Document oeeR8kZ1nD0vzY7a0n0VxpyDw

/ *t a <->/ / V. --y / O NOTE: THIS DOCUMENT DiD NOT COME FROM PPG FILES widens-- 9f a patient complains of shortness of breath and shows calcification or pleural thickening on a routine chest x-ray, asbestosis and other as* bestos-related diseases can be ruled out with a few simple questions about job history. Bight? ? :l Wrong-, says Dr. Henry A. Ander son of Mount Sinai School of Medi cine's environmental sciences labora tory in New York City. What is needed to prevent possible misdiag nosis is a complete lifetime history of where the patient has lived and worked, plus the job history of family members whom he or she may have lived with for 30 or 40 years. The once-prevalent notion that as bestos exposure must be intense or prolonged to produce any ill effects is . refuted .by Mount Sinai studies of . Micrograph from Mount Sinai's Or. Arthur Langer shows asbestos fibrils workers' families. Dr. Anderson 300 A to 400 A wide in lung tissue of city dweller whose hobby of found that even one day's exposure to refinishing furniture also exposed him to high levels of the mineral. fronts Is enough to produc* ple^B fibrosis. "When someone 30 large. It flakes down from ceilings ence," says Dr. Selikoff. From 1952 to yeai^id who has never been sick a and hot water pipes, it blows through 1951, 18.3 cancer deaths were ex lay in his life comes up with these ra-.' the ventilating systems of large of pected and 57 occurred, while from liographic changes, it is highly sig- fice buildings, it is squeezed out into 1962 to 1971, 17.6 cancer deaths were nficant," he says, - the roadside air when we jam on the 'expected and 104 occurred. Of all Of the 210 family members exam- ; brakes. We spackle and patch walls workers who died, 45% died of cancer. ned 25 to 30 years after the time of with it, we rub it on our skin in talc The risk to "asbestos neighbors" heir household contamination with -.:' products, and in many areas we drink (people who have lived within half a . sbestos, 38.6% had chest x-ray abnor-; itinthetapwater.. ' mile of an asbestos plant) is espe- lalities, pleural or parenchymal or Once in the lungs, asbestos fibers cially visible in the incidence of jth,. that are characteristic of as- -- stay put The longer they have been mesotheliomas, which now seem to be estos exposure.' A comparative there, the greater their effect Dr. An almost as directly tied to asbestos ex- imple oF a "well" population did not derson predicts that physicians will posure as asbestosi3 itself. These rare im up any of the observed changes -: soon be-starting to see the peak ef tumors of the pleura and peritoneum n lung tissue. Nearly 8% of the fam-"' fect of "the relatively light "by account for about one in 10,000 deaths ly members had clinical symptoms stander" asbestos exposure of ship in the general population. But Dr. ompatible with asbestos-related lung yard workers during World War II. " Selikoff found that about 7% of deaths isease And, among the children of - Even in the primary risk group, among asbestos workers was due to ne 13-year asbestos worker, four whose work consists mainly of han mesotheliomas. Studies from Britain ases of mesothelioma have appeared. dling asbestos, the adverse effects are and South Africa have found tra Nowadays, of course, asbestos likely to be long delayed. Dr. Irving J. ceable asbestos exposure in the back 'orkers don't breathe nearly as much Selikoff, who is head of the Mount grounds of S5% to 97% of mesothe f the "magic mineral'' as they used Sinai laboratory, and his associates lioma cases studied. In a London s (though a planned further 00% reuction of the amount of asbestos bers_permitted in the air at work lac^^is been postponed, at least have been following $32 members of the insulation workers' union in the New York metropolitan area who were registered union members on study, neighborhood asbestos expo sure actually accounted for slightly more mesothelioma deaths than fam ily contact, indicating to Dr. Selikoff nti^^er the November elections), Jan. 1, 1943. For the first nine years, that the family hazard and neighbor*'-' ad they don't track much of it home, only 73 deaths occurred, with 76.4 ex hood hazard are "equally significant: *'j ut the substance has become far pected. "The next two decades, how After the workers, family mem- iore prevalent in the environment at ever, saw a worsening of their experi bars, and neighbors of asbestos mines TU , | zmr*ai wmtjt n ---------- ------- =----------------- -J--&B-00 05424-*"M**T* bsrst-500 )ne Filmlc-ib* tablet a day supplies: 'ontroUed-Release Iron Sulfate, (j^B lent to italiron--105mg.) .. 