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b views like this," says science policy expert M. Granger Morgan, head of the depart- ment of engineering and public policy at Carnegie-Mellon Uni- vcrsity. But "what's unusual," he says, "is for people not to be arguing in the same forums. If they don't go to the same confer- ences it's [usually] be- cause they have differ- ent disciplinary back- grounds, rather than because they don't No Meeting of the Minds on Asbestos The debate on the health hazards of asbestos has become so polarized that researchers from one camp no longer go to the other camp's meetings SCIENTIFIC MEETINGS ARE USUALLY RELA- tively civilized affairs, a chance to exchange research results and thrash out their inter- pretation. But Bruce Case, director of the Center for Environmental Epidemiology at the University of Pittsburgh, recalls a con- ference he attended in June 1990 on the health effects of asbestos in a very different light: It "was like nothing I've ever attended before. This is the first meeting I'd ever gone to where I got the feeling that the whole thing was a kind of political setup." Called "The Third Wave of Asbestos Dis- ease: Exposure to Asbestos in Place. Public Health Control," the conference reflected the view that a spate of asbestos-triggered diseases would strike thousands of construc- tion workers, firemen, custodians, and other people exposed to microscopic asbestos fi- bers that crumble from building and pipe insulation, brake pads, and hundreds of other sources. According to Case and others who attended the meeting, researchers who hold a contrary view-most of whom were not present-were vilified during discussion periods that followed many of the presenta- tions. The conference organizers charge in turn that a December 1988 conference held at Harvard University was badly slanted in the opposite direction. That meeting, they claim, was dominated by researchers who believe that chrysotile asbestos, the most commonly used type in the United States, poses relatively little health risk to the gen- eral public at the levels ofexposure generally encountered, and that expensive removal of properly maintained asbestos-containing materials such as insulation and cement is not warranted. Welcome to the world of asbestos re- search-a world riven by deep fissures and bitter disputes. It is a world where science and the law dramatically interact in a slew of multimillion-dollar law suits, ranging from legal actions brought by victims of asbestos- related illnesses to efforts by school systems to recoup the costs of removing asbestos- containing materials. And it is a world where scientists with opposing views no jonger seem to be able to talk to each otherat a scientific level. "In environmental science it happens fairly regularly that there will be diverse 92E o ~mment Old guard and revisionist. Irving Selikoj)`'arguea that all fiber types should be strictly regulated; Brooke Mossman says the commonest type poses little public Iwsard want to hear the other party line." The fissioning of a discipline Asbestos researchers weren't always at odds with each other. In the early 1960s, studies that convincingly linked asbestos exposure to mesothelioma-a rare cancer of the lining of the chest or abdomen that's nearly always fatal-paved the way for a flood of research aimed at figuring oat whose health was endangered by asbestos and how much of the silicate fiber had to be inhaled to cause cancer. Non-industry re- searchers at that time were generally united in a crusade to persuade regulatory agencies and asbestos manufacturers to institute stringent controls on the amount of air- borne asbestos fibers that workers were ex- posed to, says Arthur Langer, a mineralogist and director of Brooklyn College's Institute of Environmental Studies. At this time, says Langer, one scientist galvanized the field to institute regulatory change more effec- tively than any other: Irving Selikoff, a med- ical researcher at Mt. Sinai Hospital, who co-authored a landmark 1964 paper on high rates of inesotheGoma and other cancers in New York City insulation workers ex- posed to asbestos. "He was something to watch," recalls Langer, who worked at Mt. Sinai from 1965 to 1988. "I was there when we confronted all of the disbelieving forces of industry and the reluctant forces of the federal government. We were in the tretiches in gore up to our ankles and sometimes the . ! gore was our own gore." During the 1970s, however, the pangaea began breaking apart. The tectonic force came from a number of epidemiological studies suggesting that some types of asbes- tos fibers may be more hazardous than oth- ers. These studies, which focused on asbes- tos miners and workers who milled and wove asbestos into fireproof material, indi- cated that a smaller percentage of workers exposed to chrysotile, or "white asbestos," were dying of inesothelioma than those workers exposed to so-called amphibole fi- bers such as crocidolite, amosite, or a mix- ture of fiber types. During the 1970s, several researchers, including Hans Weill, chief of Tulane Uni- versity School of Medicine's pulmonary dis- eases division, and J. Christopher Wagner, former chief of pathology of the British Medical Research Council's Pneumo- coniosis Research Unit, began arguing that different types of asbestos fibers should be regulated differently. Indeed, many other countries had already begun to do so, notes veteran asbestos researcher John Higginson, an epidemiologist at Georgetown Univer- sity Medical Center's Institute for Health *Policy Analysis. Huge economic intereats were at stake: An estimated 95% of asbestos used commercially in the United States is chrysotile, which is by far the most heavily mined type of asbestos. This revisionist philosophy was quickly attacked by Selikoff and members of an ft`1" l1/ R) SCIENCE, VOL. 254 M~ ~

