“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.