Dr. Harbut Retracts His Support for the Ban Asbestos Bill

[Guest guest]

Many on this list have worked greatly in support of the recent passage of

Sen. Murray's " Ban Asbestos Bill " , including me. I think Sen. Murray is the

best.

That having been said, some well-meaning staffers apparently traded support

from a number of industry trade associations for the EXclusion of

vermiculite, taconite and talc in the Bill which ultimately passed the Senate.

Now,

regardless of the nuances of the industrial hygiene and geology, workers who

are

exposed to these 3 fibers get asbestos related diseases and cancers.

I have decided I just can't betray the science or my patients with support

of this bill in it's present form. A number of our colleagues and I are

working on an appropriate sign-on letter for all the occupational health

professions represented on this list, but I've pasted below an " op-ed " I wrote

for

physicians, but which was rejected by JAMA, in hopes of engendering discussion

and debate.

The Seattle Post-Intelligencer remains the " paper of record " for our area of

medical and scientific interest, and it's Investigative Chief,

Schneider, continues to keep a watchful eye on events and report them with great

accurracy. See the Seattle PI archives for great detail

In any case, a Happy New Year to all, in which it is clear we have our work

defined.

I sure do welcome comments on the rejected article below, the proposed

" sign-on " and all related thoughts.

“Primum Non Nocereâ€

I am the Co-Director of the National Center for Vermiculite and

Asbestos-Related Cancers at the Karmanos Cancer Institute in Detroit.

My team is deeply involved in working toward diagnosing, treating and

preventing cancers caused by exposure to asbestos. We don't do professional

expert

witness work. We don't have any special relationships with lawyers. We do

as doctors, researchers and scientists are supposed to do when they are

involved in attempting to defeat a disease.

We fight like hell.

One of the ways in which we have fought is to attempt to prohibit the use of

asbestos and asbestos containing products in the United States. Contrary to

what many people believe, asbestos use is still legal in the United States,

and its regulation is at best weak.

You may recall that in early December the Asbestos Disease Awareness

Organization released a report which identified asbestos fibers in children's

toys

and common household products. The results were startling. A few years ago,

investigative reporter Schneider of the Seattle Post-Intelligencer

found asbestos in crayons.

To help stop these practices, and to help reduce the projected 10,000 deaths

per year from asbestos related diseases, I testified in front of the United

States Senate in support of Senate Bill 742 which promised to prohibit the

use of asbestos containing products in the United States. It was modeled on

similar prohibitions passed throughout Western Europe and the rest of the

world.

The bill was not perfect at its inception. It relied on data which was not

as current as I’d like. Physicians in my specialty know that asbestos fibers

may best be defined as those minerals which cause asbestosis, pleural plaques

and asbestos cancers. The definition of asbestos fibers under which

medicine, science and industrial hygiene now labor, was actually formulated by

the

government almost three decades ago. It is as accurate as any medical

knowledge which is thirty years old and formed by government committee.

That having been said, most physicians and scientists working in the field

supported the bill, because it was an important step in the reduction of

asbestos diseases.

I was in Washington, DC on October 5th of this year when United States

Senators addressed a group of patients, advocates and physicians at the

Mesothelioma Applied Research Foundation's annual " lobbying day. " Years

earlier, I,

along with one of my patients, had testified in support of this bill, and in

October, while in the same hearing room, we were informed that the bill had

just unanimously passed the United States Senate.

Upon hearing the news of passage in that same room where my patient and I

had together testified, my emotions were difficult to keep in check. On one hand

I was thrilled, on the other I felt that this step had taken too long.

This story does not have a happy ending.

We learned some days later that the staff people who were responsible for

" negotiating " a compromised bill had negotiated away the inclusion of products

which contain less than 1% by weight of what the government was now defining

as asbestos. That meant that my patient who died shortly after his testimony

would not be included as having died from " asbestos cancer " by his

government.

Furthermore, it meant that products containing vermiculite from Libby,

Montana, the site of a national asbestos scandal, and talc from New York, which

also contains asbestos, would be exempt from the regulation established by this

new law.

At first I was numb. I spoke with my colleagues at the Environmental

Protection Agency and my colleagues in Libby, Montana to see if I was somehow

misreading the change which was negotiated without our consultation. I spoke

with

a retired Assistant Surgeon General who had run the National Institute of

Occupational Safety and Health.

