Effect Measure

Public health disgrace in Minnesota

If you’ve ever been to Duluth, Minnesota in the wintertime, at the top of the state on Lake Superior, you know how cold it can get. And if you go another 50 miles up the shore you’ll come to Silver Bay. Also cold. And dangerous in another way. It is a cancer hot spot for perhaps the deadliest cancer we know, mesothelioma.

Silver Bay is in the iron range and was the site of one of the most famous of the early environmental cases, when the Environmental Protection Agency was new and so was the idea of protecting people from an unhealthy environment. The case involved the Reserve Mining Company, the major employer and benefactor of Silver Bay. Reserve Mining had been dumping its mine tailings into the Lake for almost three decades at that point. Tailings are the waste separated from the iron ore by huge crushers. These tailings were clouding the water and, fishermen said, destroying life in the lake. Then it was discovered that the tailings contained asbestiform materials that were getting into the unfiltered drinking water of Duluth and Two Harbors downstream from Silver Bay. Suddenly it was life on land that was also at stake. The case was settled on Appeal after a contentious trial in the 1970s. By the 1980s the the tailings were being disposed on land instead of the Lake (more on the Reserve Mining case in this excellent 2003 report from Minnesota Public Radio). Now the cancer issue has reappeared in the context of some particularly egregious behavior by the leadership of the Minnesota Department of Public Health:

The Minnesota Health Department suppressed research about additional deadly cancers among Iron Range miners for a year, even though a top government scientist warned that the findings raised significant new health issues.

The department discovered in March 2006 that a rare, asbestos-related cancer had stricken 35 more miners than the 17 previously known. All of the miners have died. The state didn’t release the new information until March of this year, a decision that some health experts are now criticizing.

The findings sparked renewed concern about taconite dust and lung cancer among the 4,000 workers in the state’s iron ore industry.

Health Department documents obtained by the Star Tribune show that officials had planned last year to disclose the information to mining unions, businesses, federal regulators and others. But state Health Commissioner Dianne Mandernach rejected those plans last fall.

Documents also show that the department feared that public disclosure of the findings would create controversy. (David Shaffer, Minneapolis Star-Tribune)

This story is disgraceful. Commissioner Mandernach claimed the delay was to allow the Department to “get its ducks in a row.” Internal memoranda and emails obtained by the Star-Tribune make it clear, however, that it was a deliberate cover-up to avoid renewed calls to look into the hazards of mine dust:

That contentious history is reflected in department e-mails, memos and notes released under the state public-records law. They show that officials worried about public reaction to the latest research, which covered 1997 to 2005.

“Many will believe that they confirm the health hazards of the miners that have long been feared and predicted,” said a March 2006 talking-points memo by Dr. Alan Bender, who heads the environmental epidemiology section that conducted the research.

Another briefing paper, prepared last year for the commissioner, said: “Release of the findings is likely to generate demands that the government do more to protect workers.”

Bender, who has long advocated more research into occupational hazards, urged at the time that the findings be released.

For years, the Health Department has regularly released public-health research. Officials could not cite another case in which findings were withheld for a year.

[snip]

Internal documents show that the Health Department drafted a news release in June 2006 about the 35 additional cases of mesothelioma, but planned to release it only if word of the findings leaked out.

The documents reveal that department officials were so concerned about a possible leak that they excluded two prominent University of Minnesota researchers from scientific consultation because they had been critical of the Health Department in the past.

This is nothing short of disgraceful. Really disgraceful. Commissioner Mandernach needs to go. She has shown she has no understanding of the public health mission of her Department and an all too obvious showing of where she thought her bread was buttered.

I’m sure she can find other employment in the Bush administration. She’s just their type.

Comments

  1. #1 Scott Belyea
    June 18, 2007

    …the department feared that public disclosure of the findings would create controversy.

    …the Health Department drafted a news release in June 2006 about the 35 additional cases of mesothelioma, but planned to release it only if word of the findings leaked out.

    You’re right … disgraceful.

    Commissioner Mandernach needs to go. She has shown she has no understanding of the public health mission of her Department and an all too obvious showing of where she thought her bread was buttered.

    No argument. Even if you wanted to look at it only from a “public relations” point of view, they would have been better off to disclose this as soon as was feasible, even if they then said that “Investigations are continuing.”

    This sort of coverup has got to be the worst of both worlds.

  2. #2 Matt W
    June 18, 2007

    Silly as this sounds, is there a link between enteric absorption of asbestiform products and lung cancer? I thought that the hazard came from inhalation, and was synergistic with smoking.

