.8
I~~~~~~~~~~~~~~~~~~~~~~~~~~
..limination of Environmental Hazards Leslie L. Alexander, MD, FACR Brooklyn, New York
It is almost commonplace for the modem consumer to receive a notice of safety recall of his automobile because of a defective part. One may get as many as two or three notices for the same vehicle. Nor is it strange for physicians to receive innumerable notices of recall of drugs or medical devices because of real or potential hazards. Recently physicians have been given the option to report in confidence any defects or untoward reactions that they fear should be corrected. ' Sponsored by the American College of Physicians, the Food and Drug Administration, and the United States Pharmacopeia, the Medical Device and Laboratory Product Problem Reporting Program is working well. In the area of environmental health hazards, the lines of responsibility are drawn less clearly. While most physicians agree that preventive medicine is preferable to defensive medicine, where does environmental enforcement begin? Are physicians at fault when patients (and indeed governments) fail to assume responsibility for diseases engendered by pollutants? Admonitions against tobacco smoking,
Leslie L. Alexander, MD, is assistant editor of this Journal. Requests for reprints should be addressed to Dr. Leslie L. Alexander, 1492 President Street, Brooklyn, NY 11213.
excessive alcohol consumption, and adverse dietary preferences abound. Yet individual lifestyles and occupational and environmental pollution continue relatively unchanged-largely through choice. One sinister pollutant is asbestos. It is a naturally occurring group of hydrated minerals characterized by fibers or bundles of crystal fibrils. It was used as incombustible wicks for lamps by the Greeks as early as 430 BC2 and today is found in thousands of commercial products, including heat-resistant textiles, reinforced cement, special filters for industrial chemicals, asbestos-cement pipes, automobile clutch facings and brake linings, thermal insulation, floor tiles, gaskets, and millboard, as well as in the air we breathe, the water we drink, and the food we eat. It has been known since antiquity that asbestos is a health hazard. In the first century, Pliny the Elder referred to asbestosis in his description of diseases of slaves whose occupation was the weaving of asbestos into cloth.2 It was not until 1918, how'ever, when American and Canadian life insurance companies declined coverage to asbestos workers because of health-injurious conditions in the industry and mortality figures from a major insurance company were cited that the first reports of asbestosis in the United States appear-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 4, 1979
ed.3'4 Although commerical production of asbestos insulation products were recorded as of 1874, it was not until 1964 that asbestos insulation products began to bear hazard warnings. This was despite the fact that lung cancer with asbestosis had been reported in England and the United States in 1935.4 Although health hazards attributable to asbestos are under surveillance by apprehensive environmentalists, consumer groups, unions, insurance and industrial lobby groups, as well as federal and local governments, how does one avoid controversy in attempting to eliminate an apparently essential strategic commercial commodity? Shall the safe, pleasant, and more rewarding life associated with asbestos be sacrificed for the relatively small numbers of people who have been made ill or died as a result of past exposure? Should efforts be directed at banning or safety regulation? Because of the prolonged latency of development of asbestosis and lung cancer, corrective measures in the asbestos industry were somewhat tardy in evolution. Although published literature implies that miners, millers, and manufacturers were aware of the lethal nature of their raw materials, fabrication processes, and finished products the predominant concern was sales rather than health hazards and safety refinement. Workers merely quit or 323
progressively became disabled. In 1943, the German government formally recognized lung cancer with asbestosis as a compensable occupational disease.4 Tentative standards for worker exposure were set and patchy state workman's compensation laws were enacted, often with statutes of limitations for time and less than exemplary compensation. Statutory regulatory efforts also were promulgrated grudgingly. On April 25, 1978, the Surgeon General of the United States issued a Physician Advisory on the health effects of asbestos. It stressed occupational and exposure history, careful managment of lung disease, smoking cessation, and cancer surveillance. It also emphasized that proper ventilation and engineering controls and the use of respirators are essential.5 A significant salutary effect has been the proliferation of class-action suits against the major asbestos manufacturers by workers whose lives were at risk. The largest pending action of more than 1,000 asbestos-related suits
)A4..
