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Hey, government people, have you heard about mesothelioma?
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Just when you think it cannot become worse, it does.
For many decades, we have known about the hazards of asbestos, as well as its relationship to mesothelioma and other thoracic and abdominal malignancies. We even see there is a growth industry among our friends in the legal world, with the emergence of for-profit firms apparently devoted only to mesothelioma and asbestos litigation.
The present tale really is a sad one, as most oncologists know, but government functionaries — and, in particular, the Environmental Protection Agency — apparently do not.
Significant health hazard
In the early 20th century, asbestos was frequently used as insulation. It also found application in the housing industry, for lagging — or coating — of pipes in the production of ships, and in the manufacture of brakes and various other useful items.
It eventually became clear that asbestos posed a very significant health hazard, with the evolution of malignant tumors of the pleura, lung and peritoneum occurring among workers exposed chronically to asbestos. Thus, asbestos miners, navy and merchant marine personnel exposed to lagging, construction workers and many others developed highly aggressive, intractable tumors.
Key scientific papers in the 1960s — particularly from Australia, which had a major commitment to asbestos mining — defined very clearly the cause-and-effect relationship between asbestos exposure and cancer, usually with a lag period of 10 to 30 years.
With the passage of time, it became increasingly clear there was considerable collateral damage. Family members of these workers, such as wives who were exposed to asbestos while washing work clothing, also began to develop these malignancies.
Both government and the asbestos industry ignored the evidence for decades, partly aided by medical and scientific guns for hire who created false sets of data to challenge the incontrovertible epidemiologic evidence.
Eventually, laws were passed to regulate asbestos mining and the use of the product, and huge litigations against the manufacturers were successful — often predicated on their having ignored high levels of proof of asbestos carcinogenicity, or even fabricating evidence or interpretation of data to the contrary.
Internationally, a series of increasingly stringent laws was created, absolutely limiting the use of asbestos, creating safety standards for industries that use this substance, and even defining stringent criteria for the abatement of asbestos in the construction industry.
U.S. regulation has always lagged (no pun intended) behind the rest of the developed world with regard to asbestos, and the product has been used more freely here than elsewhere.
Nonetheless, there has been increasing stringency and much greater awareness in the general community of the hazards posed by the product, and we seemed to be heading in the right direction — albeit perhaps too slowly.
It is quite clear that Joe Public came to understand these issues, based on the dramatic reduction of consumption and use of asbestos internationally. However, of importance, asbestos has never been completely banned in the United States despite the availability of many alternative products, unlike the situation in many other developed nations.
This reflects a nice example of the phrase “the law is an ass,” wherein one of the U.S. federal courts overturned legislation limiting asbestos use because of purportedly insufficient evidence. Although bipartisan legislation has required the EPA to initiate a detailed study, this has been amazingly stalled for the past 3-plus years. Never forget that the government is here to help you.
‘The wrong direction’
Now, enter a new conservative government that has opined that industry will be protected at the expense of the general populace, and things have again started to change ... in the wrong direction.
A series of industry stooges has infiltrated the senior levels of the Environmental Protection Agency — a new addition to my list of favorite oxymorons — and they have started to deconstruct a whole series of rules and regulations previously created to protect us from a range of hazards.
Although they have come to recognize that global warming doesn’t exist (irrespective of draconian climate changes, hurricanes, melting of the ice pack and glaciers, etc), that deforestation and extensive pillaging of the natural environment are innately of benefit to the world, and that more cigarettes, coal use, etc, will somehow benefit conservative government and life in general, a new life-terminating challenge has recently been added to the list: reduced regulation of asbestos.
In 2019, in a Trojan horse set of rules designed to obfuscate the situation, the EPA has effectively de-regulated asbestos. It has done this by creating mechanisms for the asbestos industry to use loopholes in the regulations that will increase the availability of asbestos in relevant industries, such as construction and chemical manufacturing, and in the fabrication of brake linings.
Annoyingly, this has been done under the (fake news) rubric of creating rules to improve the regulatory environment for asbestos. In addition, it has become easier to import asbestos into the United States for distribution and wider use.
So what should we be doing? Well, for a start, we must let our congressional representatives know we support the bipartisan Alan Reinstein Ban Asbestos Now Act of 2019, introduced into both houses on Capitol Hill earlier this year, with a view to limiting manufacture, distribution and use of asbestos in the United States.
We should ask candidates for election or re-election where they stand on these issues. Thoracic — and general — oncologists should be proselytizing to their patients and their families about the continuing dangers of asbestos exposure, and the chicanery of government and the EPA in liberalizing the regulations that relate to this proven carcinogen.
We really should be posing a question to ourselves: How will history judge us for failure to oppose the arrant stupidity du jour — namely, the increase of cigarette smoking on college campuses, the ready availability of weapons of mass killing in U.S. communities, and now the reversal in oversight, regulation and limitation of exposure of the U.S. population to asbestos.
Perhaps the glass-half-full person would see it as an oblique vehicle for better population control. I most certainly do not.
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Atrium Health. He can be reached at derek.raghavan@atriumhealth.org.
Disclosure: Raghavan reports no relevant financial disclosures.