Mesothelioma science wrap-up

MN Governor inks cancer study

Minnesota Gov. Tim Pawlenty approved a $4.9 million dollar study of mesothelioma and taconite worker’s health Monday, after reaching a compromise with Range legislators. The Minnesota Department of Health has confirmed at least 58 miners’ deaths due to mesothelioma.

Mesothelioma science news wrap-up

Breaking the logjam of injustice

Our mission is simple: we want our day in court for plaintiffs dying from mesothelioma. Federal multi-district litigation docket 875 has obstructed that end and requires reform. If the judicial panel that oversees MDL 875 refuses to fix the problem after appeals through the proper channels, then we welcome the intervention of the US Senate to hold hearings and pass legislation that will remedy this injustice.

Our firm reported in March 2007 that navy veterans suffering from painful, aggressive, and terminal mesothelioma have had their day in court buried forever in the federal court responsible for asbestos litigation. The infamous “black hole” multi-district litigation docket to which these cases are removed continues to obstruct the rights of mesothelioma plaintiffs to a speedy jury trial.

A star chamber for the 21st Century

MDL 875 is a holding tank that was created to resolve pre-trial issues and questions of fact that are common to asbestos cases, settle the cases if possible, then return the cases back to the originating federal court for trial once the pretrial issues were resolved or when settlements could not be reached.

The hope was that the One Big Federal Court Program would prevent each district court in each major city from having to go through the lengthy, repetitive process of answering the same pretrial questions over and over and would provide a centralized court that could set up rules for settling cases. It would allow defendants and plaintiffs to quickly get down to the business resolving their case.

The judge presiding over the MDL was imbued with extraordinary powers to influence settlements, resolve pretrial issues, and remand the case for trial.

The current presiding federal district judge, Judge James Giles of the Eastern District of Pennsylvania, took over the multi-district asbestos docket after the death of Judge Charles Weiner in 2005. Judge Weiner resolved thousands of cases, yet thousands more remain holed up in the MDL. An estimated 3,000 of those cases are by malignant mesothelioma plaintiffs, in extremis claimants whose life expectancy is measured in weeks or months.

The key complaint from numerous plaintiffs is that Judge Weiner didn’t settle common questions and he didn’t coordinate. He acted as a forced arbitrator, letting plaintiffs know that they could either settle or see their cases stuck in MDL forever. This gave defendants tremendous leverage, especially with meso cases, because the single biggest tool for justice—a trial in front of a jury—was effectively taken away from plaintiffs. Defendants responded with miniscule settlement offers, or none at all.

The new MDL judge, Judge Giles, has signified that he will continue what Judge Weiner began. His only forward movement on asbestos litigation has been his attempt to dismiss thousands of asbestosis lawsuits that defendants claim were diagnosed by fraudulent doctors. While stalwarts in the pro-asbestos world such as the U.S. Chamber of Commerce have lauded this move, the life-and-death issue of cases filed by mesothelioma victims remains untouched.

How a meso case gets stuck in the black hole

The MDL order does not contemplate that the MDL judge will hold onto cases forever, without remanding them to federal district court for trial. Instead, it creates a framework where a plaintiff files suit, the case is removed to the MDL docket to resolve and coordinate common pretrial questions of law, and then “remanded” back to district court so the trial can proceed if a settlement cannot be reached.

MDL 875 proceedings include the development of cases for settlement, trial or other disposition. They also include supervision of extensive discovery concerning the ongoing flow of asbestos-related personal injury actions in the courts. MDL activities also include prioritizing cases for resolution.

Although theoretically MDL 875 can remand cases for trial, in reality the court has enforced a practice in which it will not remand a case until “all avenues for settlement have been exhausted.” This can take years, and when the meso claimant dies, significant parts of his compensation claim expire as well. Moreover, the MDL has a policy of severing punitive damages from compensatory damages, which means that even when cases are remanded, the most financially meaningful part of the claim remains in perpetual MDL orbit. Even under the best circumstances, the defendants get a windfall by never having to face punitive damages, which translates as artificially lowered settlement offers.

