HEALTH PACHealthPolicyAdvisoryCenter

No. 61 November/December 1974

1 Asbestos Research:WINNING THE BATTLE BUT LOSING THEWAR. Half a century of medical research re-veals industry's scientific strategy—minimizethe problem and shift the blame.

7 Oil Refineries:IT'S ALWAYS GRAVEYARD SHIFT. Changesin technology profit the owners and disablethe workers.

28 Vital Signs31 Peer Review

WINNINGTHE BATTLEBUT LOSING

THE WAR

Asbestos ResearchI f hen it comes to coverups, the leaders ofUS industry make the Watergate conspir-ators look like a bunch of amateurs. Whilethe Watergate coverup quickly was un-covered, industry has been successfully en-gaged in covering up occupational and en-vironmental hazards for decades. In so doingit has used medical science to back up itstraditional weapons of economic and polit-ical power.

The tobacco industry, for example, re-sponded to reports of a link between smok-ing and lung cancer by funding scientistswhose studies invariably found smoking safe

or the evidence for a link to cancer incon-clusive. (1) When this tactic no longerworked, industry poured more money intoresearch to fund studies that would draw at-tention away from the obvious problem, howto curb cigarette consumption. In 1972 indus-try spent $23 million on research comparedto $2 million spent by the US government.(1, 2) As a case in point, Harvard MedicalSchool recently accepted a $23-million grantfrom eight tobacco companies to study "en-vironmental influences on the lung" and "co-factors" that may trigger lung damage fromsmoking. (3) By the very definition of theproblem, the results of the study, no matterwhat their technical quality, cannot help butshift attention away from smoking itself.

The plastics industry recently engaged ina classical coverup of polyvinyl chloridehazards. It simply suppressed information forthree years that polyvinyl chloride causesliver cancer in rats. (4, 5) Only when threeworkers died of liver cancer in B.F. Good-rich's Louisville, Kentucky plant did industryfinally admit knowledge of the hazard.

The granddaddy of occupational healthcoverups, however, is the coverup by the as-bestos industry of asbestos hazards. A Lon-

don physician first reported asbestos diseaseback in 1900. (6) A historical review of re-search papers on the subject since then re-veals industry's strategy: Ignore the prob-lem, then minimize or deny it and when allelse fails try to shift the blame.

But industry cannot pursue its aims with-out help from others—doctors, research scien-tists and academic institutions. In the case ofasbestos, scientists and institutions whose re-search was funded by industry have consist-ently found asbestos blameless or not a seri-ous hazard, while those not so funded havejust as consistently found it to be a danger-ous, unhealthy material.

What strategems were used by medicalscientists to design and execute studies thatapparently exonerated asbestos? How andwhere did industry locate these pliant indi-viduals? What impediments did non-industryscientists face in gathering information onthis occupational hazard? And why didn'tthe non-industry scientists bring this situa-tion to public attention sooner?

The answers to these questions illustratethe extent to which occupational and envi-ronmental health science is for sale in thiscountry. In a more subtle way, they indicate

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how industry-sponsored research shapes theway scientists look at a problem. Thus eventhose not biased in favor of industry mustwork in a scientific context largely shapedby industry—refuting objections raised by in-dustry, examining questions posed by indus-try, battling with scientists paid by industry.And this takes place within an even largersocial and economic context dominated byindustry's vast resources of money, influenceand information.

Under these circumstances scientists whohave not sold themselves to industry haveoften desperately tried to pursue neutral sci-entific inquiries in a social setting that is any-thing but neutral. Not understanding howindustry controls the contours of the situation,they generally, as we shall see, limited theirdebate to scientific journals while workersand the general public were largely keptunaware of the hazards that had been un-covered, thus allowing industry to continueon its merry way.

The evidence in support of these conclu-sions was gleaned from a study of over 200medical articles on asbestos published in theUS, Canada and Great Britain before 1974.These represent the vast majority of papersprinted on the subject in the English lan-guage. Papers were located and designatedas industry-sponsored or not according toprocedures listed in the Note on Method.Roughly one-third were funded by industry.

ASBESTOSIS:THE FIRST COVERUP

Asbestosis is a lung disease similar tocoalminers' black lung, caused by scar tis-sue forming around asbestos fibers trappedin the lungs. Its earliest symptoms appearmild—a slight, persistent cough and short-ness of breath upon exertion. It usually de-velops about ten or more years after the

victim's first exposure to asbestos dust. Ifdust exposure continues, the disease caneventually lead to serious lung damage anddeath, triggered either by common pulmo-nary infections or by heart failure from over-work of the organ in pumping blood throughthe diseased lungs.

Ignoring the ProblemFor three decades the asbestos industry

simply ignored reports of occupational dis-ease from the so-called "magic mineral." Thefirst case of asbestosis was diagnosed by aLondon physician in 1900. (6) The doctor didnot even see fit to publish this medical firstin a scientific journal; he just reported it toa government commission, which interredthe report in its official records. (7) It layunknown to the medical community for morethan two decades.

But what doctors did not know, the asbes-tos industry certainly did. In 1918, US andCanadian insurance companies stopped sell-ing personal life insurance policies to as-bestos workers (8)—a fact of which Johns-Manville and other asbestos manufacturersmust certainly have been aware. Manyworkers, according to later physicians' re-ports, discovered the hazards of the job soonafter being hired and left shortly (9, 10)—again a fact which the companies must haveknown.

The medical profession rediscovered as-bestosis in 1924, when Dr. W. E. Cooke re-ported in the British Medical Journal thedeath of a 33-year-old woman who hadworked since age 13 in an asbestos factory.(11) On autopsy, he found massive depositsof asbestos dust in the woman's lungs.Eleven more such case studies were pub-lished in Great Britain during the 1920's.They were reported by pathologists at hospi-tals in London and Wigan and at medicalschools in Leeds and Durham. Many victims

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had prior cases of tuberculosis and diedwithin a few years of being hired. But insome cases asbestosis was found at autopsywith no sign of tuberculosis, unequivocallyimplicating asbestos itself as a cause of thedisease. (12, 13)

On this side of the Atlantic, the first casehistory of asbestosis in the United States wasreported in 1930 at the Mayo Clinic, where anautopsy on a cardiac victim revealed heartfailure due to asbestosis. (14) In the sameyear a pathologist at Yale reported anothercase. (15) By 1935 a total of 28 asbestosiscases had been reported in Great Britainand the United States. (16)

Minimizing the ProblemAfter years of doing nothing, the US as-

bestos industry in 1929 responded to thedrumbeat of medical reports by commission-ing the Metropolitan Life Insurance Com-pany to conduct a study on asbestosis. (17)Met Life was assisted by the Department ofPublic Health at McGill University in Mon-treal (18), whose cozy relationship with theasbestos industry will be discussed later inthis article.

Medical examinations were conducted be-tween 1929 and 1931, but the results werenot published until 1935. A total of 126 as-bestos workers were selected at randomfrom five plants and mines in the US andCanada, mostly Johns-Manville facilities.67 of the 126 workers examined were classi-fied as positive cases of asbestosis, 39 asdoubtful and only 20 as completely free ofany sign of asbestosis. (17) On their face,these figures represent an epidemic of dis-ease. Calculated as percentages, the find-ings showed 53 percent of the workers hav-ings asbestosis, 84 percent with some signsof disease (positive plus doubtful) and only16 percent with no signs of asbestosis at all.Amazingly enough, however, the authorsdid not even publish these percentages, sodevastating is their impact. Rather, theysimply listed the number of workers in eachcategory and hurried on without comment.Short of suppressing the data, they couldhave done no less.

In addition to minimizing the incidence ofdisease, the authors also minimized its se-verity. Time and again, the authors reiter-ated that the workers appeared healthy, thatthey were not disabled. Yet their own paper

4 presents evidence to the contrary. Out of 121

physical examinations, 96 workers (79 per-cent) complained of persistent coughing orshortness of breath, typical early symptomsof asbestosis. But the authors summarily dis-miss the response: "Too much emphasisshould not be placed on statements of sub-jective symptoms."

The US government served as handmaidento industry in this case by publishing theMet Life study as a Public Health Report ofthe US Public Health Service.This gave thestudy the imprimatur of the federal govern-ment despite its genesis in industry, its in-dustry funding and its appalling pro-indus-try bias. (17) Few actions more clearly illus-trate the interlock between industry andgovernment.

Science and PoliticsIn 1931, the British government made as-

bestosis a compensable disease under itsworkmen's compensation laws, and somepreventive measures were taken to limitworker exposure to asbestos fibers. In theUS, where both workmen's compensationand occupational health programs were un-der state jurisdiction, similar actions werenot taken until the 1960's.

More important, in neither country did thehazards of asbestos become a major publicissue during the 1920's and 1930's. Discus-sion was largely confined to scholarly medi-

cal journals and later to government bu-reaucracies. The doctors and scientists whouncovered asbestosis did not draw out itseconomic and political implications in theirpublished papers, although such journalswere their main national and internationalforum for presenting their findings. To besure, almost all the papers reflected a hu-mane concern for the afflicted workers. Butoccasional appeals for help in dealing withthe problem were invariably directed to in-dustry, whose self-interest was to minimizethe hazard and clamp a lid on a public dis-cussion that might alarm workers and cus-tomers. Instead of quixotic appeals to indus-try, what was called for was public, politicaldiscussion on controlling the hazards of as-bestos—eliminating all unnecessary uses ofthe material and controlling exposure whenits use was mandatory.

This failure to develop public debateabout asbestos planted the seeds of ourpresent failure to cope with the problem. To-day asbestos, with its thousands of uses inhomes and industry, has insinuated itself sothoroughly into daily life that it is difficultto conceive of eliminating its widespreaduse any more than we can contemplategiving up the automobiles that pollute ourair and waste our energy resources.

But back in the 1920's and early 1930's,when asbestosis reared its head as the firstof many asbestos health hazards, the asbes-

tos industry was small and the uses of thematerial still limited. Manufacture of asbes-tos in commercial quantities only began inthe first decades of this century—Johns-Man ville was founded in 1901 (20) and thelargest British Company, Turner Brothers, in1916. (21) World production of asbestos in1920 was only 200,000 tons, 5 percent ofpresent production. In 1925 Johns-Manville'stotal sales were only $40 million. (20) And aslate as 1933, according to a British govern-ment report, only 35,000 to 40,000 peoplethroughout the world worked with asbestos.(22)

Before World War I transite water pipe(water pipe strengthened by asbestos) had notyet been developed; today it is the singlemajor use of asbestos. Asbestos insulationfor ships did not come into widespread useuntil the shipbuilding boom during WorldWar II, when several million shipyard work-ers were exposed, many with dire conse-quences. (23)

LUNG CANCER:MORE OF THE SAME

In 1935 two doctors at the Medical Collegeof South Carolina reported an autopsy on anasbestos worker who had both asbestosisand lung cancer. (24) Other cases followed,and by 1942 ten had been reported. (25) Itappeared that the incidence of lung cancer

Note On MethodA study was made of about 200 medical

articles on asbestos published in the UnitedStates, Canada and Great Britain before 1974.The search was begun using bibliographiespublished in the 1972 NIOSH criteria docu-ment on asbestos (8), the 1971 NationalAcademy of Science report on asbestos (59)and a computer search of materials in theNew York State medical library system. Thesewere supplemented by references found inthe original articles. All but about 30 refer-ences were found. Articles were designated asindustry-sponsored if one or more of the au-thors gave a company address in the paper,if a grant from an industry or an industrial as-sociation was acknowledged in the paper orif the paper was part of a series in which the

initial paper acknowledged industry support.In a very few cases papers were listed as in-dustry-sponsored when they were reported assuch in "History of Johns-Man ville Research,"published by the company for the 1972 OSHAhearings on asbestos (18), even though thepapers themselves did not acknowledge thissupport. (This omission has occurred moreoften in recent years as asbestos has comeunder increasing attack as a health hazard.)

Papers reported at international confer-ences were excluded from the tally of indus-try and non-industry articles since new ma-terial was invariably published elsewhere inthe literature and many papers comprisedgeneral talks that offered no new data. 5

among asbestosis victims was unusuallyhigh, leading to the suspicion that asbestoscauses cancer as well as asbestosis. Since theasbestos industry was already under attackin the 1930's because of asbestosis, it didnot ignore these reports as it had done solong for asbestosis but quickly shot back adenial that asbestos causes lung cancer.

Denying the ProblemThe industry position was presented in a

1938 paper by Arthur Vorwald and JohnKarr (26) of Saranac Laboratory, a tubercu-losis facility in upstate New York. The paperdid not speak of industry sponsorship, butthe relationship among Vorwald, Saranacand the asbestos industry was longstanding.Between 1930 and 1946 Saranac was thesite of animal studies by L. U. Gardner,funded by the Quebec Asbestos Mining As-sociation (QAMA), on the effect of asbestoson tubercular and normal lungs. (27, 28)After Gardner's death in 1946, Vorwald be-came director of the Laboratory and con-tinued Gardner's animal studies underQAMA sponsorship. (29) Johns-Manville Cor-poration in its History of Johns-Manville Re-search points proudly to its long associationwith Saranac.

Vorwald and Karr dismissed the case stud-ies linking lung cancer with asbestosis be-cause the group of workers examined,asbestosis victims, were not a typical, ran-dom group of asbestos workers. It was quitepossible, they argued, that asbestosis vic-tims might be especially susceptible to lungcancer.

Based on medical knowledge at that time,the Vorwald and Karr argument could notbe dismissed out of hand. Scientists couldnot definitely prove or disprove the lungcancer-asbestos link based only on casestudies of asbestosis victims. What wasclearly called for was a large-scale, plant-wide study—an epidemiological study inwhich an entire population of workers em-ployed at some particular date was followedfor a period of years and all cases of dis-ease recorded. But the Catch-22 was that theasbestos companies had custody of the per-sonnel records on which such a study wouldnecessarily be based, and they did not wantthe study to be conducted. Scientists did notprotest the industry's denial of access to thisinformation or insist in their scientific papers

6 that epidemiological studies be carried out.

