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HEALTH / PAC Health BULLETIN BULLETIN PoAldviicsoyry Center No. 71 July August / 1976 1 Disaster in Plastic THE VINYL CHLORIDE COVERUP. A plastics industry coverup finally unravels after many workers die. Goodyear workers in Niagara Falls fight back - and gain broad support. 9 Workers'Compensation: PREVENTIVE CARE FOR INDUSTRY. Workers'compensation programs are often proposed as models for medical malpractice. But history shows they were enacted at the initiative of industry and opposed by their ostensible beneficiaries - the workers. 17 Peer Review 23 Vital Signs Disaster in Plastic THE VINYL CHLORIDE In 1964, the medical staff of BF Goodrich COVERUP Company, embarrassed by reports of liver damage caused by vinylidene chloride (a chemical analogue of vinyl chloride), tested the liver function of workers in the Louisville, Kentucky plant. The readings of one worker, Earl Parks, were abnormal; nevertheless, Goodrich kept him working at the same deadly job cleaning - the interior of reactors in which molecules of vinyl chloride (VC) are linked to make the polymer, polyvinyl chloride (PVC). In October, 1964, Parks was hospitalized with what was initially diag- nosed as a bleeding ulcer. Doctors treated the " ulcer " without surgery and Parks was Aw fi fa / f Ya Notice To Subscribers Health / PAC has successfully held down its publication costs over the years. As a result general subscription rates for the BULLETIN have not changed since its inception eight years ago. But rising costs have finally caught up with us. Beginning October 1, 1976, therefore, subscription rates will go up. The new rates will be 8 $ Student subscription, $ 10 Regular subscription, and $ 20 Institutional subscription. Subscribers will continue to receive occasional special reports at no extra cost. released. He was rehospitalized in May, 1965 and operated on. Doctors found not an ulcer but severe liver damage; cancer was not mentioned. (1) Parks filed a workman's compensation claim for disability from liver damage caused by working with vinyl chloride. Goodrich contested the claim but acknowledged that Parks had finally been removed from contact with the chemical. During the hearing before the Kentucky workmen's compensation board Parks tried to introduce evidence of liver ailments among his fellow workers, but Goodrich blocked him (despite their know- ledge of Dow Company studies released in 1961 showing that VC was toxic to the liver). Still, state authorities were sufficiently con- vinced to order Goodrich to pay a partial claim. Parks'condition worsened progres- sively and in March, 1973 he died - of angiosarcoma, a rare liver cancer. His was one of three angiosarcoma deaths that Goodrich reported on January 22, 1974. (2) In all, between 1965 and 1973, Parks collected $ 6,000 in benefits from Goodrich. A worker's life is still cheap in the U.S. * * # This article is about vinyl chloride - one of 20,000 chemicals in industrial use. It is known to cause several diseases, the most serious, angiosarcoma, has an estimated US mortality rate of.014 per 100,000 population. This is insignificant in comparison with all other US cancer deaths, which in 1973 were 167 per 100,000-20-30 angiosarcoma deaths per year in the US compared with 380,000 from all cancers. No one knows how many other industrial chemicals contribute to total cancer mortality, although it is estimated that as much as ninety percent of all cancers are environmentally induced. So far, 1,400 carcinogenic chemicals have been identified. A lot of time and money has been 2 expended on VC research. A 1975 scientific bibliography on the toxicology of VC contained 389 entries (3) and more research is currently being undertaken. The purpose of this article is not to add one more item to the list, but to use the VC story to illustrate the problems of identifying occupational hazards and to describe the new strategies for struggle that the VC experience suggests. The Coverup Polyvinyl plastics have been made in the US since 1927. The first scientific study of VC toxicity was a 1925 report of experiments in which it produced fatty degeneration of the liver and kidneys in animals. (4) The publication of articles accelerated with each succeeding decade and by 1970 the body of scientific literature was considerable. The most curious aspect of the studies is the per- sistent under - rating of the significance of the findings, often by the authors themselves. (5) And so the dangers of VC to workers were not fully acknowledged in the US and western Europe until the first deaths were disclosed in 1974. All of the two dozen chemical firms that produce PVC in the US are equally at fault for failing to protect workers from this toxic, carcinogenic chemical. If BF Goodrich is singled out, it is only because the company is a case study of corporate irresponsibility. At an industrial health conference held in Chicago on April 30, 1959, two Goodrich employees the corporate medical director and a company scientist presented - a paper on the harmless nature of vinyl chloride, contradicting 25 years of research. (6) In their paper, Wilson and McCormick reviewed sixteen articles - a fraction of the available studies. Their selection was very curious: few of the articles appear in stan- dard bibliographies on VC; two are merely reviews extolling the applications of the new material; most of the European and all of the Soviet literature, dating from 1949, describ- ing the toxic effects on workers, are ignored. (7) Of the sixteen articles, four strongly im- plicate VC as a carcinogen. Interestingly, these studies were supported by govern- ment, not industry. Against these results, Wilson and McCormick cite their own article on non toxicity -, which turns out to be another superficial review of the literature. (8) In other words, Goodrich supported no original research on VC. The results reported by Wilson and McCormick were not their own, but those of an unpublished, undated and unverifiable study. One can only be outraged by Wilson and McCormick's conclusion " that polyvinyl pyrrolidone is nontoxic and can be used in the human body. Polyvinyl chloride (PVC) has been stored with little reaction in the chest cavity. Some slight skin irritations have been observed in workers manufacturing PVC.'' (6) On this unbelievably shoddy work, BF Goodrich based its VC safety and health policy [sic] for the next fourteen years. By 1973 twenty - one Goodrich VC workers had died. In 1960, two workers were massively exposed to VC in the Goodrich plant in Niagara Falls, Canada, and died of vinyl chloride poisoning. (9) This prompted exper- imental laboratory studies of the toxicity of VC following acute exposure. (10) The experiments were then repeated and modi- fied by Dow Chemical researchers, this time looking at toxicity following chronic, low- level exposure. (11) Dow found that VC had a " slight ' capacity " to cause liver and kidney damage to animals on repeated exposures. The cautious experimenters of this paternal- istic company extrapolated their findings to assess the hazard to humans. They con- cluded that a time weighted - average, i.e., averaged over an eight hour day, for all ex- posures should not exceed fifty parts per million (ppm). Dow acted on the advice of its scientists and in 1961 reduced exposure in its plants to 50 ppm - a level still too high to protect workers against cancer. Dow made no press announcement about its research findings, and this anti union - company never informed its workers of the dangers. Other companies, such as BF Goodrich, ignored the Dow results. When new and pressing evidence of the carcinogenicity of VC was presented in 1970, the chemical industry went further and actively suppressed the results of the studies. The New Evidence P.L. Viola, a medical director employed by Solvay, a Belgian chemical firm, presented his findings on the carcinogenic potential of VC to the 1970 X International Cancer Congress held in Houston, Texas. Imme- diately after the Congress he was contacted by another researcher, Cesare Maltoni, who had been working since 1967 on the toxi- cology of VC at the Instituto di Oncologia in Bologna. Using slides of Viola's experi- ments, Maltoni began investigations to specify the type and degree of carcinogenic risk from vinyl chloride. (12) He found that rats exposed daily to as little as fifty ppm of vinyl chloride for one year developed cancer of the liver. Other cancers also developed in the lung, brain and lymphatic system. As is common, Maltoni's work was supported by industry: initially by Mont- edison of Italy, and later by ICI (Great Britain), Solvay (Belgium) and Rhone - Progil (France). The terms of the research contract were highly specific: the project's proprie- tors controlled the results and any release of information was subject to their consent. (13) Published by the Health Policy Advisory Center, 17 Murray Street, New York, N.Y. 10007. Telephone 212 () 267-8890. The Health / PAC BULLETIN is published 6 times per year: Jan./Feb., Mar./Apr., May June /, July / Aug., Sept./Oct. and Nov./Dec. Special reports are issued during the year. Yearly subscriptions: 5 $ students, $ 7 other individuals, $ 15 institutions. Second - class postage paid at New York, N.Y. Subscriptions, changes of address and other correspondence should be mailed to the above address. New York staff: Barbara Caress, Oliver Fein, David Kotelchuck, Ronda Kotelchuck, Steven London and Ken Rosenberg. San Francisco staff: Robin Baker, Elinor Blake, Thomas Bodenheimer, Dan Feshbach, David Landau, Eugene Lancaric, Ellen Shaffer. S.F. office: 558 Capp Street, San Francis- co, Cal. 94110. Telephone (415) 282-3896. Associates: Robb Burlage, Morgantown, W. Va.; Constance Bloomfield, Desmond Callan, Nancy Jervis, Kenneth Kimmerling, Louise Lander, Howard Levy, Marsha Love, New York City; Vicki Cooper, Chicago; Barbara Eherenreich, John Ehrenreich, Long Island; Judy Carnoy, Carol Mermey, San Francisco; Susan Reverby, Boston, Mass. BULLETIN illustrated by Bill Plympton. Health Policy Advisory Center, Inc. 1976. 