UH researcher leads breakthrough on a deadly cancer

An international team led by University of Hawaii Cancer Center researcher Haining Yang has identified a protein known as HMGB1 as a critical link in the development of malignant mesothelioma, one of the deadliest forms of cancer.

The findings were published in the current issue of the online journal "Cancer Research."

Mesothelioma has been linked to occupational and environmental exposure to asbestos and the naturally occurring mineral fiber erionite. The average survival for those diagnosed with the disease is less than one year, in part because the cancer is highly aggressive and resistant to current treatments, and partly because it is usually diagnoses it its late states.

HMGB1, a "damage-associated molecular pattern" protein, had been previously associated with the transformation of mesothelial cells. The new study outlines the specific role HMGB1 plays in the growth and development of malignant mesothelioma.

The new findings have been welcomed as a important step in improving the prospects for early detection of mesothelioma and developing strategies for prevention.

The study included investigators from the University of Hawaii Cancer Center, the John A. Burns School of Medicine, the San Raffaele University and Research Institute in Milan, the National Institutes for Health in Bethesda and the New York University School of Medicine.

NY Mesothelioma Attorney Says New Study Shows Wide Risks Created by Workplace Asbestos Exposure

A new British study reporting that workers exposed to asbestos run a higher risk of developing life-threatening illnesses in addition to mesothelioma is a disturbing finding but not entirely a surprise, New York mesothelioma attorney Joseph W. Belluck said today.

The study, recently published in the Journal of Occupational and Environmental Medicine, found that workers who were exposed to asbestos between 1971 and 2005 had a significantly higher risk of developing cardiovascular disease and suffering strokes than those who were not.  

“Asbestos is already linked to mesothelioma, an incurable cancer, and several other serious lung disorders,” said Belluck, whose New York personal injury firm, Belluck & Fox, LLP, dedicates its practice to representing clients with asbestos-related diseases.

“The fact that medical researchers are correlating it with other deadly conditions only highlights its dangers and points to the need for further study of the consequences of asbestos exposure,” he said.

Asbestos is a material that was widely used in shipyards, building, construction, the automobile industry and ceiling and floor tiles. Health organizations, both in the U.S. and internationally, have recognized it as a dangerous carcinogen. Some countries have banned it.

Asbestos is the only substance known to cause mesothelioma. This aggressive cancer affects the lining of the lungs and abdomen. An estimated 2,500 to 3,000 Americans lose their lives to mesothelioma each year.

In the British study, researchers found that workers exposed to asbestos showed a higher rate of death from ischemic heart disease, which is a reduced blood supply in the heart muscle. In addition, 63 percent were more likely to die of a stroke.

Belluck said anyone exposed to asbestos that has become ill should contact an experienced mesothelioma lawyer to learn about their legal options.

“Although it is true that workers are most frequently diagnosed with mesothelioma, they are certainly not the only people who are at risk,” Belluck said. “Asbestos was used in the construction of residences, office buildings and other places where the general public may be found. Even though asbestos is not used now, there are still older structures where asbestos has not been removed, making the threat more widespread.”

Many sufferers of asbestos-related diseases will need extensive medical treatment, he said.

“A successful mesothelioma or asbestos claim can make dealing with the disease, at lease from a financial standpoint, more manageable,” Belluck said. “That leaves victims free to focus on treatment and spending time with their loved ones, which is always most important.”

Belluck & Fox’s Mesothelioma and Construction Lawsuits Among Top New York Verdicts of 2011

Two Belluck & Fox, LLP, mesothelioma verdicts are among the Top New York Verdicts of 2011, according to recent results from Verdict Search.

The $32 million verdict obtained in the case of Dummit v. A.W. Chesterton (No. 190196/10) placed No. 4 on the list. The $19.5 million verdict in the case of Konstantin v. 630 Third Avenue Associates (No. 190134/10) placed No. 10 overall and first in the construction category.

The firm secured both verdicts in August 2011 in New York Supreme Court. Judge Joan Madden presided over both cases.

Founding partner and veteran New York mesothelioma attorney Jordan Fox led the Belluck & Fox legal team. Senior litigator James Long, partner Brian Belasky and associates Seth Dymond and William Papain assisted him over the course of the two nine-week trials.

