Is there an exposure to asbestos which does not “legally cause” mesothelioma? Evidence from: C Gilham et al. Occup Environ Med (2015);0:1–10. doi:10.1136/oemed-2015-103074 Gilham et al, compared asbestos fibre burdens from the lungs of mesothelioma and lung cancer cases and from these, developed risk equations. 79% of the fibres they observed were amosite; the subjects were all resident in the UK. Fibre burden and diagnosis were objective and precise; which means the main uncertainties were in unintentional bias and biological variability, about which not much more could be done except by sub categorisation by genetic and epigenetic profile (which would require a much bigger study). Using mathematical methods adapted from the design of optical telescopes and electronic circuits, we have extended the reported analysis to make an original estimate of de minimis. Compared with background, and for asbestos fibres which are longer than 5 micrometres, the smallest detectable increase in the

Smoking as a contributor to the cause of occupational lung cancer has been taken to court, but the situation is unclear. The detailed mechanisms now being worked on will allow greater certainty in the future, but not yet. In the alternate, inflammation could be used as a catch-all mechanism. Any cause or contributor to inflammation could be cited as a contributory cause. Cancer is indivisible, BUT, details of the mechanism could provide defences based on timing of exposure, and de minimis. Smoking causes cardiovascular disease. Occupational or product contributions to this would be possible. Indivisible and divisible outcomes are both possible. Likely claims involving smoking would be when fine dust exposure is alleged to be a cause of indivisible heart disease. More speculative would occupational causes of debilitating high blood pressure or angina; both of which are divisible. Evidence from: A report of the Surgeon General (2010) ISBN 978-0-16-084078-4 How Tobacco Smoke Causes Diseas

HSC have implemented the requirement to set reduced levels of protection when work with asbestos is described as sporadic. Evidence from: HSC/06/55 July 2006. “A comparison of the risks from different materials containing asbestos” At the 9 May meeting, the Commission agreed that including in the Approved Code of Practice (ACoP) a peak exposure level of 0.6 fibres per cm³ in the air measured over a ten minute period would provide a useful determinant of when exposure might be considered to be sporadic and of low intensity. Exactly how this ties in with the Compensation Act 2006 remains to be seen. It is highly likely that claims will be made when known exposures are below the level described as sporadic. Would they be in breach or not? Further detail: 6#5-6 11  

The effect of the Barker judgement was reversed within a matter of weeks. This Bill provides that joint and several liability applies to these kinds of claims. Evidence from: Hansard: Amendments agreed 19th July 2006. “Compensation Bill” The absolute language used in this bill is intended to give rise to a guarantee of compensation for mesothelioma cases. However the language used is absurd and will give rise to uncertainties. Included is the possibility that exposure to asbestos the day before a diagnosis of mesothelioma is made, could be found responsible for the disease. There are other scenarios where the Act will give offence against natural justice. There is growing concern that contribution to risk should be measured in a more rational way. The real tests will come when an administrator or public body has a duty to minimise exposure to past liabilities. Further detail: 6#5-6 8  

Noise induced hearing loss is still an issue. This reform of duty of care standards will bring more people within the claimant population. Poor understanding in the courts risks providing compensation for trivial harm. Given that exposure measurement is also subject to considerable uncertainty, a Duty to ensure exposure (with hearing protection) is less than 85 dB(A) would seem to be in accord with the requirements of civil liability (for the 50 year old male manual worker). That is, exposure below this value would not be shown to have on the balance of probabilities, contributed to measured HTLs. Evidence from: andrew@reliabilityoxford.co.uk A full description of the noise Directive its strengths and weaknesses. The Radar report is available to subscribers: 1#10 1

The research should provide the means to estimate the attributable case load for leukaemia, rectum cancer, lung cancer and “all” cancer. Work cohorts in this study were dental, medical, industrial and nuclear. Evidence from: WN Sont et al. American Journal of Epidemiology Feb (2001) Vol. 153 #4 p. 309 In practice the results were of doubtful statistical significance. The approach to risk adopted in radiation regulation and medicine seems far removed from an approach based on the balance of probabilities. The Radar report is available to subscribers: 1#3 4

This academic paper finds a power relationship between cumulative smoking and death from lung cancer. This is as expected. The form of relationship permits the calculation of the date when risk was doubled, which may be useful in ‘injury-in-fact’ arguments, and when risk was first detectable which may be useful in ‘de minimis’ arguments. Evidence from: N.Yamaguchi et al. International Journal of Epidemiology (Dec 2000) Vol. 29, p 963. Potential exposure to insurable outcomes can be estimated using functions of this sort. Radar report is available to subscribers: 1#1 6