Emergence of Asbestos-related Health Issues and Development of Regulatory Policy in the UK
Period 1 1924 to 1974): The Pre-risk Management Era of Asbestos Production and Regulation
Characterization of the Period for Its Approach to the Management of Asbestos Risk
The use of and research on asbestos in the UK began much earlier than 1924.
Alleman and Mossman (1997, p. 70), for example, discuss how the mineral was a topic of exploration within the Royal Society almost from the Society’s inception in 1660. Geoffrey Tweedale (2001) provides a detailed account of asbestos produc- tion before and after 1924. This date of 1924 is significant for our purposes, because it is the year that saw William Cooke publish the first medical paper reporting a death caused by fibrosis of the lungs.1 The papers Cooke published on the death of Nellie Kershaw were significant because they made a direct link between fibrosis of the lungs and the asbestos fibers that Nellie inhaled while working in the spinning room of an asbestos factory in Rochdale, England (Bartrip 2004, p. 72; Selikoff &
Greenberg 1991, p. 898). From that moment on, asbestos was considered a health hazard requiring some kind of management.
The 50 years of asbestos production and management in question can be largely characterized by industrial expansion and influence, as well as quasi-self- regulation.
Industrial Expansion
The use of asbestos boomed with the expansion of industry and the wars that were prevalent during the 1930s, 1940s, and 1950s, with world production jumping from 339,000 tons in 1930 to 1.2 million tons in 1950 (Jeremy 1995, p. 255). Demand for the mineral was high in the UK, and when imported it was transf ormed locally to support the electrical and engineering sectors, the motor car industry, and shipbuilding after the rearmament following World War I (Jeremy 1995, p. 255).
Rearmament was good for the asbestos industry, but World War II was especially significant, as the mineral came to be seen and treated as an essential component of the war effort. After the bombings of World War II, manufacturers were producing asbestos during the rebuilding process to such an extent that capacity had to be expanded (Monopolies Commission 1973, p. 12). The largest British player in asbestos, Turner & Newall, saw their workforce explode from 5,000 in 1926 to 40,000 in 1961 (half were based in the UK and the other half abroad), and sales were over £300 million by 19582 (Warren 1997, p. 53). This early era of asbestos use was one of growth and large profits.
1 Later, in 1927, Cooke termed this fibrosis of the lungs, pulmonary asbestosis (Borron et al. 1999).
2 At some of the times between 1926 and 1980, T&N returned to its shareholders a 16% yield on their investments (Warren 1997, p. 53).
Self-Regulation
With the health risks of asbestos achieving widespread recognition only within the medical profession in 1927/8 (Jeremy 1995, p. 257), any control of asbestos dust up to that point was at the whim of industry. The regulations concerning dust content in factories’ air was enforced only minimally, if enforced at all, on the moral basis of providing the workers with comfortable working conditions. In 1926, when Turner and Newall had 5,000 employees (Warren 1997, p. 53), with the exception of the very general Factories Acts there was not a single piece of legislation or regulations that required industry to manage in any way the asbestos dust that these 5,000 workers were breathing.
Even with the advent of the first Asbestos Regulations in 1931 (which are dealt with in more detail below), the inspections and fines that these regulations demanded for the management of asbestos health hazards were very ineffective. There were a grand total of only two convictions (with fines) handed down as a result of the 1931 Regulations between the years 1931 and 1969, the year when new regulations were being drafted. There was only one conviction in the following years of 1970 and 1971. Even in relative terms, the fines that were levied for these violations averaged just £12 in the cases from 1931 to 1969, and £25 for the fine in 1971 (Tweedale 1999; Tweedale 2001, p. 212). With the extreme rarity of convictions based on the Asbestos Regulations of 1931, and the small amounts of the fines,3 any actions taken by the industry to manage the health risks associated with asbestos would have had to be almost entirely voluntary.
