an er^eit in the poeumocooiose*14 Reprint requests ebould be adeemed to David E. LiUcafcid. Mount Sin School of Medians, Divirioe of Environmental and Ocnyarral Medicine, Department of Comnmury Medi ans, Bax 1057,1 Gtsuw L- Levy Fiscs. New Yak NY 10029. Jownti of Public Health 791 Further assignments in occupational med icine followed. In 1920, Lanza left the PHS to practice and consult in the private sector. Six years later, he was hired by the Metropolitan Life Insurance Company to "provide industrial medicine and indus trial hygiene services to companies whose group life insurance policies were held by the Metropolitan."14 The Metropolitan also provided these services to companies whose disability or workmen's compen sation policies it carried. The recogniboo of silicosis and its as sociation with employment practices, coupled with a high injury rate in many industries (particularly in mining), led to the enactment of workmen's oompeasabon statutes in the United States between 1910 and 1930.11,17 Corporations bore this system's coat as a humrw expense. It was therefore only in the 1920s that the Metropolitan's services wen needed by industry. At the same time, asbestosis wss identified as s distinct entity caused by asbestos.' No direct evidence exists that these reports were alarming to the indus try. However, subsequent events suggest that the companies did not immediately acknowledge (or desire to do so) the haz ard created by asbestos exposure. One response was a 1929 request by several asbestos companies to the Metro pobtan for an industrial hygiene survey of several of their plants. The survey also was to determine if asbestosis even exist ed.4-1* If the disease did not exist, then there could be no liabilities from it. An additional concern was whether asbestosis led to tuberculosis in a manner akin to silicosis, since asbestos was a silicate. If asbestosis did so, the compensation costs would be much greater. Lanza, an expert in the pneumoconioses, was to direct the study. Lanza was weO aware of the legal implications of such work. For example, in November 1929, he had sent to Mr. Allan WardweO (of Davis and Folk, a Wall Street law firm and Johns-ManviDe's out side corporate counsel) a bibliography on asbestosis.1* A year later, Lanza wrote to Wardwefi concerning the definition of asbestosis to be used in the workmen's com pensation schedule for New Jersey, then being codified.30 The surveys found that asbestosis, present in large segments of the industry's workforce, did not predispose to tuberculosm.31* In 1931, Lanza sent the American plants survey findinp to Wardwell, noting: "It is, of course, understood that this report is confidential and it wfll be given no publicity by us except with the consent of the firms cooceroo&"3* A sim ilar report for the Canadan plants (written by Lana's superior, E. McConocfi. MD) was also sent to WardwtU.23 Three months later, at a meeting with JohnsManviDe officials, Lana recommended the inclusion of asbranms under work men's compensation: ''(He) is very strongly of the opinion that asbestos* should be made compensable.... He feels that this is (he only protection which thetmhstiyhas. . .permitting the daeaie to remain outside the compensable da* lends eimxiragement to unethical lawym and physicians to work up claims.''* By 1932, Johns-Manville had several suits against it from workers wnh tosd.r In contesting these suits, the cor poration sought to question the diagnosis of pulmonary disease. In February, Lanza wrote to F.V. Meriwether, MD, of the US Bureau of Mines, requesting his assist ance in reviewing some x-rays from ManviBe, New Jersey, plant.21 In a fo*. tow-up letter from S.A. Williams (JohnsManville Vice President for Minm and Production), Meriwether was told "you will readfiy appreciate that we desire the results ofyour readings to be held in strictcat confidence and that no unnecessary publicity be gives so the fact that you are making these readings for us.. -wewi* if possfote. to prevent the results of ow efforts being used against us either in the pending suits or in any suits which may be brought against us."37 Meriwether subse quently agreed.3* Vandiver Brown, Johns-ManviDe's general counsel, coordi nated the logistics.30 In 1933, Williams wrote to A. R_ Fisher (manager ofthe Manv-Oc, NewJer sey, plant) concerning Lanza's reply to questions from a physician at Johns-ManviQe's Waukegan, Illinois, plant.31 The Waukegan physician had reportedly asked Lanza, "Do you agree with my recommendatioo that employees definitely be mnde aware of the fact that asbestoa dust is hazardous to their health?" Lanza replied: "I doubt if the hazard is sufficient to justify warning posters.... This is es pecially true in view of the extraordinary legal situation." The legal aspects of the situation had had an impact on a physi cian's (Le., Lanza's) approach to a med ical problem, i.e., they led him to ignore iL Later in the exchange, the plant physician noted: "I have made a diagnosa of asbes tos*. ... In my judgment the best dispo sition ofsuch a case is to remcxre him frixn the dust and give him a job in some other put of the plant." Lusta replied: "It i difficult.... One of the difftrulties anc vexations ... of poeumoconiosa it tbn economics as svefi as production factor* mum be balanced against the medical fro tors." In November 1933, Lanza met wid Johns-ManvtOe executives to dbcuts th completion of the Metropolitan surveys.1 Attendees included W. R. Seigk (chair 792 American Jomal of Pubic Health June 1991. VoL SI. N& AaMatoa Ming aprayad during con struction. Courtaay of Mltehall Cohan. man of the board), E. M. Voorhees (sec retary and treasurer). Brown, and Wil liams. i thought that resurveys of both the plants and the employees would be necessary. He stated that it would be advantageous if Wardwell spoke with the Metropolitan's president to stress the im portance of the project's completion. Voorhees asked about obtaining annual dust counts in the plants "in the event we should ever be involved in litigation." t -anya suggested that the Saranac Labo ratory, a tuberculosis sanatorium and re search facility, would be better positioned for such a task. A follow-up meeting, again in Set- gie's office, was held in late December, 1933.u Joining the meeting were S. Simp son (president of Raybestos-Manhattan) and M. F. Judd (another Raybestos-Man- hanan official). Among the topics of dis cussion was pending litigation: "It was de cided that this committee ... would ... obtain Dr. Lanza's recommendation with respect to locating or developing an expert whose services might be utflirrd Cram the standpoint of court work." At the same time, L. U. Gardner, MD (medical director at the Saranac Lab oratory) wrote to Lanza oonceming the disposition of some mine workers at the Philip Carey Company (in Canada) who had developed stiiccsis.