Document LgnqDGyKV2Xn59xamkL31LwGq

FILE NAME Manville JMA DATE 1966-1968 DOC JMA229 DOCUMENT DESCRIPTION Manville & Knowlton Services 1966-68 Report & Letter TO H. M. Ball W. P. Gibbons Roger Hackney C. W. Hite H. M. Jackson A. B. Marchant G. H. Martens Jr. K. Lindell W. P. Raines K. W. Smith A. C. Smith M.D. A May 31 1966 CC C.B. Burnett F. E. Dutcher D. L. Hinmon F. H. May Jr. R. F. Orth J. L. Allen vA W. F. Goodwin R. F. Knapp G. D. Murray C. L. Scheckler Yvan Couture - Asbestos T. S. Patterson - Toronto DH Carl Thompson Hill and Knowlton BACKGROUND FACTS ON THE ENVIRONMENTAL HEALTH ASPECTS OF ASBESTOS Each of us is exposed each day to the possibility of questions from within or outside the company regarding the various aspects of asbestos and public health As you know we developed a position statement in the form of questions and answers at the time of Dr. Selikoff's March 1 publicity release Now that several additional attacks on asbestos from other sources have occurred it seems well to date it Accordingly we worked with Hill and Knowlton and Dr. to produce the attached statement that is recommended Kenneth for use Smith for Con't Page -2- May 31 1966 the time being As you will see this statement does not contain any new ammunition for use in rebutting criticism there simply has not yet been time to develop such ammunition from the literature search phase of our current activity However the wording is dated to reflect the two most recent public attacks We'll update and issue as additional facts come to our attention If you have queries from the press please refer them to me or in my absence to Bill Raines Director of Public Relations or Jon Allen Manager of Press Relations fjs att F. J. Solon Jr. INTERIM POSITION STATEMENT For use in reply to possible queries REVISED 5/31/66 ENVIRONMENTAL HEALTH ASPECTS OF ASBESTOS The following may be attributed to Dr. Kenneth W. Director of Manville Corporation Smith Medical GENERAL COMMENT No one really knows what testimony which points a causes finger cancer Therefore any medical at a potential suspect is under- standably of interest and concern to the public As an asbestos producer Manville tions and maintains thorough records on M records do not indicate that cancer conducts medical examina- the health of its employees occurs any more frequently among the employees at the company's asbestos mines and asbestos- processing plants than among the general population With regard to claims of exposure of the general public to the inhalation of asbestos fibers as a result of their use in ceiling and evidence is floor tile available brake linings etc. Asbestos is not one very little scientific but a variety of different minerals It is important that objective scientific studies be made to determine whether any of the various types of asbestos present potential health hazards to miners workers users or the general public To that end Manville and the Asbestos Textile Institute have been cooperating Service in a study of since 1963 with the U. the asbestos industry S. Public Health The study is being headed by Dr. Lewis Cralley of the Public Health Service Manville is a member of the Quebec Asbestos Mining Associatio which is also sponsoring a program of medical research on possible effects of asbestos on workers who mine and process it Con't Page -2- COMMENT IN REGARD TO DR SELIKOFF'S FINDINGS Reference by Dr. Irving J. Selikoff to an elevated incidence of cancer among those exposed to asbestos dust is based on limited reports relating to a relatively small group of workers who install and remove a variety of insulation materials including some which contain asbestos COMMENT IN REGARD TO THE OF THE ARCHIVES OF ARTICLE IN THE MAY PATHOLOGY A.M.A ISSUE Recent articles speculating about asbestos as an air contaminant call for emphasis on the scientific limitations by the authors themselves For example the article just published in the May issue of ARCHIVES OF PATHOLOGY of the American Medical Association refers to finding scanty asbestos in some of 500 autopsies performed Yet the authors specifically state that none of the subjects had pulmonary disability and all died from other causes The authors do pose some questions they say deserve study CARL THOMPSON HILL AND KNOWLTON INC Public Relations Counsel 150 EAST SECOND STREET ' NEW YORK 17 N. OXFORD 7-5600 October 7 1966 Mr. F. J. Solon Jr. Vice President Manville Corporation 22 East 40th Street New York N.Y. 10017 taeka Dear Jack ea The reference to the symposium I mentioned yesterday by phone came from Gershon Fishbein's Environmental Health Letter which said as Te follows seal ASBESTOS PNEUMOCONIOSIS SEMINARS COMING UP tiem ab - Much concerned with the problem of asbestos and its DD a effects on workers the Public Health Service's Division mek of Occupational Health will sponsor a seminar on the sub- ject Dec. 7-8 in Cincinnati to bring up to date some of the information which has been accumulating recently Of particular concern is the reported increased incidence of mesothelioma associated with extensive exposure to asbestos fibers The Pennsylvania Department of Health is reportedly investigating some clusters of cases in neighborhoods near factories using asbestos or fibers Since this has received public distribution I see no reason not to have our Washington office check further and am asking them to do so The other item about the Pennsylvania Department of Health is of significancteo you and we know that there have been some recent references to studies done around Lancaster Pa Sincerely ret e sdd die wen es amt Se Thompson Carl Thompson - Draft 8/12/66 7 oe Y Asbestos and Human Health industry The march of modern brought with it many previously ' unsuspected health hazards to those opposed to various substances > ---- achieve maximum protection to workers , industrial medicine has become an important part of industry a distinct branch of medical practice , . _ and a function of public health authorities at all levels of government Industry has a