True to their professional codes, they keptsilent. So nothing happened—except 20 moreyears of growing profits for the asbestosindustry.

Despite more evidence of lung canceramong asbestosis victims after World War II(30, 31), industry kept silent. Then in 1955 aBritish scientist conducted the plant-widestudy that was clearly called for in 1938,and found an unusually high rate of lungcancer among all asbestos workers. (32) Thescientist, who was a member of England'sprestigious Medical Research Council, drewhis data from records kept by the Britishgovernment after enacting legislation on as-bestos in 1931.

Still Denying the ProblemIn what for them was a lightning fast

response, the Quebec Asbestos Mining Asso-ciation commissioned a study the next yearof lung cancer among asbestos miners inQuebec. This was 21 years after the firstreports linking asbestos and lung cancer.What industry badly wanted was a white-wash job—and it got one.

The study was conducted under a QAMAgrant by the Industrial Hygiene Foundation(IHF, now called the Industrial Health Foun-dation). IHF, located in Pittsburgh, performsoccupational health studies for corporations.It is openly pro-management (see BULLETIN,September, 1972), and is supported almostentirely by major US industries. Within thelast decade it has become affiliated with theCarnegie-Mellon Institute, a small, presti-gious university in Pittsburgh, and has main-tained close ties to the Department of Indus-trial Health at the University of Pittsburgh.(Most IHF senior staff hold appointments atthe University of Pittsburgh.)

As in the asbestosis case, the contrast isstriking between the enormous size andscope of this experiment and that of the non-industry case studies—a fact that lent credi-bility to the industry study. The IHF investi-gation was an epidemiological study of agroup of 6,000 asbestos miners from the twolargest mines in Quebec. All workers withfive or more years of exposure who were onthe employment rolls in 1940 were followeduntil 1955, and their medical records, deathcertificates and insurance records examinedfor evidence of lung cancer.

(Continued on page 20)

Oil Refineriesm he petroleum industry is hated by millions

of Americans. Oil-soaked beaches, air pollu-tion, high prices and exorbitant profits areamong the abundant reasons for the public'sjustified anger.

Oil refinery workers have also traditionallynot been enthralled with the industry. A pri-mary reason is that refinery workers spendmuch of their lives working amidst toxicfumes, vapors and dusts, oppressive heatand deafening noise. Most directly of allAmericans, they face the lethal consequencesof the industry's drive for maximum produc-tion.

The oil companies attempt to instill an im-age of oil refinery operations as devoid of hu-man labor power. While this image is untrue—almost 90,000 workers are now employed inUS refineries and more will be in the futuredue to new construction—it serves a usefulpurpose for the industry; this image concealsthe fact that technological progress undercapitalism has brought not safer workplacesbut increased disease and death.

The Bad Old DaysRefineries operating at the turn of the Cen-

tury were extremely hazardous places. Theoccupational dangers of running a new indus-trial technology involving flammable liquidsand vapors at extreme temperatures and pres-sures were learned through experience. Ex-plosions and fires were frequent.

On the 15th of July, 1915, the still cleanersat Standard Oil's Bayonne, New Jersey re-finery walked off their jobs. (A still is a dis-tillation chamber.) They struck in part overdemands for better working conditions. Fivedays after the strike began, the New YorkTimes reported that even the scab still clean-ers hired by Standard had quit because they"found those conditions unbearable." (1) Thestill cleaner's job was particularly perilous.Dressed in an asbestos suit for protectionfrom heat as high as 250 degrees Farenheit,it was their responsibility to chip away at thecoke that remained on the surfaces of thechamber once the gasoline had been sepa-rated out. Paid $2.00 to $2.40 a day for theirlabor, stillmen probably developed black

IT'SALWAYSGRAVEYARDSHIFT

lung, the disease of the coal miner, from con-stant exposure to coke dust.

The workers at the Bayonne refinery struckbecause the company forced them to enterthe stills before they were safely cooled. Forevery minute the stills were shut down, Rock-efeller and Standard Oil lost profits. The strikewas eventually lost by the workers, whoseranks were broken by the company throughthe use of an army of strikebreakers, policeand the courts. The strike left nine workersdead and about 50 injured. Still it was thebeginning of strikes in the oil industry forsafe working conditions.

In the not-so-good old days, exposure tohazards was not limited to the still workers.A corporate history of Standard Oil of Indi-ana describes another process at the refineryas follows: "The noxious sulphur dioxide pro-duced in roasting the copper sulphide and thefine floating dust made the millhouse an in-ferno. It was the dirtiest and most unhealthywork in the refinery. . . . The work was donemostly by foreigners. Workmen had to wearrespirators, and most men could stand only afew days of it. If they stayed too long, thefumes ate the skin off their faces, turned theirhair green, and made their eyes bloodshot.One of the great curiosities about the refinerywas an old white horse that hauled the cop-per sulphide to the dump. Its white hair hadturned green." (2)

"I think you need recognitionof the fact that every plant isin business to make money,and it takes a team effort. Oil isnot our product; money is."

William Miller, Sun Oil CompanyNational Petroleum Refiners Association1973 Refinery Maintenance Conference

In 1941, H. N. Blakeslee, then Director of theDepartment of Accident Prevention for theAmerican Petroleum Institute, the industry'strade association, looked back at early re-finery work: "Twenty-five years ago it wascustomary for men cleaning tanks to workin relays. Each man came out of the tank as

8 he became dizzy from breathing the vapour.

He would rest for a short time until his dizzi-ness had passed and then replace some otherman in the tank. Occasionally, a man stayedtoo long and had to be dragged out and re-vived by artificial respiration, that is, if some-one were present who knew how to performartificial respiration. .. . Some refineries evenmaintained rescue squads to do the rescueand resuscitation work. An individual at-tached to one of these squads says that res-cues became so common that they ceasedto be exciting." (3) One of the few statisticalindications of the high refinery accident ratesat that time came from the Baytown, Texasoil refinery of Humble Oil Company, where in1920 there were 2,266 accidents among athousand employees. (4)

The Worse New DaysIn the old days a typical oil refinery was

identified by the great black clouds of densesmoke pouring forth from its stacks. Todayrefineries look a lot cleaner with little visibleevidence of pollution.

Open tanks of toxic chemicals have gen-erally been replaced by mazes of pipelinesand closed vessels. Because oil may continu-ously flow from one unit to another by push-ing a button, there is thought to be less work-er exposure to dangerous chemicals. Forthose workers who, like the stillmen and tankcleaners of old, are exposed to toxic agents,modern respirators offer protection.

Despite this reassuring appearance, oil re-fineries may actually be more dangerousworkplaces today than they were in the firsthalf of the 20th Century. Not only do workersstill face the likelihood of fire and explosion,they are also exposed daily to a vast arrayof toxic agents, among them chemicals thatcan asphyxiate and produce skin and lungdiseases and cancer.

These occupational safety and health prob-lems have become more severe since WorldWar II. During and immediately after the waryears, new processes based on new tech-nology were introduced to increase produc-tion of petroleum products. Yet after thewidespread use of the new technology beganand refineries grew in size, the industry dras-tically reduced the size of the refinery work-force and the level of maintenance. Whilethese two factors account for the occupation-al dangers of the American oil refinery, amore basic explanation is the profit maximiz-ing goal of industry.

Between 1946 and 1971, United States con-sumption of petroleum products rose from un-der five million barrels per day to over 15million barrels per day, an increase of 200percent. (5) This growth reflects increased de-mand created by World War II and the Kor-ean War for high-octane aviation fuel; in-creased air travel, which brought greater de-mand for kerosene-based turbine fuel; the re-placement of coal with oil; and constructionof large buildings that used residual fuel oilfor heating. Post-War highway constructionincreased demand for asphalt, and the devel-opment of a huge petrochemical industry-making thousands of petroleum-based prod-ucts, from plastics to synthetic fibers, out offeedstocks such as liquefied petroleum gas -also contributed to industry growth.

The single most important reason for thegrowth in demand of petroleum products,however, has been the increasing reliance onmotor vehicles as the dominant means oftransportation. In 1940, the motor vehicle topeople ratio was 1:4; in 1950,1:3; and by 1970,1:1.9. (6) This trend resulted in an increase ofover 200 percent in gasoline demand between1946 and 1971. (7)

Technological change and expansion ofcapacity have enabled U.S. refineries to in-crease their input by almost 225 percent be-tween 1946 and 1971. (8) Thus an understand-ing of the industries' new health and safetyhazards depends upon an understanding ofthe technological changes responsible for in-creased production and profits.

Technology to the RescueBefore World War II, the petroleum indus-

try's profits were limited by relatively simplerefining techniques; only a very limited quan-tity of hydrocarbons suitable for direct usein high-octane aviation fuel and motor gaso-line could be refined out of a barrel of crudeoil. But with large military demands for avia-tion fuel and with motor-vehicle gasoline inshort supply and high future demand beingpredicted, the industry developed the tech-nology to produce increasingly profitable"light ends," such as gasoline and naturalgas, and less of the not-so-profitable heatingoils, a trend that has continued to the present.Of the new processing methods the most im-portant has been catalytic cracking (cat crack-ing).

The appeal of catalytic cracking to the in-dustry is its ability to make more gasoline

more efficiently from a wide variety of feed-stock materials. The method involves thebreaking down of large hydrocarbon mole-cules into new compounds which may varyfrom simple hydrogen gas to gasoline toheavier fuels.

In this process, a catalyst and hot oil vaporare mixed and then heated to a high temper-ature in a large reactor vessel where the oilbreaks down into lighter products. Catalystand vapor are then separated, the catalystflowing into another large vessel, the regen-erator, and the oil vapor further separated by

After the War, the government-built refineries were sold to thecompanies at or below cost.

distillation into its various fractions. In theregenerator, the coke that had formed on thecatalyst during the earlier stage is burnedoff. The regenerated catalyst is then recycledto the reactor for more contact with oil vapor,and the process begins again.

Catalytic cracking found its first applica-tion during World War II in the manufactureof aviation gasoline. Today it is the most im-portant process used to make automotivegasoline. The early history of the process' in-troduction suggests why new technology inthe oil industry is associated with increasedwork hazards.

In 1942 Standard Oil (New Jersey) built thefirst commercial fluid catalytic cracker (FCC),the type of cat cracker most commonly usedtoday, after cooperating on research and de-velopment with six other oil companies. (9)One estimate suggests that between 1928 and1952, $50 million was spent on the develop-ment of the fluid type unit alone. (10) The de-velopment of the fluid catalytic cracker hasbeen described as a project smaller only thanthe building of the atomic bomb. (11)

In the rush to get new units in operation,some things were neglected. Errors in designhad to be corrected on units in service, notjust in future models. The impact on thehealth of refinery workers brought about bythis new process would not be considered bythe industry until cat crackers had been op-erating for a number of profitable years. Even 9

today, although catalytic cracking remainsthe most important refinery process, all thelong-term effects of these units on the healthof those working in or living near the refineryare still not known. There are, however, someworrisome clues.

Cat Crocking and CancerBy the turn of the Century it was known

that exposure to certain petroleum products,such as wax paraffin oils and cutting oils,could cause cancer. (14)

In 1942, the same year the first commeraialcatalytic cracking unit went into operation,scientists at the Barnard Free Skin and Can-cer Hospital in St. Louis, Missouri found thatsamples of some high boiling catalyticallycracked oils caused cancer when applied tothe skin of mice. (15) In 1945 the carcinogenic(cancer-causing) properties of these oils wereconfirmed in other experiments. (16) In 1947,five years after the introduction of the cataly-tic cracking unit, scientists in the Medical De-partment of Jersey Standard Oil concludedthat " . . . a potential cancer hazard existedwhere man came in contact with these oils."(17) And in 1951 Standard reported that meas-ures for minimizing worker exposure to car-cinogenic oils, such as better personal hy-giene practices, keeping units closed andpainting pipelines containing these oilsorange had been instituted. (18) While it isunclear to what extent carcinogen exposurewas really minimized at Jersey refineries, itis certain that other oil companies did littleor nothing to prevent contact with such po-tentially hazardous hydrocarbons.

Yet the industry was worried about theproblem; it was one that could threaten itsuse of what was fast becoming the most im-portant and perhaps most profitable refineryunit. Prodded by the earlier efforts of Jersey,the American Petroleum Institute (API), theindustry's trade association, funded a studyin 1949 at the University of Cincinnati's Ket-tering Laboratory to find out the cancer-caus-ing potential of intermediate and finished pe-troleum products. (19) To do this, the Ketter-ing researchers experimented with mice andsurveyed company medical departments tofind whether cancer was a problem afflictingrefinery workers.

The Kettering scientists tested about 120different oil fractions by applying them to theskin of mice and then observed whether, and

10 within what period, cancer developed. Mice

rapidly developed cancer from some frac-tions, confirming the results of previous re-search by Standard. The primary carcino-genic agents in these oils were found to becertain polycyclic aromatic hydrocarbons.According to the study, the new catalyticcracking processes produced greater concen-trations of these carcinogens than did theolder thermal cracking processes, whichwere increasingly being replaced by cata-lytic units. (20)

The most potent carcinogens—the ones thatmost rapidly caused tumors in mice—were lo-cated in the heavy gas oils and residual prod-ucts of catalytic cracking. A potential dangeralso existed at all refinery units processingoils distilling at over 675 degrees Farenheit(including crude distillation), or near pipe-lines transporting these fractions. In finalproducts, potent carcinogens were found inthe heavy gas oils used for fuel in powerplants, ships and large buildings.

