Document nkwXMNBX0zkr832VZqnb7x38w

Boston low -Januory 16, 1983 jBy David Mehegan 7 cancer. UCC 008702 asbestos ontrial Billions are at stake in suits by victims of diseases they claim asbestos has caused. But some experts say the link is far from clear. .* By David Mehegan * -------------- David mehigan b a state nna rot the GLOBE HAGAZSNM. t's wrong and I'D swear to the I day I die," Andrea Kilroy says, "this country has got to com pensate people with catastrophic illness. To leave us at the mercy of each admin istration is inhuman." Andrea Kilroy of Barnstable is 36. Seven years ago, when she was 29, she was found to have cancer, but it was not until 197B, when she was referred to the Sidney Farber Cancer Institute in Boston, that her condition was diag nosed as mesothelioma. Mesothelioma is an incurable cancer that occurs in tbe pleura, the membrane encasing the lungs, or in the lining of the abdominal cavity. It is known today that mesothelioma is an asbestos-related disease. Andrea Kilroy never worked with or near asbes tos, but her father, Arthur Kilroy, did. He is 72, and from the late 1930s to 1973 he was a rigger in the Boston Na- ; val Shipyard. He worked sometimes in ' the holds of ships, .where asbestos insu lation was removed from or installed on pipes, and he would inhale the fibers, without even being aware of it. Then he [ would come home, his clothes covered ' with asbestos fibers, and his family ; would breathe the dust. For Andrea, the : result was catastrophic. Some of the needlelike fibers evidently worked their ' way through her hmgs into the pleura, and by a process that is not understood,' by themselves or in concert with some other agent, caused the cancer. _ Though mesothelioma is still a rare type of tumor, it has apparently been on the rise lately. Dr. Karen Antraann, a mesothelioma specialist at the Sidney Farber Cancer Institute, says she saw an average of two new cases a year five years ago. Now she sees about twenty cases each year, and more of the pa tients are spouses or children of asbes tos workers. Mesothelioma is painful and uniformly fatal, usually within a year of diagnosis, though long survivals can occur with an aggressive program of chemotherapy, radiotherapy, and sur-. gery, such as the Farber Institute uses. After the physical suffering,' the hardest part of Andrea Kiho/s illness is paying for treatment. "My visits at the tURiAvt Cancer victim andrea kilroy Farber cost as much as five hundred or a thousand dollars, an<f hospital stays have run. as much as ten, twenty, or thirty thousand dollars," she says. So cial Security disability coverage pays 80 percent of the cost, and the state Med icaid program picks up a portion of the rest. But the uncovered costs amount to thousands of dollars. "The economics are sheer agony," says Kilroy. "If it weren't for ray par ents, I'd be out on the street. 1 know many people who have lost their homes, their children have had to leave college. I can't provide for the boys [she has two sons]. I'm just so furious with JohnsManville -- they're dealing with people who are suffering severely." Andrea Kilroy is furious because last August 26, the Manville Corporation (formerly Johns-Manville) of Colorado, the world's largest asbestos manufac turer, filed for bankruptcy under Chap ter 11 of the US bankruptcy code. Manville is not broke. It is a solvent company with an estimated net worth of S 1.1 billion. But it is groaning under a load of lawsuits filed by an estimated 16,500 individuals who allege that they contracted diseases or suffered injury as a result of working with asbestos pro ducts manufactured by Manville. Before August 26, five hundred new suits were being filed each month, and tbe com pany estimated that, if it had not de clared bankruptcy, there would have been as many as 50,000 more lawsuits. The potential combined liability of that many suits, tbe company said, would be more than its net worth. The long-range effect of the bank ruptcy is uncertain. There is no doubt about the short-run effect, however -- it stops cold all litigation against Man ville, along with UNR Industries and Amatex (two other asbestos firms that have filed for bankruptcy). Though plaintiffs' lawyers made motions to overturn the filing, the court has reject ed them. That means Andrea Kilroy and the thousands of other plaintiffs won't get a dime from Manville, at least not for several years. And for some plain tiffs, several years will mean never. here is an immense body of lit Terature on asbestos and disease, but the study of the link began slowly. Scientific studies appeared as early as 1906, and others, published