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					                                                                                                                         World Report




  IARC in the dock over ties with asbestos industry
  Alleged links between the International Agency for Research on Cancer (IARC) and the asbestos
  industry have been condemned on the eve of a crucial UN conference. David Holmes reports.

Does asbestos corrupt more than just         not associated with the resolution        was a table based on a 2000 study             For the IARC statement on
DNA? That is the question now being          emanating from the meeting. IARC          by UK researchers John Hodgson                participation in the Kiev
                                                                                                                                     conference see www.iarc.fr/en/
asked of the International Agency            did receive a number of emails            and Andrew Darnton showing                    media-centre/iarcnews/pdf/
for Research on Cancer (IARC) after          requesting us not to participate          that chrysotile caused one case of            Chrysotile.pdf
a series of recent decisions triggered       in the meeting and our response           mesothelioma for every 100 caused             For the Kiev conference
a storm of protest from governments,         was announced on our website.”            by amosite and 500 caused by                  invitation to attend see http://
                                                                                                                                     www.pic.int/Portals/5/
non-governmental         organisations,                                                crocidolite. In 2009, the same authors        download.aspx?d=SKMBT_
and health campaigners and left              “‘We consider that it is                  published a significant revision of            C35312032110280_page1.pdf
the agency, which is an arm of WHO,           unacceptable that a scientist,           these figures, with a new ratio of             For IARC’s conclusions on
open to accusations that range from                                                    1:10:50, but this new estimate was            chrysotile asbestos see News
                                              who is a promoter of chrysotile                                                        Lancet Oncology 2009; 10: 453–54
the relatively benign charge of poor                                                   omitted from the IARC presentation.
                                              asbestos use, should be a lead             IARC’s invitation to the conference         For a BBC investigation into the
judgment to allegations of corporate                                                                                                 global asbestos trade see http://
capture by the asbestos industry.             scientist on an IARC research            was issued by the Russian Scientific           www.bbc.co.uk/news/
  The row erupted late last year,             project regarding chrysotile             Research Institute of Occupational            world-10623725
when IARC accepted an invitation              asbestos’.”                              Health (SRIOH), who were the joint
to send one of its scientists,
Valerie McCormack, to present data at        Expanding on that response, Gaudin          Panel 1: Asbestos 101
a conference in Kiev, Ukraine, entitled      explained that the Kiev conference
Chrysotile Asbestos: Risk Assessment         was seen as an “opportunity to              The term asbestos comes from the ancient Greek word meaning
and Management (panel 1). That               emphasise the dangers related to            inextinguishable, and is used today to describe a group of six
                                                                                         related silicate minerals that are divided into two types on the
decision sparked a flurry of emails and       the use of asbestos, in this particular
                                                                                         basis of their fibre morphology. Chrysotile, also known as white
letters to the Director-General of IARC      case stressing to this audience that
                                                                                         asbestos, is the sole representative of the serpentine type; so
Christopher Wild, including one seen         the often-overlooked lung cancer
                                                                                         called because of the twisted appearance of its microscopic fibres.
by The Lancet from the Italian Minister      burden is in absolute numbers much
                                                                                         The second type, the amphiboles, all have straight, needle-like
of Health Renato Balduzzi, on behalf         larger than the mesothelioma burden.        fibres, and this type accounts for the remaining five minerals:
of the Italian Government, imploring         The same scientific presentation             amosite (brown asbestos), crocidolite (blue asbestos), and the
IARC to shun the conference over             was given at the 2012 annual UICC           more rarely occurring tremolite, anthophyllite, and actinolite.
suspicions that the organisers were          meeting in Montreal and is based on a
                                                                                         Chrysotile asbestos is the only type of asbestos still produced
in cahoots with the Russian asbestos         scientific paper led by IARC staff.”
                                                                                         today, and accounts for more than 95% of all asbestos ever mined.
industry.                                      That       paper—Estimating       the
                                                                                         All types of asbestos are classed as carcinogens by WHO’s
  Sources inside WHO tell The Lancet         asbestos-related lung cancer burden         International Program on Chemical Safety, and an IARC working
that in the days leading up to the           from mesothelioma mortality—has             group of 27 scientists who met in 2009 came to the “fundamental
meeting, high-ranking WHO officials            been criticised for inaccurately            conclusion” in The Lancet Oncology that “all forms of asbestos are
urged IARC to cancel its attendance at       downplaying the risks of asbestos,          ‘carcinogenic to humans’.” And in addition to the increased risk of
the Kiev conference. A spokesperson          an over reliance on data from               lung cancer and mesothelioma associated with all forms of
for WHO’s Director-General Margaret          studies done in Quebec funded by            asbestos, the IARC scientists also concluded that “sufficient
Chan declined to comment; however,           the Canadian asbestos industry,             evidence is now available to show that asbestos also causes cancer
speaking on behalf of IARC, Nicolas          and      policy     recommendations         of the larynx and of the ovary”.
Gaudin denied that Margaret Chan             that failed to take into account            The exact mechanism through which asbestos fibres cause cancer
nor any other senior WHO officials             WHO’s recommendation to end                 is unclear, but several mechanisms have been proposed, none of
had tried to intervene, and continued        all asbestos use. McCormack also            which are mutually exclusive. The oxidative stress theory turns on
that “IARC is not privy to possible          ignored several requests seen by            the inability of phagocytic cells to engulf asbestos fibres that
discussions internal to WHO on this          The Lancet to include updated figures        become lodged in the lungs, leading the cells to produce large
subject. Discussions at IARC focused         pertaining to the mesothelioma risk         amounts of DNA-damaging free radicals as they try and fail to
on the importance of presenting the          posed by chrysotile compared with           clear the fibres. Another theory is that asbestos fibres interfere
relevant science to the audience of          amosite and crocidolite in the data         with the process of cell division, and still another theory proposes
the Kiev meeting and in ensuring             presented at the Kiev conference.           that the fibres help to concentrate other toxic substances such as
with the organisers that we were             Slide 6 of McCormack’s presentation         tobacco smoke to increase the risk of lung cancer.


