Document mB34avZ9K2BbEdDb9pYrnvjEB

FILE NAME: Doubt Science (DBTS) DATE: 2007 DOC#: DBTS007 DOCUMENT DESCRIPTION: Welch Journal Article from IJOEH - Asbestos Exposure Causes Mesothelioma, But Not This Asbestos Exposure: An Amicus Brief to the Michigan Supreme Court Asbestos Exposure Causes M esotheliom a, But Not This Asbestos Exposure: An Amicus Brief to the Michigan Supreme Court LAURA S. W ELCH, MD* CMmaannuuffaaccttuurrienrsg oafnadsbiensstousrabnrcaekesin, dsuusptpryortaemdicbuys mcuarniey, We make no claim to know the "correct" answer to disease causation in the specific case under review in rmeoqnuyesotefdantheexMpeircthriegganardSiunpgretmheeaCbioliutyrtotof adsibsemsitsosstdeustsit the court. Our concern is with the sweeping and unequivocal claim that any conclusion that asbestos fSrcoimentbisratskesarteo ccaounsceemrneesdothweiltihomtaheas s"jwuneekpsincgienacne.d" from brakes has caused a signature asbestos-related dis ease in a particular person must be `junk science."We ufrnoemqubivraokceasl ccalauismeds athsaigt naantyurecoanscbleusstioosn-retlhaatetdasdbiseesatoses find that sweeping pronouncement itself is what veers from accepted, reliable mainstream scientific methods iunfaacptuarretircsu'laswr peeeprsinogn mpruosntobuen"jcuenmkesnctisenacree."wThhaet mveaenr and conclusions. farnodmcoancccelupstieodn,s.reTlihaibsleartmicalienosturtelainmesscthieenetivfiicdemnceethsoudps Ample Evidence Supports the Conclusion That Asbestos panodrtidnogesthceaucsoenmcleussoitohneltihomataa,sabnedstodsesfcrroibmesbtrhaekedsefceann from Brakes Can and Does Cause Mesothelioma dsiaonnt.s'Keayttewmorpdtss-, atosbfeasbtorsic;abtreakdeosu; bcthraybsooutitlet;hmiseccohnancilcu; Chrysotile causes cancer, including mesothelioma. `There is general agreement among scientists and health agen occupation; epidemiology; mesothelioma. cies ... [ejxposure to any asbestos type (i.e., serpentine INT J OCCUP ENVIRON HEALTH 2007;13:318-327 o[cfhlruynsgotcilaen]ceorr, ammepshoitbhoellieo)mcaa,nainndcrneoasnemtahleiglnikaenltihlouondg ompanies that made and sold asbestos-contain andMpalneyuroatlhderisroervdieewrss."s1upport this conclusion, such as those from the American Conference of Governmental ing brakes asked the Supreme Court of Michi gan to effectively rule that it is impossible to ItnhdeuEsntrviiarloHnmygeinetnailstPsr,2ottehcetioAnmAegriecnacny,4TthhoerIanctiecrnSaotciioentya,l3 csuornetrtaoctasabsbesetsotsosf-rroemlateadsbdeissteoassebsraaksesa.!reAssulpthoyfsiecxiapnoAPsrgoegnrcaymfo,6rtRheesOeacrccuhpoantiConaanlceSra,f5etthyeaNndatHioenaalltThoAxdicmoliongisy and scientists, we are concerned about the epidemic of asbestos disease that continues to cause the deaths tration,7 the Consumer Products Safety Commission (CPSC),8 the World Health Organization,9"11 and the of thousands of workers each year in the United States. The signers of this paper represent hundreds World Trade Organization.12This scientific consensus is also reflected in the Consensus Report of the 1997 of years of experience researching, diagnosing, and treating asbestos-related diseases in workers and their Helsinki Conference,13and publications from the Amer ican Cancer Society14and the National Cancer Institute families. We have published extensively in this field for more than 30 years and have conducted dozens of of tThheoNroautigohnaslcIinensttiiftuicteisnqoufiHryeareltqhu.1i5res consideration of eapsbideestmosioalnogdicdisaenadse.oMthaenrysotufduiseshaivnetotesthtiefieidssbueefsoroef aclolnacvluasiliaobnlethiantfocrhmryastoiotinle. aAsbcceostrodsincgaluys,eisnmreesaocthhienligomthae, legislative and regulatory bodies regarding asbestos and disease and in court proceedings at the request of scientists properly consider numerous accepted sources of scientific data, including epidemiologic studies of all individuals suffering from mesothelioma and other asbestos-related diseases. varieties, case reports and series of case reports, con trolled animal experiments, and toxicologic studies.1'16"23 Asbestos industry arguments to the contrary have not been *Dr. Welch is joined by 51 other signers onto this communica tion; see end of document. nsuiepspoarnteddmovaenrutifmace.tuCrehrrsyshoatvileeaarsgbueesdtofsomr minoinreg tchoamnp3a0 f Chapin u DaimlerChrysler Corporation et al, Case No. 133178, Supreme Court of Michigan. ytheaartstehietrhee risthinatsuthffeiicriepnrto ducts do evidence ntoo t cause reach disease or a reliable Address correspondence andreprint requests to; Laura S. Welch, MD, Medical Director, Center to Protect Workers Rights, 8484 Geor conclusion. Numerous scientific articles and criticisms have specifically exposed the artificial uncertainty cre gia Avenue, Silver Spring, MD 20910, U.S.A 318 ated by the proponents of chrysotile asbestos, and their position has been repeatedly and consistently rejected by the mainstream scientific and regulatory comTimkeunmitiaensy.18s"2c0i,e24n-t2i6sts, we are concerned with the development and expansion of "doubt science. 