Document mBORXEyE10MawzpVNwneGYbRO

TEMPLE UNIVERSITY HEALTH SCIENCES CENTER PHILADELPHIA, PENNSYLVANIA 19140 OFFICE OF THE VICE FEESIDIOT FOE HEALTH SCIENCES May 9, 1974 Richard Fleming Group Vice President- Chemicals Air Products and Chemicals, Inc. Five Executive Mall Swedesford Road Wayne, Pennsylvania 19087 13 May 1974 Copies to: A. R. Adams J. T. Barr T. LCarey E. M. Spurlock W. M. Smith Dear Dick: The enclosed article is from Medical World News and represents one. additional viewpoint on occupational disease. .1 am forwarding it to you for your information. All good wishes. Cordially, Paul Kotin, M.D. Vice President Enclosure RECEIVED MaY 14 i974 J. T. BARR BECEIVK MAY If; 1974 jl Fleming, v. f. X-991 AP00003104 I IJ perhaps some old ones--harbor new dangers John H. Stender, head of the Occupa tional Safety and Health Adminis tration, ordered a review of work place hazards and accidents several months ago, he wasn't prepared, he conceded, for some of the "gruesome exam ples'' of electrocutions, suffocations, burns, and fatal falls the agency's regional offices turned up. "The hazards that working men and women are facing today, as they go about their work are as unnecessary as the damage I suffered working on boil ers 30 years ago," declares Assistant Secretary Stender, who has a hearing loss to remind him of his years as a factory worker. But a menace not included in those reports was about to surface. The widely used industrial chemical vinyl chloride (VC) was linked unmistakably early this year with the rare-or previously rare-angiosarcoma of the liver. Once considered for use as an anesthetic, the gaseous substance now has awakened deep concern in physicians, and members of labor, industry, and government. The 11 cases confirmed in the U.S. (and a 12th in England) had harsh implications for thousands of workers, for industry facing the immediate need to change production methods, and for public health officials. VC's carcinogenic potential was conceded early by John O'Neill, chief of the division of health standards in the Occupational Safety and Health Adminis tration (OSHA), the Department of Labor's agency responsible for setting and enforcing safety codes. "There is no use denying it," he says. "We are faced with a new occupational disease." The nnr.vnr.cerricnt of the VC hazard come in January after officials of the B. F. Goodrich plant in Lou! ";!!>-, Ky., nhuv.-d !y plant physician John L. Creech, informed government officials that four liver angiosarcoma deaths had occurred among former employees involved in producing polyvinyl chloride continued MEDICAL \VCfLD NVS/.Vy 3,1974 33 AP00003105 INDUSTRIAL MEDICINE I (PVC) frosi VC. Fnysicai exacir.s-i'.ns and a search of medical records there and a: other plants scon gave the to tal: five deaths and two workers with the disease but still alive at Louisville: three deaths at the Goodyear plant in Niagara Fails. X.Y.tand one death a: the Union Carbide plant in South Charleston. W.Y&. In mid-February, at a star.dir.g-roonr.-or.ly OSHA hear ing :r. Washington, D.C., a 43-year-df Italian researcher, Dr. Cesare Mahoni. director of Bologna's Institute of On cology. presented results of his animal studies that shotved-for the first lime-thar VC produced angiosar coma of the liver in rats. Moreover, it did so at levels (250 ppm; many had considered safe. Although Dr. Maltoni's research did not prove VC caused the liver cancer in hu man beings, ii did provide strong circumstantial evidence. Also testifying was Dr. Irvir.g J. Selikoi?, director of the environmental sciences laboratory at Mount Sinai School f Mc-dicine in New York, who found the hearing some thing o: a parados. Although it appeared that a new prob lem. had beer, identified ar.d steps taken to meet it. he said: "It is equally true that there has been evidence of potenti'.'ly -ri'.`: ciseate among vinyl chloride-polyvinyl chlo ride 'YU ?vr- -v-.rk-.-r; ;...- if. year.- that h*s been incom pletely appreciated ar.d tr.aiequitely approached by medical scientists and by regulator;.' authorities.'' The f.rst four cases of angiosarcoma of the liver from Louisville were confirmed at the National Cancer Insti tute by Dr. Louis Thomas, chief of pathology, and Dr. Hans Popper, former Mount Sinai dean and now a Fo garty schular at NIH. They also have come up with a clue that potentially, at least, holds out hope for reversing or retarding the disease process. Shortly before the disclosures about VC were made at the OSHA hearing, Dr. Popper received a report from col leagues at the University of Bonn in West Germany of a peculiar liver lesion seen in some 50 VC workers there. Early in February, during a visit to Bonn on another med ical