525 mg. Mus High Potency Vitamin C itamin C (as Sodium Ascorbate) .... 500 mg. 'lusthe B-Complex ... :ontains no folic acid) iacinamida .......... 30 mg.' alcium Pantothenate 10mg. itamin Bi >-.,, (Thiamine Mononitrate).... ,, 6 mg. itamin S, (Riboflavin) 6 mg. itamin 3* ` . . , ' /:-,vJ.v (Pyrldoxine Hydrochloride) ... 5 mg. itamin 31S . . (Cyanocobalamln) ... 25 meg.. JDICATION3: For conditions in which on deficiency occurs concomitantly ith deficient intake or increased need rthe 8-complex vitamins (contains no lie acid). . 3srat-Folic-5D0* & ne_Filmtab tablet a day supplies esameformulaaslberet-500p|us: alic Acid.......... ... .800 meg. NS: In non-pregnant adults, r tn^^atment of iron deficiency and evention of concomitant folic acid de- icncy where there is an associated ficient intake or increased need for ? B-comptex vitamins. Also indicated pregnancy for the prevention and atmerit of iron deficiency where there a concomitant deficient intake or in- ased need for B-comp!ex vitamins eluding folic acid). . ... 'NTRAINDICATION; Pernicious ;mia. .' j~ ' - ,.J; " RNINGS: Folic acid alone is lmper therapy in the treatment of perious anemia and other megaloblastic rmias where vitamin Btl is deficient.' ECAUTION: Where anemia oxists, nature should be established and ferlying causes determined. Iberetic-5C0 contains 800 meg. of folic acid * tablet. Folic acid especially in >es above 1.0 mg. daily may obscure nicious anemia, in that hematologic ussion may occur while neurological ilfestations remain progressive. /ERSE REACTIONS: The likelihood tasUj^ttolerance Is remote. If such uU^P r, the tablet may be taken r a meal. Allergic sensitization has n reported following both oral and jnleral administration of folic acid. uwto , AbOotl. do* :jS--Film.jj|d IibUlj, Abbott NOmmSDOCUMOlTPlD ASBESTOS Gcn<im*e NOT CO! and plants, who comes next in risk of asbestos-related disease? Possibly auto mechanics who spend much time repairing brakes, possibly people who live or work in buildings that have . been constructed or repaired with products containing asbestos. .In some high-rise buildings fire proofed with asbestos spray two to five years earlier, the Mount Sinai in- . vestigators found airborne asbestos * levels "not much different from some of the concentrations we have mea- f sured near asbestos factories/' re--: ports Dr. William J. Nicholson. :.v;Dr;. Nicholson and his colleagues ' studied 19 buildings in five cities, tak Dr. Anderson found one day's exposure to asbestos produced abnormal changes. ing a total of 116 air samples. The now-discontinued fireproofing process . cident (someone banging into the used in these buildings is one in which ceiling with a ladder while replacing. dry asbestos and dry binders are- a light bulb) can damage the surface blown with a hose through a water, and loosen the asbestos. - . spray.in order to bind the asbestos to ' A related problem in many of these the steel framework. The process is buildings is that the sprayed grill- ineffective--some fibers get wetted work is in contact with a moving air and activated and some don't, and if a stream that forms part of the air re sealant isn't used, the asbestos is ex circulation system. "If you look in the tremely friable. "The asbestos falls' return air plenum, it is really fright- off and it's something of a bad show," . ening because asbestos is everywhere says Dr. Nicholson. '. and it is just an impossible situation ; The fibrous spray has also been to clean up," says Dr. Nicholson. "The . used for acoustical and decorative whole air supply system has to be re purposes. It caii erode with time, re- designed and made compatible. What ' . leasing fibers into the air in concen we need now is engineering research trations far above "normal" back . to see if we could convert to an ef- ground occurrence: The method may ficient filtering system," he says. * have been used in as many as half the : Better building maintenance proce- large multistory buildings built in dures are also needed, he emphasizes, . this country since 1953, but the EPA .