27,28A centerpiece of the "doubt science" model is the asser tion that whatever piece of evidence supports the posi tion of the industry in question (or whatever piece of evidence might be as yet undetermined) is the critical pwieecaeckonfoewvildedengceet,htaot tihneduesxtcrlyu-ssipoonnosofraeldl ortehseerasr.cWh hcialne and does often provide valuable scientific insight and developments, the efforts of the tobacco and asbestos industries to deny their products cause cancer have becIonmtheisa rpeagraarddi,gmwefoarre"dcoogunbitzsacnitenocfet.h"e fact that the primary articles upon which the asbestos brake manu fearcatluMreorstorresl,yCinhrtyhsislemr aatntderowthereerpaasibdesftoorsbbyrFakoerdm, Ganenu facturers. Publications by Hessel,29 Goodman,30 and PGaeunseteranlbMacoht3o1r,3s2, awnedreCharlylsleexrp. rFeussrltyhefrumnodreed, tbhye pFaopredr, by Hessel et al. appeared in a journal funded by the Ford Motor Company and a subsidiary of General Motors. Wong33has been reported to have undisclosed origins as an expert witness report for a brake manu facturer.34 Laden acknowledges funding by a law firm that is "national asbestos counsel"for another asbestos brake manufacturer.35 The Scientific Community is in Consensus that Even Brief and Low-level Exposure to Asbestos Can Cause Mesothelioma The mainstream scientific community has long recog nized and continues to recognize today that there is no "safe" level of exposure to asbestos.12,13 As noted by NIOSH: fEixbceerssciovnecceanntcreartiroinskssshtauvdeiebdeeton ddaetme.onEsvtarlautaetdioant aollf athllreasvhaiolladbloerhfuomr aan"sadfaet"alepvroelvoidfeassbneosteovsiedxenpcoesufroer.3a6 Attempts to postulate thresholds for exposure have beeTnhedislmacikssoedf aasd"elofginiceadl n"soanfese"nlesev.e"l37for exposure to asbestos has been supported by subsequent research. Fthoartesxuabmsptalne,tiaallaerxgceesFsremncohrtasltiutydyorceccuernstlyatcoenxcplousduerde leexvaemlsibneinlogwthceurrerelanttiornegshuilpatoberytwleeveenlsh.3i8stAorriceacleanstbsetsutdoys uthseataanldindeiasreadsoeser-arteesspfounrstheerrelsautipopnosrhtisptehxeisctsonbceltuwseioenn exposure to asbestos and disease and that no safe level of exposure exists.39 One of the main studies upon which the asbestos brake manufacturers rely40similarly concluded that all levels of occupational exposure to asbestos increase the risk of mesothelioma: Cneovmerpaerxepdostoedt,haolslelewvehlos onefvperrobwaobriklietyd aonrdwihnotewnseirtey r[ioskf,exepxocesuprtesutobjaescbtseswtoitsh] lhoawdparnobinacbrieliatyseodfseixgnpiofsicuaren.t For exposure classified as "sure"the ORwas 13.2. Application of this study to the current case under review would result in his placement in the "sure" exposure cat leigkoerlyy,toancdoncotrnascetqmueensotltyhheleiowmoaultdhabne ouvneerxp13ostiemdeisndmivoirde uals. Despite this, the asbestos brake manufacturers assert that the Agudo study proves that no person can ever get mesothelioma from asbestos brakes. That argument is unsound and contrary to the consensus of the scientific ceoxmpomsuurneittyo tahsabtestthoesrebeilsownowdheicmhoandsvtrearbselehteharletshheoflfdecotsf do not occur. Accordingly, "an occupational history of brief or low-level exposure should be considered suffi cient for mesothelioma to be designated occupationally related" to asbestos exposure.13 Mesothelioma Is a Signature Malignancy for Asbestos Exposure There is no debate that asbestos causes mesothelioma, and that the great majority of mesotheliomas are demonstrably caused by asbestos.41 Some mesothe laisobmesatsosareexpnoesvuerer, aabnled ttohebsecieinndtiifviciducaolmlymluinnkiteydhatos dtieofninreedgatrhdeisneg caassbeesstoass e"xidpioospuartehiics"unbaevcaaiulaseblein. forma However, we know that many individuals do not know that they have been exposed to asbestos.42 Many more die before being interviewed regarding potential exposures, forcing researchers to make assumptions about exposure based upon information from next of kin, job titles, or death certificates; these sources often fail to reflect alljobs and exposures.43,44Many epidemi ologic studies assess occupational exposure but not para-occupational or environmental exposure, because only occupational information is available from exist ing records. The fact that a percentage of mesothe liomas are labeled "idiopathic" does not, however, sup pspoortnttahneeocounsclu(is.eio.,n nthoant--tahsebreestoarse-relalargteed)nummbeseorsthoef lsiooumrcaes.s Tofointfhoermcoantitoranryfa,ilaedlatrogedesmtuodnystoraftenuemvideeronuces for "spontaneous" mesotheliomas,45 and a detailed roevveirew90o%f mhaedsoetihtehleiroma ahicsatoserys ionf Aexupsotrsaulriae foorusnudbstthaant tialTahsebeasstboessitnoslubnrgakteissmuaen.42ufacturers attempt, without support, to recast the definition of "idiopathic." First, VOL 13/NO 3, JUL/SEP 2007 w w w .ijoeh.com Asbestos Causes Mesothelioma 319 in an attempt to undercut the indisputable link between asbestos and mesothelioma, they suggest that "idiopathic" mesotheliomas are not caused by asbestos rather than accepting that these are cases where indi vidual exposure has not been identified. Second, they attempt to place mesotheliomas with demonstrable occupational exposures to asbestos--specifically aTshbeersetoiss nforosmciebnrtaifkicess--upinportht efor"iediitohpeartphoics"itiocant.egory. Mesothelioma is a signature tumor for asbestos exposure. Individuals with known occupational expo sures to asbestos cannot be recast into the "idiopathic" or "unknown exposure" category. When confronted with an individual who has a demonstrated mesothe lioma and demonstrated occupational exposure to asbestos, the mainstream scientific community recog nizes that the cause of that mesothelioma is the asbestos exposure of the individual even if that expo sure was "brief or low-level." Because Mesothelioma Is a Signature Malignancy with Essentially One Cause-- Asbestos-- the Scientific Community Has Long Considered Individual Cases ofMesothelioma to Be Sentinel Events It is