The History of Asbestos in France
Period 8 2002–2007): Double Standards and Substitutes for Asbestos
Some ministers still do not understand the issue. They consider the publication of the Institut National de la Santé et de la Recherche Médicale (1997) report to be a
“shock and a surprise.”12 On March 3, 2004, the Conseil d’Etat (French Council of State) acknowledged the state’s responsibility and its failure to take proper steps to prevent the risks associated with occupational exposure to asbestos dust. This failure is particularly notorious for its lack of research and inadequate regulations. It is a sad illustration of the problem created by having a vast amount of information that is rendered indigestible because of poor organization and too little cross-referencing (Lewis 1978; Rasmussenn 1975). However, decision makers continued to defend themselves. “If the INSERM report would have been published ten or twenty years before, we [would have] banned [asbestos, but] we were not always [aware] … [of the] causal links, before [the presence of a] presumption that we had never had
11 Some analysts noticed that victims associations, and the INGO that represented them, were not allowed to offer their points of view in this debate.
12 Such as the Minister of Social Affaires, Jacques Barrot.
previously. (…) only in 1994 and 1997 (…) appears not absolute certainty, but [only] the presumption that, even below these levels … it could be risky.”
In 2006, a new and famous event revealed a double standard in French govern- ment behavior. The warship Le Clemenceau was supposed to have its asbestos removed while in India, but following a long international discussion with various interlocutors the ship was forced to return to Brest (in Northeastern France).
The interlocutors included the Egyptian government (for permission to cross the Suez Canal), the Supreme Court of India (regarding whether such asbestos removal could take place in India), the French Conseil d’Etat (which attacked the decision to send the ship to India), and various French ministries (e.g., industry, defense) as well as the President. Greenpeace played an important role in the media coverage, choosing to highlight the case as a symbol of asbestos problems to come and an illustration of unethical environmental practices. The United Kingdom and the United States have fared no better in their dealings with old warships.
The second point concerns the difficulties in establishing and maintaining safety levels for the removal of asbestos from such warships, as well as from buildings.
In 2006, approximately 100 million square meters of buildings in France still contained asbestos (Dériot & Godefroy 2005). More important is the third point, which concerns acceptable alternatives to asbestos. The 1998 INSERM report asked for more research on this question.
Currently, only 40 countries (15 of them in the European Union) have banned asbestos. It may be true that after 1996 France played an important role in the WTO’s addressing of the regulation and banning of asbestos. However, three issues remain regarding France’s apparent health-protection position in the broader social context: double standards, the removal of asbestos, and asbestos substitutes.
First, a strategy of double standards has been pursued by the asbestos industry and the French government. The strategy reveals a contradiction between the high level of security in France itself and the low level of security in Third World or emergent countries with which France has relationships. When asbestos was banned in France, the French multinational firm Saint-Gobin, for example, continued to mine and manufacture it in Brazil, with the full cooperation of the Brazilian government.
This habit of double standards – an asbestos ban domestically and loose safety regulations overseas – was vigorously defended in France. The government argued that no asbestos-related diseases had been reported in these developing countries, ignoring the fact that there had been no epidemiological studies in these countries that reliably established either the presence or absence of adverse health effects from mining, processing, or using asbestos. Because of this lack of research and information, individuals and institutions in these underprivileged countries cannot make a persuasive case for legislative reforms that protect work- ers and their environment from the dangers of asbestos (Harris & Kahwa 2003).
Another application of the double standard can be seen in the defense of the social utility of asbestos for the construction of cheap housing in these countries (Thébaud-Mony 1990). This argument reflects a double standard because it attaches a different (and greater) value to convenience and economic benefits than to public health.
Discussion
Because of the many positive attributes of asbestos, especially its fire-resistant capacity, it was difficult to argue that its risks outweigh its benefits. Above all, asbestos was very cheap. Consequently, it is everywhere – in buildings products, ships, etc. – which means that it would be very costly to remove it all. Given the high cost of indemnification, can anything be cited that would lead us to conclude that the risks do indeed outweigh the benefits? In the historical part of this chapter, we mentioned several such factors: scientific uncertainty, special-interest politics, national and local politics, litigation, the AIDS scandal, and institutional change (creation of governmental agencies).
