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|ISSN 1470-8108||Issue 99||Autumn-Winter 2015-16|
A week before Christmas 2015, the Minister for Defence Personnel and Veterans Mark Lancaster MP announced a government U-turn in the compensation policy for ex-service personnel suffering from the asbestos cancer, mesothelioma. The improvements to be implemented in the benefits regime, which resulted from campaigning by The Royal British Legion and victims groups, will bring government awards for veterans more in line with those for civilians.1 The changes will be implemented as of April 11, 2016 and allow former members of the armed services diagnosed with mesothelioma on or after December 16, 2015 to receive a lump sum of £140,000 instead of smaller weekly or monthly payments dispensed under the War Pensions Scheme.2
While welcoming the move which could benefit thousands,3 the Royal British Legion pointed out that some of the injured will continue to be disadvantaged saying:
we remain disappointed that around 60 veterans who are currently in receipt of a War Disablement Pension for Mesothelioma will be unable to apply for the new lump sum compensation award. Whilst we are pleased that the Minister has indicated that he will review special arrangements for these individuals, we urge him to do so quickly under the terms of the Armed Forces Covenant and in light of the limited life expectancies and extreme suffering of these veterans.
MPs David Mackintosh and Madeline Moon called on the Government to ensure that all affected veterans were treated equitably while General Lord David Richards, former Chief of the Defence Staff, condemned the discriminatory practice as a mean-minded anomaly contrary to the ethos of the Armed Forces Covenant. Lord Alton, who has campaigned assiduously on mesothelioma issues in the House of Lords, was highly critical: To recognize an injustice and to say you will put it right in the future represents progress but to then say you wont apply the same criteria to those who are already dying of this disease defies logic and common decency.
Attempting to clarify the likelihood of the new scheme being opened to veterans whose diagnoses were received prior to the December 16 cut-off date, enquiries were made with the Ministry of Defence (MOD). On January 4, 2016, an MOD spokesperson replied:
Whether to extend the lump sum to current claimants is a complex issue and has been discussed across Government; but we are committed to supporting veterans and are considering what more can be done for this group.
Under the Armed Forces Covenant, the government promised to ensure that the Armed Forces face no disadvantage as a result of their Service. Considering the severity of mesothelioma, the short life expectancy of those affected, and the relatively small sums involved, there can be no excuse for the failure to treat all veterans equitably.
Recognizing that Britain is in the grip of an asbestos crisis, the All-Party Parliamentary Group on Occupational Safety and Health issued calls in October 2015 for the complete eradication of the health hazard, citing big numbers in an 11-page leaflet entitled: The asbestos crisis. Why Britain needs an eradication law.4 Calling for a definitive solution to a long-term problem, the parliamentarians reported that:
Deploring the complacency over asbestos which perseveres throughout the country, MP Ian Lavery, Chair of the All-Party Group and its Asbestos Sub-Group, said:
We believe that the Government needs to start now on developing a programme to ensure that asbestos is safely removed from every workplace and public place so that we can end, once and for all, this dreadful legacy which has killed so many people, and will continue to kill until asbestos is eradicated.5
While the European Parliament has endorsed a 2028 deadline for the removal of asbestos from public buildings and Poland has a 2032 deadline for the removal of all asbestos from the national infrastructure, no such measures have been considered by the British government which continues to defer to the industry-friendly policy of safe management of a deadly hazard, under which occupational and environmental exposures remain commonplace.
The call for definitive action was warmly received by asbestos victims groups and trade unions. Graham Dring, new Chair of the Asbestos Victims Support Groups Forum, said:
Such a law is essential if we are to put an end to the ongoing tragedy of needless asbestos-related deaths, and the heartbreak this causes for those left behind... The only sure way to prevent exposure in the future is to get it [asbestos] removed We owe it to future generations to stop the epidemic of asbestos diseases by removing the root cause from our workplaces, public buildings and homes.6
Frances OGrady, the General Secretary of the Trades Union Congress, echoed Mr. Drings comments:
The proposal from the all-party group for the safe removal and disposal of asbestos from all workplaces and public buildings is the only way of ensuring that future generations do not have to live with the continuing legacy that asbestos will leave unless action is taken now.7
Support was expressed by the Hazards Campaign, the Joint Union Asbestos Committee, and the GMB, Unite and UCATT trade unions, while insurers rang alarm bells over the potential effects of the recommendations on asbestos removal contractors and their insurers:
Not only will they (contractors) have to work closely with asbestos surveyors and the HSE but it is likely that they will be asked to also undertake the removal of the low level asbestos materials ... it is likely that brokers will receive an increase [sic] demand from their contractors to include the removal of non-notifiable asbestos in their coverage. Unfortunately, many insurers find this hard to accommodate which may leave their contracting clients without the necessary cover or looking for an alternative carrier.8
An article published on November 26, 2015 highlighting the continued failure of UK authorities to engage with the ubiquity and seriousness of the asbestos challenge considered the Welsh Governments intransigence on the asbestos in schools issue.9 Responding to a petition calling for the creation of an asbestos database for Welsh Schools, the Education Minister Huw Lewis said such a measure would constitute a tremendous bureaucratic burden to local authorities. This response was deemed not good enough by campaigner and petition organizer Cenric Clement-Evans with Owen Hathway of the National Union of Teachers Cymru adding: No teacher, or for that matter pupil, should ever be placed in a situation where their health, and in some cases where asbestos is concerned their life, is put at risk.