3 " The results were not generally available until May, 1974. In 1972, the US Manufacturing Chemists Association, an industrial group, was aware of the European research, but maintained that it was under an injunction of confiden- 1974 prompted intense pressure from organized labor: OSHA set a temporary emergency standard of 50 ppm. The permanent standard, adopted in October, 1974, was still a compromise: industry defeated the no " detectable -the level " only tiality and therefore could not reveal Maltoni's findings. The ostensible purpose of this secrecy was to avoid premature release of unvalidated findings that might lead to unwarranted speculation. In January, 1973, the National Institute of Occupational Safety and Health (NIOSH) made a general request for information about 23 chemicals, including vinyl chloride. On March 7, 1973, the Manufacturing Chemists Association recommended a pre- cautionary label on VC containers that made no reference to toxic effects on animals or PVC WORKER people in other words it appears to have deliberately deceived NIOSH regarding the true facts, " according to a later report by Dr. J.T. Edsall of the American Association for the Advancement of Science. (14) PVG WORK PVC ORKER Bill Plympton The company chemists continued to play games: in July, 1973 they met with NIOSH officials and representatives of the European chemical industry. The only public record of what transpired at that meeting is the chemists'account. It is not clear whether they informed NIOSH of the full import of Maltoni's findings, or whether they just reported that studies were underway. What is known is that NIOSH and the Occupational Safety and Health Administration (OSHA) did nothing as a result of the meeting. The industry standard remained unchanged until Goodrich announced the three worker deaths in January, 1974. level that affords protection against a known carcinogen that was proposed by scientists and unions. The new standard was 1 ppm. With tight standards in the US, industry may decide to shift operations to countries with less stringent laws or no control laws at all. Companies like Goodrich don't have far to go: the Quebec government has set no limit on VC. (16) Health and labor laws in Canada are not federal; each province drafts Government Regulation its own. The Canadians have no equivalent of OSHA and standards are not mandatory. A threshhold limit value of 500 ppm Conditions in underdeveloped countries are (weighted time - average) was established in worse; superexploited workers in South 1959 by the the American Conference of Korea, for example, enjoy no protection Governmental Industrial Hygienists, a pri- whatever. vate group that set industrial standards until Three other vinyl chloride scares involving OSHA took over this task. After publication the US Food and Drug Administration have of the Dow results, the hygienists adjusted flared up and died down in the last two the standard from a maximum 500 ppm years. The first involved the use of PVC in time weighted - average value to a maximum packaging: residual VC in plastic bottles was value of 500 ppm over any time period. (15) found to migrate - and had a special attrac- In other words, industry continued to block tion for alcohol. This type of packaging was any real change. Even after the passage of banned for all wines and liquors. PVC was the Occupational Safety and Health Act in also used in meat packaging, and the packers 1970, the standard remained 500 ppm. The were suffering from the fumes released 4 announcement of three deaths in January, when heat was applied to seal the PVC film. The Food and Drug Administration was again called up to correct the situation and to check that VC did not leach into meats and other foods packaged in this way. Thirdly, VC was a widely used propellant in aerosol sprays, and the Environmental Protection Agency calculated that in the typical windowless apartment bathroom, VC con- centrations could reach 250 ppm after using an aerosol deodorant or hair spray. After Ralph Nader's Health Research Group applied intense pressure, these products were banned. New Threats For the last two years the Environmental Protection Agency has been dragging its feet on setting a standard to control air pollution near vinyl chloride production plants. It is estimated that some 4.6 million Americans live in areas around PVC plants and are exposed to this carcinogenic pollutant. Six percent of VC is lost during the process in which polyvinyl chloride is produced. Most of it escapes directly into the atmosphere as air emissions, with lesser amounts dissolved in effluent streams and entrapped in sludge and solid wastes. Industry takes the position that there is no risk because VC dissipates in the air. But readings around plants have shown concentrations as high as 33 ppm. (15) The federal environment agency is con- cerned about this atmospheric contamination and, under the authority of the Clean Air Act, has proposed regulations that would limit air emissions to 10 ppm and would cut by ninety percent the amount of cancer- causing VC gas released into the atmos- phere. (17) The proposal was made in December, 1975 and is still not approved. According to Environmental Protection Agency toxicologist, Dr. William Marcus, the delay is caused by the Administration's requirement that a study be made of the standard's technological implications and its inflationary effects, as well as a cost benefit / analysis of health risks. This is a familiar ploy used by the Ford Administration to delay standard setting - at least until after the November elections. VC Research In October, 1975, Dr. Joseph Wagoner, Director of Field Studies and Clinical Investigations for NIOSH, released to the press disturbing results of new epidemio- logical studies by Dr. Peter Infante on the effects of VC in the atmosphere. (18) Infante found that twice as many babies with birth defects were born to women living in three Ohio communities where PVC was produced as to women in other areas of the state. Three times the expected number of severely handicapping birth defects of the central nervous system were reported. Half again as many deaths from brain tumors as would be expected were found in the adult male population. Infante's work was done in northeastern Ohio where General Tire, Goodrich and Uni- royal have plants that polymerize VC (Ashtabula, Avon Lake and Painesville). 19 () With the caution common to scientists, he acknowledged that these findings do not constitute a direct link between VC and the increased occurrence of fetal deaths, birth defects or brain tumors. Like other carcino- genic chemicals, VC has been proved to induce mutations. (20) The problem is that Three times the expected number of severely handicapping birth defects were reported. Infante's technique was thought too crude to detect anything so fine as a link between a single chemical and birth defects; further studies were needed. In April, 1976, Infante and workers co - at NIOSH, the Center for Disease Control and the University of North Carolina published the results of another study, this one carried out at the Firestone PVC plant in Pottstown, Pa. (21) All the VC PVC - workers and eight percent of rubber workers were interviewed (a total of 253 workers) to ascertain paternal age, pregnancy outcome and dates of conception. Job histories were obtained from company records. The analysis showed that wives of VC workers had more miscarriages after their husbands began working in VC units, and more miscarriages than women whose husbands were not exposed to VC. 5 The study suggests that the additional mis- search is being made of birth and death cer- carriages may be due to direct VC exposure of fathers. This study underestimated dam- age because it relied on the recall of husbands rather than interviewing wives to get pregnancy data or consulting hospital records. Epidemiologists needed to obtain adequate occupational, residential and medi- cal histories. Three new studies are tificates for the years 1970 to 1974. All cases and controls are being interviewed, and their residential and occupational histories re- corded. The results are not yet published, (24) but it is known that there is a high inci- dence of nervous system birth defects in this population. The role of the Center for Disease Control attempting to do just that. in this study raises a number of serious questions. Is this agency undertaking studies Current Studies The Painesville, Ohio community, where Infante observed high rates of central ner- vous system birth defects, was restudied by the Center for Disease Control in Atlanta, the agency recently designated to supervise NIOSH, but a relative newcomer in occupa- tional disease research. Hospital records were reviewed and all cases of nervous system birth defects were followed up. Parents were interviewed to obtain occupa- tional and residential histories. These results found no association between birth defects and either residence near the Uniroyal PVC plant or employment in the plant. (22) Infante has reviewed this study and found so many errors as to invalidate the results. For example, CDC included in the study two handicapped children whose mother lived in Ashtabula, 20 miles away; they used these cases to prove that the parents of children without birth defects live closer to the Painesville plant than those of children with with the express purpose of disproving another agency's work? Is its mission to allay public apprehension? Why is CDC, which has no special competence in occupational health, carrying out studies at all when NIOSH is the research agency created in 1970 expressly to deal with occupational health? NIOSH has been chronically under- funded since its inception and has had to delay important and desperately needed research for lack of funds. Is it now in competition with the much larger and wealthier CDC? (NIOSH's budget this year is $ 30 million; CDC's is $ 100 million.) Observers cannot help but suspect that the Ford Administration, dissatisfied with the work of NIOSH and its relative concern about workplace hazards, is trying an end - run around NIOSH by encouraging activity by CDC, possibly a more compliant agency. A third study is underway in Shawinigan, Canada, where nine VC workers at the Goodrich plant died of angiosarcoma. The site was chosen because Quebec Province keeps a central registry of all tumors and a The role of the Center for Disease Control raises a number of serious questions. rather complete record of fetal deaths. (The problem with comprehensive fetal death registration is that miscarriage in the first trimester is sometimes mistaken for a heavy menstrual cycle and not reported.) This three month - pilot study is supported by the American Public Health Association; Dr. Gilles Thriault of Laval University is the birth defects, just the opposite of what would be expected if PVC from the Painesville plant was causing defects. But what the study didn't note, Infante points out, is that this person lives close to the Ashtabula plant, which also makes PVC. (23) A similar study is being carried out in South Charleston, West Virginia, by the Center for Disease Control using an 6 improved and expanded methodology. A principal investigator. He will review all death certificates for the years 1960 to 1974 and consult the tumor registry for the town of Shawinigan and for the control town of Louiseville. He will be looking for the distribution of cancers and will plot the rates for each year against the Goodrich produc- tion profile. If the findings warrant it, a longer study may be undertaken on the etiology of cancer, which would involve interviewing to obtain occupational and residential histories. (25) PVC PVC comprehensive surveillance of workers ex- posed to toxic substances. Such a system PVC must include provision for medical examina- PUC PVC PVC tion after the worker's exposure has ceased, since the latency period for most cancers is very long. For this provision to be effective, PVC PVC PVC PVC PV PVC PVC the federal government must administer it in order to ensure strict confidentiality for the individuals concerned and to evaluate and preserve individual records regardless of PVC PYC PVC PV PVC PVC PVC PVC PV VC PVC PVC changes in employment. Employers should be required to establish registries of workers exposed to toxic chemicals and to give names of workers who leave their employ to NIOSH for that agency to conduct the subsequent PVC PV PVC PVC PVG medical surveillance and epidemiological studies. (26) The problem of providing a safe working PV PVC PVC NC 1 PVC environment is not only a medical and technical one; occupational