PUBLIC HEALTH


until his recent obituary. Hall was one of Australia’s most


Asbestos – still F


Alan MacDermid looks at the enduring ill-effects of asbestos on UK health


EW people in this country, apart from mountaineering enthusiasts, would have heard of Lincoln Hall


celebrated climbers and is perhaps best known for an ascent of Everest six years ago, aſter which, on the way down, he collapsed suffering from cerebral oedema, one of the most serious manifestations of altitude sickness. Two Sherpas with him tried valiantly to


help the delirious Hall until he lost consciousness, at which point the expedition leader ordered their withdrawal from what would have been a futile sacrifice. Incredibly, Hall managed to survive the night at 8,600 metres, apparently with the aid of transcendental meditation. He was rescued the next day by four climbers from another expedition. Given his strenuous career in the most


pitiless of the great outdoors, it was sadly ironic that Hall should have succumbed at the age of 53 to a disease more associated with heavy industry, shipbuilding, engineering and construction – asbestos- related mesothelioma. It may also seem a puzzle that one so


young should have been afflicted by a disease whose gestation period can be up to 50 years from exposure. In fact, it was


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attributed to contact he had as a boy in his back garden in Canberra, building dens with his father, presumably using asbestos sheeting. Hall’s death is a salutary reminder that


the asbestos story will continue to dog us even though it is years since imports were banned in this country.


Peak still to come According to the Health and Safety Executive (HSE), asbestos is the single greatest cause of work-related deaths – from mesothelioma, asbestosis and lung cancer - in the UK. Although asbestos has now been banned, certain materials were still manufactured and used until 1999. It is estimated that at least 50 per cent of all asbestos used in the construction of buildings in the UK is still present. Cases of asbestos-related diseases will


continue to increase, with mesothelioma deaths alone now expected to peak at 2,500 a year by 2015, thanks not only to the long latency period but also the emergence of a new generation of victims. Te burden of disease suffered by workers in asbestos manufacture and heavy industry has been inherited by workers in other trades associated with the building industry, with a far wider geographical spread. Life expectancy is also having an effect. People


who once would have died from other things are living long enough for the disease to develop. So is this a time bomb for a National Health Service already under pressure with restricted resources? Te answer is probably no, but for reasons


which are hardly a cause for celebration. Te sad fact is that the NHS has little to offer mesothelioma patients beyond palliative care, which itself will be of limited duration given the rapid course from diagnosis to death taken by this brutal disease. “It is potentially still a big problem - we


are in the unknown territory of gauging the effect on the trades who have been suffering secondary exposure to asbestos products,” says Mark Britton, Professor of Respiratory Medicine at Surrey University, and Vice- President of the British Lung Foundation. “Generally, though, the cost is going to be in human rather than financial terms.”


Poor prognosis Treatment offers little hope for mesothelioma patients. Because the condition presents quite late, surgery - pleurectomy - has not produced encouraging results. Professor Britton says: “Without wishing


to sound negative, because the patient dies fairly quickly – mean survival being less than 12 months – there is not a long chronic disease phase. Tere is not a huge resource issue from the chronic care point of view.” Chris Clark, a consultant chest physician


working in the West of Scotland, says: “I started out years ago hoping that some effective treatment would emerge but it’s not there yet.


PHOTOGRAPH: SCIENCE PHOTO LIBRARY


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