influential group of occupational health ex- perts he had established at Mt. Sinai. The Mt. Sinai group, which continues to form the focus of opposition to regulating the fiber types differently, argues that the fiber- type studies are riddled with uncertainty. They argue, for example, that epidemiologi- cal evidence suggests that workers exposed to different fiber types were contracting asbestosis, a disease characterized by scar- ring of the lungs, and were dying of lung cancer (as opposed to mesothelioma) at similar rates. Moreover, Mt. Sinai epidemi- ologist William J. Nicholson and other Mt. Sinai researchers have pointed to a few stud- ies that show similar mesothc6oma rates in people exposed to 98% chrysotilc and 2% erocidolite, 60% chrysotile and 40% amosite, and 100% amosite. "Atl you have to do is see one or two mesothelioma patients to know it doesn't take much asbestos to produce it," says Selikoff. "I'm only interested that The splitting difference. Everybody agrees that amphibole fibers (right) ane exdremelj hazardous, but nsearchers an deeply divided over the hazards ojchryaotite fibers (ieft) human beings not be further exposed to asbestos. And those who say they should be further exposed really have to explain why." Duelling conferences Weill got an early taste of what the field was devolving into: In January 1978, when Selikoff was organizing a major scientific meeting, the International Conference on Health Hazards ofAsbestos Exposure, Weill called Sclikoff and says he was told he could deliver a paper on how doses of differeni asbestos fiber types affected the health ol workers in asbestos-cement factories. Two months later, however, Selikoffsent Weill a letter informing him that the paper would be relegated to an informal workshop dur- ing the conference. Weill responded that the public agencies that funded him and Selikoff "surely...do not intend and would not condone the exclusion of legitimate points of view from all segments of the Consensus Report Draws Fire From Both Extremes "[It's as ifJ the tobacco industry had suddenly come out with a But in as contentious a ficld as asbestos, the fact that 16 oftho "~ brand new report saying that allsthe iesearch on the tobaccoo- •18 pand members signed off on the review was remarkable, says cancer connection for the past 40 years had been shown in their panel member Arthur Langer, a minetalogist at Brooklyn Col- own '_ own little studies to be worthless," he says.,, lege. If any study can be said to represent a consensus in the : Epidemiologist WilLliam Nicholson, a colleague ofLandrigan's field, this is probably it . . . . . .. >- ':.'... : :. -"' .,.. -.. .: : . . . . discouraging," says Mt. Sinai epidemiologist Philip Landrigan. appended to the review. ~'- ~: of us who have been tn the field a long tsme, this [rcportJ is certainty from the available data," Upton states in a letter : (HEI-AR), the non-profit organiution that administered the The report notes that there's strong evidence linking long and review. According to the report, which was published in Sep- thin asbestos fibers with mesothelioma, a rare cancer that tember, the literature indicates that levels of airborne asbestos virtually always leads to death. But it fails to absolve chrysotile fibers inside buildings containing well-maintained asbestos in- fiber-which constitutes nearly all the asbestos used in U.S. _:-•- sulation vary little from levels in the environment. However, it building insulation-of a role in triggering mesotheliomu. '. ` notes that janitors, renovation workers, and asbestos removal Because of this, Wagner refused to sign off on the report. In a workers can be exposed to higher levels of airborne asbestos letter appended to the study he states, "I do not accept the Fact ' fibers and should be adequately protected. that pure chrysotiles will cause mesotheliomas." Moreover, ~: The report has angered some public health officials because Wagner told Science, "Several others [on the panel] felt as I did, _. it fails to suggest changes in EPA policy--speeifically, that but felt the pressure to sign it anyway." Arthur C. Upton, an .. owners ofpublic buildings institute asbestos monitoring prote- epidemiologist at New York University and chairman of the dures similar to those mandated for schools under the EPA's review panel, confirmed that other panel scientists felt similarly Asbestos Hazards Emergency Response Act of 1986. 