Balkinization: The FCC's authority to regulate indecency.

The FCC's authority to regulate indecency.

Can the FCC regulate indecency in cable and satellite programming just as it regulates broadcast indecency? The excellent Matthew Yglesias makes a very common mistake:

The FCC has apparently gotten bored regulating the airwaves and wants to get into the cable and satellite radio games from which they've traditionally been barred on the grounds that, unlike the broadcast spectrum, we're not talking about a crowded public resource.

The FCC's authority to regulate indecency in broadcast does not come from the fact that broadcast spectrum is scarce. Indecency regulation involves removing certain (offensive) things from broadcast programming. Spectrum scarcity merely gives the FCC the authority to require licensees to *add* things to their programming that otherwise wouldn't be on television at all, or would exist in greatly reduced amounts (e.g., children's television, equal time, equal opportunities, political advertising, etc.).

The FCC's authority to regulate indecency consistent with the First Amendment comes from the claim that children are always present (or potentially present) in the audience and that television is a "pervasive" medium. What does this mean? Let me explain by quoting from a first amendment and telecommunications scholar well known to readers of this blog:

Television is pervasive because it is difficult to keep it away from children and children away from it. Once television is in the home, parents must continually supervise what children watch, which is difficult and time-consuming. Many households now own multiple television sets, so that children can watch in the privacy of their own room, away from parental supervision. It is always possible for parents to remove television completely from the home. However, because of television's cultural importance, many parents do not feel able or willing to deny their children the right to watch television at home, especially when the children can watch it at their friends' houses.
Although concerns about children make the most sense doctrinally, it's important to remember that they have little to do with scarcity. Even if there were 500 channels, the problem of parental supervision would still exist, and might even be enhanced. Nor does this justification for regulation turn on the fact that broadcast television is an especially powerful medium of communication, or that it is conveyed in the easily assimilable form of pictures. Parents can watch rented movies on a VCR that are every bit as unacceptable for children as anything one might watch on television. But these movies cannot be regulated in the same way that television broadcasting can.
This . . . rationale for broadcast regulation is often described as the protection of children, but the real issue is parental control. The two are not necessarily the same. We generally assume that parents love their children and discipline them in ways that are, on the whole, best for them. But parents do not always do so, and we do not second-guess their decisions except in extreme cases. Parents are currently free to bring home R-rated videos full of violence and nudity and let their children watch them. They can subscribe to premium cable channels showing these movies and leave their cable lock boxes unused. If violence and indecency really are bad for children, and we think protection of children is paramount, we should take steps to criminalize such behavior, whether or not parents misguidedly believe such exposure is harmless. Yet I suspect that such proposals would be severely criticized, and not merely by civil libertarians. Most parents do not want the government deciding what is best for their children when the decisions are contrary to their wishes; they want the government to assist them in controlling their children in ways they think appropriate.

The standard argument currently offered by most courts is that broadcast indecency rules shouldn't apply to cable because cable television is not "pervasive" in the same way that broadcast television is pervasive. Every home has a television, but not all homes have cable. Cable television is "invited into" the home, so parents take the risk that it will contain risque material. Parents don't have to have cable in their homes if they don't want to.

This argument has always struck me as somewhat of a dodge. A majority of American homes have cable, and they get access to free broadcast channels through their cable box. It's silly to say that Janet Jackson can't show her nipple on channel 5 but she can show it on channel 75 because channel 75 is a cable channel and channel 5 is a broadcast channel viewed on cable. The FCC is making the converse argument: because a majority of homes now experience broadcast channels through cable, it makes no sense for broadcast channels to be bound by indecency requirements but cable channels (which are accessed through the same remote control) to be free of these requirements.

One argument that courts have often made is that cable is different because it's easier to block cable channels; parents can just use a cable lock box that blocks access to an entire channel. But parents could also use V-Chips if they wanted. They just don't want to, or haven't bothered to learn how to. If cable should be free of indecency regulation because cable channels can be blocked, broadcast television should also be free of indecency regulation because broadcast channels can also be blocked. In fact, the V-Chip allows broadcast channels to be blocked with far more precision than by using a cable lock box.

In fact, the argument for different standards for cable and broadcast turns out to be entirely pragmatic. Essentially we have a compromise in the United States: Parents get a "safe" set of channels that their kids can watch without concerns about indecency. The government has decided that these "safe channels" will be the free broadcast channels during normal viewing hours. (Note that the broadcast indecency regulations don't apply from 10:00pm to 6:00am). The choice makes some sense because it costs parents the least amount of money to receive these channels. On the other hand, parents are responsible for supervising their children for any other media choices they bring into the house, including cable television, satellite, dvds, and vcr tapes.

I think this is the pragmatic compromise on which indecency regulation is actually based, whatever courts happen to say in their opinions. It's not clear that this compromise is entirely consistent with the First Amendment. But assume for the moment that it is. If this is the real point of the compromise, the First Amendment problems don't go away if the FCC begins imposing indecency regulations on cable and satellite programming. In fact they become much worse. I think that if the FCC starts to apply indecency regulation across the board to cable and satellite, courts will strike it down, and they should.

UPDATE: Marty Lederman's comment following this post points out quite correctly that Congress has never given the FCC the same statutory authority to regulate cable indecency that the agency possesses to regulate broadcast indecency, and that is why new legislation would probably be required to expand its powers (That legislation would probably be unconstitutional, in my opinion, for the reasons described above). Local governments, however, have passed cable indecency ordinances in the past, and courts have struck these down on constitutional grounds, see, e.g., Cruz v. Ferre, 755 F.2d 1415 (11th Cir. 1985), along the lines discussed in the post-- i.e., that cable is different from broadcast because you invite it into your home. Congress also passed cable indecency regulation in the 1996 Telecom Act requiring segregation and blocking of indecent content on certain cable channels. The Court struck down most (but not all) of this in the Denver Area and Playboy cases.

