News from EOM

Pollution is the largest environmental cause of disease and premature death in the world today

20 October 2017

Philip J Landrigan et al

The Lancet Commission on pollution and health

“Diseases caused by pollution were responsible for an estimated 9 million premature deaths in 2015—16% of all deaths worldwide—three times more deaths than from AIDS, tuberculosis, and malaria combined and 15 times more than from all wars and other forms of violence. In the most severely affected countries, pollution-related disease is responsible for more than one death in four”
The Lancet Commission on pollution and health addresses the full health and economic costs of air, water, and soil pollution. Through analyses of existing and emerging data, the Commission reveals pollution’s severe and underreported contribution to the Global Burden of Disease. It uncovers the economic costs of pollution to low-income and middle-income countries. The Commission will inform key decision makers around the world about the burden that pollution places on health and economic development, and about available cost-effective pollution control solutions and strategies.

Infographic: http://www.thelancet.com/pb-assets/Lancet/stories/commissions/pollution-2017/Pollution_and_Health_Infographic.pdf

The Lancet commission on pollution and health: http://thelancet.com/commissions/pollution-and-health

New work of the EOM fellows

Budnik LT, Austel N, Gadau S, Kloth S, Schubert J, Jungnickel H, Luch A: Experimental outgassing of toxic chemicals to simulate the characteristics of hazards tainting globally shipped products. PloS one 2017, 12:e0177363.

https://www.ncbi.nlm.nih.gov/pubmed/term=Experimental+outgassing+of+toxic+chemicals+to+simulate+the+characteristics+of+hazards+tainting+globally+shipped+products

Abrahamsen R, Fell AK, Svendsen MV, Andersson E, Toren K, Henneberger PK, Kongerud J: Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway. BMJ Open 2017, 7:e014018.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Association+of+respiratory+symptoms+and+asthma+with+occupational+exposures%3A+findings+from+a+population-based+cross-sectional+survey+in+Telemark%2C+Norway

Thurston GD, Kipen H, Annesi-Maesano I, Balmes J, Brook RD, Cromar K, De Matteis S, Forastiere F, Forsberg B, Frampton MW, Grigg J, Heederik D, Kelly FJ, Kuenzli N, Laumbach R, Peters A, Rajagopalan ST, Rich D, Ritz B, Samet JM, Sandstrom T, Sigsgaard T, Sunyer J, Brunekreef B: A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework. The European respiratory journal 2017, 49(1)

https://www.ncbi.nlm.nih.gov/pubmed/?term=A+joint+ERS%2FATS+policy+statement%3A+what+constitutes+an+adverse+health+effect+of+air+pollution%3F+An+analytical+framework

An academic researcher's guide to increased impact on regulatory assessment of chemicals

by  Marlene °Agerstrand et al, in Environmental Science: Processes and Impacts, April 2017

DOI: 10.1039/C7EM00075H, Link: http://pubs.rsc.org/en/content/articlehtml/2017/em/c7em00075h

The interactions between academic research and regulatory assessment of chemicals may in theory seem straight forward: researchers perform studies, and these studies are used by regulators for decision-making. In practice, even for chemicals that have been researched by independent scientists, the regulatory chemical assessments have been shown to be based primarily on toxicity studies sponsored and/or conducted by the chemical industry. This is problematic for at least two reasons. First, we run the risk of making less informed decisions when excluding peer-reviewed studies. Second, there is an inherent conflict of interest in the system when the main responsibility for data gathering and risk assessments lies on the party that has economic interest in having the chemical on the market. To help bridge the gap, °Agerstrand and her colleagues give an overview of the general workings of legislation of chemicals and propose a set of actions to increase the usability of independent studies.

see also SYRINA, below:

A proposed framework for the systematic review and integrated assessment (SYRINA) of endocrine disrupting chemicals

by Laura N. Vandenberg et al. in Environmental Health, (2016) 15:74

The issue of endocrine disrupting chemicals (EDCs) is receiving wide attention from both the scientific and regulatory communities. When using the SYRINA framework, the overall objective is to provide the evidence base needed to support decision making, including any action to avoid/minimise potential adverse effects of exposures. This framework allows for the evaluation and synthesis of evidence from multiple evidence streams. Finally, a decision regarding regulatory action is not only dependent on the strength of evidence, but also the consequences of action/inaction, e.g. limited or weak evidence may be sufficient to justify action if consequences are serious or irreversible.

