TESTIMONY BEFORE United States Senate Committee on the Judiciary by Philip J. Landrigan, MD, MSc, DIH Professor of Occupational and Environmental Medicine Chairman, Department of Community and Preventive Medicine Professor of Pediatrics The Mount Sinai School of Medicine "A Fair and Efficient System to Resolve Claims of Victims for Bodily Injury Caused by Asbestos, and Other Purposes" April 26, 2005 Mr. Chairman and Members of the Committee on the Judiciary, I am pleased to appear before you today to review the impacts that asbestos has had on the health of American workers, and to discuss the legislative remedies that have been proposed for dealing with the asbestos epidemic. My name is Philip J. Landrigan, MD, MSc, DIH. I am a physician, a board-certified specialist in occupational medicine, and Chairman of the Department of Community and Preventive Medicine in the Mount Sinai School of Medicine in New York. I am Editor-In-Chief of the American Journal of Industrial Medicine. I am President of the Collegium Ramazzini, an international scientific society in occupational and environmental medicine. I have had many years of experience of dealing with the clinical manifestations and studying the epidemiology of the diseases caused by asbestos. A copy of my biographical sketch is appended to this testimony. The late Irving J. Selikoff, MD, the "Father of Asbestos Research in the United States", was one of the founders of the Department that I now chair at Mount Sinai. This Department contains New York's largest clinical facility in occupational medicine and one of the nation's largest research and training programs in occupational health, a program that Dr. Selikoff established 30 years ago. We have been designated by the National Institute for Occupational Safety & Health (NIOSH) as the major provider of diagnostic services to the men and women who worked at Ground Zero, the site of the World Trade Center in the terrible days and weeks that followed the attacks of September 11, 2001. We have now examined over 12,000 of those workers - police officers, firefighters, construction workers, paramedics, and building cleaners. Many of them were exposed in their work to asbestos. The testimony that I shall be presenting today reflects the collective knowledge and experience of our occupational medicine group at Mount Sinai, and most especially the thoughts of my colleague, Stephen Levin, MD, Director of the Selikoff Center for Occupational and Environmental Medicine.
The Asbestos EpidemicAsbestos has been and continues to be an occupational and environmental hazard of catastrophic proportion. Asbestos has been responsible for over 200, 000 deaths in the United States, and it will cause millions more deaths worldwide. The profound tragedy of the asbestos epidemic is that all illnesses and deaths related to asbestos are entirely preventable. Clinical and epidemiologic studies, many of them initiated by Dr. Selikoff at Mount Sinai, have established incontrovertibly that asbestos is a human carcinogen. All forms of asbestos are carcinogenic. Asbestos has been shown to cause cancer of the lung, malignant mesothelioma of the pleura and peritoneum, cancer of the larynx and certain gastrointestinal cancers. Asbestos also causes asbestosis, a progressive fibrotic disease of the lungs. Asbestos has been declared a proven human carcinogen by the Environmental Protection Agency (EPA) and by the International Agency for Research on Cancer of the World Health Organization. Asbestos and cigarette smoke are powerfully synergistic in the causation of lung cancer. Nonsmoking asbestos workers have five times the background risk of lung cancer. Smokers who have had no exposure to asbestos have 10 times the background risk of developing lung cancer. But asbestos workers who also smoke have 55 times the background risk of lung cancer. This is the classic and best-studied example in the medical literature of a synergistic interaction between two proven human carcinogens. New use of asbestos has almost completely ended in the United States and in most other developed nations as a result of government bans and market pressures. Those forces were stimulated by the epidemiologic studies that I have noted above and by the release of information on the carcinogenicity of asbestos that previously had been suppressed by the asbestos industry. By contrast, extensive and aggressive marketing of asbestos continues in the developing world, where sales remain strong and worker protections are too often weak.
Problems with the Proposed Fairness in Asbestos Injury Resolution ActThe proposed Fairness in Asbestos Injury Resolution Act contains serious scientific problems as currently written. It creates criteria for assessing the causation of disease by asbestos that are not based on scientific evidence and that are not consistent with current knowledge in occupational medicine.
Difficulties with the proposed exposure criteriaThe bill contains medically unsupported requirements for minimum duration of exposure to asbestos. Contrary to the requirements for minimum duration of exposure set forth in the bill, there is clear evidence from carefully conducted epidemiological studies that exposures to asbestos for even one month under heavy exposure conditions can increase the risk of lung cancer two-fold and also increase the risk of death from asbestosis. The requirement for 5 or more weighted years of exposure to asbestos to establish a diagnosis of asbestosis is not supported by scientific evidence. Also unsupported by the published medical literature are the minimum requirements set forth in the bill of 8, 10 or 12 years of exposure for establishment of asbestos causation in a case of lung cancer. The bill contains a medically unsupported proposal for discounting exposures to asbestos. The bill establishes three exposure classifications:
- Moderate exposure for persons who worked in areas that experienced "regular airborne emissions of asbestos fibers",
- Heavy, for persons who worked in direct installation, repair or removal of asbestos, and
- Very heavy for those who worked in primary asbestos manufacturing or a WWII shipyard