matter, he obtained slides and photos of "this peculiar fibrosis-chronic toxic fibrosing liver lesions. ' Studying these at the NCI.Drs.Thomas and Popper noted similar ities between the liver lesions in the German VC workers and liver biopsy material taken from one of the Louisville victims before the angiosarcoma had developed. "This has increased our suspicions that exposure to VC will lead to this lesion, which will lead to angiosarcoma," says Dr. Popper. "This is not yet proved but is highly suspicious-and very important. Why? Because if wo can catch it at that stage, perhaps we can prevent develop ment of tin. cancer l.v removing a worker fivin exposure." ltut at the Ouonyunr plant in Niagara Falls, via ra a team of environmental scientists from Mount Sinai Medi cal School spent three days doing intensive mass medical 3 AP00003106 examinations of workers, Frank Mica'.e. president of the 300-mcmher Local P-277 of the Oil. Chemical, and Atomic Workers Union iGCAW). wasn't feeling too encouraged. - '.'I'm 39 years old and 1 have five kids. I've worked here 21 years, right out o: high school. What do we know about the chemicals we work with, what they car. do to us? There have always been fumes in the plant. We never wore masks. Sure, guys are thinking about quitting, but if you quit, you go to another plant, with other hazards. I just don't know." Sf some were unsure of what to do first. others were not. Considering the potential impact of the VC threat, the consumer-oriented Health Research Group, a Nader affil iate, called on the Food and Drug Administration, the En vironmental Protection Agency, and the Consumer Prod uct Safety Commission to order the recall of aerosol sprays-smong them hairspravs and pestiddes-using VC propellant. Otherwise, the group said, "consumers may be subjecting themselves to a significant risk of cancer." The FDA ar.d EPA have asked manufacturers to volun tarily pull their VC-propc-'.led products from the nation's store shelves. In New York. Dr. Edward Ferrar.d of the city's environmental protection unit began analyzing hun dreds of consumer products for VC ar.d PVC content. And the Manufacturing Chemists Association hired a Califor nia firm to study morbidity and mortality rates among VC/PVC workers, while an animal study it funded earlier now has shown that mice, when exposed to only 50 ppm of VC, can develop angiosarcoma of the liver. Meanwhile, the National Institute for Occupational Safety and Health tN'iOSH'. which serves as OSHA's re search arm but is within HEW. had already begun its own industry-wide study of VC PVC workers, visiting six polymerizing plants from which it will select former em ployees for follow-up. And next week, leading scientists from Germany, Italy, Rumania, England, ar.d other countries will attend a two- dav meeting in New York, arranged by the American Cancer Society ar.d the New York Academy of Sciences, to review what now is known about VC-ar.d what to do about it. Union leaders have readied their own battle plans. Louis Bc-liczky, director of industrial hygiene for the Rub ber, Cork, Linoleum : Plastic Workers. AFL-C10, states flatly that health and safety r.ow are key issues in labor relations, contract talks, and the union's owr. projects. He notes that the rubber workers have contracts with the schools of public health at Harvard p.nd the University of North Carolina and six rubber companies for'long-torm studies of the plants and the workers, including VC/PVC handlers. The cost to the union: roughly 31 million. The VC situation is just the latest chapter in the steady awakening of workers to the nature of oceupationrd haz ards hanging c-ver their head?, says Ar.-heny Ma-./.neriii, le/i.-!a:hv dirvet -m: UCAV. 7: .". union rvpre.!-_*!:t.-\ t.'i \ t. vvi-rr.t-r.-. "The men at Niagara Falls arc caught. They're in a di- Jemma. What's their option? Work anc eat today so they MEDICAL C.rtLD KE-.ve ttfJ can die 20 years from now. Today it's angiosarcoma. To-. morrow-who the hell knows. "Look, we're on the brink of a revolution in the delivery of medical care, and occupational health will bo in the forefront. The private practitioner, who may be feeling pretty smug now, is going to be left behind unless lie wakes up. The doctors the men have been seeing haven't been the ones who diagnose their occupational diseases. "Being called by your first name doesn't count. They're going to want to know that when they walk into the doc tor's office, he'll know what to look for, what to ask about; that he knows something about the real world, the world of work; and that if he secs two or three guys with the same type of symptoms, he'll have the guts to yell about it, out loud.'' Mazzoechi's