RECEIVED wilt?ena re incl 1 OFFICE OF THE DIR ECT I 3 NATIONAL CANCER School of Public Health Arthur L. Frank, M.D.. Professor of Public Health Chair. Department of Environmental and Occupational Health April 24, 2009 John E. Niederhuber, MD Director, National Cancer Institute 31 Center Drive Bethesda, MD 20892 Dear Dr. Niederhuber: As an NCI alumnus from the 1970?s, and a physician and scientist who has worked in the area of asbestos related cancer for some forty years, I am dismayed at the attitude and facts being put out by NCI on its website and its ?fact sheets?. Having trained at Mount Sinai with Dr. Irving Selikoff I have had a solid grounding in this issue. After becoming aware of the serious errors on website and a new proposed statement which compounds the current problems, I contacted Dr. Richard E. Manrow, your Associate Director of the Of?ce of Cancer Content and Manager and NCI Clearance Officer for the Of?ce of Communications and Education, about a new fact sheet about asbestos. A particular citation of serious concern in the current fact sheet on the NCI website was a meta-analysis of some very poor literature, all paid for by a legal ?rm, and quoted on the NCI website. This paper is unreliable and should not serve as the basis for any statement by the NCI. Apparently the new revised asbestos sheet to be posted on the website within the next few days has revised language. To quote from Dr. Manrow?s comments ?the revised language regarding automobile mechanics and brake repair will state that whether there is increased risk of mesothelioma or lung cancer associated with asbestos exposure from brake repair is controversial, but the evidence to date does not support an increased risk.? The reason that the evidence to date does not support an increased risk of mesothelioma in mechanics, as an occupational group, is because the studies are of extremely poor quality. proposed new statement does also not recognize, and Dr. Manrow would not recognize when I spoke with him, that brake mechanics can develop asbestosis, a disease with a threshold of exposure that is far beyond what would be needed for the development of lung cancer and mesothelioma, making this point moot. Indeed, the proposed new statement fails to recognize that some studies show an increased risk of lung cancer. If the NCI were to go online with statements that the evidence to date does not support an increased risk there would be thousands of dangerous compounds that would be getting a free ride, given that for most situations in most speci?c jobs there are no studies, therefore there is no evidence. Mail Stop 1034, 245 N. 15th Street, Philadelphia. PA 19102-1192 I TEL 215.762.3930 FAX 215.762.8846 E-MAIL alf13@drexel.edu John E. Niederhuber, MD April 24, 2009 Page 2 What is truly ironic about such a statement is that it is incontrovertible that asbestos, including the type of asbestos found in brakes does, in fact, cause lung cancer and mesothelioma. This was just reaf?rmed in the past few weeks by IARC. The EPA has a special cancer hazard notice to auto mechanics. Since we have not banned asbestos in this country, those who might read this statement could well think asbestos brakes are safe, putting at risk both professional and ?shade-tree? mechanics, and their family members. The focus of an NCI fact statement should be on the nature of the substance, not on speci?c job categories where one or another category might or might not have good epidemiology supporting the issue. No one disagrees that benzene causes leukemia, but should there not be a study in a speci?c group with exposure to benzene, then one could truly say there is no evidence, but it would be a fallacious argument. What I also found disturbing was that Dr. Manrow seemed unmoved by the questions of science, and in true bureaucratic fashion was stating that this statement had been generated by what he called ?content experts? who felt that this was an appropriate statement. When I asked for such content experts he would not share them with me. He told me if I am unhappy I should write to you; I am taking him up on his suggestion. Least you think this is my View alone, regarding the hazards of brakes, I am enclosing for your review a recent 2007 article on this very topic signed by over 50 international physicians and scientists which addresses this very issue, and lays out a case against your proposed statement. One wonders if this was considered by your experts and if it was, how NCI could offer the proposed new statement, given the evidence discussed in the peer reviewed literature? As a scientist who has been working in preventive medicine and public health his whole career, I have seen, especially over the last decade, that science has been bastardized due to political concerns. I hope that this is not a continuing example of this, and would hope that you would look into this situation and see that the NCI is more appropriately represented on its public face and website by truly accurate information and not information that is biased, incomplete, and represents poor science. Thank you for your consideration of this matter. Sincerely yours, Ma Arthur L. Frank, MD,