Notwithstanding the strong disagreements among these letter writers, most of them make valid points concerning the call for a worldwide ban on asbestos.1,2,3 I would like to comment on 2 of the letters.
Laurie Kazan-Allen implies that one cannot legitimately question the ban-asbestos lobby without being a lackey of the chrysotile industry. She claims that the final word on chrysotile risks was produced by “a panel of 17 experts from 10 countries, which drew on the resources of 140 collaborating centres, institutions and individuals …” Having been one of the individuals involved in that process, I can affirm that the image she conjures of an army of scientists coming together in a harmonious and coordinated fashion to answer the questions is misleading. The document was written and approved by a small group of people, not by an army of scientists. Further, given the report's equivocal recommendations, its calls for additional research and its many acknowledgements of data limitations, it is clear that this panel did not consider that it was handing down the final truth on chrysotile.
Most importantly, Kazan-Allen also misrepresents the substance of the panel's valid and valuable report. As shown by the important extracts that Kazan-Allen quoted, the panel did not recommend a worldwide ban on asbestos. Indeed, the panel recommended research concerning the economic and practical feasibility of substitution for chrysotile asbestos as well as further research on the risks of cancer following exposure to relatively low levels of chrysotile.
Finally, whether chrysotile is suitable for “Korean, Indian and Japanese lungs” is surely not for Canadians to decide; but neither is it for the English or Americans to decide. Although scientific postulates have a universal character, public health policy must be rooted in social realities specific to each country. Even if they share a common understanding of the risks associated with a given factor, it is entirely legitimate for different countries to devise different policies in light of their different local circumstances.
Regarding David Muir's letter, surely the principle he espouses would apply not only to asbestos and pesticides but to all export products whose use might involve differing standards of health and safety for workers or consumers. Canada would have to set up monitoring systems in each country to which each such product was exported. For example, before exporting cars to a foreign country, we would need to monitor that country's tobacco and alcohol regulations and practices as well as all aspects of its national road safety policies (such as seat belt laws, speed limits, highway design and policing of driving safety). National and local policies and practices regarding fossil fuel combustion and its control would have to be monitored before oil was exported anywhere. There are many more examples of products (pharmaceuticals, nickel, plastics, various foods) that might not be used as safely abroad as we would hope. The sheer magnitude of the effort required to establish and maintain bilateral multi-product monitoring programs with each country to which Canada exports goods renders the proposal a non-starter, not to mention the potential for diplomatic conflict.
Signature
Jack Siemiatycki
Professor Institut Armand-Frappier Université du Québec Laval, Que.
References
- 1.LaDou J, Landrigan P, Bailar JC III, Foa V, Frank A, on behalf of the Collegium Ramazzini. A call for an international ban on asbestos [editorial]. CMAJ 2001;164(4):489-90. [PMC free article] [PubMed]
- 2.Camus M. A ban on asbestos must be based on a comparative risk assessment [editorial]. CMAJ 2001; 164(4):491-4. [PMC free article] [PubMed]
- 3.Siemiatycki J. Should Canadian health care professionals support the call for a worldwide ban on asbestos? [editorial]. CMAJ 2001;164(4):495-7. [PMC free article] [PubMed]