in 1924,1935,1955, and 1963, implicated asbestos in various diseases, principally mesothelioma, lung cancer, and asbestosis (also known as diffuse interstitial fi brosis -- a sometimes-fatal scarring of the interior lung tissue promoted by as bestos fibers). Some studies have also found higher incidences of other kinds of cancer -- of the pancreas, of the gas trointestinal tract, of the larynx -- among asbestos insulation workers, but these findings are less universally ac cepted among scientists. The most influential American study was published in 1963 by Drs. Irving J Selikoff and E, C. Hammond of the Mount Sinai School of Medicine in New York City. Their study of 17,800 asbes tos insulation workers who were tracked from World War II found unusu ally high incidences of several cancers among the workers, especially of lung UCC 008703 cancer There were 9_2 cases among as bestos insulators for every case in the unexposed general population. It took a long time for these studies to have any effect mi public policy, part- ly because not all studies found links be tween asbestos and disease. The most notorious study exonerating asbestos was the 1946 Fleischer Repwt. from the Harvard School of PubSe Health, which indicated that there was no evi dence of risk for users of asbestos pro ducts, such as shipyard pipefitters. The flaw in that Continued on page 34 CONTINUED FROM PACE 9 study was that the workers were studied only two or three years after exposure began, and it is now known that asbes tos-related diseases often do not manifest themselves for twenty to forty years. As recently as 1961, an item in the Journal of the American Medi cal Association reported confi dently that "in the American literature there ts no evidence that there is a relationship be tween asbestos and lung can cer." In 1938 the US Public Health Service recommended an industrial exposure limit of five million particles per cubic foot of air in the workplace. This standard was not formally adopted by the Bureau of Labor Standards until 1964, and then only as a guideline. The pre5sent legal limit was set by the Occupational Safety and Health Act of 1970: an eight-hour average of five fibers per cubic centimeter (revised downward to two fibers in 1976), each fi ber no longer than five microm eters in length. Whether this , ! | standard will prove low enough to eliminate risk remains to be seen, but it is a dramatic im provement over previous, un controlled conditions. But for thousands of olders workers and members of their families, it came too late. lthough asbestos -- the Aproduct name for a fam ily of heat-resistant mineral fibers -- began to he used commonly in various pro ducts early in this century, it was not until World War U that it became a' major natural re source whose use was mea sured in the millions of tons. It makes superb insulation,, and during die war years, in hun dreds of shipyards, as many as one and a half million workers were exposed to asbestos used for insulation in new or rebuilt ships. For thousands of those workers, bad ventilation and poor health controls combined with heavy inhalation of fibers to produce terrible cases of dis ease, many of which did not show up until the 1960s and 1970s. The thousands of still-living workers employed in govern ment-owned shipyards -- such as the Boston Nava) Shipyard -- during World War II are prevented by law from suing the government for injuries re ceived in the workplace. As for the private yards, once a work er accepts a workman's com pensation settlement, he for feits the right to sue the em ployer. Therefore, personal in jury lawsuits began to be filed around the country, starting in 1973, in both federal and state courts, against "third parties" -- most often the roughly twenty-six manufacturers of asbestos who supplied their products to the workplace without providing the informa tion that the products were hazardous. The suits allege that the companies knew of the hazards as early as World War 11 but hid the facts. How the courts will cope with the staggering volume of suits is an open question. Al most twelve hundred asbestos cases are pending in US Dis* trict Court in Boston, many of them several years old, and more than five hundred others are pending in Massachusetts courts. Until the Manville bankruptcy filing, new federal cases were being filed in Bos ton at a rate of twenty-five a week, and they still are arriving UCC 008704 ij at a rate of about five a week. ]. in most cases, the defendant is , "M*s-Manville et al.." the tt \ el. being the twenty-five other ! companies that might have supi plied asbestos to a worker's , place