..
in the United States is the recent $i billion claim in Los Angeles Supreme Court.6 Senate hearings to regulate the flow of interstate commerce by establishing programs, standards, and procedures for determining responsibilities and liabilities arising out of product related injuries (S 403, The National Product Liability Insurance Act), and the actions of the Natural Resources Defense Council are partial measures for the control of hazardous environmental pollutants. Castleman, however, feels that such measures appear to place the consumer at a disadvantage.4 The American Society of Safety Engineers (ASSE) feels that product liability deals mainly with short range solutions and are cure-oriented rather than preventive. In keeping with the recommendations of the more than 14,500 safety professionals of ASSE, it appears that current and future legislation must emphasize product safety rather than product liability litigation, with emphasis on hazard evaluation in prod-
uct design and engineering, manufacturing, purchasing of raw materials and components, product marketing, and product usage instruction and labeling.7 In terms of elimination of environmental health hazards, including carcinogenesis, few health scientists can
disagree. Literature Cited 1. Problems with medical products, medical news. JAMA 240:1575, 1978 2. Levine RJ (ed): Asbestos: An information Source. In US Public Health Service, (Bethesda, MD) DHEW Publication, NIH 781681, 1978, p 1 3. Hoffman FL: Mortality from respiratory diseases in dusty trades (inorganic dusts) bulletin 231. US Department of Labor, Bureau of Labor Statistics, 1918 4. Testimony of Castleman BI before the Committee on Commerce, Science, and Transportation, US Senate, 95th Congress, 1977 5. Surgeon General of the United States: Physician Advisory: Health Effects of Asbestos. Washington, DC, US Department of Health, Education, and Welfare, April 25, 1978 6. Asbestos firms named in suit. Am Med News, November 17, 1978, p 8 7. Statement of the American Society of Safety Engineers before the Committee on Commerce, Science, and Transportation, US Senate, 95th Congress, 1977
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..limination of Environmental Hazards Leslie L. Alexander, MD, FACR Brooklyn, New York
It is almost commonplace for the modem consumer to receive a notice of safety recall of his automobile because of a defective part. One may get as many as two or three notices for the same vehicle. Nor is it strange for physicians to receive innumerable notices of recall of drugs or medical devices because of real or potential hazards. Recently physicians have been given the option to report in confidence any defects or untoward reactions that they fear should be corrected. ' Sponsored by the American College of Physicians, the Food and Drug Administration, and the United States Pharmacopeia, the Medical Device and Laboratory Product Problem Reporting Program is working well. In the area of environmental health hazards, the lines of responsibility are drawn less clearly. While most physicians agree that preventive medicine is preferable to defensive medicine, where does environmental enforcement begin? Are physicians at fault when patients (and indeed governments) fail to assume responsibility for diseases engendered by pollutants? Admonitions against tobacco smoking,
Leslie L. Alexander, MD, is assistant editor of this Journal. Requests for reprints should be addressed to Dr. Leslie L. Alexander, 1492 President Street, Brooklyn, NY 11213.
