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Causal understandings: Controversy, social context, and mesothelioma research

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Abstract

Asbestos-related diseases are often considered a ‘thing of the past’ in the global North. Yet, asbestos products remain widely used in the global South, especially in low cost housing. Like many occupational diseases, the history of asbestos is fraught with scientific controversy. The role of the asbestos industry in fostering uncertainty has been investigated for decades. But, less is known about the ways in which publicly-funded, not industry-funded, science has produced ignorance about the health consequences of exposure. To explore the contribution of publicly-funded science to the construction of ignorance, we examine the continuities and discontinuities among three hypotheses of mesothelioma causality: the amphibole hypothesis, the SV40 hypothesis, and the genetic hypothesis. Placing our analysis of scientific controversy in the context of asbestos mining in South Africa, we summarize the key features of the long-standing amphibole hypothesis, track in detail the emergence of SV40 as a causal agent, and outline the ongoing debate over genes as causes of mesothelioma. Regardless of the source of funding, we argue that by operating within conceptually closed biomedical frameworks, each hypothesis generated scientific controversy that made the political, social, and economic context of asbestos mining, milling, and manufacture in South Africa and other regions of the global South invisible, thereby limiting causal understanding.

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Notes

  1. Our research does not indicate that changing diagnostic criteria has influenced controversies over mesothelioma causality after 1960. Since 1960 the basic histological features of mesothelioma have been relatively stable, although there are several histological types that often require a panel of immunohistochemical markers for definitive diagnosis. Mesothelioma is underdiagnosed in settings with limited resources. Prevalence figures are therefore not accurate worldwide (Finnish Institute of Occupational Health, 2014).

  2. Of the 208 papers examined in our systematic review described below, 120 listed sources of funding. The primary sources of funding were governments, non-profit foundations, universities, and unions, with 65 papers listing the National Institutes of Health as funder. Only 2 papers listed industry and another 8 involved collaborations with industry.

  3. With the assistance of a science librarian, we searched the PubMed database on June 11, 2013 using the search terms ("simian virus 40"[MeSH Terms] OR "simian virus 40"[All Fields]) AND ("mesothelioma"[MeSH Terms] OR "mesothelioma"[All Fields]). We retrieved 234 articles. After screening for English language and articles focused on SV40 and mesothelioma, we excluded 26 articles. A total of 208 articles met our inclusion criteria. Both authors abstracted and coded each article, collecting the following information: year of publication; journal; corresponding author; sample size; type of article (review, primary, letter, case report, news); funding source; country of study; type of research (molecular pathology, epidemiology, immunology); type of study (in vitro, in vivo, animal models, human); use of PCR; causal claims. Any differences between the two abstractors/coders were resolved by discussion (Higgins and Green, 2008).

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Acknowledgements

The authors thank the participants in the 2011 Workshop Debating Causation: Risk, Biology, Self, and Environment in Cancer Epistemology, 1950–2000 at Princeton University and the 2016 Boston Colloquium on Race and Epistemic Marginalization at Boston University for their insightful comments on earlier versions of this paper. We also thank Anne Fausto-Sterling for discussions around the concept of publicly-funded science. We extend our gratitude to the late Frank Kellerman for his assistance with our search.

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Braun, L., Kopinski, H. Causal understandings: Controversy, social context, and mesothelioma research. BioSocieties 13, 557–579 (2018). https://doi.org/10.1057/s41292-017-0109-5

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