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| ISSN 1470-8108 | Issue 68 | Autumn 2007 |
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Contents:
1. Annual UK Asbestos Meeting Statistics from Cancer Research UK document an explosion in the incidence of mesothelioma, an asbestos-induced cancer, over the last decade.1 Rates have risen by 38% in women and 31% in men; mesothelioma is the most rapidly increasing of all cancers in women and the 3rd highest in men. For three years, sufferers have remained in limbo as the only licensed chemotherapy for treatment of this fatal disease has been under review by the National Institute for Clinical Excellence (NICE).2 The lack of official guidance has had many knock-on effects, not least of which has been the denial by Primary Care Trusts (PCTs) of funding for treatment with Alimta (Pemetrexed Disodium). As rumor and speculation mounted about the NICE stalemate, the annual Parliamentary Asbestos Seminar took place in Westminster; held under the auspices of the Asbestos Sub-Committee, the three hour event on May 16, 2007 provided the opportunity for experts to update politicians on current asbestos developments in Europe, North America and Australia. The meeting, chaired by MP Michael Clapham, was attended by parliamentarians, asbestos disease sufferers, members of asbestos victim support groups, trade unionists, health and safety campaigners, environmentalists, academics and concerned citizens. The first presentation, Action Mesothelioma Day (AMD) 2007, was made by Tony Whitston, Chair of the Asbestos Victims Support Groups' Forum. With the threatened withdrawal of all NHS access to treatment with Alimta, mesothelioma sufferers, their families and supporters turned out in large numbers on AMD (February 27, 2007) to better treatment and care for mesothelioma sufferers. The most important message those affected by mesothelioma wanted to hammer home on the day of action was the urgent need to end hazardous exposures. To this end the Forum produced a DVD entitled: Mesothelioma - The Human Face of an Epidemic which was shown on city center big screen TVs and the internet on AMD.3 Congratulating the filmmakers on their achievement, Mr. Whitston concluded his presentation with a screening of their work. In the next presentation, Mesothelioma – Treatment Challenges in the UK, Dr. Helen Clayson, Clinical Director of St. Mary's Hospice, compared the progression of mesothelioma and lung cancer; she found that with mesothelioma there was: less public and professional awareness, more pain, greater uncertainty and delay in being diagnosed, an extreme psychosocial impact and certain death. Pleural effusions were more common in cases of mesothelioma, breathlessness was more acute and surgery and chemotherapy less effective than for lung cancer. As mesothelioma is a prescribed industrial disease, a coroner's investigation is required; this is a disturbing experience for grieving families. The changing geographical distribution of mesothelioma means that many cases are now occurring outside traditional asbestos hotspots and away from local centers of excellence; this compounds problems patients encounter with medical care and treatment. The possibility of the only licensed treatment for mesothelioma (Alimta) being withdrawn will almost certainly have a negative impact on research into other treatment possibilities and will add to the sense of neglect and abandonment felt by patients and their families. Although the Mesothelioma Framework 2007 stipulates that all mesothelioma patients should have early access to specialist palliative care, lack of funding has resulted in many unfilled consultant posts in the UK. Mesothelioma fatalities in Australia have reached unprecedented levels, according to the presentation Update in Medical Research in Australia by Dr. Greg Deleuil, Medical Adviser to the Asbestos Diseases Society of Australia. From 1996 to 2006, the annual number of deaths more than doubled; over the last 25 years, the death toll has risen from 110 to 931/year, a 900+% increase. Dr. Deleuil detailed the implementation of the Australian Government's coordinated research and treatment strategy; at its heart is the National Centre for Research on Asbestos-Related Diseases (NCARD). The headquarters of this Perth-based body opened in Autumn 2006. Under the directorship of Dr. Bruce Robinson, A$6.2 million in government funding is being disbursed for research on prevention, diagnosis, epidemiology and treatment of mesothelioma. The Australian Government's proactive approach is in marked contrast to that found elsewhere. Mrs. Linda Reinstein was well qualified to address the subject of the next presentation Asbestos Illness in the United States; her husband Alan died of mesothelioma in 2006 after a three year battle with this brutal illness. With their colleague Doug Larkin, the