The asbestos industry in Britain from 1924 until 1969 was self-regulated. This self-regulation worked in dangerous conjunction with another characteristic of this
“pre-risk management” era, namely, that research on hazards was exclusively the province of industry. This situation tended to ensure that the potential harm of asbes- tos would be understated (Jeremy 1995; Tweedale 2000) (this industry- sponsored science and the denial of the scope of the asbestos hazard is addressed in more detail in later sections). Given these characterizing factors, it is clear that 1924 to 1969 was a period in which “risk management” as we know it today scarcely existed, at least to the extent that we can call it a “pre-risk management era.”
Relevant Actors in the Use and Management of Asbestos, and Key Events
Given the fact that asbestos use in the UK was self-regulated during the first half of the twentieth century, it is important that we provide the reader with a profile of the major industrial players who determined the conditions that allowed the health-related
3 For instance, £12 in 1945 would in 2005 be £344.95 (using the retail price index), £366.89 (using the GDP deflator), £1,086.32 (using average earnings), £1,211.68 (using per capita GDP),
£1,483.31 (using the GDP); £25 in 1971 would in 2005 be £236.71 (using the retail price index),
£242.31 (using the GDP deflator), £419.62 (using average earnings), £494.89 (using per capita GDP), £532.77 (using the GDP) (MeasuringWorth 2007).
hazards to manifest. It is also important that the reader understand the nature of the asbestos industry prior to 1974, because this industry financed most of the research studies on the potential health impact of asbestos, research that was supposed to guide the development of the asbestos regulations.
Industry
Of the three major firms that manufactured asbestos-related products, Turner and Newall (T&N) was by far the largest (Monopolies Commission 1973, p. 12; Tweedale 2001, p. 4; Warren 1997, p. 53). The company was established in 1871 as Turner Brothers and in 1907 was renamed Turner Brother Asbestos (Tweedale 2001, pp. 2, 5).
This company was actually merged with three other companies, which propelled it to the status of a major asbestos manufacture. As Warren describes it:
Turner and Newall (T&N) which was formed in 1920 by merging four other firms: Turner Brothers Asbestos, The Washington Chemical Company, Newalls Insulation, and J.W.
Roberts. T&N was floated on the London Stock Exchange in 1925 and acquired Ferodo Ltd a brake linings manufacturer soon after, making it the largest vertically integrated asbestos based business in the UK (Warren 1997, p. 53).
The other two major industrial players in the UK were The Cape Asbestos Company Ltd. and British Belting & Asbestos (BBA). As the Monopolies Commission described in detail, these “leading competitors” were very much a post-war development, following on the coattails of T&N, at least insofar as “the history of the [asbestos] industry in the United Kingdom in the 1920s and 1930s was in effect the history of T&N; to some extent it has remained so to the present day” (Monopolies Commission 1973, p. 12).
Government
Despite the characteristically industry-driven approach to asbestos management that dominated the decades prior to 1974, the British government was technically involved with the safety of all factory workers. More specifically, the 1931 Asbestos Regulations meant that there was some kind of recognition of the potentially hazardous nature of the mineral. Lucy Deane, the first female Inspector of Factories, warned in 1989 (i.e., prior to the 1931 Regulations) that asbestos was dangerous, “on account of [its] easily demonstrated danger to the health of workers and because of ascertained cases of injury to bronchial tubes and lungs medically attributed to the employment of the sufferer … the evil effects of asbestos dust have also instigated a microscopic examination of the mineral dust by HM Medical Inspector. Clearly revealed was the sharp glass-like jagged nature of the particles, and where they are allowed to rise and to remain suspended in the air of the room in any quantity, the effects have been found to be injurious as might have been expected.” (Deane 1898; Gee & Greenberg 2001).
Although this report was later confirmed by similar reports in 1909 and 1910, and irrespective of whether these earlier reports “appeared in the annual reports of HM
Chief Inspector of Factories, which were widely circulated amongst policy-makers and politicians” (Gee & Greenberg 2001), the asbestos industry was largely its own regulator when it came to taking any action against asbestos hazards.
