Document g2YO2ZkwMYa428B2mj4kpxY3e

Occupational MAY 1974 Outbreaks of occupational disease rock industry THE nightmare-; about invidious oc cupational disease have turned to stark reality for two major com panies. An epidemic of peripheral neu ritis struck 128 of 950 production V'Oikers at the Columbus. Ohio plant of Columbus Coined Fabrics id>v. Borden Chemical Co. last August and September. Cause of the outbreak remains a mystery, al though scientists suspect the solvent methyl butyl ketone (MBK). Early this year, B. F. Goodrich Co. rocked the chemical and plas tics industries when it disclosed three cases of a rare liver cancer called angiosarcoma of the liver in its vinyl chloride polymerization process plant in Louisville. NIOSH investigated, and Dr. Marcus Key, director of NIOSH, announced that "it would appear that a new occu pational cancer has been discov ered . . ." The suspected carcinogen: vinyl chloride. The price for past ignorance has been high. Workers have paid with their health. Some had paid with their lives. The companies have May 1974/OCCUPATIONAL HAZARDS 43 N 0to3 N CT> Oo borne the medical and compensation costs, strained labor relations, the probing intensity of Federal and State health agencies' investigations, and the glare of adverse publicity. Thoughtful industrial hygienists and medical directors wonder when and where the next occupational disease disaster might strike. The next scientific discovery in the field could send shock waves through your industry or your com pany, despite the presence of top- notch safety programs as measured by traditional standards. For this reason, the CCF and Goodrich cases warrant the attention of every in dustrial hygienist, occupational phy sician, and safety manager. Epidemic strikes Columbus Coated Fabrics (CCF) prints and dyes textiles and fabrics and coats fabric wall coverings with plastic. Last spring, some workers in the plant's north and south print shops began complaining of dizziness and weakness. By August, doctors had hospitalized five workers with pe ripheral neuritis, which had been caused by an unknown toxic chemical. Peripheral neuritis is an inflammation or degeneration of the nerves in the arms and legs. Symp toms include a tingling feeling or numbness in the limbs and weak ness or paralysis in the muscles. Late in August, Dr. Donald Billmaier, a physician with the State of Ohio's Department of Health, was notified about the hospitalized work ers. Lionel Nosenchuck, CCF's spokesman, told Occupational Hazards the company called the Department of Health because it was concerned about the mounting incidence of the disease. Dr. Billmaier said a doctor treating one of the hospitalized workers called to inform him. "I learned about the outbreak by phone late in the afternoon on Wed nesday, August 22," Dr. Billmaicr said. "The next day I interviewed the hospitalized workers, reviewed their hospital records, and researched medical literature on known chemi cal neurotoxins. "On Friday. I met with CCF's management and explained my sus picion that the disease was job-re lated. The company agreed to let me conduct an industrial hygiene NIOSH hopes to pinpoint the causes of two recent outbreaks of occupational dis' ease through extensive laboratory tests, including animal tests. survey and organize physicial exam inations for other workers in the two print shops." CCF also called its workmen's compensation insurance carrier, which sent Dr. Norman Williams, head of the department of commu nity health and preventive medicine at Jefferson Medical College, to con sult with the company. The news reached AFL-CIO headquarters in Washington D. C. Union officials called Dr. Samuel Epstein, a professor of environ mental health and human ecology at Case Western Reserve University School of Medicine, and asked him to advise Local 487 of the Textile Workers Union of America, the bargaining unit for CCF employees. Suspect found Drs. Billmaier, Williams, and Ep stein and company and union offi cials met on September 10. Company officials listed nearly 100chemicals used in the plant. They were- grouped as solvents, resins, stabilizers, pigments, and plastic izers. None was a known neurotox in. Only one chemical had changed in the past few years. In August 1972, CCF substituted the solvent methyl butyl ketone (MBK) for the solvent methyl isobutyl ketone (MIBK). MIBK is photoreactive (its fumes turn to smoke when ex posed to light) and is considered a pollutant. MBK was substituted be cause it was less of an atmospheric pollutant than MIBK. One part MBK was mixed with four parts methyl ethyl ketone (MEK) to make the most commonly used sol vent in the plant. Because no peripheral neuritis had been reported before the use of MBK and because the change from MIBK to MBK was the only change in worker chemical exposure in re cent years, MBK became the prime suspect as the cause of the periph eral neuritis. Up to this time, there were no