CONTENT
- Politics, not science, basis for France's ban of asbestos
- Chronology of events leading to France's asbestos ban
- Chrysotile-related lung cancer is a threshold phenomenon: HSE
- Editorial Comment: Toward intellectual terrorism
- European Commission's asbestos legislation deemed adequate
- Scientists challenge INSERM's conclusions
- What scientists have said about the INSERM Report - Policy Perspective - Chrysotile-cement products: Is a ban justified?
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On July 3, 1996, the government of France announced its decision to ban asbestos products on its territory, effective January 1, 1997. According to the decision, the production, import, and sale of asbestos-containing products, including asbestos-cement, will be prohibited. The ban was announced only 24 hours after the release of a report by INSERM* (a national research agency) upon which the French decision was supposedly based. The French ban also comes less than five years after the Court of Appeals overturned a similar initiative in the United States because the scientific evidence demonstrated that a ban was likely to do more harm than good.
Pressure for political action
Several months prior to announcing its ban, the French government responded to mounting and vocal concerns over the friable asbestos insulation problem by tabling long-awaited legislation aimed at monitoring and controlling exposures to asbestos in buildings. In light of this comprehensive new policy and France's long-held controlled-use position, the ban came as a surprise to industry analysts. But a closer look at the events leading up to the ban demonstrates that for this hugely unpopular administration besieged by a string of crises and scandals, a ban was the most politically expedient solution. It is a culmination of many factors that ultimately lead to the ban rule, and only a small number of these are directly related to the asbestos issue (Chronology of events leading to France's asbestos ban).
On the political front, over the past two years, there had been tremendous pressure on the recently elected French government resulting from the tainted blood scandal, nuclear testing in the South Pacific and a costly and disruptive general strike. With regard to asbestos, France's crisis began as the U.S. problems did - sparked by concerns over exposures to asbestos insulation materials installed during the 50s, 60s and 70s.
"Considering that many of the substitutes that the EPA itself concedes will be used in the place of asbestos have known carcinogenic effects, the EPA not only cannot assure this court that it has taken the least burdensome alternative, but cannot even prove that its regulations will increase workplace safety."U.S. Fifth Circuit Court of Appeals
Ruling Against the EPA's Asbestos Ban
In 1994, reports of allegedly asbestos-related lung cancer among teachers who had worked for several years in buildings containing low-density asbestos insulation materials gave rise to alarming media accounts of the potential risks of exposure. As in many of the cases reported, little is known about the specific exposure conditions or whether or not the lung cancers were asbestos-related. Later that year, in October, the presence of asbestos insulation materials at Jussieu University sparked concern over the safety of building workers and general occupants and led to the creation of a vocal anti-asbestos committee.
In 1995, the media went into overdrive on the asbestos issue, publishing report after report on the risks of insulation materials in buildings - some calling the problem a "deadly epidemic" and accusing French industry and government officials of conspiring to conceal the true risks of asbestos from the public. The cumulative effect of these reports left most viewers believing that all categories of asbestos fibres and products constitute a grave danger to the general public and to workers.
The Plainte Contre X Suit
Riding the wave of paranoia that had begun to sweep the nation, early in 1996, the "victims' rights" group, ANDEVA, was created to increase pressure on the government to institute a ban and to seek compensation for people who claimed to be victims of asbestos-related diseases. In June, ANDEVA would go one step further and initiate a civil suit against all individuals, including government officials, industry representatives and even scientists who had purportedly conspired to delay the implementation of more stringent regulatory measures. A similar suit over the tainted blood scandal resulted in the conviction and jailing of a number of public officials. Needless to say, the stakes were high.
INSERM Report: The final straw
The final straw came with the publication of the INSERM report which estimated that 1,950 people would die of asbestos-related diseases in 1996. The report also inferred that building occupants were at risk due to the presence of in-place asbestos insulation materials, and that chrysotile workers were at significant risk, even at low levels of exposure (i.e. 0.1 f/cc). The French government, under tremendous pressure, moved quickly and within 24 hours, announced a total ban of asbestos. The short delay between the publication of the INSERM Report and the announcement of an asbestos ban suggests that for the most part, the decision had been taken prior to the publication of the INSERM evaluation.
Often cited as the basis of the French Ban, the INSERM report has come under close scrutiny by leading experts, not only in France, but elsewhere. For example, The Royal Society of Canada, convened a panel of experts to review the report. The Panel review concluded that the basis of INSERM's impressions were seriously flawed. Other scientists, including French geochemist Claude Allègre, have been highly critical of INSERM's use of a linear dose-response model in light of the fact that risk models supporting a threshold for chrysotile asbestos are gaining favour in the scientific community. In addition, INSERM's use of dose-response slope not proven to be representative of past or present exposure conditions in France and its reliance on arbitrarily selected exposure levels to predict risk rather than using actual exposure data, suggests that the published numbers have been systematically inflated (see Scientists challenge INSERM's conclusions for a more detailed review).