Posted 3:32 PM by JB [link]

Comments:

Great post. Some things to consider:

I think the much of the criticism of TV programming is legitimate. It is true (proven by research) that our norms are affected by what we see. Anyone who doubts this doesn't have kids. "Who tells the stories defines the culture." Now the markets decide the stories. Whatever keeps eyeballs on TV screens is "good" (generally: violence, sex and humor). Because we become desensitized, the frequency and intensity must be increased.

The biggest problem with "indecent" TV programming is not that viewers may copy what they see. The problem is that our cultural norms are being set.

Media that is funded by advertising targets the limbic brain, the emotional seat, which is also the part of the brain that affects attention, memory (think of how memorable emotional events can be), attitudes, motivation and behavior. Manipulating emotions is the most effective way to get and keep attention. Unfortunately this part of our mind also shapes our attitudes and motivation. Being exposed to repeated images of violence creates a culture of disrespect. This is not a correlation, it is a known causal relationship.

# posted by

a-train : 3:23 PM

The "invite into your home" theory is somewhat out of date given the breadth of cable/satellite television in this country. Once, given the paucity of sets, you might even say the same thing about regular channels.

Also, the nature of programming these days suggests the "safe harbor" for parents of sorts is questionable. Cf. soap operas with ABC Family Channel at 12-4pm. The nature of program makes it just silly to worry about the infamous MNF sort of moment when sexual stimulant ads are allowed. But, who says the gov't these days are good at perspective?

As to critics of media today, surely, it influences society. Obviously, on some level, all speech does that. The gov't can't regulate just on that basis. Again, you can have perfectly "decent" (legally speaking) programming that demeans culture. One might suggest certain 50s programming did just that, in a fashion. The guidelines in place are just too over and underinclusive to truly further such ends.

# posted by

Joe : 10:12 PM

Obviously, on some level, all speech does that. The gov't can't regulate just on that basis. Again, you can have perfectly "decent" (legally speaking) programming that demeans culture.I agree, I think there is a problem with the potential abuse of power. But it is not like we have "free speech" on TV now, the programming is controlled by major corporations whose main motive is profit; TV is not currently a "voice" for the communication of ideas or facts. It is a tool to sell things.

"I believe television is going to be the test of the modern world, and that in this new opportunity to see beyond the range of our vision we shall discover either a new and unbearable disturbance of the general peace or a saving radiance in the sky. We shall stand or fall by television."- E.B. White (Harpers 1938)

# posted by

a-train : 10:46 PM

All speech that reaches a lot of people has to be paid for in such imperfect way. It is "sold" somehow. Television has for years promoted ideas, maybe not as much as we'd like, but it has. Educational programming alone, which like ads that pay for newsprint brings with it a lot more, provides lots of "ideas."

What pays for such ideas skewers the message, but we are talking about ideas (and information, much of a valuable sort) all the same. It is not all/nothing affair here.

# posted by

Joe : 7:33 PM

Joe you are right. TV and modern media do both, but clearly the "selling things" part of the equation currently dominates.

This is a major problem. Someone once said: "you are free to say whatever you want as long as it doesn't matter."

This is the kind of "free speech" we have in America. Ones ability to speak freely and to have it matter, is almost directly a function of the amount of money you can command or control. Is speech truly "free" if one speaker has a megaphone and the other is speaking through a gag?

This is a complex problem, but to me it seems that the current system is failing our society horribly.

Along the lines of this subject there is an interesting post at For the Record.

Excerpt:
It turns out that there is something called "carve-out" which describes what inevitably happens when a media outlet depends upon advertisers for income: that is, the outlet avoids biting the hand that feeds it. So, for example, if a paper (or whatever) gets significant advertising dollars from department stores, then it is unlikely to do much to investigate possible wrongdoings or negative impacts by such stores, and if some scandal occurs concerning a store, this is likely to be ignored or downplayed. As she put it, bad news concerning department stores is "carved out" from the spectrum of subjects upon which it is acceptable to report.

What's the relevance of this to explaining media's sycophantic treatment of Repubs, given that Repubs and Dems advertise (mainly in campaign years) in about equal proportion? Well, carve-out can apply not only to those who advertise, but to those who make advertising dollars available. More recently---and arguably, much more lucratively---media degregulation has served as a potentially grossly profitable enterprise, as media companies aquire properties and thereby increase advertising revenue. So, for example, it turns out that the NY Times is part of the "New York Times Corporation", a multi-media company whose revenues increased 20% in 2004, from 2 billion to 2.4 billion, due largely to increased advertising revenues.

It's no secret that big media prefers Republican to Democratic administrations. As Sumner Redstone, CEO of Viacom (which is the parent of CBS) put it in explaining his endorsement of Bush:

From a “Viacom standpoint, the election of a Republican administration is a better deal,” Redstone told an audience of CEOs in Hong Kong in late September, “because the Republican administration has stood for many things we believe in, deregulation and so on.” In the widely-reported remarks, he added: “I vote for what’s good for Viacom.”

# posted by

a-train : 11:01 AM

The FCC was established by the Communications Act of 1934 as the successor to the Federal Radio Commission and is charged with regulating all non-Federal Government use of the radio spectrum (including radio and television broadcasting), and all interstate telecommunications (wire, satellite and cable), sportsbook, as well as all international communications that originate or terminate in the United States. It is an important factor in US telecommunication policy. The FCC took over wire communication regulation from the Interstate Commerce Commission. http://www.enterbet.com

# posted by

Unknown : 2:04 PM

mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
. have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
. exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
. exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of . exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. . has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
.treated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.

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