Document 6R7z6yzmaOVOZ8NE5gr6aG9jE

FILE NAME: Asbestos Information Association (AIA) DATE: 1979 Mar30 DOC#: AIA032 DOCUMENT DESCRIPTION: Memo to AIA/NA Legal Research Committee Report from Asbestos Associated Disease at US Shipyards Conference .'il.A>iMi* &%*<& March 30, 1979 ^EMOftAflDOM TO FROM: RE' Asbestos information Association/^. Legal Research Committee Carey Z* Gross m C&dwalader, Wickersham & Talt Asbestos-Associated Disease* V^th Particular Reference to U.S. Shipyards, a Conference at the Mount Sinai Medical wetter Rgvember.21-29 } 1 M JL.------- TM~- . . on November 27, 28 and 29, 1978 1 attended a conference given at the Poet-Graduate School of Medicine of the Mount Sinai School of Medicine in Mew York. The conference waa a post-graduate course and was part-of the 1973-1979 program of the Uni verity's Occupational Safety and Health Education Center, supported by the National Institute'for Occupational Safety and Health. * Approximately 300 People attended the conference, roughly broken dow* as fi'on'lnlorwisK.* *}*# ealoeucCtiQorn-s,* ,,v &ti0?nSiV5> t w<f 2(!* *onr. * i o n m m *. <**'" *'" * * "S U I M V . . < * * * * 0 * 0 M r . Ut.r.Wo* . i d .* 0 c o n f i n e * of bv oarttoiiint it the mierenie and do not necessertlsr T i W the opinion. Of W l i . * of . *rir. * l*M 'i!!3E' ,,,,cor<1ln* of o oroo.**. i* avallntle fro. * erf1" ' PUUWTIfFS E X H IB IT UCC 08153 item SO.max ;AUv&TA?SUSO&fc.* . Much of ths presentation was medically oriented, with a lot Qt attention to historical data and epidemiological studies. Dr, Irving J, Selikoff and Dr. Kaye H. Kilo urn directed the conference. A raajorxty of the speakers seemed to turaet the^r presentations to the needs and situations of plaaotiifs in aba3bos~'related disease litigation, Tde first day of the conference involved vary little ''new" information, I sensed that many metalers of the audience were new to this area and a thorough historical presentation was being made for their benefit- Events and studies with which we are all familiar wore presented and emphasized. $he conference began with an introduction by Dr, Selikoff, quoting the August 8, 197$ statement of HEW; approximately a-u million workers have been exposed to asbestos...1,5 to 2.5 million are now being exposed.,,effect of exposure won't appear for 15 to 30 years." _ Without being exhaustive , same of tf.s r.&aas and dates that ware pretented in that first day of the conference were; C D 190? - Or. H. Montague Murray reported first recorded death of asbestosis in Great Britian; {2 $ 1930 - first case report -study on asbestos! in C.S.JL, exposure was IniSouth Africa; > 0 (3) 193$ - Drees sen, et al, proclaimed the. -^VT of $mppcfj m 1955 - Wright pioneered analysis of pulmonary function patterns; and (5 ) X95? ~ 0 !Donnell and Viarb called attention to lung cancer (in 13 out of 2? cates in hospital rr&ar factory, lung cancers were in the lower lobe). ~ 2~ UCC 008154 Hem 3D.mS>i Further's many general statements about asbestos-related diseases re made, Exaaplcs are; CL'} changes in normalcy of x-rays are largely seen after long latency period - approximately 20 years; (2 ) one out of every five Insulation workers in this country dies of lung cannery (3) historically * cancer has been seen much more in the lower lobes of the lungs and linings instead of the non-peritoneum and higher in the lung where those carcinomas normally occur; and (t 5 asbestos-re 1ate1 cancers are often beyond the skill of a surgeon's knife (autopsy photos supporting this proposition were,presented),, Dr. Salikoff stated that recent data shows & statistically significant increase in the appearance of carcinomas in the larynx, pharynx, and kidney in'asbestos workers. The clinical latency period for these cancers appears to be roughly 15 to to plus years. hr, Selikoff feels' that the real' problem with exposure to asbestos is cancer not sstjestosisA significant factor In this area is the end product uge, Dr, Sellkoff seems to feel that workers in companies manufacturing asbestos-containing end products have more health problems than those in the production arid mining'segment of the industry. . Dr.. Selikoff asserted that, in 1 3 5 $ doctors began -to see mesothelioma cases in workers exposed tef only amesita. This was suprising, since eprllet' medical opinion .held that mesothelioma was caused by crysot lie exposure . References were; Waner~X97^British Journal of Medicine, and Molly few-house. Re further asserted that brief exposure to asbestos', if excessive, nay be as hazardous as long term