challenge to the private practitioner is not so easily met. For example, Dr. John Peters, occupational and environmental disease specialist at the Harvard School of Public Health, says lie was askt-rl by the man ager of a small textile plant in New England to look into an outbreak of respiratory problems among the- workers some months ago. The manager himself had suffered se vere chest pains. He had been hospitalized with o diag nosis of myocardial infarction, spent several days in the 1CU, a total of three weeks in the hospital, and three more weeks at home before returning to work. Other employees also had experienced chest pains, cough, malaise. One of the women workers had been hospitalized twice. The diag nosis: acute viral illness. The textile- manufactured was a crushed velvet syn thetic material used for couches, coats,.and the like, recounts Dr. Peters. "I looked at the process used, but I found nothing that would explain the symptoms. They used a fluoropolymer, an anlislain, water-repellent mate rial. It is known to produce a toxic fume when heated to high temperatures. But no high temperatures were in volved in the process. So, I was stuck there." Next, he questioned all 14 workers involved in the oper ation. Seven had no complaints, The other seven gave al most identical stories. They arrived at work fooling fine, had no problems for about two hours, then noticed the on set of dry throat, chest pain, cough, weakness, especially in the legs, then fever and chills. "Their cigarottcs-these seven were smokers-tasted awful," says Dr. Peters. "They went home feeling terrible, wont to bed feeling ter rible, but woke up feeling bettor and went back to work." The clue, of course, was the smoking. The polymer on their hands was transferred to the workers' cigarettes, which burn at a sufficiently high temperature to produce the fumes. "And that's what they had," states Dr. Poters- "polymor fume fever." It is exactly like flu that lasts 24 hours, sometimes longer. The only treatment needed: "Wash your hands before smoking." Dr. Peters concedes that a physician seeing the patient in his office would h.-.vo had little to go on to make the correct diagnuris. "] nm convinced that theu-is a lot of uiirvmgnir.od oc<T!!V::i*\-a! di.-vu-u* it: thoro vivv. ` .1 wailing ):. ad Is., None of t],o.-- cat. - oi poi\ i.kt :u:..c iV.v: v.: ; ..\c been on the lists compiled by the Bureau of Labor Statis tics or the National Safety Council. The Cuuncil, a private cci niir.ued ss AP00003107 INDUSTRIAL MEDICINE organization. e.-timates that more than 2.4 million work ers si;.'Tired disabling injuries on the job, resulting in lost work days. ir. 1972. Preliminary BLS data for that year, based on dirferc-n: criteria, show 5.6 million recordable in juries ar.d illnesses, whether or notWork time was lost. But some are convinced the "standard estimate" of 14.000 job-related deaths and two million injuries each ve&r falls far short of reality. Dr. Lc-rin E. Kerr, president of the American Public Health Association, cites a feder ally financed report that indicates 20 to 2-5 million injuries and 25,0'Xi deaths a year are closer to the true figures. Oth ers. including some government officials, have estimated lOO.Gtt deaths-btit nobody really knows. Health hazards peculiar to certain occupations and in- was little pressure for strong occupational health and safety legislation. "Industry was happy with the voluntary approach to oc cupational hazards," says Dr. Marcus M. Key, NIOSH di rector. "Labor was more interested in hazard pay than in the prevention and control of hazards. And we in the Pub lic Health Service were satisfied with the holy trinity of research, training, and technical assistance to states." Sheldon \Y. Samuels, director of health, safety, and en vironmental affairs for the AFl^-CIO's Industrial Union Department, notes that in one Midwestern industrial state, "not a single case of occupational cancer was re ported for the entire year of 1970 and the first three months of 1971," despite widespread use of known.indus trial carcinogens. To him, this was "gross and obvious un derreporting." Aind the federal government's arm was hardly stronger. A 1970 report noted that although inspectors discovered hazards in more than 907? of factories entered, only about 1% of the companies were called to account and barely one in a thousand penalized. Labor Department records show that from 19G3 to 196S, safety and health complaints were filed against 154 companies. The passage of the Occupational Safety and Health Act of 1970, which became effective April 28, 1971, and estab lished the NIOSH as OSHA's research arm, was the culmi nation of many events. Key among them