“These verdicts represent a measure of justice for the mesothelioma victims and their families who suffered needlessly because asbestos continued to be used long after its dangers were recognized,” Fox said. “Our clients and their families, as always, motivated us.”

Mesothelioma is a cancer of the lining of the chest and abdomen caused by exposure to asbestos, a naturally occurring heat- and fire-resistant fibrous mineral. Asbestos has been used in a variety of industrial machinery and equipment, and in consumer products.

Mesothelioma victims typically show disease symptoms years or even decades after exposure to asbestos in an industrial or manufacturing workplace. The disease is eventually fatal, but aggressive therapy may prolong the lives of patients who are diagnosed early.

In Dummit, a jury found Crane Co. and Elliott Turbomachinery Co. responsible for the asbestos exposure that led to a U.S. Navy veteran’s diagnosis of pleural mesothelioma. Mr. Dummitt had worked in the boiler and fire rooms aboard seven U.S. Navy ships between 1960 and 1977. He claimed that he was exposed to asbestos from his work repairing valves.

In returning its verdict, the jury determined that Crane and Elliott acted with a reckless disregard for the safety of others in failing to warn. The jury apportioned 99 percent responsibility to Crane and 1 percent responsibility to Elliott. The award included $16 million in past pain and suffering and $16 million in future pain and suffering to Mr. Dummitt.

In Konstantin, the jury found Tishman Liquidating Corporation, formerly known as Tishman Realty and Construction Co., responsible for Mr. Konstantin developing mesothelioma of the tunica vaginalis, one of the rarest forms of cancer in the world. Like all cases of mesothelioma, this form of the disease is not curable.

Mr. Konstantin claimed that he was exposed to asbestos during the construction of a high-rise building in Manhattan. During a period between 1976 and 1977, he claimed, he had inhaled asbestos that was released from joint-sealing compounds that his co-workers were using.

The jury found Tishman 76 percent liable and to have acted with reckless disregard for the safety of others. The jury awarded Mr. Konstantin $7 million for past pain and suffering, and $12 million for future pain and suffering. The verdict amount also included $64,832 for past lost wages, and $485,325 for future lost wages.

Both Mr. Dummit and Mr. Konstantin were diagnosed with mesothelioma in 2010.

Verdict Search is a legal research database of verdicts and settlements from across the U.S. The database is often used as a reference for publications such as The New York Times and The National Law Journal.

Mesothelioma Approach Combines Surgery and Light

A mesothelioma treatment approach that includes light-activated chemicals and a lung-sparing surgery is being called “safe” and “encouraging” by some of the nation’s top mesothelioma researchers.

Radical pleurectomy and decortication (P/D) involves the removal of the thickened pleural membrane around the lungs and separation of the pleura from the chest wall. The goal is to allow the lung to expand more easily.  Because it is less likely to remove all of the mesothelioma cells than the more extensive approach known as Extrapleural Pneumonectomy (EPP), some doctors have only considered P/D for patients who would not tolerate lung removal. The debate among the world’s mesothelioma experts continues.

But at the University of Pennsylvania, doctors are achieving notable success in treating mesothelioma with a combination of P/D and adjuvant photodynamic therapy (PDT). Photodynamic therapy involves the treatment of cancer cells with a light-sensitive agent and light in the hopes of disrupting cancer cell DNA. In their newly-published study, 38 patients underwent the two procedures. Thirty-five of the 38 (92%) mesothelioma patients also received systemic chemotherapy. Ninety-seven percent of the patients had stage III/IV mesothelioma and most (82%) had the most common epithelioid variety.

Many newly-diagnosed mesothelioma patients die of the disease within a year. But after radical P/D and PDT, the median survival in the University of Pennsylvania study was 31.7 months for all 38 patients.  Patients with the epithelioid subtype lived even longer with a median survival of 41.2 months. Those with epithelial mesothelioma also had a slower rate of disease progression. Median progression-free survival was. 9.6 percent for all patients and 15.1 percent for the epithelioid group.

