A Texas jury awarded $1.2 million this month to the wife of an engineer who died from mesothelioma cancer, allegedly caused by working with asbestos additives to drilling lubricants and cement.   The suit was originally brought by Danny Puckett and his wife; he died earlier this year from the disease - for which the only known cause is  asbestos exposure.

The lawsuit was filed against Montello, Inc., Union Carbide, and several other defendants. Union Carbide was a manufacturer of multiple asbestos products;  Montello is a distributor of drilling equipment and products in Texas.  The suit charged that asbestos in cement additives and drilling mud additives used by the Dowell Company, for whom Mr. Puckett worked between 1975 and 1985, caused the development of his malignant mesothelioma.  He was 59 when he died.

Drilling mud is a mixture of dirt, chemicals and water that is poured into wells being drilled in order to help force the dirt and rock broken up by the drill bit to the surface.  It is continually mixed on site while the drilling is in operation.  Mr. Puckett testified that he used the additive to mix the “mud,” or slurry three or four times a week.  When going through that process he said that the air was so thick from the asbestos dust that it blotted a street light.  Asbestos workplace exposure in the oil fields is one of the reasons that Texas is among the top five states for deaths from asbestos cancer.

During his period of employment he worked part time with a cement crew and later as a supervisor.  Asbestos was a popular additive to Portland cement because it made the cement more resilient and caused it to bond effectively.   The verdict came against these two defendants because the rest had either settled in the case or been dismissed; most asbestos litigation involves multiple defendants.  In the jury award the two remaining defendants were each allotted 15% of the responsibility for Mr. Puckett’s death.

The Superior Court of the City and County of San Francisco has taken a path that the federal courts and several state courts have opted for already, in deciding to create an asbestos “department” within the court administration.  All asbestos cases will be referred to a single judge who will move them through preliminary phases in an efficient manner.

All discovery issues and other issues that typically bog a potential civil case down will go before the asbestos judge who will clear the way for asbestos lawsuits to go to trial or, the court hopes, to be settled.  “The goal is to make sure that we don’t have cases endlessly trailing for trial and that we attempt to have cases settle before they use up a jury panel,” said Presiding Judge James McBride.

In 2008, an astonishing 45% of all jurors summoned for civil cases by the S.F. Superior Court heard asbestos cases.  Impaneling jurors is a challenge for every court administration and in San Francisco, the stack of asbestos claims seems to have tied up a remarkable amount of the trial time and space available.

Generally the defense attorneys are positive about this development.  In asbestos cases, it’s the asbestos companies and businesses whose employees suffered from asbestos exposure that are the defendants.  Attorneys representing the asbestos companies see value to an organized approach to moving cases along.

Some plaintiffs’ attorneys agreed, noting that a standard procedure for preliminary activity will create consistency throughout the process.  Said one plaintiff’s attorney, “If you have a judge like Judge Kahn who is supervising a case from beginning to end, that judge is going to be able to see who is taking the low road, and who is taking the high road,” he said.  “Some firms use hardball tactics, which go against the idea of getting cases resolved easily and quickly.”  It goes without saying that a quick settlement is invaluable to a mesothelioma cancer victim, most of whom have mere months to live after diagnosis is made.

Other plaintiff’s attorneys saw the move differently, because an attempt to induce settlements in these cases may if effect deny the plaintiff an opportunity to go before a jury.  It appears that San Francisco has been identified as a jurisdiction generally friendly to plaintiffs – which often means suspicious of corporations.  Some plaintiff’s attorneys see juries, or the threat of a San Francisco trial, as a source of leverage with the defense.  That’s why the Superior Court docket is stacked with asbestos litigation.

Researchers at North Carolina State in conjunction with the National Institute of Environmental Health Sciences have completed a study of the behavior of carbon nanotubes when inhaled by laboratory mice.  Nanotubes are the basic molecular building blocks for nanotechnology, the construction and use of micro-sized devices to be used for medical purposes and in other applications.

Nanotechnology is still in its formative stages, but research in the field is moving rapidly.  For some time there has been speculation on what these microscopic nanotubes might do if inhaled by humans.  The research project was specifically focused on the speed with which these tubes might reach the pleural area, which is the outer lining of the lung.  It is also the area in human lungs where asbestos fibers most commonly lodge when inhaled.

Eventually, asbestos fibers that lodge in human pleural tissue can cause pleural mesothelioma, the lethal and fast-moving cancer that has killed thousands of people who worked around asbestos products in the years when asbestos was found in over 3,000 products.  It’s important at this point to note that mesothelioma cancer usually takes between twenty and forty years after the asbestos fibers are inhaled to develop as a disease.  The inhaled fibers slowly work their way through the lungs into the protective outer layer, or pleura.