- For instance, some caution i3 neces- /..'I banned it in 1973 after New York sary whenever any workman goes City, Boston, ar.d Illinois had already ;; into the plenum space--to fix any sup* ^prohibitedit. - ply network of air, water, or electric- r-.-Although there is no way of pin-, - ity that passes through it--in order pointing which buildings were con not to ' dislodge the asbestos. "The structed with this method, it is pos maintenance men need to be aware of sible to take air samples--albeit at . the possibility of knocking off the as considerable cost and effort (a3 Dr. bestos and sending it through the Nicholson points out, to study a single building," says Dr. Nicholson. An sample requires a day's use of an elec other urgent need is to find tech tron microscope). If the building has a niques for safe demolition of such considerable problem, the asbestos buildings--if not handled carefully, dust may be easy to spot and periodic asbestos escapes into the air. air sampling can be augmented with Airborne asbestos from these build regular visual checks. The surface can ings affects not only the people inside, be coated with a sealant or rcspmyed Dr. Nicholson emphasizes. Concentra with another fireproofing material tions outside the buildings ranged up (asbestos can be mixed with cement to 48 ng/M3 of air, compared with a into a substance that firmly adheres). high of 200 ng inside, suggesting that But even with sealed asbestos, an ac- these buildings make an important .. - j! I j! j i ___ J * ` C<f"BB**0005425 MPTd. -runt OIO-`- < ofent analgesic far relief of niild to moderate pain darvocst-n'ioo prDp&r/phtns napsylat* wito acetaminophen Indications: Fox ffte refief of rrM to moderate pain, either stone or cccmp3nied by fever. Contraindications: Hycsrsensitiviiy to propoxyphene or to acetaminophen. Warning*: Qrvg Dependence--Propoxyphene can produce drug dependence characterized by psychic dependence arid, less frequently, physi cal dependence end tolerance. Propoxyphene vhtt only partially suppress the witndrawel syn drome in individuals phys.caiiy dependent on morphineor ciaer narcotics. The souse liability of propoxyphene is qualitatively similar to that of codeine although quant,tetrvety less, and pro poxyphene should be prescr,beo vhtn the same degree of caution appropriate to the use ot codeine. Usage in Arnbolftoy Patents -Propoxyphene may impair the mental end/or physical ap,lines required for ins pehcrmence Of potentially hau^< is tasKs. such as driving a car or cperat- *eiy. The patfent shojIO p? cautioned ' ZCO& Jy Usagi in Pregnancy--Safe use in pregnancy has not been established relative to possible adverse effects cn fetal development. Therefore, propoxyphene should net be us ad in pregnant women unless, in the judgment cl the chysi&an, the potential benefits outweigh tne possible hazards. Usage in CrulCr*n~?rcooxyphene is hot recommended for use in c.ntcren, because documented clinical experience has been insuffeient to estabfish salery and a swtaole cosage regimen in tfie pee-atne age group. Precautions: Confusion, anxiety, and tremors have been reoorted in a few patients receiving propoxyphene COnccmt'anny w:;n ciphsnadnne. The centrat-nenrous-system dep'essant eitect of propoxyphene may be additive :n mat of otner C.N.S. depressants, inchjong a.cohci. Adverse Heeetions: The most frequent adverse reactions are C'Zdmess. sedation, nausea, and vomiting. These effects seem to be more promt- nenl in ambulatory tnan in ncnambuiatoiy oatients, and some of these adverse reactions may be at'eviated <1 Lie pehent fes ccwn. Olier adverse reactions include ccnstipation, e'odominal pan. ston rashes, l.gh'nradedness. headache, weaViess, euphoria, dysphoria, and minor visual frshjtbances. Die chrorvc ingestion ot propoxyphene in doses exceed,ng 300 mg per day has caused toxic psychoses and convulsions. | mx-J Apieon.it L-.h/rraten avfrlahte to the picfes Sion on reguest. r*. I (TTx -1*H r'hr-nsrm E'.'f'T` |; i rt^usVi \p'inp nNLi bL`o0 t ^ 1v1" 1 ASBESTOS continued contribution to the asbestos load in urban air generally. (Prolonged expo sure to concentrations of over 100 ng/M3 is a significant risk.) Small buildings as well as large ones can contain asbestos hazards, even if no asbestos was used in the original