The Subversion of ResearchWhile experiments with mice and analysis

of carcinogens in petroleum fractions couldhelp define a potential health problem for hu-mans, API's Medical Advisory Committeewanted to know how many refinery workersactually developed cancer. In 1950 the Com-mittee sponsored an epidemiological study todetermine the number of workers who haddeveloped cancer. (21) The Kettering Lab col-lected records of cancer cases from companyfiles and began a current case registry, a cen-tral file for keeping and analyzing cancerrecords as cases are found. Initially 1,200cases were received from 14 companies. (22)These cases formed the historical survey. Sixyears later, only 2,108 individual case rec-ords had been sent to the current case regis-try. (23)

The low number of reported cases did notprove that workers were at low risk; the ex-planation was that the oil companies refusedand/or were unable to cooperate with thestudy. In 1955 a report by the Subcommitteeon Carcinogenicity of the API's Medical Ad-visory Committee, which supervised the proj-ect, commented: "It is . . . discouraging torealize that only sixteen of twenty-five com-panies have participated in this effort andthat in the last few years the number of par-ticipants may have diminished even morethan this. For instance, in 1954 only twelvecompanies participated in the epidemiologi-

cal studies . . . it must be recognized that ifparticipation does not continue in this proj-ect it is doomed to failure through no faultof Dr. Phair [the scientist at Kettering conduct-ing the study], but strictly due to the failureof cooperation on the part of the participatingcompanies and their medical directors on theMedical Advisory Committee. . . . if we areunable to obtain cooperation the epidemio-logical studies might just as well be termin-ated." (24)

In 1956, the Medical Advisory Committeeended the survey, concluding that there was". . . no evidence of occupational cancerwithin the population surveyed." (25) Giventhe small number of cases reported due tothe lack of company cooperation, the con-clusion was inevitable. The conclusion alsoreflected the fact that, whereas it may take20 or even 30 years after exposure for can-cer to be detected, the study ended in 1956,ten years or so after the widespread use ofcatalytic cracking began.

"The number of peopleexamined and found healthyby our medical physiciansgives eloquent light to the factthat this is not a hazardousoccupation."

Dr. Harold Golz, Former DirectorCommittee on Medicine and EnvironmentalHealth, American Petroleum Institute21 June, 1973.

The Medical Advisory Committee, com-posed of oil company medical directors, didnot seem particularly concerned, at least asreflected in the Committee's minutes, aboutthe study's six years of wasted effort and thefact that no conclusive results were reached.But the scientists who had worked on theproject were concerned and were willing toexplain their failure. According to their re-ports, now located in the API library, marked"For Information Only—Not for Publication,"there were two principal reasons why "ac-tive steps could not be taken": ". . . certainof the companies had no centralized medicaldepartment to collect the necessary data past

or future," (26) and ". .. all outside or unusualinvestigations were postponed because of thehigh priority of technological changes in re-fining operations brought about by the Kore-an emergency. Consequently, it proved im-possible to secure serious consideration ofsimple requests for access either to records orworkers." (27)

The first comment speaks for itself; somecompany medical departments were conven-iently useless. The second statement is a ra-tionalization, the use of so-called national se-curity concerns to cover up corporate irre-sponsibility. Even after the Korean War, in-formation was not forthcoming from the com-panies, and so the study had to be terminated.

Although much of the blame for the APIstudy's failure can be traced to its membercompanies' uncooperativeness, some of it be-longs to the shortsightedness of the scientistswho conducted the research. The most dis-tressing shortcoming was their failure to con-sult the workers themselves concerning con-tact with possible cancer-producing chemi-cals. Despite the scientists' healthy suspicionthat certain hydrocarbons were likely to pro-duce cancer, their abiding faith in the goodintentions of industry resulted in their falselyassuming that " . . . high engineering stand-ards and good housekeeping, with respect tothis modern automatic equipment has, in gen-eral, restricted the contacts of workmen withthese products." (28)

But had the scientists spoken to oil work-ers, their suspicions would have been height-ened and new research directions suggested.They would, for example, have discoveredthat cat crackers were not, as the industryhad claimed, totally closed systems. Pumpsand other equipment leaked oil mists andvapors during normal operation. They alsowould have discovered that during mainte-nance shutdown, workers enter vessels andclean pipelines where sludges or residuescontaining potent carcinogens remain.

In 1947, before its cancer prevention pro-gram began, Standard surveyed six of itsrefineries to determine how many workerswere exposed to carcinogenic oils. It foundthat lab personnel, sample collectors, dockworkers and tank-car loaders were subject todaily exposure; that cracking unit operators,tank cleaners and pilot plant operators wereexposed frequently; and that maintenancemechanics and pipefitters were exposedevery few days. (29) 11

Today—30 years after the introduction ofcat cracking—the extent of the cancer dangerto workers is still unknown. Certainly the in-dustry has the economic resources to do bet-ter. Industry profits from catalytic crackingbetween 1942 and 1957 exceeded $350 mil-lion. (30) In contrast, the API spent less than$750,000 studying the hazards of cat crack-ing. (31)

Although the actual extent of cancer amongrefinery workers remains cloudy to this day,some frightening new evidence has beenfound about the health of people who livednear refineries. In 1974, three scientists at theUniversity of Southern California School ofMedicine announced the results of a studyof cancer death rates among people livingnear refineries in Los Angeles County. Theyfound that among males living in areas nearrefineries and chemical plants in 1968 and1969, 40 percent more than the norm died asa result of lung cancer. (32)

Dark FutureThat health and safety issues are not a ves-

tige of the past in the oil industry can againbe seen in the problems surrounding a cur-rently intensifying hazard to oil workers—the refining of high-sulfur-contented crude oil.Much of the crude oil refined in the future islikely to be from the Middle East, SouthAmerica or parts of the United States that pro-duce crude with naturally high sulfur con-tents.

Depending on its source, crude may con-tain from 0.1 to 7 percent sulfur by weight.The removal of some sulfur during refininghas been necessary to meet pollution stand-ards for sulfur oxides, to prevent sulfurpoisoning of refining catalysts, to inhibit cor-rosion of pipelines and processing units andto increase the octane-raising potential oflead gasoline additives.

Through a number of processes, sulfur com-pounds are converted to hydrogen sulfideand mercaptans (other sulfur compounds).About 50 tons of hydrogen sulfide (H2S) areextracted from 20,000 barrels of high sulfurcrude oil in processing. (33)

A description of its effects upon healthis provided by Stellman and Daum in theirbook, Work Is Dangerous to your Health:"At concentrations above 700 ppm, the bodycannot cope with the excess gas, whichreaches the brain and causes breathing to

12 stop. Suffocation occurs in a matter of min-

utes unless the victim is removed and givenartificial respiration. Long-term exposure tolow levels may cause chronic lung disease."(34)

When mingling at cracking units with car-bon monoxide, another chemical which de-prives the body of oxygen, the combined ef-fect can be especially dangerous. When notconverted to elemental sulfur, H2S is disposedof through burning at the flare. This releasesanother dangerous pollutant, sulfur dioxide.

Major disasters have occurred as a resultof B.2S exposure. Ray Davidson of the Oil,Chemical and Atomic Workers Union reportsone incident as follows: "In April, 1968, anaccident in the American Oil Company re-finery at Texas City, Texas, resulted in threedeaths and fourteen injuries directly attrib-utable to hydrogen sulfide. C. L. Lester, 28,and C. L. Wenning, 23, were sent to make arepair on a piece of refining eguipment. Itwas supposedly clear of all fluids and gases,but somewhere along the line an error wasmade—HoS in large volume was in the vessel.The two men unbolted a flange and the gasflogged out. They collapsed on a workingplatform twelve or fourteen feet from the

"In our analytical lab alonewe've had one case of bloodcancer, the man passed away.A man in another section hadcancer of the bladder; it's beenremoved. We have two menwhose blood vessels have beeneaten away due to thechemicals, and one has plastictubes for arteries and veins inone side of his body."

A Refinery Worker,Texaco Refinery.January, 1973

ground. Later appraisals were that they diedinstantly, but fellow workers who did notknow this instinctively rushed to the rescue.One after another they approached the acci-dent scene and collapsed of hydrogen sulfideasphyxiation." (35)

More Sulfur, More ProblemsMany American refineries were not built

to process crude containing over 1 percentsulfur. The metallurgy of crude distillationunits built to handle sweet (low in sulfur)crudes cannot withstand the corrosive actionof high-sulfur, or sour crudes, which eat awayat pipelines, valves and vessels. A 1973 in-dustry survey found that in 47 of 200 refiner-ies, crude distillation units could not resistcorrosion from high-sulfur crudes. (36)

With any relaxation of air-pollution stand-ards for sulfur dioxide, many refineries willprocess higher-sulfur crudes and will pollutethe community as well as the workplace evenmore. In refineries built with special corro-sion-resistant metals and extensive sulfur-removal equipment, so long as there is moresulfur in the crude, there is still a greater dan-ger of exposure to HS and SO2 gases. Addi-tional maintenance will be required to com-bat greater corrosion; it is unlikely, however,that companies will hire the necessary peo-ple to do this work. Furthermore, even the sul-fur-removal units installed for pollution con-trol have their dangers. If poorly maintained,they will be a major source of additional HL,Sgas.

The Economics of MaintenanceBecause of industry negligence in investi-

gating probable cancer-producing health haz-ards, it has not been conclusively establishedthat such dangers exist from catalytic crack-ing. When it comes to unsafe working condi-tions caused by poor equipment maintenance,however, the record is a convincing and un-equivocal indictment of the oil industry's dis-regard for workers' physical well-being.

The lack of necessary maintenance and thedelays involved in the little maintenance donemeans that refineries, with few exceptions,are in bad condition. Workers complain thatthey literally live in benzene, a hydrocarbonthat causes blood disease, probably includ-ing leukemia. This is due to poor maintenanceof catalytic reforming units, the refinery proc-ess that produces benzene for blending intohigh-octane gasoline. Thousands of poundsper day of different hydrocarbons such asbenzene leak from the average refinery. (38)

Although refineries have become increas-ingly automated during the last quarter of acentury, the ability of refineries to producegasoline and other products remains depend-ent on human labor. Workers must replaceleaking pump packings or sulfur-corrodedpipelines, clean out the lead sludge from gas-oline storage tanks, soak up oil spills and rigscaffolds high against the great vessels ofcat crackers. A Public Health Service studyof refinery air pollution emissions says that"improved housekeeping" is ". . . often theonly practical control method for some [pol- 13

lution] sources, such as pipeline valves, pumpseals, and sampling operations." (39) And aNational Petroleum Council report suggeststhat "Processing leakage . . . is best controlledby good housekeeping to detect and repairleaking flanges, valves, and stem packingand shaft seals." (40) With explosive materi-als under high pressure and at extreme tem-peratures, refineries require an adequatenumber of skilled workers capable of care-fully operating and diligently maintaining thecomplicated processing units. Yet, manage-ment has not allowed workers to operate re-fineries safely.

The reason maintenance is ignored is nothard to discern—it is expensive. HydrocarbonNews reports that maintenance comes to 15percent of the total costs of refining. (41) Re-cent maintenance costs for Continental Oil'sfive US refineries have come to 13.7 percentof operating and overhead expenses. (42)Donald Hepburn, a refinery maintenancemanager with Caltex, says that "Direct main-tenance repair costs account for 30 to 35 per-cent of the controllable [emphasis added] re-finery expenses." (43) Any way you measureit, maintenance costs money. While the oilcompanies increased the amount of oil re-fined by 240 percent between the years 1945and 1971, maintenance material and labor ex-penditures have decreased by almost 10 centsper barrel of oil from 1946 to 1969. (44) In-plant pollution controls have not been addedand working conditions have, therefore, wor-sened. How this affects health can be appre-ciated from an examination of the day-to-dayproblems workers face at the refineries.

TurnaroundsRefinery managements have reduced the

frequency and length of turnarounds, the pe-riod when a unit is completely shut down forcleaning and repair. According to J. F. Hiltonof Standard of California: "In recent yearsthe run lengths of petroleum processingplants have increased dramatically. Not toolong ago, a standard turnaround for plantswas only one year. Many plants were notable to run that long. Now two or three yearsis not unusual, and we look forward to con-tinuous plant runs of even longer than this."(45)

For many units, four years of uninterruptedoperation has become an aim, if not a reality.At Gulf Oil's Philadelphia refinery, for exam-

14 pie, two crude distillation units were once

shut down annually; now they are slated torun for three years, although both are over20 years old. (46)

Eugene Peer, formerly with Exxon, now arefining specialist with the Federal EnergyOffice, has stated that "the tendency now isto run a unit until it practically takes itselfoff line." (48) Old units in particular are runwithout maintenance until they fall apart.Management accepts the risks of sudden fail-ure, instead of shutting units down for pre-ventive maintenance; shutdowns are costly.To turnaround a large crude distillation unitfor a week, which also shuts down units"downstream," may result in losses of overa million dollars. Standard of California re-ported a few years ago, before oil prices rosedramatically, that the normal shutdown ofone 80,000 bpd (barrels-per-day) catalyticcracker might cost $1.25 million in expensesand lost profits. (49)

Industry claims that additives that reducepipeline corrosion, better onstream inspectiontechniques and stronger pipelines safely al-low longer run lengths and minimize hazard-out start-up and shutdown periods. Howevertrue in theory, workers in many refineries areunable to inspect thoroughly the thousandsof miles of pipeline for corrosion. A MobilOil official says, "the general condition of aprocess unit can be established during a ma-jor overhaul when thorough inspection of allequipment is made. Unfortunately, such ex-tensive inspection is costly. Thorough exam-ination of equipment can now be supple-mented by 'onstream' inspection, althoughthese facilities are limited by accessibilityand are, therefore, limited in their applica-tion." (50)

Clearly they were limited, for example, atShell Oil's Pasadena, Texas plant in 1968,when a corroded pipeline the thickness of abeer can, carrying sulfuric acid and propy-lene, exploded, killing two men and causingserious injury to two others. (51) At the Dela-ware City, Delaware refinery of the Getty OilCompany a pipeline rupture in February,1972 almost destroyed an entire coker. (52)Fortunately, no one was injured. Both inci-dents suggest that pipeline monitoring wasinadequate and/or that units were left on-stream for too long.