The position of the British government in the first half of the twentieth century in regard to asbestos was further complicated by its view of the perceived necessity of the mineral in “the war effort.” As the Monopolies Commission (1973, p. 12) observed: During the war T&N and its major subsidiaries, and other manufacturers of asbestos products in the United Kingdom, were declared controlled undertakings by the Ministry of Supply under the Defence Regulations and their activities were almost wholly directed towards furthering the war effort.
Given the primacy of the war in the 1930s and 1940s, and the acknowledgement of the importance of asbestos by the British government, which classified the indus- try’s activities as “controlled undertakings by the Ministry of Supply under the Defence Regulations,” it is not surprising that the 1931 Asbestos Regulations were not enforced more stringently nor reformed for nearly 40 years.
Key Events
At the outset of this section, we identified the death of Nelly Kershaw and the subsequent publication of William Cooke’s paper, which identified asbestosis and linked it to asbestos exposure, as the key moment at which the mineral came to be considered a hazard in need of management. A series of other medical discoveries and publications proved equally important during this period. The disheartening fact is that these scientific papers are not key events because of their impact on the way the asbestos industry chose to operate, but rather because these discoveries and papers were ignored. As we shall see below, the asbestos industry, as well as the British government, had access to medical information that linked asbestos to a host of deadly diseases. Rather than accepting the dangers of asbestos exposed by this work, the industry chose to conduct its own research into the problem and for the most part continued with “business as usual.”
Along with Cooke’s early work on asbestosis, Dr. Edward Merewether reported a statistical analysis in the Annual Report of the Chief Inspector of Factories for 1947. In his report, he stated that “cancer of the lungs or pleura was present in 13.2% of cases [of asbestosis death from 1924 to 1946], compared to an incidence of 1.32% in silicotics and a similar figure in the general population” (Jeremy 1995, p. 258). In essence, these statistics demonstrate a link between asbestos and lung cancer. In 1955 this link was confirmed by Dr. Richard Doll’s work on the risk of cancer in asbestos workers (Doll 1955).
The third major killer disease associated with asbestos exposure did not come to light until 1960, when Wagner et al. (1960) published their first paper indicating a relationship between pleural mesothelioma and asbestos exposure. Mesothelioma, a type of cancer almost uniquely associated with asbestos, takes hold when malignant cells develop in the mesothelium, a protective lining that covers most of the body’s internal organs.
Its most common site is the pleura, the outer lining of the lungs and chest cavity, but it may also occur in the peritoneum, the lining of the abdominal cavity, or the pericardium, a sac that surrounds the heart (Mossman et al. 1990).
As the number of cases of asbestosis, lung cancer, and mesothelioma increased, so did the visibility of the asbestos issue. “Between 1964 and 1967, stories about the health hazards of asbestos appeared in such national newspapers as The Times, The Sunday Times, The Daily Herald, The Guardian, The Daily Telegraph, The Morning Star, The New York Times, and The Wall Street Journal, as well as in local and regional papers. In January 1967, the BBC broadcast a film on the subject on its early evening news program, 24 Hours. Thereafter, asbestos health hazards regu- larly featured in newspaper and television reports.” (Bartrip 2004, p. 73).
Table 3.1, taken from Bartrip (2004, pp. 74–75), lists the key medical events and publications during this period of asbestos use. Other key legislative and institu- tional events are discussed later.