not necessary to have an epidemiologic study of a specific occupation to be able to conclude that an indi vidual's exposure to a toxic substance in that occupa tion can be a cause of disease. To the contrary, as noted by Dr. Lemen, Sdpoeecpifiidceomcicoulopgatiicoanlsstduodinesont eneededtotobebepesrtfuodrimedednotor stahkoewnroisrkcaoufsdailsceoasnenebcetfioornes pcroenvcelundtieodn. aTcotiwonasit aforer enpoitdwemarioralongteydstbuudtiehsaosfbeeaecnh toackceunpabtyiomnaalnygrionupthies msaetidoincob-lyegoaclcpurpoafetisosnio. nSauscthhemoisnclyonwcaeyivtoedprtohvinekcianug hasabsebsteoesn-revleartyedhdairsmeafsuels.'t*o6the future prevention of This is particularly so when examining mesothe lioma. Repeated studies have shown that all levels of eoxvepro,suunrelikinecmreaansey tohteherirskcaonfcmeress, oftohrelwiohmicah.88t,h40erMe oarree multiple, well-documented causal factors, mesothe lioma is overwhelmingly caused by asbestos. As noted by one of the studies upon which the asbestos brake manufacturers rely: Mlogeiscotehxeplioosmuarei,s taherarerefocraencsuerrvweiitlhlanocnee umsainjogr eeaticohfcoasrethasisadsiesnetaisneeltheavnenftomr icgahntcseeresmwmithorme ureltaisfoacntaobrlael causation.47 Ienve1n9ts83(SRHuEts-tOei)n dtheavteloapreedoaccluisptatoiof nsaelnlytinreellahteeadl.t4h8 Mesothelioma as a sentinel disease for asbestos expo sure was on the initial list of SHE-O, and all subsequent revisions. In fact, the worldwide acceptance of mesothe lioma as an asbestos-related cancer began with the case serWieshpeunbelixsahmedinbinygWtahgenqerueinstiIo9n60o.4f9causation of sen tinel diseases such as mesothelioma, the scientific com munity recognizes that case reports and case series reports are useful and valid tools. wCahseeresetrhieesrearaerepaidrteincutilfaireldy oincfcourrmreanticvees ionfsvieturyatiroanres ccaounsdailtifoancstoforsr.w..h. iIcnhftahcetr,ereacroegfnewit,ioifnaonyf,eevsetnabalissmhealdl nliuvemrbaenrgoiofscaarsceosmoaf tahned"smenatliingenla"ndtismeaesseos--thesluicohmaas, which is strongly related to asbestos exposure.50 The scientific community has concluded that, for sentinel diseases such as mesothelioma, case series reports can be sufficient by themselves to allow reliable conclusions to be drawn regarding causation. Again, as noted by Checkoway: Cthaesier osewrniesrigrehptowrthsencatnhebheeavlitrhtuaolulytcocomnecliussiaveveirny raatirveeldyisceoamsemoornancounndciotimonm.5o0n manifestation of a rel We do not suggest that such conclusions are indis putable or inviolate; scientific knowledge rarely is. The relevant question is whether reliable and scientifically justifiable conclusions can be drawn based upon such information, when considered in connection with all other available evidence. They can. In fact, proper application of the scientific method requires consider ation of all forms of available evidence. Accepted Methodfor Evaluating Disease Causation in an Individual: Generally and as Applied to Asbestos Exposure and Mesothelioma Examining the question of causation of disease in an iinnddiivviidduuaall geexnpeorsaeldlytionvaoltvoexsicfoaugreqnute2s)tiodnose:s1t)hewaasgtehnet cinaduisveidthuael deisxepaosseepdretosetnhtisinsuthbestainndcieviadtuaal;le3v)elwwashtehree disease has occurred in other settings; and 4) have other competing explanations for the disease been excTluhdeerde?is no reasonable dispute regarding Question 2--asbestos causes mesothelioma. Additionally, there are no well-accepted competing explanations regard ing mesothelioma that must be excluded, resolving Question causation 4o.fAasmaerseostuhlet,liwomhean, considering the issue once an occupational oorf pliasrhae-doc(cQupuaetsitoionnal 1e)x,ptohseurseolteo qasubeessttioosnhraesmbaeienninegstfaobr 320 Welch www.IJoeh.conn INT J OCCUP ENVIRON HEALTH examination is whether the exposure or set of expo sures of that individual is similar to exposures that have been documented to cause mesothelioma in others-- QuTeshteiomn a3i.nstream scientific community is in consen sus regarding the resolution of Question 3. As dis cussed above, there is no safe level of exposure to asbestos. Even exposure at current regulatory levels results in excess mesotheliomas.7'38 Accordingly, the consensus of the scientific community is that any occu pational or para-occupational exposure to asbestos-- even "brief or low-level exposures"--must be consid ered causal in an individual with a mesothelioma. The Claim of the Asbestos Brake Manufacturers That the Studies upon Which They Rely Trump All Other Scientific Knowledge Is Scientifically Unsupportable. The asbestos brake manufacturers cite a number of epi dcaemnniooltocgaiucssetumdeiessotahselpioromoaf. tThhaet amsbaensutofascftruormersbcralakiems the fact that these studies did not detect a statistically significant increased risk of mesothelioma in the occu pational groups studied is conclusive proof that no person can ever contract disease from working with asbTeshtaots cblraaikmesi.s simply not scientifically supportable. We need not examine here the individual shortcom ings of the studies relied upon by the asbestos brake manufacturers. Others have done so cogently and in dmeataniul.f1a6c,3t4uWrerhsi'leswoeuerpirnegjecctliaoimn oisf stuhpepaosrbteedstobsy btrhaeksee critiques, the fundamental scientific failing of their cinladiimvidiusanlosttubdiaesse.dThoenrethiseaodbivffioeuresnlciembiteattwioenesn oaftrtuhley negative result and a non-positive result. A true nega tive study must be large, sensitive, and