of employment. None of the Massachusetts cases has come to trial. US magistrate Robert DeGiacomo ordered the bankrupt firms severed from the list of defen dants named in the complaints so that trials couldproceed, but this ruling has been challenged by lawyers representing the unbankrupt firms. Wrangling over the issue continues. In the Philadelphia Court of Common Pleas, where the number of cases is comparable to Boston's, an attempt was made to grab the bull by the horns and try all the cases. Five judges were appointed to do nothing else. "For ten weeks we went full blast " says Judge Andrew Klein. "We fin ished fourteen cases. In the meantime, eighty-three new ones came in. If we had no new , cases, we would not get through the present caseload in this century." Meanwhile, Andrea Kilroy and others like her wait and worry. ost civil suits don't Mcome to trial -- they are settled -- and this has been true of asbestos litiga tion as well. As many as half of ; all suits filed (more than thirty thousand have been filed, against 260 companies) have been settled. But in contrast with most types of civil litiga tion. out-of-court asbestos set tlements have not solved the overall problem. The asbestos manufactur ers were insured against law suits, and so they felt reason ably safe. But they had no idea of the number of cases that were to come. Plaintiffs' law yers began to go to defendants' lawyers and say, "I baVe a hun dred cases here which I'd be happy to settle out of court." The defendants would get out their calculators and figure that settling might cost, say, an -rage of $8000 per case, whereas defending would cost $20,000 each, even if the de fense won them all But more important in the equation, even one lost case could mean- * judgment of $l millio;>, $5 W& lion, or $10 million. Plam^p have won 72 out of 147 UlAt nationwide so far, and there have been several million-dol- lar-pius judgments. So the companies quietly agreed to major block settle'ments. In December 1980,' Raybestos-Manhattan (newly renamed Raymark, IncJ settled ! 680 cases out of court with the asbestos law firm of Kreindler & Kreindler for $15 million. In late October, Owens-Cormng EbergJas-Corporation ---not an asbestos manufacturer, but one that did make an asbestos product for a time -- settled j with 140 plaintiffs for a total of j $2.38 million, the latest batch in a series of 400 settlements the company has made to date. But a surprising thing hap- 1 pened. The more the asbestos ) companies hacked away at the -' pile, the bigger it became. As bestos litigation became a growth industry, and many ma jor law firms around the coun- . try today do* little else. Man- ; ville reported that at the time it : filed for bankruptcy, it had set- : tied 3500 claims out of court at an average of $16,000 each, . but the cost of litigation plus , settlement had risen to *. $40,000 per case and there had > been several punitive judg ments averaging $600,000 each. Worse still for the com panies, many insurance carri ers were refusing to pay for settlements. This is what makes asbes tos litigation unique. In even the largest catastrophes, such as the Kansas City Hyatt Hotel disaster, the number of possi ble plaintiffs is limited. But as bestos has proved to be a per- ; sonai injury lawyer's dream a disaster with -a~seeming)y endless supply of plaintiffs. ManviUe reported that in set tling 3500 cases, it spent more on legal fees ($24.5 million) than on payments to claimants ($24 million). And that's only the defense bill. here ^ some bother- Twrne questions about all this. Among the roost obvious and most important, yet least frequently asked, are these: How many of the thou sands and thousands of people suing the asbestos industry are really sick or disabled, and of those who are, how many can really attribute their illness to asbestos? If a lot of the cases are frivolous nr questionable, it would mean that the tort sys tem is being cynically exploited to the detriment of the merito rious cases. The question is difficult to answer. One obvious reason is that only 150 of the 30,000 complaints filed have come to trial. As for the others, plain tiffs' lawyers of course say 90 percent are meritorious, while , defendants' lawyers say just the opposite. But one way to approach the question is through scientific and medical circles, and here there is a sur prise. The common public per-: ception is that asbestos-related disease is sweeping, or soon wiif sweep, the country like bu bonic plague. Yet many au thorities believe the prevalence of asbestos-related disease has been vastly exaggerated One such authority is Dr. Edward