Where the Dust Settles – Lessons from the past provide warnings for the future by Duncan Graham

I am often asked why a novel about asbestos is relevant today. The immediate response is to remind ourselves of the fact that people are still dying from mesothelioma and other fatal asbestos diseases to this day, or to highlight how the recent epidemic of silicosis from man-made stone and tunnelling is a case of tragic déjà vu.

But the relevance of the novel is wider than that. The reasons why the asbestos tragedy occurred in this country are repeated time and again across many industries. The lessons are either ignored or forgotten. It should still be a warning to governments and private enterprise alike.

In the novel, Harry Langlands, a prospector, discovers blue asbestos in a remote gorge in the Kimberleys. The find leads to a mine and mill run by conglomerate V&L Ltd with the aid of state and federal governments. It is said to be a ‘magic mineral’ ideal for any number of applications from brake linings to insulation to cement building boards. There was a great deal of money to made from the ‘miracle fibre’. And everyone rushed in for a piece of the pie, including asbestos cement manufacturer, Henry King Industries, who took advantage of the housing boom after the war.

Even before the mine was opened, scientists knew asbestos dust was potentially harmful. They might not have known the full extent of the danger, but that is not the point. Caution was called for. It could not be assumed to be safe. By the 1950s, medical science knew it could cause lung cancer, and by the 1960s, the scientific community was aware of a new frightening and universally fatal cancer called mesothelioma that in essence could only be caused by asbestos. Did these dangers halt production? Not at all. Governments and the companies turned a blind eye. Lobbyists disputed the connection with some fibre types or claimed cancer only occurred with smokers. Medical science was used as a weapon to obsucate or delay the inevitable when it should have been used to sound alarm bells and to take stock. Why? In a word, greed. And the same scenario gets played out time and again.

In the novel, the West Australian medical officer, Dr Neil Smith tells James Henderson’s solicitor, Viviana:

‘I was asked to do a job by the Health Department and when I tried to do it, protect the health of West Australian workers, I was blocked at all turns. It seems to be a common human failing – to wait until the problem is blindingly obvious before acting. Everyone is always arguing about when evidence is sufficient to justify action. Asbestos was no different.’

Later, when explaining why she was adamant about fighting the case all the way to the High Court, Jenny Henderson, tells Viviana:

‘We all have choices, Viviana. James and I made our choices when we sailed from England in 1956. I made choices when I decided to marry him and follow him to New South Wales. My family told me I was throwing my life away by not marrying a doctor I knew from England. But they were my choices to make, not theirs or anybody else’s. That’s why James would forgive me if I chose not to go on with this case. He would understand my reasons, my fears. Yet that’s not the point. You see, Viviana, what he could not forgive is that these companies didn’t give him any choice. They hid things from him. He was not given the chance to change his future, our future. He understood perfectly what it was like to make a bad decision and live with the consequences. That was something he could control. This wasn’t. And that’s why the case was a point of principle for him. That’s ultimately why I have decided to fight on for his sake. To try and bring them to account for taking away his ability to decide what was best for him. It’s what’s fair. They knew it was dangerous. They must have. I know in my heart I’m right.”

Have we learned anything from the asbestos debacle? Several recent examples suggest we haven’t.

In 2018, Justice Katzmann in the Federal Court, gave judgment in favour of three women who sued Ethicon and Johnson & Johnson on behalf of thousands of women who were implanted with vaginal mesh by their surgeons. It was a medical catastrophe. In her impressive and carefully considered reasons, Justice Katzmann found that the decision of the manufacturer to proceed to sell the device was ‘precipitous and opportunistic’ and ‘rash’. They did not wait for long term studies on safety and efficacy to be conducted. At [3764], she found:
‘The preponderance of evidence supports the applicants’ case that all the devices were introduced with unseemly haste and without due attention to the safety of the women for whom they were indicated and to whom, both indirectly and directly, they were promoted.’

She then quoted the evidence of an expert called by the companies, who said:

‘With very limited evidence, and with very limited knowledge about the surgical principles, vaginal mesh surgery was widely implemented in a very short period. There may have been good reasons for that, of which the high risk of recurrence following native tissue repair is probably the most important. However, I believe that patients have suffered from the over-rushed introduction of vaginal mesh surgery.’

She went on to find that:

‘[A]t all material times Ethicon was driven by commercial considerations. Staying ahead of the competition was their pre-eminent concern. Safety was a secondary consideration.’

Sound familiar?

During the COVID epidemic, many people were rightly anxious about the risk of the virus to their health. Governments sought rapid solutions to curb the spread of the virus. Vaccines were developed, but the safety of the vaccines could never have been assured without proper clinical trials. Nonetheless, they were rushed onto the market by governments with assurances of safety. The drug companies made hefty profits. What few knew was that the government legislated to protect those administering or supplying the vaccines from liability for complications. Many people have suffered significant complications and are without an obvious remedy. Rather than delay introduction of vaccines until there was reasonable evidence of safety, it seems the preferred course was to justify their hasty introduction to the market and then to protect themselves and suppliers from liability for the consequences of that haste. Governments reject the need for a full inquiry into the response to the epidemic.

Large segments of the community are now concerned about climate change, diminishing natural resources or pollution. Many companies see these problems as opportunities for pecuniary gain. While there is nothing wrong with private enterprise developing and promoting solutions, it should not be ‘precipitous and opportunistic’. Governments should not approve measures without adequately assuring themselves that the solution does not create a new problem.

Take salmon farming, for instance, thought to be a great way to protect our oceans from overfishing and providing a sustainable source of food. What assessment was made about the safety of the practice or its impact on the natural environment before it was developed and expanded its operations? Now there is a furore about it, highlighting the never ending tension between commercial imperatives and the protection of the environment or our health.

What innovations to protect the planet will be introduced without adequate evaluation of their safety or efficacy?

The so-called ‘forever chemicals’ (per- and polyfluorinated alkyl substances, PFAS) provide a further case in point. PFAS were developed and used because of their capacity to repel grease and water. This magic was the product of the stability of chemical bonds and resistance to being broken down. And because they basically don’t degrade, they are ubiquitous (just like asbestos), found in food sources, water, the environment and in people. Research is ongoing about their health and environmental effects. Many might see concern about PFAS as alarmist, but so did government and companies for many years when dealing with asbestos.

Even with climate change, we see science being used as a weapon to deny there is a problem or to attack personally those who are concerned about it. No amount of scientific evidence will ever be enough for the climate change sceptics. For many, scientific evidence will only ever be sufficient when the writing is literally on the wall, which is precisely what happened with asbestos.

History will be repeated unless governments act not when a problem is ‘blindingly obvious’, but when risks are identified from a reasonable body of scientific study. Greed is a powerful motivating force to deny there are risks associated with a product or process or to conceal health risks from those exposed to those risks. People want to trust those that lead them. They want to believe that companies have them in mind when they innovate. Governments and companies spend millions of dollars in public relations and marketing. They want you to believe their messages – that they are truthful, that they act in your best interest and that you can trust them. Time and again, that proves to be false and merely spin.