Mass Screening for Asbestos Disease: A Medical Scam. Lawrence Martin, M.D. Associate Professor of Medicine Case Western Reserve University School of Medicine, Cleveland firstname.lastname@example.org Presented at: U.S. Chamber of Commerce Institute for Legal Reform Washington, D.C.
Lawrence Martin, M.D.
Associate Professor of Medicine
Case Western Reserve University School of Medicine, Cleveland
U.S. Chamber of Commerce
Institute for Legal Reform
July 20, 2005
asbestosis (scarring within the lungs; usually causes symptoms and may be fatal)
asbestos-related pleural scarring (affects only lining of the lungs; almost never causes symptoms)
800,000+ attorney-generated claims for these conditions, mostly for asbestosis; both conditions are rare in everyday pulmonary practice.
Conclusion: Diagnoses have been ‘manufactured’Mass Screening for Asbestos Disease:A Medical Scam
In asbestos screening exams, ‘reading a chest x-ray’ means:
1) Describe type and extent of any abnormal shadows (either inside or lining the lungs).
2) Comment on possible diagnoses based on abnormal shadows.
4. Each PAHBR knows the following when reading attorney-generated screening chest x-rays: a) he will not be shown films of people claiming no
asbestos exposure (i.e., no control x-rays to interpret);
b) there will be no outside audit of his readings;
c) if he pleases the attorneys he can read hundreds or
thousands more chest x-rays, and make a ton of money.
5. If a clinical exam is needed, the examiner is another attorney-hired physician who just echoes the initial PAHBR report, and makes a clinical diagnosis “with reasonable medical certainty.”
Plaintiff-attorney-hired physicians usually write on each report:
“My evaluation does not constitute a doctor-patient relationship.”
Variable legal interpretations regarding liability: See Baum K (MD & JD). Independent Medical Examinations: An Expanding source of physician liability. Annals Internal Med 2005;142:974-78.
1) Courts have routinely allowed blatantly-manufactured diagnoses into evidence. Despite the horrific consequences (numerous companies put out of business, hundreds of thousands of jobs lost or not created) Congress has been unable/unwilling to correct the problem.
2) Defendants have rarely challenged this bogus screening methodology. Instead, defending companies usually just pay for all phony claims, especially when bundled with a few legitimate ones (e.g., malignant mesothelioma).
3) Academic pulmonary community has either been silent about the screening scam or, in several instances, accepted its diagnoses as valid: in effect, sanctioning a methodology that is non-scientific and medically unethical.
Two major U.S. lung disease organizationsAmerican College of Chest PhysiciansAmerican Thoracic Society (Journal: Chest) (Journal: AJRCCM)
Complete details, including all correspondence, on web site www.lakesidepress.com/Asbestos/asbestos-index.htm
ATS past president (2002, in letter to ABA): “significant asbestosis can be present with…even a normal chest x-ray.”
ATS past president (2003, in letter to Senators Hatch & Leahy): “The ATS does not have a position on the need for, merits of, or construction of asbestos litigation reform legislation.”
ATS Statement author (on his web site): “Over the past 12 years I have treated thousands of persons with diseases associated with asbestos.”
ATS Statement author (in a medical review): “We can already see how asbestos-related diseases in people exposed to environmental “background levels” of asbestos are increasing.”
ATS Statement author (in testimony before NIOSH): “Asbestos is one of the leading causes [of lung cancer] among non-smokers, and occurs at dramatically high rates among asbestos-exposed smokers.”
Advisor to ATS author panel (in journal editorial): “The problem of over diagnosis [of asbestos disease], if it exists, is not any failure of these criteria, but only failure to apply them.”
“Given that the criteria require evidence for nontrivial exposure to asbestos… and the criterion requiring exclusion of alternative diagnoses, misdiagnosis is unlikely in practice…”
In fact, misdiagnosis is extremely common “in practice,” since the main “practice” of asbestos diagnosis is by plaintiff-attorney-hired physicians. This fact was completely ignored in the ATS review.Numerous specific criticisms regarding anti-science, pro-plaintiff bias of ATS Statement
Four letters published March 2005, criticizing the ATS Statement.
For example, the article states that smoking almost never causes x-ray changes that could be confused with early asbestosis. This is factually incorrect, based on a significant body of medical literature which was not referenced in the ATS article. As noted in one letter: “To disregard this evidence discredits the American Thoracic Society as a scientific body.”
Because ATS is a major medical organization, and the only one with an “Official Statement” on asbestos disease, the article’s out-of-context ‘one-liners’ and scientific mis-statements are ripe for quoting by plaintiff attorneys in support of their made-up claims.
Q. And do you disagree with that statement? [ATS statement regarding smoking effects on chest x-ray]
A. It’s incorrect.
Q. Okay. You disagree with that statement?
A. No. It’s incorrect.
Q. Okay. Do you dispute that that statement was made by the American Thoracic Society?
A. The statement is incorrect as it stands.
A. [ATS] published this article and [you] did not quote the entire medical literature relevant to this problem. There are four letters published in the journal which must be read to put this in context. Any you have chosen to ignore those letters.
Q. Doctor, isn’t that the full statement of the board of directors of the American Thoracic Society, yes or no?
A. This is a statement which has been disputed with subsequent letters…that this journal published disputing this statement in regards to the item that you just mentioned.
Q. Right. Doctor, I want to be clear. I want the jury to understand. This article is the full article that was published by the board of directors of the American Thoracic Society, correct?