A. Gaensier, a profes sor of surgery and physiology at Boston University and a lec turer on medicine at Harvard and Tufts universities. Gaensier established the first lung function laboratory in New England, at Boston City Hospi tal, in 1950. A specialist in oc cupational lung diseases, he heads a research project, fund ed by the National Institutes of Health, that conducts yearly surveys of shipyards and fac tories in an effort to devise methods for early diagnosis of asbestosis._________ . If a large number of people were coming down with asbes tos-related diseases, Gaensler's team might be expected to be aware of thefn. But he says as bestosis and mesothelioma are "exceedingly rare" diseases. "I [ have not sfcen a new case of as| bestosis in two or three years," he says. "Ninety percent of the cases referred to this laborato~ry do not have asbestosis. As bestosis is a disapppearing dis ease." Dr. Barry Levine, a hmg specialist at Harvard Medical School and Massachusetts Gen eral Hospital, agrees: "It's a rare phenomenon, to find true asbestotic disease." Of those referred to Levine with posa ble asbestosis, be says, "most have either pleural plaques [whitish marks on the pleura], which are completely asymp tomatic, or they are heavy smokers with obstructive lung disease" (Le., smokers' dis eases). Dr. William Weiss, director of the Division of Occupational Medicine at the Hahnemann 'Medical College in Philadel phia, is another authority on lung disease. "I would agree with Gaensier," Weiss says. "Both diseases [mesothelioma and asbestosis] are quite un- common. A lot of injustice is being done: A lot of people with no disability are getting money, and other people at the other end of the spectrum who de serve compensation are getting lost in the shuffle." Not all authorities see it this way, of course. Dr. Irving j. Selikoff does not Selikoff is a flamboyant 67-year-old profes sor of environmental medicine at Mount Sinai School of Medi" cine and director of its Envi ronmental Medicine Laborato ry. It was Selikoffs study of 17,800 asbestos insulation workers that really blew the as bestos issue out of the quiet circles of scholarly study and into the public consciousness. Selikoff is not only a scholar but also a gadfly. He is aggres sive, accessible to the press, al ways good for a snappy quote, and he offers higher estimates of risk for most asbestos-relat ed diseases than other investi gators. His work is said to be invaluable to present knowl edge of asbestos hazards, but he is regarded by some experts in-asbestos diseases as a aeatot whose careless public state ments about .the dangers of as bestos have contributed to pub- UCC 008705 lie paranoia. Selikoff, for bis part, has implied that several of the authorities mentioned in this article are running dogs of tbe asbestos industry. Selikoff and bis ^laboratory staff go about the country con ducting disease screenings in union halls, reporting the re sults to the workers, tbe un ions, and often to the press. His public remarks about his find ings are often vague and omi nous. "Were in tbe midst of a nationwide survey of members of the insulation workers' union wbo are thirty or more yean from the onset of their work," he said in a recent telephone in terview. "We've $een about twenty-five hundred so far. Eighty-five percent have abnor mal X-rays." Most of the ex penses of the screenings are paid by the union locals. Selikoffs team conducted one suejj study at the General Dynamics Quincy Shipyard in 1981. The screenings were held at the union hall of Local 5 of the Shipbuilder's Union. It was not a scientific study: No medical or occupational rec ords, from either company or union, were used. Regardless of their demonstrated exposure to asbestos or lack of it, all workers with more than ten years of service, including re tired workers, were screened in the same way. The tests in cluded lung function studies, Xrays, blood tests, and other tests. At the tune, Selikoff went public with preliminary results -- that a high percentage of those tested "have shown ab normal chest X-rays, which in dicates that they have a high n$k of contracting asbestos-re lated cancer or other diseases. The results of tbe tests illus trate an immense problem -in the shipbuilding industry na tionwide." Selikoff takes the position that his results actually understate the extent of dis ease, "because the sick ones do not come in to be screened." UCC 008706 There are other physicians, less well known than Selikoff. who also incline toward high estimates of asbestos-related disease. Dr. David Christian!, a pulmonary physician at South Braintree's Norfolk