* When any of these workers hied a compensation dam, the Saranac Laboratory would review the x-rays for the Metropolitan. Gardner noted Out the dosing of the Carey mine would precipitate the filing of many suck danns for silicosis and silioo-tuberculosis. Carey had dealt with this situation by transferring these men to its operations across the border in Michigan, where there was no compensation law. By the end of 1933, it was dear that the industry and at least one of its insurers were concerned with asbestosis-related litigation and wanted to minimize the as sociated economic impact. A key figure in these activities was an employee of Met ropolitan Life, Lanza. It was through his assodation with the asbestos industry that the foundation was laid for future formal concerted action to conceal research find ings relating asbestos exposure to both asbestosis and cancer. The Codification At an early 1934 meeting, officials of Johns-Manville, Raybestos-toanhattan, and Metropolitan Life were "advised... as to the relatively better position in which the companies would be placed in the event of litigation if... an outside expert of recognized reputation ... would state that he had made certain recommenda tions. . .and that these recommendations had been followed."15 Lanza stated that he would discuss this role with Dr. P. Drinker of Harvard University. Until late 1934, die efforts of the in dustry, of die Saranac Laboratory, and of the Metropolitan had been directed at keeping research fading* confidential. For instance, in 1933, the Saranac Labo ratory had released confidential data on silicosa.*-17 As a result, the Wisconsin Industrial Commission was able to publish a report on silicosis and tuberculosis that was nooe-too-fzvorabic to the industry. Lanza scolded the Saranac Laboratory for this unauthorized release.* Outright de ception began in December 1934." Lana was publishing the results of the 1931 sur vey. Brawn, concerned about the article (then in galley proofs), discussed some changes with ooe of Johns-ManviUe's out side counsels (G. Hobart). Within a week, Hobart sent Brown a marked-up version of the paper, noting that "ooe of our prin cipal defenses ... has been that the sci entific and medical knowledge has been insufficient until a very recent period to place upon the owner* of plants or facto ries the burden or duty of taking special precautions against the possMe onset of the disease to their employees."*A week later. Brown forwarded these comments to Lanza, noting that " I trust that you wil give his comments and suggestions, as well as tltoae mentioned in my letter, your most serious consideration. I am sure that you understand fully that no one in our organization is suggesting for a moment that you alter by one jot or tittle any sdentific facts or inevitable conclusions re vealed orjustified t* your preliminary sur vey. AD we ask b that all of the favorable aspects of the survey be included and that none of the unfavorable be unintentionally pictured ia darker tones than the circum stances justify."41 The desired changes were made prior to publication.41-0 In early 1935, Lanza sent a reprint of the published article to Wardwell, noting: "the Public Health Reports publication gives this piece of work authoritative and dignified presentation."44 Subsequently, S. E. Whiting (Assistant Chief Engineer of the Liberty Mutual Casualty Insurance Company), requesting a reprint from Lanza, referred to the continued funding of the Saranac Laboratory by IJbeny Mu tual and the Metropolian.0 He also sug gested that the Saranac Laboratory re lease the Lana survey results to these insurance companies, who would in on convey the fadings to the industry. The date were subsequently so released.4* (n late 1936, the asbestos industry again found itself in legal troubles as it had compensation cases to settle. Simpaoo de scribed the problem in a letter to H. D. LaMont of the Asbestos Manufacturing Company: "They claim it [asbestosis| leads to Tuberculosis, but we do not find this to be the case. Stffl, we cannot go into court and state definitely and specifically that it will not do so."47 Simpson went on to describe the Saranac Laboratory's ca pability to address the tuberculosis-asbcstosis issue. He also suggested that mem bers of the industry (Johns-Manville, Thennoid Rubber, Keasbcy and Mathson, Asbestos Manufacturing, Russell Manufacturing, and Rxybestoa-Manhattan) contract with the Saranac Laboratory to conduct these experiments: "to have four or five (or even more if we oould get them) Asbestos manufacturers take ever this study ... and then we could deter mine from time to time after the findings are made, whether we wish any puMkationornot.. .it would be a good thing to distribute the information among the med ical fraternity, providing it is of the right type and would not injure our compa nies.'* OnNcwember9,1936, Simpaoo met with Lanza, McConnell, Brown, and Gardner to discusa the possibility of con ducting such studies.4* Nine days later, these companies (Appendix A) con tracted with the Saranac Laboratory, with the provision that "the results obtained will be considered the property of those Amcrieu Journal of Public Health 793 who art advancing the required funds, who will determine whether, to what ex* tent, and in what manner they shall be made public. In the event that it is deemed desirable... the manuscript ofyour study will be submitted to us for approval prior to publication."4*'* There matters rested for three years. Gardner was unable to complete his ex* periments. The medical literature contin ued to accumulate on the noxious effects of asbestos.*-' In the winter of 1940, Brown advised Gardner that the funding would be extended by a year and that the terms of the original agreement continued to apply.51 Presumably, this last comment referred to the provision concerning in dustry approval prior to publication. In 1942, Ivan Sabourin (chiefcounsel for Canadian Johns-Manville) joined in these endeavors. On May 6, be sent a medical report to Gardner that he (Sab ourin) had "taken the liberty of drafting for you ... for the benefit of my cli ents."52 The report was to be sent by Gardner to various state workmen's com pensation boards. Soon afterwards, Sab ourin became the general counsel for the Quebec Asbestos Producers Association (a Canad" asbestos industry associa tion), which would undertake much of the asbestos-cancer research conducted dur ing the coming decade. Cancer Gardner's asbestos work continued. An interim report noted that 81.8 percent of animals exposed to asbestos had devel oped lung tumors, an overly high rate.53 Gardner thought the result to be impor tant: "The question of cancer susceptibil ity now seems more significant than I had previously imagined." A copy of the re port was sent by one sponsor, Keasbcy and Mattison, to its parent. Turner and Newall (a major asbestoa manufacturer) in England, with the comment "we fed that reference to the question of cancer sus ceptibility should be ontinwd from the re port since it is incoodumve."3* Concurrently, the aabcsaoa industry and the Metropolitan turned their atten tions to Canada This