Videotaped Deposition of Dr. Paul Kotin in the South Carolina Asbestos Cases (1979)

The videotaped trial deposition of Dr. Paul Kotin, Johns-Manville's senior vice president for health, safety and environment, taken in October and November 1979 to be shown to juries in the asbestos cases in federal court in South Carolina. The first tape opens partway through cross-examination by plaintiffs' attorney Ron Motley, with J-M's counsel, Mr. Wilson, objecting. Motley takes him through Dr. Wilhelm Hueper's 1942 book, how much of his own research before he joined J-M in 1974 had concerned asbestos, early teaching of industrial medicine, his 1973 statement to the EPA on exposure to carcinogens, the Wagner and Selikoff studies, Dr. Thomas Mancuso's 1963 letters and report to Philip Carey, the 1938 Dreessen study behind the 5 million particle limit, Mr. Hemeon's 1947 dust survey for the Asbestos Textile Institute, shipyard dust counts, Saranac's Kaylo experiments and warning labels. On the second tape Wilson's redirect covers Doll's textile study, how the limit was reviewed, warnings, smoking, Selikoff's death figures and the state of epidemiology and occupational medicine, before a short recross.

What Dr. Kotin testified about asbestos and health

Kotin agrees that he concluded in 1955 that asbestos causes lung cancer, and that in the 1950s he held that "Exposure to a carcinogen at any level was capable of initiating a cell change". He changed that view in 1974; of Dr. Selikoff's position that no level is safe he says, "He's wrong, but he says it." He accepts Wagner's data linking asbestos and mesothelioma, says a 1956 Danish study was "highly suspicious that asbestosis was a complication of the insulation workers", and agrees users should have been told of exposures above the 5 million particle limit. He dates knowledge that insulators could get asbestosis to about 1963–64. On redirect he says that in 1955 "The only population that was studied was the textile workers", and that 1964 knowledge showed the limit "was wrong". He calls pleural changes not a disease, and says smokers with asbestosis fare worse.

About this copy

Our copy is Johns-Manville's own set of the videotapes (box 15-90008): two tapes, 5:13:39 in all, shown in full except blank tape. The first tape begins partway through the cross-examination; the tapes before it were not in the set.

Transcript

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

Tape 1: cross-examination by Ron Motley

Do you recall in Dr. Lanza's book, also, K-10, Exhibit K-10, that he talks about lawsuits being filed against the asbestos industry in the 1930s by workers claiming to have asbestosis? I don't recall, but I'll be glad to read it. All right. I'll come back to that in a little bit. Sure.

Now, while you were with the government in 19, beginning I believe in 1961, did you make the acquaintance of a scientist by the name of Wilhelm Hueper? Yes, sir. And would you tell the jury who Dr. Hueper was? Dr. Hueper was chief of the, I guess they call it the environmental cancer section at the National Cancer Institute at that time. all right and dr Hueper was active in the field of occupational diseases beginning when do you know oh i'd say 10 15 years before that 20 years before that are you familiar with the book he wrote back in way back in 1942 yes sir i hand you a copy that uh of this book and ask you if you've ever seen before yes sir i have and it's entitled occupational tumors and allied diseases by wc Hueper dated 1942 is that correct that is correct and if you look where did where did that particular book come from look in the front of it if you don't know the charles dennison md memorial library where is that don't know you don't know do you teach at university of colorado school of medicine yes sir do you not recognize that as the university of colorado school of medicine library i have my secretary pretty much go to the library for me well you don't know then that that is in fact the name of the library it is in fact the name of the library the university of colorado yes sir all right now you teach there now is that correct that's correct professor of pathology.

Now, doctor, I'm going to give you some Xerox pages. You can consult the book if you like, but these are the pages we're going to be talking about, and I've taken the liberty of marking that as Exhibit K-11. Now, let me ask you one question at the start, and that is, were you familiar you after getting your medical degree with the warner institute for therapeutic research in new york city yes sir i was aware of it was that a laboratory for research into cancer it was a laboratory for research i don't know because what okay i'm sorry was it an acknowledged uh and prestigious research laboratory i knew it i know it but it wasn't the saranac lab let's put it that way now doctor if you will look uh look in the table of contents yes sir and here does is it listed for uh some oh five or six pages various uh diseases yes sir okay and on page xx yes see that is there listed occupational cancers of the respiratory system yes sir you see that now this book was published in 1942 is that correct yes sir all right now if you look over on the next page page xx1 yes sir do you see mention of the disease asbestosis i do all right now i believe that the discussion begins on page 399 is that correct yes sir okay if you would sir turn over to page 399 now let me ask you this sir Dr. Hueper received an award in 1974. Are you familiar with that? I sure am.

And in fact, I believe you sent him a telegram congratulating him upon his receipt of that award, did you not? I might have called him. Obviously, I did congratulate him, yes. And would you tell the jury what that award was? Well, you see, that probably was the UN award that was the year, was it not? What is the Society of SIOEH?

The SIOEH, Society of Occupational Environmental Hygiene. And did Dr. Hueper not receive their first award? Yes, sir, he did. And was it not called the Percival Pott Award? Yes, sir.

Who was Percival Pott? Percival Pott was a British surgeon that lived in the 18th century who described the scleral cancers and chimney sweeps as an occupational disease. He described occupational-oriented cancer. Of one type. One type, yes. And was Dr.

Hooper not the recipient of the first percival pott award for distinguished service in the field of occupational cancer yes sir now doctor on page 399 do you see a discussion of asbestos yes sir all right would you read the first two sentences and then i want to ask you a question about it you mean chemical and technological aspects yes sir asbestos designating a group of silicate minerals of crystalline fibular structure was known to the ancient world. At that time and during the following centuries, it was used occasionally in the production of perpetual lamp wicks, slouts for cremation, and other purposes partly of curiosity character. Radon? Yes, sir. It was only since the latter third of the last century that this material has attained a major industrial importance and has become of serious significance from the standpoint of industrial hygiene. Now, in 1942 doctor did you agree with dr.

Hooper with respect to the fact that in the last third of the 20th century since the last third of the 19th century and I soon on into the 20th century that asbestos has obtained major industrial importance no I think it's a material that has been used with increasing frequency all right sir and that it had become by 1942 a matter of serious significance from the standpoint of industrial hygiene yes sir doctor you mentioned on direct case reports you recall that I sure do now do you agree that case reports even though they might be isolated represent sometimes the first warning of a subsequent appearance of large numbers of similar occurrences there are instances where they have but by far greater instances where they happen all right now doctor do you recall that the first case reports in which people talked about asbestosis and lung cancer occurred in this country way back in 1935 yes sir and the case report continued to be reported in the literature from 1935 all the way up to 1964. yes sir and in some of those case reports beginning in 1942 doctors were writing about asbestosis and lung lung cancer in shipyard workers and insulated insulation workers there were case reports yes yes now look at page 405 yes sir sentence that begins previous okay would you read that please 405 yes sir previous experience with other industrial neoplasms what is a neoplasm a cancer all right perens lung cancer of the joachim stahl miners you get the spelling from here and lung cancer of chromate workers has shown that such isolated cases may represent the first warning of a subsequent appearance of large numbers of similar tumors of undeniable occupational derivation now do i understand dr Hueper there back in 1942 was saying that case reports might lead to later confirmation of a cause and effect relationship between a substance and cancer he says it may represent and i think that is exactly what he said do you agree with him it may represent at any time okay now would you read down the medical legal and social aspects asbestosis carcinoma lung is not included in any group of occupational tumors recognized by any country the evidence presented is sufficiently serious and the number of persons exposed to the suspected causative agent large enough to indicate a thorough and extensive clinical statistical and environmental investigation of the incidence and causative interrelation doctor i think the word is experimental investigation statistical and experimental investigation of the incidence and causative interrelation of asbestosis and pulmonary carcinoma all right let me let me uh i assume a carcinoma is cancer correct and when he says pulmonary carcinoma he's talking about lung cancer correct doctor are you not aware that subsequent to dr. Hubert's writing in 1942 that in the countries of Germany and Great Britain by 1950 asbestos is lung cancer was considered a compensable disease doctor do you agree or do you have knowledge that by 1950 the countries of great britain and germany recognized lung cancer in association with asbestosis as a compensable disease yes sir now doctor now doctor if you could turn back to page 400 i have all right do you see there i think i marked it about a third of the way down do you see where dr Hueper says occupational contact with asbestos is present in any in many industries using asbestos products that's what dr yes sir and do you see where he lists a whole bunch of purposes including insulation materials yes sir all right do you agree that in 1942 that occupational contact with asbestos was present in many industries using asbestos products including insulation materials Well, that was the objective form of the question here, but it does not state when he agreed with it and whether he agreed with it now or whether he agreed with it at the time. Well, and the text clearly refers to the manufacturer of those materials. No, sir, it does not. Now, Dr. Well, let the doctor read it.

Well, you can all read it, Mr. Wilson. You can read whatever you'd like. Let the doctor read it. I just plainly object to the form. Dr.

Kotin, do you or did you agree in 1942 that occupational contact with asbestos is present in many industries using asbestos products? It was present in industries using, I don't know what he means by many, in industries using asbestos products, yes. And you previously agreed that by 1930 at least it was recognized that asbestos was used in insulation materials. Yes, sir. And are you familiar with Dr. Alfred Angrist?

Yes, sir. and are you familiar with his publication in 1942 in the American Journal of Pathology? Yes, sir. And is the American Journal of Pathology a journal on which you served the editorial board? Yes, sir. And do you agree that in 1942, Dr. Angrist reported two cases in this particular journal of asbestosis and lung cancer in shipyard workers?

Yes, sir. all right now doctor um turn over to page 401 if you will and i believe that we marked in there the section i wanted to ask you about what page are you going 401 do you see where dr Hueper phrases very briefly the history of asbestosis yes sir okay do you see where he talks about fatalities from asbestosis in the united states does he say in there fatalities from asbestosis as a main or contributory cause of death were published in the United States by Lynch, Stewart, Butcher, Coleman, and Shule. Yes, sir. Now, do you understand him to mean that there were writings about people dying from asbestosis written by authors whose names were Lynch, Stewart, Butcher, Coleman, and Shule? Yes, sir. Okay, and do you see where he reports that the Metropolitan Life Insurance Company recorded between 1924 and 1936, 17 cases in which asbestosis contributed to the lethal outcome of the main disease. Yes, sir.

Now doctor with respect to that, has your review of the literature revealed to you that by 1936 there were writings in the literature of persons dying of Asbestosis of asbestosis yes sir okay now do you see on page 401 I believe the next part we mark talk about the length of exposure to the disease now would you read what Dr. Hueper said back in 1942 about how long it took to get sick with asbestosis. Asbestosis usually develops after an exposure of three to 15 years parenthesis marks close parenthesis but may not produce objective symptoms and for many years after the cessation of exposure to asbestos material all right is that a correct statement as you understand it of the latency period uh back in 1942 excuse me is what his understanding was in 1942 or if that is what his understanding is today doctor from your review of the literature which you described that you undertook was that your understanding of the latency period in 1942 as expressed in the literature as expressed in the literature now what dr. Hueper says is it may produce symptoms subsequent to cessation of exposure that happens all right now would you read the symptoms of asbestos the first symptoms are dyspnea and a cough with expectoration all right well let me ask you about that you've already said dyspnea is shortness of breath is that correct yes sir and what is a cough with expectoration cough with spitting okay do you agree with that statement in 1942 it can't happen all right now go ahead read the next thing later there is pallor cyanosis palpitation of the heart loss of appetite and weight and piercing pains of the chest during breathing now there's several terms in there that i don't understand what do you mean about what the doctor you for mean by power pale okay cyanosis a bluish tingeing of the skin what does that come from inadequate oxygenation of the blood palpitation of the heart beating of the heart so that you're aware of its beating loss of appetite weight I can even understand that now what what about piercing pains in the chest during breathing what would cause that what what does asbestos do to the lungs to cause that to the lungs it wouldn't it might produce some uh changes of uh well i guess the lungs would be i was dissecting it into its part sure the fibrosis could cause a constriction of the lung and there could be pain as the restricted lung tries to expand yesterday and uh then would you you read the next sentence the shortness of breath becomes the sharpness of breath becomes aggravated during physical exertion okay um explain that to me why is it that asbestosis causes an aggravation of the of the shortness of breath when you when you work because you as you're working or running or doing any exercise you are placing a greater demand for uh oxygen and the body okay now would you read the next sentence please in the beginning in the beginning the physical examination reveals scarcely any pulmonary changes but there later appears a diminution of resonance especially over the lower parts of the lung particularly the right side where dry and practical crackling sounds are perceptible in auscultation all right now what does auscultation mean hearing sounds from the chest through a stethoscope in other words the doctors saying back in 1942 a doctor can put a stethoscope up to a man's chest and hear things that are going on in the lungs that somebody's got asbestosis yes sir now would you read the next sentence the respiratory capacity is decreased and there is a diminution of the respiratory shift of the pulmonary borders during respiratory movements of the lung now what does that mean well he's describing restrictive pulmonary disease the respiratory capacity is decreased the amount you breathe is lowered that's something a doctor back in 1942 could look for in trying to find out whether an asbestos worked or had asbestosis yes okay the next and the diminution of respiratory shift of the pulmonary borders in other words as with my analogy of the lungs being balloon-like the balloon is blown up less than these kind of people okay and uh being respiratory movements of the lung yes the next starts with the heart the heart is often enlarged due to the increased functional demand placed on it because of the decreased respiratory surface and impaired circulation in the lung caused by pulmonary fibrosis now we didn't talk about this this morning and it's my fault i meant to ask you about it but is there a heart condition that sometimes complicates asbestos yes sir and what is it called core pulmonale yeah i was going to say right-sided hypertrophy but core pulmonology i was trying to avoid the technical term right-sided heart hypertrophy what do you mean by that well the heart as you know was divided into chambers four of them two on the left side two on the right side, and the right side of the heart, which pumps against the gradient of the lungs, as distinguished from the left side of the heart, which pumps blood throughout the body, is the one that naturally would respond to any increased resistance in the lungs. Do people who have asbestosis sometimes get sick with right side heart hypertrophy or choropulmonale? They can, yes. can that be fatal can it be short a life shortening yes yes now we're down to the sentence that reads the enlargement the enlargement of the right side of the heart becomes accentuated as cardiac insufficiency ensues now basically he's saying it it can get worse is that what he's saying correct okay and so the heart gets weaker and weaker is that what he's saying no he's saying that the enlargement of the heart in that sentence increase uh progresses does that mean though that basically the heart is having to work harder yes sir okay and it eventually gets weaker and weaker can eventually yes now we started with that fancy word for x-ray the lincoln examination of the chest shows an early diffuse interstitial fibrosis having reticular honeycombing The Rankin examination of the chest shows an early diffuse interstitial fibrosis having reticular honeycomb- like outlines and showing progressive tendencies which later cause a filmy hazy appearance of the lung.

This condition has been termed ground glass appearance. appearance. The hilum shadows are enlarged in the more advanced stages. The movements of the diaphragm are reduced. The microscopic examination of the sputum executed with proper methods and thoroughness reveals the presence of golden brown asbestos bodies. Now we'll get to the asbestos bodies in a second, but is Dr. Hueper here describing what back in 1942 what a general practitioner or anybody might see if they looked at a chest x-ray of a person with asbestosis the general practitioner wouldn't know what he was looking at what he is describing is the highly sophisticated diagnosis of an x-ray specialist okay so an x-ray a radiologist in a hospital down in Charleston South Carolina could read this and then look at an x-ray of somebody who worked in the shipyard and find out whether or not he had asbestos is that correct radiologist yes anywhere but one in Charleston South Carolina could read this and understand what dr.

Hooper was described he was a competent rent canologist yes sir in a rip rip canologist is a radiologist radio and how long doctor before 1942 where x-rays used to diagnose people who had dust diseases like asbestos so many many many years many years but they're okay now Now, what is, back in 1942 when Dr. Huford wrote this, do you agree or disagree that that's a correct description of the type of things that you would see with somebody who had asbestos? I would agree, yes, sir. Now, Dr. Huford mentions asbestos bodies. What does he mean by asbestos bodies?

Dr. Asbestos bodies are a reaction of the lung to the presence of asbestos fibers. The reaction consists of the encapsulation of the asbestos fiber by the defense mechanisms of the body, including the cells and so on. And then the asbestos body becomes encapsulated. The asbestos fiber, I beg your pardon, becomes encapsulated. Now the material that encapsulates this asbestos fiber consists of serum, protein.

It consists of some of the iron that is circulating in the body at all time and certain pigments that are part of the body so that a pathologist can look at a section of lung or a specimen of sputum and identify the presence of this body. now in 1942 it was assumed as I was taught and as indeed I did teach early that asbestos bodies were exclusively indicative of asbestos in the lung the term asbestos body has been superseded by a term I'm anticipating because I believe I've heard you say this before ferruginous ah ferruginous body f-e-r-r-i-g-u-g-i-n-o-u-s i might have lost my ferruginous let me ask you this about let me finish oh i'm sorry i thought you and these ferruginous bodies are called ferruginous because the term is derived from the latin word ferro for iron because a pathologist will use an iron type stain to identify these bodies they're caused by fibers not asbestos fibers alone an array of fibers can cause it can produce it thank you doctor now over on page 403 yes sir dr. Hueper starts talking about asbestosis and carcinoma of the lung that means asbestosis and lung cancer never right all right would you read the paragraph beginning it is it is only in very recent years that serious consideration has been given to the possibility of a cancerogenic action of asbestos asbestosis upon the lung what is cancerogenic me cancer causing and an analysis of 18,000 280 death certificates for cancer of the lung and larynx and males from England and Wales from 1921 to 1932 Ken away and Ken away did not find any cases of lung cancer in asbestos workers. Since 1935, an appreciable number of cases of asbestosis associated with carcinoma of the lung have been reported from England, Germany, and the United States. Lynch and Smith, Lynch, Gloyne, Wood, Horning, Nordman, and Egbert and Geiger. The incidence of lung cancer among workers in whom an asbestos was found at autopsy is relatively high, ranging from 17% more than 2 out of 17 cases to 20% with 2 or 3 or possibly 3 out of 12 cases. Teleky noted that there exists a minimum of 39 and a maximum of 78 autopsies in fatalities from asbestosis.

The records not being clear in this respect. Tellicke only knows of six cases of pulmonary cancer with asbestosis and feels that the ratio is high in comparison to the number of necropsies. What is a necropsy? Autopsy. Kulch mentioned the occurrence of 12 cases. Lynch 3, Egbert and Geiger 1, Gloyne 2, Domenici 2, Bader 1, Nordman 2, Wood 3, and Horning 1.

Lynch and Smith found among 35 autopsies with asbestosis two cases of pulmonary malignancy, 6%, whereas there was an incidence of only 0.3% of this type of neoplasia among approximately 2,300 autopsies of the general population. Now, is that consistent with what you said about lung cancer being a rare disease in the 30s and 40s? An uncommon disease, yes. It's certainly not as common as it is now. Now, let me ask you this question about what you just read, Dr. Cote.

And that is whether or not, in 1942, Dr. Hueper had done a commendable job of bringing together all the cases of asbestosis and lung cancer in the literature. I think Dr. Hueper did a very comprehensive job, but as with so many of the studies, an uncritical job. All right. Now, the doctor on page 404, the second paragraph starting an evaluation.

Would you read that, please? An evaluation of the evidence presented revealed certain features connected with these cases which are suggestive of an occupational causation. There is an incidence of lung cancer in asbestosis of the lung, which is definitely excessive. All right. Now, Dr. Hueper wrote this in 1942.

Is that correct? Correct. And I believe that in 1955, you reached the conclusion that asbestos was a carcinogen. Is that correct? Put it along, yes, sir. Yes.

And between the years 1942 and 1955, did Dr. Hueper continue to publish articles in which he urged that asbestos was a carcinogen? He did, yes. In fact, in the 1950s, you co-authored a paper with Dr. Hueper in which both of you wrote that asbestos caused cancer. Isn't that correct?

I don't remember. It was in the 1950s, yes. Now, Dr., you recall when we were talking about Dr. Lanz's book that was written back in 1938, the one K-10, I believe. Oh, yeah. and he mentioned that some of the dangerous occupations were mixing asbestos up you remember that and another one was sawing asbestos you remember that yes I'd ask you to take a look at these two pictures and then I'm gonna try to see with the cameraman and I can work this so that the jury can see to the question and the use of the photographs is that how you want me to hold uh can you zoom in on that mr cameraman objection yes and and and also to the zooming in on the picture uh hold on mr cameraman can you hold them yeah let me know how that's good excuse me we like to have a little bit better practice under these circumstances since photographs have not been ruled admissible to keep them off camera until such times they are ruled admissible Well, then they can be shown to the jury. Can you get it, Mr.

Cameraman? Yeah, I got that one. All right. Now, Doctor, let's talk about it a minute. Mr. Paul, on Star Day, I object.

We have not had an opportunity to even look at the things he's offered to witness. Madam, I also object to the zooming in on the camera not being in conformity with the order of the United States District Court in South Carolina. Doctor, have you taken a look at that picture? I have, yes, sir. what is that worker doing? I guess he has a saw in his hand and he's sawing. Is there dust liberated from the use of that saw?

There's dust being liberated, yes sir. Do you have an opinion as to whether... Objective form of the question is the pictures speak for themselves. Do you have an opinion sir whether or not there's a potential hazard involved in the operation of that saw all as is depicted in that picture well i don't know that the picture is that informative to me because i don't i see a lot of white stuff floating around that could or could not be any one of many things including asbestos all right but generically can sawing create a problem yes all right now doctor this is uh k 12. the last one was k11 i believe so i believe this is k12 it's 12 and 13 the pictures are 12 and 13 this is k-12 the first picture that saw was k-12 mr cameraman can you focus on that all right doctor would you take a look at that yes sir now what does that worker do well it's a worker wearing a respirator and a hard hat who is uh has a hole-like material and he's uh mixing something okay did you agree uh with Dr. Lanza and Dr. Merewether that the mixing up of dry materials which contained asbestos is a potentially hazardous activity.

It can be potentially hazardous. Yes, thank you. Now. Well, is this about time for you to break lunch? Excellent. Now, Dr.

