Document Ne3b4YNYL7aVpKkgEEeXoogvD

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(Mo kllllitMl Inputtant possibility related to increased awareness o( aeaothelloes should M kept in mind when considerin'} neighborhood osposutos. This factor hss boon evidenced in several studios, rot ossaplo, tho following inforsatien hss boon tskon Ifoa Tsblo II in tho McOoneld snd McDonald study UtTltr Distribution oj reports^ cases of sesetheliooa by ptovineoi I1K0-1TW * Ontario Ountoc etJiar . Provinces NS Of reported mm. a tf 101 St nr-itwed by pathology Panel ST SO IT accepted as naeothalions Tit 41t sn Tho study by McDonald and McDonald (HTJI was baaod on a foraal national survey of all patholoDists in Canada. Tho dillotoneos in persontssee accoptod as aosotbolioaa n?t, Til. ITI) wore statistically sionitleant If t .!>. tho lowot potcontafo accoptod in Ouoooc i*lt| aupporta tho falsoly hiohor tryst tins with increased awaronsss in that doodtaphic atoa. ft is untoaaonablo that OdMh has fdllod to cits the only report of s tarsal nationel survey of all patholodiats. conducted in Canada and published by Neoonald and McDonald IldTlI. On eosoumity osposuto, duotins ftoo tho auanary of that paperi "Ms raao other than those ocaupationally or dopostically osposed had Hood within Id Piles of asbestos oinos or sills. ` heichhorhood oaposuros Iasbestos factories and ahipyards) wore resorted for d of lid sesothelionas reoarded as definite* in the article by Oreoshore and Lloyd oaoiea ildTdi. noweoer. soaaible past esposores. local svarsness and lacs ot tellable baseline rstes render a tarsal eealwation isposaiplo. The discussion by Webster iltTJ) points sot the difficulties in interpretine the Sooth Africa sesotheliona caperlence. Another conplete patholopieal survey was reported for Scotland for tho r led ftos ms to lSIT ltd eaaeai period. The study oat nstsned and carried out as s retrospective patched case-control (two sots of controls were selected!. of the SI cases who had residential caposure, all out one also had apse evidence of occupational eaposore to aebestes. (There were I feoaies with c . r 1i raaidantial nptiai* without occupational aapoaura. I Thu*. conaidartn* th# nuabar of atudlaa that hava boon cooplatad. tharo ta llttla evidence that paat residential aapoauraa haa appr act ably incraaaad tha dak. Sooa eaaaa would oa npvrtcd nan aabaatoa operation* dua to tha aaall but aeeaptad natural rata, and tha incraaaad awaranaaa of tha dlaaaaa naar aabaatoa oparationa. Maaothalioaa daatha In occupationally vaooaad cohorta have boon wall docuaantad. Thla documentation waa available oalora 1*71. Loop latent parioda lor tha dtaaaaa are cvUencad -- oaantnp that currant eaaaa ware wipoae* Iona aao at a tiar whan tha lavala ware undoubtedly hljher. In addition. Man wattiaa aapoaur*' dua to faetora auch at aMpbuildina and Iona work daya undoubtedly contribute to recant eaaaa It anould bo raitaratad tnat non* of tna aoaotholioii.a atudiaa thua lat ralarrad to have bean accoapaniad by nuaarical eotiaatv* of actual atpoauraa. and hone* arc not ot practical nalp in arrivina at a nuncrteal atandard. Tna only recant puolication divine aona `new inaiaht* cited bv 0H* waa a Paper praaantad, but not yet in print, by Mwhouee and berry, while it ia not baliaaad that tha protection* cf aaothalion* death* in a workforce aapoaad before I***, uain* tna Maibull diatributlon, nalp in any way to aatabltah a TU. on* baaic aaauoptlon ot that paper iai `Both the decree and lenath of aapoaur* at* of iaportanca.