In the research project with carbon nanotubes and mice, the nanotubes passed through the lungs and into the pleura in one day, at which point clusters of immune cells began to cluster on the pleura.  Within two weeks, fibrosis (scarring of the pleura) had occurred.  These effects mimic the damage that asbestos fibers do in the human pleura.  The earliest symptoms of asbestosis include fibrosis within the lung, caused by asbestos fibers that remain there.    For many people with asbestos damage, benign pleural plaque develops from tissue accumulation (such as immune cells) that eventually calcifies.

The mice in the research study received exposure to the air contaminated with nanotubes for a single six hour period.  Only those mice that received the highest doses showed damage in the pleura, which is consistent with the fact that lesser amounts of asbestos exposure are far less risky to humans than situations where the air is full of floating asbestos fibers.

Finally, the damage done to the mice by this single laboratory exposure was gone in three months.  There has not yet been any research on what happens with repeated exposure to nanotubes in the air.  Nevertheless, the similarity of inhaled nanotube behavior and inhaled asbestos fiber in the initial stages of exposure is startling.

Detroit’s Barbara Ann Karmanos Cancer Institute, in cooperation with Blue Cross Blue Shield of Michigan (BCBSM), will launch a targeted health initiative in January 2010 focused on environmentally-associated cancers.

The goal of the study is to associate cancer development in the state with existing potential environmental causes.  According to the Institute’s CEO Ann G. Schwartz, PhD, approximately 70 percent of all cancers are linked to occupational and environmental causes.  Asbestos is the only known cause for the lethal cancer mesothelioma.

“A medical evidence-based approach will be presented to doctors participating in BCBSM’s Physician Group Incentive Program in early December,” Dr. Schwartz said. “The initiative is being designed to detect cancers [such as asbestos cancer] and other serious illness resulting from exposure to arsenic and asbestos, two of the state’s most frequently encountered carcinogens.”

Asbestos and arsenic have been chosen for this analysis because they are substantial health hazards in Michigan and continue to take a serious toll on the state’s residents, according to the Institute.   Michigan has the nation’s largest arsenic- contaminated water table, located primarily in the southeastern part of the state, along with an estimated 300,000 homes with asbestos-contaminated attic insulation.

This effort is designed to utilize existing data that has identified both workplace and environmental arsenic and asbestos, and according to the initiative’s director Michael Harbut, M.D, “We can determine who is at risk, what preventive care may be recommended and more accurately diagnose and treat those at risk because of the water they drink or air they breathe.”

According to the news release from the Cancer Institute, “Smokers are 50 times more likely to develop lung cancer if they also are exposed to asbestos.  In addition, colon cancer has been associated with asbestos exposure.  Contrary to popular belief, asbestos has never been banned in the United States.”

At any given time there are several clinical trials underway for chemotherapy treatment of mesothelioma patients.  The two drugs that have proven to be effective with some types of mesothelioma cells are pemetrexed and cisplatin.  Researchers are now experimenting with the use of these drugs in combination with other chemotherapy drugs to see if additional positive results can be obtained.

All cancers are complicated diseases and malignant mesothelioma is no exception.  There are several types of cells associated with the disease; some can be reduced by one type of chemo drug while others are unaffected by it.  One of the unfortunate facts about this affliction is that it is often not diagnosed until the mesothelioma symptoms are evident, meaning that the malignancy is sufficiently advanced that there is relatively little chance of halting it, let alone curing it.  For that reason, many of the clinical trials are for palliative treatments; the goal of these studies is to extend a patient’s post diagnosis survival time.

It’s encouraging to see research on early diagnosis.  The history of this disease has been that physicians work through the diagnostic procedures for more common diseases with the same symptoms, resulting in a lengthy decision making process that allow this fast-moving malignancy to spread.

A Michigan based study is currently recruiting for a study that is attempting to identify “biomarkers,” or molecular evidence that mesothelioma cells give off in the early stages of the disease.  The researchers are looking for the characteristics of protein cells, which will provide information on what sort of mesothelioma treatment can be utilized to slow its early development.  These will be chemotherapy drugs that take a different approach to cell control than those used for late-stage malignancies.

Exposure to both vermiculite and asbestos are included in the participant profile, meaning that the base of potential mesothelioma victims is now recognized in the medical community as including those who were exposed to the vermiculite produced by the W.R. Grace mine in Libby Montana and the products manufactured from it.

Contact information on this study: ClinicalTrials.gov identifier: NCT00897247

Locations:

Barbara Ann Karmanos Cancer Institute Recruiting                                          Detroit, Michigan, 48201                                                                                                 Contact: Clinical Trials Office                                                                                           Barbara Ann Karmanos Cancer Institute                                                                      313-576-9363

Sinai-Grace Hospital Recruiting                                                                                Detroit, Michigan, United States, 48235                                                                  Contact: Naimei Tang     313-966-3300