was passage of the Federal Coal Mine Health and Safety Act of 1969. That 'landmark legislation, stimulated by such mine cave-ins as the 196S Farmington, \Y.Va., disaster in which 78 miners were killed and by the black lung scourge, marked the first federal "coming to grips" with an occupa tional disease. The 1959 coal mine act provided federal funds to in demnify some of its victims and their widows and set standards aimed at disease detection, prevention, and con trol. With 1972 amendments adding benefits averaging $300 a month for diseases resulting from coal dust inhala J v.ho recognize ecc-jpetcnal His er.i yell about them. tion, some $1 billion a year is being paid to 235,000 totally disabled men and to 140,000 widows and dependents. j dustries have been recognized since well before the age of Further, every working miner--some 100,000 under i plastics. In 1545, miners ir. the Em Mountains of Central ground coal workers in 23 states-will be x-rayed regularly j Europe were known to have an unusually high frequency by NIOSH as part of a National Study of Coal Workers' j of fata! iur.g disease, determined four centuries later to lie Pneumoconiosis. This study is the first to assess the extent ! bror.ehoger.ie carcinoma associated with high radiation of anatomical disease in a national industry Based on j levels from uranium-bearing or*. early findings, Dr. Kerr, also director of the Mine Workers j The BrltUk .VMvci Jv.in\a\ '74) cites the scrotal of America's occupational health department, expects lS'x | cancer found among chimney sweeps in the ISth century to 20 x to have x-ray evidence of pncumocon iosis. ! and the observations of bladder cancer induced by aro- Dr. Kerr stresses that the law calls for-ancl that exist I matie amines in the 19; h. And ir. the early 20th century, ing technology could aehieve-climination of this disease. radium poisoning considerably shortened the lives of "It can be wiped out in one generation. It can be made ns women who painted luminous dials on watches and dorks. rare as typhoid. The wav to do it is get rid of the dust, Dipping their brushes into the radium-containing paint, which we've known how to do since at least 1918-you ven then moistening the brushes with their lips to make a fine tilate and use water." A win i i-e.-vs of an industrial hazard by no means implies Despite -s..u. vtitc.'v.-s for rt f ill:.- thv-c !'!! ow ing the 1911 Triangle Shirtwaist factory fire in New York City in which 144 women sweatshop workers died, there that `omeikir.g v.:.`l U done it. Dr. .lo.-eph K. Wagoner, director of the division of field studies and clini cal investigations for NIOSH, notes that the first reports continued 36 AP00003108 INDUSTRIAL MEDICINE ;:-*r*t* of Madder cancer in dye industry workers came in 1893. "The British showed in 1962 that ujiward of CSS of people exposed to lieta-naphthylamine and 23T of those exposed to benzidine were devolvj'ing bladder cancer. But in the U.S.. as late as lt'fi>. journals could still report that out of 360 workers in one facility. 93 had developed that cancer and-IT died of it." XIOSH has the right of entry into any plant-but for re search, not enforcement purposes. It also numbers among its undermanned forces a more outspoken breed of offi cial. less willing to countenance delays. A high point of the XJOSH's young career was the forc ing into the open the story of unsafe working conditions at the Pittsburgh Corning Corporation's asbestos insula tion plant in Tyler. Tex. A key role in that action was played by Dr. William Johnson, a young public health phy sician, who found in old files reports of earlier surveys that showed count# o: asbestos particles far above the out moded threshold level#. These surveys also gave no warn ings of the health hazard# and, most damaging, showed a total absence of follow-up. A quickly scheduled X10SH inspection in 3971 disclosed "a ventilator system so dogged we knocked chunks of as bestos out of the duets with a broom." The unshielded cafeteria was adjacent to the production area, and work ers were so totally unaware of the asbestos hazard they used airbuses to blow fibers from one another's clothes. A small ($210) fine imposed by OSHA was followed by outraged protests from workers and their union, OCAW. This led to reinspection, a larger fine ($7,990), and threats of additional penalties if violations remained. The com pany decided, instead, to close the plant. It removed its machinery and equipment and buried underground what it didn't take. $190-mil!ion class-action suit has been filed against the corporation by a group of former workers. But mean while, under contract with the XC1, a long-term follow-up study of all $7$ former