'To those to Wagner. However, "this issue cannot be resolved asbestos fiber should be regulated differently because they pose a public health concern remains,' he says. Nicholson, a member varying levels of health risk (see main story). Although it has of the HEI-AR panel, refused to sign the report. - drawn some fire, the report has won broad support. Revisionists, too, have found plenty to disagree with. In "The panel would certainly not concur that asbestos poses no addition to sidestepping policy recommendations, the review problem.... But there's a grave danger of overgeneralizing tiptoes timidly through the minefield of data on the health about asbestos as if all hazards are the same," says Archibald effects of different asbestos fibers, charges panel member j. Cox, former Watergate prosecutor and chairman of the board Christopher Wagner, former chief of pathology of the British of directors of the Health Effects Institute-Asbestos Research Medical Research Council's Pneumoconiosis Research Unit. ings poses little health risk to office workers. But the report, even be relatively inactive." Nicholson contends shorter fibers "Asbestos in Public and Commercial Buildings: A Literature may cause more cancer than longer fibcrs simply because Review and Synthesis of Current Knowledge," stops short of shorter ones are far more numerous. "Unless one can demon- siding with the revisionists' contention that different types of strate their carcinogenicity is 100 times less, their importance as aearchers, namely that well-maintained asbestos in public build- have much less carcinogenic activity than longer fibers and may - central arguments of the "revisionist" school of asbestos re- The report states, "Animal data suggest...that'very short fibers A $4-million literature review commissioned by the Environ- at Mt. Sinai, also criticized the report for playing down the mental Protection Agency (EPA) has corroborated one of the health risks of asbestos fibers less than 5 micrometers in kngth. A 2S NOVEMBER 1991 le A NEWS & COMMENT 929

biomedical research community." After these early salvos, both sides dug in and amassed furthcr ammunition during the 1980s, says Higginson. The revisionist camp was the first to launch a major offensive: the Harvard symposium, held 14-16 December 1988 at Harvard University's Energy and Environmental Policy Center. It concluded that the health risk posed by the roughly 30 million tons of asbestos in buildings is small-far less than most other environmen- tal health hazards, such as tobacco smoke and radon. Though the symposium, whose proceed- ings were published in August 1989, received little public attention at the time, these con- dusions burst into the public spotlight last year when Brooke Mossman, a research pa- thologist at the University of Vermont School of Medicine who was a key speaker at the meeting, and four colleagues published an article in Science (19 January 1990, p. 294). It states: "The available data and com- parative risk assessments indicate that chtyso- tile asbestos is not a health risk in the non-occupational environment." The article triggered a spate of news reports and magazine ar- ticlcs, many of which stated that it was safci~--ond cer- tainly chcaper--to•leave as- bestos in place than to re- move it. This theme was echoed recently in a report from the Health Efl`'ects In- stitute, an independent nonprofit organization (see box). To the Mt. Sinai camp, the Harvard symposium was tainted because part of Third waver. Philip Landrigan says the other side was invited but chose not to show up. the funding carne from the Safe Buildings Alliance (SBA), a lobbying group for former asbestos makers, and it was dominated by researchers from the revision- ist camp. In addition to Mossman, the list of speakers included Morton Corn, an envi- "Third Wave": Roiling the. Waters Although the "Third Wave" conference took place more than 16 months ago (see main story), it is still roiling the asbestos-research community. In December, the . Annals of the New York Academy of Sciences (NYAS) plans to publish the 56 ~ ronmental scientist at Johns Hopkins University and a h f h S co-aut or o t e cienor paper. Nobody from the opposing camp was on the ~ program. Mt. Sinai's Nich- olson had been scheduled ~ to give a talk on "Airborne l l l 8b f i i eve s o nera ers m n the non-occupational envi- ronment," but he told Sci- ence he skipped the sympo- sium because he felt that he'd been invited as a token advocate of the Mt. Sinai views. "I felt that the vari- ous views with respect to research results on asbestos were not appropriately rep- resented," he says. Many of the speakers, he also contends, had either testified or con- sulted for former asbestos manufacturers associated with SBA. Mossman dismisses the notion that her condusions arc influ- enced by industry and squeezes off a round of her own: At Mt. Sinai, she says, is "a group of individuals who basically have said, `The hell with the scientific community- forgct it, we're going off on our own.'" Soon after the release of the Harvard report, Selikoff set about organizing the "Third Wave" conference. As its title indi- cated, the meeting would focus on the pos- sibility that a wave of new asbcstos-related diseases would show up in the general pub- lic. (The first two waves had struck miners and asbestos workers.) To help pay for the conference, Selikoffwas given $50,000 from a fund administered by lawyers representing school systems suing former asbestos manu- facturers to recover billions of dollars in asbestos removal costs. The meeting was organized by