|Sergey Kashansky, pro-asbestos|
Russian government official
by Rory O’Neill, Editor, Hazards, December 2013
Lies and lobbying have their limits. If critical opposition from global health bodies was to be contained, the industry needed someone on the inside. And it pulled it off. In 2013, the World Health Organisation’s cancer agency, IARC, appointed Sergey Kashansky, a pro-asbestos Russian government official, as a collaborating scientist on the IARC Asbest Study.
Outraged scientists from the US, Canada and India, including retired US Assistant Surgeon General Richard Lemen, co-authored a 12 November 2013 protest letter to IARC director-general Christopher Wild. The letter noted: “It is, in our view, a dangerous precedent and entirely unacceptable that IARC has appointed as a collaborating scientist a person who works with the asbestos industry to defeat the efforts of the WHO to protect public health by ending the use of chrysotile asbestos.”
It added: “Dr Kashansky’s involvement in the marketing efforts of the asbestos industry and the Russian government to promote export and use of asbestos represents a conflict of interest that contravenes the ethical standards that IARC is supposed to observe.”
Kashansky presented the official Russian pro-exports line at the December 2013 ICA conference in India. Russia produces about 1m metric tons of chrysotile each year, just over half of the global production total. It is by far the world’s biggest exporter, and its biggest customer is India.
Kashansky had form. In a 2006 presentation in Montreal, Canada, he concluded: “The role of chrysotile asbestos in etiology of mesothelioma remains disputed,” a claim only ever heard from the most extreme industry propagandists. His contribution on ‘Mesothelioma and chrysotile in Russia’ was posted on the website of the Chrysotile Institute. In a video clip of the presentation Kashansky adds, as a postscript: “I missed one conclusion… exposure to chrysotile asbestos did not show any increased risk for the development of mesothelioma.”
Kashansky wasn’t the only advocate of continued chrysotile use to be developing a close working relationship with IARC staff. Four IARC scientists co-authored with Kashansky an August 2013 paper in the journal Cancer Epidemiology.7 Also listed as an author was Evgeny Kovalesky, a Russian government scientist who provided testimony in August 2012 on behalf of the Brazilian Chrysotile Institute.
Kovalesky’s evidence to the Brazilian Supreme Court supported the industry campaign to block a proposed ban on chrysotile mining and export. It is a battle the asbestos industry appears to be winning. Brazil’s chrysotile production continues to rise, up from 287,673 metric tons in 2008 to a provisional figure for 2012 of 306,500 metric tons. Its asbestos consumption has soared, from 131,000 metric tons in 2008 to 185,000 metric tons in 2011.
Like Kashansky, Kovalesky’s affiliations are well known. He was described by Laurie Kazan Allen of the International Ban Asbestos Secretariat as one of the “well-known industry mouthpieces” on the asbestos lobbying circuit, a group also including Bernstein. She added that Kovalesky, “well-known for his ties to the Russian asbestos industry,” was part of the Russian delegation to the Rotterdam Convention meeting in May 2013, where Russia spearheaded the asbestos industry’s successful lobbying effort to block a requirement that chrysotile exports should be accompanied by an explicit health warning.
There were soon indications IARC’s Russian connection could be working in the asbestos industry’s favour. IARC agreed that Valerie McCormack, one of the four IARC contributors to the Cancer Epidemiology paper, should speak at a November 2012 Chrysotile Asbestos: Risk Assessment and Management conference in Kiev, Ukraine. The decision sparked a flurry of protest emails and letters to the director-general of IARC Christopher Wild. They included one from the Italian health minister Renato Balduzzi on behalf of the Italian government, imploring IARC to shun the conference because of suspicions the organisers were in league with the Russian asbestos industry.
The Kiev conference was co-organised by the Scientific Research Institute of Occupational Health of the Russian Federation, Kovalesky’s Moscow employer. Bernstein, speaking in the same session as McCormack, addressed the conference on ‘Health risk of chrysotile as used today.’ Russian lobbyists Kovalesky and Kashansky were also on the speakers’ roster.
McCormack and her IARC colleagues were consorting with and collaborating on asbestos papers and projects with individuals responsible for pushing asbestos in India, Brazil and worldwide. IARC had all the hallmarks of an agency that had “captured” by industry.
IARC was twitchy, but unrepentant. In a statement ahead of the Kiev conference, the WHO agency defended its involvement. “The Agency is aware of concerns about its participation in the conference but is convinced that the best science needs to be communicated to all stakeholders, in line with our mandate as a research organisation,” it noted. IARC added its participation was “on the basis that IARC will not take part in or be signatory to any resolution emanating from the conference.”
RUSSIAN ROULETTE Russia has taken over from Canada as the unofficial head of the global asbestos lobby. Its scientists, some working closely with the World Health Organisation (WHO) cancer research agency IARC, now travel the world promoting chrysotile use. It is a PR campaign that isn’t going unchallenged.