Reinsteins founded the Asbestos Diseases Awareness Organization (ADAO), a campaigning group which has, in just three years, become a leading voice for America's asbestos victims. Despite all that is known in the U.S. about the damage done by asbestos, exposure to this acknowledged carcinogen remains common. Ignorance and impotence combined with corporate devotion to the bottom line means that people, including children, are still receiving potentially lethal exposures from the environment4 and from contaminated substances contained in private homes, public buildings and consumer items. Workers are routinely being exposed to asbestos; a classic example of this is the situation of the tunnel workers whose duties under the federal complex on Capitol Hill expose them to high levels of airborne asbestos. Anecdotal evidence amassed in the U.S. by the ADAO has revealed a startling contrast between mesothelioma sufferers' profiles in 1990 and 2007:
While mesothelioma is considered the signature asbestos-related disease, thousands of Americans are suffering from other illnesses caused by their exposure to asbestos including asbestosis, lung and other cancers and respiratory diseases. The significant under-reporting of these diseases and miscoding on death certificates combine to produce statistics which do not report the true incidence of asbestos-caused illness in the U.S., a country where the cost of dying from an asbestos-related disease can reach $1 million. The trauma of these diseases for the individual and his/her family is multifaceted and long-lasting. Mrs. Reinstein concluded her presentation by confirming the ADAO's total commitment to eradicating hazardous exposures, banning the global use of asbestos and supporting those who have been affected by the deadly dust. Doug Larkin, a Washington-based political consultant, reacted to the mesothelioma death of his father-in-law by exercising his well-honed public relations skills to help build the ADAO into a nationally recognized body. As the communication director, Doug, with his wife Kim, worked alongside the Reinsteins in mobilizing efforts to raise awareness of the U.S. asbestos legacy. Formulating a clear-cut vision and mission statement, developing a grass-roots organization and liaising with local, state and national media outlets were pivotal steps in the ADAO's legislative campaign. Networking with individuals, whether victims, grieving family members, or Members of Congress, and cooperating with organizations working towards the same goals in the U.S. and abroad, reinforced the ADAO's core message. Educational efforts initially focused on Congressional representatives of states, such as California, Washington and New Jersey, which were worst impacted by asbestos-related disease. It was crucial, Larkin pointed out, for the ADAO to dissociate itself from industry-sponsored or law firm funded groups such as the Asbestos Study Group (ASG). From its name you would never guess that the ASG was “an industry coalition formed to fight for limits on asbestos-related lawsuits. Members included Haliburton, Honeywell, Pfizer, Viacom and General Motors.” In 2003, ASG's war chest exceeded $6 million. It is no wonder that politicians were sceptical when the ADAO came on the scene purporting to be an independent body representing victims. Through its consistency and scrupulous advocacy position, which forbids donations from commercial firms, the ADAO's reputation and effectiveness has enabled it to make an important contribution to the U.S. asbestos debate. Legal Challenges for UK Mesothelioma Claimants and the Future Management of their Claims was the title of the presentation by Master Steven Whitaker, the procedural judge at the Royal Courts of Justice (RCJ) who oversees the operation of the RCJ's asbestos diseases list involving mainly mesothelioma claims. The volume of cases processed by this London-based judicial service has risen dramatically over the last 5 years; currently 600 cases a year from all over England are being dealt with. The success of procedural streamlining combined with an increase in early diagnosis of asbestos-related disease has led to more live claims being issued. Despite the success of the 2006 campaign to ensure that the RCJ list was not impacted by changes in the court system, there is no room for complacency. Current threats to the RCJ's mesothelioma service and the consistency and efficacy of its operations include:
Concluding his remarks, Master Whitaker said: “Both claimant and defendant 'interests' should be vigilant to ensure that otherwise welcome changes do not unintentionally affect the progress that has been made in the last 5 years in the efficient dispatch of these asbestos disease claims.” Since the devolution of Scotland, many issues affecting sufferers of asbestos-related diseases have been considered by the Scottish Parliament, as a result of which significant gains have been made north of the border. A prime example of this is the availability of Alimta for all Scottish mesothelioma patients under a decision taken by the Scottish Medicines Consortium. Should the National Institute of Clinical Excellence issue a negative decision on NHS prescription of Alimta, this ruling could affect the prescription regime in Scotland. This threat has been met by a coordinated campaign, led by Scottish asbestos victims' support groups, which included: extensive lobbying of Members of the Scottish Parliament (MSP), the subject of Alimta prescription being raised in the Scottish Parliament, the sending and publication of letters to Scottish newspapers, the submission of petition PE 1006 to the Scottish Parliament Public Petitions Committee and a Holyrood meeting, organized by the Scottish Trades Union Congress, at which legal representatives and campaigners argued for universal access to Alimta treatment. Throughout the campaign the input and support received from John McFall, MP for West Dunbartonshire, and Des McNulty, MSP for Clydebank & Milngavie, were absolutely crucial. This well-coordinated strategy was discussed by Tommy Gorman, a member of the Clydebank Asbestos Group, in his presentation Asbestos Issues in Scotland. In 2006, a similar campaign succeeded in overturning years of unfairness when the Rights of Relatives to Damages (Mesothelioma) (Scotland) Act became law. Previously, loopholes in Scottish legislation had resulted in fewer than 20% of asbestos victims claiming damages during their lifetimes.8 For much of the seven years since his schoolteacher wife, Gina,9 died of mesothelioma, Michael Lees has been researching the issue of Asbestos in UK Schools. In this time, the former RAF pilot has amassed a wealth of information on the widespread use of asbestos in school buildings, the persistent lack of safeguards and the inability of government agencies to protect teachers, caretakers and students from the consequences of deadly asbestos exposures. In 1967, Dr. Lloyd Davies, the Head of the Medical Inspectorate of Factories, warned the Department of Education about the hazards of low level exposures to asbestos in UK schools; he advised that a precautionary approach was needed to protect those at risk and stressed the particular vulnerability of pupils to hazardous exposures.10 Virtually no effective action was taken. In the years 1991-2000, 73 primary and secondary schoolteachers died of mesothelioma; if educational assistants and nursery nurses are included, a total 145 mesothelioma school-related deaths took place. The proportional mortality ratio for mesothelioma of female teachers is twice that of female nurses. The most recent government statistics show that mesothelioma deaths from school-related exposures are increasing. While some data are available on the consequences of occupational asbestos exposures at schools, there are no studies detailing the effect on children. The majority of the UK's 24,000 schools contain asbestos; asbestos-containing products were used extensively in the 13,000 schools built between 1945-1975. These products deteriorate over time and lack of systematic monitoring and effective management of these products has exacerbated the potential for fiber liberation. New regulations introduced in 2004, which mandated the implementation of a more effective regime for dealing with asbestos in public buildings, do nothing for those who were exposed in the 30+ years since Dr Lloyd Davies' warning went unheeded. The low priority given to the asbestos hazard by government agencies, including the Department for Education and the Health and Safety Executive (HSE), has continued for decades. The current Department for Education guidance on asbestos has not been revised since 1986, even though the Schools Minister flagged this up as a matter of urgency three years ago. As recently as December 2006, the HSE reiterated that the existing guidance on asbestos in schools was perfectly adequate and did not need updating. The asbestos exposure which was documented at a recent trial in Derby revealed the colossal failure of both government agencies to protect school users; although the headmaster was acquitted, Derby City Council was heavily fined for the exposure to amosite asbestos which took place during school refurbishment work. With too few health and safety inspections at schools and the unceremonious cessation of an HSE awareness campaign targeted at schools, the future looks bleak. There is no comprehensive training of head teachers and school governors in asbestos awareness and no adequate asbestos guidance for schools. Decades of underfunding have produced a persistent human risk in schools due to the lack of asbestos audits, management systems and removal programs.11 The final presentation, Asbestos