• Bruce Case, M.D. to Roger Worthington  "This is to inform you that your website posting regarding Marilyn Bertrand contains inaccurate medical description and false allegations regarding the asbestos mines ..."(8/17/98)

• Roger Worthington responds to Dr. Case "Thank you for your comments and the friendly "heads up." I always appreciate a little notice before the storm. " (9/11/98)

• Dr. Bruce Case " I have only ever done that once, and it was obviously a silly thing to do and I won't do it again." (4/19/01)

• Bruce Case, MD, EPA Consultant for Asbestos: Misrepresentations and Slander Against Other Scientists  (4/16/04)

          RE:   "Without Prejudice"

This is to inform you that your website posting regarding Marilyn Bertrand contains inaccurate medical description and false allegations regarding the asbestos mines at Thetford, Quebec. Particularly irksome are your comments regarding the statement: "In 1949, Dr. Garret Schepers learned during a visit to the Thetford Mines that the treasurer of Asbestos Corporation, Ltd. had recently passed away because of pleural mesothelioma". The problems with this statement are as follows:

1. The term pleural mesothelioma was not used in Quebec at that time.

2. The widely cited documentary evidence for this case has been checked against the medical records and found not to correspond to them.

3. The "treasurer" of a company is not someone with light exposure. Even a resident of Thetford Mines who did not work in the mines would have had an exposure in excess of 1 fiber/ ml in this era, but more to the point you are unaware of the work history of this "treasurer".

4. Mesothelioma is not caused by casual exposure to asbestos. Many Thetford Mines and Asbestos Township residents (and myself, I might add) keep asbestos rocks in their houses as ornamental pieces. There is no excess of disease as a result (please see our recent New England Journal article on lung cancer and the upcoming letters which accompany it).

5. Chrysotile asbestos rarely, if ever, causes mesothelioma. Mesothelioma in the mines of Quebec has been proven to be due to amphiboles, and to occur exclusively in those with occupational exposure. Please see: [Citations at the end of this letter] * * *

Finally, the course of disease you describe indicates that the case in question is peritoneal. No peritoneal mesothelioma has EVER been described in relation to chrysotile mining, even at the highest levels of exposure. However, misdiagnosis of serous papillary carcinoma of the ovary or peritoneum is probably responsible. This disease has no relation to asbestos exposure. Incidentally, in Quebec, 70 to 75% of mesotheliomas among women are not related to asbestos exposure. Those few that are have been occupational, caused by commercial amphibole exposure in the gas mask and other industries, have been compensated by the Provincial Board responsible.

I strongly suggest, for your own protection, that you remove this page from your site.

Regards,
Bruce Case, MD, MSc, D. Occup. Hygiene, FRCP(C)
McGill University and University of Quebec
Departments of Pathology, Epidemiology, Biostatistics and Occupational Health.

September 11, 1998

Dear Dr. Case:
Thank you for your comments and the friendly "heads up." I always appreciate a little notice before the storm.

You obviously feel very passionate that asbestos isn't so bad. Generally speaking, passion is a good thing. But passion without compassion, in my opinion, can quickly rot and give off a foul stench. Myself? I am prejudiced against the companies who have conspired to poison millions of innocent people all over the world. I guess that comes from having watched some of the best people on earth suffer and die a horrible death because of asbestos. All of this was preventable. You sound like a smart man. You've read the literature. I'm sure deep down you agree.

You have "strongly" suggested, "for [my] own protection, that [I] remove this page from [my] website." The page in question [http://www.mesothel.com/pages/bertrand.htm], entitled "The Serpent in the Rock," is a story about a courageous young lady, Marilyn Bertrand who was diagnosed with both pleural and peritoneal mesothelioma. She recalls sleeping with a "furry" asbestos rock that she would snuggle with in her bed at night as a child. The asbestos rock was given to her by her brother who worked at the Thetford Mines in Quebec.

You want me to remove this "for my own protection?" So that we're clear, explain to me why I need to protect myself. From whom? For what? There has been a long and sordid history of the asbestos industry attempting to silence its critics. I hope you are not part of that nefarious effort.

You assert several bizarre theories. Now let me assert the prevailing views on these subjects:

1. Pleural Mesotheliomas were reported in the medical literature by 1943. The first U.S. report of mesothelioma in connection with asbestos exposure was in 1947. Many authors have written that the serious health effects of asbestos were known in the industry long before they were reported in the medical literature. Many U.S. juries have agreed that the asbestos industry did indeed sponsor a cover-up.