In recent months, the urgent need for a carefully formulated and timetabled eradication program was reinforced by the publication of peer-reviewed papers and commentaries which concluded that:
The latest mortality data from the Office of National Statistics reported a 13% increase in mesothelioma deaths between 2010 and 2014.13 This confirms, as do statistics from the Health and Safety Executive, the human toll being paid for asbestos exposures in the 20th century. As bad as these figures are, a paper published in October 2015 suggested that many asbestos deaths could be going unrecorded due to misdiagnoses:
Mortality due to IPF [idiopathic pulmonary fibrosis] has risen steadily in the UK over recent decades, with the condition now accounting for approximately ~5000 deaths each year The strength of the association between IPF mortality and historic asbestos imports was similar to that seen in an established asbestos-related disease, i.e. mesothelioma. This finding could in part be explained by diagnostic difficulties in separating asbestosis from IPF and highlights the need for a more accurate method of assessing lifetime occupational asbestos exposure
In summary, the findings of this study are in keeping with the hypothesis that in England and Wales, a proportion of UIP [usual interstitial pneumonitis] pattern pulmonary fibrosis currently diagnosed as idiopathic may in fact be due to the difficulties of accurately accessing historic asbestos exposure 14
While Britain retains pole position as the country with the highest age-adjusted mesothelioma mortality rate in the world, its neighbors are also badly affected. A working paper entitled: Eliminating occupational cancer in Europe and globally released at the 2015 conference of the European Trade Union Institute provided shocking data on Europes asbestos catastrophe:
Of the 102,500 occupational cancer deaths in the EU28, asbestos causes between 30,000 an old estimate and 47,000 (based on this paper) every year, and the numbers are still rising. Cancer and occupational cancer mortality is increasing due to growing life expectancy and gradual reduction of other causes of death, such as communicable diseases and injuries. 15
A declaration circulated in the European Parliament towards the end of the year (2015) also highlighted the scale of the epidemic The EU estimates that asbestos-related cancers will cause up to 500,000 deaths by 2030 in Western Europe and urged the European Commission to create and finance a Europe-wide programme aimed at the removal of all asbestos from public and private buildings.16 It is now well past time for the governments in Westminster and Brussels to confront their respective asbestos challenges and heed demands from civil society for a safe, phased and planned removal of all the asbestos that still remains in place [Only then] can we ensure that future generations will not have to experience the same deadly epidemic from asbestos-related diseases that we suffer today.17
Parliamentary Mesothelioma Debate
On November 20, 2015, the second reading of the Mesothelioma (Amendment) Bill took place in the House of Lords.18 The proceedings began with comments by Lord Alton, the sponsor of the bill, and continued with input from multiple peers over the next three hours. In his remarks, Lord Alton highlighted the governments continued failure to mandate a guaranteed revenue stream to progress research into cures and/or treatment for the fatal asbestos cancer, mesothelioma. Other important contributions made to the debate came from: Lords Avebury, Freyberg, McNally, Winston, Kakkar, McKenzie, Wills, Howarth, Giddens and Baroness Finlay. The governments response, given by Lord Prior of Brampton, Parliamentary Under-Secretary of State, Department of Health, was critically received in particular his comments that the essential problem is not a lack of funding but a lack of sufficient [quality] research applications. Despite the leading role played by UK scientists in mesothelioma research, government spokesmen have continually dismissed the countrys failure to provide funding with accusations of unworthy research proposals. On November 20th this excuse did not go down well and demands were made for Lord Prior to re-examine the facts and update the House in 2016.
Diffuse Mesothelioma Payment Scheme
On November 30, 2015, the first annual review of the Diffuse Mesothelioma Payment Scheme (DMPS) for the period April 6, 2014 to April 5, 2015 was published by the Department for Work and Pensions.19 The DMPS, funded by the insurance industry and administered by a private contractor, was set up in 2014 as a scheme of last resort for UK mesothelioma sufferers unable to obtain civil compensation from negligent employers or insurers. According to the review: the total number of applications received was 410 with 255 accepted, 90 denied, 10 withdrawn and 50 decisions pending. The total compensation paid out was £24,000,000. There were no formal complaints. These figures were lower than estimated forecasts.