Cement is Harmless: Fact or Fiction? was given by Industrial Hygienist Robin Howie. Over recent years, a sustained campaign carried on in the national media by journalist Christopher Booker has alleged that chrysotile asbestos “poses no threat to human health.” Having begun his presentation with a series of graphic images that documented the widespread presence12 of asbestos-cement (ac) roofing materials throughout the UK infrastructure, Mr. Howie proceeded to contest this statement. Research published in 1997 concluded that among a cohort of 11,000 chrysotile miners in Quebec, there was an elevated risk of lung cancer and mesothelioma deaths. Another of Booker's arguments, that “asbestos fibres undergo a chemical change when mixed with cement, which binds them and coats them with calcium, thus making them non-respirable,” was duly dispatched by Howie with new research undertaken by Professor Fred Pooley who, having analyzed four samples of ac products manufactured between 1940-late 1960s, found that:
Mr. Howie concluded his presentation by stating that: “It is a dangerous fiction to state that asbestos cement is harmless.” During the discussion session which followed the presentations, speakers revisited the issue of Alimta. Mesothelioma patient Keith Shadwick explained how treatment with Alimta was central to the best treatment and said it was disgraceful that such a vital lifeline could be withdrawn. He also detailed the distress and waste of effort caused by the lack of a central NHS information point on any medical problem, mesothelioma included. Dr. Jeremy Steele, Consultant Medical Oncologist from St. Bartholomew's Hospital, estimated that the total cost for treating all eligible UK mesothelioma patients would be £4 million; he expressed his frustration at not being permitted to prescribe a proven and licensed treatment to suitable patients. According to a report published the week before the seminar, the UK has the lowest take-up rate of new cancer drugs in Europe;13 it also has the lowest cancer survival rates.14 In France, Spain, Germany and Italy more than 50% of patients are receiving treatment with drugs launched since 1985; the UK figure is 40%. Co-authors N. Wilking and B. Jonsson single out the National Institute for Clinical Excellence for critical attention: “Nowhere in Europe is the decisive role played by economic evaluations more evident than in the UK, where the National Institute of Clinical Excellence (NICE) issues guidance for England, and the All Wales Medicine Strategy Group (AWMSG) and the Scottish Medicines Consortium (SMC) issue guidance for Wales and Scotland respectively…. (there is) an issue with NICE's capacity to cope with the growing workload of evaluation and undertake new reviews. The time for a product to be referred to NICE can be up to 18 months and this is prior to the beginning of any review. The actual timeline of a NICE review is 62 weeks while it is 3 months for the SMC.” The researchers point out the irony of the current situation: "the UK ranks as the number one country in the amount of direct cancer research funding, with the charitable sector contributing more than the government in research funding. Yet… the UK lags behind other EU countries in terms of the ability of cancer patients to access new cancer drugs." Less than 2 months after the seminar, NICE issued its final draft guidance on the use of Alimta for the treatment of malignant pleural mesothelioma; reversing a previous ruling, NICE's independent appraisal committee recommended the use of Alimta for the treatment of mesothelioma sufferers “who are considered to have advanced disease and for whom surgical intervention is considered inappropriate.”15 The announcement on July 9, 2007, which ended the UK postcode lottery, was warmly welcomed by the Asbestos Victims Support Groups' Forum; Chair Tony Whitston urged Primary Care Trusts (PCTs) to “fully comply with this guidance to make immediate arrangements for the provision of Alimta for the treatment of mesothelioma.” Unfortunately, campaigners had scant time to savour this victory. On August 24, 2007, NICE gave notice of two appeals against its Final Appraisal Determination (FAD) and Guidance on Alimta.16 Attempts on September 18, 2007 to discover the identity of the appellants or the grounds of the appeals were stonewalled by a NICE spokeswoman who said that appeal hearings are usually held within 3 months. Until a ruling is made on these appeals, she said, PCTs are expected to make their own decisions on prescribing Alimta. According to the NICE website, work on Alimta began on August 14, 2004 with the publication of the topic summary;17 3 years on, the situation remains unresolved. The latest reversal is a bitter blow for those who had thought the years of uncertainty and confusion had been brought to an end. Speaking on their behalf, Tony Whitston commented: "The appeal of the NICE Final Appraisal Determination (FAD) approved the use of Alimta for the treatment of mesothelioma has been greeted with dismay by mesothelioma patients. Their hopes of early treatment have been dashed by this news, which nobody expected. Notwithstanding the appeal, we would advise mesothelioma patients to ask their PCTs to fund treatment on the evidence provided in the current FAD, which approves funding for this treatment." 