2. All fiber types, including chrysotile, cause disease, cancer and mesothelioma. There may be differences in the degree of tumorigenicity. But what does it matter to the victim? Whether crocidiolite is more or less deadly than chrysotile is of little consequence to a man with a baseball sized tumor shooting out between his ribs. We can rank the carcinogenic potential of fiber types all day, but in the end, isn't that like asking who was meaner: Hitler or Stalin? Whether you kill 100 or 100,000, we're still talking about an atrocity that was idiotic and totally preventable.

3. The chrysotile asbestos from the Thetford mines (or any other mine in Quebec) is hardly as benign as mother's milk. Begin, et al. studied a group of pleural mesotheliotics who were exposed in Thetford and Asbestos and concluded that there was a big increase in the rate of mesothelioma among chrysotile miners and millers. Dr. Begin's team ruled out tremolite "contamination" as a significant factor (question: how do you contaminate poison?). Dr. Roggli has also debunked the argument that chrysotile does not cause mesothelioma in American industrial and shipyard workers. Dr. Suzuki has concurred. But that does not stop The Asbestos Institute and its apologists from continuing to promote the exportation of chrysotile throughout the world.

4. The argument that chrysotile asbestos does not cause peritoneal mesothelioma is more piffle and nonsense. In Marilyn Bertrand's case, she was first diagnosed with pleural mesothelioma and the disease later spread to her peritoneum. Many "peritoneal" mesotheliomas originate within the thoracic cavity in the mesothelium covering the diaphragm. There are small channels through the diaphragm known as Virchoff's pores. Virchoff identified these more than a hundred years ago by inserting ordinary India ink into the pleural space. He found that the black ink transfers speedily from the pleural cavity into the abdominal cavity. We now know that the Virchoff pores are not the only routes taken by the asbestos fibers, as many also arrive via the lymphatics of the pleura. If India ink carbon particles can so transfer, so can asbestos fibers that are vastly smaller. So too can mesothelioma cells which start above a diaphragm. A small cluster of mesothelioma cells can burrow through the diaphragm and resurface in the abdomen. In addition, because there is more space below the diaphragm than above, tumor cells more readily move into the space below, and a small diaphragmatic mesothelioma will sometimes present as a large peritoneal mesothelioma. Pathologists who evaluate an abdominal tumor seldom look for a primary site above the diaphragm and vice versa.

5. There is probably no safe level of exposure to asbestos, below which mesothelioma will not occur. Asbestos in North America is ubiquitous, thanks in large part to our neighbors to the North. A percentage of our population may be susceptible to mesothelioma, even at very low levels of exposure. The notion that asbestos could not have caused mesothelioma where the asbestos body count is below 20 bodies/g wet lung tissue is probably flawed since chrysotile fibers do not readily form asbestos bodies. In fact, it has been reported in the literature since the early 1940's that chrysotile causes cancer, but does not leave "the proof in the pudding", i.e., asbestos bodies. It is also probably fallacious to state that "everyone has asbestos in their tissue." The asbestos lawyers like to espouse this view to American juries. It is supposed to be comforting, I guess. But it seldom works.

6. The number of people in the U.S., Great Britain, France, Australia and probably Canada who are contracting mesothelioma is increasing each year. Churg recently told a group of lawyers that in the U.S. we can expect around 3,000 new mesothelioma patients each year until about 2050. In England, the government projects that each year, 10,000 Brits will contract mesothelioma by 2020. The snake is getting hungrier. And Canada continues to export the poison to "developping countries."

7. To my knowledge, the asbestos industry has never spent a nickel on research to find a cure for mesothelioma. They have however, spent millions -- perhaps billions -- on phony class actions, bloodthirsty defense lawyers, inept trial experts, compromised medical consultants, fraudulent asset transfers, and bogus bankruptcies. I suppose if they spent money to find a cure for mesothelioma they would have to admit that asbestos is deadly dangerous. They would rather invest their money in pimpery and legal tomfoolery than in finding a medical cure for the disease and death they have wrought.