In past years, many processing unit fail-ures or repair difficulties would have broughtan immediate shutdown by management. To-day, workers are ordered to "get it while it's

running," like fixing your car as it travelsdown the highway. A member of the Oil,Chemical and Atomic Workers Union(OCAW) describes the results of this policy atTexaco's Westville, New Jersey refinery: "Sev-eral years ago, a man was severely burnedon a job that was supposed to be done whilethe unit was down, and they [management]said, 'We'll get it while it's running.' Theunion had warned them about this and toldthem not to weld on units when they wererunning; we'd never done that in the past.. . . The company insisted on doing this; rightacross the bargaining table they said, 'We'regoing to weld on units.' One week after theymade that statement the welder struck an arcand burned this man from his toes up to hiswaist. He spent most of one year in the hos-pital with his legs all burned up. Six othermen also suffered burns." (54)

Preventive MaintenanceIn addition to minimizing the number and

length of maintenance turnarounds, reducingpreventive and daily maintenance is anotheropportunity for cutting costs while maintain-ing profits. For one refinery manager, "Toachieve a peak of efficiency for a scheduledmaintenance scheme.... it is necessary to re-duce inspections and scheduled repairs to aminimum compatible with preventing break-downs." What this means, in the words of oneSun Oil worker, is that "Safety comes first—as long as it doesn't interfere with produc-tion." At one refinery, in regard to mainte-nance work, "A backlog of about three to sixweeks for the whole of the labor force is con-sidered to be ideal." (55) At the Phillip's Pe-troleum refinery in Bartlesville, Oklahoma,management considers a six- to eight-weekdelay to be appropriate. (56)

Refinery workers know that maintenancecannot always wait for days, not to mentionweeks or months, without resultant dangers.A leaking pump emitting a few pounds ofhydrocarbon vapor daily may not be an ur-gent concern to management because thecost of the wasted oil is less than the cost ofshutting down the pump to replace or repairit. To those who work around leaking pumps,however, such conditions are a hazard thatshould qualify as a job for emergency main-tenance.

At Texaco's Westville, New Jersey refinerya few years ago a pipeline on a unit froze andcracked. A pipefitter repaired the line and

"The total reduction [of refineryemployees] since 1959 is 3650or over 36 percent. At today'slabor rates, that represents asavings of $37,000,000 per year,and is equivalent to theaverage net profit of sales ofalmost $500,000,000."

Shell Oil Company internal memo.June 1, 1966

wrote a work order for an insulator to coverit. The company sat on the work order re-quest. Some days later the line froze again.This time a valve blew out and sent aroma-tics into a nearby heater, resulting in an ex-plosion that destroyed 40 percent of the unitand caused a foreman to suffer a fatal heartattack. (57)

Management would prefer to redefine mostcases of emergency maintenance as jobs thatcan wait. Donald Hepburn, a maintenancemanager with Caltex, describes a projectaimed at improving maintenance efficiency:"I forget the exact numbers, but . . . the firstday I think there were 37 jobs and by thetime we left two weeks later, it had comedown to three on the last day, because some-body was defining for the people in the fieldwhat was an emergency job. This had a verydramatic effect, and the operations peoplein that refinery began to re-educate their peo-ple. They did it effectively and it kept downthe number of emergencies." (58)

Caltex's desire to end "unnecessary" emer-gencies holds true for all oil companies. Anofficial of American Oil's Whiting, Indianarefinery says that, "We too prefer not to doemergency jobs, because of their inefficiencyand make every effort to question the operat-ing pople to ascertain if it really is an emer-gency." (59) According to an executive ofTotal Leonard, an independent refining com-pany, "We make every effort to question thenecessity of doing the work. Emergency workis inefficient." (60)

Adequate maintenance means the employ-ment of adequate numbers of maintenancepersonnel. During the OCAW strike against 15

Shell Oil in 1973, the company equated theunion's demands for more maintenance work-ers with featherbedding. The charge will notstand up to scrutiny, but an examination ofits implications will tell us a great deal aboutthe economics of plant maintenance and byinference the politics of occupational healthand safety.

Fewer People, More MoneySince the end of World War II, manage-

ment, through layoffs and attrition, has con-tinuously reduced the number of workers em-ployed in US oil refineries. In 1947, there were146,000 US refinery workers; by 1972, but 89,-000, a 39 percent reduction over 25 years. (61)This workforce reduction cannot be explainedby the reduction in the number of refineries(from 399 in 1947 to 247 in 1972) because totalrefinery capacity during this period has in-creased by almost 150 percent.

An informal survey of ten refineries by theNational Petroleum Council found that work-force size had been reduced by an average of46 percent between 1956 and 1966. (63) RayDavidson, Assistant to the President of OCAW,describes the effects of this trend on a butanerecovery unit at ARCO's Houston, Texas re-finery: "During a slack period, part of theunit was shut down and the workforce wascut from six down to two. When business re-covered, the company not only reopened theentire unit but also added another sectionto it—and kept the workforce at two men.Then an entire new unit . . . was built adja-cent to the butane recovery unit. This newequipment with a separate function was tiedin with the butane recovery unit . . . and oneman was added to the workforce. Now threemen operate facilities at least as twice aslarge and complex as those formerly oper-ated by six men." (64)

Similar situations prevail at other refiner-ies. M. L. Fahrmann, an official of Standardof California, spoke for the entire industrywhen he said, "The concept of operating onthe basis of a planned shortage of manpowerhas frequently been used by maintenancemanagement, and with good results." As hedescribed his company's practice, "Preven-tive maintenance, tank repairs and other rou-tine maintenance work are advanced or de-ferred." In summary, "Higher management isgenerally interested in maintaining the com-pany workforce below that required by the

16 basic work load [emphasis added]." (66)

One way to accomplish this is to assignmore tasks to each worker. For example, gastesting is key to safety in a refinery. The gastester is responsible for checking for explo-sive and hazardous concentrations of ben-zene, hydrogen sulfide, carbon monoxideand other substances. Without notice fromthe gas tester that vapor levels are safe, en-try is not allowed into vessels and tanks, andwelding or use of electricity is prohibited. AtSun's Marcus Hook refinery there have in thepast been 21 gas testers. The company haseliminated 12 of them and plans to train unitoperators to do the monitoring. (67) While in

theory this is beneficial for individual work-ers who acquire additional skills, in practiceit means that workers lose the benefits of thespecialization of the gas tester, who is familiarwith this work on a daily basis. Other com-panies also plan to eliminate the gas tester'sjobs.

Cross-crafting carries this practice one stepfurther. As the workforce is reduced, thereare fewer people to maintain greater capac-ity. For maximum efficiency, the companiesattempt to abolish craft lines. Instead of beinga welder, a pipe fitter or a rigger, a workerwould be a mechanic with several skills. Andunit operators are expected, though not al-ways trained, to do maintenance work. Since

training is inadequate, all kinds of workershave difficulty working safely. In an industryreplete with dangers that make a virtue ofspecialization, cross-crafting can be a men-ace.

At turnaround' time there are not enoughpeople available to shut down and clean theunits fast enough for management. Outsidecontractors are hired to do part or all of thiswork. The contracting crews, which rush fromone job to another, are not aware of refineryhazards, especially those associated with un-familiar equipment.

Some refinery workers believe that thecompanies hire outside contractors to takeadvantage of a provision of federal safetyand health law that makes the contractingemployer, not the oil company, responsiblefor death or injury on the job.

Contractors' employees are rarely awareof the meaning of gas warning alarms;sometimes the alarms may sound without theslightest notice being taken by the contract-ing crews. Other unsafe contracting crewpractices include not having standbys, work-ing without permits and entering vesselswithout gas testing.

Labor force reductions also result in fewerpeople being around when a unit fails. Ac-cording to Hugh Robinson, Managing En-gineer for the Oil Insurance Association:"It is quite astonishing to walk through manylarge refineries today and note just how fewpersonnel are at the units. When the processis running under proper conditions there is nodoubt that this represents a cost savings.When abnormal conditions arise, then we be-lieve there is more than what used to be con-sidered the normal potential for loss. Not onlyare there fewer operators available for cor-rection of the abnormal conditions, but shoulda piece of machinery or a control or pipingfail, there are fewer personnel immediatelyavailable for fire fighting activities." (68)

The industry claims that workforce cut-backs have been made possible through auto-mation. However, O. L. Hurley of AmericanOil says, "With less equipment, fewer peoplehave been required. Much of the change,however, has been the result of the need to re-duce processing costs in any way possible tomeet an ever tightening squeeze on profits[emphasis added]." (69) Robinson of OIA,while more aware than Hurley of the danger-ous results of such decisions, offers a similarexplanation for both manpower and mainte-

nance reductions: "You might ask why we[the Oil Insurance Association] are complain-ing about . . . losses at this time? Haven't wealways been plagued by such events? True,but seemingly not on the same scale nor inareas where so much value was exposed tothe resulting effects of the breakdown. Neitherhave we had the strain on available mainte-nance personnel in the past that we seem tohave today. Much too often, we believe, main-tenance programs are being neglected in theoverall push for economy." (70)

From 1946 through 1972, about 30 of thelargest oil companies (virtually the entireAmerican oil industry) together made morethan $94 billion in profit. (71) Such a profitwas based in part on the sacrifices workingpeople were forced to make of their safetyand health. Oil workers are increasingly re-fusing to make such sacrifices.

The Shell Strike and BeyondOil workers, like coal miners, have not been

complacent about unsafe working conditions.Workers have often organized unions be-cause of them. According to Harvey O'Con-nor, in his History of the Oil Workers Union—CIO: "Unionism found its origin in the firesand accidents that swept through the Shellplant, built [in Pasadena, Texas] in 1928-29.A safety and welfare committee demandedprotection. They asked for gas masks, asbes-tos hoods, goggles, remote controls and aircontrol values to make refining processessafer. They wanted two men on dangerousjobs to help one another in case of accident.They asked for a new ambulance to replacea broken down vehicle, nurses on all shifts,and jobs for widows of men killed on the job."(72)

Bitter strikes against workforce reductionswere waged at the Gulf, American and ShellOil refineries in the late 1950's and early1960's. The strike at Shell's Pasadena refin-ery lasted just under a year, but was ulti-mately lost due to the company's ability^ tomaintain production using supervisory andtechnical personnel.

Today there is a rising level of workerconsciousness about the nature of job haz-ards and the importance of controlling theproductive processes that cause them. Duringcollective bargaining many unions are in-creasingly less willing to accept deteriorat-ing working conditions in return for higherwages. As one Shell worker put it, "We rec- 17

ognize that all the things we have gained inthe way of wages and everything else, if youdie getting them, they are not going to do youany good." (73)

In 1973 4,000 Shell Oil workers representedby the OCAW called their first national strikeover occupational health and safety issues.After five months the strike was settled. Whilethe giant oil company made some conces-sions and countless numbers of other unionworkers and environmental and consumergroups learned about the realities of oil in-dustry work, the final settlement did not satis-fy the Shell workers. Shell Oil retained finaldecision-making power over health and safe-ty policy.

OCAW's original industry-wide bargainingprogram in 1973-74 comprised a sweeping setof demands, including establishment of jointmanagement-labor safety and health com-mittees, safety and health monitoring and em-ployees' training programs and access to in-formation indicating the chemical identity ofall substances used in the refinery. In addi-tion, OCAW demanded all available morbid-ity and mortality data, appropriate free med-ical tests for workers and the right of work-ers to refuse work endangering their health.OCAW also proposed a special fund forhealth and safety research and education, tobe financed by management contributionand maintained jointly by OCAW and the in-dustry. (74) OCAW's demands were relativelyextensive, given that little previous nationaloil bargaining had occurred over health andsafety issues.

While many oil companies agreed to atleast some of the demands (not including thefund proposal or the right to refuse workclause), Shell refused to bargain seriously formonths and was the only company struck.(75) Finally Shell agreed to establish com-mittees and to provide OCAW with morbidityand mortality data.

The Shell strike experience shows that vic-tory will not be easy. While refinery tech-nology does not offer much in the way ofhealth protection to workers, it does make theoil companies less vulnerable to traditionalunion strike strategies.

Years ago, when oil workers walked out,refineries shut down completely. But in 1959,when OCAW struck American Oil at TexasCity, Texas, management began operatingrefineries using supervisory, technical and

18 clerical personnel. (76) Today, due to further

automation, it is even harder for a strike toaffect production. Furthermore, the industry'svast economic resources make it a formidableadversary. Of the 25 largest industrial cor-porations ranked by 1972 sales, nine are pe-troleum companies. (77) The major compa-nies control the sources of oil, its production,transportation, refining and marketing overmuch of the nonsocialist world. Twenty cor-porations control 86 percent of US refiningcapacity. (78) And the major oil companiesare now really energy companies, controll-ing supplies of coal (which can be convertedto gasoline), oil-bearing shale and uranium.So when a strike reduces output, the struckcorporation may speed up production at itsrefineries elsewhere in the world or may se-cure supplies of finished products from friend-ly "competitors." Or it may provide coal fromits mines to power plants that have switchedfrom burning oil.

The political impact of the industry is enor-mous. Striking oil workers face not only com-pany resistance but generally unsympathe-

In the case of one employee/Henderson, he was ordered tolight off a furnace.... Heobjected it was unsafe. Twoother operators told the fore-man it was not mechanicallysafe... . The foreman called theDepartment Manager at homeand then told Henderson thatthey had decided it was safeto light off.... Mr. Hendersonstruck the torch and wasburned to death.

Affidavit of T. JacobsNLRB Case #20-CA-7565Filed, 1970.

tic public officials and government agenciesas well. The industry has been successful inconvincing many administrators and legisla-tors, both Republican and Democratic, that"What's good for oil is good for America."

Despite the hurdles to be overcome, the five-month Shell strike renewed an intensifiedstruggle between those who direct productionand those who actually produce our goodsand services. The strike was significant be-cause OCAW was willing to step into anarena of work policy and plant control whereunions have often feared to tread. As healthconditions continue to deteriorate in the oilindustry, strikes and other worker actionsover health and safety issues are inevitable.

Given the limited effectiveness of the strikeweapon, oil workers will have to developnew strategies and tactics in order to winbetter working conditions and to resist thefurther deterioration of the refinery workplaceplanned by management. Oil workers,through the leadership of the OCAW, are in-creasingly aware of the nature of refineryhazards and of the need to struggle to endthem. This struggle, to be really successfulnecessarily involves workers eventually tak-ing control over the nature of technologicalchange, operating rates, maintenance levelsand the size of the workforce in refineries.Genuine workers' control of refineries wouldplace safety and health, not profits, first onthe agenda. Such priorities would likely proveincompatible with the continued existence ofcapitalism.—Rick Engler. (Rick Engler has been a staftmember of the Committee to Support the ShellStrike and has worked with the Oil, Chemi-cal and Atomic Workers Union on a numberof projects. This article is excerpted horn alarger study designed for oil workers on thepolitical economy of refinery occupationalsafety and health.)

