2021-11-10 Doubt Is Their Product: Bladder Cancer

BNA & bladder cancer
<< In the summer of 1979 I ran the program at the Montefiore Medical Center/ Albert Einstein College of Medicine in the Bronx that introduced medical students to occupational medicine. As part of that curriculum, we placed the first-year students with the International Chemical Workers Union, which represented workers at the old Calco Chemicals (later called American Cyanamid and now Wyeth) plant in Bound Brook, New Jersey. The workers at the factory manufactured, along with many other products, commercial dyes. The students’ assignment was to investigate the hazards the workers faced and to design and implement an educational program to reduce these dangers.

Never allowed into the factory, we would meet with the workers in diners and parking lots. The union members told us that the Raritan River down stream from the factory would run red some days, blue others, and green others, depending on the work product at the time. They also told us about the bladder cancers that were afflicting several of their coworkers and about their lawsuit against DuPont, which produced the chemicals then used in the manufacture of the dyes. These chemicals are known generically as aromatic amines (not that they are particularly fragrant, but aromatic is what chemists call molecular structures that are based on the benzene ring). The workers’ lawsuits had ended abruptly some years earlier, when DuPont’s lawyers produced a letter dated 1947 from a medical director for the company warning the medical director of Calco of the hazards of beta-Naphthylamine (BNA), one of the chemicals in question. The workers’ attorney told them DuPont would have been legally liable only if it had known or should have known of the risk posed by BNA and then failed to tell its customers. Since it had warned Calco of the dangers, their attorneys explained, DuPont was off the legal hook, and under workers’ compensation laws, workers are barred from suing their employer. The men with bladder cancer would have to settle for workers’ compensation payments, which would cover their medical bills and only a portion of their lost wages, with no payments for pain and suffering.

One of the workers gave us a copy of the DuPont letter, which contains information that, to my knowledge, had never been made public. The second paragraph begins this way: “The question of health control of employees in the manufacture of Beta Naphthylamine is indeed a grave one.

As you know, we have manufactured Beta Naphthylamine for many years. Of the original group, who began the production of this product, approximately 100% have developed tumors of the bladder.”

Now that is a smoking gun. Reading the letter for the first time, I stared in disbelief. I knew that the link between the aromatic amines and bladder cancer was well established, but I had never heard of any chemical that caused cancer in every one of a group of exposed workers. Could “100%” have been a typo? Should the number have been 10 percent, bad enough in itself? Either way, the admission by a medical director at DuPont demanded an investigation, and the more I learned, the more appalled I became. The number was not a mistake. The aromatic amines are killers, and the manufacturers knew this and did little until it was too late. In the annals of callous indifference to the health of industrial workers, this story is just as unseemly as the asbestos story, if less well known and affecting fewer people.

The saga begins in 1856, when William Henry Perkin, an eighteen-year-old British chemistry student, was attempting to synthesize quinine, a drug used throughout the British Empire to prevent malaria, from the coal tar that formerly had been a useless by-product of the distillation of coal to produce gas for lighting. Instead of quinine, however, Perkin came up with a delicate purple solution, which he named mauveine, which the French would shorten to mauve. His discovery became the first commercially feasible synthetic dye and the first of a series of scientific and industrial advances relating to dyes achieved in Europe in the second half of the nineteenth century, thereby creating an important new industry that provided the growing textile industry with bright and inexpensive colors.

Armed with the first patents, the English chemical industry dominated the global dye market but not for long, as Germany rushed to catch up. Seeing an opportunity for sustained industrial development, the German government built formidable university laboratories to train scientists and provide the basic research the organic chemical industry needed — perhaps the earliest example of a large-scale “industrial policy.” With the private sector matching the government’s efforts, German scientists soon obtained hundreds of patents. Their nation quickly surpassed the British and dominated the market for decades.

The early dye industry was large and profitable, but its importance in economic history stems primarily from its relationship to the development of the synthetic organic chemical industry; aspirin, sulfa drugs, and phenolic resins were all derived from coal tar. The patents and production processes for the new dyes became the basis for the global expansion of organic chemical production, a vast and incalculably important contributor to modern industry and modern life.

However, a darker downside also existed: bladder cancer. The first cases among dye workers were diagnosed in 1895 by Ludwig Rehn, a surgeon in Frankfurt-am-Main, a center of the German chemical industry. Rehn reported that three of the forty-five workers employed in the production of fuchsine, another early purple dye, developed bladder cancer, an exceedingly rare disease at the time. Ten years later he had identified thirty-eight workers with bladder cancer, and other physicians in Germany and Switzerland soon reported dozens of additional cases among dye workers. In those initial reports, the chemical or chemicals responsible for the cancer were the subject of speculation. Published reports consisted primarily of a listing of cases, accompanied by the names of the chemicals to which each worker was known to have been exposed. Over the course of several decades a consensus developed, as reported in the 1921 International Labour Organization (ILO) monograph Cancer of the Bladder among Workers in Aniline Factories. Examining the accumulated evidence, the ILO asserted that the chemicals most likely responsible for the cancer cases were benzidine and beta-naphthylamine. It urged “the most rigorous application of hygienic precautions” to prevent further cases from developing.

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