A long vertical pipe sits against white-painted brickwork in the corner of a cramped storeroom. Two men wearing orange boiler suits and gloves crouch at its base. One uses a scraper to remove lumps of what looks like wet papier-mâché from the outside of the pipe, into a red bag held by the other.
Both men are breathing through facemasks, their air sucked from outside the isolation unit: a short, makeshift corridor constructed from black plastic panels and transparent polythene sheeting. An extractor fan hums relentlessly.
It might look like a scene from a horror movie in which scientists fight to contain a virus, but the truth is more banal – though no less deadly. The two men are removing asbestos insulation from a heating pipe in a west London hospital.
Ordinarily there would be bright yellow tape with the words "WARNING asbestos" on it, the site supervisor tells me. But this is an especially sensitive job. The neighbouring ward's beds are filled by patients with acute respiratory conditions, and the hospital's management decided that advertising the true nature of the work might cause alarm.
Thirteen people a day in the UK die from exposure to asbestos – more than double the number that die on the roads. In the USA, asbestos will be responsible for around 10,000 deaths this year, meaning it kills close to as many people as gun crime or skin cancer.
Health fears associated with asbestos were first raised at the end of the 19th century. Asbestosis, an inflammatory condition affecting the lungs that causes shortness of breath, coughing and other lung damage, was described in medical literature in the 1920s. By the mid-1950s, when the first epidemiological study of asbestos-related lung cancer was published, the link to fatal disease was well established.
Yet in 2012, rather than falling, worldwide asbestos production increased and international exports surged by 20 per cent. A full ban did not come into force in the UK until 1999, and the European Union's deadline for member states to end its use was just nine years ago. Today, asbestos is still used in large quantities in many parts of Asia, eastern Europe and South America, while even in the USA and Canada, controlled use is allowed.
The remarkable endurance of this magic mineral turned deadly dust is a complex tale. One of scientific deception and betrayal, greed, political collusion, the power of propaganda, and, above all, the willingness of some executives to knowingly subject hundreds of thousands of vulnerable people around the world to severe illness and even death in the pursuit of profit.
One man for whom the risks of asbestos are all too clear is Winston Bish. Two years ago the former carpenter, now aged 70, took part in a questionnaire study on lung health. Among the half of participants randomly selected to have a CT scan, he was subsequently diagnosed with mesothelioma, a rare cancer that develops in the protective linings of organs, most commonly the lungs. There is no cure.
"When the doctor said 'mesothelioma', I didn't really know what it was," says Bish in a hoarse whisper, caused by cancer-related nerve damage to his vocal cords. "Now I know it's the worst form of lung cancer you can get."
As a boy, Bish was good with his hands and used to stay behind after class for extra woodwork lessons. He left school at 15 and spent his working life in the building industry. He had frequent contact with asbestos in a variety of forms, including in guttering and roof panels.
"We were cutting those up from sheets with handsaws and knocking nails into them," Bish says. None of his employers warned him or his co-workers of the dangers of working with asbestos, and doing such work without facemasks or ventilators was commonplace, he says. It's a far cry from the precautions taken by specialist asbestos removal teams today.
Bish and his wife Jennifer married in 1966 and had two children. In the mid-1970s, he built a four-bedroomed detached house on the outskirts of St Ives, Cambridgeshire, as the family's home. As was normal practice at the time, he put asbestos fireproofing panels in the garage roof – they are still there.
It was not until the 1980s that Bish remembers fears about asbestos spreading among building workers. "We became aware through word of mouth in the industry," he says. "I don't remember any big advertising campaigns at that time. Even now there is very little awareness."