References1. George Gibbs and Evelyn H. Knowlton, The Resurgent

Years 1911-1927, A History of Standard Oil of New Jer-sey (New York: Harper, 1966), p. 142.

2. Paul Giddens, Standard Oil Company (Indiana): OilPioneers of the Middle West (New York: Appleton-Century Croft, 1955), p. 28.

3. H. N. Blakeslee, "A Portrait in Safety," IndustrialSafety Survey, VII (October-December, 1941), 3-4.

4. Henrietta Larson and Kenneth W. Porter, Historyof Humble Oil and Refining Company (New York:Harper and Brothers, 1959), p. 211.

5. Calculated from American Petroleum Institute, Petro-Jeum Facts and Figures (1971) and US Bureau ofMines data.

6. Statisical Absract of the United States.7. US Bureau of Mines.8. Ibid.9. John L. Enos, Petroleum Progress and Profits: A History

of Process Innovation (Cambridge: MIT Press, 1962),p. 187.

10. Ibid., p. 196.11. Ibid., p. 196.12. Ibid., p. 204.13. John W. Frey and H. Chandler Ide, A History of the

Petroleum Administration for War, 1941-1945 (Wash-ington, D.C.: Government Printing Office, 1946), pp.193, 213.

14. G. I. Davis, "Coal and Petroleum Products as Causesof Chronic Irritation and Cancer," Journal of theAmerican Medical Association, XII (May 30, 1914),pp. 1716-1720.

15. The American Cancer Society, Proceedings of theFirst National Cancer Conference, and Federal Se-curity Agency, The National Cancer Institute of theUnited States Public Health Service (1949), p. 245.

16. K. Sagirua, W. E. Smith and D. A. Sunderland, "Car-cinogenic Action of Certain Catalytically Cracked Oilswith High Boiling Points," Cancer Research, IX (Oc-tober, 1949), p. 631.

17. J. P. Holt, N. V. Hendricks, R. E. Eckardt, C. L. Stantonand R. C. Page, "Symposium on a Cancer ControlProgram for High Boiling Catalytically Cracked Oil,"Cancer Research, IX (October, 1949), p. 31.

18. Ibid., pp. 32-37.19. Kettering Laboratory, Condensed Summary of the Ob-

jectives and Findings of an Experimental Program forthe Appraisal of the Potential Carcinogenic Charac-teristics of Certain Petroleum Products (1960), p. 1.

20. Kettering Laboratory, Final Report, API Research Proj-ect MC 1, Investigation of the Potential Hazards ofCancer of the Skin Associated with the Refining ofPetroleum (1960), p. 7.

21. Ibid., p. 9.22. Kettering Laboratory, fleporf of Progress in the Epi-

demiological Studies, Appraisal of the Potential Car-cinogenic Properties of American Petroleum Products(1955).

23. Ibid.24. "Report of the Subcommittee on Carcinogenicity to

API Medical Advisory Committee," October 31, 1955,p. 4., in History of the Subcommittee on Carcinogen-icity, 1955-1957.

25. Kettering Laboratory, Condensed Summary . . ., op.cif., p. 6.

26. Kettering Laboraatory, Report of Progress . . ., op.cit., p. 4.

27. Kettering Laboratory, An EpidemioJogical Study ofCancer Among Employees in the American PetroleumIndustry (1958), p. 1-19.

28. Kettering Laboratory, Condensed Summary . . ., op.cit., p. 5.

29. K. Sagirua, op. cif., p.31.30. Enos, op. cit., p. 219.31. Letter from E. O. Mattocks, Department of Technical

Services, American Petroleum Institute to Members ofthe Medical and Health Committee of the Board ofDirectors, March 6, 1961.

32. Herman R. Mench, John T. Casagrande and Brian E.Henderson, "Industrial Air Pollution: Possible Effecton Lung Cancer," Science, January 18, 1974, pp. 210-212.

33. Sidney Miner, Litton Systems, Inc., Preliminary AirPollution Survey of Hydrogen Sulfide, A LiteratureReview (Washington, D.C.; US Department of Health,Education and Welfare, Public Health Service, 1969),p. 23.

34. Jeanne Stellman and Susan Daum, Work Is Dangerousto Your Health (New York: Vintage, 1973), p. 161.

35. Ray Davidson, Peril on the Job (Washington, D.C.:Public Affairs Press, 1970), p. 32.

36. National Petroleum Refiners Association, United StatesDomestic Petroleum Refining Industry's Capability toProcess Sweet/Sour Crude Oil (1973).

37. "Explosion and Fire Experience in the HydrocarbonProcessing Industry," speech to Combustion Institute,Central States Section, April 8, 1970, p. 6.

38. Atmospheric Emissions from Petroleum Refineries—AGuide for Measurement and Control (Cincinnati, Ohio:Public Health Service, 1960), p. 31.

39. Atmospheric Emissions . . . op. cit.40. National Petroleum Council, Factors Affecting U~.S.

Petroleum Refining, Impact of New Technology (1973),P- 7.

41. "Hydrocarbon Processing Industry Has Made SteadyProgress in Better Maintenance Practices," Hydrocar-bon News, November, 1971, p. 13.

42. Ibid.43. Donald F. Hepburn, "Management of the Total Main-

tenance Function," Proceedings, National PetroleumRefiners Association Refinery Maintenance Conference,January 17-19, 1973, p. 2.

44. National Petroleum Council, op. cif., pp. 63, 71.45. J. R. Hilton, "Reliable Mechanical Equipment Keeps

Plants Onstream," Proceedings, American PetroleumInstitute, Division of Refining, 1966, p. 39.

46. Personal interview with Gulf officials, August, 1973.47. Personal interview, July, 1973.48. Personal interview, July, 1973.49. "Chevron Reports on Cat Cracker Rims," OiJ and Gas

Journal, November 9, 1970, pp. 57-61. 19

50. G. R. Deacon, "Some Aspects of Productivity in Re-finery Operations," The Manufacturing Function inthe Oil Industry, 1964 Summer Meeting of the Instituteof Petroleum, p. 22.

51. Davidson, op. cit, p. 91.52. Getty Oil Company, 44th Annual Report, 1972, p. 18.53. Oil Insurance Association, Fired Heaters (Chicago:

OIA Publication 501, 1971), p. 29.54. Personal interview, February, 1973.55. Deacon, op. cit., p. 26.56. National Petroleum Refiners Association, Proceedings,

1972 Question and Answer Session on Refinery Main-tenance, p. 39.

57. Personal interview. May, 1974.58. National Petroleum Refiners Association, Proceedings,

1972 Question and Answer . . ., op. cit., p. 37.59. National Petroleum Refiners Association, Proceedings,

1973 Refinery Maintenance Conference, p. 22.60. National Petroleum Refiners Association, Proceedings,

1973 Refinery Maintenance . . ., op. cit., p. 22.61. Calculation from Bureau of Labor Statistics, Employ-

ment and Earnings Statistics.62. Calculation from American Petroleum Institute, Pe-

troieum Facts and Figures (1971), p. 135.53. National Petroleum Council, Impact of New Technol-

ogy on the U.S. Petroleum Industry, 1946-1965 (1967),p. 305.

84. Davidson, op. cit., p. 104.65. Personal interview, July, 1973.66. M. L. Fahrmann, "Maintenance's Function and Re-

sponsibility to Management," American Petroleum In-stitute, Division of Refining, Proceedings, 31st MidyearMeeting, Session on Refinery Maintenance, May 9,1966, Preprint No. 23-66, pp. 1-2.

67. Personal interview, April, 1974.

68. "Past Decade Loss Trend Showed Steady Improve-ment—Short Term Experience Indicates DangerAhead," American Petroleum Institute, Division of Re-fining, Proceedings, 32nd Midyear Meeting, Sessionon Operating Practices, May 16, 1967, p. 4.

69. O. L. Hurley, "Effects of Changing Trends on Main-tenance Organization and Requirements," AmericanPetroleum Institute, Division of Refining, Proceedings,31st Midyear Meeting, op. cit., p. 1.

70. "Continuing Underwriting Problems in the Oil andPetrochemical Industries," paper presented at the Al-berta Risk and Insurance Management Society Meet-ing, April 3, 1969.

71. Compiled from Chase Manhattan Bank, FinancialAnalyses of a Group of Petroleum Companies, 1946through 1972.

72. Harvey O'Conner, History of the Oil Workers Inter-national-CIO (Denver: Oil Workers InternationalUnion, 1950), p. 293.

73. Barry Weisberg, Our Lives Are At Stake, Shell Strike1973 (United Front Press, 1973), p. 4.

74. Research Department, Oil, Chemical and AtomicWorkers, OCAW National Oil Bargaining Program1973-1974 (1972), p. 47.

75. Oil, Chemical and Atomic Workers, To Eliminate In-dustrial Health Hazards (1973).

76. Milden J. Fox, Jr., "The Impact of Work Assignmentson Collective Bargaining in the Petroleum Refining In-dustry on the Texas Gulf Coast" (unpublished Ph.D.dissertation, Texas A&M University, 1969), p. 80.

77. "Fortune 500," Fortune Magazine, May, 1973.78. Permanent Subcommittee on Investigations, US Sen-

ate Committee on Government Operations, "Prelimin-ary Federal Trade Commission Staff Report on ItsInvestigation of the Petroleum Industry," Investiga-tion of the Petroleum Industry (1973), p. 18.

20

Asbestos(Continued from page 6)

All of this sounds impressive until one ex-amines the IHF report itself. (33) Among nu-merous errors in method was one central,scientifically inexcusable flaw—the investi-gators, Daniel Braun and T. David Truan,virtually ignored the 20-year time lag be-tween exposure to an agent causing lungcancer and the first visible signs of disease(the so-called latent period). They studieda relatively young group of workers, two-thirds of whom were between 20 and 44years of age, well under the expected agefor lung cancer. Indeed only 30 percent ofthe workers had been employed for 20 ormore years, the estimated latent period forlung cancer. With so many young people inthe study, too young to have the diseasealthough they might well be destined to de-velop it, Braun and Truan of course did notfind a statistically significant increase inlung cancer among the miners. As becameobvious later, they had drowned out a cleardanger in a noisy background of misleadingdata.

Braun and Truan were obviously aware ofthe latent period for cancer, since they citedin their own paper a number of works thatspecifically discussed the phenomenon andestimated its duration for lung cancer. (33)For example, Braun and Truan cite US Pub-

lic Health Report No. 26 by W. C. Heuper,head of the Environmental Cancer Sectionof the National Cancer Institute, which esti-mates a 20-year latent period for lung can-cer. (34) In another cited paper, Heuper spe-cifically reported an 18-year latent periodfor lung cancer among asbestos workers.(35)

The practice of looking at a workforcewith limited asbestos exposure is not an iso-lated error in a particular experiment; it is a

Prostitution PaysThe careers of those who have conducted

major industry-sponsored studies have pros-pered, despite the fact that their findingshave consistently been contradicted by inde-pendent studies.

A. J. Lanza, who directed the MetropolitanLife study on asbestosis in 1935, rose fromAssistant Medical Director at Met Life to be-come Chairman of the Institute of IndustrialMedicine at New York University MedicalSchool. Until his death in the early 1960's hewrote textbooks on lung disease and main-tained his liaison with industry as a con-sultant and writer for the Industrial HygieneFoundation. (19)

Arthur Vorwald, chief author of the 1938Saranac study on lung cancer, carried out

hallmark of epidemiological studies fundedby the asbestos industry. It allows the studyto look credible, while avoiding the fearedresult. This was true in the 1935 MetropolitanLife study on asbestosis, which was why thescientists there did not find asbestosis in itsadvanced, most critical stage. Even in the1970's researchers funded by industry con-tinue to conduct studies on young workers,despite scores of experiments by non-indus-try scientists showing that the various as-bestos diseases take anywhere from 10 to 30year to develop. The culprit clearly was notscientific ignorance, but economic self-inter-est—that of industry and of the scientists whodo its bidding.

THE LID BLOWSBy 1960, medical research on asbestos

was at a watershed. By then a total of 63papers on the subject had been published inthe US and Canada and Great Britain. The52 papers not sponsored by industry, mostlycase histories and reviews of case historiesby hospital and medical school staff, indictedasbestos as a cause of asbestosis and lungcancer. The 11 papers sponsored by the as-bestos industry presented polar oppositeconclusions. They denied that asbestoscaused lung cancer and minimized the seri-ousness of asbestosis. The difference wasdramatic—and obviously dependent on the

further studies for industry and in 1946 be-came director of the Saranac Laboratory.Later he was a faculty member in industrialmedicine at Wayne State University inDetroit.

Daniel Braun, chief author of the 1958 In-dustrial Hygiene Foundation study on lungcancer, also didn't suffer for his affiliationwith the study, although his paper was pub-licly criticized by other scientists and latercontradicted by many other studies. Braun isnow President of IHF and Chief Medical Di-rector for US Steel, one of this country'slargest corporations.

J. C. McDonald, director of the 1971 McGillstudy on asbestos miners, continues to con-duct industry-sponsored studies and is nowChairman of the Department of Epidemiologyand Public Health at the McGill MedicalSchool.

doctor's perspective, whether treating thevictim of disease or serving as agent for itsperpetrator.

In the early 1960's the research picturechanged dramatically as a result of threeseparate studies. In 1960 a new malady wasadded to the lexicon of asbestos diseases:mesothelioma, a rare and invariably fatalcancer of the lining of the chest or abdomi-nal cavity. At that time a South African doc-tor found an unusually high incidence ofmesothelioma among asbestos workers andtheir families, as well as those living nearasbestos mines. (36)

In 1963 a study of lung smears from 500consecutive autopsies on urban dwellers inCape Town, South Africa showed that thelungs of 26 percent had asbestos bodies, thecharacteristic bodies originally found in thelungs of workers with asbestosis. (37) Bothstudies received extensive publicity andraised the specter of asbestos as a modernenvironmental hazard affecting all citizens.