continuing role in protecting the health and safety of its workers and the users of its products In the asbestos industry -- mining and fabricating -- an industrial health hazard is asbestosis , a recognized disease of the lungs known to 40 medicine for years Asbestosis is discussed in some detail elsewhere in this brief At this point it is important to note the following facts Modern methods of industrial hygiene mines and factories have reduced asbestosis to the point where it is no longer considered a common health hazard for workers Ceth Ceth . Asbestosis only occurs after prolonged and excessive occupational exposure which is now generally controlled o . Because of its long history the medical literature on asbestosis is extensive and both prevention and treatment are well understood Recently however there have been published in medical journals and the lay press as well suggestions that with exposure to asbestos lung cancer may be associated | The implications of these suggestions are naturally of great concern to the asbestos industry The industry is concerned with the health of its own employees -- asbestos miners and fabricating workers ry 2- Q _ In addition there is concern also for workers in customer industries -- | asbestos insulators and construction workers who might use Finally the suggestions involve the health of the general public , however slight may be their exposure and however remote disease may possibility exposure might lead to be the that such In the past 20 years the condition of lung cancer has received . gre increasing medical and public attention because the reported mortality aa . from lung cancer has increased substantially in numbers | It is generally | _ conceded however that at least a part of this reported increase is apparent - > rather than real That is it results from expanded knowledge of cancer ; tremendously improved diagnostic techniques and procedures and what a prominent and respected medical journal has called greater lung cancer consciousness among doctors Furthermore even part of the lung cancer increase is due to more people living longer as a result of the greatly decreased mortality from other diseases , particularly infectious diseases Fewer people die young of tuberculosis for example they survive to reach cancer old age In any case the reported increase in lung cancer cases has resulted in serious and laudable efforts to identify the cause or causes It is natural and rational that all substances inhaled into the . ; | lungs should be among prime suspects Cigarette smoking has received _ most of the attention and blame , although general air pollution has also Uranium mining apparently increases risk been widely accused lung cancer In the search for factors that may be involved asbestos dust was inevitably added to the list of substances to be studied among Unfortunately the tendency particularly laymen has te ea been to equate investigation with incrimination and there are some oman tens en -3- believe who tend to a suspect is guilty until proven innocent innocent until proven guilty " -- not ~ A few hundred years ago it was generally believed that maggots were spontaneously generated by the Repeated rotated around the earth + heat of the sun and that the sun observations seemed to confirm these | po beliefs ) mequelon mequelon mequelon P and * believed A little over a hundred years ago it was yellow fever were caused by the miasma -- or bad air -- that from cholera swamps Misty years ago pellagra was thought to be an infectious disease observations on which these medical beliefs relatively were in their timetime , based were disease sophisticated erroneous but the conclusions were as as the theory The of earth the sun spinning around the ! These theories could not be confirmed by experimentation aud experimentationand were eventually disproved by experimentation Suggestions associating lung cancer with neither asbbeystos been confirmed nor disproven by experimentation nor have many observations aud aud conference conference of asbestos workers Without such support the subject should be conference conference conference regarded with scepticism at the present time The fact that the question has been raised however has resulted evidence in increased studies to collect necessary e of what the facts are to make a determination a = : ere I. What is Asbestos Any attempt to assess the effect of asbestos on health is fact complicated by the that asbestos is not a single chemical or | ; physical entity Asbestos is a name given to a group of minerals not _ to one particular mineral The two major groups of these minerals , pyroxene asbestos and amphibble asbestos comprise various types chrysotile amosite crocidolite , anthophyllite tremolite , actinolite brucite and picrolite In the United States chrysotile amosite and crocidolite are used for different kinds of products , but chrysotile is by far the most common About of the asbestos XX used country principally from mines in Canada in this is chrysotile Each of these types of asbestos differs from the others , chemically and physically To add to the complexity there are at least | five different varieties of chrysotile each with a distinct chemical a composition so that the product of one Canadian mine is not identical with the product of another Canadian mine In recent years some of the writers on asbestosis have become aware that there is they have attempted have been exposed | significance in the to specify the type . different types of asbestos and to which asbestosis victims may. _ Such differentiation has not been as clearly observed by those who theorize on the asbestos cancer association Their writings e te tend to speak of asbestos generally ignoring the very real and important e differences among the various types and indeed disregarding the distinct e have possibility that the subjects of their studies may not been exposed- _ to asbestos ofany type whatsoever WY three Each of the most important types of asbestos chrysotile, amosite and