exposure to lower concentrations. Emphasis was placed on reports that an UCC 008155 increased incidence of cancer was found in workers whc had been exposed to asbestos for only one day &v the Patterson plant (such workers wore purpox'te&iy exposed to very high dust levels and had conditions), Another aspect of- asbestos-related diseases .was discussed by Dr. Selikaff. In the profession it- is now called * ` '^bystanders" disease,, fhis does not refer to those working directly with asbestos-containing materials. Bather, bystanders are individuals who contract an asbestos-related disease with out primary occupational exposure to asbestos-containing materials. U'hose are generally, but not necessarily;, family members of the asbestos worker, ' Pr, Sslikoff summarised lessons concerning asbestos- related diseases learned during the last 15 years: 1. Doae-disaase response relationships 2. Pre-eminence of cancer is replacing ssbestosls; . 3 . Pleural xeaotkelicma presenting with scant exposures; . ' >4. Importance of end-product use; and ' - 5 . Cigarette smoking and its effect on cancer in . -, . asbestos workers, -** . v Researchers are now finding that, in animal models, glass fibers can cause th same mesothelioma as is seen in humans exposed to asbestos, However, it is. riot yb known if the results will appear in humane exposed to glass fibers. U Nyjiw* IKVJM1.56 Simr SO.max 1 Dr, Nicholson assented that, in the shipbuilding industry, those associated with thermal insulation have the greatest chance of contracting asbestos-related diseases- The"speaker emphasised importance of the total working environment, rather than just the particular trade. The prevalence of fibers and dust throughout the shipyard lst according to Dr, Nicholson, evidenced in abnormalities among all shipyard workers. Guards without previous yard jobs and draftsmen without any experience in the yards have teen diagnosed as having some of the. asbestosrelated diseases. It is estimated that approximately 4-1/2 million different individuals were employed in shipyards during World War 21* Dr, Seilkoff dlsoussed the fact that researchers have seen in utero transfer*of asbestos exposure in animals but not in humans. He also asserted that children of workers who ip. contract asbestos-related diseases show symptoms; 20-30 years after birtn. The atsumptier, is teat tney Inhaled fibers in their home, probably carried by their father's clothing or hair or tody, not from in utero exposure. Dr. Selikoff noted that exposure cannot re-ally be stopped once a single 'exposure has occurred because the inhaled, fibers continue to expose the lungs end the lung lining. The speakers pointed cut that, for laymen reading some of the epidemiological data, it la important to understand the "healthy worker effect" 1 general, the best comparison for all studies is the H.S. population data. But for the first . . UCC 008157 Stem lO.max five, years of most studies of aoy type of workers* there seems to ho 3O~b0f fewer deaths that? among the general population. This 13 bec*USfi the Spheral population has a higher proportion Oa siok people, while the working population is generally healthier. Therefore, for the first five to ten years of employment* the working population la healthier than the general population, As a result, if researchers find Identical statistics from the general population and from workers early In their careers* something is wrong. Dr, Selikoff discussed the feet that, workers usually die of lung cancer with asbestosis, though there are cases -h where death is due to aaheatosis (very short of breath) wltlTfcba , A presence of.lung cancer. Pulmonary scarring and cor pulmonale cs.ua difficulty in pulmonary functions, although'there are no good data yet about correlations between these two conditions and heart attacks. There was an interesting and in-depth presentation of the mineroiosy of asbestos, In parts it was ouite specific chemically, but most of what was discussed should he common -knowledge to member's, of the asbestos industry. Apparently deposits of crocidolite are contaminated with amosite, This raises an interesting point with respect to litigation in which tne specific types of asbestos,,or asbestos fibers is Important. Dr. Danger discussed "Brownian movement" which plays an Important part in the airborne quality of asbestos fibers. ~S~ OCCOOSI58 item 30 max * The ,,very small fibers do not fail rapidly due to other atoms and molecules moving in the atmosphere. These other particles push the small asbestos fibers around - often pushing them awards, in a vacuum, the smallest fibers would settle - but this is not so in the atmosphere. Therefore, sose fibers may never settle regardless of gravity. This leads to an increased duration of possible exposure to the fibers. Dr. Danger assorted that there are no known safe exposure levels to asbestos. However, he believes that, as dose exposures decrease, there should be a decrease.in the in&idersae of the various dise*ases, He said th'at there is no known exposure standard in the United States to prevent caneera. As a result, the industries end sciences work on a regulatory system trying to minimise exposure and possible related diseases. . ' Dr. Nicholson discussed difficulties with early dust mea$uraments. The basic problems noted were; 1. Few counts wars done; * ' 2 . Those that ware dene did not use current techniques5 3. All particles (mppcf!| were counted rather than ' . only .-fibers^ and , Conversion, factors were- uncertain..- Mr. Michael Kbod, Director of Safety and Communications, international Brotherhood of Boiler Makers, read from a Chicago Tribun newspaper article.* "The federal government has the heaviest of responsibilities .in finding solutions fee problems of .Millions of workers exposed,.'1 &r,, Wood then asserted that ~7~. UCC 008159 Steal 30.max rangement mast collectively 'civgain ever the safety and health ''insult'1 it has rendered its workers, ' Curing a question and answer period there was a discussion concerning the devalued American dollar and the effect It nay have on asbestos-related diseases, 'A speaker asserted * that many foreign ships are feeing drought to the United States for repair, Therefore 3 shipworkers m y be working on these ships without knowing what materials they are being exposed to. This nay increase the likelihood of their exposure to asbestos and asbestos-containing materials. it was stated that medical expertise in clinical and pathological interpretation throughout this country is generally sufficient, further* the American College of Radiology is how training its- technicians to read and interpret -rays so that there will be a higher degree of accuracy in the specific area of Pulmonary problems and x-rays relating to pulmonary diseases. * ' ' Br Selikoff gave a brief presentation on the ILO i * (International Labor Office), classification system. This system van designed to classify films and x-rays for epidemiologists, statisticians and others In the.field. Its function is purely one of classification (the preamble to its design states that this classification is not for workmen's compensation and the like;- 'hat follows is a very brief summary of what Dr. Selikoff said. Pneumoconioses are dust diseases of the lung. ILQ began labeling x-rays to provide a standard classification system for lung diseases, The classifications originally showed - -~ -- o c c m i f o ..... K&m $0 max fe'h&fr was occurring in those exposed to coal`dust and $or.s ^ t silica. The classifications described nodules, Out when'the pedical profession began seeing asbestosis films they could not use the same descriptions fop two reasons. First, there were no nodules. Second, asbestos-related problams were apparent not only in the lungs, but also in ths pleura, and the initial classification slides did not relate to non-lung problems. Sr. Seliicoff reiterated that it is important to remember that there is a much greater amount of pathology in the lungs than can be seen on x-rays. X-rays always under estimate what is there. Because of this, a whole new set of. standards and classifications were developed regarding asbestos end asbestos-related diseases and films showing each ofythese. ?he result is a new il9?S) glassification system/ This will Include a proposed set. of standard films so that anyone looking at the films w i n know exactly what is meant by the various classifications < Irt-other worts, doctors can compare th of their patients to the standard films that come with t .assxfication package. Thers is also a proposal that there be 30t of end-category films. These films would show both ends of each category so that a particular classification will include <1 film from the middle (.or avehsge.) of that category end both extremes of that category. Dr. Rabin asserted that etesotheIlona, of the pleura rarely encountered among people without any .sheetos exposure. *10 stated that autopsies will reveal less than one out of 10,000 iJC008!.6l Stem 30 max oer&ors have r.asctH s1iomat sf the pleura, ;ye" 2 to ,,Ct? of persons -* Kith asbestos