medical data identifying MBK as a neurtoxin; scientists still have not proved it was the cause of the disease outbreak at CCF. ts3 co OJ N o 44 OCCUPATIONAL HAZARDS/Moy 1974 1 00* Court rules OSHA preempts Ohio Industrial Commission In October 1973, the Ohio Indus trial Commission scheduled a hear ing to discuss closing the Columbus Coated Fabrics plant until the cause of the peripheral neuritis outbreak there had been found and removed. Three days before the hearing date, CCF won a temporary re straining order from the U. S. Dis trict Court for Southern Ohio pre venting the Industrial Commission's hearing. Later, at a hearing before the court, CCF argued the Industrial Commission could not hold a hear ing because OSHA had preempted its authority to do so. The company based its argument on Section 18(a) of the Job Safety Law', which states: "Nothing in this chapter shall prevent any State agency or court from asserting jurisdiction under State law over any occupational safety and health issue with respect to which no standard is in effect under Section 6." (Section 6 of the Job Safety Law gives OSHA au thority to promulgate standards.) CCF reasoned that because the company was covered by OSHA standards, the Ohio Industrial Com mission had no authority over the plant in the field of occupational safety and health. Attorneys for the Industrial Com mission argued that Section 18(a) applied only to those States which had approved OSHA State plans. Because Ohio did not have an ap proved State plan, they reasoned, Ohio could enforce its State laws on occupational safety and health. The court ruled the Industrial Commission's interpretation of Sec tion 18(a) was contrary to the ex press wording of the Job Safety Law and its legislative history. No hearing was held. II Worker exposure to chemicals at CCF was through inhalation, inges tion, and absorption through the workers' skin. Dr. Billmaier's industrial hygiene survey had shown levels in in-plant air of 500 to 700 ppm, ranging as high as 1,000 ppm, of MEK; and 0 to 25 ppm, ranging as high as 49 ppm, of MBK. The threshold limit value in the OSHA standards for both of these chemicals is 100 ppm. An OSHA inspection of CCF in June 1973 had revealed excessive worker exposure to other chemicals. After that inspection, the company was cited for non-serious violations of OSHA TLV's for antimony, lead, chromium, 2-butanone, and chromic acid. After an earlier OSHA inspec tion in Aprii 1973, CCF was cited for non-serious violations of stand ards governing combustible and flammable vapors in air and for poor housekeeping, as well as for other minor violations of OSHA standards covering machine guardine, walking and working surfaces, and materials handling. CCF did not contest any OSHA citation, although it did ask for and receive an extension from August to December to implement indus trial hygiene controls to abate the hazards uncovered by OSHA's June inspection. OSHA gave CCF credit for good faith when calculating fines for the citations. CCF had a full time safety director and access to its parent company's corporate safety staff. CCF's accident frequency rate in 1972 was 11.2 compared to the chemical industry average rate of 4.12 and the industry-wide average rate of 10.17 during the same year. Corwin Smith, president of TWUA Local 487, accompanied the OSHA inspector on the April in spection. He told OH editors he was satisfied with the results of the OSHA inspections, except for the absence of a citation for excessive solvent vapors in the plant. Work practices in the CCF plant added to workers' chemical expo sure. Workers frequently ate lunch at their work stations making inges tion a second avenue of exposure. They used a bucket of dirty solvent to remove ink from their hands and arms; thus absorption through the skin was a third avenue of exposure. Dr. Bobby Craft of NIOSH said his analysis also showed that employees who frequently worked overtime were more likely to have peripheral neuritis than those who did not. NIOSH called The September 10 meeting pro duced a joint labor-management safety and health committee to im plement industrial hygiene controls in the plant. Drs. Billmaier, Wil liams, and Epstein formed a medical committee to advise them. Two sets of recommendations also grew out of the September 10 meeting. One set dealt with improving industrial hygiene in the print shops: MBK was removed and MIBK re turned to use. Work began immedi ately on improved ventilation. CCF provided organic vapor masks, gloves, and other personal protec tion and built a separate, enclosed eating area in the plant. The second set dealt with finding and treating other workers who might have the disease end with learning what caused the outbreak. The doctors suggested NIOSH be called and its resources used to set up a medical monitoring program and to investigate the toxicity of chemicals used in the plant. A NIOSH team, headed by Dr. Bobby Craft, arrived in