Why is asbestos still killing people? Nic Fleming finds out in a twisting tale of industry cover-ups and misinformation that spans decades.
A long vertical pipe sits against white-painted brickwork in the corner of a cramped storeroom. Two men wearing orange boiler suits and gloves crouch at its base. One uses a scraper to remove lumps of what looks like wet papier-mâché from the outside of the pipe, into a red bag held by the other.
Both men are breathing through facemasks, their air sucked from outside the isolation unit: a short, makeshift corridor constructed from black plastic panels and transparent polythene sheeting. An extractor fan hums relentlessly.
It might look like a scene from a horror movie in which scientists fight to contain a virus, but the truth is more banal – though no less deadly. The two men are removing asbestos insulation from a heating pipe in a west London hospital.
Ordinarily there would be bright yellow tape with the words “WARNING asbestos” on it, the site supervisor tells me. But this is an especially sensitive job. The neighbouring ward’s beds are filled by patients with acute respiratory conditions, and the hospital’s management decided that advertising the true nature of the work might cause alarm.
Thirteen people a day in the UK die from exposure to asbestos – more than double the number that die on the roads. In the USA, asbestos will be responsible for around 10,000 deaths this year, meaning it kills close to as many people as gun crime or skin cancer.
Health fears associated with asbestos were first raised at the end of the 19th century. Asbestosis, an inflammatory condition affecting the lungs that causes shortness of breath, coughing and other lung damage, was described in medical literature in the 1920s. By the mid-1950s, when the first epidemiological study of asbestos-related lung cancer was published, the link to fatal disease was well established.
Yet in 2012, rather than falling, worldwide asbestos production increased and international exports surged by 20 per cent. A full ban did not come into force in the UK until 1999, and the European Union’s deadline for member states to end its use was just nine years ago. Today, asbestos is still used in large quantities in many parts of Asia, eastern Europe and South America, while even in the USA and Canada, controlled use is allowed.
The remarkable endurance of this magic mineral turned deadly dust is a complex tale. One of scientific deception and betrayal, greed, political collusion, the power of propaganda, and, above all, the willingness of some executives to knowingly subject hundreds of thousands of vulnerable people around the world to severe illness and even death in the pursuit of profit.
One man for whom the risks of asbestos are all too clear is Winston Bish. Two years ago the former carpenter, now aged 70, took part in a questionnaire study on lung health. Among the half of participants randomly selected to have a CT scan, he was subsequently diagnosed with mesothelioma, a rare cancer that develops in the protective linings of organs, most commonly the lungs. There is no cure.
“When the doctor said ‘mesothelioma’, I didn't really know what it was,” says Bish in a hoarse whisper, caused by cancer-related nerve damage to his vocal cords. “Now I know it's the worst form of lung cancer you can get.”
As a boy, Bish was good with his hands and used to stay behind after class for extra woodwork lessons. He left school at 15 and spent his working life in the building industry. He had frequent contact with asbestos in a variety of forms, including in guttering and roof panels.
“We were cutting those up from sheets with handsaws and knocking nails into them,” Bish says. None of his employers warned him or his co-workers of the dangers of working with asbestos, and doing such work without facemasks or ventilators was commonplace, he says. It’s a far cry from the precautions taken by specialist asbestos removal teams today.
Bish and his wife Jennifer married in 1966 and had two children. In the mid-1970s, he built a four-bedroomed detached house on the outskirts of St Ives, Cambridgeshire, as the family’s home. As was normal practice at the time, he put asbestos fireproofing panels in the garage roof – they are still there.
It was not until the 1980s that Bish remembers fears about asbestos spreading among building workers. “We became aware through word of mouth in the industry,” he says. “I don’t remember any big advertising campaigns at that time. Even now there is very little awareness.”
In October 2012, he had the lining of his right lung removed surgically, and now lives with the knowledge that the survival rates for mesothelioma patients are poor. Only about four out of every ten people diagnosed are still alive a year later, although the outlook is better for those able to have surgery to remove the cancer. Bish has recently completed a course of chemotherapy, and is hoping to be enrolled in a trial of a novel drug.
