BASED ON AVAILABLE DATA, CAN WE PROJECT AN ACCEPTABLE STANDARD FOR INDUSTRIAL USE OF ASBESTOS? PERHAPS Sheldon Samuels Industrial Union Department AFL-CIO Washington, D.C. 20006
Many scientists still verify that “nature abhors a vacuum.” The discovery does not require a physicist on whose pate apples fall. For every action, there is still a reaction; nature is still continuous; and the Good Lord passed no special legislation that would permit thresholds of “safe” exposure just to make practitioners of occupational health comfortable with mythical solutions to real world challenges. But just in case I a m wrong, 1 will supply some apples. In honor of our Oxford moderator [Dr. Leo Kinlen], I would like to remind you-in addition-that this is the 500th anniversary of the birth of Thomas More. It would be unforgivable if I neglected to think about how More might approach the problem before us, to think about the perspective of his primary work entitled, appropriately, Utopia. My colleagues in management are saying: “I told you s-Samuels wants Utopia!” Actually I don’t because in More’s Utopia, like most utopian schemes, the problem of dirty work is solved by using bondsmen, a caste of imported laborers. In the utopic world, even as an ideal, historically the worker seldom fares well. What we have to learn from More is that in Western society the worker is traditionally in a special caste. The standards applied to the general population are not applied to him, a lesson learned by my European brothers, but not yet by the American worker. If we accept More’s caste system, then an acceptable standard, defining acceptable in its accepted or social consensus sense, is possible. Not accepting the caste system, only necessary risks would be taken and a standard would be promulgated acceptable to labor, but not to management. My assessment of the management position is based not on what they have said, but on what they have done. We have been taught the bitter lesson of not basing our position on promises but on experience. Cancer began to be associated with asbestos exposure about 40 years ago and scarring of the lungs was identified at least 40 years before that. Modern control, in great part, was delayed consciously by the industry. In fact, modern control in our country didn’t begin until 1971 with the passage of the Occupational Safety and Health Act. I won’t go through all of that morbid history. Paul Brodeur is here and he has written Expendable Americans, an excellent book. I suggest you buy it and read about some of this history. But there are some elements in that history that have special interest. The official document which Paul Kotin referred to, The Federal Register proposal, dated October 1975, published at a time when we felt that within a matter of months we would have hearings, has some specially interesting information. Most significant to an international audience of this kind is the fact that the OSHA five fiber temporary standard, which was issued in response to great pressure from my organization and has since been replaced by a two fiber standard (which we have challenged), is still the standard of the American Conference of Governmental Industrial Hygienists (ACGIH). This unofficial organization takes the rather unAmerican stance of being in business for one purpose: exporting standards less
215
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Annals New York Academy of Sciences
stringent than our own to you, because many of you come from countries that adopt in ignorance (I hope) ACGIH standards by reference. Their five fiber asbestos standard is not acceptable to government or labor in our country. I hope that you make it as unacceptable in yours. Many other ACGIH standards also differ from OSHAs “new” standards. It really is time that we ended the international charade of consciously confusing ACGIH values with standards of the United States. Another interesting point made in the document is that our government was very much influenced by the British experience. The two fiber standard and its rationalization by the British Occupational Health Society (who helped their government set the standard) describes very clearly that what they were talking about was not a standard that would protect workers against cancer. Possibly because of feasibility considerations, I read their description of the supporting data to mean that they arbitrarily chose environmental values associated with one set of biological effects, rather than another, against which they wished to protect the worker, on nonbiological grounds. Since they chose the least stringent values, health was secondary to some other, perhaps economic, consideration. The environmental value OSHA now is proposing, a 0.5 fiber standard, is based only on feasibility. Feasibility is the controlling parameter for every environmental standard in this and every other country (albeit surreptitiously). There has never been a workplace or community environmental standard that was based solely on biological data. You can’t