Document 8VDYoe60EZvNa540jRXdaLkpy

AMERICAN JOURNAL OF GR07AB3V INDUSTRIAL MEDICINE 1olume 20, Number 1, 1991 jUN 2 5 9S1 Scon : ACKNOWLEDGMENT to reviewers BtJSrd of Editors of the American Journal of Industrial Medicine is grateful to its referees for their careful and judicious reviews of scientific contributions to the Journal during the past year. Their judgments have not only guided us in our selection of papers for publication, but their advice and critical analyses have, we believe, also been valuable to authors in preparing more complete and pertinent reports. Not that the investigators have always agreed -- we've had some vigorous debates -- but even these have served to sharpen and clarify the points being made. The authors have the last word, of course. They bear the ultimate responsibility for what they write. However, the review process, in maintaining the academic rigor of the Journal, serves both readers and authors in the intimate interweaving that is the fabric of science. OCNS1 ft. ABERLE U*enny of Caliform* E.D. ACHESON Dept of Heal* R Social Secumy (UK) ANDOS AHLBOM Kawliwh Ihum HENRY A. ANDCRSON Depl of He*MU A Social Served (W!) W. KENT ANGER Ovfae Health Scearn Umvcnay SHUN1CHI ARAKI Untvmcy of Tokyo NICHOLAS A. ASHFORD Mau. lMomm of Techaoiogy OLAV AXELSON Lmkopmg Univenny DEAN BAKER Ml Suim School of Medcii* DAVID V. BATES Uiitenaj of Boo* Columbia RAYMOND BEGIN CHU Sherbrooke. Quebec J. GEORGE BEKESI Mi Siam School of Meteine C. BCMY Um of Sydney, Auunlia EUIA BINGHAM Uiuvcnarjr of Cmciandi AARON BLAIR NO. Bcdoda KENNETH BUDBORD N1H. Bcdwsda ARNOLD R. BROOY N1EMS. Smirk Triangle Pat r. BRUGNONS Umverviy of Vetoes J.N. BUTCHER University of Miammxa MOIRA CHAN*YEUNG University of Sntuh Columbia NICOLA M. CHERRY McGill University THOMAS W. CLARKSON Um*tmry of Rocbcsaer BERNARD COHEN Ml. Siam School of Mdcirn JOHN E. COTES Ncwcaafe on Tym Medic*! School (UK) MASSIMO CRESFV Inu Regia* Elen*. Rome MARK R. CULLEN Yale Ufuvemiy DCVRA L DAVB National Academy of Scwscss PIERRE DCCOUFLt CDC. Atlanta UETDCRNEVIK Umvcnny of Oonborg P. DCVUYET Emma Hoapnal. Burned GREGORY L DIAMOND Syracuac Research Corporation RONALD r. DODSON Uatvemry of Tasna ALAN M. DUCATMAN Mam Imotud of Technotofy ROONEY EHRUCN University of Cap* Tow* Medical School EDWARD A. EMMETT Work Safe Australia ANDERS CNGLUND Bygghalua. Seudaa FTERRE ERNST McGill University MURRAY M. FTNKELSTON Oecano Miauvy of Labour A.S. FISCHBEIN Mi Siam School of Medina* LAWRENCE J. nSHBEIN Risk Science laminae. Washington. D C EDUARDO L nUNCO ImtMut Amaad-Fnppmr. Canada ARTHUR L. FRANK Uoivcmcy of Kentucky ALFRED FRANZBLAU Uoivcrwy of Michigan DCRRA FRIED Mi. Siam School of Modem JOHN A. ntOCNES University of Caiifoma HOWARD mUMKXN Emory Umvetmy FRCORIC E. GERR Ml Sumi School of Medrnmt G.W. GIBBS SHE InTI Comuliaas. Albcna. Canada UNDA GLfCKMAN Ml Siam School of M*dma* JAMES H. GOOBOLD Mi Siam School of Madmac ROSE H. GOLDMAN The Cambridge ttapnal. MA BERNARD GOLDSTEIN UMDNJ-R W Johnson MeehcaJ School PHIUPTE J. GRANDJEAN Odeaae Utuvumry MORRIS GREENBERG Umvenay of London JOHN S. HAR1NGTON Ml Siam School of Medcum MAUREEN HATCH Cohuohu Umvenay RICHARD B. HAYES NO. Beihwrts DITTRICH HENSCHLER Uaivenay of Werthiaf ROBIN HERBERT Ml. Siam School of Medicine GUNNAR HILLERDAL Uaivcnny Itapnal. Uppsala. Swede* ROBERT HOOVER NO. Bates* STEVEN HOROWITZ Be* Israel Medical Can. NY BENGT jARVOHLM Umwwy of Cnmhnrg ECKHARDT JOKANNING Ml. Siam School of Mednae PAUL KATLAN Me. Siam School of Medicine KAYE H. K2LSURN USC. School of Mntrine HOWARD M. KOTN UMDNJ-R.W Johamm Medical School N. KOHYAMA Nmnaal laanane of laduamal HcaBh. Japan Commuted on bock cover CURRENT JOURNAL l PLAINTIFF'S t EXHIBIT \$0fl iQo AMERICAN JOURNAL OF ~ INDUSTRIAL MEDICINE Volume 20, Number I July 1991 Research Articles Radiographic Abnormalities in Asbestos Insulators: Effects of Duration From Onmt of Exposure and Smoking. Relationships of Dyspnea With Parenchymal and Pleural Fibrosis R. Lilis, A. Miller, J. Godbold, E. Chan, and I.J. Selikoff.................................. Parental Occupational Exposures and Risk of Childhood Cancer: A Review Lindy M. O'Leary, Anthony M. Hicks, John M. Peters, and Stephanie London.................................. ...................................................................... Silicon Carbide