Asbestos study suggests bias in experts
Majority of US claims are invalid, says team of radiologists.
Most asbestos lawsuits in the United States
are being brought by claimants who are probably not sick, a study warns. The
researchers found that experts hired to interpret lung X-rays in these cases are
vastly exaggerating the damage caused, with potentially devastating effect on
the companies required to pay compensation.
Asbestos, once widely used as a fireproof
insulator, is made of microscopic mineral fibres that are easily inhaled and
work their way deep into the lung. Once lodged in the lung tissue, they are
attacked by the body's defences and become surrounded by scar tissue.
The particles are particularly nasty because
they are long and sharp, and can cut their way through lung tissue, unlike more
spherical particles such as coal dust. The cumulative toll on health is called
asbestosis; sufferers' lung function is affected, they cough and wheeze, and may
even die. Some people also get a specific type of cancer, called mesothelioma.
The health effect commonly take a few decades to
appear. The peak exposure in the United States, for workers in shipyards,
building sites, and asbestos mining and manufacturing, was between the 1940s and
the 1970s, so the number of emerging cases should now be dropping. Instead, more
and more people are bringing cases every year.
B-readers
To assess damage to a potential claimant's
lungs, his or her chest is X-rayed and examined by a certified expert called a
"B-reader", hired by the claimant's lawyer. If the lungs are judged to
be harmed by asbestos, the lawyer seeks compensation for the claimant from their
former employer, or from the numerous trusts set up for workers suffering from
the disease.
Hundreds of thousands of people sue every year
and billions of dollars are awarded in compensation, with disastrous effects on
many of the companies involved. According to the study, published in August's Academic
Radiology2, "More than 60 US companies
have sought voluntary bankruptcy to deal with such claims."
The problem, according to Otha Linton, co-author
of the paper and director of the International Society of Radiology, is that
most of these claimants aren't actually sick.
Linton and his team studied X-ray films of the
lungs of 492 claimants. B-readers retained by the plaintiffs' lawyers had
diagnosed 95.9% of them with "parenchymal abnormalities", enough scar
tissue to make them officially ill. Linton then gave the same films to six
B-readers who had no idea what the study was about.
The interpretation of the independent experts
was staggeringly different. They diagnosed parenchymal abnormalities in only
4.5% of the cases.
Biased readings?
Reading X-rays can involve a degree of
subjectivity, and B-readers do sometimes disagree on how badly damaged a lung
is. But Linton says that such a fundamental difference in interpretation is
unheard of.
He believes the results show that the B-readers
hired by claimants' lawyers are producing biased readings, whether intentionally
or not. And if one expert does not find damage to a lung, a lawyer is likely to
keep trying until he finds an expert who does, Linton says. "If I am a
plaintiff's lawyer, I am going to find witnesses who will, rightly or wrongly,
honestly or dishonestly, agree with me."
The finding is "as disquieting as it is
startling", say radiologists Murray Janower and Leonard Berlin in an
editorial that accompanies the study2, although
they are careful not to say that the data point to outright fraud.
The latest paper is not the only study that
casts doubt on certain B-readers. A 2002 report by the non-profit RAND Institute
for Civil Justice, and a 1990 paper in the Journal of Occupational Medicine3
both conclude that lots of healthy people, and lawyers, are getting cash they do
not deserve.
However, Dave Chervenick from Goldberg, Persky
and White, a law firm based in Pittsburgh, Pennsylvania, that specializes in
asbestos cases, says his firm's screeners find asbestos damage in only 15% of
cases. He does not think there is a widespread problem. "It's my sense that
not a whole lot of this is going on," he says.