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Key references omitted from 2004 ATS Official Statement on asbestos disease diagnosis
-- a result of unwarranted author bias.

Lawrence Martin, M.D., FACP, FCCP

For Adobe format of this and related sites, see:
The 2004 ATS Statement on Asbestos Disease Diagnosis: Scientific and Ethical Problems

For related documents in HTML format, see:
ATS Official Statement 2004 -- a Flawed & Biased Statement

ATS Bias: Origins of Anti-Science in the 2004 Official Statement on Asbestos Diagnosis
'Open Letter' to ATS/AJRCCM

The following three references show that profusion reading of 1/0 can be found in non-asbestos-exposed factory workers, and in middle-aged smokers. To quote from Dick, et al: Non-specificity of 1/0, apart from the fact that 1/0 is usually an over-interpretation when made by plaintiff-attorney-hired-physicians (PAHP), belies the 2004 ATS statement (page 696) that 1/0 is "presumptively diagnostic."

The following two references, together with the Gitlin article (see below), show that PAHP significantly over read surveillance films.

The following two articles show the tremendous variability in B-reader interpretations that was known back in 1988-1991. It is this variability that has made it easy for PAHP to read practically every film in a subjective manner, to arrive at the desired (paid-for) diagnosis. Even in 1991 Dr. Ducatman was calling for Had his recommendation been implemented in 1991, or pursued by the relevant medical journals like Chest and AJRCCM, we would not have the PAHP-generated epidemic of phony asbestos diagnoses with us today. The ATS Statement not only doesn't question these phony diagnoses, but relies on them for some of its conclusions.
The following reference (a letter to the editor) shows that PAHP are paid more to make an asbestos diagnosis than to find no abnormality, and that the film is simply shopped around until the attorneys get the diagnosis they want. What is so striking about omission of this article is that another article by Egilman is cited in the Official Statement [Ref 159], to support its slant that the only problem with the PAHP surveillance readings is lack of patient counseling.
The following article shows that the film triad method (PA, left and right oblique) was considerably more reliable compared to the PA-only method. This was a blinded B-reader study in ceramic fiber-exposed workers. Lawson, et al recommended that This article, along with three others quoted in the ATS review (Lee, et al [44], Ameille et al [45], and Ross [150]), undermine the PAHP process of using a single PA film for diagnosis. Again, the bias is that the ATS Statement authors -- despite all the above peer-review medical references – still used the PAHP-generated diagnoses when it suited their purpose!
In February 2003 the American Bar Association passed a resolution calling for strict medical standards for diagnosing asbestos disease. It's purpose was to stem the tide of abuse created by plaintiff-attorney-generated asbestos screenings. The ABA resolution was of course well known to ATS -- Dr. Thomas Martin, ATS president at the time (no relation) wrote a letter objecting to the proposed standards. In this letter he wrote: Apart from the fact that the ATS Official Statement does not provide data to support many of its diagnostic statements, it is most revealing that the ABA document was not referenced. In a state-of-the-art article with 160 references, one of which is an obscure NIOSH report (Ref. 160), omission of the widely-disseminated ABA document can only mean one thing -- bias.
The following three legal references appeared in time for inclusion in the Official Statement, since the Statement quoted Ohar, et al (148), which came later. The detailed information in these legal articles demolishes the spirit, the methodology, and the conclusions of the plaintiff-attorney-sponsored screening process, and shows what a scam it is and has been. For example, from Setter, et al [physician indicated by "------" is named in the article]: The ATS Statement authors, as experts in the field, surely are aware of the mountain of information that informs the three articles below. Yet they chose to ignore it in toto. To have acknowledged the non-scientific, ethically-questionable methods of the PAHP screening process would have invalidated several of their conclusions. The bias becomes all the more apparent when one considers that the plaintiff-attorney-driven asbestos scam is arguably THE MOST IMPORTANT DEVELOPMENT IN THE REALM OF ASBESTOS DISEASE DIAGNOSIS since the original 1986 ATS statement. It has affected almost a million claimants and would-be claimants, their families, every physician who deals with lung disease, and of course the very fabric of our legal tort system. Along the way it has generated countless newspaper and magazine articles, and caused the U.S. Congress and several state legislatures to consider passing special legislation to curb the abuse. Only undue bias can explain how this development -- and its basis in physician mis-diagnosis -- was ignored in the ATS Statement.

* * *

The following article and accompanying editorial were published too late to be cited in the ATS Official Statement. However, the results (90+% over-reading of chest x-rays by Plaintiff-Attorney-Hired Physicians) were known in 2003 through congressional testimony, and are quoted in the above article by Setter, et al. The Gitlin study and accompanying editorial show clearly why it is wrong to base any conclusions on asbestos diagnoses generated by PAHP.

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