County Hospital for Respiratory Care, says that in Norfolk's exper ience, "in the more heavily ex posed trades, those with more than twenty years of occupa tional exposure, there is about a 50 percent prevalence of fi brosis [asbestosis]." And Nor folk administrator John Barmack says, "Something like 50 percent of the sheet metal workers we studied showed signs of asbestos disease." ne of the reasons for Othis controversy is that diagnosing the major asbestos-related diseases and establishing their causes in in dividuals is difficult, despite what has been observed in studies of large populations. Consider mesothelioma. It is known that asbestos is a ma jor causative agent, but the dis ease also occurs in people with no known exposure to asbestos. Karen Antmann of the Farber Institute wrote in a 1980 New England Journal of Medicine article that "asbestos may not be the only causative factor eventually implicated in meso thelioma, since only 7.2 per cent of asbestos workers have the disease and approximately half the reported patients have no documented asbestos expo sure." No one is sure of these fig ures (some investigarors find that 80 percent of cases are as bestos-related}, because meso thelioma is extremely difficult to diagnose, and there are so few cases that large-scale stud ies are impossible. More to the point, there is no central, relisble registry of confirmed cases. It is likewise hard in par- ular cases to establish asbesos as the cause of lung cancer. It is known that a smoker has a higher risk of lung cancer if he or she works with asbestos -- the so-called synergistic effect of tobacco smoke and asbestos -- but it is also true that tuqK> cancer is virtually never sew in nonsmokers. One nationaS? known king cancer expert, pa thologist Dr. Oscar Auerbach of Veterans Hospital in Orange, New Jersey, goes so far as to say, "My studies show that if you don't smoke, you will not l get lung cancer no matter bow I much asbestos you inhale.'' Asbestosis, the third major illness associated, with asbes tos. can also be hard to diag nose. Since it is not a tumor or a virus- or bacteria-caused ail ment, but a reaction of lung tis sue to the presence of mineral fibers, it can be diagnosed with 100 percent certainly only by tissue biopsy. In advanced cases, there is usually a combi nation of signs that together give a reliable diagnosis: dys pnea (shortness of breath), dry i` rales (crackling sounds in the j lungs), impaired lung function. X-ray evidence, clubbing of the fingertips, and a history of ex posure to asbestos. But in milder cases, which are by far the most numerous, the problem is more complicati ed. A person may have a histo| ry of exposure and may have a > lung X-ray thrt shows white ' lines indicating abnormalities, but may have none of the other , signs of asbestosis. And there is widespread dissatisfaction among lung experts about the ' validity of X-ray evidence of as- . bestosis -- the lines that show on the films look the same ia j asbestosis as they do in a van- , ety of other illnesses. Barry ; Levine says. "A person with obstructive lung disease [i.e., a j cigarette smoker's disease. I such as emphysema] can be read as having an X-ray com patible with asbestosis." And Dr. Raymond Murphy, an occu pational lung disease specialist at Boston's Faulkner Hospital, calls X-ray interpretation in cases of slight or early asbesto sis "one of the most subjective in radiology." What is known about these diseases and their relationship to asbestos comes from epide miological studies -- studies of Continued on page 42 Asbestos CONTINUED FROM PACE 39 large groups qf people over time (the larger the numbers and the longer the time period, the bet- : ter). But epidemiology does not explain the links between environmental factors and disease: It simply identifies them. Suppose, for example, one studies two tnou- sand men who worked as.asbestos insulators in World War 1L shipyards. Suppose also that one studies for comparison two thousand men who worked as aircraft assemblers, without exposure to asbestos, over the same period. Such a study wfl! probably show a higher rate of hmg cancer, asbestosis. and mesothelioma among the asbes tos-exposed workers, tboogb no two such stud- j ies will give the same statistical result. { Now suppose a man who worked for thirty years as a pipefitter -- working around asbestos insulation -- contracts lung cancer at age 65. Suppose he also smoked two packs of cigarettes a day for thirty years. He does not sue the tobac co manufacturer because he knows he bought the butts himself and because no one has ever . won such a' suit. So he sues Manville