take the relevant and critical biological data and deduce or calculate any of the numbers in vogue. At least that has not been done yet, in part because of the threshold problem, in part simply because no matter what the laws of any country say, there does exist the economics of realpolitik. The 0.5 fiber standard is feasible even if you consider only existing, by that we mean best available (not simply possible), technology. The proposed 0.5 fiber standard is already being achieved in well-controlled situations such as most work stations a t Johns-Manville plants, according to Dr. Kotin and reports from our affiliates. We believe, and the courts agree, and the vinyl chloride decision makes very clear, that standards can “force” technology. Therefore, we believe that there is a need to aim at the best possible technology value proposed by NIOSH, which is 0.1. But even at that level we would not be satisfied. If we were satisfied, it would be temporary, because of the importance of taking no unnecessary risk. Remember that a threshold has not been demonstrated and theoretically may not be possible for individual effects on individuals and can not be possible for the population exposed. I refer you to a very excellent report, that considered not only carcinogens but other toxic substances, by our National Academy of Science. It made very clear, in the opinion of the panel chaired by Dr. Norton Nelson, that at best we can discuss what is perhaps defined as a nonobservable effect. Statistically, there can not be a no-effect level. Observability, of course, is a function of our technology. What then is the ultimate or necessary standard? Are we talking about zero? Not a t all. Ideally (a concept I use in its dialectic sense), in a community or workplace environment, a standard prescribes a permissible (environmental) exposure level (PEL)* which is a limiting value associated with a ratio of necessary risk. By implication, a PEL prescribes a level of biological damage deemed necessary, to be contained and not to be exceeded. When the PEL is exceeded, by definition, the risk is presumed to be elevated unnecessarily. An elevated PEL and hence an elevated risk, *A PEL can be monitored directly by physical or chemical measurements or by observing the presence or absence of properly functioning equipment or work practices previously characterized by environmental measurement.
Samuels: Perhaps
217
then, always justifies police action. The ideal does not include, as Dr. Kotin correctly quoted me, an absolutely “riskless void.” We do not ask for that vacuum abhorred by nature. Unlike the position of the asbestos industry, however, we reject post facto biological monitoring as the basis of future control. In the case of asbestos, what (concretely) are we talking about? The ambient level measured by Dr. William Nicholson in this city appears to be an average concentration of the mass represented by the value ten thousand fibers per cubic meter or 0.01 fibers/cc. At that level, Drs. Selikoff and Hammond tell us, significant numbers of cases of mesothelioma have not been recognized in the general population which can not be attributed to a workplace or bystander exposure. Mesothelioma has been almost always related to asbestos exposure alone and, thus far, there are almost no mesotheliomas unrelated to a workplace. Mesothelioma, then, may be a good surrogate to choose as a measure of the class of asbestos-related effects. The use of measurable surrogates provides not the measure of the effects themselves, but of an index of the effects. In much the same way, in the OSHA coke oven standard, the permissible exposure limit for plural coke oven emissions is a singular measure of the benzene-soluble fraction of total particulate matter (BSFTPM) present during carbonization. The choice of a surrogate is based on a judgment of the very rough representativeness and the feasibility of monitoring the surrogate. Dr. Eula Bingham, former Chairperson of the OSHA Standards Advisory Committee on Coke Oven Emissions, noted four major considerations in the selection of an “indicator substance”: a “reasonably good” association with the disease; specific as possible; - an available, reliable analytic method; and - rapid but “not prohibitively expensive” analysis. -
-
