STATEMENT OF Dr. Brad Black, MD
Lincoln County Health Officer and Director
SENATE SUPERFUND SUBCOMMITTEE HEARING TESTIMONY
9:30 AM Thursday, June 20, 2002
Good morning Chairperson Boxer, committee members, and our Montana Senator Max Baucus. As a physician and community member of Libby, Montana for 25 years, I could orate a lengthy story, but with 5-minute time constraints, I would like to tell a brief background story and then emphasize 3 important points as they relate to the Libby asbestos exposure.
I became aware of the occurrence of ARD in workers in 1977-1978—my first year in Libby. In 1978, my medical practice partner, the late Dr. Richard Irons, had engaged in conversations with WR Grace management pertaining to his desire to work with them to reduce health risk for asbestos exposure to Zonolite workers, their family members of the community. Unfortunately his concerns were not acknowledged. Nor were the EPA’s concerns regarding the 1980 assessment of vermiculite-associated asbestos acknowledged. In 1999, a Seattle PI article depicted a broad scale asbestos exposure in Libby. As Lincoln County Health officer, my first response was disbelief that any widespread environmental exposure could cause lung disease. Subsequently, the past several years have been a painful and humbling educational process for myself. During the past few years I have seen numerous community workers whose lives have been significantly impacted by asbestos-related disease. Several friends have developed lung disease and have lost over one-half of their lung function. From this experience, I would like to share with you the three important observations.
#1. The Libby exposure was extensive. The ATSDR has conservatively and efficiently screened for ARD. As Medical Director of CARD in Libby, we have followed up a large number with abnormal screens and evaluations. I have recently done analysis of our patient population and found the ATSDR’s observations to be very accurate. Somewhere between 1,300 to 1,400 individuals are very likely to have asbestos-related abnormalities. This does not include the ATSDR’s screening in 2001, which could add another 200-300 individuals.
#2. The ARD related to Libby asbestos has appeared different then that related to commercial asbestos called chrysotile. Experience has shown it to have a higher rate of causing progressive lung disease. Dr. Alan Whitehouse has studied a group of Libby patients and observed a progression of disease in 70% of diagnosed patients. Some patients develop a rapidly progressive lung disease (note included case report). Non-occupationally exposed individuals have developed lung disease that is more severe than WR Grace employees of >15 yrs. work.
#3. The incidence of malignant mesothelioma is exceedingly high. This type of tumor involves the lining of the chest or abdominal cavities. This invasive cancer eats into the chest wall and spinal column causing severe pain and is uniformly fatal. It has a high causal relationship to asbestos exposures and is termed the sentinel tumor of asbestos exposure. The occurrence of this tumor is 1 in 1 million in the general population. In Libby we are experiencing 100 times this expected incidence. Twenty-three mesotheliomas have occurred as a result of Libby asbestos exposure, with six having resulted from non-occupational exposure. Since I had submitted testimony for this hearing in April, two more individuals have been diagnosed. Their exposure history was living in Libby, one working as a forest service administrator and the other as a school health nurse. Another lady with the tumor was exposed simply working in a professional office where Zonolite workers attended appointments in dusty work clothing. Mesotheliomas can occur with relatively low asbestos exposure.
Few investigators have studied or observed the health effects of Libby asbestos. In addition to Dr. Alan Whitehouse (Board-certified chest physician, Spokane WA) whom I mentioned, Dr. Corbett McDonald (McGill University) has familiarity.
At the request of WR Grace, Dr. McDonald studied a group of Zonolite workers in 1986. Subsequently, he has done a follow up of this group and noted “these vermiculite workers suffered severely from malignant and non malignant respiratory disease.” Death from mesothelioma was 10 times higher than commercial (chrysotile) asbestos miners in Quebec. He concludes that study of workers exposure to Libby tremolite is important in that it is the only study that quantifies the risk of exposure to tremolite-like asbestos in the absence of any other fiber types.
In closing, I want to express my concern pertaining to how we will be able to meet the asbestos-related health care needs we are sure to face over the next 20-30 years. WR Grace has been providing funding for the CARD Clinic and an insurance program. However, their commitment to caring for affected individuals is waning and suggests that their support is short-lived. The need for research and developing therapies is high priority.
Additional concerns extend beyond Libby to: (1) exposures from WR Grace export plants all around the US (2) areas of California where release into the environment of naturally occurring tremolite is a result of large-scale construction activities.
I thank the Superfund subcommittee for allowing us this opportunity, and our Montana delegation for their support, and special thanks to Max with his perseverance in advocating for Montanans.
Brad Black, M.D.
Lincoln County Health Officer; Libby, Montana
Medical Director of Center for Asbestos-Related Disease