www.thelancet.com Vol 381 February 2, 2013                                                                                                                      359
        World Report




            For the Rotterdam                                                                                                withdrew the SRIOH’s designation as
    Convention’s Annex III see       Panel 2: The shifting burden of chrysotile
                                                                                                                             a WHO collaborating centre because
           http://www.pic.int/
    TheConvention/Chemicals/
                                     Asbestos minerals have been prized for centuries for their ability to withstand heat    of its “promotion of continued use
 AnnexIIIChemicals/tabid/1132/       and mechanical and chemical damage, and were most widely used as additives in           of chrysotile asbestos and conflicts
  language/en-US/Default.aspx        construction materials throughout the 20th century, particularly in the post-war        of interest endangering WHO’s
For more on Canada’s role in the     construction boom in developed countries. However, mounting evidence of the             credibility”. According to IARC’s
      global asbestos trade see      carcinogenicity of asbestos led to the banning of amosite and crocidolite from the
     World Report Lancet 2010;
                                                                                                                             Gaudin, “the request to consider the
                 376: 1973–74
                                     1980s onwards in many developed economies, followed by bans on chrysotile               study first came to IARC from Russian
                                     throughout the 1990s and the early part of this century. Now, more than                 scientists, who approached IARC
        For WHOs fact sheet on
  asbestos see http://www.who.       50 countries ban the use of all forms of asbestos, including the entire European        shortly after the official signature of
    int/mediacentre/factsheets/      Union, and a de-facto ban exists in many other countries such as the USA and
            fs343/en/index.html
                                                                                                                             a Memorandum of Understanding
                                     Canada. Almost all of the worldwide consumption of asbestos is now concentrated
    For the report on the WHO
                                                                                                                             between IARC and the Russian
                                     in developing economies. According to United States Geological Survey figures, just
European region’s 2010 Parma                                                                                                 Federation in 2007”. The Lancet
                                     over two-thirds of the world’s asbestos consumption is accounted for by the rapidly
     summit see World Report                                                                                                 understands that the request was
         Lancet 2010; 375: 969       developing BRIC nations: China (30% of world consumption), India (15%), Russia
                                     (12%), and Brazil (9%).
                                                                                                                             supported by the Russian member of
                                                                                                                             IARC’s Governing Council. 2007 was
                                     Measuring the exact burden of disease caused by asbestos is notoriously difficult, in
                                                                                                                             the year that the Russian Federation
                                     part because of the often long time lag between exposure and the onset of the
                                                                                                                             resumed financial contributions
                                     disease, and in part because of problems with the diagnosis and coding of cases. As a
                                                                                                                             to IARC, including full payment of
                                     result, most surveys are likely to underestimate the number of cases of asbestos-
                                                                                                                             arrears, after what Gaudin terms “an
                                     related disease. Nevertheless, WHO estimates that over 107 000 people die each year
                                     from asbestos-related lung cancer, mesothelioma, and asbestosis from occupational
                                                                                                                             interruption in assessed financial
                                     exposure alone, with the figure likely to be far higher once environmental exposures     contributions” dating back to the
                                     are taken into account. WHO also estimates that 125 million people in the world are     early 1990s. However, Gaudin asserts
                                     still exposed to asbestos at the workplace, although the monitoring of the use of       that “the study on the quantitative
