Document ZGxRByJ1OydDwYp6Vk5ZRagJ

OUTLINE 1. HISTORICAL PERSPECTIVE -Rec^c.t 2. PIPECOVERER EDUCATION ^ e-dio. c^eci 3. INDUSTRIAL HYGIENE S-140 SAFETY STANDARD 4. EPIDEMIOLOGY pedCtCfced ST00D5290 DOW 06808 ST00Q529I 1. WHAT KIND OF A SURVEILLANCE PROGRAM DID WE HAVE IN THE PAST? 2. DID WE NOTIFY THE EMPLOYEES OF THE RESULTS INCLUDING THE PRESENCE OF X-RAY FINDINGS, SUCH AS PLUERAL PLAQUES? 3. DID WE EVERY SUMMARIZE THE RESULTS Ce.g,, HOW MANY PEOPLE POTENTIALLY EXPOSED TO ASBESTOS HAD PLEURAL PLAQUES,)? 4. DID WE DO ANY EPIDEMIOLOGICAL STUDIES ON ASBESTOS EXPOSURE AND CAUSES? DOW 06609 PIPECOVER (ASBESTOS) MONITORING Early 1960s - chest x-rays and vitalometers, Late 1960s - New data published by Irvin Selikoff AND OTHERS. August, 1969 - Project Asbestos Elimination. Chuck Kramer to Mr. Sinai for one week with Dr. Selikoff, ST000529Z New program started: - Initial series of 5 chest x-rays, - Pulmonary function. - Smoking history questionnaire. - Actively working pipecoverers. - Films read by Dr. William Straub, Midland Hospital. - Letter to pipecoverer's home address as to results. Ip new findings, seen by Dow M.D, Authorized visit to Dr, Quinter Burnett, Saginaw. - Open door policy. DOW 06610 PROJECT ASBESTOS ELIMINATION Beginning on August 4, 1969 and continuing for four days thereafter a series of meetings were held in the conference room at 438 building. The people attending included all of the Coverers, Field Service Unit supervision end production personnel Field Service Unit section managers were responsible for having the proper* personnel at the meeting. Subject: Kow does the handling of asbestos insulation effect me? Whet are the solutions: How do we implement these solutions? Speakers: -o A j ' cxc* , Moderator, Roy DsGesero * Environmental Health Aspects, - The Hazards of Asbestos, Larry Warren - What Wo Can - New Materials and Methods The same presentation was given to the Uiv'WA-Management Bargaining Committee (coverers reguest) on August 19th. Conclusions: On August 11 it became mandatory that approved respirators be worn when working with asbestos-containing materials. Purchasing was instructed to notify Airetil DVS that we would purchase no more Aircell after 90 days and an intensive drive made to find a non-asbestos substitute for Calcium-Silicate. Caveytemp 1500 was the most likely candidate and Phillip-Carey Company agreed to eliminate asbestos from this product on a trial basis, On October 29 the same procedure was instituted with regard to Calcium-Silicate. A continuing search is being made to come up with better material and techniques for insulation. We still are using asbestos-containing materials on high temperature applications and in oven insulating circuits. ST0005293 7-17-70 CS dc>' HZS0001S page 5 MEDICAL INFORMATION The Medical Department is concerned about the hazards of excessive asbestos exposure not only because of the possibility of developing asbestosis, a permanent scarring condition of the lungs, but also because of the increased risk of developing lung cancer. We know that cigarette smoking along with exposure to asbestos dusts increases the risk of developing lung cancer about 80 times. Therefore, it is against your best general interest to smoke from a health standpointmore so, if you are a pipe coverer. Always wear the proper protective equipment when working with asbestos containing insulation materials. The Medical Department maintains surveillance of all pipe coverers through periodic chest x-rays, measurements of