Freshman congressman Larry Bucshon (R-IN) scolded OSHA chief David Michaels for using the term "cancer" as a buzz word. The congressman, who is also a thoracic surgeon, said:
"I don't like it when people use buzz words that try to get people's attention, and cancer is one of those."
The exchanged occured last week at a House congressional oversight hearing called "Workplace Safety: Ensuring a Responsible Regulatory Environment," where Members were examining some of OSHA's enforcement and regulatory initiatives. Assistant Secretary of Labor for OSHA, David Michaels mentioned lung cancer in response to an earlier question from the subcommittee chairman, Tim Walberg (R-MI), about the agency's plan to propose a new health standard for workers' exposed to respirable crystalline silica. Walberg said:
"You can be hit by lightning far more opportune than you can with silicosis."
"I'm not sure that's the case, there is plenty of silicosis, but more importantly, far more deaths occur from silica-related lung cancer than silicosis. We feel it's an important issue to address."
Dr. Michaels' reference to silica-related lung cancer is the phrase that caught the attention of Congressman Buschon.
"...I'm a thoracic surgeon, so I want to focus a little bit on what you said earlier as it relates to silica dust. I'm curious about your comment about silica-dust related lung cancer, because I've been a thoracic surgeon for 15 years and I've done a lot of lung cancer surgery, and I haven't seen one patient that's got it from silica dust.
According to the American Cancer Society, the number one causes are cigarette smoking, second hand exposure, asbestos exposure as it relates to mesothelioma, which is actually not lung cancer. Occupational exposure is not on the top of that list, that I'm aware of, and I could be wrong, but silica dust is not one of the top things. ...I don't like it when people use buzz words that try to get people's attention, and cancer is one of those. ....Do you have scientific data to show the increase of lung cancer is....caused by silica dust exposure?
As the OSHA chief noted, both the World Health Organization's International Agency for Research on Cancer (IARC) and the U.S. National Institutes of Health's National Toxicology Program (NTP) recognize respirable crystalline silica as carcinogenic to humans. NTP's most recent Report on Carcinogens identifies 54 substances as known human carcinogens, and another 186 as reasonably anticipated to be human carcinogens. NTP began examining the scientific evidence on the carcinogenecity of silica in the late 1980's. NTP's panel of experts designated silica in 1991 as "reasonably anticipated to be a human carcinogen" based on evidence of lung cancer in exposed workers, and in 2000, revised its classification to "known to be a human carcinogen." IARC listed crystalline silica as a "carcinogenic to humans" in 1997.
The OSHA chief mentioned both the IARC and NTP evaluations to Rep. Bucshon, but the Doctor-Congressman he seemed more fixated on what he thought the American Cancer Society says about lung cancer causes.
"Can you submit the best study that you know to the committee so I can review that, because I'd be interested to see that. Because again, if you look at the American Cancer Society (ACS), it's not on the top of their list."
It's true that crystalline silica is not the leading cause of lung cancer. That's tobacco smoking, but it's not as though the ACS is silent about silica as a cancer cause. It took me about three seconds to reach the ACS's webpage called "Learn about Cancer: Known and Probable Human Carcinogens" to see:
"As part of the American Cancer Society's role in informing and educating people about cancer and its possible causes, this document provides lists of substances and exposures that are known or suspected to cause cancer. The lists below have been developed by two highly respected agencies - the International Agency for Research on Cancer (IARC) and the US National Toxicology Program (NTP)."
Respirable crystalline silica is listed prominently on this ACS webpage as a known human carcinogen.
The OSH Act of 1970 gives the Secretary of Labor the authority to issue standards that address workers' exposure to toxic agents. The statute sets the bar high, saying that standards should protect workers from suffering "material impairment of health or functional capacity." An excellent paper summarizing the exposure-response data on silica for silicosis, lung cancer and renal disease was published in 2005. The author, Kyle Steenland of Emory University School of Public Health, also refers to studies that suggest a possible association between silica exposure and autoimmune disorders.
While Congressmen Walberg and Bucshon were taking the OSHA chief to task for using cancer as a "buzz" word, and worse yet, possibly proposing to update its inadequate standard on crystalline silica, it was only Congresswomen Lynn Woolsey (D-CA) who wondered the same thing I did: With all the evidence of health risks to workers exposed to respirable crystalline silica, why is it taking the Administration so long to act?
Wow. Just ... wow. It's alarming that someone with a medical degree can fail to understand a) the fact that none of his patients has never had a particular disease doesn't mean that disease doesn't exist; and b) the fact that an agent is not the top cause of a disease doesn't mean we shouldn't try to prevent exposure to it.
some doctors avoid asking patients about their work exposures because they dont want to be involved with workers comp system.
David Michaels also respectfully mentioned to Congressman-Doctor Bucshon that an individual and their physician can rarely say with certainty what caused their particular case of cancer (i.e., specific causation.) It is with the evidence provided by epidemiological studies of groups of workers that we can understand the relationship between the risk of an outcome given a particular exposure (i.e., general causation.)
Thanks for reporting on this, Celeste. It's disappointing to learn that some of our congressmen think that their role in this system is reviewing a single study to single handedly determine whether or not a substance should be managed for carcinogenesis. It's no wonder Republicans want to defund the EPA: they think they can do it's job on their own.
It's not a failure to understand, it's an attempt to deceive. We expect doctors and scientists to be forthright. We expect politicians, even ones who used to be doctors or scientists, to argue in bad faith: in short, lie. That's what we should expect because that's what we usually get.
We expect politicians, even ones who used to be doctors or scientists, to argue in bad faith: in short, lie.
Politicians are not lying. They are avoiding the truth.