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WebMD Live Chat Transcript: The Hazards of Asbestos with David Egilman, M.D.
Transcribed by WebMD Staff
David Egilman, M.D., M.P.H., a world expert on health and safety issues in the workplace, is the medical director of the South Shore Health Center near Boston. Board certified in both internal medicine and occupational medicine, he has spent the last 20 years holding companies accountable for exposing their employees and the public to dire health risks. A widely-published author and well-known speaker, Egilman has testified before Congress and in courtrooms, and has been investigating the dangers of asbestos for over two decades. Egilman received his medical degree from Brown University, where he is currently clinical associate professor in the department of community health. He is a member of or on the board of directors for numerous associations, including the Center for Atomic Radiation Studies, Inc., the International Commission on Occupational Health, and the American Public Health Association Committee on Health.
events_moderator Welcome to WebMD Live. Today we will be discussing "The Hazards of Asbestos" with David Egilman, M.D.
events_moderator Welcome to the show, Dr. Egilman. We all know asbestos is hazardous, but what diseases are associated with asbestos exposure?
Dr_Egilman A scarring of the lungs that prevents you from being able to take a deep breath and which generally progresses, gets worse and worse, so as you get older you get more and more short of breath. Eventually, your lungs get so small that if you get a lung infection or a cold you may die because your lung loses its reserves and you cannot tolerate even a minor chest condition. Then asbestos also causes cancer. It can cause cancer in the lung, the lining of the lung, or anywhere in from the nose, really, to the rectum in the GI tract, because some of the asbestos that gets into the lung is swallowed and gets into the esophagus, stomach and colon. All of these diseases usually don't happen until the asbestos has been in the lungs for 20 years or longer. Although, in some people, who are either unlucky or have very high exposures, the scarring of the lung called asbestosis can occur within several years of breathing in the dust.
events_moderator Where are people at risk of asbestos exposure?
Dr_Egilman In the United States it is usually workers who are called into alter the structure of buildings. Either when they destroy buildings or when new rooms or additions are made in buildings, or to the pipes in buildings. The roofs, ceiling tiles, floor tiles or pipes may be covered with asbestos products. The process of removing these products releases dust. Also, some brakes still have asbestos in them, and people who remove brakes may be exposed to dust either during removal or when they shave brakes to fit the car. This doesn't go on much anymore, but still may occur sometimes. In other countries, like South America, Central America, Africa and Asia, asbestos is still used much the way it was used in Europe and the United States in the 20s, 30s and 40s. The United States, Canadians and British companies still mine asbestos in other countries and use asbestos in those countries in products. These are probably the worst current exposures and may cause asbestos related disease in 3-5 years in some people who are heavily exposed.
events_moderator What products are these companies producing?
Dr_Egilman They are producing all the products that used to be produced in the U.S. and Europe. For instance, asbestos sprays for insulation, pipe covering with asbestos, asbestos cloth, asbestos insulation for boilers, asbestos cement for construction and particularly asbestos cement water pipes ( which are the main water pipes used in developing countries). These uses for asbestos have been prohibited in Europe and the U.S. However, Canadian companies, encouraged by the Canadian government are trying to overturn the ban on asbestos in Europe and continue to export asbestos to developing countries.
events_moderator How much asbestos exposure is necessary to contract a disease?
Dr_Egilman Well, for the scarring of the lung, a fair amount. No one knows exactly how much, but more than would generally be encountered in Europe and the U.S. by most people who do not regularly remove asbestos or work in construction around asbestos. Cancers can be caused by very low exposures. Theoretically, even a single fiber can cause cancer of the lung--or of the lining of the lung--but very few people exposed to low doses will develop cancer. There is more or less a linear relationship between the amount of asbestos that gets in to the body and the number of cases of cancer that occur in groups of people. The less asbestos that gets inhaled into the body, the fewer of the number of cancers occur per population, and vice-versa.
events_moderator What factors affect the duration of time between asbestos exposure and when the disease shows up?