It was a troubling statement; IARC was certainly guilty of a scientific and ethical double standard. When it comes to the tobacco industry, WHO agencies including IARC are required as a matter of policy to maintain a safe distance. In 2008, WHO published ‘Tobacco industry interference with tobacco control’, spelling out the dangers of inadvertently or deliberately allowing the industry to influence policy, research and practice. It noted: “Such strategies include direct and indirect political lobbying and campaign contributions, financing of research, attempting to affect the course of regulatory and policy machinery and engaging in social responsibility initiatives as part of public relations campaigns.”
Public relations giant Hill & Knowlton pioneered this tobacco industry product defence strategy. And it made sure Big Asbestos used the same playbook as Big Tobacco. Included in a Hill & Knowlton internal list of eight success stories is asbestos. Under ‘results’, it notes: “Despite the validity of the of many of the claims made against asbestos and the efforts of various groups to eliminate the material from our society, the industry still exists and is producing products that are safe.”
The asbestos industry used the same public relations consultants, the same litigation ruses, the same smoke and mirrors and even the same scientific experts as the tobacco industry. The end result for many is the same cancer.
WHO accepts there are “fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” It is a position many believe should apply equally to asbestos. But where WHO has explicit policies to combat tobacco industry interference, it actively courts the involvement – interference - of the asbestos industry. The participation of a WHO agency in asbestos industry linked activities is a matter of choice, and not as it claims “mandate.”
But it was not just the presence of IARC’s Valerie McCormack at the asbestos conference that vexed the cancer agency’s critics, it was the content of her presentation.8 The paper she presented - Estimating the asbestos-related lung cancer burden from mesothelioma mortality9 - has been slated for downplaying the risks of asbestos, an over reliance on data from studies done in Quebec that were funded by the Canadian asbestos industry, and policy recommendations that failed to take into account WHO's recommendation to end all asbestos use. Three of the five authors – McCormack, Kurt Straif and Graham Byrnes - were IARC scientists.
McCormack's presentation, based on the 2012 British Journal of Cancer paper, included a table taken from a 2000 study by then UK Health and Safety Executive (HSE) researchers John Hodgson and Andrew Darnton showing that chrysotile (white asbestos) caused one case of mesothelioma for every 100 caused by amosite (brown asbestos) and 500 caused by crocidolite (blue asbestos).
In 2009, the same authors had to admit they had got their sums wrong – really wrong. Hodgson and Darnton said the ratio was really 1:10:50. This new estimate, though, was omitted from the IARC presentation. IARC stuck with an estimate suggesting the mesothelioma risk posed by chrysotile was 10 times lower than the revised - and far more alarming - corrected estimate published three years before McCormack’s paper and presentation.
The IARC-led paper’s claims were refuted in detail in a response from US and Canadian academics published in the British Journal of Cancer on 27 June 2013.10This said the authors of the paper “fail to impose quality control standards to their study” and concluded: “The McCormack et al (2012) study minimises the health risks posed by chrysotile asbestos and suggests that ‘strict regulation’ in lieu of eliminating all asbestos use is acceptable. The suggestion that continuing ‘controlled use’ of asbestos is realistic is the asbestos industry’s position and is contradictory to the World Health Organisation’s recommendation that all use of asbestos should stop (WHO, 2006).”
IARC’s rebuttal was a scientific non sequitur. The response published in the same edition of the British Journal of Cancer,11 noted: “For chrysotile, the only asbestos fibre type being mined today, a small mesothelioma burden should not be interpreted as a small total cancer burden. The future chrysotile-related cancer burden will predominantly consist of lung cancer. The results being presented in Kiev are therefore entirely consistent with the overall assessment of the IARC Monograph program, that chrysotile, as all other forms of asbestos, is a Group 1 human carcinogen.”
None of the critics had questioned whether lung cancers would make up the largest share of the asbestos-related cancer burden, or that chrysotile was a potent human carcinogen. Most, like IARC, believe lung cancers caused by asbestos exposure will claim at least twice the number of lives as mesothelioma. But the lung cancer figure is extrapolated from the mesothelioma figure. If you under-estimate the mesothelioma figure by a factor of 10, then you do the same for the substantially larger asbestos-related lung cancer toll. And if the numbers disappear, so does the case for doing something about it.
Stung by the post-conference fall-out, a separate joint statement from WHO and IARC, issued on 19 February 2013, continued to defend the contentious paper and IARC’s trip to Kiev. It noted: “IARC confirms the completeness and accuracy of all data and statements of scientific results published in the British Journal of Cancer(Estimating the asbestos-related lung cancer burden from mesothelioma mortality, doi:10.1038/bjc.2011.563) and presented at a conference in Kiev.”