Columbus on September 11. About this time, cases of peripheral neuritis were cropping up outside the print shops, in other areas of the plant. NIOSH responded by helping extend new industrial hygiene practices to the entire plant. NIOSH also launched an epi demiological study to learn of other cases of peripheral neuritis among users of MBK. Some possible cases have been found and are still being investigated. Research begins The search for the cause began under NIOSH supervision. The company retained scientists at Ohio State University and Wells Labora tories to conduct chemical and ani mal studies. These scientists are in vestigating not only the effects of exposure to MBK alone but also to 23326003 May 1974/OCCUPATIONAL HAZARDS 43 MBK in combination with other chemicals. Tennessee Eastman Co., the manufacturer who supplied MBK to CCF, is also supporting research. Suppliers have provided information on the composition and purity of the chemicals used at CCF. NIOSH analyzed the chemicals, searching for impurities that may have caused the disease. Dr. Craft said, "We will not have the results of these studies until 1975 and even then we may not have an answer to what caused the disease. If the disease was not caused by MBK alone but by a synergism between MBK and an other chemical, or by an additive effect on the workers from exposure to many chemicals and we have not zeroed in on the right combination, we may come up empty handed after this series of experiments." Medical screening NIOSH grappled with the ques tion of how to diagnose peripheral neuritis in its earliest stages. A pro gram was launched to learn if doc tors could use electromyograms (EMG) as an initial screening de vice to detect the disease. EMG's measure the electrical impulses gen erated by active muscles. Typically, an EMG is given only after a'broader physical and neu rological examination. Because the test was usually used on the al ready ill, doctors had no agreed upon baseline of what was normal. Dr. Norman Allen, head of the department of neurology at Ohio State University's School of Medi cine, proposed a numbered rating system that combined findings from an EMG, a physical examination, and symptomotology to diagnose peripheral neuritis. NIOSH had the proposed rating system reviewed by nationally recognized experts in neu rology and by scientists at the Na tional Institute for Neurological Disease and Stroke, part of the Na tional Institutes of Health in the U. S. Department of HEW. With a few revisions, Dr. Allen's system was adopted. Screening re vealed 128 cases of peripheral neu ritis. A continuing medical surveil lance program is underway. No new cases of peripheral neuritis have been found since MBK was removed from the plant and the new indus trial hygiene measures were imple Photo courtesy oj Mt. Sinai School of Medicine NIOSH's occupational disease research is conducted by thoroughly trained lab oratory personnel using the best research equipment available. mented. All but 10 workers of the 128 afflicted at CCF have regained their health. Plant closing? Long before peripheral neuritis struck, labor relations between CCF and Local 487 were notably uncon genial. CCF's Nosenchuck told us: "The Columbus plant has more work stoppages than any of the other 150-plus Borden plants in the United States or Canada." With the outbreak of the disease, relations between CCF and the union broke down completely. The union asked its members not to re port to work and filed a complaint in the U. S. District Court for Southern Ohio asking the court to declare the union's work stoppage protected under the National Labor Relations Act. At the height of the stoppage, about 500 of the 950 union members were staying home. In October, the Federal Media tion and Conciliation Service was called in. On November 5, the union and management signed an agreement on improved health con ditions in the plant, and the work stoppage ended. According to Nosenchuck, CCF paid temporary total workmen's compensation benefits to every worker who filed a claim. At press time, the number of workers receiv ing workmen's compensation claims stemming from the outbreak had dropped to 10. In February, the CCF contract with the union expired, and the union went out on strike. Spokes men for both the union and the company have told OH the main strike issues involve wages and benefits, not safety and health. At press time, the strike is still on. Borden has announced it is considering closing the plant, claim ing union demands for wages and benefits are too costly. Nosenchuck told us Borden has already removed some equipment from the plant. Cancer discovered As negotiating prospects grew dimmer at CCF, a second occupa- Q) *0 Q O Q 46 OCCUPMIONAl HAZAKDS/Mey 1974 tional disease nightmare unfolded. On January 23, 1974, B. F. Good rich Co. announced it had voluntar ily reported to NIOSH and the Kentucky Department of Health three cases of a rare liver cancer