crocidolite, exhibit distinguishing characteristics Chrysotile - By far the leading producers are Canada and the Soviet Union Smaller deposits are found in Rhodesia China and the United States Chrysotile a pyroxene asbestos , occurs where areas of ~ subsequently serpentine rock have been cracked by earth movement and reacted by hot volcanic waters under intense pressure This reaction transforms the granular serpentine into fiborous chrysotile Chemically chrysotile is hydrous magnesium silicate with a positive electrical charge Because of this positive charge chrysotile can be attacked by : acids Commercial fibers contain small varying amounts of iron and titanium . . Crocidolite - The bulk of the world's supply comes from South Africa although there are small mines in Australia It is an amphibole asbestos occurring in rich sedimentary rock Chemically . crocidolite is a ferrous sodium silicate with a negative electrical characterized charge a It is by a very deep blue color . Amosite - The Transvaal district of South Africa is the only place where amosite is found It is a member of the amphibole asbestos family occurs in the same type of rock as does crocidolite and has the same negative electrical charge Chemically amosite is a ferrous magnesium silicate With these basic differences it might be expected that the three- types of asbestos would vary in biological effect and numerous observations confirm the expectation There seems to be broad agreement that chrysotile . the most common type in use in the United States , is least likely to produce asbestosis as result of exposure fm re eg ee ee ee  types There is no proof that any of the three of asbestos produce cancer produce lung in animals or in man But in any case it should RedReodo be remembered that data may implicate say crocidolite can not be assumed to apply to amosite still less to chrysotile | | Wagner ( ) experimented with three types of asbestos >fl ' / fhe on various laboratory animals and found that crocidolite produced i the most severe reactions and that amosite was more than five times f Ek as irritating as chrysotile He reported in 1963 . / , oa tes '. . ' ., With chrysotile dust it was possible to produce in the lungs of guinea slight fibrosis in severe lesions effect was observed in two rabbits monkeys while no significant Amosite dust causes marked asbestosis in all three kinds of animals Lesions occur more rapidly in guinea exposed to this dust than in those exposed to chrysotile There is indication that the disease is progressive in monkeys and rabbits an Similar pathology to that which occurred in : for 22 months was observed in a monkey exposed to chrysotile .. a monkey exposed to amosite for four months The impure crocidolite dust caused severe disease in , the rate of respiratory infection among animals guinea and more marked than with the other types exposed to this dust was It is possible that this may be due to the high quartz content of the dust - . . | ; J of Finally asbestos bodies could be demonstrated in the lungs ; animals exposed to all three types of asbestos dust These were : scanty in the animals exposed to chrysotile and usually segmented i Only occasional fibres were observed In contrast to this the asbestos bodies in the animals that were dusted with amosite and segmentation was rare fibres were were plentiful extremely numerous and far outnumbered the bodies : - e w 8 _ _ ; ; ' 27 oe Meda ey Be oda ne . emc sw . me we ak 7 ne as } Following further investigation Dr. Wagner offered an explanation for this observation at a medical symposium ( 7 ) 1965 e A method of producing asbestos dust clouds has been devised . and an animal inhalation experiment carried out to test ... - The elimination rate of Rhodesian chrysotile has been found to be three times greater . than that of the amosite and crocidolite which suggests an explanation for the previously observed reduced fibrogenicity of this dust difference in the elimination rate remains to be determined The reason for the , i + of of Ot -7- me cere ns ereta -- At the same meeting Schepers ( ) expressed doubt whether any ne eee ey oe of the reported lung cancer cases claimed to be associated with previous prema asbestosis could be identified with chrysotile exposure Gar en 2 me My first impression is that there now is less certainty that asbestos inhalation is associated with pulmonary neoplasia than there was ten or twenty years ago Perhaps this is due to the greatly ees come ce 4 oes , reduced dust exposures Asbestos may after all prove to be carcinogenic ce only in overwhelming dosage Thus the high prevalence of neoplasia we which was reported several decades ago may be a function of the severity ee of exposure rather than an indication of high carcinogenic potency sem carcinogenicity I suspect that in final analysis the be rated as of low order of asbestos will . *. vee _ ay Finally there is the question of whether inhalation of chrysotile is associated with neoplasia On critically reviewing the work histories of eleven cases of lung canceirn chrysotile workers I find that all of these had at one time or another also been exposed to other forms of asbestos mainly amosite or crocidolite Their predominant exposure was to chrysotile but since there is such strong evidence incriminating amosite as a carcinogen the fact that thes-- . men also had been exposed to amosite is disruptive of a chrysotile se theory : of per () . 