exposure develop pleural nssotheiiors.. therefore, according to Dr. Babin, share is a definite correlation between exposure so asbestos {.either pscupation&lly or by ocns.act with one so exposed) and the development of pleural mesithelicma. Kobe, however, that according to speakers at the emibrar.ee, studies in Turkey have revealed pleural sesothellcaa as a 1 . result of exposure to xeolite. Diffuse pleural thickening, diffuse pleural plaques (mainly on the diaphragm) and pleural calcification are often seen in asbestos workers. In pleural thickening, the pleura often creates a case around she lung causing anortnoss o-- breath Dr, Tierhtein stated that a conglomerate shade- on the lung x-ray does not necessarily mean carcinoma, iso dhe presence of an asbestos fiber on a biopsy does not- necessarily mean ashestesis. However, primary carcinoma of the lung .is metasuahle to the pleura. There may be 'a very s-cpoisticn-el new instrument or. the horiaon which 111 help iffrentlets baoween carcinoma and. pulmonary fibrosis, is called a "kata scan," (spelling phoneric;. The following is a summary of points made by Dr. Tiers vein with respect tc primary bronchogenic carcinoma. 1. Pulmonary ashesItsis may mask a tumor; 2. The cancer Is more frequent in the liwer lebes; 3. The cancer la usually "peripheral"p -10~ ' UCC 008162 item 3Q.max . Carcinoma i* increasingly common ithcut pulmonary aebestosia^; ana + * 5. It is dlffioult -o differentiate bet-,.-ear. p l s u m carcincre, pjeurel tttaaiasas and msaothelibiaa. ther* i at'5 to ` visibility of i f a t a d U u edicma in d,caroming priKr.: c ,, nc,oe>nlc , sauisi wan y t ttu d r a t *, Of the fibers ln tbe lung tissues. Time patients eaUgnant S M o t h a H o M t-oald ta tast'd by galliu* inning and differentiated f r a t i m e 1th benign pleural Involvement, . fte. ^abin stated that lung case* Is eight times as great in those exposed to asbestos as in the general 1,$. population. He also asserted that hlacd-gas studies are tmlikely to help diagnose aabestcsU, Apparently it is cordon ' to nave negative x-rays although various pulmonary problems **ist> Xt is * via, that aebestosis w d " ' ~ carcinomas have no dow-**** wia-,Sir.ship to ore another - each has their own dose-reapcnts eve. diagnostic thoracotomies are net recommended by Dr. * * * . H e noted that there hare been thras deaths due to diagnostic thnraectrnies at r-:t. $ins,i. hers appears to be? a law resistance tc post-tboraoQt.or.y infection. ' According to Dr. Churg, mesothelioma fs mrch less common than the lung cancers but much mere specific. larcincma _or the pleura is lung parenchyxi surrounded by mesethglie-r.a. Hisuologiearly, mesothelioma r.ay look very .similar tc carcinoma of the pleura. Any tumor that pats into ehe pleura -will m o w UCC 008163 hem 30.max in the same manner. Mesotheliomas are 70-75% epithelial, Dr. Suzuki noted that a histological section is, not a wroo*d+ -.ca*n to determine asbdstosis, ^ ' t k light mioroseope y be used, according sc ~r. Danger, as long as one understands the caveats to its use, Ktre . sophisticated instruments include the light beam ini the electron beam microscopes. An interesting caveat to the British asbesccs star.cards ttaa discussed fey Dr. Nicholson. The British standards were designed to prevent {or lower the incidence of) asbestos,is. He asserted that no one knew what were '-safe" standards to prevent cancer, The problem tilth the standard for car tirogens > as stated at the conference, is that even at the present time we d e p o t know thresholds for carcinogens, Therefore, D r ,Nicholson .recommended reducing exposure `levels as much as possible, In discussing current* standards ha noted that there is no historic or scientific basis for the "tro fiber standard*n further, the five micron length t^as stated to be ar. arbitrary cut-off to allow the counting of fibers rich the light mis rosccpe. Dr* Nicholson stated that we ion*t kr.ov that shorter fibers do nos cause problems, Similarity, he asserted that chars are , - 100. times as many fibers shorter than fire miertns ad those more than, firs microns in length. Dr. Selikoff believes that 1 ?ry diffiou have dust counts done. F u r t h e r h e asserted that apcrixir.ately --JL2-- utemm ftsm SD.max W i Of a man's Ufa is lost if W o o an wtto., Ka M i n o w tht It to important w ^ ^ strictly averages ana that the .,,its ' u t , * * for vary * wrtar. The p u w p 0f H b , from 0Iwet of * * , ,, ,, CI,itIc41_ tt is important to TMMr that for search porposas a study panod of less than 20-25 years Is not as significant1as the Period after 30 years* ` . Dr. Seiikoff continued by stating that then i* a sharp ^ponaa relationship f*r lung tt0ttr ,, the longer a worker sorted with asbestos, the more likely he is to get lung >41 canosr - but again the latency period is crucial*. The tissue burden continues'to affect with no further exposure other than the initial exposure which can be one month, `one year, even one ***** r f * * the initial the longer the induction period (dose-induetion period). These were said to be the biological parameters that must he taken into consideration. One segment of the conference was directed toward , discussing family contact diseases. 