Kotin, when Mr. Wilson initially examined you, he went into some detail with respect to your background prior to your assuming your present position. and I have had the opportunity to review many of the articles that you have written and I believe that you would agree with me that your majority of your articles deal with your experiments and findings with respect to the effect of Certain substances on the air that the general population breathes. Is that correct? the model that I used was hydrocarbons and the experimental models that I use in animals the principles of My studies have a universal applicability to chest diseases. We're going to come to that. Thank you. Okay now Dr.

Kotin Will you agree that there were others who were involved in? dust diseases such as silicosis and asbestosis during the same period of time that you were mainly involved in the effect of hydrocarbons. Yes sir. And Dr. Leroy Gardner and Dr. Arthur Vorwald who are directors of the Saranac laboratory are two of the persons who were doing research on asbestos disease at the same time you were doing research on hydrocarbons. Is that correct that is correct okay and dr cutton the uh the fact of the matter is that from 1961 through 1966 you spent very little time on asbestosis because of your devotion to cancer research is that correct no that is not correct because basically uh well first of all i don't know what you mean with your very littles and very more uh or very much but basically to the the extent that asbestosis might have been a link in the production of lung cancer I would agree yes but it was not the it didn't occupy most of my time by any manner of means it occupied little not very little little well do you remember that last Friday much of the same group of lawyers was here in the same room and we took your testimony uh what's called a discovery deficit yes sir okay and on page 98 mr wilson i asked you this question doctor is it true that you spent very little time between the years 1961 and 1966 on the subject of asbestosis because your attention was primarily devoted to cancer matters and your answer was that's absolutely true i should have commented it on the very little i don't know the berry i don't uh all right you throw me with the berries okay um now doctor before you assumed your present position in 1974 is it correct that number one you never did any animal research yourself on asbestos or asbestos diseases that is correct number two before 1974 you never authored or wrote any articles dealing with asbestos or asbestos disease I thought you asked me earlier and cited a situation where I co-authored a paper without you but I don't but on my own work I did nothing in the way of publishing and number three before 1974 you never conducted or participated in the conduct of any epidemiologic study of asbestos workers that is correct and number four before 1974 you never conducted nor participated in the conduct of any study to determine the levels of asbestos to which various industrial workers might be exposed correct and number five that before 1974 you did not join any of the various occupational medicine specialty groups.

In terms of the American Occupational Medical Association, that is correct. Right, and number six, you never presented any papers at the Saranac Laboratory Symposia on Asbestos Diseases. Correct. And you never presented any papers at the Industrial Health Foundation or at its predecessor the industrial hygiene foundation seminars on asbestos diseases correct and number seven before 1974 you had never visited an asbestos fabricating plant or an asbestos mine correct and before 1974 this is number eight you never conducted any studies yourself on insulation products which contained asbestos to determine whether or not experimental animals might develop asbestos correct right and are you personally aware that dr. Gardner bore wall and Garrett Schepers all conducted such tests on insulation products which contained asbestos they conducted research on products containing asbestos yes and dr. coat and the fact of the matter is that the Dreessen study that 1938 study that mr wilson asked you about you didn't even read that until you went with the government in the late 1950s early 1960s did you correct and the fact of the matter is doctor that you weren't even aware of and had not read the fleischer study that mr uh wilson asked you about until you went with the government isn't that correct no i I can't give you a date on that, but you're wrong. I think I've testified before that Dr.

Philip Drinker and I were friends, certainly acquaintances, and we discussed the area of occupational and environmental health. But basically, insofar as the specific article itself, the government date would be the correct one. All right. So you did not read the Fleischer study before you went with the government in 1958? Correct. Now, Dr., let's talk a second about Dr.

Selikoff's paper in 1964. The fact of the matter is, his initial findings were published, were presented in 1963 at the annual convention of the American Medical Association in Atlantic City, New Jersey, weren't they? That's correct. And they were published in April 1964 in the Journal of the American Medical Association. Correct. And I believe you testified yesterday that the American Medical Association journal is one that is more widespread than the so-called specialty journal.

It's read widely, yes. So if a company had a plant physician, an asbestos company had a plant physician, if he didn't read anything else, he's likely to have read the Journal of the American Medical Association, wouldn't he? I can't say but he would it's a journal that he would get yes most doctors are members of the American Medical Association aren't correct and all members of the American Medical Association get the journal the American correct now doctor when Dr. Selikoff was in New York in October 1964 that was a very important conference wasn't it yes sir and I believe you've testified previously that 90 to 95 percent of the world's asbestos experts were at that conference. Is that correct? Some figure approximating that, yes.

I believe you said somebody dropped a bomb on the on the meeting room that all the expertise in the world would have gone out the window. A major, major portion would go out the window. And virtually every asbestos expert in the world was there, weren't they, Doctor? I don't know what you mean by virtually. I think the 90, 95 percent, nine out of ten were there, right. Dr.

Kotin, were you there? No, you know why I wasn't there. I was appearing before Congress. I had planned to go there, I helped fund the conference, and it was my intention to go. I had people there, but I wasn't there. All right.

Now, Dr. Kotin, do you agree that to the extent that a company had a medical director in 1950, 1950, that that medical director, I'm talking about an asbestos product company, had a responsibility in 1950 to monitor the literature for articles on his products. You should be aware of it, yes, sir. Now, let me ask you, doctor, you indicated that you weren't at the New York Academy of Sciences meeting, is that correct? As I recall, I did not attend any of the sessions. Do you remember Do you remember testifying down in old Greenville, Tennessee, back in February of 1977?

You're right. Do you remember being asked this question on page 53, Mr. Wilson? Yeah. I believe Dr. Selikoff gave his report on October 26, 1964.

Isn't that correct? Correct. And your answer was, I don't remember the exact date, but it was the fall. I was at the conference. I did not attend those sessions. So if you told, well, did you say that? yes it says there yeah but i did not attend the sessions i was the sponsor of the conference and did not attend the scientific sessions because the day he presented it i was testifying before congress and the fact of the matter is doctor that you testified in 1978 on the deposition that you were at that conference could very well be i just didn't attend the the sessions that the papers were presented now doctor did i understand you to did i understand you to testify this morning that it was rare i believe you said very rare for a industry to have a medical director back in the 1930s i think it was very i didn't say very rare i said it was very unusual and then i added the word rare okay and in fact you testified before that you could count occupational doctors on two hands back in the 1950s correct which would be consistent with that yes sir let me hand you uh a couple of documents doctor council we can receive yes don't stop this is the first time the documents have been presented to us yes uh and uh uh if you don't mind i would like an opportunity to at least review i'll be delighted to my question was do you want the camera to run while you're doing that dead time not necessarily can you cut the camera please and i'll give you all of these documents that I'm going to use in this segment, if you'd like, Mr.

Wilson. Okay? Now, Dr. Kotin, I have given you a copy of Exhibit 14. Yes, sir. K14, which purports to be a copy of something entitled The Encyclopedia of American Associations, First Edition, 1956.

Yes, sir. Do you have a copy of the same thing I have? I do. All right. And then I've given you a copy of page 172. Do you see that?

I sure do. All right. do you see any the american industrial hygiene association listed there yes sir and you familiar with that association i am and do you see the industrial hygiene foundation of america listed there yes are you familiar with that organization yes sir all right do you see the industrial medical association mentioned there i sure do now do you see where it says that that association has 3 300 members oh yes sir and that it was founded in 1915 yes sir and you see where it's an organization of medical directors and plant physicians yes sir all right now and also and also i think i'd like to define medical directors and plant physicians i would say that the assumption is that these medical directors and plant physicians were all full-time physicians as the medical director was at the Johns-Manville corporation in fact today a majority of the members of these organizations first of all the american industrial hygiene association is made up of industrial hygienists but the industrial medical association and its successor organizations have a balance of both full-time and part-time members and the 3300 members i think is essentially a meaningless number until you identify those which were full-time and those which were part-time i see so your responses were reference to full-time Biomedical dragon in the sense of your questions about Johns- Manville's medical director. Yes, okay now doctor do you I'd like for you to take a look at exhibit K-15 now with respect to exhibit K for K 14 the previous exhibit at least by 1956 there were 3,300 Persons physicians engaged in some form of industrial medical practice. Do you agree with that? There were 3,300 physicians who belonged to the association. I see.

Okay, do you know what the criteria for membership was? The ability to pay the dues. All right, sir. You don't know? Doctor, are you suggesting to the jury that those gentlemen, the 3,300 members of the American Industrial Medicine Association, were members just by virtue of their pay and their dues? Well, their interest in the field.

All right. So there were 3,300 people who were interested enough in industrial medicine in 1956 to at least pay their dues? yes sir all right now if you would sir uh i believe that exhibit uh 15 is purports to be volume one of the journal of industrial hygiene yes sir are you familiar with the journal of industrial hygiene it's since changed its name but it's successors yes all right what's the the president of the american journal of industrial hygiene i think uh american have an american in it i think is it not the archives of environmental health It might be, but at least it's changed its name. And what's the date this first issue was published? Doctor, I believe that we're talking about Exhibit 15, the Journal of Industrial Hygiene, Volume 1, May 1919. Right. About 60 years ago, if my math is correct.

Right. Now, page one of that journal is an article by Harry E. Mock, Lieutenant Colonel United States of America Office of the Surgeon General you see that yes sir all right now do you see that he's formerly chief surgeon of Sears Roebuck yes sir okay doctor on page one you see where dr. mark writes in the last decade has witnessed the birth of a new specialty in the medical profession industrial medicine and surgery yes sir is that complete with your understanding of when this specialty developed 1910 or so no i think the specialty developed with the recognition of it as a specialty in terms of official residency training a prescribed program for certification as a specialist because in 1919 you only had to do this to certify yourself as a specialist to say i am a specialist in it all right well now doctor when was the board a specialty for occupational preventive medicine created i don't remember but it was well after 1919 and i could get the dates how about 1948 could be all right well i'm going to show you a document in a minute maybe that'll refresh your recollection sure now doctor uh do you see on page one further down where it's bracketed and the author says it meaning the practice of industrial medicine surgery involves the prevention of disease and accidents among the entire group of employees yes sir all right and do you see where it goes on to talk about examination of the hazards of each occupation yes sir all right oh now doctor does that comport or does that agree with your understanding of the practice of industrial medicine in 1919 it certainly is dr moxon yes sir all right now look over on page two if you don't mind you see in the uh the bracketed part in the first major paragraph would you read that please from a specialty known only to a few hundred physicians and whose value is recognized only by those industries employing medical services it rapidly became a measure in the national preparedness program today the language of the industrial physician is spoken familiarly by thousands of physicians and laymen Now, Doctor, does that agree with your understanding of the number of people practicing industrial medicine in 1919? No, what it does is say that the subject was becoming a matter of interest and awareness. All right. Now, Doctor, do you see on page two in the second column?

Yeah. You see where Dr. Mock says today, talking about industrial medicine, It is receiving the greatest attention from physicians industrial engineers social workers and employers in general Medical schools and engineering schools are teaching students various phases of industrial medicine and surgery. Do you see that? Yes Does that agree with your understanding of when occupational medicine began being taught in medical school No, and more than that, it doesn't agree with the opinion of the American Association of Medical Colleges or other people as well. All right, sir well we'll get to that in just a second now doctor uh on page three do you at the bottom do you see uh some discussion of the committee on factories all right do you recognize the name theodore sacks i don't see his name here on the third line sir says the committee on factories of the Chicago Tuberculosis Institute, composed of Drs.

Britton, Sachs, and Henry Fable. No, I don't know Dr. Sachs. All right. You don't know of his work on threshold limit values? I don't know Dr.

Sachs, no. All right. Now, doctor, on page 4 in the second sentence, do you see the name Dr. Alice Hamilton? Yes. Do you know who she is?

Yes. all right was she not co-author of a textbook on occupational diseases with Dr. Harriet Hardy yes okay you recognize her name yes sir so she was practicing occupational medicine at least back in 1919 yes I recognize the parents of the area one of the parents she was one of the Titans one of the parents of the area yes all right now doctor do you see in the second uh column of uh page four a discussion of the american public health association yes sir would you read that please in the american public health association doctors w.a evans e.t fisk alice hamilton e.r hayhurst and b.s warren with some 50 other physicians recognizing the influence of this form of public health work formed the section on industrial hygiene and that organization during the fall of 1914 now tell the jury what the american public health association is it's an association which is concerned with with public health the membership is made up of a broad array of professionals and non-professionals all right doctor does what dr mock says about the formation of the section on industrial hygiene of the american public health association agree with your understanding of when it was created it does now i didn't know it was created in 1914 exact time I know was created many many many years ago over 60 years ago anyway now doctor will you look at the bottom part of phase four please yes sir all right and would you read the Senate starting with but public recognition but public recognition of Bruce specialty of industrial medicine was given in 1915 by this association in the annual meeting of last year the preventive medical section of the American Medical Association, Dr. Otto P. Geyer, chairman, had a symposium on industrial hygiene. Since then, industrial medicine and surgery has had a place on annual programs of that section. On every annual program of that section, is that correct?

On every annual program of that section. Have you attended any meetings of the preventive medicine section of the American Medical Association? I have. Did you attend any back when you were in medical school or right after you graduated? No. So you don't know whether or not you ever attended any of the annual symposiums on occupational medicine not only did i attend but a diligent review of all the programs will see that i participated as a a speaker in some all right how much time do you have i'm advised dr cohen we're about out of time on this tape we were discussing uh k uh 15 a 1919 medical article in a medical journal is that correct yes sir now industrial hygiene yes have you and i believe that that's the official uh magazine of that uh organization that we were talking about of industrial physicians and surgeons isn't that correct no the american industrial hygiene association no sir the american industrial medicine the at this time industrial medical association yes sir all right now you see on page five sir are you with me yes sir had you ever heard before today of the american association of industrial physicians and surgeons yeah i had yes all right and would you read to the uh for me what it says about that association starts with the incorporation i'm going to object to the form of the question let's model if you want to dress you read it and ask him if he agrees with it rather than the doctor well i prefer to let the doctor read go ahead doctor starts the incorporation papers i'm looking for it on page five right the incorporation paper show 125 physicians and surgeons as charter members of this organization its aims have been to simulate scientific study and research in all branches of the industrial medicine to stimulate industries to adopt a comprehensive health service and to raise the standards of physicians engaged in industrial practice all right sir now you've expressed some knowledge of that organization is that correct i was aware of it that's all i said i was did you know that it was founded back in 1916 i did not did you know that it had 125 doctors as charter members I did not all right now do you see down further in the Senate's where it lists the number of doctors that it had it says that present this organization has approximately 600 members and this document k-15 was written in 1919 all right but I would reiterate that that membership is not synonymous with being a full-time corporate position i understand doctor good now uh do you see uh with respect to the united states public health service yes sir okay do you see where they mentioned dr lanza who wrote that 1938 textbook right do you do you see where the united states public health service had investigated industries other than the aspects since by 1919. yes sir okay now Now, Doctor, I'm going to hand you Exhibit K-16.

Mr. Motley, if you're going through a number of exhibits in this fashion, can we have a continuing objection to them and save interrupting you as you go along? Oh, certainly. Now, Doctor, what is the title of that particular document? Introduction to Industrial Medicine. Introduction to Industrial Medicine.

Did you see a year that it was published? 1947. 1947. Will you turn to the bibliography, sir? Yes, sir. How many pages of references does that textbook cite on industrial medicine in 1947? One, two, three, four, times three and a half, seven. Seven pages of reference on industrial medicine and that textbook was published in 1947. 47.

I find that not at all surprising. We've been reviewing literature and been discussing reports of occupational situations. Okay, now, doctor, turning to another subject, I believe you stated on previous occasions that there was not a single department of occupational medicine in the United States in 1950. Is that correct? That's correct. There have been divisions of occupational medicine, but not departments.

Okay, and did you also state on friday that occupational medicine was not taught and that you would have been surprised to learn that there were more than one or two courses on occupational medicine taught in the entire country in 1950 yeah okay now doctor uh do you teach at the university of colorado yes okay well dr uh Kotin does uh exhibit k-17 appear to be a the announcement of the school of medicine for the university of colorado in denver colorado yes sir is that where you teach now yes sir okay do you see uh doctor over on uh page 30. yes you see course number 150 yes sir does that read public health applications of microbiology and the problems of public health epidemiology and preventive medicine yes of course and it they taught those medical students that for 40 hours did you see that they sure did with virtually 39.9 of the hours devoted to principles of infectious disease as they would be in 1931 all right do you see that in there there, sir? Yeah, principles and applications of microbiology. That's the study of diseases caused by infectious agents. Okay, well, you look at course number 153. Yes, sir. All right, do you see the course taught medical students at the school where you teach back in 1931 was called industrial hygiene?

It was a free elective for seniors, and I think the offering of the course in terms of its actual participation by students is is uh are entirely different things so that there was no structured required course of students at the university of colorado in industrial hygiene it was an elective not a mandated course we'll get to that in a second okay Okay. Now, Doctor, if you look at number 18, is that also a bulletin of the University of Colorado? Yes, sir. And it's dated 1948. Yes, sir. All right.

Now, if you will, please, sir, over at page 9. Yes, sir. Now, not only were there courses taught in industrial medicine at the University of Colorado in 1948, there was an entire division of industrial medicine, wasn't there, Doctor? Oh, yes. I've said there were divisions of industrial medicine. There were no departments.

Oh, excuse me. And would you read what the bulletin says about the division of industrial medicine as opposed to the department of industrial medicine? The laboratory was organized in 1939 under the direction of Dr. James J. Waring and Mr. Donald Cumming.

Do you know Mr. Cumming? No, sir, I don't. You didn't know that he collaborated with Dr. Gardner at Saranac Laboratory on the asbestos form? I'm sure that there are hundreds of people that collaborated with Dr.

Gardner that I don't know. Excuse me, doctor, I object to the policy question on the grounds that... Okay. Now, doctor... now if you look on page 21 sir yes sir in addition to uh having a division of industrial medicine did they not also have a division of industrial hygiene i'm looking for at the bottom of page 21 yes sir so at the university of colorado in 1948 they had a division of industrial medicine and a division of industrial hygiene is that correct 1948 or 49 that wouldn't surprise me oh that wasn't surprised all right doctor didn't you testify then in 1950 there was not a single Department of Occupational Medicine in the United States I'm still looking for one I haven't seen them come to that and that there weren't any required I asked the witness questions you're free to do so but you're not free to argue with the witness or comment doctor and you also testified that there weren't any required courses is that correct but I'm aware yes where did you go to the university of illinois school of medicine 1934 35 to 39 35 to 39 yes sir and you went to medical school i sure did and you took all the required courses that they required i was granted the degree of doctor of medicine all right now doctor uh will you look please sir at page 24, oops, didn't give it to you. Excuse me. 19. What is it?

It's the University of Colorado School of Medicine. Now, doctor, is this not the bulletin for the University of Colorado School of Medicine where you teach for 1950? See that in the front? Yes, sir. All right, look on page 24. for yes sir doctor don't you see where not only did the university of colorado where you teach have a division of industrial medicine in 1950 but also a degree a doctor of science in industrial medicine in 1950. do you see that yes sir now doctor uh don't you know that dr anthony lanza also had a school of industrial medicine at new york university beginning in the late 1940s i have referred to that yes sir and and commented on its uniqueness yes number 20 doctor now so will you identify what you're handing to the doctor when you hand it to him yes sir i will i appreciate that mr wilson number 20 is the proceedings of the occupational disease symposium northwestern university medical school department of industrial medicine september 1938 do you see that yes sir all right so at least in 1938 the northwestern university medical school had a department of industrial medicine isn't that right yes sir and that's a department that ain't a division all right now doctor uh look at page two if you don't mind you see where it's marked yes it's 1928 yes would you read that please the american medical directory has tabulated the number of industrial surgeons limiting practice to industrial work and those giving a special attention to industrial practice in a 10-year period the practitioners in both these classifications have doubled the number all right thank you well that doesn't surprise me at all that's right no the industry is growing that industry was growing and consequently the need for physicians to take care of persons injured in the workplace or requiring medical care of all other kinds I think there's a logical parallel in availability of service to parallel the increase in industry okay now doctor uh turn over to page three if you will yes sir look at the second column yes sir do you see where it's reported the results of a survey of medical schools yes all right would you read that please shuford and reported in the monthly labor review for may 1920 she found that there were 30 medical colleges offering some instruction in vocational hygiene some instruction could be as much as an hour in a four-year curriculum i don't know what some instruction means would you read on and maybe you'll find out okay of these two courses leading to certification on satisfactory completion offered limited amounts of work in the curriculum leading to the md degree four offered some instructions leading to one to four degrees in public health and 15 offered limited postgraduate instructions in public health industrial content not stated all right now doctor on page uh the bottom of page three to the report a more recent uh survey that is before 1938. the next analysis of schools offering training and industrial hygiene was conducted by Bristol published in the Journal of the AMA March 1934 some degree of improvement had occurred 13 schools of medicine the public health gave separate courses in industrial hygiene 24 assigned one or more lectures to the subject in general public health or hygiene courses and 18 gave only brief attention in general public health or hygiene courses 21 the medical schools apparently gave no specific instruction of all. Fifteen schools of medicine and public health reported field trips to industrial plants as part of the instruction in industrial hygiene.

Well, the lumping of schools of medicine and schools of public health really makes that sentence uninterpretable. Yes, sir. Now, let's see if you can interpret the first part of column two. Now, do you see in there, doctor, where they talk about your alma mater, the University of Illinois, and what was required for students at the university of illinois while you were there yes i would you read that during the academic year 37 to 38 10 schools gave more than six hours of organized instruction industrial hygiene as part of the required instruction and the magnitude of time allotted the schools rate in the following order university of illinois women's medical college university of pittsburgh university of ohio northwestern virginia cincinnati jefferson long island and boston All right, so did you take the required six hours of industrial hygiene while you were at the University of Illinois? In the four-year period, I'm sure I was exposed to six hours. Thank you.