5 of carcinogenicity II What is Asbestosis . Asbestosis , first described derscribedesul1ti9ng24 diseases called the pneumoconioses , is one of a class of diseases which requet when excessive quantities of dust are inhaled over a long period of time True asbestosis is characterized by the presence of particles of asbestos lodged in the lung, so that the surrounding lung tissue becomes fibrous Clinical symptoms arenot always present but in its severe form asbestosis is disabled may accompanied by breathing difficulty and in such cases the victim be | y, lung 1 Q. of great cancer is the relevance fact that to the alleged link between asbestosis and 15 diagnoses of asbestosis itself are still uncertain Despite the undeniable existence of the disease and its a ren eee , . extensive literature even the most experienced physicians have difficulty Lf . on, fs ofes in distinguishing asbestosis from other pneumoconioses and even from yt? completely unrelated chest diseases The situation is made more complicated by the fact that pneumoconioses dusts are sometimes caused by a mixture of various , . silicasilica col cement or sticstic such as cement carbon silics If lung disease patient has been exposed to mixed dust lives in an polluted city and is a heavy smoker how accurately can specific of his disease be determined Much more common than asbestos is silicosis caused by the inhalation of stone dust Silicosis has been proven to be associated with tuberculosis On the other hand all evidence to date supports the view that there is no association between asbestosis and tuberculosis Furthermore silicosis is progressive while asbestosis is static The disease only gets worse through continued exposure to asbestos dust Finally there is a difference of opinion among scientists as to whether 090 the lesions induced by asbestos in experimental animals is identical with human asbestosis or merely resembles the human disease - The difficulty of diagnosing asbestosis was pointed out by Sander ( ) in 1955 who cited some of the confusing symptoms and reported the varying diagnoses made by a group of physicians in examining ray films All these examples I assume represent patients who present themselves to their physicians with symptoms of dyspnea with a bt history of some exposure to asbestos dust and with chest films of the .. character I have mentioned How easy it is to fall into the trap of a , _,' gunshot misdiagnosis Unless other possible causes for the ray es changes are considered first and a detailed past occupational history is eo ' evaluated along with the character and extent of the most recent dust exposure another worker who actually needed reassurance will be told that his lungs are full of asbestos dust and that he should quit his trade . From that point on his symptoms usually increase to a marked degree , and < he has developed what to him is a real disability In my experience such . induced disability is commoner in some areas than is the disability from the disease itself _ ... number of my films from the textile mill in North Carolina for which I am consultant representing cases which I had classified as early or first asbestosis were called essentially negative by a number of physicians present who had had long experience with this disease The reverse also was true some films I had called negative which others . thought represented stage asbestosis The same disagreement was found with the other films which were presented It was our final conclusion that and that it can the next by the it is impossible to clearly define a first case be called essentially negative one day and first stage same reader This was not new It has been emphasized repeatedly by Pendergrass beginning in 1938. A similar experience was reported in 1960 by Williams and Jones ( ) who took 38 ray films of asbestosis patients and mixed in at random films from nine patients with other chest diseases , and six normal chest films The films were then shown to two panels of radiologists and chest specialists who were asked to interpret them The authors wrote -10- \ There were several surprising findings in this study One +. was the extent of the disagreement between the observers in the diagnosis a es on of the films from the certified cases of asbestosis These patients had .,. T Ce ; .. all been seen and certified by the pneumoconiosis medical panels and , * had initially been selected by us as classical examples of the disease Yet when the same films were viewed in the present trial the number s , . Oo to show changes consistent with the diagnosis of asbestosis varied thought from 40 to 80 approximately according to the observer * . 11 widely mo ... conclusion it is apparent from the observers : 6 tn ee pee in the group of films from other findings ed ' appearances in asbestosis pulmonary diseases , that the radiological x . are by no means specific , and may be confused with such differing diseases as chronic bronchitis and . rn _ sarcoidosis and other pneumoconioses Presumably if other inteemrpshtyisteimaal _ fibroses such as scleroderma lymphangitis carcinomatosa xanthomatosis + _ or beryllium granuloma had been included in this group the confusion , _ would have been even greater eee , st .at a The situation has been summarized by Demy 1962 ( ) a emp ere tt ee ee there is no specific radiologic ray diagnosis of pulmonary asbestosis and the picture of expertness and infallibility with which lawyers like to introduce their particular expert medical witness is a legal fiction to impress the jury Lawyers should be introduced to the Second Aphorism of Hippocrates , who writing on ancient medicine stated Whoever , having undertaken to speak or write to . on medicine have first laid down hypothesis are clearly mistaken in what they say their argument Sincer the diagnosis of asbestosis is so often questionbale| a diagnosis of asbestosis accompanied by lung cancer must be even more questionable since diagnosis of primary lung cancer is still an uncertain art | Questions . . | feature Questions Another of asbestosis which negates the lung cancer association WriWtritee asbestosis es is the progressive nature of the lesions of e The malignant feature of cancer is its ability to spread while asbestotic wee / fibroses are limited to the area of the included asbestos particle prema Experiments conducted by Vorwald et al ( ) revealed that the fibroses produced in animals by exposure to asbestos dust do not spread or become worse The authors said in 1951 . | ed -11- pulmonary reproduce which are disease Although in man asbestosis is a chronic with diffuse . fibrosis which in one