In 97 percent of the mesothelioma patients studied, surgeons report “macroscopic complete resection” of the mesothelioma tumor using this lung-sparing technique. Interestingly, although overall survival was longer than usual for patients with epithelial mesothelioma, the time it took for their disease to begin growing again was not.  The researchers conclude that this may be due either to the preservation of the lung and/or to the PDT.

Their study, published in the Annals of Thoracic Surgery, ends with this upbeat summary: “We conclude that the results of this lung-sparing approach are safe, encouraging and warrant further investigation.”

Do Mesothelioma Victims Deserve Better?

Malignant mesothelioma is a horrific disease that often leaves victims with little medical recourse other than a slow death. John Johnson had the disease. And his legal struggles show that mesothelioma victims deserve better.

Johnson, 69, was a marine. Since 1961 he worked as a carpenter, mechanic, and plumber. Any of his jobs could've exposed him to the asbestos that likely caused his disease, the Los Angeles Times reports. So he sued 65 companies for compensation.

At the end, Johnson put off his medical appointments to wage his legal battle. Where did he collapse?

40 minutes after his last day of depositions.

Malignant mesothelioma is a rare cancer that can attack the lining in your lungs, heart, and abdomen. Symptoms include chest and abdominal pain, shortness of breath, swelling, clotting, and bowel obstruction. However, symptoms don't show up until 10 to 40 years later.

Asbestos exposure causes the disease. Injuries date back as far as the 1930s. Today, mesothelioma injuries make up the largest ongoing mass tort case in the country.

The irony is that everyone already knows that asbestos causes mesothelioma. What's usually being litigated in court is whether the particular defendant was actually the source for the victim's exposure.

Figuring out the exact source can be difficult because asbestos was used so commonly during the mid-1900s.

Johnson's lawyer believes companies seek to delay finishing these cases because a victim's recovery will be reduced greatly once they die. This is a sentiment echoed by many mesothelioma attorneys.

In Johnson's case, he was slammed with over 25 hours of depositions to determine his exposure source. Once he died, damages for Johnson's own pain and suffering were lost. His family can now only sue for his medical bills and loss of companionship, according to his lawyer.

Jury awards in mesothelioma cases average about $3.8 million. Multiplied across thousands of victims and any company could easily face bankruptcy.

The solution to this problem isn't clear. Some argue that a mass settlement funded by the whole industry is the answer. But movement in that area is slow.

For now, the only thing certain is that mesothelioma victims deserve better than what the current system offers.

Asbestos Scare in Alcoa Plant Causes Concern for Employee Safety

Asbestos was discovered in the New York plant of the aluminum-manufacturing giant, Alcoa Inc.

The discovery, made after a fire broke out in Alcoa’s Massena West plant on March 29, led investigators to find asbestos contained in the building’s ceiling.

The Occupational Safety and Health Administration (OSHA) is conducting investigations into both the fire and the asbestos.

Alcoa, its employees and OSHA are concerned about the potential asbestos exposure because asbestos is known to lead to respiratory diseases like lung cancer, mesothelioma and asbestosis. There are no known cures for asbestos-related diseases.

Alcoa’s Response
One of the company’s representatives confirmed the rumor that asbestos was contained within the ceiling and reiterated the company’s commitment to protecting employee safety.

“All safety precautions are being taken to ensure the health and safety of our employees,” she said.

Alcoa, which is headquartered in Pittsburgh, will be conducting tests on debris samples to look for asbestos fibers that may have entered the air. After the proper areas are tested and are found to be safe, operation will resume within the approved spaces.

“While a significant portion of the casthouse still remains closed due to structural integrity issues, Alcoa is focusing on getting accessible casting complexes up and running as safely and quickly as possible.”

Asbestos: Dangerous and Prevalent
Asbestos is a naturally forming mineral that isn’t dangerous in its natural state, but does become a respiratory hazard when it is disturbed and its fibers become airborne.

Mesothelioma, which can take up to 50 years to manifest, becomes a threat for employees who may have been working in an asbestos-contaminated environment for years. In addition to industrial settings like aluminum plants, asbestos exposure is commonly found in the industries of mining, engineering, construction work and in the Navy.