  3. #3 revere
    June 18, 2007

    Matt: The intestinal roue has always been a matter of contention. There is a clear increase in risk of gastrointestinal cancer (mainly colon) in asbestos workers. One assumption has been that this is from asbestos fibers brought up via the mucociliary escalator and then swallowed. This is one argument for the g.i. route of exposure. On the other hand it is possible the colon risk is from fibers making their way via some other route, e.g., via the lymph system from the lung.

    Asbestos and cigarettes are synergistic for lung cancer but not asbestosis or mesothelioma.

  4. #4 Rich Puchalsky
    June 18, 2007

    I have a sort of interesting book about the original case: Judgement Reserved: A Lnadmark Environmental Case by Frank Schaumburg. It’s clearly written by someone sympathetic to industry, but still somewhat informative about the degree to which people were still feeling their way through the legal system about these kinds of things, not so long ago.

  5. #5 nsthesia
    June 18, 2007

    revere:

    I’m not surprised that the info was withheld. And I am sure that YOU are not surprised either. Disillusioned (once again), but surely not surprised.

    Eons ago, in the mid-80s, I had a few patients with pulmonary mesothelioma that I followed. Their disease could all be traced back to an asbestos exposure. Of course they did not last long, but true to the old adage that only NICE people get cancer, these were some memorable patients.

    One man had worked in a shipyard for a year, another had worked in a body shop and had done brake work for a handful of summers while making some extra money to build a home.

    The latter man built his home, raised his family and presented in his 40s with this horrible disease. He fought a good fight and died way too early.

    His daughter, who was in her late teens, came to see my collegue for “a physical.” I think she just wanted some closure after all the months of struggle with her Dad. Exam done, labwork drawn, she asked how her Dad could have gotten this awful disease. Needless to say, my collegue was surprised as the link between asbestos exposure and mesothelioma had been discussed.

    The daughter looked shocked. She said SHE worked with asbestos on a daily basis. (Mid 80s). She was told that the type of exposure was important, that a “solid” form was less worrisome than a loose, fibrous form. She said she worked in a packing area of a large utility company and that her work area looked like a blizzard was taking place. She was asked if she wore protective gear. No.

    Come to find out, altho the dangers of asbestos were WELL known at this time, it was left up to corporations to protect workers or cease utilizing these known carcinogens. Guess what the majority chose? The workers were not informed. It was not until the corporate world was FORCED to eliminate these materials that conditions improved.

    So, your “new” situation from 2006 is just a remake of the old scenario. In the corporate world, the bottom line IS the bottom line. Personnel is now Human Resources (or Human Remains, as a CEO friend affectionately calls it). And a human is a disposable commodity.

    I often wondered how that girl did as the years passed.

  6. #6 revere
    June 18, 2007

    nthesia: I am surprised and not surprised. This kind of behavior from health departments is beyond the pale, although I know for a fact it happens. When it does, we need to call them on it. Regarding meso patients, I’ve seen more than my share, alas. It is a terrible disease. Swiftly lethal but in the year or so there is much pain. As you say, the knowledge of the hazards of asbestos was well known for a long time. Asbestosis was well described by 1930. The first lung cancers started to appear in the thirties and by 1942 the relationship with asbestos was part of the first text book on occupational cancer (Hueper; he devoed 7 and half pages to it). By 1949 the lung cancer relationship was generally accepted by the scientific community, although the industry didn’t bother to tell the workers and in fact took pains to cover it up. The mesothelioma connection was discovered in the fifties and generally accepted with Wagner’s landmark paper in 1960. The dangers of product use were evident all along but received widespread recognition with the work of Selikoff and others in the sixties.

    What really has gotten rid of asbesotos (in the US) was asbestos litigation. Although it is estimated that asbestos workers only recover about 10% of their out of pocket costs via lawsuits, it has had a profound effect on the companies — a profoundly good effect. Before the Borel case few workers could ever win a lawsuit. Now the companies just roll over, except in special cases. Litigation works, especially when the feds have stopped protecting workers through OSHA and regulations. But tens of thousands more workers will die from a disease they contracted before the litigation worked to protect all of us.

  7. #7 Matt W
    June 18, 2007

    So is there a biologically plausible mechanism for these people to have gotten mesothelioma from intestinal exposure to asbestos?

  8. #8 Matt W
    June 19, 2007

    My apologies on the multiple posts but you can’t edit past posts.

    But are these people getting mesothelioma of the pleura, or are they getting it of the gut? Pericaridium? The cover-up’s only about the miners themselves, and not the public who were exposed to the tailing via the water?

  9. #9 epifreek
    June 19, 2007

    I agree that Commissioner Mandernach should go. Her behavior has been egregious. She was chosen as Commissioner of Health by Governor Tim Pawlenty (a rising star in the Republican party) primarily because of her anti-abortion stance. She is a former nun who went from being a medical records clerk to running a very small hospital. She did not have prior public health experience and is not a healthcare professional.

