Asbestos Questions and Answers
United States Asbestos Screening Scam

Case Synopses of Actual Asbestos Claims

Lawrence Martin, M.D.

The following are actual cases of asbestos-related claims that I was asked to evaluate. Sometimes evaluation requires only a review of extant records (as in deceased claimants); most often it involves examining the claimant and reviewing his x-rays and medical records. The claims were evaluated for various attorneys or for the Bureau of Workers' Compensation. It should be noted that physicians can only make a medical assessment; the outcome of all such claims is determined by claims administrators (for BWC claims), negotiation among attorneys or, in cases that go to trial, juries.

Bogus Diagnosis of Asbestosis #1

A physician without any special qualifications was hired by plaintiff's attorney to certify a diagnosis in many ex-foundry workers. Since all the workers had similar exposure history at the foundry, the physician assumed they would all have similar disease. However, since most of the workers had no lung condition except that due to smoking, certification of occupational lung disease required that he make up a diagnosis.

Perhaps to save time, or perhaps because he just didn't know what he was doing, he adopted a "cookie cutter" approach. Every letter from the physician about each claimant included the following boilerplate statement, irrespective of the actual evidence:

"His symptoms, clinical examination, employment history, and chest x-rays are consistent with the diagnosis of Asbestosis and or Asbestos exposure related disease."

In fact, in almost every case nothing about the patients' exams, test results or chest x-rays were consistent with the diagnosis of asbestosis or asbestos-related disease. Lacking evidence to support these conditions, no claim was allowed at the administrative level.

Bogus Diagnosis of Asbestosis #2

Mr. W.K., born in 1935, worked for many years at Ford Motor, but never diectly with asbestos products. In 2001 he was solicited by plaintiff attorneys to have a chest x-ray; that x-ray was then interpreted by a plaintiff-attorney-hired physician as consistent with asbestosis. Then that x-ray report was forwarded to another physician who wrote in 2002:

“On the basis of the medical history review, which is inclusive of a significant exposure to asbestos dust, the physical examination and the chest radiograph, the diagnosis of bilateral asbestosis is established within a reasonable degree of medical certainty. This diagnosis is causally related to his workplace exposure to asbestos at the Ford Motor Company.”

In fact, this process, and both physicians were part of the now-notorious process known as The United States Asbestos Screening Scam. In this scam the physicians simply made up hundreds of thousands of bogus asbestos disease diagnoses, reusling in millions of fraudulent asbestos claims.

But the bogus diagnosis did not stop in 2002. The patient had been a heavy smoker, and like many smokers he developed lung cancer. His cancer was diagnosed in early 2009 and he died that year. No autopsy was done. The plaintiff attorneys then sent the medical file back to the second physician, who wrote in 2010:

1) History of lung cancer and death from lung cancer which to a reasonable degree of medical certainty are both causally related to workplace exposures to asbestos at the Ford Motor Company as well as to prior smoking history.
2) All previous Impressions and Recommendations [referring to his 2002 report] are otherwise unchanged.
3) The above opinions are stated to a reasonable degree of medical certainty.”

As result, a new claim was then filed for asbestos causation of Mr. W's death. But by then he had had numerous chest x-rays and 4 chest CT scans; not a single one of these x-rays/CT scans showed any evidence of asbestos disease. Nor had his treating physicians ever even entertained the diagnosis of asbestosis. Yet the plaintiff attorney's physician, the one who wrote reports in 2002 and 2010 NEVER acknowledged any other x-ray reports or make any attempt to reconcile his made up diagnosis with the patient's medical file.

To the laymay the plaintiff-attorney-hired physician's report may seem straightforward. But when the claim is analyzed professionally it is seen for what it is: bogus at its core, a diagnosis simply manufactured by unethical physicians. It is a good example of the cases that comprise the decades' old asbestos screening scam.

A Case of Presumed Asbestosis

Mr. E.C. was 74-years-old at the time of evaluation. He worked for a car manufactuer from 1951 to 1982, as a pipe fitter and plumber. He smoked from age 17 to 57. He developed progressive shortness of breath starting in 1993, and in 1997 was diagnosed with "interstitial lung disease," cause undetermined.

A high resolution CT scan of the chest in June 1997 showed:

"Definite interstitial pulmonary disease which is linear and reticular primarily. A small amount of honeycombing is present. The findings are most marked at the lung bases. Review of a 1994 CT scan shows that the diaphragmatic indistinctness present on today's exam was beginning at that time, although was less severe. Findings are consistent with asbestosis but may also be seen in UIP and collagen vascular disease."