Now, I'm going to hand you, sir, K-21. The K-21 purports to be a profile of the United States Public Health Service, 1798 to 1948, by Bess Furman, the united states department of health education and welfare 1973 did i read that correctly yes sir would you look please sir at page 339 yes sir okay would you read the third paragraph please on the home front the home front public health service under surgeon general cumming was becoming a leading factor in the application of epidemiology as a practical science in this country all right now doctor would you read down to the next to last paragraph sentence it was evident it was evident that this had become a subject to be taught in schools of public health in the autumn of 1919 johns hopkins university parliament maryland had established the first school of hygiene and public health in the united states with dr william h welts that seasoned consultant of the public health service at its head He persuaded Dr. Rupert Blue, then Surgeon General, to detail Dr. Wade Hampton Frost as resident lecturer in epidemiology as a preliminary to becoming the first in the world to hold a university chair in epidemiology. All right. Thank you, Doc.

This was in the Johns Hopkins School of Public Health. School of Hygiene. Hmm? Now, I haven't asked Marlon to object to the procedure here because it is not questioning. It's simply reading. I haven't asked him a question, Mr.

Coffey. That's exactly what I'm getting ready to do, Mr. Carter. Now, Dr. Kotin, prior to you reading this, were you aware that the Johns Hopkins University had founded a school of hygiene and public health in 1919? I can't honestly say that it was founded in 1919, but I'm fully aware of the school because in the not-too-distant past, I was asked if I would be interested in a professorship at the Johns Hopkins University School of Hygiene.

So you weren't aware that it was in existence in 1919? I don't remember that it was organized in 1919, of course, but it was around for many, many, many years, and perhaps the first, I was aware. Now, Dr. Kotin, you taught at the University of Southern California, didn't you? Yes, sir. And you testified that you had been surprised and amazed if more than one or two schools in the country offered courses in industrial medicine, isn't that correct?

That's correct. Now, the truth of the matter is, Dr. Kotin, that they were teaching industrial medicine at the University of Southern California the whole time you were there, weren't they? Next point. No, that was... The point, the question around the discharge of medical...

It was in the curriculum. It was not taught to any greater extent than I said that it was. That basically, it was being introduced at an ever- accelerating rate into the curriculum of medical schools. I had a hand in bringing it in and introducing it into the curriculum, so that sure it was being taught, but it certainly was not what you would pretend that it would be, and that is an integral part, an indispensable part, and even a substantial minor part of the school curriculum. That is, I think, a full representation of the education in industrial medicine in American medical colleges during this period now doctor do you remember testifying here on Oath Friday when you were asked a question on page 89 yeah were there any courses taught in industrial medicine in the 1950s your answer was not that I'm aware of again there may have been one or two in the medical school I bet a month's salary that there probably was not a course a lecture might have been given but not a course you recall that i sure do all right now dr Kotin talked about the manner in which medical information is distributed or disseminated it's a fancy word for getting the word out isn't it disseminated i don't know what you mean by a fancy word but it's what okay it it describes what i think the question was directed to now i believe you testified that there were only two occupational disease specialty journals the journal of occupational medicine and the british journal of industrial medicine do you recall that no i didn't say they were the only ones i said they were the only ones i was aware of all right doctor are you aware of a publication called the archives of environmental health yes sir do you not recall that that journal devotes itself to matters of occupational and environmental medicine you asked primarily it It was environmental medicine that was an integral part of the Archives of Environmental Health. I think you asked specifically about occupational medicine.

Now, Doctor, don't you know that the Archives of Environmental Health is published by the American Academy of Occupational Medicine? Yes, but they have interest beyond that. Well, it's called the American Academy of Occupational Medicine. Yes, sir. And it was founded in 1946, wasn't it? If you say so.

All right. and one of their publications is the archives of environmental health yes sir beginning in 1946 isn't that correct yes sir all right and the american occupational medical association was founded in 1915 what yes sir and the industrial you know answer the question if you don't don't speculate on the date please well i can show you the dates if you'd like to see him Dr. Kotin i have if you say so and the industrial hygiene foundation was founded in 1935 what that i don't all right give me h5 are you familiar with the publication of the industrial hygiene foundation called the industrial hygiene digest i am yes sir and is that not uh let me hand you uh k-22 sir which is what k-22 purports to be the encyclopedia of associations Association, dated 1979. Do you see that? Yes, sir. All right. And do you see on the next page a list of various associations?

Yes, sir. And do you see the American Academy of Occupational Medicine, founded in 1946? Yes, sir. And you see where it lists the publications, the Archives of Environmental Health? Yes, sir. And the Journal of Occupational Medicine?

Yes, sir. And that's the one that you are most familiar with the journal of occupational medicine all right yes they publish both because i think it's the journal of occupational medicine that clearly addresses occupational medicine okay the archives of environmental health has a broader scope as the title would imply all right and doctor do you see the american occupational medical association on the next column sir yes sir and it was founded in 1915 yes sir and you see that uh its publication uh was formally called the american association of industrial physicians and surgeons under formally well i hadn't asked it yet you have to be patient i'll ask the question see the six lines sir at any rate it used to be called yes formerly 19th american association of industry positions now the one that i was interested in was the industrial health foundation you see that yes sir and it was founded in 1935 yes sir and you see that its publications include the industrial hygiene digest yes sir now do you see the next one the occupational health institute yes sir founded in 1945. yes sir Yes, sir. You keep reading things through them and you say you see it. If you want to ask him a question, propel him to questions with these facts in it so we'll know it's in your question. To have him read a document, you're trying to have the witness read into evidence things that he may have no knowledge of, but you're having him read it through a document. I object to that procedure.

Doctor, do you see the Occupational Health Institute? Yes, sir. And that it was founded in 1945? Yes, sir. Now, Doctor, with respect to all of these various organizations, will you agree with me that there were more than two journals devoted to occupational medicine being circulated in this country since beginning in 1915? There were more than two publications, but basically the number of publications and the questions originally concerned were the journals that were recognized as occupational medical journals.

Clearly the Journal of Occupational Medicine is the one that by its very title and by its identification of several organizations is the journal that purports to contain medical information relating to occupation okay And I ask if documents K-16 through K-22 are offered for the truth of the matters contained therein? Well, you can ask, Mr. Coghlan, but I don't believe this is the proper place to be debating anything. Thank you for the formal questions. Now, Dr. Kotin, I've given you K-23.

Yes, sir. And that's the Journal of Industrial Hygiene, January 1926. Yes, sir. do you recognize the journal of industrial hygiene published by the harvard school of public health to be an authoritative and reliable journal yes sir all right is that another journal that you perhaps couldn't recall which was devoted to occupational medicine beginning at least in 1926 yes subject to the question uh just a minute dr Kotin the council keeps using the term industrial hygiene occupational medicine environmental medicine public health interchangeably and I don't think they are. Now, Dr. Kotin, are you familiar with the fact that from time to time various organizations Organizations beginning back in the 1920s for example, Saranac laboratory would have symposium Conferences on occupational diseases. Yes, sir Well doctor do you agree to that curve?

Yes, sir And do you agree that there were conferences on the pneumoconiosis? Held in various parts of the world beginning in the 1930s there were some held yes sir and pneumoconiosis is a term meaning what diseases associated with scarring of the lung including asbestos yes sir i'm going to object to the form of your question that the entrance to be drawn there from was that there were conferences with respect to asbestosis beginning in the 30s doctor i've handed you what purports to be the proceedings of a conference concerning effects of dust upon the respiratory system uh held by the industrial commission of wisconsin in 1932 do you see that yes sir all right if you would sir um look at the uh table of contents do you see you recognize the names of any of the speakers yes sir dr gardner that's the gentleman who was at saranac that we talked about correct Yes, sir. And you see Mr. Cummings, the man I asked you about? Yes, sir. And you see where in 1932 he was the assistant director of the Saranac Laboratory?

Yes. Is that the same Mr. Cummings that we talked about in reference to the University of Colorado? I don't know, but basically he was somebody interested in the study of tuberculosis, as the contents indicate here. All right. And you're not familiar with whether or not he co-authored any works on asbestosis with Dr.

Gardner? I think he has, actually. All right. and do you see the name of mr bloomfeld yes sir and do you recognize his name it's come up earlier today yes but do you not recognize him as an authority in the area of industrial hygiene in the 30s yes sir all right and do you see the name of dr albert e russell surgeon united states bureau of mines yes sir and did you recognize him as an authority on the dust diseases he was searching in the u.s bureau now if you turn to page 180 yes sir would you read the sentence beginning this this is the x-ray of a man who had or has asbestosis his occupation is that of cleaning and restoring the asbestos on pipes in one of our government hospitals he had been working as a trade about six years i think and you will see he has fibrosis of the lung the character of the fibrosis is quite a bit different from that of granite workers he had disability and the government compensated him for it now doctor uh a person who cleans and restores asbestos on pipes is what kind of work they'd be classified as an insulation worker thank you i'll check your phone and we'll ask your questions on the ground for the reading of the statement contained in the document is not in any way required to create a foundation to ask the question to answer the doctor we're simply asking him once again to read the document doctor will you look uh in the appendix of this particular document please yes do you see the names of the persons who attended the conference concerning the effects of dust upon the respiratory system held before the industrial commission of wisconsin in 1932 yes sir all right do you recognize uh any of the names as titans or persons involved in occupational medicine at the time i object to the form of the question because the document has not previously been admitted into evidence authenticated in any way and consequently Well, any names appearing therein would be hearsay at this time. Go ahead, Doctor. Well, I'd have to really look at it. Yes, go ahead.

Take your time. Well, again, I'd have to know a lot more before. What do you want them as, as persons in the field or titans? Well, let's do persons in the field first and go on to titans. Well, I recognize the name of Dr. Bloomfield, Dr.

Sappington. What other names do I recognize? You don't recognize the name of Dr. O.A. Sander. We have a master risk here as being an employee of the Employers Mutual.

Do you not recognize his name in conjunction with the Asbestos Textile Institute? It doesn't ring a bell. All right. Now, Mr. Wilson, do you have my Exhibit K-2? Doctor, I'm going to hand you Exhibit K-25, and I'll tell you what it purports to be.

It purports to be a list of the persons who attended various symposiums or conferences at the Saranac Laboratory beginning in 1952. Would you, I think you can see the list of names there. you see that seventh saranac symposium yes sir all right do you know anything about the seventh saranac symposium i know the proceedings were published as i recall yes maybe i can help you help me do you recall that the seventh saranac symposium was the symposium that was on occupational cancer isn't that the one that you said that you were invited to attend but weren't able to it was a saranac symposium i don't remember that it was the seventh one but i was invited to attend one on occupational cancer yes sir and you recall that there was a symposium on occupational cancer held at the saranac laboratory sometime in the 1950s 50s yes yes do you see a list of names there sir yes sir of attendees how many pages of attendees are there at the saranac symposium on occupational cancer in 1952 the council is important your question is that the count that a lot is limited to cancer we object to the question a lot a large number of attendees a large number of opinions do you see the names of any corporations listed there i object i object to the form of questions that might be stated this is important to be be a list of that N.E.D., I don't know whether it is or not, an object to any further question from some supported niche that the witness himself cannot identify. And further, to the extent the document is authenticated, it's a conscience to speak for himself. Oh, I see. Actually, uh, each page is not a name. Yes, I believe it's, uh, really two pages.

Yeah, that puts it in a different, begins to make some sense now. Do you see a list of various organizations which the individual represented? Yes, sir. Do you see any corporations listed there? Yes, sir. If you read far enough, I believe you might find somebody from Owens, Illinois.

Can't you read all of the questions? Well, it would be. I can't read all of it. Do you see anybody? Do you see the name of anybody from Johns-Manville Corporation there? again I haven't looked at it and I'm not going to right now but all right sir well we'll give you an opportunity to look at it over not perhaps I thought that we were reserving objections mr. Carpenter but if you would like to object you can go ahead you want me to take it home well you can I'll entrust it to you overnight yes Now, Dr.

Kotin, attached to this document, I suppose I'll separate it, and I will, is is this will be k-26 and does that purport to be a list of the attendees at the 1955 saranac symposium it just says mcintyre saranac conference it doesn't give any date oh yes it does on the next page february 7 8 and 9 1955. are you familiar with uh the mcintyre saranac symposium that was held in 1955? Offhand, the McIntyre-Saranac title isn't familiar, no. You're not familiar with the McIntyre Institute? Yes, but I just don't, you asked if I knew about the McIntyre-Saranac conference, and I say that one I don't remember. Now, doctor, where's your stick? I hand you what purports to be a volume entitled Transactions McIntyre-Saranac Conference.

Would you you look at that please sir yes sir all right do you recognize uh if you would this is k-27 and it purports to be the transactions of the mcintyre san act symposium 1955 yes sir all right would you turn to the table of contents please you yes sir do you recognize any of the names in the table of contents as persons active in the field of occupational medicine in 1955 yes sir all right would you tell me which of those names you recognize dr mccord dr trudeau dr Schepers dr van orstrand dr kleinfeld tabershaw albert hardy holiday waters will bait your quick scandals and then yes you did recognize the name of dr. Schepers and dr. Harriet Hardy yes sir okay now doctor do you see any papers on there that one called the effect on the lungs of commercial hydrous calcium silicate products yes sir all right do you know what a calcium silicate a commercial calcium silicate product is it's a product containing calcium hydrated calcium silicate all right do you know whether any products which contain hydrated calcium silicate also contained asbestos and were used as insulation products yes there's some work in fact Johns- Manville manufactured a product called Thermobestos which was a calcium silicate product that contained asbestos didn't it that's what i was referring to all right sir and if you would dr uh Kotin also looking in the table of contents see if you see the name of dr mcloughlin no i don't if you hand it back perhaps i can find it okay sure on page uh an article starting to take 83. oh yes the dust diseases of great britain the article was entitled dust diseases in great britain is that correct correct did you know Dr. McLaughlin? I did not. Would you turn to page 83, please?

Yes, sir. Would you look at the bottom where they describe who Dr. McLaughlin is? This is the medical inspector of factories. Of Great Britain? Of the HM, His Majesty's Medical Inspector of Factories.

Are you familiar with the inspector of factories arrangement in Great Britain? To a degree, yes. Was it Dr. Merewether, the 1930 article that Mr. Wilson talked to you about? Wasn't he the inspector of factories in Great Britain?

Yes, sir all right does the fact that mr mclaughlin was inspector of factories refresh your recollection about him no the name just doesn't register you're not familiar with any of dr mclaughlin's articles on silicosis and coal workers disease turn to page 89 please doctor yes sir by the way doctor let me ask you one question you've been the medical symposiums where uh the papers were subsequently published haven't you yes sir tell the jury what happens how those things uh the doctors get up and read the papers and then they're subsequently published in a bound volume like that some are some are yes but uh if the dr mclaughlin was there and presented a paper does it normally occur that the paper is published later there is no normal some do some don't okay all right would you read page 89 please objective can i have it back and i'll point out the pattern well you can see where i have the doc the senate's beginning cases object the question that dr coates has already indicated now shall i read yes sir go ahead and read cases of asbestosis however are now appearing in workers who do asbestos lagging of pipes and boilers all right now what kind of worker would do asbestos lagging of pipes and bullets an insulation okay doctor do you know whether dr mclaughlin's article that appears in that bound volume was subsequently published in the united states literature medical literature? It could have been, yes. Publication in the proceedings does not preclude its publication in other journals as well. I hand you, doctor, what is labeled as K-28. See that, sir? Yes, sir.

On the next page, the name of the journal is listed. Would you look at that? I can recognize the format. The archives of industrial health what was the archives of industrial health there was these journal published by the American Medical Association as one of its subspecialty journals subspecialty of industrial health subspecialty of industrial health yes sir and that particular article appeared in what year of that journal 1955 1955 that is that the same article by dr. McLaughlin that appears in that blue book i closed it but i page was it page 83. is that the same article i'll tell you in a moment all right yes sir all right now doctor we were talking earlier about exhibit number 26 and i asked you to look sir at the names in the middle of this column the people who were at the saranac symposium in 1955 and asked you if you recognize the names of any of those gentlemen as being associated at that time with john's memo Do you see the name Dubeau? Under Norton Nelson, yes.

Do you know Dr. Dubeau is the plant physician of Johns- Manville? I did not. Did you see the name Kenneth Smith? Yes. No, I didn't hear, but I know the name Kenneth Smith.

Is it in the same page? Yes, sir. Right below Dr. Dubeau. It sure is, yes, sir. All right.

Is that the same Kenneth Smith that you said was medical director of Johns-Manville? yes sir on the next page do you see the organizations which those gentlemen were members of the ones that have checks fine do you see the name john's mantle yes sir all right now doctor uh we we talked earlier about uh dr uh lanza's 1938 textbook and then i handed you k-16 which is a textbook on industrial medicine from uh by dr uh hazelette hazel hazelette yes sir dated um 1947 correct yes sir now here's a another article i'd like to go ahead and identify that and this is entitled industrial maladies the malady is disease isn't it yes sir and that's dated 19 and 34 isn't it yes sir and who was the author you have a number on it yes sir k-29 and who is the author of that particular book sir thomas leg do you know him ever heard of him yes but i don't know well he was active in industrial medicine way back yeah now uh doctor do you uh look over on page 190 of that 1934 textbook yes sir do you see a discussion of the disease asbestos yes sir now are you familiar with this particular textbook entitled industrial maladies I've known the book but I haven't read this all right was that the far-fetched publication on industrial medicine first time yes sir yes sir I the Knoxville medical publication if we could take about five minutes break how much more time do you have because I think we got run out of your time that's right you want to stop it for a second okay i'm ready dr Kotin uh i believe that you joined Johns-Manville july the 1st of 1974 june 1st i assume that you joined Johns-Manville a reasonable period of time after the school year ended at temple it was unrelated to that All right, sir. Did you make your decision to go with Johns-Manville sometime earlier than June the 1st, obviously? Yes, sir. All right. Now, Dr. Kotin, I believe you said earlier that you reached the conclusion in 1955 that asbestos was a carcinogen.

Isn't that correct? Correct. and and doctor as a cancer research scientist you reached the conclusion in the early 1950s that cancer-causing agents or carcinogens did not have a no threshold effect is that correct now would you explain to the jury what you meant back in the early 50s about a cancer- causing substance not having a threshold effect exposure to a carcinogen at any level was capable of initiating a cell change which could not necessarily would go on to the production of a cancer yes so a carcinogen is a cancer-causing substance yes sir all right now so if I understand what you just said correctly dr. Kotin if a substance like asbestos which was demonstrated at least to your satisfaction to be a carcinogen any exposure there was no way that as a scientist you could determine and say this was your opinion in the 50s that any dose of asbestos no matter how small could not result in some instances in the formation of a cancer no that's there was no evidence to say that it could not all right and the greater the dose the greater the risk yes sir now i believe you held the view that there was a not a safe level of exposure to a carcinogen like asbestos for two decades at least yes in fact okay sir when you were the when you were with the united states government on numerous occasions you testified in congress and before federal agencies that there was not Not a safe level of exposure to any cancer-causing substance. That is correct. Now, Doctor, as late as November of 1973, were you of the opinion that a compound or substance which demonstrates carcinogenic activity at any level must be considered a carcinogen? Yes, sir. and will you have the further opinion that ingestion or inhalation by human beings of any amount of a compound shown to be a cancer-causing substance in test animals experimental animals must be regarded as a threat to human health under under certain conditions of experimentation yes doctor i hand you a copy of the phone one we got I don't know what the next number is, but after you, sir, oh, I'm sorry, excuse me. 30, K-30.

This will be K-30. The record K-30 purports to be the statement of Paul Kotin, witness for the Office of Hazardous Materials Control, United States Environmental Protection Agency, Washington, D.C., dated 12 November 1973 and I asked you sir the second page measure signature yes sir is that a copy of the statement you made in November 1973 with respect to the fact that in your opinion at that time there was not a safe level of exposure for human beings yes sir now now dr. sets 1974 sometime in 1974 you changed your mind as you expressed on direct testimony is that correct correct now do you agree with me that dr selikoff whom you've quoted on numerous times on direct does not agree with you and he holds the view that there is no safe level of exposure to asbestos direct to the form of the question now i agree with you that he says that he's wrong but he says he's wrong but he says in addition to that the international agency for research against cancer disagrees with you do they not same object Yes, sir, and the United States government and its official position on asbestos disagrees with you. Does it not? Yes, sir And in addition to that dr. Kotin you yourself Have some second thoughts about that In light of some recent studies that have been published in Great Britain in that correct No, my second thoughts relate to the shape and curve of the dose response curve. I'm not on the basis of Whether indeed there are experimental data to suggest a no-effect level.

There are volumes of publications in the very, very recent past which I have referred to. The fundamental studies going on at the McCarter Laboratory in Wisconsin. Studies going on at the University of Toronto, Department of Pathology and Dr. Farber's laboratory. Studies that are going on, yea, verily, at the National Cancer Institute. Studies that are going on in some of the national or then the atomic energy commission national laboratories studies devoted to dna repair studies devoted to the reversibility of the interaction between carcinogens and macromolecules and cells so that there has been a body of information which uh has been accumulated over the past uh five to ten years which serves as the basis for this opinion now doctor you wrote the forward to dr Selikoff's book that's been previously identified with books entitled asbestos and disease yes sir and that was written as recently as 1978 wasn't it yes sir and in it dr Selikoff clearly says that there is no threshold limit value for asbestos incites numerous authorities that he sure does dr selikoff still thinks enough of my opinion and i would emphasize that knowing that and thinks enough of my knowledge and expertise in the area to have selected out of the thousands and thousands of persons who work in the field me to serve as the author of the forward i don't think he would want to demean something as permanent as a book between hard covers by having somebody who we felt knew nothing about the subject break the forward move the strike is unresponsive now I think it's immediately for that that's for the judge to decide thank you doctor now doctor do you agree that the disease mesothelioma which you described as a cancer of the lining of the lungs is a fatal disease?

Yes sir. And do you agree that in persons not exposed to asbestos it's a rare disease? Uncommon, yes sir. And I believe you agreed yesterday with Dr. Selikoff's statistics that over 11 percent of insulation workers die of mesothelioma. In his data, yes sir.

Now doctor, we discussed yesterday Dr. Dr. Hueper's 1942 book in which he discussed asbestos and lung cancer. Do you recall that? Yes, sir. All right.