In September 2015, the authors of Survival patterns in lung and pleural cancer in Europe 1999-2007: Results from the EUROCARE-5 study reported that survival times for lung and pleural cancer patients remains poor in European counties and decreased with advancing age at time of diagnosis. Priority should, they concluded be given to prevention The management of mesothelioma needs a multidisciplinary team and standardised health care strategies. Recommendations included banning asbestos, improving treatment access and implementing measures to allow early diagnosis. 20
Papers published in November 2015 detailed findings on the treatment or occurrence of the deadly asbestos cancer, mesothelioma. In their paper: Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma, Swiss researchers reported that:
In the present cohort, active treatment seems beneficial to the patient since surgical excision of local tumour relapse has good long-term outcome in selected patients. Thus, second-line treatment may prolong PRS [median post-recurrence survival]; however, these results need to be confirmed in a prospective manner.21
Following a multi-institutional phase II study into the efficacy of trimodality therapy chemotherapy followed by extrapleural pneumonectomy and radiation therapy for mesothelioma patients, Japanese scientists concluded that:
TMT [trimodality therapy] in patients with MPM [malignant pleural mesothelioma] is feasible in Japan, with similar survival and risk rates compared with those in North America and Europe. However, it should be emphasized that the risk-to-benefit ratio in our study, as well as in the US/European studies, is not satisfactory.22
The results of an American study of gender differences in malignant pleural mesothelioma (MPM) longevity suggested that survival rates seemed to favor female patients: Insight into the survival advantage of female patients may advance the molecular understanding of MPM and identify therapeutic interventions that will improve the prognosis for all MPM patients. The researchers identified molecular differences associated with gender and histology.23
On May 1-4, 2016, the 13th International Conference of the International Mesothelioma Interest Group will be held at the International Conference Centre in Birmingham, UK.24 During plenary sessions, workshops, roundtables and poster presentations, researchers, clinicians, medical professionals, scientists and social activists will, according to the organizers address the entire patient pathway and look beyond the scientific topics alone.
1 Royal British Legion Press Release. Legion helps secure pay outs for thousands of veterans with asbestos-related cancer. December 17, 2015.
2 MoD Press Release. More flexible compensation for veterans with cancer caused by asbestos. December 16, 2015.
3 According to a background paper by the Royal British Legion, more than 2,500 naval veterans could die from mesothelioma between 2013 and 2047.
4 All-Party Parliamentary Group on Occupational Safety and Health. The asbestos crisis. Why Britain needs an eradication law. October 16, 2015.
5 Press Release by MP Ian Lavery, Chair of All-Party Parliamentary Group on Occupational Safety and Health. Parliamentary group calls for eradication of all asbestos in Britain. October 16, 2015.
7 TUC. TUC supports call for eradication of all asbestos in Britain. October 16, 2015.
8 UCATT calls for eradication of all asbestos in Britain. October 16, 2015.
9 Flint R. Asbestos database warning which North Wales schools contain substance would be too bureaucratic says Education Minister. November 26, 2015.
10 Ferrante D et al. Pleural mesothelioma and occupational and non-occupational asbestos exposure: a case-control study with quantitative risk assessment. Occup Environ Med 2015:0:1-7. August 11, 2015.
12 Stayner L. Para-occupational exposures to asbestos: lessons learned from Casale Monferrato, Italy. November 9, 2015.
13 Office of National Statistics. Final Mesothelioma deaths England and Wales 2010-14. August 17, 2015.
14 Barber CM et al. UK asbestos imports and mortality due to idiopathic pulmonary fibrosis. October 28, 2015.
15 Takala J. Eliminating occupational cancer in Europe and globally. October 2015.
16 Written Declaration submitted under Rule 136 of the Rules of Procedure on asbestos. September 7, 2015.
17 All-Party Parliamentary Group on Occupational Safety and Health. The asbestos crisis. Why Britain needs an eradication law. October 16, 2015.
18 Hansard. House of Lords Debate. November 20, 2015.
19 Diffuse Mesothelioma Payment Scheme: annual review 2014 to 2015. November 30, 2015.
20 Francisci S, Minicozzi P et al. Survival patterns in lung and pleural cancer in Europe 1999-2007: Results from the EUROCARE-5 study. September 2015. European Journal of Cancer.
21 Kostron A. et al. Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma. Eur J Cardiothorac Surg. Nov 20, 2015.
22 Hasegawa S et al. Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial).November 17, 2015.
24 The International Mesothelioma Interest Group (IMIG) website:
Compiled by Laurie Kazan-Allen