Document 91xQO2K7BEYN8BvVoKN6z21z6

FILE NAME: OWILL DATE: 2002 OWILL098 DOC#: OWILL098 DOCUMENT D ESCRIPTIO N : Book Excerpt - Asbestos Blues- Labour, Capital, Physicians & the State in South Africa O V '2-- AFRICAN ISSUES jo ck Asbestos Blues McC u l l o c h A w h iah* I'rotrwir S(k i.il S<kDi c KMI1 UnixcfsHv m SIg Labour, Capital, Physicians & the 8 State in South Africa lAMt'SCURREY OMokI INDIANA UNIVERSITY PRESS lili munin^lon \ lndi.in.i|Mjlis 178 Dust & Disease attractive by the political turmoil that followed the Sharpevillc massacre. The paper Wagner gave at the 1959 Pneumoconiosis Conference brought him to the notice of Dr John Gilson, the head of the Medical Research Council's Pneumoconiosis Unit at Llandough Hospital in Wales. Gilson persuaded Wagner to join the Pneumoconiosis Unit in 19(52, where he worked until his retirement in 1988. When Wagner returned briefly to South Africa in 1966 he was confronted by senior figures from what he terms `the South African medical establishment', who accused him of damaging the local economy.47He was taken aback but glad he had chosen a career outside South Africa. The discovery by Sleggs, Wagner. Webster and Marchand was felic itous. To make that particular find at that time took a mixture of skills. Chris Sleggs was the local clinician treating tuberculosis patients with new-generation drugs. He expected his patients to recover. The most trou blesome patients in a hospital like West End were those who did not suffer from tuberculosis and therefore didn't respond to treatment. The worst of all were lung cancer patients; their decline and inevitable deaths under mined the morale of patients and staff.48 Mesothelioma cases were conspicuous at West End, and Sleggs had good reason to find a way of treating them. Paul Marchand was a young surgeon at the beginning of a distinguished career. Marchand's skills meant that the biopsy material sent to Wagner, the pathologist in Johannesburg, would have been relatively easy to interpret. Marchand also struck up a friendship with Chris Sleggs that was important in helping to overcome Sleggs's intellectual isolation. Marchand encouraged Sleggs. and they remained in contact until Sleggs's death in 1987. As head of pathology at the PRU lan Webster wanted to understand asbestos-related disease, and he was in part responsible for the appointment of Wagner. Chris Wagner was a gifted pathologist who responded creatively to the puzzle presented by Sleggs's patients. Sleggs was the first to recognise the connection between place and disease and to suggest that asbestos may be the cause of the extraordinary tumours that were appearing at West End. Yet until the end of his life he remained unconvinced that mesothelioma constituted a distinct disease, believing instead that the cause lay in some interaction between tubercu losis and asbestosis.*4'1There are several possible reasons for his rigidity. He was a tuberculosis specialist, and he had little time to keep abreast of research on asbestos and cancer, the very literature to which Wagner was contributing. As superintendent of West End he was oveworked and often irritated by the demands on his time made bv Webster and others at the r Interview with C h iis Wagner. 4" 'I Ins was suggested lo mo by Ton y D avies w ho Ini m oie than .1 doc ado ebree ten! <1tiiheic.ulosis ciic!uahem programmi* in Z im bab w e In lo m ew with Pro! 'In in D avies. 21 Novem ber 1998. |{i.timloniein. Inhunneshurg Arc ordm g to l.tn Webster. C h ris S leggs believed that plastic p ie n iisv dc velopeci in tubercu losis patients m the Northern C a p e <1nei that with interaction with dust produced mesothe liom a S ee lan W ebslm M e so th e llo m a to u s Illin o is in S o u th Afri .1 P a th o lo gy anC* K\pet intentai Pathology*, in H arold 1\ W h ip p le (ed ] litologu n l kfjc< Is 0/ Asbestos* A nnals of the New York A cadem y ol Sc iene c*s. voi \A2. U IV embei pp Dust & Disease 179 I' RU. His correspondence with Webster extended over almost thirty years, yet they never managed to get on first-name terms. Sleggs's practical concerns in running a regional hospital meant that he was less interested