Dr_Egilman The most important is the amount of asbestos that is inhaled. The more you inhale, the faster the disease occurs. The second most important factor is whether you smoke in respect to lung cancer. Smoking cigarettes and getting asbestos in your lungs is like throwing a lit match onto a gasoline-soaked rag. A lit match or a soaked rag can start a fire by itself. Together, there are 100 times more cancer compared to people who don't smoke or don't have asbestos in their lungs versus people who smoke and have asbestos in their lungs. Smoking does not affect the cancer of the lining of the lung (this cancer is called Mesothelioma).
events_moderator How are asbestos-related diseases diagnosed?
Dr_Egilman Usually too late. That means they are diagnosed in most people after the disease has already started. That is the lung cancer, and the cancer of the lung lining. Sometimes workers in particular get regular X-rays as part of a U.S. government requirement to X-ray workers who are exposed. The scarring disease of the lung and the cancers are occasionally diagnosed on these X-rays done to comply with the law. Unfortunately, even then, it is usually too late to save the person's life, because both lung cancer and the cancer of the lining of the lung are almost always fatal, even if caught early.
events_moderator What would lead to a misdiagnosis of asbestos-related diseases?
Dr_Egilman Mesothelioma and lung cancer are frequently hard to tell from each other. In fact, there is a panel of experts that reviews Mesothelioma cases. Even the experts disagree whether it is Mesothelioma or lung cancer. There are other chemicals, other dusts and other diseases (like sarcoidosis) that can also cause scarring of the lung. Sometimes these diseases can be confused with asbestosis.
events_moderator Can you describe the pain associated with Mesothelioma?
Dr_Egilman Usually, it is not painful until it gets fairly large. (That is, several inches, at least in size along the plane of the space between the lung and the chest wall). Once it gets to be very big, it expands locally between the lung and chest wall and can be very, very painful.
events_moderator Are there different types of Mesothelioma?
Dr_Egilman Yes, but they all have the same outcome. That is, they all usually cause death within two years after diagnosis. The differences are based on the types of cells observed when looked at under a microscope. It doesn't really matter from the perspective of the patient. There is no treatment for either type that are standardized. The research treatments are the same no matter what the type of Mesothelioma. For all purposes, it doesn't matter what kind it is. Even the experimental treatments are the same.
events_moderator Can you explain how Mesothelioma is treated?
Dr_Egilman There are a variety of "standard" treatments. They involve primarily chemotherapy, and local surgery. There are some experimental treatments which can involve stripping of the entire lung, and some other treatments that involve immune treatments or light treatments and others. None of the experimental treatments have been fully explored in terms of whether or not they are any more helpful than the standard chemical treatments. There is nothing more to be said about them until the research results are completed on them. For people who currently have Mesothelioma, there is not a great answer on where to refer someone on future promising treatments or current treatments. There are experimental protocols at hospitals in Boston and elsewhere. I hate to mention any specifically by name, because I don't have any data from any of these protocols. None is available yet that would favor one over another.
events_moderator Has anyone ever lived after a Mesothelioma diagnosis?
Dr_Egilman Maybe. Some people who live after being diagnosed with Mesothelioma may not have had Mesothelioma. Many physicians feel that if someone lives for more than 5 or 10 years after being diagnosed with Mesothelioma then there was an error in diagnosis. This is an example of how strongly people feel about the fact that Mesothelioma has a terrible outcome, almost universally. There are some cases where Mesothelioma has probably been cured or gone away on its own. There are case reports of this happening, but it is very uncommon if it has occurred at all. It is one of the few diseases that AIDS is better than.
events_moderator How can someone improve their chances of survival?
Dr_Egilman There are no treatment modalities besides the standard chemotherapy (which may or may not prolong survival) that have been shown to work in studies. Good nutrition, good mental health and beliefs in some value system may improve outcome (by "beliefs in some value system," I mean to include prayer, meditation, etc.). It is not clear whether these work either, but the treatment side effects of prayer, meditations, etc. are certainly less than the experimental therapies currently being tried.
events_moderator Where should someone go for Mesothelioma treatment?