change in focus be gan with a Metropolitan actuary's report to C. W. Wheatley, MD (assistant direc tor of the Metropolitan's Medial Divi sion) of a high tuberculosis rate at the Johnson Company in Thctford, Que bec.55*5* This finding agsin raised the iswe of asbestosis and tuberculote. The Met ropolitan decided that a survey of the Johnson Company was needed.52 During a trip to Quebec in October, 1944, Wheatley met with Sabourin, among others.5* Sabourin's clients had been deal ing with asbestosis compensation claims and were in the process of establishing an asbestosis clinic at Thctford. Quebec. The Quebec view was that asbestosis in creased the nsk of tuberculosis. At a meet ing of Sabourin, O. C. Smith (president of Bell Mines), A. PcnhaJe (manager of the Asbestos Corporation mines), A. Johnson (president of the Johnson Company), and the Metropolitan staff, the logistics of es tablishing the clinic (the Thedord Clinic) were discussed. Dr. P. Cartier, of the Montreal Anti-Tuberculosis Society, was to direct the clinic. In the United States, meanwhile, the concerns about Gardner's findings contin ued. One sponsor wrote to Brown in April 1946, indignant that the draft mentioned cancer.5* After Gardner's death in Octo ber 1946, Brown wrote the other sponsors to suggest that someone else at the Sa ranac Laboratory complete the report. As work proceeded accordingly, the spon sors reiterated their right of approval of all public releases of the findings.*0'*1 In the interim, Lanza sent Gardner's last draft to Professor Kenneth Lynch, MD, of the Medical School of South Carolina for re view. Lynch recommended the publica tion of die report without revision.*1 As the drafting of a final report neared completion in late 1947, Fisher wrote to J. P. Woodard (a Johns-Manvflk senior executive) that the final report should be reviewed by "the top man of the Quebec Asbestos Producers Association."*5 By late November 1947, Sabourin was very anxious to have the report completed to counter local Quebec groups upset about the health effects of asbestos exposure. Yet there was still no final report. In March 1948, a frantic Woodard noted to Lanza that labor problems in Quebec were related to asbestos,*4 Two months later. Brown wrote to Muehieck(presideatof Keasbcy and Mattisoo) suggesting that the Asbestos Tenths Institute (ATI) review the report. (The ATI, an industry trade association, had been founded in 1944 to promote asbestos textiles. Its membership (Appendix B) had considerable (but not total) overlap with the sponsors.*) Muehkck thought that the sponsors should review the work.** Brown noted that although some sponsors were not ATT members, the ATI members had provided most of the funding.** Therefore, Brown argued, the ATI, not the sponsors, should cooduct the review. Muehkck finally agreed.*7-** By this time. A. J. Vorwald, MD, had been appointed as Gardner's succes sor* With much urging from Woodard, he completed a draft of the Gardner re port (including a cancer section) that was ready for review.**-70 One sponsor had already indicated that the cancer section should be removed: now, other sponsors concurred.5*-**'7* Brown agreed; Lanza was told to handle the matter.7*" ^ In the process of this review, all of the sponsors (except Keasbey and Mattison, and Raybestos-Manhattan) received cop ies ofthe draft that had been numbered by Brown. The reason was simple: "It is ob viously undesirable that the report in its present form receive any distribution or publicity outside a limited number of peo ple in our respective organizations."7* The next month. Dr. Hamlin, medical di rector for American Brake Block, reas sured hit superiors that the report was not controversial "since moat of the basic (acts with the exceptions of the more de tailed studies mentioned in the report are already known ... no unfavorable reac tion need be anticipated. "7*>7* About two weeks after the review committee decided to remove the cancer section. Brown communicated this conclusion to W. T. Kelly (Hamlin's boas at American Brake Block). Brown noted that all of the copies of the report had been "retrieved... ex cept the one we sent you, which ... Dr. Hamlin would like to keep. I wish, how ever, you would prevail upon him to re turn it.... Eveiyone felt that it would be most unwise to have any copies of the draft report outstanding."7* Kelly subse quently asked Dr. Hamlin to return the draft.** The January 31,1949, draft of the re port had the section entitled "Neoplasm" marked through with the ward "out."*1 The revised report was published in 19SI.B One member of the investigative team has stated that this act was unrelated On Match 8,1949, Brown wrote Sa bourin thnt "because of our doae associ ation in Canada with others interested in the solution ofthe asbestosis problem, the results of these experiments should be madeavafiable to them in advance of pub lication. ... I am presiding you ... as counsel to Quebec Asbestos Mating As sociation [the successor to the QAPA)with two copies of the report"** By June, 1949, the report had begun be promoted in the Unted Staten. For instance, Gatke noted that the Massachusetts Industrial Board "would likely be more lenient in 794 Americas Journal of Public Heatt June 1991. Vd. 81. No. 6 their decisions if they had the advantage of the information disclosed in this re* port."*5 As K. Smith, MD (the medical direc tor of Canadian Johns-Manville) noted, the report left many questions unan swered, including the importance of fiber size, and specific aspects of the asbestoscancer issue.** *7 Vorwald wrote to Smith in October. 1949, suggesting that the x-rays of the Quebec workers be reviewed for lung cancer.** A study protocol was quickly formulated.** Smith wrote to Lin de11 (president of Canadian Johns-Man ville) that "there has been a tremendous increase in the number of articles in med ical journals during the past year which deal with the subject of occupational can cer. Very high on the list of causes ... is asbestos. There seems to be increasing proof that asbestos fibers do cause lung cancer. This conclusion is drawn only from articles reported in the journals.... I have been unable to find any x-ray evi dence of lung cancer among our employ ees. .. but this whole subject could cause our companies unlimited embarrassment and untold expense if labor leaders made use ... of the subject.... If we are to defend ourselves in the compensation courts, we must have proof. I believe that we should discuss this matter at a QAMA Meeting and ... ask ... [the Saranac Laboratory) to outline a sug gested plan of study."40 (Smith had al ready reviewed the Saranac Laboratory report at the QAMA meeting in 1949.*1) He noted: "As Car as J-M is concerned, I know of two hazards in our operations which may lead to pulmonary malignancy, namely asbestos and silica. There is ever increasing evidence in the medical litera ture today that these materials lead to lung cancer." A study was needed. By March. 