Epidemics of non-infectious disease

Our plain-English summary of Epidemics of non-infectious disease, by P.J. Lawther (Proceedings of the Royal Society of London. Series B, Biological Sciences, 1979).

The study

• Author: P.J. Lawther
• Journal: Proceedings of the Royal Society of London. Series B, Biological Sciences
• Published: 1979;205(1158):63-75
• Read it: PubMed · Publisher

Abstract

Epidemics of non-infectious disease are often caused by exposure to industrial products, intermediates or by-products, either in the work-place or as a result of the contamination of a wider environment. Although the prime objective of research must be the recognition of the hazard and the evaluation of its magnitude so that illness may be prevented, close collaboration of clinicians, epidemiologists and toxicologists should lead to the acquisition of much knowledge of the mechanisms by which disease is caused. Catastrophes, though always regrettable, must be seen as experiments demanding careful analysis and exploitation. Many examples of different types of problem will be selected from the numerous epidemics from the time of the Schneeberg and Joachimsthal miners to the recent concern with contamination of the environs of Seveso by dioxin.

In plain English

This article was a short, informal paper presented to a discussion meeting, not an original study. The author chose examples of epidemics of non-infectious disease, including carbon tetrachloride, polycyclic aromatic hydrocarbons, asbestos, mercury and dioxin, to argue that clinicians, epidemiologists and toxicologists should work together. In the asbestos section, the author summarized earlier work by others. These included Wagner and colleagues' observation of many cases of pleural and peritoneal mesothelioma associated with often slight exposure to crocidolite in the northwest region of Cape Province. They also included a report from Turkey that covered 39 patients from villages where asbestos had not been found but where a local white soil contained volcanic glass fibres, and five cases of pleural mesothelioma in rural India among people with no history of asbestos exposure. The author wrote that these tumours were rarely seen in chrysotile miners and that their cause might be related to physical rather than chemical properties of fibres. The author concluded that great caution was needed before asbestos substitutes could be declared safe. The author also warned that results from animal injection experiments do not necessarily apply to people.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review: an informal discussion-meeting paper that describes selected historical epidemics from published work. It reports no original data. A short discussion comment by W. N. Aldridge on malathion poisoning follows the paper.
• Who was studied: No study population. The author discussed examples of epidemics selected from the literature, covering carbon tetrachloride, polycyclic aromatic hydrocarbons, asbestos, mercury and dioxin.
• Exposure: Asbestos was one of several topics. The author described chrysotile (white asbestos) and the amphiboles crocidolite (blue), amosite (brown) and anthophyllite. The section also covered volcanic glass fibres in a white soil used in Turkish villages.
• Main results:
  • The author recounted that Wagner and colleagues (1956) noted large numbers of cases of pleural and peritoneal mesothelioma associated with exposure, often slight, to crocidolite in the northwest region of Cape Province. This is a description of others' work.
  • The author stated that these mesotheliomas are rarely seen in chrysotile miners and suggested that crocidolite has some special property.
  • The author described Baris (1975), an analysis of 120 pleural mesotheliomas and asbestos pleurisies in Turkey. It included 39 patients from the villages of Karain and Urgup, where asbestos had not been found but a local white soil contained volcanic glass fibres.
  • The author described Das et al. (1976), who reported five cases of pleural mesothelioma in rural India among sugar cane industry workers with no history of asbestos exposure.
  • The author wrote that some animal experiments showed that chrysotile's tendency to cause mesothelioma when injected into the pleura could be increased by altering particle size and shape to resemble crocidolite fibres.
  • Citing Newhouse (1973), the author wrote that the excess of lung cancer in asbestos workers had been shown to be greatest in those exposed over long periods, going back to when concentrations were high.
  • The author wrote that fibro-fatty pleural plaques are thought to be of no clinical import. Calcified pleural plaques were described as endemic in parts of Finland where the soil contains much anthophyllite.
• The authors' conclusion: The author concluded that mesothelioma may have a long latent period and its causation may be related to physical rather than chemical fibre properties. In the author's view, great caution is therefore needed before the safety of asbestos substitutes and other man-made fibres is assured.
• Limitations the authors state:
  • The author stated that the informal communication could do no more than illustrate the general points made.
  • The author cautioned that results of injecting test animals intrapleurally with comparatively large doses of suspect fibres are not necessarily applicable to man.

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