* Cvidanca waa praaantad to aupport a doa*>r**pona* ralationahlp. taan thouah aoat atntnaliooat have oaan reported with abort atpoauraa. tha intanaitla* and path lavala 2* to 4i year* aao can only bo conjectured. Tha author* notoi "It ahould bo atraeaad that tha population w* ar* conaldarin* war* all firat arpoaad to aabaatoa prior t*. ltd*, and neat of the* before 1**1. Therefore, th* condition* raaponnih.r, ar* not thee* which ahould be achiavad today, th* evidence of a do** raapona* ralationahlp alow* that inprovad factory oavitonaont* at the praaant anl in th* future ahould aarfcadly reduce riak*....* Thua. th* now avidanc* cited by HIM roar* ftoo a oanuecript auoportin* a do*oroapona* lot ooaothollona and coportlny `narkadty reduced riak* at the preaent tlo*. la addition, thi* article la refraahlni in ita erlticiaw of ita owa data -- atataaant* apparently .ynorod by OCBA. In th* ftopoaal, otu atataat "aoaethelloae death* have occurred aoonf th* apectfic <iroup of Ilf worker* whoa* etperienc* prior ta ml had lad to th* developaent 41 th* current atandard* Itbie refer* to the knot cohort reported by tha ION |l*t*|l awafeatinf tnat tnia would invalidate th* atandard. ha dlacuatad in detail aarliar. t*c eenert *f it* include* a apectrua of paat eapoaute* |*o* eatreaely hlfh lifatlaa aapoaur** even a* late *a 1*MI. aany far la ****** of th* corrent Old* atandard. baaed a* th* tneviado* ftoa other cohort*, aaaathali*** death* would be eupected In the Inet eohort. hbe* ufforte ta ratat* doao ta the Hal of aacoaa aaaetholleae are conatdartd, thaaa arc *0(1 llkuly to be auccvaxfui in on occupation*! Htilnt a Inca thv chance tot devrlupino unjitli- oapoauto data la virtually nonoatatvnt In 'nouavheld and coamuntty* caata and in thvt* vnvironnvnta mat* la a laiv chance ot indaterninabla apontanaoua occurranca ot aaaothallona. Tha "haw* fytdancf Oaatrointaatinal Cancel Tha avallahla incarnation an qaatiointeatmil cancat in tha DOHA ralarancaa at* aunnanaad in tha fotlevtn>| table. tunnary table of Infernation an Caatrointaatlnal* Cancer Death* In fn'Cltod Otudloai "*' bforaw -JSls- HP In SS&S& ' l14>llnatlon rmto Pro 1971 other . t 1 im 19*1 10 I.0T 2.5 M on 19*4(10) 1971** IT a* 4 11.1 a* 1.9 a ii,m IHT 01 70.0 11,30 ITO - 10.0*** 20 1*9 1*71 13 9.10 If tu ion M 12.01 10 17000 ion 90 21.41 IT 1404 ion 99 49.0 1* tot f -N m( m 11 9.0 Oenetelly tea's lto-ito or aubaot*. vaiyln* vith IN tody. updated infernation far proceeding cohort obtalnad by aaotrodition. Obtalnad by paraanal coaaunteation. Pavievinf tha dau ovailabla on oaatrointaatinal ** ptraent* o niaad picturo, Tbora la a wo- to throa-fold Incraaao in tlak ahovn m aona atodtoa, vhllo other atudiea have ahovn little ot no incraaao in obaarvad ovtr aapactvd. Tha conalatancy ol an aacaa* in oboorvod over aapoctad, aa i* ahovn in lonp cancar. la not II mm iwir w,rf 'iir piiMt vlik reaped to tiiKiiniHtlMl, In any went, thtit loci not iMtii to On any 'new* evidence rincn 111! which' ,-IatifIr* to* pro Iff} olrturo. Mieri>ni>d reelnnal rlaka reflected in iricreaieJ i it oh **y account (m c*r nl ton incrkoo aoen in tone ol in# alull*e. All of *M .Itta tkn tooethei lutitu tut any incroite in (in* 11 luwhat ! lhar th# two to throw tint* rentinned in tho mnuhI >r.d also iMicatai tnt tho oieoai riak occur* only in tno nit heavily eapnoed Cktoiory (McDonald at al). o evidence to rurioet that a I l/ec atandard ia unaalo lor laatromtoatinal cenctr haa noan proiontad by OfHA. IfiS "MS* Othpr uoplim rollowin* a btial diacutaton el poaaibl* Incroaaod riak ol cancor ol tno laryni. oropharyn* and oaopnaju*. tho VIM propoaal atatoai `Hcvavet, data concotntna thoaa neoplacaa aiv lot* ottansioa than tor luny cancor aaaotneliona and 'laatrolntottmal cancor and luttnor aaporionco* at* aw*itod. In any caao( thay at* not vary cornon tunora in yonotal and any incrcaao dooa not with heavily on tno ovorall cancoi riak ol aaboatoa worker*.' It aay bo conjectured that it ia unlikoly tnat any poaaihlo incroaaid riak al thoao tunsr* will ovot bo fully docuaontod. II tno !ii| eotert-eortaitty atudtoa on tho heavily epoked wotketa el the pan have boon unable to docuaont an incroaaod risk* t liara otnor nonplaaaa certainly cannot aupport tho contention that tha lar lower lewd ol a 7 l/cc atandard will have any advert# laoect on oottality Iron thoao tunora. T!