DOI 10.1186/s12940-016-0156-6, Link: https://ehjournal.biomedcentral.com/articles/10.1186/s12940-016-0156-6

Asbestos, asbestosis and cancer controversies

May 2017

Eight to fifteen per cent of lung cancer cases and nearly all mesothelioma cases are caused by asbestos. Problems in compensation issues ensue from strict legal requirements for eligibility and regulations of the corporate accident insurance institutions pertaining to eligibility for occupational disease benefits. The latter include:

• the unscientific requirement for set numbers of asbestos bodies or fibers to be found in lung tissue in order to "prove" disease causation if lung specimen are available. 

Although the validity of such evidence has been discredited by independent scientists, it is still used as evidence by some US and German pathology departments. This means that denying a causal relationship, e.g. in a case with lung fibrosis (asbestosis) or lung cancer with an asbestos load of 25 fiber-years in the absence of identification of a significant concentration of asbestos fibers or asbestos bodies in the lung (see so-called ‘‘hit and run’’ phenomenon), contradicts the medical scientific knowledge.’’ See below for more details

• The main strategy that the Italian asbestos industry and their expert witnesses have employed to rebut claims of asbestos causation in cases of malignant mesothelioma has centered on the thesis they have developed that brief exposures to asbestos are sufficient to induce mesothelioma. See below for more details

• Frequently, epidemiological evidence regarding causal relationships and exposure histories is also often being ignored by insurance-affiliated medical experts.

1. Statement for a revision of the 2014 update of the Helsinki criteria

• Asbestos, asbestosis, and cancer: The Helsinki criteria for diagnosis and attribution. Critical need for revision of the 2014 update. Baur X, Woitowitz HJ, Budnik LT, Egilman D, Oliver C, Frank A, Soskolne CL, Landrigan PJ, Lemen RA.  Am J Ind Med. 2017 May;60(5):411-421. doi: 10.1002/ajim.22709. https://www.ncbi.nlm.nih.gov/pubmed/28409857

2. Controversies and Unsound Science in the Context of the Worldwide Asbestos Tragedy  

• Unreliable proposed 'new standard' for assessing asbestos exposure. Egilman D, Baur X, Soskolne CL. Occup Environ Med. 2016 Oct;73(10):709. doi: 10.1136/oemed-2016-103704. https://www.ncbi.nlm.nih.gov/pubmed/27466612

• Asbestos: Socio-legal and Scientific Controversies and Unsound Science in the Context of the Worldwide Asbestos Tragedy - Lessons to be Learned. Baur X. Pneumologie. 2016 Jun;70(6):405-12. doi: 10.1055/s-0042-103580. https://www.ncbi.nlm.nih.gov/pubmed/27124367

• Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma. Terracini B, Mirabelli D, Baur X, Landrigan P; Collegium Ramazzini. Am J Ind Med. 2016 Jun;59(6):506-7. doi: 10.1002/ajim.22590. https://www.ncbi.nlm.nih.gov/pubmed/27785864

see also Collegium Ramazzini Statements: 

http://www.collegiumramazzini.org/download/Helsinki_Consensus_Asbestos_Comments(2015).pdf

The Collegium Ramazzini recognizes the work of the 2014 expert committee convened by the Finnish Institute of Occupational Health (FIOH) to update the 1997 and 2000 Helsinki criteria on Asbestos, Asbestosis and Cancer in light of new advances in research. The published consensus report of the Helsinki Committee (Wolff, Vehmas et

al. 2015) and its more extensive on-line version (Helsinki Criteria Update 2014 Asbestos, Asbestosis, and Cancer) provide a valuable synthesis of many aspects of current knowledge of the hazards of asbestos. The Collegium Ramazzini is, however, very concerned about the sections of the 2014 Helsinki consensus report that discuss criteria for pathological diagnosis of the diseases caused by asbestos.

Applying the 2014 Helsinki report recommendations on pathology diagnosis will lead to:

• Missed diagnoses of cases of disease caused by asbestos,

• Failure of workers’ compensation systems to properly compensate workers who have been exposed to asbestos, and

• Lost opportunities for public health authorities to recognize asbestos hazards and to prevent asbestos-related disease.

http://www.collegiumramazzini.org/download/Causation_Malignant_Mesothelioma_Comments(2015).pdf

According to Italian law, exposures leading to occupational disease not only determine liability for personal damage, but are also a potential criminal offence. In both civil and criminal trials, a key role is played by experts called to determine whether the relationship between exposure to asbestos and the occurrence of mesothelioma in a worker is a causal relationship. The Collegium Ramazzini is deeply concerned that acceptance of the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma will contribute to the unjust denial of workers’ compensation and civil damages to affected workers, that it will hinder efforts to diagnose and prevent malignant mesothelioma, and that ultimately it will undermine the health of the public in Italy and in countries around the world.