Now, did you find Dr. Hueper's cancer articles to be excellent reviews of the data in the mid-1950s? As I indicated, they were very, very comprehensive and in some areas critical and in some areas uncritical. and I would say and I think it's important that certainly the general opinion at the time was that they were comprehensive and of uneven quality doctor I asked you whether you have ever made this state the reader is referred to the comprehensive and excellent review of Hueper in recent developments in environmental cancer for a critical study of the newer data relating to occupational cancer. That was one of his critical papers, as I indicated. All right, and in that paper, he talked about asbestos in cancer, didn't he? He did.

All right, and he said that all asbestos workers were subject to lung cancer, did he not? No, not in the form of the question. No, what he said was that all asbestos workers were in an environment where there was a carcinogen there. All right. now doctor you familiar with the fact that periodically there were held pneumoconiosis conferences in South Africa yes sir are you familiar with one that was held in 1959 yes sir and I believe it was at the 1959 conference that dr. Wagner spelled in the United States like Wagner presented his paper on mesothelioma and persons exposed in the neighborhood and occupation. Is that correct?

Correct. And was Dr. Wagner's paper published in the medical literature in January 1960? In 1960 early, yes sir. Now Dr. Wagner's paper in 1959 had data which indicated and proved to you that asbestos and mesothelioma had a cause and effect relationship isn't that correct that in the northwest cape coast uh it did dr wagner made a very very important point then in his article and and still does that he still cannot explain the difference between the occurrence of mesothelioma in the northwest cape of south africa and the non- occurrence of mesothelioma in the transvaal area of south africa where the ore body the ore contents and no geologists so i rely on geologists for telling me are essentially the same certainly the exposures were the same the population at risk is it the same so dr.

Wagner was of the opinion that there could be no doubt that the in his mind that the mesothelioma is caused in the Northwest Cape were caused by exposure to asbestos but he did concern himself with what might the explanation be for the what is still referred to as the paradox of south africa the absence of mesotheliomas from the transvaal area now doctor perhaps you didn't understand my question and i'll ask it again do you agree that you yourself came to the conclusion in 1960 that dr wagner and his paper presented in 1959 had data which to you you indicated an asbestos-mesothelioma cause-and-effect relationship. Yes, sir. All right. Doctor, are you aware of the fact that before Dr. Wagner presented his paper in 1959 that there were case reports in the literature dating back to 1946 where doctors had associated, in case reports, asbestos with the disease mesothelioma? There were case reports, yes.

Thank you. Now, do you recall in Dr. Wagner's 1959 paper that some of the cases that he studied were insulation workers? Well, if I had a copy of the paper, I'd be glad to. All right. Now, Doctor, if you will look on page 267, case number 30, do you have an exhibit number?

This will be exhibit number 31. one do you see doctor on page 267 case number 30. yes sir from the age of 21 to 26 he worked in a factory in the cape as a boiler maker and fitter he volunteered the information that he had worked continuously with asbestos lagging pipes and boilers i believe you testified earlier that a person who lagged pipes and boilers that's a british term for an insulation work isn't that correct that's correct all right now do you see where dr wagner found that this man had both asbestosis and pleural mesothelioma yes sir now if you look at what will be exhibit 31 which is the follow-up study by dr Sleggs and dr wagner you see that excuse me 32 yes sir okay if you would uh do you recognize uh this paper yes sir all right If you'd look at page 30 doctor, yes, sir What's the date of that? 1961 January 1961 If you look down At the next to the last sentence where it starts the industrial use of asbestos Yes, and then in the middle of the paragraph I believe dr. Dr. Sleggs writes, asbestos cement and an asbestos clay compound are used extensively for insulating boilers in power stations, industries, and railway locations. Right. Locomotives. Three of our patients were employed in this way.

Do you see that? Yes, sir. And then he says, another patient was employed manufacturing fireproof clothing. Cases of asbestosis have been observed in a variety of industries on the Witwatersrand. on now i know i didn't pronounce that correctly but that's the area that he's talking about isn't it yes sir does that refresh your recollection doctor about the fact that included in dr wagner's epidemiologic study in 1960 were insulation workers yes sir now yeah if i could doctor i'll mark these so we won't lose silence i have a tendency to do that now the majority of the people that dr wagner examined over that period of time were people who didn't work with asbestos but just happened to live in the area where asbestos was being worked with some of the cases yes sir now was dr wagner's study an epidemiologic study doctor yes he used a population that do you excuse me i bet he could identify now i believe you agree sir do you not that a company medical director had an obligation in 1955 to be aware of the doll study on cancer lung cancer and in 1960 of the Wagner study on mesothelioma he should be aware of it now doctor are you familiar with the 1963 paper of dr. Selico the one in the journal American Medical Association yes I remember that I recall that I don't This will be exhibit number 33. And do you see the title of the paper, Asbestos Exposure and Neoplasia?

Yes, sir. And I believe you said earlier that neoplasia means cancer. Correct. And is this not an epidemiologic study? Yes, sir. And is it not a significant study?

Yes, sir. And in that study did Dr. Selikoff in 1963 report an increased incidence of cancer, lung cancer? sir yes sir asbestosis yes sir and mesothelioma yes sir in insulation work yes sir and was that paper not read at the annual convention of the american medical association in june of 1963 yes that was published in april of 64 right now doctor do you know um dr thomas mancuso yes sir is he an epidemiologist he does epidemiology yes sir are you familiar with the paper he reported in 1962 of a study of an asbestos product manufacturing company if it were shown to me i could tell you whether i would require it i might look for it but do you recall that he did work uh in the 60s on asbestos it would work in the 60s on a variety of things including water okay now let me ask you this doctor do you think that any doctor company medical doctor who was in attendance at the American Medical Association Convention in Atlantic City, New Jersey on June 17, 1963 and heard Dr. Selikoff present this paper. Do you think that that should have promoted some reaction on his part with respect to labeling insulation products that he manufactured which contained asbestos? No, it certainly should have evoked the reaction to him to pursue the to pursue the situation more doctor um this year and uh counsel the copy of the document that's been produced previously dr um i've handed you exhibits 34 35 and 36. have you ever seen these documents before this morning All right, number 34 purports to be a letter from Dr.

Mancuso to Mr. Knippa, plant manager of the Philip Carey Manufacturing Company, dated May 23, 1963. Have you ever heard of the Philip Carey Manufacturing Company? Yes, sir. Now, exhibit number 35 purports to be a letter from Dr. Mancuso to Mr.

Knippa, dated August 15, 1963. yes sir and number 36 purports to be uh the philip carey manufacturing company occupational health program thomas mancuso september 23 1963 and on the second page there appears to be what appears to be the station area of the philip carey manufacturing company do you see that yes sir all right now doctor um do you know the name of the company that succeeded to the philip carry manufacturing company? No sir. You ever heard of the company called Sellotex? I've heard of it yes sir. Dr. look if you would at the May 23 1963 letter and do you see under background on the first page a national awareness is developing relative to the potential and harmful harmful effects of asbestos and asbestos products. This stems from, number one, the relatively recent scientific reports in England, Germany, and Africa, and the United States showing a strong association between asbestos and lung cancer and mesothelioma of the pleura and peritoneum.

Is that correct? Yes, sir. I think I asked him that. Do you see that on the paper? I see it on the paper. Now, Now, with respect to reports in Africa on cancer, mesothelioma, the pleura, and peritoneum, do you know of any reports suggesting that association other than the Wagner reports in 59 and 60, which we talked about a few minutes ago?

Those were the ones that were the major ones. Now, with respect to the association between asbestos and lung cancer, do you know of any reports in England other than the Dahl study in 1955 that we talked about? Epidemiological studies, that was the first one, yes sir. Do you know of any any studies in Germany and the United States prior to 1963 in reference to mesothelioma and lung cancer? Prior to the 63 report? Okay.

No epidemiological studies. Now you were with the United States government in 1962 were you not? Yes sir. And did the United States government not have an agency called the United States Public Health Service yes sir and did it not also have a Bureau of occupational health and safety safety and health safe Bosch yes and that was operative in 1962 yes sir and while you were involved in environmental areas Bosch was involved in occupational areas is that correct well there's a big difference another difference Bosch was a regulatory agency and we were a scientific-based agency. I see. Thank you, Doc.

Now, do you know whether or not there was a meeting in 1962 in Washington with members of representatives of the asbestos industry and the U.S. Public Health Service with respect to asbestos and cancer? There were several meetings. I could call two or three of my people and find out when they were. I don't recall the exact date of any such meeting okay well if dr mancuso in this letter says that these various scientific reports the limitations of the industrial hygiene report and other unpublished data were reviewed and discussed in a meeting in washington dc with representatives of the asbestos industry and the u.s public health service over one year ago and the need for extensive research expressed you have a recollection that a meeting took place but you don't know exactly when is that correct well and perhaps one of my people might have attended all right now doctor if you would look over uh on page three under paragraph two do you see where dr mancuso discusses take a positive approach to consumer guidance and assistance this would take several forms and then under a he says the development of a recommended practice manual containing illustrative ventilation control designs safe handling procedures and other similar guidelines do you see that page 3 sir paragraph 2 the pages are not I'm sorry no that's all I can come to is the top of the page the asbestos environmental hazards can be definitely controlled yes yes sir which which paragraph that are you on the paragraph 2 do you see that develop oh yes okay now you since the early 1950s have been advocating the dissemination or spread of information to consumers with respect to the handling of hazardous substances haven't you yes sir and is that what dr. Reid that paragraph a and if you haven't already read it and then I'll ask your question about it you can if you would read it into the record okay because i'll read it because if you read it i'll read it because of your voice paragraph a and you correct me if i don't say something correctly the development of recommended practice manuals containing illustrative ventilation control designs safe handling procedures and other similar guidelines for the effective control of dust under various types of consumer uses period do you see that Yes, sir.

This could be prepared after an analysis of consumer uses and practices has been made by the industrial hygiene engineer recommended in paragraph 3. Do you see that? Yes, sir. The ventilation examples and recommended practices would relate to various products and cover broadly all operations of consumer use. Do you see that? Yes, sir.

This approach could be initiated by a single asbestos industry for competitive sales or an agreement developed on an inter- industry basis as to the contents of these various manuals and their distribution. Do you see that? I do. All right. Number one question with respect to that, Doctor. In your review of Johns-Manville records, did you see anywhere where Philip Carey had contacted Johns-Manville in respect to an inter-industry-wide safe practices manual in 1963?

No, I did not. You did not? No. And, in fact, to your knowledge, was there any safe practices manual published prior to the one published by the National Insulation Manufacturers Association in 1969? Not that I've seen. Doctor, have you had an opportunity to review, I know very cursorily or briefly, the letter from Dr.

Mancuso to Mr. Knipa dated May 23, 1963? Just this morning, yes. Do you see on the last page, page 6, where Dr. Mancuso signs consulting medical director? Yes, sir.

Do you know whether or not Dr. Mancuso, in fact, in 1963, was a consulting medical director to the Philip Carey Corporation. On the basis of what I read here. Yes. Now, if you would turn to Exhibit K-35, which purports to be a letter from Dr. Mancuso to Mr.

Knippa, plant manager, dated August 15, 1963. Do you see that? Yes, sir. Okay. Now, Now, in the letter, do you see the second paragraph? Yes, sir.

And tell me if I read correctly. These are recent articles. The most recent and perhaps the most important is the paper presented at the Medical Association meeting in Atlantic City on June 17, 1963, which has not yet appeared in medical literature. Do you see that? Yes, sir. All right.

Let me ask you, Doctor, if in fact Dr. Selikoff's paper that we talked about earlier, Exhibit 27, was not read at the American Medical Association meeting June 17, 1963. It was. I think your exhibit designation is not correct. It might not be, Mr. Wilson.

It ought to be Exhibit 33. Okay, that's Exhibit 33, Dr. Coven. Now, Dr. Kotin, assume, if you will, sir, that accompanying the letter, which is Exhibit 35, was a copy of Dr. Selikoff's paper entitled, Asbestos Exposure and Neoplasia.

In other words, that along with this letter of August 15, 1963, was enclosed a copy of Dr. Selikoff's paper. Would you assume that, please? Yes, sir. based on that assumption do you believe that this letter and the previous letter with respect to a safe practices manual and dr selikoff's report of june 17 1963 on insulation workers which we have discussed provided a basis for action for the philip carey manufacturing company with respect to labeling their products or preparing a safe practices manual well i certainly should have pursue this thank you now doctor if you would turn to k-36 k-36 is um the september 1963 report much dated september by dr mancuso you see it sir it's dated september 23rd yes sir 1963. yes sir okay would you turn over to page 10. do you see paragraph four yes sir and correct me if i read this correct incorrect number four and this is under the previous page recommendations okay discontinue the practice of placing on philip carey's payroll employees of subcontractors in different areas of the country because of the occupational disease liability it has already been established by the recent studies supported by the union that the union members have a high lung cancer rate. It is highly likely that these installers exposed to asbestos over the years and generally continuing the same type of work will develop high lung cancer rates. It is inadvisable to place the company in the position of defending against such claims and having such suits associated with Philip Carey.

Such legal and medical costs can be avoided as well as workman's compensation claims. Such employees should remain the employees of the subcontractors parenthesis example noted in a national study dash death certificate of lung cancer case reported as an employee of the philip carey manufacturing company in chicago dash actually a subcontract employee now doctor do you understand in that paragraph that dr mancuso is talking about insulation workers is that the question i object to the phone go ahead doc yes he's talking about insulation workers yes doctor is this information contained on page 10 a sufficient amount of information on which philip carey should have undertook some activity with respect to labeling their products well they should have pursued it how they ultimately would have wound up i guess would be determined by a lot of factors all right now if you would turn to page five off. You see paragraph 2? Yes, sir. Tell me if I'm reading it correct. Conduct medical studies which have a direct bearing on sales of the company's products and legal liability through a medical director, medical consultant, university contract, or other arrangement.

Do you see that? Yes, sir. This relates to the questions which are inevitable and will be raised by all users and consumers and in general by the public because of the accumulation of recent scientific reports showing the positive association between asbestos and cancer of the lung, pleura, and peritoneum. Did I read that correctly? Yes, sir. In addition to cancer, positive association also exists with cor pulmonale, parenthesis, right heart failure due to the fibrosis of the lungs, end of the parenthesis.

Pulmonary emphysema, parenthesis, which follows fibrosis, end of parenthesis, chronic bronchitis, bronchiectasis, and pneumonitis. Did I read that correctly? You did. As a consequence, there's a formidable array of medical problems now being recognized as directly related to asbestos exposure. Did I read that correctly? You did.

Doctor, is this paragraph another piece of information that should have prompted action by the Philip Carey Manufacturing Company with respect to labeling their products and advising consumers of the various diseases associated with asbestos they should have pursued some action as a result of this yes now if you would look at page 6 first paragraph internally within the company the question has been raised as to why medical problems particularly relating to cancer and asbestos were not recognized before actually they were recognized but the asbestos industry chose to ignore and deny their existence evidence of this was as recent as the industrial hygiene foundation study sponsored by the asbestos industry at a cost of forty thousand dollars which provided a basis for the companies to argue against this recognition of asbestos and lung cancer the report when properly analyzed had many weaknesses upon which the conclusion was drawn and these weaknesses have been recognized in scientific circles reputation does that mean what does reputation mean refuse or what do you understand reputation to mean doctor rebuttal to rebuttal of this report has already appeared in press and will appear in a number of publications consequently the aspect of industry cannot rely on this report for legal defense now are you familiar with the study that was funded by the asbestos industry and conducted by the Industrial Hygiene Foundation The doctor, are you familiar with any cancer study funded by the asbestos industry and conducted by the Industrial Hygiene Foundation? I guess it refers to the Braun and Truan study. I'm sorry. The Brown, T-R-A-U-N, and Truan, T-R-U-A-N. in doctor assumed that the philip k manufacturing company placed no warning labels on their insulation products until 1972. do you have an opinion as to whether or not the philip carey manufacturing company acted reasonably and responsibly in the light of the three documents which we've described here today. I object to respond to the question. I remember that it's not the least of which is that it presupposes that the Philip Carey Company was made back in an insulation product that was only from the 70s.

Go ahead, Doctor. Repeat the question. All right. Doctor, assume that the Philip Carey Manufacturing Company continued to market a thermal insulation product containing asbestos and soil sometime in 1969. Assume further that the Philip Carey Manufacturing Company continued to distribute asbestos fibers called asbestos shorts as an insulating cement up until 1972 and assumed that the full of care manufacturing company neither placed warning labels on either of those products or distributed a safe practices manual to consumers or users of those products do you have an opinion as to whether or not based on exhibits 34 35 and 36 the Philip Carey company me acted reasonably and responsibly after 1963 well just within the limits of the question that you asked they could have been more responsible yes sir Thank you. Can we take a short break, Mr.

Wilson? I'm moving on to another subject. All right. Ten minutes? Yes. I've never seen this, you know.

Are you ready? Now, Dr. Kotin, we talked yesterday about the threshold limit value for asbestos. And would you tell the jury again your understanding of what the threshold limit value for asbestos was? Well, historically it was 5 million particles per cubic feet from 1938 on to the late 1960s where it was then restated in terms of fibers rather than dust, successively was reduced from 12 to 2 fibers per cc in the period between the late 60s and 1976. 1976. Now, as I understand it, the threshold limit value for air that contains asbestos dust was based in large part on Dr.

Dreessen's study of 1938, which you talked about on direct examination. Correct. And as I understand it, you were personally unaware of Dr. Dreessen's study until you went with the government sometime either in 1959 or 1960. Correct. Now, do you recall all uh dr berryweather's report that you talked about on direct in 1930 where he said that appropriate methods for suppression of asbestos dust may only be fully determined when the harmful effects of low concentrations of dust are found out do you recall that yes sir and do you agree with that yes sir all right doctor are you aware of any dust studies conducted by any asbestos manufacturing company between the years 1938 and 1964 sporadic ones are you aware of any other than dust counts any attempt to determine the level at which disease would not appear in workers exposed to asbestos i'm unaware doctor in fact the only dust study conducted by anyone before 1964 in regard to insulation workers and shipyard workers was a Fleischer study in 1946.

Isn't that correct? Right. Now, doctor, do you agree that if the asbestos industry knew that exposures above five million particles per cubic foot were dangerous, that they should have advised any users of their products to avoid levels above five million particles per cubic foot? or not to the cost of agriculture to give an opinion and to be tantamount to a legal conclusion or a comment on the cost of the insurance business? Go ahead, Doctor. Do you understand the question? I'll read it again.

Do you agree that if the asbestos, let me start off by asking you this. I believe you said earlier that the asbestos industry knew by 1938 that the threshold limit value was five million particles per cubic foot or should have known yes sir and that levels above five million particles per cubic foot were potentially dangerous yes sir do you agree that if the asbestos industry knew that exposures above five million particles per cubic foot were dangerous that they should have advised any users of products which contained asbestos to avoid levels of exposure above five million particles per cubic foot I would have recommended doctor do you know of any warning label or any communication by any asbestos company between the years 1938 and 1964 to insulation workers with respect to avoiding exposure to levels above the threshold on the day I know Now, doctor, if exposures by users, in fact, exceeded five million particles per cubic foot, do you agree that warning labels should have been placed on products? No, I agree that exposure to concentrations greater than five million particles per cubic be cooked who were above the threshold limit value and therefore capable of being potentially hazardous yes sir and that should have been communicated to users of the product how yeah i would do it i would do it there's no way for a worker to know that what he's breathing is dangerous unless he's told it is doctor that's correct Now, Doctor, if you would look at the Dreessen study that I believe was identified as K-3. Yes, sir. That's what it says on here, K-3. Now, if you would, turn with me to page 23. if you see a paragraph entitled particle size yes sir and tell me if i read this correctly the measurement of dust particles suspended in the air of asbestos textile plants is difficult because of the presence of both asbestos and cotton fibers the differentiation of these fibers under the microscope is not always possible especially when the fibers are short and fine Did I read that correctly?

Yes, sir. Now, isn't it a fact, doctor, that the threshold limit value of five million particles per cubic foot, based on the Dreessen study in 1938, counted all particles? Asbestos, cotton, rock, or any other substance that might have been in the air that was sampled. That is correct. Now, if, let's take a plant where asbestos insulation products are manufactured, and are you familiar with a product that was called 85% magnesium? Yes sir.

And was not the product 85% magnesium an insulation product that contained magnesium carbonate and about 15% asbestos? That's as I understand it yes. And do you know that when the product was baked and came out on the assembly line that it was in shape with saws? It was treated, yes. Trim. Trim.

Trim. And in the trimming of that product, air, dust would have been liberated. It could have been if there weren't as often. Right. And to the extent that there was dust in the air, that dust from the 85% magnesium product will contain some asbestos and some magnesium carbonate, is that correct? that's reasonable all right now doctor do you agree that anyone who read threesome should have reached the same conclusion that you've expressed and that is that it counted all particles and not just aspects go ahead doctor repeat your question let's rephrase it then Do you agree that any person, any reasonable construction of the Dreessen report would have concluded that the standard measured all particles and not just asbestos? I would have assumed that.

I would have, to me, it would have encompassed what you're saying, all particles. All right. Now, Doctor, turn, if you would, to page 46. Yes, sir. Now, do you see down at the bottom of the page the paragraph that starts, about? Yes, sir.

It says, about 15 months before the study was begun, approximately 150 workers in these asbestos textile factories were replaced by workers with little or no previous exposure. Although an effort was made to examine as many as possible of these former workers, less than half could be examined. Do you see that? Yes, sir. All right. And then he says, partly as a result of these personnel changes, the group of employees examined in this study had an unusually low average age.

Do you see that? Yes, sir. There was an abnormally large percentage of workers with less than five years' employment in the asbestos textile industry and an abnormally small percentage of persons who had worked 10 years or more in the industry. Do you see that? Yes, sir. Now, by 1938, one of the, it was well established, was it not, Doctor, and Dr.

Dreessen recognized it, that length of employment was one factor that you had to put in the equation of dose response. Yes, sir. All right. Please turn over to page 58. Now, do you see there's a bunch of graphs in that report? Do you see that on this page, page 58, there's two graphs?

Yes, sir. All right, right in the middle of them, smack dab in the middle of them. There's a sentence that begins, many. Do you see that? Yes, sir. It says, many of the percentage values must be viewed with caution because they are based on small numbers of workers.