1950, the issue had be come whether further study should be un dertaken by William Smith, MD (a tooricoiogistat Lanza's unit) or by the Saranac Laboratory.4*'*1 (Following Lanza's re tirement from the Metropolitan in 1948, he founded the Institute of Industrial Medi cine at New York University.**) Site visits suggested that both facilities could com plete the work.43'45-*' Lanza drew up a coatract which left "little choice to the donor if the results of the study are unfa vorable to company interest and are sub mitted for publication. However, I (K. Smith] fail to see how they can find any thing more unfavorable than that which already has been published.. ."** In Sep tember, Vorwald submitted a competing contract for the Saranac Laboratory, which stated that "the Saranac Labora tory reserves the right to publish the re sults of its investigations in the recognized manner. . . whereby the manuscript prior to its publication is submitted to the spon soring company for its review and approv al."44 Later that month, the QAMA noted that "a relationship between the inhala tion of asbestos dust and pulmonary can cer has been slated publidy by certain health authorities. ... It is necessary for us to . . . prove that this statement is not correct or to accept it and the conse quences that go with it. Our position in this matter is the same as the Association and Industry found itself in 1937 as regards to asbestosis.''100The proposed study would use "the same methods as our antago nist. " Animal studieswen. also suggested. Another activity "would consist of more publicity coming from our association... rather than taking the defensive attitude that we have.. . . That we arrange to have our doctors lecture at medical schools yearly. That we attempt to affiliate our doctors in some manner with research centers such as Saranac and in such orga nizations as the Industrial Hygiene Asso ciation and the Institute of Industrial Med icine [Lanza's New York University group)" Despite the long association between Lanza and his industry colleagues, the lack of sponsor control of publications in the New York University proposal led to the Saranac Laboratory's being swarded the contract.4*'101 In November, Lanza, Sabourin, and Woodard met with Vor wald to review the project.101 The studies began and were soon almost complete.' Smith (now medical officer for JohnsManville) thought that an epidemiologic approach was needed. He wrote JohnsManville officials that "we would be wise to wait [for a news release] until we have proof of no causal relationship between asbestosis and pulmonary cancer... we might not wish to bring attention to the asbestos industry if the cancer research is not entirely favorable.''1 In July, 1951, Cartier reviewed can cers among eight asbestos workers.1 He observed: "some causal factor will pro duce the same variety of tumors and there fore why do we observe such a variety of (cancers)... [if) we may assume that the asbestos factors might produce a broochogeaic carcinoma ... then only two cases of the series would serve as evi dence because the other cases are me sothelioma or lymphosarcoma or second ary malignancy in cases without exposure or without asbestosis.'' (Ironically, JohnsManville would argue two decades later that mesothelioma was not a distinct can cer.5) In October, Vorwald presented ha initial findings to the QAMA: "Although only six months had elapsed . .. animals which were killed during this time pre sented no greater incidence of pulmonary cancer in the dusty group than in the nondusty group... he is certain that there is no association between the cancer and as bestos, but. .. cannot state this scientif ically, for at least twenty months must elapse before conclusive evidence can be produced and in the meantime, this statis tical survey [the epidemiologic study) should be carried oo.""* In February. 1952, A. L. Fisk. Jr. (Johns-Maoville's Legal Department) wrote to lanza: "As you are aware, the Industrial Commission of Illinois has pro mulgated rules as to the labeling of sub stances harmful to the health and safety of employees ... in our opinion asbestos fiber comes within the preview of the reg ulations. ... It is our intenboqjo label our bags containing asbestos fiber, using th< following: " `CAUTION--ASBESTOS FIBER' [nhaiaboo of asbestos fiber over long per odt MAY BE harmful. The material shout be toed aa not to create dust or, tf this is tx possible, employees should be eouippe with adequate protective devices."1* For unknown reasons, a warning lab was not added to the bags for another years.* The QAMA-sponsored Saranac La oratory animal study continued. At months, the animals exposed to asbest had a higher incidence of cancer th those not exposed.107 The study was i published. The industry was well awan the stakes involved. For example, in IS the Indiana State Division erf Indust Hygiene contacted National Gypsum c ceming the safety of asbestos spray p uct*.1 The National Gypsum safer rector wanted to reply that the applies should wear respiraton. A National ( sum executive characterized the stq tion as "full of dynamite,'' stating th am much concerned that National mw is on record... that Tbermaoc is hazardous business. If this snow we are out of the Thermacousuc ness." Votwald's tenure at the Saranac oratory was ended in 1953, after tempted to investigate further the tos-cancer relation.* He sc employment as a professor at a Cal American Journal of Public Hea institution. Lanza flew to California to prevent that Vorwald would be offered the position (personal communication, W. Smith).10,_l" The trip is alleged to have been paid for by the Metropolitan. A sim ilar fate befell W. Smith (a toxicologist in Lanza's unit) after he had indicated an in terest similar to Vorwald's (personal com munication, W. Smith). At the Seventh Saranac Symposium in 1952, the asbestos-cancer relation was discussed and the carcinogenic potential of each of the fiber types noted.1 12 Attend ing this meeting, in addition to industry physicians, were representatives of the Liberty Mutual, the Travelers, the Amer ican Mutual, and other insurance compa nies. Tumcr and Newall (in Rochdale, En gland) sent a physician, J. Knox, to attend this meeting. At the Seventh Saranac Symposium, he met W. Smith. Stimulated by the reports at the symporium, Knox decided to examine the Rochdale asbestos workers' lung cancer experience. He be gan to trace the Rochdale workforce, col laborating with Sir Richard Doll (then an epidemiologist at the London School of Hygiene) on the data analysis. By Decem ber 1953, both men had realized that lung cancer mortality was much above what it should have been.111 A paper was drafted with Knox as the senior author.114 In June, 1954, Knox wrote W. Smith, describing Turner and Newafl's response to the research findings: "This letter is ad dressed to you in your private capacity. The letter of 31/5/54 is the official answer which I must give at present. Its tone must have given you quite a jolt. When your letter came in February, Doll