Asbestos is a generic term used to describe six naturally occurring minerals made up of thin fibrous crystals. Chrysotile, or white asbestos, is the only form still in use, and accounts for 95 per cent of the asbestos mined and used by humans historically. Its curly fibres make it more flexible than a family of five other forms known as the amphiboles – amosite (brown asbestos), crocidolite (blue asbestos), anthophyllite, tremolite and actinolite – which all consist of needle-like fibres.
The characteristics of asbestos – strong, lightweight and heat-resistant – and the fact it could be split into fibres, mixed with other materials and easily shaped meant that use of the mineral soon caught on. Large-scale mining began in the second half of the 19th century in the USA, Italy and Canada, and during the 20th century it was incorporated into a huge variety of products, especially building materials such as concrete, pipes, cement, bricks, tiles and insulation for buildings and ships. It was also used in car parts, protective clothing, mattresses and even cigarette filters. The industry significantly expanded during both World Wars.
You may not have to look hard to find asbestos where you live or work. Many buildings still have asbestos-based components, including pipe insulation, decorative coatings, ceiling boards, fireproofing panels, window in-fill panels and cold water tanks.
Research into precisely how asbestos causes mesothelioma and other forms of lung cancer is ongoing. The fibres are so small that most can only be seen under a microscope. Billions can be inhaled in a single day with no immediate effect, but longer-term the consequences can be deadly.
The fibres can become lodged in the lining of organs such as the lungs, causing damage that interrupts the normal cell cycle, leading to uncontrollable cell division and tumour growth. Asbestos is also linked to changes in the membranes surrounding the lungs – the pleura – including pleural thickening, the formation of scar tissue (plaques), and abnormal collections of fluid (pleural effusion).
“There is absolutely no doubt that all kinds [of asbestos] can give rise to asbestosis, lung cancer and mesothelioma,” says Paul Cullinan, Professor of Occupational and Environmental Respiratory Disease at the National Heart and Lung Institute, Imperial College London. “It’s probably the case that white asbestos is less toxic in respect to mesothelioma than the amphiboles. The industry tries to argue that you can take precautions so that white asbestos can be used safely, but in practice, in the real world, that is not what is going to happen.”
This is the firm scientific consensus. But not everyone agrees.
“The Canadian government does not support the science on asbestos,” says leading anti-asbestos campaigner Kathleen Ruff. “It has not banned asbestos in Canada. We still import thousands of products that contain asbestos. Those in government oppose the views of the whole Canadian and world scientific community,” says Ruff. “They are not stupid, so I can only conclude it’s cynically done for political expediency.
“The industry has hired scientists in the same way the tobacco industry did, who claim the risks are not there,” says Ruff. “Their research has been used to delay action to protect people from asbestos and to prevent it being banned. Many have been exposed and have died as a result. There’s no doubt it’s been very lucrative for those scientists who have gone down that path. But it’s also a complete betrayal of scientific independence and integrity, and of their responsibility as human beings not to harm others.”
The World Health Organization estimates that 107,000 people die every year as a result of occupational exposure to asbestos. In the UK, the Health and Safety Executive puts the figure at about 4,700: in 2011, 2,300 British people died from mesothelioma, 2,000 from other related lung cancers and 400 from asbestosis. Tradespeople are at particularly high risk.
Attempts to calculate likely future deaths have produced widely varying results over the years, partly because the greatest risks of developing mesothelioma come between 30 and 50 years after exposure. A 2010 study predicted that 61,000 men in the UK will die of mesothelioma between 2007 and 2050 – compared with 30,000 between 1968 and 2007. The peak year for mortality was predicted to be 2016.
While most cases occur among those who work directly with materials containing asbestos, others become sick through more casual environmental exposure. In 2004 it was reported that hospital workers and school teachers ranked fourth and eighth respectively in a list of the most frequently cited occupations on mesothelioma death certificates, and that a quarter of US deaths from the disease occurred in those who had not worked directly with it.
Some healthcare workers report that this proportion may be growing. Liz Darlison is a consultant nurse at University Hospitals of Leicester NHS Trust and a founder of Mesothelioma UK, which provides information and support for patients.
“It is still predominantly carpenters, joiners, laggers,” says Darlison. “But those of us who work with this disease are fearful because increasingly we are seeing more women and more people who've had casual exposure such as teachers, doctors, nurses, secretaries, and people who have sat on the knee of a dad who has worked with asbestos.”
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