Los Angeles County is considered a "hotspot" for asbestos cancer. In fact, according to the Environmental Working Group, for the years 1979-2001, Los Angeles County recorded the highest incidence of mesothelioma in the country. Despite being ground zero for meso, for many years meso patients who live here have been advised that the extra-pleural pneumonectomy is the only real hope and the only doctor qualified to perform the surgery practices 2,987 miles away in Boston.

West Coast patients who want to pursue the EPP have a choice. Instead of flying to Boston, they can seek treatment from the very same surgeon who operated on meso patients with Dr. Sugarbaker in Boston from 1992 to 1994 as resident and chief resident of thoracic surgery at Harvard's Brigham and Women's Hospital. His name is Dr. Kemp Kernstine, director of the department of thoracic surgery and lung cancer program at the City of Hope National Medical Center in Duarte, California, just outside of Los Angeles. Like his colleague, Dr. Robert Cameron of UCLA's David Geffen School of Medicine, Dr. Kernstine is one of a handful of thoracic surgeons nationwide with expertise in treating meso who also has a passion for advancing benchwork research on early diagnosis and novel therapies.

Dr. Kernstine takes a pragmatic and humble approach to treating mesothelioma. He believes strongly in the merits of the EPP, but he's not convinced in all cases that the EPP is superior to the P/D. He encourages his patients to consult with as many qualified meso experts as possible. "I encourage patients to get as much information as they can," he says. "There is no standard of care for this disease, and there certainly isn't a magic bullet."

With refreshing candor for a surgeon who learned his craft at Brigham and Women's Hospital, regarded as the home of the multi-modal therapy which features the EPP, Dr. Kernstine has high praise for surgeons such as Dr. Cameron who pursue the P/D. "I would absolutely recommend to meso patients that they get a second opinion from Bob."  In fact, he recently helped a 50 year-old pleural meso patient arrange a consultation with Dr. Cameron.

City of Hope is one of the oldest cancer centers in the U.S., and was one of three hospitals originally designated as a cancer center by the U.S. government. As a member of the Southwest Oncology Group, Dr. Kernstine is part of the umbrella organization for mesothelioma research that is one of the largest of the National Cancer Institute-supported cancer clinical trials cooperative groups in the United States. "The group focusing on mesothelioma includes non-surgeons," Dr. Kernstine explains, "because there are mesothelioma patients for whom surgery isn't an option." Helping develop treatment protocols and flexibility are part of his approach to a poorly understood and aggressive disease.

"At the same time, if a patient has a big, bulky tumor, you need an aggressive approach. If they don't have a lot of disease you can do other things. But for a bulky tumor, with no systemic spread, no nodal involvement, and no mediastinal involvement, the EPP is preferable." Dr. Kernstine is optimistic about possibilities for screening and early detection. "Looking at RNA and DNA to screen for recurrence has promise as well," he says.

With Dr. Cameron performing the P/D and his colleague and friend Dr. Kernstine performing the EPP, Los Angeles is a one-stop shop for meso patients. For more information about Dr. Kernstine and his mesothelioma treatment protocol, or to arrange a consultation, please call 626-256-4673.

Support the Ban Asbestos Ac

Legislation's never perfect. But the Ban Asbestos Act sponsored by Senator Patty Murray gets it 99 percent right, and we support it, along with the 100 other U.S. senators who voted unanimously to approve the bill.

Let your congresswoman or congressman know that you support House bill H.R. 3339, the companion legislation now up for consideration by the House Energy and Commerce Committee.

When the Mesothelioma Applied Research Foundation was asked more than six years ago by Sen. Murray to draft language for a bill that would create a funding stream for benchwork research and treatment strategies, the doctors and advocates on the Meso Foundation's board jumped at the opportunity to help. The bill contained three crucial "first step" provisions which would, for the first time ever, compel the National Insitute of Health to fund research on asbestos-related cancers. It would have funded a registry for mesothelioma incidence, and would have allocated more than $4 million per year for treatment programs at respected cancer centers. The foundation lobbied hard for the creation of a database, tissue bank, and funding for research centers of excellence.

Before this initial push there was little effort to direct national funding in a coordinated, collaborative effort towards basic and applied meso research. At the time, it seemed like asking for the moon. The federal government had simply cast a blind on eye on the research and treatment needs of the asbestos disease epidemic.

Thanks to Sen. Murray's legislation, the moon is now well within reach. The current Ban Asbestos Act, if passed, goes far beyond those original goals and provides $10,000,000 for asbestos disease research in its first four years alone in the form of grants to network institutions researching asbestos-related diseases. The research that this bill will initiate is staggering, but a review of its provisions shows that for the first time federal, state, and local efforts will collaborate and be coordinated to actually find a treatment and cure for mesothelioma.