By 2000, out of 66,000 cases only 1,000 ever qualified for remand. The MDL’s discretion on when pretrial issues had been resolved was so great that meso cases rarely got back to federal court for trial. Also by 2000, Judge Weiner had closed 44,723 cases in MDL 875, orchestrated settlements for unfiled claims, and facilitated settlements in state court jurisdictions at the request of state court judges. He is estimated to have resolved or dismissed over four million claims comprised in those 44,273 cases.

This breakneck pace of efficiency with regard to nonmalignant claims sounds great, but for terminal mesothelioma plaintiffs whose cases are never completely resolved or who are forced to accept pennies on the dollar because defendants know they’ll never face a jury, the injustice has been even greater.

Plaintiff’s lawyers like federal court and their juries and would gladly try cases there. There are many features of federal law that facilitate the just disposition of personal injury claims, such as the 6-hour limitation on depositions. Meso lawyers shudder at federal courts because of the MDL graveyard, not because of the procedural law, jury pool, or bench.

Judicial solution

Since a mesothelioma claimant’s life span averages 6-18 months from the time of diagnosis, there must be a mechanism to get their claims resolved if they are to have any meaningful chance of receiving fair compensation for having been poisoned. Justice delayed until after you’ve died is justice denied. What’s crucial is some change in the MDL process to accommodate in extremis, dying meso victims, who are a small percentage of the total docket.

Since the multidistrict litigation court is itself supervised by a panel of federal judges, it made sense early on to seek their intervention to unclog the backlog. The panel, however, refused to intervene, choosing instead to stamp its approval on this miscarriage of justice.

Following the panel’s ruling, Judge Weiner’s policy of holding meso cases hostage in the black hole was challenged in the 3rd Circuit Court of Appeals. In April 2000 the appeals court upheld Judge Weiner’s approach and agreed with the asbestos companies when it noted approvingly that the court had resolved a prodigious number of claims—44,000 in the first six years alone. But there’s a world of difference between disposing of claims and sending them back to district court where they can be tried. For meso victims, there’s the added factor of time. Even a month’s delay can mean the difference between life and death.

And for all the claims of judicial efficiency, the court still has a backlog of over 100,000 cases, and mesothelioma victims continue to die before their cases are ever heard.

The 3rd Circuit, the supervising judicial panel, and the MDL court itself have all made it clear that they will never release their grip on these cases. Dying meso patients whose claims are languishing in the federal black hole continue to be denied the right to have their case brought before a jury.

Legislative solution

The idea that legislators can put gentle pressure on the court to un-hitch the most pressing mesothelioma cases from the black hole is unlikely to succeed. Constitutionally, the court is insulated from congressional interference and free to interpret the laws as it sees fit. Practically, with an estimated 3,000 meso cases locked up in the black hole, and each case potentially worth several million dollars, a sudden release of these claims would put huge financial pressure on the defendants who have successfully bottled them up for so many years. It is inconceivable that these companies would give in without a fight.

In our democracy, that leaves one option: legislation. The section of the U.S. Code that authorizes and regulates multi-district litigation already has exemptions carved out for antitrust. Adding language that guarantees in extremis plaintiffs, such as mesothelioma, lung cancer and advanced asbestosis victims, the right to have their cases quickly addressed is feasible, fair, and in line with pronouncements of the MDL court itself. Justice delayed for a mesothelioma victim is no justice at all.

We encourage the U.S. Senate to hold hearings on this crucial issue so that victims don’t have to wait for the afterlife in order to get what they deserve. We encourage victims and their families to write, and call their U.S. Senator to urge that hearings be held on the asbestos MDL. Asbestos defendants have all the time in the world. Asbestos victims do not.

Trimodality treatment of malignant pleural mesothelioma

1: J Thorac Oncol. 2008 May;3(5):499-504

Batirel HF, Metintas M, Caglar HB, Yildizeli B, Lacin T, Bostanci K, Akgul AG, Evman S, Yuksel M.