As stated at the beginning, the purpose of this chapter is to continue the analysis of the scientific and public controversy surrounding asbestos (Reber 2006) and to understand the rationality of the decision-making process for regulating or banning asbestos, with reference to several13 key elements of the precautionary principle as defined by the Conference of Rio (1992). In other words, the purpose of the chapter is to elucidate the key factors affecting the application of the precautionary principle to policy making, such as when a lack of scientific certainty is or is not put forth as a reason to postpone proportionate regulations. We first addressed various aspects of this scientific uncertainty, how various institutions have confronted it, and the uncertainties that remain, particularly concerning the use of asbestos substitutes.
Then we considered the factors that have contributed to progress in asbestos regulation, with the ultimate goal of totally banning its use.
Lack of Full Scientific Certainty Regarding Health Hazards
In retrospect, we can admit that the health danger of asbestos has been known since 1964. Nonetheless, according to Claude Got (Dériot & Godefroy 2005), one of the major French advocates of asbestos regulation, “France took the first measures of precaution” 46 years later than the United Kingdom, 31 years later than the United States,14 and 13 years later than the International Conference of New York.
The proceedings of this conference can be accessed at the medical faculty library of Paris University. Surprisingly, the INRS15 published several articles in its review Travail et Sécurité (1954), admitting the dangers of asbestos and advocating preventative technical steps to overcome these dangers. However, none of these conclusions were propagated or utilized to inform appropriate political decisions.
The INRS was indeed playing a devious game. Between 1950 and 2004, it pub- lished 362 papers on asbestos in Travail et Sécurité. The INSERM’s 1997 claim that
13 In this chapter, it is not possible to make the same assertion for all these characteristics.
14 In 1918, American insurance companies refused to issue life insurance policies for employees who worked in asbestos-related industries.
15 See: http://en.inrs.fr/ (retrieved November 11, 2007).
there were no French articles on asbestos before 1996 is patently false. The INRS had long established that such documents existed. Prior to the creation of the InVS, the INRS was the only institution that could have alerted the public authorities about the asbestos problem, yet they failed to do so. Created in 1947, the INRS is composed of an equal number of employers and employees, thereby guaranteeing both an absence of research independence and a lack of expertise on public health. In addition, it was the former General Director of INRS, Dominique Moyen, who spear- headed the creation of the CPA in 1982. Even though the INRS did not play a role in alerting the public authorities, “it has taken the occasion to prevent certain risks.”16
The “lack of full scientific certainty” was always present in the controversies surrounding asbestos. There are different types of asbestos fiber and the term asbestos applies to all these types collectively. Biological effects should be considered for each type individually. The identification of specific types in air samples requires sophisticated technologies, such as electron microscopy, x-ray diffraction, or energy dispersive x-ray spectroscopy. Even with such equipment, however, the chemical composition of each fiber type is complex (Mossman et al. 1990).
In their now famous article, Mossmann et al. recapitulated these difficulties, summarizing the medical and scientific controversies concerning asbestos-related diseases. In the following year, Bignon (1992) presented a set of four unresolved scientific questions about asbestos-related diseases: (1) Is the development of asbestos-related lung cancer always preceded by pulmonary fibrosis? (this issue was still unsolved in 1992); (2) How are the causality of mesothelioma by different fiber types to be understood? (controversial interpretations appeared in 1992); (3) In what percentage of mesothelioma cases is there no exposure to asbestos? (most epidemiological studies indicate approximately 20% to 30%);17 (4) What are the health effects of exposure to low amounts of asbestos. Asbestos substitutes have also come into question. It seems that nothing is completely free of danger.
Efforts of the Asbestos Industry Against Stricter Regulations
Why was it possible for the government to have these scientific articles available but yet take no coherent policy action? The production of asbestos is globalized.