than Wagner or Webster in the rather abstract question of causation. Researchers at the PRU solved the mystery of the tumours at West End. but they offered Sleggs no means for treating his patients. Kit Sleggs retired from the Department of Health in 1974. and he and Kathleen moved to Fish Hoek. near Cape Town. He continued to work on his case notes just as he had done over the previous twenty years. Sleggs suffered a severe stroke in 1982, which left him unable to write. He died at Fish Hoek on 22 June 1987. In his memoriam Paul Marchand wrote: 'Much of the credit must go to Sleggs for recognising what was at the time a new disease and also for helping to define the hazards o f asbestos.''" There has been some controversy over should have been the senior author of that first article by Wagner, Sleggs and M archand.' 1It was. after all, one of the most important occupational health discoveries of the twentieth century. Should the credit have gone to Sleggs, who did the initial work and proposed the connection with asbestos, or Wagner, who established the precise nature of the tumour? Ian Webster, backed bv his medical director, Harry Gear, said the paper was a pathology paper that only postulated the association with asbestos, therefore Wagner's name should go first. But the import of the paper was on causation and not the description of the tumours. Sleggs and Marchand wrote a second article emphasising the casual factor, which was published in the South A frican M edica l Journ al in January 1961.'2 But by then the credit had gone to Wagner. Sleggs was a diffident chest specialist running a regional hospital for Coloured and black patients. Wagner was working exclusively on asbestos-related disease at South Africa's premier occupational health institute. Wagner went on to a brilliant research career in the UK. Sleggs remained at West End pursuing his own vocation. Toward the end of his career in 1985 Wagner received the Charles S. Mott Prize from the General Motors Cancer Research Foundation. It was in recognition of his South African work from thirty' years earlier and his continuing contribution to cancer research. When Wagner died in May 2000 the Brit/sh press was full of glowing obituaries. One writer commented o f Wagner's 1960 paper: ` It would be difficult to over emphasise the importance of this study, which was to become the most quoted paper in occupational medicine. It initiated an explosion of research into asbestos-related diseases.',l There is a postscript to Wagner's career, which was unknown to those who wrote such obituaries. The intensity of asbestos litigation and the vast sums of money involved have sometimes led to a falling-out between asbestos companies. One such case is that of Owens-Illinois Inc. (O-I) and T&N Ltd. which began in the Eastern District Court of Texas in June 2000. One u` ln Momoiiam ('hruMopliri KM" S lo p s ' liv Paul Man hand, }> 728 ' Set* Man hand. `Disrovoiv nl Mesothelioma* ' Set* Waguei, Sieges am! Man hand, ` Diffuse Pleural Mesothelioma*, pp 28 84 "O h ilu aiv ('iinstophiM VVagn*i Daily Trl(\iiiaj)h. 11 Jtilv2000 180 Dusi & Disease of the issues at stake was the level of knowledge that O-I had about the dangers of asbestos, and in particular its attempts to improperly influence the medical literature. An affidavit presented in defence of T&N by Paul Hanley, a New York attorney, who since 1981 has acted on behalf o f that company, involved Chris Wagner. According to Hanley, on 16 December 1987 he met a Mr R. Bruce Shaw, a New York lawyer representing both T&N and O-I, a major U S asbestos manufacturer. O-I used large quantities of amosite but it had never used crocidolite. At that time Hanley and Shaw were representing the same clients, and they discussed issues relating to pending litigation. Hanley recalls: At the December 16 meeting Mr Shaw also informed me that 0-1 had been paving Dr Wagner S6.000 per month for some period of time irrespective of whether Dr Wagner did any work for 0-1. and further that the money was paid by O-I to a bank account in the US in the name of a third party. Hanley agreed to attend a meeting with Chris Wagner in the UK