Marmara University Hospital, Department of Thoracic Surgery, Istanbul, Turkey. hbatirel@marmara.edu.tr

INTRODUCTION: Multimodality treatment has achieved significant success in local control and treatment of early-stage malignant pleural mesothelioma patients. However, its favorable effect on survival is questionable. METHODS: We have instituted a trimodality treatment protocol consisting of extrapleural pneumonectomy, adjuvant high-dose (54 Gy) hemithoracic irradiation, and platin-based chemotherapy in a multi-institutional setting. Preoperative pulmonary function tests, echocardiogram, chest computed tomography, and magnetic resonance imaging scans were performed in all patients. Twenty patients have been treated with this protocol during 2003-2007. Seventeen had a history of environmental asbestos/erionite exposure. Clinical stages were T1-3N0-2. RESULTS: Median age was 56 (41-70, 8 female). There was one postoperative mortality (% 5) due to ARDS. Morbidity occurred in 11 patients (% 55). Histology was epithelial in 17, mixed in 2, and sarcomatoid in 1. Sixteen patients underwent extrapleural pneumonectomy. Microscopic margin positivity was present in 14 patients with macroscopic complete resection. Twelve patients completed all three treatments. Median follow-up was 16 months (1-43). Overall median survival was 17 months (24% at 2 years). Eight patients had extrapleural lymph node involvement (internal mammary [n = 3], subcarinal [n = 2], pulmonary ligament [n = 1], diaphragmatic [n = 1], subaortic [n = 1]). There was better survival in patients without lymph node metastasis (24 versus 13 months median survival, p = 0.052). Currently, 7 patients are alive, 6 without recurrence, and 2 patients at 40 and 45 months. CONCLUSIONS: Trimodality treatment in malignant pleural mesothelioma seems to prolong survival in patients without lymph node metastasis. Novel techniques are needed for preoperative assessment of extrapleural lymph nodes.

W.R. Grace tries to define its way out of asbestos poisoning

This important news involving WR Grace and asbestos illustrates why the definition, diagnosis, and treatment of asbestosis and asbestos cancers should be on a clinical basis rather than a geological basis. W.R. Grace is trying to escape its liability for poisoning an entire city by claiming that what is asbestos now was not legally asbestos then.

This type of semantic gamesmanship clearly shows why asbestosis and asbestos cancers are what should define asbestos fibers, not a Congressional definition or legislative fiat. When certain materials cause death under defined clinical conditions, they are asbestos. The industry’s disingenuous claim, that even though the substance kills it belongs (or should belong, or might belong, or once belonged) to a different mineralogical nomenclature and is therefore beyond the reach of regulation, is horrific.

Anything less than a complete ban on asbestos continues to hold open the door for death motivated by greed. The asbestos industry plays to win. So must we.

Essay contest winner #4: Megan Volpert

When I was a sophomore in high school, my algebra class was in a tiny room.  They had moved us there while temporarily closing down the math wing to remove asbestos from the building materials.  We joked that math had been killing us all along, but had no real concept of the slow poisoning we’d been exposed to.  That was many years ago, but most of the public is still unaware of the dangers of asbestos.  How can we spread the word?

Everybody likes to breathe freely, right?  There is a ban on cigarette smoking in public places that is sweeping the nation, mostly because nobody wants to get cancer or suffer respiratory problems because of what another person chooses to do with their body.  The people who support these public smoking bans would be interested to learn about asbestos.  They will not want to expose themselves to the risk of cancer because of what a business chooses to do with their building materials.  Therefore, a campaign to spread the word about asbestos could be similar to the campaign to ban public cigarette smoking.

Another way to spread the word about asbestos would be to reach out to cancer research organizations.  Everybody knows a lot about the threat of breast cancer, for example, and about fundraising efforts like Walk for the Cure.  One of the main dangers of asbestos is that is can cause mesothelioma, a respiratory cancer.  Cancer research organizations could do a better job of highlighting mesothelioma and its relationship to asbestos.

A final way to educate about the dangers of asbestos would be to give information directly to the people most involved with it.  Construction workers and building maintenance people are most as risk because they are exposed to asbestos on the job every day.  These kinds of workers often have very strong unions, and the unions should use their network of connections to increase awareness among their members so they can protect themselves better.

However we spread the word about the dangers of asbestos, the point is that we have to do so.  Many people die every year from asbestos-related illness–because we all face exposure to this hazardous material, we all have a responsibility promote education about it.

Death rattle for Canadian chrysotile industry?