or more similar to the requires years to develop it is species of animal characteristic lesions of human asbestosis possible to tissue change's in Long asbestos fibers are essential the production of ae the peribronchiolar fibrosis short fibers are incapable of producing this reaction BO! Sop The mode of action of the long asbestos fiber in the wo production of asbestosis is primarily mechanical rather than chemical in nature discontinuance ... Established experimental asbestosis ceases to progress on . of dust exposure The experimental investigation shows in fact that on discontinuance of exposure there was an appreciable clearing of the mature pulmonary lesions due to contraction of the fibrous tissue Gross and Smith ( _ ) compared the progressive nature of asbestosis with progressive silicosis suggesting that the explanation might be found in the contrast in shape between the long asbestos fiber and the round silicon particle Their paper published in 1959 observed In contrast to silicosis asbestosis is not a progressive disease Basically silicosis owes its characteristic progressiveness to '. the fact that silica particles deposited in one site may be transported by tissue fluid generally as edema fluid to uninvolved portions of the | lung to initiate new lesions Asbestos fibers in contrast cannot pass the intricate barrier presented by the lattice work of tissue fibers as ; readily as particles of the same diameter which are substantially spherical . Also since asbestos has a very considerable solubility dissolution of the fibers offers a plausible explanation for the paucity of mineral found in asbestotic scar tissue Both of these factors prevent the transport of significant amounts of asbestos fibers from their site of deposition to new locations and therefore explain the progressiveness of asbestosis - si; ? : 7 - EN eS EL a ee . Pr oe ee ee, The causing potential of a substance is usually tested ae . through animal experimentation in which a clear dose relationship is demonstrated Animals exposed to heavy doses of the carcinogen over . long periods of time usually develop cancers Those more lightly exposed -- either in time or dose -- may show no signs of malignancies -12- ; : - . Asbestos has | produced lung cancer laboratory animals animals animals There Furthermo seems to be no relationship for - Ay clear time a asbestosis in humans Y Kleinfeld et al ( ) have remarked on this lack of correlation between exposure and pulmonary disease o= The study group comprised 56 asbestos workers They were : selected on the basis of having had an exposure to asbestos dust as asbestos insulators for 14 years or more and no previous occupational dust exposure 11 .In general the correlation between the degree of a Sept function impairment and the clinical and roentgenographic at pulmonary as a whole and no consistent findings was poor for the exposed group To be found between the duration of exposure and correlation could lung function impairment this group The lack of a good correlation between the degree of pulmonary function impairment and the : clinical roentgenographic and environmental findings observed in the present study has also been reported by Bader et al a = ; oo The comment of Gross ( ) in 1963 on lack of evidence is appropriate - proofthe association of pulmonary carcinoma - .In recent years of many publications It seems only with asbestosis has been the topic for the establishment of proper to expect the same rigorous critericaancer and asbestos as etiologic relationship between pulmonary is caused by have been demanded for the that pulmonary cancer _ excessive cigarette smokin.g . . a - , Se on . e Pew -13- III What is an Asbestos Body Asbestosis is characterized by the presence in the lung of inhaled particles of asbestos Although asbestosis is difficult to diagnose in true cases of asbestosis the inhaled particles golden brown in color symmetrical shaped up to 5 microns thick and 50 microns long will form tiny tissue growths called asbestos bodies Apart from the problem of what type of asbestos may comprise any given asbestos body the term has gradually been extended in use . to apply to any similar lesions found in the area of the lung which form around a foreign body It is known that many cases of pneumoconiosis are of mixed origin xixi A Nevertheless some clinicians and pthologiswthso have reported the presence . of asbestos bodies have not employed chemical analysis This losse identification has even been applied to particles found in the lungs of xi subjects with no known exposure to asbestos whatsoever . Ye Ne \ Pa a os et Cauna et al ( ) in 1965 reported the difficulty of identifying Te asbestos as opposed to other particles in a study of autopsied human lungs . 4 \ ee ee Deter es : The problem of absolute identification of asbestos in asbestos bodies is a difficult one and to our knowledge no successful histochemical procedure has been devised Chemical examination of lung tissues for ' acid insoluble residues yields a value for total silica that might represent asbestos or other silicates No chemical determinations were wD - done in these cases An attempt was made to identify the element silicon . vet egameoo in asbestos bodies from a known case of asbestosis by electron probe 4,wer analysis Although iron was readily identified no silicon was 8 encountered The bodies seen in talcosis are identical to those in asbestosis and are thought to be the result of contamination with tremolite material ,,another fibrous silicate It is associated possible are with tremolite that the bodies seen in our -14- er cert 7 . & o we ve Bo _ - In a December 1965 symposium on asbestos , three experts discussed the same problem of identifying an asbestos body Vorwald ( ) | | _ stated 4 2 * nme, . In view of my experimental and clinical studies of pneumoconiosis . with special reference to asbestos and from the standpoint of the clinicalpneumocnios pathologist looking at tissue from mortem material of the lungs * it would appear that a real