In October 2012, he had the lining of his right lung removed surgically, and now lives with the knowledge that the survival rates for mesothelioma patients are poor. Only about four out of every ten people diagnosed are still alive a year later, although the outlook is better for those able to have surgery to remove the cancer. Bish has recently completed a course of chemotherapy, and is hoping to be enrolled in a trial of a novel drug. Removal men
Asbestos is a generic term used to describe six naturally occurring minerals made up of thin fibrous crystals. Chrysotile, or white asbestos, is the only form still in use, and accounts for 95 per cent of the asbestos mined and used by humans historically. Its curly fibres make it more flexible than a family of five other forms known as the amphiboles – amosite (brown asbestos), crocidolite (blue asbestos), anthophyllite, tremolite and actinolite – which all consist of needle-like fibres.The age of asbestos
The characteristics of asbestos – strong, lightweight and heat-resistant – and the fact it could be split into fibres, mixed with other materials and easily shaped meant that use of the mineral soon caught on. Large-scale mining began in the second half of the 19th century in the USA, Italy and Canada, and during the 20th century it was incorporated into a huge variety of products, especially building materials such as concrete, pipes, cement, bricks, tiles and insulation for buildings and ships. It was also used in car parts, protective clothing, mattresses and even cigarette filters. The industry significantly expanded during both World Wars.
You may not have to look hard to find asbestos where you live or work. Many buildings still have asbestos-based components, including pipe insulation, decorative coatings, ceiling boards, fireproofing panels, window in-fill panels and cold water tanks.
Research into precisely how asbestos causes mesothelioma and other forms of lung cancer is ongoing. The fibres are so small that most can only be seen under a microscope. Billions can be inhaled in a single day with no immediate effect, but longer-term the consequences can be deadly.
The fibres can become lodged in the lining of organs such as the lungs, causing damage that interrupts the normal cell cycle, leading to uncontrollable cell division and tumour growth. Asbestos is also linked to changes in the membranes surrounding the lungs – the pleura – including pleural thickening, the formation of scar tissue (plaques), and abnormal collections of fluid (pleural effusion).
"There is absolutely no doubt that all kinds [of asbestos] can give rise to asbestosis, lung cancer and mesothelioma," says Paul Cullinan, Professor of Occupational and Environmental Respiratory Disease at the National Heart and Lung Institute, Imperial College London. "It's probably the case that white asbestos is less toxic in respect to mesothelioma than the amphiboles. The industry tries to argue that you can take precautions so that white asbestos can be used safely, but in practice, in the real world, that is not what is going to happen."
This is the firm scientific consensus. But not everyone agrees.
A town named Asbestos
Two hours' drive east of Montréal, Canada, opposite a meat-packing factory, a blue-and-white advertising hoarding stands on a piece of scrubland. It reads: "Batir l'avenir ici: Terrains industriels a vendre" ("Build the future here: Industrial land for sale"). There are many similar signs in the town of Asbestos. Asbestos, Quebec: A graphic novel
Such efforts to attract new businesses and jobs gained greater urgency in the summer of 2012. It was then that the town's Jeffrey Mine, a hole in the ground measuring a little over a mile across (and into which the Eiffel Tower could fit), ceased production of white asbestos after 130 years.
Named after its most notable export, the town once met approximately three-quarters of the world's demand for asbestos. Attempts to diversify have had limited success, and jobs are thin on the ground. Halfway between the advertising hoarding and the mine is the town's newest building, a cancer clinic. Most locals, however, appear to believe the industry's claims that white asbestos can be safely used.
"They believe that if you have cancer, it is because you smoked," says Dr Jessica van Horssen, an environmental historian at York University, Toronto, who has a forthcoming book on the relationship of the town's population to their environment, and how it affects their identity and attitudes. "The view is that asbestos can be handled safely now. The industry covered things up and it's as if the people learnt that this is what you are supposed to do. You must say it's not so bad, that it saves more lives than it kills, and if we say it's okay enough times people will believe it."
Many outsiders have suggested the town is on borrowed time. The mine only survived following the collapse of the global industry in the 1980s thanks to government subsidies. Its population, now around 6,000 (down from 10,000 in the 1970s), is ageing as well as shrinking. There were once ten primary schools, now there are two. Many homes are boarded up.
"It's a bit of a ghost town," says van Horssen. "There are few people out on the streets. When outsiders walk around, the locals will turn and look, and if you go into a local café everything goes quiet." In 2006, the Mayor, Jean-Philippe Bachand, proposed that the town change its name, as those trying to attract new businesses reported it was an obstacle. One of his suggested alternatives was Phoenix. The population voted against the name change, then voted Bachand out of office.