0. Anderson explained that this relates to children and woman exposed to workers oho were occupationally exposed to asbestos, it is b e l i e f that the dust ^ l i b e r s brought back- into the homo by the worker were carried on their oodles,, in their hair and on their work clothes. Thera is a relative risk factor of tan'for women with mesothelioma. This means that a woman with mesothelioma is ten times as likely to live (or have lived) in a hone with an asbestos worker than, a woman in the control group. ' -13UCC00&I65 Rem -30.max * Ac0^ i n s so Andarson, asbestos fibers persist in , 6h8 *** Xn i o m homes that were tested, asbestos'fibers *sr fcurid on fet>* ^ H s 3 ceilings and framework over* the door tw much as 30 j'ears after the last; known working date of the asbestos worker. Wives have been found to h&ye the greatest bftanoe of contracting asbestos-related diseases. Curiously, daughters were found to develop asbestos-related diseases the least, less than their male siblings/ No one is sure why this is so. Following the above background in the medical and epidemiological aspects of asbestos-associated diseases, presentations were made relating to workmen's compensation, product liability and legal aspects of the asbestos disease . problem, tations. i will know turn to a summary of soma of those presen * Xn discussing the scientific basis for regulatory determination of disability. Dr. Kiiburn noted that *kdisability i$ an opinion,,r if* explained that there are four classes of pulmonary/ respiratory impairment that correspond to the four classes of cardiovascular impairment, Hr, Howard Vincent then said that -the length of time from time- of injury to the first disability check received by the claimant is approximately SO days in injury oases and approximately one year in occupational illnesses. He continued Chat one out of every ten .injury cases is contested and ,,her* is an average award o f `25,000, Six oat of every ten illness cases sra contested and there is an average award of lass .Til UCC008166 Item SO.mcx than *$10,'000. According to Mr. Vau.1 Giilanwater the earlless cu occupational diseases are set apart fro accidental injurias Ar reasons:'<,!} the disease is not accidental hut is usually expected; arid (2) the disease has developed over a long period of tliSa versus d sudden onset (like an accident), compensable disability can also be divided into two categories -- a disability of a medical or physical nature and a de facto inability to earn wagas. The two types usually * occur simultaneously^ tut they pan occur independently, 4. here are four classes of disability t torporary-total; tcmporary-partial j permanent-totaij and permanent^-partial. A core detailed discussion of these four classes of disability is contained in the American Medical Association guide" fco permanent disability. It is important to remember that in determining disability the focus is not on the loss of earning capacity but in the cause ;f the .lost of earning capacity Cl e,4 is it cc.cupatior.ar?), gs Cf LfCtooer 1 , 1978 the maximum, rate of" compensation ras $3$$ ccr xaek. t lir. Matthew Shainer* revealed that a determiration zf i1.s- .ability is not only dependant on a diagnosis but also on age, ,educationj, industrial history.and' available employment which the claimant can obtain after ^injury, -Further* disability n ~ *legal sense doss not become pemanenfe until it ranches narl~vrr medical improvement. This determination is made by &r. administrative law judge. Mr, Sha fuer said that written radical reports r.ay not b introduced into evidence in disability hearings and in asbcsfeosls oases it as generally desirable - and often aecessarv - -1$*** CCOOS167 Item Sp,rna.x to have medical expert witnesses testify, if a claimant returns * t0 "*k &ft*r iT^ us^ "His doss not preclude a finding of permanent or uotal