WEBVTT

NOTE Machine transcript of the film's sound; not yet checked.

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We've been talking today about one example
of environmental disease, namely that

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caused by asbestos.

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This obviously is only one of many
examples of important diseases in humans

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produced by environmental agents.

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Indeed, it's generally accepted today that
perhaps 90% of all human cancer is a

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result of environmental exposures of
various types.

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Subject of education of medical students
and physicians, therefore, in

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environmental medicine,

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and environmental pathology is exceedingly
important. In fact, it's my view that a
few

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years from now and today environmental
medicine and environmental pathology are
to

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medicine what

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microbiology was in the first part of the
century. It's therefore essential that

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every aspect of the

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medical curriculum, undergraduate and
postgraduate, embody concepts of

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environmental medicine

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and foster knowledge, detailed knowledge,
of the principles of environmental

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agents and

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environmental exposures. I think it's
particularly appropriate that this program
is

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addressed to

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pathologists because pathologists should
take the lead in this development.

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It can happen in

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various ways in various curricula, but
obviously it should be embedded in the

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critical basic science

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areas, pharmacology, pathology,
physiology, as well as in all clinical
disciplines.

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This requires

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requires attention to this, depending on
the curriculum, subcommittees, and so on,

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to put

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this into actual operation in a medical
school. During the clinical years, special
attention

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should be given in developing knowledge of
physical diagnosis, history taking on the

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part of physicians and medical students to
create within them the techniques

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and concepts

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necessary to develop histories of
occupational exposure and to do
appropriate

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physical examinations,

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laboratory and radiologic tests. It's
important moreover that students

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understand the basic principles and nature
of environmental agents and in

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all of their important classes much after
the fashion that we've tried to

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create today with the subject of asbestos.
I'd now like to refer to Dr.

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Paul Kotin who will give us a glimpse into
the future. Looking into the future

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one can perhaps make five or six salient
points.

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First, with the description of

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asbestos related disease, the obvious
question that comes to mind is, can a

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substitute be found for asbestos in
commerce?

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Are the social needs, the

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important social needs that asbestos has
met in the past, can they be met by

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by other substances.

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Well, clearly in the discussion,

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past uses of asbestos were referred to

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with the obvious implication

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that alternative substances have been
found.

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Perhaps the only word of caution is to
reiterate,

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yet once again, that for fibrous materials

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on the basis of what we now know, it is
the geometry,

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the dimensions of the fiber rather than
its chemical makeup

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which appears to be the important factor

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and the pathogenesis of disease and we
should be vigilant that we don't
substitute

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one type of fiber

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for an asbestos fiber with some assurance
that the legacy of asbestos will

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not in a latter day

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be reflected yet as a result of exposure
to substitute materials

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this is the situation is

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relatively encouraging of course because
we have learned so much in the world of

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industrial hygiene

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that the control of environmental exposure
is now a sophisticated engineering

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art and in fact

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provides the basis for much of the
regulatory activity of the various
regulatory agencies.

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A second factor to look to and consider in
the future of course is the fact and

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again latent

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period was again iterated and reiterated
as being measurable in decades segments of

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the lifespan if

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you will that the cases of asbestos
related disease and the shipyard workers
are perhaps

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the best example reflect exposures of the
past but it is important to recognize

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that there are

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many cases of asbestos related disease I
believe in a latent period which will

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become overt or

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manifested in the years and decades to
come and it is important to recognize that

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they do reflect

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the past and rather than reflect failures
of

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control for the present.

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The third factor is the matter of
continuing exposure. Really there are two

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universes of exposure. There is the
occupational universe and the general

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population exposure. The occupational
environment, the mine, the mill, the

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primary producer of asbestos products,
just to be in compliance with

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regulations has an acceptable environment,
I believe.

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Engineering rather than really

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numbers determine what controls there are
and certainly there's

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no excuse to use anything but

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the most advanced engineering techniques
in environmental control.

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The second universe,

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versus that of the user of the product,

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the producer of asbestos products,

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is one in which perhaps the situation

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in the occupational environment is not
exactly mirrored.

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And it is there that we have to be
constantly on guard

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that we do have a controlled environment.

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I guess the ultimate and the final point

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I would like to make is the individual
himself,

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each of the 220 citizens in the country,

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what can they do particularly since if
whenever

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asbestos disappears from

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commerce in terms of new products it is a
part of our environment that's going

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to persist for decades perhaps centuries
first it's part of the Earth's crust but

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secondly in the world of of construction
it has been used for past in

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the past

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extensively. Many of the structures we
build are eternal

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so there's going to

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have to be demolition and the like and
it's important to recognize that in

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demolition a hazard no less potentially
grave than that which

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was first

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described in the manufacturing of asbestos
product.

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The individual can

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first of all be aware, be vigilant, and
the Department of Health, Education and
Welfare

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is assuming a responsibility. Yes, this
presentation today

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is one manifestation

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of the awareness program. Ours today
happens to be at the professional level,
but I

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can assure you

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at the individual citizen level there is
no less energy being expended for
education.

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And then finally, since lung cancer is by
far the most

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all-pervasive and on a

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quantitative way the most hazardous of all
asbestos-related disease,

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the undeniable association with smoking
demands for yet one more reason, if

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one more reason were really necessary,

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to have cigarette smoking reduced to an
irreducible minimum in the

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general population.

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That's it.