* *8tS* tl * Tha atudy by riotchoi (Hill, rooortod on a 1* year follewuo of IH non laalactod Iron 11,111 available for atudyl with tHtil plafoaa and III control* (without placuoa aoloctod Iron tho tan* workforce), tno control* wore notched for ao* (within I yoara), but not lor enrol of eapoaur* of aookino habit*, a natched-pair anaiyaia waa not poaalblo, a* tho author* rococo! rod that tho control* were definitely younger than tho caaoa. Tho incraato In riak. within a % year aye croup, of ton* dtaoiaea. notably Ion* cancer, ta well known, in* data wet* analytod aa two retri'*p-u*-pri*pajtiva aeiiairty atudioa (caaoa and control* aoparaioiy), wain* local rata* for coopariaon. owcawa* ol factor* *rt a* tho aoalt percent*?* of tho worklore* lallowod. lac* of etpokwro tiaoa or tin** Iron ontot of eapoaaro. oc actwal nwaoriTal oatin*to* of eipoaero to aaboatoa flbot It la ancloar how the roaulta of that atody aupport tho contention that a I l/ec atandard will have any advorao Inpact on norbidtty at aortaltty. The draft of tho papor by (do* ||M) doacrlbo* another 1*1low*wp ported lot a cohort with plooral placeta and a notched control atudy for part of tho cohort, ha In th* dtacoaaiwn of too atwdy ay riotchar lltlil. no inlornonon to ooatlabl* la aepport th* cMlinllM that the 1 1/ee itiMitd mi 11 have any dytut tapact on Mteidlty of aortality. too ***** tyldinci on undfieroynd nut el Hiner* *0 ho** elected to coaaant on thlo paper In treat <1*1*11 bveeut* ot th* obvtoua topuitanco attached to it oy oiHfc and beraua* of th* oejot inplicationa inherent in uncritically accept in* tn* aubatanc* of tnio atudy and ita concluaiona. ha previously Indicated, th* 01HA pcopoaal it preolaed on new' inforoation* about th* tone effect* of atbeatoa. Tn* atudy oy filllaa et-af (1*7|, SIM ref*ronco Ho, 41, appear* to b* th* on* roforonc* ooat rolled upon by OtHA.* efor* ditcutaina thta hlOIH atudy in d*pth, a diacuailon of th* pioblooa Inherent In anall aaopl**. o*ntion*d a*v*ral tin** piovioualy, la appropnat*. To clarify too* of the prohleoo ataociat*d with analytiny th* roautta of t**ll aaopl**. conaldtr th* followin'! Tootin' a l>tatl*d alternation of lnt*r**t, th* oba*rv*d level of alynitlcanc* (ao-cal1*d p-value, or )uat P| repreaent* tn* chancd ot observin' a value aa lacy* or larier if In fact th* workforce happened to b* a tendon ample (representative of or ttailtr in health characteristic*) fron th* tenoral population. Por raaopl*. for an .eapected (Cl of >, th* cnanc* of observin' *a*ctly 1 death* Iron a aaapl* ot the 'enetel population la approaloat*d by th* Poiaaoo diatributton a* .tit. Th* chance of observing t or out* 1$, 4, 7, I, etc.) la approatoatod to b* Mil and to th* p-valu* lor a one-tided alternative of Intoroat (that la. If th* atudy populatio.. diffora Iron th* atandard population, we ar* only mtor*at*o if there ar* nor* d*atha|. Hallo opinion diffora tn th* *aorlouaneat* of a P of .It or .!, *te.. It I* true in any ovont that, tn* aoall*r p Is, th* nor* It eatta doubt on th* pntelbtlity that tn* 'atudy* population ta alnllar to th* `atandard* population. (In other word*. If th* two population* ar* truly th* aano, tn* difference* ob**rv*d wer* 'unlltoly. I It OtiriM % 0 It 10 10 tifwtrt 1 1.1 I. . * 10.0 11.0 11.0 tnt e 1.0 .Oil l.i .011 l.l .040 1.0 .ill 1.0 .014 1.0 .011 1.4 .110 roi Mny pottible outconec, relotiyely Mill