contain accurate exposure data. Even then, the study will be negative fornolmy wpirtohvirnegsptehcatt tnoothpeeresoxnpocsaunreelveevrelgesttusdiicekd.frFomar asbestos dust released by brakes, the best that can be said for the studies is that they are inconclusive. Instead, such a claim is based on the scientifically unsupportable proposition that one study, or group of studies, trumps all other evidence, no matter how extensive and well-documented that evidence is. Addi tional discussion of the implication of "negative" epi demAsiolnoogtiecdstuabdoievse,maeyxabme ifnoautinodnelosfewthheereq.5u1e-5s4tion of wrehqeutihreesr caonssuibdsetraanticoen iosfcaallpasbcileentoifficcdaiussciinpglindeisseaansde all available evidence. This is particularly true when asserting that exposure can not cause an effect. Thahremcfuolncelfufseicotn(et.hga. tascoemrteaienxpchoesumriecails idsenvootidcaorf cinogenic) must be based on a synthesis of the wsinhgollee satvuadiyla.bHleenlicteer,aatullreth: eitsccaienntniefivceervriedleynocne o(in.ee. tehxeisotrsemticuaslt beexpceormimbeinnetadl.,65and epidemiologic) that Substantial insight into this issue is provided by the industry consultants hired by Ford, General Motors, and Cashbreysstloesr-.bWrakheenlithigiraetdionto, trheepriensdeunsttrtyhecoanustoultianndtussatrsyseirnt that their cited epidemiologic studies trump all other evidence, and conclusively refute the claim that asbestos from brakes can cause mesothelioma.29,30 Conversely, wrehgeanrdhinirgedepbiydetmheioploowgiecrsitnudduiesstrtyhtaot wpreorveiddeamteasgtiimngontoy that industry, Dr. Hessel rejected this same position: Bogeycasutusedioesf sbuycthheremcsoeglvneizsegdenliemraitlalytiodnos,neoptipdreomviiodle stiuofnfi.cTiehnattbiasswishtyothsuepapsosertsscmonencltuosfiohnesalatbhoruistkcamuusast rsetulydioens indahtaumfraonmcetollxsiacnodlogtiiscsaulesstaunddieesxipnerainmimenatlas,l clinical studies.56 The opportunistic rejection of whatever evidence exists contrary to the position of the industry being defended is a hallmark of "doubt science."We disagree with both extremes. Epidemiologic evidence may, in cases, be sufficient to make reasoned and well-founded judgments regarding causation after consideration of other available evidence, even if evidence from one or more other scientific disciplines is absent. Conversely, creoanssoidneerdaticoonncolfusoitohnesr srceigeanrtidfiicngevcidaeunscaetiomnayinalltohwe absence of positive epidemiologic studies regarding a speIctifiiscupnospciuelnattiifoinc.for the asbestos brake manufactur etrrusmtop aasllseortthethraetvitdheenircec,hjoussetnaseiptiwdeasmuionlsocgieicntisftiucdfioesr the tobacco industry to claim that lack of understand ing of the mechanism by which tobacco causes cancer made it impossible to conclude that cigarettes cause cancer. Proper application of the scientific method requires that all available evidence be considered when examining issues of causation. Evidence Supporting the Conclusion That Asbestos from Brakes Can and Does Cause Disease, Including Mesothelioma decaTdhees.dTanhgeerhaozf aarsdbefstroosminebxrpaokessurheastobeaesnbreesctoogsniiznedfrfiocr tion products has been known and accepted for over 70 yisetarps.uIbnlis1h9e4d8, GreegnaerrdailnMg otthoers'hcahziaerfdisndcursetraitaeldhywghieenn manipulating asbestos brake materials in the factory.57 Bbryak19es58w, athsesduaffnicgieerntolyf ewxpelolsudroecutomaesnbteesdtosthdautstitfrwomas VOL 13/NO 3. JUL/SEP 2007 w w w .ljoeh.com Asbestos Causes M esotheliom a 321 included in the American Industrial Hygiene Associadon's Hygienic Guide series.68 Additionally, mesothe liomas have been documented repeatedly in workers at friction-product factories.34,59"62 Today, the asbestos brake manufacturers assert that this danger is confined to the friction-product manu facturing facility. However, there is no scientific justifi cation for asserting that dust from an asbestos brake bcaunt ccaaunsneodtisceaausesewhdeisneathsee bwrahkeenisthgarot usnadmien abrfaakcetoriys ground in a garage. Mechanics who work with asbestos brakes without dust-con trol measuresareexposed to asbestos. Numerous studies have demonstrated that mechanics who worked with asbestoscontaining brakes without dust-control measures were exposed to asbestos dust This is particularly true when the mechanic grinds, files, or sands the new asbestos brake and uses compressed air or dry brushing to clean outwear dust from old asbestos brakes.63-66Both the EPA and OSHA have issued guidance to reduce the risk of disease from asbestos exposure during brake work.7'67'68 OSHA requires the use of dust controls when employees work with asbestos-containing brakes and dutches (for specific details see appendix F of the standard).7 The EeePsAinhajsuraidsdoipctteiodntshensoetsgtaonvdearrndesdfboyr mstuatneicaispbaelsetomsp-clooyn itsrsoulepdlagnusi.d67anOcethteor mreegcuhlaantoicrys taogernecdiuecseheaxvpeossiumreilsartloy asbestos from brakes and clutches.69-72 tiveEqduuasltl-yciomnptroorltamnte,aistuhraessbeceann plroowveern tehxaptoussuereof elefvfeecls during workwith asbestos brakes.73,74Accordingly, to pro vide a reliable basis for the conclusion that asbestos from brakes can never cause disease, a study of brake mechan ics would ascertain whether individuals considered "exposed" to asbestos brakes used dust-control practices. None of the studies relied upon by the asbestos brake manufacturers contains such information. Studies have shovm increased incidences of non-malignant