health is also an economic and political problem. The engin- eering controls that would eliminate worker exposure to toxic substances are expensive and companies have been resisting worker PVC C PVC demands and government directives to provide them ever since the industrial revolution. The common practice is to take BPlympton stopgap measures after an accident or illness At the same time, Rejean Harvey, a biologist working with Thriault, will be has occurred because they are less expensive as a direct cost to the company and, in economic terms, more attractive to manage- studying air pollution and carrying out a ment. (27) geographic and topographic survey in Shawinigan, which is subject to temperature changes that create peculiar air inversions. What he is looking for in this town of 37,000 Qubecois is the pattern of residential risk associated with fallout from the Goodrich Better maintenance of machinery and equipment would help ensure a healthier and safer workplace, but companies persistently pare their costs by cutting payrolls. Adequate maintenance cannot be performed by a reduced workforce, increasing the PVC plant. dangers inside and outside the plant. (See The Union Position BULLETIN, November / December, 1974) Communities are exposed to health hazards Occupational and medical records have long been a bone of contention between labor and management. Companies usually keep medical records compiled by doctors they as a direct consequence of such management policies. In effect, workers and the com- munity are subsidizing the companies - with their own health and safety. employ and workers rarely have access to them. A worker's personal physician may not be trained in industrial medicine and may However, state and federal agencies that regulate industry are less than aggressive in protecting workers and communities. OSHA, not see enough workers in the same occupation to be able to recognize any trends. In these circumstances, the link the Environmental Protection Agency and the Food and Drug Administration rarely take the initiative in prevention; more often between VC and angiosarcoma went unde- they react to crises, usually under intense tected for years. pressure from organized labor. Moreover, Union spokesmen have demanded that the state administrations have failed to imple- grossly inadequate data base revealed in the ment the 1970 OSHA Act. In these 1974 VC crisis be augmented by instituting circumstances, workers must rely upon 7 collective bargaining to obtain the protection that is their right by law. Goodyear Strike Local 8-277 of the Oil, Chemical and Atomic Workers Union (OCAW) went out on strike at the Goodyear PVC plant in Niagara Falls on March 16, 1976 over a wage and contract dispute. Management kept the plant operating at one third - capacity by using supervisory personnel. Strikers, maintaining a 24 hour - picket line, noticed that the alarm system had been turned off. The continuous monitoring system, installed in compliance with the OSHA standard on VC, was used to alert workers when VC _ concentrations exceeded allowable limits (not greater than 1 ppm averaged over any 8 hour period or 5 ppm averaged over 15 minutes). When operating, red lights located in ten strategic spots around the plant would flash. When the alarm went off no worker would enter the building without a protective respirator and workers inside would troubleshoot for the faulty valve that was the source of the leak. On a normal day the alarm would go off ten to fifteen times. The strikers issued a bulletin alerting the community to the dangers of increased VC emissions in the already polluted - atmos- phere of Niagara Falls. The local news media responded and so did environmentalists across the country. At the United Auto Workers Conference on environmental and economic justice and jobs, held in May, one hundred members of public interest research groups, unions and environmental organiza- tions signed a petition condemning Goodyear for endangering lives. Addressing the conference, Dr. Barry Commoner of Wash- ington University called for solidarity in the scientific community to stop the Goodyear violations. Other support came from the Scientists'Institute for Public Information, which issued a protest, and from a coalition of environmental groups in California who released a statement condemning the company. Potential for Struggle said, we learned the hard way - by losing 27 men. But what of those 15,000 industrial chemicals whose properties are unknown? Is the community going to wait for another crisis before insisting that industry act responsibly? (29) Passage of the Toxic Substances Control Bill would make a difference. It would require industry to test every chemical before it is used in the workplace. This bill was first introduced in 1971 but languished in limbo between House and Senate versions that were never reconciled. Another draft was submitted in 1973 but died in the same deadlock. In 1975 a third attempt was made, What of the 15,000 industrial chemicals whose properties are unknown? but so far there has been no action. (30) And there won't be any until public pressure proves stronger than industry's lobby. Workers must be trained in job safety and health so they can identify specific hazards and use legal resources to have them corrected. The OCAW strikers at Goodyear reacted to the switched - off monitoring system because they were aware of the dangers of VC. Only an informed workforce and community can fight effectively for their protection. David Wegman and co workers - in Boston organized a successful project to train indus- trial workers in the detection, reporting and correction of hazards in their working environment. (27) In order for workers to exercise control they need the information, education and training that are too often the prerogative of health professionals. Usually the worker's only source of information is management. Wegman admonishes health professionals to develop many more ways to aid workers in their efforts to protect their health. The Goodyear strike sets a new precedent with far reaching - implications. According to The Profit Motive Tony Mazzocchi, OCAW official, this is not Goodrich is one of the Big Four US rubber an issue on which unions and environ- companies, but it ranked only 36th among mentalists can take different sides. Every- the top 50 chemical producers in 1975 and 8 one's health is at stake. In the case of VC, he (Continued on page 14) " Bill Plympton Workers'Compensation As the controversy over medical malprac- PREVENTIVE tice insurance swirls on in the courts and CARE FOR legislatures throughout the country, many INDUSTRY have turned to workers'compensation as a model for resolving the crisis [See BULLE- TIN, January February / , 1976 and May / June, 1975] Under so called - medical liability compensation systems, state boards would award patients compensation on a " fault no - " basis, without trying to determine the extent of the attending physician's responsibility, but based solely on the degree of patient injury or disability. In the process, patients would in most cases lose their rights to sue for damages in the courts. The following article by Dan Berman, long time - health and safety organizer and writer and San Francisco resident, looks at the granddaddy of no fault - insurance systems, the workmen's [now workers '] compensation system. He shows how it was enacted to head off a growing wave of suc- cessful suits by workers against industry, and to create the public impression that injured workers were being well cared for. Workers'compensation was predictable, cheap, and removed companies from the embarrassment of open jury trials. Its basic structure has remained unchanged to this day. In the first five years of this century pub- lic consciousness of workplace slaughter in the giant monopolies was a _ constant reproach to the consensus of " thoughtful men of all classes " which the new elite of big businessmen and bankers were trying to forge. The popular and socialist media were full of stories about atrocities at work, which directly or by implication questioned the legitimacy of capitalism. Labor, badly beaten in a series of strikes in the late 1880s and early 1890s, was on the ascendency by 1900, but unions were making almost no progress in organizing the new mass production - industries in the monopoly sector. Unions had been practically elimin- ated in the steel industry. There were bloody struggles in both the hard rock and coal mines, the only industries where industrial unions managed to make permanent inroads. 9 Between 1890 and 1914 both unionized craft workers and the mass of the unorganized saw all their wage increases negated by inflation, and many of their efforts to organize stymied by the open shop campaign of the National Association of Manufac- turers. It is no wonder that thousands of workers turned to the Industrial Workers of the World, the famous " Wobblies, " and millions of voters to the Socialist party. (2,6,20). Work in those days was hard and dangerous for most workers and hours were extremely long. A study reported in the labor press in 1904 estimated that 27,000 workers were killed on the job annually, 4 () and a 1907 Bureau of Labor report put the toll at 15,000 to 17,500, of 26 million male workers. (9) Judging from contemporary accounts manual work in mining, manufacturing, and transportation was the most difficult. Mack Sennett, the inventor of the Keystone Cops, began work at the age of seventeen at the American Iron Works in East Berlin, Connecticut: " In my day it was common for four men to hoist a four hundr-e pdo u-nd rail, place it on the shoulders of a single man, and expect him to tote it a hundred yards. " (5) Corporate Redistribution of Blame By 1908 the questions of workmen's compensation and job accidents had become major items on corporate agendas. Existing common law doctrine made it almost impos- sible for workers to collect damages for injuries suffered on the job, because the worker had to prove the employer was at fault. This was particularly difficult for severely injured workers or for the families of workers killed on the job, who had to depend on the testimony of supervisors or co workers - subject to pressure from the boss. The employer could argue in defense that: * the accident had resulted from the worker's own carelessness, * the worker " assumed the risks " of the job in taking it, or that * a fellow employee of the injured worker had caused the accident. These defenses were usually enough to pre- vent successful worker suits. (7, chapter 3) The reaction of reformers in some states was to pass laws weakening the common law 10 defenses of employers. In states where these Executive Action At the turn of the century new organi- zations sprang up among the corporate elite to help coordinate political activities, mold public opinion, deal with labor, and plan for the future. The National Civic Federation (NCF) was organized in 1900, and the American Association for Labor Legislation (AALL) in 1906. Their prin- ciple support came from the monopoly sector. The first NCF president was " Dollar Mark " Hanna, wealthy banker and manufacturer and manager of Mc- Kinley's successful Republican campaign against William Jennings Bryan in 1896. The NCF also gained solid backing from men such as Andrew Carnegie and Judge Elbert