This is somewhat personal. In the early 1980s, as a general internal medicine fellow, I gave a series of talks about important medical problems that generalist physicians often missed. One was asbestos related disease. Although asbestos had been heavily regulated since 1973, there were stilll large numbers of people exposed to it alive in the 1980s. One of my primitive slides, seemingly a picture of type writing, stated that around then, 2 to 4 million people who had histories of significant asbestos exposure were likely alive. Asbestos is known to cause several cancers. It is likely the nearly exclusive cause of mesothelioma. It also causes lung cancer, and may act synergistically with smoking, and likely gastrointestinal and head and neck cancer. It causes asbestosis, which can lead to respiratory failure.
In 2018, the evidence that asbestos is a major health hazard is quite clear. (See summaries by The National Cancer Institute, the Agency for Toxic Substances and Disease Registry, the Occupational Safety and Health Adminstration.) Note that the rates of death from mesothelioma per capita are declining, but still substantial (look here). The application of asbestos can be very hazardous, but once applied it can still endanger not only those who remove it, but firefighters, other first responders, etc. People can be exposed indirectly, e.g., from asbestos on the clothes of people who work directly with it.
Unlike other countries, the US never banned asbestos outright. However, per the NCI report,
In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. In addition, manufacturers of electric hairdryers voluntarily stopped using asbestos in their products in 1979. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; however, uses developed before 1989 are still allowed.
Trump Called the Movement Against Asbestos a Plot by Organized Crime
As we discussed in 2016, Donald Trump has pooh poohed all that. Per Mother Jones,
In his 1997 book, The Art of the Comeback, Trump warned America not to buy the crusade against 'the greatest fire-proofing material ever used.' He claimed the movement to remove asbestos—a known carcinogen—was actually the handiwork of the mafia:
'I believe that the movement against asbestos was led by the mob, because it was often mob-related companies that would do the asbestos removal. Great pressure was put on politicians, and as usual, the politicians relented. Millions of truckloads of this incredible fire-proofing material were taken to special 'dump sites' and asbestos was replaced by materials that were supposedly safe but couldn’t hold a candle to asbestos in limiting the ravages of fire.'
Trump claimed asbestos is '100 percent safe, once applied,' and that it just 'got a bad rap.'
This year, Rolling Stone revealed,
Trump has also on multiple occasions blamed the collapse of the two World Trade Center towers on the absence of asbestos. In June, All in With Chris Hayes aired a clip of Trump defending the material before Congress in 2005. 'A lot of people say that if the World Trade Center had asbestos is wouldn’t have burned down, it’s wouldn’t have melted. OK?,' he said. 'A lot of people in my industry think asbestos is the greatest fireproofing material ever made.' Trump went on to compare asbestos to a 'heavyweight champion' compared to other building material, which he likened to a 'light-weight from high school.'
The article also stated that
As Hayes notes, Trump’s penchant for asbestos is almost certainly due to the cost of having it removed, which was undoubtedly a nuisance to a man known for stiffing contractors and cutting every regulatory corner imaginable.
Trump's beliefs, not to put too fine a point on it, to be nonsense, albeit somewhat consistent nonsense. In 2016, I wrote,
It is disturbing when one candidate for the most powerful political office in the US repeatedly disregards the best clinical and public health evidence, and offers ill considered opinions about public health that could potentially harm patients.
Now Trump is President, and in a position to act on nonsense.
Trump's EPA Appears Ready to Relax Asbestos Regulation
This week, the distinguished occupational health journal Rolling Stone reported,
On June 1st, the EPA enacted the Significant New Use Rule, which allows the government to evaluate asbestos use on a case-by-case basis. Around the same time, the EPA released a new framework for how it evaluates chemical risk. Not included in the evaluation process are the potential effects of exposure to chemicals in the air, ground or water. It’s as absurd as it sounds. It is ridiculous,' Wendy Cleland-Hamnett, who recently retired after four decades at the EPA, told the New York Times. 'You can’t determine if there is an unreasonable risk without doing a comprehensive risk evaluation.'
The new evaluation framework is a nifty way for the EPA to circumvent an Obama-era law requiring the EPA to evaluate hundreds of potentially dangerous chemicals. Asbestos is among the first batch of 10 chemicals the EPA will examine, and also one of the most blatantly dangerous to public health.
Quartz explained further,
On July 1, the US Environmental Protection Agency issued a 'significant new use rule,' which invites manufacturers to petition the EPA to seek approval of any new asbestos product on a case-by-case basis.Today, the New York Times reported that the EPA's new approach was launched by Trump political appointees over the objections of career, professional staff.
The rule says that the EPA will evaluate new asbestos products as 'new use' if they’ve determined they aren’t currently being manufactured. The categories the EPA says it will consider as new uses include 'adhesives, sealants, and roof and non-roof coatings; arc chutes; beater-add gaskets; extruded sealant tape and other tape; filler for acetylene cylinders; high-grade electrical paper; millboard; missile liner; pipeline wrap; reinforced plastics; roofing felt; separators in fuel cells and batteries; vinyl-asbestos floor tile; and any other building material (other than cement).'
Top officials at the Environmental Protection Agency pushed through a measure to review applications for using asbestos in consumer products, and did so over the objections of E.P.A.’s in-house scientists and attorneys, internal agency emails show.So it looks like these top officials are trying to operationalize Trump's enthusiasm for asbestos despite the absence of any new evidence that asbestos is less dangerous than previously thought, and despite the suggestion that Trump's enthusiasm may be self-interested.
On No, Russians Too
Two years ago, it seemed that one could attribute all of Trump's bias against asbestos regulation had to do with his real estate development background. However, Rolling Stone found another possible influence on him.
As with many of his more insidious actions as president, there’s a Russia connection. As the Washington Post points out, until recently, 95 percent of asbestos used in the United States came from Brazil, while the rest came from Russia. But the South American nation recently banned the mining and sale of the toxic substance, opening the door for Russia to fill the gap, which will be even larger if the U.S. resumes using the carcinogen in building materials. Russian asbestos manufacturers are thrilled. In July, the Russian company Uralasbest posted an image of its asbestos packaging, which features a smirking President Trump.
The NY Times verified that
the Russian firm Uralasbest posted on Facebook an image of its asbestos packaging that featured President Donald J. Trump’s face along with the words: 'Approved by Donald Trump, 45th president of the United States.'
So it appears that the push by EPA political appointees to make asbestos regulation lax again would benefit Russia, a country for which Trump seems to feel great affection.
Summary
Donald Trump long has had strong opinions on all sorts of topics. His opinions about the public health hazards of asbestos seemed more informed by his self-interest as a real estate developer than anything resembling clinical or epidemiological evidence. When he was just a rich real estate developer these seemingly misinformed opinions were of little consequence.
Now he is US President and his misinformed decisions could have major consequences, including eventually lethal ones. Unfortunately, he seems to make such decisions so rapidly that no one can keep up. And few of the people he has appointed to top leadership positions, particularly in health care and public health, seem inclined to stand up for more logical, evidence-based, and unconflicted and uncorrupted decision making.
Obscure parts of asbestos regulation may not get a lot of attention, and may not be as dangerous as decisions about, say, nuclear weapons, but they still could be quite dangerous. I hope those who care about medicine, health care, and public health will speak out against any new laxity in asbestos regulation. In 2016 we had an opportunity to prevent a regime of the conflicted and uninformed. Now we must challenge its bad decisions more directly.
Musical Interlude
The immortal Warren Zevon, Lawyers Guns and Money: "how was I to know she was with the Russians too?" - Live Version
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