the Collegium Ramatzini, a non-profit, international body of 150 cnvi- ronmental health scientists, ofwhich Selikoff is president. With cash in hand, Selikoff and Philip J. Landrigan, chairman of Mt. Sinai's depart- ment of community medicine and the meeting's co-chair, put together a program committee to help plan the list of speakers. Selikoff and Landrigan maintain that they tried to have a balanced program, but some prominent researchers from the revisionist school say they were not invited, and others declined to participate. Mossman already had made other plans that prevented her from delivering a paper titled "Why I think asbestos should not be removed from build- ings." But she suggested that either Corn or Bernard Gee, a medical researcher at Yale University and a co-author of the Science paper, would be better able to address the issue. Gee recalls Landrigan telling him 4 conference papers and the edited discussion that occurred in the formal sessions. This ~ has infuriated several researchers, who told Science they tried to alert the academy to what they saw as a biased conference. Take J. Corbett McDonald, director of the Institute of Occupational Health and Safety at McGill University in Montreal, who along with several other researchers had been contacted by Bill Boland, executive editor of the Annals, 2 months prior to the ' conference. Boland had asked the researchers for theii •overall itnpressions" of the '-.. conference program and to advise him whether publication of the conference would : . be an asset to the Annals. McDonald blasted the proposed conference in his reply -:_ dated 1 May 1990, stating: "The program...re8ects the Mount Sinai position to an ' almost unbelievable degree. The topics to be discussed make little attempt to address objectively the relevant scientific and policy issues....Few of the scientists responsible for important research in this field were invited to the meeting let alone to spak" ' McDonald condudes by stating, "I think it most unlikely that the papers will make any important contribution to knowledge or do more than add fuel to a situation in ~..: whlch there u already monv heat than Lght." = k:;. o ;, S=1} Academy officials concede that there have been criticisms of the eonference. "A •:. couple ofpeoplc thought it would be a bad idea [to publish the proceedings], but they `..-' were at least, how should I put it, concerned partics," says Boland. In fict, the academy ,;j tried-in vain as it turned out-to add balance to the publication by the Annals. On .. . 20 November 1990, Oakes Ames, the executive director of NYAS at the time, wrote ; to McDonald stating that, "Dr. Philip Iandrigan [co-chair of the confcrence] believes that thet+e was ample opportunity at the conference for diffarnt views to be cxpressed," .:- but he invited McDonald to contribute a paper to be appended to the proceedings to .° "pnesent the diflerent arguments fitlly." McDonald declined: He told Science, •I didn't ` think it was appropriate to add any sort of crodibility to the [confctrncej:' Two other : scientists possessing "diffctrnt views"--Case-and epidemiologist Graham W. Gibbs, an.; . asbestos consultant based in Alberta, Canada--were also offered the chance to "am- plify" their conference prrscnrnioU Case declined, saying "that wouldn't have been ' much of a step if I'd agreed to do it,k while Gibbs wrote a forwatd to the, proceedings ; that Landrigan says was "simply not approQriate.'. .

about the Third Wave conference at a con- gressional hearing on 26 April but denies he was asked to present the paper. As for Corn, who headed the Occupational Safety and Health Administration in 1976, Landrigan stated in a 1 June letter to Mossman that "although Dr. Corn is an old friend and colleague, we did not invite him to present, bccause the focus is on health rather than on engineering aspects of the problem." Two other authors of the Science paper declined to attend, both pleading prior commit- ments. In addition, Selikoffinvited Wagner, who declined. He told Science, "They did not want to hear my side anyway." Adds Mossman, "We were invited in a way that made us feel that they didn't really want us there." L One uninvited revisionist was epidemiolo- ~ gist J. Corbett McDonald, director of the Institute of Occupational Health and Safety at McGill University in Montreal, whose re- search-by his own accounting-had a"di- rect bearing" on about two-thirds of the Third Wave conference's papers. At the meet- ing, McDonald was one of the revisionists harangued in absentia by audience members. Five months after the conference, Landrigan wrote to McDonald to apologize for "the several unflattering remarks that were made about you and your work." For many U.S. asbestos researchers, there seems to be little movement toward a ceasefire: The Third Wave meeting's pro- ceedings arc about to be published by the New York Academy of Sciences, and that has set off another round of skirmishing (see box, p. 930), and an attempt by the Health Effects Institute to come up with a consen- - sus document has also drawn fire from both sides (see box, p. 929). The funher apart Mt. Sinai researchers and the revisionists drift, the harder it will be to mend the rift, says Dorothy Nelkin, a New York Univer- sity social scientist who has studied contro- versy in science. The only way to resolve the issues, adds Morgan, is for the scientists to get back to doing science. "If there are kgiti- mate scientific disagreements," he says, "thry're not going to get resolved unless people spend time paying attention to each other's arguments and try to design experi- ments that come to grips with those argu- mcnts." Until that happens--if it ever does-- judges and regulators will continue to be caught in the middle of this long-distanceJ scientific "debate."  