UN Agencies

International organizations such as the WHO and the ILO have long been important sources of information about toxic substances such as asbestos, but these agencies are expected to provide more than just information. Most people presume that the WHO, the ILO, and many other public health agencies intercede directly when an epidemic occurs. Recent revelations of the degree to which these agencies are manipulated by industry representatives explain how the asbestos industry was able to dissuade the WHO and the ILO from intervening to stem the asbestos cancer epidemic (Castleman 1999, 2001; Castleman and Lemen 1998b; Rosenstock and Lee 2002; Watterson 1993).

The asbestos cancer epidemic currently sweeping the globe would have been largely preventable if the WHO and the ILO had responded early and forcefully. Not only was the WHO late in recognizing the emergence of the asbestos cancer epidemic, but the WHO also ignored it for years and, quite without explanation, continues to fail to address the problem of asbestos mining and manufacturing and world trade of a known human carcinogen.

The WHO, through its International Agency for Research on Cancer (IARC) and in the collaborative program with the International Program for Chemical Safety (IPCS), together with the ILO and the UN Environment Program, has on several occasions assessed the effects of asbestos and different asbestos fiber types on human health, but it has not done so in a timely manner and has had no real effect on the continued global use of asbestos (IARC 1973, 1977, 1987, IPCS 1986, 1989, 1996, 1998; WHO 1989, 1997).

Early reports linking asbestos and cancers of the lung and pleura by British, South African, and Italian investigators in the 1950s (Doll 1955; Tweedale 2002; Vigliani et al. 1964; Wagner et al. 1960) laid the foundation for the definitive investigations of insulation workers in the United States by Irving Selikoff and his colleagues. Selikoff’s studies showed the greatly increased mortality of insulation workers exposed to asbestos and made clear that an epidemic of occupational and environmental cancer was under way (Selikoff et al. 1964). In the following decade, IARC studied the carcinogenicity of asbestos fibers, but it was not until 1986, 22 years after publication of the article by Selikoff et al. (1964), that the WHO published its first document on asbestos. By that time, the asbestos cancer epidemic was claiming tens of thousands of lives. By 1973, the full range of the danger of asbestos was apparent (Hammons and Huff 1974; Huff et al. 1974, 1975). It was at this point, as least 30 years ago, that one might have expected the WHO to take up the cudgel against asbestos.

All one need do is review the list of asbestos industry advocates involved in the writing of the WHO documents to see how the confusion arose over which asbestos fibers were to be considered carcinogenic (Egilman et al. 2003; Infante, in press; Lemen, in press; Tweedale 2000). The last WHO publication to recommend a protective exposure standard for asbestos was published 15 years ago (WHO 1987). The WHO’s only recent publication is a pamphlet on how to avoid asbestos-induced health effects (WHO 2000).

The WHO appears to be satisfied at this point that it has addressed the asbestos problem with a series of publications, none of which gets to the root problem of the epidemic.

Antero Aitio of the IPCS recently stated,

   At present, WHO has no activity on asbestos in 
   progress--mainly as WHO work is more geared 
   toward risk assessment than risk management--and 
   quite apparently, asbestos at present is more a 
   problem for risk management--especially of 
   course in building renovation all over the world, 
   and in many areas, increasingly, in developing 
   countries. (Aitio A. Personal communication) 

If the WHO had spent the past three decades pressing the world community to end asbestos mining and manufacture, the world could have gone a long way to add asbestos to polio and smallpox viruses as conquered agents.

Part of the explanation for this bland acceptance of the asbestos cancer epidemic is that the WHO and the ILO have allowed organizations such as the International Commission on Occupational Health (ICOH) and other asbestos industry consultants and experts to manipulate them and to distort the scientific evidence. The WHO and the ILO were lulled into inaction by conflicting scientific reports of the epidemic. The WHO and the ILO unfortunately respond readily to political pressure and industry influence, and they fail to overcome industry public relations techniques employed for obfuscating scientific issues. To this day they continue to play little more than a minor role in efforts to control of reverse the asbestos cancer epidemic.

The ICOH is a private organization of occupational health and safety specialists. Many ICOH members are employees of major corporations or consultants to industry. When called upon as experts, they avoid the suggestion of a “conflict of interest” by stating that they are representatives of an unbiased international commission. The WHO did adopt disclosure rules, but despite exhortation from scientists, it continues to be criticized for its poor implementation of these rules. The WHO has declined requests to adopt a policy of publicly releasing the conflict of interest disclosure statements of individuals appointed to its expert panels (Axelson et al. 2002).

