Now, after Mr. Guilder’s death and over a year later, Florida’s 3rd District Court of Appeal has reversed this decision. The Daily Business Review reports, from Law.com:

The 3rd DCA reversed on several grounds, agreeing with Honeywell that Senior Judge Richard Yale Feder erred by allowing into evidence a prejudicial letter from a Bendix employee to an asbestos supplier in the 1960s which illustrated Honeywell’s knowledge of asbestos dangers. The appellate court ruled the judge should have redacted a prejudicial section.

The three-judge panel also determined Feder should have included third parties on the verdict form so jurors could apportion comparative fault and Guilder’s children were not entitled to loss of consortium.

Guilder’s initial victory was one of the highest ever awarded to a single mesothelioma victim back in April 2008. He suffered from peritoneal mesothelioma, the rare form of deadly cancer caused by asbestos exposure.

After losing their father and being stripped of their award, the family suffers.

Honeywell, on the other hand, is “pleased”.

Watch a report on this new development on Asbestos News Minute.

Most disturbing is that the company knew of asbestos’ deadly effects as early as 1946, 40 years before this Niagra Falls man had worked with the valves, and still did nothing.  They made no effort to provide warning to those using their product.  Thus the jury decided to hold Fisher Controls wholly responsible for the worker’s asbestos-related cancer and his death.

The Buffalo News reports, “Court officials said the verdict, which includes a $750,000 punitive damages award, marks both the first time Fisher Controls has been found liable for using asbestos in its products and the first punitive damages award in a New York State asbestos case in more than 20 years.”

It was a bittersweet victory for the family and friends of this gentleman.  We hope that the resolution of this case will serve as an example and a warning to those companies who would bypass safety for profit.

Watch it on Asbestos News Minute.

In a sobering account of one doctor’s diagnosis of mesothelioma, “A patient’s journey” (BMJ, subscription required), Dr. Kieran Sweeney seeks to expose the dire shortcomings of healthcare professionals’ interactions with their patients. Through conversation, facial expressions, and mannerisms a doctor has a profound effect on how a patient copes with being diagnosed with a terminal disease. Dr. Sweeney hopes to make a change in the way that doctors currently conduct themselves when addressing the needs of sick patients.

Dr. Sweeney’s story opens in the hospital. He was there for testing and no one seemed to want to let him know exactly what was going on.  What follows is shocking:

While I was having the check film, my wife asked the specialist (cancer) nurse why everyone was so downcast. At that point, everyone around knew I had a mesothelioma, except me. I learnt about it by reading the discharge summary over a glass of sauvignon blanc with lunch at home: malignant mesothelioma. ‘Patient is aware of the diagnosis,’ said the discharge summary.

From there on out, Dr. Sweeney had entered “the kingdom of the sick,” as he called it. He quickly became entirely disconcerted by the healthcare professionals treating him and through his story offers some suggestions:

…one’s journey to this bleak place can be rendered more bearable if everyone who shares a professional role at the various staging posts bears the bleakness of the terminus in mind. Some simple ground rules could improve the nature of the professional patient interaction, if not actually displace its underlying, transactional mindset.

Please can all healthcare professionals stop asking patients to “Do this for me?” I’m not doing it for them, I’m doing it for me. The key point here is about locus of control. If I am asked, or more often instructed, to do something “for me”—meaning the health professional— then the locus of control for the transaction lies with that person. But the focus of the transaction should be me, the patient. Structured in that way, the “for me” defines the interaction as transactional—I am cared for—but not relational: one is left with the feeling that the professional does not care about me but does something to me.

Please can we avoid crass attempts at humour? There is nothing funny about clutching a plastic bag with all your clothes in, except your pants, socks, and shoes—just stop and think what that must be like—while trying to secure a hospital gown around you, and following, like some faithful gun dog, a radiology attendant who without introduction commands you, with a broad grin to acknowledge his witty lack of grammar, to “follow I!”

His point is not to completely categorize all healthcare professionals as out-of-touch, insensitive stoics. He intends to show that what doctors mean to convey and what they actually convey can end up being quite different. Not only this, but many times members of the same healthcare team have very different, sometimes contradictory, approaches to the personal aspect of treating the patient. He urges that this issue must be addressed.

Being a patient diagnosed with mesothelioma is especially difficult. There just aren’t the same resources available. With awareness groups such as Asbestos Disease Awareness Organization, this is hopefully something that will continue to change. Yet as it stands, mesothelioma patients truly need their doctors to treat them, not as just another patient, but personally, as individuals.

Dr. Sweeney closes stating:

In the care I have received, the transactions have been timely and technically impeccable. But the relational aspects of care lacked strong leadership and at key moments were characterised by a hesitation to be brave. What I have always feared in illness was anonymity, being packaged, losing control, not being able to say “this is who I am.” In the end, one is left alone, here, in the kingdom of the sick.

His story is a call to action. Perhaps the suggestions he’s provided will be taken to heart by many clinicians whose intentions are assuredly not to be cold and impersonal. The healthcare community needs stories like these, and not just from doctors, in order to evaluate and train themselves in the highly delicate art of patient relations.