et aL There is no question that he has hmg cancer. ! But was his cancer caused by asbestos? The large-scale study is useless in settling the issue. When such a case'gets to court, the plaintiff ar gues that the cancer resulted from asbestos, and the defense argues that it was caused by ciga rette smoking. Epidemiologists have a way of 'calculating probability of causation, but without knowledge of how asbestos and smoke interact to produce cancer, the calculation becomes aca demic and technical In court an expert medical witness will be expected to simplify. Is it likely that a person's condition was "aggravated" by his exposure to asbestos? Is there a "reasonable probability" that his condition was caused by as bestos? Proof is impossible, and expert testimo ny varies as much as it did in the case of John Hinckley's sanity. One of the key disputes among scientists and physicians concerns lesions called pleural plaques, sometimes called pleural thickening. Pleural plaques are whitish marks on the pari etal, or outside, surface of the pleura. Everyone agrees that they show up on virtually all workers with occupational exposure to asbestos, and sometimes in people, such as secretaries in as bestos factories or wives of asbestos workers who wash their husbands' dusty clothes daily, with secondary'exposure. UCC 008707 The question is, what do plaques mean? Some authorities suggest that they indicate ex* posure to asbestoa, and therefore put a person at higher risk of contracting disease. But Gaensler argues that plaques do not themselves constitute or lead to disease. "They are a signpost of expo* sure,'* he says, "they are MKiOUnful, they are not symptomatic, they do wInpair function, they have no meaning in pcqpans." Dr. Philip Enterline, an epidemiologiat it the Graduate School of Public Health at the University of Pittsburgh, says, "There have been many stud ies of pleural plaques, and they are inconclu sive.'' But some doctors argue that since (deques are abnormal and dearly a response to asbestos, they represent "pleural disease." Drs. Christian! and David Kern of Norfolk County Hospital take this position. "It is an effect, it is a response," Chrisliani says. Some authorities, notably Irving Selikoff, call pleural thickening "pleural asbestosis:" This is not a small issue, because if pleural thickening constitutes asbestosis, then the num ber of asbestosis victims -- and potential or ac tual suits -- jumps dramatically. Dallas attorney Fred Baron, a prominent plaintiffs advocate who has about seven hundred asbestos cases, says, "We have settled hundreds of claims for people with pleural thickening, f believe they have been injured -- it is an insult to their lung that will cause problems later." In fact, many workers who feel fine are suing because they have been told they have plaques and they are worried that if they do not sue now, they will contract a dis ease later, after the statute of limitations ex pires. Whatever plaques mean, there seems to be widespread agreement, Selikoff to the contrary, that they do not constitute asbestosis. Indeed, the carelessness with which the term is being tossed around has concerned many scientists. Oscar Auer-1 bach says, "What's happening is that a lot of doctors are find ing asbestos bodies in the lungs , [asbestos fibers engulfed by bo- | dily defense cells called macro- j phages] and calling it asbesto- \ sis. But if the bodies are there without disease, that is not as- j bestosis. Asbestosis is fibrosis [scarring] around the bronchi [bronchial tubes}." In response to this problem, a task force composed of rec ognized authorities in asbestos and disease was empaneled by the National Institute for Occu pational Safety and Health to clarify the issue. According to the just-completed report, in order for an illness to be cor rectly diagnosed as asbestosis, both fibrosis and asbestos bod ies must be present inride the lung. Dr. Hans Weill, head of the pulmonary diseases section | at Tulaoe University Medical School and a member of the task force, says flatly, "There , is general agreement, except for the New York group [Le., i Irving Selikoff and his associ atesj, that there is no such thing as pleural asbestosis." Ail observers agree that someone with heavy occupa tional exposure over time to as bestos is at great risk of get ting a terrible case of asbesto sis. An example is Ricardo To. lenrino of Westwood, age 76, who installed and tore out and refitted asbestos linings in' ship boilers for thirty years at the Boston Naval Shipyard. Tolentino's lungs today are so badly scarred that he can barely walk without losing his breath. But