Dr_Egilman That is really a personal question, since for some people, the advice has to be personalized. Some people may prefer no treatment.
events_moderator When did companies discover that they were exposing people to dangerous levels of asbestos?
Dr_Egilman About a 102 years ago. In 1898. Workers were reported to get sick from asbestos exposure. In an official report of Parliament in 1898 made by "Lady Inspectors," this discovery came about. The first death from asbestos disease was reported to Parliament in England in 1906. U.S. insurance and mining companies became aware of asbestos health hazards by 1918. Mr. Hoffman, an actuary with Prudential Insurance, wrote a paper for the Department of Treasury/U.S. Government called "Health Problems In the Dusty Trade" in 1918. In that paper he said, "In the experience of Canadian and American insurance companies, insurance is usually denied to asbestos-exposed workers, due to the health injurious nature of the work." Asbestos companies in the U.S., along with some insurance companies, especially the Metropolitan Life Insurance Company (which served as "the pivot man") were coordinators for the companies. They began to conspire to hide the health effects of asbestos from workers, customers and government agencies beginning in 1930.
This conspiracy continues to date, both in the U.S., but especially internationally, where Canadian companies, in particular, are trying to force asbestos products into third-world countries and Europe. They are using the World Trade Organization to launch a legal fight against the prohibition for the use of asbestos in Europe and other countries. So, while the history is old, it is a continuing tale of cover-up, misinformation and wanton intentional disregard for the health of others.
events_moderator What exactly is asbestos used for?
Dr_Egilman It was used as an insulator and as a fire-retardant, but it was not necessary. It was primarily a binder to bind the insulation and fire proofing together. It, by itself, is a poor insulator, although it was used in many insulation products. W.R. Grace, whose insulation products were sprayed in many buildings and schools. Even after it was banned by the EPA, W.R. Grace substituted paper for the asbestos in their product. Paper is obviously not very fire resistant, but it was allowed to be used in place of asbestos, and the fire properties of the insulation were equivalent. Asbestos was also used in ceiling tiles and floor tiles. Many floor tiles were made up of 70 to 80 percent asbestos. It was used in joint compounds to put wall board together, and in tape for wall board. It was also used around pipes and boilers, both as pipe insulation and as lock insulation. It was also used as a cement.
events_moderator When did companies stop using dangerous levels of asbestos in America?
Dr_Egilman Only certain uses of asbestos were ever banned. Most uses of asbestos are still legal in the U.S. Most companies stopped making most asbestos products in 1972 when OSHA set exposure limits, or limited the amount of exposure that workers could have, while they were working with products. Other companies continued to sell asbestos products, like joint compounds, well into the 80s. Other companies, primarily brake companies and cloth manufacturers, used asbestos in their products into the 80s. Some asbestos products are still used in the U.S. today as I mentioned before. In fact, it is still appropriate to use asbestos for some limited uses. An example would be the "O" rings on the space shuttle, which used to be asbestos. As a result of the substitutions of silicon for asbestos, the space shuttle, Challenger exploded. It is important to note that asbestos can be used safely in some uses, if workers are told how to use it and take precautions. Some uses are unsafe in any circumstances, like the spray insulations made by Grace, and others.
events_moderator How has the medical literature been corrupted in asbestos exposure?
Dr_Egilman Well, I do see some lawyers are on the Web. I am impressed that any lawyers have any technical capabilities whatsoever! :-) In fact, asbestos companies failed to publish studies stating that asbestos caused cancer in people and animals and failed to publish studies showing that small amounts of asbestos could be dangerous. Some companies knowingly changed the results of papers and published papers that said that studies indicated that workers were not getting cancer, when they were in fact getting cancer .
events_moderator How many buildings still have dangerous levels of asbestos?
Dr_Egilman I don't think there is any study on that. Dangerous is difficult to define. Although asbestos may be in a building, it is only dangerous if it is released into the air. Much of the danger occurs when the asbestos products in buildings, like the ones I mentioned before, are disrupted through construction or degrade in time. Of course, what goes up must come down. So, all buildings that have asbestos in them will eventually be torn down. The process of destroying or reconstructing the buildings are the most dangerous. I don't think anyone knows how many buildings have asbestos in them. It was a popular product because it was cheap and heavily promoted.
events_moderator How are buildings tested for asbestos?