No lung biopsy was done to characterize the cause of the interstitial disease. Mr. C. states that as a pipe fitter and plumber he was exposed to asbestos when converting old asbestos-covered pipes over to copper. On his application to the Bureau of Workers' Compensation he wrote:

"I was employed as a pipe fitter and plumber for 30 years at the [factory]. During the course and scope of my employment, I worked on the pipe gang in the power house which involved pulling asbestos insulation/pipe covering off of pipes so that copper lines and cable could be run. I was also worked around boilers which were covered with asbestos insulation. I was also employed at the Plant Fire Department and was involved in battling several fires in the seat cushion department. As a result of my various positions with [the company], I was exposed to asbestos or products containing asbestos."

At the time of my evaluation Mr. C. claimed shortness of breath with any exertion. With portable oxygen, he was able to do most activities of daily living. He needed portable oxygen only with movement, but not at rest. I assessed his claim as follows:

"Given Mr. C's occupational history and the nature of his interstitial lung disease, it is reasonable to assume the diagnosis of asbestosis. Absent a biopsy, this diagnosis is not proven. However, in terms of medical management, biopsy results would most likely not change anything.

"From the constellation of findings (exam, chest x-rays, pulmonary function tests) and Mr. C's occupational exposure history (assuming it is accurate), it is more likely than not that his interstitial lung disease is asbestos-related."

(Lawrence Martin, M.D.)

Case With Autopsy

Mr. H. died at age 71 of metastatic lung cancer and liver failure. He had a history of both asbestos exposure and heavy smoking. The autopsy found:

  • Small cell carcinoma of right lung, metastatic to right hilar lymph nodes, paratracheal lymph nodes, liver (diagnosed on liver biopsy at Cleveland Clinic Foundation) and vertebral bodies.
  • Jaundice of skin and sclera.
  • Pulmonary fibrosis with numerous asbestos bodies, consistent with pulmonary asbestosis.
  • Pleural plaque, right lower lobe of lung.

The finding of pulmonary fibrosis and asbestos bodies confirmed the diagnosis of asbestosis, since his chest x-ray also showed interstitial fibrosis. The question asked of me related to the contribution of asbestos in causing Mr. H's lung cancer and death. I affirmed the relationship and quoted two references to support my assessment.

  • "...further studies have been published that show no increase in relative risk [for lung cancer] at low exposure levels. All these series taken together show an impressively consistent threshold-type pattern. This would be entirely in keeping with what is now known about pathogenesis, and the dependence of increased risk upon the presence of asbestosis. Epidemiological evidence is, perhaps not sensitive enough to provide a conclusive answer to the question of whether a threshold for lung cancer exists, but further support has recently come from two studies designed specifically to test the hypothesis: both found that risk of lung cancer only increased in cohort members with signs of pre-existing asbestosis. Both studies also provided strong evidence that the response of asbestosis was a determinant of lung cancer risk independent of exposure." (Raymond Parkes, page 481, Occupational Lung Disorders, Butterworth Heineman, Oxford, 1994.)
  • "Since Doll's classic article, it has been suggested that asbestos exposure alone in the absence of asbestosis increases the risk of lung cancer; however, the currently available evidence indicates that the increased incidence of lung cancer occurs only in those who both smoke and have asbestosis. ...There is a wealth of statistical data indicating that in the absence of sufficient exposure to induce asbestosis, it is impossible to demonstrate an increased risk of lung cancer." (Morton & Seaton, pages 347-348, Occupational Lung Diseases, W. B. Saunders Co., Philadelphia, 1995.)

After quoting these references I wrote:

"In summary, Mr. H's death from lung cancer would be considered related to asbestos exposure as well as to smoking. It follows that, given his work history as provided in the records, long term asbestos exposure did put him at greater risk for developing lung cancer than if he had not been so employed."

(Lawrence Martin, M.D.)

A Case of Throat Cancer

Mr. C., a 57 year old man with a history of heavy smoking and drinking, died of throat cancer in February 1995. Prior to his demise a chest x-ray was sent by his attorney to a radiologist in another state, to check for the presence of asbestosis. That radiologist filed the following report:

"A PA chest radiograph dated 2/2/95 was evaluated for the presence and classification of asbestos related pneumoconiosis utilizing the ILO 1980 guidelines.
The film quality is 1. Irregular interstitial opacities are seen in both mid and lower lung zones, the size and shape of which are classified as s/t, and the profusion is 1/1. No pleural defects are seen. The examination is otherwise normal.
OPINION: Interstitial fibrotic changes consistent with asbestosis in a patient who has had an adequate exposure history and latent period."