problem is what is an asbestos fiber It Oe seems to me that we must perfect techniques where we can specifically oe ot identify an asbestos fiber as asbestos distinct from other fibers present in the lungs that are not asbestos Let us also recognize that not all bodies that we see in the lungs coated or uncoated contain an asbestos fiber There are -{: es bes hee en ) em etry many bodies to wit the graphite body which is coated with ferratin and iron which is segmented the bodies seen in worker's pneumoconiosis the bodies seen in tremolite talc workers I have seen A the rouleux formation of degenerated red blood corpuscles which under oe ordinary stains often as segmented asbestos hematoxylin appear enu bodies ere ong wes And Holt ( ) added Rae eRe . eaten me + ROR Again assuming that everything that looks like an asbestos eevee E 8e . body an asbestos body seems completely fallacious because in the literature ge you will find photographs of for example talc bodies The center is me - es not black I suppose that if there is a talc hazard this must be one ee . of the most serious ones because every woman when she powders her nose surprised inhales very large concentrations of talc and I should be there geneexrtraelmely T if were not talc bodies in the lungs of women in se rte ee, : The criticism of Schepers ( ) was directed at recent studies OE which have been given attention in the lay press -15- I am frankly astonished at the facility with which asbestos ebesetn albonlgiasnhdetdhoroughly exposed to the dust and that might even have the pulmonary fibrosis I believe I am : consensus of experience of quoting correctly of asbestos bodies is both pathologists in the U.S.A. that the findings The superabundance of rare and in diseased lung tissue always ; significant ' cases in Cape Town and The suggestion that this Miami therefore is a mystery brakes does not may be the result of abrasion of automobile , correlate with the prevalence of driving habits There are automobiles or local an in New York more automobile brakes abraded per linear mile ' City than in either Cape Town or Miami If this is : factor I am sure Drs Selikoff and the have long since Churg and other pathologists would reported on this phenomenon For the time despite to this interesting presentation by Dr. Thompson I being am and continue to believe that the prevalence of obliged function of asbestos bodies is a hundreds of occupational exposure to asbestos dust I have examined lungs of persons who never have been industries and none of these has shown employed in asbestos have examined the lungs of thousands ofaesxbpeestroismebntoadliecsontLrioklewise I ne animals Again asbestos bodies have never been detected in hamster guinea pig rabbit cat dog or a single mouse rat monkey unless a had previously been deliberately exposed to such an animal When I see my first unexposed subject with respirable asbestos dust course revise my scepticism asbestos bodies I shall of - an . ; . . . _ -16- i i i | { IV i What is an Asbestos Worker The opinion of Schepers is that the prevalence of asbestos bodies is function of the occupational exposure to asbestos dust Obviously asbestos miners and workers in asbestos fabricating plants fit this category It might be assumed that an Asbestos Worker the name applied to a member of the International Association of Heat and Frost Insulators and Asbestos Workers is also occupationally exposed to asbestos dust This may be true in some cases but it is not categorically true Members of the called Asbestos Workers Union work with a wide variety of materials including different types of asbestos Certain insulating materials contain amosite fiber and a magnesium ' silicate base others contain a mixture of amosite and chrysotile fiber still other insulating materials contain a mixture of these two fibers with calcined diatomaceous earth which contains a fair percentage of cristobalite In recent years fiber glass has competed with rock wool and rock cork Since workers tend to specialize in the installation of certain materials it is possible that many asbestos workers have never been in contact with any type of asbestos fiber whatsoever Most reports linking asbestos to lung cancer have been based on studies made among these asbestos workers who install various roofing and insulating materials And in only a minority of lung cancer cases has there been reported concurrent findings of asbestosis or asbestos bodies in the lungs 17 xxxxxxx The comment of Isselbacher et al ( ) made in 1953 still | _ applies today . Few reported cases of lung cancer related to industrial / asbestos exposures provide data on the character and quantity of dust exposure This is a serious deficit in exact study of etiologic correlation -18- V. The Health of Asbestos Miners and Fabricating Plant Employees In the United States and Canada reports suggesting an above- average incidence of lung cancer with asbestos have not come from studies _ conducted among those groups most heavily exposed On the contrary the exposure of workers in the insulating trades where such reports have Dele Dele Dele originated may be considered comparitively moderate at most and complicated by exposure to other dusts and other factors This anamolous situation would suggest that slight or moderate exposure to asbestos is more dangerous on than heavy exposure -- a premise that is dubious the face of it | So far as is known employees of asbestos fabricating plants ^'Ai positive in the United States with a exposure to asbestos , and a positive tendency to develop asbestosis , are no more likely to develop lung cancer than the general population Lanza ( ) commented in 1952 ome 11 ... some of the mines and fabricating plants would dduusstt thhaatvsuepercviasinoncer medical supervision working extensively for over thirty years it was a frequent complication of exposure to asbestos . would have become evident long ago especially as the supervision asbestos workers is both thorough and comprehensive Although no definitive study of