breathing ability and health screening examinations. After an initial series of chest x-rays are taken, if you are under 40 years of age or have been pipe covering less than 10 years, follow up x-rays will be taken every year. If you are over 40 years of age or have been pipe covering more than 10 years, follow up chest x-rays will be taken every 6 months. In recent years we have markedly reduced the use of asbestos in the Midland Plant. Our long range plans call for complete elimination of asbestos; however, until this is possible through the substitution of other materials, you are urged to use extreme caution when working with asbestos containing insulation. Should you have any question relating to your health in regard to the handling of these materials, please contact the Medical Department at 6-2243. DOW 06612 October, 1972: HAND DELIVERS ALL PIPECOVERER FILMS TO Cleveland, Ohio. December 5 and 6, 1972: - "Redout e.c* VISIT TO MIDLAND TO EVALUATE OUR MONITORING PROGRAM. Punt visits to Chlorine Cells and PJPECOVERERS' WORKING AREAS. - What does pleural calcification (plaques) AND PLEURAL THICKENING REALLY MEAN? - Meeting at Dow Suite. - Consultation with each coverer regarding FINDINGS. ST0005295 DOUl 06613 ST000529S 3 rr'^~ /* ic-fi-C--'''' 11311 SHAKER BOOlEVARO / CLEVELAND, OHIO 44104/(216) 791 '1000 November 20, 1972 D. J. Ducoramun, M.D. Medical Department Dow Chemical Co. Post Office Box 1693 Midland, Mich. 48640 .Dear Dr. Ducommun: Enclosed is a list of the men who show some abnormality that might be related to their exposure. Several of the others have some abnormalities but of a very minor or insignificant nature and in no way related to their occupation. The reading on these films is consistent with that used in the L0 or U1CC classification. Thus, 0/0 means that there is nothing in the lung parenchyma, to suggest a pneumoconiosis. In contrast, 1/0 means that there is a pattern which could be con sistent with the most minimal changes related to a pneumoconiosis and the more severe categories go on up to 3/3 and the size of the densities are also classed by letters. As you can see, the bulk of the abnormalities had to do with changes in the pleura, only two men showing something that I thought was definitely in the lung parenchyma itself. I still utilize the term "asbestosis" to indicate only that kind of abnor mality which is intra-parenchyma1. I am aware that abnormal pleura thickening and calcification is related to asbestos exposure hut I do not use the word "asbestosis9to cover pleura thickening. X take this attitude because the term "asbestosis^as far more clinical significance than simple thickening or plaque formation in the pleura. The latter, unless extraordinarily extensive, has no real clinical importance. This is a rather subtle point end if the word "asbest os! s" is used to include such things as pleura changes, one has great difficulty in medical/legal, or even in patient/doctor relationships. It is also interesting that none of the men under the age of forty showed any abnormality related to exposure and those who showed the most striking changes are all over the age of fortyfive. DOUl 06614 Pag* 2. D. J. Ducommun, M.D. November 20,,1972 It would be nice if you could pull these films and we could go over them together. Also, take any others out that you would like to discuss. I am looking forward to seeing you in December. with best wishes. you Gl-W/b enc: __ Wright, M.D. Head, Medical Research Division ST0005Z97 DOW 06615 ST0095298 