2. Asbestos and the Teaching Unions – by Michael Lees The Health & Safety Executive (HSE) acknowledges that the majority of the 24,000 schools in the UK are likely to contain asbestos, and that children are particularly at risk of developing mesothelioma. They also admit that some local authorities "have still not established complete control of asbestos in their premises.”18 Despite this the Government's track record when it comes to dealing with the asbestos crisis in schools has been abysmal. For decades the teaching unions have fought tenaciously in an attempt to persuade the Government to make schools safe from the dangers of asbestos. Since the early 1980s, the National Union of Teachers (NUT) has tried unsuccessfully to persuade successive governments that every school should carry out an asbestos survey, the results should be centrally collated and there should be a timetable for the phased removal of all asbestos. Over the years, the NUT, the National Association of Schoolmasters and Union of Women Teachers (NASUWT) and other teaching unions' requests have been rejected on the grounds that Government policy is that asbestos should not be removed as it is safer to leave it in place and manage it. The Government also considers that the responsibility for surveying and assessing the extent of the problem lies not with them but with school governors and local authorities. Confidential papers accessed under the Freedom of Information Act show that the real reason for the Government's refusal to act is the overriding concern that asbestos removal would be extremely expensive, and if a national audit was carried out, parents might panic when they realize the extent of the problem and expect all the asbestos to be removed. Confidential Department for Education (DfES) documents state: "Commissioning a nationwide survey might provoke panic."19 "A centrally funded initiative to assess the risk to teachers and pupils would not only be inappropriate, given where the statutory duty lies, but would also lead to pressure for centrally funded initiatives to remove all asbestos and for other aspects of building work. That would be extremely expensive, as well as risky and disruptive for the schools concerned."20 The confidential documents show similar financial reasons are also behind the Government's failure to ensure that all schools carry out asbestos surveys. During the consultation for the 2002 asbestos regulations DfES successfully argued against asbestos surveys being made mandatory; they wrote to the HSE saying "I must admit like you, we are not very keen on the idea of surveying all schools. The cost of surveys and removal and reinstatement would be prohibitive…."21 However, their concerns even extended to them refusing the unions' requests to update the asbestos guidance; a confidential Ministerial briefing stated: "We do not recommend an asbestos-specific communication as this would unreasonably raise the profile of the asbestos issue…. It could very well give rise to a panic reaction in individual schools, and lead to claims for additional capital resources."22 As the years passed and the schools crumbled because of underfunding, it became clear that the asbestos situation was worsening. The number of teachers dying from mesothelioma gradually increased. In 2004, after a number of serious asbestos incidents in schools, the HSE eventually heeded the calls of the teaching unions and asked them to join a campaign to improve asbestos management in schools. A year later, before the first meeting had even taken place, the HSE dropped the schools' campaign. Despite repeated requests from the teaching unions, new asbestos guidance has still not been issued. Last year, even as Northern Ireland completed the UK's first comprehensive asbestos survey of school premises, the Scottish Parliament deferred, relying on the lack of centrally collated data as an excuse to do nothing.23 As recently as May this year, Jim Knight, the Schools' Minister, admitted in Westminster that he had no idea which schools contained asbestos or the condition it was in; he maintained that the safe management of asbestos in schools was not his responsibility but that of school governors and local authorities.24 Knight also turned down requests by MPs and the unions for a Parliamentary debate writing: "We consider that asbestos in schools is being adequately handled by the Department for