and I had not finalized our paper. On completion we sought permission to publish and, to my great surprise, were refused by the company--at present. Up until a few days ago, I had hopes of a more favorable turn of events but the ban remains. The head line news about lung cancer has scared people over here and it was thought we might attract undesirable publicity in our area.... I am sending you personally a copy of our paper. Perhaps the people to whom it would be most unwise to mentioo it would be those associated in any way with our industry.'"14 When Doll learned of the ban, he wrote Knox: "For my own part, I feel that any positive findings with regard to the cause of cancer must be made available to all research workers on the subject. . .it is by bee publication that the work can be tested and utilized (or disproved) by others.""1 In 1955, the manuscript was published; Knox was ac knowledged anonymously.114 That indus try-supported investigators in North America had previously gleaned the causal association could not have been known by Doll. Discussions of the cancer-asbestoa link within the asbestos industry ensued. The QAMA and the Asbestos Textile In stitute, for example, communicated with each other about the subject."7 Yet an industry manual compiled by the Magne sia Insulation Manufacturers Association (another industry trade association) stated that asbestos "offers no hazard to the '`'orker."111 Also, it is apparent that, at a National Cancer Institute (NCI) discus sion in 1955 on asbestos and cancer, at tended by Vorwald and K. Smith, no dis closure of either Gardner's or Vorwald's findings was made."* The meeting con cluded that "there have been no asbestoscancer animal experiments." It noted that given the widespread use of asbestos, if it were carcinogenic, the public health im plications would be great. Also in atten dance was an NCI staff member, W. Hueper, PhD. Hueper was very much coovinoed of the causal relationship be tween asbestos and lung cancer.IJ0 In February 1956, K. Smith wrote to Daniel Braun, MD, (the medical director at the Industrial Hygiene Foundation (tHF)J, concerning Hueper's statements that asbestos caused cancer.121 (The IHF [Appendix C] was established in 1936 to provide dust control information to its membership, which included many mem bers of the asbestos industry.*-4) K. Smith noted that "we have too much at stake to allow . . . such indiscriminate state ments." In response, Braun prepared a report on asbestos and lung cancer for the QAMA (under the auspices of the IHF).122-124 (The Asbestos Textile Insti tute had rejected an IHF proposal for fur ther work on asbestos and cancer because it would "stir up a hornet's nest and put the entire industry under suspicioo."123.!1*) A final report was soon com pleted.127 The copies were numbered. Braun stated that "a comparison of rela tive frequency of hing cancer and asbes tos# is less reassuring... this is because of an underreporting of asbestosis cases. The incidence of asbestosis indicated by the medical records is far below that which would be expected. ... However, this may be 12_596 of the recorded cases of asbestosis in this state of development of lung cancer, a figure slightly lower than those quoted by authors who confine themselves to this type of comparison." The consequences of the industry's pre vious underreporting of asbestosis now became dear. The ooodudmg sentence of the report was less equivocal: "The re sults suggest that a miner who develops the disease asbestosis does have a greater likelihood ofdevelopingcancer of the lung than a person without this disease." Once the QAMA had received the report, Sabourin met with Braun to pro duce a "condensation" for publication.19 Concurrently, K. Smith wrote to Sabourin that "(we) have noted deletion of ail ref- af-vnear Journal of Public Health Juat 1991. Voi. II. No. 6 erenoes to the association of asbestosis and lung cancer. . . . While we believe that this informadot is of great scientific value, we understand the desire of the QAMA to emphasize exposure of the as bestos miner and not the cases of ashestosis."17* K. Smith noted that the pub lished condensation would be criticized "because all of (he authors today correlate lung cancer to cases of asbestosis." In 1958, the Archives of Industrial Health published the "condensed" Braun report (without the quoted concluding sentence).130 In his letter of acceptance, Stoldnger, the editor (a major figure in the development of threshold limit values) noted his pleasure that "the main conclu sion of the paper was against the associ ation of lung cancer with asbestosis, for I had come to a similar conclusion on ob viously far less information.... I am en closing a review which contains a few statements that I have marked in this con nection that appears in theAnnualReview Medicine, Volume 7, 1956. You will recall at this time evidence greatly favored the positive correlation of lung cancer and exposure to asbestos.'"31132 At a 1958 symposium, the "condensed" report was presented. Sabourin reported to the QAMA that the news of this symposium provided "wonderful public relations val ue.'"13 By the early 1960s, the industry and its associates had succeeded in suppress ing much of the knowledge gleaned over the prior two decades concerning asbestos and cancer. During the 1960s, academic scientists and physicians, such as Selikoff and Wagner, discerned the relationship between asbestos with cancer.114 These findings were quickly appreciated by the general medical community.ll> The indus try was in a compromised position. In 1963, K. Smith suggested the purchase of a shredding machine to "destroy com pletely all copies ofcorrespondence which you do not wish to retain.... I believe that thas highly essential but aD copies of correspondence at such confidential na ture should be thoroughly destroyed so that our potitioo in Workmen's Compen sation claims cannot be doubted."11* In the mid- 1960a, the industry began to place warnings either oo the bap of asbestos or oo the sides of the wooden crates used to ship the products containing asbestos. In 1965. a series of Johns-ManviDe memos dearly state that for products exported from the United States, the warning oo the bap should be covered and those oo the crates, sanded oA.u,,ua Similar memos exist for other members of the industry. For instance, a 1964 EaglePicher memo concerning such warning la bels stated the following: "This is large enough type face [1/8 inch height] to be completely legible, yet does not `shout CAUTION from the roof tops.""3* In 1970, an Owens-Coming memo succinctly stated the reluctance to use such labels: "Reference is made . . . regarding the warning label.. . . Are you saying that we have to do this now? I naturally would like to delay this requirement as long as pos sible."140 A little more than a decade ago (in 1977), the following exchange took place within the Phillip Carey Company: "I got very strong reactions in Japan to our re quirement to translate