You found "particularly irksome" the following statement: "In 1949, Dr. Garret Schepers learned during a visit to the Thetford Mines that the treasurer of Asbestos Corporation, Ltd. had recently passed away because of pleural mesothelioma." First, you object that the term "pleural mesothelioma" was not used in Quebec at that time. I think this is somewhat sad. The article is about a young lady with mesothelioma whose only known exposure was to asbestos rock that originated from the Thetford Mines -- a horrible place that first began producing mesotheliomas at least by 1949, making her disease TOTALLY PREVENTABLE if not for corporate greed and stupidity. You seem to suggest that because her exposure history does not fit your defintion of "occupational" that her mesothelioma is trivial. I'm "irked" that this innocent young woman was poisoned with asbestos from the Thetford Mines and now has to spend each day of the rest of her life courageously fighting the evil wrought by the wicked white powder.

But to relieve your pain over the accuracy of the above sentence, please see the article published by Dr. Paul Cartier, "Abstract of Discussion", AMA Archive of Industrial Hygiene and Occupational Medicine, Vol. 5, pp. 262-63 (1952). Dr. Cartier writes about two cases of pleural mesothelioma, including the case of William Cooling, who was the Treasurer for Asbestos Corporation. The article indicates that Mr. Cooling had no occupational exposure but worked for many years (since 1920) in an industrial setting. Also see Barry Castleman's treatise, "Asbestos: Medical and Legal Aspects," 4th Ed., pp. 77--81 (1996).

I was somewhat intrigued by your pique over this piece of arcane history so I corresponded with Dr. Gerrit Schepers to further check the timeline. He assured me that the content of the "offensive" statement was basically correct, although the date was off by a few years and the venue for his meeting in 1949 was in Asbestos, Quebec, not Thetford. Dr. Schepers, a living legend who knows as much or more about the asbestos cover up than anyone, opened my eyes to a few more details.

So, in the interests of historical accuracy, and in effort to shed more light on the conspiracy between U.S. and Canadian asbestos companies to cover up and suppress medical data on the health dangers of asbestos, let me revisit this old issue on which much ink has been spilled. (See Barry Castleman's book for the full picture).

In 1949, Dr. Schepers met with Drs. Paul Cartier and Kenneth Smith at Johns-Manville Company in Amianthus ( Asbestos), Quebec. Dr. Cartier managed a health clinic in Thetford Mines, and Dr. Smith was the Medical Director for Johns-Manville. Dr. Schepers was an occupational lung disease specialist from South Africa. While at the Saranac Laboratory in New York, Dr. Schepers examined a large accumulation of lung tissue samples from deceased Thetford employees. The samples had been sent to Saranac for research since 1942. Dr. Schepers advised Drs. Cartier and Smith in 1949 that there were two cases of "pleural mesothelioma" on file in the Blackman Library of the Saranac Laboratory, under the heading "Quebec Asbestos Industry Cancer Cases." These two cases had been hand-delivered to Saranac by the lawyer for the Quebec Asbestos Mining Association (QAMA), Ivan Sabourin.

However, the two pleural mesothelioma cases referenced by Dr. Schepers did not include the "Secretary-Treasurer" data (i.e., "the Cooling case"), as that case had not yet been referred to the Saranac Laboratory by 1949. Dr. Schepers learned of "the Cooling case" after 1952, when Dr. Cartier himself published the abstract identified above. Mr. Cooling died in 1949 and was presumably a patient of Dr. Cartiers -- but Dr. Cartier apparently did not mention this to Dr. Schepers.

Interestingly, Dr. Schepers mainly studied tumor tissue from retired Thetford asbestos workers. It seems that these workers had developed their cancer AFTER they retired. Consequently, their families were barred from recovery under Quebec's statute of limitations. Conversely, Drs. Cartier and Smith were allowed to study only "working" asbestos workers. The six (6) cancer cases they conceded knowing about in 1949 were all active worker cases. They likely had no knowledge of the Saranac Laboratory's eleven (11) cases, as those cancers had developed AFTER the men had retired. This "6 plus 11" situation was astonishing because all seventeen derived from the same pool of 6000 employees. In a control group of 5000 saw mill workers, there were five lung cancer cases. Thus, the asbestos workers displayed a 3x higher incidence of cancers than the control group. Therefore, the (unpublished) research at the time grossly under-reported the incidence of cancer among the exposed population by excluding retirees. Because of the latency of asbestos cancer, the retirees were at relatively greater risk than their younger counterparts, which raises the specter that their exclusion from the research was a matter of corporate influence rather than clean science.