This is particularly true in the groups with more than 10 years' employment. Now, have you had a chance to study these graphs before today? I've read them. I've seen them many times. And what Dr. Dreessen is talking about is there were so few people who've worked for more than 10 years that he expressed caution that the conclusions with respect to people exposed more than 10 years must be tempered or cautioned with the fact that they didn't have a lot of people in that correct that is correct but it was as i say contained in the paper which looked at the conclusions that i read yesterday we're going to come to the conclusion correct now do you agree uh turn over to page 90 please grass do you see a discussion of the number of people who had asbestosis and the dust counts and the number of years they were working yes sir all right do you see what dr jason says the percentage of persons with asbestosis increases greatly with increasing length of employment.

Lanza, McConnell, and Fennell reported a similar trend. Their percentage values are higher than these. There are two explanations for the small number of persons employed 15 years or more. And then he goes on to explain that the textile plants have not been in existence, some of them, for as few as six years. Do you see that? Yes, sir.

Now, Doctor, don't you agree that it was dogma in 1938 that, as a general rule, it took 10 years of exposure before you could expect to see X-ray changes of asbestosis? Yes, sir. Now, on page 91, I'm looking for what I'm trying to point you to the place I wanted to read to save a little time, Doctor, but I'm now having some difficulty here. You see, at the first sentence, it says the incidence of asbestosis increases with increasing dust concentration. I believe you stated that that's the other part of the dose-response curve, length of employment and intensity of exposure. Isn't that correct?

Correct. Now, do you see in the paragraph entitled Threshold Concentration of Asbestos Dust? You see that? Yes, sir. All right. You see the sentence that reads, because of the importance of the problem, it seems to be desirable to use such data as are at hand to define tentative safe working conditions that may serve as standards for the guidance of factory managers and engineers until more complete data are available.

Do you see that? Yes, sir. Now, isn't it a fact, doctor, that Dr. Dreessen's conclusions were set forth to be tentative until more comprehensive data could come along? I think all special limited values recognize the fact that as new data are generated, the numbers have to be looked at. Right.

And one of the problems that he addressed was the fact that there hadn't been enough opportunity to observe long-term, low-level exposure to asbestos deaths. Isn't that correct? Yes, sir. Now, do you know whether or not any of the asbestos companies ran any tests from 1938 to 1964 on their own employees to find out the effects of long-term, low-level asbestos exposure? Well, they monitored their population, their work populations. Did they set up studies, a structured study?

I'm unaware of any. Okay. In retrospect, Doctor, as a Monday morning quarterback a little bit, wasn't it important to have tested Dr. Dreessen's tentative conclusions and find out whether or not long-term, low-level exposure to asbestos dust might be harmful? A monitoring of the population on the basis of both exposure and response was in order, yes. All right.

Now look up back on page 90. Since there is no satisfactory way of locating and examining persons who drop out of an industry because of disability incurred therein, the percentage values of the foregoing tables are necessarily minimal estimates of the prevalence of asbestosis. Do you see that? Yes, sir. Now is that what's known as the healthy worker syndrome in epidemiology I don't think that's what he means there all right now would you look on page 93 mm-hmm yes sir discussed earlier that before dr. Dreessen got down there to run his study 150 of the employees were replaced do you remember that yes sir now let's let's look at what dr.

Dreessen workers employed at the time of the study had asbestos I'm sorry page 93 second paragraph the paragraph starting according to table 43 it's the second sentence eight percent go ahead I'm with you all right eight percent of the 378 workers employed at the time of the study had asbestos this does not completely represent the incidence of asbestosis because about a hundred and 50 employees were discharged from these factories 15 months before the present study was made many of the discharged asbestos workers had asbestosis as the reports of shule donnelly and mcfeeters show although an attempt was made to examine as many as possible of these discharged cases only 69 could be examined 43 of whom had asbestosis according to the diagnostic standards employed in the study now if I'm not much of a mathematician doctor but I believe 43 of 69 is over 60 percent in that correct yes sir do you think that the fact that 150 workers were discharged before dr. Driesen got there and they're over 60 percent of the ones who were discharged had asbestosis affected the conclusions that were drawn by dr. Driesen he obviously did not include him include him in his study when he made conclusions doctor i'm advised that the take is exhausted then we need to quit everybody let's start break because unless you want to doctor if you would turn over to page 119 yes sir do you see a bibliography there yes sir all right and does he not have a bibliography on asbestosis I beg pardon? He has a bibliography on asbestosis doesn't he? Yes sir. It begins on page 119 and runs all the way over to page 124.

You see that? Yes sir. There's about 50 references in there isn't it? 35. Okay. 35? Well if you look at it closely doctor you'll see there's 41A, 8A, 8B in the references. references. There's a few with some subparts.

You know what you were saying on page 123 where you stopped at just the 35th. It's no moment but that's what it is. Yes. Well, there are a lot of references there. That's a lot of references. Alright.

Now, are you familiar with some case reports in the early literature in the 1930s by Dr. Ellman? Yes, ma'am. And you recall that one of the cases that he reported with an insulation worker and are you familiar with some case reports by dr wood and glowing yes sir and are you familiar with the fact that some of the cases they reported were insulation workers there were some they were included yes sir and do you see where dr Dreessen cites those studies yes sir all right now oh uh doctor also uh there's a reference there there to, on page 120, to the international conference on silicosis held at Johannesburg in 1930. That's reference number 19. Do you see that?

Yes, sir. OK. And apparently there was a discussion there of asbestosis, too. Dr. LaPaula, that question, there's nothing to indicate that at all. Do you see that reference 19, doctor?

Lavasetto, Domenico? Yes, it is the same. Lavasetto pulmonary asbestosis, records of the International Conference on Psoriasis held at Johannesburg, August 1930? It does say it. And does it say the author's observations on workers handling pure asbestos and asbestos mixed with cotton or other vegetable dust? Yes, sir.

A well-established case may develop in 79 years, and the disease can cause death after 13 years of heavy exposure? That's what it says on page 120. Dr., I believe that Mr. Wilson might be able to help me out because I don't have an extra copy, but... No, but before we leave the Dreessen Report, there's one comment I would like to make. And that is, I think the Dreessen Report, as you pointed out, is a very, very responsible study.

He, unlike the Braun and Truan study, identified all the shortcomings of this study. And as a result of that, it would seem to me that the conclusions of the study probably were taken at an appropriate level of seriousness because it is a comprehensive study. Now, Mr. Wilson, you have a copy of the Proceedings of the New York Academy of Sciences with you. If you could hand Dr. Curtin your copy and we'll mark that.

It's next. Don't mark it. But can we Xerox agree that the pages I'm going to talk about will be Xeroxed and put in the stickers? Does that suit you? I have no objection. All right.

Dr., I want to... I have a continuing objection to marking all of these things as exhibits. You understand that? Yes, sir. Dr., we'll put that right there and use it a little later. Okay?

Okay. Now, if you would, turn to page 316. That's going to be marked as this one. 38, I think, Mr. Beaver. Yes, sir. Have you found the article, doctor?

I have. All right. And that's entitled, Present Threshold Limit Value in the United States for Asbestos Dust, a Critique. Do you see that? Yes, sir. And I think you're familiar with that article, aren't you?

We looked at it yesterday. I think we looked at it yesterday or the day before. I say you're familiar with that article. Yes, sir. All right. And do you know Mr.

Schall? Personally, no. Do you know that his paper was presented at the New York Academy of Sciences in October 1964? It's included in the proceedings. Okay. Okay.

And from your familiarity with the article, do you agree with me that it is a critique or a critical evaluation of the threshold limit value which was based on Dr. Dreessen's work? So stated in the title. Okay. Would you look at page 318? Yes, sir.

Excuse me, not 318. Page 319. Yes, sir. you see where dr excuse me Mr. Schall points out the limitations of the study because of the lack of long- term low-level exposure i recall it yes sir all right and do you see down at the bottom where he cites the Merewether report that mr wilson asked you about uh to the effect that Merewether and price state that with continued exposure to high concentrations dust fibrosis may be fully developed in from seven to nine years and that death may result in about 14 years with less concentration fibrosis may not be fully developed for 15 to 25 years do you agree with that statement uh in as as that was the evidence that existed in the 1930s Now, over on page 320, do you see where Mr. Schall talks about the number of people who were exposed? No further, yes, sir.

And that only 333 of the people examined had worked for less than five years? Correct. and that that was an extraordinary number of people who had worked for a short period of time well didn't they conclude didn't even dr dreeson conclude that the average age of the workers examined that these textile plants were lower than any other industrial factory that the united states government had studied when he called attention to that yes all right doctor are you aware of anything in the medical literature before Mr. Schall's critique criticizing the threshold limit value on the grounds that there were not enough people examined who have been exposed for long enough and that it did not evaluate long-term low-level exposure i'm not aware do you know whether or not the asbestos industry ever had a study conducted for it critiquing the threshold on it back i'm unaware that he you haven't seen anything in the literature to reflect that i have none okay i turn your attention sir to exhibit number 37 and that is entitled the industrial hygiene foundation of america are you familiar with the industrial hygiene foundation of america yes sir and it's entitled report a preliminary dust investigation for the asbestos textile institute are you familiar with the asbestos textile institute i've been informed yes i i know what it is and this report bears the date june 1947 is it not it does and that's nine years after the treason stuff yes sir and that's also 13 years after dr lanza's study back in 1934 yes sir and that's some 17 years after dr Merewether's study in great britain yes sir now do you know what the asbestos textile institute is no it was a trade association does it still exist i'm told it is i've never it's a trade association of asbestos companies that make asbestos textile with it correct and john's bamba was a member yes sir and ray dustin's manhattan was a member and material showing me yes union asbestos and rubber company was a member yes sir southern asbestos company was a member that i don't remember that i don't remember that i don't remember but i know at some previous time you showed me the membership list and the names you mentioned up until that last one i remember did you know mr heenian h-e-n-e-o-n an engineer for the industrial hygiene foundation no sir are you familiar with any articles that he's published on dust diseases i'm not do you know whether or not he was a member of the american conference of governmental industrial hygienists so very well have been on the basis of his association was the industrial hygiene foundation uh a respected and authoritative research laboratory i believe it was okay now if you would doctor uh turn with me to the page one object of investigation yes sir you see where it says this project was a preliminary investigation of the asbestosis problem in textile plants of members of the asbestos textile institute with the immediate object of defining the specific nature and the magnitude of the problem in all its phases do you see that yes sir okay and you see the summary on that same page? The facts upon which this report is based were obtained on visits during the past three months to all plants of Institute members except one who wished the visit postponed to a later date. Complete cooperation was extended at all plants. You see that?

Yes sir. And over on page two do you see a discussion of the type of study that was undertaken. Engineering, medical supervision of workers, and physical testing, dust counts, etc. Do you see that? Yes, sir. All right, you see on page 2, this is in 1947, the sentence, only five plants have had any medical x-ray surveys of employees.

Do you see that? Yes, sir. Do you remember that Dr. Lanza back in 1945 recommended x-ray surveillance of asbestos workers i do where mr heenan says in the others therefore there is a serious lack of information as to the incidence of asbestosis the lack is more serious in a sense because in most of these plants no compensable cases of asbestosis have occurred to draw attention of top management to the problem you see that yes sir while the medical survey conducted by one plant recently shows only about three percent of the employees with asbestosis. Two other plants appear to have about twenty percent of the employees affected. Do you see that?

I do. Do you consider a 1947 doctor that three percent of the workforce having asbestosis was a serious health problem? the fact that it was never published, of which the problem was to ask Dr. Kotin these kinds of questions, at least without having this document previously admitted in the evidence, which was not admitted in any jurisdiction at the time of the warning. Go ahead, Doctor. I have a question. Yes, sir.

Do you consider a 3% incidence of asbestosis to be a serious health hazard in 1947? It's a health hazard, yes, sir. And 20% is even a greater health hazard, isn't it? Yes, sir. Okay. Okay.

Now, if you would, please, sir, did you tell me that in 1948 that one of the reasons you chose to go into air pollution was that you considered that the asbestos problem was well under control? It was being studied, as you pointed out yourself, by the Saranac people and others as well. So you went into air pollution. And the availability of Los Angeles is a nice laboratory. Yes, sir. Still got problems there, though.

Now, if you would, sir, take a look at K-39. Do you recognize Mr. H.M. Jackson, that name? Safety Engineer, Johns Manor Corporation? The address here is Woodard and the signatory is Doerr.

Do you recognize the name Mr. Woodard? No. Did you know, did you didn't know that he later became president of John's Manor? Well, assume he was president of John's Manor. All right.

No point, sir. Well, I don't know the answer to that, Mr. Wilson, for God's sake. I think he was president in the 1950s, but I could stand to be correct. Now, do you recognize the name Arthur J. Bulwark?

I do. And who was Dr. Bulwark? As he says, I'm the signature director of the Trudeau Foundation and the Sarat Laboratory. Have you seen this letter, Father, today? Never.

It's not in the any files of John's Mammal that you've ever seen. No, sir. So would you read that? She can take you down. I read the whole letter. Do you read it?

This letter is dated April 17 1951 from dr. Boal to mr. J period page Woodard, Johns Manor Corporation, 22 East 40th Street, New York, New York. Now Doctor, have you had a chance to read the letter of April 17, 1951 from Dr. Vorwahl to Mr. Woodard?

I have. Do you see in there that Dr. Vorwahl talks about a visit by Dr. Keller? Do you know who Dr. Keller was?

Samuel L. Keller? No, I really don't. Okay. He was a plant physician at the Johns Manor Waukegan, Illinois plant. Does that refresh your recollection?

Yes, sir. Okay. Now, do you see where Dr. Vorwald talks about the fact that Dr. Keller came down to the Sananac Laboratory and brought a bunch of x-rays with him? You see that?

Yes, sir. And you see that Dr. Vorwald says, while he was here, Dr. Keller, we spent a great deal of time reading and reviewing a large series of chest retinograms, or x-rays, of approximately 64 employees in the plant. The cases which he presented may have been a highly selected group. Nevertheless, I was astounded with the number of cases presenting x-ray evidence of asbestosis.

It is obvious that the situation in Waukegan is serious enough to warrant your most considered attention. Should the cases which we so recently reviewed be an index of the industrial hygiene conditions existing in that plant, it seems highly advisable for you to improve the plant conditions before irresponsible agents stimulate action which might reflect unfavorably on the industry do you see that yes sir all right doctor do you know uh whether or not any dust counts were taken at rockegan in 1951 okay now doctor uh getting back to this Hemeon report getting back to this Hemeon report um on page two under dust camp do you see that Yes sir. He starts talking about the threshold limit value. He says the maximum permissible dustiness for asbestos is commonly taken to be five million particles per cubic foot. This represents good attainment in the dust control program. It is emphasized, however, that dust elimination to this extent does not positively ensure that no asbestosis will develop in some workers after a long working life, greater than 20 to 25 years.

Scientific evidence is obscure on this point. It is recommended, therefore, that studies be initiated aimed to develop another yardstick because it is suggested that when control below 5 million is attained, present dust count methods may not properly measure the remaining hazard. Do you see that? Yes, sir. yes sir you may doctor um is this not some of the same criticism that was leveled at the recent study by Mr. Schall in the 1964 article that we discussed there are similarities all right now doctor if you would turn over to uh page four yes sir down under discussion of concentrations concentrations. The figures for carding room dustiness.

What's a carding room? That's a room where fibers are actually literally put on cards for ultimately, for ultimate weaving into textile products. Now a lot of people in the south are familiar with textile plants. Do textile plants have carding rooms too? They do. Okay.

The figures for carding room dustiness indicate that with reasonably good enclosure and exhaust to the machines Concentrations well below three million. I guess that means particles per cubic foot are obtainable four of the plants visited Exceed the five million particles per cubic foot limit materially. Do you see that? Yes, sir Now if five million Particle per cubic foot that was the threshold on his day at that time in 1947. Is that professor? Do you understand?

Mr. Hemeon is pointing out that for the plants in the carding room the levels exceeded materially the threshold on his day He so states. Now doctor if you will look at page five. There's a table there that says dust survey for Asbestos Textile Institute and they list the various rooms where work is being done. You see preparation, carding, mule spinning, ring spinning, twisting, weaving, spooling and winding. Do you see that?

I do. Are you familiar with whether or not those were operations undertaken in a textile plant? They are. And then he's got one, two, three, four, five, six, seven, eight, nine, ten plants they looked at. Is that correct? A through J.

Ten up. Do you know of any study ever taken, undertaken in this country, including the Dreessen study, where somebody looked at ten plants at one time? I'm unaware of any. That's a big study in the doctor. Covers ten plants. Yes, and Dr.

Dreessen only covered four didn't it yeah okay now do you see the values listed no i was just going to say the number of plants is just one factor the number of people studied as well as an important we're going to get to that in a minute fine now do you see the various dust counts that were taken at those 10 plants yes sir some of them pretty high aren't they 10 to 25 13 to 18 7 to 11 30 to 50 11 to 15 you see that yes sir do you consider in 1947 that those were acceptable levels of dustiness they were above the threshold in the bedding all right now if you would sir turn over to page 14 now he's talking about the fact that they examined the practices the medical practices that these plants and they're right yes sir he says half of the plants have no positive information is to the incidence of asbestosis among the workers. The situation in these respects is indicated in Table 2. And then he lists all the ten plants and whether or not they have x-rays taken, doesn't he? Yes, sir. Okay. And you see that one, two, three, four, five of the plants don't even do x-rays today.

See that? I have to count them, but one, two, three, four, five, yes, sir. And in fact, only one of the plants had periodic x-rays made. One out of ten. Yes, sir. Okay.

And Dr. Lambert, back in 1935, said that's what you're supposed to do is have x-rays, periodic x-rays, didn't you? He recommended it. Doctor, do you know whose plant that was? Johns-Manville. Okay.

Thank you, Mr. Wilson. The other nine didn't have any, though, did they? Johns-Manville did. Okay. Well, good for Johns-Manville.

Now, Doctor, on page 15, do you see the incidence of asbestos? The estimated incidence of asbestos. okay now which one of those plants was the jm plant plant h yes okay let's keep that in mind when we get over to asbestos now council if you want to comment uh i don't mind you asking i will draw the comment as well estimated incidence of asbestos did um did mr Hemeon and the other people from the industrial hygiene foundation attempt to estimate the incidence of asbestosis in the the employees apparently on page 15 he has a section devoted to that all right now you see what plan a had 400 people employed yes sir and do you see that plan a has recorded cases diagnosed as asbestosis to the extent of about 20 percent and in the past nine years has compensated on the average two cases a year you see that i read that yes in 1947 doctors 17 years after dr Dr. Merewether, 13 years after Dr. Lanza, and 9 years after Dr. Dreessen. Do you consider that's an acceptable health situation at that plant?

That's the bottom of the question. Do you, sir? No, I think you should comply with the threshold in the value. And you see, you read on the other table the name of the plant, JM, didn't you? Yes, sir. Do you see here the name of the plant there?

Do you read Mannheim? What? Next to plant A. Do you see writing? It's scribbly. I can't read it.

You can't read it. Okay. All right. Now, do you see that the other plants are discussed, and one of plant C has 3 to 4 percent asbestosis, then plant D has an employment of 150, and he found four cases of asbestosis. Plant H, which I think you identified as being John's mambo, had a textile employment of 300 and finds five or six cases annually that the physician believes show early changes due to asbestos. you see that yes sir you consider five or six cases of asbestosis at a plant of 300 annually 13 years after dr lancet would be an acceptable level of asbestosis in that john's mammal plant get to the form of the question that's not what the report says it says it shows early changes i would like i would like to look at the film myself i see i have the films looked at since i'm not a radiologist that's what you think that uh that these five or six people who had early changes due to asbestos should have been advised that they had early changes due to asbestos they could or could not have been do you think it would be proper to continue to expose these five or six people a year who had early changes due to asbestos to continue levels of asbestos if they're below the threshold limit value i think you'd have to all right you'd have to judge it on an individual case i see and plant j has counted potential cases of asbestosis amounting in number to about 20 percent comparable with plan a did you see that yes sir is that an acceptable level of asbestosis in 1947. and the text will out in this in terms of this study yes no i think compliance with the threshold limit value now and then he says other plants have conducted no systematic x-ray survey so they couldn't determine the incidence of asbestosis do you see that says that now on page 16 doctor do you see the next the last sentence these observations suggest that there may well be a marked divergence in medical procedures interpretations and attitudes respecting the diagnosis of asbestos there's a very urgent need for a concerted cooperative medical effort to develop improved diagnostic procedures and uniformity of interpretation. Do you see that?

Yes, sir. Now, do you agree with Mr. Hemeon based on the dustiness of the plants and the level of asbestosis in 1947 that that should have been done? What? The last sentence. There's been urgent need for concerted cooperative medical efforts to develop improved diagnostic procedures and uniformity of interpretation.

Yes, there should have been some effort to standardize the diagnosis of the disease okay now over on page 17 do you agree that one of the most important elements of a program of protecting health of workers in an asbestos environment is the periodic medical examination it's certainly an important point and then dr ramsay emphasized that in 1935 that was one of his conclusions okay do you see the next sentence then you agree with Mr. Hemeon on page 17 when he says that. Periodic x-rays are important. Periodic medical is the first sentence, sir. One of the most important elements of a program of protecting health of workers in dusty occupations is a periodic medical. Yeah, you said periodical x-ray examination.

I'm sorry, I did misquote it. You agree with that? Yes, sir. And an x-ray would be part of that examination? Yes, sir. The lack of scientific information regarding all aspects of asbestosis is serious do you see where he says that yes do you agree with him in 1947 that that was a problem yes sir this cannot be over-emphasized Mr.

Henium said you see that you agree with him I don't know what he meant by over- emphasized well it's very important it's important yes the obvious procedure to help overcome this deficiency is to employ every tool now available that will throw more light on the facts do you see that you agree with him that that should have been done should use what was available to you all right the importance of the periodic medical x-ray examination can perhaps best be emphasized by stating that dust count investigations cannot in the present state of knowledge give us assurance as to the extent of our success in eliminating the hazard do you see that yes sir do you understand what he's saying i'm trying to i want to read it to you go ahead i'll be quiet but i think you have to complement medical examinations with dust counts otherwise you just don't know whether or not the dust levels are doing any good unless you examine the workers to see if they're getting sick you know right that's what i conclude that he means that's what dr Merewether said way back in 1930 what yes and yes and you agree with it I think you have to do both. All right. Now, look at the next to last paragraph, Doc. More important for the long term, the accumulation of factual information regarding the health status of exposed workers statistically interpreted in relation to dustiness studies and to mechanical developments in dust control equipment will eventually indicate that the battle of asbestosis control is being won. This aspect of the problem is elaborated in the following section. Do you agree with that?