After 1964, the French – and more importantly, the international – industry developed two strategies. The first strategy was to promote “controlled use,” through which asbestos manufacturing purportedly could be made safe. This option allowed the asbestos industry to gain the support of most trade unions,18 which defended it as an acceptable compromise to protect jobs. The second strategy was to provide research grants to scientists and physicians. However, their role in promoting
16 Recognized by P. Huré, who was in charge of the Department of Chemical and Biological Risks of the INRS (Dériot & Godefroy 2005).
17 “This question will probably take more than 20 years to be resolved” (Bignon 1992).
18The trade union Force ouvrière asked for a ban on asbestos and did not attend the Permanent Asbestos Committee meeting in 1982.
science is now suspected. Some analysts now speak of the dubious nature of the research contracts with the asbestos companies. These contracts came with the stipulation that the asbestos industry/companies would have permanent control over the publication of the results (Lenglet 1996; Thébaud-Mony 2003), which means that the industry could control the generation and dissemination of scientific knowledge to serve their own interests. It seems that this strategy allowed the indus- try to dominate for many years the international scientific controversy regarding the different toxicity levels of various asbestos fibers.
Several interesting issues arose during the CPA period (1977–1994). First, some of the scientists involved were not informed of asbestos substitutes being used by the industry, despite the fact that an INRS article in Travail et Santé recommended the use of such substitutes. The industry defended its position by attributing the possible health risks of asbestos to the factors other than their products themselves, stressing the benefits of the latter. Thus, they used the press in an attempt to trivialize the hazardous nature of asbestos products. For example, one article states that
“asbestos is everywhere … the dangers are essentially caused by the inadequacy in implementation … Be quiet. If your house is in good condition, you have on the contrary more security (with some construction materials using asbestos)”
(Chambre syndicale de l’amiante 1976).
Indeed, among public policymakers, industries, unions, and CPA members, the lack of scientific certainty regarding asbestos hazards and the differences in hazardousness properties between asbestos and its substitutes was used to postpone radical decisions such as banning asbestos. Controlled use was presented as a workable compromise.
From the historical perspective, one can all too easily say, as many analysts have, that policymakers have made only “instrumental” use of the sciences, treating them as a black box and preferring to follow short-term prevention strategies with the
“controlled use” of asbestos. However, to make their case, these analysts selected a particular experiment to sell as “the right one, before the others,” forgetting about the complexity of the controversy as a whole and thus increasing scientific uncertainty.
In a sense, this use of science can be viewed as both instrumental and anachronistic.
A traditional concept “holds that the science and engineering community should lay out the ‘facts,’ making it clear what is known and what is not known” (Morgan &
Henrion 1990, p. 17). Their actual retrospective position is not that of the former decision-makers. One could hypothesize, of course, that the decision makers were not cynical, just that they were accepting (false) economical calculations and waiting for complete or at least greater scientific certainty, while pretending that they could justify all this to the public and themselves later (Dériot & Godefroy 2005).
Institutional Change in the French System of Government
Bignon once pleaded, “[W]e must admit our limitations and express the wish that scientists, industrialists, politicians, and consumers will endeavor to work together in order to reach a consensus on acceptable risk” (Bignon 1992, p. 445). This comment
represents one way to take account of the precautionary principle concept without actually mentioning it. In the late 1990s, such a lack of adequate communication among the different spheres came to be regarded as lethal in France.
Around 1998, new agencies in the French government were created to address the issues discussed above. In 2000, Kourilsy and Viney reported to the Prime Minister on the interpretation of the precautionary principle. In establishing a link to these agencies, they mentioned the Agence Française de la Sécurité Sanitaire des Aliments (AFSSA, The French Food Safety Agency), 19 an agency that was to be concerned with communication problems during crisis periods. Also added was the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS, the French Health Products Safety Agency).20 Of more direct relevance to asbestos in the workplace, the Agence Française de Sécurité Sanitaire de l’Environnement et du Travail (AFSSET, The French Agency for Environmental and Occupational Health Safety)21 was created to coordinate expertise in health and the environment.
These specialized agencies were expected to provide transparent and multi-faceted expertise in more areas than just the dominant one. What is new about this approach to risk assessment and management is that these agencies are independent, formal, and well-structured; this was not the case with the CPA.