American experience ignored
In many ways, the French asbestos crisis closely resembles that which was experienced in the U.S. in the 1980¹s: Asbestos in buildings became a public health issue, and the U.S. Environmental Protection Agency (EPA) announced a proposal to ban asbestos. But many of the flaws inherent in the analysis EPA put forth in favour of a ban were repeated by INSERM: failure to recognize a difference between the risks associated with different types of asbestos fibres; failure to consider studies that showed no detectable risks to chrysotile workers at low levels of exposure; and, no reference to the hazards associated with the use of substitutes. The difference is that in the U.S., the pleas of scientists for calm and reason, and the sober and measured analysis of the Court that reviewed the costs and benefits of a ban won out.
In the late 1980's, American scientists urged their government to move quickly to calm the public hysteria regarding asbestos insulation in buildings. Failure to do so, they explained, would provoke hasty removal at a great cost to society. In addition, if improperly carried out, such action would put building occupants and workers potentially at risk. And while the EPA continued to lobby for a ban, it did publicly recognize that asbestos-containing insulation materials in good condition posed no risk to the public, and recommended management over universal removal. In many ways, this marked the beginning of a shift in public opinion, spurred by outrage over how much government and private sector money was wasted on unnecessary and costly removal operations.
A year later, the U.S. Congress mandated an extensive review of the asbestos in buildings issue by the Health Effects Institute (HEI). Similarly to the EPA's position on in-place insulation materials, HEI concluded that building occupants were not at risk if the asbestos insulation was in good condition and not easily disturbed; and favoured management programs over universal removal. HEI's extensive risk evaluations also included comparative analyses which demonstrated that at the fibre levels recorded, the risks to building occupants are many times lower than everyday risks such as driving a car, being exposed to second-hand tobacco smoke or even being hit by lightning.
A few months later, the U.S. Court of Appeals issued its ruling striking down the EPA's proposed ban of asbestos in the United States. The Agency was chastised for not exploring less burdensome regulatory options, given the tremendous costs associated with specific product bans (e.g. in excess of $100 million for each hypothetical cancer case avoided in the asbestos-cement sector). Based on its review of the expert scientific testimony, the Court concluded that a ban could actually increase the risks Americans face.
Despite knowledge of these and other relevant lessons from the U.S. experience, France has proceeded with its ban of asbestos-cement and other products. Politics, not science, clearly ruled the day. Only time will tell what price French society will have to pay for this decision.
* Final version of the report is not yet available. The INSERM report was not peer-reviewed.
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July 1994
Media reports of purported asbestos-related lung cancer among teachers who had worked in buildings containing asbestos insulation materials gain national attention.
October 1994
Presence of asbestos insulation materials at Jussieu University sparks concern over the safety of building workers and general occupants. Leads to the creation of a vocal Anti-Asbestos Committee.
April 1995
Jussieu's Anti-Asbestos Committee holds a conference titled Asbestos: A Public Health Problem.
May 1995
Early in its mandate, the newly elected Juppé government faces a debilitating general strike. National and international opposition to France's nuclear testing in the South Pacific grows.
June 1995
Article published in the widely circulated magazine Sciences et Avenir qualifies the presence of asbestos insulation materials in buildings as a deadly epidemic and accuses French industry and government officials of conspiring to conceal the true risks of asbestos from the public.
September 1995
An incendiary television program, titled Deadly Asbestos based on the Sciences et Avenir article, is aired. Its sensationalist presentation suggests that all categories of asbestos fibres and products constitute a grave danger to the general public and to workers.
October 1995
In response to intense public pressure, France introduces new asbestos legislation requiring the development of a country-wide registry of asbestos-containing buildings and a plan for the monitoring and management of in-place materials. A cabinet shuffle led to a four-month delay in the implementation of the legislation.
February 1996
"Victims' rights" group, ANDEVA, is created to pressure the government to institute a ban and to seek compensation for people who claimed to be victims of asbestos-related diseases.
May 1996
France's National Academy of Medicine issues a report urging calm in the face of rising public concern over asbestos insulation in public and commercial buildings. The Academy also warned against the hazards and the costs of blind removal programmes.
