There's a lot to like about Canada (their health care system, for starters) but there are some things that are less than praiseworthy (I understate), and towards the top of that list would have to be a hundred years of peddling, with government support, protection and outright lying, a product that brought the world one of the 20th century's greatest public health catastrophes: asbestos.
Asbestos is a fibrous mineral that exists in two main categories, the serpentine minerals and amphibole group. Asbestos saw myriad uses and 90% of those used the serpentine form whose main representative is called chrysotile asbestos. It is no longer mined in the US but the main source in North America was always Canada. Use of asbestos in industrialized countries has shrunk dramatically and the sole mine in Thetford, in Quebec, now only employs about 300 people. But they still export this fiber to places in the developing world and the industry is protected -- and promoted -- by the Canadian government.
Make no mistake. Asbestos is a deadly product. It causes a scarring of the lungs (an interstitial fibrosis) in workers and lung cancer and cancer of the lining of the lungs and abdomen in workers, their spouses and children and in consumers. The fragile confederation between Quebec and anglophone Canada has been exploited by asbestos lobbyists and pro-asbestos messages have infiltrated the news media with regularity.
I know quite a bit about asbestos and its history and used to joke that the Canadian asbestos industry would say anything, even that it wouldn't hurt you to eat it for breakfast. It was just a joke. I thought. Then one weekend, maybe 15 years ago, I got a call from the Canadian Broadcasting Corporation (CBC) asking if I would agree to be interviewed on their popular Sunday morning live coast to coast broadcast. I was to come on after the Canadian Minister of Mines (or some minister, anyway, don't remember at this point), who had been saying publicly that asbestos was so safe he wouldn't hesitate to put a teaspoon in his morning coffee. Holy shit!, I thought. They really are saying you can eat it for breakfast. So I got on the phone and listened to the first part of the interview and he said it again!
The Canadian government, in fact, has been doing this for a century. Even in the decades where we knew how deadly asbestos dust was, they aggressively marketed it to the developing world on the grounds that doctors in those countries now knew well how dangerous it was and would protect the workers. I remember well a visit to a shipyard in Ismailaya, Egypt, on the Suez Canal, and seeing workers using asbestos without any personal protection. I asked the company doctor about it. He told me that it was his understanding that asbestos was harmless as long as workers weren't exposed for too long. Egypt, let it be said, has one of the better trained medical cadres on the African continent.
But the resistance to this irresponsible behavior is growing in Canada. Quebec's public health authorities are demanding that the government cease support for the mining and use of asbestos:
The group has sent a letter to federal Health Minister Leona Aglukkaq criticizing the government for its support of the mineral that has been banned in many countries as a health hazard.
The issue is a sensitive one in Quebec, home to the country's only operational asbestos mine, located in the town of Thetford Mines.
In the letter sent to Aglukkaq by the Canadian Association of Physicians for the Environment and the Rideau Institute, Quebec public health officials said they are "extremely disturbed" by what they call "misleading, inadequate and, at times, false information" about the risks of asbestos found on Health Canada's and other government websites.
"This industry in Canada should not be promoted like it is currently with federal and provincial funds," said Dr. Pierre Gosselin, a researcher affiliated with Quebec's National Institute of Public Health. (Mines and communities.org)
Conservative Prime Minister Stephen Harper continues to support the industry and Canada's health minister has yet to respond to her Quebec colleagues. Rumors are circulating that the provincial government is sitting on a report of asbestos cancer in the community near the mine. The Canadian public health institute report was delivered to the government in March (8 months ago).
Meanwhile I continue to drink my coffee black. No sugar. No cream. And no asbestos.
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This mine remains a national shame. What should be a no-brainer (closing a mine that extracts exclusively carcinogens) is clouded by politicking, posturing, and lies. Up here in Canada (except in Quebec) we like to make fun of French Canadians a little bit, but this is something we all need to work together on to put behind us.
Ouch. Yeah. We're not too bad at public health except where it comes in conflict with resource industries (sour gas wells, uranium, pulp mills, asbestos etc.)
Can you reduce my ignorance some please?
I was under the impression that the risk of asbestos related diseases was largely associated related to the form (amphiphole vs chrysotile) and that since most potential consumer exposure was to the more workable chrysotile the actual consumer asbestos risk was while real and worthy of, if not eliminating at least reducing, not extreme. OTOH asbestos workers are potentially exposed to both compounds and in the most well established as significantly harmful exposure - respiratory - so were at much greater risk not only because of the magnitude of exposure but because of the type of compound they were exposed to.
Is that an incorrect understanding?
