Book Review

Asbestos and Its Diseases

N Engl J Med 2008; 359:544-545July 31, 2008

Article

Asbestos and Its Diseases
Edited by John E. Craighead and Allen R. Gibbs. 403 pp., illustrated. New York, Oxford University Press, 2008. $79.50. ISBN: 978-0-19-517869-2

Asbestos, a well-known carcinogen, is responsible for the dramatic increase in the incidence of pleural mesothelioma among men in Western countries in the past 40 years. This increase is a result of the substantial occupational exposure to asbestos throughout the workforce from the 1930s to the 1980s. The nature of the effects of asbestos on health is also one of the most controversial issues in occupational health, and in the rich body of scientific literature on the subject, almost any opinion possible has been documented.

In this book, scientists with a long-standing history in asbestos research cover a broad variety of topics. The 16 chapters consider etiology, diagnosis, prognosis, and treatment of asbestosis, asbestos-related lung cancer, and mesothelioma of the pleura and peritoneum. In addition, there are discussions of epidemiology, risk assessment, and legal and litigation issues. As such, this book is a comprehensive source of information. The editors have given the contributors the freedom to express their personal viewpoints, and this approach is the source of the book's primary strengths and weaknesses.

The facts and arguments presented by individual contributors provide interesting insight into the historical development of asbestos research. Most of the contributors have been part of this history, and they describe in detail the background and content of hallmark studies, including the initial observations by physicians, the considerations involved in designing and conducting the studies, and the discussions that arose after the initial publication of these studies. These stories show that scientific progress — especially in the epidemiologic studies showing the profound risks for workers' health — often depends on the groundbreaking work of a few dedicated people.

The highly personalized approach also has its disadvantages, since most contributors take a narrative approach to presenting their opinions and conclusions. Given the many thousands of articles available on almost any topic in the asbestos debate, key issues must be derived from a systematic review of the available literature, such as the differences in carcinogenicity among fiber types, the derivation of safe occupational exposure levels, and the risk to public health posed by typical levels of environmental exposure. It is sometimes difficult to disentangle the rigid scientific conclusions from the personal viewpoints in discussions of controversial issues. In some chapters, strong convictions are presented as scientific facts, most notably in statements such as this one, from chapter 8, which asserts that mesotheliomas “occur rarely among persons exclusively exposed to `chrysotile' and it is currently believed that `pure' chrysotile does not cause the neoplasm,” and this one, from chapter 13, which states that malignant mesothelioma “is developing in septuagenarians and octogenarians, whose only recognized consequential documented exposure to amphibole asbestos occurred during or shortly after World War II.”

Overall, this book is a rich source of historical facts and studies on asbestos and its diseases, yet highly personalized with strong individual viewpoints. It is less authoritative as a source for risk assessment and litigation issues.

Alex Burdorf, Ph.D.
Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands
a.burdorf@erasmusmc.nl