Br J Ind Med: first published as 10.1136/oem.48.6.430 on 1 June 1991. Downloaded from

430 Forum

49 Muehleck E. Letter to WWF Sheperd bles paranoia. In the so that the statement (Turner and Newall). 8 March, 1943. fully developed , that 50 Hardy HL. Personal communications, form of this psychosis the individual the disease was "discovered by the 1982, 1989. adopts a false premise and then uses ancients," while adding historical 51 Brown V. Letter to E Muehleck (Keas- every device of selection and bias to colour and apparent verisimilitude, is bey & Mattison Co) and JFD Rohr- bach (Raybestos-Manhattan). 22 support it. In the case of a person who manifest nonsense. October, 1948. thinks he is Napoleon or she is the This temptation to dramatise and 52 Brown V. Letter to sponsors (Amer Virgin Mary it is easy to recognise the emotionalise is apparent throughout Brake Shoe, Gatke Corp, Keasbey false premise. is the whole book. I have not and Mattison, Raybestos-Manhattan, It less easy with a counted the Thermoid Corp, Union Asbestos and subject which has been ventilated in emotional adjectives but the book is Rubber Co, Russell Manufacturing the media over the last 25 years to such liberally besprinkled with them while Co, United States Gypsum Co). 27 an extent that the average man in the the author flogs himselfinto a lather of October 1948. 53 Brown V. Letter to WT Kelly (Amer street tends to agree with the premise indignation. One early example is a Brake Shoe). 12 November, 1948. or something very like it-that asbes- reference to the "devastating" pul- 54 Lanza AJ. Letter to AJ Vorwald. 14 tos has been an unmitigated disaster monary disease at the beginning ofthe December, 1948. and that it should be banned. century. There was such a but 55 Vorwald AJ, Durkan TM, Pratt PC. disease, Experimental studies of . In support of his hypothesis Mr it was called pulmonary tuberculosis Arch Ind Hyg Occup Med 1951;3: Castleman has combed the world and this was such an ever present 1-43. literature in a remarkable way. It is a disease that when Dr Murray dis- 56 Brown V. Letter to sponsoring compan- ies (see ref 54). 21 March, 1951. pity that a book which has been so covered the first case of asbestosis in 57 Vorwald AJ. First interim report/asbes- painstakingly researched should start 1899 he did not publish it, even as a tosis andpulmonary cancer (to Quebec with a false premise and arrive at medical curiosity. He must have dis- Asbestos Mining Assn) Saranac Lake, entirely the wrong conclusions. It is cussed it with his colleagues because NY: Saranac Laboratory, 7 May, 1952. Vorwald archives, Armed For- characteristic of paranoia that the he was invited to give evidence to the ces Institute of Pathology, Washing- arguments are logical and well presen- Department Committee on Compen- ton, DC. ted. It is the conclusion that is wrong, sation for Industrial Diseases in 1906 58 Woodward JP (Johns-Manville). Min- utes of discussions held at Saranac because it is arrived at in advance of to which Mr Castleman makes Lake on 7 November, 1950-14 the evidence and derives from emotion reference. November, 1950. Vorwald archives. rather than scientific balanced At the beginning of the century 59 For export only. Canadian Broadcasting appraisal. there was a deal of Company; broadcast 4 October, 1988. great interest in 60 Kamal AAM, Sayed GM, Hassan MH, The difficulty is that he is not industrial disease. The priorities were Massoud AA. Usage of personal entirely wrong. Asbestos is a dan- lead and mercury poisoning from protective devices among Egyptian gerous material which has killed many which people were obviously dying, industrial workers. Am J Ind Med 1988;13:707-16. people and will continue to do so, and phossy jaw, which destroyed the though less and less as our knowledge beauty of young women. The Reply by Murray increases. Our main problem is that occupational chest diseases were so Sir,-Castleman chooses to criticise the effects of exposure are delayed up obscured by tuberculosis that the http://oem.bmj.com/ my account ofthe chronology ofasbes- to 40 years, during which time our Departmental Committee of 1907 in tos and its effects. I don't mind him expectations are increasing and our the United Kingdom found itselfuna- doing this, for none of us is perfect. diagnostic methods are improving so ble to define these diseases adequately After all, I criticised his book, "Asbes- that we have to run fast to stay in the for compensation purposes even tos: Medical and Legal Aspects." same place. Moreover, medicine has though the existence of potters rot, Contrary to what he says, however, my always had its priorities. Some grinders