Where once their fathers and grandfathers were hailed as war heroes for providing the asbestos to make uniforms, buildings and military vehicles fire-resistant, now the town's inhabitants are branded international pariahs, says van Horssen. Little wonder that they don't take kindly to the criticisms of outsiders, she adds.
"Many of the people who campaign against and write about asbestos have never visited a mining community. There is also a class issue of working-class inhabitants being told by educated uppers what is best for them. Some of it can be quite patronising and their response is 'You've never been here and you don't know me'. Generations have lived and died with this mineral. It's who they are, and they can't be ashamed of it."
Birth of an industry
Some 3,000 miles from the hoarding in Quebec is another sign: "Asbestos: Once a magic mineral, but always a killer dust". The plaque is on the ground opposite the town hall in Rochdale, north-west England – to many, the birthplace of the modern asbestos industry. The Turner Brothers Asbestos Company, which later changed its name to Turner and Newall (T&N), began weaving asbestos cloth in the town in 1879.
Within just 20 years, the Chief Inspector of Factories for Britain had highlighted that working with asbestos could cause lung injuries and called for ventilation of workplaces. The first death officially attributed to occupational exposure to asbestos, however, was that of Nellie Kershaw, a yarn spinner who worked at the Turner Brothers factory in Rochdale for almost five years before her death in 1924, at the age of 33. She had been signed off work two years earlier, diagnosed with "asbestos poisoning". The company refused Kershaw's request for compensation and later declined to contribute to her funeral costs. Her remains lie in an unmarked grave.
"One of the first things that strikes you when you look at asbestos is just how long ago it was discovered to be toxic," says Geoffrey Tweedale, former Professor of Business History at Manchester Metropolitan University. Following a US legal case in 1995, Tweedale and fellow historian David Jeremy obtained a copy of the T&N company archive. They studied the almost one million documents and Tweedale went on to co-write two books on asbestos and the industry.
What this extraordinary collection of internal papers showed was how much some senior figures in the asbestos industry knew about the damage they were causing to their workers, and how their response was to launch a campaign of scientific concealment and distortion, and public misinformation that dates back over 80 years and continues today.
In 1927 a doctor called Ian Grieve wrote a detailed study of the health of workers at the J W Roberts asbestos textile plant in Leeds. He used X-rays to confirm his evaluation that the hand-beating of asbestos mattresses for locomotives (to remove lumps) could cause asbestosis within five years. A government enquiry set up a year later found that a quarter of workers with five or more years of experience in asbestos textile factories had fibrosis, rising to half of those who had worked in the industry for ten years. Regulations on dust control, medical surveillance and compensation were introduced in Britain in 1931.
Two years after Grieve's findings, executives from US asbestos companies Johns-Mansville (the owners of the Jeffrey Mine) and Raybestos (a manufacturer of automotive parts) asked Metlife, the country's largest insurer, to investigate whether the mineral was an occupational hazard for workers at five textile mills. It was found that only 17 of 108 male workers studied and three of the 18 women were free of asbestosis. These results were not published.
Nor were those from a 1930 study by physician Dr George Slade, who found that most of the workers at the T&N-operated New Amianthus asbestos mine in Eastern Transvaal, South Africa, suffered shortness of breath and weight loss and had asbestosis. Evidence of high levels of asbestosis and other health problems among Johns-Manville workers in Asbestos and the nearby Thetford Mine was similarly covered up. Contrary to the evidence on their desks, asbestos company executives claimed workers in the Canadian mines showed no signs of asbestos-related diseases, and that any ill health was the result of conditions in factories further down the production line.
Industry-backed research carried out at the Saranac Laboratory in New York State in 1940, showing that 80 per cent of mice that inhaled asbestos fibres developed pulmonary cancer, was not published. Before and during World War II, Johns-Manville company doctors closely monitored the health of Jeffrey Mine workers, telling them they were sick because they smoked or made other poor lifestyle choices, while telling their bosses that asbestos was the real culprit.