the . .. [warning] Label into Japanese. . . . Confidentially, the Kakiuchi staff told me jhd they detiherately left out the word cancer from the text because this must not even be men tioned in Japan in connection with asbes tos. Altogether they are against s warning label because they do not wish to raise problems with the workers. They are al ready attaching a label oo each bag ac cording to Japanese law. Kakiuchi would prefer to sign a certificate holding us blameless from harm.. .. Asbestos Cor poration and Bell have both gone this route per attached blank forms. Kakiuchi are of the opinion that we cannot impose American law on foreign counties and on Japan in particular-- . I do not believe that we should raise problems with people who are more primitive than we ate, or less educated."141 The reply: "As far as the caution label is concerned ... we must be sure to cover ourselves only where the law of the land requires. I sug gest we gp ahead with the new caution label in English and French only. Whm do you think the Japanese, Finns, Swedes md Dutch will have to say about that?"142 By the late 1970a, the industry was under attack in the courts and in the press. One Johns-Msoville memo, labeled "Confidential", dated January 12, 1979, addressed to John A. McKinney, presi dent of the company. The wfuanoe axdtootiag Jofaee-Maav* ud Mbeseos has rhsngrri Asmstragy ia recent days ... now die awgrhy afpre sent-day management it beSq temtfy . The shift ia tha thrust ofpdbic I is cnidal is that flnorebli leprititioa oa oompematioa wfl not ba pomMe if tbs ciedMhy of tha 1. JM poaitioa: Prior to 1964. we lacked soemific knowledge about cancer has. aide of asbestos. FACT: In the aud-SOa, JM ottciais knew of scientific studies showmi a retanooship between cancer and asbestoe. 2. JM statement to North Carolina judge: So-called "cover-tp team" not avail able. FACT: Letters had been used in a New Jersey trial several weeks before . .. 3. JM posioon: though sprayed asbestos in appropriate for use in schools, we see no evidence of danger. FACT: If no problem, then why an in appropriate use? 4. JM position: There wiU be no future problems with workers. FACT: Workers in Mexico arc not being protected. 5. JM posiboo: Knoxville trial shows theta * no company. FACT: KncncvUe judge tele tfae Amocisied Press "off the record** chat Ms ndiag oa pmibve rtamsgr l does not dear the compay of a "cover-up" charge. 6. JM pontine Since 1964. JM has "come " with employees about asbestos FACT: A current 41 year employee of JM has called me to say that he has a spot on his hag... but oo one at JM has ever oommnnicated with has about k. 7. JM poaitioa: There was oo cover up. FACT: A curat employee.. .says hie father worked for JM for 35 yean at Manvfle and was never told about dangen. Father eras drunasod because of `minen' asthma*... he bad to take JM to court to get compensation for an asbrstna rrlafrrf dneaee. 8. JM poaitioa: We have oommunseated openly with employees about illnesNa. FACT:.. .it was company practice into tfae early 70s not to tel a penoo about hia 9. JM position: JM has takes precautions to prevent cxocmive cqpmute to fiber glam FACT: Plant manager... is reluctant to pom HS A E bulletin becauae precau tion* not taken at hia plant... I caa caafy see why we have Conclusions Tha care study tDustntes bow a se rin of ooocotedactiu was planned and earned ottt during half sceotuiy, in which data were generated and then suppressed Some of the prindpals in these activitiei were elm leaden in occupational medi fine. The societal rrxpmae to the azribrv alence and inaction by these leaden wid reaped to toduetriel caidnnfpm wag th Occupational Safety and Health Ad o 1970. TheOccupational Safety and HeaM Administration removed some of then leaden from the dominating poaitioa they had held in the development of ni -- IQOI Vni II Nn I Jourml of Public Heakh * tonal policy on industrial carcinogens. The success of this approach remains un dear. Another interesting aspect of this ep isode is how the information became pub lic. It was by legal actions that these doc uments were produced (through "discovery," the legal process of infor mation disclosure). None of the comparues involved provided these papers freely to the general public. Indeed, to have done so would have greatly compromised 50 yean of corporate safety and health poli cies. If major legal reform had been en acted prior to this litigation, it is possible that these documents would not have be come public knowledge. It is equally dis turbing that none of these data were ob tained through the existing occupational safety and health enterprise erected dur ing the past two decades. The effective ness of the current framework for devel oping and enforcing occupational safety and health considerations must therefore be qucsbooed. However, a complete dis cussion ofthis issue is beyond the scope of the present work and should be consid ered by the occupational health policy community. The degree to which scientific fraud permeated published reports is also of concern. The activities described suggest that fraud in noo-govemmenully sup ported research occurs, and that it has po tentially great impact on health policy. However, unemployment or withdrawal of research support may be the ultimate "reward" for those who do not participate in such activities. The implementation of mechanisms to prevent such fraud should not await yet another public health trag edy. Despite the disclosures of suppres sion and fraud, no mechanisms have been implemented to prevent future such oc currence*. It was not only in the asbestos indus try that voluntary corporate compfiancs with sobetal norms of conduct in worker health and safety were violated. Michaels has shown that similar problems exated in the aniline dye industry.' As tbs recent A. H. Robms-Dalkon Shield episode tPustrates, in the 1970s, some corporations (outside the asbestns industry) thought lit tle about suppressing detriments! medics! knowledge. Until such activities pens, the potential for future similar public health disasters to occur continues. Acknowledgments The author would like to thank Dn. M. Gordon Wotaa* Abd Wotnaa. end L J. SefikoC and Ms. M. Burger for their many comments ud suggestions concerning this manuscript and Messrs. R. Motley, D. Austem, T. Cmmpler, J. Rion, C. Patrick. J. Gelman, and S. Hoftna* and Dn. D. Ozanoff, I. J. Selikoff, and B. Cas tlemu for their assistance in obtaining seems to many of the documena referred 10 m this manuscript. All comments and condusnns are the author's. This work was supported in part by NIH gram K06-ES00I61. References Sou: The references for this paper include ex hibits used as evidence in several legal proceedinp. All of (he correspondence, reports, etc., for which no other identification information is provided were used as exhibits at the JohnsManvitte v. United States. CV 465-83 (Federal Circuit Claims Court, DC) 1983. AD such ex hibits are available from the Claims Court in the District of Columbia. Other cases in which these exhibits were used are also cited. If no case citation appears for a given 'cner, memo, or aocpubtnbed article, then the reader may assume that the reference may be found as part of the evideooe introduced in the Jofans-ManviOc v. United Stales litigarirat The other pro ceedings (with corresponding abbreviation* used in the reference list) are as follow*; Laura Bialy, Administratrix of the estate of Theodore Bialy v. Johns Manvillc Corp. et al. Civ. Act. CAN 79-1336 (D.NJ.) (1986). (Cited aa "Bialy''). Pauieoe Kulzer as Executrix of the Estate of Richard Kulzer v. Pittsburgh Coning Corporation et al. Civ. Act. 87-00867 Fed eral District Court. Western DisL New York (1990). (Gted as "Kulzer"). 