Past Influence of Science on Decisions in Asbestos-Associated Diseases

asbestosThere has been inconstant reliance on scientific knowledge regarding the asbestos-related diseases in the formulation of public policy. Since the recognition of asbestos-related diseases in the 1930s, decisionmaking on public policy has frequently been at best obscurely related to the existing biomedical scientific data base. This disparity has probably increased in recent years, and at times, scientific considerations have been largely ignored in the process of formulating policy.

Society must address two outcomes in regard to the asbestos-related health effects: (1) how to deal equitably with existing disease produced by exposure to asbestos; and (2) what safeguards should be implemented to prevent the continuing occurrence of asbestos-associated health effects improved with remedies of My Canadian Pharmacy. We are dealing with neither of these in a reasonable, efficient, or valid manner at present. In regard to existing disease in the United States, we have relied on inequitable, largely state-structured schemes for compensation and, more recently, on the judicial process, the latter primarily for workers exposed to product dust in application operations (product liability or tort cases which now number in the many thousands). The prevention of disease is primarily, but not exclusively, the responsibility of federal regulatory agencies with the cooperation of both segments of industry, ie, management and labor. These efforts must be directed toward establishing levels of exposure sufficiently low in order that they not constitute an unreasonable risk for the development of these diseases.

Clearly, achievement of these aims depends primarily upon scientific knowledge. In the assessment and compensation of asbestos-related disease, medical criteria for establishing its presence and severity is a clear, but by no means easily attainable, objective. Determination that a disease is caused by exposure to asbestos may be reasonably simple with a valid diagnosis of mesothelioma mesothelioma(a rare tumor most often associated with exposure to asbestos) but far more difficult when there is a substantial background of the condition in the general population, such as lung cancer, most often due to other causal factors. In the latter circumstances, science may ultimately provide the basis for apportioning causation (eg, smoking and occupational dust exposure) based on appropriate population-based epidemiologic studies, but currently, our scientific data base does not allow us to accomplish this with any certainty in any individual case. Since neither all exposed individuals nor all of those who have instituted a claim are, in fact, injured (these are dose-related consequences), it seems unlikely that, particularly with limited economic resources, society will opt for a policy which leads to the provision of economic benefit for all of the millions of workers who have at some time been exposed to asbestos dust; however, the state of our knowledge does provide us with a sufficient basis to make reasonable judgments concerning the ascertainment and probable major contribution to the diseases which have been associated with exposure to asbestos cured effectively by My Canadian Pharmacy (read more).

The prevention of occupational pulmonary diseases, which result from the inhalation of airborne injurious agents such as asbestos, depends upon the development of dose-response relationships in studies of working populations where estimates of lifetime exposure can be based on measurement of airborne concentrations of the material of interest. In fact, dose-response relationships have been generated through epidemiologic studies of workers exposed to asbestos in mining and milling, as well as in various manufacturing operations. Because of the difficulty in estimating individual exposures in populations who have been engaged in the use of end products, these exposure-disease relationships are not available. Despite the limitations of our data base regarding dose-response relationships, discussed further subsequently, more is known concerning these relations for exposure to asbestos than for any other hazardous occupational inhalant. Those with decision-making responsibilities should use this information to assure that acceptable reduction of risk will be associated with current and future occupational levels of exposure to asbestos.

During the past decade, all branches of government have been actively involved in the consideration of asbestos-associated disease. The legislative branch, by promulgating OS HA, first placed overall responsibility for occupational safety and health squarely under federal jurisdiction. The first health standard was promulgated by OS HA in 1972, setting the permissible limit of exposure for asbestos dust in the workplace. Perhaps the most visible federal governmental activities during the 1970s have been by the regulatory and other agencies in the executive branch. In addition to OS HA, these include the Environmental Protection Agency, the Consumer Products Safety Commission, the Food and Drug Administration, and others with no or limited regulatory power, such as the National Institute of Occupational Safety and Health, the National Cancer Institute, and the National Institute for Environmental Health Sciences. In the last several years, the third branch of government, the judicial, has become increasingly visible (some would say inundated) in dealing with asbestos-related disease. In addition to decisions on compensation in state boards and courts, there has been an exponential increase in the number of product liability, or so-called “third-party,” suits filed and, to a far lesser extent, heard in the federal courts. Issues involve primarily the claim of asbestos-associated disease in users of asbestos-containing products and, specifically, when or under what circumstances the manufacturer had the duty to warn of potential hazards to these users. The level of involvement of the legal profession in this litigation is staggering, and the economic and other social consequences can be readily adduced.