Document gaNKdngnnnjZVOxK2Oy1zJ20Q

Community Health ASBESTOS: THE BLUE, THE BROWN, AND THE WHITE In 1979, ProfE. D. Acheson and Dr M. J. Gardner, ofthe MRC Environmental Epidemiology Unit at Southampton, prepared for the Advisory Committee on Asbestos a report on the ill-effects of asbestos on health.1 2Since then investigations into the ill-effects of asbestos have continued apace and in November, 1932, Professor Acheson and Dr Gardner were asked to examine any data published since 1979 that they considered would require substantial change to be made to the 1979 report and to present their new findings to the Health and Safety Commission. They also reviewed evidence which was available in 1979 but not presented to the Advisory Committee, and the 1977 report by Dr J. G. Moms an the health experience of workers in an asbestos factory in Rochdale: In a Yorkshire TV programme, Alice: A Fight for Life, broadcast on July 20, 1982, doubts were raised as to whether DrMoms' work had been properly considered by the Advisory Committee. Acheson apd Gardner's new report3 was issued by the Health and Safety Executive last week. Acheson and Gardner conclude that they have found no material that was available to the advisory committee in 1979 which on reconsideration would have altered the conclusions of their previous report. The present report is confined to the issue ofthe limit in the workplace; ofdata on this issue the authors say that their previous conclusions would be altered as follows: "Amostte I brown asbestos I imports have effectively ceased and chrysotile I white asbestos I is at present for practical purposes the only type of raw asbestos fibre imported into the UK. "The evidence that asbestos fibre causes alimentary tract cancer in man is less convincing than in 1979. "The case that amosiic is more dangerous than chrysotile has strengthened in respect of both peritoneal and pleural mesothelioma. We recommend that formal prohibition of the manufacture and importation ofnew products made ofamosite and crocidolite (blue asbestos I should be considered. "The range in the slopes of the dose-response relationships for lung cancer and chrysotile exposure has widened since our report of 1979. At one extreme the risk associated with the manufacture of textiles in South Carolina may have been greater than has been previously reported in relation to any other chrysotile application, while at the other extreme the presence of any increased risk with increasing exposure in a large cohort of men who manufactured brake linings is questionable." Evidence published since 1979 has supported the first report's conclusions on two topics: firstly, that the relation between mortality from lung cancer and exposure to asbestos is linear; and, secondly, that peritoneal mesothelioma has never, for practical purposes, and pleural mesothelioma has rarely occurred in human beings after exposure to white asbestos alone. Among the report's recommendations are the following: "In view ofthe fan that all forms ofasbestos can be c rcinogenic, further improvements in control should be made as advances in engineering make them reasonably pranicable and the use of all types of asbestos should be curtailed as safer and effective substitutes become available. "Steps should be taken to ensure that measurements ofexposure to asbestos in the workplace are made and recorded in such a way that it is possible to determine what benefits(ifany) have occurredas a result of improvements in the control ofdust. "We draw attention to the fan that little epidemiological information is available about the efTens of work :ne asbestos cement industry where chrysotile only has been usei. : :nis is now the largest single senion ofthe asbestos industry in tae UK, further research should be carried out at the earliest opponunity." 1 HcoJtb tad Safety Cotamaiioci Aabcna: vet 2: final report tf the Arfrioj Coot* ounce London: HM Stationery Office. 1979. 2 Acbceon ED. Gardner MJ. The control limit for mbara*. Heohh and Safety Communion London: HM Stationery Office. 1903. 5-90. The report also points out that all types of asbestos are extremely durable; workers may be exposed to them not only during construc tion bui also during servicing and demolition. Public policy should take account of these fans and precautions should be taken whenever asbestos is handled. Last week the Government announced a change of policy on the demolition of disused power stations containing asbestos: the power stations will now be stripped of all asbestos by the Central Elenricity Generating Board before they are sold to private contranors for demolition, thus reducing the risk of release of asbestos fibres by inexperienced contractors. The implications ofthe latest findings have not yet been discussed by the Health and Safety Commission. It seems odd that the Commission did not take this opponunity; the repon could have waueda couple ofweeks. The question now seems to be not whether but when use ofasbestos should be banned in new projects. Perhaps the Commission judged the matter too sensitive for a comment ofits own at this stage. CAMPAIGNS AGAINST SMOKING Every four years, representatives from many countries meet to exchange information on national smoking patterns. About 1000 people anended the 1983 conference on Smoking and Health in Winnipeg last month. Amidst those dedicated to eradtcatingflhe smoking habit were an unknown number of representatives/from tobacco companies, including British American Tobacco, who were taking note of this expression of solidarity betwaten the underfinanced and far-flung pressure groups, cancer knd heart charities, and other health organisations. / At the 1979 conference in Stockholm, Australia emerged as a nation strongly committed to preventive action. Hour years on, Australia is still taking the lead in health education and lobbying against the present advertising powers ofthe tobaaco industry. One Australian doctor happily identified himself as /member of a civil disobedience group, BUGA UP (Billboard Utilising Graflitiists Against Unhealthy Promotions), which, while also attacking sexist and alcohol advertising, largely devotes itself to defacing cigarette advertisements in order to expose the trutlyabout smoking. Another Australian group is called MOP UP (Movement Opposed to the Promotion ofUnhealthy Products). The work ofthese activists has had a significant impact in the ernes of Sydney, Perth, and Melbourne. Such guerrilla tactics/would be unnecessary were Governments to ban tobacco advertising entirely; and it looks as though Australia may well be thoTirst Western nation to achieve such legislation. / The general feeling at the coherence was one ofencouragement. Although the UK Government hardly seems committed to legislative anion, nor does it/give much financial encouragement to health education, the message ofthe anti-smoking lobbyists, such as ASH (Anion on Smoking ind Health) and the Bristol groups GASP and AGHAST,1 seems To be gettmg through: whether financial reasons underlay their decision or not, one million people in the UK have given up smokm/since 1980, and there are now twice as many adult non-smokers at smokers. Delegates from the Third World concentrated less ah the increasing numbers of smokers and the insidious and seductive pressures of the cigarette companies on a vulnerable market and more on the early measures nations are evolving to aid/ind encourage cessation. Recommendations from individuals at the conference and from the session ooups emphasised the vulnerability ofthe Third World, the high rates ofsmoking among women, including nurses, and the preventioil of smoking in children. Research on the success of cessation'techniques was discussed, including the role of nicotine chewing gum. The rights claimed for non-smokers included a xmol+im atmosphere as the norm. In the end, however, it was dea^hat the role ofnational governments in overcoming the force ofme tobacco industry by legislation, taxation, and comprehensive programmes ofhealth education was crucial in diminishing disease dnd death caused by smoking. 1 - Set Lsmca 1903; u: 293.