“I
am truly humbled by both the careful scientific work and real
passion to protect the public's health contributed by those I have
worked with on this policy. It is refreshing to me, even as a
senior person in the field where one can easily loose hope that
public health can make a difference to people in these rather
cynical times, to be working so collaboratively across
organizations like this,” says Jim Gaudino,
Multnomah
County epidemiologist associated with the Joint Policy Committee,
who shared his perspectives on the Asbestos Statement with The
Epidemiology Monitor.
Because of the unprecedented nature of the Statement, the Epi
Monitor asked persons associated with the preparation of it to
share their thoughts about both the statement itself as well as
the process used to develop it. Here is more of what they had to
say.
EpiMonitor: What do you think is most notable about the
statement?
Ross
Brownson (Washington University at St. Louis):
It is a good example of a policy statement based on sound
etiologic data (e.g., from IARC) and a growing problem, esp. in
some parts of the globe. And the consensus process led by the JPC
worked well with many rounds of revision, resulting in a better
product. Let's hope it does some good!!
Robert Platt (McGill University):
The degree to which the scientific evidence is consistent.
Phi
Landrigan (Mt. Sinai School of Medicine):
I think it is a strong statement that addresses a well established
carcinogen. It is very timely given that the Government of Canada
has just announced that it is awarding a bail-out loan to sustain
the Quebec asbestos mine.
I co-signed the letter.
Eduardo Franco (McGill University):
As far as I know, this is a first example of joint advocacy by
professional epidemiology societies. It could have been any topic
among so many in which epidemiologists have contributed to
identify harms or preventive strategies. It happened at this point
that asbestos was chosen because we had Colin Soskolne and
Kathleen Ruff who volunteered to do the massive amount of research
work that was required.
Jim
Gaudino (Multnomah
County Oregon):
Most notable to me is the very fact that this issue remains an
extraordinary public health problem in the world and that there
have been so many barriers for people, especially workers, to be
free of the risks from the preventable illnesses caused by unsafe
exposures to asbestos!
The
policy itself is an amazing compendium of the science that
supports the actions called for in the statement, and the
government and industry policies and politics that has prevented
having a world free from asbestos-related health risks.
Colin Soskolne (University of Alberta):
Epidemiologists have never before come together to evaluate what
cancer agencies, labor groups and public health entities had
previously agreed upon concerning the relationship of the various
forms of asbestos to morbidity and premature mortality. Since
vested, moneyed interests have long been using manufactured
controversy around the epidemiological evidence to foment doubt,
this statement exposes such arguments and lays such malfeasance
to rest. Through this Statement, no longer can any illusion of
controversy be maintained. For the first time, a Statement is
available that puts forward, from an epidemiological perspective,
the clear evidence confirming that all forms of asbestos should be
banned.
Robert McKeown (University of South Carolina):
The JPC-SE has done a number of policy statements that have had
wide endorsement. One of the notable ones had to do with the
impact of HIPAA on epidemiologic research, which was published in
JAMA in 2007 and so had pretty wide exposure. However, I don't
think the committee has done one that has garnered some of the
endorsements this one has (Epi Section of APHA is on JPC-SE, but
the parent organization also endorsed this one, as did the
Canadian Public Health Association), but I may be wrong. Also, I
don't recall one that was as controversial or politically charged
as this one.
EpiMonitor: What do you think is most notable about the process
that was used to develop the statement?
Jim
Gaudino:
Representing the expertise of an impressive group of
colleagues who are members within the over 11 professional
societies of Epidemiology in North America, with other groups
joining in, the policy serves as a major milestone for the
international cooperation of scientists and public health
practitioners working in the field of epidemiology who can now
together call for the protection of people from public health
hazards.
With
this policy, Joint Policy Committee of the Societies of
Epidemiology has graduated to become a real voice for public
health. Congratulations to my colleagues serving currently and
previously on the JPC-SE!
