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Hazards 104, October -December 2008
 Docs-for-hire blame anything-but-work for work poisonings
When workers developed the shakes, poor memory and depression working for a South African manganese company, their union knew the job was to blame. The government's compensation body agreed. So why did the company's medics instead suggest the symptoms were caused by alcohol, drugs or Aids?

Hazards issue 104, October-December 2008



The men move uneasily, with a tell-tale “cock-walk”, a lurching, leaden footed gait. They have tremors and get confused. And they have something else in common – they shared the same workplace.

A team of medical specialists confirmed there were at least 10 cases of debilitated manganese-related chronic illnesses at the Assmang manganese processing plant in Cato Ridge, South Africa. The workers knew already their symptoms were caused by their jobs in a grimy manganese smelter. The 10 had all been certified previously by the Compensation Commissioner as being permanently disabled as a result of manganism, a Parkinson’s disease-like condition caused by exposure to excessive levels of manganese.

The company, though, didn’t like what the specialists or the compensation authorities had to say. So Assmang dumped them “like hot potatoes”, a government inquiry heard in August this year.

Evidence to the long-running Department of Labour inquiry revealed the firm then replaced them with a new team of doctors that revised the diagnoses to suggest the sick workers might be suffering from alcohol and drug abuse, Aids, stress, arthritis, diabetes, liver disease, iron deficiency or carbon monoxide poisoning or idiopathic Parkinson's disease (no specific identifiable cause) - but not manganism. Another 27 workers, earmarked by doctors as possibly suffering from manganism, were also “cleared” by the new team of medical doctors and some were put back to work.

Metal in the blood

Puleng Mminele, the occupational health and safety coordinator with Numsa, the metalworkers’ union representing many of the affected workers at the mining and metal processing giant, is certain “over-exposure to manganese dust, fumes and its compounds in the workplace” is to blame for the workers crippling symptoms.

“An independent health and safety consultant, Bernard Winston Randolph, was offered a mask during a visiting to the company in the last two years but commented that even with this mask he could feel how his throat became sore and irritated during his visit,” Mminele told Hazards. “He also spoke of the poor visibility on the factory floor because of the presence of the manganese dust and fumes.”

What HSE doesn’t know could hurt you

In 2004, the Health and Safety Executive (HSE) raised concerns about the adequacy of the UK’s control limit for manganese – but the UK standard has remained unchanged. And this occupational exposure limit, HSE believes, could be twice that at which health problems emerge

The UK exposure limit for manganese and its inorganic compounds is 0.5mg per cubic metre . An HSE regulatory impact assessment, however, notes that concentrations at or above half this level, 0.25mg per cubic metre, “can cause neurological changes,” although the changes “would be sub-clinical, and would take place gradually, such that individual workers may remain unaware of their impaired motor co-ordination, or might even consider such changes a result of ageing, rather than of occupational causation."

No-one knows the extent of any manganese problem in the UK. The HSE impact assessment notes “there are no health surveillance data from UK industry directly relating to the effects of exposure to manganese. Nor are there any statistics concerning the numbers of manganese-exposed workers who have changed employment or retired early due to the irreversible neurotoxic effects of manganese. There is no information concerning whether or not manganese-exposed workers might seek medical treatment for health effects caused by exposure to manganese."

With so little data, HSE said “it is not possible to assign any monetary costs to the health benefits” of any new standard “based on standard parameters such as loss of income or costs of medical treatment.” The paper puts the numbers exposed occupationally to manganese in Great Britain at between 65,000 and 90,000.

Maximum exposure limit for manganese and its inorganic compounds: Regulatory Impact Assessment, HSE, 2002 [pdf]

Speaking about his 30 March 2007 occupational hygiene inspection, Randolph said workers in one process “were surrounded by so much dust and fumes that they were difficult to distinguish in the haze.” He added: “To date, the mechanical extraction ventilation system is still non-existent and this must have serious consequences on the employees’ health.”

The Cato Ridge furnace has no roof ventilation in the furnaces, says the union. There are no medical monitoring systems. And respiratory protection is not up to the job. Tests have subsequently established several hundred workers have extremely high levels of manganese in their blood.

In statements ahead of the inquiry, where Numsa has been representing the affected workers for over a year, “they told how they had never been warned of the dangers of manganese dust.”

This was not a company with a faultless health and safety record. In the months the inquiry has been running, Assmang has experienced two explosions, killing seven workers. The most recent, a furnace blast in February 2008, killed six and triggered another Department of Labour investigation into Assmang. It emerged the company had ignored a warning from an independent engineer two days prior to the explosion that serious structural damage to the furnace could result in a “major explosion which would cause extensive loss of equipment and endanger the lives of all personnel working around the furnace.”

