Document x8gwQzX5nadkZNoGb9b7qMj0

0k VOLUME'.' NUMBER 10 I PLAINTIFF'S EXHIBIT Thg Harvard Medical School Health Letter AUGUST i960 ! THE .ASBESTOS PROBLEM i An asbestos curtain was once the .ere symbol of safetv and secuntv When primitive stage lighting made the nsk of theater fires a constant worry, the presence of a hreproof curtain reas- i sured audiences that a blaze could be contained long enough for them to escape it. Now the tables , are turned; disease caused bv asbestos has become a matter of serious concern. i ; since antiquity, asbestos had been made into such items as permanent lamp weeks or novelty tabrics that would not burn. But eariv m. this centurv, the use of asbestos crew like wildfire so v 1 speak). A potential health hazard was - istiected verv eariv. out F wa*r.': ur.t;: the i960':- that its :U.l , magnitude became evident. : THE MATERIAL. A**-#;,* a- f.urul. soft rock made ui;> of compressed hoar.' t m.r fine best insulators know;-., it protects what it cover , from heat. corrosion, or electrical uam.me : .use strong ami duraiue Tice mineral ribers can be Handled in ways similar to vegetable brers, c can be .'Dim. made ;nrv> feh. nr bonded 'with othm substances to form durable materials By now tr.ere are 3.000 uses of a.-nce-to- insulation for buildings is made from the maternu. huge amounts nave also been used to .m-unite 'miners and pipes m shins, automobile brake linings and clutc.n plates leave been made of asm.-*:"* 'ince the early 190v~. Asiv**to$ has been mcorporitc: unto cement to strengthen it for use in pipes anti other formed objects Asnestos niters are used in the manufacture of some imported wane.' F r many years, hair dry ers wore insulated with the material. Untii recently, asbestos was .mmoniy incorporated .r.to the *packiine and taping com pounds used for drywall construction. From 1946 to 1973, asbestos was added to coatings tnat coui:i be sprayed onto walls or other structures in la-u of piaster.ng them In ah. some 30 million tons have a*? .: in the Urated mates since the beginning of this ceu vary, and by its end. according to one estimatev come half a million people will have died as a result ! of their exposure to asbestos. THE PROBLEM: As be stos produce' cises-'e vniy when it is .nnaied <or possibly swallowed Mir.uscuie fibers of the material. some t srr.a.: to oe seen with a standard microscope; are drawn, into the lungs There the fibers are taker, m by ends responsible for cleaning the air passage,', outhese fibers cannot easily be oroken d-'wr : r removal. Instead, the tibem remain ir. place or mzgrs.te SiOwiy toward the rerohery oftr.e lunu- .' cm mg. ever. tra% e. acres* toe diaphragm .r.t me abdominal cavity peritoneum;, whereTM' tr.rrs or mmy arm. c tr.ere aster being swai.uwe-.i It .smears tnat asbestos create' :-r v.-v..' - .- .. oecause of its pry s.ca. properties, rot : ...' ' -zv- i' ^ 55f?r.r-. '. ..u.danger Si ^ a.- \rndt M.D --umuir Stan- clicr Aver-, SI D - 'r SI D Fs. a: -. Reginald Greene M D mac. u. cf- 'oi.ifr i..o -Tboiog'. |ohanna Peritnutter. Si D C'bste--,, ir.: L. Ajiarrw Wanhaw si 0 `David \vei?m/n S' A . cr:r SIC - --j VrU m mon^ion orewn, M D . - r*". rvC-.t - -nan ti.-." . cD Si O L-J merger, "hocus hctciuiwn M D , zer- RiU trpner. Sc^aenojum SI D Sled gne Marshall Sfromc Si D a i Edward 'soipow SID Neu'j.og-. [ud ilh Vvu rrma n PhD D\ER.AL MANAGER Lvnn Brown Kar^aun "rLir.'arz O' me jilt. ?-rtae^: anO ` "so ' rrmiii'in s -- LLA 000131 LIH00131 merits would settle out in the large airways, which are better ecumoed to remove foreign sure stances than the vert small ones. The shape also matters: needle- :.-;e dimensioni, whic.n are typical ot the asbestos crystal appear to increase its ability to cause disease. L'm'ortunateiy many of the possible substitutes for asbestos, such as certain newer tomes of fiberglass, acquire these cr.amcteristics in the process of being developed into better insulators. In other words, the desirable proper ties ot asbestos as an insulating material are also the ones that make it dangerous. Even so, it appears so tar that asbestos is more potent ir. causing disease than other effective insulating substances, such as fiberglass and rockwail. Thirty or so years after asbestos dust is inhaled, but sometimes much sooner i depending on dose), it begins to cause several times of detectable disease 11) Asbestos is is a sometimes fatal condition, that results from significant, but not necessarily heavy exposure. It hardly ever occurs except in people who hav e worked with asbestos or with products containing it. This is, however, the most common disease produced by exposure to the material, though not the most common cause of death, which is lung cancer. Asbestosis :s a kind of scamng process, one that takes place within the lung tissue itself or on its outer surface. Asbestosis causes the air spaces to become smaller or obstructed . and the iung itself to become more rigid. There is no effective treatment to orevent or reverse the scarring A.- .1 result, breathing is difficult, u.xyger. and carbon dioxide are ;um,>y. excnanged. and lung injections are easily acquired. Tm- dis-m.-e -r its cmukciitior.' car. nroirres.-. ever, withi/.i further exposure to asbestos. Lung infection.