Having chosen BSFTPM as a surrogate for all the carcinogens in coke oven emissions, OSHA then selected “the lowest level feasible. Such a determination involves a measure of subjective judgment which OSHA believes is justified by the nature of the hazard being dealt with and the intent of the Act.” That level, 150 pg/m3. assuming a linear dose-response model and fifteen years of latency, is associated with a relative risk of 1.477 times the “normal” risk. Assuming a quadratic model, the relative risk is 1.072. Assuming that level to be indeed “the lowest level feasible,” and that the process to be controlled is necessary, then the associated relative risk is necessary. Selected for practical purposes as a surrogate, in this case as an index of eflects. the expected epidemiological experience for mesothelioma in a normal population very often circumscribes the necessary level of risk for asbestos exposure in a work population. This level of risk and its associated ambient environmental value 0.01 fibers/cc (the background value) cannot be reduced feasibly in most work situations. Nor can it be achieved in many other situations save and accept by the substitution of another material in the work process, or the abandonment of the process itself. For most work populations, then, a PEL justified by feasibility is 0.01 fibers. This level yields a naught necessary risk or a nonobserved effect. But that is coincidental. In other work situations, the necessary risk is higher if the material or process is necessary, and a higher PEL is justified. But all workers need never be exposed to the higher level and unnecessary elevations to that point from ambient levels justify police action. In forcing the development of the technology necessary to achieve even the higher PEL, different frames of times are justified appropriate to the difficulty of the
218
Annals New York Academy of Sciences
engineering task. Excessive schedules of abatement also result in unnecessarily elevated risk and, therefore, justify police action. Biologically, the risk for an individual is not the same as that of a population. Theoretically, PELS could be devised for each worker and his personal work situation which could be associated with a personal ratio of necessary risk. The ethical problems associated with the determination of personal necessary risk are extremely difficult and are unlikely to be seriously studied in this decade. In this short time, I cannot begin a substantive discussion of the meaning of “feasible” or “necessary.” I would note only that the terms are not interchangeable. What is accomplished by this approach, for individuals or populations, is an attempt to collapse the caste system reflected in social values that encourage setting disparate community and workplace standards based on the conscious decision to sacrifice workers lives, a decision at the heart of industry proposals. We seek the same uniJorm approach to both sets of standards. The rejection of Utopia is a rejection of this caste system, not simply by workers but by society as a whole. In reflection of this fact, utopic literature in general has been replaced in the mythologic vein of this century, interestingly, by the novels 1984 and Brave New World, which fictionalized the real-life rejection. Gunnar Myrdal demonstrated that if blacks could shed their skins, they could step across the barriers of the caste in which they have been contained. He could just as well have studied workers, who by shedding blue collars for white, change their caste. The just society would not ask that we change the color of our collars to escape a caste.
Many scientists still verify that “nature abhors a vacuum.” The discovery does not require a physicist on whose pate apples fall. For every action, there is still a reaction; nature is still continuous; and the Good Lord passed no special legislation that would permit thresholds of “safe” exposure just to make practitioners of occupational health comfortable with mythical solutions to real world challenges. But just in case I a m wrong, 1 will supply some apples. In honor of our Oxford moderator [Dr. Leo Kinlen], I would like to remind you-in addition-that this is the 500th anniversary of the birth of Thomas More. It would be unforgivable if I neglected to think about how More might approach the problem before us, to think about the perspective of his primary work entitled, appropriately, Utopia. My colleagues in management are saying: “I told you s-Samuels wants Utopia!” Actually I don’t because in More’s Utopia, like most utopian schemes, the problem of dirty work is solved by using bondsmen, a caste of imported laborers. In the utopic world, even as an ideal, historically the worker seldom fares well. What we have to learn from More is that in Western society the worker is traditionally in a special caste. The standards applied to the general population are not applied to him, a lesson learned by my European brothers, but not yet by the American worker. If we accept More’s caste system, then an acceptable standard, defining acceptable in its accepted or social consensus sense, is possible. Not accepting the caste system, only necessary risks would be taken and a standard would be promulgated acceptable to labor, but not to management. My assessment of the management position is based not on what they have said, but on what they have done. We have been taught the bitter lesson of not basing our position on promises but on experience. Cancer began to be associated with asbestos exposure about 40 years ago and scarring of the lungs was identified at least 40 years before that. Modern control, in great part, was delayed consciously by the industry. In fact, modern control in our country didn’t begin until 1971 with the passage of the Occupational