The Chrysotile Debate As Framed by a Canadian Journal
An issue of the Canadian Medical Association Journal (CMAJ/ volume 164/ issue 4) which appeared early in 2001 featured a series of articles examining whether health care professionals should support international calls for a ban on the mining, use and export of chrysotile. Between 1990 and 1998, Canada exported 4,741,156 metric tons of chrysotile; it is the world’s leading exporter of the mineral and has been at the forefront of industry’s campaign for national policies based on "controlled use." It is not before time that the country’s medical establishment was asked to take a stand on the continued sale of this class 1 carcinogen.
The first CMAJ article: A call for an international ban on asbestos by J LaDou et al [http://www.cma.ca/cmaj/vol-164/issue-4/0489.htm] stated the position adopted by an independent group of eminent international scientists: "to eliminate the burden of disease and death that is caused worldwide by exposure to asbestos, the Collegium Ramazzini calls for an immediate ban on all mining and use of asbestos." The following article: Should Canadian health care professionals support the calls for a worldwide ban on asbestos by J Siemiatycki [http://www.cma.ca/cmaj/vol-164/issue-4/0495.htm] disagreed with the Collegium’s argument, concluding that a new international panel of experts was needed to study the subject and make recommendations. While the panel would "exclude anyone who has significant experience or interests in asbestos research," it would call upon "asbestos experts of all stripes to act as consultants and advisers." The author wryly observed that: "constituting such a panel may be almost as challenging as answering the basic questions." In the final article: A ban on asbestos must be based on a comparative risk assessment [http://www.cma.ca/cmaj/vol-164/issue-4/0491.htm] the author, M Camus, stalls for time by opting for a "comparative risk assessment of chrysotile and its substitutes." According to Camus: "The Collegium’s call to ban asbestos is insufficient in all respects. A ban must be assessed more thoughtfully following a comparative risk approach before being adopted."
The contents of these papers caused an international outcry; the CMAJ received letters supporting and denouncing the authors’ conclusions; some of the correspondence appeared in the CMAJ issue published on October 30, 2001 [vol. 165, issue 9: http://www.cma.ca/cmaj/vol-165/issue-9/pdf/pg1189.pdf]. While David C. F. Muir, Laurie Kazan-Allen, Tee L. Guidotti and David V. Bates were pro-ban, David Janigan, Didhar Ahmad and Richard Wilson et al deemed such drastic action unnecessary: "Let us urgently study the list of issues raised by Michel Camus and agree upon a proper comparative risk assessment." In his response, Philip Landrigan, President of the Collegium Ramazzini, highlighted the issue of double standards saying:
"It is quite hypocritical of those industries (which manufacture hazardous products such as asbestos) to relocate to the least-developed nations and then to claims that workers there can work safely with toxic materials such as asbestos. Anyone who has travelled in the poor nations of South America, sub-Saharan Africa and Southeast Asia will have seen workers using asbestos in the most uncontrolled conditions, for example, cutting asbestos-concrete pipes with circular saws or trowellling asbestos insulation on to walls in the complete absence of any form of respiratory protection. The argument that workers can be protected against asbestos in nations that have no legal infrastructure in occupational health is a cruel joke."
The follow-up by M Camus reiterated his support for a comparative risk assessment of chrysotile and its substitutes and fudged the issue of double standards by advising that Canada cautions "the countries to which we export such materials and products against incorrect uses and careless exposures." Methods for protecting users in the developing world included: "better labelling, cooperative education, training programs and improvements in the ‘traceability’ of products."
It is of interest to note that the CMAJ chose not to publish letters from recognised asbestos experts: Dr Morris Greenberg and Dr Barry Castleman. Greenberg’s acerbic letter was highly critical of the lack of action on asbestos by Canada’s medical establishment; he wrote "the story of asbestos disease in Canada has been one of long denial… After countenancing the international march of asbestos deaths for a hundred years, can the Canadian Medical Association in all conscience oppose the call for a worldwide ban on asbestos." Castleman focused on the World Trade Organization case brought by Canada against the French ban on chrysotile; he condemned Canadian arguments in support of "controlled use" as "fairy tales designed to prolong exports of Canadian asbestos."
_______
December 2, 2001