H. Gary from the steel industry and Cyrus McCormack and George W. Perkins of International Harvester. Only the Rockefellers stayed aloof from active participation. In the first five or six years of its life the National Civic Federation preached the mutuality of interests of capital and labor and the importance of dealing with organized labor through collective bar- gaining and a written contract. The NCF theorized that there was no such thing as class conflict, and tried to make arbitration substitute for strikes when unions did manage to organize. (21) Though most of its chief corporate supporters bitterly re- sisted unions in their own bailiwicks, the NCF was in principle pro union -. In practice this meant trying to " channelize the labor movement into conservative channels " wherever possible. (3, pp. 11, 12) Samuel Gompers, founder of the American Federation of Labor, had decided in the late 1890s that bread - and- butter trade unions had to work with the trusts; eventually he became a vice president of the NCF. (4) Both Gompers and John Mitchell of the United Mine Workers were personal friends of big business leaders of the organization, hunting and dining with them and consulting with them for investment advice. (10, p. 168) The American Association for Labor Legislation (AALL) was active in promot- ing uniform labor legislation on a state - by- state basis throughout the United States, on the theory that this would prevent companies from moving their operations to states with less restrictive legislation. The AALL made particular legislative efforts in the areas of industrial disease and industrial accidents and, later on, in workmen's compensation. It succeeded in passing federal legislation banning the use of white phorphorus in making matches, thus eliminating " phossy jaw, " a disease which caused the victims'jaws to stink and rot away. (10, p. 168) In addition to advocating specific programs for companies and government at the state and federal level, both the NCF and the AALL were concerned with more general " ideological and social problems, " especially the threat of socialism, which was understood as the " only serious ideological alternative to... policies of social responsibility. " (3, p. 117) A long letter from an executive of the Lackawanna Steel Company to his vice president recommended that he contri- bute to the National Civic Federation because " the socialists and extreme radicals are very distrustful of it "; because it gives lawmakers " a sought - for excuse " to resist anti business - legislation; and because it has been able to project an aura of civic minded - impartiality to its programs. Though it sometimes looked like the NCF got involved in programs which many employers would criticize, the organization's executive wrote that it "... only takes up a subject after it has assumed an important national aspect and it appears... that it... will be fought to an unfair conclusion. Also there are many big men on the inside of the [NCF] who are able to inform and influence the action of legislators even after the [NCF] has been obliged to yield to popular clamor and let some subjects get away from them. " (22) 11 employers ' ' liability " laws were passed, workers began to win more and larger settle- ments. As costs spiraled and open jury trial became a public embarrassment, the Na- tional Civic Federation (NCF), a lobbying group founded to coordinate the political activities of monopoly sector corporations and banks, (See box, page) began to lobby for a workmens'compensation system which would " substitute a fixed, but limited charge for a variable, potentially ruinous one. " (8, pp. 259,260 259,260) In 1908 the federal Bureau of Labor began to make careful estimates of the number of industrial casualties, (9) and the new $ 10 million Russell Sage Foundation financed the Pittsburgh Survey, which paid a great deal of attention to working conditions. A whole book in the Pittsburgh Survey, Crystal Eastman's Work Accidents - and the Law (1910), was devoted to the wrongs of common law and " employers'liability " practices, and the necessity for replacing them with a system of workmen's com- pensation. NCF led the forces for reform. Speakers on workers'compensation at the 1908 meeting of the NCF included leading bankers, lawyers, insurance company executives, and Russell Sage Foundation experts; everyone but workers and their unions seemed to be represented. By 1909 the NCF's Department of Compensation for Industrial Accidents and Their Prevention had become the center for lobbying and publicity. Experts from England and Germany (including a Major Piorkowski from Krupp) came to address the Federation. Model compensation laws written by both the NCF and the American Association for Labor Legislation (AALL), a similar group which concentrated more on occupational diseases and industrial inspec- tion, began to be requested by states all over the country. Occupational diseases never merited much attention in the model laws (3, chapter 2; 10, chapter 6), and so it remained until the late 1960s (11, chapters 4, 5), despite a major flurry over silicosis during the 1930s after the Gauley Tunnel Disaster. (See BULLETIN, September, 1972). By the time government and foundation studies were completed and the NCF and the AALL had completed their conferences and come to their conclusions, the only question left to be answered was whether or not com- pensation insurance would be carried by 11 private or state owned - companies. (3, p. 51; 10, chapter 6) Theodore Roosevelt's address to the NCF in 1911 included workmen's compensation as a major theme. Conserva- tive court opposition was overcome within the next year, and with active promotion by the NCF's reorganized " Compensation Department " and the AALL all but six states had some kind of compensation law by 1920. (3, chapter) The basic model for US " industrial safety " and " workers'compensation " pro- grams was first developed in Bismarck's Germany by a conservative capitalist class under challenge by the fastest growing - socialist movement in Europe; it was first tried out systematically in the United States by US Steel. (1, pp. 325-330; 7; 12, p. 15; 13) This program, soon superseded by state workmen's compensation laws, paid workers or their families fixed amounts for job- related injuries causing disability or death without regard to fault. The plan, for all its purported liberality, stated explicitly that " No relief will be paid to any employee or his family if suit is brought against the company " and workers who received any " relief " from the plan were required to sign away any further remedies against US Steel. (13, p. 76) Injured workers were supposed to receive partial compensation for lost wages and full compensation for medical expenses incurred as a result of the injury. In return for certain compensation at a low rate, the worker gave up all other " rights and remedies " against the employer, such as suits for negligence under the common law. Most employers bought private insurance against industrial injury losses, but large employers could insure themselves. Claims were adminstered through state industrial accident commis- sions, but premium rates were set through a private rating bureau, the National Council on Compensation Insurance, according to benefit levels set by state legislatures. From inception to enactment to enforcement, private business interests had total hege- mony over the workmen's compensation system. Unions Stymied In the earliest period of lobbying and public relations around workmen's compen- sation, organized labor was conspicuous by 12 its absence. In 1911 unions had only 2.3 million members in a workforce of over 30 million, and many were fighting for their very survival, having had little success in penetrating steel, meatpacking, oil or other big new industries. Union reluctance to join the corporate- sponsored rush to write compensation laws was understandable. After all, workmen's compensation was first tried out by US Steel, in a context of union busting - and a corporate welfare paternalism designed to keep unions out. (13) Furthermore, the compensation programs were being propounded at a time when workers were beginning to win larger and more frequent negligence judgments against employers, as traditional common law defenses were weakened and juries be- came more sympathetic. As James Wein- stein has written: " Compensation laws, in contrast, could be expected only to pension off the worker during his period of disable- ment at something less than his regular wages. In addition, almost all unionists, conservative or socialist, opposed govern- ment regulation of working conditions on the theory, often only implicit, that government was controlled by business, either directly or through conservative politicians or judges. " (3, p. 43) ~ Later on, when Samuel Gompers, head of the AFL, had reluctantly endorsed the concept of workmen's compensation under pressure from his big business friends and from the belief in the inevitability of some kind of legislation, the labor movement and the Socialists each developed their own positions on the issue of workmen's compensation. The programs of both labor and the Socialists called for compensation levels of 100 percent of lost wages (in contrast to 50 or 66 2 percent), retention of the right to sue at common law before a jury, and for owned state - insurance companies to prevent the diversion of most premiums to insurance interests rather than injured workers. In 1910 Crystal Eastman showed that only 24 to 37 percent of employer pre- miums in " employers'liability " programs were paid out as benefits in some form by the insurance companies. (14, pp. 286-290) With the addition of reasonable presumptions concerning occupational disease liability, the labor socialist / proposals of sixty years ago would make a fine platform for a radical restructuring of workers'compensation today. As labor and the Socialists had feared, almost all their demands were defeated. In no state were benefits close to 100 percent of lost wages. In New York State, organized labor's program banning private insurance companies was sacrificed for fairly high initial benefits, and a state owned - company was allowed to co exist - with private companies. (3, chapter 2) In Missouri the enactment of a workmen's compensation law was held up by a strong labor movement until 1926 over the issue of a state owned - fund, but the battle was lost. (15) Of the big industrial states, only Ohio totally excluded private insurance companies from the compensation business. (See box) A Century of Stagnation The private workmen's compensation system and the unenforced safety laws which passed in most states proved to be every- thing their corporate sponsors had wanted. Both management and insurance interests benefited by the shift from risky jury trials to controllable administrative agencies. Costs to companies were stable and averaged around one percent of payroll; occupational disease payments were almost non existent - ; and companies were protected from negli- gence suits at common law. Physicians were hired to deal with work injuries and to rep- resent the companies within the compensa- tion bureaucracy, creating that institutional ghetto called " industrial medicine. " Despite some new scrutiny due to the renewed interest in the work