May 10, 2005

Senator Arlen Specter
Chair Senate Judiciary Committee
United States Congress
Washington, DC

VIA FACSIMILE: (202) 224-9102

         RE: Medical Criteria: Senate Bill 852

Dear Senator Specter:

         There are a number of aspects of the above-referenced bill with which we have disagreement.  This letter will focus on exposure criteria for malignant disease, specifically lung cancer and malignant mesothelioma, as well as for nonmalignant disease.  References to relevant medical and scientific literature are provided.

         The present exposure-duration criteria for lung cancer with which we take issue are set forth in Sections (d)(7)(A)(iii), (8)(A)(ii)(I)(bb), (II)(bb), (III) and (IV)(bb), as well as (8)(B).  For malignant mesothelioma, the exposure criterion with which we take issue is set forth in Section (d)(9)(B)(iv).  For nonmalignant disease, the relevant Sections are (d)(2)(C), (3)(C), (4)(C), and (5)(C).

Lung Cancer

         The data in the medical and scientific literature support a linear dose-response relationship between asbestos exposure and the development of lung cancer.  Although the slope of the line varies depending on the industry in which the exposures occurred, it is nevertheless a straight line.  No threshold has been demonstrated in epidemiologic studies of exposed working populations. 

         The weighting of years of “substantial” exposure to asbestos as part of the Medical Criteria is arbitrary in and of itself, and without basis in the medical and scientific literature.  To compound the effect of this error in judgment by adding the additional requirement for eight to 12 years of exposure, will result in the denial of compensation to many with an asbestos-related lung cancer that will be disabling at best and fatal at worst.

         Section (d)(8)(B) deals with lung cancer in the potential claimant who has smoked cigarettes.  An individual with asbestos exposure and a history of smoking must be referred to a Physicians’ Panel for assignment of “disease category” and “relevant smoking status.”  What does “relevant smoking status” have to do with eligibility for compensation?  Asbestos is a lung carcinogen on its own.  Asbestos and cigarette smoke act synergistically to increase the risk for lung cancer.  Is cigarette smoke to be used to bolster the claim to compensation for lung cancer?  Or is cigarette smoke to be used to refute the claim.  In our opinion, based on the relevant scientific literature, a history of cigarette smoking should only serve bolster the claim and make referral to a Physicians’ Panel irrelevant and unnecessary. 

Malignant Mesothelioma

         We are relieved to find that the S. 852 does not contain an exposure-duration criterion for malignant mesothelioma, as the scientific literature irrefutably shows that low level exposure to asbestos increases risk for malignant mesothelioma.  Accordingly, we believe that a history of any “other identifiable to asbestos fibers” is basis for compensation for malignant mesothelioma.  Review by a Physicians Panel should not be necessary.

Nonmalignant Disease

         Similarly, for nonmalignant disease, weighting of years of exposure is arbitrary.  Much shorter periods of intense high level exposure to asbestos can result in the development of nonmalignant asbestos-related disease. 

         Thank you for your attention to our comments.

Very truly yours,

L. Christine Oliver, MD, MPH, MS, FACPM         

Michael R. Harbut, MD, MPH, FCCP
Chief, Center for Occupational/Environmental Medicine – Royal Oak, MI

Cc: Senator Edward Kennedy

REFERENCES

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Becklake MR.  Asbestos-related diseases of the lung and other organs:  Their epidemiology and implications for clinical practice.  Am Rev Respir Dis 1976; 114:55-95.

McDonald JC. Asbestos and lung cancer: has the case been p.roven? Chest 1980;78:374-376

Dement JM, Harris RI, Symons MJ, Shy CM.  Exposures and mortality among chrysotile asbestos workers.  Part II: Mortality. Am J Ind Med 1983;4:421-433.

Chahinian AP et al. Diffuse malignant mesothelioma. Prospective evaluation of 69 patients. Ann Int Med 1982;96:746-755.

Howel D et al. Routes of asbestos exposure and the development of mesothelioma in an English region. Occup Environ Med 1997;54:403-409.

Hillerdal G. Mesothelioma:cases associated with non-occupational and low dose exposures. Occup Environ Med 1999;56:505-513.

Report to Congress on Workers’ Home Contamination Study, Conducted Under the Workers’ Family Protection Act. US DHHS  CDC/NIOSH   1995.

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Newhouse ML, Thompson H.  Mesothelioma of pleural and peritoneum following exposure to asbestos in the London area.  Br J Ind Med 1965;22:261-269.

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Aroesty J, Wolf K.  Risk from exposure to asbestos.  Letters. Science 1986;234:923.

Anderson HA, Hanrahan LP, Schirmer J, Higgins D, Sarow P. Mesothelioma among employees with likely contact with in-place asbestos-containing building materials.  Ann NY Acad Sci 1991;643:550-572.

Lilienfeld DE.  Asbestos-associated pleural mesothelioma in school teachers:  a discussion of four cases.  Ann NY Acad Sci 1991;643:454-458.

Stein RC, Kitajewski JY, Kirkham JB, Tait N., Shinha G, Rudd RM.  Pleural mesothelioma resulting from exposure to amosite asbestos in a building.  Respir Med 1989;83:237-239.

National Research Council National Academy of Sciences.  Asbestiform fibers-nonoccupational health risks.  Washington, DC:  National Academy Press, 1984.

*** POSTED MAY 11, 2005 ***