Education and the HSE."25 This year, all the teaching unions have highlighted their concern about the gravity of the situation as demonstrated by the increase in asbestos incidents in school premises. The NASUWT carried out an audit of their members and found that many schools were not properly managing their asbestos. Out of the 5,000 individuals polled, 73% said that asbestos-containing products in their schools were not correctly labelled, 51% said asbestos was not being properly managed and 79% said there were no plans for its removal. The Association of Teachers and Lecturers unanimously passed a motion to lobby for the rapid removal of all asbestos from schools and colleges. Renewing its call for the progressive removal of asbestos from schools, the NUT stressed that the opportunity must not be missed to remove all asbestos when schools are refurbished under the Building Schools for the Future initiative. The lack of effective asbestos guidance and training for head teachers and governors were cited as issues of concern by the Professional Association of Teachers (PAT). They also emphasized that it is not possible for the Government to allocate resources in proportion to risk without a full national assessment of the problem stating: "We simply do not know what the risk is and that is entirely unsatisfactory."26 The PAT is calling for a Parliamentary debate about the whole issue of asbestos in schools. In Scotland, the Educational Institute of Scotland (EIS) pointed out that poor maintenance and vandalism in schools have made them more vulnerable to the dangers of asbestos. The EIS stressed that all schools must adhere strictly to the asbestos regulations. An urgent review of local authority schools to ensure no dangerous asbestos remains in walls and ceilings is a priority of the Scottish Secondary Teachers Association (SSTA); the SSTA wants all asbestos removed from schools. The NUT expressed the frustration and feelings of many teaching unions that government policies have failed to protect teachers and children when they said: "For more than 20 years the NUT has called for the removal of asbestos from all schools... progressive removal is the safest and most effective solution. It is permanent which means that neither time nor money will be spent in the future worrying about how to manage the risk. Providing that it is removed professionally, there will be no future risk of fibre release and no need for concern that a time-bomb is present, which may lead to premature death of staff and pupils."27 On October 1, 2001, T&N Ltd. ceased paying asbestos-related disease claims when its American parent company, Federal Mogul (FM), filed for voluntary Chapter 11 reorganization in the U.S. and administration under the UK Insolvency Act of 1986.28 Years of cross-Atlantic negotiations, scores of court appearances and millions of pounds of professional fees later, the UK courts approved plans for T&N to exit the administration process. The sixth anniversary of the administration is an appropriate time to examine the current situation facing those suffering from T&N-generated asbestos illnesses in the UK. According to a spokesperson for Kroll, T&N's UK administrators, as of mid-September (2007), 483 claims had been made; “claim levels are,” he reported “below what was expected so far.” A total of £4,386,032 ($8.8m)29 has been paid out in compensation for 147 claims: an average of £29,837 ($60,087).30 More than 75% of all claims are from former employees, 47% of whom qualify for top-up insurance payments from the Employers' Liability (EL) Trust. The value of claims is dependent on a number of parameters and factors. Claimants opting for a detailed individual review could receive twice as much as those choosing the fast-track expedited review; they could also receive less. Reflecting the more generous regime north of the border, Scottish claimants receive higher compensation payouts than English, Welsh or Northern Irish claimants and, in all cases, people with mesothelioma receive more than those with lung cancer or asbestosis. The maximum payout as specified in the matrix of claims values is £325,000 ($656,758) under the individual review process for mesothelioma in Scotland; the minimum mesothelioma award under the expedited review process elsewhere in the UK is £100,000 ($201,397). According to the trust administrators, payments for the first 25 successful claims were sent out on April 16, 2007; 19 additional cases were paid two weeks later. Solicitors confirm that checks are being received; in at least one case, within 8 weeks of first contact with the trust administrators. Those claimants with post-1969 employment receive the highest awards as most of them are entitled to compensation from the EL Trust; this group has been receiving payouts equal to 68% of their claims. HYPOTHETICAL CASE: A 60 year old ex-T&N