environment, the compensation system has remained almost unchanged. The Occupational Safety and Health Act of 1970 set up a President's Commission on State Workmen's Compensa- tion Laws chosen " from people inside the system, " according to its business school director. (16) A bill introduced in 1973 by Senators Harrison A. Williams and Jacob Only Ohio, of the big industrial states, totally excluded private insurance com- panies from its workmen's compensation plan. Today Ohio pays out 96 percent of its premium income as cash and medical benefits to victims, compared to 53 percent for private insurance companies nationally. Today workers'compensation benefits could be nearly doubled at no new cost to employers by eliminating the role of the private insurance companies. A good first step would be to investigate why it costs Ohio 4 cents and private insurance companies 89 cents to return a dollar of benefits to workers hurt on the job. Sources: Daniel N. Price, " Workers ' Compensation: Coverage, Pay- ments, and Costs, 1974, " Social Security Bulletin, January, 1976, pp. 38-42. Compendium on Workmen's Compensation, directors: C. Ar- thur Williams Jr. and Peter S. Barth; editor: Marcus Rosen- baum (National Commission on State Workmen's Compensation Laws, Wash. D.C., 1973). Javits to set national standards for state workers'compensation programs has gone nowhere in Congress. The current versions of the bill have been watered down by striking provisions which would give workers the right to choose their own physicians in compensation cases and would make com- pensation for occupational diseases much 13 easier to obtain. Even so, its chances of passage are small. Management and insur- ance interests, frightened by the multi- billion dollar benefits for coal miners under the various black lung compensation laws, are eager to keep the federal government out of the compensation business. The corporate- dominated Occupational Safety and Health Administration has been quietly encouraging the reform of state compensation laws on a " voluntary " basis, to undermine pressure for federal action. (17) With living standards falling for workers and with the OSHA law itself under strong business attack around the country, it is doubtful that important changes will occur in the near future in the compensation system. (18, 19) The old pattern of government and corporate sponsored - studies leading to cheap " reforms " seems to be repeating itself. In a general atmosphere of political conser- vatism, a holding action seems to be the order of the day. What happens in the work- place cannot be separated from what happens in the rest of society. -Daniel M. Berman (This article is an ex- cerpt from Death on the Job, to be published in 1977. Copyright 1976 by Daniel M. Berman. Reprinted by per- mission of Monthly Review Press.] References 1. Gordon M. Jensen, The National Civic Federation (Ph. D. dissertation, Princeton University, 1956). 32.. UpJtaomne sS iWnecilnasitre,i nT,h eT hJuen gCloer p(oNreawt eY oIrdke,a l1 9i0n6 )t.h e Liberal State (Boston: Beacon, 1968). 4. Phillip S. Foner, History of the Labor Movement in the United States (New York: International Publishers, 1964), v.3. 5. Mack Sennett, King of Comedy (New York: Doubleday, 1964), v.3. 6. Richard O. Boyer and Herbert W. Moraes, Labor's Untold Story (New York: Cameron, 1973). 7. Joseph A. Page and Mary - Win O'Brien, Bitter Wages 8. (New York: Grossman, 1973). Roy Lubove, " Workmen's Compensation and the Prerogatives of Voluntarism, " Labor History, Fall, 1967, pp. 254-279. 9. Frederick L. Hoffman, " Industrial Accidents, " Bulletin of the 10. Bureau of Labor (Washington, D.C., 1908). William Domhoff, The Higher Circles (New York: Random House, 1970). 11. Daniel Berman, Death on the Job (Ph. D. dissertation, St. Louis: Washington University, 1974). 12. Marcus Rosenblum, ed. Compendium on Workmen's Compensation (National Commission on State Workmen's Compensation Laws, Washington, D.C., 1973). 13. Katherine Stone, " The Origins of Job Structures in the Steel Industry, Review of Radical Political Economics, Summer, 1974, pp. 61-97. 14. Crystal Eastman, Work Accidents - and the Law (New York: Russell Sage Foundation, 1910). 15. Robert Kerstein and Edward Goldenhersch, Workmen's Compensation in Missouri (photocopy, written Public Interest Group, St. Louis, 1972) later published under other authorship. 16. Interview with John F. Burton (Chicago, March 13, 1973). 17. See papers given at Interdepartmental Workers'Compensa- tion Task Force, co sponsored - by the Occupational Safety and Health Administration (Chicago, February 10-16, 1976). 18. Toxic Materials News (May 1, 1975) v.2, no. 9, citing speech by President Gerald Ford to US Chamber of Commerce. 19. Edmund Faltenmeyer, " Ever Increasing Affluence Is Less of a Sure Things, " Fortune (April, 1975), beginning p. 92. 20. Jack London, The Iron Heel (New York: Grayson, 1948) especially chapter 3. 21. Weinstein, The Corporate Ideal..., op. cit., p. 117. most of the analysis here is from Weinstein and William Domhoff, The Higher Circles (New York: Random House, 1970), who both devote chapters to the rise of workers'compensation. Foner, History of the Labor Movement..., op. cit., p. 384; and Jensen, Gordon M., The National Civic Federation (American Business in an Age of Social Change and Social Reform, 1900-1910) (Ph. D. dissertation, Princeton University, May 1956) emphasize the National Civic Federation's strategy of buying off craft unions so they wouldn't organize more workers and would resist Socialist pressures. Jack London in The Iron Heel, op. cit., p. 230, wrote: " out of the unpractical idea of profit sharing - , arose the practical idea of grab sharing - .'Give us more pay and charge it to the public,'was the slogan of the strong unions. In In charging the public, it was charged to the great mass of unorganized labor and of weakly organized labor. This idea.. was. merely carried to its logical conclusion, on a large scale, by the combination of oligarchs and the favored " unions. ' 22. Cited in Jensen, The National Civic Federation, op. cit., p. 332. The letter was written in 1912. (rr Vinyl Chloride (Continued from page 8) chemicals account for only 27 percent of total company sales. (31) Of the 500 largest US industrial corporations, Goodrich ranked 107th in 1975, with total sales of $ 1.9 billion. (32) The profit margin was a mere 1.3 percent (net income as percentage of net sales), earning Goodrich a profitability rank of 267th out of 500. Often relatively smaller companies with low profit margins invest least in research 14 and development. (33) Dow Chemical, which carried out research on the toxicity of VC in 1959, ranks third in the top fifty chemical producers and chemicals account for 69 percent of total sales. With this total reaching $ 4.9 billion in 1975, Dow is two and one half - times as large as Goodrich; its profit margin is also much larger - 12.6 percent in 1975, earning it the profitability rank of fourteenth in the first 500. The conclusion to draw from this analysis is not that companies should be larger be- cause big corporations can do more research, but that research should be nationalized. The protection of workers cannot be left to profit hungry - industries and all chemicals should be tested before they are introduced into the workplace. R. Jaeger, a hysiologist attending a workshop on VC toxicity in May, 1974, in response to a presentation of recent studies undertaken at Dow, lamented, " it is a sad state when experimental toxicology must confirm the tumorigenicity of a chemical which is listed by Chemical and Engineering News as the compound ranking 22nd in their top 50 chemicals, with a production of 5.35 billion pounds in the US last year. " (34) Other VC Diseases lymphatic and central nervous system, and they pinpointed VC as the cause. (38) Clinical reports of other disorders are still coming in. Dr. Fernand Delorme, the Canadian pathologist in Quebec Province who uncovered nine deaths from angiosar- coma at the Goodrich plant in Shawinigan, is concerned that VC may be responsible for other liver disorders. (39) Pulmonary fibrosis and other respiratory symptoms are being scrutinized for their incidence and pre- valence among VC workers and for the role of VC exposure in their development. (40) The story of slow and reluctant acknow- ledgement of the etiology of angiosarcoma is not an isolated event, even in the history of vinyl chloride. There was similar foot- dragging in the diagnosis of acro osteolysis - and Raynaud's syndrome, two diseases that Aftermath It's a sad story. What is frightening about it is the possibility that equally ugly and deadly facts are buried under thousands of other unresearched industrial chemicals. The story of vinyl chloride must be under- stood so that action can be taken to prevent the introduction of new substances damag- ing to our health - and more needless deaths. -Meredeth Turshen NIOSH found more than the Meredith Turshen is a health writer based in Washington, D.C.. expected number of deaths from cancer of the liver, lung and the References lymphatic and central nervous 1. B. Kramer, " Vinyl chloride risks were known before first deaths, " Wall Street Journal, October 2, 1974. 2. J. Klein, " The plastic coffin of Charlie Arthur, " Rolling Stone, systems, and pinpointed VC as January 15, 1976. 3. H. Heimann, et. al., " A bibliography on the toxicology of vinyl the cause. chloride and polyvinyl chloride, " Ann NY Acad Sci, 246: 322 (1975). 4. J. Muller, Arch Exp. Path Pharmak, 109: 276 (1925). 5. 5. J. Marsteller, et. al., " Unusual splenomegalic liver disease as evidenced by peritoneoscopy and guided liver biopsy among polyvinyl chloride production workers, " Ann NY Acad Sci, 246: 99 (1975). 6. R.H. Wilson, & W. McCormick, " Plastics in the toxicology of synthetic resins, " Arch Ind Health, 21: 536 (1960). 7. S.R. Tribukh, et. al., " Working conditions and measures for their sanitation in the production and utilization of vinyl affect the hands of VC autoclave cleaners, chloride plastics, " Gigiena Sanit, 10: 38 (1947). 8. R.H. Wilson, & W. McCormick, " Toxicology of plastics and rubber plastomers - and monomers, " Ind Med & Surgery, 23: causing clubbing of the fingers, severe pain, and sores. The first incriminating reports 479 (1954). 9. H. Danziger, " Accidental poisoning by vinyl chloride - report of two cases, " Can Med Assn J, 82: 828 (1960). appeared early, in 1939, (35) and were later confirmed in the Soviet and East European literature. (7, 36) Again the infor- mation was ignored - until 1967, when Goodrich announced 31 cases of acro- 10. E. Mastromatteo, et. al., " Acute inhalation toxicity of vinyl chloride (1960). to laboratory animals, " Am Ind Hyg Assn J, 5: 395 11. T.R. Torkelson, et. al., " The toxicity of vinyl chloride as deter- mined by repeated exposure of laboratory animals, " Am Ind Hyg Assn J, 22: 354 (1961). 12. C. Maltoni, & G. Lefemine, " Carcinogenicity bioassays of vinyl chloride; current results, " Ann NY Acad Sci, 246: 195 (1975). osteolysis among its workers. (37) Simul- taneously, similar reports were published in 13. C. Levinson, Work Hazard: Vinyl Chloride, ICF, Geneva, 37 (1974). 14. J.T. Edsall, " Report of the AAAS Committee on Scientific Free- England, Belgium and France. NIOSH has conducted a chloride retrospective survey of 1,294 vinyl chloride workers who dom and Responsibility, " Science, 188: 4189, 687 (1975). 