This story from yesterday’s Sherbrooke Record is a must-read for anyone interested in the pathos, misinformation, and outright dishonesty that still drives the asbestos industry. With mere annual sales of 200,000 tons per year, and unable to compete with paragons of worker safety like Russia, Brazil, China, and Zimbabwe, the chrysotile mines in Canada are slated for closing.

This article briefly touches on the dangers of chrysotile, notes that it has been banned worldwide with few exceptions, and closes with a moving discussion of the industry’s efforts to save asbestos mining through the most cynical ploy imaginable: as a crucial aspect of workers’ rights! There are no discussions of other workers’ rights such as health, occupational safety, or the right not to be exposed to lethal carcinogens, which the article grudgingly admits that chrysotile may perhaps possibly be.

For anyone who thinks that the global asbestos industry is dead, this article clearly lines out who the major players are, their strategy for selling in poor countries, and their attempt to circumvent science with fraudulent pretensions to concern for the job security of laborers. Incredible!

California soccer mom in tough match with meso

Gloria Serrins is a 54 year-old mother of three beautiful daughters who lives in Mission Viejo with her husband, Phil, to whom she has been married for 31 years. Outgoing, vivacious, and completely dedicated to her family, Gloria now finds herself in a scenario that on one could have predicted.

In July, 2007 Gloria realized that something was wrong with her health. Vigorous, athletic, and normally full of energy, she could feel that something was out of synch, but didn’t know what it was. At first Gloria thought it might be the flu, but that didn’t explain the constant discomfort she felt whenever she was seated.

The discomfort caused her to fidget, and ultimately to have problems sleeping. Since Gloria always slept on her right side, it was too painful to lie down.

Trouble in paradise

Gloria and Phil were approaching their 31st wedding anniversary and he had set up a cruise to Alaska. Normally engaged and excited to be doing things with “the love of her life,” Gloria simply couldn’t muster any excitement about being away from home. The trip was extremely important to Phil so that they could celebrate their marriage, and also because Phil’s father had died at an early age after a lifetime of hard work. “I made up my mind early on that I’d take those extra minutes, hours, and days to be with my family. I miss my father every single day, and vowed that the only thing we really have in life—time—I would share with Gloria and the girls.”

Phil Serrins adores his wife, and he had sacrificed an 80-hour week career track to lead a lifestyle that would let him be there for them. Whether it was the school play, a family weekend trip, or traveling for soccer games, Phil and Gloria pulled together for thirty-one years, always in the same direction, always with the same goals in mind, always bound together by love.

Gloria vowed not to say anything to Phil about the pain because she knew that if he had any inkling, he would cancel the cruise and have her in front of a doctor immediately. The cruise was terrible, with Gloria’s discomfort descending into misery, compounded by an inability to sleep more than a couple of hours each night. Gloria was still afraid to say anything because Phil had developed a pain in his right eye during the trip and she was petrified that they would both be sick at the same time. Unable to withstand the pain any longer, she told Phil when they returned to California, after having endured almost unbearable pain and sleep deprivation on an ocean-bound cruise.

Web detective

Just as she had known he would, Phil whisked Gloria to St. Joseph’s, where a CT scan, MRI, and x-ray revealed spots on her lung. Dr. Brian Palafox was unable to conclusively diagnose, so Phil took charge. He got on the Internet and began consulting with doctors who he knew through his chiropractic practice.

Dr. Palafox affirmed that the only way to get a conclusive diagnosis was via a tissue biopsy. On Oct. 15 Gloria went in for surgery and, and the surgeon performed the biopsy and a talc pleurodesis. Subsequent immunohistochemical staining confirmed mesothelioma, biphasic type. When the Serrins learned that the oncologist recommended by Dr. Palafox only saw one mesothelioma case per year, they decided to continue looking.

Gloria was diagnosed with bi-phasic pleural mesothelioma on October 16, 2007.

Following her diagnosis, Gloria consulted with Dr. Cameron in Los Angeles, and Dr. Rusch and Dr. Pass in New York. All three surgeons determined that Gloria as not a candidate for surgery because of the cell type and advanced stage of her disease. Gloria began treating with one of the nation’s leading medical oncologists, Dr. Vogelzang at the Nevada Caner Institute in Las Vegas.