asthma and ganister disease review was not rejected for publica- subjects take the centre of the stage were well known. It was not until 1918 tion. It was never submitted. I was according to social demands of that the role of silica became manifest asked my opinion ofthe book by one of medical advances. What Mr Cas- and this became the priority in on October 1, 2021 by guest. Protected copyright. my colleagues in the London School of tleman does is to turn the spotlight, the research into occupational pulmonary Hygiene and, having an unexpected blinding light of hindsight, on what disease to such an extent as to limit the weekend to spare, I read it and wrote was a very obscure problem and over study of asbestos because it was a what I thought. The book was publi- illuminate it as though it had occupied silicate. This was true until the 1950s shed in 1986 and I wrote what I did in centre stage for the greater part of this when coal workers July 1988 so, even if I had wanted to, it century. took over centre stage. Silica and coal was a bit late for a review. At the very beginning he starts to dust are still as fibrogenic as they To put the record straight and to let bend the facts to suit his argument. always were but Mr Castleman awards your readers determine whether it was Pliny did not recommend bladders as a no medals to the medicine and hygiene "churlish" or not, this is what I wrote. protection against asbestos but against professions for having controlled these vermilion which caused acute mercury problems. "Asbestos: Medical and Legal poisoning. It may be that some people Instead he concentrates single min- Aspects. Second Edition BI Cas- in ancient times were affected by dedly on his subject and accurately, for tleman, Law and Business Inc 1986. asbestos, just as our stone age ances- the most part, records the references to Mr Castleman does not like asbestos. tors may have been affected by silica asbestosis in the medical literature. He does not like the people who mine from the manufacture or use of flint What he lacks is a broad view of the it, process it and adapt its products for tools, but there is no evidence for Mr developing subject. He approaches his sale. His dislike has grown into an Castleman's comments about Roman task with the enthusiasm and obsession and his obsession into single slaves. None of the Greek or Roman intolerance ofthe new convert who has issue fanaticism which closely resem- physicians described the effects of discovered the secret of salvation. His Br J Ind Med: first published as 10.1136/oem.48.6.430 on 1 June 1991. Downloaded from

Forum 431 enthusiasm betrays him on several of his favourite Dr Selikoff, is that believe, that the duty of a doctor in occasions into telescoping time. For there is a synergistic action so far as industry, as I said in my article, was to example he refers to Sir Thomas bronchogenic carcinoma is concemed, point out the potential dangers. Legge, who had questioned Montague between asbestos and smoking. Yet So, ifhe wants to accuse me, unjus- Murray in 1906, as soon afterwards Mr Castleman does not mention it. He tly, of not recognising that there were lamenting, "looking back in the light does not appear to recognise that there some articles on asbestos and lung of present knowledge it is impossible is no relation between cancer before the war, I accuse him, not to feel that opportunities for dis- and smoking because this too is not justly, of drawing the long bow about covery and prevention were badly mentioned, probably because it might cases in ancient times. Kevin Browne missed". Mr Castleman gives the date dilute his argument. and I have made it clear that there of that quotation as 1934 which is not Perhaps the most ludicrous chapter were no references to asbestos related exactly soon after 1906. Actually Sir is that concerning brake linings. First disease in ancient times.' There has Thomas Legge said it beforehand in of all he confuses the manufacture of been no riposte about this. Let him 1928 which was sooner but not much. brake linings with their repair and produce the evidence. In any case, do This is one ofthe few references which maintenance. Of all the references he you listen to every oracular statement Mr Castleman does not have, but it quotes there is only one which refers about every disease? If ever Alz- illustrates the perils of hindsight. It is specifically to garage mechanics and heimer's disease is associated with very easy to be wise.... even for such even there the effects are speculative. aluminium, all the Cassandras of the an expert as Sir Thomas. How much He does not find it surprising that the world will jump up and