Document JOjd3Y7oQ12QzomeqEZbb5Ze

-1 * E A medically oriented "detective story." EXHIBIT VI 3 Last summer I walked through a ceramics plant to see how dusty it was because one of my patients had devel oped lung trouble after working there for several years. Within the plant itself the air seemed fairly clean. However, %vhen I walked outside, I saw piled against a shed a number of open sacks .of whitish powder which the manager told me was talc. It was to be added to the clay. A small breeze stirred the surface of the talc, picking up some dust and blowing it throughout the back yard. Some blew into my face and onto my clothes. I asked whether the workmen inhaled the talc, and the answer of the manager, who appeared an intelligent and careful man, sug gested he believed that the talc consti tuted no hazard. 1 worried about this since California talcs, as well as other talcs, are mixtures of minerals, of which a large percentage is asbestos. Asbestos,causes lung can- cer in.workmen who inhale it, and. interestingly enough, these workmen also have an increased incidence of cancer of the gastrointestinal tract, par ticularly of the stomach. Then, 'with this entire subject still fresh in my mind, I went shopping with my wife at a market near our beach home in Laguna. There is a Japanese population in Laguna, and this par ticular market carries food intended for the Japanese purchaser. I was star tled to see a sack of rice intended for Japanese consumption bearing on it the label "coated with glucose and talc." Japanese people have a high in cidence of stomach cancer. Tale coating on rice meant that the Japanese, at leas* in the Los Angeles are3, were eat ing talc with their food. The obvious question was whether the two facts were related. Later, in Los Angeles L by R. R. MERLISS, M.D. visited several markets, and in each I found that rice intended for Japanese M M H H M W nM nH M nM BM H M M M M I consumption bore the label "coated with glucose and talc." The next piece of information needed was how widely used talc-coated rice is in japan itself. I found 1 could not buy Japanese im ported rice in Los Angeles. The United States, at least in this area, does not im port rice from Japan. However, I bought a sack of California-produced talc-coated rice, and visited several stores in the Japanese area of Los An geles, asking in each case the Japanese owner whether this is the type of rice commonly used in Japan. In each case he told me that it was. Beginning of a hypothesis i.e.,This, then, represented the genesis .of a hypothesis: that the high in cidence of cancer of the stomach in Japanese is due to their eating of asbes tos-contaminated talc adhering to the rice. The further development of the hypothesis led me to spend a number of evenings away from home reading relevant studies. I learned that the age- inadjusted rate of cancer of the stomach Japanese men from 1962 to 1963 was the highest for all nations. It was 67.96 per 100 thousand men and was seven intimes the frequency of that in men the United States. Investigation of the original report on the health prob lems of asbestos workers by Irving Selikoff of Mount Sinai Hospital showed that the workmen exposed to inthis mineral had a significant increase gastrointestinal cancer, especially A n Internist. Dr. M crliss has been in private practice in the Los Angeles area. He Is senior attending physician emeritus o f the Los Angeles County Cencrai Hos pital. In addition to the numerous articles he has had published in professional jo u r nals. he is also the successful author o f two published novels. Lllo and Hoalth/March 1973 forms of asbestos. The difference be tween these two minerals is not in their chemical composition but rather in their structure, asbestos being fibrous while talc is flaky or granular. Composition of talc There is no firm commercial denni- tion for talc. The composition of com mercial talc varies with the deposit. Vermont talcs are said to be a granular type of mineral relatively free cf as bestos. while California talc contains fibrous silicates, classified as amphi bole asbestos. Talc miners and processors develop a lung disease called talcosis, just as asbestos miners develop asbestosis of the lungs. There is a good deal of simi larity between talcosis and asbestosis. stomach cancer. Presumably the in- In one study' older talc workers crease came from the inhalation of fi- showed more than four times the ex bers of asbestos, which then settled in pected incidence of lung and pleural the pharynx or the nasopharynx (that cancer. The presence of pleural can- part of the respiratory tract shared with cer, or mesotheliomata, is especially re- the mouth), and were swallowed, be- vealing. since this particular type of coming trapped in the glands of the tumor is very rare, and occurs primar- stomach, causing development of can; ily as a result of asbestos inhalation, cer there. Autopsies on six talc workers with Rice meant for the American con- talcosis showed the presence of the sumer is milled mechanically. On the characteristic "asbestos body" in the other hand, California rice prepared lungs of every one.2 This is a fiber of for the Japanese consumer is treated asbestos, coated with iron-containing with glucose, which forms a sticky film, protein material, which will give a to which the talc is applied. The talc positive stain for iron, is tTiouihrnrpT(T5erve the, liavor of the Up to 30 per cent of various talcs, rice. About 2 per cent of all the talc depending on their points of origin, produced in the State of California from 1959 to 1963 was used as a rice additive. I had a sample of the sack of rice awbrohcliechcalsaabsrescisftiolaasbr.gleCelhyarsyvsaorfliiibetetrio,eusths eofscilalaimcsaspitcheasi-l, I bought