    She is best known for placing information on the Minnesota Department of Health website and in an educational pamphlet that suggested a link between abortion and breast cancer. She sailed through this debacle seemingly unscathed. Unfortunately, I suspect it will happen again. This is yet another example of politics trumping science in public health.

    See:
    http://citypages.com/databank/24/1203/article11776.asp

  10. #10 gilmore
    June 19, 2007

    Matt W wrote:
    But are these people getting mesothelioma of the pleura, or are they getting it of the gut? Pericaridium?

    I’m NOT in health care, but am an asbestos worker (soon to be “insulator”) as was my uncle and father. MY understanding is that mesothelioma is a lung disease.

    Regardless, it is a death sentance. 6 months to a year. Many of my (union) brothers and sisters have died from this nasty disease.

    Friable or loose / crumbling materials are typically the culprit. Most often pipe insulation, which had much higher asbestos concentrations than say ceiling tiles.

    The U.S. manufacture of asbestos was banned in 1974, but product / materials in the warehouse made there way into workers hands for years afterwards. . . WITHOUT warnings.

    Along with litigation came asbestos removal. LOTS and LOTS of schools. . . The effects of asbestos often take up to 20 years to appear. . .

  11. #11 revere
    June 19, 2007

    Matt: I haven’t seen the data, but my gues is that the meso cases are in workers. I don’t know if they are pleural (the lining of the lung) or abdominal (the lining of the abdominal cavity). These are all relevant pieces of information, which I don’t have but aren’t relevant to the Commissioner’s behavior.

    If they are workers (say miners) then the question is whether they got their disease from asbestos in the workplace such as insulation, gaskets or whatever (i.e., the usual product use) or whether it was from exposure to mine dust. It is the latter possibility that is the politically and public health important question and preventing inquiry there is the likely reason for the cover-up. It is also possible, and would be quite ominous, that the only known expsures are to some environmental exposure back in the days when the tailings were being dumped into the Lake (the water has been filtered for a long time but meso has an average latency of 30 – 35 years).

    The presumptive route for ingestion would be mechanical, through the intestinal walls, or via the lymph system. Remember, asbestos causes pleural plaques and pleural meso even though there is no direct connection between the alveoli and the pleural cavity, so it isn’t necessary to have direct contact. Also many workers will have abdominal meso (although most have pleural), further emphasizing that direct connection to the lungs isn’t necessary. The enhanced risk of colon cancer is also generally accepted.

    gilmore: Asbestos manufacture is not banned in the US. Its use is banned in insulation products. You can still find it in imported brake and clutch products. I have posted on the OSHA warning on brake products recently here.

  12. #12 Matt W
    June 19, 2007

    Gilmore, you’re right. Mesothelioma is primarily a lung disease, but more generally speaking it’s a disease of the mesothelium, which is a kind of tissue that’s found in most of the protective linings of our internal organs. While pleural (lung) mesothelioma is the most common, you can also have mesothelioma of the pertineum (which surrounds the abdominal cavity) or of the pericardium (which surrounds the heart).

    The reason for my inquiry is that it’s not obvious to me that ingesting asbestos would cause pleural mesothelioma. It may cause it, but I’m not sure. I don’t do occ/enviro epi.

    A cover-up is still a cover-up, but I was just looking for a few more facts.

  13. #13 Darin
    June 19, 2007

    props to the Star-Tribune. This is the reason we need good investigative journalists and a free press.

  14. #14 Path Forward
    June 21, 2007

    And OH the APOLOGY:

    (see the Statement by Commissioner of Health Dianne Mandernach regarding release of mesothelioma data, at http://www.tinyurl.com/3yzjje)

    I was reading along, thinking mildly sympathetic and slightly supportive thoughts, right up until I got to the last line:

    “I will do everything I can to maintain the department’s credibility, and above all, to preserve the excellent reputation that this agency has earned.”

    MAINTAIN? PRESERVE?

    If she can’t bring herself to say “restore” and “rebuild”, I won’t even consider accepting the “apology.”

  15. #15 freespeech
    June 22, 2007

    Since her beginnning at MDH the Commissioner has isolated herself from longterm employees including nationally respected scientists. She seeks no advice and when given to her she usually rejects it blaming the messenger rather than the message. She does not have the rudimentary knowledge of public health. She doesn’t understand that the main function of public health is to collect and disseminate data and that in fact public health departments are information agencies. For example, She has banned the printing of all newsletters with no exceptions, or reasons for the ban.

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