The Pump Handle

[Update 4/22/2011: see CDC's NIOSH corrects asbestos statement]

It was almost too much to believe. Here I was attending the Asbestos Disease Awareness Organization’s (ADAO) annual meeting, mingling and learning from patients and researchers about asbestos-related disease, and I hear that the Center for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) has just issued its treatise on asbestos. That document, called a “current intelligence bulletin” is supposed to convey the most up-to-date scientific information on a hazard and risk of harm from exposure to it. The NIOSH subtitle actually says it’s a “state-of-the-science” report.

We depend on our public health agencies to provide an independent assessment of the best available information about hazards and health risks. When it comes to asbestos (and other contaminants,too) this is especially important because the scientific literature is loaded with studies paid for by corporations and organizations that have an economic interest in downplaying the risk (here, here, here, here.) We’ve known since at least the 1940′s that worker exposed to asbestos were at increased risk of developing lung cancer, and in 1971, the WHO’s International Agency for Research on Cancer (IARC) designated chrysotile asbestos, amosite asbestos, tremolite asbestos, anthophyllite asbestos, and crocidolite asbestos as carcinogenic to humans. In 2009, IARC reconfirmed this designation for cancers of various sites. In the U.S., our National Toxicology Program designated asbestos as a known human carcinogen in 1980, and has reconfirmed that classification in each of its ten subsequent Report on Carcinogens. Finally, and most recently, the President’s Cancer Panel report, issued in 2010, devotes an entire section on asbestos-related cancers from both workplace and environmental exposures. There’s no question that exposure to any commercial form of asbestos is associated with increased risk of cancer.

Imagine the disbelief—like a bad April Fool’s joke—when we learn that in the year 2011, NIOSH labels asbestos: “a potential occupational carcinogen.” A potential carcinogen? That’s like saying tobacco smoke or solar radiation might be carcinogens.

The link between asbestos and cancer of several types is unequivocal. In fact, if one of my public health students wrote in an assignment or exam that asbestos is a “potential occupational carcinogen,” I’d insist on meeting with them to discuss their answer. The whole public health community knows that asbestos is a known human carcinogen. Except for NIOSH.

I won’t have any trouble explaining to students or reporters why NIOSH has it wrong. But, what about others who read NIOSH’s statement and accept it. It comes afterall from the CDC. I cringe at the thought of individuals and firms who get rich defending asbestos users holding up this document in court. They now have a brand-spanking new document from the CDC saying asbestos is only potentially a carcinogen.

I’ve no doubt NIOSH officials have an explanation for their “potential occupational carcinogen” phrase. It probably sounds reasonable and rational to their ears. To my ear drums, it’s worse than fingernails on a blackboard.

NIOSH says they used the “potential occupational carcinogen” phrase because it appears in a 1980 policy on carcinogens issued by OSHA at the end of Jimmy Carter Administration. (It was published on day three of the Reagan Administration, and has never been used by OSHA.) The history of that 1980 policy tells us that OSHA was trying to devise a system to set regulatory priorities for toxic materials. OSHA proposed criteria for classifying contaminants that were suspect carcinogens; it was not for compounds that were already well-established by the scientific community as carcinogenic to humans. In fact, the very first health standard OSHA issued was on asbestos, in 1977, because the evidence was clear the deadly fibers caused cancer.

I’m also troubled by NIOSH’s qualifier: occupational, as if non-occupational exposure to asbestos aren’t also associated with cancer. I’m sure NIOSH thinks it makes sense for them to restrict their assessment to “occupational” exposures because their authority comes from the OSH Act, not some broader environmental statute. That kind of narrow thinking—–as if the work environment does not affect the communities outside the fence line—-does not advance public health. In fact, it is exactly because of exposures at work, that individuals with no known occupational exposure, are developing asbestos-related cancers. Julie Gundlach was only 35 years old when she was diagnosed with peritoneal mesothelioma. Her father was an IBEW-member electrician and likely brought the deadly fibers home on his work clothes. Heather Von St James was only 36 years old when she was diagnosed with pleural mesothelioma. Her dad also worked around asbestos as a fireman and construction laborer. (I met both of these courageous women at the ADAO conference this weekend, and they want you to know that asbestos is not banned in the U.S.) There is no magic barrier that separates hazards at work (the work environment) from becoming hazards in a community.

NIOSH’s Current Intelligence Bulletin 62 includes more than this carcinogen classification. But it lost even more credibility with me when NIOSH gives “equal time” to studies (funded by asbestos interests) that raise doubt about adverse health effects of asbestos exposure. NIOSH also provides a venue for others who manufacture uncertainty about the risk of exposure to other long, thin durable mineral fibers. How disappointing.

This week (April 1-7) people around the globe are marking Global Asbestos Awareness Week. The WHO estimates an annual global toll from asbestos-related lung cancer, mesothelioma and asbestosis from occupational exposures alone is 107,000 deaths and 1,523,000 disability-adjusted life years. Senator Max Baucus (D-MT) and his colleagues joined earlier this month in passing Senate Res. 63 to designates this week National Asbestos Awareness Week. Individuals whose lives have been changed forever because of an asbestos-related disease have set aside time this week to participate in events to raise awareness about the deadly toll of the malevolent mineral. Little did we think that CDC’s NIOSH would need the lesson.