What this radiologist did not know is that a chest CT scan had been done on Mr. C. a month earlier. The CT scan is much more sensitive than the plain chest x-ray for picking up interstitial fibrosis. Mr. C's CT scan was negative, showing none of the changes described by the out-of-state radiologist.

After reviewing this information I wrote:

"There appear to be two issues in this case. First, did Mr. C. have asbestosis, and second, was his cancer related in some way to occupational exposure. The first question is easily answered by reviewing the x-rays obtained before he died, particularly the CT scan of his chest on 1/5/95. The CT scan is far more sensitive for interstitial lung disease than the chest x-ray. If the CT scan is negative, as was mentioned in [the] report, than Mr. C. didn't have asbestosis and the 2/2/95 x-ray was over-interpreted by Dr....

"The second question is also easily answered by his history. Heavy smoking and drinking are well-recognized habits that greatly increase the risk of developing head and neck cancer. There is no reason to implicate any occupational cause in this case. Furthermore, even if Mr. C. did have asbestosis, there is no evidence that asbestosis increases the risk of the [throat] cancer.

"In summary, there is unequivocally no evidence for either asbestosis or occupationally-related cancer in this case.

(Lawrence Martin, M.D.)

A Case of Pleural Mesothelioma

Mr. S. worked as a chemical engineer in Factory A from 1958-1971. Based on affidavits of ex-co-workers, Mr. S. was exposed to friable asbestos in Factory A. In 1971 he transferred to a Factory B in another city. By all accounts, while Factory B did have asbestos-covered pipes, Mr. S. was not exposed to friable asbestos in Factory B.

Mr. S. was diagnosed with malignant mesothelioma in September 1996 and died of the disease in July 1997. A lawsuit was filed against the owners of Factory A. In response, the Factory A owners placed the blame on Factory B.

I was asked to determine where the asbestos source that most likely caused the mesolthelioma originated. I wrote:

"Based on all the information known about mesothelioma and asbestos, it is far more likely than not that Mr. S.'s mesothelioma was directly related to asbestos exposure at Factory A. Medically speaking, malignant mesothelioma is assumed related to asbestos providing there is evidence of both of the following conditions:

  • the diagnosis is confirmed histologically
  • there is documented exposure to friable asbestos in the past
  • the asbestos exposure began at least two decades prior to diagnosis, to account for the known long latency period of this disease

"Mr. S's case satisfies all three criteria. Therefore I can state, with a reasonable degree of medical certainty, that his mesothelioma was related to his years of employment with Factory A."

(Lawrence Martin, M.D.)

A Case of Peritoneal Mesothelioma

Mr. P., was diagnosed with malignant peritoneal mesothelioma in 1995 at age 80. He died of the condition two years later, age 82. The question asked of me was whether asbestos contributed to his death.

Mr. P. worked as a sheet metal worker from 1947 to 1976, and during this time was exposed to "asbestos-containing pump packing and gasket materials."

In 1992 a CT scan (done for medical reasons) showed "Calcified pleural plaques are suggestive of prior asbestos exposure."

Another CT scan in 1995 showed: "Extensive pleural calcification is consistent with asbestos exposure."

Abdominal surgery in October 1995 showed Mr. P. had peritoneal mesothelioma.

In answer to the question I wrote:

"In summary, Mr. P. died at age 82 of malignant peritoneal mesothelioma. Before that cancer was diagnosed in 1995, he had been diagnosed and treated for other malignancies [including prostate]. CT scans showed pleural calcification, consistent with remote asbestos exposure. He was a sheet metal worker and, from his affidavits, was exposed to asbestos.

"Pleural mesothelioma are well accepted as due to asbestos exposure, providing remote asbestos exposure can be documented. Peritoneal mesothelioma is a less common malignancy. According to Morgan and Seaton's textbook, Occupational Lung Diseases (W.B. Saunders, 1995):

"Peritoneal mesotheliomata occur less frequently than pleural mesothelioma. It is presented that peritoneal mesotheliomata are caused by asbestos fibers migrating from the lung periphery through the diaphragm into the peritoneum, by ingested fibers making their way through the gut wall into the peritoneum, or by swallowing of fibers that been removed from the lungs by the mucociliary escalators." (P. 353)

"Given Mr. P's work history, and given the presence of pleural changes on CT scan ascribed to likely asbestos exposure, it does seem more likely than not that his peritoneal mesothelioma was asbestos-related. In this case, therefore, it would be occupationally-related. Although he died at advanced age, and in fact lived longer than expected from his birth year (1915), it does seem that the cause of his death was likely an occupationally-related malignant mesothelioma."