called angiosarcoma of the liver which fatally afflicted employees working in the vinyl chloride poly merization process plant in Louis ville. The men had died of the disease in September 1971, March 1973, and December 1973. Only 20 to 30 cases of angiosarcoma of the liver occur in the United States each year. NIOSH rushed to the scene and immediately began an investigation. On February 1, Dr. Marcus Key, Director of NIOSH, briefed other Federal health agencies, including the National Cancer Institute, the Food and Drug Administration, and the Environmental Protection Agency, and then announced: "On the basis of the medical, epidemiologic, and tokicologic find ings, thus far, it would appear that a new occupational cancer has been discovered: angiosarcoma of the liver. It is associated with the poly merization of vinyl chloride in the manufacture of polyvinyl chloride. Vinyl chloride is the chief suspect among the more than 50 chemicals used in the plant." Polyvinyl chloride is made by stringing together single molecules of vinyl chloride in the polymeriza tion process. The vinyl chloride monomer (VCM) is manufactured in 14 plants employing 1,500 work ers. VCM is polymerized into poly vinyl chloride (PVC) in another 37 plants employing 5,000 workers. U. S. companies made 5.2 billion pounds of PVC last year, one quar ter of the world's supply. The pro duction of the plastic PVC is second only to the production of polyethy lene plastic. The major producers of PVC are Goodrich, Goodyear. Firestone, and Uniroyal among rubber companies; BP Industries, Conoco, Exxon, Shell, and Tenneco among the oil companies; and Allied Chemical. Borden Chemical, Diamond Sham rock, Dow Chemical, Monsanto, Olin, PPG Industries, Stauffer Chemical, and Union Carbide among the chemical companies. In 1971. OSHA promulgated as a standard the recommended list of threshold limit values (TLV) of the American Conference of Gov ernmental Industrial Hygienists (ACGIH). The TLV for vinyl chlo ride at that time was 500 ppm and was the OSHA standard at the time Goodrich announced finding the cancer. ACGIH lowered its recom mended TLV from 500 ppm to 200 ppm in 1972. For several years, the vinyl chloride industry has aimed at a standard of 50 ppm, and Good rich was close to this standard in its Louisville plant. OSHA's re cently issued emergency standard for vinyl chloride sets 50 ppm as the TLV. Worker exposure About 270 of the 1,200 employ ees in Goodrich's Louisville plant work in the polymerization process. Worker exposure begins when VCM is transferred from railroad tank cars to storage tanks and then to the polymerization reactor vessels. More chemicals are added and the batch is "cooked" for 10 to 12 hours, producing a PVC slurry. The slurry flows from the reactor vessels, to the blow-down tank, to the blend ing tank, and then to a dryer. The now powdery PVC is packaged for shipment. The polymerization process from the reactor tank to the blending tank is a closed system, but workers who enter the reactor vessels to clean them after every third batch are ex posed. Near the blending tanks, dryers, and packaging lines, workers may be exposed to vinyl chloride gas from leaks in the system and from the gas coming off newly made PVC, and from PVC dust. Soon after Goodrich announced finding the rare liver cancer, Good rich doctors met with workers in small groups and explained the medical findings. Each worker re ceived a copy of the NIOSH recom mended industrial hygiene practices the company was following. The president of the Distillery Workers Union Local which represents the polymerization workers was named to the investigation team. Goodrich has hired TabershawCooper Associates to conduct an epidemiological study of angiosar coma in Goodrich vinyl chloride facilities. Goodrich operates five plants, including the Louisville plant, that make PVC, and one plant that makes VCM. NIOSH briefing On February 13, NIOSH briefed industry, labor, and science leaders on the Goodrich cancer outbreak. Vernon Rose, assistant director for research and standards develop ment, described NIOSH's recom mended industrial hygiene practices. They included: Housekeeping to clean up old resins in the plant background and storing PVC resins and wastes in closed containers in the future. . A system to inventory how much VCM was put into each batch and how much PVC was produced to learn how much VCM was escap ing from the system. Construction of eating facili ties separate from the production process. Fresh, clean coveralls, gloves, foot covers, and head covers for workers at the beginning of each day and showers for workers at the end of each day. Impervious suits with selfcontained breathing apparatus for workers cleaning the reactor vessels. Self-contained breathing appa ratus for workers transferring VCM from tank cars to storage tanks and reactor vessels. Dust respirators for packers. Continuous monitoring to de tect leaks in the piping