15. EPA, " Scientific and technical assessment report on vinyl chloride and polyvinyl chloride, " EPA 6-75-004 - 600 / (1975). 16. G. Allen, " Polykiller, " Maclean's, April 19, 1976. 17. EPA, " National emission standard for hazardous air pollutants: had at least five years'exposure; they found proposed standard for vinyl chloride, " Federal Register, December 24, 1975. more than the expected number of deaths =~ 18. New York Times, October 25, 1975. from cancer of the liver, lung and the 19. P.F. Infante, " Oncogenic and mutagenic risks in communities 15 with polyvinyl chloride production facilities, " Ann NY Acad Sci (in press). 20. Mutation Res, 31: 163 (1975); Lancet, I: 459 (1975); Lancet, 2: 410 (1975); L. Hillestad & E. Thiis Evensen - , unpublished. 21. P.F. Infante, et. al., " Genetic risks of vinyl chloride, " Lancet, "* pp. 734-35 (April 3, 1976). 22. L.D. Edmonds, et. al., " Congenital malformations and vinyl chloride, " Lancet, p. 1098 (November 29, 1975). 23. P.F. Infante, Personal communication. 24. L.D. Edmonds, Personal communication. 25. G. Theriault, Personal communication. 26. G. Perkel, et. al., " Surveillance of workers with history of expo- sure to vinyl chloride, " Ann NY Acad Sci 246: 311-12 (1975). 27. D. Wegman, et. al., " Health hazard surveillance by industrial > workers " Am J Publ Health, 65: 26 (1975). 28. M. Turshen, " An analysis of state job safety and health plans, " March, 1976, OCAW, Washington, DC. workers, " Am J Publ Health, 65: 26 (1975). 30. T. Redburn, " Bitter living through chemistry, " Environmental Action, November 8, 1975. 31. E.V. Anderson, " Output of the top 50 chemicals drops sharply, " Chem & Eng News, May 3, 1976. 32. Fortune, May, 1976. 16 33. M. Turshen, An'analysis of the medical supply industries, " Int J Health Serv 6: 279 (1976). 34. R. Jaeger, " Vinyl chloride monomer: comments on its hepato- toxicity and interaction with 1, 1 Dichloroethylene -, " Ann NY Acad Sci, 246: 150 (1975). 35. Z.T. Wirtschafter, & E.D. Schwartz, J Industr Hyg, 21: 126 (1939). 36. 1. Suciu, et. al., " Contributii la studiul imbolnavirilor produse de clorura de vinil, " Med Interna, 15: 967 1963 (). 37. R.H. Wilson, et. al., " Occupational acro osteolysis ,- " JAMA, 201: 577 (1967). 38. R.J. Waxweiler, et. al., " Neoplastic risk among workers exposed to vinyl chloride, " Ann NY Acad Sci (in press). 38. R.J. Waxweiler, et. al., " Neoplastic risk among workers exposed to vinyl chloride, " Ann NY Acad Sci, (in press). 39. F. Deforme, & L. Makk, " Angiosarcomes du foie chez des ouvriers ayant ete en contact prolonge avec le chlorure de vinyle, " L'union Medicale du Canada, 104: 1843 (1975). 40. A. Miller, et. al., " Changes in pulmonary function in workers exposed to vinyl chloride and polyvinyl chloride, " Tubercle, 56: 242 (1975). Now available from Health / PAC: A CRITICAL LOOK AT THE DRUG INDUSTRY: How Profit Distorts Medicine by Concerned Rush Students An excellent 31 page - pamphlet by a group of Chicago medical students exposing some of the major pitfalls of the drug industry for clinicians and explaining why these pitfalls exist. 50 plus 35 postage. YOUR RIGHTS AS A HOSPITAL PATIENT by Boston Medical Committee for Human Rights A 68 page - illustrated booklet including sections on your rights to emergency treatment, hospital admission, informed consent and medical records. $ 1.00 plus 30 postage. Order from: Health / PAC, 17 Murray Street, N.Y., N.Y. 10007 16 A we should seek the necessary Peer Review funds from the mining indus- try. Coming from a country where scientists are generally considered, and usually are, honorable men, there seemed nothing particularly wrong in ASBESTOS RESEARCHER CHARGES DISTORTION this somewhat strange North American way of doing things; nevertheless it took me two years to persuade the QAMA [Quebec Asbestos Mining Dear Health / PAC: A copy of of your article published in the Health / PAC BULLETIN of November / Association - ed.] to support our work. Since then (October 1966) we have had research grants from the QAMA Insti- December, 1974 has just been sent to me. You have done me tute of Occupational and En- vironmental Health over an and my colleagues at McGill a grave injustice. To expect that I can persuade you of this is 8 year - period. At no time has there been any interference with our research programme beyond our reasonable hope but at least I believe you should be told the truth even though you may choose to ignore it. Time and space are not sufficient to review your paper fully; much is concerned or any requirement to see our reports prior to publication. During the same period our asbestos studies have also been supported by the Cana- dian Medical Research Coun- cil, the U.S. Public Health with events and persons be- fore my time. Some aspects, however, are well known - to me and I will describe just a few of them. Service, the British Medical Research Council and the Canadian Federal Govern- ment. Never, have I or our senior scientific staff received I came from Britain in 1964 any part of our salaries or any as Chairman of the Depart- ment of Epidemiology and Health at McGill, having been funds for personal use from the asbestos industry. McGill University has subsidized our Director of the Epidemio- research, certainly not the re- logical Research Laboratory, a unit of the British Medical Research Council for which you express so much respect. In the autumn of that year I was persuaded by my friend, Dr. Christopher Wagner, the South African pathologist who discovered the association be- tween asbestos exposure and verse as you imply. Under the heading, Prosti- tution Pays, you refer to the way I personally have bene- fitted from all this. I came to McGill as a departmental chairman and resigned from that position in 1972 to prosti- tute myself to the Interna- tional Planned Parenthood mesothelioma, of the very great need for epidemiological studies of Quebec workers Federation (IPPF) for 2 years. My salary as a McGill profes- sor was and still is less than exposed to pure chrysotile. that of an average general Later in the year I was invited practitioner in the Province of by the Canadian Federal Government to undertake such Quebec; my salary with IPPF was a good deal less still. I am a study and it was suggested now about to move back to 17 England as Professor of Occu- it except the chance to do category whose standar- pational Health and Director important work. We have dized mortality was about of the TUC Institute of Occu- been and are in asbestos 20% above that of the pational Health at the London research for one reason only rest. Two thirds of the ex- School of Hygiene and Tropi- and that is to understand its cess mortality in this cal Medicine. My salary there effects on man so that they group was probably due to will amount to less than can be prevented. We have pulmonary fibrosis, shown $ 20,000. per annum. So much for successful prostitution! I worked hard at this and have never hidden or knowingly on the death certificate as either asbestosis or in the mention these figures of my misrepresented our findings. guise of various respira- material gains during the past On page 22 you discuss our tory or cardiovascular di- 12 years in case you care to cohort mortality study in the agnoses, and the remain- compare them with those of Quebec mines at some length. ing third to cancer, mainly the'independent'scientists Either you are ignorant of of the respiratory tract. " you hold in such high regard. basic epidemiological method Sometime you might also like and have had no knowledge- You managed to convey to see whether our physical able person to advise you or exactly the opposite effect. I conditions of work even begin you have deliberately chosen might add that Dr. Selikoff's to compare with the frank to mislead your readers. The group has since carried out a luxury of the laboratories and essence of a cohort study is similar cohort mortality study offices in which some called so - the comparison between the in the Quebec chrysotile mines independent investigators experience of workers ex- and mills with virtually iden- operate. In concentrating on our posed for short periods and at low concentrations and those tical findings to our own. He confirmed both the magnitude prostitution to the asbestos with long and heavy exposure. of risk of lung cancer and the industry you forgot to mention It is you who chose to draw a fact that mesothelioma is very that during the same period negative conclusion from our rare in this industry. we were also selling ourselves study and to downgrade our You say (page 26) that to the Canadian Department statement - in heavy type at Selikoff et al reported an in- of Health and Welfare for de- the beginning of the article- crease in gastro intestinal - velopmental work on influenza that the lung cancer death rate cancer'two years ago '. I don't vaccines, for studies of the in the heavily exposed was know the date to which you cause and control of uterine cancer and the cause of neural five times greater than nor- mal. At the top of p 22 you refer but we reported it in 1971, at a time when he, at a tube defects; to the Quebec deliberately misquote from p public meeting, said he was government for studies of 684 of our paper in order to unsure about such small in- urban air pollution and care of distort our findings. Because creases! Indeed, we reported the mentally retarded, and to it is so important I give below most of the findings I have the US government for studies exactly what we wrote: - mentioned at a public meeting of the impact of universal " At face value, the find- to unions, employers and the health insurance in Quebec ings suggest that our co- press in Thetford Mines on (something which even your hort of workers in the February 27th, 1970. country may get round to one chrysotile mining industry You attempt to belittle the day). We also managed a few had a lower mortality than very important possibility- small jobs like replanning the the population of Quebec indeed probability - that the entire Quebec public health of the same age. This is various types of asbestos fibre system and are now engaged generally true of employed have different health effects in the same task for occupa- persons, provided they are (pp 23-26). It is this ostrich- tional health services in the not subjected to an occu- like attitude that is probably Province. The prostitution pational hazard sufficient condemning the American business has been so good in to offset the considerable public and workers alike to fact that it would not have selective advantage of continuing mortality from been of serious concern to us being and remaining fit for mesothelioma because certain if the asbestos industry had taken its favours elsewhere. work. This advantage was clearly lost by the men in ' independent'scientists re- fuse to accept that crocidolite 18 We have gained nothing from the highest dust index - and amosite are almost cer- tainly very dangerous sub- stances. You give much space to the financial interests of the chrysotile mining industry but ignore completely how de- lighted the South African producers of crocidolite and amosite must be at the attitude of NIOSH and its ad- visors. You ought to speak to Dr. Christopher Wagner some time about the biology, politics and prostitution connected