In reality, the state was not well enough organized to tackle the scientific uncer- tainty about asbestos before the INSERM started to provide collective expertise in 1996, and before the sanitation agencies were created in 1998. More transparency was required for this assessment, and it was necessary to take into account the relationship between science and decision making within the framework of the precautionary principle. The efforts also needed to be cooperative – and of a scale that is only possible in specialized agencies.
During the period of the CPA the health effects of asbestos exposure were for the most part simply kept invisible (Pezerat 1995). There were no assessments of asbestos exposure at workplaces or in public and private buildings, and no systematic survey was conducted of asbestos-related diseases. There was no risk assessment by public health authorities or labor inspectors (Thébaud-Mony 2003)22 before 1996. If risk management was deficient, so was risk communication.
The French Government’s position between 1977 and 1996 can be summarized as
“don’t alarm the public, but take inventory of the public buildings concerned; do the best you can to control asbestos.” This was not a true policy of vigilance, but it was perhaps a policy to reassure and quiet the public.
We also have to raise the question of how the state delegated its authority to the CPA, which was presented as an innovative space to be used for stakeholder dialogue.
Some scientists were regularly invited to participate, to give their audience an
19 Created on April 1, 1999. See: http://www.afssa.fr/ (retrieved November 11, 2007).
20 Created in March 1999. See: http://afssaps.sante.fr/ang/indang.htm (retrieved November 11, 2007).
21 The former Agence de sécurité sanitaire de l’environnement (AFSEE) was transformed in 2005.
See: http://www.afsset.fr/index.php?pageid=779 (retrieved November 11, 2007).
22 For investigations completed during this period of time, see Cordier et al. (1987).
impression of state-of-the-art research on asbestos. The primary asbestos companies were also present. As in England and the United States, the asbestos company executives in France were the first to know about the serious health effects of asbestos exposure among their workers (Lilienfield 1991). Yet, the companies insisted that the prevention measures be applied first to the workers, through their controlled use of asbestos, and only later to the public. The industry reaction to these warnings allowed company executives to avoid for many decades, and throughout the world, the adoption of measures that would restrict the manufacture and use of asbestos (Thébaud-Mony 2003).
In July 2004, the AFSSET received a solicited request within the framework of the French National Health and Environment Plan (PNSE) to assess the risks of exposure to man-made mineral fibers to both asbestos workers and the general population. In its conclusions, the PNSE issued a series of recommendations for improving the traceability of asbestos products, increasing knowledge about their potential hazards, and reinforcing preventative measures; further, it argued for the continuation of research into other types of siliceous man-made mineral fibers, including mineral wools (glass wool, rock wool, and slag wool) and continuous glass filaments. On February 7, 2005, the same agency received a solicited request from its funding ministry, Direction Générale de la Santé, Ministère de la Santé (the French Ministry of Health, Environment, and Employment) to conduct an assessment of the risks associated with asbestos fibers shorter than 5 mm.
On January 9, 2006, the expert group reported that the data gathered up to that time demonstrated no asbestos risk to humans. However, the group did not believe the data were sufficient to rule out a “potential” risk, including in metrological terms; nor were they able to provide a satisfactory solution for managing the risk.
The group, therefore, recommended that the further investigations planned by AFSSET be carried out.
After the introduction of asbestos substitutes, it became even more difficult for epidemiologists and clinicians to determine the types of fiber that were responsible for the disease, especially in workers who had been exposed to more than one type during their lifetime (i.e., asbestos, natural fibers, or synthetic fibers).
Public Policy Making Under Conditions of Uncertainty
In 1990, Morgan and Henrion (1990) presented decision criteria under uncertainty:
(1) utility-based criteria, involving decisions based on the value of outcomes; these values in turn are based on a cost-benefit analysis that is either (1.1) deterministic (the conventional choice; Mishan 1973) or (1.2) probabilistic, which applies when there is uncertainty. A (1.3) cost-effectiveness criterion may be used, sometimes on non-economic grounds, to help determine the alternative that can achieve the objective at the lowest cost. A (1.4) bounded cost criterion is used to maximize the amount of risk reduction within budgetary constraints. To determine if this criterion is met, one uses the maximize multi-attribute utility, which is based on