and vessels used in the polymerization process. Eight-hour breathing zone samples for each worker to mea sure the extent of his exposure. Dr. Henry Falk, an epidemic in telligence officer from the Center for Disease Control, talked with the families of the angiosarcoma victims and investigated their medicai records. He also found and re ported a fourth cancer case. This worker's death in 1968 had been attributed to cirrhosis of the liver. Dr. Falk said all four angiosarcoma victims had non-alcoholic cirrhosis. They died at the average age of 46 years. Each had an average expo sure to VCM of 17 years. Dr. William Lloyd, director of NIOSH's office of health surveil lance and biometrics, whose early studies showed 20 to 30 cases of angiosarcoma of the liver occur per year in the United States, said a more thorough study of death cer tificates was underway and would include examination of certificates 23326005 Moy 1974/OCCUPATIONAL HAZARDS 47 for VCM workers whose death was attributed to cirrhosis. Dr. Joseph Wagoner of NIOSH said an epidemiological study of VCM workers was being launched. He said the plants chosen for the study would have a 15-year pro duction history, large VCM worker populations, and be located in States whose health department main tained detailed, comprehensive rec ords. At press time, eight plants had been selected for the study. NIOSH's Dr. Edward Fairchild reported a literature search was underway. He said 100 to 150 re ports could be found, but that trans lating some from Russian, German, and Polish would slow the work. OSHA action On February 15, OSHA held a public hearing to take suggestions on how OSHA should proceed. Sheldon Samuels, director of safety, health, and environmental affairs for the Industrial Union Department of the AFL-CIO, presented a peti tion on behalf of the IUD and the United Rubber Workers urging an emergency standard for vinyl chlo ride. Tony Mazzochi, legislative di rector for the Oil, Chemical and Atomic Workers union, supported the petition. Statements from Good rich, Shell Oil, and the manufac turing Chemists Association urged OSHA to follow the regular stand ards setting procedure for vinyl chloride. This would allow thor ough research and public comment on the new standard without the 6-month deadline imposed by an emergency standard. OSHA issued an emergency tem porary standard for VCM on March 29. The emergency standard reduces permissible exposure to VCM from 500 ppm to 50 ppm. It also re quires continuous monitoring of the workplace and use of personal pro tection whenever the standard's TLV is exceeded. On the same day, OSHA proposed a permanent stand ard for VCM which parallels the OSHA standards for cancer-causing substances issued last January and aims to eliminate all human expo sure to VCM. As we go to press, NIOSH has found nine angiosarcoma victims-- the original four, three more at the Goodrich plant (two of whom are living), one at a Union Carbide polymerization plant in South Charleston, West Virginia, and one at a now closed Goodyear VCM manufacturing plant in Buffalo, New York. On February 21, Ralph Nader's Health Research Group petitioned the Food and Drug Administration, the Environmental Protection Agency, and the Consumer Product Safety Commission to ban PVC aerosolized products and PVC pesti cides. As yet, none of the agencies has taken action on the petition. More coming? Perhaps the most disturbing les son learned from the CCF and Goodrich cases is that occupational disease outbreaks like these can happen again in almost any indus try, can happen, in fact, in your own plant. There are 25,000 chemicals on NIOSH's 1973 Toxic Substances List. OSHA has promulgated stand ards for only 500 of them. And as if fate had designed to prove the frailty and fallibility of occupational health knowledge, the chemicals suspected of causing both outbreaks were among this slim fraction cov ered by OSHA standards, and worker exposure to those chemicals was within the standards' limits. Certainly more of these outbreaks may occur as new medical and scientific discoveries are made due to intensified research and height ened awareness of occupational health. Vinyl chloride monomer: Is it a cancer-causing agent? Though the three cases of angiosar coma reported by B. F. Goodrich Co. were the first to point to vinyl chloride monomer (VCM) as a human cancer-causing agent, the carcinogenicity of VCM has been under investigation by the Manu facturing Chemists Association (MCA) since 1971. The first suspicions of the pos sible cancer-causing properties of VCM were voiced in 1970 at the Tenth International Cancer Con gress by an Italian scientist, Dr. P. L. Viola who described malignant tumors in the ear canals, lungs, and bones of rats subjected to extremely high levels of VCM vapors. In May 1971, Dr. Viola visited the United States and met with the Occupational Health Committee of the MCA. Based on this meeting and other evidence, MCA