June 1996
"Victims' Rights" group, ANDEVA, initiates claim - Plainte contre 'X' - a civil law suit similar to that launched in the tainted-blood affair. It accused the French asbestos industry, scientists and government officials of having conspired to delay the introduction of more stringent asbestos legislation.
July 1996
INSERM publishes its review of asbestos risks. Its estimates of 2000 asbestos-related deaths in 1996 are at the top of national news reports.
Only 24 hours after INSERM's 200-page report is published, the Government of France announces its intention to ban all uses of asbestos effective January 1, 1997.
The HSE, the U.K.'s health agency, publishes its Review of Fibre Toxicity. Contrary to INSERM it concludes that there is a threshold for asbestosis and asbestos-related lung cancer.
August 1996
Canadian and Quebec governments urge France to review its ban position. Several political and scientific missions follow. Political, technical and scientific exchanges continue.
October 1996
ANDEVA sues The National Academy of Medicine for its May 1996 report aiming to put the risks of asbestos in buildings in context. ANDEVA claims that the Academy Report is irresponsible and misleading.
November 1996
Professor at Jussieu University argues that France's ban policy combined with a "public psychosis" with no scientific basis is leading to costly, unnecessary and potentially dangerous removal. His arguments are widely cited in French media.
January 1997
Ban is passed by French assembly. It is now law.
Royal Society of Canada releases scientific review of INSERM. Report which is critical of its methodology and risk model. Based on this review, the Government of Canada concludes that INSERM provides no new information that would cause a reevaluation of its controlled-use approach.
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Chrysotile-related lung cancer is a threshold phenomenon: HSE
In its detailed scientific review of fibre toxicology for chrysotile asbestos, the U.K.'s Health and Safety Executive concludes that the weight of epidemiological evidence points to a practical threshold for asbestosis and lung cancer.
Findings on the human health effects of exposure to asbestos
In July 1996, the Health and Safety Executive (HSE) in the U.K. published a Review of Fibre Toxicology which provides a framework and guidelines for the evaluation of fibre toxicity. The HSE states that the incidence of disease - specifically, pulmonary fibrosis, lung cancer, and mesothelioma - is contingent upon the degree of hazard as determined by: (1) fibre type; (2) fibre size distribution; and (3) level of exposure. With regard to the first two determinants, the incidence of disease was found to be greater for amphiboles than for chrysotile, and long fibres were found to be more hazardous than short ones.
As for exposure, the HSE concluded that there is "a threshold level of exposure below which no radiological or clinical manifestation of pulmonary fibrosis (asbestosis) will occur." Similarly to asbestosis, lung cancer shows a dose-response relationship with respect to asbestos exposure, suggesting that "asbestos-induced lung cancer, like fibrosis, is a threshold phenomenon." The Doll and Peto risk assessment for chrysotile- induced lung cancer previously applied in the UK was based on a linear no-threshold model applied to mortality data from chrysotile textile workers. According to HSE, this approach is not supported by the toxicological evidence, leading the report to state that "a practical threshold is likely".
"These observations suggest that asbestos-induced lung cancer, like fibrosis, is a threshold phenomenon. It can be concluded that exposures which are insufficient to elicit chronic inflammation/cell proliferation will not incur any increased risk of lung cancer."
Health & Safety Executive
Few mesothelioma cases attributed to chrysotile
For mesothelioma, the HSE notes that "very few cases of mesothelioma can be reliably attributed to chrysotile, despite the many thousands of workers who have had massive and prolonged exposures to this type of asbestos. In contrast, mesotheliomas have been observed among some workers who experienced only brief exposures to amphiboles. These differences are most likely explained by the limited durability of chrysotile in the lungs, in contrast to amphiboles which are more persistent." And while the HSE notes that theoretically, there could be a threshold for asbestos-related mesothelioma, there is not enough dose-response data in either animal or human studies to confirm this.
Significance of the HSE Report
The HSE report is important for several reasons. First, it is among the first peer- reviewed scientific meta-analyses to recognize the large body of evidence indicating a threshold for chrysotile-related disease. Second, it offers a regulatory framework to industry by specifying principles for assessing the toxicity of other fibres for which only limited data exist. And finally, it stands in sharp contrast to the INSERM report, which was released only a few weeks earlier, and whose analysis is based on a linear, no-threshold risk model.
Also significant is the fact that the HSE Report makes no recommendations for lowering the existing chrysotile exposure limits in the U.K. As such, the exposure limit for work with chrysotile remains 0.5 f/ml, the import and use of amphiboles is banned, and work with in-place amphibole-containing materials is subject to a 0.2 f/ml limit.