With a subscription to BMJ you can read Dr. Kieran Sweeney’s full story about his diagnosis of mesothelioma, “A pateint’s journey”.

This update includes important excerpts from the recent statement by the US Surgeon General Steven K. Galston about National Asbestos Awareness Week.  It provides several educational resources about asbestos and asbestos-related diseases, including many sites which are multilingual.  Finally, the update has a section suggesting what you can do to help raise awareness about asbestos.

I suggest visiting the ADAO website for the details of the update yourself.  However, the “Prevention and Advocacy” suggestions are worth repeating, here. 

From the update:

SAMPLE FACEBOOK and TWITTER MESSAGE: “Asbestos is a carcinogen. Ban asbestos now. Send your Congressional Representatives a letter from www.banasbestos.us ”

Forward the www.banasbestos.us link to your contacts, post your message on FaceBook and send on Twitter. Ask your friends, families and colleagues them to send letters and messages too!

It’s an easy cut and paste to help raise awareness about this deadly substance that continues to inhabit so many of our public buildings, transportation, and even entire towns.

The pericardium is a fluid filled sac which surrounds the heart. It serves as protection by keeping the heart from being irritated by surrounding membranes and by preventing the heart from overexpansion during increased blood flow.

                       Photo courtesy of the National Heart Lung And Blood Institute.

Pericardial mesothelioma is caused by fiber particles which become wedged inside the pericardial fluid. These stuck fibers create scar tissue which then leads to the formation of cancerous cells. As a result, the heart beat becomes irregular and the heart inflamed.

Unfortunately, as is the case with all types of mesothelioma, the disease is often diagnosed in the late stages. This leaves few options for treatment. The treatment options currently used for pericardial mesothelioma are frequently radiation therapy and chemotherapy. These types of treatments are quite effective, but with them runs a risk of damaging healthy cells while ridding the body of the unhealthy cells. Surgery is also sometimes used to remove cancer cells.

A great resource on pericardial mesothelioma can be found at PericardialMesothelioma.org.

For more information, visit AsbestosLegalWatch.com.

The peritoneum is made of two parts, the visceral and parietal peritoneum. The visceral peritoneum covers the internal organs and makes up most of the outer layer of the intestinal tract. The parietal peritoneum covers the abdominal cavity. Cells in these linings secrete a fluid which allows organs to move against one another. The cells of the mesothelium are designed to create fluid, but the cancer causes them to overproduce, creating a build up of excess fluid in the abdominal cavity. Because pleural mesothelioma is more common and often spreads to the peritoneal cavity, it is important to determine if pleural mesothelioma is the primary cancer.

Treatment of Peritoneal Mesothelioma

In the February 2008 edition of the American Journal of Clinical Oncology, researchers from Columbia University reported that combined resection, intraperitoneal chemotherapy, and whole abdominal radiation therapy and found it to be an effective treatment for malignant peritoneal mesothelioma.

The latency period for abdominal mesothelioma appears to be 20-30 years, which is shorter than the time it takes to develop pleural mesothelioma in the lungs and it is much less common, making up less than 20% of all cases.

The Columbia University study involved 27 patients with malignant peritoneal mesothelioma and followed a regimen involving several steps:

• Surgical debulking followed by four intraperitoneal courses of cisplatin alternated with four intraperitoneal courses of doxorubicin
• Four doses of intraperitoneal gamma interferon
• Laparotomy with resection of residual disease
• Intraoperative hyperthermic administration of intraperitoneal mitomycin
• Cisplatin followed by whole abdominal radiation therapy.

The multimodality of therapy proved effective, showing a median survival of 70 months and a three-year survival of 67%. It is interesting to note that seven patients in the study went a full 17 months before seeing any evidence of the disease.

Roughly 80% of malignant pleural mesothelioma cases start as pleural plaques. Pleural plaques are smooth, white, raised irregular areas of fibrous collagen tissue that develop on the pleura and vary in size from small to large. Pleural plaques are not considered pre-malignant, but they are an indication of exposure to asbestos (and thus indicate an increased risk of its associated diseases). They do not require treatment, but their presence should prompt regular medical check-ups.

To date, treatment options for mesothelioma have been limited as only a small number of patients respond to surgical intervention; however, recent efforts have focused on exploring new combinations of therapies for treating malignant pleural mesothelioma and extending survival.

Surgery

There have been some encouraging preliminary results in comparing surgery to conventional chemotherapy. At the American Society of Clinical Oncology meeting in Chicago in 2007, results were presented of a multi-center Phase II feasibility study of trimodal therapy for malignant pleural mesothelioma. Patients had four cycles of cisplatin and premextred chemotherapy, followed by an extrapleural pneumonectomy (explained in detail below), followed by hemithoracic radiation. Median survival time for the group was 16.6 months.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) is a surgical procedure that involves the removal of the lung along with its coverings. Of all treatment approaches attempted, extrapleural pneumonectomy has been most consistently associated with long-term disease-free survival. Also, with the lung removed, a higher amount of radiation can be delivered.