worker with mesothelioma whose occupational exposure took place after 1969 and who chose an expedited review of his case would be entitled to £100,000 and would recover £68,000 ($136,930); by 2012, he, or his estate, could receive a further £14,000 ($28,191) giving the claim a total value of £82,000. If the same claimant had been employed before the 1969 cut-off, he would receive £17,000 ($34,232) now and a possible £9,000 ($18,124) by 2012 to give a total of £26,000. Solicitors report relief amongst claimants that checks are being received. Although legal representatives report that claims are being processed efficiently and that the trustees are acting in reasonable faith, some victim support workers report that “the administrators of the T&N scheme are taking a very hard line on applications…” Literature: The September 2007 issue of the International Journal of Occupational And Environmental Health31 contains the paper Asbestos Exposure Causes Mesothelioma, But Not this Asbestos Exposure: an Amicus Brief to the Michigan Supreme Court by Dr. Laura S. Welch. This paper analyzes the well financed propaganda campaign by asbestos defendants to label as “junk science” evidence supporting the conclusion that “(chrysotile) asbestos from brakes can and does cause mesothelioma.” Dr. Welch concludes: “Asbestos causes mesothelioma. Mechanics are exposed to asbestos dust during the servicing and replacement of brakes… the scientific community is in consensus that brief and low-level exposures to asbestos can cause mesothelioma. The scientific literature contains hundreds of cases of mesothelioma among brake mechanics; and epidemiologic studies of mechanics known to have performed repair work on asbestos-containing brakes have demonstrated increased levels of nonmalignant diseases… This combination of evidence, and the vast amount of additional scientific information regarding asbestos and mesothelioma, provides more than sufficient evidence to allow someone to conclude within a reasonable degree of scientific certainty that mesothelioma in a mechanic who worked with asbestos-containing brakes was caused by that asbestos exposure.” The Independent Asbestos News, a new quarterly publication which can be accessed online,32 covers a range of technical developments relevant to the asbestos removal industry and individuals/firms engaged in asbestos management and auditing. Subjects featured in the July/August 2007 issue included: the formation of a UK Asbestos Training Association, the “Duty to Manage Asbestos” and legal fallout from hazardous exposures. Chest CT Screening of Asbestos-Exposed Workers: Lung Lesions and Incidental Findings by T. Vierikko and R. Jarvenpaa appeared in the January 2007 issue of the European Respiratory Journal.33 Screening of 633 workers, including current and former smokers, detected noncalcified lung nodules in 86 workers; in only four cases were symptoms regarded as clinically important. The research validated the advantages of computed tomography and high-resolution computer tomography over plain radiography for detecting lung cancer in asbestos-exposed workers but numerous incidental findings were a major concern for future screening programs. The journal also included an editorial entitled Screening for Lung Cancer in a High-Risk Group: but I Still Haven't Found What I'm Looking for… by G. A. Silvestri. Whilst acknowledging the desirability of diagnosing lung cancer at an early stage, the author pointed out the pitfalls of screening high risk groups such as cohorts of asbestos-exposed workers and concludes: “Until the results of the randomised trials on screening are made available, when it comes to screening for lung cancer, I still haven't found what I'm looking for…” In the paper Diachronic Study of Pleural Plaques in Rural Population with Environmental Exposure to Asbestos, the results of research undertaken in seven villages in Northern Greece over 15 years were discussed.34 The authors concluded that the “radiological appearance of pleural plaques and respiratory function in people previously exposed to asbestos environmental pollution worsens over the years. The prevalence of mesothelioma was found to be higher than expected.” Events/ Meetings: Alice – A Fight for Life: As part of the 25th anniversary celebrations of a remarkable British documentary, a screening of Alice - A Fight for Life35 will take place on October 3, 2007 at 18:00 at the National Media Museum in Bradford. On October 15, 2007, Producer/Director John Willis will show clips from Alice and speak about this program at a session to be chaired by Geoff Druett. To book a place to attend, email: jo.gough@itv.com Mesothelioma UK Patient/Carer Day: Following on from the success of its inaugural Patient/Carer Day in 2006, Mesothelioma UK will be holding its 2nd Mesothelioma UK Patient/Carer Day in London on October 13, 