in January 1988 to discuss mesothelioma. At that meeting in London, on 24 January, Shaw and Wagner discussed amosite and crocidolite at length. According to Hanley: Mr Shaw privately confirmed to me after the meeting that he was trying to persuade Dr Wagner to say or write publicly that only crocidolite asbestos was an undeniable cause of mesothelioma, and that the role of amosite asbestos was non-existent or at most minimal. At the time mv lay view was that this position was scientifically unsupportable. For that reason Hanley thought Shaw would be unable to persuade Wagner. i was therefore quite surprised when, in a paper written two years later. Dr Wagner wrote in a published paper that the evidence was overwhelming that the main cause of mesothelioma was crocidolite asbestos - and that amosite asbestos was implicated in just a few cases The paper fails to mention any financial support from 0-1.vl Hanley's testimony has only come to light because of a falling-out between asbestos companies. He is not a member of the anti-asbestos lobby but an experienced attorney whose career has been spent defending the industry. His evidence comes in the form of an affidavit. If what he says is true, it would not be the first time that industry has sought to unfairly influence the creation of medical knowledge about the hazards of asbestos. When I interviewed Chris Wagner at his home in Weymouth in 1998 he told me that he regretted ever having worked on asbestos-related disease. He was only interested in science, and asbestos was always about politics. Allnl.ivit of I'jiu I 1 H anley. Ji. 24 Jiiintiv 2000 in suppm l ot <l<'loinlout's m otion loi iclio f Irom tlHuult iiul^m cnt m <u so o l ( ixvm s-lllm n is hu \ VfrN ltd In tin* IJ.S District Q u ir t f<>i I lie* IK.st, in D is Iik t oi Texas. M .irsh.ill D ivisio n . C A No 2 MOCVOM 17 Dl p. 10 v*line! |)|> 10-11 iM W fr jM M lir ~yfr _ 9 The PRU Survey m The disaster in the Northern Cape At the Pneumoconiosis Conference held in Johannesburg in 1959 Sleggs and Wagner presented the results of their research on mesothelioma. Their work was obviously important, and delegates endorsed the need for further study. Immediately after the conference the asbestos industry approached the CS1R. the major scientific research body in South Africa, with a proposal for an asbestos research project. There was nothing unusual in that initiative, as it had been the pattern in Britain and else where for government authorities to co-operate with industry. At the same time the industry closed ranks over the issue of environmental pollution. In July 1959, M.F. Baxter of the CSIR wrote to Dr Orenstein, then director of the PRU, about the proposed survey. 'As you know', wrote Baxter, `the mining people tried to dissociate themselves from any responsibility here particularly in regard to the incidence of asbestosis and mesothelioma in the non-mining (civilian) population.'' Orenstein promised to discuss the issue with the Government Mining Engineer, and then 'take the matter up with the members of the asbestosis (sic) mining industry'.2 The Government M ining Engineer, Tony Gibbs, accepted the link between asbestos and mesothelioma, and he asked Ian Webster from the PRU to co-ordinate a survey of the north-west Cape.3 There followed a meeting between Ian Webster, Justin Mackeurtan and Richard Gaze from Cape's London office. Gaze, a chemist, was aware of disease at Barking, and that was why he supported the project. Justin Mackeurtan, who was managing director of Casap. opposed it.4 After some discussion it was agreed that the project would be funded bv the asbestos industry, supported by a small grant from the South African Cancer Association.3 ' Lt'lli'i hom M I* HavltT. C S IR lo Di OronsUuii. P R U . Johannesburg. (> Julv 1959 Genera! Ari.mgiMiUMili Tln* M S S ui vr\ Kil*s 1201/1. N G O H Papors - limi lnt(*i\K'\v u illi U n WVhsti'r. A 1V< <*iiilx*r 1997 4 lim i lirp o il o l thr l*iafn*s* o l S fo so ih rlio m a S u iv t y a s nt JU A p rii 1W j. Pneum ocom osis Rcscan h U n ii. S on ili Ahi ili (anni il ini Si inolili, ami Industriai Rt*s**art i). tm puhlishcd. p 2. NCO H l\ipt*is 181