called a conference for VCM manufacturing comoanies in November 1971. Con ference attendees agreed to sponsor research on VCM under the aus pices of the MCA. The contract for the VCM cancer study was let in February 1973. According to the study's protocols, four groups of 600 rats, mice, and hamsters (100 males and 100 fe males of each species) will be ex posed to VCM levels of 0 ppm, 50 ppm, 200 ppm, and 2,500 ppm. They will be exposed 7 hours per day, 5 days per week, for 12 months. The animals will not have food and water during exposures. For comparison purposes, an other group of 100 rats of one sex will be exposed to 2,500 ppm of VCM vapors along with their food, water, and bedding, following Dr. Viola's procedures. The object of the MCA study is to: Duplicate European experi ments using VCM manufactured in the United States. To extend VCM cancer studies to mice and hamsters as well as rats. To develop possible doseresponse relationships. To determine the no-response level. The MCA study got underwaylast July, but an equipment break down ruined the experiment. A new experiment was launched in September. 43 OCCUPATIONAL HAZAPDS/Moy 1974 Activists push for lew approach to occupational health By CARL MUSACCHIO, Managing Editor "It's our mission to provide an open forum where management and organized Labor can meet for free discussions on health issues." 1 1 "Hopefully, our discussions will result in occupational health policies based on sound scientific data." Occupational health is emerging as one of the hottest labor relations issues of the 1970's. No doubt, labor-management confrontations over health issues will increase as the decade draws on and the num ber of class action citizens' suits will soar. Amid the growing turbulence, the Society for Occupational and En vironmental Health offers an alter native to raw confrontation. So Dr. Samuel S. Epstein, president-elect of the society, told Occupational Hazards: "It is the mission of the Society to provide an open forum where representatives of manage ment and organized labor can meet with experts from government and the academic world for free, some times adversarial discussions of oc cupational health issues. Hopefully the discussions will result in occupa tional health policies based on the soundest scientific data available, policies arrived at in open discus sion among all affected parties and experts in the field." Epstein, professor of environ mental health and human ecology at Case-Western Reserve University Medical School, Cleveland, will take over as president of the Society at year's end. Dr. Irving J. Selikoff, of the Mount Sinai School of Medicine of the City University of New York, has been president since the group was formally organized in No vember, 1972. The Society for Occupational and Environmental Health may seem, at Moy 1974/OCCUPATlONAl HAZARDS 49 .iwuei; 23326007 50 0,`OJPATI0UAl HAZARDS/Moy '.*>7- "Industry has failed , . . But organized labor and independent scientists were never in the van either." -.-v* i "Organized labor doesn't own me, and it doesn't own the society. Financing comes from labor, government, and industry." "There is a lot more occupational disease out there than anyone knows of. Much of it unreporteu. or undiagnosed." 23326008 i -* - Monaging editor Corl Musacchio questions Dr. Samuel S. Epstein. first glance, to be another of the several groups formed by health professionals, many on the faculties f medical schools and universities, .vho discovered occupational health after a stint with the ecology and consumer movements. Their battles with corporate management con vinced these academic activists that management held a monopoly on expertise in occupational and en vironmental health, and it was time they played trust buster. They freely offered their skills to organized labor whenever confrontation over health issues loomed. Surely there is a good deal of that spirit in the Society. As Epstein put it, "Management has always wanted occupational health matters dealt with in-house, by loyal com pany men. The new, independent professional realizes these are mat ters of social policy and they should be settled in the open, not behind closed doors." But the society offers more. For one thing, there's quality. The group's 300 member; include many of the country's best-known taients in community, environmental, and :upationa! health and medicine. - or another thing, there's balance. Membership is drawn from industry, organized labor, government, and academia. It includes, for example, John Shed ;an, 'legislative director of the United Steel Workers, and Dr. Merle Bundy, medical director of U. S. Steel. Epstein, aware that in some quarters the society is re garded as an instrumentality of labor, emphasizes the society's bal anced aspect. "Organized labor doesn't own me, and it doesn't own the society," he said. Financing, for example, comes from labor, government, and indus try. The Society's