Original Letter to the editor of AJRCCM, e-mailed 10/25/04 and rejected within 24 hours of receipt
|
2004 Asbestos Disease Guidelines Ignore
Mass Screening Abuse
I had hoped that the long-awaited ATS update on diagnosis
of non-malignant asbestos diseases (1) would be thorough and point out the diagnostic
abuse of mass asbestos claims. Instead, key
references are omitted and some of the statements seem slanted toward supporting these claims.
This is unfortunate when one considers the growing evidence that most of these claims are
medically specious.
1) The authors provide no reference for their assertion that the difference between 1/0 and 0/1
profusion readings "is generally taken to separate films that are considered to be positive for
asbestosis from those that are considered to be negative." It is well known that a B-reading of
1/0 is non-specific and non-diagnostic, as it is commonly found in middle-aged smokers and in
ex-factory workers never exposed to asbestos (2-4).
2) The authors do not reference their assertion that "the sensitivity of the plain chest film for
identifying asbestosis at a profusion level of 1/0 has been estimated at or slightly below 90%.
The corresponding specificity has been estimated at 93%."
Is this information from plaintiff-attorney-hired B-readers (PAHP)?
The authors do not acknowledge the fact that most ILO
readings by PAHP are over-interpreted (5-7), or that PAHP are paid more for a positive diagnosis
than a negative one (8). This is crucial information, as it should invalidate all medical
conclusions based on "diagnoses" generated by PAHP.
3) The authors provide no explanation of why ATS lowered the profusion score for diagnosing
asbestosis from 1/1 (in 1986) to 1/0 ("presumptively diagnostic").
4) The disclaimer that the 2004 criteria "are intended for the diagnosis of nonmalignant
asbestos-related disease in an individual in a clinical setting for the purpose of managing that
person's current condition and future health" is naive at best, disingenuous at worst. Just like the
1986 article, the new ATS review will be quoted in the legal arena. Unwittingly or not, the
authors have published unsupported statements that can (and will) be taken out of context and
quoted in court.
5)There is (incredibly) no Conflict of Interest Statement (CIS) for the authors, yet such a
statement is provided in every other article in the same issue, including letters to the editor and
studies where it would be hard to imagine any conflict. Furthermore, the web site regarding
manuscript submissions indicates the CIS is an ironclad requirement. Is ATS itself exempt?
Considering the partisanship of asbestos litigation, each author's experience consulting for
plaintiff vs. defense sides should have been spelled out in detail.
I have had the opportunity to examine hundreds of these mass asbestos claims on behalf of
defendants, and am dismayed at the lack of scientific or medical merit for most of them. Solid
legal and medical discourse is beginning to acknowledge this abuse of diagnosis (6-11). Now,
sadly, ATS has squandered a golden opportunity to publish an above-suspicion review and
champion science and objectivity in the diagnosis of non-malignant asbestos disease.
Lawrence Martin, M.D.
References 1. Official Statement of the American Thoracic Society. Diagnosis and Initial Management of
Nonmalignant diseases related to asbestos. Amer Rev Res Crit Care Med 2004;170:691-715. 2. Weiss W. Cigarette smoking and small irregular opacities. Br J Indust Med 1991; 48:841-844. 3. Dick JA, Morgan WKC, Muir DFC, et al. The significance of irregular opacities on the chest
roentgenogram. Chest 1992;102:251-260. 4 Meyer JD, Islam S, Ducatman AM, et al. Prevalence of small lung opacities in populations
unexposed to dusts. A literature analysis. Chest 1997;111: 404-10. 5. Reger RB, Cole WS, Sargent EN, Wheeler PS. Cases of alleged asbestos-related disease: a
radiologic re-evaluation. J Occup Med 1990;32:1088-90. 6 Gitlin JN, Cook LL, Linton OW, Garrett-Mayer E. Comparison of "B" readers' interpretations
of chest radiographs for asbestos related changes. Academic Radiology 2004;11:843-856. 7. Janower ML, Berlin L. "B" Readers' Radiographic interpretations in asbestos litigation: Is
something rotten in the courtroom? [Editorial] Academic Radiology 2004;11:841-842. 8. Egilman D. Asbestos screenings. Amer J Indust Med 2002;42:163. 9. Setter DM, Young KE, Kalish AL. Asbestos: Why we have to defend against screened cases.
Mealey's Litigation Report, November 12, 2003;18:1-16. 10. Bernstein DB. Keeping junk science out of asbestos litigation. Pepperdine Law Review,
Volume 31, No. 1, 2004; 11-28. 11. Brickman L: On the Theory Class's Theories of asbestos litigation: Disconnect between
scholarship and reality. Pepperdine Law Review, Volume 31, No. 1, 2004; 33-170. |
Return to ATS "Official Statement"