down like more so for the non-expert Mr Cas- millions of people who have been Castleman and say, "I told you so". tleman. exposed to asbestos from brake linings But I was there at the time, which It would be tedious to enumerate since the beginning of the century Castleman was not, and the main the many examples of selection, bias have suffered rarely if at all from problems, so far as cancer was concer- and emotionalism throughout the asbestos related disease. ned, were the bladder cancers in the book. Even though he recognises that He refers (p 611) to his own chemical industry and skin cancer in what is written does not suddenly exposure and that ofhis younger sister the cotton industry, both of which become common knowledge (p 134) he and his mother; he does not say if his have been brought under control. (We continually makes the assumption that mother is dead and if she died of an did some things right in the 1940s and it does. He does not appreciate the asbestos-related disease. He admits 50s, though it has taken until now to gradual accretion of medical and (p 619) that some people die of causes appreciate it.) Lung cancer was a rare hygiene knowledge, though at one unrelated to their asbestos exposure disease outside smoking. Even Doll, point he recognises that scepticism is a but he brings them in as well. when he did his study, published in tradition in science. He selects He does have the grace to publish 1955, thought that the controls references which suit his arguments the statement of Francis May at introduced by the 1931 regulations and ignores those that do not. He Appendix 2 pages 655-680 without (the first regulations in any country to sneers at industrial doctors and comment. In contrast to the rest ofthe tackle the problem of asbestos) would http://oem.bmj.com/ hygienists, some of whom he names. book it is not a diatribe but a sober, prevent future cases of lung cancer. He did not know any of them, competent, well balanced statement Dust problems in the 1950s were individually or corporately, but he is about the background of asbestos primarily those of coal miners. Maybe liberal with his insults. He has his related disease and the responsibility this was because of the small numbers favourites and his "betes noires". of employers." in the asbestos using industries, but Some people are favourites when he Dr Robert Murray there have to be priorities when quotes them in favour of his 15.7.88 resources are scarce, as they undoub- arguments, but villains when they do tedly were. How long did it take the not conform. He uses discredited I see no reason to change my opin- United States Surgeon General to on October 1, 2021 by guest. Protected copyright. information like the infamous Califano ion, and his letter to you, containing accept the evidence about smoking? document, but not the more recent more references than my article, is And how long did it take the United information by Doll. He praises the further evidence of his paranoia about States to accept the evidence about ILO for having raised the problem in asbestos. I paid tribute, in my review, coal workers' pneumoconiosis? the 1930s, but criticises it for its Code albeit left handedly, to his delving into There can be no doubt that 1960 of Practice in 1984. He does not refer past publications and I accept, as I said was the Rubicon so far as asbestos and to Convention 162 and Recommenda- in my article, that there were indica- cancer were concerned. Not even Cas- tion 172 of 1986. He might be forgiven tions from German and Czech papers tleman can assert that mesothelioma for not having the final text of the about lung cancer in relation to asbes- was known to be associated with Convention and Recommendation, tosis. I said that it was these that had asbestos before 1960, even though but he ought to have known that an alerted my old chief, Merewether, and Merewether had referred to lung and international instrument, debated by a given rise to the investigation of 1947 pleural cancer. I remember having tripartite body, was in prospect. which was not published until 1949. seen a mesothelioma in about 1950 in The most damning indictment of But these were anecdotes, numerators the postmortem room of the hospital the fanaticism of the book is the without denominators, and not a basis in Bury, Lancashire. I had never seen absence of any reference to smoking. for action. Even in the light of his such a white cuirass of a tumour, but Cancer ofthe lung was a relatively rare discoveries, Merewether did not con- the Home Office pathologist who was disease until the epidemiological study duct a campaign against the asbestos doing the postmortem examination of Sir Richard Doll in the United industry in the United Kingdon. He said, "Asbestos", as though he had Kingdom in 1947. The evidence, even believed, as he persuaded me to seen it before. I was too young and Br J Ind Med: first published as 10.1136/oem.48.6.430 on 1 June 1991. Downloaded from