To top this off, in the early 1960's Dr. Irv-ing Selikoff and his associates at Mt. SinaiMedical Center in New York broke indus-try's hegemony over medical and personnelinformation by using the welfare and retire-ment records of the asbestos insulators'union as the basis for conducting an epi-demiological study. Now for the first time inthe US, scientists not beholden to industryconducted large-scale definitive studies ongroups of asbestos workers. Beginning in1964 the investigators reported an unusuallyhigh incidence of lung cancer and mesothe-lioma among asbestos insulation workers,with time lags of 20 and 30 years, respec-tively, between exposure and disease. (38-41)By focusing on workers with 20 or moreyears of exposure to asbestos, these studieshighlighted its hazards. Together with theSouth African studies they made the "magicmineral" front-page news throughout theworld.

Industry Fights BackThe asbestos industry was in trouble and

they knew it. The slow pace of researchstudies in the past would no longer sufficeto keep the lid on what had become a steam-ing cauldron of unfavorable publicity. Nowasbestos companies decided to pour moneyinto research. Johns-Manville, giant of theasbestos industry, for example, spent $8.5million on research and development in 21

1972, a large fraction of which went to out-side medical research centers. (42) In con-trast the National Institute for OccupationalSafety and Health (NIOSH), the federal gov-ernment's main research agency in the field,spent a mere $260,000 on a grand total ofthree outside asbestos research grants thatyear. (43)

As a result, an industry that had onlymanaged to generate 11 research papers onasbestos in the three decades before 1960has come up with 33 in little more than adecade since then. The recent studies arejust as self-interested as ever. Industry hasstopped denying that asbestos causes lungcancer, mesothelioma and asbestosis (al-though it has not publicly admitted it,either). But research proposals that industrythought would minimize the problem or shiftthe blame have been given unstinting sup-port.

Minimizing the ProblemA major industry effort was a massive

epidemiological study published in 1971 byJ. Corbett McDonald and his associates atthe Department of Epidemiology and PublicHealth at McGill University in Montreal.This was funded through a grant from theInstitute of Occupational and EnvironmentalHealth of the Quebec Asbestos Mining Asso-ciation. (44) The subjects were miners in thetwo largest asbestos mines in Quebec.

Over 11,000 miners were traced, thosewho were born between 1891 and 1920 andwho had worked in the mines for at leastone month sometime before November 1,1966. Of these, about 2,500 had died before1966. The cause of death on each death cer-tificate was recorded.

Like the earlier IHF study on asbestosminers, this one looks guite impressive untilit is examined carefully. Then we find asbefore that the workforce studied has hadrelatively limited exposure, that the long la-tent period for cancer is virtually ignoredand that many other serious methodologicalerrors were made.

Consider the duration of exposure of theworkforce. The data presented by McDonaldand associates shows that many of theminers worked in the mines for only a shorttime and then left. One-third of the miners inthe study had worked less than a year in themines, two-thirds had worked less than 10

22 years. (44) (In contrast, almost all workers

examined in Selikoff's studies had at least20 years of exposure. (38-41)) Since mostworkers in the McGill study had limited ex-posure to asbestos, it is not surprising thattheir mortality was not much different fromthat of the general population. McDonaldwent even further: "The findings suggestthat our cohort of workers in the chrysotilemining industry had a lower mortality thanthe population of Quebec of the same age."(44) (Chrysotile is the name of the type ofasbestos fiber mined in Quebec.)

To check whether miners with heavy ex-posures had a higher mortality rate thanthose with lesser exposures, the McGillgroup compared mortality rates amonggroups of miners with different levels of ex-posure. In so doing, they acted as if thelatent period for cancer had gone out ofexistence, thereby thoroughly befouling thecomparison. For example, a worker with aparticular exposure who had worked be-tween 1910 and 1915 was put in the samecategory as one who had received an equalexposure while working from 1960 to 1965.Yet the first person might have developedasbestos disease, while the second couldn'tpossibly have done so, since not enoughtime had elapsed since first exposure. Never-theless, the data presented by McDonaldshowed the lung cancer death rate for thosemost exposed to dust to be five times greaterthan those least exposed.

Other members of McDonald's departmentat McGill have also published articles mini-mizing the hazards of asbestos. Philip Enter-line and M.A. Kendrick published an epidem-iological study on workers at an asbestos fac-tory which, by their own admission, looked ata young group of men who had worked atthe factory for a relatively short time. (45)The authors further excluded from theirstudy those over age 65, who had of courseretired and left the plant, thereby eliminatingthose most likely to show the ill effects ofworking with asbestos. As a result, they in-correctly concluded that low dust concen-trations are not dangerous. When Enterlinemoved from McGill to the University ofPittsburgh, he was rewarded for his earlierwork with a coveted prize from Johns-Man-ville, access to the company's records toconduct an epidemiological study of its re-tired employees. The study was also fi-nanced by Johns-Manville, according to itsHistory of Johns-Manville Research, al-

though Enterline does not acknowledge suchsupport in his paper. (46) No surprise, thisstudy also came up roses—reporting only asmall increase in death rate (15 percent) forretired employees.

Credibility GapIn contrast to the above studies, those not

supported by industry consistently foundasbestos to be a serious health hazard. WhileBraun and Truan, McDonald and Enterlineall found no increase in mortality rate due toasbestos or only small increases up to 20percent, studies not financed by industryreported an increase in mortality rate amongasbestos workers of from 200 percent to 9,000percent above that of the general popula-tion. Non-industry studies in addition tothose by Selikoff and associates were con-ducted by Doll, (32) Mancuso and Coulter(47) and Dunn and Weir. (48) (All of theseexcept Selikoff's were carried out by staffmembers of government agencies.

After at least a dozen epidemiologicalstudies, the gap between industry and non-industry results persists. And as long as in-dustry can find researchers whose work forthem looks scientifically credible, the gapwill continue. The name of the game is nottruth, of course, but delay. It has been sofor over 50 years. Delay for industry meanstime to make more money, and since theresearch of the early 1960's time to diversifyand seek alternatives to asbestos.

Shifting the BlameAnother way to gain time is to try to shift

blame. So pro-industry scientists have re-cently concocted one after another theorypurporting to prove that asbestos workersand their families were not dying from as-bestos but from some impurity, some con-taminant or some unusual type of asbestos.

It's Trace MetalsOne of the early theories was that trace

metals were contaminating asbestos andcausing the diseases attributed to asbestos.In 1967 Paul Gross of IHF reported in anindustry-sponsored study that rats breathingasbestos fibers artificially contaminated withtrace metals developed lung cancer, whilethose breathing unadulterated asbestosdidn't. (49) The theory seemed implausibleto many scientists, who pointed out that thetwo groups of rats were exposed under sig-

nificantly different conditions (namely, themetal-enriched asbestos dust was finer andpenetrated the lungs more than the regulardust). Nevertheless, Gross persisted and histheory picked up support, especially amongscientists close to industry. Lewis Cralley, apro-industry scientists at NIOSH and an as-sociate of Gross on several scientific papers,championed this theory. Along with severalother NIOSH scientists, Cralley conducted atleast four studies on this hypothesis inNIOSH's own labs, tying up a substantialfraction of the very limited resources there.One of the three outside research grantsmade by NIOSH in 1972 also tested thistheory, with Cralley as its director. (50)Meanwhile Gross continued his experimentswith industry support until six years later heperformed a carefully conceived experimentthat finally laid his own theory to rest. (51)

Ho, It's Special FibersAnother theory not yet laid to rest is that

certain types of asbestos fiber are danger-ous, while others are safe. Ninety-five per-cent of the asbestos used in the US andCanada is of one type, chrysotile. Since the

bad-fiber theory has its origins in industry-sponsored research, it comes as no surprisethat fiber types other than chrysotile havebeen blamed for asbestos disease. For ex-ample, McDonald and associates invokedthis theory to explain the difference betweentheir results and Selikoff's. The discrepancycould be explained more simply of course:McDonald and associates carried out a poorstudy and their results are invalid.

Nevertheless, since there are five differenttypes of asbestos fiber and each has differ-ent physical and chemical properties, it hasbeen difficult either to prove or disprove thetheory. Because the theory if true wouldhave important practical consequences,many scientists have felt obliged to investi-gate. Today it is discussed and debated invirtually all asbestos papers, industry andnon-industry. Recently Selikoff and Ham-mond conducted a major study on amositefiber largely to address this problem andfound no difference in mortality betweenamosite and chrysotile workers. (53) The dis-cussion and experiments go on and on.

No, It's Storage BagsProbably the ultimate in fishing around for

something else to blame was the theory pro-pounded by Gibbs of McGill and funded bythe Quebec Asbestos Mining Association,that the polyethylene bags in which asbestosis stored are contaminating the asbestos.(54) This idea died of its own weight, withoutneed of others to shoot it down. Nevertheless,it lasted long enough to be funded by indus-try, printed in the literature and delivered asa paper at the 1969 Johannesburg Interna-tional Conference on Pneumonoconiosis.

The single proposal from industry sourcesthat appears to have some plausibility is thatthe so-called asbestos bodies commonlyfound in the lungs of city dwellers may infact be caused by fibers and particles in theair other than asbestos. Gross at IHF has in-duced "asbestos bodies" in rat lungs withother minerals and fibers (55), and debatestill rages on whether most of the bodies inhumans are or are not due to asbestos.

While industry has lost most of these bat-tles, the eventual outcome of each is less im-portant than the fact that each salvo has tiedup scientific resources, defined research is-sues and bought time. In the case of almostevery industry proposal, some non-industry

24 scientists have had to conduct experiments

in rebuttal, using up some of the meager re-sources in the process.

STILL BUYING TIMEFollowing passage of the federal Occupa-

tional Safety and Health Act in 1971, majorattention was focused on the new nationalstandard for asbestos. Following an emer-gency appeal by many labor unions, a hear-ing was held in 1972. George Wright, Johns-Manville's chief science advisor, was able atthe hearings to call on five studies backingup J-M's contention that the standard of fiveasbestos fibers per cubic centimeter shouldbe maintained, not lowered. Of the fivestudies, four had been funded by the asbes-tos industry. (For more details, see BULLE-TIN, March, 1973.)

But most important, industry's studies, de-spite their faults, helped put a scientific coverover industry's interests. Industry could notprevent the asbestos standard from beinglowered to two fibers per cubic centimeter,but it contributed to a delay in its effectivedate for four years until 1976. Thus the asbes-tos industry won precious time to regain itsinitiative in this struggle. For workers too, thetime lost was critical. Dr. Selikoff estimatesthat this delay could eventually take asmany as 50,000 lives. (56)

But even when the fiber limit comes downthe battle is not over yet, not by a long shot.The 1972 NIOSH report on asbestosbases its two-fiber recommendation primarilyon the British standard. But the British stand-ard is based entirely on a single study. (57)This study turns out to be an epidemiologicalstudy performed at Turner Brothers AsbestosCompany, Great Britain's largest, by thecompany medical director! (21) This is theequivalent of a Johns-Manville study deter-mining the US asbestos standard. The flackthat has now developed over the standardhas nothing to do with its British industrialauspices, however. What has happened isthat Turner Brothers' new medical directorhas recently re-examined the workers at itsRochdale plant and they show a far greaterincidence of asbestosis than previously ob-served. (21) This startling discovery was notmade in the industry paper, but is based onan analysis of the data presented there byDr. Selikoff and others. Apparently the com-pany's medical director didn't realize the im-plications of his own data—it was presented

Creepy CralleyLewis Cralley was a top US government

official in occupational health until his retire-ment last year, and through his affiliationwith the Industrial Hygiene Foundation(IHF) was an important link between indus-try and government research. Starting in1964 Cralley directed a US Public HealthService study of health conditions in the as-bestos industry and suppressed its findingsfor six years until they were released byother NIOSH officials over his objections. Be-tween 1968 and 1972 he published fourpapers with Gross and deTreville at IHF, al-though during the last two years he wasNIOSH project director for various asbestosgrants, at least one of which was to IHF. As aspecialist in lung disease, he played an im-portant role at NIOSH in funding and direct-

ing government asbestos research. He re-cently edited a book on occupational healthwith his twin brother, Lester Cralley, Assist-ant Director of Environmental Health Serv-ices for Alcoa and board member of IHF.

Upon retirement he was presented with theUS Public Health Service Meritorious Serv-ice Medal, "in recognition of his researchinto developing safe worker exposure levelsto such potential occupational hazards asuranium, asbestos, silica, beryllium, and dia-tomaceous earth dust."

(For a more detailed discussion of Cral-ley's activities, See Chapter 4 of ExpendableAmericans (Viking, 1974) by Paul Brodeurand the Health/PAC BULLETIN, September,1972.)

in the article in a complex set of graphs andtables—and furiously denies that he showedan increase of asbestosis over the earlier ex-periment. But government and academicscientists in England and the United Statesclearly do not agree, and official reconsider-ation of the two-fiber standard is likely totake place soon.

THE ACADEMIC PAYOFFWhile its sponsorship of medical research

has been buying time for the asbestosindustry, it has also been spurring on indi-vidual scientific careers. Most prominentamong these are Paul Gross of the IndustrialHealth Foundation and J.C. McDonald of theDepartment of Epidemiology and PublicHealth at McGill University Medical School.The asbestos industry sought and foundthese individuals at institutions with which ithad friendly relationships over the years.IHF had carried out pro-industry research onlung diseases for many years, including the1958 Braun-Truan study. The Department ofEpidemiology at McGill had assisted Metro-politan Life in its 1953 asbestosis study andvery. probably aided Braun and Truan intheir study of Quebec asbestos miners.

The large influx of money also helpedtransform what started out as typical med-

ical research empires into institutional basesfor asbestos industry research. Today Mc-Donald is Chairman of the McGill Epidemi-ology Department and Braun is president ofIHF. (Paul Gross is retired.) These centersnow stand as academic havens for pro-indus-try scientists and help bring other scientistsinto the industrial research orbit. From Mc-Gill during the last decade papers on as-bestos have poured out that are supportiveof industry interests and in many casesopenly financed by industry.

