Medical cases involving asbestos have been documented in the United States by both scientists and industry sources since the early part of the twentieth century.
Not until 1970, however, were regulations passed in the US to create protections for American consumers and workers. The delayed industry and policy actions are the focus of millions of asbestos lawsuits in the US today. Scores of articles and books have been published accusing the US asbestos industry of suppressing this medical information over decades to avoid the expense and liability associated with protect- ing workers and subsequent medical expenses (Schepers 1992, 1995; Bowker 2003;
Brodeur 1985).
Europe predated the US in evidencing asbestos harm to shape public health policy. Observations of asbestos-related illnesses were recorded in Vienna in 1897 by a physician who reported that “emaciation and pulmonary problems in asbestos weavers and their families left no doubt that dust inhalation was the cause”
(Castleman 1996, p. 2). In 1898, factory inspectors in Great Britain reported dam- age to asbestos workers’ bronchial tubes and lungs. In formal reports each year, the inspectors continued to describe asbestos’ effects on workers’ health and urged studies be initiated to track the health condition of former workers (Castleman 1996, p. 3). Several deaths attributed to asbestos inhalation were reported in Italy, France, and Great Britain in the early 1900s, and a German pathologist in 1914 is believed to be the first scientist to report scarring in lung tissue of a deceased asbes- tos worker (Castleman 1996).
Asbestos-related illnesses and deaths also were noted in the US at about the same time, but these reports did not lead to policy action. Epidemiological evi- dence from 1900–1910 revealed an inordinate number of asbestos workers con- tracted lung disease compared with other worker populations (Bowker 2003). In the US insurance companies were among the first to note the connection.
According to Bowker (2003) and the Environmental Working Group,1 in 1918 some insurance companies began charging higher rates for asbestos workers or denying them coverage completely. The US Bureau of Labor Statistics published a report conducted by an insurance company that noted a statistically unexpected number of early deaths for asbestos workers (Bowker 2003; Hoffman 1918). In spite of growing evidence regarding the deleterious health effects of asbestos exposure, both in Great Britain and the United States, many owners of asbestos mines, mills and processing plants had no procedures in place to protect workers and consumers from exposure.
1 See: Environmental Working Group website: http://www.ewg.org/
Great Britain was prompted to enact worker protection laws after independent scientific studies were published. In 1924, the first published medical report of a death due to asbestos exposure appeared in BMJ (British Medical Journal). The author, Cooke (1924), described the case study of a female employee who had worked in the spinning room of an asbestos factory. Many asbestos-focused medical papers followed, including one by British occupational health specialist, Thomas Oliver (1925), who first coined the term “asbestosis” shortly following Cooke’s BMJ report. In 1927, Cooke (1927) published an additional paper based on his original case study, and he also used the term asbestosis; thus the term became part of the permanent medical nomenclature. Several other reports followed and were published in esteemed British scientific journals. In 1931, responding to mounting medical evidence, Great Britain adopted safety regulations for asbestos workers (Asbestos Resource Center 2008; Bowker 2003).
The US lagged behind Great Britain in the science and medicine of asbestos.
Italy, France and Canada also were reporting asbestos-related illnesses and were well ahead of the US Asbestos exposure was, however, scientifically linked to lung disease as early as 1917, at the University of Pennsylvania School of Medicine. Dr.
Henry Pancoast found lung scarring present in fifteen asbestos workers. Ten years later the first asbestos-related disability claim for workmen’s compensation was supported. One of the most comprehensive early reports was authored by an employee of the Prudential Insurance Company and published by the US Department of Labor and Statistics in 1918 (Castleman 1996). The report of the
“dusty trades” showed that asbestos workers experienced a significantly higher premature death rate than other workers. The comprehensive monograph illustrated the insurance company’s ability to monitor worker hazards and subsequent health effects. Except for insurance companies’ proprietary research, no US-based medi- cal studies were published until 1930, when Millls (1930) described a single case of asbestosis diagnosed in a man who formerly worked in an asbestos mine in South America. The report was published in the journal Minnesota Medicine and later referenced in JAMA (Journal of the American Medical Association) (Brodeur 1985, p. 14; Castleman 1996, p. 17).
Through the 1920s and 1930s, the British factory inspectors continued to issue asbestos reports and publish studies on both sides of the Atlantic, providing critical information about the disease anatomy and progression. Two inspectors in particu- lar, Merewether and Price, argued for policy to protect asbestos workers and raised the issue of future medical needs. They acknowledged the principal problem that delayed policy decisions – asbestosis could be mistaken for other chronic diseases, such as bronchitis, pulmonary tuberculosis, and broncho-pneumonia (Castleman 1996, p. 12). Several US journals published international asbestos studies, such as the Journal of Industrial Hygiene and JAMA. The JAMA publication on asbestosis likely had the greatest impact on American physicians, as it was mailed directly to about 80% of all licensed physicians (Castleman 1996, p. 17). Asbestosis studies in prominent UK journals such as The Lancet and BMJ also were widely read by American physicians. In 1930, asbestosis was the focus of a paper presentation at the annual meeting of the Radiological Society of North America. According to
Castleman (1996, p. 19), the presenter, British scientist Dr. J. V. Sparks, expressed surprise at the dearth of US-based studies on asbestosis. Because Canada was the major supplier of asbestos for the Great Britain, Sparks imagined this was likely true for the US, as well. He expected US asbestosis confirmation to parallel Great Britain’s medical discoveries.
Following the alarming number of international reports of serious asbestosis cases, the 1930s represents a surge in US-based research and publication related to asbestos exposure. Independent scientific articles also were published in US medi- cal journals soon after the Minnesota Medicine study was published. The studies were both internal and external to the industry (for a review, see Castleman 1996;
Brodeur 1985). For example, a major insurance company, Aetna, published a definitive report in 1934 stating there was no known cure for asbestosis and it usu- ally resulted in death (Bowker 2003, p. 18).