Over a two year period, WHO’s IARC has through a fatal combination of defensive blundering and wishful dissembling published a paper dramatically under-estimating the cancer risk posed by chrysotile, defended that under-estimate and then presented that under-estimate as fact at a conference critics believe was solely arranged to create a flaky scientific veneer for a chrysotile asbestos sales pitch. It had done it all in collaboration with Russian asbestos scientists.
WHO head of communications Gregory Härtl refused repeated requests fromHazards for an explanation of its agency’s increasingly accommodating relationship with the asbestos industry. The question hanging over the agency now becomes more grave. Just who is WHO protecting? We are still waiting to hear.
4. Take the money and run
The asbestos industry plan has been a success, by any standards. A key global health agency has been infiltrated. And global exports of chrysotile increased by 20 per cent in 2012, even before the 2013 leg of the industry’s promotion tour spurred by its latest scientific investment. Over the five years from 2008, and despite a vocal campaign for a ban, worldwide production remained steady at around the 2m metric tons mark annually.
ICA is bullish. Its submission prepared for the Rotterdam Convention meeting in May 2013 said there are willing markets out there, claiming a “group of countries that represents some 70 per cent of the world’s population still use chrysotile and strongly believe this can be done safely and in a responsible manner.”
But the industry also knows it is vulnerable. In 2011, just 10 countries – China, India, Russia, Brazil, Kazakhstan, Indonesia, Thailand, Sri Lanka, Vietnam and Ukraine - accounted for 94 per cent of global chrysotile consumption. The industry needs to defend these markets and develop new ones if it is to survive. This has made chrysotile product defence a multimillion dollar industry in its own right.
The asbestos lobby’s investment in Bernstein and other compliant scientists is a critical part of the plan to rehabilitate and market chrysotile. “The pro-asbestos views put forward by these scientists are rejected by independent scientists as having no credibility. Not a single reputable scientific body in the world supports their position,” said Kathleen Ruff. “But they are very popular with the asbestos industry, which has money to pay them to show up again and again at asbestos industry events, such as the one in India, to help sell asbestos or to defeat proposed bans on asbestos.”
According to a 2013 report published by WHO’s Europe office,12 it is the rest of us that lose out. “The profits made from the production of and trade in asbestos are much smaller than the societal costs of managing asbestos exposure and compensation for its consequences,” the report of an expert meeting noted.
But the industry’s product defence campaign is not about the greater good, it is about the good of the asbestos industry. As Kathleen Ruff observes: “While the asbestos industry has money to defend its financial interest, those who will be harmed as a result, and who will die painful, unnecessary deaths from asbestos-related diseases, have no money to defend their interest, which is life itself.”
While WHO and IARC policy might recognise the real costs of asbestos usage, their practice is increasingly accommodating the industry peddling the world’s biggest ever industrial killer. They work on projects together, they write scientific papers together, and they stand together on conference platforms.
At best WHO and IARC are being naïve; at worst – and the worst case seems increasingly the only conceivable explanation for their behaviour – they are being complicit in guaranteeing the continuation of asbestos trade and the deadly epidemic that trails behind it.
References (part 2)
7 J Schüz, SJ Schonfeld, H Kromhout, K Straif, SV Kashanskiy, EV Kovalevskiy, IV Bukhtiyarov, V. McCormack. A retrospective cohort study of cancer mortality in employees of a Russian chrysotile asbestos mine and mills: Study rationale and key features, Cancer Epidemiology, volume 37, issue 4, pages 440–445, August 2013.
8 IARC in the dock over ties with asbestos industry, The Lancet, volume 381, issue 9864, pages 359-361, 2 February 2013. doi:10.1016/S0140-6736(13)60152-X.
9 V McCormack, J Peto, G Byrnes, K Straif, P Boffetta. Estimating the asbestos-related lung cancer burden from mesothelioma mortality, British Journal of Cancer, volume 106, number 3, pages 575-584, published online 10 January 2012. doi: 10.1038/bjc.2011.563.
10 RA Lemen, AL Frank, CL Soskolne, S H Weiss and B Castleman. Comment on ‘Estimating the asbestos-related lung cancer burden from mesothelioma mortality’ – IARC and Chrysotile Risks, British Journal of Cancer, volume 109, pages 823–825, published online 27 June 2013. doi:10.1038/bjc.2013.301
11 V McCormack, J Peto, G Byrnes, K Straif and P Boffetta. Reply: Comment on ‘Estimating the asbestos-related lung cancer burden from mesothelioma mortality’, British Journal of Cancer, volume 109, pages 825–826, published online 27 June 2013. doi:10.1038/bjc.2013.302
12 The Human and Financial Burden of Asbestos in the WHO European Region: Meeting Report 5-6 November 2012, Bonn, Germany, WHO Regional Office for Europe, 2013.