I told them that in spite of the work of so many and in spite of the heart

and soul which had been poured into this effort, I felt that if this bill were

made into law, it would ultimately do more harm than good.

And so did they.

I was contacted by Senate staffers, as were some of the other physicians and

scientists involved, and attempts were made to convince us that this was the

best that could be done. That it was a first step. That it had to be

understood that this is how politics works. That it could be " fixed " later.

I was on the Board of Directors of the Mesothelioma Applied Research

Foundation. I told the Chair and the Executive Director that I could not face

my

patients who are sick or dying from exposure to taconite, vermiculite or talc

and tell them that I compromised away their reality in favor of a " first

step. "

I offered to resign from the MARF Board in order to allow the organization

to speak with a unified voice in support of the bill. My offer was accepted.

Now, I must tell you that I am no stranger to making tough, uncomfortable,

medical decisions. When I was the medical director of the refugee camp at

Goma, Zaire during the Rwandese Civil War, I poured fresh water and oral

rehydration solution into oil cans held up by 8-year-olds. There was still oil

residue in the bottoms of some of those cans.

I knew that I was giving some of these kids serious kidney disease or liver

disease along with their water and ORS. I knew that some of them would get

leukemia as a result of this exposure to benzene and these petroleum products.

Everyday of my life I think of this. I actually do weep.

It was a choice, allow the child to die that night, or give them water and

rehydration in a tainted container. May God forgive me if I made the wrong

decision.

So why am I writing this " piece of my mind " ?

When physicians become involved in public policy, the process and the

entrapments can be very heady stuff. I never dreamed I'd be testifying before

the

United States Senate, and that they would listen to me.

Consequently, I believe that it is very easy to lose sight of the primary

duty of a physician. Galen taught us: " First, do no harm. " He had it right

then. He’s got it right now.

This was the basis that I used to decide that the situation as it exists

today in regard to the regulation of asbestos is safer for patients and the

public than that which would be created by the bill which passed the United

States Senate, which excludes from consideration significant amounts and types

of

asbestos and asbestos containing products, but claims to “ban asbestos.â€

People will die from asbestosis and asbestos cancers as a result of exposure

to these products. They are products that the government has excluded from

its definition of asbestos.

I am, nonetheless, troubled by this decision. I hope I am doing the right

thing.

I hope I can influence enough United States Senators and United States

Representatives to amend this bill to actually ban asbestos. I had also asked

my local Medical Society, my State Medical Society and the AMA to endorse the

original bill. I had asked the American Thoracic Society to endorse the

original bill. I had also asked the American College of Occupational and

Environmental Medicine and the Association of Occupational and Environmental

Clinics to endorse the original bill.

I find myself now in the humiliating position of having to ask these

excellent organizations to reconsider their endorsements based on our unique

and

special role as physicians, whether we are practicing in an examination room or

a hearing room.

In honesty, I feel betrayed by the staff people and senators who welcomed my

testimony; that of my patient who died from lung cancer as a result of

taconite exposure; and the testimony of my colleagues, and then without

consulting

us, changed the bill to exclude taconite, vermiculite and talc and similar

asbestos-containing products.

They explained to me that this is the way Washington works. This is the way

politics is. I need to be " realistic. "

But I am not a politician. My involvement in this public policy debate, as

that of so many physicians, is an extension of my work to protect my patients

and to help them live, to be free from disease and to reduce suffering.

We must first do no harm. If physicians do not act in an uncompromising

fashion on issues like this, then to whom can our patients turn for an

unwavering, steadfast commitment to their well-being?

I think that when physicians lose sight of their first obligation, the

consequences can be dreadful. History is full of such examples.

So we must consistently and predictably act to " First, do no harm, " in spite

of obstacles and dangers and pressures, for this is the ethos of the

physician.

R. Harbut, MD, MPH, FCCP

Co-Director, National Center for Vermiculite and Asbestos-Related Cancers

Karmanos Cancer Institute

Wayne State University

Center for Occupational and Environmental Medicine

118 N. Washington

Royal Oak, Michigan 48067

248.547.9100

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