the health of American asbestos factory workers has been published as yet such a study is now being carried out by the U. S. Public Health Service The health of Canadian asbestos miners however has been studied the . and results show that the lung cancer rate among these _ workers is not significantly higher than among the general population tal, ane2 The study was published in 1958 by Braun and Truan ( ) a. According to the findings in this from lung cancer does not study the mortality rate appear to increase with length of exposure or . with degree of exposure a fact which the carcinogenicity of asbestos presents strong evidence against oo that Comparison of the experience among the asbestos of various segments of the miners with shows that unexposed unexposed the observed number of comparable population deaths among the miners is not _ ' significantly greater than the expected numbernumber cases among the asbestos The rate for proved rate of 22.5 per 100,000 mfionrertshe 2r5e.s3t poferth1e00,000 compares well with the for adult males throughout the Dominion of CaPnraodvai.n..ce and 20.8 per 100,000 ... the basis of what are date it seems fair to conclude believed to be that the complete and reliable - of Quebec do not have asbestos miners in the Province than do comparable a significantly higher death rate from lung cancer _ _ segments of the general population urbanized lower Furthermore ; , the death rate from lung cancer in the contiguous to the asbestos asbestos operations is areas widely scattered throughout the Province comparable to that in areas than in some of Quebec and is . areas within the Province - i \ . ; . f foe evre EY add - quotes - epidemiological epidemiolgical epidemiological date ie .me me, e e -20- VI Chemical Physical and Biological Tests With Asbestos In an effort to identify known carcinogens all types of * asbestos have been subjected to exhaustive chemical analyses Minute traces of some suspect substances have been found but in such infinitesimal scientists quantity that no significance is attributed | studying . the question . In 1965 Goldblatt and Goldblatt ( ) commented on the fact that the statistical observations on which the asbestos cancer theory is based are not supported by chemical or biological experimentation The authors said But at no stage in all these impressive researches was any clue obtained which might have offered any support to the possibility that asbestos could act as a carcinogen There is no reliable criterion by which one can anticipate carcinogenicity and as is well known relatively carcinogen sufficient minute changes in the structure of a chemical to diminish or eliminate carcinogenic action are T T . regarded carcinogen If asbestos is indeed to be as a some - need is felt to demonstrate property which can be regarded something more than inertness the as eo : as, ann: i ee vee eo eee At the 1965 Symposium Schepers ( ) reported the results of animal experimentation His work shows that chrysotile asbestos is neither carcinogenic of itself in rats nor does it promote the effect of a known carcinogen beryllium when that substance is administered with asbestos Said Schepers . emn Le 21 . a ee In a study completed a few years ago at Saranac Lake we . proceeded as follows We used laboratory bred albino rats which in previous experiments with beryllium sulfate beryllium oxide and beryllium fluoride had yielded abundant pulmonary carcinomata See Progress in Tumor Research Karger Basle 1962 Two groups of rats were started respectively on exposures to chrysotile dust and beryllium sulfate dust A third group served as en undosed control After six months of exposure the beryllium group was split into two halves One group continued . in the beryllium environment Another group was now exposed to chrysotile dust for six months The original chrysotile group was dealt with in half identical manner i.e. one was continued on chrysotile and the other ' half transferred to beryllium exposure All exposures were terminated after a year The prevalence of pulmonary neoplasia was statistically . contrasted for each group In essence the following was found Group 1. ' Group 2 Group 3 . Group 4 Group 5. Undosed controls No neoplasia Chrysotile exposure only No neoplasia Beryllium exposure only About 1/4 of the animals developed pulmonary neoplasia Beryllium followed by chrysotile developed pulmonary neoplasia About 1/5 Chrysotile followed by beryllium About 1/10 developed pulmonary neoplasia ; - neny e yet tle eb fe 7 One may infer the following from this experiment tte ee ee __. a The animal species is normally not pulmonary carcinoma prone but possesses a latent potential toward neoplasia when adequately challenged b. Beryllium sulfate is a potent carcinogen when inhaled for six or more months at a daily aerosol concentration of 12 gamma per cubic foot of air c Chrysotile evinced no carcinogenic potential in this animal species d Chrysotile did not act as a carcinogen with beryllium sulfate e The lower incidence of neoplasmata in Groups 4 and 5 does not necessarily imply that chrysotile acts as an carcinogen but may perhaps be explained by the lesser exposure period to the beryllium and the shorter available induction time for pulmonary carcinogenesis oe Dr. Schepers had previously commented sceptically on the ee em reports of asbestos bodies found in the lungs of persons with no history of exposure , and had discounted the theory that automobile quantities brakes might release harmful of asbestos dust into the air me \ tans amt we Dr. Kenneth W. Smith ( ) Medical Director Manville Corporation , presented the results of tests which disprove this theory ra In our Research Center we are continually testing our brake linings and those of other companies on various types of automobiles and trucks When . we first heard of the supposed association of the disintegration of the brake lining with the asbestos bodies in lung juice we immediately started a program of pulling the wheels off these test automobiles and