For years the FAAM conference has been a mainstay of the autumn events calendar. This year it moved to new spring dates, and what a fantastic event it turned out to be. It’s hard to summarise such an excellent conference in one blog post, so I’m going to focus simply on the bits that blew me away. But first, a mention that next year’s FAAM is likely to be at the end of April – watch this space for updates.
The first day’s amazing morning session was kicked off by keynote speaker John Cherrie, who asked “how did we get here?”, and more importantly, “where do we go next?”. Drawing on his lifetime of work modelling asbestos exposure, he provided insight into where we should put our policy effort.
Professor Cherrie explained how the presence of asbestos and its removal are complex, but the resulting exposure can be modelled. This lets you compare likely exposure among building users, for example, in buildings that contain asbestos, when asbestos is being removed, or when this work has been finished. You can also of course factor in exposure in the asbestos workers tasked with removing the material.
Models also let us compare with the dangers of doing nothing (i.e. manage in situ), and only dealing with asbestos when the building is at the end of its life – typically when it is 100 years old.
John went into a huge amount of detail, exploring predicted exposure for groups including teachers, maintenance workers and firefighters. He looked in more detail at removalists wearing respirators, but also the potential risks to those nearby during and after removal works. The key takeaway? We can expect around double the asbestos exposure if we do nothing with a building, compared to what happens if we remove its asbestos.
Gillian Nichols of the Health and Safety Executive (HSE) presented insight from the Great Britain Asbestos Worker survey – an astonishing, unique resource. For 54 years the HSE has been following up with those exposed to the material. From the top, the survey tells an interesting story of shifting understanding and priorities: at first it tracked asbestos manufacturing workers, then insulators, and latterly those exposed through removals.
The UK regulators showed incredible foresight to introduce this only a few years after the UK started regulating asbestos and a full four years before the HSE even existed! The fact it has been maintained for more than 50 years is deeply impressive, and has resulted in a superb resource.
Gillian shared some highlights from the project. Over time, more than 120,000 workers have completed at least one of the questionnaires, and granted the HSE permission to follow up with the NHS and their health records. Interesting nuggets of information ranged from the time spent in an enclosure per week having doubled since the early 90s, to the fact that smoking among asbestos workers is nearly triple that of the general population.
When everyone in the asbestos industry knows how smoking has a multiplying effect on mesothelioma consequences, this last is a stark statistic, but it’s borne out by disease numbers. Asbestos workers are more than 13 times more likely to die from mesothelioma than the population at large. But they also seem more susceptible to a whole range of other cancers. Lung, stomach, kidney and rectal cancers are all from 1.5 to 2 times more common. If this isn’t a wake up call to asbestos workers to take removal methods more seriously, look after their respirators – and be more diligent even with shaving – I don’t know what is.
One last slide from Gillian really caught my eye, illustrating the unsurprising correlation between mortality and the length of time spent in this hazardous industry. But the statistics also show that our regulations are having an effect. Those who began in the industry since the 1990s (around the advent of wet stripping), have mortality rates 10-fold lower than those who started out in the earliest years of the industry.
With all that’s known about asbestos and asbestos use, you might think we have a definitive definition for what it is. It’s surprising when you explain to those outside of the industry that’s not strictly the case. Thus doctor Andrey Korchevskiy provided a though-provoking conclusion to the mind-blowing morning session.
Those of you who have experienced Andrey talking at FAAM before will know that the fast pace and sheer mountain of information that he presents is astonishing – and just before a break might have been ambitious for the organisers. But the clarity and inescapability of his argument was clear.
Dr Korchevskiy demonstrated how the bio-persistence (how long a fibre can last in lung fluids), rigidity and smoothness of fibres maps incredibly closely to the lifetime death stats that we have been measuring for decades. This correlation explains why we know that crocidolite and amosite (both very rigid) are significantly more hazardous than chrysotile.
More than that, it can be used to predict when non-asbestos fibres might become mesotheliomagenic (likely to cause mesothelioma). For example, fibre dimensions, bio-persistence and rigidity can be used to predict whether carbon nanotubes can cause mesothelioma.
For decades we have struggled and failed to absolutely and definitively define asbestos. Maybe in mesotheliomagenic we have a term that can be linked more to health outcomes, than the geological origin of the original fibre.
The afternoon commenced with a heart-rending talk by mesothelioma sufferer Sue Farrall, who provided a timely reminder of why so many of us choose to work in this field. She explained her experience: an incredibly slow diagnosis where the possibility of mesothelioma was just not considered, despite her having classic symptoms, because she didn’t fit the profile of an elderly man that has worked with asbestos.
Sue shared her story, from the huge operation she underwent to remove the entirety of her pleural membrane and diaphragm, to the quite astonishing 29-plus mile walked marathon she completed despite being out of breath after two flights of stairs. Amazing.Dr Yvonne Waterman of the Global Asbestos Forum gave us all an update on what is happening around the world – underlining why her organisation has changed its name to the Global Asbestos Forum, rather than ‘just’ being European.
Alas, there was not much in the way of good news. Yvonne explained the likeliness that the EPA in the U.S. would be reduced to a mere token organisation, and relayed how government funding for the South African asbestos cement removal programme was being embezzled. Even the excellent Flanders declaration that all asbestos in schools would be removed – and that the government would pay – has apparently merely led to a doubling of project costs. How depressing.
The bright spark in Yvonne’s talk was the launch of her new magazine. At 87 pages, this has been no small undertaking – and it has been completed in this same classy style that is the hallmark of everything she does. Filled with fascinating articles, from leading lights in the industry, and all with the amazingly beautiful pictures taken by Tony Rich. If you haven’t seen a copy yet I would get on the mailing list before they all go: [email protected].
The day’s final session was one I’d particularly been looking forward to. Phoebe Smith of the HSE managed to overcome what might have been considered the graveyard slot; the end of a very long day where your brain just can’t absorb any more. Her energy was astonishing, carrying her around the conference room while she involved everyone, blowing away all the cobwebs in no time.
Phoebe is a clinical psychologist, and the human factors technical lead for the HSE. I can almost hear you ask what ‘human factors’ is: it’s essentially why people do (and don’t do) what you and your procedures would ideally like them to. This is a constant complaint in the asbestos industry, and Phoebe’s talk gave me the beginning of an insight into where we have been going wrong – for probably 20 years.
I’m still reflecting on what I learned, but Phoebe turned much of what we do upside down by explaining the importance of when NOT to have a procedure. She explained the need to pick your moments, and only put the effort into a procedure where the risk and consequences warrant it, because to get it right is a much bigger task than you might think.
So, when the situation warrants it, how do you create the ideal procedure – one that people will actually follow? Phoebe showed how it must work:
Are all overlapping, and creating the ideal procedure means distilling them all down in a way that works for all groups. Phoebe’s work is insightful, and it feels like something from which we can all learn a huge amount. I hope I’ll have the opportunity to engage with her more in the coming weeks and months.
So many highlights, and as the more observant among you will note I’ve only got to the end of day one! Even then I haven’t had time to mention Garry Burdett and James Staff’s comparison between electron and phase contrast microscopy (PCM), and really how closely they can perform. Fortunately this is likely to be the subject of a FAAM webinar in the coming months.
You’ll notice I also haven’t had time to summarise day two, which featured a comparably stellar lineup of speakers, covering a similarly stimulating range of subjects. All in all this really was a fabulous conference. I’d like to extend a huge thanks to the FAAM conference committee for organising it, and most especially Sara Mason. Sara, long-serving chair of that group, and longtime FAAM committee member, is stepping down. As swan songs go, this was fantastic.
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