Dr_Egilman There may or may not be testing done. For private buildings, it would be up to the owner. The EPA has set recommendations for schools (public schools) and these were supposed to be tested and evaluated years ago.
events_moderator How can victims of asbestos-related diseases and their families get financial compensation?
Dr_Egilman They may or may not be able to, depending on a variety of legal or other issues. It also depends on the country they live in. There are worker compensation statutes in most states and most countries in the Western world that would provide some money to families of asbestos victims. And, there are many such victims who find lawyers who can sue in court. The asbestos companies that made the products recover money to pay medical expenses and help families exist after the loss of their loved ones. Of course, there is no money that can compensate adequately or even closely, for the taking of someone's health or life. So, in my view, there is never going to be adequate compensation for the kinds of things that were done intentionally to expose people to hazardous products in order to make money. For example, no corporate official has ever been prosecuted for any act that resulted in intentionally exposing people to asbestos and injuring or killing them. Most of the companies that produced asbestos products produced documents that indicated that they knew that some people that were going to use their products would get sick or die as a result of that use, and they intentionally chose to not warn them. They also chose not to produce substitute products that they could have been produced without asbestos that would not have inflicted any injury to users.
events_moderator Are there any support groups for sufferers of asbestos exposure and their families?
Dr_Egilman Yes, there are local support groups. There is a national support group called The White Lung Association. I think it is in Baltimore, Maryland.
events_moderator How often do people who work for asbestos removal companies get diseases?
Dr_Egilman Hopefully, none. Those companies are supposed to follow EPA regulation and if followed, there should be no exposures to even a single fiber. However, there are some companies that do removal on a "fly by night" basis using unemployed people and other people who are not well trained as human guinea pigs to remove asbesto0s without protection. There have been many stories across the country in local newspapers about such operations.
Since it is expensive to remove asbestos properly, these companies can make a lot of money trading the health of their employees for removal fees.
Since OSHA has only about 700 inspectors for the whole country it is hard to catch them.
events_moderator What type of research is being done for asbestos-related diseases?
There are research protocols being done to try to develop treatments for Mesothelioma and of course, there are lot of protocol for treatment of lung cancer. The treatment of lung cancer would be the same whether it was asbestos, smoking or other caused.
There are some protocols for treatment of the scarring of the lung, called asbestosis, in addition, there are some studies that are looking at preventing these diseases in workers who are already exposed but don't yet have the disease. These look at Vitamin A and Retin-A and other vitamins in vegetables, particularly broccoli which seems to have some anti cancer agents in it. So much for George Bush. He should eat his broccoli and so should you.
events_moderator How can people find out more about the history of the conspiracy of the asbestos industry and the medical and legal issues involved?
Dr_Egilman There are some books, There is a book by Barry Castleman called "Asbestos: Medical and Legal Aspects" (Take it out of the library - it costs about 140 bucks). A book by Paul Brodeaur called "Outrageous Misconduct" and another book by him called "Expendable Americans"
events_moderator What do you recommend for cancer pain?
Dr_Egilman Pain really needs to be dealt with on an individual basis. First, I recommend meditation and non-drug therapies, which can be quite effective and have no side effects. When using drugs, usually a combination of drugs is helpful. Some drugs that deal with that include the morphine family and others including anti-depressants or a combination thereof. Marijuana may be helpful in addressing some of the nausea experienced by cancer patients.
The main problem in treating pain is that doctors don't give enough pain medicine. One needs to have a doctor who is willing to give enough medicine. This is because of the anti-drug addiction phobia in the country.
In fact, another problem is, patients think that they may become "addicted" to pain medicine.
This is not likely to occur and not very important anyway, for people who are going to die within several years.
events_moderator Thank you for joining us today, Dr. Egilman.
Dr_Egilman My pleasure.
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