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Desperate times: Growing health scare



AMAGASAKI, Hyogo Prefecture - 05/30/2006 -The shelf is littered with mushrooms that cost 25,000 yen, leftover packets of 300,000-yen medication, dried shark cartilage, and medicine bottles covered in dust.

They all proved useless, but a 52-year-old woman in Hyogo Prefecture refuses to throw out the stuff.

They are painful reminders of when her husband consumed the products one after another while repeating the same question: "Will this work?"

They didn't. At the age of 51, he died of mesothelioma, a rare cancer caused by exposure to asbestos.

The couple's desperation has spread across the nation. Patients are praying for a cure, those exposed to asbestos particles are in a panic, and medical researchers are rushing to prepare for what many fear will be an explosion in mesothelioma cases.

Mesothelioma may not emerge for 30 to 40 years after the patient inhales asbestos particles.

The husband in Hyogo Prefecture, for example, was diagnosed with the disease in late June 2002 and told he had about three to five years to live.

A former securities salesman, he had lived near machinery manufacturer Kubota Corp.'s former plant in Amagasaki, Hyogo Prefecture, until he was 20 years old. He is believed to have inhaled the mesothelioma-causing particles during that time.

The symptoms of mesothelioma are relentless and the prognosis is usually bleak. The husband became so sick that he sometimes could not keep the medication down.

Asbestos dust and fibers slowly pierce the lungs, causing malignant cells to develop in mesothelium, a fine lining covering the lung and other internal organs. Even a small amount of asbestos could prove fatal.

The couple were determined to overcome the cancer. They received anti-cancer drugs, sought other medication, and tried unapproved drugs and folk remedies. They would attempt anything that promised even a sliver of hope.

The husband switched to a new drug treatment and battled the cancer for a year. But his condition quickly deteriorated, and he died.

"We didn't have an inkling as to where we could go for treatment," his widow said.

Eli Lilly Japan KK, a pharmaceutical manufacturer based in Kobe, has been attempting to develop a "wonder drug" to give mesothelioma patients a chance.

For the past few years, the company has been inundated by inquiries from patients willing to be used as "guinea pigs."

"We are painfully aware of the wishes (of patients) who want to have a shot at the new drug, knowing there is the risk of side effects," said Toshio Fujimoto, a company doctor in charge of clinical trials at Eli Lilly. "We are giving top priority (to the mesothelioma cure)."

The company is now involved in a trial run of a drug called pemetrexed, marketed under the name Alimta. Pemetrexed suppresses enzymes that cancer cells need to survive. Used in a cocktail with other cancer-treatment drugs, pemetrexed was found to be effective in controlling mesothelioma.

Pemetrexed was approved for use in the United States and the European Union in 2004. However, the drug still carries concerns that it could cause serious side effects and may trigger a sudden relapse. It is not the miracle drug that will make mesothelioma go away.

In Amagasaki, the extent of the health problem is sinking in. The city is now conducting health checks for residents who lived in Amagasaki from 1955 up to 1975. The plant spewed particles of highly toxic blue asbestos during those years, when asbestos was widely lauded as an effective fire-resistant insulator for pipes and buildings.

Of the 877 people screened by May 2, 269, or 30.6 percent, were sent for a thorough examination--an extremely high percentage compared with a regular cancer screening in which about 5 percent are generally rerouted for further tests.

As of May 2, the test results for 213 were available: 106 were found with no problem; three needed immediate treatment; and 104 required follow-up observation. Of the 104, 65 were found with symptoms related to asbestos exposure.

"We are working on the principle that if there is the slightest doubt, order a thorough checkup," said Goro Asano, chief of the Amagasaki city health department. "We would rather be overcautious than sorry. It is possible that doctors appointed by the health-care center could miss something."

Mesothelioma is often not found until the cancer has progressed to near critical stages. Diagnosing mesothelioma in the early stages is difficult, requiring highly trained eyes reading an X-ray or CAT scan image to detect the slight thickening of the membrane covering the lungs that takes place after asbestos exposure. The specialist must also be adept at handling a thoracoscope used to examine the chest cavity.

It is not unusual for doctors stationed near asbestos-related workplaces, such as shipbuilding dockyards and factories, to be skilled in mesothelioma diagnosis. But now that more patients are expected to come down with asbestos-related complications, general practitioners will also be expected to handle the tricky procedure.

Hospitals around the country are gearing up for the expected onslaught.

Juntendo Hospital in Tokyo's Bunkyo Ward opened an asbestos and mesothelioma outpatient clinic last summer. Other hospitals in prefectures that experienced outbreaks of asbestos-related diseases have followed suit.

Takashi Nakano, a professor at the Hyogo College of Medicine in Nishinomiya, Hyogo Prefecture, is considered Japan's foremost expert on treating asbestos-related illnesses.

Nakano used to see many patients who came all the way from Tokyo and Kyushu. But the number has come down.

"I am still invited by various regional medical associations to give talks. But I notice a distinct change in the type of questions I get now," Nakano said. "The doctors have come to realize the seriousness of the matter. They are facing the issue head on."

Nakano said the challenge now is to prevent mesothelioma.

Some people who inhale asbestos come down with cancer, but others manage to remain cancer-free. Nakano said he wonders if it is possible to analyze the difference through genetic testing or develop a system to catch the symptoms in the early stages.

Nakano is planning to set up a research center devoted to asbestos-related illnesses.

Kubota Corp. has agreed to pay "relief" money ranging from 25 million yen to 46 million yen to residents who live or have resided near the former Amagasaki plant and developed asbestos-related diseases. Bereaved families are also entitled to the payments.

Tomie Nakamura, 65, a mesothelioma patient in Amagasaki who underwent surgery to remove her left lung, says more needs to be done to prevent the misery.

"Many patients in the same hospital ward died one after another because their cancer wasn't found until it was too late," she said. "Money won't make the suffering experienced by the patients and families disappear.

"I want the government to hurry up and come up with a system for early diagnosis and treatment."(IHT/Asahi: May 30,2006)

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