Document jgvGv2N6zgmq8M4Yg0mzM68N5

I PLAINTIFF'S EXHIBIT - s T01061n r~ r h* L l~ Council Report -- Asbestos Removal, Health Hazards, and the EPA Council on Scientific Affairs. American Medical Association Resolution 193 (A-90), which was adopted by the House of Delegates of the American Medical Asaociatfon,-catted onthe Council on ScientificAffairsto study the situation regarding asbestos abatement the risksto health, andthe appropri ateness of Environmental. Protection Agency regulations, policies, and control measures. This jeport reviews the current status of asbestos abatement as applied to schools and pubtic buildings, which currently accounts for the major eatpendture of public funds. (JAMA. 19l6fcefe497) TIME AND AGAIN, governmental agencies such as the US Environmental Protection Agency (EPA) and the-fed--eral OecupattenalTSafety aixLHealth Administration (OSHA) have ' been blamed for tbeir seeming insensitivity or lack ofresponse to aituatioas.thst the public perceives as crises. Once again the EPA has been admonished, but now the accusation is for bang overieakms as It attempts to molligr the pubhok con cerns about asbestos. Fbr many years, health experts have warned about the consequences of in haling asbestos fibers, wftieSrtHOspec- tive a their lorm, might lead to debDi- ^ Utiag hag impairment orcancer and ultimate death.1 Innumerable products aad applications have taken advantage of this 0berb unparalleled indestructiMifcy and versatility. Thus, thepossM^ ities fur unsuspecting'exposure have been endless: floorand ceiling'dies; hair dryers; ceiling insulation; filters for cig arettes; packaging for beer, 'wines, and parenteral fluids; brake linings; even drinking water By for the largest amounts of asbes tos, however, wge_used in the con struction trades and iodustrial or other processes, wberejtservedprimarily as a reinforcing fiber, thermal insulation, or fire-etop. It is in these areas ofapplication where there stall are the greatest F*omtoaCoavlon Soanbffc Affairs. A/naricanMadcto Aaaooatton. Chicago. U.- TN lopoit vw occaewd by vw houm oi Ooiooiiu c* the Amarican Madcal AwocaaSon a Sto-rterim matting on Daeambar 4,1990. Tti* tapert is not mandad to bajcanNruador to aar m standard ot msdica/ c*. Standard* t* madfct! can sra datowNnad on a baas ot a* te lacfe and pirctaiManoaa tovotvad m an indMouat aua antTara aubiactto ettonga aa acianobcknowtadga and tocOnet- ogy tdvanc* and panama of practice me**. Th* . port maacti Sia W*c or tha toanUttc Martoura u 4 Oaoantoar i9S0. Haprtn raauaan to tha Couroi on SoontMc Affairs. Grotaton Sctones and Tbchnptogr. Amwicaft Madical Aaaoctotton. SIS N Slat* St, Chicago. tL 90610 (Jarad M.Loab.PhO* numbers ofpotential human exposures. The courts are still jammed with legal proceedings as thousands of shipyard conatruttion_and asbestos insulation woriceraortheirbetrs seek legal redress for pulmonary disease and mesothelio ma allegedly caused by past exposures toasbeatoe. In the early 1980s, parents and ad ministrators of a number of public schools were dismayed to find students delightedly bouncing basketballs against gymnasium wails and ceilings to bringdown a showerofwhite Auzy stuff that often turned out to be asbestos. Congress reacted promptly with the Asbestos Hazard Emergency Response Act of 1986 (AHERA1 The act required that all public and private schools be inspected for the presence of asbestos and that immediate management ef forts be undertaken toprevent a further .threat to health. The current policy of the EPA, however, does not necessarily require removal1 Consideration has since been given to extending the AHERA program to afi public build ings. `Hie EPA haa announced that nearly 94% of the nationh public school districtaand private schools have com plied-with'initial requirements of the AHERA; this represents 28 states with 96% orgreater compliance and 40 states with more than 90% compliance.* For some 107 000 primary and sec ondary schools alone, the price tag was initially believed to be at least 93.4 bil lion (Wall Street Journal. September 8, 1988:BU By including public and com mercial buildings, the EPAb estimate grew to $63 billion `discounted at 10% over SO years'* and even as high as $150 billion.* The EPA now believes that an additional 733 000 sites (ie, 20% of all government, residential, and pri vate nonreaidential buildings) contain some form of friable asbestos and will need renovation,* at an ultimate coat for removal of $100 billion to $150 billion. New York City, NY, alone is believed to have asbestos in 67% (or 153 000) of Us commercial buildings.