asbestos-related diseases among mechanics known to have per fmoramliegdnawnotrkdwisiethasaesbienstoms-ecconhtaaninicinsg obcrackuerss. Eixnceinssdiivveidnuoanls known to have worked with asbestos-containing basrabkesetso.6s5,7e5xIptoissuureninveeresdaelldy atoccceaputseed atshbaetsttohseisaims ogurenatteorf than the amount needed to cause mesothelioma. Accord binrgalkye, -srteupdaieirs wdeomrkoenrsstrdaetimngonesxtcreastse asthbeasttotshiessien awsobreksetorss were historically exposed to quantities of asbestos far in excess of that needed to cause mesothelioma. Proper scientific inquiry cannot ignore the hundreds of reported cases of mesothelioma in mechanics. We reject the contention of the asbestos brake manufacturers that cthoenssicdieerntciasstemreupsot rctlsooser chaisseosrerhieesr oefymeseasontdherleifoumsea itno mrepecohrtaendi.csT,hiisrrceosnpteecnttiivoen folifes hinowthemfaacneyofcsaosuensd ascrei entific reasoning, which requires thoughtful considera tion of all available evidence. As discussed above, the consideration of case reports is even more critical when examining rare, sentinel dis eases such as mesothelioma because of the great diffi culty in conducting epidemiologic studies with suffi cient power to reliably detect increases in disease.53,54 Hundreds of cases of mesothelioma in mechanics have been reported in the medical literature, including dozens of cases in the studies relied upon by the asbestos brake manufacturers.16 posTehseopfroeucrisdeinscuumssbioenr,onfocarsiesstihsenoptoismsibpiolirttyanthtafot rsopmure cases may have involved exposures to asbestos from sources other than brakes. The important point is that proper scientific inquiry not only can consider these reports, but, in fact, must consider them. Contrary to the suggestion of the asbestos brake manufacturers, these cases cannot be cavalierly dismissed as "unscien tific" or "insufficient to support conclusions regarding causation." When considering the important question ofwhether working with asbestos-containing brakes can mcaeussoethienlcioumraab,lec,asienesveirtiaebslymutesrtmbeincaol ndsiisdeearseeds,asnudchevaals uatTedh,eraelonisg nwoitthhianlgl onthoevrelavraeiglaabrldeinevgidtehneceu.se of Sir AcluusstiionnBtrhaadtfoarsdbeHstiolls'sfvroiemwpborianktsestocaanrrivcaeuaset tdhiesecaosen. Application of his viewpoints has been an accepted and fvoarliddemcaedthesodanfodrreexmaaminins astoiotondoafyq.7u6eHstisioonws nofwcisaeuswaotirodns are worth repeating: wHheircehtwheenshaorueldnisnteuddyifafsesroecniat tvioienwbpeofionrtes wfreomcryacllaouf ssautgigoens.teWd--hatthIatdowenoctanbeluiesvefeu--llyanldaythdisowhans sboemene bhearfdo-raenwd-efacsatnrualcecseopft ecvauidseenacnedtheaftfemctu.sNt boeneoboefymedy noirnaegvaiienwstptohientcsacuasne-barnidn-gefifnedcitshpyuptaobthleeseisviadnedncneofnoer wcainthbgerreeaqteuriroerdlaesssasstirneenqgutha,niosnto. Whehlapt tuhseymcaakneduop, oanuyr omthinedrswaoynotfheexpfluanindianmgetnhteasleqtuoefsftaicotns--beifsortheeurse, itshatnhecraeusaenyanodtheeffrecatn?swer equally, or more, likely bCroankteramryantouftahcetuarellr-so,r-tnhoetrheinisgnpoossiitnigolne oscfitehnetifaiscbdeisstcois pline or type of study that takes precedence over others. Thoughtful scientific inquiry requires consider ation of all evidence when making determinations regarding causation. C O N C LU SIO N Asbestos causes mesothelioma. Mechanics are exposed to asbestos dust during the servicing and replacement 322 Welch w w w .ijoeh.com INT J OCCLP ENVIRON HEALTH ofbrakes. While the asbestos brake manufacturers claim that the average amount ofasbestos released from brake repair work is comparatively low, there is no reasonable dispute that exposure levels were higher when mechan ics routinely ground, filed, and sanded brakes and used compressed air to blow out brake wear debris, and did this workwithout dust control. It is those historic higher eexntpiofiscurceosmtmhautnciatyusiesdindicseoansseenaspupseathriantgbnrioewf.aTnhdeloswci- level exposures to asbestos can cause mesothelioma. The scientific literature contains hundreds of cases of mesothelioma among brake mechanics; and epidemio logic studies of mechanics known to have performed repair work on asbestos-containing brakes have demon strated increased levels of nonmalignant diseases. This combination of evidence, and the vast amount of additional scientific information regarding asbestos and mesothelioma, provides more than sufficient evi dabelnecedetgoreaelloowf sscoiemnetiofincecteortcaionntcyluthdaetwaimtheinsoathreelaiosomna in a mechanic who worked with asbestos-containing braSkienscwe a2s0c0a0u,seFdobrdy,thGaetnaesbraelstoMsoetxoprso,suarned. Chrysler have paid over $30,000,000 to hire consultants for the panudrpofosre toefstgifeynienrgatrienggarthdeinvgertyhopsaepeprasptehresyinrelCyouuprotsn.!, One of the main industry experts has acknowledged that the papers were conceived and authored for the purpose of buttressing testimony in court cases involv ingTmheecshaamneicsexsupfefretrianlsgofraocmknmowesleodthgeeldiotmhaat.!this busi ness model is a pattern he has also followed with dioxin, benzene, hexavalent chromium, beryllium, formaldehyde, and glycol ethers. Recent revelations rthegesaerdeixnpgeurtnsdiinsccloonsnedecitniovonlwveitmhepnutbolifctahteioenmopflaoypearpeorf favorable to the chromium industry have been well publicized and led to the retraction of that paper.77,78It fisinianncneod wbayy stuhrepsreisinmgatnhuaftacthtuereerxspecrtosncalnuddepaptherast