with that. Finally (page 24), to pick on Graham Gibbs for noting the interaction between asbestos fibre and polyethylene and to suggest this was aimed at di- verting attention from asbes- tos is about as ridiculous as you can get! His astute observation, far from detract- ing attention from asbestos, prevented experimental path- ologists all over the world from wasting time and re- sources on experiments which would have been invalidated by the presence of oil liber- ated from plastic by asbestos fibre. At no time did he or anyone else suggest these oils had anything to do with the effects of asbestos on man. If you are still with me, I would like to finish on another note. During the past 3 years or so life for many honest medical scientists - of which our group at McGill is only one, has been made hell by people like you, Brodeur and the like. No doubt this is your intention; I suppose you be- lieve that people like us should be driven out of their jobs or out of their minds. I would like you to know that you are being very successful. Competent and sensitive peo- ple cannot take this kind of abuse, why should they when there are more attractive and more rewarding opportunities open to them. My friends think I am a lunatic to accept yet another university position in occupational health. I think they are probably right and I would not do so in the USA. A climate is being created on this continent in which no ob- jective scientist with any concern for survival will go into research of social impor- tance. Why don't you attack the real problems in industrial health and research in your country? Where are your comments on the fact that in the USA (unlike Europe) the worker has virtually no say or control in the safety of his working environment? Why no demands that research policy and resources be dir- ected jointly by worker and management? Why make it well nigh impossible for hon- est and objective investigators to work in this continent rather than help protect them and publicize their findings? If you plan to visit Montreal in the next few months I shall be happy to discuss any of these questions as fully as you wish. - Corbett McDonald, MD The author replies As further evidenced by your letter, our disagreements are indeed profound. First, I would like to respond to a number of statements in your letter that are either false or misleading. You conclude the second paragraph with the statement, " McGill University has sub- sidized our research, certainly not the reverse as you imply. " Yet in February of this year you stated before a govern- ment commission, the Beau- dry Commission, that of the $ 1.5 million spent on your as- bestos research program over the last ten years, $ 1.1 million came from grants by agencies outside the University. Of this $ 1.1 million, $ 975,000 came from the Quebec Asbestos Mining Association (QAMA) via its Institute of Occupa- tional and Environmental Health. The remaining $ 400,000, for salaries of senior scientific staff, you further testified, was paid in part by the Canadian Medical Research Council and in part by McGill University (the proportions were not specified). If re- ceiving roughly $ 3 for every $ 1 the University spends isn't a subsidy, then I don't know what a subsidy is. The Uni- versity's contribution pales even further with the realiza- tion that senior staff salaries are a relatively fixed obliga- tion for any university and, short of a financial crisis, must be paid regardless of faculty research activities. It is out- side funds, not faculty sala- ries, of course, that establish such a major scientific pro- gram. Three paragraphs later you charge that I " deliberately misquote " you in order to distort your findings. The quote as it appears in my article- " The findings sug- gest that our cohort of workers in the chrysotile mining indus- try had a lower mortality than the population of Quebec of the same age -is " the same as the version given in your letter. I did not misquote you. Your apparent objection is that, by isolating the quote from its context, I have, in your opinion, distorted its intended meaning. The longer quote, however, illustrates equally well my contention that you consistently minimize the dan- gers of asbestos. Let us examine this quote in detail. 19 That asbestos miners had a telephone company workers. to the lowest. You found these lower mortality rate than the (Journal of Occupational Med- results, but you didn't choose population of Quebec of the icine, 18, 166 (1976)) Retired to express them in these same age is the first evaluative industrial workers show evi- terms. (Indeed, just as with sentence in the abstract pre- dence of even lower ratios at the death rate from all causes, ceding the article, and the lead ages in their early 60's, which you didn't calculate the death sentence in the article's final is near the median age of the rate from respiratory diseases section - the summary and evaluation of findings. In both instances the sentence sets the tone for the discussion which asbestos miners you examined. However, using the data presented in your article (p. 683), one finds that asbestos anywhere in your paper- although the data needed to do so was present in your ' Table 6.) follows and, as authors of workers have a mortality rate You did calculate the five- scientific papers well know, is the kind of easily understood summary statement that is picked up by the news media exceeding that of most other industrial workers - nearly 92 percent of the general rate. (Curiously, although you pre- fold increase in death rate from respiratory cancer. As you note in your letter, it is presented in heavy type at the and by casual readers of the sented the necessary raw beginning of the article. (What article. data, you did not compute this you don't mention is that the The problem with the sen- figure anywhere in your pa- entire abstract in which it tence is that it is misleading- there is less to it than meets per.) The figure gains signifi- cance when one considers that appears is presented in bold- face type.) More important, the eye. Itn he original asbestos miners should pre- let's look at what you actually Health / PAC BULLETIN arti- sumably be healthier than the say in your paper about the cle I argued that by including average worker since they are increased death rate: " The in your study many workers with limited and / or recent ex- selected to do heavy physical labor (and would be expected difference in rates for respir- atory cancer between those posure to asbestos you under- estimated asbestos - related to have a mortality rate toward the low end of the usual maximally and minimally ex- posed may well be closer to deaths. But even in the ab- industrial range). Many sci- threefold than fivefold. " So sence of such shortcomings, the statement that asbestos entists would have found this fact a cause for concern; you why don't you just say that asbestos miners suffer a three workers have a lower mortali- chose not to present it. to fivefold increase in death ty from all causes than that for the Quebec population of similar age does not rule out In the next sentence you acknowledge the customarily lower mortality rate for indus- rate from respiratory cancers rather than gratuitously refer- ring to a possible exaggera- the presence of serious, wide- trial workers. Then you go on, tion? Isn't a three to fivefold spread hazards in the industry. " This advantage was clearly increase increase a matter of Industries tend to select the lost by the men in the highest serious concern? This is an- healthiest, most active adults dust index - category whose other example among many of for employment, excluding standardized mortality was the point that I argued in the the less healthy, the chroni- about 20% above that of the BULLETIN article, that you cally ill and the handicapped. rest. " (Was the advantage consistently minimized the Thus mortality rates for in- lost by the men? Or, more dangers of asbestos in your dustrial workers are lower accurately, was it lost to paper. than those for the general them?) You might have stated You insist, however, that I population, as you acknow- that you found a death rate distort your arguments in ledge in the second sentence from cancers of the bronchus, order to show that you minim- of your quote. In quantitative trachea and lung five times ize the hazards of asbestos. terms, for workers in indus- greater among workers in the (You say, " It is you who chose tries generally considered less highest dust index - category to draw a negative conclusion hazardous, it is not unusual to compared to those in the from our study and to down- find a ratio of mortality of lowest dust index - category- grade our statements. " - your workers to the general popula- and that you found a death emphasis.) The concluding tion of less than 75 percent for rate from all other respiratory sentences of your original all ages from 40 to 64 years, as diseases four times greater in article again make my case " It 20 observed, for example, among the highest category compared is clear that the Quebec chrysotile workers have had statement is simply not true. published scientific papers nothing like the experiences of In 1968, Graham Gibbs, and not to personally inter- American insulation workers after having demonstrated the view scientists about their or the London factory workers presence of the polyethylene work. I did this both because with respect to malignant oils in asbestos fibers, con- the papers are a good repre- mesothelioma, and it seems cluded: " Four possibilities sentation of the authors ' unlikely that they are com- need to be considered. The thoughts at the time of writing patible with respect to lung adsorbed compounds from and because I think the cancer. These findings strong- polyethylene, whether present contending parties'justifica- ly suggest either that chryso- as the original additive or as tions for their roles after the tile is less likely to cause new compounds, may (1) fact are less reliable and less malignant disease of the lung themselves act as carcino- important than their actions and pleura than other forms of gens; (2) enhance the carcino- during the heat of controversy. asbestos, such as crocidolite, genic activity of other sub- I should also mention that I or that workers engaged in in- stances such as trace metals, was aided in my work by sulation and processing are asbestos itself, or associated Robert Phillips, then a student exposed to additional factors oils; (3) inhibit the action of at Mt. Sinai Medical School which explain the difference. " carcinogens present in the and several years before a This indeed minimizes the fiber; or (4) have no influence summer intern at Health / dangers. It is you not I who on the biological action what- PAC. We discussed the re- draw a negative conclusion soever. " (American Industrial search papers at length, but in when what was needed was a Hygiene Journal, 30 463: the end I wrote the article and clarion call to act on the (1969). These four possibilities am solely responsible for the dangers to asbestos miners were repeated nearly verbatim analysis presented there. As which you yourself have found. at the 1969 Johannesburg in- the analysis showed, studies Next you go on to assert ternational conference on as- sponsored by industry have that when Dr. Selikoff's group bestos. (Proceedings, p. 