AS YOU CAN SEE, THE BULK OF THE ABNORMALITIES HAD TO DO WITH CHANGES IN THE PLEURA, ONLY TWO MEN SHOWING SOMETHING THAT I THOUGHT WAS DEFINITELY IN THE LUNG PARENCHYMA ITSELF, I STILL UTILIZE THE TERM "ASBESTOSIS" TO INDICATE ONLY THAT KIND OF ABNORMALITY WHICH IS INTRA-PARENCHYMAL* I AM AWARE THAT ABNORMAL PLEURA THICKENING AND CALCIFICATION IS RELATED TO ASBESTOS EXPOSURE BUT I DO NOT USE THE WORD "ASBESTOSIS" TO COVER PLUERA THICKENING, I TAKE THIS ATTITUDE BECAUSE THE TERM "ASBESTOSIS" HAS FAR MORE CLINICAL SIGNIFICANCE THAN SIMPLE THICKENING OR PLAQUE FORMATION IN THE PLEURA. THE LATTER, UNLESS EXTRAORDINARILY EXTENSIVE, HAS NO REAL CLINICAL IMPORTANCE, THIS IS A RATHER SUBTLE POINT AND IF THE WORD 'ASBESTOSIS" IS USED TO INCLUDE SUCH THINGS AS PLEURA CHANGES, ONE HAS GREAT DIFFICULTY IN MEDICAL/LEGAL, OR EVEN IN PATIENT/DOCTOR RELATIONSHIPS. DOUI 0661 6 December 20, 1977: - Meeting with Dr, Irvin Selikoff, Sinai, N.Y. - Review of monitoring program, - Recommended additions: - Sputum cytology - frequency? - Annual hemoglobin and stool for occult blood. - Annual urinalysis including microscopic. - Annual exam of mouth and throat, ** Chest x-ray interpretation using ILO system. - Consider maintenance workers in survey, ST0095299 February 28, 1978: - Visit to Johns-Manville Headquarters, Denver. Dr. George Wright, Dr. Paul Kotin, Dr. William Paui - Sputum cytology program: - No value in pleural mesothelioma, - Difference in prognosis and longevity? - Has encouraged smokers to stop, - Research program. 13 months, - Cost, - Results affected by respiratory infection as well as smoking. DOU June, 1978: - PlPECOVERERS' LETTERS DISCONTINUED, - PlPECOVERERS' REVIEW WITH PHYSICIAN DOINS PHYSICALS STARTED. October 6, 1982: - Asbestos MSR-approved by U.S, Area medical directo November 1982: - PlPECOVERERS' REVIEW PROGRAM DISCONTINUED,- ooesoooisj November , 1983: - OSHA Emergency Temporary Standard CHANGES PEL FROM 2 FIBERS/CC TO 0.5 FIBERS/CC OF AIR (8 HOUR TWA). - We propose returning to pipecoverers' review. DOW 06618 IST000530 I MEDICAL SURVEILLANCE REQUIREMENT HEALTH SURVEILLANCE PROGRAM OON CHEMICAL U.S.A. ASBESTOS HEALTH HISTORY: Physical Measurements BLOOD CHEMISTRIES: Aik Phosphatase. SGOT, SGPT, Total Bilirubin. Glucose, Cholesterol. BUN, GGPT, Total Protein, Globulin, Albumin, LDH, Serum Creatinine CBC S URINALYSIS: VISION: STOOL HEMOCCULT: TONOMETRY: ELECTROCARDIOGRAM: _ CHEST X-RAY: PULMONARY FUNCTION: FVC, FEVi, FEVi/FVC F*F25-7S ' AUDIOGRAM: Annually Every 2 years Every 2 years r' Over age 40 Over age 40 under age 40 Over age 40 Every 2 years Every 2 years Every 2 years Every 2 years Every 4 years Every 2 years Annually Annually Every 2 years PERIODIC CORE EXAMINATION CHEST X-RAY EXIT Every 2 years Annually Health Surveillance Council 10-6-82 210-4 <eeu DOW 06619 LUNG CANCER 5 8-10%.YEAR SURVIVAL IN LUNG CANCER PATIENTS HAS REMAINED LUNG CANCER IS LEADING KILLER IN MEN NOW, AND WILL BE THE LEADING KILLER IN WOMEN IN THE 1980'S. 25% 5%LUNG CANCER ACCOUNTS FOR OF ALL CANCER DEATHS, OF ALL DEATHS. 5IN THE PAST YEARS MORE AMERICANS HAVE DIED OF~LUNG CANCER THAN WERE KILLED IN ALL THE WARS IN OUR NATION'S HISTORY..' IN THE U.S.A. CIGARETTE SMOKING IS RESPONSIBLE FOR MORE THAN 80% OF LUNG CANCERS. 45RISK INCREASES RAPIDLY AFTER AGE IN SMOKERS, ESPECIALLY IN THOSE WHO SMOKE MORE THAN 1 PACK PER DAY. IF A SMOKER 15QUITS, HIS RISK RETURNS TO BACKGROUND LEVEL IN YEARS. P.J. 0ROIVNSON, M.D. 1. ARE DOW'S TESTS SUFFICIENT? 2. SHOULD DOW MEET MORE OFTEN WITH THE COVERERS? 