The studies at IHF during the last decadehave been more closely associated withthree people, Gross, deTreville and LewisCralley. Gross and deTreville were IHF di-rectors and Cralley was a US governmentofficial in occupational health. Until his re-tirement last year Cralley was an importantlink between industry and government re-search through his connections with IHF. Be-tween 1968 and 1972 he published fourpapers with Gross and deTreville at IHF,even while as a government official heplayed an important role in funding and di-recting government asbestos research (seebox above).

A measure of the central role of McGilland the IHF in industry-sponsored researchis the fact that these two institutions con-ducted 25 of the 33 studies supported by the 25

asbestos industry and published since 1960.What industry hoped to get from this re-search was perhaps best characterized byIvan Sabourin, then attorney for the QuebecAsbestos Mining Association, quoted by PaulBrodeur in his book, Expendable Amer-icans. Sabourin told a 1965 meeting of the As-bestos Textile Institute that QAMA sought"alliance with some university, such asMcGill, for example, so that authoritativebackground for publicity can be had." (58)

The asbestos industry may also be devel-oping a base on the West Coast through theconsulting firm Tabershaw-Cooper Associ-ates, directed by Irving Tabershaw, formerpresident of the Industrial Medical Associ-ation and now editor of its journal, and W.Clark Cooper, former director of the US Bu-reau of Occupational Safety and Health andeditor of the 1971 National Academy ofSciences report on asbestos in the environ-ment. (59) Both are retired professors of Oc-cupational Health at Berkeley School of Pub-lic Health. For years, Cooper and nowTabershaw-Cooper Associates have been re-cipients of asbestos industry grants, fundedmostly through the National Insulation Man-ufacturers' Association. (18) The firm, despiteor perhaps because of its industry connec-tions, also has held at least one NIOSH con-tract to write federal standards for a hazard-ous chemical. (60)

The Scientific FailureThis year is the 50th anniversary of W.E.

Cooke's report in the British Medical Journalon a worker death due to asbestosis, anevent that marked the rediscovery of asbes-tosis by the medical profession. (11) Sincethen over 200 medical articles on asbestoshave been published in the English lan-guage—and the number of victims of asbes-tos-related diseases has increased steadily.

Lung cancer due to asbestos was first re-ported in 1935. Mesothelioma due to asbestoswas reported in 1960. And the learned scien-tific debates go on, with industry's mer-cenary scientists trying first to deny the haz-ards of asbestos, then to minimize them orelse to shift the blame. Against them, non-industry scientists have been demonstratingthe hazards of asbestos and trying to clinchthe scientific case against it, but never quitesucceeding against industry's enormous re-sources.

26 Meanwhile, tens of thousands of lives

have been lost to asbestos-related diseases,and the end is not in sight. Today the manyhundreds of thousands of people whoworked in shipyards during World War IIare facing an epidemic of cancer caused bythe use then of asbestos insulation. Familiesof asbestos production workers are now be-ing found to develop the same diseases astheir breadwinners in the factories. (61) Twoyears ago, Selikoff and associates confirmedanother disease to be caused by asbestos,gastrointestinal cancer. This is the fourth as-bestos disease, and if the past is any guide,others are still to follow.

Looking back at the medical debates thathave raged, it is clear that asbestos researchwas only one factor in a much larger socialand economic picture. To the extent thatmedical scientists

In the late 1920's and early 1930's, when as-bestos was already known to cause asbes-tosis, the industry was still relatively small.If medical people had not then limited them-selves to operating within narrow profes-sional roles and had taken their informationabout asbestos to asbestos workers and thepublic, the expansion of the asbestos indus-try might have been nipped in the bud andthousands of lives might have been saved.

Even today, while some medical scientistswork with labor groups and communicatetheir findings to the public, their scientificpapers still narrowly focus on the medicalissues and fail to expose the very real scien-tific-political strategies used by companiesagainst them and on behalf of more pliantscientists. If this is not done, scientists inother occupational health fields will not beable to learn from the lessons of the asbestosstruggle and will end up repeating many ofthe errors of the past, sometimes at greatcost to human life.

The vast majority of scientists probablystill wish to keep their labs untouched by theoutside world, narrowly pursuing circum-scribed scientific questions. But if they refuseto acknowledge and interact with the worldsof economics and politics, they may, as inthe case of asbestos, win the battle to dis-cover truth and lose the war to save humanlives.—David Kotelchuck(Robert Phillips, an internat Health/PAC this past summer and a med-ical student at Mt. Sinai Medical School, sur-veyed much of the medical literature re-ferred to in this article.)

References 32.

1. New York Times Magazine, May 4, 1969, p. 36.2. Council for Tobacco Research, Inc., Report ot the Coun- 33.

cil for Tobacco Research—USA (New York, 1972).3. New York Times, December 27, 1972, p. 1.4. Washington Post, September 5, 1974, p. A2. 34.5. Wall Street Journal, October 2, 1974, p. 1.6. H. M. Murray in Charing Cross Hospital Gazette (Lon-

don, 1900). 35.7. H. M. Murray, Report of the Departmental Committee on

Compensation for Industrial Disease (London: H. M.Stationery Office, 1907), p. 127. 36.

8. National Institute for Occupational Safety and Health,Occupationai Exposure to Asbestos—Criteria for a Rec-ommended Standard (Washington: US Government Print- 37.ing Office, 1972), p. III-4.

9. A. C. Haddow, Proceedings, British Journal of Medicine, 38.II (1929), p. 204.

10. J. Donnelly, "Pulmonary Asbestosis," American Journalof Public Health, XXIII (1933), p. 1275. 39.

11. W. E. Cooke, "Fibrosis of the Lungs Due to the Inhala-tion of Asbestos Dust," British Journal of Medicine, II(1924), p. 147. 40.

12. H. E. Seiler, British Journal of Medicine, II (1928), p. 982.13. H. E. Seiler and M. D. Gilmour, British Journal of Med-

icine, I (1931), p. 1112. 41.14. R. G. Mills, "Pulmonary Asbestosis: Report of a Case,"

Minnesota Medicine, XIII (1930), p. 495.15. W. B. Soper, "Pulmonary Asbestosis: A Case," American 42.

Review of Tuberculosis, XXII (1930), p. 571.16. D. S. Egbert, "Pulmonary Asbestosis," American Review

of Tuberculosis, XXXII (1935), p. 25. 43.17. A. J. Lanza et al., "Effects of Inhalation of Asbestos Dust

on the Lungs of Asbestos Workers," US Public Health Re- 44.ports, Vol. 50, No. 1 (1935).

18. Reported in "History of Johns-Manville Research," amanuscript prepared for the 1972 U.S. Labor Department 45.hearings on asbestos and distributed by the AsbestosInformation Association of North America, New Yorkoffice. 46.

19. A. J. Lanza, Silicosis and Allied Disorders, IndustrialHygiene Foundation Medical Series No. 12 (Pittsburgh,1936).

20. W. R. Goodwin, President of the Johns-Manville Corpo- 47.ration, in an address to the Newcomen Society (Decem-ber 16, 1971).

21. H. C. Lewinsohn, "Medical Surveillance of Asbestos 48.Workers," Royal Society of Health Journal, 92 (1972),p. 69.

22. E. R. A. Merewether, "A Memorandum on Asbestosis," 50.Tubercle, XV (1933), p. 69. 49.

23. I. J. Selikoff ef al., "Late Effects of Occupational Ex-posure to Asbestos in U.S. Shipyards in World War II," 51.presented at International Symposium on Safety andHealth in Shipbuilding, Helsinki (1971).

24. K. M. Lynch and W. A. Smith, "Pulmonary Asbestosis," 52.American Journal of Cancer, XXIV (1935), p. 56. 53.

25. H. B. Holleb and A. Angrist, "Bronchiogenic Carcinomain Association with Pulmonary Asbestosis," American 54.Journal of Pathology, XVIII (1942), p. 123.

26. A. J. Vorwald and J. W. Karr, "Pneumoconiosis and Pul-monary Carcinoma," American Journal of Pathology, 55.XIV (1938), p. 49.

27. L. U. Gardner and D. E. Cummings, "Studies on Exper-imental Pneumoconiosis," Journal of Industrial Hygiene, 56.XIII (1931), p. 65. 57.

28. L. U. Gardner, "Chrysotile Asbestos as an Indicator ofSubtile [sic] Differences in Animal Tissue," AmericanReview of Tuberculosis, 45 (1941), p. 762. 58.

29. A. J. Vorwald et al., "Experimental Studies of Asbes-tosis," A.M.A. Archives of Industrial Hygiene and Occu- 59.paionatl Medicine, III (1951), p. 1.

30. E. R. A. Merewether, Annuai Report of the Chief In-spector of Factories (London: H. M. Stationery Office,1947). 60.

31. S. R. Gloyne, "Pneumoconiosis," Lancet, 1 (1951), p. 810. 61.

R. Doll, "Mortality from Lung Cancer in AsbestosWorkers," British Journal of Industrial Medicine, XII(1955), p. 81.D. C. Braun and T. D. Truan, "An EpidemiologicalStudy of Lung Cancer in Asbestos Miners," Archives ofIndustrial Health, XVII (1958), p. 634.W. C. Hueper, Quest into Environmental Causes of Can-cer of the Lung, US Public Health Monograph No. 36(1955).W. C. Hueper, "Environmental Causes of Cancer of theLung Other Than Tobacco Smoke," Diseases of the Chest,XXX (1956), p. 141.J. C. Wagner ef al., "Diffuse Pleural Mesothelioma andAsbestos Exposure," British Journal of Industrial Med-icine, XVII (1960), p. 260.J. G. Thomson ef al., "Asbestos as a Modern Urban Haz-ard," South African Medicai Journal, 37 (1963), p. 77.I. J. Selikoff ef al., "Asbestos Exposure and Neoplasia,"Journal of the American Medical Association, 188 (1964),p. 22.I. J. Selikoff ef al., "Relation Between Exposure to As-bestos and Mesothelioma," New England Journal of Med-icine, 272 (1965), p. 560.I. J. Selikoff et al., "The Occurrence of Asbestosis amongInsulation Workers in the United States," AnnaJs ot theN.Y. Academy of Science, 132 (1965), p. 139.Reviewed in I. J. Selikoff et al.. Cancer ot InsulationWorkers in the United States, Lyons Conference on As-bestos (1972).Johns-Manville Corporation, Report to the US Securitiesand Exchange Commission, Form 10-K (Washington,1973), p. 6.NIOSH Contract and Research Agreements (Washing-ton: US Public Health Service, September, 1972), p. I-vi.J. C. McDonald et al., "Mortality in the Chrysotile As-bestos Mines and Mills of Quebec," Archives of Environ-mental Health, XXII (1971), p. 677.P. Enterline and M. A. Kendrick, "Asbestos Dust Ex-posures at Various Levels and Mortality," Archives ofEnvironmental Health, XV (1967), p. 181.P. Enterline et al., "Respiratory Cancer in Relationto Occupational Exposure Among Retired AsbestosWorkers" British Journal of Industrial Medicine, XXX(1973), p. 162.T. F. Mancuso and E. J. Coulter, "The Cohort Approachwith Special Reference to an Asbestos Company," Ar-chives of Environmental Health, VI (1963), p. 210.J. E. Dunn and J. Weir, "Prospective Study of Mortalityof Several Occupational Groups," Archives of Environ-mental Health, XVII (1968), p. 71.See reference 43, p. 2.P. Gross et al., "Experimental Asbestosis," Archives ofEnvironmental Health, XV (1967), p. 343.P. Gross and R. A. Harley, Jr., "Asbestos-Induced Intra-thoracic Tissue Reactions," Archives of Pathology, 96(1973), p. 245.See reference 44, p. 685.I. J. Selikoff ef al., "Carcinogenicity of Amosite As-bestos," Archives ot Environmental Health, XXV (1972).G. W. Gibbs, "Some Problems Associated with the Stor-age of Asbestos in Polyethylene Bags," American In-dustrial Hygiene Association Journal, XXX (1969), p. 458.P. Gross ef al., "Pulmonary Response to Fibrous Dustsof Diverse Compositions," American Industrial HygieneAssociation Journal, XXXI (1970), p. 125.New York Times Magazine, January 21, 1973, p. 64.G. Berry, Hygiene Standards—Theory and Applicationin Biological Effects of Asbestos, World Health Organiza-tion, I.A.R.C. Paper No. 8 (1973).Reported in Paul Brodeur, Expendable Americans (NewYork: Viking, 1974), p. 135.Committee on Biologic Effects of Atmospheric Pollutants,W. C. Cooper, Chairperson, Asbestos: The Need for andFeasibility of Air Pollution Controls (Washington: Na-tional Academy of Sciences, 1971).See reference 43, p. 62.New York Times, September 19, 1974, p. 1.

Occupational Health PacketWhile everyone talks about preventive health on the shopfloor,someone is actually doing something about it. This packet in-cludes four Bulletins which provide for the first time an analysisof how industry and government have dealt with the problem;case studies of occupational diseases—of white lung diseaseand of the most terrifying occupational health plague—asbes-tosis; and a profile of the miners' struggle with black lung dis-ease. (September, 1971, March, 1973, September, 1972, November-December, 1974.) $2.00.

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28

Vital SignsSWIMMING IN BEDS

While nearly everyoneagrees that there is a growingexcess of hospital beds, hos-pital construction is neverthe-less undergoing a boom un-paralleled in the rest of theeconomy. US Department ofCommerce statistics showhospital construction for thequarter ending June 30 up 9percent over last year, whileprivate construction has drop-ped 3 percent in the same pe-riod. Many attribute this tothe ending of wage and pricecontrols for health care inApril of this year.

PSRO: TO BE OR NOT TO BEThis year's raging debate

in the AMA has been whetherdoctors are more damned ifthey embrace the creation ofPSRO's (Professional Stand-ards Review Organizations)than if they don't. (For discus-sion of PSRO's, see BULLETIN,July/August, 1974.) In Los An-geles County, it would seemthat the latter is the case.