Critics who correctly note that the bill does not ban all forms of asbestos have a legitimate complaint about the last minute shenanigans that led to this disappointing exception, but this is not a valid reason for derailing the entire bill. Much of the bill's success has been due to the fact that its supporters have refused to be drawn into issues of causation, the one area that will elicit the full-blown wrath and opposition of the asbestos industry. The bill's neutral focus on developing better treatment through research led to an extraordinary alliance between asbestos industry advocates, anti-asbestos advocates, doctors, and trial lawyers. The Ban Asbestos Act currently awaiting congressional approval is true to that initial aim of fighting asbestos disease through funding research.

"This bill will end the orphan status of mesothelioma, where hospitals are forced to beggar their resources as isolated fiefdoms, and where the world's leading researchers are forced to research, treat, and study in a relative vacuum. Asbestos diseases for too long have been a clear and present danger that have gone unnoticed by our government. Under this bill, the federal government will at least take a first step towards stopping the reign of asbestos terror. The bill won't eliminate all asbestos dangers, nor will it fund research commensurate with the scope and evil of the asbestos epidemic, but under our current regime, it's much better than the alternative, which amounts to simply waiting for all occupationally exposed Americans to die," says attorney and advocate Roger Worthington.

For fiscal years 2008-2012, the NIH, in collaboration with federal, state, and local agencies, will establish an asbestos-related disease research and treatment network to support the detection, prevention, treatment, and cure of asbestos-related diseases, with particular emphasis on malignant mesothelioma. The network brings together research initiatives of the National Institutes of Health, and at least ten outside asbestos-related disease research and treatment centers.

These centers will consist of nonprofit hospitals, universities, or medical/research institutions that have exemplary experience and qualifications in research and treatment of asbestos-related diseases, access to an appropriate population of patients with asbestos-related diseases, and are geographically distributed throughout the United States, with special consideration given to areas of high incidence of illness.

In addition, the centers will conduct laboratory and clinical research, including clinical trials, relating to mechanisms for effective therapeutic treatment, early detection and prevention, palliation of symptoms, and pain management. They will offer patients travel and lodging assistance as necessary to accommodate the maximum number of patients practicable, and serve patients at centers able to conduct meaningful clinical trials. Crucially, they will collaborate with the Department of Veterans Affairs to provide research benefits and care to veterans who have suffered excessively from asbestos-related diseases, particularly mesothelioma, and coordinate the research and treatment efforts of the center with the network and the National Virtual Mesothelioma Registry and Tissue Bank.

The bill also directs the NIH to provide to each center a grant of $1,000,000 to support the detection, prevention, treatment, and cure of asbestos-related diseases, with particular emphasis on malignant mesothelioma. Additional research initiatives in the bill are provided by directing the Department of Defense to support research on mesothelioma and other asbestos-related diseases that has clear scientific value and direct relevance to the health of members and veterans of the armed forces, with the goal of advancing the understanding, early detection, and treatment.

The research provisions alone make the legislation worthy of our support. But the fact that it passed the U.S. Senate on a vote of 100 to 0 in a day and age when no one can agree on anything, and the fact that its companion bill now awaits action in the House as H.R. 3339 mean that the time to support this bill is here and now.

According to Dr. Robert Cameron, who drafted the original language for the earlier bill's research provisions in 2001, "Every year we wait, thousands more people are condemned to die from asbestos poisoning. The time to act was 30 years ago. Whatever the best answer is, more foot dragging and apathy are not a part of it."

With 10,000 or more Americans dying every year from asbestos, with the bulk of those exposures having occurred in industrial/construction trades and in the navy, the science is clear that there is no safe threshold for asbestos exposure. Lest anyone equivocate, we believe that all asbestos is evil, and anyone who inhales it is at risk, without regard to age, fitness, wealth, power, gender, or skin color. Because we back this landmark bill does not mean we discount the evils of taconite, vermiculite, or any of the other toxic poisons that even today the asbestosiform mineral industry is unleashing into the marketplace.

We agree with the Meso Foundation's official position on the bill. The full statement by executive director Chris Hahn can be read here.

Make no mistake about it: this law will help meso sufferers right now. The bill's not perfect, and it won't help everyone. If this is the best law we can come up with after eight years of struggle, of investment, of coalition-building, and of non-stop lobbying, what chance do we realistically have of a "perfect" bill if this one fails? Legislation takes momentum, and this bill has it. We would rather accept a compromise that is 99% in our favor rather than the complete defeat that will result if this bill fails.

This bill may be able prolong lives today and will clearly pony up more federal dollars to cure meso tomorrow. It will put millions at the disposal of scientists and surgeons whose lives have been devoted to beating this scourge. Let's use it as a starting point to get the ball rolling. Perfection can wait.

Washington judge rejects Volkswagen's attack on domestic partners

Judge Mary Roberts of Washington Superior Court rejected Volkswagen's effort to perpetuate discrimination against domestic partners when she overruled the automaker's blatantly discriminatory motion that claimed that there is no loss of consortium when the partner is seriously injured. Mesothelioma victim Bill McKnight and his registered domestic partner, Steve Parsons, will be allowed to proceed with the loss of consortium element of their lawsuit against the defendants responsible for Bill's asbestos poisoning. "It was the right ruling," said attorney Roger Worthington. "We're pleased with this fair result."