That these data would be important in arriving at the conclusion that he says yes. And one of the first things you did when you came to Johns-Manville was to start developing a database, didn't you? Yes, sir. You hired a statistician, didn't you? I did. And there wasn't one there before you got there, was there?

There wasn't. All right. now doctor over on uh on page um 19 are you going to be on this long because i want to you want to take a break i got about five moments can you have we take a break what do you want your question well let's take a break yes sir this is a combination Now, Dr. Kotin, let's continue to look at this 1947 death survey for the Asbestos Textile Institute. Yes, sir. If you would, turn over to page 19, and it says statistical studies of medical records. Yes, sir.

And Mr. Hemeon says there are two very important questions concerning the physiological nature of asbestos that have not yet been answered by any published investigation. Now what does physiological mean? Having to do with the body. With the body. Okay.

In other words, the effect of asbestos on the body. That's what he's saying. That's correct. Two questions about the effect of asbestos on the body that haven't been answered. all right number one what is the expectation of asbestosis in workers exposed more than 15 to 20 years to low concentrations of asbestos dust among the 500 odd workers who composed the subjects in the u.s public health service study there were abnormally few who had been exposed for more than 15 years and practically none over 20 years these facts seriously affected the conclusions that could be drawn do you see that yes sir now when he says the u.s public health service studies he talked about dr Dreessen's study i assume he means that and is he making the same criticism back in 1947 that Mr. Schall made in 1964. yes sir now the second question is is there a progression to advanced asbestosis after exposure of an individual has been discontinued or has been reduced to very low levels due to action of dust deposits from earlier exposure this question is is of very great importance to intelligent medical supervision of workers in these plants now doctors what he's saying there what we were talking about earlier and that is whether or not a person who's got early asbestosis ought to be allowed to continue to work in the plant even if the asbestos dust is lower than the safe level. He's saying that issue has not been answered.

Yes, sir. Do you know whether the asbestos industry funded any studies between 1947 and 1964 to find out whether somebody who had early asbestosis ought to be removed from exposure? No. And your review of the records have revealed none. Is that correct? That's correct.

Now, Doctor, if we could, please turn over to page 21. one now i believe uh mr Hemeon here is saying what we agreed on earlier and that is to really understand whether or not you got the problem licked you got to match medical surveillance examinations of the workers with dust camps is that what he's saying now over on page 22 appraisal of reduced dust hazard you see the third paragraph there where mr Hemeon says the The information available does not permit complete assurance that 5 million, I guess that's 5 million particles per cubic foot, is thoroughly safe, nor has information been developed permitting a better estimate of safe touchiness. Do you see that? Yes, sir. He's being critical of the threshold limit value, isn't he? As reported in the recent study. Yes, and he's urging that further studies be undertaken in it.

Isn't he, Doc? Yes, sir. and you don't know and you haven't seen any records to indicate that any studies were followed up as a result of this 47 critical criticism that hadn't i'm not aware of any now will you look down on the measurement of dustiness yes sir he says the non-fibrous particles in most textile operations can comprise 80 to 95 percent of the total dust seen in dust count you see that yes sir again what he's pointing out is the fact that the recent study counted all dust cotton rock and everything else not just asbestos isn't that correct yes sir all right now if you would doctor let's look at page 23 a second you mentioned uh to mr wilson that johns mambo had bought uh dr selikoff sometime in the late 1960s an electron microscope you remember that yes sir well do you see here on page uh page 23 that uh mr heenan had an electron microscope yes sure sir yes okay so he used an electron microscope in this report didn't he just like that excuse me he's like i haven't seen this full report but he's just obviously he has an electron microscope way back in 1947 Now, on page 27, this is his recommendation. Do you see that? Yes, sir. And he recommends that information be exchanged among the member countries. Do you see that?

Yes, sir. He says that they ought to develop new techniques for dust control. Do you see that? Yes, sir. He says on page 28 they need to institute periodic medical exams. Do you see that?

Yes, sir. they need to organize a diagnostic panel for asbestosis you see that b oh i'm sorry i'm still up in a i'm sorry sir see uh b organization of a diagnostic panel for asbestosis page 28 oh yeah you can start page yes sir and a statistical study of existing medical records do you see that yes sir and physical testing further death studies do you see that Yes, sir. And he says at the bottom and the conclusion This is a step- by-step program aimed at the elimination of asbestosis cases from the plants of Asbestos Textile Institute members Isn't that correct? Yes, sir. Now doctor, isn't it a fact that the threshold limit value for asbestos five million particles per cubic foot Was the only standard that we used for all operations insulation work, shipyard work, textile factories, mines, mills the whole asbestos operation it was the one threshold under value all right now doctor do you know whether or not the asbestos textile institute followed through on mr Hemeon's recommendation that dust studies be conducted i'm unaware of any i don't know okay if i could If you would, sir, this is 40 and 41, the minutes of the Air Hygiene Committee of the Asbestos Textile Institute, November 19, 1947. And if I'd ask you to look at that for a second. And I don't have the one copy, doctor, so if you don't mind, I'd like to stand here.

Do you see where it's reported that Mr. Hemeon came in? Yes, sir. All right. And it says, Mr. Hemion of the Industrial Hygiene Foundation proposes the following program.

Do you see that? Yes, sir. And is that, you can turn the page over to see. Is that the program that he recommended in the June 1947 report? I have that. All right, sir.

Is that basically and essentially the same program he recommended in that June 1947 study? Substantially. All right. Now, I hand you what's labeled K-41, which is the minutes of the general meeting of the Asbestos Textile Institute, June 17, 1948. Yes, sir. Let's take a look at that, sir.

Do you see where it's recorded that members, representatives from John's Mammal and Red Vestas Manhattan were there? On the list of attendees, yes, sir. Did you know Mr. Fred Walkum? No, sir. 47 and again in November of 47. I'm sorry.

Does it not indicate that the study was rejected? Yes. Now, Dr. Kooten, this low-level exposure, when he says low-level exposure, they're talking about exposure to levels below the threshold limit value is that how you understand that's how i understand it now these babies and wives in the homes of asbestos workers do you have an opinion as to whether or not they're exposed to levels greater or less than the threshold limit value of 5 million particles per cubic foot that was in effect from 1938 to 1968. basically i think we could measure it and find out the simulated conditions or not but I am satisfied that to the question there's no way the answer can the question can be answered because taking into account amount of fiber and duration of exposure not the best using the over five million particles per cubic feet I don't think you can assume that they were low-level exposures in fact there are no data to support that and i've taken the position unrelated to this that and others have as well that uh because they weren't in the plant the corollary was not necessarily that they had low level exposure that's true for everybody that works with asbestos insulation workers shipyard workers plant workers and that's true doctor's response yes first response the fact that you can't consider that that it was low-level exposure in places other than the plant. Well you can measure, you can't measure. Do you know whether or not any asbestos company ever advised any worker before 1964 to change their clothes before they went home so they wouldn't subject their children and their wives to asbestos dust after the farm?

I don't know of any such thing. And there's disease now in children and wives of asbestos workers in their doctor's families? There are reported diseases, yes. Now, Now, Dr. Kotin, this 1947 report, exhibit number K-whatever- it-is, the best study. Can you give me the number, please?

K-37. That has never been published in the literature, has it? I've never seen it. You've never seen it, and you've tried to keep abreast of the literature, I believe you said. I think so. And that's a significant study, isn't it, Doctor?

Exactly. It's a study on the situation that was reviewed by the Industrial Hygiene Foundation in 1947, yes. It's a significant study, isn't it, Doctor? I don't know if it's reviewed by significance, but did it reveal important information? Yes, it did. Now, Dr.

Kotin, let's talk a second about the Fleischer study, okay? sorry that's the one that was done of shipyard workers that you talked about on direct do you remember that yes sir and that was done in uh i believe 1946 wasn't it yes sir excuse me for a second while i found my coffee perhaps mr wilson can give you the copy that he introduced on the rest is this yours have you found the one that mr wilson used doctor so i have nothing here one other than what you've given me this morning come on i have one chocolate i'd kind of like to follow along well can we stop and take a second i probably can find two there's no use to have now um dr Kotin uh the flasher study was a study of shipyard workers wasn't it yes sir And the threshold limit value of five million particles per cubic foot of total dust have been in effect for Eight years when that study was running that correct Well, I've only got one minute. Mr. Wilson doesn't mind me leaning over your shoulder. I'll let you look at mine. I Don't even mind And I wanted to turn over doctor to the place where they got all these death camps, yes, sir, okay It's table two on page 14. Mr.

Wilson now let me ask you to k2 let me ask you a few general questions before we get back about this life stuff number one i have a copy here of the bibliography that was prepared of all the medical articles in the john's mammal library that was prepared after you got here and this is uh exhibit number what's this number 42 and i'd ask you to identify this doctor she was yes sir is that the bibliography that was uh compiled with your direction after you got here in 74. yes sir now i believe you've looked through that before but tell the jury whether the flasher study was found in the medical articles of john samuel after you got here is it included in this yes no there's one of many many that are not included but it's not included in yeah all right now you yourself were not aware of the flasher study didn't read it until 1960 something i went with the government about 1960 something okay now doctor if you would let's take a look at these dust camps now do you see that they had uh two dust counts total dust and asbestos dust you see that yes sir and the threshold limit value measures what total dust all right you see the dust counts reported there yes the range 3.5 to 8.7, is 8.7 above or below? For that single measurement, it's above. All right, and the average was what? Let me make one point. All right, go ahead. That you can have, that's why we use time-weighted averages, because you can still be within the time- weighted average and still have an occasional count above that.

In fact, that happens all the time, and that is figured in into developing the concept of a threshold limit value, the acceptance and recognition that some measurements may be above. right now do you know what kind of study they did at the shipyard yes sir all right it was time weighted average right yes sir all right so the average is reported in this column as layout and cutting and navy yard a is 6.1 is that above or below it's above the navy rd was 4.2 is that above or below below 20.0 is that above or below okay 10.9 is above it yes sir cutting with the band saw 15.1 that's above it that's three times above it yes sir all right and then the next one's 39.5 that's that's eight times above it yes sir and the next one is 73 plus that's astronomical isn't it well it's a lot more than than eight times right 4.6 that's below right 6.8 that's above key point one that's below 11.4 that's above 6.0 that's above 31.0 that's above 84 above that's way above because my also appearing on the video i said we only have one copy mr wilson wants to retain his copy and if it's stricken it just has to be stricken but we don't have a copy making we've got time constraints you want to stop the table go make a copy and i'll start over you can just read the numbers they're self-evident whether they're above or below i agree with mr wilson doctor on down the chart is it not true that with three or four exceptions the 30-some-odd camp were all about the fresh orange of that and that's right but three are out of my county with fewer yes sir there's one and 30 somewhere above is that right that's correct okay so 10 were below and 90 were above yes sir okay now doctor do you know what george wright is yes sir dr george and dr george wright was a consultant to john's mammal back in 1972 was he not yes sir and are you familiar at the time are you familiar with the um osha hearings they had to set a level of exposure to asbestos back in 1972 yes sir and are you familiar with dr wright's testimony i was aware that he testified his details are you aware that he testified that dust exposure for insulation workers in the 30s and 40s and 50s were grossly in excess of the threshold and do you have any information before 1964 to indicate otherwise not that i'm aware of and to the extent that someone knew that a dust count might be above the threshold limit value is it not your firm opinion sir that that person ought to have been advised to avoid exposures above the threshold okay he should have yeah he should have not have been exposed to the group all right doctor we're going to move on to another search Dr. Kotin are you familiar with a study done of insulation workers in denmark back in 1956 you recall that that was a survey of insulation workers at that shipyard who have been exposed for more than 20 years to asbestos and other things. I think he was in fact published in the Danish Medieval Bulletin. Yes, sir. Back in 1956. And do you recall that Dr.

Frost was the author of that and that in his summary he stated, 31 workers engaged for 20 years or more in different kinds of insulation works were examined for occupational lung disease. They had been exposed to dust containing asbestos, chisel glue, magnesium, glass wool, and rock wool. Nine were found to have definite signs of pulmonary asbestosis. Nine. Nineteen showed abnormalities of the pleura, the lining of the lung that you showed the jury up there and that's 19 and 31 12 of these being bilateral does that mean on both sides of the land yes sir okay in 11 cases calcification of the pleura was found that's the the uh that's the deposits that get on the floor is that what he's talking about calcifications of the pleura yeah just calcification of the pleura okay and those are all asbestosis um and calcification of the poor are diseases related asbestos exposure they're not diseases changes in the poor are not diseases they are changes to the body that occur from asbestos exposure and in the opinion of authorities whose supreme whose authority is universally recognized they are not categorized as disease dr. Selikoff calls it plural asbestos And Professor Edward Gaensler calls it pleural changes, but I think the prevailing opinion is that, as Dr.

Gaensler has said so well, that pleural changes are not disease, they are stigmata of exposure, and are not related to disease. Well, Dr. Selikoff in that book that you wrote before takes a different position there. Yeah, may I read what Dr. Gaensler says? Pardon?

And I guess this has to become part of the record. Because the question is of such great significance, I did ask Dr. Gaensler. Dr. Gaensler is professor of thoracic surgery at Boston University School of Medicine. Again, recognized.

Excuse me, who are you, what are you reading from, doctor? I will show you a letter, a memo on Boston University Medical Center signed by Dr. S. Gaensler, an explanation of plaques. We only have two minutes on this take. Plaques are a slight thickening like a callus between lung and chest wall.

Sometimes calcium is deposited in them and they can be clearly seen on chest x-ray. It has been reported both from New York and from Dresden, Germany, that as many as 80 percent of the persons have these slight harmless thickenings when there has been an exposure to asbestos, however slight. We have seen them in executives of shipyards who worked in offices only and in persons who many years ago were exposed for only a few months. Rarely they also occur in unexposed persons. such person such plaques must be considered an x-ray abnormality but they know but they in no way impair health or breathing or lung function nor do they appear to be harmful in any way they are merely a sign of asbestos exposure but not a sign of disease now doctor whether or not these plural thickenings and plaques cause impairment. Dr. Frost back in 1956 reported that they existed in asbestos workers.

That's correct. And Dr. Selikoff and some others don't necessarily agree with you and this other gentleman who you quoted and say that in fact it might even be an increased risk to mesothelioma when you have those things. An increased risk to mesothelioma when you have those calluses on the plurals. But I would emphasize again that notwithstanding this difference that Dr. Selikoff and I have, he thinks enough of my opinion to have honored me by writing the preface or the opening to his book.

Move to strike. Now, doctor, with respect to Dr. Frost again, and let's forget about these pleural calcifications. You don't think they cause harm and other people think to do let's talk about asbestosis because you agree i think that that is a bad disease can be yes sir all right now dr frost found 31 workers out of the 31 workers he found nine to have definite signs of pulmonary asbestosis isn't that correct yes that's an incident rate of what 33 percent. Out of 31, what was it? I'd like to see it.

Oh, sure. Yes, sir. We're going to talk incidents. I would like to take a look at it. This is number 44. I'm looking for a table.

I'm going to have to read it because I don't see a table. No, no. There isn't any table, Bob. No....figure of around 30% and that's the striking incidence of asbestos-resistant abacus. For me it was striking. Yes. 30% incidence of asbestos.

That's a large incidence. It's a significant amount of disease. That report made it highly suspicious and I'm going to use terms and I ask you to pay close attention. That That report was highly suspicious that asbestosis was a definite hazard to insulation workers, wasn't it, Doctor? It was highly suspicious and definite, I don't know, it was highly suspicious that asbestosis was a complication of the insulation workers in this population. Thank you.

Now, Doctor, I hand you K-45. What is that? K-45 is the Industrial Hygiene Digest, June 1957. I believe you expressed some familiarity with the Industrial Hygiene Foundation and the Digest, did you not? I did. All right.

And is not the Industrial Hygiene Digest a monthly publication that contains medical abstracts or summaries of medical articles reported in the world literature? Literature abstracts. It's probably just medical. Okay. If you would turn to the back. literature abstracts rather than just... Turn to the back, please, doctor.

The very last page of the index. Okay. Look under. Do you see the word asbestosis in the index? Yes, sir. And do you see a citation? 761.

All right. Now, if you would, turn to abstract number 761, which is over on page 16. yes sir do you see reference to the frost study of asbestosis in shipyard workers i do all right and do you see that they report that man of the workers had asbestosis exactly all right and the title of the thing is asbestosis with pleural calcification among insulation workers did you see that yes sir all right is that the same study that we were talking about a minute ago with the significant disease and insulation workers? Yes, sir. Do you know who gets copies of the Industrial Hygiene Digest? Members of the Industrial Hygiene Foundation. Members of the Industrial Hygiene Foundation.

So if a company had a medical director, then he didn't read anything else. I just read these abstracts in the back. He could have very easily found the reference to the Frost study, couldn't he? If he read this, he would have seen the reference to the first thing now dr. you spent a great deal of your professional career conducting research into the health effects of air pollution did among other things yes and in that research you used experimental animals to find out how certain things affect the lungs yes sir now back in the 1920s and 30s and 40s and 50s there was a research laboratory in new york called saranac laboratory wasn't it yes sir and these fellas up there dr Vorwald and dr gardner and later dr Schepers were experts at running tests on animals to find out if certain substances could cause disease in those animals weren't they yes sir and they were to asbestos what you were to hydrocarbons weren't i don't I don't know if they'd be flattered with that analogy. That's probably different, Doc. You're the world's leading expert on hydrocarbons, and these fellas were among the world's leading experts on asbestos, weren't they?

I would say so. Fine. And in the 1930s, Dr. Gardner and Mr. Cummings, who later came out here to Colorado, and others, ran tests on animals, subjected them to asbestos, didn't they? Yes, sir.

And they concluded that asbestos caused asbestosis, didn't they? They did. And are you familiar with the fact that they ran tests using different kinds and qualities of asbestos? Different products, yes, sir. And in some of the things they used contained as little as 14% asbestos and the rest was serpentine rock, right? As I recall, that was one of the experimental models, yes.

And they exposed those animals for periods ranging from two to four years, didn't they? Yes, sir. And they expose them to levels anywhere from 6 million particles per cubic foot up to 138 million particles per cubic foot. That's an intolerable dose. Right. And one of the reasons you expose animals to higher levels than human beings breathe is because an animal don't live as long as a human being.

Isn't that right? That's one. One reason. One of many, many. Right. It's not necessarily the determining one. and do you agree that animal experiments have a high index of meaningfulness for human beings?

In direct proportion to the quality of the study. Right and Dr. Vorwal and Dr. Gardner were pioneers in developing scientific techniques for testing animals with dust diseases weren't they? They were among the very first yes. Now doctor Doctor, was it not known that in 1950 that substances containing small percentages of asbestos fiber would produce asbestos?

I think some of their studies showed that. I don't know what you mean by small. Less than 20%. It was shown that... Well, as long as you give me a number, yes. Less than 20%.

Yeah, okay. Do you agree that an agent that can cause disease in a mouth can also cause disease in human beings? Some can, some do not. Right. And recently several companies had studies done with experimental animals using a substance, some type of fiberglass, to find out whether fiberglass could cause disease in human beings. Isn't that right?

To find out whether it could cause it in animals and then see what relevance these findings would have to make. Okay. And based on those studies, your company and others concluded that fiberglass could be used by human beings without any disease. Isn't that correct? correct? Yes sir. So you yourself think that those kind of studies are useful to find out whether or not a product causes harm in animals so that you can have some reasonable basis to conclude that it doesn't cause disease in human beings?

The only correction I would make is that it's part of an array of information and data. It isn't the only thing. Okay and doctor you you were writing back in the early 1950s that companies ought to run tests on their products before they sold them. i recall taking that position right and doctor in 1950 were you of the opinion that it was better to find out in experimental animals that a product caused disease than to discover it later in industrial workers who use that product yes sir now i'm going to hand you exhibit number 46 doctor which purports to be made by the president of Johns Mountain, back in 1955. You see the speech in there, Doctor? Yes. And you see the section called Responsibility to the Consuming Public?

What page is that on? I think it's on page 7, but I know 17 or something like that. I have it. 17 is right. And you see in there where he talks about warning labels? Let me read this. May I?

Yes, would you read that section End of the record, please. Well, since you're winding down, I'll read. I've been trying to preserve my voice, as you can hear. Yes, I know. Well, let's go. Why don't you read it, please?

I'll be delighted to. Thank you. Keeping you in trim, having you jump up and down. Without objection, of course, to the use of the document and so forth. It says here, as with the rest of industry this is in 1955 by the president of young men we are also aware of our responsibilities to the consuming public I found my topics I'll give you your thank you sir today the products of industry are designed to promote the health and comfort of the public industry is constantly striving to bring about more pleasant living through improved products that better values to the consumer more every effort was made nowadays to protect the consumer with safer products and better methods of handling them years ago industrial research was unconcerned about problems of health and safety that might be involved in a product when the product was developed it was put on the market today our industrial research organizations probe into every health hazard and every safeguard is insisted upon before the product is marketed to the consumer and now the last sentence He says an industry has inspired to a very great extent the movement to label properly Certain types of products that might harm the consumer. He were not forewarned.

Do you see that? I do and do you concur with what mr. Fisher said back in 1955 about Making every effort to find out whether product is safe before you sell. Yes Doctor and your review of the records. Oh And you also agree that products are belated. Well, we're inappropriate.

There's no caveat And, Doctor, do you know of any tests that were run by any asbestos insulation company on their products to find out whether or not those products could cause human beings, could cause disease in human beings before they were sold? Any insulation company? No. Yes. Now, Doctor, have you been made familiar with a product called KAYLO, K-A-Y-L-O? I believe I read it in some of the correspondence that I saw for the first time a few days ago.

All right, sir. Doctor, I'm going to hand you a letter from Dr. Borewall to Mr. Bowes of the Owens, Illinois Glass Company. The date is November 16, 1948, gentlemen. November 16, 1948.

