Gavin Marshall (Victoria, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to speak on a matter of public importance—that of the plight of many people who live with the aggressive cancer mesothelioma and those who may in future contract it due to asbestos exposure either at home or in their workplace. As many senators would be aware, this is certainly not the first time I have raised in this place issues to do with asbestos exposure. I take heart that many Australians continue to try to ensure that the workers and families exposed are given some recompense when their health is cruelly taken from them. These people were victims of some of the worst workplace and corporate behaviour Australia has ever seen. This, combined with government inaction, means that we owe these Australians a duty to do everything in our power to ease their plight.

Many Australians and their families will be affected by asbestos exposure. This exposure can, and does, lead to the following diseases: pleural plaques, benign asbestos related pleural disease, lung cancer, mesothelioma and asbestosis. Of these diseases, the most devastating is mesothelioma. For those not familiar with this disease, it is one of the most aggressive forms of cancer. It continues to grow, never reaching a stable size. Australia has been hit particularly hard by asbestos related disease, largely due to our long and extensive manufacture and use of asbestos products. Per capita, we now have the world’s highest incidence of mesothelioma. To give some idea of the magnitude of this asbestos related disease, it is estimated that, from 1945 to 2020, the total number of deaths will be around 18,000. Given that the yearly incidence of mesothelioma is still growing, we may lose many more Australians to this unforgiving disease in the decades to come.

There is no cure for mesothelioma. Treatment ranges from chemical injections and surgery to radiotherapy and chemotherapy agents. These are all treatments to make life more comfortable for sufferers but, as I have stated before, there is no prospect of a permanent cure. The average life expectancy from diagnosis to death is a mere 152 days. This is illustrated by the fact that the median age for diagnosis in men with mesothelioma is 70 and their median age at death is 70; the median age for diagnosis in women is 71 and the median age at death is 72. Of course many people, unfortunately, contract these diseases at a much younger age.

As we have seen, treatment options for mesothelioma are limited. However, recent studies have provided evidence that the chemotherapy agent Alimta can inhibit tumour growth and increase life expectancy. It has been shown that this drug can improve the standard of care for mesothelioma, inhibiting the growth of the cancer, and in most cases it can add roughly three to six months to the life expectancy of someone suffering from mesothelioma.

This is significant, given the poor prognosis that mesothelioma sufferers have. When diagnosed with this disease, many people try to achieve all that they had wanted to do in life while they still have time and to put their affairs in order. For such a rapidly escalating disease, three to six months can mean a massive difference to the life that they have left. It also plays a role in the quality of the time that remains. In the earlier stages after diagnosis, it can significantly improve the quality of life by combating the loss of appetite, fatigue, pain and cough that go along with this disease. In the later stages, due to the reduction it gives in some of the harsher symptoms, it becomes another strong treatment option for palliative care.

The issue that arises with this particular treatment is its prohibitive cost. It costs around $20,000 for one 18-week cycle of this drug. Given the short time frame between diagnosis and death for mesothelioma sufferers and that many require a diagnosis to access the treatment or funds for the treatment through state compensation funds, most use only one cycle. It is not currently subsidised for these people under the PBS. Given how precious each day is to mesothelioma patients and their families, there is surely a strong case for this treatment to be subsidised for mesothelioma sufferers.

Every sufferer reacts differently to the disease, and people with this disease will make their own decisions about treatment. This treatment should be a viable option available to those with mesothelioma should they choose to use it. Not many people would be aware that this same treatment is subsidised through the PBS for those suffering from lung cancer. This leads to the anomaly where several thousand people a year use subsidised Alimta for lung cancer while a smaller number of mesothelioma sufferers pay full price. There is clearly a strong equity argument here.

Given that the cost to the PBS is already large for this treatment, it seems strange that a relatively small group of people who are absolutely deserving of government support should be denied a subsidised treatment. This argument for equity is made even stronger when one considers that, for people exposed to asbestos, asbestos related lung cancer occurs at a ratio of two to one to mesothelioma. We have an obligation to support people with mesothelioma in their attempts to have a better quality of life in the time they have remaining. Many people who have lost loved ones to mesothelioma and who themselves have been exposed to asbestos have pointed out the unfairness of this anomaly, and I have not heard any valid reason as to why Alimta can be provided to some and not to others.

In the past, Australians were heavy users of asbestos, using vast quantities in commercial and domestic building products. Australia had its own asbestos mines, mining large quantities from 1940 until the late 1960s. Most buildings constructed during this period had some form of asbestos in the materials, with many thousands of homes being built using asbestos cement sheets. Most Australians have no doubt encountered an asbestos product, given that its use in all products was banned only in 2003. It was used in thousands of products until its use was somewhat restricted in 1983. These products still live on in our homes, public spaces and workplaces, and this is why people still continue to be affected. No Australian is immune from the dangers of asbestos.