PCC employees is being under taken at the East Texas Chest Hospital, a 230-bed state facility in Tyler, roughly a mile from the front door of the plant. The building, its present owner unknown, now is being used as a warehouse. Grady Faulk, administrator of technical programs at the hospital, who will also administer the Tyler Asliestos Workers Study, says 691 men are known to be alive, and 23-including three of the seven long-term workers-are known to be dead, with 1A4 still to be located. He esti mates that some 750 to 800 men will be examined twice yearly. Asbestosis, mesotheliomas, and hnig-oanrcrs often take 2'J years or more to develop. The Tyler plant opened 20 years ago in 1954. Some of the unhappiness with OSHA, particularly that of unions, steins from the rapid pace the agency has set in turning hack enforcement powers over health and safety ivguliti'C:* to the states. The AKL-CTO's Samuels r-fors to the jivc.-ihf.ity of "5" mix,I-j>1 :iall of them different. We object to the federalization of the 1970 Act on the basis of paper promises and without uniform stringency," Or. Selikoff* opinion of OSHA's asbestos standard `would hav6 to be written on asbestos-coated paper." he says. The union has done more than talk. Last month it filed suit in federal court to prevent OSHA from approv ing any more state plans and to rescind approvals that had already been given. The law provides for returning enforcement powers to the states if their proposed programs are judged "at least as effect h'e~ as the federal. These powers now have been returned to 16 states, and the plans of nine others have been approved. However, not all states want to take back this responsi bility. Kansas, Louisiana, Nebraska, Ohio, and South Da kota chose not to submit proposals; Georgia, North Da kota, New Hampshire, and Pennsylvania, which had submitted them, later pulled them back. Thus, the OSHA inspection force of S00 compliance officers and industrial hygienists will retain this overwhelming assignment: to tal surveillance and enforcement power over at least nine and perhaps 25 states and continued "overseeing" respon sibility in all other states. OSHA also has been criticized for seeking what some believe is a middle ground between safety levels proposed by labor and environmental scientists such as Dr.` Selikoff ar.d standards argued for by industry. The divergence was particularly sharp during OSHA's 1972 hearings in Wash ington that led to the agency's first new standard, the one affecting asbestos. Some 100,000 to 200,000 individuals work directly with that fibrous, metallic silicate, and sev eral million more work with it indirectly. The standard in 1972 was a maximum of 5 fibers per cc, as a time-weighted average fee- an eight-hour day, with peaks not to exceed 10 fibers. Industry sought to retain that. The NIOSH had proposed a 2-fiber standard with a two-year delay in enforcement. Dr. fViikxiffi argued that only :. zero te'.ei t,.'i!.i I " considered safe. Tr.s uoi;.'. divi sion: a 2-fiber standard but starting four years later, in 1976. It also rejected the NIOSH recommendations for 38 AP00003109 outside medical surveillance of asbestos workers and for tough warning labels on asbestos products. Said an outraged Dr. SelikofF, whose long-term studies of asbestos w orkers have shown strikingly high incidences of asbestos's, lung cancer, and mesotheliomas: "My opin ion of that decision would have to be written on asbestos- coated paper." Dr. Homayoun Kazemi, director of the U.S. Beryllium Case Registry, does not object so much to the standard for that metal, which has been in effect since 1949 (a max imum average o: 2 gg/m* of particulate beryllium over eight hours and a peak below 25 eg.'it.'). But with more than 30.009 workers potentially exposed to beryllium fumes and dust in tour major refineries and 3,000 process ing plants, Dr. Kazemi vigorously protests the failure of management at many plants to maintain that level--and the failure of OSH A to police them. "People are stiii being exposed to very high levels, and the plant owners know it," declares Dr. Kazemi. chief of the Massachusetts General Hospital pulmonary unit. In recent years, some new patients have been "neigh borhood cases," not beryllium workers but those living near a plant using the metal. Ant! r.ev.