Make Asbestos Great Again? - Trump Once Claimed "Movement Against by Asbestos was Led by the Mob," Now EPA Wants to Relax Asbestos Regulation

Introduction:  An Old Public Health Menace

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.

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).'

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.

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

Trumping the Evidence - The Donald Denies Asbestos Related Disease, Post-Traumatic Stress Disorder, Chronic Traumatic Encephalopathy but Asserted Vaccines Cause Autism

One of the main causes of health care dysfunction identified by demoralized health care professionals in our 2003 qualitative study was threats to evidence-based medicine, and by extension, evidence-based public health and health policy.(1) Since then, we have frequently discussed threats such as manipulation and suppression of clinical research to further vested interests, and distortion of research dissemination, such as ghost written articles, often enabled by individual and institutional conflicts of interest.

These and other causes of health care dysfunction which we discuss, however, have hardly been the stuff of political debates. In particular, US presidential campaigns often feature very bland discussions of health care, when they feature them at all. These discussions, furthermore, usually are limited to health insurance, but rarely challenge the unusual American system which relies on for-profit health care insurance.

So Health Care Renewal usually does not provide much content relevant to political campaigns.

The 2016 presidential election season has not been usual. True, one campaign, that of Hillary Clinton, has featured the detailed, but relatively bland policy points that we usually see.

Her opponent, Donald Trump, is very different. He is known for wide ranging unscripted comments. In particular (barely) reported instances, his comments have included apparent attacks on the clinical or public health research evidence base. (I used the word "appearent" since nothing Mr Trump writes or says is ever that clear.)

Denied Asbestos Related Disease

The best reported example is the oldest. A Mother Jones article from June, 2016, noted that in Mr Trump's presumably ghost-written book, Art of the Comeback, he wrote that asbestos is "100 percent safe, once applied," and it "got a bad rap." He also claimed that

the movement against asbestos was led by the mob, because it was often mob-related companies that would do the asbestos removal.

It is possible that these comments arose from Mr Trump's resentment of the costs of asbestos removal from his many real estate holdings.

Nonetheless, the evidence that asbestos is a major health hazard is old, but quite clear. (See summaries by The National Cancer Institute, the Agency for Toxic Substances and Disease Registry, the Occupational Safety and Health Adminstration.) Asbestos can cause asbestosis, which may lead to severe respiratory insufficiency, lung cancer, and mesothelioma. 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.

Ridiculed the Concept of Post-Traumatic Stress Disorder (PTSD)

On October 3, 2016, the Washington Post reported,

Donald Trump told a group of military veterans on Monday that some members of the military develop mental health issues because they are not 'strong' and 'can't handle it.

'When you talk about the mental health problems, when people come back from war and combat, they see things that maybe a lot of the folks in this room have seen many times over. And you're strong and you can handle it, but a lot of people can't handle it,' the Republican presidential nominee told an audience of military veterans at an event in Northern Virginia on Monday morning.

Allowing for Mr Trump's famously chronically garbled syntax, he appeared to say that PTSD is not a mental illness, but simply a manifestation of weakness. However, there seems to be no data to support this assertion, rather the contrary seems more likely to be true (for example, see the links in this article.)

Scoffed at Chronic Traumatic Encephalopathy (CTE)

In a story apparently only reported in the sports sections of the media (for example, here in USA Today on October 12, 2016), Mr Trump appeared to dismiss the dangers of concussions,

Trump likewise demonstrated a poor grasp of concussions and lashed out at the NFL when he commented on a woman who passed out in the crowd.

From the speech:

'That woman was out cold, and now she’s coming back. We don’t go by these new, and very much softer, NFL rules. Concussions..’oh, oh! Got a little ding on the head. No, no, you can’t play for the rest of the season.’ Our people are tough.'

This isn’t the first time Trump has ridiculed the NFL for its increased awareness of brain injuries. At a rally in Iowa earlier this year, he made similar comments.

Via Mic:

'Football’s become soft. Football has become soft,' GOP presidential candidate Donald Trump said (twice) at a rally in Iowa on Sunday.

'But football’s become soft like our country has become soft,' he added to cheers and nods. 'It’s true. It’s true.'

'What used to be considered a great tackle, a violent head-on [tackle]. … You used to see these tackles and it was incredible to watch, right?' Trump said.

Rather than being a "little ding on the head," there is pretty convincing evidence that concussions can lead to real neurological problems. See the website of the Boston University CTE (chronic traumatic encephalopathy) Center, which provides this summary,

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.

The Center's personnel wrote a 2009 review article(2), available here, which supplies considerably more detail.