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Mere months after the French Government announced that the import and use of asbestos fibre and asbestos products was prohibited effective January 1, 1997, French scientists have begun to rise up against this pointless and irresponsible decision. France has fallen prey to intellectual terrorism where asbestos is concerned: these are the words of internationally known geochemist Claude Allègre, whose lab is located at Jussieu, the university research centre that is on its way to becoming a symbol of overreaction to a minor problem.
France's case is an example of what can happen when political authority gives way to special interest groups. By asking for the systematic removal of asbestos from France's public buildings, these interest groups - who advocate "environmental protectionism" - are in fact proposing a remedy that is worse than the disease. Indeed, no other study has surfaced to contradict what many others have proven to date: that the risk of contracting a lung disease following prolonged exposure to small concentrations of chrysotile asbestos is insignificant. There has been no formal study of the 8,000 researchers who have gathered at Jussieu over the last twenty years to obtain additional data on non-occupational exposure to asbestos, which was the point of the debate on asbestos in France. As Allègre points out, rumour has replaced rigorous research and statistics.
Allègre places the real risks confronting people who work in asbestos-insulated buildings in perspective. He invites the people of France to look at the example of the U.S. which, a decade ago, undertook the systematic removal of asbestos from public buildings, only to realize later that this onerous task was ultimately unjustified.
Banning asbestos-cement does not solve anything
In banning asbestos-cement, the French Government has made a futile gesture and is sending the public and numerous countries that use asbestos the wrong signal. The gesture is futile because it in no way resolves the issue of asbestos in buildings, the issue that was the crux of the debate last July. Worse yet, the French government¹s decision will result in the almost total removal of asbestos from public buildings. There are many buildings containing asbestos for which a sound management program would resolve any potential problems. The ban on friable asbestos products decreed in France in 1978 should have been followed up with regulations on the management and control of asbestos, which the lawmakers failed to do. This inaction moved the associations involved in the defense of workers and occupants of buildings containing asbestos to demand that all asbestos products be banned and has given them a certain legitimacy in the public¹s eyes. The problem has taken on such importance that asbestos is now perceived as a plague which, like contaminated blood, can infect each and every one of us without our knowledge.
Stifling freedom of expression
The asbestos hysteria that has overtaken France is also the source of a series of legal actions intended to seek out the guilty parties behind this institutionalized laisser-faire. By knuckling under to special interests and doing nothing to set the record straight, the French government has given more power to the lobby groups and allowed a climate to develop in which discussion is all but impossible. Lobby groups like ANDEVA, an association for the defense of asbestos victims, are dragging before the courts anyone who dares demand a less alarmist attitude towards the problem of asbestos in buildings, as witnessed by ANDEVA¹s recent lawsuit against the Académie nationale de Médecine. Such groups have taken the government hostage. In the absence of any public debate, what has happened to the foundations of a society that calls itself democratic?
In this context, what can be said about the media's role? Motivated entirely by sensationalism, the French media allowed themselves to be swayed by the subjectivity of the pressure groups, fanning the flames of this mass hysteria. Before approving the government¹s decision and helping to spread a climate of terror, the media should have done their job by asking the responsible authorities relevant questions about the justification of their action, about the costs to the taxpayers, specifically in terms of job losses, and by allowing those opposed to banning asbestos to express themselves freely.
Because the risks associated with asbestos are known, they are also easier to control. And what will be used to replace asbestos? We should all be worried about the precedent that this decision could create for the use of other potentially hazardous substances. The fact that in occupational settings, some forms of crystalline silica were recently recognized by IARC as Class-I carcinogens, shows that banning asbestos is not a solution and that what is needed is more adequate regulation. As Allègre writes: "Zero-risk does not exist, cannot exist, should not exist. In every society, the individual must assume personal risks, and the strength of political power lies in its ability to prioritize the inevitable risks to society. All of human evolution in the last three million years has taken place in an environment that was neither neutral, nor empty." In an interview with Figaro published in December 1996, Allègre issued a plea for respect of today¹s scientific thinking: "We live in a society that is afraid, and that is developing this crazy idea of zero-risk."
Denis Hamel
Director, Regulatory Affairs.
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The European Commission first adopted an asbestos exposure directive 13 years ago. The directive required that employers consult their workers as an essential part of the evaluation procedure. In addition, it set asbestos exposure limits and prohibited the use of sprayed asbestos and insulation material.
Following a review of its asbestos exposure directive which considered new epidemiological evidence, the European Commission has deemed the legislation sufficiently stringent to protect workers, in particular from the risks of asbestosis and lung cancer. The Commission added that only a pan-European decision to ban asbestos would incite it to amend the legislation currently in place.
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