Destroyed by dust

The union says exposure to manganese has had a devastating effect on Assmang workers. “They cannot continue working as a result of their physical symptoms. They walk with difficulty, many of them use walking sticks. They experience tremors and they shake. They have low concentration spans, and are afflicted with memory loss. At home many have erectile dysfunction and diminished libido,” Mminele said.

Assmang workers
STAND TOGETHER The white Assmang workers affected by manganism have now joined Numsa, a black-dominated trade union. Their previous union was siding with management. Photo: Numsa

Assmang image
DIGGING THE DIRT Assmang opened the Cato Ridge smelter in the 1950s, to process manganese ore. Its South African mines produce millions of tons of manganese a year. Photo: Assmang

Numsa says several workers have already died of manganese-related disease. Protesters carried a coffin into one session of the hearings, shouting “this is where our brothers and sisters end up!”

Their families, too, are suffering. “Their moods swing and they experience depression. This spills over into spouses and families. Once strong men have been reduced physically and mentally, they have diminished self esteem and are now more dependent on their families. This has a detrimental effect on their marital relationship.”

But the company’s behaviour could make their plight much worse, he said. “Those that are being compensated by government battle to survive on this money that does not even cover their medical bills. And the company is challenging this compensation on the grounds that it does not believe these workers are suffering from manganism.”

In May 2008, as the inquiry was in full swing, a company news release announced: “Assmang Limited does not believe that any workers at its Cato Ridge plant have manganism,” adding that it “had fully supported the workers,” pointing out that some of those affected but not yet assessed for government compensation had been kept on the company payroll.

The company said “on the basis of later medical evidence the company disputed the original diagnoses”, adding that it wanted to see all the workers “medically re-examined” and on 19 and 20 May 2008 “a recognised USA specialist neurologist on manganism was contracted and was in Durban to conduct the examinations.”

Doctoring the evidence

Assmang had already said it doesn’t believe any workers have manganism and it has tried to stop further cases being assessed for compensation. Ahead of the most recently concluded session, held in September 2008, Assmang threatened to cut off benefits to those disabled but not yet receiving government compensation unless they agreed to an examination by the company’s new team of medical advisers.

So far five sessions of the public hearings have taken place, “with the company showing more and more intransigence each time,” said Mmineli. When the hearings resumed in November 2008, the company reiterated its demands for new medicals.

The union, though, has no confidence in the experts lined up by the company. Mmineli says in September 2008 the inquiry heard how independent doctors that had examined the patients “were sidelined in favour of a company doctor who found no evidence of manganism.”

Dr Susan Tager, a senior neurologist who heads the movement disorders clinic at Wits University, was a member of the original Assang expert panel, set up after emergence of suspected cases of manganese-related chronic disease. She and her colleagues confirmed workers had developed manganism. In August 2007, however, Tager was among several prominent neurologists and specialists replaced on Assmang’s expert panel and excluded from conducting further medical examinations of Assmang patients.

Giving evidence at the September 2008 hearings, she expressed surprise at the conclusion of the company’s new medical advisers – who said there were no cases of manganism at all at the firm, instead suggesting the symptoms could be caused by drug and alcohol abuse, Aids, or a range of other disorders.

Asked at the inquiry about the Assmang patients earmarked in medical tests as “possibly” having manganism who had been told to return to work, she said she believed it was unethical to send such a patient back to work and be exposed to further manganese toxins. Among the dead at in the most recent furnace blast, was one of the workers who had been returned to work.

Unreasonable tactics

But the company’s attempts to sweep away evidence of disease related to manganese dust and fume went beyond the use of local medics. The firm is demanding that all the patients are reassessed by US neurologist Dr Warren Olanow, to provide a definitive diagnosis. Research by Numsa suggested he was far from an impartial choice.

Doctoring the evidence

Why was Wits University neurologist Susan Tager “dumped like a hot potato?”, Numsa attorney Richard Spoor asked at a public hearing into the Assmang manganese poisonings. Tager herself was mystified when she and colleagues were dropped last year from Assmang’s expert panel after confirming cases of manganism in the company’s workers. “I don't know. If someone were to tell me, I would be happy to know,” she said.

Tager told the Department of Labour public hearings in September 2008 she stood by her diagnoses and said she did not think it was “advisable” for anyone - even a highly experienced clinician - to revise a diagnosis merely on the basis of reviewing a patient's medical file. She told the inquiry Dr Murray Coombs, a new member of the Assmang panel whose firm, Elixir Corporate Health Solutions, already provided consultancy to Assmang, had rubbished her diagnoses - even though Coombs had not seen or physically examined any of the 10 workers and based his opinion on a review of their medical files.

Numsa’s attorney Richard Spoor told the hearing Coombs had instead suggested that workers might be suffering anything from alcohol and drug abuse to Aids, stress, arthritis, diabetes, liver disease, iron deficiency or Parkinson's disease, but not manganism. Spoor described Dr Coombs as a general practitioner “who to the best of my knowledge has no experience with manganism,” but who still charged Tager “acted in an unscientific manner and drew conclusions which were not possible to make.”