3. IS YOUR X-RAY INFORMATION GIVEN TO YOU "CORRECT" IN YOUR OPINION? ti. WOULD YOU LIKE YOUR OWN DOCTOR INVOLVED IN THE MONITORING PROCESS? 5. SHOULD THE UNION REQUEST AN OUTSIDE RADIOLOGIST'S REVIEW? r ST0005303 / 06621 EST000530? 1. ARE DOW'S TESTS SUFFICIENT? 2. SHOULD DOW MEET MORE OFTEN WITH THE COVERERS? 3. IS YOUR X-RAY INFORMATION GIVEN TO YOU "CORRECT" IN YOUR OPINION? H, WOULD YOU LIKE YOUR OWN DOCTOR INVOLVED IN THE MONITORING PROCESS? 5. SHOULD THE UNION REQUEST AN OUTSIDE RADIOLOGIST'S REVIEW? DOUI 06622 rST0005308 ASBESTOS 1907 - FIRST REPORT OF TOXICITY (ASBESTOSIS-FIBROSIS) 1941 - WORLD WAR II HEAVY USE IN SHIPBUILDING 25 YEAR LATENT PERIOD. 1960's FIRST REPORTS OF CARCINOGENIC HAZARD. HEAVY ASBESTOS EXPOSURE --S> 5 X RISK OF LUNG CANCER. CIGARETTE SMOKING ABOVE --*10 X RISK OF LUNG CANCER'. SMOKING & ASBESTOS EXPOSURE90 X RISK OF LUNG CANCER. INCONCLUSIVE EVIDENCE REGARDING 6.1. CANCER FROM ASBESTOS. MESOTHELIOMA --"SIGNAL" CANCER FROM ASBESTOS,. RARE. IS DOSE-RELATED. DOW 06623 FST0005309 DOW SCREENING PROGRAMS ASBESTOSIS SCREENING STOPPED IN EARLY 60'S BECAUSE OF NEGATIVE STUDIES THEN. NEW DATA FROM SELIKOFF IN 1969 ADVISED RENEWED SCREENING; EVIDENCE OF HAZARDS AT EXPOSURE LEVELS BELOW THE OLD TLV. S'Cidtcs . -; DOW 06624 TST00053I 0 DOW SCREENING FOR COVERER ANUALLY OFFER: PULMONARY FUNCTION TESTS P A CHEST X-RAY HEALTH SURVEILLANCE EXAM HI STORY BLOOD TESTS . URINALYSIS * STOOL HEMOCCULT IN ADDITION TO ABOVE/ FOR THOSE OVER AGE NO/ OR WITH MORE THAN 10 YEARS COVERING/ OFFER EVERY 6 MONTHS: PULMONARY FUNCTION TESTS P A CHEST X-RAY DOW 06625 I IES0001Sj DATA REVIEW PROCESS: *-RAY FILMS READ BY MICHIGAN DIVISION M. D. AND all Chest films read again by consulting radiologist; THEIR REPORTS REVIEWED BY THE DOW M, D. PULMONARY FUNCTION TEST RESULTS COMPUTER ANALYZED THEN REVIEWED BY DOW M. D. ALL .COVERERS ARE INVITED FOR INDIVIDUAL REVIEW OF THEIR X-RAYS AND REPORTS, PULMONARY FUNCTION RESULTS/ AND HEALTH SURVEILLANCE DATA, USUALLY SCHEDULED SEVERAL WEEKS AFTER THEIR X-RAYS. ABNORMAL FINDINGS ARE REFERRED TO CONSULTING THORACIC SURGEONS FOR EVALUATIONS - SOME CASES WILL HAVE ADDI TIONAL TESTS, SUCH AS TOMOGRAMS, CT SCANS, BRONCHO SCOPY WITH CYTOLOGIC WASHINGS, MEDIASTINOSCOPY, BIOPSY. [ $T00053 I 6 1 . PULMONARY FUNCTION TESTING NORMAL AGE EFFECT -- LOSE 25-30 CC/YR. IN VITAL CAPACITY ASBESTOS EXPOSURE CAUSES DOSE-RELATED ACCELERATED LOSS, WITH DIMINISHED FVC, REDUCED FEVp USUALLY NORMAL RATIO FEV]/FVC. I 11 DOW 06631 LUNG CANCER 1900 LESS THAN 80 CASES IN WORLD LITERATURE. 1912 400 CASES REPORTED. 1914 - 1917 1WORLD WAR MEN BEGAN SMOKING IN LARGE NUMBERS. 1930 2,357 DEATHS FROM LUNG CANCER. 1943 9,205 DEATHS FROM LUNG CANCER. 1950 18,313 DEATHS FROM LUNG CANCER. 1950 - 1975 185% INCREASE IN LUNG CANCER IN MEN. 239% INCREASE IN LUNG CANCER IN WOMEN. ALL OTHER CANCER FELL FROM 1950*75 TO 1940 LEVELS. rsTOO053 I 7 DGU 06632 ?STOO 1)5318 LUNG CANCER 5 YEAR SURVIVAL IN LUNG CANCER PATIENTS HAS REMAINED 8-10%. LUNG CANCER IS LEADING KILLER IN MEN NOW, AND WILL BE THE LEADING KILLER IN WOMEN IN THE 1980'S. LUNG CANCER ACCOUNTS FOR 25% OF ALL CANCER DEATHS, 5% OF ALL DEATHS. IN THE PAST 5 YEARS MORE AMERICANS HAVE DIED OF LUNG CANCER THAN WERE KILLED IN ALL THE WARS IN OUR NATION'S HISTORY. IN THE U.S.A. CIGARETTE SMOKING IS RESPONSIBLE FOR MORE THAN' 80% OF LUNG CANCERS. RISK INCREASES RAPIDLY AFTER AGE 45 IN SMOKERS, ESPECIALLY IN THOSE WHO SMOKE MORE THAN 1 PACK PER DAY. IF A SMOKER QUITS, HIS RISK RETURNS TO BACKGROUND LEVEL IN 15 YEARS. I DOW 06633