While the LA County Med-ical Association studiously ig-nored the advent of PSRO's,presumably hoping theywould thereby go away, theInterns and Residents Associ-ation of Los Angeles CountyMedical Center, headed bymilitant housestaffer RexGreene, was the sole appli-cant to form a PSRO. With nocontenders, the federal gov-ernment was obliged to givethe group a PSRO planninggrant.

When the medical commu-nity became aware of this de-velopment, it was up in arms.Threatened with "students run-ning the teachers," physiciansare mounting a full-scale fight

to quash the nascent PSRO.The housestaff group mustshow 25 percent supportamong county physicians toreceive conditional recogni-tion by HEW. Then upon noti-fication, if 10 percent of thecounty's physicians object, avote must be taken. The groupmust then receive majoritysupport, or the whole processstarts over again.

Some physicians havethreatened to strike, severalhospital officials have votedto boycott PSRO efforts andseveral hospital directors anddepartment chiefs have writ-ten their staffs urging themnot to "wander into his[Greene's] clutches." The bat-tle will be an uphill one forthe housestaff group, butmeanwhile interest in PSRO'shas never run so high in LosAngeles County.

At the same time the SenateAppropriations Committee hasmoved to allay fears thatother troublesome PSRO's willcome into being. On Septem-ber 11 it voted to slash $28million from the $58 millionPSRO budget for Fiscal Year1975. If the measure passesCongress, officials claim thatno new PSRO contracts willbe awarded. Currently some40 to 60 new PSRO areas wantto come into the program andothers are waiting until moremoney becomes available.

KENNEDY MANPOWERBILL DEFANGED

Senator Edward Kennedysuffered a resounding defeaton a health manpower meas-ure containing some sweepingprecedents for the medicalworld. Kennedy's bill wouldhave authorized some $5.1 bil-lion for health manpowertraining over the next fiveyears while requiring (1)every entering medical stu-

dent to serve two years inareas of medical shortage (onpain of loss of license for fail-ure to follow through); (2)regulation by HEW of thenumber, type and location ofall internships and residen-cies; and (3) establishment ofnational standards of licen-sure and relicensure of physi-cians every six years. Themeasure, passed by the SenateLabor and Public WelfareCommittee, was defeated 57-34on the Senate floor.

A much watered-down sub-stitute sponsored by GlennBeall (R.-Md.) was subsequent-ly passed. The measure wouldauthorize $454 million in cap-itation grants to medicalschools over the next threeyears while requiring that 25percent of a school's studentsagree to serve in areas ofmedical need after graduation.It would also limit the numberof foreign medical graduatesadmitted to internships andresidencies (eventually not toexceed 25 percent); expand theNational Health Service Corpsand authorize $165 million inscholarships over the nextthree years; and require thatschools administer three-yearresidency training programsin%primary care and familypractice. The measure nowgoes to the House.SOUTHERN EXPOSURE

A recent study by the South-ern Regional Council hasfound the health status of 11Southern states lagging be-hind the rest of the country onalmost every significant index.Infant mortality was lowest inArkansas—19.6 infant deathsper 1,000 live births (stillhigher than the national av-erage of 19.2)—and highest inMississippi—29.1 infant deaths.Nonwhite infant mortality wasuniversally higher than white,ranging from 25.7 in Arkansas

to 39.7 in Mississippi.The ratio of primary care

physicians to population fallsfar below the national aver-age of 1:781. Mississippi andAlabama had 1:1,860, SouthCarolina had 1:1,829 and Ar-kansas had 1:1,821. FourSouthern states rank amongthe five in the nation havingthe fewest primary care phy-sicians per population.

The report attributed thelow health status of the Southlargely to the related prob-lems of poverty, housing, sani-tation, environment and nu-trition.A TOUCH OF CLASS

Some of the frustration andprejudice encountered by for-eign housestaff in the US washighlighted by former Presi-dent Nixon in his recent hos-pitalization for phlebitis. Uponmeeting Dr. Robert Toumajian,a third-year surgical residentof Armenian descent who wastreating him, Nixon suggested,"If you want to be rich, youshould go into the Armenianrestaurant business." Touma-jian commented later that theremark "bugged me a little,"and he thought Nixon "wascondescending." "The stereo-type of an Armenian is thatyou have to be cleaning rugsor running a restaurant,"Toumajian said.DO IT YOURSELF

Trouble with transportationto and from medical facilities?A patient at Roosevelt Hos-pital, New York City's busiestmidtown hospital, devised hisown solution. As hospital au-thorities reconstruct the event,the youth, admitted earlier inthe evening for being drunkand disorderly, apparentlyfound the hospital ambulance(complete with keys in the ig-nition) parked in the hospitalparking lot, and drove home.While the hospital used a

back-up ambulance, the policefound the missing vehicle twohours later parked in a resi-dential neighborhood in Brook-lyn. A new twist in self-help.O.R. WORKERS BEWARE

Operating room workers aresubject to higher than expect-ed rates of cancer, spontane-ous abortion and birth defectsamong their children, appar-ently as a result of breathinganesthetic gases, a startlingstudy done by the NationalInstitute of OccupationalSafety and Health and theAmerican Society of Anesthe-siologists has revealed. A sur-vey of 29,000 doctors, nurses,anesthetists and techniciansrevealed far higher rates ofcancer and miscarriages thannormally expected amongwomen, increased rates ofliver and kidney diseaseamong both men and women,and increased rates of birthdefects among children bornto both men and women op-erating-room workers. The twogroups that sponsored thestudy are now seeking to es-tablish criteria for safe oper-ating-room conditions.NEW WOMEN'SHEALTH PUBLICATION

The Fall issue of HealthRight, a publication of theWomen's Health Forum, hasmade its appearance. The firstissue leads off with an articleentitled "Women's HealthMovement: Where Are WeNow?" Other articles dealwith attempts at limiting wom-en's rights to abortion and aninterview with a nurse aboutthe role of consumer participa-tion from a worker's perspec-tive.

Subscriptions to HealthRight are $5 a year. The ad-dress is: 175 Fifth Avenue,Room 1319, New York City,N.Y. 10010. 29

PHANTOM SALES,REAL PROFITS

The nursing-home industryis coming in for some sharpscrutiny in New York State, inpart due to a recent series ofhard-hitting exposes in theNew Yorlr Times. Aside frompatient neglect, often vergingon the scandalous, the Timeshas focused on schemes de-signed to enhance nursing-home owners and operatorsby bilking New York State'sMedicaid program. Medicaidprovides 90 percent of nurs-ing home income in the stateand paid $560 million for nurs-ing home care last year.

These schemes include pay-roll padding, nepotism, kick-backs from suppliers, falsifica-tion of costs and withholdingof services paid for by Med-icaid from patients. Chiefamong them, however, is saleand leaseback—the practice ofselling a nursing home to ones-self or one's associates andthen leasing it back at a high-er rate. The operator, thushaving incurred additional ex-penses in rent, mortgage pay-ments and/or depreciation,can then apply for and gen-erally count on getting an in-creased reimbursement fromMedicaid, which pays on acost-plus basis. This practiceno doubt accounts for the factthat over half (200) of NewYork State's 378 private nurs-ing homes applied for changesof ownership last year alone.

The practice of sale andleaseback is exemplified inthe case of Eugene Hollander,former President of the Metro-politan New York NursingHome Association, who at-tempted to sell his four nurs-ing homes to Touro College, asmall, newly established liber-al arts college in Manhattan,for $29 million. Mr. Hollander

30 then leased back the homes at

approximately $1.4 million ayear, yielding Touro an esti-mated $100,000 a year in in-come. He then applied to Med-icaid for an increase in reim-bursement rates. Medicaidsurprisingly turned down therequest, stating that it did notsee why it should contributeto Mr. Hollander's favoritecharity.

While the sale of the Hol-lander homes was presentedin his application to the Stateas a fait accompli, there hasnow come to light an earlieragreement between Hollanderand Touro College that wouldautomatically cancel the saleif the State refused to granthigher reimbursement rates.When charged with being lessthan forthright about the sale,a lawyer for Touro Collegedenied "the impression thatTouro College was engaged insome unethical scheme, whichit was not." He continued, "Ineed hardly point out thatsuch operations have becomealmost classical procedureand are a major source of in-come to many of our leadingcolleges."

Dr. Bernard Lander, Presi-dent of Touro College, is nonewcomer to the nursing homebusiness. Before coming toTouro, he was the former Di-rector of Medic-Home Enter-prises, a large out-of-statenursing home chain known tohave links to at least 38 othernursing homes in the City.And if Touro's trustees werenewcomers, they are no doubtbeing quickly initiated. Theyinclude former US Representa-tive Emanuel Celler, whoselaw firm represented Touro inthe nursing home transaction,New York City Mayor Abra-ham Beame, Senator JacobJavits, State Controller ArthurLevitt, State Assembly minor-ity leader Stanley Steingut

and, until recently, State At-torney General Louis Lefko-witz, who just resigned to in-vestigate—you guessed it—thesale and leaseback of nursinghomes in the state. Mean-while, seeking horizons be-yond the nursing-home busi-ness, Touro is applying to theState for a charter to establisha medical school.

CHARITY EXCLUDES POORVoluntary hospitals staved

off a potential threat to theirmode of operating financiallywhen the federal Court of Ap-peals for the DC Circuit onOctober 9 reversed a ruling ofthe DC District Court that hadrequired as a condition of tax-exempt status that private,nonprofit hospitals providefree or below-cost services topersons unable to pay (seeBULLETIN, May/June, 1974.)

The Court of Appeals up-held an Internal RevenueService interpretation of theword "charitable" in the taxlaw that found the promotionof health per se to be a char-itable purpose and that per-mitted hospitals to qualify fortax-exempt status as char-itable institutions if they main-tained an emergency roomopen to all and provided hos-pital care to all those able topay, either directly or throughthird-party reimbursement. Thecourt took the IRS at its wordthat it requires hospitals underthis ruling to accept Medicaidpatients, a notion that Med-icaid recipients' in many partsof the country would dispute.The court also ignored the factthat an estimated 20 millionAmericans have no coverage,public or private, for the costof hospital care. The Amer-ican Hospital Association,which had stayed clear of thesuit during its earlier stages,participated as friend of thecourt in the appeal.

Peer ReviewSECOND THOUGHTSFROM THE SOUTHDear Health/PAC:

The rush in which we wroteour article ["Southern Empire:Hot-Handed Duke," BULLETIN,July/August, 1974] allowedseveral errors to creep in, aswell as several omissions. Be-cause of this we would appre-ciate your printing this letter.

First, Tim McGloin, the ar-ticle's co-author, was incor-rectly identified as a memberof the New American Move-ment (NAM). He is not. He is amember of the Citizens Con-cerned About Durham HealthCare (CC), a community or-ganization that has been work-ing for several years to im-prove Durham's health system.

Two significant omissionsconcerned us. First, the finalform of the article did not con-centrate enough on the actualorganizing work going on. In-sufficient credit went to theCC for the role they played inorganizing the early hearingsbefore the Health PlanningCouncil for Central North Car-olina. No attention at all wasgiven to the unionization cam-paign underway at Duke. Thisunion effort is mobilizingmany workers at Duke andthe unions are playing a ma-jor role in organizing opposi-tion to the expansion plans.

Another important omissionis the fact that NAM is an op-enly socialist group and thatwe are central to the organiz-ing effort. This is no accident.Our socialist perspective pro-vides us with the essentialtools in understanding the ac-tual realities of class andpower in Durham. The situa-tion here, where private inter-ests are clearly manipulating

the public interest and thepublic purse for private gain,exposes the myth of the "pri-vate sector." Duke's moneycomes from its workers, its pa-tients, and the taxpayers. Itspolicies directly influence thepublic's welfare. Because of alegalism. Duke claims that itis private and that no one cantell it what to do. As socialistswe are saying what people al-ready know: Duke is a public,i.e., social, institution in theprofoundest sense of the wordand that it must meet the peo-ple's needs. Because peoplealready feel this way they re-spond to us. By strongly argu-ing the issue on the basis ofclass (i.e., a rich man/corpo-ration vs. workers approach)we have gained a real follow-ing and excited the interest ofmany people at Duke and inDurham. Because we talkabout organization and polit-ical power we are takenseriously.

We have not found themuch-feared reaction of peo-ple turning off at the meremention of the word "social-ism." Some are put off, butmany others are curious aboutwhat we mean. It is easy topoint to the issue we are allworking on as an example ofhow society is divided into un-equal classes. And it is quiteobvious in this case that thosenot in the ruling class mustorganize to win their rights.A surprising number of folksagree that they are socialisttoo.

Our strategy, in this citywhere the largest industry ishealth care, is to bring to-gether a wide variety ofgroups into a multi-racialworking class coalition. Thisis the only way we will beable to beat Duke.

An important questionhaunting many people across 31

the country is whether to sur-face now as socialists, that is,whether the working class is"ready." It appears, at leastin Durham, N.Cthat the work-ing class is just as ready asthe Left. We'll keep youposted.

—Paul Bermanzohn for theDurham Health Collective-NAM

Health PAC replies:We know that attribution is

a sensitive matter in many ar-ticles, so we are sorry that

Tim McGloin was misidenti-fied. We must point out, how-ever, that we signed the ar-ticle according to the authors'written instructions.

The two omissions cited inthe letter were not accidental.Although some information onorganizing in Durham was in-cluded in the authors' firstdraft, we did not feel the factsabout Citizens Concerned andunionization presented in thatdraft were adequate or wellsubstantiated. Furthermore,they were not germane to themajor theme of the article,Durham's medical empire and

its relationship to local andnational elites. This omissionwas made in consultation withthe authors.

The fact that the New Amer-ican Movement is an "openlysocialist group" was omittedbecause we did not feel theauthors were concrete abouthow this nomenclature affectstheir organizing—either help-ing or impeding it.

We think the letter raisesimportant issues which areworthy of discussion in theirown right and could not be ad-dressed adequately in theDurham article.

32

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