Once the patient is under complete general anesthesia, an incision is made extending from below the shoulder blade, around the side along the curvature of the ribs to the front of the chest on the side of the diseased lung (thoracotomy). Next, the surgeon collapses the diseased lung, cuts off its major blood vessels, and the lung’s main bronchial tube (air tube) will be clamped and cut and the lung removed. The pleura is then removed from the chest wall.

Systemic Therapy

Pemetrexed (Alimta) and Combinations

Vinorelbine Plus Platinum

Investigators in Denmark have explored the use of combining vinorelbine rather than pemetrexed in combinations with platinum agents cisplatin and carboplatin. The vinorelbine and cisplatin group were mostly in advanced states (stage III or IV) and had a median survival rate of 11.6 months. The vinorelbine plus carboplatin group median survival rate exceeds nine months for stage III and IV patients in the study.

Other Targeted Therapies

Angiogenesis Inhibitors

Cancer cells have the ability to spread, called metastasis, which means they can penetrate into lymphatic and blood vessels, circulate through the bloodstream, and then invade and grow in normal tissues elsewhere. Cancer researchers studying the conditions necessary for cancer metastasis have discovered that one of the critical events required is the growth of a new network of blood vessels. This process of forming new blood vessels is called angiogenesis.

Tumor angiogenesis is the proliferation of a network of blood vessels that penetrates into cancerous growths, supplying nutrients and oxygen and removing waste products. Tumor angiogenesis starts with cancerous tumor cells releasing molecules that send signals to surrounding normal tissue. The signal activates genes that make proteins to encourage growth of new blood vessels.

Scientists studying tumor growth found that cancer cells grew into tiny tumors but failed to link up to the organ’s blood vessels. Without angiogenesis, tumor growth stopped.

A drug trial using a combination of gemcitabine and cisplatin plus bevacizumab as angiogenesis inhibitors showed, unfortuntely, that this drug combination did not show any significant improvement in progression-free survival.

Other trials with targeted drugs in an attempt to use angiogenesis inhibitors as a way to stop cancer progression are underway.

For more information, visit AsbestosLegalWatch.com.

Mesothelioma which starts in the space around the heart, or pericardium.  

Mesothelioma, or cancer of the mesothelium, is a disease in which cells in the mesothelium become abnormal and divide uncontrollably. The abnormal cells can metastasize and spread to nearby tissues and organs, resulting in malignant mesothelioma.

The mesothelium is a protective membrane made of mesothelial cells which forms a sac of lubricating fluid around most organs, allowing the organs to move and function properly. The mesothelium is given different names, depending on where it is, e.g., the heart (pericardium), abdomen (peritoneum), lungs (pleura), or other organ.

Mesothelioma is a rare cancer. Approximately 2,000 to 3,000 cases are diagnosed each year, but the incidence rates are increasing. Mesothelioma often occurs more often in men than in women and a major risk factor is a history of asbestos exposure. The risk of developing mesothelioma increases with heavier exposure to asbestos, but there have been cases of individuals with brief exposure to asbestos later developing mesothelioma. Family members of asbestos workers are also at increased risk for developing mesothelioma if exposed to asbestos dust brought home on clothing.

For more information, visit AsbestosLegalWatch.com.

Senator Kean wants to call attention to the fact that there is no cure for mesothelioma.  He hopes that by raising awareness about the fatal asbestos-related disease, research and effective treatments will grow. 

Kean says, “Our designation of each September 26^th as ‘Mesothelioma Awareness Day’ will help ensure that the public, researchers and policymakers don’t forget about those suffering from this disease… Thousands of rescue and constructions workers labored for months at Ground Zero in hazardous conditions.  We don’t know if those who worked at the World Trade Center site will develop mesothelioma, but we do know that we want to have effective treatments ready to help anyone who falls ill.”

Senator Kean’s legislation has already been approved by the New Jersey Senate and moves, next, to be heard by the General Assembly.

We hope that by next year several of the non-participating states will follow the lead of those who have already become a part of Mesothelioma Awareness Day. 

According to the Reuters report, “ADAO Congratulates the Acting U.S. Surgeon General, Steven K. Galson, and Thanks the U.S. Senate for Efforts to Encourage Warning About Asbestos Danger”:

Every reputable United States and international health agency including the Environmental Protection Agency, the World Health Organization, the International Labor Organization, International Agency for Research on Cancer, Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, and the American Cancer Society agree there is no safe level of asbestos exposure. Most recently, the International Agency for Research on Cancer (IARC) reconfirmed that all commercial asbestos fibers - including chrysotile, the most commercially used form of asbestos - cause lung cancer and mesothelioma. In addition, the IARC newly confirmed that there is sufficient evidence that asbestos causes ovarian cancer and reconfirmed asbestos causes laryngeal cancer.

In his statement, the Surgeon General drew attention to the fact that, “…there is no level of asbestos exposure that is known to be safe and minimizing your exposure will minimize your risk of developing asbestos-related disease.”  Acknowledging this important information, the ADAO believes that the Surgeon General’s statement highlights the need for a full scale ban on all asbestos material and manufacturing.

The Surgeon General released his statement to kick-off “National Asbestos Awareness Week”, which falls during the first week of April each year.

Read the “Statement from Acting Surgeon General Steven K. Galson about National Asbestos Week”.