-. >uch as pneumonia or np'nvhi::;. ,u'e extreme:'/ threatening to people with asbestosis. They should be \ lgorousk. treated, usually with antibiotics, at the first sign of a respirators injection, stooping -mokmg is critical: cigarette smoke not only makes asbestosis more dangerous, difficult to live with, and hard to treat, it markedly increases the risk of lur.g cancer in anybody who has been, exposed to asbestos 2) Lung cancer is extremely cuir.mnn among people who have worked with asbestos, man;, ot whom smoke. For some unknown reason, the combination of cigarette smoke and asbestos is much worse than would be predicted by adding together the risks from each. Anyone who has been exposed to even small quantities of asbestos dust should do everything he or she can to stop smoking. The outlook for those who stop is much better than for those who continue. As is the case with all lung cancer, by the time symptoms occur, it is usually too late for curativ e treatment, and no good tests for earlier detection are available. i,3) Mesothelioma, several other types of cancer, occur mainly in people exposed to asbestos dust. These tumors arise from the membrane that lines the chest or abdominal cavity, and they are highly malignant. Although they are rare, mesotheliomas can occur even after a limited exposure to asbestos dust and may affect people who were not directly involved in handling tr.e material, such as relatives of asbestos workers. A very long time -- forty years or more -- can elapse between exposure and the appearance of mescmelioma. although many cases appear earlier. some other type.- >a cancer. .;urr.::j me .ur.c=. ms- appear to oe sorrow hat more rr.on m oeople exoosed to asbestos oust A few other rir-ease- may also be more common, nr a :: appears mat the suicide rate m former asbestos workers :s much as tw 0 to three tim.es higher than m. the general > wu.at. 'fr;:' *.n^rn.-te.' v-" ar.M `.r.rir lairA *\pusurt? r.o aibe^ios0 ~ :-> t ".li'i1 t r*. . v: " CmmUr.uec: o". LLA 000132 The answer to the first question is reasonably straightforward for people who do not work with the material. Asbestos is only dangerous when it produces dust. Left undisturbed or bonded into durable slates, tiles, or other materials, it presents virtually no risk. But asbestos-containing insu lation around pipes or boilers and in walls, wail coverings, or spackling compounds that are sawed, cut, sanded, or are exposed to damage from routine use, may give off considerable quantities of asbestos dust. Nobody should work with such materials unless he or she is adequately trained and is fully protected from inhaling the dust. Deteriorating asbestos materials should be removed, covered with an effective sealant, or enclosed under another covering. Expert advice is needed both to determine whether there is an asbestos problem in a given area and to choose the proper method for dealing with the hazard. Spray-on wall coverings that contain asbestos present a special problem. This inexpensive technique was rarely used in homes but quite frequently in school construction. Water damage, heavy use, and occasionally vandalism have caused the coatings to begin disintegrating in some schools, and several states have begun programs to detect and correct the problem. Unfortunately such efforts are expensive and, all too often, underfunded. People who work with asbestos and its products, including those who repair existing objects that contain the material or are covered with it -- such as plumbers, shipyard workers, brake and clutch workers, construction workers -- are entitled to protection from asbestos and the diseases it causes. They should be fully aware of the amount of asbestos dust that they breathe while they earn a living. Unfortunately, employers -- both private industries and the government -- have often been negligent, failing to inform employees about asbestos exposure or to protect them from it. Workers at risk of exposure should insist that the air they breathe be frequently sampled and analyzed by an appropriate method. Employers and workers should cooperate in bringing fiber counts in the air well below the current legal standard (2 million fibers per cubic meter), which is probably at least twenty times too high. Face masks and respirators are not as effective as ventila tion control or improved handling, such as "wet processing." The second question -- what national action should be taken -- is much more difficult to an swer. There is no doubt that asbestos represents a major public health problem, one that extends beyond the large group of people who suffer from occupational exposure. Every possible way should be found to remove it from the human environment. But eliminating the substance from existing structures or from industrial applications may not be feasible for technical, economic, or political reasons. Meanwhile, there is controversy about the amount of asbestos exposure that is compatible with good health. Enforcing existing regulations, let alone more stringent ones, is difficult. To date there has been no coherent, effective government program for dealing with the as bestos problem. Responsibility has fallen partly on the states and partly on several federal agen cies. At a minimum, the federal government should be expected to take the initiative in developing a unified program to conduct research on asbestos diseases, measures to control exposures, and substitute materials. Technical advice and support should be offered to local control programs, and a poLicy should be developed for the future. Asbestos