Dr. Paul Kotin on Asbestos: A Look at the Future

The last eight minutes of a videotaped program on asbestos disease for pathologists, from about 1978. The moderator, who is not named, says environmental medicine will be "to medicine what microbiology was in the first part of the century" and asks that medical schools teach doctors to take occupational histories. He then introduces Dr. Paul Kotin, Johns-Manville's senior vice president for health, safety and environment and a former director of the National Institute of Environmental Health Sciences. Kotin looks ahead: substitute fibres, the cases still in their latent period, occupational and general-population exposure, asbestos left in buildings and demolition, and smoking.

What it says about asbestos and health

Kotin warns that fibre size, not chemistry, causes the disease, so substitute fibres need watching, and that demolition of asbestos-containing buildings carries a hazard "no less potentially grave" than manufacturing. He says today's cases "reflect the past" rather than "failures of control for the present", that the mine, mill and primary producer working to the regulations have "an acceptable environment", and that users of asbestos products are where "we have to be constantly on guard". He closes on the "undeniable association" of lung cancer with smoking.

About this copy

Our copy is a transfer of a print from Johns-Manville's own film archive (box 04-03392), shown in full, 7:34 long. The close of a program on asbestos disease for pathologists. The moderator who introduces Dr. Kotin is not named on the tape.

Transcript

A machine transcript of the soundtrack, not yet checked against the film; names and technical words may be wrong.

We've been talking today about one example of environmental disease, namely that caused by asbestos. This obviously is only one of many examples of important diseases in humans produced by environmental agents. Indeed, it's generally accepted today that perhaps 90% of all human cancer is a result of environmental exposures of various types. Subject of education of medical students and physicians, therefore, in environmental medicine, and environmental pathology is exceedingly important. In fact, it's my view that a few years from now and today environmental medicine and environmental pathology are to medicine what microbiology was in the first part of the century. It's therefore essential that every aspect of the medical curriculum, undergraduate and postgraduate, embody concepts of environmental medicine and foster knowledge, detailed knowledge, of the principles of environmental agents and environmental exposures.

I think it's particularly appropriate that this program is addressed to pathologists because pathologists should take the lead in this development. It can happen in various ways in various curricula, but obviously it should be embedded in the critical basic science areas, pharmacology, pathology, physiology, as well as in all clinical disciplines. This requires requires attention to this, depending on the curriculum, subcommittees, and so on, to put this into actual operation in a medical school. During the clinical years, special attention should be given in developing knowledge of physical diagnosis, history taking on the part of physicians and medical students to create within them the techniques and concepts necessary to develop histories of occupational exposure and to do appropriate physical examinations, laboratory and radiologic tests. It's important moreover that students understand the basic principles and nature of environmental agents and in all of their important classes much after the fashion that we've tried to create today with the subject of asbestos. I'd now like to refer to Dr.

Paul Kotin who will give us a glimpse into the future. Looking into the future one can perhaps make five or six salient points. First, with the description of asbestos related disease, the obvious question that comes to mind is, can a substitute be found for asbestos in commerce? Are the social needs, the important social needs that asbestos has met in the past, can they be met by by other substances. Well, clearly in the discussion, past uses of asbestos were referred to with the obvious implication that alternative substances have been found. Perhaps the only word of caution is to reiterate, yet once again, that for fibrous materials on the basis of what we now know, it is the geometry, the dimensions of the fiber rather than its chemical makeup which appears to be the important factor and the pathogenesis of disease and we should be vigilant that we don't substitute one type of fiber for an asbestos fiber with some assurance that the legacy of asbestos will not in a latter day be reflected yet as a result of exposure to substitute materials this is the situation is relatively encouraging of course because we have learned so much in the world of industrial hygiene that the control of environmental exposure is now a sophisticated engineering art and in fact provides the basis for much of the regulatory activity of the various regulatory agencies.

A second factor to look to and consider in the future of course is the fact and again latent period was again iterated and reiterated as being measurable in decades segments of the lifespan if you will that the cases of asbestos related disease and the shipyard workers are perhaps the best example reflect exposures of the past but it is important to recognize that there are many cases of asbestos related disease I believe in a latent period which will become overt or manifested in the years and decades to come and it is important to recognize that they do reflect the past and rather than reflect failures of control for the present. The third factor is the matter of continuing exposure. Really there are two universes of exposure. There is the occupational universe and the general population exposure. The occupational environment, the mine, the mill, the primary producer of asbestos products, just to be in compliance with regulations has an acceptable environment, I believe. Engineering rather than really numbers determine what controls there are and certainly there's no excuse to use anything but the most advanced engineering techniques in environmental control.

The second universe, versus that of the user of the product, the producer of asbestos products, is one in which perhaps the situation in the occupational environment is not exactly mirrored. And it is there that we have to be constantly on guard that we do have a controlled environment. I guess the ultimate and the final point I would like to make is the individual himself, each of the 220 citizens in the country, what can they do particularly since if whenever asbestos disappears from commerce in terms of new products it is a part of our environment that's going to persist for decades perhaps centuries first it's part of the Earth's crust but secondly in the world of of construction it has been used for past in the past extensively. Many of the structures we build are eternal so there's going to have to be demolition and the like and it's important to recognize that in demolition a hazard no less potentially grave than that which was first described in the manufacturing of asbestos product. The individual can first of all be aware, be vigilant, and the Department of Health, Education and Welfare is assuming a responsibility. Yes, this presentation today is one manifestation of the awareness program.

Ours today happens to be at the professional level, but I can assure you at the individual citizen level there is no less energy being expended for education. And then finally, since lung cancer is by far the most all-pervasive and on a quantitative way the most hazardous of all asbestos-related disease, the undeniable association with smoking demands for yet one more reason, if one more reason were really necessary, to have cigarette smoking reduced to an irreducible minimum in the general population. That's it.