Between 1950 and 1953, the Saranac Lab received tissue from four other mesothelioma cases from Canada. In 1954, Dr. Schepers visited with Dr. Vorwald about all of the accumulated cancer cases. Dr. Vorwald was the Director of Saranac Laboratory, which had been commissioned by QAMA and others to prove that asbestos was relatively benign. Dr. Schepers encouraged Dr. Vorwald to publish the available research which showed an unusually high incidence of lung cancer among asbestos miners. Dr. Schepers, who eventually succeeded Dr. Vorwald at Saranac, reported that by 1957-1958, there were data on about 90 asbestos-associated cancers. Most of these lung cancers were from Quebec, but others originated from several asbestos textile industries in the United States.

But Dr. Vorwald would not budge. He simply would not write about or publish any articles about these known cases of asbestos cancer. Why? First, Dr. Vorwald had an agreement with the asbestos industry not to publish anything about asbestos health problems without their prior consent and right to edit. Second, Dr. Vorwald was a consultant to the asbestos industry and his medical integrity was probably compromised. And third, Dr. Vorwald's specialty was bacteriology, and he may have lacked the expertise to expound on issues relating to pathology anyway (which raises the question, why was he hired by the asbestos companies in the first place?)

Dr. Schepers himself had experienced pressure from the asbestos industry to keep quiet. In 1950, he prepared an unpublished thesis that reported on the high incidence of cancer among Canadian miners and millers. He handed the thesis to Dr. A.J. Lanza, who in turn handed the document over to Vandiver Brown, the top lawyer for Johns-Manville. In a face to face meeting, Mr. Brown asked Dr. Schepers to suppress the report. Why? Mr. Brown, who probably has done more to sully the name of lawyers than anyone, frankly admitted that bringing attention to the disease and death caused by asbesos would harm the economic interests of Manville. Dr. Schepers refused to scuttle his work, as he was duty-bound to give his thesis to the South African Government. The report, however, was never published.

So, in summary, Dr. Schepers certainly knew about pleural mesothelioma in 1949; he discussed two pleural mesothelioma cases originating from the Canadian mines with Dr. Cartier and Dr. Smith in Asbestos, Quebec in 1949, Mr. Cooling died of pleural mesothelioma in 1949 after working for Asbestos Corporation Ltd as a secretary treasurer at the Thetford Mines since 1920; and Marilyn Betrand would not have mesothelioma today if the owners of the mines and mills in Thetford cared more about people than they did about peddling asbestos for profit. Period.

If you have information to the contrary, please share it with us. If the details of the "Cooling case" are sketchy beyond what we know from the available Vorwald files or from Dr. Scheper's memory, the Quebec mining companies and their government sponsors could go a long way to clear things up if they would open up Cooling's file. Under the Quebec Records Concerns Act, the parties with knowledge are protected from having to disclose what they know to "outsiders."

And so, I ask you, what is your interest in this debate? Who do you work for? Have you ever been hired by an asbestos mining, milling, manufacturing or lobbying company? I know that your immediate employer, McGill University, does not exactly have a spotless record. We both know that back in 1926 the Metropolitan Life Insurance Company founded the Department of Industrial Hygiene at McGill. And we both know about the asbestos industry's efforts historically to suppress or influence medical data regarding the severity and incidence of disease from the asbestos mines in Quebec.

You chose the words "Without Prejudice" to introduce your E-mail to me. I make no bones about my bias. Asbestos is evil and those responsible for the pain, suffering and death of thousands of people worldwide should be held accountable. I don't pretend to be pious. I teach my son not to trust anyone who claims to speak the absolute truth or with absolute moral authority. The issue, it seems to me, is whether a man's bias is fair or unfair.

Since you introduced the subject, please be honest with me and disclose whether you have ever been financed, as a testifying legal expert or researcher, by an asbestos manufacturer, miner, miller or trade association. And can you please explain why the Asbestos Industry is fighting so passionately against efforts by the French to remove asbestos from French Universities?

Best Regards,
Roger G. Worthington, Esq.