excessive alcohol consumption, and adverse dietary preferences abound. Yet individual lifestyles and occupational and environmental pollution continue relatively unchanged-largely through choice. One sinister pollutant is asbestos. It is a naturally occurring group of hydrated minerals characterized by fibers or bundles of crystal fibrils. It was used as incombustible wicks for lamps by the Greeks as early as 430 BC2 and today is found in thousands of commercial products, including heat-resistant textiles, reinforced cement, special filters for industrial chemicals, asbestos-cement pipes, automobile clutch facings and brake linings, thermal insulation, floor tiles, gaskets, and millboard, as well as in the air we breathe, the water we drink, and the food we eat. It has been known since antiquity that asbestos is a health hazard. In the first century, Pliny the Elder referred to asbestosis in his description of diseases of slaves whose occupation was the weaving of asbestos into cloth.2 It was not until 1918, how'ever, when American and Canadian life insurance companies declined coverage to asbestos workers because of health-injurious conditions in the industry and mortality figures from a major insurance company were cited that the first reports of asbestosis in the United States appear-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 71, NO. 4, 1979
ed.3'4 Although commerical production of asbestos insulation products were recorded as of 1874, it was not until 1964 that asbestos insulation products began to bear hazard warnings. This was despite the fact that lung cancer with asbestosis had been reported in England and the United States in 1935.4 Although health hazards attributable to asbestos are under surveillance by apprehensive environmentalists, consumer groups, unions, insurance and industrial lobby groups, as well as federal and local governments, how does one avoid controversy in attempting to eliminate an apparently essential strategic commercial commodity? Shall the safe, pleasant, and more rewarding life associated with asbestos be sacrificed for the relatively small numbers of people who have been made ill or died as a result of past exposure? Should efforts be directed at banning or safety regulation? Because of the prolonged latency of development of asbestosis and lung cancer, corrective measures in the asbestos industry were somewhat tardy in evolution. Although published literature implies that miners, millers, and manufacturers were aware of the lethal nature of their raw materials, fabrication processes, and finished products the predominant concern was sales rather than health hazards and safety refinement. Workers merely quit or 323
progressively became disabled. In 1943, the German government formally recognized lung cancer with asbestosis as a compensable occupational disease.4 Tentative standards for worker exposure were set and patchy state workman's compensation laws were enacted, often with statutes of limitations for time and less than exemplary compensation. Statutory regulatory efforts also were promulgrated grudgingly. On April 25, 1978, the Surgeon General of the United States issued a Physician Advisory on the health effects of asbestos. It stressed occupational and exposure history, careful managment of lung disease, smoking cessation, and cancer surveillance. It also emphasized that proper ventilation and engineering controls and the use of respirators are essential.5 A significant salutary effect has been the proliferation of class-action suits against the major asbestos manufacturers by workers whose lives were at risk. The largest pending action of more than 1,000 asbestos-related suits
)A4..
..
in the United States is the recent $i billion claim in Los Angeles Supreme Court.6 Senate hearings to regulate the flow of interstate commerce by establishing programs, standards, and procedures for determining responsibilities and liabilities arising out of product related injuries (S 403, The National Product Liability Insurance Act), and the actions of the Natural Resources Defense Council are partial measures for the control of hazardous environmental pollutants. Castleman, however, feels that such measures appear to place the consumer at a disadvantage.4 The American Society of Safety Engineers (ASSE) feels that product liability deals mainly with short range solutions and are cure-oriented rather than preventive. In keeping with the recommendations of the more than 14,500 safety professionals of ASSE, it appears that current and future legislation must emphasize product safety rather than product liability litigation, with emphasis on hazard evaluation in prod-
uct design and engineering, manufacturing, purchasing of raw materials and components, product marketing, and product usage instruction and labeling.7 In terms of elimination of environmental health hazards, including carcinogenesis, few health scientists can
disagree. Literature Cited 1. Problems with medical products, medical news. JAMA 240:1575, 1978 2. Levine RJ (ed): Asbestos: An information Source. In US Public Health Service, (Bethesda, MD) DHEW Publication, NIH 781681, 1978, p 1 3. Hoffman FL: Mortality from respiratory diseases in dusty trades (inorganic dusts) bulletin 231. US Department of Labor, Bureau of Labor Statistics, 1918 4. Testimony of Castleman BI before the Committee on Commerce, Science, and Transportation, US Senate, 95th Congress, 1977 5. Surgeon General of the United States: Physician Advisory: Health Effects of Asbestos. Washington, DC, US Department of Health, Education, and Welfare, April 25, 1978 6. Asbestos firms named in suit. Am Med News, November 17, 1978, p 8 7. Statement of the American Society of Safety Engineers before the Committee on Commerce, Science, and Transportation, US Senate, 95th Congress, 1977
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