THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract N01-OD-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON ASBESTOS: SELECTED HEALTH EFFECTS
Jonathan M. Samet, M.D., M.S. (Chair), Professor and Chairman, Department of Epidemiology,
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Lonnie R. Bristow, M.D., Private Practice and Former President of American Medical Association,
Walnut Creek, California
Harvey Checkoway, Ph.D., M.P.H., Professor,
Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
Paul Demers, Ph.D., M.Sc., Associate Professor,
Department of Health Care and Epidemiology, University of British of Columbia, Vancouver
Ellen A. Eisen, M.S., Sc.D., Adjunct Professor,
Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
George D. Guthrie, Jr., Ph.D., M.A.,
Geology and Chemistry Group, Los Alamos National Laboratory, Los Alamos, New Mexico
Rogene F. Henderson, Ph.D., D.A.B.T., Senior Scientist,
Lovelace Respiratory Research Institute, Albuquerque, New Mexico
Joseph W. Hogan, Sc.D., Associate Professor,
Biostatistics Section and Center for Statistical Sciences Department of Community Health, Brown University, Providence, Rhode Island
Agnes B. Kane, M.D., Ph.D., Professor,
Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
Fadlo R. Khuri, M.D., Professor,
Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
Roberta B. Ness, M.D., M.P.H., Chair and Professor,
Department of Epidemiology, University of Pittsburgh, Pennsylvania
Michael J. Thun, M.D., M.S., Vice President,
Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia
Assistants with Graphical Data
Li Su, Graduate Research Assistant in Biostatistics,
Department of Community Health, Brown University
Yunxia Sui, Graduate Research Assistant in Biostatistics,
Department of Community Health, Brown University
Mary Burr Paxton, Study Director
Rose Marie Martinez, Director,
Board on Population Health and Public Health Practice
This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following for their review of this report:
John C. Bailar, Professor Emeritus, University of Chicago, Illinois
Peter R. Buseck, Professor, Department of Geological Sciences and Department of Chemistry and Biochemistry, Arizona State University, Phoenix
Robert G. Coleman, Professor Emeritus, Stanford University, Atherton, California
Arthur Frank, Professor and Chair, Department of Environmental and Occupational Health, School of Public Health, Drexel University, Philadelphia, Pennsylvania
Robert F. Herrick, Lecturer, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
Karl T. Kelsey, Professor, Departments of Cancer Cell Biology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts
Alfred I. Neugut, Program Director, Cancer Epidemiology and Control, Division of Epidemiology, Mailman School of Public Health, Columbia University, New York
H. Catherine Skinner, Research Affiliate and Lecturer, Department of Geology and Geophysics, Yale University, New Haven, Connecticut
Mark Utell, Professor, Departments of Medicine and of Environmental Medicine and Critical Care Division, University of Rochester, New York
Gerald van Belle, Professor, Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
David Wegman, Dean, Health and Environment, University of Massachusetts, Lowell
Noel S. Weiss, Professor, Department of Epidemiology, University of Washington, Seattle
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Paul D. Stolley, University of Maryland, School of Medicine, Baltimore, and by Edward B. Perrin, University of Washington, Seattle. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.