2007.36 A varied agenda will cover issues such as current innovations in medical treatment of mesothelioma, minimization of symptoms, changes in the UK benefits regime and psychological and emotional support following a mesothelioma diagnosis. Delegates will have the opportunity to engage in a panel discussion with eminent UK medical experts including: Drs. Helen Clayson, Mick Peake, Jeremy Steele, Mr. John Edwards and Nurse Consultant Natalie Doyle. For more information telephone the Mesothelioma UK Help Line on: 0800 169 2409, email: mesothelioma.uk@uhl-tr.nhs.uk or visit the website: http://www.mesothelioma.uk.com The Asbestos-Related Disease Claims Conference: A one day conference is being held in Doncaster on November 16, 2007 by the Sheffield and Rotherham Asbestos Group (SARAG). Speakers, including Master Steven Whitaker, Coroner Christopher Dorries, Dr. Gurnam Basran, Barristers Harry Steinberg and Michael Rawlinson, will present a program attracting 5 hours of continuing professional development credits. For more information, phone Paula Walker: 0114 282 3212 or email: sarag@aizlewoodsmill.co.uk Request for Assistance: In 1973/74, Robert (Bob) Tolley worked for Humphreys & Glasgow Ltd. (HGS) in Eastbourne, East Sussex. Mr. Tolley died on September 28, 2006, only 2 months after being diagnosed with mesothelioma. He was 67 years old. The family is trying to trace witnesses who remember working with him at Humphreys & Glasgow Ltd. on gas conversions. Please contact his daughter Christine Dennis by email at: chris@nimaprint.co.uk or millietalula@supanet.com ___________ 1 http://info.cancerresearchuk.org/cancerstats/incidence/trends/ 3 http://www.youtube.com/watch?v=gLTDknLVm4A 4 U.S. environmental asbestos hotspots include Libby, Montana, Ambler, Pennsylvania, New Orleans, Louisiana, and post-9/11 New York City. 5 There is an increasing number of U.S. mesothelioma sufferers under 40 years of age; the ADAO list of U.S. mesothelioma sufferers included one who was 23 and three in their thirties. 6 California, Florida, Pennsylvania, New York and Ohio. 7 See newsletter issue 55, Summer 2004. 8 See newsletter issue 65: One Step Forward, Two Steps Back. 9 Gina Lees was a primary schoolteacher for 30 years; she taught in 25 schools, most of which contained asbestos. Gina died from mesothelioma at 51 years of age; the coroner ruled her death was due to industrial disease. 10 According to Mr. Lees, there are 9 million children and 800,000 teachers in UK schools: “over a 5 year period of exposure, a child of 5 is 5.3 times more likely to develop mesothelioma by the age of 80 than their teacher of 30. In addition, because of their physiology, children are thought to be more vulnerable.” 11 For detailed information on asbestos in UK schools go to: http://www.asbestosexposureschools.co.uk 12 Howie stated that: ac contains 10-15% by weight of chrysotile asbestos, 25 million tonnes of ac products were installed in UK buildings, the area of installed ac sheeting is 13,000,000,000 square feet or about 230 square feet per man, woman and child in the UK today. 13 Wilking N, Jonsson B. A Pan-European Comparison Regarding Patient Access to Cancer Drugs. Karolinska Institute. May 2007. Weblink: http://ki.se/content/1/c4/33/52/Cancer_Report.pdf 14 Lawrence J. Britain is Sick Man of Europe for Providing Cancer Drugs. May 10, 2007. http://news.independent.co.uk/health/article2527714.ece 15 http://guidance.nice.org.uk/page.aspx?o=439345 16 http://guidance.nice.org.uk/page.aspx?o=450607 17 http://guidance.nice.org.uk/page.aspx?o=207007 18 HSE Head of Asbestos Policy LAFORUM/04 Nov 23, 2004. 19 DFE meeting with Gen Sec NUT Nov 5, 1993. 20 Ministerial Briefing Background Note for Parliamentary reply to Michael Clapham Jun 17, 1997. 21 Letter DfEE to HSE Aug 21, 1997. 22 Letter DfEE to Schools Minister Eric Forth MP Mar 4, 1994. 23 Scottish Parliament S2W-28619 Douglas Hamilton / reply Peter Peacock Oct 23, 2006. 24 Hansard Parliamentary question Andrew Rosindell MP/ Jim Knight MP Minister of State for Schools May 3, 2007: Column 1861W. 25 Jim Knight MP Minister of State for Schools / Rt Hon John Denham MP Jun 25, 2007. 26 General Secretary PAT, Philip Parkin, conference address July 2007. 27 NUT Asbestos Focus on Removal in 2007. 28 See: British Asbestos Newsletter, issues 45, 46, 48, 51, 53, 55, 56. 58, 60; website: http://www.lkaz.demon.co.uk 29 Payments towards legal and medical costs have also been made where appropriate. 30 44 claims have been rejected or withdrawn. 32 http://amac.org.uk/July07.pdf 33 Eur Respir J 2007;29:6-7 34 Sichletidis L. et al. Diachronic Study of Pleural Plaques in Rural Population with Environmental Exposure to Asbestos AJIM 2006;49:634-641 35 See newsletter issue 65, articles 1 & 2. 36 http://www.mesothelioma.uk.com/uploads/Patient%20Day%202007%20Programme.pdf ___________ Compiled by Laurie Kazan-Allen |