And if you would, read the first page, and the second page is about who's going to pay for the study. I don't think that's relevant, unless you want to read it. No, no. The third page is a summary. All right. Page three.

Yes, sir. Now, on the first page, he talks about three copies of a report on the results of animal experiments with calo dust. Do you see that? Are you speaking of the letter, or are you referring to the letter now? Yes, sir. I'm sorry.

The letter. Enclosed, you will find three copies. Yes, sir. All right. now he says that in that sentence however the experimental study of the effects of inhaled calo dust on normal uninfected animals is now finished and conclusions expressed on that subject are final rather than tentative you see that i do now you see down that the third paragraph during the 30 to 36 months period however definite indication of tissue reaction appeared in the lungs of animals inhaling calo dust. Do you see that? I do.

And therefore, I regret to say, our tentative conclusion quoted above must be altered. In all animals, you see that? All animals, sacrificed after more than 30 months of exposure to calo dust, unmistakable evidence of asbestosis has developed, showing that calo on inhalation is capable of producing asbestosis and must be regarded as a potentially hazardous material do you say that I do all right now would you look over on page three please Martin has stipulated with counsel from Georgia among other states where a more formal objection as to form might be required by the rules of practice that an objection has to form is sufficient for purposes of this deposition and that the substantive basis asking for them need not be articulated at the time the objection is made also miss ronnie this time i assume the ongoing objection to the use of these documents is still in effect sure now do you see page three doctor and you see where dr vorwald he was the director of the san act laboratory what a titan a titan in the field agree with that yes thanks i realize that our findings regarding KALO are less favorable than anticipated. However, since KALO is capable of producing asbestosis, it is better to discover it now in animals rather than later in industrial workers. Thus, the company being forewarned will be in a better position to institute adequate control measures for safeguarding exposed employees and protecting its own interests. Do you see that?

Yes, sir. Now, Dr. Deyou? Have you, prior to this morning, had an opportunity to review the attached document which is the interim report on the biological activity of calo dust? I have not done that. Dr.

Do you agree with Dr. Vorwald that this product, calo, do you know the product calo? Do you know that it's a thermal insulation product? It's an asbestos containing product. It's a thermal insulation product that contained asbestos used by insulation work. Yes, sir.

Do you understand that, sir? Yes, sir. All right. Do you agree with Dr. Vorwoff that since Kalo is capable of producing asbestosis, it is better to discover it now in animals rather than later in industrial work? I do.

You do agree. All right. Doctor, as a result of receiving this report, do you have an opinion as to whether or not the Owens Illinois glass company the manufacturer of the product Kayla should have advised industrial users of the product Kayla of the results of this experiment I would have to answer as I've answered earlier. They certainly should have pursued it not having been there I don't know exactly what they should have done. They should have gone out and done some dust Studies where Kayla was being used. They should have pursued the implications of the study.

Yes now This gentleman is A letter, March 12th, 1943, from Leroy Gardner to Mr. Bones of Owens, Illinois, 48, March 12th, 1943. Doctor, do you see in the third sentence there, this is a letter from Dr. Gardner. He was director of the Sananac Laboratory in 1943, wasn't he? Right.

You see the third sentence there? the fact that you are starting with a mixture of quartz and asbestos would certainly suggest that you have all the ingredients for a first-class hazard. You see that? Yes, sir. Do you agree with Dr. Gardner that the mixture of quartz and asbestos certainly would constitute a potential hazard? Potential hazard, yes.

All right. Now, Doctor, the next letter I'm going to give you is one dated February February the 12th, 1943, from Owens, Illinois, to Dr. Gardner. Now this is a letter dated February the 12th, 1943, asking Dr. Gardner to conduct the KALO experiments. And in there do you see where he talks about the product KALO, the fourth line says, It, KALO, is intended to use this material for certain interior structural uses, also as an industrial thermal insulating material for pipe etc do you see that yes sir and that's the product that insulation workers would use it yes sir and you see in fact down there at the bottom the following points merit consideration number three it should be considered from the standpoint of employees working in the plant where the material is made or where it may be sawed to desired dimensions and also considered from the standpoint of applicators or erectors at the point of use do you see that i do and there's an applicator or erector at the point of use and insulation work yes sir now doctor do you know whether or not have you seen anything in the records of the Johns-Manville Corporation to indicate whether Johns-Manville retained the Saranac laboratory or any other laboratory to run tests on its product Thermobestos.

I have not seen any. And this Thermobestos before asbestos was removed was it not a calcium silicate product similar to kayla it was a hydrous calcium silicate containing asbestos fibers yes sir now with respect to precautions that were available as dr borewall suggested back in 1948 were respirators available yes sir were warning labels in use back in 1948 for some products some products yes were exhausts available for saws where calo might have been cut Exhausting was available, yes, sir. Doctor, do you have any more instruction manuals on how to use products safely and used back then? Don't have resistance, yes, sir. Okay. Now, let me OCF this.

Ron, how much more time? Fifteen minutes. Try and telescope it if you can. Yes, sir. Appreciate your kindness. Now Doctor, I've given you a, what is the date of that letter, sir? 6-12-56. 6-12-56.

And who is it from and to who is it addressed? No, it's a non- letterhead of W.J.H., whoever that is, and it was addressed to W.J. Stewart, dash 6, but it is on a plain white sheet of paper. It does not have a letterhead. Okay. It bears the date, June the 12th, 1956.

Yes, sir. Did you know Dr. Shipp? No, sir. and the memo reads Mr. Ira Brock called this morning and asked if we ever prepared a brochure on the health aspects of calo dust similar to the one Ed Ames prepared for fiberglass some years ago do you see that yes sir and then it says we told him no yes sir but the animal experiments at Saranac were written in a highly technical manner and this is the only published material that has appeared do you see that yes sir now do you know what they're talking about there with respect to the uh highly technical published material on calo it's wjh who i assume to be wj hazard this certainly is an assumption on my part do you um do you see that language sir yeah i'm not close to that published material that might be recording okay i'm gonna hand you k27 and save a little time ask you to look over here page 343 sure and you see that there's an article by dr Schepers yes sir if you would please turn over to page 343. okay now what is the title of that article effect of inhaled commercial hydrous calcium calcium silicate dust on animal tissues. Okay, and is calcium silicate what calo is?

Yes, sir. And thermodust. Yes, sir. All right, would you look over at the conclusion? Yes, sir. Do you see where Dr.

Schepers, in his conclusions, find that the dust caused marked chronic bronchiolitis with terminal peribronchial, peribronchiolar focal fibrosis, bronchiectasia, and epithelialization of anoractic alveoli. The final lesions closely resemble those found in experimental asbestosis and included asbestos bodies. Do you see that? Yes, sir. All right. And then do you see that he says that it seems likely that the crisis child, that's asbestos.

Yes, sir. Component of the commercial product rather than the hydrous calcium silicate was the cause of the deleterious effects on the tissues of the experimental animals you see that otherwise he's saying that it's the asbestos that made the animals sick that's what he believed yesterday now i hand you a copy sir of the k51 and ask you if you've ever seen that before today oh yeah this is this is just the thing we just read right that's that was what was published in the literature yes sir and it was published in the ama archives of industrial health back in 1955 shortly thereafter all right and the ama archives of industrial health is that a reliable and authoritative journal i find it to be serious and you see that dr Schepers repeats his conclusions about that calcium silicate causing asbestos same conclusions contained between the hard covers thank you now do you know when um fiberglass insulation products came on the market doctor the market for 30 40 years a long period of time right and the fact that's probably the major insulation product that's used today in I think so So, yes, sir. Okay. Let me see it. Excuse me one second, doctor. I've got one other document I want to ask you about in reference to this Kalo business, and we'll move on and conclude.

I can't find it. I'll be there. Now, doctor, let's talk a second about warning labels and we'll be through. Do you agree that carcinogens, cancer-causing things, that people who are exposed to cancer-causing things ought to be told about. It depends on the biological availability. You will recall early I made the point that the agent is part of the potential hazard.

The availability is not. Therefore, there are certain instances in the world that most everybody, certainly in the room and maybe in the world, is familiar with is that people are exposed to cancer- causing agents. coming out of the exhaust of an internal combustion engine in her automobile, and there is no warning, and I'm not aware of any feeling on the part of anybody that the automobile should be labeled. But, Doctor, I believe you also said that studies have revealed that people just exposed to automobile dust exhaust or fumes exhaust, there's no evidence. Because the dose is low enough. That's right. But the carcinogen is still there.

Yes, sir. Right. But in 1955, you concluded that asbestos caused cancer, and that was as a result of a study of human beings who died of cancer from working with asbestos. But still in compliance with the same dose response that was responsible for the conclusions in the automobile exhaust analogy. In 1955, you concluded that asbestos caused cancer in human beings. Yes, sir. and don't you believe doctor and haven't you believed throughout your career that when it's demonstrated that a substance causes cancer in human beings that people who are exposed to that substance ought to be told under circumstances where it might become biologically active at an adequate dose yes now there's no question whatsoever in your mind today that asbestos causes cancer not only to people who work with the product but the wives and children of the workers they're still human beings and still respond in compliance with those response yes sir to this day doctor john's manuel doesn't have the word cancer only if that's that's just warning like that no john's man those labels are in full compliance with the requirements of the occupational safety and health act and haven't you written doctor that warning labels ought to be placed on substances that cause cancer saying it causes cancer as long as the warning is there and as long as the government has a a position that it feels represents public policy doctor didn't you write in 1977 that special labeling should be used when indicated or required for example the use of descriptive terms such as lung irritant skin irritant or potential In other words, producers must concern themselves with end uses and the uses.

I do. It was in the forward to a book called Asbestos-Related Diseases, which I marked as K-52. Do you remember saying that? It wasn't in the forward. It was in a chapter in the book. I'm sorry.

In a chapter. I was going through it. Correct. Now, Dr. What number was that, sir? K-52.

Okay. Doctor, do you agree, this is October 1979, do you agree that the fact that insulation workers and shipyard workers could get sick from asbestosis has been known for decades? Approximately 1964-63, yeah. No sir? Decades means 20 years, that's it. Approximately, yeah.

Yeah. Decades is not a finite term. Doctor, so listen to me carefully, okay? Do you agree, sir? I know that. I said decades.

Did you understand I said decades? Yes, sir. More than one decade. More than one decade. Haven't you testified? I have.

Haven't you testified, doctor, that knowledge that insulation workers could get asbestosis has been known for decades? Exactly. And the interpretation of the decades was between one and two decades, yes, sir. I was referring specifically to the 63 to 64 data, which was all preamble to that testimony, yes, sir. Now, isn't it true, doctor, that you concluded asbestos caused cancer in 1955? Yes, sir.

Thank you, sir. No further questions. Dr. Kotin, it's now about 1225. I have some redirected foundation, and I'll ask you, sir, if you feel capable of going forward with that. I'd really rather not.

I testified four days instead of the three that was originally scheduled and started early today in an effort to be accommodated. I'd rather not testify. Thank you. anymore at this point then we'll have earned the deficit uh uh i got one more question mr wilson two more now i forgot dr Kotin in 1977 you testified that your salary with john's member was ninety thousand dollars has your salary increased or decreased since that time don't ask the question Number two, do you understand, Dr. Kotin, that you're under oath and that Mr. Wilson has proposed that this deposition be suspended and that as a witness under oath in the middle of testifying that you're not supposed to discuss your testimony with Mr. Wilson?

Well, that's a legal question. So then I'm not going to agree to adjourning the deposition. You have to take what I'm saying. You don't have to agree. I understand that. Deposition is an attorney.

I understand that. Right.

Tape 2: redirect by Johns-Manville's counsel, and recross

Dr. Kotin, in connection with the last question that Mr. Motley asked you about when you were aware that asbestos was a carcinogen or caused cancer, under what circumstances were you aware that it could cause cancer in 1955? By the published work of Professor Dowell and his associates who examined the group of textile workers in the United Kingdom. them. Was there any evidence in 1955 that insulation workers or shipyard workers were at risk to cancer? The only population that was studied was the textile workers and the only conclusions that could be drawn were those applicable to textile workers.

Why could you not extrapolate from the textile workers to the insulation workers? Well, I think there's sort of a universal principle in analyzing medical data that the individual populations have characteristics special to them, both in terms of their exposure, both in terms of their environment, and as Dr. Selikoff has written, as many, many have written, that the extrapolation requires a comparability of what you're trying to what you have to compare to that which you are trying to compare it with and if you don't have that commonality then it's a flawed comparison dr mr motley asked you about a study made by dr Dreessen in 1938 1938, and specifically whether or not Dr. Dreessen, in counting the dust to which the workers in that textile mill were exposed, counted all of the particles or just the asbestos particles. Do you recall those questions? I do.

In what work environment was the Dreessen study made? In a textile environment where the exposure was incidental to the manufacturing of asbestos textiles. And do you draw any conclusions from that as to the amount of asbestos that he was measuring? Yes, that virtually the total dust that he was measuring was equatable with total asbestos. There were obviously some cotton in the dust as well, but it was a work exposure in which not not only I, but the entire world that was addressing the issue of the dust in the workplace studied by Dr. Driessen, as being considered asbestos exposure, asbestos particles in the five million particles per cubic foot.

For in fact, if you look at the publications of Dr. Selikoff, off publications of keepers the publications of Dr. Hardy as far as the American Conference of Government industrial hygienists were concerned they all use the same five million particles per cubic foot and the interpretation was that they were dealing with five million particles found in the workplace of asbestos textile workers how does that compare with the the Fleischer-Drinker study in 1946. Well, I think one can further verify, in fact, make indelible the fact that the five million particles per cubic foot are treated by all involved and were treated by all involved as being an asbestos exposure by the fact that Dr. Fleischer and his associates felt it necessary to separate the asbestos component of the dust they measured. They were not measuring an asbestos operation.

They were measuring an operation in which insulation was the focal point of exposure in a highly complex environment so that to give their data the precision that they wanted it to have, they measured total dust and then, as they have done in a table in their paper, they had a table in which they put down that component of the total dust which was asbestos. Now it's clear that Dr. Driessen had at least the competency in his associates that Dr. Dr. Fleischer and Dr. Drinker had, and they were satisfied that they didn't have to do that for the textile operation in contrast to the Fleischer-Drinker study.

Dr. Do you have an opinion as to whether or not the results of the Fleischer-Drinker study were interpreted by the medical community as to be within the then threshold limit value for asbestos? Let me make that perfectly clear, that five million particle determination after it was made and concluded by Dr. Driessen was not put in some archives and then forgotten. It was under constant review. It was part of a whole array of workplace standards that were reviewed annually. annually, and the persistence of the 5 million particle standard or level through the years and years was not the result of any calculated omission, because in fact the group of the American Conference of Government and Industrial Hygienists annually meet to review threshold limit values, so that it was a studied omission.

They felt that it was unnecessary to change, and in fact, when the 1964 conference was held and new data were presented, they did, in fact, change so that it isn't neglect that was responsible for the persistence of the five-million pardons. It was just scientific judgment that there was no data to challenge it. Object to the responsibility of the question. Dr. Kodman. answer. You were asked by Mr.

Motley on cross-examination that if the asbestos industry knew that exposures above five million particles per cubic foot were dangerous, would you agree that they should have advised any users of products which contained asbestos to avoid levels of exposure above five million particles per cubic foot? Yeah, where that likelihood of exposure did did exist, but in fact. Let me ask you, under what circumstances should that notice have been given? Well, the likelihood of that exposure should exist. For example, I would judge 70, I don't know. There are certain people in this room, certainly my watch, has with it some radioactive material so that in the middle of the night I can look at my watch.

Now, there's no question that radioactive material is potentially a hazardous agent. Yet, there is no notice on my watch that my carrying it carries any calculated risk. In fact, it doesn't, even though it has perhaps the most hazardous agent known in the environment, radiation. And the reason it doesn't have it is because it is untenable to believe that any hazard is going to come. Well, I think that's the philosophy behind all warning. So that on a package of Anacin, forgive me, American home products, which contains phenacetin, there is no notice that phenacetin, technically saying not important, phenacetin, is associated with, in the literature, with an increased risk to development of kidney cancer. what it says on a package of medicine containing this drug is warning use only as directed so that the quality the content the need for any kind of a label warning or whatever you want to call it is directly related to the specific situation and that's how in fact the federal government operates or in fact an automobile a potentially lethal agent potentially it's lethal to tens of thousands of people on the highway there's no sticker on your windshield next to the one that says use unleaded gas only that says you're dealing with a a potentially lethal agent.

Object to the response to this question, I have the answer. Did Dr. Selikoff in 1964 establish that insulation workers were exposed to more than 5 million particles? Not at all. The 5 million particles was not an issue. I think all of the studies indicated that the insulation workers at the studies in the field of industrial hygiene were not exposed to an excess of 5 million particles.

The real issue was, and is to this day, the level of science in 1938, which concluded that five million particles was a safe level of exposure. Dr. Selikoff showed that the level of science was inadequate in terms of what he had learned almost two decades later. So that, again I would reiterate, the issue is not that there were exposures above the 5 million particle level. It was just that the level of knowledge in 1938 was superseded by a level of knowledge in 1964, which said that 5 million particle level was wrong. And this is again acknowledged as intrinsic to the establishment of all threshold limit values.

This is why the ACGIH meets every year. This is why OSHA continually, as it states in in its documents published in the Federal Register, in every standard that it sets, it emphasizes the fact that the standard is subject to revision. The Secretary of Labor testifies that. Revision upward, because it might have been too conservative, or revision downward, if it might have been too liberal, on the basis of knowledge that is accumulated with the march of science, advancing knowledge. Excuse me, I object to your responsiveness. Can we take one second?

Will you cut the tape for us, please? Dr. Kotin, on your direct examination, I asked you about smoking and its effect on the lungs' susceptibility to asbestosis. Does smoking have any relationship to asbestosis? Yes, it has a relationship that is manifest in the disease itself from its earliest time. You asked if it has any relation to susceptibility.

I answered then and would answer now that I'm unaware of any convincing evidence that smoking is related to susceptibility to asbestosis but from the moment that you get your earliest changes then clearly the worst thing you can do is continue to smoke because while as I say the data in relation to susceptibility almost have the opposite implication once the disease is there and that is everybody's data shows that if you are a smoker even with the mildest form of asbestosis certainly with severe forms of asbestosis you are sicker you are more prone to to the symptoms associated with interfered lung function you are more prone to infection and basically uh your death rates are higher check the responses dr Kotin uh mr motley in his cross-examination I want to ask you about some figures that Dr. Selikoff had reported in his recent book about causes of death in insulation workers, and he made the statement that Dr. Selikoff's figure showed that 12% of insulators die of asbestosis, that 23% of them die of lung cancer, and that 11% of them die of mesothelioma. Are those correct statements? No, the correct statement is that of insulator workers who die, the causes of death are, in fact, the percentages that Dr. Selikoff cited in his study.

They are special to Dr. Selikoff's study. They are specific to the time he reported the study for, in fact, causes of death, not not only of insulators but of everybody, varies with the passage of time on the basis of the changes in the environment, if you will, on the basis of natural catastrophes. In other words, the causes of death in 1975, a non-hurricane year, the percentage of death due to the hurricane would be a lot different in a hurricane area than they would be in 1976 if there were no hurricane. What Dr. Selikoff meant was that at his time, Counting the deaths in his population, that percentage died from asbestosis, lung cancer, and measles.

In fact, as Dr. Selikoff's data shows, and as the data from the National Institute of Occupational Safety and Health show, that asbestos-related diseases fall into three categories. Asbestosis is a declining disease. And, in fact, Dr. Robbins testified so before Congressman Miller's committee in June or July of this year. And asbestosis is a disease on the wane.

So clearly the causes of death, the next time Dr. Selikoff follows this population in relation to asbestos, asbestosis will show a different percentage. Now, the 17,000 plus people that are in Dr. Selikoff's study, the 14%, the percentages don't apply to them. That would be absolutely, well, I'm trying to find the right word. It's so completely outlandish. the 9% applied to the percentage of those that died in fact the reason the US government puts out every year death rates for different diseases is that they change every year and if you go back over the years you'll find that they change positions for many many years it was pneumonia typhoid and infectious diseases more recently heart disease moved into first place and then and cancer was third, it became second, and then stroke changed place, perhaps, with another form of disease.

The point I'm trying to make is that the causes of death vary, and this is as factual as any of the law of gravity, if you will. All right. So that to assume that Dr. Selikoff's data has any relevance, and he'd be the first to admit that, beyond his population at that time, and it related only to the number of people dying during the period he studied not the total population at risk the 17,000 it does not mean that 12 Speech and the responsiveness in the end. It does not mean that 12% of all insulation workers are going to die of asbestosis does it Directly form it very very positively does not mean that Dr. Mr.

Motley, in his cross-examination, inquired of you as to whether or not epidemiology was a known science in the 30s, and if techniques to evaluate the incidence of disease were available in the 30s, and animal experimentation was going on in the 20s and 30s, and you indicated that they were let me ask you if those if that knowledge was available to you at that time why did it take until 1964 to find out whether insulators were at risk to asbestos disease basically the discipline of epidemiology the the the discipline of animal experimentation was of course known in those days but it was was known at a level consistent with the state of knowledge at the time. In fact, the epidemiology in those days was purely and exclusively acute disease epidemiology. What do you mean, acute? Diseases that we traditionally know, that we classify acute, diphtheria, pneumonia, whooping cough, diseases that come in a short time. Now, the science of epidemiology, just as the science of mechanics, is a constant. The principles are the same.

The principles that allowed Mr. Ford to build a Model T early in the century, the mechanics, the engineering, the technology, the physical laws, were no different than the technology that allowed us to put a man on the moon in the 1970s. Yet there's no way Mr. Ford, in inventing his automobile, had the body of knowledge to put a man on the moon. And the same thing applies to this. In fact, acute disease epidemiology is so different than chronic disease epidemiology for a lot of reasons.

First of all, as I say, acute disease epidemiology is usually associated with infectious disease, one cause. Only the diphtheria germ can cause diphtheria. Only the tuberculosis bacillus can cause tuberculosis. I'm sorry, doctor, just a minute. I'm sorry. Okay, fine.