(Lawrence Martin, M.D.)

A Case of Congestive Heart Failure

Mr. B. worked in a steel mill from 1958 through 1988, and retired at the age of 61. At age 65 he had a heart attack and subsequently developed congestive heart failure. In this condition the heart is enlarged and fluid backs up into the lungs. Between 1988 and 1995 he had numerous hospitalizations for congestive heart failure, and became physically incapacitated because of this condition.

In 1994 a screening chest x-ray in 1994 was sent to a radiologist B-reader hired by plaintiff's attorney; the radiologist was only told that the claimant had a history of asbestos exposure. The B-Reader was unaware of any prior chest x-rays or of the patient's cardiac condition. He read the x-ray as "consistent with asbestosis."

Mr. B was examined for the asbestos claim in 1998, and his medical records were reviewed in detail. It turns out there was a normal x-ray in 1990, before Mr. B. had his first heart attack. Numerous chest x-rays since then all showed changes consistent with congestive heart failure. The shadows interpreted by the B-reader in 1994 were nothing more than the residua of Mr. B's congestive heart failure. There was never any evidence of asbestos lung disease, and any competent physician who knew full history would never have interpreted the chest x-ray as did the attorney-hired B-Reader.

Chest X-rays Don't Lie

Mr. D., 54, claimed asbestos-related disease from his work at a steel company, where he was employed 1965 to 1998. He worked as a millwright, caster operator, machinist, pipe fitter and electrician-helper, and claimed he was exposed to asbestos "throughout the plant" but not in any specific job. He found out about possible asbestos lung disease after a union screening exam in the early 1990s. He had not previously been evaluated by a physician for this problem. Mr. D. smoked about a half pack a day for many years.

Because of non-respiratory illnesses (principally back pain), Mr. D. had had numerous chest x-rays before and after the asbestos screening x-ray; all were read by radiologists (uninvolved with the claim) as not showing anything to suggest asbestos-related disease. The most recent chest x-ray report (July 1998) stated:

"CHEST: PA and lateral views compared with previous examination of 10-16-96 shows no significant interval change. The cardiomediastinal silhouette is normal. The lung fields are clear. The pulmonary vascularity is normal. There are moderate degenerative changes of the dorsal spine.
IMPRESSION: No acute disease."

In addition, Mr. D's pulmonary function studies were normal.

In contrast to all this information, the radiologist hired by plaintiff's attorney, even though he never saw the records or the claimant, wrote that the chest x-ray was "consistent with asbestosis."

After examining the claimant and reviewing all the records, I wrote:

"In summary, there is no evidence for asbestos-related lung disease in Mr. D. Serial chest x-rays read by radiologists uninvolved with his asbestos litigation have showed no evidence for pneumoconiosis. The reading of the chest x-ray [by radiologist hired by plaintiff's attorney] appears to be an over-interpretation. In fact, Mr. D does not meet any of the clinical, laboratory or chest x-ray criteria for asbestosis."

(Lawrence Martin, M.D.)

An Egregious Defense

Egregious bias in defending legitimate asbestos cases can also be found, as in the following case.
A 59-year-old man died in 1985 of pulmonary fibrosis. He had a documented history of extensive work exposure to asbestos during the 1960s and 1970s. Pulmonary fibrosis first became manifest in 1975, in a pattern typical of asbestosis. Autopsy revealed extensive pulmonary fibrosis and at least one asbestos body per high power field. The patient's employer, who was sued on the claim of asbestosis, stated through experts that the claimant died of "idiopathic pulmonary fibrosis." In 1988 the company's pathology expert wrote that he found:
"A single ferruginous body, possibly an asbestos body was demonstrated [but] the overall [histologic] pattern is that of an end stage lung with fibrosis of a nonspecific nature...on the basis of the evidence I do not consider this disease process to be asbestosis...the pulmonary disease should be placed in the category of idiopathic pulmonary fibrosis...[the diagnosis] is...clearly...not...asbestosis."

This same expert had previously published, in a specialty medical journal (statement paraphrased):

'asbestos bodies are not always observable because they are cleared from the lung and undergo dissolution with time, and therefore particle counts do not correlate directly with the severity of pulmonary parenchymal disease.'