Castleman (1996) describes a large-scale study sponsored by the asbestos indus- try that resulted in less serious conclusions than Aetna’s. The Metropolitan Insurance Company was approached by asbestos industry officials and asked to conduct studies of workers’ health. Although the study uncovered alarming details, such as 53% of workers had asbestosis, the results only reflected active workers and not those who had left work due to illness. The disease rate likely was even higher.
In spite of the overwhelming evidence, the study’s authors minimized the data and did not recommend regulation of the industry. They argued that no serious disabili- ties were noted among workers. Further, the study made no mention of British factory inspectors’ reports and the British workplace regulations that resulted, nor were published medical studies used to support their conclusions (Castleman 1996). The report was completed in 1931, but was not published until 1935. The investigators did recommend that asbestos-related industries more regularly moni- tor workers’ health, address asbestos dust in the workplace, and pre-screen job candidates to eliminate those whose current health conditions put them at greater risk for asbestos-related illnesses, and continue the study of workers’ health (Castleman 1996, p. 34).
American insurance companies and scientists continued to conduct studies of health records and workers in the thirties and forties. This was aided by the science of radiology, which allowed more definitive diagnoses of lung diseases (Castleman 1996). Scientists could determine the point at which symptoms would begin to occur after exposure and when lung-scarring appeared. Findings continued to indi- cate elevated levels of asbestos-related illnesses and deaths, but still no government regulations were in place.
The only concrete outcome of the insurance companies’ research findings was the continued practice of charging higher insurance premiums for asbestos workers than for other employee groups (Bowker 2003). Although no formal policies were in place at the time, some mines had voluntarily created worker rules to reduce direct exposure to asbestos. The guidelines were not enforced, however; few workers were inclined to follow rules when their inconvenience seemed to outweigh the risks.
Asbestos miners received the most attention in medical studies, both scientific and proprietary, but later research examined workers exposed to the mineral
through the product manufacturing environment. For example, a study of a Massachusetts cigarette filter manufacturing plant found that workers who were employed in the factory in 1953 had unusually high rates of asbestos-related dis- ease and mortality compared with cohort groups (Talcott et al. 1989; Dodson et al.
2002). The researchers concluded that the unusually high morbidity and mortality rates in the cigarette factories were caused by “intense exposure to crocidolite asbestos fibers” (Talcott et al. 1989, p. 1220). Additionally, a case study of two deceased cigarette filter factory workers, one who worked a short time in the ciga- rette filter factory during the 1950s and one who worked for several decades begin- ning in the fifties, suggested that even short exposure led to high levels of crocidolite asbestos accumulation (Dodson et al. 2002). Both died from asbestos-related dis- eases, confirmed by lung tissue analysis. Similar postmortem studies conducted on asbestos workers in mines and other types of manufacturing environments found the more common form of chrysotile asbestos.
Trade journals, such as one published for the International Association of Heat and Frost Insulators and Asbestos Workers, also issued reports on asbestosis in miners, but without describing the implications to those in related industries (Castleman 1996, p. 19). It is unlikely that workers exposed to asbestos outside the dusty mines considered themselves to be at risk, without the line being drawn for them.
Asbestos Industry Initial Response to Mounting Medical Evidence
Contrary to the incontrovertible evidence linking asbestos exposure to serious illness and premature death, the US asbestos industry expanded during the depression and beyond. It did so in part by developing an international cartel and strategically eliminating competition that had developed alternative products, by using the weapons of buy-outs and price-fixing. While the Federal Trade Commission ruled that some degree of corporate malfeasance was evident, no penalties were issued to any companies involved. The industry also successfully prevented trade unions from gaining increased compensations for those who worked around asbestos.
Concern regarding shared liability may have prevented the unions from pushing harder for special compensations for asbestos workers (for a comprehensive review of the asbestos industry’s successful attempt to delay regulations, see Castleman 1996; McCulloch & Tweedale 2008).
As this review of medical discovery shows, hundreds of industry reports and scientific studies proved the serious health problems that resulted from direct or indirect exposure to asbestos. The first reports recognizing asbestos’ effects on workers emerged in the late 1800s in Europe, then these medical studies acceler- ated in the 1920s and became prevalent in the US in the 1930s and beyond. Yet these reports seemed to gain little traction with government. For example, the Department of Natural Resources (DNR) states on its official website for Wisconsin that the medical problems associated with asbestos exposure did not occur until the late 1960s:
In the United States, asbestos became popular in the early 1900s and its use peaked during WWII into the 1970s. While use of asbestos is not banned by legislation, it is not commonly used by American manufacturers anymore due to health concerns and liability issues. However, there is a strong international market, so imported materials may contain asbestos.
During the late 1960s, evidence emerged indicating that asbestos fibers were a dangerous health risk and by the 1970’s, the federal government began to take action. During the 1980’s, the concern regarding asbestos resulted in the new industry of asbestos abatement (Wisconsin Department of Natural Resources 2006, 2007).
Esteemed US medical journals such as JAMA and the New England Journal of Medicine published studies detailing disease rates among asbestos workers begin- ning in the 1930s (Lerman 1992). A recent search for articles on MEDLINE and other health databases revealed thousands of published reports using only the two key term “asbestos” and “mesothelioma,” which limited the search significantly.
It is likely that thousands of other asbestos-related health articles were published in the past 70 years. Clearly there is a time lag between medical evidence of asbestos- related health risk and government acknowledgement of it. The above statement from the DNR suggests that the regulations passed in the 1970s represented a timely reaction to new findings.