construction. Late last year, a report from the Mount Sinai labora tory linked the U3e of commercial spackling, patching, and jointing ma terials to a possible risk. The investi gators based their warning on an analysis of 15 samples of consumer spackling and patching compounds that were purchased at hardware stores between 1972 and 1974. Five of the products contained "appreciable amounts" of asbestos minerals. Spackling and drywall taping-compounds consist of extremely fine grained white powders or premixed pastes. These- are composed primarily of plaster of Paris but often other materials that naturally contain as bestos are included in the commercial product. The asbestos fibers spread as dust when the spackling is mixed or sanded or the debris is cleaned up. The Mount Sinai investigators found "detectable fiber concentrations in adjacent rooms during mixing and fibers were still suspended in the room air for a least 15 minutes after mixing had ceased." They also found that significant concentrations of as bestos remained suspended and could pervade ' living quarters after the rooms had been swept. The Mount Sinai researchers sug gested that the labels on these prod ucts should dearly state their content and provide instructions on how to minimize the hazard (such as protect ing people in the working area with appropriate respirators). Most of the companies, however, have since taken steps to remove the asbestos from their product. Commenting on these findings, Da vid P. Rail, director of the National Institute of Environmental Health Sciences, says, "they suggest the pos sibility of significant exposure during home construction and repair. The re sults are alarming when considered in relation to other evidence being ac cumulated indicating "that"far-less" environment is capable of producing ' asbestos-related disease." Most environmentalists agree that li all U.S. city dwellers run a real risk of asbestos contamination. Last year, during studies that confirmed the contention that asbestos fibers can be found in the lungs of nearly every ur ban resident, researchers in Chicago noted a significant association be tween the number of fibers found and the incidence of lung cancer. This was true even in persons with no known exposure to asbestos who had a "far smaller" number of asbestos bodies in ` their lung3 than would be found in the lungs of most occupationally ex posed workers, reported Dr. Andrew M. Churg of the University of Chi cago's Pritzker School of Medicine. Drs. Churg and Martha L. Wamock found asbestos fibers in 93% of the cases they studied, suggesting that nearly all city dwellers have at least a slight theoretical risk of asbestos-re lated neoplastic disease. For the other conditions attributed to asbestos, in cluding the characteristic chest x-ray findings, there appears to be a thres hold factor protecting most people who have not had fairly intense as bestos exposure. Airborne asbestos can be measured today, but it was not the general practice to do so 30 or 40 years ago, so no one can directly correlate the amount found in air today with any past health experience. There is no way of knpgdp.3 the level of exposure then. djSweVer, the^jborld production n'tthen'was 50,000 tonsil year, now it is overy*4^0O0O millionn---ttoonns. According to 5T-* Dr. Nicholsonjthe total U.S. use of as bestos has risen from 156,000 short tons in 1920 to 720,000 short tons in 1965. "To be fair, though," he says, "the largest growth has occurred in those uses unlikely to contribute i. ( l;f greatly to atmospheric pollution." The gaps in epidemiologic correla tion of airborne asbestos and as bestos-related disease in the general population are large enough, but in recent years the controversy over as /<oj /1\ t />/ // ; / : i bestos has centered on water pollu tion, where the gaps are even larger Lake Superior has been the focus of 'V the bigjfesrscare. T .1 T>_* . * . i107 ASBESTOS cenfinvd tion Agency sued the Reserve Mining cause cancer. At the hearings. Dr. Ar- 1977 dosing date, since the contro Company in Silver Bay, Minn., for nold Brown, a pathologist at the versy may not be settled by then. polluting the lake by dumping about Mayo Clinic in Rochester, Minn., said, And on May 21, 1975, Reserve 67,000 tons of waste into it each day. "I see no evidence for an increased