athsbeecsotonstrianryb,rtahkeesexcoannernaetvioenr coafutsheemspeosnosthoerliinogmian.duTso try is the expected conclusion of doubt science. Despite the best efforts of the asbestos brake manufacturers and their hired experts to fabricate scientific uncer tainty where none exists, the mainstream scientific community and regulatory communities have consid ered the available evidence and concluded that the danger to mechanics from asbestos in brakes is real. JFord, General Motors, and Chrysler have admitted in litigation that, since 2000, they have paid over $30,000,000 to these experts. See, Ford and General Motors, Answers to Interrogatories, Unden v. General Motors, Case No. 05:6311, Circuit Court for Hillsborough Cou^nDtye,pFolsoirtiidoan, oafnDd eCnhnriyssPlearuIsRteSnFboacrmh, J1u0l9y91s,p2r0o0d5u,cMedalitnialvit.iBgaentinoent.t Auto el al, Case Number 04-16236 CA 42, Circuit Court in and for Dade County, Florida. Apparently, the asbestos brake manufacturers hope that these arguments can be used to sway the Supreme Court of Michigan and other courts. As scientists who have devoted substantial portions of our professional lives working to research, prevent, and treat asbestosrelated diseases, we reject these attempts to fabricate uncertainty where none exists. Instead, we request that fthroemse caoruorutsndattethned twootrhledwwohrko ohfathvoeuscaonndcsluodfeedxptehratst asbestos, in any form, and through any occupational exposure, can and does cause disease. Laura S. Welch, MD Medical Director, Center to Protect Workers Rights, Silver Spring, MD Professorial Lecturer George Washington University School of Public Health and Health Sciences H enryA. Anderson, MD Chief Medical Officer Wisconsin Division of Public Health Madison, Wisconsin J ohn C. Bailar III, MD, PhD Professor Emeritus University of Chicago Chicago, Illinois Presently: Washington, DC J ohn R, Balmes, MD Professor of Medicine University of California, San Francisco Professor of Environmental Health Sciences School of Public Health University of California, Berkeley Director, Northern California Center for Occupational and Environmental Health UC Berkeley-UC Davis-UCSF Lundy Braun, PhD Associate Professor Departments of Pathology and Laboratory Medicine and Africana Studies Brown University Providence, Rhode Island APrronfoeslsdorB,rDodeyp,aPrthmDent of Molecular and Biomedical Sciences North Carolina State University Raleigh, North Carolina Barry Castleman, ScD Kensington, Maryland David C. Christiani, MD, MPH, MS Professor, Harvard School of Public Health Professor, Harvard Medical School Cambridge, Massachusetts Physician, Massachusetts General Hospital Boston, Massachusetts DDeirvercatoDr,aCvies,nPtehrDfor Environmental Oncology University of Pittsburgh Cancer Institute Professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health Pittsburgh, Pennsylvania VOL 13/NO 3, JUL/SEP 2007 w w w .ijoeh.com Asbestos Causes Mesothelioma 323 J ohn M. Dement, PhD, CIH Professor, Division of Occupational and Environmental Medicine Department of Community & Family Medicine Duke University Medical Center Durham, North Carolina Ronald F. Dodson, PhD President, Dodson Environmental Consulting, Inc. Tyler, Texas Anders Englund, MD Former Director Medical and Social Affairs Swedish Work Environment Authority Former Director UICC Stockholm, Sweden Bradley Evanoff, MD, MPH Associate Professor of Medicine Washington University School of Medicine St. Louis, Missouri Arthur Frank, MD, PhD Professor, Chair, Department of Environmental and Occupational Health Drexel School of Public Health Philadelphia, Pennsylvania Fernanda Giannasi Safety and Health Engineer Labour Inspector at the Brazilian Labor Inspectorate in Sao Paulo State Manager ofAsbestos Replacement Project Work and Employment Department in Sao Paulo State Coordinator of the Virtual-Citizen Ban Asbestos Network for Latin America Founder of the ABREA-Brazilian Asbestos Victims Association Sao Paulo, Brazil Michael Gochfeld, MD, PhD Environmental and Occupational Health Sciences Institute Robert WoodJohnson Medical School Piscataway, NewJersey Bernard D. Goldstein, MD Professor, Environmental and Occupational Health Graduate School of Public Health University of Pittsburgh Pittsburgh, Pennsylvania J ulietta Rodriguez GuzmAn, MD Graduate Occupational Health Program Universidad El Bosque Colombia Douglas Henderson, MD Associate Professor of Pathology Head, Department of Histopathology Flinders Medical Center Adelaide, South Australia ARossboinciaHteerPbreorfets,sMorD, Department of Community' and Preventive Medicine Co-Division Director Mount Sinai Center for Occupational and Environmental Medicine Director, World Trade Center Monitoring and Treatment Program Data and Coordination Center Mount Sinai School of Medicine New York, New York JAasmsoesciHatuefDf,iPrehcDtor for Chemical Carcinogenesis National Institute of Environmental Health Sciences National Institutes for Health Research Triangle Park, North Carolina Peter F. Infante, DrPH Professorial Lecturer, Environmental and Occupational Health School of Public Health and Health Services The George Washington University Washington, DC Former Director Office of Standards Review Health Standards Programs Occupational Safety and Health Administration Washington, DC T ushar KantJ oshi, MBBS, MS, MSc Centre for Occupational and Environmental Health Lok Nayak Hospital New Delhi, India David Kreibel, ScD Professor of Epidemiology School of Health and Environment University of Massachusetts