During the 1940s and 1950s, when miners died, their lungs were secretly autopsied and smuggled to the Saranac to be studied. The findings, that asbestos fibres caused cancer, were suppressed. "The whole community was treated as a giant laboratory, with the miners acting as lab mice," says van Horssen. "History shows working-class people and other marginalised populations have often been used in this way, as guinea pigs."
The epidemiologist Professor Richard Doll, famous for his work linking smoking to lung cancer, published a study showing that Rochdale textile workers were at elevated risk of lung cancer in 1955. Yet even the growing evidence emerging during the 1950s and early 1960s still had little impact on the asbestos industry. Between 1960 and 1980, production entered its fastest period of growth. A US Geological Survey study found that 80 per cent of world production during the 20th century came after 1960, by which time it was clear that asbestos caused lung cancers such as mesothelioma.
As Tweedale and co-author Jock McCulloch, Professor of History at the Royal Melbourne Institute of Technology, explain in their 2008 book Defending the Indefensible, each time the evidence showing that industry lobbyists were wrong became overwhelming, they just changed tack.
When independent research began to show irrefutable evidence of hazards, the industry began to argue that disease was only common in older workers because conditions in the past had been poor, and that new measures taken to control dust inhalation meant safe production was possible.
In 1960 a scientist named J C Wagner identified 33 cases of mesothelioma in South Africans living near an asbestos mine. Crucially, most did not work at the mine. In 1964, New York physician Irving J Selikoff found high levels of asbestosis, lung cancer and mesothelioma in insulation workers. The industry shifted position again, now arguing that while forms such as blue and brown asbestos were responsible for diseases, white asbestos from Canada could be safely used.
Scientists who published inconvenient results were vilified and harassed. Following the publication of Selikoff's findings, for example, Johns-Manville began recording and circulating his talks to executives and company medical researchers. Internal documents with titles such as 'Discredit Selikoff', released years later, reveal the lengths they went to in seeking to undermine him and his work.
An array of organisations combining industry research with public relations was established across the world, using names such as the Asbestos Research Council and the Asbestos Information Committee. The Quebec asbestos mining industry funded the setting-up of the Institute of Occupational & Environmental Health at McGill University. Any natural gaps or uncertainties in the research that showed asbestos caused disease were highlighted and exploited in an early version of the now-prevalent 'manufactured uncertainty' tactic. If these strategies sound familiar, there's a good reason: the industry was being advised by a US public relations company that had previously defended big tobacco.
"The first thing I noticed, looking at the documents, was that the asbestos industry used Hill & Knowlton, the same public relations firm that the tobacco industry were using," says Tweedale. "There are clear parallels in the way they approached their problems."
The redefinition of white asbestos as an entirely different and safer mineral has formed the core of the industry's defence from the 1960s to the present day. The Asbestos Institute, an international umbrella industry organisation, changed its name to the Chrysotile Institute in 2004. The industry has carefully selected the research it has funded in order to serve its interests. Using normal gaps in scientific knowledge about precisely how asbestos causes disease and about the relative toxicity of the different forms, it has in many places successfully undermined the truth that all asbestos is potentially dangerous in a world where damage and poor monitoring of building components is inevitable.
Because the asbestos industry encompassed so many different types of job, trade unions were slow to present a united front to defend their members on the issue. The social position of the majority of victims also helps explain why it took so long for countries to introduce legislation on asbestos use.
"Asbestos-related diseases disproportionately affect working-class people in semi-skilled or unskilled jobs, their relatives and others who lived near the factories," says Tweedale. "There was this tremendous death toll but it didn't have big repercussions because they were 'just working-class people'."
Bish agrees. "In manufacturing industry, there have always been casualties in the workforce," he says. "If it had affected the lives of politicians and high-living people rather than just the general working public, I think things would have been different. It would have been banned much sooner."
The views of the people in the town of Asbestos are echoed elsewhere in Canada, right to the highest levels of public life. Trade unions in Quebec have aggressively supported the industry. Canadian law, in backing "controlled use" of asbestos, stands in opposition to calls from the Canadian Medical Association, the Canadian Cancer Society and the Canadian Public Health Association for a ban.