Asserted Vaccines Cause Autism

A September, 20, 2016, Huffington Post article noted that Mr Trump has been a proponent of the theory that vaccines cause autism at least since 2012,

The Republican nominee is a full-blown proponent of the notion that vaccines cause autism, a theory that researchers have studied and rejected over and over after a medical journal helped launch the notion with a 1998 article since retracted.

Lots of autism and vaccine response. Stop these massive doses immediately. Go back to single, spread out shots! What do we have to lose.
— Donald J. Trump (@realDonaldTrump) October 22, 2012

I am being proven right about massive vaccinations—the doctors lied. Save our children & their future.
— Donald J. Trump (@realDonaldTrump) September 3, 2014

Again, at best, the link between vaccines and autism is very controversial at best.  Most reviews suggest that the evidence supporting any relationship is very limited, for example, see the 2003 review by Wilson et al(3) and the 2016 review by Taylor et al.(4)

The Republican Party Platform Which Trump Presumably Approved Asserted that Pornography is a Public Health Hazard

At least partially related is this story, as reported by CNN in July, 2016,

The Republican Party will declare internet pornography a 'public health crisis' under an amendment added to the draft party platform Monday at preliminary meetings in Cleveland.

North Carolina delegate Mary Frances Forrester successfully proposed the amendment in a subcommittee of the platform committee Monday morning.

'The internet must not become a safe haven for predators,' the provision states. 'Pornography, with its harmful effects, especially on children, has become a public health crisis that is destroying the life of millions....'

It appears that this provision conflates adult and child pornography.  There seems to be no good evidence that adult pornography creates health risks.

(Note: there is some irony in this story, as Mr Trump has appeared, albeit fully dressed, in several softcore porn videos, see stories here and here.  He also nominally wrote a racy novel, which was actually ghost written, see story here.  Also, his current wife also has appeared in one "lad mag" photo shoot sans clothes, see story here.)  

Comments

We have been discussing threats to the clinical and public health evidence base for a while.  We are used to discussing distortions of the evidence base that serve to support vested interests.

However, I cannot recall casual attacks on specific parts of the evidence base by apparently woefully uninformed political candidates.  It is not unusual for candidates for public office to talk about health care, public health, and related policies.  It is unusual for them to make assertions about specific evidence about particular diseases, and their risk factors and causation.

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.

But Mr Donald Trump is a very unusual candidate.  Perhaps this is why Scientific American, which "is not in the business of endorsing political candidates," took a strong position against what Mr Trump has been saying about science.

'If it disagrees with experiment it is wrong.'
—Richard Feynman

Four years ago in these pages, writer Shawn Otto warned our readers of the danger of a growing antiscience current in American politics. 'By turning public opinion away from the antiauthoritarian principles of the nation's founders,' Otto wrote, 'the new science denialism is creating an existential crisis like few the country has faced before.'

Otto wrote those words in the heat of a presidential election race that now seems quaint by comparison to the one the nation now finds itself in. As if to prove his point, one of the two major party candidates for the highest office in the land has repeatedly and resoundingly demonstrated a disregard, if not outright contempt, for science. Donald Trump also has shown an authoritarian tendency to base policy arguments on questionable assertions of fact and a cult of personality.

Americans have long prided themselves on their ability to see the world for what it is, as opposed to what someone says it is or what most people happen to believe. In one of the most powerful lines in American literature, Huck Finn says: 'It warn't so. I tried it.' A respect for evidence is not just a part of the national character. It goes to the heart of the country's particular brand of democratic government. When the founding fathers, including Benjamin Franklin, scientist and inventor, wrote arguably the most important line in the Declaration of Independence—'We hold these truths to be self-evident'—they were asserting the fledgling nation's grounding in the primacy of reason based on evidence.

While this election may have effects that go way beyond science, particularly the integrity of the clinical and public health evidence base, those concerned about these issues need to take heed now before the voting is finished.  

References

1. Poses RM. A cautionary tale: the dysfunction of American health care. Eur J Int Med 2003; 14 (2003) 123–130.  Link here.

2. McKee AC, Cantu Rc, Nowinski CJ et al. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropathol Exp Neurol. 2009 July ; 68(7): 709–735. doi:10.1097/NEN.0b013e3181a9d503.

3. Wilson K, Mills E, Ross C et al. Association of Autistic Spectrum Disorder and the Measles, Mumps, and Rubella Vaccine: A Systematic Review of Current Epidemiological Evidence. Arch Pediatr Adolesc Med. 2003;157(7):628-634. doi:10.1001/archpedi.157.7.628. Link here.

4. Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine 2016; 32: 3623–3629. Link here.