program com mittee, responsible for setting pro ject priorities, is also balanced among labor, management, and government. New approach The Society began as the result of an informal discussion between Dr. Epstein and Dr. Selikoff. Both are men of international repute: Crisp, no-nonsense Epstein as a cancer researcher and specialist in environmental medicine; the affable Selikoff for his landmark research into occupational disease among asbestos workers. During the discussion, British Epstein and New Yorker Selikoff found they were in full accord on this issue: "It was apparent to us that the distinctions between occu pational, environmental, and con sumer health were artificial and un founded," Epstein said. "Most toxic agents are first identified and used in the workplace, but eventually they find their way into the com munity either as products for sale or as pollutants. Widespread cases of community disease in the vicinity of plants using hazardous sub stances like lead or asbestos prove that." What disturbed Epstein most was that the fragmented approach, flow ing from those "artificial" distinc tions, had resulted in "two sets of exposure standards for toxic sub stances--one applying to the work place, the other to the community in general. I can see no scientific or ethical basis for such a situation," Epstein said. First goal of the Society, then, would be to consider occupational and environmental health issues in their entirety--not as fragments, but as an entity. To do that, the so ciety would have to draw from a wide range of disciplines: doctors, lawyers, engineers, toxicologists, and workers. Epstein and Selikoff favored the open forum for free exchange of wide and varied viewpoints. "Most existing forums were too frag mented. There was no central, pro fessional forum where the view points of management, labor, gov ernment, and academics could be related," Epstein said. The Society's forums would also overcome some of organized labor's disadvantages. "Most expertise in occupational health is in manage ment. Labor usually has a hard time fielding experts to match the array that management can muster. But at our conferences, the inde pendent professionals are there to provide backup expertise. What's more, we don't require formally trained experts. Many of the labor representatives have a high level of self-developed expertise, and they have made some of the most valu able contributions," Epstein said. During 1973 the Society held forums on: carcinogens, byssinosis, beryllium, the Roberts Report (a report to the British Parliament on the efficacy of safety legislation), and the standards setting process. This year, sessions are planned on lead, polyvinyl chloride, the health hazards of alternate energy sources (nuclear power particular ly), and pesticides. "We are also setting up a pro cedure for reviewing NIOSH criteria documents. They will be distributed to Society members who are experts in the specific areas covered by the documents before their official pub lication," Epstein said. Open forum Because of some of his views, in cluding support of the Oil, Chemical and Atomic Workers' strike against Shell Oil Co. on health issues, some in industry question Epstein's im partiality, maintain that he speaks only for labor. We asked him to comment on their observations. "What is a labor point of view anyway?" he asked. "I find view points ranging from, `Health is the most vital issue' to `Don't talk about it.' I don't consider myself allied with labor. Rather, I'm allied with anyone, wherever he comes from, who will work with me to control the health and safety hazards to the worker and the consumer." Epstein notes that though he was 23326009 May 1974/OCCUPATIONAL HAZARDS 51 an AFL/CIO consultant on health, he has taken issue with the AFL/ CIO position on the carcinogen standard question. The union wanted a permit system, Epstein pushed for a permit coupled with a user tax high enough to make employers think twice before using any of the 14 carcinogens and sus pected carcinogens covered by the standard. "Whenever we schedule a confer ence, all interested parties are given a chance to participate," Epstein said. "When I set up the beryllium conference, for example, the first group I called on was management. They refused to participate. I was disappointed, but they were given the opportunity." Management participation is essential to the success of a confer ence, and is in management's best interest, he believes. "You can't sweep these things under the rug anymore," Epstein said. "Times are changing. An active group of for ward looking labor leaders and scientists realize that a high priority has never been placed on health before, and they're determined to make up for lost time." Time io speak out Does the fact that so many scien tists saw the need for a Society for Occupational and Environmental Health constitute an indictment of what has been called the "industrial hygiene