1. Markowitz G, Rosaer D. The iDusioo of medial certainty, sificoea and the poli cies of industrial disability, 1930-1960. Milbank Quarterly 1989; 67 (Suppi. 2, Part I): 1-26. 2. Ozanoff D. Failed warnings: asbestosrelated disease and industrial medicine. In: Bayer R. (ed.). The Health and Safety of Workers. New York: Oxfixd Univer sity Pres* 1988:139-230. 3. Mkhads D. Watting for the body count corporate deasion-maJong and bladder cancer in the U.S. dye industry. Mwheal Anthropology Quarterly 1988; 2:215-32. 4. Roancr D, Markowitz G. A "Gift of God": the public health controversy over leaded gasoline in the 1920s. AJPH 1985;73:344-51. 5. Brodeur P. Outrageous Mboonduct Tbs .kabtmoa Industry on Trial. New York: Pantheon Book*. 1985. 6. Castinman BT. Asbestos: Medical and Legal Aspects. New York: Harcoutt Brace Jovaaovich. 1984. 7. Nicholson WJ, Perkd G. andScOoffU. iVw|phf^|| o^ocuft lo tibesioi po^ illation at risk and projected mortality, 198O-3QQ0l AJ1M 1982; 3:239-311. 1 Libenfefd DE. Mandd JS, Com P. Sdmman LM. Projection of asbesme relaiad disease in the United State* 1985-3009: L Cancer. BJ1M 1988; 45:283-91. 9. Srlikcff U, Lee DHK. Asbemos and Diaeras. New York: Academe Pm* 1971 10. Andre GG (ed.). Span's EncydopedH of the Industrial Art* Manufacturers and Commercial Products. New York: E. and F. N. Sport, 1879. 11. (AnonymousJ. Management by Morgan. Fortune. 1934 March: 82-89, 128. 130, 132. 135-d. 141-2. 144, 146. 12 WeiB H. Jones RN. Occupational puimo* nary diseases. In: Fachman A? (ed.). Pul monary Diseases and Disorders. 2nd ed. New York: McGraw Hill. 1988. 13. Forbes JJ, Davenport SJ. MorgaGC. Re view of literature on dusts. U.S. Bureau of Mines Bulletin 978. Washington. DC: Govt Pruning Office. 1950. 14. Goldstein DH. Anthony J. Lanza. MD, 1884-1964. Arch Envtron Health 1964; 9:271-4. 15. Dcrickson A. Federal intervention in the Joplin epidemic. Bull Hist Med 1988; 62:236-51. 16. (AnooymousJ. Workmen's Compensa tion for silicosis. Safety Eng 1934; 57:71-4. 17. Gelman JL. New Jersey Workmen's Compensation Law. Sl Paul, MN: West Pubfahing, 1988. 18. [Anonymous). Report on a Dust Study of the Maovde Plant of the Johns-Manviile Company. 1930 (Bialy Exhibit 2). 19. Letter from Lana to Wardwell, Novem ber 25. 1929 (Bialy Exhibit 3). 20. Letter bom Lana to Wardwelt, Novem ber 11.1930 (Bialy Exhibit 7). 21. (A/Yxrytnous). Report of a Dust Study of the Charleston, SC Plant of the General Asbestoa A Rubber Division of Raybestos-Manhattan, Inc., 1930 (Bialy ExhMt 4). 22. [Anonyroous). A Study of Dust Coocfi- tioas in the Mannheim Plant of the United Stales Asbestos and Rubber Division of Raybestoa-Manhattan, Inc., 1930 (Bialy Exhibit 5). 23. Pedley F. Report of the Physical Exaatinationa of Asbestoa Workers in Asbestoa and Thetford Mine* Quebec. November, 1930 (Bialy Exha* 8). 24. Letter from Lana to WardweO, March 20, 1931 (Bialy Exha* 11). 25. Letter bom McCoonel to Wardefl. July 9, 1931 (Bialy ExtuM 13). 26. KfimitesofJuly 15,1931, meeting between Lana* McConnel, and varioua JohnsManviDe officials (Bialy Exhi* 14). 27. Letter bom Williams to Meriwether, Feb ruary 26, 1932 (Bialy Exiubit 16). 28. Letter from Sayers to Surgeon General, February 20.1932 (Bialy Exh** 15). 29. Letter from Sayers to Meriwether, April 11, 1932 (Bialy Ext** 20). 30. Letter from Lana to Meriwether, March 24,1932 (Bialy Exha* 17). 31. Letter from Wiftama to Fisher, Augum 29. 1933 (Bialy Exha* 25). 32. Minute* of November 28, 1933, meeting ofLam, Setgl* Voorhse* Wffliam* and Brown (Bialy Exlubif 29). 33. Minutes ofDecember 29,1933, meetingof Seigie, Voorbcc* Williams, Brown. Sin^non, and Judd (Bialy Exhibit 31). 34. Letter from Gardner to Lutz* December 12, 1933 (Bialy ExhR* 30). 35. Minuim ofJaauay4,1934, meeting ofthe Raybestos-Manhtttan-Johns-MurviUc Committee for Coordinating and Sun- dartthe Way* and Means of Elsa- 798 American Journal of Public Health June 1991, Voi. 81. No. 6 inatmg Dual and Protectant the Health of Employee* Engafed in Manufacturing Operation (Billy ExhR* 33). 36. Lenar from Gardner to Knight, April 14, 1933 (Buly Exhft* 23). 37. Letter from Gardner to Lanza. Apnl, 1933 (Billy Exhibit 22). 38. Lener from Lanza lo Cummings, Apnl II. 1933 (Bialy Exhibit 24). 39. Lener from Biown io Linza. December 10. 1934 (Billy Exhibit 32). 40. Letter from Hobart to Brown. December 15. 1934 (Bialy Exhibit 331. 41. Lener from Brown to Lanza. December :i. 1934 (Billy Exhibit 33). 42. Lanza AJ, McConnell WJ. Fehnel JW. The effects of the inhalation of asbestos dust on the lungs of asbestos workers. Public Health Repons 1933; 30:1-12. 43. Lener from Judd to Brown, December 24. 1934 (Bialy Exhibit 36). 44. Lener from Lanza to Wardwell, January 16. 1933 (Bialy Exhibit 60). 43. Lener bom Whiting to Lanza. February 19,1936 (Bialy Exhibit 64). 46. Memo to Lanza, February 23,1933 (Bialy Exhibit 66). 47. Letter from Simpsoc to LiMom. Novem ber 10, 1936 (Bialy Exhibit 84). 48. Lener from Brown to Gardner, January 17. 1940 (Bialy Exhibit 113). 49. Memorandum of Agreement between the Saranac Laboratory and American Brake Block Corporation, Asbestos Manufac turing Company, Gatke Corporation, Johns-Maovtlle Corporation. Keasbey A Mattison, Raybestos-Manhattan, Incor porated, Russell Manufacturing Com pany, United States Gypsum Company, Thennoid Company, and Southern As bestos Company, November 20,1936 (Bi aly Exhibit S3). 30. Lener from Brown to Simpson, Novem ber 23, 1936 (Exlubit D at Deposition of David E. Lilienfcid, March 28. 1989, United States District Court, Eastern Dis trict of Texas, Beaumont Division). 51. Lener from Brown to Gardner, January 17,1940 ((Bialy ExNb* 115). 52 Lener bom Sabourin to Gardner, May 6, 1942 (Exhibit 15 at Deposition of David E. LdienfeJd. March 28,1989, United Stales Distho Court. Eastern Distna of Toon, Beaumont Division). 53. Lener from Gardner to Brown, February 24.1943 (ExhM 7 m Deposition of David E. Lilienfcid, March 28. 1989, United States District Court, Ertm Dimhct at Texas, Beaumont OMrtonV 34. Letter from MueMeck to Shephard, March 8. 1943. SS. Letter bom Wheatley to Burnette, July 26. 1944 (Bialy Exist* 140). 36. Letter from MorecroA lo Wheatky, June 13. 1944 (Bialy Exkbn 135V 57. Memorandum bom Wheatky to Arm strong, July 3, 1944 (Bialy Fjthff* 137V 58. [Anoaymou|. Noteaoo a Trip toCanada. October 16-21. 