* In an effort to gain a rational perspec tive on the situation, the EPAfc Office of Tbxic Substances established a pro gram of policy dialogue directed to the public* concern over the presence of asbestos in publicand comaierrial budd ings. The first public meeting was held My3,1989, in Washington, DC. Subse quently, the Office nf Tbxic Substances hired the Conservation Foundation lo cated in Washington, DC, to hold addi tional meetings with a group of35 per sons representing the unions, building owners and managers, real estate agents, mortgage bankers, insurance companies, asbeetoe manufacturers, building contractors and consultants, public health groups, and government agencies. These meetings were in tended to produce a consensus as to what federal and state agencies and pri vate parties should do to address the matter of asbestos in public and com mercial buildings.7 The graph final re port appeared in June 1990. Not sur prisingly, opinion was divided on whether regulations should indeed be extended to include nonecbool build ings; the reasoning had more to do with economics than with public health.1 Meanwhile, several editorials and sci entific articles have attempted to instill a sense of reason into a debate that fo cuses primarily on a misunderstanding ofhealth risk. The debate will probably continue as long as there are uncertain ties regarding health risk, especially as they pertain to nonoccupational expo sures, and the mechanism of asbestos pathogenicity remains unexplained. Msmbtn oflh$ Councion SdtfltAc Alter* nctoda <Tw foteMng: WMtenC. Scad. MO. fecaon.Arte Chairman: E. Harv*r Ettas. A MO. Durham. NC. Viet Chairman. Yank O. Cobit. A MD. Jackaonstot. Ft* A Bradtoy r**nbr*r. MO. WO. Royal Oak. Mfcfc Mtehsfl S. Kartan. MO. Bawdy Hte. CaK; Vfflam R. Kamady. MO. kSmaapofe. Utm; Mfehaal P. Moulton, San Antonio. Tax: Panda Joy Nununn. MO. Syracuaa. NY: W. Doug las Skater. MO. Macon. Qa. Richard M StenMbat. MO. CteWana. Ohio; Jack P Strong. MD. Now Oriato. La; Haray N. Wagnar. A MO, QaWitoto. Md; and Robatt H. Whaam US. andTfcaodwtC. Doaga. MO. MS, aaff author*. Chicago. . 999 JAMA, August 7.1991 --Mai 268, No. 5 Asbestos Ramowal--Council on Scientific Attairs -Mra-m association 81I 90L01S Mosaman et al,* for example, sought to differentiate between the comparative health hazards of the various asbestos fiber types--ie, serpentine and anphibole--as well as to comment on the de clining incidence of asbestos-related disease that should become manifest be cause less hazardous fibers are now be ing used. Then too, the permissible ex posure limit in industry has been lowered dramatically over the past 20 or so yean; OSHAb proposed rule of July 17,1990, would further reduce the per missible exposure limit from 0.2 fiber per cubic centimeterto 0.1 fiber per cu bic centimeter ofair." Unfortunately, the hazard of asbes tos still in place affords a potential risk of indeterminable magnitude. Building occupants in genera) are presumed to be at relatively low riak of exposure, inas much as indoor fiber concentrations are found to be no higher than levels in out door air." However, there can be no denying that custodians, fire fighters, and maintenance, repair, and demoli tion workers will encounter situations where the ambient concentrations ofas bestos fibers--type unknown--meet or exceed levels permitted by OSHA. This group may very well be victims of what Selikoff and others have referred to as the third wave" of disease11 (the "first -wave" being those workers involved in the mining and milling ofasbestos ore in the early 1930s and 1940a, and the "sec ond wave" being pipe fitters, shipyard and insulation workers, and others in cluding the user* of asbestos-containing products who, during World War II and into the 1960s, were also exposed to massive amounts of asbestos fibers). Evidence is now accumulating on the fate ofschool custodians.0 The role of EPA administrators has not been easy as they have attempted to balance the worries and demands of an aroused public against inconclusive medical evidence, ft* current EPA ad ministrator has replied to some critics by explaining in detail the EPAb stance on its asbestos abatement policy. One generally misunderstood point that bears repeating is that the EPA does not mandate removal of asbestos mate rial unless "material damage is exten sive and severe, and other actions [such as special maintenance, repair, encap sulation or enclosure) will not control fiber release."*" The EPA should be commended on its most recent efforts to clarify some of the scientific uncertain ties surrounding this issue, which in clude support of the Health Effects Institute-Asbestos Research in Cam bridge, Maas. Admittedly, the EPA has responded slowly as a number of school districts have been panicked into taking costly and sometimes unwarranted actions. The agency has developed educational materials in cooperation with the Na tional Education Association and the National Parent-Tbacher Association and has set up programs for accredita tion of trained inspectors. Moreover, citizens may call a toll-free number (800368-6888) to discuss questions regard ing asbestos in schools.1* Measures such as these will undo some ofthe confusion that now prevails, but there will un