Document p2adjKnD5ONz8ZjmMBgyKnwnD

til JohnS'Manville fr, hr. P r i L Kot i n Mf'orfjp W. Wright, M. D. Internal Correspondence Om September 23, 1974 TFt.rPHONK OONVFPSATION WITH HILTON LEWINSOHN, 9/19/7* (1) The Turner Brother's cohort has now been enlarged to iqi v-y io those indivichiale employed since 1933 who have 10 or sure years exposure and increasing the period of observation from the late '60's to 1972. They have followed not only the employees still on the ]ob but also those who have Left employment. In this cohort of employees who started work since 1933, they have now recorded 26 cases of asbestosis diagnosed by the sore liberal criteria proposed by tho workmen's Condensation Board of Great Britain. These criteria are considerably sx>re liberal than those originally utilized by Dr. Knox <n his p.'rvicuulaewdciona on tne original cohort of 291. In my Judgement the finding of these esses is r'asonably good evidence that there haa been a substantial exposure for this population especially during that period between 1933 and perhaps 1960. When I spoke about this with Dr. Lewinsohn and he agrees with me that there must have been a transition period during which the fiber count dropped following the institution of the regulstions in 1933. I hsve no certain way of knowing what these counts may hsve been but on the basis of what I know about other observations 1 would expect that the counts at the beginning of 1923 might have been in the range of 50-100 fibers per cc and X would expect that even as rscently as lata 1950's it would hsve been something of the order of 25 fibers per cr. wp know that in the middin 1960's when smmbrsne filters were beqinninq to be used and fiber counts be made by the Turner Brother's Hygienists the counts were in the n^ighboihood of 10 fibers per cc. Moreover, it has really only been in the period subsequent to 1966 or 1969 when they had a fairly high proportion of their oper ation going at below 5 fibers per cc. I make these points because I would anticipate that those individuals who showing any evidences of asbestosis or of broncho-- ionic cancer and possibly even mesotheli Dr . P.u> l Kotin September 23, 1974 P.iqe 2 persons who were exposed in that period prior to 1'50 or 1955 when the fiber count* war* nuch higher than our current standard of 5 and tin projected standard of 2. (2) At present there have been 29 death* in th* cohort of j9i persons. On the basis of th* British Rational Statistics for a population of this sia* having th* age distribution that this population ha* they would have anticipated 40 deaths during th* period of observation. This indicate* clearly that,a* has been observed in other industrial population*^ the working population is a selected group and have a lower mortality experience during their working age* than is true of the general public, for this reason it is somewhat lacking in validity to cooper* the pattern* of mortality in any working population to what are celled the National Statistics which is s population having a vastly different mortality pattern. When the causes of death are broken doun It show* that out of th* 391, 7 lung cancers were observed where as 4.8 were expected on th* beei* of BetIons1 Statistics. Subjected to ststisticel analysis this difference is not significant. There were 3 asaothwllowas, and of course this is obviously a statistically significant difference. If one makes an adjustment end looks et this experience in terns of 40 expected deaths rather then 29 then the portion caused by lung cancer Is not abnor mal, although of course the mesotheIlona death* do con stitute a larger than expected group. It would appear f then that on the basis of proportion of total deaths or those observed compared to the ejected there is no statistically valid difference between tbs working pop ulation and the general public In Orest Britain fron this cohort of 391 persons. My own impression would be that if they had large enough numbers there would be some statistically different findings but they would be rather small. I aay this because I am con vinced in my own mind that they did not overnight diminish their exposure by the amount that I think is necessary to get o completely sefe working place. On the other hand. I fael vary strongly that their ex perience thus far cannot be uaad to promote the con tention that somewhere between S and 2 fibers per cc is *n unsafe level. Dr. Lewinsohn is sanding me this anterial I'.iu L Hot in, M, D . September 23, 1974 Page #3 in greater detail aa soon as he can, I asked specifically whether or not the cancer deaths and the mesothelicma deaths had beer, in those people who had been employed prior to 1955 and he indicated that his recollection is that this was fhe case but he will look int-o this and make certain that he is correct. (3) nr. Lewinsohn explained to me how this renewed interest in the Turner Brother's experience caaM about. He says that Granada Television has a program call World Action and ' " had interviewed Dr, Selikoff on the subject ot vinyl chloride. At thet tine he told then about the controversy between Lewinsohn and hineelf and suggested that they look into '\e Turner Brother'a story. Granada Television has done so and they plan to have a television show on this subject. They have already filmed Turner Brother's operations. Lewinsohn*s examining of patients and Holaws doing hygiene studies. They plan to interview Selikoff on this spscific subject sometine in the very near future and they have promised to interview Lewinsohn after they have inter viewed Selikoff. The Turner Brother's people felt that in any case they were obligated to say exactIv what the circumstances wwia and xurtnemore they do not believe the circumstances are indicative of a need to set e standard lower than already exists in Great Britain. For these reasons they have been completely open in telling any inquirers whet the circuswbances are. George w. Wright. M. D. GWW/bem