The Institutional Framework for the Management of Asbestos Risk
The small number of state-run agencies responsible for the protection of factory workers, the pressure of the wartime economy, and the toothless regulations that were supposed to manage asbestos hazards together meant that the government
Table 3.1 List of key medical events and publications in the history of asbestos Key events
1924 W. E. Cooke publishes the first paper on asbestos related disease 1925 Thomas Oliver coins the term “asbestosis”
1930 Edward Merewether confirms that inhalation of asbestos dust can cause a fatal disease 1935 Kenneth M. Lynch and W. Atmar Smith identify a “possible relationship” between
pulmonary asbestosis and carcinoma of the lung
1955 Richard Doll finds that certain asbestos workers face a “notably higher risk” of contracting lung cancer than the rest of the population
1960 Wagner, Sleggs, and Marchand publish their first paper indicating a relationship between pleural mesothelioma and asbestos exposure
1964 Selikoff, Churg, and Hammond demonstrate that insulation contract workers face a health hazard resulting from asbestos exposure
Key publications
1930 Merewether E. R. A., & Price, C. W. Report on effects of asbestos dust on the lungs and dust suppression in the asbestos industry. London: Her Majesty’s Stationary Office 1955 Doll, R. Mortlity from lung cancer in asbestos workers. British Journal of Industrial
Medicine, 12(2), 81–86
1960 Wagner J. C., Sleggs, C. A., & Marchand, P. Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape province. British Journal of Industrial Medicine, 17(4), 260–271
1964 Selikoff, I. J., Hammond, E. C., & Churg, J. Asbestos exposure and neoplasia. JAMA, 188, 22–26
paid little attention to the management of asbestos. As mentioned above, this lassitude resulted in just two convictions based on the 1931 Asbestos Regulations from their inception until 1969 (Tweedale 2001, p. 212).
The release of the first report by the British Occupation Hygiene Society (BOHS)4 on chrysotile asbestos standards in 1968 signaled that this and other professional organizations would ultimately come to play a role in asbestos management. However, the BOHS was established in 1953 (Ogden 2003, p. 3), which means that it was largely silent and ineffective regarding the asbestos issue for a decade and a half.
What can explain the paucity of convictions by the government inspectorates and the silence of a significant scientific/professional body such as the BOHS for so many years? Given that these organizations were not highly involved with the management of asbestos, what other organizations or institutional frameworks were in place to take up the slack, and how did this situation affect the management of asbestos?
Industry-University-Research Complex – The Asbestos Research Council The laissez-faire position of most government institutions and significant professional bodies coincided dangerously with the emergence of a pseudo “Industry-University- Research Complex,” which Geoffrey Tweedale (2000, 2001) has efficiently recorded in his history of the Asbestos Research Council.
In the 1950s, the industry was skeptical about the purported health hazards associated with asbestos.5 It was afraid that its wartime profits would be reduced by workers’ compensation claims, let alone the increasing regulation of the manufacture of asbestos-related products. As a result, the “Big Three” industry players (T&N, Cape Ltd., and BBA) began funding university academics to conduct research on asbestos. Instead of individual research projects being funded here and there – such research had been conducted in the 1950s at the University of Reading with support from the Big Three – the Asbestos Research Council (ARC) was established in 1957 to formalize the research enterprise. Prior to the establishment of the ARC, Turner Brother Asbestos – T&N’s main factory – had established the Asbestosis Research Committee (ASR) in 1942. The ASR would eventually be the model on which the ARC was based (Tweedale 2000, pp. 724–726). Although this research was “in-house” by nature, it did take place at the British Postgraduate Medical
4 Perhaps an explanation at this point of what the BOHS is would be good?
5 Recall the following quotes from T&N in Jeremy (1995, p. 254): “We repudiate the term
‘Asbestos Poisoning.’ Asbestos is not poisonous and no definition or knowledge of such a disease exists” (T&N’s Turner Brother Asbestos board view, 1922). “Disease associated with asbestos is rare. The general public is not at risk, and very few workers are. The whole subject has been sensationalised because some recent medical research is of a kind which easily attracts headlines, and because asbestos dust can, in a minority of cases, lead indirectly to cancer, which is always a
‘scare’ word” (draft by UK Asbestos Information Committee 1967).
School in London, and it tended to focus on dust-counting technology and animal/
tissue-culture experiments.