RICHAIw Sro1~ Scientific -Sleuths Solve a Murder Mystery Truth can sometimes be stranger than fiction-or at least as strange as a madc-for-TV movie. Take, for example, the case of Patricia Stallings. Convicted of the murder of her infant son, she was sentenced to life in prison-but was later found innocent, thanks to the medical sleuthing of three persistent researchers. The story began in the summer of 1989 when Stallings brought her 3-month old son, Ryan, to the emergency room of Cardinal Glennon Children's Hospital in St. Louis. The child had labored breathing, uncontrollable vomiting, and gastric distress. According to the attending physician, a toxicologist, the child's symptoms indicated that he had been poisoned with ethylene glycol, an ingredient of antifreeze, a conclusion appar- ently confirmed by analysis by a commercial lab. After he recovered, the child was placed in a foster home, and Stallings and her husband, David, were allowed to see him in supervised visits. But when the infant became ill, and subse- quently died, after a visit in which Stallings had been briefly left alone with him, she was charged with Srst-degree murder and held without bail. At the time, the evidence seemed compelling as both the commercial lab and the hospital lab found large amounts of ethylene glycol in the boy's blood and traces of it in a bottle of milk Stallings had fcd her son during the visit. But without knowing it, Stallings had performed a brilliant experiment. While in custody, she learned she was pregnant; she subsequently gave birth to another son, David Stallings Jr., in February 1990. He was placed immediately in a foster home, but within 2 he weeks staried having symptoms similar to Ryan's. David was eventually diagnosed with a rare metabolic disorder called methylmalonic acidemia (MMA). A recessive genetic disorder of amino acid metabolism, MMA affects about 1 in 48,000 newborns and presents symptoms almost identical with those caused by ethylene glycol poisoning. Stallings couldn't possibly have poisoned her second son, but the Missouri state prosecutor's office was not impressed by the new developments and pressed forward with her trial anyway. The court wouldn't allow the MA4 diagnosis of the second child to be introduced as evidence, and in January 1991 Patricia Stallings was convicted of assault with a deadly weapon and sentenced to life in prison. Fortunately for Stallings, however, W'illiam Sly, chairman of the department of biochemistry and molecular biology, and James Shoemaker, head of a metabolic screening lab, both at St. Louis University, got interested in her case when they heard about it from a television broadcast. Shoemaker performed his own analysis of Ryan's blood and didn't detect ethylene glycol. He and Sly then contacted Piero Rinaldo, a metabolic disease expert at Yale University School of Medicine whose lab is equipped to diagnose MMA from blood samples. When Rinaldo analyzed Ryan's blood senun, he found high concentrations of inethylmalonic acid, a breakdown product of the branched-chain amino acids isoleucine and valine, which accumu- lates in MMA patients because the enzyme that should convert it to the next produc't in the metabolic pathway is dcfcctive. And particularly telling, he says, the child's blood and urine contained massive amounts of ketones, another metabolic consequence of the disease. Iike Shoemaker, he did not find any ethylene glycol in a sample of the baby's bodily fluids. The bottle couldn't be tested, since it had mysteriously disappeared. Rinaldo's analyses convinced him that Ryan had died from MMA, but how to account for the results from two labs, indicating that the boy had ethylene glycol in his blood.) Could they both be wrong? When Rinaldo obtained the lab reports, what he saw was, he says, "scary " One lab said that Ryan Stallings' blood contained ethylene glycol, even though the blood sample analysis did not match the lab's own profile for a known sample containing ethylene glycol. "This was not just a matter of questionable interpretation. The quality of their analysis was unacceptable," Rinaldo says. And the second laboratory? According to Rinaldo, that lab detected an abnormal component in Ryan's blood and just "assumed it was ethylene glycol." Samples from the bottle had produced nothing unusual, says Rinaldo, yet the lab claimed evidence of ethylene glysol in that, too. This September, Rinaldo presented his findings to the case's prosecutor, George McElroy, who called a press conference the very next day. "I no longer bclieve the laboratory data," he told reporters. Having concluded that Ryan Stallings had died of MMA after all, McElroy dismissed all charges against Patricia Stallings on September 20, 1991.  MIC1z1.1.8 Ho1FMeN 15 NOVEMBER 1991 NEWS !c COMMENT 931 le