Robert Murray, a former president of the ICOH, was a paid consultant to the asbestos industry,

   whose writings on asbestos in the British Journal of 
   Industrial Medicine in 1990-91 establish him 
   uniquely as a defender of the asbestos industry for 
   its past and present business conduct. (Castleman 

Murray held an official position with the ILO while he represented the ICOH and the asbestos industry. During Murray’s leadership of the ICOH, consultants to the asbestos industry became prominent on the relevant ICOH scientific committees. The ICOH Scientific Committee on Fibers for many years has been dominated by members affiliated with the asbestos industry. Scientific committee members have claimed to “represent the ICOH” at meetings around the world, often misleading both international agencies and developing countries about asbestos while not disclosing their industry connections (Ashford et al. 2002; Grandjean 1997; LaDou 1998; Richter and Berman 2000; Watterson 2000).

The evidence is everywhere to be found. Castleman and Lemen (1998a) cited a few recent examples:

   In July 1997, copies of WHO draft reports called 
   "Asbestos and Health" and "Asbestos and 
   Housing" became available for technical review. 
   Both report drafts read as if they had been written 
   by the asbestos industry. 

Although at least 85% of asbestos today is used in asbestos-cement construction materials,

   the housing draft offered only the vaguest information 
   [about] the hazards of building with 
   asbestos-cement sheets and pipes; it did not warn 
   of the need for special cutting tools equipped with 
   suction hoods and high-efficiency dust capture. It 
   said nothing to director encourage people to use 
   safer substitute materials for asbestos-cement pipe 
   and sheet products. The health report described 
   high exposures to asbestos as largely a thing of the 
   past, in complete disregard for the way asbestos 
   products ... are made and used today.... 
   Castleman and Lemen (1998a) 

in many developing countries (Castleman 1999). Neither of the WHO reports mentioned the proliferation of national bans on asbestos by European countries.

Critical early reviewers of the reports said that they suffered from many errors of fact and imbalance. Morris Greenberg, HM Inspector of Factories, United Kingdom, pleaded for an extension of the review process, “for the reputation of the WHO” (Greenberg 1997). Alan Dalton, a health, safety, and environment coordinator for the Transport and General Workers’ Union, pressed the WHO to do better, noting that an editorial in The Lancet (Lancet 1997) had lamented the decline in the WHO’s reputation for technical expertise (Dalton 1997). Philippe Grandjean, of the University of Southern Denmark Odense, urged the WHO to emphasize that there were alternative building materials that could be used instead of asbestos cement (Grandjean 1998).

The WHO Regional Office for Europe published the “Asbestos and Health” report in 1999 (WHO 1999). The report received immediate criticism from the International Confederation of Free Trade Unions and from Lorenzo Tomatis, former director of the IARC. One month after the report’s publication, it was withdrawn. The report was revised and reissued in an improved form a year later (WHO 2000).

The battle against asbestos is in danger of being lost where the human costs may be greatest, in developing countries desperate for industry. Relentless efforts are being employed in the intensive campaign to establish and maintain the asbestos industry in these countries (Castleman 2000, 2001; Kazan-Allen 2003; Reuther 1997). The Indian asbestos industry, assisted by Canadian interests, announced plans to stage a conference in Delhi in 2000 to promote the manufacture and use of asbestos products. Before the meeting, a WHO letter was widely circulated in which an official of the WHO Regional Office for Southeast Asia wrote that the asbestos-cement industry and its products are “highly eco-friendly” (Aldana et al. 2000). WHO officials are often poorly informed about asbestos and subject to manipulation by industry representatives; this is particularly so in the WHO regional offices (LaDou 2002).

The ILO is a coordinating body that plays an important role in promoting occupational health and safety. It sets minimum standards in the field of occupational health and safety (Takala 1999). ILO conventions are intended to guide all countries in the promotion of workplace safety and in managing occupational health and safety programs. The ILO Conventions and Recommendations on occupational safety and health are international agreements that have legal force only if they are ratified by the governments of the member states. The ILO has no enforcement authority, and most member states do not ratify the ILO Conventions (LaDou 2003).

The ILO shares responsibility with the WHO for the failure to address the asbestos cancer epidemic. Responding to industry pressures and unrelenting scientific distortions, member states failed to support ILO efforts to confront the epidemic. The lack of participation of its member states discourages the ILO from taking on important occupational health issues. The ILO Asbestos Convention of 1986 (ILO 1986) is a good example. Written 18 years ago and not amended since that time despite major studies that show that all forms of asbestos cause asbestosis and cancer, the ILO Asbestos Convention does not ban asbestos, only crocidolite and certain manufacturing processes. Member states of the ILO are under constant pressure from the international asbestos industry to protect jobs and national prosperity. The ILO Asbestos Convention, as weak and outdated as it is, has been ratified by only 27 of the 176 ILO member states (Table 1; LaDou 2003).

The asbestos cancer epidemic is often portrayed as a classic struggle of workers and communities against the entrenched wealth, influence, and greed of industry. It is most certainly that, but this is only part of the story. The asbestos cancer epidemic is first and foremost a public health issue that requires the forceful and effective intervention of public health agencies. In this regard, the UN and many other responsible agencies have failed miserably because they were captured by the industry they were supposed to control.

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