Also, while I certainly wouldn't eat asbestos of any form, is there conclusive evidence that it causes harm with a GI port of entry? I thought that that was unclear. Have there been new studies that have made it conclusive (I haven't read on this for a few years)?
Finally, I know that this will sound excessively critical and I am sorry, but don't you think calling it "one of the 20th century's greatest public health catastrophes" is a bit over the top? I mean the competition for the top ten is quite steep. AIDS, diabetes, obesity related diseases in general, the rise in skin cancer casued by depleted the depleted ozone layer, the massive marketing of tobacco, the 1918 influenza outbreak, even other influenza pandemics, various wars, coal both its mining and its emissions, the starvation caused by Stalin's policies and by Mao's, and on and on. In comparison asbestos has caused a relatively small number of the very rare cancer mesothelioma, an increase risk of lung cancer, a slightly larger number of cases of asbestosis cases, and maybe a few other cancers if we accept the evidence as conclusive. On the scale of public health catastrophes it really doesn't even rank up there. Let's keep a sense of scale.
Don: All forms of asbestos are hazardous. The only disease potential difference I know of is for mesothelioma, where both chrysotile and amphiboles cause it (some of the early asbestos-associated meso cases were actually reported by Cartier in Thetford in 1952); but the amphiboles are more potent, although the asbestos industry has been trying to promote chrysotile as the "safe" asbestos purely on the basis of its lesser potency for meso. There is an ongoing controversy about whether chrysotile-caused meso is really the result of some tremolite (amphibole) contamination, but it's an irrelevant point since Thetford chrysotile has tremolite in it, too. Both are equally potent with respect to asbestosis and lung cancer.
There are other cancers associated with asbestos (GI, larynx and some others) I didn't mention but the most likely exposure for GI is through ingestion of fibers that came up the mucociliary escalator. But lymph is another possibility so I don't have a firm opinion about it. OTOH, the reason for saying he would put it in his coffee and drink it was not a technical point about route of exposure but a rhetorical point. He had no technical knowledge or training. He was only promoting the industry by trivializing the hazard.
Regarding your point about exaggerating the catastrophe, deaths and disability are very high (minimum of hundreds of thousands). I agree AIDS eclipses it, so I said "one of". Your other examples are by and large debatable and unquantifiable and while likely take a huge toll, are not the direct result of a cynical, heartless and criminal industry and were not easily preventable. Since you are a pediatrician, I might also have put lead poisoning on the list for the same reasons. Since public health is about prevention, I put on my list those things for which prevention was easily achievable and disease that was easily preventable (we've know of the hazards of asbestos since the mid 1930s).
And perhaps I can be excused for having this weigh heavily in my personal list, having seen many workers and their family members die cruelly of asbestos disease, deaths they didn't need to suffer were it not for the negligence (and worse) of companies and government agencies. As for sounding hypercritical, yes,you do. I would have thought that the context of the post made it clear what I have just explained. Perhaps you are too literal. Excuse me if that sounds critical.
Don, you're making the assumption that only mesothelioma and asbestosis are asbestos-related. This is not so. There are other cancers that are caused by asbestos exposure, but many of them have not been accurately attributed because they were not accepted as caused by asbestos until relatively recently.
My father worked in the oil patch in the 1960s for less than a year, and in construction after that. He had some asbestos exposures through his work - not excessive exposure, one would think. However, some 30 years later he was diagnosed with a lung cancer. We suspected asbestos exposure as at least a contributing cause, but the worker's compensation board rejected it. Two years later we reapplied, and the claim was accepted because more study had been done and it was concluded that yes, indeed, asbestos contributed to that form of cancer.
We don't know how many people have had asbestos related disease who have fallen through the cracks of the reporting over the years. The Canadian government should have stopped producing, selling and defending asbestos a very long time ago. It galls me that my government continues this farce.
It galls me no end that my government continues to defend asbestos.
So how much would it cost to retrain those 300 people doing the mining---perhaps for more interesting work?
While we're apportioning indignation re the public health, and it being Hanukkah, let me mention that some of us (Jewish but not his constituents) quite spontaneously last night and this morning sent Senator Lieberman Hanukkah greetings pointing out his (to use the term) un-Jewish behavior in threatening to prevent a healthcare reform bill's passing unless it leaves 55-64-year-olds (most recently), public-option beneficiaries, etc. out in the cold. Meanwhile, I remain puzzled why this blog is so quiet now regarding the whole issue of single-payer/public-option/etc.
Good point on lead also. And no it doesn't come off as hypercritical. A little defensive but not too critical. This is an issue that has touched you so a bit of hyperbole is just to be expected.