there is more dispute about lesser degrees of expo sure. There have beat esti mates that as many as thirty million workers -- electricians, pipefitters, coppersmiths, iron workers, utility repairmen, and others -- have had secondary exposure to asbestos between World War II and the enact ment of exposure limitations in 1970. Are all these workers doomed to come down with as bestos-related disease? Some have, including Herbert Walsh (not bis real name) of Sand wich, an ironworker who devel oped mesothelioma, though be never worked directly with as bestos. Another is John Reilly (also a psuedooym), who devel oped asbestosis after thirty years working around asbestosinsulated pipes as a steamfitter with a public utility. But most authorities think a future plague of asbestos-relat ed disease is unlikely. The fear about such an occurrence can be traced largely to a document usually known to scientists as the "Estimates Document." Released in 1978 by the Occu pational Safety and Health Ad ministration (OSHA), the Esti mates Document stated that "the expected average cumber of cancer deaths associated with asbestos per year [in the next thirty to thirty-five years] will be between 58,000 and 78,000," and that asbestos : alone will account for 13 to 18 percent of total cancer deaths. This paper was publicly en dorsed by Joseph Cahfano, then secretary of the Department of Health, Education and Welfare, and it is still widely dted as a source in journalistic reports. . Yet within the field of epide miology, its figures have been ' rejected as fantastically inflat- Two distinguished British epidemiologists, Sir Richard Doll and Richard Peto, wrote in a 1981 article in the Journal of the National Cancer Institute that "the OSHA paper [a* they call the Estimates Document] should not be regarded as a se rious contribution to scientific thought.... It seems that who ever wrote the OSHA paper did so for political rather than sci entific purposes." (The Doll and Peto paper was published as a book, The Causes of Can cer, by Oxford University Preas in 1981.) Hans Weill of Tulane says more bluntly, "The Esti mates Document was a dis grace." Since the peak of exposure occurred during World War 11 and since occupational expo sure standards have been in ef fect for twelve years,.it is rea sonable to expect that there will be some approximate peak of new asbestos-related ill nesses, followed by a decline. . But when will the peak occur? And how high will the peak be? Too little is known about dose-response ratios to answer this for_sure. Enterline-arguey that the asbestosis peak has al ready passed, about ten years ago. But what about asbestosrelated cancers? Most sources agree that they are increasing. How fax off was the Estimates Document? Selikoff says there are 8200 asbestos-caused cancer deaths per year now, and that a peak of about 10,000 will occur about 1990. But most other au thorities put forth much lower ` numbers. A 1981 paper pub lished by J. Corbett and Alison McDonald, epidemiologists at Montreal's McGill University, UCC 008708 Shipyard workara pour through tho goto* of tho Brornorfon, Washington, Navy yard in 1941. estimates total annual cancer mortality due to asbestos as 1.5 percent of the 400,000 annual US cancer deaths, or about 4500 cases. Philip Enteriine at the University'of Pittsburgh puts the number at about 4054. Others have given similar estimates. Enterline concludes, "The rote of asbestos in our overall cancer problem has been greatly exaggerated. Elimination of all asbestos from our environment would have an imperceptible effect on the cancer problem." There is probably more uncertainty and wor ry about future rates of mesothelioma than about other asbestos-related diseases, mainly be cause, as British epidemiologist Dr. Margaretv Becklake wrote in an article in the American Review of Respiratory Disease, "The roost dis concerting aspect of the relationship between malignant mesothelioma and asbestos exposure is its documented association with apparently low levels of exposure." Still, even if only one fiber of asbestos can cause mesothelioma, as some people think, it is dear that one fiber does not necessarily cause it. If that were so, given the millions of workers exposed to at least a few fibers, there would be huge numbers of mesothelioma cases. Indeed, it is thought that virtually all urban dwellers (and many rural dwellers who live near natural depos its) have at least a few asbestos fibers in their lungs. No one disagrees that the greatest exposure to asbestos, in terms of numbers of workers, oc curred during World War II. Given the thirty-toforty-year latency of