doubtedly always be unresolvable dif ferences between what the public per ceives and what authorities consider to be the major public health riska. Some would say that many ofthe mis conceptions of Che peat and present could have been avoided if the public had been better informed or educated about the subject of relative risk as it pertains to human health. Yet, educa tional efforts by scientific organizations and government agencies have met with frustration and some of their at tempts have been abandoned. Until there is a better understanding of the process of riak perception and how to deal with it, any real advancement to ward an enlightened society is unlikely. In the meantime, the real hazards to health--smoking, improper diet, inade quate exercise, high-risk recreational activities--are disregarded by many persons while they complain about the evUi of industries whose actual hazards to health often pale by comparison. The case of asbestos is neither the first, nor is it apt to be the last, of these seeming misconceptions, imbalances, and between scientific fret and the need (or action. Society has al ready reeled oar the impact of dioxin, polychlorinated biphenyls, and other in dustrial wastes that were inappropri ately dumped some decades ago at Love Canal, NY, and Times Beach, Mo. Cleaning up the misdeeds of the pest and attending to such consumer scares as Alar (damtnoside) residues on a small sample of apples have consumed vast amounts of capital and human energy. Some of these cleanups and other con trol efforts may be of questionable benefit. Asbestos, unlike any number ofother potentially dangerous minerals or chemicals, will never be entirely elimi nated from the environment. There fore, developing improved procedures for managing its proper use, contain ment, and disposal offer the only realis tic prospects for the prevention of asbestoe-related injury and disease. In other words, it is better that society ose its limited financial resources in learn ing how to bve safely with this valuable materia] than in attempting to remove it totally from the environment." At present, the beat offered riddance to bad rubbish is to remove it from one site and place it in another. But this ploy merely delays the inevitable when the risk ofexposure will rise again at anoth er time. The Council on Scientific Affairs sug gests that there is a lesson to be learned from the asbestos dilemma. Hindsight suggests that if a Consensus Confer ence had been sponsored by the Nation al Institutes of Health in the early 1980s, the EPA might have better fo cused and directed its regulatory efforts. Ideally, the conference would have made a major attempt to enlighten society about major health hazards and realistic cost projections for ameliorat ing the asbestos riak. The EPA can still perform a major service by clarifying and publicizing the beet available means ofremediation. Physicians and others in medicine and biology, on the other hand, must continue to drive home to the public the far greater causes of mor bidity and mortality, such as smoking, drug and alcohol abuse, improper diet, and inadequate exercise, 1. Courted oo Scientific Afhira, Amaricaii Medical Aaaoaation. A phyortmih guid* to aabeetae-relat ed ******* JAMA. 19644624888-28S7. S. Zurer P&. Manyaabartea removal project* died u aeodlaae, eottly, tad rfaky. CJtom Netea. 19004(8)41-22. Z. School* complying with AKEKA. Chenrienl*- m-prafrut Bull. 1990,11(1)4. 4. Con M. Penpactive an to* p*unti*l riak sad management option* far tabarto* lo huflrlingi Pre- Ntiud at to* 22nd International CwiptN h Occu pation*] Uaaltli; September 1964; Sydney, Auotralia8. AtkeatM m Bwildrap*.- A National Swney tf A/tarioo-Cfenlererv fnabU Material* Wuhtagton, DC: US EnrtroamanU] Protection Agency; 1964. EPA publication MO 1644401 f. Aaaewtin to* oabeatoo fink. Conewmer* Am July 1990:10-12. T. TOman ID. A*booto* ia public mid eaowneraal buildup. CbreucafcHJi-Prgpvee* Bull. 1990,11 (1)4. I. Dialogucra agra* to diaegrae. Aebecfar /amea Auguit 19004(8)4. 9. Moeaman BT, Bignoo J. Cora M, Seaton A. Gee JBL. Aabeetoa: ariantifie development* and impli cation Cor public policy. Some*. 1990&72H401. 10. OSKA pwpoooo halving PEL for workplace aabeetoa. Ooeup Health Soft**. July 1900:120. 11. Cbaaaou J, Hatfield J, Sehaha B, Dutrow E, StakoJ. Airborne tohaatoo in pubbe building*- nm Am 1990^1:100-107. 12. Brieber JL. Tb# third wave riak. Aateato* It um 19904(8)4-17. U- Redly WL Aabeatoa removal Seine* 199024& 1063-1066. 14. McNally RC. The EPA reapoade. Aetata* /*- iwi 19904(4)42-21. 16. 1%* ABCt ofAthttio* re School* Waahiagton. DC: US Environmental Protection Agency: June 1989. EPA Peetictdaa and Iterie Subetaacao publi cation T&TB9. 16. Pauli JM. Core M, Lea* PSJ, Bieyoo* PN. Non-occupational axpoaare to aabaoto* in build- mgv Am Ind Hyf Alooe J 1906;47:497-601 JAMA. Augutl 7,1901--^31286. No 5 Aabeetoa Removal --Council on Scientific Aflstr* W7