In other words, the defense expert's conclusion was directly contrary to his own published work, thus damaging his credibility on this case. From my review, the evidence for asbestosis was unequivocal. For the defense to claim instead that the patient had "idiopathic pulmonary fibrosis" was, I wrote, medically illogical. An example of egregious bias.

The Weight of the Evidence

Mr. V. who died at age 65 of lung cancer. It was a right upper lobe mass diagnosed by needle biopsy on 10/23/97. He was found to be inoperable due to brain metastasis, and died on April 6, 1998.

He was noted to be an "active smoker of three packs per day [who] "quit in 1990." He had "worked in the steelmill with heavy exposure to asbestos and toxic fumes." After his demise his widow filed a claim alleging that his lung cancer was due to asbestos exposure.

The first hint of lung cancer -- and the origin of the death claim -- was from a chest x-ray read on July 14, 1997. On that date a physician read a screening chest x-ray as follows:

The soft tissues and bony thorax are normal. There is no hilar prominence or mass. Density in right upper lobe, question mass - suggest cat scan. There is no pleural thickening. There are irregular opacities present in both lower lung fields.
Conclusion: With significant history of exposure to asbestos dust, these findings would be consistent with asbestosis. There is chest roentgenographic evidence for possible malignancy.

In this case the screening chest x-ray was obtained to look for asbestosis, and the physician found a lung mass suggesting cancer. Even so, without any further evidence at the time, the physician wrote "consistent with asbestosis."

Mr. V. was not actually evaluated for lung cancer until two months later, when he had the first of several chest x-rays and CT scans. In the aggregate, these x-rays and scans show that the first physician was way out of line in his presumptive diagnosis of asbestosis.

9/25/97 CT Scan of the chest:
"There is a 4 x 4 x 6 cm soft tissue density mass noted in the right upper posterior aspect of the lung. The mass appears to be extending to the right upper posterior pleural surface. There is lymphadenopathy anterior to the superior vena cava and the ascending aorta. There is also lymphadenopathy noted in the right hilum, adjacent to the right main pulmonary artery. There is also multiple small lymph nodes noted in the pretracheal region. The findings are consistent with right lung neoplasm with mediastinal lymphadenopathy. The left lung is expanded and clear.
IMPRESSION: Right lung mass with mediastinal lymphadenopathy. Fatty infiltration of the liver.

10/23/97 Chest X-ray (after needle biopsy):
CHEST: Inspiration and expiration views were obtained after completion of bronchoscopic biopsy of right lung mass. There is a questionable minimal pneumothorax on right side, seen only expiratory film. Again noted is an ill defined mass in right upper lobe. Rest of the lungs are clear.

10/24/97 Chest X-ray (after thoracentesis -- removal of fluid from right chest):
CHEST: AP inspiration and expiration views are obtained post thoracentesis. There is a small apical pneumothorax on the right A right upper lobe mass is present. There is fullness of the right hilum. No gross pleural fluid is seen. The left lung is clear. The heart is at the upper limits of normal in size.
IMPRESSION: Small right pneumothorax. Right upper lobe mass similar to the exam of 10/23/97 at [Medical Center].

11/3/97 CT Chest Scan:
Multiple serial computer tomographic cuts were obtained in the chest, beginning at the level of the lung apices and extending down to the level below the diaphragms. There is a spiculated mass in the posterior segment of the right upper lobe, highly suspicious for neoplastic process. There also is a suggestion of a very small nodule versus focal area of fibrosis in the interior aspect of the right mid lung base appreciated on Scan Number 39 on the lung widow settings. In addition, there are some scattered lymph nodes noted in the pretracheal region.
IMPRESSION: Spiculated mass in the posterior segment of the right upper lobe, highly suspicious for a carcinoma. Suggestion of an additional satellite nodule versus fibrotic nodule in the interior aspect of the right mid lung best appreciated on Scan Number 39. Adenopathy in the pretracheal region.

On November 25, 1997 Mr. V. was evaluated by a radiation oncologist, who reviewed the above history and noted: "Past medical history is significant for he patient being a heavy smoker prior to 1990." Mr. V. was given radiotherapy to his brain and chest but he died shortly afterwards. The death certificate listed the immediate cause of death as "Metastatic Carcinomatosis due to lung cancer," with other significant conditions listed as "Spinal cord compression." No autopsy was done.