Looking it up it seems that the National Cancer Institute http://www.cancer.gov/cancertopics/factsheet/Risk/asbestos is a bit less convinced that asbestos related health problems are all that common though.
"Studies have shown that exposure to asbestos may increase the risk of lung cancer and mesothelioma (a relatively rare cancer of the thin membranes that line the chest and abdomen). Although rare, mesothelioma is the most common form of cancer associated with asbestos exposure. In addition to lung cancer and mesothelioma, some studies have suggested an association between asbestos exposure and gastrointestinal and colorectal cancers, as well as an elevated risk for cancers of the throat, kidney, esophagus, and gallbladder (3, 4). However, the evidence is inconclusive.
Asbestos exposure may also increase the risk of asbestosis (an inflammatory condition affecting the lungs that can cause shortness of breath, coughing, and permanent lung damage) and other nonmalignant lung and pleural disorders, including pleural plaques (changes in the membranes surrounding the lung), pleural thickening, and benign pleural effusions (abnormal collections of fluid between the thin layers of tissue lining the lungs and the wall of the chest cavity). Although pleural plaques are not precursors to lung cancer, evidence suggests that people with pleural disease caused by exposure to asbestos may be at increased risk for lung cancer (2, 9)."
Of course even a single case of an easily preventable disease is too many.
24fps, I do not assume either way. Revere tells me that the evidence is conclusive despite what the National Cancer Institute says. I am sure that he is convinced by the data and has good reasons to be confident that the National Cancer Institute's hemming is uncalled for.
In Australia most uses of asbestos were banned about 25 years ago. The company responsible for most asbestos products, James Hardie Industries, was forced to set up a scheme to compensate its workers who had been poisoned. They tried to avoid their responsibility by restructuring, moving to The Netherlands etc and this caused a major public outcry. It's probably true to say that James Hardie is now Australia's most despised company (one book on the issue is called Killer company: James Hardie exposed), and awareness of the dangers of exposure to asbestos is very high. This is not surprising since there are many cases of (susceptible) people suffering mesothelioma after very minor exposure to asbestos.
When you have an industry that is borderline (?) criminal, preserving jobs and livelihood should not be a foremost concern. The number of lives lost to asbestos exposure grossly exceeds the number of people whose livelihood depends on it. Thetford Mines should be shut down permanently, regardless of whether or not there is a plan in place to retrain these workers.
NP: entirely agreed. But it seems worth pointing out that the cost of cutting out this criminal industry, even with retraining, would not be spectacularly huge.
I thought there was a safe way to extract and work asbestos; that said, risks would be minimized, since the main problems are in the asbestos dust (which is only released when one, for example, saws an asbestos-made component).
Stand-still objects containing asbestos are harmless, right? A fiber cement pannel containing asbestos is only harmful when someone cuts it and releases its dust to the air.
Anyways, that´s something to think about, since studies have shown that synthetic fibers' dusts can also cause cancer. I am thinking that pretty much all small fibers will cause lung diseases. The main points here would be "exposure" and "safety equipment".
Fernando: Yes, the safest place for asbestos is in the product, on the pipe, in the ground or locked up in a shingle. But the history of the asbestos industry is the history of people breathing asbestos fiber throughout its life cycle from mining to product use or environmental exposure. Like lead, it is too dangerous to use, which is a shame because it has many beneficial uses.
I was born and raised in Québec, and my father spent some time in Thetford Mines trying to get a new jewelry manufacturing business started after his old one failed spectacularly.
He brought home several chunks of asbestos as souvenirs for my younger sister and me. I remember playing with the rocks, pulling off shreads for fun. The rocks disappeared after a couple of years, around the time we moved to Toronto. We had no freakin' clue.
My sister and I are now in our forties and for the past 10-20 years or so, we've shown a real tendency to get very congested after a cold or flu, with coughing that continues for weeks. We're both alwso very sensitive to dust, with me wheezing after cleaning the garage and my sister having full-out asthmatic attacks -- going to the ER to get treated -- when her basement was renovated. She actually had to move out of the house for a month.
I've been ascribing our bad lungs to living with two chain-smoking parents until our early twenties. Now I'm wondering if the asbestos we carelessly played with may also have been a factor.
I'd been wondering why the mines were still open as most uses of asbestos are also banned throughout Canada. It's not only Harper's government, as eager as I am to blame him for anything now that he's embarassed us in Denmark. It was the previous governments as well.
I did my medical degree in Quebec, and I saw a lot more mesothelioma and asbestosis, largely in people from the Thetford Mines area, than I would have expected given their low prevalence in the general population. It's funny, it seems that even the people who get sick are very resigned to these mines staying operational.
One black coffee not asbestos.. LOL..