Clinic caseload continues to grow

CARD a partner in disease research

For 2,800 asbestos victims, Libby’s Center for Asbestos Related Disease, the CARD clinic, is a lifeline and the front line for treatment of asbestos disease.

And the victims keep on coming: The clinic gets 20 to 25 new patients a month.

“They keep wandering back, and it’s pretty clear this will go on and on,” said Dr. Brad Black, director of the nonprofit CARD clinic and right now the lone physician on the staff of caregivers.

Blacks expects it will be 2025 to 2030 when new patients with asbestos-related disease stop coming through the door. That’s because roughly 80,000 people came and went in Libby from the time vermiculite ore first was shipped in the mid-1920s to the mine’s closure in 1990.

About two-thirds of those 80,000 potential victims are connected to Libby from 1950 and later, and that’s the target group for much of the research now under way.

The CARD clinic has joined with investigators from Mount Sinai School of Medicine in New York, the University of Montana and Idaho State University to launch the Libby Epidemiology Research Program.

A $4.8 million federal grant will fund the research over the next five years. The principal investigator is Dr. Stephen Levin, a nationally known expert in occupational medicine and asbestos diseases. He has worked closing with the CARD clinic’s clinical and research initiatives since 2001.

“We think this is some of the most important research to better understand the unique fiber mix, especially for childhood exposures,” Black said.

Evidence already shows that even relatively low-level exposures to Libby asbestos can cause serious lung disease and cancer. That’s why it makes sense, Black said, to focus on the risks of exposures during childhood when the lung is still developing and maturing.

Researchers are developing a registry of Libby High School graduates from 1950 and later and want to track those 7,000 to 8,000 Libby alumni. Ideally they would like to study a group of about 300 people who lived in Libby during childhood and then left.

Also being analyzed is the National Death Index to determine any patterns in deaths of former Libby residents.

“Death certificates are notoriously in error,” he said. They often list a cause of death with no mention of advanced lung disease.

Over the next three to four years the University of Cincinnati will focus on 600 Libby young people who were exposed to asbestos dust but were too young in 2000 to be screened. The screening was limited to those 18 and older.

A bone of contention for Black is the U.S. Environmental Protection Agency’s omission of childhood susceptibility to asbestos disease in its baseline risk assessments.

Children raised in Libby while the mine was in operation had the opportunity to accumulate fibers in a number of non-occupational ways.

“How much did it take [to affect] children?” he wonders. “They’re out there playing, stirring up dust.”

Curtis Noonan, a University of Montana associate professor of biomedical and pharmaceutical sciences, spoke about the need for research as a UM panel discussion last week about Libby’s future.

“The question out there is ‘how clean is clean?’” Noonan said. “How does one quantify exposure” especially with children. “Not all piles [of vermiculite] were created equal. Not all children play with the same vigor.”

A SECOND focus of the research will be to address the progression of lung scarring, which is thought to be more rapid in the Libby population than among workers exposed to commercial forms of asbestos.

If an accelerated progression rate is demonstrated among the Libby population, investigating this more aggressive biological effect could point scientists to new information about asbestos-related scarring and approaches to prevent scarring after exposure, Black said.

Research also will focus on the relationships among auto-immune disorders and blood markers related to asbestos-disease development among Libby victims.

To handle both the burgeoning case load and the research components, the CARD clinic is on the brink of expansion. A 3,072-square-foot addition is scheduled to be built next spring, including four new patient rooms, another pulmonary function testing laboratory, space for six-minute-walk breathing tests and dedicated space for research activities.

A federal appropriation will cover much of the cost of expansion, but the clinic currently is working to raise the rest of the funding.

Dr. Alan Whitehouse, a renowned Spokane pulmonary specialist who treated Libby patients for years at his private practice, merged his case load with the CARD clinic five years ago and was seeing patients there two weeks a month. He since has retired from clinical work but still keeps in touch, Black said.

That leaves Black to shoulder the load, and he’s in it for the long haul.

“It’s something you can’t walk away from,” he said.

The CARD clinic in Libby continues to provide federally funded screening for people who were exposed to asbestos from the W.R. Grace & Co. vermiculite mine.

To be eligible for the screening paid for by the Centers for Disease Control, you must have lived, worked or recreated in the Libby area prior to the year 2015 for at least six months (this does not need to be consecutive).

It also must have been at least 10 years since your first potential exposure to asbestos in the Libby area. The screening involves a chest X-ray and breathing test.

For more information call the CARD clinic at (406) 293-9274.

 Features editor Lynnette Hintze may be reached at 758-4421 or by e-mail at lhintze@dailyinterlake.com