Lowell Lowell, Massachusetts Joseph LaDou, MS, MD Director, International Center for Occupational Medicine University of California School of Medicine San Francisco, California Philip J. Landrigan, MD, MSc Professor and Chairman Department of Community and Preventive Medicine Professor of Pediatrics Mount Sinai School of Medicine New York, New York President, Collegium Ramazzini James Leigh, MB, MD, PhD, MA, MSc, BLegS Senior Lecturer and Director Centre for Occupational and Environmental Health School of Public Health University of Sydney New South Wales, Australia Stephen M. Levin, MD Associate Professor, Department of Community and Preventive Medicine Mount Sinai School of Medicine Medical Director Mount Sinai--IJ Selikoff Center for Occupational and Environmen tal Medicine New York, New York EugeneJ. Mark, MD Professor of Pathology Harvard Medical School Massachusetts General Hospital Boston, Massachusetts Arthur McIvor, PhD Professor of Social History Director, Scottish Oral History Centre History Department University of Strathclyde Glasgow, Scotland 324 Welch www.IJoeh.com INT J OCCUP ENVIRON HEALTH David Michaels, PhD, MPH RDeirseecatrocrh, TPrhoefePsrsoojrecatnodnAScctiinengtCifihcaKirnmoawnledge and Public Policy Department ofEnvironmental and Occupational Health TheHGeaelotrhgSeeWrvaicsehsington University School of Public Health and Washington, DC Karen B. Mulloy, DO, MSCH AssBocioiamteePtrriocfsessor, Department of Preventive Medicine and University of Colorado School of Medicine DDiernevcetorrH, Oeaclcthupational Health and Safety Denver, Colorado L. Christine Oliver, MD Assistant Clinical Professor of Medicine Harvard School of Public Health Cambridge, Massachusetts Rory O 'Neill Editor, Hazards Magazine Sheffield, England Domyung Paek, MD, MSc, ScD PSrcohfoeossloorf, POucbcluicpaHtieoanltahl and Environmental Medicine Seoul National University Seoul, Korea Lewis Pepper, MD, MPH Assistant Professor, Environmental Health Boston University School of Public Health Boston, Massachusetts Bernardo Reyes Director, Institute of Political Ecology Santiago, Chile Cecile Rose, MD, MPH ActSincgieHnceeasd, Division of Environmental and Occupational Health NDeantivoenra,lCJeowloirsahdMo edical and Research Center Kenneth D, Rosenman, MD Professor of Medicine MChiicehfi,gDanivSistiaotne oUfnOivcecrsuiptyational and Environmental Medicine Department of Medicine East Lansing, Michigan Brian S. Schwartz, MD, MS ProfMesesdoircionfeEnvironmental Health Sciences, Epidemiology, and Johns Hopkins University Bloomberg School of Public Health Baltimore, Maryland Michael Silverstein, MD, MPH Clinical Professor of Environmental and Occupational Health Sciences UniMveerdsiitcyinoef Washington School of Public Health and Community Seattle, Washington Rosemary K. Sokas, MD, MOH DScirheocotolro, fDPivuibsiloicn HofeEalntvhironmental and Occupational Health Sciences University of Illinois at Chicago Chicago, Illinois Nancy' L. Sprince, MD, MPH PUrnoifveesrssoitry, DofeIpoawrtamCeonltleogfeOocfcPuupbaltiiconHaelaalnthd Environmental Health Iowa City, Iowa Ken Takahashi, MD, MPH, PhD Acting Director of WHOCC in Occupational Health Professor of Environmental Epidemiology UKnitiavkeyrusisthyuoCfiOtyc,Jcauppaantional and Environmental Health Tim K. Takaro, MD, MPH, MS Associate Professor Faculty of Health Sciences Simon Fraser University Burnaby, British Columbia Daniel Thau T eitelbaum, MD Adjunct Professor of Environmental Sciences The Colorado School of Mines Golden, Colorado Associate Clinical Professor of Preventive Medicine DThenevUern,ivCeorlsoitryadoof.Colorado Health Sciences Center at Denver KayTeschke, PhD Professor and Chair Division of Public, Environmental and Occupational Health Department of Health Care and Epidemiology VThanecUounviveer,rsBitCy,oCfaBnraidtiash Columbia Lorenzo T omato, MD Former Director TInrtieesrntea,tIiotanlyal Agency for Research on Cancer (IARC) Ivancica T rosic, PhD UInnsitviteurtseityfoorfMZeadgirceabl Research and Occupational Health Zagreb, Croatia Robert Vojakovic, AM, JP POrsebsoidrnenPtaorkf,thAeuAstsrbaleisatos Diseases Society of Australia, Inc. Andrew Watterson, PhD, CSHP Professor of Health DUnirievcetrosri,tyOocfcSutpiraltiinogn,al and Environmental Health Research Group Stirling, Scotland David H. Wegman, MD, MSc Dean and Professor of Work Environment School of Health and Environment University of Massachusetts Lowell Lowell, Massachusetts Th e views expressed in this paper are those of the individuals sign ing it. The affiliations listed with those signers are for identification purposes only, and the views expressed herein are not necessarily the views of those affiliate entities. References 1. HU.uSm.PaunblSicervHiceeasl.thToSxiecrovliocge,icaUl.Sp.roDfileepfaorrtmasebnetstoosf. AHtelaanlttha, aGnAd: Agency for Toxic Substances and Disease Registry, 2001. VOL 13/NO 3, JUL/SEP 2007 w w w .ljoeh.com Asbestos Causes Mesotheliom a 325 2. AAsmbeesrtiocas:nTCLoVn(fre)rCenhceemiocfalGSouvbesrtnamnceensta7lthInEdduistitorinalDHocyugmieneinsttas. 3. Dtioiang.nPousbislicaantdionin#it7iDalOmC-a0n4a0g.eCminencitnnoaftinOonHm: aAliCgGnaIHnt, d2i0s0e1a.ses r7e1l5a.ted to asbestos. Am J Respir Crit Care Med 2004; 170:691 4. aEsnsveisrsomnemnet nutapldaPtreo. teWctaisohninAgtgoenn,cyD.CA: iUrb.oS.rnEePAasb(eEstPoAs /6h0e0a/l8th5. I8n4t/e0r0n3aFti)o,n1a9l8A6.gency for Research on Cancer. Asbestos: Mono gFrraanpche:oInARthCe, E19v8a8lu. ation of Carcinogenic Risk to Man. Lyon, 6. NU.aSt.ioDneapl aTrotxmiceonltoogfyHPeroagltrhaman.dRHepuomrtaonnSCeravriccienso, gPeunbsl,ic1H1tehaeltdh. Service, 2005. 