167) consistently over half a cen- carried out a similar study on If Graham Gibbs at no time tury come to polar opposite Quebec asbestos miners his findings were " virtually iden- tical " to your own. Since the suggested that these oils had anything to do with the effects of asbestos on man, then why conclusions about the health hazards of asbestos than those not so funded. results of the Mt. Sinai study was he so concerned about Because of length and time have not yet been published, I called Dr. Selikoff to confirm, their carcinogenic activity? Of course he was interested in limitations I was only able to address the second question if I could, whether this is a their effects on humans. descriptively. I observed that proper characterization of the I too would like to finish up studies sponsored by industry relation between your results. on another note. I started my have followed a pattern - first Apparently it is not. We shall have to await publication of article on asbestos research as - a case study to answer two denying that asbestos causes disease, then minimizing its the paper by Dr. Selikoff and questions: (1) Do the results of dangers (as you did in your associates for them to explain industry sponsored - studies in 1971 study) and finally shifting this in their own words. the field of occupational health blame (as Graham Gibbs and Finally, accusing me of differ from those of studies Paul Gross did). But the more being " as ridiculous as you not funded by industry? (2) If interesting and important can get, " you deny that your they do, what is the nature of associate Graham Gibbs stud- these differences? problem, especially for occu- pational health scientists, is to ied the interaction of asbestos Because so many papers seek out the differences in fibers with oils from their have been published on as- scientific method that could polyethylene storage bags as a possible way to shift blame from asbestos as a carcino- bestos, much of the Health / PAC BULLETIN article of November December /, 1974 give rise to the different lines of research and the different conclusions. I summarized genic agent. " At no time, " was devoted to answering the these fairly explicitly in a later you say, " did he or anyone else suggest these oils had first question mentioned above. article, published in the Sep- tember, 1975 issue of Science anything to do with the effects of asbestos on man. " This I decided early in the study to restrict my attention to For The People magazine. Since it bears on some of the 21 points raised in your letter, e.g. that you " have not hidden or knowingly misrep- resented " your findings, I reproduce one relevant pas- sage below: " Today industry still seeks to dominate asbestos re- ers, who are more likely to show signs of disease. Data will be presented that are de- signed to illuminate the haz- ard to this group of workers, and summary and conclusions will typically begin with a statement about the most cry that " a climate is being created on this continent in which no objective scientist with any concern for survival will go into research of social " importance.'Again this stands reality on its head. For the first time in recent dec- search. This is done by supporting individuals whose scientific practice demon- strates built - in biases useful to industry. These biases usually are the result of scientific and social values rather than dishonesty or conspiracy on the part of scientists. A critical examina- tion of industry - funded as- bestos research does not reveal overt falsification of data. In fact in many of the large scale - industry experi- ments (for example the Met- ropolitan Life study in 1935 and the McDonald studies in the 1970's) data indicating asbestos dangers is circum- spectly presented in the re- ports themselves. " It is clear that the critical difference between industry- and worker oriented - research does not lie in the experimen- tal methods employed, but in the questions that scientists try to answer and in the assumptions made when they analyze and present their data. If a scientist suspects that workers are often harmed on the job, he or she will adopt this as an implicit hypothesis and will focus attention on serious hazard uncovered by the study. " On the other hand, a scientist who designs a study with the assumption that workers are not often harmed on the job is more likely to study a much larger, more heterogeneous group of work- ers in a given plant or industry. In this case, data will first be presented lump- ing the workers together into a single group, which tends to bury the effect of unhealthy subgroups within the larger group. " Summary and conclusions will usually open with a state- ment about the similarity in the mortality pattern of the entire group of workers as contrasted to that of the general population. A com- parison of the papers of Selikoff and McDonald, for example, illustrates these dif- ferences clearly. " In brief, the problem is not one of falsification of data or misrepresentation, but of the biases which all of us bring to our studies that profoundly influence the questions that we ask and the conclusions that we draw. ades, in the United States at least, scientists who favor the interests of management are no longer able to shape occu- pational health policy and practice unchallenged. Occu- pational health scientists whose concerns are first and foremost the health and safety of workers are now able to join with them in the struggle for improved conditions and make some headway. (And it is a struggle, I assure you.) But because you can still view yourself as an objective scientist, and can't or won't see your deep seated -, pro- industry bias, you can only view the criticisms made of your study as a personal attack. They are not. They are the first waves of long overdue - change. The question is whether you will welcome them, as I do, as an important advance for working people or whether, like Canute, you will try to order them back on be- half of an industry that con- sistently puts its own well- being before its workers very lives. -David Kotelchuck older, heavily exposed work- You end your letter with a ea SUBSCRIBE TO THE HEALTH / PAC BULLETIN student subscription $ 5 [] regular subscription $ 7 [] institutional subscription $ 15 Y' Name: Address: 2222 Health / PAC, 17 Murray Street, New York, New York 10007 Vital Signs YOUR JOB OR YOUR FERTILITY ... That's how the question is posed for many women of childbearing age working in hazardous environments. Ex- emplifying the problem is Norma James, a 34 year - - old single mother working in a General Motors battery plant near Toronto, Canada. Mrs. James was forced out of her job because of the dangers of lead exposure to unborn chil- dren. After waiting for a month for a comparable job, Mrs. James had herself ster- ilized in order to maintain her former job on the night shift which allows her to care for her four children during the day. The policy of not allowing women of childbearing age to work in potentially hazardous areas is a widespread one. Fighting this practice, which results in job discrimination against women, are women's groups and some trade unions including the United Steel- workers. Their position is that women should be afforded equal access to all jobs, and that work environments should be made safe for both men and women. On their side they have the Equal Employment Opportunities Act, Title VII of the Civil Rights Act and, in the case of lead, mounting evidence that exposure affects male fertility and the health of the sperm as well. (Medical World News, June 14, 1976) BESIEGING THE COURTS Plaintiffs will have to stand in line if challenges to PL 93-641, the new planning law, keep mounting (See BULLE- TIN, May June /, 1976) As it is, lawsuits number ten and chal lenge - the constitution- ality of the law, and the designations of Health Service Agencies, Health Service Areas and public regional planning councils. According to Washington Developments (June 12, 1976), HEW, the administering agency, has won one suit and lost another; two have been dismissed and six have yet to be decided. REDUCING CHARITY TO BUSINESS AS USUAL The Supreme Court, on technical grounds, has just refused to hear an appeal by the Eastern Kentucky Welfare Rights Organization concern- ing the tax exempt - status of non profit - hospitals. To quali- fy for tax exempt - status, hos- pitals traditionally had to pro- vide charity services. Res- ponding to intense pressure by the hospitals, however, the Internal Revenue Service in 1969 changed the regulations, making it sufficient for a hospital to maintain an open door policy in its emergency room and to participate in Medicare and Medicaid. Pov- erty groups brought suit, arguing that the IRS ruling would discourage the provi- sion of charity services, but lost in the lower courts. (Wall Street Journal, June 9, 1976; Hospital Week, June 4, 1976) TO LATIN AMERICA WITH LOVE Adorning the cover of a birth control comic book, written in Spanish and distri- buted by the Agency for In- ternational Development throughout largely Catholic - Latin America, is the Virgin 23 , Mary with the caption, " Little Virgin, you who conceived without sinning, help me to sin without conceiving. " (Jack Anderson, Daily News, June 19, 1976) CRIME PAYS .... ... Or, at least that's the message from New York Courts in sentencing Bernard Bergman and Eugene Hol- lander, New York City nursing home czars convicted of de- frauding Medicaid of millions of dollars. Bergman, who ad- mitted to stealing $ 1.2 million, was sentenced to four months in prison and Hollander, pleading guilty to heisting mitigating factors he cited $ 1.2 million, was sentenced to were Bergman's " illustrious spend five nights a week in a public life and works. " Few halfway house for a period of are the people who could not up to six months. Both agreed conduct an illustrious public to make partial restitution, al- life and works on a $ 2.5 though authorities claim the million free ticket from the sums stolen were actually $ 2.5 State. million and $ 7 million respec- Another mitigating factor tively. may have been Judge Frank- - Avoiding any consideration el's relationship to Bergman's of deplorable conditions in the lawyer, Dean Monroe Freed- homes and those who suffered man of Hofstra Law School, or died as a result, Marvin under whom Frankel teaches a Frankel, the judge sentencing course in (you guessed it) Bergman, characterized the legal ethics, according to Jack four month - term as a " stern Newfield in the July 19, 1976 one " that would deter nursing issue of the Village Voice. home wrongdoing. Among the a Health / PAC's New Book PROGNOSIS NEGATIVE: CRISIS IN THE HEALTH CARE SYSTEM edited by David Kotelchuck NEW A HEALTH / PAC 7176 THE EDITORS OF THE AMERICAN HEALTH anthology of many of the best recent articles from the Health / PAC BULLETIN, as well as important health policy articles from other publications. Major sections cover Health Care institutions, Health Workers and Government Intervention in the Health A HEALTH / PAC BOOK PROGNOSIS NEGATIVE CRISIS IN THE HEALTH CARE SYSTEM System. published by Vintage Books (Random House). Price $ 2.95 per copy (paperback). For bulk orders, order directly from publisher. For small orders send $ 2.95 each plus 21d postage to: Health / PAC 17 Murray Street 24 New York, New York 10007