Over decades, hundreds of thousands of Australians have unknowingly been exposed to asbestos products in their homes and at work. Many of us would remember using asbestos mats at school. Many others, of course, were knowingly exposed to asbestos and asbestos products. These have been asbestos miners, wharfies, nurses, cleaners, men and women serving in the armed forces, brickies and even people washing clothes covered in asbestos fibres brought home from the workplace. There is now a wave of cases of asbestos related diseases appearing among a new generation of home renovators.

People working and living with asbestos were routinely lied to for a period of over 50 years. Often, when they raised concerns they were ridiculed and their concerns dismissed as scaremongering or just plain wrong. I can remember quite vividly when I first started my apprenticeship with the Victorian railways being informed by different people in the union of the day that asbestos was dangerous and we should avoid its use. I remember being assured by the senior foreman at the time that it was just troublemaking on behalf of the unions and he could assure me because he had worked with asbestos all of his life and there was nothing wrong with him. The irony of the fact that someone who was at extreme risk of contracting an asbestos related disease was in front of me and assuring me that everything was safe has not been lost on me, and we certainly know better now.

Mesothelioma takes many years to develop after the first asbestos exposure. It rarely occurs in the 15 years after the first exposure, and in many cases delays of 30 to 40 years are common. You may develop an asbestos related disease from just one exposure. Even worse, the risk is cumulative—that is, the longer the exposure to asbestos particles, the greater the risk of developing an asbestos related disease in the future—and malignant pleural mesothelioma is the most aggressive asbestos related disease. It is due to these facts that the number of people who will contract diseases associated with asbestos will continue to grow. Predictive modelling suggests that the incidence of new mesothelioma cases will increase. Even though asbestos exposure has decreased dramatically, mesothelioma will not peak for another 10 to 15 years, growing up until 2020.

Many countries have also grappled with the unforgiving effects of the use of asbestos. The UK and many large European countries had extensive mining and industrial use of asbestos. Germany, France, Sweden and the Netherlands have all had to deal with the human cost of this substance and its use. These countries have all struggled with the large toll resulting from the effects of asbestos on workers and consumers. They have shared Australia’s experience in looking to ensure compensation, sanctions and better regulation. They have also struggled to respond adequately to the rising human toll.

We must remember that even though many countries did not produce asbestos or even products containing asbestos, it lives on due to its extensive use in construction materials and other imported products. Exposure to asbestos products and its subsequent disease have reached far beyond the countries where they were produced. Alimta is reimbursed for mesothelioma sufferers in most OECD countries, including those I mentioned before—the UK, Germany, France and Sweden—as well as Japan, Korea, Finland, Poland, Italy, Spain, Switzerland and many others. In most cases reimbursement is universal and not limited by budget. In the UK, where they have a model for listing subsidised pharmaceuticals very similar to our Pharmaceutical Benefits Advisory Committee, they have just decided to list Alimta for mesothelioma sufferers following a lengthy review process. This has been hailed as a commonsense decision by patient groups and medical practitioners.

In Australia we have the case where access to subsidised Alimta for mesothelioma sufferers depends on your status under many state compensation schemes with many sufferers finding they must pay for Alimta privately. Given that the total cost of future asbestos claims in Australia is estimated to start at around $6 billion, the cost of resolving the current inequity with this drug, which is costed at around $7 million, must be put in overall perspective.

In facing this problem, we must remember how we have arrived at this situation. As a nation we started to produce asbestos and asbestos related products in large quantities from the first half of last century. The industry rapidly expanded and grew to employ many Australians, and asbestos products were incorporated into our everyday lives. Yet even as the asbestos industry was in its early stages, research was being done into whether the substance had any harmful effects. Meanwhile, the asbestos industry here and overseas grew rapidly.

It took several years before the research into asbestos became compelling. By the 1940s and 1950s it was readily apparent to the companies involved that there were significant health risks to those exposed to asbestos. Yet the industry did not stop. It grew bigger. This evidence was to be covered up, ridiculed and ignored for over 50 years by companies such as James Hardie. Already, during my term in this place, I have dealt with the deceitful behaviour of asbestos companies directly. Much to our shame, successive state and federal governments fell prey to the same type of lobbying prevalent in the tobacco industry. Both the tobacco and asbestos industries lobbied government with a potent mix of half-truths and economic strength, refuting valid public health claims and muddying the waters of public debate.

This resulted in the long time it took to protect the Australian public from asbestos and take action against the disgusting corporate morality that pervaded the asbestos industry. It is amazing to think that, despite what was known, asbestos was only partially banned from certain products in 1983 and it took until 2003 for a full ban to be implemented. This can only be described as a gross failure of our nation’s industry to protect its workers and a damning indictment of our corporate culture.

Over decades, many Australians have paid for this industry openly and honestly through the dedication of their working lives and then the loss of their health. It is time for both government and industry to recognise this and go towards a just duty of care. We as a society should be judged by our care for those permanently scarred by this abhorrent neglect of ordinary working families. We have a duty of care to the people affected that cannot be reduced to cost alone. They deserve better. This drug, which has now been approved for mesothelioma sufferers in most other OECD countries, should be considered for approval as a subsidised treatment for sufferers of mesothelioma in Australia.