                                     asbestos is almost non-existent in many of the countries that still allow its use.      cancer risks of chrysotile in Russia (in
                                                                                                                             Asbest) was not discussed during the
                                                                                                                             sessions of the Governing Council,
                                   organisers of the Kiev conference.             (author of Asbestos Medical and Legal      and was not a condition of the
                                   IARC’s published response to the               Aspects), the authors argue that           resumption of participation [in IARC]
                                   requests that it avoid the conference          “Kovalevskiy is a leading promoter of      or financial contributions by the
                                   makes a passing reference to IARC’s            use of chrysotile asbestos. He testified    Russian Federation”.
                                   decision to collaborate with the SRIOH         before the Supreme Court of Brazil            The timing of both IARC’s atten-
                                   “on a study of cancer in chrysotile            in August 2012, as witness on behalf       dance at the conference and
                                   workers in Asbest, Russia”, the full           of the Brazilian Chrysotile Institute.     the decision to collaborate with
                                   title of which is: Historical cohort study     He testified that there is no evidence      Kovalevskiy and the SRIOH is especially
                                   of cancer mortality following exposure         whatsoever to justify banning the          sensitive, coming as it does on the eve
                                   to chrysotile asbestos at the Uralasbest       use of chrysotile asbestos; that he        of the sixth meeting of the Conference
                                   plant in Asbest, Russian Federation. The       opposes placing chrysotile asbestos        of the Parties to the Rotterdam
                                   lead author on this paper is Evgeny            on the Rotterdam Convention’s List         Convention, which will take place
                                   Kovalevskiy, and it is IARC’s decision         of Hazardous Substances; that, in the      in April. Among other things, the
                                   to work with Kovalevskiy and the               past, harm to health was caused by         conference will discuss the proposed
                                   SRIOH in particular that has given rise        the use of amphibole asbestos and          listing of chrysotile asbestos in
                                   to the gravest concerns within WHO,            excessive, prolonged exposure levels       Annex III of the Convention (panel 2).
                                   and the most vehement criticism                to chrysotile asbestos, but that, today,   All other forms of asbestos are already
                                   from outside the organisation.                 chrysotile asbestos is causing no harm     listed, and were chrysotile to be listed,
                                      In a letter to IARC’s Director-             to health in Russia. We consider that it   exporters would need to obtain “prior
                                   General Wild signed by Richard                 is unacceptable that a scientist, who is   informed consent” from importing
                                   Lemen (retired US Assistant Surgeon            a promoter of chrysotile asbestos use,     states, and take steps to ensure that
                                   General and adjunct professor at               should be a lead scientist on an IARC      importing governments are able to
                                   the Rollins School of Public Health,           research project regarding chrysotile      assess adequately the risks posed by
                                   Emory University, Atlanta, GA, USA),           asbestos.”                                 the chrysotile in a local context. It will
                                   Arthur Frank (Drexel University                   The authors then go on to point         be the fourth time that the listing of
                                   School of Public Health, Philadelphia,         out that several years ago, WHO            chrysotile has been considered and, as
                                   PA, USA), and Barry Castleman                  Director-General Margaret Chan             before, there is expected to be strong


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                                                                                                                                          World Report




opposition from parties aligned with         economic diversification in the area.
the asbestos industry.                       As a direct result, Canada reversed
   The listing of chrysotile was             its position and announced that it
first proposed in 2006, after a               would no longer oppose the listing
comprehensive review of evidence by          of chrysotile in Annex III. However,
the Rotterdam Convention’s Chemical          in 2013 Russia will, for the first time,
Review Committee (CRC), composed             have the power to veto chrysotile’s
of 31 scientists nominated by various        listing, and campaigners argue
countries. At that time, Canada was          that the Kiev conference and IARC