Despite an aggressive and arduous regimen of chemotherapy, Gloria consulted with Dr. Cameron again after her doctors determined that the Alimta/cisplatin regimen was not working. Unfortunately, she was still ineligible for surgery. Although a different chemo cocktail showed no progression of the tumor, it failed to show that the tumor had shrunk, either.

Chemotherapy has been discontinued, and five weeks from now she will do another CT scan to look into additional treatment. Gloria is struggling her hardest to keep the cancer at bay.

An American family

Gloria was born in 1953 in Goeppening, Germany, the daughter of a U.S. WWII army veteran and a German national. Her father, Francisco “Frank” Carillo, brought the family to the U.S. that same year, and the family relocated in southern California.

Gloria and Phil’s first daughter, Ricki-Ann, was born in1980. The family moved to Mission Viejo because Phil was studying to be a chiropractor. Gloria and Phil’s second daughter, Stacy, was born in 1981, and their daughter Lindsey was born in 1984. After Lindsey’s birth, Gloria became a full time housewife.

The dynamic and loving Serrins family has been built in large part by the unstinting love and devotion of Gloria. The unique character of each daughter was carefully nurtured so that each grew up to be a mature and responsible adult. Ricki-Ann loved being outside, and never played with dolls but liked sports, bikes, and action. Ricki-Ann played little league baseball as the only girl on her team, and later became an accomplished soccer player. Stacy loved play with Gloria’s jewelry, makeup, and clothing. At age three she entered dance school, and learned tap and ballet. Gloria would drive Ricki-Ann to soccer practice and Stacy to dance class and had to coordinate the transportation so no time was wasted. Stacy danced until she was twelve. The family never missed going to one of Stacy’s recitals.

Like her older sisters, Lindsey was always busy with sports and dance, and Gloria spent all her time taking care of the three girls. Gloria would volunteer at the girls’ elementary school until eventually she was at the school every single day. With three daughters at the same school at the same time, she helped the teachers any way she could. Gloria took care of other children as well, and when she became familiar with the kids and their parents she’d set aside Friday as the day to take her daughters and their friends to lunch at Taco Bell. The kids loved having Gloria in the classroom, and Phil would often come by the school on his lunch break. The daughters loved having their parents around at school.
Ricki-Ann graduated from the University of Maryland on a soccer scholarship.

Ricki-Ann is an assistant soccer coach at Tulane University in New Orleans. Stacy attended Santa Barbara City College where she studied art and dance. Stacy graduated from beauty college and works as an esthetician at the Montage Resort at Laguna Beach. Lindsey was recruited to UCLA for their crew team, and graduated in 2005 as a history major. She now works as an elementary school teacher in New Orleans, near her older sister. All three daughters attribute their success to their nurturing, involved, and tireless mother. Gloria’s devotion and dedication to her family, and her extraordinary toughness, are exemplified best when she says, with no trace of pride, “All three of my girls were natural childbirths. I didn’t want it any other way.”

After thirty-one years of marriage, Gloria and Phil have grown together spiritually and emotionally. They both love to garden and spend their weekends together in the yard. With numerous flowers in the yard, the centerpiece is Gloria’s rose garden. Gloria loves crafts, decorating, wildlife, and dogs. She has a blue-gold macaw that chatters gregariously in their home, and two Australian shepherds, Berkeley and Mac. She and Phil love to take their daily promenade around the neighborhood, and they enjoy walking along the nearby nature trails and wilderness areas.

“Gloria always kept things in check and kept me on track,” Phil says in disbelief, shaking his head at the catastrophic calamity that has befallen his family. “She was the one who was reasoned and even-handed with the kids. She never rushes to judgment or breezes past things. Gloria sees life, where most people just run through it. If she’s on skis, she won’t race down the mountain, but will stop and look at the trees and the animals, and even at the snow. We go to movies all the time. While the kids were growing up it was about Gloria being there to see them and raise them. We went to every school function, not just to be supportive but to be together. And now…” his voice trails off, “…this.”

PHLBI announces position on asbestos ban legislation

The following announcement was released by the Pacific Heart, Lung & Blood Institute today regarding the pending asbestos ban legislation in the U.S. House of Representatives:

The Pacific Heart, Lung & Blood Institute unanimously supports a complete ban on asbestos-containing products and adequate funding for research on asbestos-related diseases. The House Committee on Energy and Commerce’s draft bill, currently referred to as the “committee print,” is the best vehicle to address a true ban and provide meaningful funding.