1944 (Bialy Ext** 142V 59. Lenar bom Oaths to Brown, Aptfl 18, 1946. 60. Minutes at meeting of Lanza, Jackson, Woodard, Fisher. Lee, Eiseohart, Brown, Hite, and Hasten, January 21. 1947 (Bialy Exhte 177V 61. Lener bora Woodard to Lanza. August 4, 1947 (Bialy Exhft* 181). 62 Minutes of meeting of Lanza, Hite. Jackson. and Hamilton, August 6, 1947 (Bialy Exhibit 182). 63. Lener from Fisher to Woodard, October 29. 1947. 64. Lener bom Woodard to Lanza. March 23. 1948. 63. Lener bom MuchJeck to Brown, April 27, 1948. 66. Lener bom Brown to Muehleck, Apnl 30, 1948. 67. Letter from Brown to Muehleck. May 3, 1948. 68. Lener from Rohrbach to Brown, May 5, 1948. 69. Lenerfrom Woodard to Vorwald, June I, 1948 (Bialy Exhibit 190). 70. Lener bom Brown to American Brake Block. Gatke Corporation. Keasbey and Martuoa, Raybestos-Manhattan, Russell Manufacturing. Thennoid (Southern As bestos), Union Asbestos apt* Rubber, and United States Gypsum, March 3, 1949. 71. Lener bom Gatke to Brown. September 14, 1948. 72 Lener bom Brown to Muehleck and Ro hrbach. October 22 1948. 73. Letter bom Muehleck to Brown, October 28, 1948. 74. Letter bom WeOes to Brown. November 8, 1948. 73. Letter bom Brown to Butler, November 12 1948. 76. Lener bom Brown to KcQy, November 12 1948 (ExhMt 12 at Deposition of David E. Lilienfeld, March 28. 1989, United States District Court, Eastern Dis trict of Texas, Beaumont DivisaonV 77. Lener bom Woodard to Gatke, Novem ber 30, 1948. 78. Lener bom Lanza to Vorwald, December 14, 1948 (Bialy Exlubit 195V 79. Memo bom Hamlin to Kelly, Noember 3. 1948. 80. Lener bom Kelley to Brown. November 16, 1948. 81. Saranac Laboratory. Asbestos*. January 31. 1949 (Bialy Ext** 199V 82 Vorwald AJ, Durham TM. Pratt PC Ex perimental studies of asbestos*. Arch lad Hyg 1951; 3:1-43. 83. Pratt PC Deposit**. July 12 1988, U-S. Distna Court, North Georgia District, Atlanta Division. 84. Letter bom Brora to Sabourin, March 8, 1949. 85. Letter bom Gatke to Brown, Jtme 14, 1949. 86. Memo bom Woodard to Foster, Aprd IS, 1949. >7. Memo bom Smith to McCaw, February 7,19S0i 88. Letter bom Vorwald to Smith. October 15. 1949 (Bialy Exhte 3017V 89. Lener bom Vorwald to Smith, January 3, 1950 (Bialy ExM* 3019V 90. Letter bom Smith to 1 mrieg. January 28, 1950 (Bialy Exhft* 30BOV 91. Memo bom Smith to Tonerr. February 1, 1950 (Bialy Exhft* 3004V 92 Letter bom Saboix* to Cartier, February 8.1950 (Bialy Exhte 3007V 93. Letter bom Woodard to Sarth, Match 16, 1950 (Bialy Exhft* 3032V 94. (Anonymous). Annual Report. The In dustrial Health Sectioo. 1948 (Bialy Exhit* 184V 95. Letter bom Smith toCarber. June 3,1930 (Bialy Exhftit 3041). 96. Lener bom McCaw to Woodard. June 7, 1950 (Bialy Exhft* 3042). 97. Lener bom Smith to McCaw. June 19. 1930 (Bialy Exhibit 3043). 98. Vorwald AJ. Proposal on Asbestosis and Pulmonary Cancer. September 21. 1950 (Bialy Exhibit 3037). (Ancwymous|. Report to the Quebec As bestos Mining Association re: Pulmonary Cancer. September 25. 1930 (Bialy Ex hibit 3058). 100. Letter bom Woodard to Fister, October 20. 1930 (Bialy Exlubit 3064). 101. Minutes of meeting between Lanza, Sab ourin, Vorwald, and Woodard, Novem ber 7,1950 (Bialy Exhibit 3070). 102 Letter from Smith to Grainger, March 30, 1951 (Bialy ExMmi 3100V 103. Lener bora Smith to McCaw, lime 11. 1951. 104. Lener boro Cartier to Smith, July 3,1931 (Bialy Exhibit 3IUV Off. Letter bom Smith to McCaw, October 11, 1951 (Bialy Exhibit 3U4V 106. Letter bom Fisk to f February 20, 1952 107. Saranac Laboratory. Asbestos* and Pul monary Cancer. Unpublished report to the Qiebec Asbestos Mining Assoasnon. May 7, 1952 108. Letter bom National Gypsum Safety Di rector to Indiana Division of Industrial Hygiene, March 12 1953. 109. Letter boro Smith to Lanza, June 28.1954 (Personal Correspondence- W. E. Smith. MD, Bangor, MEV 110. Irwin T. On-the-job cancer--the killer they won't trach down. CavaMer 1962 Jan. l2(103V52-5.82-5. 111. Letter bom Smith to Armstrong. June 12 1956 (Personal Correspondence, W. E. Smith, MD, Bangor, MEV 112 Seventh Saranac Symposium. Unpub lished proceedings. September 1952 (Ex hft* 13 el Deposition of David E. Liben- feM. March 28. 1989, United Sutes Distna Court, Eastern D*trict of Texas. nraumnni DivisionV 113. Letter bom Knox to Smith. December 3. 1953 (Personal Correspondence. W. E. Smith, MD, (Bangor, MEV 114. Letter bom Knot to Smith, June 2 1954 (Personal Correspondence, W. E. Smith, MD, Baagpr. MEV 115. Letter bom Dol to Knot, Jtme 2 1954 (Kute Extt* 1485V 116. Do! R. Mortality bom Kmg cancer in as- borne workers. BJIM 19SS; 1281-6. 117. Letter bom Penhak to Widmaynr, Au gust 2 1954 (Bialy Exhft* 3129V 118. MIMA Ineuibdoa Manual, January I. 1955. 119. (Anonymous). Conference on Environ ment* Catdnonena, Nation* lothuio of Hea*fcBefheachk MD. May 7-8,1955. 120. UCLA Scbod of Pubic Heafeh. Cancer Control in the United States. 1946-71. DHEW Pub.No.NlH 79-1517. Weehmg- ioo DC* Govt Printing Oflke, 1979. 121. Letter bom K. Snath lo Brat*. February 19,1956. June 1991, Voi II. No. 6 Join* of Pubic Health 799 122. Lentr bom Braun to Soutar, March 16, 1956 (Bialy ExhMt 3145). 123. M boa the Indusoiai Hypene Founda tion to the Quebec Asbestos Mining Asaootoon. March 16, 1936 (Bialy ExhMt 3146). 124. Letter from Braun to Saboura, February 4. 1937 (Bialy ExhMt 3176). 123. Letter (rare Hotonea to Braun, April 26, 1937 (Bialy Exhibit 3180). 126. Minute* of Asbestoa Textile Institute meeting, March 7, 1937. 127. Braun DC. An epidemiological study of lung cancer in asbestoa in miners. Sep tember 1937 (Bialy Exhibit 3188). 128. Letter (rare Sabourin to Grainger, De cember 18, 1937 (Exhibit 23 at Deposition of David E. Uieofeld. March 28, 1989, United States District Court, Eastern Dis trict of Texas, Beaumont Division). 129. Letter bare Sabourin to Braun, Decem ber 30. 1937 (Bialy Exhibit 3194). 130. Braun D, Truan T. An epidemiological study of lung cancer in asbestos miners. Arch Ind Health 1938; 17:634-52. 131. Letter bare Stofcmger to Braun, January 2a 1938 (Bialy Exhibit 3198). 132. Cattleman BI, Zico GE. Corporate influ ence on threshold limit values. AJTM 1988; 13:531-559. 133. Letter (ram Sabourin to the QAMA, June 22, 1938 (Bialy ExhMt 3200). 134. SehkoffU.Haramood EC,ChurgJ.Asbes tos exposure and neopiaene. JAMA 1964; 18832-6. 135. Barclay WR. Asbestos. An industrial m- setwith a health cos. JAMA 1984; 232.-96. 136. Memo bore Smith to Grot, February 26, 1963 (Kulxer Exhibit 4394). 137. Memo bore Foetus to Hodson, January 29. 1963 (Kulzer Exhibit 4384). 138. Letter from Lindstrom to Jcases, January 29. 1965 (Kulzer ExhMt 4383). 139. Memo (ram McCarthy to Jones, June 19, 1964 (Kulzer Exhibit 1436). 140. Memo bora Kern to Konzcn. September 21. 1970 (Kulzer ExhMt 3929). 141. Memo bore Reiser to Prus, April 14,1977 (Kulzer ExhMt 1445). 142. Memo boo Bagenstose to Reiser, July 8, 1977 (Kulzer Exhibit 1447). 143. Memo from Unite to McKinney, January 12. 1979 (Kulzer ExhMt 4296). 800 American Journal of Public Health June 1991, Vol. 81. No. 6