7. OexcpcouspuarteiotnoaalsSbaefsetotys;afnindalHreualelt.hFAeddmReingi.st1r9a9ti4o;n5.9:O40c9c6u4p-a4t1io16n2a.l 8. CCPoSnCsumWearrnPsroAdbuocut tSAafsebteystCosominmiCssoionnsu. mCeArNPCroEdRucHtsA:ZSAaRfeDty! 9. WAloerrtl.dCHPeSaClthDOocrugmaneiznatt#io5n08. 0E.li2m00in4a. tion of asbestos related dis 10. Weasoersld. 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Lhiesrtcohrieens oMbLta,iSneamd efrtoJmM.wAivnesa. sBsersJsImnednMt oefd.th1e98v5a;l4id2i:t5y63o-f4q, ues dtieomnnioali.re19r8e6sp;1o2n3s:e4s81p.rovided by a surviving spouse. AmJ Epi 45. MgraorukndEJ,inYcoikdoeincTe. Aobfsednifcfeusoef mevaidliegnncaentfomr easositghneilfiiocmanat bapacakrt 46. fLreommeansbResAto. sAesxbpeosstousre: . RAinskn NAYssAescsamdeSncti,. 1E9p9i1d;e6m43io:1l9o6g-y2,04a.nd 47. HTeesaclhthkeEKff,ecMtso.rBgaoncaMRSa,toCnh,eFckLo:wTaayylHor, aentdalF. rManecsiost,h2e0li0o6m. a sur vHeeilallatnhc.e19to97lo; c8a8t:e16s3o-u8r.ces of exposure to asbestos. Can J Public 48. SReusttsitteoinJPD. DS,eMntiunlelalnhReJa,ltFhraezvieerntTsM(,oHccaulppaetriionnWal)E:, aMbealisuissJfMor, pPhuybsliicciHanearlethc.og1n98it3io;7n3:1a0n5d4-6p1u.blic health surveillance. Am J 49. WlioamgnaeraJnCd, aSslbegegstsosCAexMpoasrucrheanind Pt.hDe ifNfuosrethpleWureasltemrnesCotahpee 50. PCrhoevciknocwe.aBy rHJ,InPdeaMrceed.N1,9C60ra;1w7f:o2r6d0--B7r1o.wn DJ. Research Meth ods in Occupational Epidemiology. 2nd ed. London, U.K: 51. AOhxlfboordmUAn,iAvexreslistyonPrOes,sS, t2o0t0tr4u.p Hansen ES, Hogstedt C,Jensen UepJi,dOemlsieonloJ.gyIn. tSecrpanredtJatWioonrkofE"nnveigraotnivHe"eastluthd.ie1s9i9n0;o1c6c:1u5p3a-t7io. nal 52. Aabltsmenacne.DBGM, JB. l1a9n9d5J;M31.1A(7b0s0e3n)c:e48o5f. evidence is not evidence of 53. Blyainilga:rtJrCu.thH, aonwdttohediasrttosrot ftshceiesncciee.nEtifuicrJrOecnocrodl.w2i0t0h6o;u1t1:a2c1t7u-a2l4ly. 54. HogenrinzbeefragllaSc.ie"sN. eSgcaatinvde"JrWesuolrtks EinnvciorohnorHt setauldthie.s--198h1o;w7tosurpepcl 55. 4H:1e2r1n-b6e.rg S. Some guidlines for interpreting epidemiologic sCtuhedliseesa., MInI:: LIenwtrisodPuucbtliisohningto, 19O9c2:cu2p01a-t2io3n. al Epidemiology. 326 Welch www.lJoeh.com INT J O C C IP ENVIRON HEALTH 56. Hcoensssienl.PDAo. cTkeestti0m5o-CnEy-b1e3f0o.r2e0P0u7.blic Service Commission ofWis 57. C19a4s8tr;o2p0., 5F3,um72e-80a.nd dust exposure. National Safety News. 58. Aasmbeesrtiocsa.nJ AInmduIsntrdiaHl yHgyAgsiseonce. A19s5s8o;c1i9at:1io6n1.-2H. ygienic standards: 59. Godwin MC, Jagatic G. Asbestos and mesothelioma. JAMA. 60. T19e6ta8;M20J,4L:1e0w0i9n.sohn HC, MeigsJW, Vdone RA, Mowad LZ, Flan nanerdygJTeo.gMraepshoithcealsisoomciaaitnionCso.nJnOecctciucputM, 1e9d5.51-918937;72.5O:7c4c9u-5p6a.tional 61. R19o7b4inasmonoCngF,wLeomrkeenrsReAm, pWloaygeodneirnJKa.nMaosbrteasltiotysptaetxtteirlensf,ri1c9t4io0n Danedmpenact kJin(gedps)r.odDuucstt manadnuDfaiscetausrei.ngPafrakcilFitoyr.esItn,:ILL:emPaetnhoRtoAx, 62. PMucbDlioshnearlsd,A1D97,9F:1ry3J1S-4,0W. oolley AJ, McDonaldJ. Dust exposure Manedd.m1o9r8ta3l;i4t0y:3i6n1a-7n. American chrysotile textile plant, BrJ Ind 63. eSxakpaoisuKr,esHisdaunraingga Nre, pSrhoicbeastsainEg, Oonf oauY,toTmaokbeuilcehibYrakAessbeastnods 64. cRlouhtclhAeNs.,ILnatJngOecrcAuMp ,EWnvoilrfofnMHS,eWaltehi.sm20a0n6I;,12A:s9b5e-1st0o5s. exposure d12u:r1i1n0g-2b8r.ake lining maintenance and repair. Environ Res. 1976; 65. ALsobreimstoesr eWxVpo, sRuroehlofAbNra,kMe rilelperaiAr woNrikcehroslisnontheWUJ,nSiteeldikSotfafteIsJ.. 66. MHitcSkiisnhaiJDME,edK.n1i9g7h6t;4K3L:2.0E7-x1p8o.sure to asbestos during brake 67. mEnavinirtoennmanecnet.aAl nPnroOteccctiuopnHAygge.n1c9y7.0C;1u3:r1r7e-n2t1.Best Practices for WProervkeenrtsi.nEgPAAsb7e4s7to-Fs-E04x-p0o0s4u.rEenAvmiroonnmg BenratakleParnodteCctliuotnchARgeenpcayir, 68. 2O0c0c7u.pational Safety and Health Administration. Asbestos-- AUu. tSo.mDoteivpearBtmraeknet aonfdLCablourtc; hORcceuppaiartiWonoarlk.SSafMetyB a0n7d-26H-2e0a0lt6h. 69. WAdamshiinnigsttroantioSnta, t2e0D06e.partment of Labor and Industries. Work i0n0g0.SOafleylymwpiiathWAAs,beWstaosshiinngCtoluntcShtaatendDBepraakretmLeinnitnogfs.LFa4b1o3r-0a4n9dIndustries, 2001. 70. MNeawnuaHl:amBepssthMireanaPgoelmluetinotnPrPacretivceenstifoonr APurtoogmraombi.le PSitesrtvoipces vFiacceisl,iti2e0s0.1N. ew Hampshire Department of Environmental Ser 71. WnaonrckesafaendAlbreeprtaai.r. CEodnmtroolntoofn,asAbBes:toDs edpuarritnmgenbtrakoef Hmuaminaten 72. RMeisnonuerscoetsaaPnodllEumtiopnloyCmonentrto,lGAogveenrcnym. eFnatctosfAablobuerttaC,o2n0t0r4o.lling BShraokueldDuKsntotwo. PSrot.tePcat uYl,ouMr HN:eaMlthin,ne. s.oWtahaPtoEllvuetrioynMCecohnatnroicl 73. JAoghennscoyn, 1P9,9Z8u.mwalde RD, Roberts D. Industrial Hygiene Assess mOHen:tNofatSieovneanl BInrastkietuSteerfvoicrinOgcFcaucpialittiioesn--alASsbafeesttyosa. nCdincHineanlatthi,, 74. R19o7b9e.rts D. Industrial Hygiene Report--Asbestos, Allied Brake SSahfoepty. aCnidncHinenalatthi,, 1O98H0:. National Institute for Occupational 75. RNeicphaoirlsaonndWMJ.aIinnvteesntaignacteioWn oorfkHeresalOthccHuapzaatridosnailnlyBrEaxkpeoLseindintog AOscbceusptoast.io2n1a0l-S77af-e0t1y1a9n. dCHinecainltnha,ti1,98O4H. : National Institute for 76. PHriollcARB.STocheMeendv.ir1o9n9m5;5e8n:t2a9n5d-3d0i0s.ease: association or causation? 77. WWaallldSmtraenetPJ.oPuurnbalilc.aJtuionne 2to, 2r0e0t6ra. ct an influential water study. 78. Whoallddmofaint.PW. Satlul dSytretieetdJopuorllnuatla.n2t0t0o5c.ancer; then consultants got VOL 13/NO 3, JUL/SEP 2007 www.IJoeh.com Asbestos Causes Mesotheliom a 327