                                                                                                                                                               Ria Novosti/Science Photo Library
one of the largest producers and             collaboration are key planks in its
exporters of chrysotile in the world,        ongoing strategy to legitimise its
despite operating a de-facto ban on          opposition to the listing.
domestic usage, and was the largest             “The Kiev conference came out of
producer with the power to veto the          an initiative to destroy the Rotterdam
listing of chrysotile in Annex III; Russia   Convention”, says Kathleen Ruff, a
                                                                                       A chrysotile asbestos quarry in Sverdlov, Russia
was only an observer state at that           Canadian human rights campaigner
time. The Canadian representative            and senior adviser to the Rideau
exercised the veto, with the support         Institute—an independent research         asbestos, the organisation says that
of Kyrgyzstan, Iran, India, Ukraine,         and advocacy organisation based in        it recognises “the most efficient
and Peru, and chrysotile became the          Ottawa. “In 2011, those opposing          way to eliminate asbestos-related
first and only substance to have been         the listing said they wanted a new        diseases is to stop the use of all types
recommended for listing in Annex III         conference to look at the ‘modern’        of asbestos”. And yet on the same
by the Convention’s CRC to be blocked        data to counteract the Chemical           page, it states that “with Resolution
by parties to the conference. It has         Review Committee’s ruling. Kiev           60.26, the World Health Assembly
remained in that state of limbo ever         is the result. It is not a bona fide       requested WHO to carry out a global
since.                                       conference, it’s a sham conference, a     campaign for the elimination of
   At the most recent Conference             weapon to undermine the integrity         asbestos-related diseases ‘…bearing
of the Parties in 2011, the parties          of science, and it’s about more           in mind a differentiated approach to
seemed on the cusp of consensus              than chrysotile now, it’s about the       regulating its various forms—in line
after Kazakhstan, Kyrgyzstan, Ukraine,       gutting of a UN convention.” The          with the relevant international legal
India, and Vietnam (with Russia again        consensus statement issued after          instruments and the latest evidence
an observer) reversed their initial          the Kiev conference concludes that        for effective interventions…’”. That
opposition to the listing of chrysotile      “in the light of data presented in        final clause was inserted at the last
during the course of negotiations.           the conference, participants of the       minute, “without any previous
But in a move widely condemned               conference are of the opinion that        international negotiation” after
at the time, just as agreement was           under the current circumstances, the      Russia and its allies threatened to
imminent, the Canadian delegation,           issue of including (or not including)     block the whole resolution, the
which had until that point been silent,      chrysotile in Annex III to the            source says. In 2010, The Lancet
stood and declared that although             Rotterdam Convention is premature”.       reported in these pages on the
they had no disagreement with the            Although IARC is at pains to make it      Russian veto of a proposed asbestos
scientific case for listing chrysotile in     clear that it was not involved in the     ban at WHO’s European region
Annex III, they would nevertheless           discussion of the resolution, and was     summit in Parma, Italy, where Russia
oppose its listing. The Canadian             not a signatory to it, the fact that      also staged a last minute attempt
party offered no justification for their       IARC attended the conference lends it     to derail an agreement among
opposition and the listing of chrysotile     a “veneer of respectability”, says Ruff.   all members to beef up European
was again blocked, this time with               According to a WHO source who          health and environment planning
Canada as the sole dissenting voice.         wished to remain anonymous,               powers. Kovalevskiy was part of the
   As of late 2012, Canada is no longer      recent manoeuvres by the Russian          Russian delegation at the time, and
in the asbestos business, after the          asbestos industry are just the latest     told The Lancet that “NGOs in the
incoming Quebec Premier Pauline              in a decades-long campaign to resist      process might not be really non-
Marois cancelled a US$50 million             international pressure for tighter        governmental, but acting as stooges
government loan originally intended          controls on asbestos, using tactics       for some government”.
to reopen the Jeffrey asbestos mine,          that owe a great deal to the tobacco
and pledged to put the money toward          industry. On WHO’s fact sheet on          David Holmes


www.thelancet.com Vol 381 February 2, 2013                                                                                                               361

				
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