Al Rogel, a Rancho Cordova engineer, is tired of fretting about whether tiny asbestos fibers in the air might be hurting his friends in El Dorado County.
He's sick of speculation and uncertainty and hearing that no one knows enough about the dust being stirred up from asbestos-bearing rocks on El Dorado's western slopes.
"Why not do a post-mortem for traces of fibers and dust in lungs of persons who have recently died ... to determine the actual effects of the asbestos?" he snapped out in a curt e-mail to the Bee last month. "Results should settle the matter once and for all."
For someone who says he follows asbestos issues largely because companies whose stock he owns keep getting sued, Rogel had asked an awfully good question.
A study much like the one he outlined could help verify - or dismiss - the possibility of health risks from naturally occurring asbestos in El Dorado County, many researchers say.
Some, including federal health officials, say a lung tissue study would be informative and important, although it's not their top priority.
Others, including pathologists who have studied asbestos's impacts on the human body, say it may be the single most significant thing that could be done right now to whittle away at the mountain of unknowns in El Dorado.
"The best way to know if there's increased risk would be to look at the lung tissue of these people," said Dr. Victor Roggli, a Duke University pathology professor who has devoted more than 25 years to studying asbestos-related diseases.
Roggli and others say a well-designed lung study, using tissue from autopsies, could establish two things:
* Have people who have lived many years in affected areas of El Dorado County breathed in more asbestos fibers than similar people elsewhere in the county?
* Are the especially dangerous and enduring amphibole asbestos fibers present in levels linked to asbestos-related diseases?
Past research is beginning to map out upper and lower boundaries for how many fibers tend to be associated with increased illness, although results vary from lab to lab, said Dr. Bruce Case, a professor of pathology at McGill University in Canada.
In addition, fiber analysis could provide some answers sooner than waiting for a possible disease outbreak.
It can take 30 or 40 years for people exposed to asbestos to develop mesothelioma, a rare and lethal cancer, and many people with heavy exposure don't get the cancer or show changes detectable in lung X-rays.
Anyone heavily exposed, though, would retain the fibers. The body breaks down amphibole asbestos very slowly, so "the lung is a very good sampler of what your total dose was," Roggli said.
Still, there would be limits to the conclusions that could be drawn from a lung tissue study, said John Wheeler, a senior toxicologist with the federal Centers for Disease Control and Prevention's Agency for Toxic Substances and Disease Registry.
One big complication, as Wheeler sees it, is that the federal Environmental Protection Agency's sampling has shown people's individual activities affect how much dust they stir up, and so how many asbestos fibers they might inhale.
It would be tough, even after interviewing survivors, to know enough about a deceased person's activities to extrapolate to living people, each with his or her own activity pattern, the toxicologist said.
So while a lung tissue study "would certainly lend to our understanding," Wheeler said, "I don't think it would be the definitive piece of evidence of saying these people are at very high risk or they're not."
Right now, the ATSDR wants to focus on looking for early signs of disease in those who have been exposed, he said, although one of its divisions is interested in looking into lung studies.
The idea of studying lung tissue in El Dorado has been floating around since at least 2001, but air expert Earl Withycombe believes the time has come.
Withycombe, who sits on the boards of both Sacramento-area and statewide branches of the American Lung Association, hasn't always been satisfied with the pace of efforts to delve into El Dorado's asbestos issues, but says there has been serious progress.
Since 1998, better maps have been made, dust control measures have been toughened, numerous sites have been tested and human activities have been monitored.
Now, Withycombe said, a lung study is probably among the top two things that should come next - along with additional neighborhood monitoring.
Doing a lung tissue study in El Dorado County would cost "in the range of tens of thousands of dollars instead of hundreds of thousands," he said. "It's a low to moderate amount of money in the research world."
Professors at two university labs that deal extensively in asbestos testing said their labs would not charge for sample analysis if they were listed as co-authors of a research study.
Canadian pathologist Case already has taken part in a small study that found elevated asbestos in a few pets' lungs in El Dorado County, although there are problems with trying to extrapolate from animals to humans.
"Without question, the most useful thing would be to get hold of some human lung tissue," Case said.
As outlined by Roggli and Case, a lung tissue study would not have to be particularly large to tell people considerably more than they know now.
Basically, a study could be done by looking at lung tissue samples from autopsies of 10 to 20 people older than 35 who had lived for more than two decades in El Dorado County areas identified as having veins of asbestos-bearing rock.
Samples from a control group with the same general characteristics, living in other areas of the county, and ideally autopsied at the same hospital, would be evaluated for comparison.
The most practical source of the lung tissue would be from autopsies because it's risky to take samples from a living person's lung.
Whether El Dorado County simply could order such a study in the interest of public health is open to question. Any coroner, by law, can order an autopsy without family permission when a death needs to be investigated.
But there's enormous variation from county to county in how coroners approach research unrelated to the cause of death, said Gary Tindel, president of the California State Coroners' Association. Most prefer getting permission from next of kin for such research, he said.
About 200 autopsies a year are performed by Marshall Medical Center pathologists for the El Dorado County Coroner's Office on people who die from accidents and other causes, and small amounts of autopsy material, including lung tissue, are kept for five years, hospital officials said.
Sheriff Jeff Neves, who is the county's coroner, said through a spokesman that he believes a judge's order would be needed to permit the lung research.
That's stricter than the practice in Los Angeles or Sacramento counties, which sometimes allow medical research in conjunction with autopsies. Los Angeles uses an ethics committee to screen research proposals, favoring those it sees as offering significant community benefit, and always requiring survivors' permission, said Coroner's Department director Tony Hernandez.
Sacramento County Coroner Robert Lyons usually consults with his pathologists before deciding which research requests to approve, and requires next-of-kin consent for all but a few minimally invasive projects.
The Lung Association's Withycombe speculated that a lung tissue study has yet to attract much support because there are so many competing priorities for state and federal agencies, and so many diseases that are demonstrably killing more people.
But he and others remain hopeful the idea will make it onto someone's short list of projects that deserve the dollars.
One source might be state public health officials, suggested Dr. Rajen Ramsamooj, an associate professor of pathology at UC Davis Medical School.
The National Cancer Institute could be another option, said Dr. Marc Schenker, chairman of the medical school's epidemiology department, who has done other asbestos-related research.
"It's not going to answer everything," Schenker said, "but no one of these things we're doing will have all the answers."
A community meeting to discuss naturally occurring asbestos and dust-prevention efforts will be held at 7 p.m. Tuesday in the El Dorado Hills Community Services District Pavilion, 1021 Harvard Way, El Dorado Hills. Another meeting will be held June 28.
To read the Bee's previous coverage of naturally occurring asbestos in El Dorado County, please go to: sacbee.com/links
About the writer:
- The Bee's Carrie Peyton Dahlberg can be reached at (916) 321-1086 or email@example.com.