432 Notices inexperienced to insist on further his- Once again, it is a cause for suspicion, tion testing of employees. This tology and so I lost my opportunity of but not for precipitate action. So I do NIOSH-approved workshop has been fame, as he and doubtless many others not roundly condemn the asbestos developed according to American did too. industry for what they did, or did not, Thoracic Society standards for pul- We were interested in occupational do. After all, the industry in the monary function testing. As a result of cancer and we, too, had read Hueper, United Kingdom established the attending these workshops, you who, according to Merewether, was a Asbestosis Research Council, which should be able to: cancerphile. I never met him, but he has probably done more to reveal the Describe the value of spirometry was obviously a very nice man. If you problems of asbestos than any other testing in clinic and work set- fire off in every direction, you are body. tings bound to hit something some time, as Every good Victorian novel had its Describe and instruct on the he did. We had a job to do and we death bed scene and Castleman's des- basic anatomy and physiology couldn't afford to use our limited cription of the death of Tony Lanza, relevant to spirometry resources in following up all Hueper's via Harriet Hardy, is no exception. Perform tests and interpret claims. Who among us, with hindsight, does results It was for this reason that I wrote in not have regrets about his sins of Calculate correctly FVC, FEV,, my reply to Huncharek, that the reac- omission or commission? FEF2,75%, FEV,, and predic- tion ofthe asbestos industry was not as So, Castleman, criticise if you like, ted normals reprehensible as has been made out by but have the grace to admit that other The programme is under the direc- Castleman and Brodeur. This seems to people have the right to criticise your tion of John Howard, MD, MPH, have raised the hackles of Castleman. criticisms. Assistant Professor and Acting Direc- But I ask him, if we were not sure that tor of the asbestos was a carcinogen (and by 1 Brown K, Murray R. Asbestos and the Residency Training Programme at "we" I modestly include Merewether Romans. Lancet 1990;336:445. University of California College of and Doll), why should industry Medicine, Irvine. Dr Howard has con- assume the responsibility? And I ask ducted similar workshops for the again as I did in my reply to Hun- University of California, Irvine, for charek, what was the American several years. This programme has government doing? Did they shuffle been approved by the California Board off their responsibilities on to the of Registered Nursing, BRN Provider states? And what were the unions NOTICE No. 07784 for 15 hours. In addition, doing? Where were the great cham- MBA Inc offers 1-5 continuing educa- pions of workers' rights? When the tion units for successful completion of American government admits that it Spirometry: Pulmonary Func- each workshop. Approval is pending recommended, for perfectly legitimate tion Testing in Occupational from the American Board ofIndustrial 1991 reasons, the use of asbestos in navy Health (NIOSH Course 097) Hygiene for CM points. Course hours http://oem.bmj.com/ and merchant ships, then I will listen Long Beach, California, USA, 10- are 8:00-5:00 daily. The tuition fee of to complaints against employers. The 11 October 1991. $375.00 includes refreshments and US Department ofHealth, Education, instructional materials. Enrolment is and Welfare knew as much as anybody This workshop will provide instruc- limited to 25. The fee, less a 20 per about the dangers of asbestos, but tion in all aspects of spirometry cent administration charge, is there is no evidence of them having through lectures, practicums, and tes- refundable if written cancellation is recommended any restrictions on its ting. Training is intended for received two weeks prior to the use. occupational health nurses, programme date. For further informa-

I am no expert in animal studies, but physicians, technicians, industrial tion contact: McIntyre, Birkner, and on October 1, 2021 by guest. Protected copyright. I have the greatest reservations in hygienists, and others responsible for Associates, 5865 Dovetail Drive, extrapolating animal results to man. performing accarace pulmonary func- Agoura Hills, California 91301, UA.