Pfizer May No Longer be Able to Delay Paying Its Asbestos Claims of Nearly $1 Billion

Pfizer, which claims to be the "world's largest research-based pharmaceutical company," is one step closer to paying a nearly one billion dollar settlement of legal claims of harms due to the asbestos products it used to manufacture.

Pfizer Settles - More or Less - Some of its Asbestos Liability

Most people would not think of Pfizer as a producer of asbestos.  However, the back-story, as reported in the Philadelphia Inquirer, and as we discussed here in 2011, is that

Pfizer used to have a minerals, pigments and metals division and, in 1968, it bought Quigley Company Inc., which made insulation for heavy industry.

Quigley's Insulag contained asbestos.

So,

Quigley stopped production at its facility in Old Bridge, N.J., in 1992.  When it filed for bankruptcy in 2004, Quigley faced more than 160,000 lawsuits, most related to asbestos product liability.

By apparently holding out the legal fiction that Quigley was an independent entity, Pfizer seemed to use to use the bankruptcy filing to delay making any payment of these claims, most of which likely involved illnesses due to asbestos exposure.  As the Inquirer article said,

Pfizer has spent the nine years since arguing that bankruptcy law protects it from such lawsuits.

notwithstanding the fact that Pfizer itself is hardly bankrupt.

But now, as Bloomberg reported (via the New London [CT] Day),

 Pfizer Inc.'s non-operating Quigley Co. won permission to end almost nine years in bankruptcy under a plan that resolves most asbestos claims against the former insulation maker and its parent, the world's largest drugmaker.

U.S. Bankruptcy Judge Stuart Bernstein in Manhattan Wednesday approved a Chapter 11 plan under which Pfizer will contribute assets worth $964 million. He rejected a prior plan almost three years ago, saying Pfizer was improperly using Quigley's bankruptcy to shield itself from asbestos claims.

Note that Pfizer has consistently argued that it should bear no responsibility for the effects of the asbestos made by its subsidiary:

'Pfizer has never been found derivatively or directly liable for injuries allegedly caused by Quigley's asbestos- containing products,' [Pfizer spokesman Christopher] Loder said.

Pfizer used to have a minerals, pigments and metals division and, in 1968, it bought Quigley Company Inc., which made insulation for heavy industry. Quigley's Insulag contained asbestos.
Read more at http://www.philly.com/philly/business/20130627_Drug-maker_Pfizer_fails_to_escape_costly_asbestos_case.html#AltGBB8oXa8YPkAC.99

Furthermore,

Pfizer has said throughout the case that it never made or sold Quigley's products and it doesn't have liability for them. Asbestos, once widely used as an insulator, was later shown to cause cancer.

Convenient Fictions

This case received little notice in 2011 and is receiving little notice now, and mainly for its business implications.  Yet the reporting does suggest  dots to connect to reveal some larger hypocrisies.

Dedicated to improving health and well being?

Pfizer asserts on its website that it

has remained dedicated to discovering and developing new, and better, ways to prevent and treat disease and improve health and well being for people around the world.[italics added]

Yet despite this supposed dedication to health and well-being, it has long delayed any possible compensation to people who may have acquired severe, if not fatal disease from contact with one of its products.

As per Bloomberg, note the examples of

people like Brenda Hagerich, 62, of Hot Springs, Ark., may get payments on their claims. Hagerich, whose father died in 1999 of mesothelioma, said she has been waiting for a second distribution of a $125,000 payment.

Ownership without responsibility

According to current media reports,  Pfizer attorneys repeatedly contended that because Quigley was a subsidiary of Pfizer, Pfizer could not be held accountable for its actions.  Yet Pfizer owned, and presumably thus gained all revenue from and chose the leadership of Quigley.  At best, maintaining this fiction seems heartless given Pfizer's stated interest in peoples' "health and well being."

Who knew asbestos was dangerous?

The current reports seem to imply that Pfizer's accountability should be mitigated because at the time it acquired Quigley, no one knew that asbestos was hazardous.  The Bloomberg report stated,

Quigley made asbestos-containing products from the 1940s to the 1970s, including Insulag, a powdered insulation. Pfizer, based in New York, bought the company in 1968.

But,

Pfizer has said throughout the case that it never made or sold Quigley's products and it doesn't have liability for them. Asbestos, once widely used as an insulator, was later shown to cause cancer.

The last sentence implies that asbestos was only shown to cause cancer after Pfizer acquired Quigley in 1968.  However, this suggests a lack of knowledge of medical history.