Public health concerns should prevail

We support the committee print’s ban on all asbestos containing products. We explicitly reject the “less than one-percent” exemption, which would allow the continued use of asbestos as long as this toxic mineral is less than one percent by product weight. Such an exemption would allow industry to include one pound of lethal asbestos in a 100-pound bag of insulation. This one-percent exemption would perpetuate the misery of the asbestos disease epidemic and is indefensible on public health policy grounds.

We support the committee print’s broad, effective asbestos ban as the first federal legislation that recognizes what scientists have known for decades: there is no safe level of exposure to asbestos. The committee print’s broad ban also reinforces the fact that there is no scientific or public health basis for allowing the one-percent exemption. The committee print also authorizes government-funded compliance testing of products in American markets, which will safeguard against machinations by industry to dodge the ban.

The Pacific Heart, Lung & Blood Institute supports the existing committee print as the most effective, science-based standard for effectively banning asbestos. Asbestos is responsible for the worst occupational health epidemic in our country’s history. We have seen no compelling health-based reason to support an exemption that would, in our view, only perpetuate the asbestos health epidemic. Sadly, the exemption is a stark reminder of the asbestos industry’s dark history of fabricating scientific research, stifling work safety regulation, and putting profits over people.

Research funding for treatment and a cure

The Pacific Heart, Lung & Blood Institute supports asbestos ban legislation that includes funding for asbestos disease research. A ban must be accompanied by significant resources for public awareness, for better treatment and for finding a cure.

We support unified efforts to draft meaningful research legislation that will be merged with the committee print’s current ban provisions. The committee print, with its ban provisions and its still undrafted research provision, offers an unparalleled chance for advocates and scientists to obtain, for the first time ever, enormous financial resources to better treat and ultimately cure asbestos diseases. The House subcommittee responsible for drafting these research provisions is already at work. The time is ripe for advocates to unite and work with the House to consolidate and strengthen these crucial research provisions.

The Pacific Heart, Lung & Blood Institute supports provisions that:

1.    Establish a competitive peer review grant program with targeted research priorities such as biological therapies, multi-modal therapies, prevention, biomarkers, and pain management;
2.    Fund centers of research and treatment excellence from coast to coast;
3.    Fund a database, registry and tissue bank;
4.    Create an asbestos surveillance and public awareness program;
5.    Appropriate $100 million over the first five years, divided between the National Institute of Health, the Center for Disease Control, and the Veterans Administration. We note that about 1/3 of all victims of mesothelioma in the U.S. were exposed while serving in the navy or naval shipyards.

The Pacific Heart, Lung & Blood Institute believes that the opportunity for a united front is extraordinary. By working together with victims and their families, groups such as the Asbestos Disease Awareness Organization, the Mesothelioma Applied Research Foundation, doctors, advocates, cancer research institutes, and national centers for excellence, we can—here and now—draft legislation to fully fund mesothelioma research while also supporting an effective ban as spelled out in the existing committee print.

Now versus later

The Pacific Heart, Lung & Blood Institute supports the committee print’s statutory approach to an asbestos ban, and rejects the rulemaking approach used in previous attempts to ban asbestos. Statutory bans have a proven track record with toxic materials such as PCBs and DDT.

We urge all stakeholders to join with us in helping influence research funding provisions, which have yet to be crafted in the House’s draft bill. Working together to write an improved bill in the House will provide a superior version to the Senate bill, which will face robust opposition in conference committee due to its unconscionable one-percent exemption. After a century of death and disease, the time for delay is past. Our board supports an immediate, unambiguous ban with research funding commensurate with the scope of the asbestos health epidemic today.

About

The Pacific Heart, Lung & Blood Institute is a non-profit 501(c)3 corporation composed of physicians, patients, and advocates dedicated to the eradication of diseases of the heart, lungs, and blood. PHLBI conducts innovative research to benefit future generations.

Phone: (310) 478-4678 | Fax: (310) 988-2693
1615 Westwood Blvd., Suite 204
Los Angeles, CA 90024
Email: info@phlbi.org
www.phlbi.org