Beyond ceiling materials, asbestos can be found throughout thousands of various commercial and household products, particularly those built prior to the 1970s, when hazards of the mineral become widely known.

Alcoa officials appear reserved to reluctant to comment on any specific safety news until the proper tests have been completed and reported.

The company has halted partial production of materials as investigations continue. Some sources believe that portions of the plant will be out of operations until after the summer, as asbestos cleanup occurs.

Despite the detriment to the company’s operations, the fire may have inadvertently helped protect the health of current and future Alcoa employees within the New York plant.

Mesothelioma victims deserve better than wasteful legal maneuvers

John Johnson died three months ago, his body racked with malignant mesothelioma, a disease that's almost always caused by asbestos exposure. The Marine veteran had sued dozens of companies he believed shared responsibility for his condition, but he never got his day in court.

Here's the horrific question now: Did asbestos industry lawyers deliberately drive Johnson to his death by putting him through a brutal series of depositions so their clients would save money?

That's what his family, his doctor and his lawyers assert. Despite affidavits from his doctor stating that 12 hours of depositions over a few weeks would be about as much as the 69-year-old's health could stand, a Los Angeles Superior Court judge allowed the companies he was suing a total of 25 hours.

Johnson put off returning to the hospital so he could appear at every session, including the last, on Jan. 23. His face contorted in pain, he gasped out answers to questions from the last of the dozens of defense attorneys in attendance. Less than 40 minutes later, he collapsed.

The very next day he died at Hoag Memorial Hospital in Newport Beach. With him died his family's claims for pain and suffering, mental anguish and bodily disfigurement, reducing their potential recovery in or out of court by as much as 70%, in the assessment of his attorney, Roger Worthington. What's left are chiefly claims for medical bills and lost wages and for his wife's loss of his companionship.

Johnson's family, his lawyers, and his doctor have no doubt that the defense lawyers stretched out the legal process through what the family contends in court were "delay tactics and stalling," in the expectation that he would die before he reached the finish line.

"I couldn't believe that we had spent so much time trying to save this guy and these other people come in really trying to kill him," says Johnson's thoracic surgeon, Robert B. Cameron of UCLA Medical School. "You can tell when a lawyer is smelling death — they were pounding him with the same questions over and over again."

Says Johnson's widow, Sue: "We tried to keep faith with the law, because that's what you had to do to get justice for his excruciating pain. And that's what accelerated his death. I don't understand how the justice system can work like that."

Nobody does. And that's the real crime in what happened to John Johnson.

It's not rightful to blame defense attorneys for killing Johnson. Once a personal injury case gets into the legal wringer, all the parties are condemned to play out their roles, plaintiffs and defendants alike; this Darwinian struggle is especially stark when a terminal disease is involved.

"Anybody who gets sued for millions or tens of millions of dollars has the right to defend themselves," says Robert E. Thackston, a Dallas product liability lawyer whose firm represents several defendants in the Johnson case. "To say they're not entitled to go ask these questions because the guy is sick is really not fair."

Asbestos injuries, which stem from industry's coverup of the hazards of the material dating back some eight decades, overpower the ability of America's adversarial tort system to balance competing interests. As a committee appointed by then-Chief Justice William H. Rehnquist put it in 1990: "This is a tale of danger known in the 1930s, exposure inflicted upon millions of Americans in the 1940s and 1950s, injuries that began to take their toll in the 1960s, and a flood of lawsuits beginning in the 1970s."

Today asbestos cases constitute the largest body of mass tort litigation in the U.S. And it's a monstrosity. The problems identified by Rehnquist's committee 20 years ago persist today: long delays, oppressive trials, the constant relitigation of settled issues, and legal costs overwhelming victims' recovery by a margin of 2 to 1. The bankruptcies of scores of companies have wiped out the sources of compensation of hundreds of thousands of victims, and sent them scurrying to find other deep pockets.

Johnson's case illustrates every one of these shortcomings. The Newport Beach man worked as a carpenter, auto mechanic and plumber from 1961 until 1990. He was a water skier, a motorcycle racer, an avid cyclist. Then one day in early 2010 he couldn't catch his breath during a ride. Eventually he was brought in for surgery at the Veterans Affairs hospital in Long Beach.