Spoor asked Tager to comment on suggestions from Assmang's new medical advisers that she might have misdiagnosed some of the workers as having manganism when they actually had Parkinson's disease. Tager said the majority of patients visiting her Wits University clinic suffered from Parkinson's, so if anyone were to suggest that she confused these symptoms with manganism, “I would strongly object to anyone who made that allegation.” It is unlikely the other common conditions identified by Coombs, including alcoholism, arthritis and diabetes, would, if present, have been missed by the original medical panel.

Numsa has refused to let Warren Olanow, a US neurologist retained by Assmang to re-examine the workers, anywhere near their sick members. Olanow has made millions in the last three years for providing support for US defence lawyers trying to dismiss manganism cases (Hazards 103).

Spin cycle: Product defence – how industry money protects killer chemicals, Hazards 103, July/September 2008

“In manganism-related litigation in the US, Manhattan neurologist Warren Olanow was identified in court documents this year as this biggest single recipient of industry cash,” said Mminele. “Two consulting firms linked by the documents to Olanow received almost $2.9m (about £1.6m) from sources defending manganese-related compensation cases.

“He is a defence favourite in manganese litigation, who has published at least a dozen articles cited by defence experts in US manganism litigation,” said Mminele [see: Assmang’s kind of doctor].

Mizushima Ferroalloys Company Limited and Sumitomo Corporation, Assmang’s partners in a joint venture at Cato Ridge, are both members of the International Manganese Institute, the industry body linked to payouts to the defence expert witnesses.

Mminele said the union is “rejecting the company’s calls for a re-examination by Olanow on medical advice that this would put more stress on the patients and only cause their medical conditions to further deteriorate.”

The company says it considers the tests very important so the workers can “be properly diagnosed so that they may be properly treated for their medical conditions,” a claim the union dismisses as disingenuous and just “feigning care.”

What Assmang wants

According to Numsa’s Puleng Mminele: “Companies will do everything in their power to hire product defence lawyers and doctors to prove their innocence. Any negative report about the product is withheld from the public and the workers.”

He accused the company of flouting the law and using job threats to silence critics. “In the latest hearing, Brian Broekman, the Chief Executive Officer of Assmang, threatened to take his company to neighbouring countries, where health and safety laws are less onerous.

“If we are to fight these companies, strong trade unions and international worker solidarity is a necessity. Some of the affected workers have more than 20 years service with the company. Their reward for this long service is a debilitating, killing disease.” The union believes “justice delayed is justice denied”.

But it is not justice for the workers that is to be forefront of the company’s mind. Fighting the compensation cases is a last ditch attempt to duck responsibility for the ruined lives and evade prosecution in the courts. By creating doubt about the health effects of inhaling high levels of toxic fumes, the company’s directors can breathe easy for another day. After all, if Assmang can manufacture “reasonable doubt” the disease does not exist, its directors can hardly be held responsible for it.


Assmang’s kind of doctor

Warren Olanow imageDr Warren Olanow was the expert brought in by Assmang in May 2008 to provide independent medical assessments of the workers previously identified as confirmed or possible manganism victims. His impartiality, however, has been questioned. And the NY-based doctor resigned from his chair at New York’s Mount Sinai Hospital around the time a US judge disclosed industry payments to medical experts related to manganese litigation.

Documents submitted to the court revealed the welding industry made over $10 million in payments to the authors of scientific articles - dwarfing the $500,000 that the plaintiffs had spent.

A breakdown of ‘In camera submission of privileged payments’ identifies almost $1.1m of  “Payments for time spent consulting with Defendants on issues related to welding fume litigation after Dr Olanow ceased being identified as a testifying witness.”

Other entries making reference to Dr Olanow include:
• No.21: payments received relating to work by Olanow (total, almost $120,000);
• No.24: payments made by Olanow to others named elsewhere in the list as working for industry;
• No.25: Parkinson’s Disease Research Corporation  payments for work undertaken by Olanow (almost $1.7m). In the 15 months from January 2005 to March 2006 alone, 17 payments were made for work undertaken by Dr Olanow, the smallest being $19,500 and the largest $72,500;
• No.26: payments from the Parkinson’s Institute for work undertaken by authors including Olanow, but where Olanow is not identified as a recipient of payments (over $3.3m).

Dr Olanow's biographical page on the Mount Sinai Hospital website makes no reference to his work for the manganese industry. And a disclosure entry on the faculty webpage of the Parkinson's Group identifies Dr Olanow only as a consultant to pharmaceutical firms Novartis, Solvay Pharmaceuticals Inc, Teva Neuroscience, Boehringer Ingelheim and Merck Serono International SA and gene therapy firm Ceregene Inc.

Welding’s toxic legacy, Center for Public Integrity, June 2008 [pdf]
Mount Sinai HospitalParkinson's Group



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