American Journal of Industrial Medicine 22:455-456 (1992)
COMMENTARY
Asbestos and Cancer 1934-1 965: And What Happened Thereafter? Yehuda Lerman, MD, MPH
Key words: history of medicine, asbestos regulation, scientific debate
After reading Dr. Enterline’s historical review [1991], one is left with several major questions. What was done after the academic consensus was reached in 1964 regarding the causal association between asbestos and lung cancer? What is the situation in 1991-1992 regarding asbetos use? A worldwide important step in the prevention of asbestos-related diseases was the legislation process of asbestos exposure values allowed in the workplace (T.L.V.T.W.A.). In the late 1960s, after it was shown that asbestos is a carcinogen, the accepted T.L.V.-T.W.A. was 12 fibers/cm3 well above a safe level of exposure to a carcinogen. Only in the mid 1970s was the standard lowered both in Israel and in other countries to 2 fibers/cm3. These levels of permitted exposure of the mid 1970s are fourfold or more, compared with what is now considered an appropriate level of exposure. Moreover, there are countires such as Japan where the standard was still 5 fibers/cm3 in the late 1980s. Meanwhile, the use of asbestos rose in many countries and dust control was only gradually developed [Woitowitz et al., 19811. Thus, the environment in general, and for asbestos-exposed workers in particular, remained at dangerous levels of asbestos long after the consensus was reached in 1964. Although it is almost thirty years since the consensus that asbestos was a human carcinogen, we are still being confronted in the early 1990s with problems regarding asbestos use. An advanced legal step to limit exposure to human carcinogens, such as asbestos, is a restricted use of asbestos for special indispensable purposes only. Such laws were enacted in the United States, Israel, and other countries. However, those who deal with public health issues regarding asbestos exposure and related diseases, were surprised by a recent decision of the U.S. Court of Appeals to strike down the Environmental Protection Agency’s (EPA’s) 1989 rule that would have, by 1996, banned nearly all uses of asbestos in the United States. We are faced in 1991-1992 with another practical problem, namely, to find innocuous substitutes for asbestos. Man-made mineral fibers, once suggested as suitable substitutes for asbestos, may be even more potent than asbestos with regard to chronic pulmonary disease [Goldsmith, Kvutzat Yavne, Israel. Address reprint requests to Dr. Y. Lerman, 28 Sharet Street, Kvutzat Yavenh, 79233 Israel. Accepted for publication January 6, 1992.
0 1992 Wiley-Liss, Inc.
456
Lerman
19861. The U.S. Court of Appeals in its recent decision concluded that “asbestos ban and use of asbestos substitutes may actually increase the risk of injury Americans face.” I would conclude that, although, as indicated by Enterline in his review, “the issue appears to have been settled” in 1965, the subject of asbestos exposure and its related diseases will be part of our scientific thought and debate even in the 1990s. REFERENCES Enterline PE (1991): Changing attitudes and opinions regarding asbestos and cancer 1934-1965. Am J Ind Med 20:685-700. Goldsmith JR (1986): Comparative epidemiology of men exposed to asbestos and man-made mineral fibers. Am J Ind Med 10543-552. Woitowitz H-J, Beiri L, Rathgeb M, Schmidt K , Rodelsperger K , Greven U, Woitowitz RH,Lange H-J, Ulm K (1981): Asbestos-related diseases in the Federal Republic of Germany. Am J Ind Med 2:71-78.
COMMENTARY
Asbestos and Cancer 1934-1 965: And What Happened Thereafter? Yehuda Lerman, MD, MPH
Key words: history of medicine, asbestos regulation, scientific debate
After reading Dr. Enterline’s historical review [1991], one is left with several major questions. What was done after the academic consensus was reached in 1964 regarding the causal association between asbestos and lung cancer? What is the situation in 1991-1992 regarding asbetos use? A worldwide important step in the prevention of asbestos-related diseases was the legislation process of asbestos exposure values allowed in the workplace (T.L.V.T.W.A.). In the late 1960s, after it was shown that asbestos is a carcinogen, the accepted T.L.V.-T.W.A. was 12 fibers/cm3 well above a safe level of exposure to a carcinogen. Only in the mid 1970s was the standard lowered both in Israel and in other countries to 2 fibers/cm3. These levels of permitted exposure of the mid 1970s are fourfold or more, compared with what is now considered an appropriate level of exposure. Moreover, there are countires such as Japan where the standard was still 5 fibers/cm3 in the late 1980s. Meanwhile, the use of asbestos rose in many countries and dust control was only gradually developed [Woitowitz et al., 19811. Thus, the environment in general, and for asbestos-exposed workers in particular, remained at dangerous levels of asbestos long after the consensus was reached in 1964. Although it is almost thirty years since the consensus that asbestos was a human carcinogen, we are still being confronted in the early 1990s with problems regarding asbestos use. An advanced legal step to limit exposure to human carcinogens, such as asbestos, is a restricted use of asbestos for special indispensable purposes only. Such laws were enacted in the United States, Israel, and other countries. However, those who deal with public health issues regarding asbestos exposure and related diseases, were surprised by a recent decision of the U.S. Court of Appeals to strike down the Environmental Protection Agency’s (EPA’s) 1989 rule that would have, by 1996, banned nearly all uses of asbestos in the United States. We are faced in 1991-1992 with another practical problem, namely, to find innocuous substitutes for asbestos. Man-made mineral fibers, once suggested as suitable substitutes for asbestos, may be even more potent than asbestos with regard to chronic pulmonary disease [Goldsmith, Kvutzat Yavne, Israel. Address reprint requests to Dr. Y. Lerman, 28 Sharet Street, Kvutzat Yavenh, 79233 Israel. Accepted for publication January 6, 1992.
0 1992 Wiley-Liss, Inc.
456
Lerman
19861. The U.S. Court of Appeals in its recent decision concluded that “asbestos ban and use of asbestos substitutes may actually increase the risk of injury Americans face.” I would conclude that, although, as indicated by Enterline in his review, “the issue appears to have been settled” in 1965, the subject of asbestos exposure and its related diseases will be part of our scientific thought and debate even in the 1990s. REFERENCES Enterline PE (1991): Changing attitudes and opinions regarding asbestos and cancer 1934-1965. Am J Ind Med 20:685-700. Goldsmith JR (1986): Comparative epidemiology of men exposed to asbestos and man-made mineral fibers. Am J Ind Med 10543-552. Woitowitz H-J, Beiri L, Rathgeb M, Schmidt K , Rodelsperger K , Greven U, Woitowitz RH,Lange H-J, Ulm K (1981): Asbestos-related diseases in the Federal Republic of Germany. Am J Ind Med 2:71-78.