Robert McKeown:
The process was much more iterative and dialectic for this
statement. There were people on both sides of the issue weighing
in. Some of the concerns had to do with people with conflicts of
interest on both sides who had to declare those interests. That
made the process more difficult, but getting everything out in
open and involving folks without any such conflicts was essential
for the statement to be accepted. The result was that the
statement was somewhat more narrowly focused, certainly more
solidly science based, and had more balanced, or less charged
language. I think the result is a better document that may have
more influence.
Robert Platt:
That several societies that have not in the past
endorsed such statements have done so this time. SER in
particular has not participated, but this time did.
Eduardo Franco: The fact that we, as an epidemiology
community, went outside of our comfort zone as scientists who
constantly wear the professional skeptic's hat and took a strong
stance as advocates for a health promotion cause. The JPC-SE has
typically tackled issues related to the practice of the
epidemiology profession, e.g., ethics, placing data in the public
domain, government-imposed restriction of census data, etc. These
have required examining legislation, guidelines, and like
documents and prompted our community's posturing against elements
of these external documents that could represent potential threats
to our trade. With the asbestos document we produced a review of
evidence from secondary credible sources, such as the IARC's
review of carcinogenicity for asbestos, country production data,
practices by the asbestos lobby, and issued strong statements
calling for a ban on asbestos mining, trade, and use.
Colin Soskolne:
A transparent, thorough, respectful, and accountable process
involving all member societies of the Joint Policy Committee of
the Societies of Epidemiology (JPC-SE) has resulted in a Statement
that is now (i.e., after July 24, 2012 at 11 am) accessible on the
JPC-SE website <www.jpc-se.org>.
This Statement will not be easily dismissed by government and
industry groups alike, which persist in denying the science of
cause and effect relating to all forms of asbestos exposure,
regardless of the occupational or environmental setting.
The process was
inclusive of all JPC-SE member society boards/councils, which
necessitated addressing a broad range of critique, reflective of
the diversity of the various board member constituencies. Being
respectful of these critiques has resulted in a robust, definitive
Statement of which all member societies can be proud.
Epi
Monitor: What other comment would you like to make, if any?
Jim
Gaudino:
This is only the beginning. The rubber meets the road as we
present the evidence and let colleagues and the public know about
the risks and how these can be mitigated. The work continues even
more when the policy statement is issued!
Finally, with increasingly shrinking resources in public health,
we, working in public health, must work even harder across
organizations and across disciplines to have any hope of making
real impacts to improve the public's health.
Robert McKeown:
The American College of Epidemiology has a long history of
engagement with policy issues with emphasis on the importance of
making evidence-based, responsible statements and providing
guidance and workshops on the move from epidemiologic evidence to
policy recommendations. A number of articles has been published
in our journal, Annals of Epidemiology, on this topic and we are
pleased to be an active supporter of JPC-SE and to partner with
other epidemiology societies in making statements that impact the
practice of epidemiology and the health of the people.
Eduardo Franco:
The choice of asbestos was also one of opportunity. The asbestos
industry lobby has become quite aggressive and had made inroads in
some countries by succeeding in opening mines and having
legislators accept that proper safeguards can guarantee safety for
workers. We felt that we needed to counter these actions as
quickly as possible. All forms of asbestos are harmful and no
production or processing safeguards can decrease risk to
acceptable levels.
The statement comes with dissemination plan to align all
professional bodies that care for the promotion of human health.
We are particularly targeting sister societies in countries that
produce asbestos or are major end users.
Colin Soskolne:
Any group or person wishing to lend their support by endorsing the
Statement will be welcome to do so by following the procedure as
outlined in the Appendix to the Statement.
Robert Platt:
I think this marks an interesting point for the
epidemiology societies. We need to have a serious discussion of
the role of epidemiologists as advocates. My personal bias is to
be very cautious with these sorts of statements, because it's rare
that the epidemiologic evidence is as concentrated and decisive as
it is in this case. Most other cases will be much less clear cut.
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