Safety and Health Act. I won’t go through all of that morbid history. Paul Brodeur is here and he has written Expendable Americans, an excellent book. I suggest you buy it and read about some of this history. But there are some elements in that history that have special interest. The official document which Paul Kotin referred to, The Federal Register proposal, dated October 1975, published at a time when we felt that within a matter of months we would have hearings, has some specially interesting information. Most significant to an international audience of this kind is the fact that the OSHA five fiber temporary standard, which was issued in response to great pressure from my organization and has since been replaced by a two fiber standard (which we have challenged), is still the standard of the American Conference of Governmental Industrial Hygienists (ACGIH). This unofficial organization takes the rather unAmerican stance of being in business for one purpose: exporting standards less
215
216
Annals New York Academy of Sciences
stringent than our own to you, because many of you come from countries that adopt in ignorance (I hope) ACGIH standards by reference. Their five fiber asbestos standard is not acceptable to government or labor in our country. I hope that you make it as unacceptable in yours. Many other ACGIH standards also differ from OSHAs “new” standards. It really is time that we ended the international charade of consciously confusing ACGIH values with standards of the United States. Another interesting point made in the document is that our government was very much influenced by the British experience. The two fiber standard and its rationalization by the British Occupational Health Society (who helped their government set the standard) describes very clearly that what they were talking about was not a standard that would protect workers against cancer. Possibly because of feasibility considerations, I read their description of the supporting data to mean that they arbitrarily chose environmental values associated with one set of biological effects, rather than another, against which they wished to protect the worker, on nonbiological grounds. Since they chose the least stringent values, health was secondary to some other, perhaps economic, consideration. The environmental value OSHA now is proposing, a 0.5 fiber standard, is based only on feasibility. Feasibility is the controlling parameter for every environmental standard in this and every other country (albeit surreptitiously). There has never been a workplace or community environmental standard that was based solely on biological data. You can’t take the relevant and critical biological data and deduce or calculate any of the numbers in vogue. At least that has not been done yet, in part because of the threshold problem, in part simply because no matter what the laws of any country say, there does exist the economics of realpolitik. The 0.5 fiber standard is feasible even if you consider only existing, by that we mean best available (not simply possible), technology. The proposed 0.5 fiber standard is already being achieved in well-controlled situations such as most work stations a t Johns-Manville plants, according to Dr. Kotin and reports from our affiliates. We believe, and the courts agree, and the vinyl chloride decision makes very clear, that standards can “force” technology. Therefore, we believe that there is a need to aim at the best possible technology value proposed by NIOSH, which is 0.1. But even at that level we would not be satisfied. If we were satisfied, it would be temporary, because of the importance of taking no unnecessary risk. Remember that a threshold has not been demonstrated and theoretically may not be possible for individual effects on individuals and can not be possible for the population exposed. I refer you to a very excellent report, that considered not only carcinogens but other toxic substances, by our National Academy of Science. It made very clear, in the opinion of the panel chaired by Dr. Norton Nelson, that at best we can discuss what is perhaps defined as a nonobservable effect. Statistically, there can not be a no-effect level. Observability, of course, is a function of our technology. What then is the ultimate or necessary standard? Are we talking about zero? Not a t all. Ideally (a concept I use in its dialectic sense), in a community or workplace environment, a standard prescribes a permissible (environmental) exposure level (PEL)* which is a limiting value associated with a ratio of necessary risk. By implication, a PEL prescribes a level of biological damage deemed necessary, to be contained and not to be exceeded. When the PEL is exceeded, by definition, the risk is presumed to be elevated unnecessarily. An elevated PEL and hence an elevated risk, *A PEL can be monitored directly by physical or chemical measurements or by observing the presence or absence of properly functioning equipment or work practices previously characterized by environmental measurement.