In fact, evidence that asbestos was dangerous would have been readily available in 1968. Pulmonary asbestosis was recognized in 1927.(1, noted in 2).  Furthermore, by 1952, as per Dr Richard Doll(3),

The majority of workers (cited by Hueper, 1952) consider that a causal relationship between asbestosis and lung cancer is either proved or is highly probable and the reality of the relationship was agreed at the recent International Symposium on the Epidemiology of Lung Cancer.

Doll reported further data in 1954 and concluded,

lung cancer was a specific industrial hazard of certain asbestos workers....

Summary

So while Pfizer officials ought to have known that in 1968 it was acquiring a company that made products that likely caused lung cancer, for more than 40 years, they have managed to stall payments to now mainly the heirs of people who acquired severe disease due to those products.  This clearly suggests that in this matter the company leadership has consistently put its revenue ahead of its ostensible dedication to peoples' health and well being.  Then again, this is hardly the first example of dubious ethical conduct by Pfizer.  See this post for a list of the 14 legal settlements of allegations of misconduct made by Pfizer since 2000, only one of which was related to the current case.

Furthermore, dedication to short-term revenue over everything else has resulted in huge wealth for Pfizer's hired managers.  Per the Wall Street Journal, only the latest example is,

The total 2012 compensation for Pfizer Inc. (PFE) Chief Executive Ian C. Read was valued at $25.6 million, up 2.5% from 2011, as the drug maker hit two out of three key financial objectives last year. 

Mr. Read's compensation was based partly on the company exceeding targets for total revenue and adjusted earnings-per-share, while missing its target for cash flow in 2012, Pfizer said in a proxy statement filed Thursday with the U.S. Securities and Exchange Commission.

Presumably, the total revenue target would have been a bit lower if Pfizer had managed to set aside assets to pay the asbestos related claims discussed above in 2012 rather than in 2013.

This relatively anechoic example shows how hollow ring most of the claims by leaders of big health care organizations that they value patients' and the public's health.  That may be convenient public relations puffery, but again and again the bottom line seems to matter more to them.  We have shown numerous examples of mission-hostile management, and of leaders compensated outrageously out of proportion to their contributions to patients' and the public's health.  Thus, why should health care professionals, or patients believe that anything they do puts patients ahead of money?

As we have said so often, health care professionals and society at large needs to hold large health care organizations' leadership accountable for their missions, and push out leaders who put their own pocketbooks and their organizations' revenue ahead of patients' and the public's health. 



References

1.  Cooke WE.  Pulmonary asbestosis.  Br Med J 1972; 2: 1024.
2.  Hasan FM, Nash G, Kazemi H. Asbestos exposure and related neoplasia: the 28 year experience of a major urban hospital.  Am J Med 1978, 65: 649-654. Link here.
3.  Doll R. Mortality from lung cancer in asbestos workers.  Br J Indust Med 1955; 12: 81-86.  Link here. 

The Curious Case of Pfizer's Asbestos Claims

Here is a very strange and long-running story that raises some questions about how health care organizations are lead, but seems to have bee covered only in the business press.

Pfizer Goes Into the Asbestos Business (in 1968), Faced Hundreds of Thousands of Lawsuits (in the 1980s), Promised to Settle (in 2004)

Here is the background, per a 2004 report by the Associated Press, per Fox News:

Pfizer Inc. (PFE) Friday said it has agreed to pay $430 million to settle all lawsuits against it alleging injury from insulation products made by a subsidiary.

Pfizer and its Quigley Co. subsidiary were named, along with several other defendants, in 171,611 lawsuits claiming personal injury caused by exposure to asbestos, silica or mixed dust.


Pfizer acquired Quigley Co. in 1968. It sold some products containing asbestos until the early 1970s.

Pfizer will establish a trust for the payment of pending claims as well as any future claims. It will contribute $405 million to the trust over 40 years through a note, and about $100 million in insurance. Pfizer will also forgive a $30 million loan to Quigley.

Since 1982, Quigley's main business has been to manage the asbestos lawsuits.

As part of the settlement, Quigley will file for Chapter 11 bankruptcy. Its reorganization plan must be approved by the bankruptcy court and confirmed by a vote of 75 percent of the claimants.

That seems like the end of a long story, but it was not.

Bankruptcy Proceedings Go On Through 2009, No Claims Paid

By 2009, nothing had really been settled. Apparently, the bankruptcy of Pfizer's subsidiary, which was set up as if Quigley was an independent corporation, had not resulted in any resolution to the multiple lawsuits and the large claims. As reported in December, 2009, by Bloomberg:

At issue in the trial is whether Quigley, a former maker of asbestos-containing products, can confirm a plan of reorganization, ending more than five years in bankruptcy. The trial pits the U.S. government and asbestos victims against Pfizer, the world’s biggest drugmaker, with claims that its $450 million contribution under a settlement isn’t enough to satisfy its liabilities.