examined. Study of the ash form of asbestos, has a fiber more suit- demonstrated close to about four mil- able for weaving and has been used for lion asbestos-form fibers per gram. making asbestos curtains, blankets, and 1 found that the mineral laic is de- so forth. Chrysotile frequently ner.ur.s_ fined in the geologic, texts as a hydrous as a contaminant of talc. . silicate of magnesium. So are some However, amphibole asbestos fibers. * . ,* I ** . . . " the information I collected appeared to support the hypothesis that eating rice coated with asbestos-contaminated talc might contribute to cancer." fft.jith P-- -- p a W a C - g -- which are usually shorter than chryso- history of talc coating of rice in Japan. it took us so long to recognize that tile fibers, are no safer. In one study l While storekeepers have told me that smoking causes cancer. The latent pe saw from Holland ainphibole asbestos to their memory, talc-coated rice was riod between exposure aud develop mineral predominated in asbestos customarily eaten in Japan, informa ment of the cancer is particularly long bodies in the sputum of a group of men tion directly from official sources in with asbestos. In one study3 lung exposed to asbestos and having a high Japan has been slow in coming. When cancer appeared more than twenty incidence of malignant tumors of the it finally did conte it was incomplete years after the beginning of occupa pleura (the membrane that lines the and only partially revealing. I have tional exposure to asbestos inhalation. lungs and chest cavity). Moreover, min- learned that talc-coated rice, was the In another study4 the increase of lung *ers of talc that contains more amphi classical form of Japanese rice prepara cancer first appeared about twenty- bole asbestos than ehrysotile have a tion in the past. However, offictially, five years after first exposure. substantial increase in the incidence of . this has stopped in recent years. The Consequently, I expect now, should cancer of the lung. Japanese Ministry of Agriculture and the hypothesis be correct, that some At this point the information I col Forestry writes that with enforcement time in the future, after the expiration lected appeared to support the hv- of food sanitation laws in 1947, the of the latent period necessary for car pothesis that eating rice coated with addition of talc to rice has stopped. cinogenesis, cancer of the stomach in . asbestos-contaminated talc might con-, This same Japanese official source Japanese in Japan will begin to de tribute to cancer. indicates that there is no current con crease. Exactly when this drop occurs The next step in the investigation tamination of rice by talc. I have had will depend on the length of the latent of the hypothesis was to examine the five specimens of Japanese rice, im period, and the time when widespread geographical occurrence. Studies ported from Japan or purchased there application of talc to rice in Japan within Japan showed that in prefectures by visitors, examined for asbestos. Four stopped. in which rice is the major staple, stom of these demon* strate*no asbestos. The value of this hypothesis, then, ach cancer is higher. It is lower where However, one specimen of canned will be decided by the death rate from the population eats heavily of other cooked rice, currently prepared and cancer of the stomach in Japan in the staples such as soybeans or yams. The cooked in Japan and imported to future. Consequently, the next ton years . death rate from stomach tumors is America from Japan, contains a sub ' will tell whether this hypothesis is greater in Japanese who eat rice with stantial amount of asbestos, even after valid. If the death rate drops, it will every meal than in Japanese who cat it the cooking and washing process. be strongly supported. If not, one will not as frequently. Consequently, it would seem that then have to conclude that one more Finally, the stomach-cancer inci . while the use of talc-coated rice in seemingly attractive hypothesis on the dence of Japanese cannot be consid Japan has officially been abandoned, at genesis of a form of cancer will have ered a hereditary or genetic disorder, least one sample of rice from Japan is been disproved. since as Japanese migrate westward, still currently contaminated with talc. the incidence of stomach cancer falls. Thus the incidence of stomach cancer among Japanese in Hawaii is greater than among their non-Japanese neigh bors, but is roughly only a little over half as much as in Japan. History' of talc coating The most difficult aspect'of the de velopment of this hypothesis was the determination of the nature of tlie rice currently being eaten in Japan, and the At the moment, then, the hypothesis remains neither proven nor disproven. With all carcinogens, or co-carcino gens (other substances that work with carcinogens to cause cancer), the pe riod between injury and the develop ment of clinical cancer is always long. In the human being such a period be tween injury and development of cancer may run up to twenty to thirty years. .This is what makes the identifi cation of carcinogens difticult, and why REFERENCES 1 M. K lcinfcld . J. M cssite. O. Kooyman. and M. Jtaki. M ortality am ong t mH cilnleitrhs in Now York St.it. 14:1103 007. 1907. aAlcrc hm. inEe nrsv irnoond * ------- . C. C iel, J. M ajor,m otvski. and J. M rssite. TwIhai'tlahcltPhpn7oe:su1tm0m1oo-1rctoeinsm.ioisoifrsin.--3d.ainrgesp. orAt roclhs.ix Epnavtiireonnt. * I. Stoeslikeuxfpl.o(s. uCrleiurmg.ui.nunleKo.pCla.silala. mjinAo.mMl..1A. s bes tub- 22-20. 1904. * |. r . Knox, ci n l. M ortality fm in long <.mi rr .mil other ra il sc* am ong workers in an .i.tu-s.'iw textile factory. Ilrit. J. h it hist. .Wei/. 23:2`t3. m en. . Life and Hcalth/March 1973