When the ARC was formally established in 1957, the academics from Reading University were joined on the Council by academics from the University of Cambridge. In 1961, their participation resulted in the first appointment of an ARC research fellow at Cambridge. The organizational structure of the ARC is illustrated in Fig. 3.1 and is described by Tweedale (2000, p. 724) as follows:
… the ARC functioned through a management and research committee, linked by a joint-secretary. The management committee was to meet twice a year; the research committee (which was to include one medical and one technical member, and an independent expert) was to meet three times each year. The ARC’s initial budget was a little over £4000 (this at a time when T&N annual profits after tax were over £6 million) (Asbestos Research Council 1966, 1987).
However, as Tweedale shows, by the 1970s the ARC lost any kind of respect that it may have had as a research body, because it ultimately was the asbestos company that set the research agenda and determined the direction and public visibility of the research. The research strategy was set by the management committee, which in turn responded to the wishes of the sponsoring directors. As should be clear by now, these men did not see the ARC as fundamentally a council for scientific research.
Ultimately, its activities were revealed as simply an attempt to capture the scientific agenda and influence public policy (Tweedale 2000, p. 732) (Fig. 3.1).
Tweedale notes that “[t]he ARC stated publicly that it intended to concentrate on the prevention, diagnosis, and treatment of asbestosis.” With that in mind, the ARC decided internally that the measurement of dust suppression should be separated from the biological and health research. Like the work that took place in the 1940s, before the establishment of the Council, the more recent research tended to focus on animals and the chemical analysis of fibers. In fact, over 50 of the 69 pre-1976 ARC
The Big Three T&N Cape Ltd BBA
Management Committee Research Committee – 1 medical member – 1 technical member – 1 Independent Expert
University of Cambridge (ARC research fellow est 1961) University of Reading
Joint Secretary
Sub-committee on dust (est. 1960)
Sub-committee on insulation (est. 1965)
Legend Direct link Indirect link
Fig. 3.1 Structure of the Asbestos Research Council (ARC) 1957–1968
publications that Tweedale (2000, pp. 724–726) reviewed were concerned with these topics; only seven were focused on dust-fiber counting and dust control. In the ani- mal studies, it is not surprising that rodents injected with asbestos developed asbes- tosis. The studies involving the chemical analysis of fibers were concerned with determining how asbestos could continue to be used, in addition to the prevention of asbestosis.
Given that T&N alone was employing 40,000 people by 1961 (Warren 1997, p. 53) and also that there was strong medical evidence – if not proof – that asbestos was linked not just to asbestosis but also to lung cancer and mesothelioma, it is somewhat surprising that the ARC did not undertake epidemiological studies aimed at identifying the precise risks associated with various levels of exposure. This relative lack of research is explained by the fact that epidemiological studies were excluded from the ARC’s remit. By 1965, neither industry nor the government had conducted large-scale population studies on the health risks associated with asbestos (Tweedale 2000, p. 725).
By 1968/9 the ARC had shifted its research from Reading and Cambridge to the University of Edinburgh. This seems to have been an opportune decision, as the National Coal Board had previously established a charitable foundation at Edinburgh called the Institute of Occupational Medicine (IOM). With the decline of the coal industry, the IOM was looking for fresh streams of funding comparable to those previously obtained from the ARC. In return, the IOM could provide expertise for industry-based occupational research. This process culminated in 1971 with the ARC establishing the Asbestosis Research Foundation (ARF) within the IOM. This change from the early institutional arrangements of the ARC is illustrated in Fig. 3.2.
The Big Three
T&N Cape Ltd BBA
Management
Committee Research Committee
– 1 medical member – 1 technical member – 1 Industry expert Joint Secretary
University of Edinburgh National Coal Board
Institute of Occupational Medicine
Asbestos Research Foundation, est. 1971 (Special Animal Unit)
British Occupational Hygiene Society
Environmental Control Committee
(est. 1968.
Sub-committee on dust
Fig. 3.2 Organizational structure of the Asbestos Research Council (ARC) 1968–1990