After reviewing all these records I wrote:
"Lung cancer is unfortunately a very common problem in the U.S., with upward of 175,000 new cases diagnosed each year. Over 90% of all lung cancers are solely attributable to smoking, and Mr. V. was noted to have been a very heavy smoker. There is no reason, in his case, to invoke another cause of lung cancer. However, if he truly had asbestosis, that condition could be considered a contributing cause, as the incidence of lung cancer increases in smokers who also have documented asbestosis. Stated another way, compared to a smoker without asbestosis, the risk of developing lung cancer increases significantly if a smoker also has asbestosis. On the other hand, absent asbestosis, one cannot attribute remote asbestos exposure as a contributing cause to a heavy smoker's lung cancer.

"There are no employment records in the file, in fact nothing to indicate his work history save for the single sentence quoted above. There is also no supporting documentation for asbestosis, except for the single chest x-ray reading [by the physician in July 1997].

"The totality of the medical record that I reviewed strongly suggests that [his physician] over-interpreted the patient's July 14, 1997 chest x-ray. This is so because several chest x-rays read by radiologists, as well as two chest CT scans, make no mention of any asbestosis or asbestos-like disease.

"Asbestosis is a bilateral disease, and clearly his x-rays and CT scans, at least as reported by different radiologists over a several-month period, show no evidence for bilateral pulmonary fibrosis. Nor is there any evidence for pleural changes often seen with long term asbestos inhalation.

"Mr. V. may have worked with or around asbestos in his job at the steel mill, but he died of smoking-related lung cancer. The file I reviewed lends no support whatsoever for his cancer being of occupational origin."

Assuming That Which Is Not True

An ex-power house worker died at age 70 of lung cancer. He had a long history of smoking and also a history of some asbestos exposure. There was no evidence for asbestosis and his lung cancer was fully explainable by the smoking history. A lawsuit was filed attributing the lung cancer to asbestos exposure. An expert for the plaintiff wrote:

"In the classic paper by Hammond, E.C. and Selikoff, I.J. and Seidman H., New York Academy of Sciences 1979: 330, 473, it is stated that asbestos exposure in the absence of smoking history gives a six-fold relative risk of development of bronchogenic carcinoma. Cigarette smoking without asbestos exposure creates an eleven-fold risk over baseline population, but the presence of smoking plus asbestos exposure creates a fifty-nine-fold increase in the risk of development of bronchogenic carcinoma over a baseline population. That study did not indicate that asbestosis was required as a risk factor, but merely asbestos exposure."

The 1979 paper by Hammond, et. al. is frequently cited, by plaintiff experts, to support statements about synergism between asbestos and cigarette smoking. However, there is actually very little, if any evidence, that "asbestos exposure alone", without asbestosis, causes cancer. In a 1996 review of the subject Jones, et. al. wrote:

Asbestos is the most studied of all occupational carcinogens and, apart from tobacco, the most studied cause of lung cancer. It may therefore surprise the general reader that there is an important area of uncertainty about the relationship between inhaled asbestos and the resulting increase in risk of lung cancer. At issue is whether asbestos-attributable lung cancers are always associated with asbestos-induced lung fibrosis -- that is, asbestosis. This uncertainty has engendered a heated controversy, fuelled by important implications for regulation, workers' compensation, and litigation.

(Asbestos exposure, asbestosis, and asbestos-attributable lung cancer. Robert N. Jones, Janet M. Hughes, Hans Weill. Thorax 51:S9, 1996; page S9)

It turns out that the original asbestos cohort discussed in the 1979 article in fact had asbestosis, as was subsequently found at autopsy. Thus Jones, et. al. concluded:

Lung fibrosis of many causes - known and unknown - is associated with increased risk of lung cancer.

The much discussed synergism between asbestos "exposure" and smoking found in mortality studies of insulation workers turns out to be a synergism involving asbestosis, not just asbestos exposure.

After discussing the Jones, et. al. article and other confirmatory medical sources, I wrote:

"In my opinion, given lung cancer in a 70-year-old man with a history of heavy smoking and no asbestosis, it is simply wrong to assume a significant contribution from asbestos exposure. Anyone reading this letter should now appreciate that the assumptions made by [plaintiff's expert] reflect ignorance and/or mis-interpretation of the medical literature.

"I don't pretend to have the last word on this complex subject, and realize that there will likely always be differences of opinion on the issue. If [plaintiff's expert] chooses to respond in a manner that acknowledges the extant medical literature, which may well include many articles I have not quoted, I will be happy to review [his] response."

[Author's note: To my knowledge, there was no reply from plaintiff's expert.]

-- END of CASES --

Asbestos Lung Disease: A Primer for Patients, Physicians and Lawyers

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Web site initially posted 2004. Last update December 17, 2011.