Samuels: Perhaps
217
then, always justifies police action. The ideal does not include, as Dr. Kotin correctly quoted me, an absolutely “riskless void.” We do not ask for that vacuum abhorred by nature. Unlike the position of the asbestos industry, however, we reject post facto biological monitoring as the basis of future control. In the case of asbestos, what (concretely) are we talking about? The ambient level measured by Dr. William Nicholson in this city appears to be an average concentration of the mass represented by the value ten thousand fibers per cubic meter or 0.01 fibers/cc. At that level, Drs. Selikoff and Hammond tell us, significant numbers of cases of mesothelioma have not been recognized in the general population which can not be attributed to a workplace or bystander exposure. Mesothelioma has been almost always related to asbestos exposure alone and, thus far, there are almost no mesotheliomas unrelated to a workplace. Mesothelioma, then, may be a good surrogate to choose as a measure of the class of asbestos-related effects. The use of measurable surrogates provides not the measure of the effects themselves, but of an index of the effects. In much the same way, in the OSHA coke oven standard, the permissible exposure limit for plural coke oven emissions is a singular measure of the benzene-soluble fraction of total particulate matter (BSFTPM) present during carbonization. The choice of a surrogate is based on a judgment of the very rough representativeness and the feasibility of monitoring the surrogate. Dr. Eula Bingham, former Chairperson of the OSHA Standards Advisory Committee on Coke Oven Emissions, noted four major considerations in the selection of an “indicator substance”: a “reasonably good” association with the disease; specific as possible; - an available, reliable analytic method; and - rapid but “not prohibitively expensive” analysis. -
-
Having chosen BSFTPM as a surrogate for all the carcinogens in coke oven emissions, OSHA then selected “the lowest level feasible. Such a determination involves a measure of subjective judgment which OSHA believes is justified by the nature of the hazard being dealt with and the intent of the Act.” That level, 150 pg/m3. assuming a linear dose-response model and fifteen years of latency, is associated with a relative risk of 1.477 times the “normal” risk. Assuming a quadratic model, the relative risk is 1.072. Assuming that level to be indeed “the lowest level feasible,” and that the process to be controlled is necessary, then the associated relative risk is necessary. Selected for practical purposes as a surrogate, in this case as an index of eflects. the expected epidemiological experience for mesothelioma in a normal population very often circumscribes the necessary level of risk for asbestos exposure in a work population. This level of risk and its associated ambient environmental value 0.01 fibers/cc (the background value) cannot be reduced feasibly in most work situations. Nor can it be achieved in many other situations save and accept by the substitution of another material in the work process, or the abandonment of the process itself. For most work populations, then, a PEL justified by feasibility is 0.01 fibers. This level yields a naught necessary risk or a nonobserved effect. But that is coincidental. In other work situations, the necessary risk is higher if the material or process is necessary, and a higher PEL is justified. But all workers need never be exposed to the higher level and unnecessary elevations to that point from ambient levels justify police action. In forcing the development of the technology necessary to achieve even the higher PEL, different frames of times are justified appropriate to the difficulty of the
218
Annals New York Academy of Sciences
engineering task. Excessive schedules of abatement also result in unnecessarily elevated risk and, therefore, justify police action. Biologically, the risk for an individual is not the same as that of a population. Theoretically, PELS could be devised for each worker and his personal work situation which could be associated with a personal ratio of necessary risk. The ethical problems associated with the determination of personal necessary risk are extremely difficult and are unlikely to be seriously studied in this decade. In this short time, I cannot begin a substantive discussion of the meaning of “feasible” or “necessary.” I would note only that the terms are not interchangeable. What is accomplished by this approach, for individuals or populations, is an attempt to collapse the caste system reflected in social values that encourage setting disparate community and workplace standards based on the conscious decision to sacrifice workers lives, a decision at the heart of industry proposals. We seek the same uniJorm approach to both sets of standards. The rejection of Utopia is a rejection of this caste system, not simply by workers but by society as a whole. In reflection of this fact, utopic literature in general has been replaced in the mythologic vein of this century, interestingly, by the novels 1984 and Brave New World, which fictionalized the real-life rejection. Gunnar Myrdal demonstrated that if blacks could shed their skins, they could step across the barriers of the caste in which they have been contained. He could just as well have studied workers, who by shedding blue collars for white, change their caste. The just society would not ask that we change the color of our collars to escape a caste.