In addition to Barry Castleman's work, please see the work of David Egilman, Ph.D, in particular: "The Origin and Development of the Asbestos Threshold Limit Value: Scientific indifference and corporate influence", The International Journal Of Health Services Research, Vol 46 Number 4 October 1995. Also see Dr. Sam Hammar's excellent textbook, Pulmonary Pathology, Chapter 34 (Pleural Diseases).

One more note: American juries are not usually fooled by the "Fiber Defense." The Canadian asbestos companies first created this defense as a sales gimmick back in the 1930s. They touted their chrysotile asbestos as "safe", as opposed to the other fiber types from other countries. But all fiber types cause disease and death. Even the asbestos industry's best friend Dr. A.J. Lanza acknowledged the deadly potential back in 1937. Referring to Mr. Dewey's theory that some asbestos fibers are more hazardous than others, Lanza wrote: "I do not know what to say about Mr. Dewey's opinion and I cannot imagine upon what the opinion is based. Of course, the asbestos people in Canada have advanced that idea for some time as an explanation of why asbestos seems to be more clinically severe in England than in this country but I have always had the feeling that their argument was motivated by self-interest rather than to make a scientific contribution."

*** Citations included in body of Dr. Case's letter:

• Case, B.W. and Sébastien, P. (1987). Environmental and occupational exposures to chrysotile asbestos: A comparative microanalytic study. Arch Env Health 42:185-191.

• Case, B.W., and Sébastien, P. (1988). Biological estimation of environmental and occupational exposure to asbestos. Ann Occup Hyg 32:181-186.

• Case, B.W., and Sébastien, P. (1989). Fibre levels in lung and correlation with air samples. IARC Sci. Publ. 90:207-218.

• Case, Bruce W. (1991). Health effects of tremolite: now and in the future. Annals New York Acad. Sci. 643:491-504.

• Case BW. (1994) Biological Indicators of Chrysotile Exposure. Annals Occup Hygiene 38(4):503-518.

• Becklake, M.R. and Case, B.W. (1994) Fiber burden and asbestos related lung disease - determinants of dose-response relationships. American Journal of Respiratory & Critical Care Medicine. 150(6):1488-1492.

• Barrett JC, Bernstein DM, Bignon J, Case B et al. (1996) (28 authors).Consensus Statement. In: Kane AB, Boffetta P, Saracci R and Wilbourn JD, eds. Mechanisms of Fibre Carcinogenesis. IARC Scientific Publications 140: 1-9. International Agency for Research on Cancer/ World Health Organization. Lyon.

• Bruce W. Case, Andrew Churg, André Dufresne, Patrick Sébastien, Alison McDonald and J.C. McDonald. (1997). Lung Fibre Content for Mesothelioma in the 1891-1920 Birth Cohort of Quebec Chrysotile Workers: A Descriptive Study. Annals of Occupational Hygiene, 41:231-236

• McDonald AD, Case BW, Churg A, Dufresne A, Gibbs G, Liddell, F.D.K., Sébastien P., and McDonald JC. (1997) Mesothelioma in Quebec chrysotile miners and millers: epidemiology and aetiology. Annals of Occupational Hygiene 41(6):707-719.

• Case, B.W. (1993) Lung fibre content as a marker of low-level asbestos exposure. in: Gibbs, G., Dunnigan J., Kido, M. and Higashi T., eds. Health Risks from Exposure to Mineral Fibres: An International Perspective.  Captus University Press, North York, Ontario, pp. 326-333.

*** POSTED SEPTEMBER 11, 1998 ***

On April 19, 2001, Dr. Case testified in the case John Hance, et al., Plaintiffs vs. ACandS, Inc., et al., Defendants, In the Circuit Court for Baltimore City, Consol. No. 24-X00000374.

He was questioned about his views regarding chrysotile asbestos and any discussions he may have had with other attorneys:

Page 3415:  Line 18 - 20 
Q.  On that web site you have free flowing discussions with individuals about your views about chrysotile, don't you?

Pgs. 3415-3416:  Line 21, 1 - 2: 
A.  Well, I haven't devoted much attention to it lately, but that is the general idea.  That is what I would like to do, yeah.

Line 3 - 6: 
Q.  In fact, sometimes you feel so strongly about that that you send E-mails to plaintiffs' lawyers about their position about chrysotile, don't you?

Line 7 - 9: 
A. I have only ever done that once, and it was obviously a silly thing to do and I won't do it again.