examining the brake lining dust Various samples were examined after 5,000 miles of driving 10,000 15,000 miles etc. There was ample dust for examina tion but in not one of these samples of our own manufacture or samples of brake lining made by other manufacturers in this country could we identify a chrysotile fiber As far as we are concerned it is impossible for any of our type brake lining manufactured in this country to disintegrate and liberate chrysotile asbestos fibers which can be inhaled to form as- bestos bodies This is quite understandable because chrysotile asbestos fiber disintegrates when exposed to the tremendous heat created by the . material friction of the brake drum on the brake lining nee ee -. et 1. @ @. we . oe incidence u of the high addition t manufactu I would in that Ne believe th using using onl of other It app the use conferen Frank by John | look He mae e -23- VII Summary The theory that lung cancer is caused by exposure to asbestos has been proven and should be regarded with scepticism at the present time The following facts tend to cast doubt on the theory 1 Asbestos is not one substance but many substances , differing in chemical and physical composition 2. A recognized disease of the lungs , asbestosis is progressive and has no clear dose relationship . animals 3. It is laboratory certain induced in No ! ; a whether asbestosis can b7e ! oo 4 Asbestosis is difficult to diagnose and is frequently confused - | with other diseases caused by dust inhalation Fill asbestos Exposure = produced cancer in We& 6. It is not certain that called asbestos bodies sometimes . found in lung cancer victims are actually asbestos many other substances cause similar lesions 7. In the United States and Canada the occupational groups most heavily exposed to asbestos dust miners and fabricating plant workers , have no significantly different rate of lung cancer than is found in the | general population 8. The called asbestos workers in the insulating and building trades work with a variety of different materials , which may or may not include asbestos the most In any case they are exposed to various types of dust their exposure to asbestos dust is certainly moderate compared to the exposure of miners or asbestos fabricating plant employees -24- 9. Only a very small part of the population is occupationally | _ exposed to asbestos There can be no possible correlation between this exposure and the reported increase in lung cancer cases in recent years ate. e . mee oe cen woman December 9 1968 REPORT OF MEETING December 3 1968 Public Relations Committee Environmental Health Task Force ae a F. J. Solon Jr. - Chairman W. P. Raines M. M. Swetonic Bert Carl Goss - Hill & Knowlton Thompson - Hill & Knowlton NewslettFeorr Mount Sinai Project It was agreed that the money for producing the newsletter ought to come out of the basic research program budget The mechanics of writing approving printing and distributing the newsletter were discussed Hill and Knowlton agreed to prepare an outline of these mechanics - including costs --~ that could be used as a sort of check list for a meeting with Jobe and Dr. Selikoff to iron out any difficulties Matt Swetonic was assigned the task of checking with Hibbert Printing Company to see whether final printing and mailing stages of the program could be handled through the M Advertising & Public Relations production depart- ment's art costs Business Week Article Med. Various avenues of approach to Business Week for the plNaacement of a favorable story on the Mt. Sinal program were discussed The decision was made to approach the Labor Editor rather than go higher in the organization Carl Thompson of H & K outlined the specific approach and pointed out the pros and cons in the move It was decided that any attempt to place a favorable article in Contractor News should be delayed until after the Business Week approach is concluded since the latter is the big circulation book and we should go at it first San Francisco Department of Public Works Discussed the letter received by Dr. Selikoff from the San Francisco Department of Public Works requesting information on the potential dangers of asbestos to the general public Needs further investigation Solon will talk with Burt Jobe Jack Solon recommended strongly it was agreed to by all members of the committee that M set up a team of M people knowledgable in the field of asbestos and health who would be ready at a moment's notice to fly to trouble spots like San Francisco and move in on the situations -3- O'Toole and The Washington Post 62 62 62 62 Tom O'Toole of the Washington Post contacted Dr. Selikoff about a series of articles examining a wide range of environmental health problems including possible health dangers associated with asbestos beryllium coal dust radiation It is believed the series is designed as a boost for the Health & Safety Bill in the next Congress O'Toole interviewed Selikoff on December 2 an article appeared in the Washington Fost December 4 - a damaging article basically concerned with dockyard workers Ralph Nader Nader has occasionally mentioned asbestos in his listing of potentially harmful dusts Should he at some time in the future decide to crusade against asbestos it was decided that more could be gained from sitting down and talking with the man than by taking the General Motors route H & K sources indicate that Nader is a reasonable man and can be approached on that basis It was agreed however that he should not be contacted unless he takes on Manville first Manville Situation Addendum to November 6 minutes Dr. Merrill recently remembered that Dr. Demy of Somerset Hospital did indeed approach him in 1966 for work history records and that he did not follow through by providing them This is of course in direct contrast to the statement that we made to the Messenger- Gazette last month This once again points out the need for batter -4- contacts between M medical representatives and the outside scientific community especially in the Manville area