At the trial, the lawyer for the asbestos victims claimed that Pfizer was using the bankruptcy of its subsidiary to avoid liability:

Edward Weisfelner, a lawyer for an ad hoc group of so- called asbestos victims that represents 30,000 individuals, told Bernstein today that the plan can’t be confirmed because the purpose of the bankruptcy law being used to channel asbestos claims is to 'scrub' a viable company of liabilities.

Under bankruptcy law, courts shouldn’t approve Chapter 11 reorganizations where the primary purpose is to shield a third party, such as Pfizer, Weisfelner said.

'Courts are instructed to avoid the possibility that parties use bankruptcy to protect a third party that’s not submitting itself to the jurisdiction of the court, and that’s exactly what’s going on in this case,' Weisfelner said.

The US government also objected to what Pfizer was doing:

Opposition to the plan also comes from the U.S. Trustee, an arm of the Justice Department that monitors bankruptcies, which has said was improperly orchestrated to shield the drugmaker from liability.

t the time, Pfizer (through its Quigley subsidiary) also was attempting to keep the whole thing quiet, but not successfully:

The U.S. Trustee has fought to keep the trial open to the public, and said in court documents that some of Quigley’s requests to keep information confidential failed to meet legal standards for protecting 'commercial' information.

Of course, at that time, the opinions of the plaintiffs' lawyer and the US Trustee were just that, opinions.

By 2010, Judge Found that Pfizer "Manipulated" the Bankruptcy

But by September, 2010, according to Bloomberg then:

Pfizer Inc.’s Quigley unit, a former asbestos maker, was denied permission to exit bankruptcy by a judge who found the world’s largest drug company manipulated the bankruptcy process to benefit itself.

U.S. Bankruptcy Judge Stuart M. Bernstein in New York today rejected Quigley’s fourth reorganization plan and said parties should discuss dismissal of the case. He said the plan was filed in 'bad faith' by Pfizer and cited testimony that asbestos claims directed at Quigley could total $4.45 billion over the next 42 years.

No Progress by the End of 2010

Apparently despite the judge's opinion, the case still remained tied up in court. By December, 2010, no progress had been made. According to Bloomberg then:

Pfizer Inc., the world’s largest drug company, should have the bankruptcy of its Quigley unit which has protected it from asbestos-related health problems since 2004 dismissed, lawyers for the U.S. Trustee said.

While the bankruptcy has been pending, creditors with alleged asbestos-related health problems have been unable to sue New York-based Pfizer, and many have died, wrote lawyers for the U.S. Trustee, an arm of the Justice Department that oversees bankruptcy. A hearing to decide the U.S. Trustee’s request is set for Jan. 13, according to court papers filed Dec. 23.

'The harm in delaying the inevitable dismissal of this case is to the individuals who have filed asbestos claims against the Debtor and Pfizer,' lawyers for acting U.S. Trustee Tracy Hope Davis wrote in court papers. 'For some of those individuals, time may be of the essence.'

So Pfizer had stalled for so long that some of the plaintiffs had died off.

Summary

So let us summarize. For reasons that are unclear, Pfizer Inc, primarily a pharmaceutical company, bought out a company that made asbestos products in 1968. The health hazards of asbestos were soon recognized, and many people filed lawsuits against Pfizer's subsidiary, alleging they had been harmed. Pfizer promised to settle the matter in 2004, about 30 years since the exposures occurred. Yet by setting up a bankruptcy of its subsidiary as if it were an independent company, Pfizer stalled any resolution of the case for at least another six years, using what a Judge termed "manipulation." Now it is 2011, and the cases are still unresolved.

So for a company that claims it is

committed to applying science and our global resources to improve health and well-being at every stage of life.

and boasts

Pfizer Inc: Working Together for a Healthier World

This does not look good.

So question number one is should not the leaders of a company whose main business is ostensibly making people healthier be more sensitive to claims about the health effects of its products? Specifically, why did Pfizer's leaders not try to more speedily come up with a cleaner and more timely solution to this problem that would appear more sensitive to the health problems of the claimants?

It would be interesting if Pfizer's top leaders were to try to answer that question.

My policy observation is now familiar.  As we have said before, far too often the leaders of not-for-profit health care institutions seem more interested in padding their own bottom lines than upholding the institutions' missions. They often seem entirely unaware of their duty to put those missions ahead of their own self-interest. Like the financial services sector in the era of "greed is good," health care too often seems run by "insiders hijacking established institutions for their personal benefit." True health care reform would encourage leadership of health care who understand health care and care about its mission, rather than those who see a quick way to make a small fortune.