Pneumoconiosis: A Radiographic Assessment Pierre Durand, Raymond Bdgin, Louise Samson, Andrf Cantin, Serge Massd, Andrt Dufresne, Guy Perreault, and Jacques Laflamme................................. inflammation of the Visceral Pleura, a Nonspecific Asbestos-Related Pleural Reaction: Chest Radiograph and Computed Tomograph Correlation Albert Solomon, Ami-Hai Eliezer Rubin, Jacob Bar-Ziv, and Rafael Carel ... Silicosis and Lung Cancer in North Carolina Dusty Trades Worker* H.E. Amandus, C. Shy, S. Wing, A. Blair, and E.F. Heineman ...................... First-Aid Reports of Acute Chlorine Gassing Among PulpmiO Worker* as Predictors of Lung Health Consequences David A. Salisbury, Donald A. Enanon, Moira Chan-Yeung, and Susan M. Kennedy..................................................................................................... Mortality Study of British Pathologists Alisa Hall, J. Malcolm Harrington, and Tar-Ching Aw......................................... Brain Damage Caused by Hydrogen Sulfide: A Follow-Up Study of Six Patients Bjpm Tvedt, Knut Skyberg, Olaf Aaserud, Anund Hobbesland, and Tove Mathiesen .... *......................................................................................... I 17 37 49 37 71 83. 91 Table of Contents continues on next page @W1LEY-L1SS A JOHN WILEY & SONS, INC., PUBLICATION New York Chichester Brisbane Toronto Singapore 4 American Journal of Industrial Medicine 20:127-129 (1991) LETTER TO THE EDITOR Corruption of Occupational Medical Literature: The Asbestos Example Key words: medical ethics, lung cancer, asbestos hazards Recently the issue of medical conflict of interest in research has been much discussed in the literature and in the courts [Chalmers, 1990]. We would like to discuss another type of misbehavior associated with research in occupational health. This issue is that for the past several decades some researchers working for the asbestos industry have suppressed and altered research results to protect their spon sors. We have become aware of the fact that a quote taken from a paper written by one of us (H.H.), which confirmed previous reports that established a causal con nection between asbestos exposure and lung cancer, is being misinterpreted in the current discussion of asbestos-related disease [Garrard, 1987]. The paper states that "Experience has led to the acceptance of five million particles per cubic foot of air, of small enough size to be respirable, to be the safe working concentration'' [Isselbacher et al., 1953J. A thorough reading of the paper indicates that this reference was meant to apply to animal studies that had been conducted at the Saranac Laboratory. Taken in context of the whole report, which included information on two cases of lung cancer, the paper indicated that the exposure limit for asbestos then recommended either was not being properly implemented or was inadequate to protect the worker against the cancer hazard from asbestos exposure. Therefore, readers of the paper were put on notice that asbestos-exposed workers had a specific risk of contracting both asbestosis and lung cancer from their exposure. Of course, nooe of this discussion goes to the real point. Asbestos manufac turing companies were aware of the risk to product users such as insulators no later than 1930 when Merewether and Price in their seminal paper specifically mentioned insulator work as a profession likely to result in asbestos-related disease. In addition, Merewether put these companies on notice of the need to utilize ventilation and to educate workers to have a "sane appreciation of the risk'' of exposure to the dust. Another article written in 1946 has also been misinterpreted in recent times All work researched it Brown University. , Address reprint requests to Dr. David Egilman, 100 Jefferson Boulevard, 3 Jefferson Place. Warwick, RI 02912. Accepted for publication October 8. 