Letter to the Editor regarding Bullock 2020

Dear Dr. McClellan,

We are writing regarding a recent commentary by William Bullock about the history of knowledge in the US about asbestos disease (Bullock 2020). Bullock relies solely on selective publications by Drs. Alice Hamilton and Carey McCord, providing an inaccurate description of their knowledge of asbestos health hazards. He also ignores considerable available evidence and mischaracterizes our own works (Castleman 2005; Egilman et al. 2014).

Citing only McCord’s autobiography, Bullock asserts that “Dr. McCord’s writings do not include any mention of asbestos as a potential occupational health hazard.” In fact, McCord’s actual publications do just that. McCord’s (1932, p. 5) book Silicosis in the Foundry referenced asbestosis in relation to dust diseases. McCord’s (1935, p. 641) chapter on “The Hazards of Industry” in Modern Home Medical Advisor notes that silica or asbestos dust “is a menace to health and life.”

Similarly, Bullock asserts that Dr. Hamilton’s first and second editions of Industrial Toxicology failed to mention that asbestos was an occupational hazard. This is also incorrect, as the second edition (Hamilton and Hardy 1949, p. 447) includes a bolded section, “Association of Lung Cancer with Silicosis and Asbestosis.” Relying largely on French and German references, Hamilton concluded, “the incidence of cancer of the lungs amongst asbestos workers is fairly high.”

Bullock overlooks Dr. Hamilton’s letters to General Electric (GE) President Gerard Swope in 1933–34, detailed in Castleman (2005, p. 584–587). One of Hamilton’s letters described “a fairly serious condition as regards asbestos dust in the insulating department” of GE’s York PA plant. She recommended improving dust control and taking chest X-rays of the longest-exposed workers. Hamilton consulted with Dr. Leroy Gardner, a leading expert on pneumoconioses, and company doctors, reporting that one GE worker with asbestosis was replaced by a workman wearing “a positive pressure air helmet.”

Bullock’s assertion that there was a dearth of knowledge in the US about the early UK and European reports are wrong; they were promptly and abundantly cited in US publications. For example, state officials in Harrisburg, Pennsylvania published a report “Asbestosis” in 1935, citing 45 references from the UK and over 30 more from Germany, France, Italy, and Canada; in addition, they cited many abstracts of foreign articles published in the US (Fulton et al. 1935). Medical journals from other countries were widely available in US medical libraries. The Journal of the American Medical Association (JAMA) also published 10 editorials, articles and letters on asbestosis and/or asbestosis and lung cancer between 1927 and 1949 (Castleman 2005). In the 1920s, JAMA reached 80 percent of US physicians (Castleman 2005). Journals largely dedicated to publishing abstracts of papers on occupational health worldwide, Journal of Industrial Hygiene (US, 1919–) and Bulletin of Hygiene (UK, 1926–), were also available in medical libraries around the US.

Bullock incorrectly claims that Castleman and Egilman publish and testify that “this information was widespread and well known as far back as the ‘30 s”. To the contrary, we claim that asbestos mining and manufacturing companies, insurance companies and others strategically kept certain information from workers and out of the public sphere of knowledge (Egilman et al. 2013, 2014). Meanwhile, abundant information on asbestos hazards was available to company doctors, lawyers, industrial hygienists, and executives of major corporations through publications of the National Safety Council (1912–) and the Industrial Hygiene Foundation (1937–). The IHF’s monthly Industrial Hygiene Digest contained abstracts of articles on occupational health from hundreds of journals, many of which dealt with asbestos, and was mailed to member companies (Castleman 2005). The IHF also wrote 600 confidential industrial hygiene investigations for member companies and trade associations by 1953 (Castleman 2005). The prolonged, unwarned and unprotected asbestos exposure of workers and the public was caused by a conspiracy of silence which extended well beyond just the companies mining asbestos and manufacturing asbestos products. The evidence of corporate knowledge and response is revealed in documents disclosed in legal proceedings and research since the late 1970s.

Bullock claims that the “2017 Barlow et al. review is the most thorough and well-researched review to date” on history and knowledge of asbestos-related disease. Barlow et al. cited only three corporate documents in their 30-page paper (Barlow 2017). Bullock himself cites none. In contrast, Castleman’s (2005) book about the public health and corporate history of asbestos is 894 pages in length, cited hundreds of unpublished corporate documents in addition to far more extensive published literature, and benefited from intensive fact-checking and access to corporate documents from all parties through hundreds of depositions and trials in which Castleman testified during the decades between its initial publication and the publication of the 5th edition in 2005.

In sum, Bullock offers an incomplete portrayal. The accounts of Drs. Hamilton and McCord are not even explored in their entirety, and such a small window of information, citing not a single unpublished corporate document, hardly warrants a title that implies an exhaustive review of what was known, by whom, and when about asbestos hazards.

Acknowledgements

The authors have no acknowledgments.

Declaration of interest

The authors prepared this letter as independent consultants and did not receive any compensation or assistance. Egilman initiated the letter because Bullock's original article misrepresented our published work as well as Egilman and Castleman's testimony (no specific examples of which were cited). Bird continued to draft the first iteration and sent it to Castleman for further input, before initial submission. All authors later redrafted to comply with the editor's limits on words and references. All authors equally contributed to producing the content of the final submitted letter.

Dr. Egilman testifies in asbestos toxic tort litigation at the request of injured human beings and asbestos product manufacturing companies. He is Clinical Professor of Family Medicine at Alpert School of Medicine at Brown University and is president of Never Again Consulting which provides consulting services to companies and legal firms.

Dr. Castleman has testified in personal injury lawsuits as an expert witness on the public health and corporate history of asbestos, usually as a witness brought by plaintiffs, for 40 years. His book on asbestos was initially based on his doctoral thesis at the Johns Hopkins School of Hygiene and Public Health, “Asbestos: an Historical Case Study of Corporate Response to an Industrial Health Hazard.”

Dr. Tess Bird is a medical anthropologist and research affiliate at the Institute for Social and Cultural Anthropology at the University of Oxford. She has worked for Never Again Consulting as a researcher for asbestos litigation.