diseases become a medical problem only when it is too late to cure them. Preventing these diseases is a political challenge, not a medical one. HIDDEN INGREDIENTS Thousands of Americans every day consume a drug similar in structure to amphetamine ("speed") without knowing it. That sounds like a scare headline -- but is in fact true. The drug m thus case, is phenvipropanolamine -- PPA for short -- which is a common ingredient in dozens ot co;d arc cough remedies of both the prescr.p" on and the non-prescription variety. (As such, PPA is no different from many other drugs tru are consumed as ingredients in various cold remedies.) Recent articles in the British medicai journal The Lancet point out that PPA has two actions which LLA 000133 (Continued; are potentially harmful for some people. First, it can cause elevation of blood pressure. As a decon gestant, PPA acts by constricting blood vessels, and thus effect upon vessels explains why it has produced blood pressure elevation even in otherwise healthy young adult volunteers. Second, as a nervous system stimulant, PPA -- like amphetamine -- can cause symptoms such as irritability, sleeplessness, and even hallucinations. These effects are apparently more common in children -- not surprising. The point, of course, is that we should all ask about the ingredients in what we buy or take -- and we should be aware of their potential side effects. CHOLESTEROL -- BAD OR NOT? The Food and Nutrition Board of the National Research Council recently created an enormous stir in our nation's kitchens when they suggested that the dangers of dietary cholesterol may have been overstated. The suggestion was immediately attacked by many physicians (who did not hesi tate to point out that none of the authors of the report were either heart specialists or epidemiolo gists) and many organizations, including the American Heart Association. And while the ensuing flap may have been interesting to the participants, the general public was understandably left ques tioning the standard advice of the past twenty years to eat less fat and cholesterol. As a guide to the confusion, we offer the following statements: (1) No one disagrees that elevated cholesterol ieveis mean an increased risk for heart attack; for example;, the famous Framingham Heart Study data -- developed over twenty years of fol low-up -- indicate that a man with a total cholesterol of 260 (mg. per LOO ml.) has a risk for a heart attack three times that of a mar, whose count is under 195. The risk becomes five-fold at a cholesterol of 310. (2) In recent years, the correlation between a total cholesterol level and the risk for heart dis ease has been somewhat muddied by the knowledge that not all the cholesterol reflected in the total count is bad; specifically, the form of cholesterol known as HDL (high density lipoprotein) is associated with a decreased risk for heart disease. Therefore, more information is now being gathered on the relationship between various levels of total cholesterol -- and attempts to lower it -- and corresponding levels of good versus bad cholesterol. (3) The ultimate question involved in the dispute is one that has been debated for years -- namely, whether or not it pays to cut down on dietary fat and/or cholesterol. .Almost all would agree that if such dietary changes resulted in lowered '`bad" cholesterol levels and/or elevated `good" cholesterol levels, such dietary intervention would be worthwhile. But there is evidence that diet does not always improve the cholesterol pattern. Again, almost all experts would agree that diet changes would be good for some people -- especially those with a strong family history of premature heart disease, those with known heart disease, and those who are obese. And while these groups encompass many Americans -- maybe a majority -- it must also be admitted that there are other Americans who do not need to restrict dietary fats and cholesterol. In short, the argument boils down to the problem of making sensible, generalized recommen dations concerning the role of diet in changing blood cholesterol levels. Most experts in the field of heart disease have argued that since we do not need fat and cholesterol in large amounts (indeed, they can contribute to weight gain, if nothing else) and since strong evidence points to increased heart disease in general in populations chat eat increased amounts of these substances, the prudent recommendation is to hedge our bets and iower the amounts of fat and cholesterol in our diets. Admittedly, this advice is not needed by some -- but enough will benefit so that, in our judgment, this is still the best general advice to follow The goal of this Health Letter is to interpret timelv health information out .ts con'e-vs are not intended to provide medical advice tor individual praoiem The latter should be obtained from vour physician. Unfortunately. we cannot respond to personal inquiries. The Harvard Medical School Health Letter is published montkiv as a - cn-O'Oi: settee jc :~e Oecarme"t of u on t in umg education of Harvard MecLuo. >- Please address all maumes to The Harvard Medicai Scnool Health l_et:er "^CardenS: Cambridge Mass 0Z'.38 '617495-:234) individual susscr-of- 515 00 per '-ear Single cooies 51 X each 9uiX suoscnotions j: srec.-A 'e-Us's2 'i:^ Massachusetts and additional mailing offices i.ai.acie uoon *equest Second class postage oai-^a SPS : LLA 000134