Comments

#1 Karen
April 5, 2011

I’ve had two encounters with asbestos. The first was when we discovered our house’s heating ductwork was covered in disintegrating asbestos tape; watching all the care that was taken when we had professionals remove that ductwork was a real eye-opener for me — this stuff is really hazardous!

My second encounter was in a mineralogy class where we observed a chunk of chrysotile, carefully double-bagged in plastic. (And no, nobody was the least inclined to open the bags.) It seemed like such an innocent piece of rock — how deceptive!
#2 ChrisL
April 5, 2011

The terminology leaves much to be desired because it is obvious how it might be (mis)interpreted, but the NIOSH document states that:

“NIOSH’s use of the term “Potential Occupational Carcinogen” dates to the OSHA classification outlined in 29 CFR 1990.103, and, unlike other agencies, is the only classification for carcinogens that NIOSH uses.”

And, in section 6.1 of the document, “Potential Occupational Carcinogen” is defined as:

“… any substance, or combination or mixture of substances, which causes an increased incidence of benign and/or malignant neoplasms, or a substantial decrease in the latency period between exposure and onset of neoplasms in humans or in one or more experimental mammalian species as the result of any oral, respiratory or dermal exposure, or any other exposure which results in the induction of tumors at a site other than the site of administration. This definition also includes any substance which is metabolized into one or more potential occupational carcinogens by mammals.”

So it seems NIOSH is not equivocating, but is stuck with the terms they are allowed/required to use.
#3 Mark
April 5, 2011

In reviewing past NIOSH documents on other carcinogens, I found no other use of the OSHA cancer policy – but did find refereneces to IARC policy. Seems that NIOSH is not required to use the OSHA cancer policy.
#4 Clam
April 6, 2011

Potential carcinogen because asbestos in the solid form is harmless. It is only when asbestos is worked (sawn, drilled, abraded) and its fibres are released into the air and then breathed (and not for a short time) that asbestos becomes carcinogenic.
I got the giggles at

My second encounter was in a mineralogy class where we observed a chunk of chrysotile, carefully double-bagged in plastic. (And no, nobody was the least inclined to open the bags.) It seemed like such an innocent piece of rock — how deceptive!

Yes, it was innocent, unless you started crushing it and using the fibres as snuff. What moron double-bagged it? And I hope that you haven’t got any pretty stones like tiger eye on your bracelet. That’s brown asbestos. Blue tiger eye is, of course, blue asbestos. They can, safely, be polished (but under water) and, in the polished state, are totally harmless.
I would like to emphasise that I have no candle to hold for the asbestos industry and was, at one time, a Health and Safety Representative in the major firm for which I worked.
But I do dislike hysteria.
#5 Ender
April 6, 2011

http://en.wikipedia.org/wiki/Tiger's_eye

Not according to wikipedia it isn’t.
#6 Celeste Monforton
April 6, 2011

Chris L:
There’s is no statutory or legal reason for NIOSH (in the Dept of Health in Human Services) to defer to an OSHA policy (in the Dept of Labor). In fact, the OSH Act of 1970 that established both OSHA and NIOSH gives special authority to NIOSH for research and preparing these criteria documents.

It is incorrect to say that NIOSH “is stuck with the terms [in the 1980 OSHA Policy] they are allowed/required to use.” Without its own carcinogen classification policy, NIOSH should have stated clearly in its Executive Summary and Introduction, the classifications by IARC and NTP—-all forms of asbestos are known human carcinogens.
#7 James
April 6, 2011

@ChrisL /agree.

NIOSH, as a scientific/regulatory organization will use easily misunderstood jargon in very specific ways. Jargon like that is usually defined by statute or regulation, just like you found and quoted. And as a decade plus veteran of Washington D.C. and labor law Celeste knows this.

Instead of explaining to a lay audience the vagaries and inside baseball of the regulatory process, she chose to comment, in an alarming tone, on a report of what is essentially stale information (chronic inhalation of asbestos fibers from any source can increase incidence of certain cancers), because that gets eyeballs to the web site and it advances the cause.

What would be useful as a followup would be more information on why/how NIOSH made the choices to give equal time to industry studies, to use OSHA’s “potential occupational carcinogen” criteria rather than another classification. Were they responding to a Congressional mandate, or did NIOSH have discretion that may have been influenced by Big Cancer?

Or how the various reglatory agencies and government mandates for public health, safety, and environmental protection can work at cross purposes or create coverage gaps, such as when occupational chemical exposures to clothing and vehicles are brought into the home, where education and protection are non-existant; and what can be done about it with or without Congressional action.
#8 Tasha
April 6, 2011

But NIOSH is not a regulatory agency. It’s a research institution. Granted, NIOSH’s findings hold weight, so perhaps some policy makers are concerned about the effects of strong language. But NIOSH should not have to tone down their language when it is correct.
#9 Former DOL WC Examiner
April 8, 2011

The Department of Labor by law utilizes the research that NIOSH publishes in the adjudication of the worker’s compensation claims. Most WC claimants do not have the resources to dispute what NIOSH has published so their cases will be denied. To say that a federal government agency has the right to publish any words they wish is absolutely insane as they have been created to be the medical researchers for the federal government! Congress needs to mandate these government agencies or not use them as being the experts in the specialized areas.
#10 Sasha Jensen
May 5, 2011

Almost 10,000 people die per year in the US alone because of asbestos. It should be banned! http://www.banasbestos.us/ and http://www.weitzlux.com/asbestos_1962542.html