Letter to the Editor


Thank you for your recent asbestos-themed issue.1 Asbestos will, unfortunately, remain a concern in our lifetimes because 1) millions of tons of asbestos were mined worldwide;2 2) it was widely introduced into our environments over several decades;2 3) asbestos does not rot;3 4) it is mutagenic with evidence suggesting no minimal threshold dose;4 5) there is growing evidence that the newest wave of mesothelioma incidence is being driven by exposure to environmental asbestos;5 6) the incidence of asbestos-related mortality is increasing;6 and 7) the latency period between first exposure and mesothelioma is considerable.7

Historically and currently, asbestos has proven to be the most toxic or pathogenic of all occupational carcinogens, accounting for 255 000 deaths worldwide, annually (98.6% of which are cancer deaths), with ­ 37 000 being due to mesothelioma.6 Unless more countries impose a total ban on asbestos, this number will continue to rise. Currently, 66 countries have banned asbestos, with South Africa and Brazil being part of that group.8

However, there have been a number of recent and worrying international developments:

1. Donald Trump has endorsed asbestos. He has allowed his image to be used by Uralasbest, one of the world’s largest asbestos producers, with the words ‘Approved by Donald Trump, 45th President of the United States’ emblazoned on their products.9

2. The Environmental Protection Agency (EPA) has mooted new uses for asbestos. Significant New Use Rules (SNURs) on asbestos have been proposed by the United States of America’s EPA, along with six other proven carcinogens.10 This is extremely disturbing as jurisdictions in the developing world may incorrectly interpret the EPA’s actions as signalling that asbestos is safe. These proposals also indicate that a ban by the USA is unlikely in the foreseeable future.

3. Canada has introduced only a partial ban. Under their Prohibition of Asbestos and Products Containing Asbestos Regulations, Canada will introduce a qualified ban by the end of 2018.11 However, the government has allowed the chlor-alkali industry to continue using asbestos until 2030, despite there being viable alternatives, and it has also financially supported the re-mining of asbestos tailings dumps for certain valuable elements, such as magnesium.12

Given these latest developments, a worldwide ban and a decrease in asbestos-related morbidity and mortality seem to be many years away. In order to raise public awareness of these unacceptable ­dangers, I suggest we start referring to asbestos as asbestox.


Dr Jim teWaterNaude

Correspondence: 205 Library Square,

Wilderness Road, Claremont, 7708, Cape Town

e-mail: info@drjim.co.za


Dr teWaterNaude is affiliated with the School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town. He is also the Director of Diagnostic Medicine, Claremont, Cape Town; the Medical Consultant to the Asbestos Relief and Kgalagadi Relief Trusts, and the Q(h)ubeka Trust; and Treasurer of the International ­Mesothelioma Interest Group (iMig).

US President Trump has endorsed products of Russia’s Uralasbest, one of the world’s largest asbestos producers 
Photograph: https://www.snopes.com/fact-check/russian-asbestos-trump_face/ (Accessed 24 Oct 2018)



1. Ndlovu N. Editorial. Occup Health Southern Afr. 2018; (24): 5.

2. Virta RL. Worldwide asbestos supply and consumption trends from 1900 through 2003: Circular 1298; 2006. Available from: http://pubs.usgs.gov/circ/2006/1298/c1298.pdf (accessed 24 Oct 2018).

3. Asbestos doesn’t rot, it will be there forever.  Business Report; Jul 13, 2005. Available from: https://www.iol.co.za/business-report/economy/asbestos-doesnt-rot-it-will-be-there-forever-753335 (accessed 25 Oct 2018).

4. Huang SXL, Jaurand M-C, David W. Kamp DW, Whysner J, Hei TK. Role of mutagenicity in asbestos fiber-induced carcinogenicity and other diseases. J Toxicol Environ Health B Crit Rev. 2011; 14:179-245.

5. International Mesothelioma Interest Group. Available from: https://imig.org/ (accessed 24 Oct 2018).

6. Furuya S, Chimed-Ochir O, Takahashi K, David A, Takala J. Global asbestos disaster. Int J Environ Res Public Health. 2018; 15(5): 1000.

7. Reid A, De Klerk NH, Magnani C, Ferrante D, Berry G, Musk AW, Merler E. Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis. Thorax. 2014; 69:843-850.

8. Kazan-Allan L. Current asbestos bans. International Ban Asbestos Secretariat; Oct 23, 2018. Available from: http://www.ibasecretariat.org/alpha_ban_list.php (accessed 24 Oct 2018).

9. Rosenberg E. ‘Approved by Donald Trump’: Asbestos sold by Russian company is branded with the president’s face. The Washington Post; Jul 11, 2018. Available from: https://www.washingtonpost.com/news/business/wp/2018/07/11/approved-by-donald-trump-asbestos-sold-by-russian-company-is-branded-with-the-presidents-face/?noredirect=on&utm_term=.ddf30cdf6d1a (accessed 24 Oct 2018).

10. Asbestos: Significant New Use Rule. Environmental Protection Agency; Jun 11, 2018. Available from: https://www.federalregister.gov/documents/2018/06/11/2018-12513/asbestos-significant-new-use-rule. (accessed 24 Oct 2018).

11. Government of Canada. Prohibition of Asbestos and Products Containing Asbestos Regulations: frequently asked questions; 2018. Available from: https://www.canada.ca/en/environment-climate-change/services/canadian-environmental-protection-act-registry/prohibition-asbestos-products-regulations-questions.html. (accessed 24 Oct 2018). 
12. Kazan-Allan L. News item archive. Monetizing Asbestos Waste. International Ban Asbestos Secretariat; Oct 19, 2018. Available from: http://ibasecretariat.org/abs_archive_news.php?sel=all  (accessed 25 Oct 2018).

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