But basically acute disease deals for the most part with a single cause in a single disease In a very short period of time between exposure to the agent and the appearance of the disease Chronic disease involves many many things Not only in relation to lung disease, but in relation to others you hear how nutrition is a factor in chronic disease You hear about how in case of lung disease smoking might be a factor childhood childhood, diseases of the lung, and so on and so forth. In fact, I know for a fact that there was no chronic disease epidemiology in the government because the Epidemiologic Intelligence Service, the EIS in Atlanta, which has a long and distinguished history, was until the middle 60s exclusively an acute disease epidemiology program because because with your money and mine as taxpayers, I was part of the group that set up the program which gave birth to the chronic disease epidemiology aspect. So while the, in answer to your question, the disciplines were there, the categorical approaches were there, but the level of knowledge was such that it was useful for what, at that time, And above all, there was no need identified at that time for a chronic disease epidemiology for a special type of animal domiciliary care for the type of experiments that we can now do. Dr. Kotin, Mr. Motley, in his cross-examination, read to you from some correspondence correspondence from the Philip Carey Manufacturing Company that related to the publication of a safe practice manual in 1963.

And you indicated that you were not aware of any safe practice manuals at that time. Were other methods of disseminating knowledge used? Excuse me, I object to the form of the question if you're suggesting that Philip Carey distributed anything because they've admitted in their answers in their argumentaries no warning labels were put on until 1972. My question was not addressed to that because your questions were not addressed to that. You undertook to extrapolate, if I can use that word, from Philip Carey's correspondence to the industry, and my question relates now to what Johns-Manville was doing at the time. I object to the form of the question.

Go ahead, Doctor. Dr. Excuse me, sir. Excuse me, sir. I object to a misstatement in the objection that one way is what I'm carrying, that is, don't carry asbestos in its products after 1969. Mr.

Go ahead, Doctor. Do you recall the question? Dr. Would you repeat it, please? Mr. Yes.

My question was were there other methods than manuals for disseminating information about asbestos? Dr. Yes. Intrinsic to every operation was a work practice procedure. And included in this work practice procedure were all of the elements of the program. And part of it, of course, was worker protection and safety.

So that a specific manual, I did not see. But basically, the programs for control in the broadest sense were ongoing and not only were they ongoing within the corporation but the dissemination of this information also took place so that the efforts on the part of the company on the part of the education of the users of the products was ongoing in the 30s and 40s clearly as well as because it was intrinsic to the very nature of the manufacturing process and then there was a special program in which the circumstances for occupational health and safety were included. Mr. Motley, let's strike that, please. You mentioned education as far as the consumer of the product was concerned. What educational efforts were made by Johns-Manville with respect to the consumers of its insulation products?

The education for the insulation industry was non-existent because the evidence at the time was that insulation was, as was concluded by Dr. Fleischer and Rinker, a non-hazardous industry. So that education was at that time committed to those areas where a hazard was recognized as existing. Do you recall when some information was disseminated to the insulation trade? In 1964, subsequent to the identification of a hazard and the erroneousness of the 5 million particle per cubic foot standard in terms of its adequacy. Now, Dr.

Mr. Motley asked you about dust counts specifically at the Waukegan plant of Johns-Manville in 1951. You indicated you were not aware of any dust counts taken at that plant in 1951. Were you aware of dust counts generally being made in the Johns-Manville plants? Yes. I can't remember whether any were taken in 1951 in Waukegan, and if you were to ask me again, I would again have to answer I was unaware of any.

But were there dust counts taken? Of course there were. In fact, the whole business of industrial hygiene measurements, the science of industrial hygiene, was really born and developed in industry. industry. To this day, the federal government and regulatory agencies use techniques, obviously with the 1979 precision and so on, that had their fundamental principles evolved by industry. There was no place industry could turn to where they could really get the substantive need for industrial hygiene measurements that they required. They couldn't get them from from government, they couldn't get them from academia, so they did them themselves.

And to this day, the leading edge of industrial hygiene measurements are either jointly generated by industry and government, industry, labor and government, by industry itself. Certainly the government generates independently techniques as well, but all you have to do is go to the scientific literature and see the in the world of industrial hygiene publications in which co-authors by articles on the science of industrial hygiene are co-authored by people from academia and industry by people from government and academia and so on so that industrial hygiene Hygiene is a well-established, pre-1951 endeavor of industry. Dr. Kotin, Mr. Motley asked you at some length about a report prepared by Mr. Hemeon of the Industrial Health Foundation in 1947 in 1947, and stated that that report had been presented to the Asbestos Textile Institute and the recommendations of it turned down.

Does that, in your opinion, have a significant impact on the development of knowledge as far as asbestos risk is concerned? Well, I wasn't at that Asbestos Textile Institute meeting, so I can't say what went on, but but what I can do is give you the realities at the time. Whatever Mr. Hemeon recommended, if he were under the illusion that he was coming into a wasteland where industrial hygiene measurements were never taken, he was wrong. And in fact, Johns-Manville, as the record clearly shows, was doing industrial hygiene measurements. I think that if Mr.

Hemeon had recommended that industrial hygiene measurements were not to be done, his recommendations would have been as ignored as they were apparently, recommending that something be done. In other words, the world of industrial hygiene was not waiting for Mr. Hemeon to come along and say you should start measuring concentrations in the workplace. This was being done beforehand, it was an ongoing thing, it was developing, so that again what the facts and And the record is relative to Mr. Hemeon's relationship with the American Textile Institute is one thing that the record states. And I need not comment on it.

But I can comment very clearly, and I think responsibly, on what the state of industrial hygiene was at the time. SPEAKER 1. Object to responsibility. SPEAKER 2. SPEAKER 1. Dr.

Kotin, how does that relate to your earlier testimony that the field of occupational medicine was virtually deserted during this period of time or nonexistent? Dr. Well, all I can say is that if I were convinced that the field of occupational medicine was a virtually non-existing thing at the time of my prior testimony, what was then etched perhaps in wood is now or engraved in wood is etched in concrete clearly whether it's with the former or present assistant secretary of labor ferocious whether it's with the former or assistant assistant secretary of hew for science and health whether it's with the former or the present director of the national institute of occupational safety and health the query what What was the state of occupational health in the 1940s, in the 40s, immediately post-World War II? The responses uniformly and consistently were variations on non-existent, disgraceful, negligent, abominable. And again, I mention these people very specifically so that these opinions can be verified. But in a way that I would have no control over in this month of November 1979, the American Board of Preventive Medicine, the people that teach occupational health, came out with its report and analysis of the situation historically in terms of the teaching of occupational health and medicine.

Dr. Kotin, is the report that you just referred to reported in the Occupational Health and Safety Letter of November 8, 1979? It is. Let me hand you a copy of that letter and a report. Sure. After four days, her fingers are getting a little stiff.

I'm just talking about the first paragraph there. You can read it off. Dr. I've handed you a newsletter that reports on that report of the teachers of preventive medicine and I'll ask you and would you comment on that please and yes what it shows the report itself has the headline survey sites inadequacies of occupational health training in medical Now, Dr. Kotin, before we took a short break, I asked you if the report of the teachers of preventing medicine had been published or an account of it in the Occupational Safety and Health Newsletter. Yes, sir.

Would you tell the court and jury what that report contained? Yeah, well, it says the survey cites inadequacies of occupational health training in medical schools. A survey sponsored by the Association of Teachers of Preventive Medicine has confirmed what everyone has known all along, namely that occupational medicine is grossly neglected in the curriculum of the nation's medical schools, contributing to the shortage of occupational physicians generally. The questionnaire survey was conducted among 112 U.S. medical schools to determine the content and format of occupational health instruction during the 1977-1978 academic year. Only 46 or 50 percent of the 92 responding institutions specifically taught occupational health, and only 28, 30 percent required in their curriculum, usually in the preclinical years. Among those 28, the median required curriculum time was 4 hours, and that was for the 4 years in the medical school.

Doctor, does that status of occupational medicine also find support in other literature? And I would refer you particularly to a book called Crisis in the Workplace by Dr. Ashford at Massachusetts Institute of Technology. Mr. May I say a question? Mr.

Sure. Would you show it to Mr. Motley? Mr. Thank you. I'm sorry.

Yeah, you're as tied up as I am. I was going to do it, but I have the wire attached to me. Mr. Come make his day. Mr. I can't move.

Thank you. Yes, sir. This... Mr. Excuse me. Are we on the tape?

Mr. Yes, sir. Mr. All right. This is a book entitled Crisis in the Workplace by Nicholas Ashford from MIT, funded by the Ford Foundation. And one of the chapters is devoted to manpower problems.

The part that I think verifies what we've just heard from the most authoritative source, the teachers of the material. This book was published in 1976. In 1976, it is estimated that only 12 medical schools include health, occupational health, in their curriculum. According to Dr. Henry Howe of the Department of Occupational Health of the American Medical Association, there are seven educational institutions with AMA-approved two-year residency programs in occupational medicine. This again refers to the 70s.

An additional 25 residency programs are conducted by industrial firms. And industrial firms, I would comment, are not in the business of conducting residency programs. It's just that there aren't any available anywhere else. Between 25 and 50 physicians complete training in occupational medicine each year, barely sufficient to staff a dozen corporation medical programs. Dr. Kotin, Mr.

Motley asked you a number of questions on your cross-examination about the status of occupational. Excuse me, we took a break a second ago, and you'd asked a question previous to that, not objected to the form. I didn't object to the form when you came back, but objected to the form in response to that question and answer. Dr. Kotin, Mr. Motley asked you on your cross-examination a number of questions about the status of occupational medicine in the medical schools at that time.

Do you recall that? Yes, sir. He also asked you a number of questions on cross-examination about your involvement with asbestos and asbestos research. Will you tell the court and jury, please, what the Institute for Occupational and Environmental Health of the QAMA is? Yes, it is an institute located in Montreal, which is an independent institute staffed by a medical director with an advisory board, an international advisory board, which devotes all of its scientific efforts to the world of asbestos in the area of health and safety and environmental considerations. Have you been a member of that board?

Yes, I was invited to be a member of that board. I think it was 1965, along with the board had already been in existence. But it is interesting that the board, scientific advisory board, was chaired by Dr. George Wright. Its membership included Dr. Fernand Gregoire of the province of Quebec, who was the chief physician for the Workers' Compensation Board of the province of Quebec, Professor Ian Higgins of the University of Michigan, who is sort of recognized as the dean of chronic disease epidemiologists in chest diseases, diseases, having been responsible for a major part of the epidemiologic program in science that was used in relation to the development of the Black Lung Act.

His studies in Nashua, New Hampshire and Berlin on air pollution, chronic disease epidemiology is the standard in the field. Professor Marvin Kushner, who was professor of pathology and dean of the School of Medicine at Stony Brook campus of the State University of New York was on the board. As I say, I was invited to be on the board, and the board periodically meets, grants funds to academic institutions, and in general reviews in an ongoing way the world of asbestos in the world, in the areas of occupational and environmental factors doctor how long did you remain on that board well I remain on that board until I went to work for Johns-Manville because the board has a set of I guess bylaws you call them which preclude a person in any way related to a person employed by a corporation from being on the board Dr., in the course of your professional career, have you attended and participated in conferences on asbestos? Yeah, it's interesting. I kept asking myself, how could I have forgotten this when Mr. Motley was asking me questions?

But it just goes to show you forget things that are very much, at a given moment, perhaps important and even helpful to yourself. In 1967 I was at the Antigua conference on asbestos sponsored by the IOEH. This was an international conference with representatives from I don't know how many countries but certainly there wasn't any major worker in the field who did not attend. Certainly the Mount Sinai group was there, the pneumoconiosis research unit from England was there, and it again addressed the problem of asbestos-related health problems. In 1979, there have been references in the past to the conferences held in the Union of South Africa in relation to asbestos. They've been held- Mr. 1979 or- Mr. 1969, I beg your pardon.

In 1969, about every 10 years, the Department of Labor, the Department of Mines, and the Department of Environment, I guess that's what they're called, and the Union of South Africa has had a world, an international conference on asbestos. And in 1969 was the follow-up of the 1959 one, and I was invited to attend that. I would emphasize that both in 69 and 67 there's no way I could have dreamed let alone thought of that I would ultimately be coming to work for Johns-Manville I was working for the government at the time quite clearly I went at government expense and I went as as an expert in the field by virtue of my designation and responsibilities in the government. Dr. Kotin, within the past few years, have you been nominated for the position of Dean of the College of Medicine at the Medical University of South Carolina? Indeed I have.

I was honored to be nominated for the deanship and it was in 1975. It was just a year after I had come to Johns-Manville, I didn't feel that I could with any degree of a responsibility run out on a commitment that I had made that was tacit that I would stick around to at least get a program launched. But that was just one of many, I might say, that have periodically come during the course of the years. Thank you, Dr. Kotin. That's all.

Can I have about 30 minutes and we can probably shorten this? How about in the journey until 11.15? What time is it right now? About 7 minutes to 11. 11.30. How about 11.30? 11.30. I'll give you the extra time.

The more time I get, the less time it'll take. I'm for that. You ready? Technicians are ready? It's all ready. Ready?

Now, Dr. Kotin, did I understand you correctly to say, sir, that excuse me let me state for the record I think I already did it but these are all subject to my objections previously stated I believe we agreed to that. Doctor did I understand you to tell the jury that there were asbestos conferences of an international scope in South Africa in the 1930 decade? I can't be sure of that but certainly in the 1960 and in the 1950 there was. Yes sir in In fact, there was a conference in Johannesburg in 1934, wasn't there? Could very well be.

And there was another one in 1939, wasn't there, sir? Yes, sir. And there was one in 1949, wasn't there? There were a series of conferences, yes. And there was one in 1959, wasn't there? The doctor just said there was one in 1959. 1959, yes. 1959.

And, in fact, doctor, at the 1959 conference, insulation workers and asbestos disease were discussed, weren't they? I'd like to see the program. All right, sir. I'll be glad to let you see it. Would you mark this, please? Now, Doctor, before I ask you any specific questions about the 1959 conference that was held in South Africa in 1959 and included a discussion of asbestos diseases, let me ask you if you recognize any of these names.

Did you know a Dr. Gough, G-O-U-G-H, from Great Britain? I knew Dr. Gough. He is now dead. Yes, sir.

But at the time, he was a leader in the field of dust diseases. What? He was a recognized worker in the field, yes, sir. And you knew Dr. Michael John, M-I-E-K-L-E- J-O-H-N, did you not, sir? Dr.

Michael John, yes. Michael John, I'm sorry, sir. And, of course, you knew Dr. Hurwitz. Did you know Dr. Hurwitz?

No, I did not know Dr. Hurwitz. Were you at the New York Academy of Sciences meeting in 1964? I think we discussed that. That's right. You weren't there, though.

That's right. You knew who Dr. Sleggs was, didn't you, sir? Yes, he was a co-publisher with Dr. Wagner on his scientific publication, some of them. Yes, sir.

Right. In fact, he was a co-author on the mesothelioma publication, was he not? He was, yes, sir. And I believe we discussed before that in his mesothelioma study, there were several insulation workers, weren't there? As I recall, we did discuss that, yes, sir. And that was in 1959, wasn't it?

Yes, sir, just about the time that there were suspicions that maybe insulation workers were not protected by the 5 million particle per cubic foot standard, yes, sir. 1959. Well, that's when the studies were, suspicions were beginning to arise. And Dr. Vorwald, he was the director of the Saranac Laboratory for a period of time, wasn't he? Yes, sir. And he conducted experiments with asbestos in the 1940s and early 1950s.

As I recall... I'm going to object to these questions. These are all things that you went into with these very individuals on cross-examination. They were not the subject of redirecting. I think it's improper cross. And Dr.

Wagner, or as we would say in South Carolina, Wagner... We say that in Denver as well. Right. He was an author of the mesothelioma study in 1960, which convinced you that mesothelioma was a disease associated with asbestos. Excessive asbestos exposure, yes, sir. Now, doctor, I'm going to hand you a copy which we'll identify at a later time, which is a portion of the proceedings of the pneumoconiosis conference held at the University of Witten-Waterstrand, Johannesburg, February 1959.

We're going to have to... Thank you. Let me ask you first of all, sir, have you ever had an opportunity prior to today to review the proceedings of the 1959 conference in South Africa? I have an objection to the question. The report is not complete. It's very, very incomplete as a matter of fact.

Yes, sir. In fact, the volume... Have you ever seen the proceedings before, doctor? Well, I've seen... I don't remember if this was the year, but sure, I'm pretty sure I've seen Proceedings of Pneumoconiosis Conference. Pretty thick book, thicker than that one that's sitting on your desk right now, isn't it?

Well, it's a big book, yes. Yes, all right. Would you take a look at that, sir? Yes, sir. All right, and if you want to take a second to review it, I'd call your attention, sir, to certain portions of it. You're welcome to read the first several pages if you'd like.

Would you like to cut the tape while he looks at it? Mr. Hood, do you have any objection to us cutting the tape Dr. Now, Doctor, isn't it a fact that Dr. Goff, at a discussion among the doctors, including Dr. Vorwald, Dr.

Bodnar, and Dr. Sleggs, reported on cases of asbestosis in people who did insulation work at that conference in 1959? Dr. Yes, but there's nothing in here to suggest what their prior work history was, so that indeed, as Dr. Goff said, asbestosis is sometimes found in building demolishers who have been stripping asbestos insulation. Yes, and do you know that insulation workers in 1959 from time to time had to rip old insulation off the buildings?

I guess they did, he said so. All right. Now, Doctor, did you finish your answer? No, I think. What were you going to say? I was just going to say that a generally recognized principle is that in ascribing any kind of an occupational disease through an occupational situation, you need an occupational history.

I don't know what these people did beforehand. Now, at least at the time that Dr. Goff was interested in them, they were doing insulation work. Isn't that right, Doctor? That is what Dr. Goff said, yes.

Now, when you attended the 1967 and 1969 asbestos conferences, did you present a paper on asbestos disease? No, sir. I discussed many, many papers. Well, you weren't invited there to present a paper on asbestos disease, were you, Doctor? As I recall, most of the papers that were were given were people who were invited and were given the opportunity to present or not. I, as the proceedings of the conference would show, if there are proceedings of the discussion, would show that I, much as you're quoting discussion now, I note that you're quoting not the scientific paper, but you're quoting Dr.

Goff as part of a discussion, no less than Dr. Goff discussed in 1959 that I discussed in 1969. And you're telling the jury that if I present you with a copy of the transcript of the proceedings in 1967. Dr. Paul Kotin's name's going to be on there. Well I don't know that there are a transcript of the full proceedings but if there are Dr.

Paul Kotin's name is going to be his name's going to be on there if there's a transcript of it. All right now doctor you're not suggesting to this jury are you sir that there weren't any epidemiologic studies as you have defined it in the dust the trade industries in the 1920s are you know what I'm suggesting is that the epidemiologic studies of a population in those days were undertaken under these state-of-the-art at that time yes and in a case like silicosis where there were many epidemiologic studies were that were done they were done very very in circumspect populations you were dealing with the disease which at that time was exceedingly well characterized that so that as I say the state of the art and the thing you're studying would determine the effectiveness of an epidemiologic study well there were studies made in the 1920s and you didn't mean to suggest to this jury by talking about Atlanta in 1965 that there weren't any studies now what I was telling no let me tell you what I was telling thank you it wasn't what I was trying to tell him sir it's what I was telling him that as far as chronic disease epidemiology was concerned it was a facet of epidemiology that was as part of the government program in epidemiology finally recognized as a stepchild as it were and the epidemiologic service added a chronic disease epidemiology dimension to it i would submit that that is probably a very very accurate assessment of what the state of the art was doctor the united states public health service conducted dozens of epidemiologic studies of industries in the 1910s 1920s and 1930s of desk diseases did they not they examined lots of populations yes sir dr. Dreessen study in 1938 was an epidemiologic study the asbestos industry and it's one that was rather unique and special at the time and Dr. Lanza that did an epidemiologic study in 1935 for the asbestos oh sure there were they were done all I was trying to say is that they were unique they were special it was not the situation that we have at present right and they were related to a specific instance and dr fulton did an epidemiologic study in 1938 in pennsylvania of asbestos facilities didn't he looked at the populations yes sir and dr Hemeon in 1947 in his study did an epidemiologic study did well there were different qualities populations were examined yes asbestos workers were yes but let me tell you and perhaps the one of the best things that could could be done would be to have, as a witness, a professional epidemiologist. And let him evaluate the status of chronic disease epidemiology. And you and I, neither one of us are epidemiologists, although you know a lot more than I do.

I would submit that we're in different ballparks in terms of our appreciation of epidemiology, as we are in our appreciation of the law. Yes, sir. We're indeed the. Now, doctor, with respect to the threshold limit value for asbestos you're not suggesting to this jury that there wasn't any criticism of the threshold limit value for asbestos prior to dr selikoff coming along in 1964 are you quite the contrary i was telling you that that basically all threshold limit values carry with them the clear understanding that they should be looked at constantly and evaluated because of the fact that new knowledge is coming along all the time so that i wouldn't know how you define criticism would i say that people are looking at them we're looking at threshold limited values today for things unrelated to asbestos purely on the basis of the ongoing evaluation all right sir now did you know who vandiver brown was sir yes i was told who he was i didn't know him well tell Tell the jury who you were told Vandiver Brown was. He was, I believe, a vice president of Johns-Manville Corporation. Johns-Manville Corporation.

Now, have you ever seen anything that Mr. Brown might have written about the threshold limit value for asbestos back in the 1940s? I believe he was an attorney. Yes, and he was also secretary of the corporation, right? Yeah. Well, I haven't.

Certainly not in anything that's an authoritative text. Next, I suspect his knowledge of threshold limit values in the scientific area would be equivalent to my having any kind of an opinion, which I do not, sir, as to the validity of your objecting or this council objecting. It's not his field. So really what he says about a threshold limit value in advance, I think I would have some very serious question as to whether he's entitled to an opinion. Like you, you admitted you're not an expert in these areas. I suspect he was probably even less of an expert.

Less of an extra. Now, are you familiar with the Saranac Symposium, sir? You know I am. Some of you, some not. Do you know whether or not one was held in 1947? If I can be shown a program for 1947, I will agree that there was one.

Yes, sir. Do you know whether or not Johns Mammel sent Mr. Vandiver Brown to that particular symposium to present a paper? I would like to see the proceedings, and I can't. We'll mark it later. Oh, I wish we'd done it before.