2004 asbestos disease guidelines ignore mass screening abuse

Our plain-English summary of 2004 asbestos disease guidelines ignore mass screening abuse, by L. Martin (American Journal of Respiratory and Critical Care Medicine, 2005).

The study

• Author: L. Martin
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2005;171(6):665; author reply 666-7
• Type of article: Comment, Letter
• Read it: PubMed · Publisher

In plain English

This item is a letter to the editor, not a research study, and it reports no new data. The author criticized the American Thoracic Society's 2004 statement on diagnosing nonmalignant asbestos-related diseases, arguing that it left out key references and seemed slanted toward supporting mass asbestos claims. The author argued that a chest X-ray reading of 1/0 is nonspecific, citing other studies that found it in middle-aged smokers and in former factory workers never exposed to asbestos. The author also said the statement gave no reference for its sensitivity and specificity figures, did not explain why the profusion score for diagnosing asbestosis was lowered from 1/1 (in 1986) to 1/0, and had no conflict-of-interest statement. The author disclosed examining mass asbestos claims for the Ohio Bureau of Workers' Compensation and defending companies. In the printed reply, the committee said the 1/0 interpretation is inherent in the ILO classification system, cited its reference 150 for the chest-film figures, and said the guidelines were not meant for uses outside clinical diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor (correspondence) commenting on the 2004 American Thoracic Society statement on nonmalignant asbestos-related disease, printed with a reply from the ATS committee; not a research study
• Who was studied: No people were studied. The author referred to personal experience examining hundreds of mass asbestos claims on behalf of defendants.
• Exposure: No exposure was studied. The letter concerns chest X-ray (B-reading) criteria for diagnosing asbestosis and other nonmalignant asbestos disease in mass asbestos claims.
• Main results:
  • The author argued (an opinion, not a study finding) that the ATS statement omitted key references and seemed slanted toward supporting mass asbestos claims.
  • The author argued that a B-reading of 1/0 is nonspecific and nondiagnostic, citing other studies that found it in middle-aged smokers and in ex-factory workers never exposed to asbestos.
  • The author stated that the ATS statement gave no reference for its sensitivity and specificity estimates for the plain chest film.
  • The author stated, citing other publications, that plaintiff attorney-hired B-readers are paid more for a positive diagnosis than a negative one.
  • The author stated that the ATS statement gave no explanation for lowering the profusion score for diagnosing asbestosis from 1/1 (in 1986) to 1/0.
  • The author objected that the ATS statement had no conflict-of-interest statement for its authors, although one appeared with every other article in the same issue.
  • The author disclosed having examined mass asbestos claims on behalf of the Ohio Bureau of Workers' Compensation and defending companies.
  • In its reply, the committee said the interpretation of 1/0 readings as presumptively diagnostic is inherent in the ILO classification system.
  • In its reply, the committee said the reference for the chest-film sensitivity and specificity figures is number 150 in the statement, and that the source gives 90 to 95%.
  • In its reply, the committee said it did not write the guidelines for other applications and does not encourage their use outside clinical diagnosis.
• The authors' conclusion: The author concluded that the ATS had missed the chance to publish an above-suspicion review of how nonmalignant asbestos disease is diagnosed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

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• Reactions of asbestos-exposed workers to notification and screening — B.E. Meyerowitz, C.D. Sullivan, et al. (1989)

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