in- signed a stipulation with the state Reserve (which is owned jointly by cidence of cancer in those communi- agreeing to install the most sophis^ Republic Steel Corp. and Aimco Steel ties that could be attributed to the ticated air quality control facilities to Corp.) developed a process by which presence of asbestos fibers in water." virtually eliminate all visible air , iron ore in the form of pellets is ex- However, Duluth now-has a $6-inil- emissions from its Silver Bay plant ; tracted from taconite, a hard gray lion grant from the federal and state (except water vapor and steam). That rock. Three tons of taconite must be governments to build filters at its program, which will cost $34 million, mined to produce one ton of pellets; central water treatment works to is scheduled for completion in two the remainder constitutes the "tail- strain out the fibers before pumping years from the start of construction. ings" that have been dumped into the the water into the main distribution The upshot of this is that the Envi- ` lake since the plant opened in 1955. system. ;,.ronmental Protection Agency said it After nine months of hearings, a fed- Meanwhile, since Reserve did not . will conduct a nationwide sampling oral District Court injunction closed appeal the Circuit Court decision that program to determine whether there the Silver Bay facility fpr a few days, ' it must find on-land dumpings, it has are significant levels of asbestos in but it was reopened when a U.S. Cir- . come up with a $202-million project to drinking water. It has chosen 32 loca cuit Court in St. Louis gave the com- convert its operations to total on-land tions in the U.S. for monitoring as pany a "reasonable" time to begin tailings disposal with no discharge to bestos . discharge into water from . dumping its wastes on land and to re- Lake Superior or any surface waters, various sources including asbestos duce its smokestack emissions. In November 1974, Reserve applied to mining and manufacturing, mining The basis for the decision was that the' appropriate State of Minnesota of other ores such as talc and ver- the wastes posed a "potential" dan- agencies for permits to implement its miculite that can be sources of as ger hut not an "imminent" one. On- on-land tailings disposal plan at the bestos, and tbe natural run-off of as- , land sites have been proposed by Re- so-called Milepost Seven site. Hear- . bestos from rock formations. The serve and are being considered by ings were held on Reserve's proposal EPA says that asbestos may be quite Minnesota's Pollution Control but the hearing officer, Vayne Olsen, widely distributed in drinking water Agency end the Department of Natu- recommended that the agencies re- supplies throughout the nation since ral Resources. - . ject "Milepost Seven." They did so, it comes from natural as well as in But little scientific evidence is and Reserve is appealing that deei- dustrial sources. Another source may available to show whether ingested sion in the Minnesota District Court, be the walls of asbestos cement pipe fibers can penetrate the stomach or The trial should he held this fall. Re . used in water distribution systems. intestines, be picked up by the blood serve also has an appeal in the U.S. So far, the EPA has found concen trations of more than a million fibers per liter in Duluth, Seattle, San Fran- _ dsco, Troy, Vt., and Skidway Island, Ga. The agency said it won't have any !- conclusions on the public health as- . pects of the asbestos levels until early next year. . vVThe asbestos situation follows *. Agne3 Allen's law," says Dr. Selikoff. "She was a corsetiere who used to say there are some things that are much . easier to get into than out of. Medical knowledge about the health hazards of asbestos began to be collected ic the 1930s and 1940s. But we phy3i- dans didn't warn society to take it se riously and today we have a huee as bestos industry, with millions of ton? of the mineral in our modern build ings and in consumer products." Since asbestos is not biodegradable the environmental load is largely cu mulative. Even if we stopped all -usi Reserve Mining Company, which has been dumping taconite tailings in Lake of asbestos tomorrow, the problerr Superior, Is embroiled in legal battles over on-land disposal sue. would be with us a long time. J'bB 0005427_^