1990. <0 1991 WOey-Lte,' Inc. 128 Hardy and Egilman [Fleischer et al., 1946]. Since one of us (H.H.) knew several of the now deceased authors, we would like to clear the record for them as well. Here again an attempt has been made to take part of a conclusion out of context to misrepresent the facts of the paper as they were understood in 1946 [Garrard, 1987], The facts that were demon strated by this paper include: 1) a specific notice that exposures to insulators were well above S million particles per cubic foot of dust containing asbestos (the then relevant standard) even with ventilation in place; 2) a recommendation that "safe" insulation work required ventilation and respirator use; and 3) that "safe" meant that, despite the implementation of some of these controls, the insulators with 10 or more years in the trade still suffered a 6% incidence of moderate and advanced asbestosis. Finally, the authors stated that the exposures, if maintained for an 8 hr day, 40 hr per week, were not safe. Their tentative conclusion of insulating work being a "relatively safe occupation" was based on the rotation of workers. To quote, "It seems likely to us that if the pipe coverers studied had worked steadily at any of the above operations where the amount of asbestos dust in the air was consistently high, the incidence of asbestosis among these workers would have been considerably greater" [Fleischer et al., 1946]. Furthermore, it is ironic that in a paper commissioned by the Asbestos Infor mation Association, Dr. Enterline maintained that the asbestos cancer hazard was not known until 1964 [Enteriine, 1978a]. In his unpublished draft, with reference to mesothelioma. Dr. Enteriine conceded that "few authors ever expressed doubt about the relationship between this rare tumor and asbestos exposure and by 19S3, the issue was fairly well resolved" [Enteriine, 1978b]. In his published paper. Dr. Enteriine, citing company consultants (Lanza and Vorwald), stated that American experts of the 1930s through the mid 1960s did not believe that asbestos caused cancer due to the absence of published positive animal studies. One of us (H.H.) was with Dr. Gardner at the Saranac Laboratory in 1946 during the last months of his life. He had performed animal studies on cats and mice indicating that asbestos was a lung carcinogen. Unfortunately, the studies had been funded under an agreement with several asbestos manufacturing companies that granted them control over the publication of results. The companies sought to suppress the publication of this information that was unfa vorable to them [Brown, 1936]. Dr. Gardner's animal data were included in a draft of Vorwald's 1951 paper [Vorwald, 1948; Vorwald et al., 1951]. Dr. Lanza directed that Vorwald strike this from the paper at the request of the controlling companies [Lanza, 1948]. A second positive animal study was performed by Dr. Vorwald for the Quebec Asbestos Mining Association [Vorwald, 1952]. This remains unpublished. The asbestos tragedy is one that need not have occurred. It is one that research workers and other companies must learn from. Harriet Hardy, MD Department of Preventive Medicine Harvard Medical School Boston, MA 02116 and David Egilman, MD, MPH Department of Community Health Brown University Providence, RI02912 Corruption of Occupational Medical Literature 129 REFERENCES Brown V: November 20, 1936, letter to L. Gardner. Chalmers ((1990): Underreporting research is scientific misconduct. JAMA 263:1403-1408. Enterline PE (1978a): Asbestos and cancer The Tim thirty yean. Cited as unpublished in 1978b editorial. Enterline PE (1978b): Asbestos and cancer The international lag (editorial). Am Rev Respir Dis 118: 973-978. Fleischer WE. Viles FJ, Gade RL. Drinker P (1946): A health survey of pipe covering operations in constructing naval vessels. 1 Ind Hygiene Toxicol 28:9-16. Garrard HG III (1987): State-of-the-art as a defense--Is it real? In: "Asbestos Medicine," Defense Research Institute, Reno Nevada, Coursebook pp 87-12. Isselbacher KJ. Klaus H, Hardy HL (1933): Asbestotis and bronchogenic carcinoma. Am i Med 13: 721-732. Lanza A: December 14, 1948, letter to A.J. Vorwald. Mercwether ERA, Price CW (1930): Report on the effects of asbestos dust on the lungs and dust suppression in the asbestos industry. London: H.M. Stationary Office. Vorwald AJ (September 30. 1948): "Asbestotis," Report to the Johns-Manville Corporation. Vorwald Archives, Armed Forces Institute of Pathology, Washington. DC. Vorwald AJ (May 7,1932): First Interim Repott/Asbestosis and Pulmonary Cancer (to QAMA), Saranac Laboratory, Saranac Lake. NY (Vorwald Archives). Vorwald AJ. Durkin TM. Pratt PC (1931): Experimental studies of asbestosis. Arch Ind Hygiene 3:1-43. i * s /