"The surgeon opened him up, then closed him up and told him to go home and die," Sue recalls. "That's just the way he put it."

Last October, John and Sue Johnson sued 65 companies they thought likely to have made asbestos-bearing equipment he worked with in plumbing or automotive repairs. Among them were dozens of companies you've never heard of, along with such familiar names as General Electric and Ford; the list was later cut to 44. In November, UCLA's Cameron, who assumed Johnson's treatment from the Long Beach VA, judged it doubtful that Johnson would survive past the end of January. Under state court rules, that prognosis entitled Johnson to an expedited date for trial, but it was set for March 26. (After Johnson's death, the date was moved back to Aug. 21.)

Then the rhythm of litigation, as immutable as the turning of the seasons, took over. California rules allow asbestos defendants 20 hours to question plaintiffs by deposition. In itself this is an unusually liberal time frame: In the federal courts the rule is seven hours and in Texas, the birthplace of asbestos litigation, six hours per side.

Depositions started on Dec. 12, with Johnson's own lawyers questioning him in an effort to get his testimony on the record in case he died before trial. The defense's turn began on Dec. 19. In early January defense lawyers told the court that there were so many of them they couldn't manage with only 20 hours. A judge awarded them five more.

Johnson visibly weakened throughout this ordeal. Videotapes of the first session show a man with steel-gray hair still exuding vigor despite his terminal illness, wearing an expression of grim determination to answer questions posed by as many as 27 defense lawyers crammed into a San Pedro hotel meeting room or teleconferencing in. From her perch in the back of the room during the December sessions, Sue Johnson said she saw lawyers playing games on their laptops, shopping online, reading and answering emails before rising to repeat the same questions their colleagues had already asked.

By the final session on Jan. 23, Johnson could barely sit straight in his recliner at home. He gasped his way through the interrogation, knowing that unless he completed the deposition to the last minute all the testimony, including his own, could be tossed out of court if he died before reaching the witness stand. Struggling to keep his eyes open, his chest heaving spasmodically for air, he just made it. "He was in survival mode; it was primal," says Worthington, who says eight of his asbestos clients have died before trial in the last four years. No one could witness Johnson's pain and think this is how a civilized society should treat its mortally ill.

The irony of asbestos law is that there's no real dispute that mesothelioma is a death sentence, that the asbestos industry is responsible and that the victims deserve compensation. The whole purpose of the procedure to which Johnson and other sufferers are subjected is to give every defendant the chance to stick someone else with what could be, depending on the jury, an open-ended bill. It's a macabre zero-sum game that squanders millions of dollars through legal billings and blights the victims' final days.

The obvious alternative is to deal with asbestos claims administratively. Asbestos exposure is largely a thing of the past, which means the number of new plaintiffs per year is entering a long decline, from about 3,000 now to an expected 1,000 or so by 2030.

That suggests that calculating the size of a suitable overall settlement for present and future claims should be relatively straightforward — in 2005, Rand Corp. pegged the average jury award in mesothelioma cases at about $3.8 million. But previous attempts to craft such a settlement foundered in squabbling over whether the compensation was adequate or the deal was constitutional. In 1997, the Supreme Court agreed that a nationwide settlement would "provide the most secure, fair, and efficient means of compensating victims of asbestos exposure." But it invalidated a privately negotiated settlement on grounds that drafting a deal was Congress' job. An effort by former Sen. Arlen Specter to create a $140-billion victims' trust fund collapsed in 2006. After that, says Deborah Hensler, an asbestos tort expert at Stanford Law School, the system "resumed its expensive and in my view tragic course."

Why should that be? Ample precedent exists for the federal government to get its hands around this public scandal: Industrial victims such as coal miners suffering from black lung disease and soldiers exposed to Agent Orange in Vietnam have been compensated by government programs, sometimes funded by industry. Government often moves to protect industries from certain costs or liabilities, a benefaction provided to offshore oil drillers, nuclear plant builders, and airlines post-9/11.

All these programs were created to keep compensation free of costly legal maneuvering. And here we are again. Asbestos laid its icy claim on John Johnson's life. But the legal system was its accomplice in evil. Is there no better solution?