chtnt* in the `eipected* c*n itwU in o telotiv^ly Icrgo chonge in tno '0. lor NMpUi on oocerved ot 1 with eiotctnd of 1 gleet I ol MU. tncroottng tno etpectod 14 percent to 2.4, inerottoo i til poreont to 0.111. The other etenole in the obnve tebl* it echo ore `droootic* -- tn Klt.t tnd tn ooterved (01 o( II cioultt in **14. Inerettino t Id percent to II, Increttei p 4M percent to d.lld. it thoulo oe noted tntt in tne too etenplet cited toove, the obtereed eto ttlll loner then the eipected otter 10 percent increooe. In tne ootoiute oenoe, the dodett Increite in ( did not "ccplain* the foot thot the obeerved mo In eicett* t the eopedted. however, the dote ore generolly not ineettiiotgd by oioply otkingr le 0 loiter then If The obterved bill be Itraet then the eopected opproiinotely II percent of the tine It the null hypothetic it tree (i.e. the toe popelotteno ore the otbel. Tne dour ore ondlyied ototlotlcollv to tee it>the findinet ore `cunoiotent* with the noil hypothetic (Merger P-vtluetl. At con be teen tree theto etonpleo, nodett Ineteotoo in I er* tnet nececoortly bill} recelt tn o dronotie increooe in P. The type ot tnolytit diecuteed cbove in botee on e nunhet of oooenptionc. ret etenpie. it it known thot the riot ol deotb depend* upon eje, tec end bony ether teetore. Sene loctbio ore ediuoted in the onolyoio. other* My not be. toreer tonple nice* olleeiote concern ior tone unocceunted for loetern. Te illuctrote tne pootible preolent, tuppoo* * cttndtrd populotien hod M percent enoter* end 1* percent nontbooet*, bbtle o ctudy populotien hod II percent cooker* ond 11 percent noocoototo, uppoce iurther thot nonobokert end ooekero bod 'tltkt' ol 1 ond | reopectieely, in both pepuiotiont. on toe overtee then, the otondord populotien rick it I.It ll.!)*.*, bbtle the ctudy M Other poasibla (acted that mjp influence the accuracy of the analyata are egc distributions (although aee ia taken into account, difference* in die distributions ulthin auinouennl* eae account lr rirors of 1 percent nr to percent), ipprnnriatene.n ef the standard population and differences in rni-iul tnd/nr level of ucbanitatlon coanonly considered. of couiau. not all factor* render the estimate ot C too law. it is lenorally accepted that the geneial health of a cohort, dofined froo onset ol eopluyaent. uill be better than the ganetal population, at least for a feu years. Uncertainty of the standard population estimate nay alto be a factor, fret aaaopl*. two national Canter for Health tatiatic* puolicatien*. Sene* 2, No*. 2* and IS. conaider aspects of thi* problea.) Considerations of factor* auch ea dynaaic population rate* and natural variation oay oe signified whan resional rates are used. I.e naln point to be oadt froo thla diacutaion ia that variation a-.d bias unaccounted for in tbe'doiaaoh analysis anowld be an SwpocEisnb~eeniad*cais>n-Sn~nitfyiinf anal) aaegleaT The above diecuaaion ot tne prueloos inherent in studying a small cohort 1* essentia! to appreciate the fetal flews In the Cillan et at IMlOSH) paper. Keeping tne aoeve discussion In aind, the critique of the study oi Cillan et al (l7t) prepared b. Paul Kotin, N.O. and Gerald R. Chase, Ph.D.. of Johns-Nanvitle 10 appended. The it cntloue concludes that the cisls of eacesatee rata* in tne asoestoftelated malignant and nonmaliqnant disaast categories ia clearly oaaed on poor and incoopleto data analyses, (van if the claio ware baaed on valid analyses, data to incriainate aabostos rather than one or a combination al other consisting catetiela in the caueation of cancer are entirely locking. To eicribo the eaeee* of nonneltgnant reapiratorv diicaae to eibootoo and Ignore tne known espoaure to high levels of froo crystalline silica in the past, confirmed