Just as in the west London hospital and other workplaces and homes throughout the UK, asbestos components are being ripped out of the ceilings and walls of many Canadian public buildings. However, they are still being installed in others. In 2011, asbestos cement drainage pipes were fitted in the new McGill University Health Centre in Montréal.
In September 2012, things in Canada changed. The incoming government of Quebec – the only Canadian province that was still producing asbestos – kept its promise to cancel a CAN$58 million loan that would have reopened the Jeffrey Mine. Announcing the plans, the then Industry Minister Christian Paradis said that the federal government would spend up to CAN$50 million on diversifying the economy in asbestos-mining areas. He also announced that Canada would no longer oppose adding white asbestos to the UN Rotterdam Convention, a list of hazardous substances to which trade restrictions apply.
While Quebec's actions received some praise from anti-asbestos campaigners, many feel that the government of Canada has much more to do.
"The Canadian government does not support the science on asbestos," says leading anti-asbestos campaigner Kathleen Ruff. "It has not banned asbestos in Canada. We still import thousands of products that contain asbestos. Those in government oppose the views of the whole Canadian and world scientific community," says Ruff. "They are not stupid, so I can only conclude it's cynically done for political expediency.
"The industry has hired scientists in the same way the tobacco industry did, who claim the risks are not there," says Ruff. "Their research has been used to delay action to protect people from asbestos and to prevent it being banned. Many have been exposed and have died as a result. There's no doubt it's been very lucrative for those scientists who have gone down that path. But it's also a complete betrayal of scientific independence and integrity, and of their responsibility as human beings not to harm others."
In another tobacco industry parallel, the asbestos industry explored new markets as compensation claims and media criticism snowballed and governments tightened regulations. During the 1970s and 1980s, some large asbestos companies moved manufacture of particularly hazardous products to lower-income countries.
Funded by the Canadian and Quebec governments and mining companies, what is now the Chrysotile Institute sent delegations to Asia, Latin America and Africa to claim the mineral could be used safely. "When the UK and other developed countries stopped using it, the industry reinvented itself, creating a whole new geography of victims in developing countries," says Ruff.
From a peak of 5 million tonnes around 1980, asbestos production fell to 2 million tonnes around two decades ago, and has hovered around that mark ever since. Russia accounts for half of world production, with the other large producers China, Brazil and Kazakhstan. As of April 2013, bans on all types of asbestos use were in place in 54 countries – fewer than the number in which it is still used. China and India consume the most, together taking almost half of world production. Thailand, Indonesia, Sri Lanka, Brazil and Russia use significant amounts.
In 2013, an attempt to add white asbestos to the Rotterdam Convention was blocked by Russia, Kazakhstan, Ukraine, Kyrgyzstan, Zimbabwe, India and Vietnam. Supporters of the move said it would have led to improved labelling, handling and safety regulations, and saved thousands of lives. Opponents said it would increase shipping and insurance costs.
The World Health Organization estimates that 107,000 people die every year as a result of occupational exposure to asbestos. In the UK, the Health and Safety Executive puts the figure at about 4,700: in 2011, 2,300 British people died from mesothelioma, 2,000 from other related lung cancers and 400 from asbestosis. Tradespeople are at particularly high risk.
Attempts to calculate likely future deaths have produced widely varying results over the years, partly because the greatest risks of developing mesothelioma come between 30 and 50 years after exposure. A 2010 study predicted that 61,000 men in the UK will die of mesothelioma between 2007 and 2050 – compared with 30,000 between 1968 and 2007. The peak year for mortality was predicted to be 2016.
While most cases occur among those who work directly with materials containing asbestos, others become sick through more casual environmental exposure. In 2004 it was reported that hospital workers and school teachers ranked fourth and eighth respectively in a list of the most frequently cited occupations on mesothelioma death certificates, and that a quarter of US deaths from the disease occurred in those who had not worked directly with it.