establishment?" we asked Epstein. "It does, indeed," he answered unhesitatingly. "Industry has failed; I think that is a well-recognized, proper inference. But organized labor and independent scientists were never in the van either." He deplores the number of health professionals whom he regards as owned lock, stock, and barrel by management. Some are speaking out, but not always loudly enough. "At one hearing I was amazed to hear an industry lobbyist voice dis satisfaction with his company's poli cies even as he enunciated them," he said. Epstein deplores equally union leadership which shrinks from press ing health issues. "I have a report of severe health problems resulting from excessive exposures to lead at a smeller plant. The local union is unwillinc tc raise its voice because it's afraid the plant may close down or move away," he said. Epstein believes all health pro fessionals, whether they work for corporations or for labor unions, should find their tongues and speak out vigorously for effective indus trial health programs. Failing that, some employees may have to turn to the courts. "A recent meeting with the Ohio Trial Lawyers Asso ciation convinced me that class action suits for redress could be come a powerful weapon. Use of the lawsuit would call company in dustrial hygienists to account for actions verging on the criminal. In no other walk of life could people make decisions affecting the health and safety of others with impunity," he said. Epstein, like everyone else in the occupational health field, is closely following the progress of a $100 million lawsuit now in the Texas courts. Employees exposed to as bestos who are now suffering asbestosis and lung cancers and the survivors of other employees now dead of asbestos and lung cancers have brought the suit against their employer and a leading industrial hygiene organization which had con ducted a survey of the plant for asbestos fibers and given it a clean bill of health. Health and safety strike Epstein sees the strike as another weapon employees could use to make health and safety gains. A re cent decision by the U.S. Supreme Court requires that any such stop page be justified by presenting ob jective evidence of the hazard in advance. Some in organized labor see the decision as weakening their hand. Epstein doesn't agree. "If there is to be a strike on a health or safety issue, all the facts should be laid out. If a panel of qualified, objective, disinterested experts were permitted to examine the facts, and it decided health hazards did, in fact, exist, no one could take issue with the decision to strike if it came down to that. Of course, the panel would have to have access to such information as what ingredients are used in a product, or what chemi cals arc employed in a process, and in what quantities. The panel would also require all records of environ mental monitoring, all records of medical examinations. If labor must make a case for a health hazard, management should be compelled to make the records available," he said. Epstein believes not only that records should be accessible, but that they be kept much longer than present requirements call for. "NIOSH wants records of lead ex posure kept for only 5 years, for example. That's nonsense," he said. "In many cases, adverse effects may not show up until 20 years after exposure." I t Bad news coming Epstein has figured prominently in investigations of outbreaks of oc cupational diseases both at Colum bus Coated Fabrics and B.F. Good rich (see story on page 43). "I believe these outbreaks are really just the tip of the iceberg," he warned. "There is a lot more occupational disease out there than anyone knows of. Much of it is unreported or misdiagnosed. Things like these outbreaks happen because there is no requirement for advance testing of chemicals before they are introduced into the workplace. The lesson of B.F. Goodrich and Colum bus Coated Fabrics is that reliance on epidemiology as a way of mea suring hazards is wrong. We must test for agents before they are used in the workplace. The test methods are now standard in the consumer field. You'd not eat food if chemi cals added to it had not been tested, yet we daily ask workers to submit to exposure to untested chemicals. We need comprehensive test data. In the absence of such data, the substance should not be used." Most of the current industrial health standards reflect this dearth of real, comprehensive test data, Epstein believes. "They are based on gross, short term effects, not the subtle, difficult-to-recognize, long term effects of exposure," Epstein said. "Industrial standards must be brought closer to community clean air standards. Perhaps they will never be the same because com munity standards must allow for the very old, very young, and weak, but the hundredfold difference that now exists between industrial and community standards is uncon scionable." JQI092E62 S7 OCCUPATIONAL' HaZARDS/Mov 1&74 I