- beryllium hazards have been reported even more recently: It appears that the mantles of gas camping lanterns and dental alloys re lease potentially dangerous amounts of beryllium. The risks would extend no: just to campers, dentists, and den tal laboratory technicians but possibly to dental patients requiring extensive wo-k. The U.S. Beryllium Case Registry, a voluntary listing, now stands at about S40 eases and increases slowly but steadily by two or three a month. Dr. Kazemi wonders about cases not reported and is even more concerned about those in whom berylliosis goes unrecognized. But diagnosing ar.d dealing successfully with occupa tional ills car. be negated by failure to probe deeply cnough-or. occasionally, by probing too deeply. The APHA's Dr. Kerr tells the story of a S2-year-old bus driver with "hot belly"' who underwent an exploratory lap arotomy in an unsuccessful effort to pinpoint the cause of his persistent abdominal pains. "Several days later, a member of the house staff who visited the patient learned he had beer, a bus driver only a few months." says Dr. Kerr. "For most of his working life he had cor.e bridge demolition work. Using an acetylene torch, he cut through metal-and layer after layer of the red lead pair.: appr'vd to prevent rusting. What he had was the lead colic that goes with severe lead poisoning. The unnecessary operation could have been avoided if someone had asked, 'How long have you been a bus driver?' A new idea? Hardly. Bernardino Kamazzini, the father of occupational heaith, urged that approach in 1700." Of all occupational hazards, dermatoses are not the most serlou* but they are the most common. N'lOSH esti mates il:_t di-'-rdvfs fro:.: ikymk-d. :.v- and hiob'.>jV;.l v.'....-.- account f:r .pvt to 75 -i of all indu.-trial diseases ar.d affoc: from 000,000 to ToO.'.w people. But new forms of industrial cancer and other diseases are likely to be a recurrent problem until some way is found to screen the thousands of old substances now in in dustrial use and the thousands more that enter manufac turing processes, and the environment, each year. Faced with the massive task of dealing with the thou sands of substances handled, touched, or inhaled by work ers, OSHA-with recommendations from NIOSH-pulled together all existing federal health standards into one package covering some 500 toxic substances. Next, it set up the Target Health Hazards Program, directing en forcement first toward plants where workers are exposed to asbestos, lead, silica, cotton dust, and carbon monoxide. Out admittedly, these standards-and the available in- spectors-are not enough. In March, OSHA announced a 80-inonth, $8.5-million project to speed the issuance of rules governing some 400 toxic substances. These rules will deal with plant monitoring, control methods, medical requirements, and other activities; they will not change the threshold limit values to which workers arc exposed. But is there any way that the vast array of chemicals in use, and to come into use, can be checked for danger? To provide the necessaiy legislative machinery, Con gress is considering several versions of a toxic substances bill to cover agents now regulated by other laws. Still un clear is who pays for the testing of an existing chemical, how trade secrets will be protected, and who will be con sidered responsible for various misuses. While Congress debates, is anyone trying to pinpoint industrial dangers? "No one else is formally responsible, so we have taken the initiative," declares NCI's Dr. Umberto Saffiotti, asso ciate director for carcinogenesis, division of cancer cause and prevention. Of the $36 million allotted to the carci nogenesis program, some $7 million now is being used in a major bioassav program. As of March, he reports, some 450 chemicals were being screened for carcinogenicity. More than 20 laboratories are taking pan in the pro gram and most chemicals are tested by a protocol that in cludes preliminary toxicity studies followed by lifetime tests on groups of 50 animals. In addition to long-term studies, the program now is testing the reliability of short-term bioassay systems based on chemical reactivity, such as DNA binding, mutagenic activity, and in vitro neoplastic transformation. But despite all the investigations, despite standards being evolved and emergency rules issued, thousand; of workers-assured by the Occupation Safety and Health Act of 1970 of "safe and healthful working conditions" and "no diminished health, functional capacity, or life ex pectancy as a result of his work experienee''-are still all too often involuntary players in the game of industrial Russian roulette. Dr. Selikofl', noting that the government-mediral-indus- trial reaction to the VC threat was n response to an al ready pivsi-nt hut-ii d, puts it tins way: "J; -i-ihoristg : i realize thrit th.-iv may be ether :cv;::s ir. !': . wings, which we do not now suspect and which we still do not really know yet how to anticipate. We can't see ther.i- but wc hear them moving about in the forest." i MEDiCAl WOP.tO SEAS Ml/ 3. H74 33 AP00003110