by tho frequent diagnosis of ailieoai* on tne death certificates, border* on irresponsible tv. To ignore the potential for carcinogenic and cocarclnogemc effect* rtaulttnq Iron th* oiaod espoaure to ellica duet, oreenic (unea and particlta. blasting powder fuse* and posaloiy radon daughters and te aroitranly ascribe all of theit osceaa of cancer to aaoeatoa perticleo to nanifeatly irreaponeible one nae no justification in the mothedology ot acionco. Iunaiy Th* claio by OMR that `oince th* promulgation of th* V.l. poroanont asbesto* standard, censidtraol* new inforoatlon has bean forthcoming on th* toaic effect* of asbootoa' i* clearly basad on an incoppltt# and jnaciontlfic rovtaw and asaeasnent ol avoilaole dot*, lo its *2 rrfarencos OMR ha* not oroaantod valid evidence to eupport o need fer further reduction of the airborne atheatoa standard froo 2.P f/cc longei than i aicrona to M f/cc longer than | aicrona. It -fpyiyfvr rm*nr WC'wft) hcplteatton ol Iht findInca and diwuwimi of iltk iltuady known in 1*71 <mi not constitute *considteble new infotnuon. A* mi tin in Dili It It known knot heavily raposed exhorts now dattnq hack II to II yokes aoo hao saporioneod oaeoat vnrbldity and eortellty, but that Is not.`considerable n<jw inforvetion.* Tho 'now evidence* cltod by OSSA (too bettlth studios is o pelno saaoplo ol untnfereed aoloellvo reportInc. chile tinonnq a SONS aubeoaolttoo report 11*71) spoclllcalty teeoveendloq nn chanso, OSHA has nirreoreeentsd tho swallsblo inloroation on tho TSA workforce. the available Infotootlon has boon detailed in this report. When tho facts are reviewed, it Is obvious that there Is no evidence available on the TSA workforce that tuoporte a need lor further reduction in the asbestos standard now scheduled for July ISIS. Indeed, the docuaented htqb exposure levels vatendlm into the recant past, nlus the fact that such taposurea vre derived Iren static, not personal, saoplind. when coupled with tno recently published health studies, deoonstrete that the lessoned adverse health effects noted were related to lower but still substantial esposuies end provides confidence for uatntainlnq the l.l t/ec airborne asbestos standard. * elective use of ptellatnery. unpublished and ponoeer*revtewed oanuscrtpts and studies have been used by OSHA as Iwporttnt solvents of the *new inloroation.* The aoet notable eiboule is the Morbidity and uortaltty study by mosti lOitlao at al 11*711). Since the OSHA citation, the orafts of the study have underqone substantive revisions. tnclodlna the resovel of tho entire ooibidlty portion. The conclusions of that paper are of such questioned* scientific quality that it cannot he considered `new inloroation* of tho scientific coopetency and accuracy reunited for use M decision nahlnq. tn reference after reference, detailed review has shown that OSHA has cited mforostloo that was already known In 1171, none of which supports a reduction in tho stondord. Mission of references, such as s national nesothellona survey In Canada. Is inescusabla. elective reference to osrts of other reports is Just as ineacusablc. Tho very report that was cltod firewhouse and Carry H*l*|) as provtdinq evidence for a continued Increase m neaotheliuoa event known beselly asbestos espesed workers was based on a dnavreapense relationship for neeo:heiteee. runner, the imitations of that study, to nicely q^ven by the authors, need been tqnercd by MPA. no nave the rtqbt and the oollqatlon to Insist that oil reqelateiy aqencies anhere to the hiqneat icqwireoonit of vclentlflo senpotency and accuracy in rcviewinq available Ihforoatlen lor any standard. This was not done for the uelabel q, 1*7* netIce of Proposed Puleoahlnq on Occupational taposurc to Asbestos. vnuw-hjh a mm