Strict Criteria to Prove Ill Health from Asbestos

In the mid1980s the American Thoracic Society (ATS) formulated health asbestos criteria for diagnosing asbestosis. In the ATS medical journal a group of experts proposed the following health asbestos criteria for diagnosing asbestosis:

• A definite history of asbestos exposure to friable asbestos
• A definitely abnormal chest X-ray showing changes typical of asbestosis
• A definitely abnormal breathing test, showing a certain degree of impairment that could be due to health asbestos inhalation
• And findings on physical exam of the lungs compatible with the diagnosis and not due to some other condition

The authors of the ATS article recognized that asbestosis is a serious disease, for which there is no effective asbestos treatment. Patients are short of breath, at least on exertion. They have unequivocally abnormal chest X-rays. They have abnormal breathing tests. The authors specifically chose not to let the diagnosis include "healthy" people with equivocal chest X-rays or smokers whose lung impairment was due to smoking.

Some physicians and legal experts do not agree with the ATS criteria. They say that asbestosis must be recognized early, before there are symptoms and before the chest X-ray is unequivocally abnormal.

Others physicians will not certify a diagnosis of asbestosis unless the findings meet the strict ATS criteria. The result, of course, is why many cases go to litigation.

Missed Opportunity for Less Strict Criteria

A missed opportunity for less strict health asbestos criteria occurred in 1997. A group of experts met in Helsinki, Finland to "discuss disorders of the lung and pleura along with health asbestos and to agree upon state-of-the-art-criteria for their diagnosis and attribution to asbestosis." Their report, nicknamed the Helsinki criteria, was published in a Scandinavian medical journal.

Before the Helsinki criteria, the only published consensus report about clinical ill health caused by asbestos was the ATS article published in 1986. Unfortunately, the Helsinki report did not refer to the ATS article; also, it did not offer any new research or even any references to earlier research or opinion. For these reasons, the Helsinki report has not replaced the 1986 ATS report—so the stricter criteria remains today.

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