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How surgeon's probe led
to vinyl hazard findings
Fjrl wa 58--getting close to retire
ment He'd worked 27 years at the B.F. Goodrich plant in Louisville, making polyvinyl chloride (PVQ for plastics.
But he had these pains. His belly was swollen. His skin looked yellowish.
So he went to see his doctor, last July, who sent him to surgeon John L Creech, MD, for a liver biopsy. Dr. Creech was also the part-time plant physician at Goodrich, so he and Earl knew each other. Dr. Creech per formed two biopsies, and both times the lab reports indicated severe cirrho sis.
Earl died on Dec. 19, 1973. An autop sy found cirrhosis, all right, but it found something else, too: angiosarcoma in the liver.
DR. CREECH knew something about angiosarcoma. He had seen a case of it once, in 1954 as a resident at Houston's M.D. Anderson Hospital. He knew it was fatal and incurable. He also knew it was extremely rare--less than 25 cases reported annually in the U.S.
Interesting. Dr. Creech seemed to re call that another Goodrich worker had died of liver angiosarcoma in 1968. He went back to the plant's dispensary and
pulled the health records of every de ceased employee, and called a few pathologists around town.
He came up with a total of four cases of angiosarcoma of the liver in the past six years--all among the 270 workers in the vinyl chloride polymerization sec tion of the plant
A morbidity rate 100,000 times the national average was no coincidence--it didn't take an epidemiologist to see that.
"I'm not a researcher, I don't read any. of that literature," Dr. Creech told AMN. "I'm a damn good surgeon, but not even a very good medical man. But I tend to notice things like this--it's just a quirk of mine.
"I REMEMBERED that first boy, the one who died in '68. At the time I didn't realize the significance of it. After the second case, I began to get curious." A Louisville pathologist had also diag nosed two angiosarcomas among Good rich workers, "but he didn't make the connection."
Dr. Creech did. He quickly called Maurice N. Johnson, MD, director of environmental health for B.F. Goodrich.
(See Surgeon's .... p. 12)
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aerosols, such as hair spray, and PVC is the main ingredient in thousands of
plastic products.
NIOSH and the Center for Disease
Control (CDC) in Atlanta immediately began the immense detective job of digging out records on all the vinyl chloride polymerization workers in the country, and analyzing them for angio sarcoma figures--and anything else they might run across.
Gradually, a grim trend was revealed: to date, there are 14 verified cases of angiosarcoma, in four plants--Niagara Falls, N.Y. (Goodyear); Wheeling, W. Va. (Union Cat bide); Pottstown, Pa., and Louisville (B.F. Goodrich).
In addition to angiosarcoma, unusually high morbidity rates were found for variously diagnosed ailments of liv er, spleen, pancreas, and gall bladder.
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THE PARTIAL results of the investigation--not yet completed--showed a sketchy pattern. The Louisville plant ac counted for half the recorded angiosar coma deaths, reported NIOSH inves tigator Joseph K. Wagoner, MD, possibly because it was the first PVC plant in the U.S., open since 1940.
Clark W. Heath, MD, of the CDC Bureau of Epidemiology, found that 12 years was the average time spent han dling vinyl chloride by workers who died of angiosarcoma; the shortest time was six years. The earliest case was di agnosed in 1961, two decades after PVC was first produced industrially.
Complicating the problem is the fact that angiosarcoma may not always have been correctly diagnosed. "Any com petent pathologist could readily diag nose it," said Hans Popper, MD, of the NIOSH group, "but you would have to be looking for it."
More than one researcher has com mented that 14 deaths since 1961 is hardly a crisis--but angiosarcoma might well turn out to be only one piece in a big toxicological puzzle.
In February, NIOSH passed its tenta tive findings on to the U.S. Dept, of Labor s Occupational Safety and Health Administration (OSHA), which an nounced it was immediately lowering the federal maximum on airborne vinyl chloride in PVC plants from 500 ppm (parts per million) to 50 ppm.
The standard had been set at 500 ppm ten years ago, for two reasons: first, a Dow Chemical Co. scientist had found liver damage in some rats exposed to 500 ppm or better of vinyl chloride; and second, the gas was also suspected of causing a bone-eroding disease called acroosteolysis.
But plastics manufacturers responded to the OSHA edict by pointing out near-
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12 AMERICAN MEDICAL NEWS MAY 27, 1974
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Based on a variety of findings pieced together, the fibrosis was tentatively identified as a probable precursor of cancer. And, it was discovered, workers who had developed the fibrosis and then left the PVC plants continued to get worse instead of better.
In addition, Lelbach said that the German team found six workers -witfi "vinyl chloride disease" who had never worked in the vinyl chloride polymeri zation process--instead, they made floor tiles from raw PVC. Apparently, there were enough traces of vinyl chlor ide in the raw PVC to cause illness; yet it was an indication that it certainly didn't take high prolonged concentra tions to produce the syndrome.
THERE WAS some discussion at the
conference about whether the PVC plants should be closed down until the
safety of the workers could be guaran
teed--but many of the "working group"
members strongly opposed the idea.
"You're all asking questions as if we had done our homework," snapped an
irritated Irving J. Selikoff, MD, at news reporters present. "Well, we haven't
done our homework. You want us to make guesses--but we need more hard
data."
Yet Dr. Selikoff later declared that
"we have a multi-system disease here.
It's been demonstrated that wherever
the arteries go, disease shows-up." Dr. Selikoff, of New York's Mount Sinai
Medical Center, led a team of 14 re
searchers to Goodyear's Niagara plant
last month to conduct a full-scale
screening of the 240 employees in the PVC-producing sections there.
A.nether complication added to the
studies is the difficulty of diagnosing
any of the vinyl chloride-linked diseases
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a very good method of detecting either angiosarcoma or the general lesion," said Dr. Popper.
"We have a rather pessimistic outlook on conventional liver screening," agreed CDC's Dr. Heath. "We urgently need some new method."
For the time being, nobody knows quite what to do. OSHA has proposed to chemical and plastics makers for discus sion a possible plant standard of "less than one" ppm--but the major manu facturers almost immediately rejected it as impossible.
MEANWHILE, NIOSH and others have separated out a cohort of PVC workers
for what Dr. Selikoff called a "retrospec tive-prospective" study. These workers were able to provide accurate health records going back many years; they were carefully screened, and their smok ing and drinking habits, etc., were not ed, and now they will be followed for as long as it takes to identify causal factors.
Dr. Creech, after presenting his paper to the conference, went home disgust ed. He called the conference "nothing but a political move--they've got no
damn business publicizing some of these things."
And he was unimpressed by the august scientific types who attended the meeting. "They're dealing with rats, but I'm dealing with people.
"We don't have mice in Louisville, but we do have test animals. Unfor tunately, they're the two-legged kind. I could have stayed home and done a hell of a lot more work here."
The work Dr. Creech intends to do,
between office hours, operating time,
and screening exams for Goodrich
workers, is to start his own vinyl chlor
ide research project at the U. of Louis
ville.
AMERICAN MEDICAL NEWS
' 4974 13