mesothelioma, if there were to be an asbestos-related mesothelioma epidemic in the United States, it should have occurred by now: World War II ended thirty-sev en years ago. But it has not. The number of mesotheliomas has risen somewhat, but recent studies cited by Doll and Peto suggest that it remains an ex tremely rare tumor -- there are fewer than 1000 new cases per year, compared with (using 1978 figures) 53,000 colon cancers, 35,000 breast cancers, 21,000 pancreatic cancers, and 100,000 lung cancers. Another research team, Julian Peto, Brian E. Henderson, and Malcolm C. Pike, also give a figure of 1000, and they sug gest that the peak, combining occupational and nonoccupational causes, will be about 1400 cases and will occur around 1990. Selikoffs estimate is, as usual, higher: He gives a current annual figure of about 3000 cases. To say mesothelioma is a rare disease is. of course, cruel comfort to those who suffer from it. and there is no suggestion intended that 1400 cases per year, or 4000 cases, is an acceptable incidence. Still, these figures are far lower than those commonly cited, and they are a tiny frac tion of deaths caused by cigarette smoking (140,000 this year and rising every year). DoH and Peto, whose 1981 study was commissioned as a report to the Office of Technology Assess ment of the Congress, concede that the trend of asbestos-related cancer deaths is upward, but they also concluded that 30 percent of US can cer deaths are attributable to tobacco, 4 percent to occupational hazards, and 1 percent to industrial products. he asbestos companies Thave argued that the government should take a share of the responsibility for. compensating people sickened by asbestos. After all, they say, most of the demonstrated injur ies were received in govern ment-owned naval shipyards where working conditions and . medical protections were abominable. The companies have organized the Asbestos Compensation Coalition, which advocates a sharing of compen sation by industry and govemrrfent Several bills have been filed to get around the court logjam. One bill, to be refiled in the Senate next session by Gary Hart (D-Colorado), would es tablish a federal commission composed of representatives of government, labor, health, and industry. The commission would establish minimum stan dards to be applied in determin ing compensation, standards which would then be applied by special state compensation boards. Both government and the industry would contribute. "Gary's bill," says a Hart UCC 008709 r spokesman, "tries to recognize that in many cases, these peo ple were working on govern ment projects in government facilities where the gqvumment controlled the environ ment." Most plaintiffs' lawyers are vehemently against any system that would sidestep the thirdparty tort system. Plaintiffs at- ! torney Fred Baron says, "We i oppose any system where the , federal government has to pick up the tab: The companies and insurance carriers are solvent and capable of paying." Admin istrator John Bannack of Nor-, folk County Hospital agrees: : "There may be a role for gov- . eminent as a guarantor of benefits, but that role should not relieve the economic bur den from the asbestos compan ies. First, they caused the problem and they covered it up. Second, it sets a dangerous precedent when government picks up the cost of workers'. health problems caused by cor porations, because you're say-' ing to the corporate decision makers, 'You don't need to be concerned with workers' health, because if you're hit by liability suits. Uncle Sam will come in to bail you out' " Whether Bannack and Bar on arr :-- >r not on the ab stract k--- --n of equity, the reality is mat the Maiivffle, UNR, and Amatex bankrupt cies have jammed the court system. Even if two-thirds of the asbestos lawsuits were without merit, that would still leave thousands whose lives have been ruined or threatened by asbestos. Meanwhile, time is passing. It is clear that a joint government-industry compen sation system, depending on its . cost and its political support (certain to be greater now with the blockages caused by the bankruptcies), would, speed up the process by which Andrea Kilroy can get some relief from her agony over what the cost of her illness is doing to her aging parents and her children. "We need a policy for cata strophic illness," she says. "There's no need in a country like ours for people who are fighting for their lives also to have to worry about paying their bills. I don't care where the funding comes from -- the fault for this has to be laid .somewhere, but where it's laid isn't the point. We need kUp" UCC 008710