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
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
(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
- 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.,
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
(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
"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.
"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
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]
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
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
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
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.
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
"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
-- END of CASES --