Asbestos and international organizations.

More information is available on the harmful effects of asbestos, and more incontestable epidemiologic and experimental evidence is available on its carcinogenicity, than for any other environmental agent. The first reports of its use date back more than 2,000 years. Herodotus and Plinium mention it (Castleman 1986; McCulloch 1986; Selikoff and Lee 1978). Despite early awareness of the harmful effect of inhaled fibers, it was only in 1902, and only in the United Kingdom, that asbestos was first included among the dusts known to be harmful to humans (Selikoff and Lee 1978). Cooke reported on fibrosis of the lungs caused by asbestos inhalation in 1924, but the term "asbestosis" was first used to describe it in 1927 (Cooke 1924, 1927). In 1930, dust abatement was officially recognized as the best way to eliminate the damage caused by asbestos fibers (Merewether and Price 1930); a few years later a detailed study was conducted on the pathogenesis of asbestosis (Mottura 1939). This awareness notwithstanding, production and use of asbestos continued and expanded undisturbed, with no measures being taken to protect exposed workers.

A causal association with carcinoma of the lungs was first reported in the 1930s in the United States (Lynch and Smith 1935) and in the United Kingdom (Gloyne 1935). In 1938 lung cancer was recognized in Germany as an occupational disease of workers who had been exposed to asbestos (Nordman 1938). In 1942, again in Germany, lung cancer associated with asbestosis was recognized as a compensable occupational disease (Proktor 1999). Isolated case reports of tumors of the pleura in people exposed to asbestos were published in the 1930s and 1940s, and the causal relationship between exposure to asbestos and mesothelioma could have been already established by the mid-1950s. The final proof of a causal relationship is, however, generally attributed to Chris Wagner, who in 1960 reported on 30 cases of histologically confirmed mesotheliomas in miners exposed to crocidolite (Wagner et al. 1960). In 1976, a working group convened by the International Agency for Research on Cancer (IARC) concluded that asbestos in all its commercialized forms is carcinogenic to humans and that no level of exposure could be considered safe (IARC 1977).

In spite of the overwhelming evidence of its carcinogenicity and of the enormous amount of harm it has inflicted on miners, workers in a variety of industrial sectors, and members of the general population exposed nonoccupationally, the use of asbestos is still increasing in many parts of the world. Under pressure to find solutions that satisfy both health and safety as well as economic concerns, economic considerations often prevail, in particular in developing countries where job opportunities are few and poverty and unemployment are widespread (Harris and Kahva 2003).

Ladou (2004) rightly points to the inadequacy of international organizations such as the International Labour Office (ILO) and the World Health Organization in addressing the worldwide problem that asbestos poses for public health. These organizations certainly are responsible for not having acted earlier and more efficiently; however, part of the reason for their inadequacy must be sought elsewhere. There is a considerable gap between the stated goals of these organizations, which are theoretically and demagogically supported by their founder states, and what they actually can do. They were never given the power such that their deliberations, recommendations, and evaluations would automatically be considered as the basis for legislative measures. On the contrary, their recommendations, typically those of the ILO with regard to asbestos and aromatic amines, have been blatantly disregarded by most industrialized countries. Although they are indisputably useful, international organizations are not supranational authorities that can in all instances deliberate autonomously and independently from the pressures exerted by the individual countries that established them. Several countries claim to support public health-oriented initiatives fully, but they do not favor programs that might have a negative impact on short-sighted nationalistic interests or go against the lobbying of powerful corporations. If this were not so, how, as Ladou (2004) reminds us, could many countries, conspicuously including Canada and the Russian Federation, continue to produce and export asbestos? How could many virtuous industrialized countries export their risks, such as ship breaking, to developing countries where the work is carried out in poorly or unregulated conditions? And how could asbestos-containing replacement brake parts still be used in the United States?

The author declares he has no competing financial interests.

REFERENCES

Castleman BI. 1986. Asbestos: Medical and Legal Aspects. Clifton, NJ: Law and Business Inc.

Cooke WE. 1924. Fibrosis of the lungs due to inhalation of asbestos. Br Med J 2-147.

Cooke WE. 1927. Pulmonary asbestosis, Br J Cancer 2:1024-1025.

Gloyne SR. 1935. Two cases of squamous carcinoma of the lung occurring in asbestosis. Tubercle 17:5-10.

Harris LV, Kahva IA. 2003. Asbestos: old foe in 21st century developing countries. Sci Total Environ 307:1-9.

IARC (International Agency for Research on Cancer). 1977. Asbestos. IARC Monogr Eval Carcinog Risks Hum 14:1-106

Ladou J. 2004. The asbestos cancer epidemic. Environ Health Perspect 112:289-290.

Lynch KM, Smith WA. 1935, Pulmonary asbestosis. III. Carcinoma of the lung in asbestos-silicosis. Am J Cancer 24:56-54.

McCulloch J. 1988. Asbestos--Its Human Cost. Santa Lucia, Queensland, Australia: University of Queensland Press.

Merewether ERA, Price CW. 1930, Report on the Effects of Asbestos Dust on the Lungs and Bust Suppression in the Asbestos Industry. London: H.M. Stationery Office.

Mottura G. 1939 L'interpretaziene patogenetica dell'asbestosi polmonare sulla base del reperto linfoghiandolare [in Italian]. Rass Med Ind 10:321-330.

Nordman M. 1938. Der Berufkrebs der Asbestarbeiter. Z Krebsforsch 47:288-302.

Proktor RN. 1999. The Nazi War on Cancer. Princeton, NJ:Princeton University Press.

Selikoff IJ, Lee DHK. 1978. Asbestos and Disease. New York: Academic Press.

Wagner JC, Sleggs CA, Marchand P. 1960. Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province. Br J Ind Med 17:260-971.

Lorenzo Tomatis

International Society of Doctors for the Environment

Trieste, Italy

E-mail: [e-mail]