disability, Mr. Shafoer emphasised that di.saoili.ty is a torward-xoowlng concept, net just an examination of past events, Mr. Henderson added that the statute of limitations bn disability claims begins to run whan the claimant knows or reasonably should have known about his (!) exposure or (2) disease' or (3) harmful exposure, Tnere lias a discussion of some particularly difficult scientific and legal question which arise ip workmen's compensation proceedings particularly when there is a long latency period. Dr, beliKoif reiterated that tissue change is generally undetectable in asbestos-related diseases until a ao-year latency period has run. Therefore, there is a progression of disability and burden oa the tissues which follows the cessation of exposure. It is possible that the incremental insults may not U coming from onxy one_source, Tnis was related to the combined effects of smoking, environmental problems, pollutants In'the water and air, and the like, . > Mr, Shafner continued by mentioning that the last employer or lacs insurance carrier Is generality-responsible for compensation , In filing multiple claims there should he no overlapping of benefits, but there should also be no gaps, the government Has a right to a third-party,lien if the employee has been treated for compensable disease by a Vk clinic, tiorkren fs t compensation may affect the amount of social security received although social security does pot affect icrkc.eh*$ compensation -ISUGCObSthS Rem 30.max awards - It is hard to obtain total compensation through social security ' Mr. Qan Looks posed the following crucial questions for determining legal points in workmen's compensation claims; Does a disease exist at a subclinical stags? or only when it is detectable at radiographic stages? or whan pulmonary 'function changes become evident? ' With respect to the varying statutes of limitation, in Mr. Henderson's opinion, th,e time when the cause of action ^accrues could he; (l) when the plaintiff suffers harm; (2 ) when the plaintiff becomes aware of the disease prosess 5 {.3} when the ' plaintiff recognizes the causu&l realtlonahlp between exposure and the disease; or (**)- the defendant's data o^ duty {.last - exposure date), - ' . ' ' Mr. Bonald Motley asserted that a good radiologist should be able to distinguish between fibrosis caused by smoking and fibrosis caused by asbestos exposure* He also stated that asbestos fibers and cigarette smoking act independently and either can"cause lung cancer. He pointed out that a non-smoking asbestos worker has a five times greater chance of contracting *l''u''ng 'cancer then the general popula.tion. '.*t' . . . Mr. Roy stainfurth stated that compenst ion claims are usually too late or Inadequate to halt the chain of "collateral1' eyerves that occur when a worker has contracted an occupational ' disease. Soma of those events are depression, break up of the family, depletion of savings, loss Of wages, and the like. He -17* UCC 008109 item SO.msx 1 asserted that St is of utmost. importance to have attorneys who 'are veil versed in workmen1 compensation and products liability !&, Ha noted shat the time from application to the award, of benefits is often two or three years during which time the plaintiff often dies. The burden of proof is then on the widow or other representative, especially in state compensation oases, ` Thera are two states which, as yet, have not awarded any compensation to asbestos workers, Those states arc Mississippi and Louisiana. ' nr. Albert Millus pointed out there is no such thing as an inert dust, but there'are great Individual differences In the susceptibility to dust, exposure and pulmonary insult. Dr. Selikoff added that In 15* of all mesothelioma cases asbestos cannot be identified as the cause and that It does not make biological sense that only one agent could causa a cancer. The last statement was supported .by evidence from Turkey of two -different type* of oolite causing this typd ,cf cancan. . On the last day of the conference appro hours of the afternoon session were used-to demonscra^aworiciehs aompensation hearing. There was a diraot examination a n d ^ o s * ~ .examination of the plaintiff's pathologist, a d i r e c f ^ ^ n a t I o n and cross-examination cf the defendants' clinician, closing arguments and a rebuttal, Complete tapes of those presentations are available. If any AIA/NA member wishes further information cones. n-.,,& Phis conference, or wishes to obtain copies of any of the tapes, `please contact me. _ -18- ' x o I I to ... hem SQ.msx