Some healthcare workers report that this proportion may be growing. Liz Darlison is a consultant nurse at University Hospitals of Leicester NHS Trust and a founder of Mesothelioma UK, which provides information and support for patients.
"It is still predominantly carpenters, joiners, laggers," says Darlison. "But those of us who work with this disease are fearful because increasingly we are seeing more women and more people who've had casual exposure such as teachers, doctors, nurses, secretaries, and people who have sat of the knee of a dad who has worked with asbestos."
Winston and Jennifer Bish still live in the pretty, well-kept home he built for them and their children in the 1970s. He is comfortable there and had hoped it would be where he would spend many years of happy, healthy retirement. Perhaps he'll be lucky, but it's a vision that could be robbed from him any day.
Bish, though, is much more concerned that others are informed of the dangers, so they do not end up in his shoes, than with blaming anyone for his condition. "I just hope that people are made more aware of the problems linked to asbestos. It's still there in schools, offices and housing, and anyone who does DIY can come into contact with it. It can lay dormant for 40 to 50 years, and there's no cure."
"I enjoyed working in the building industry – very much so – but if I'd known the risks back then I wouldn't have gone into it," he says. "I realise now it was like playing Russian roulette. Some take the bullet, others don't. I was one of the unlucky ones."
In west London, meanwhile, a man carefully tapes up another red bag containing wet asbestos, then places it into a clear bag, which he also tapes up. The contractors remove their orange overalls, place them in a bag for disposal, then hoover each other down. Leaving the 'dirty end' of the three-stage airlock through plastic sheeting, they enter the middle stage, where they squirt water over their hair and masks. In the final 'clean end', they put on new overalls. The asbestos is taken away, destined for a hazardous waste landfill in Ipswich.
Their job is far from finished. The team will continue working at the hospital over three summers, as work can only be carried out when the heating is off. The contract for this work is worth over £400,000.
Given that asbestos could be present in any building refurbished or built before 2000 in the UK – homes, hospitals, schools, offices – it's likely that the specialist removal companies will be busy for years to come. So too will be the clinics and hospitals dealing with the human casualties of the appalling legacy of a mineral called asbestos.
- Author: Nic Fleming
- Editor: Chrissie Giles
- Fact checker: Simone Apel
- Photographer: David Ryle
- Copyeditor: Tom Freeman
- The 2008 book Defending the Indefensible: The global asbestos industry and its fight for survival, by Geoffrey Tweedale and Jock McCulloch, is the seminal account of the science that identified the health risks associated with asbestos. It also explores why the mining and manufacture continued for so long (indeed, to this day) despite the deadly consequences.
- Richard Doll's 1955 paper on the prevalence of lung cancer cases among Rochdale textile workers confirmed the findings of research from the 1940s that pointed to asbestos as a cause of lung cancer.
- J C Wagner's 1960 publication of a study that showed large numbers of pleural mesotheliomas in South Africans living near an asbestos mine. It is generally credited as the first study to show an association between this rare condition and asbestos.
- Pulmonary specialist Irving Selikoff's 1964 paper [PDF] described high levels of asbestosis, lung cancer and mesothelioma in insulation workers in the USA. It was widely covered by the media, with some declaring it to be the first definitive proof that asbestos caused cancers.
- Jessica van Horssen, an environmental historian at York University, Toronto, published her doctoral thesis in 2010. In it, she explored how people's attitudes and identities can be moulded by the environment in which they live, through a detailed study of the people of the town of Asbestos in Quebec.
- Asbestos basics from the UK Health and Safety Executive.
- Information on asbestos-related diseases from the UK Health and Safety Executive.
This article first appeared on Mosaic and is republished here under Creative Commons license. Mosaic is dedicated to exploring the science of life. Each week, it publishes a feature on an aspect of biology or medicine that affects our lives, our health or our society; it tells stories with real depth about the ideas, trends and people that drive contemporary life sciences. Mosaic is published by the Wellcome Trust, a global charitable foundation that seeks to drive extraordinary improvements in human and animal health. It covers subjects that fit with the Trust's mission and vision, but isn't limited to the research the Trust funds.