Balkinization  

Wednesday, May 02, 2007

Chaos at the DOJ

Sandy Levinson



This just in from the Washington Post:


Justice Dept. Probes Gonzales Aide's Hiring Practices

By Dan Eggen

Attorney General Alberto R. Gonzales's former White House liaison is under investigation for allegedly hiring career lawyers at the Justice Department based on party affiliation, a potential violation of federal law, officials said today.

The Justice Department's inspector general and its Office of Professional Responsibility are investigating whether Monica M. Goodling, Gonzales's former senior counselor and White House liaison, made hiring decisions on assistant U.S. attorneys based partly on partisan considerations, officials said....

The Goodling revelations raise uncertainty about whether she will testify before the House Judiciary Committee, which offered her limited immunity from prosecution last week in exchange for her testimony about the firings. Goodling, who resigned last month, has invoked her Fifth Amendment right against self-incrimination in refusing to answer questions from Congress.

Such an immunity deal requires approval from the Justice Department, which must agree that her testimony would not interfere with an ongoing criminal probe, according to administration and congressional officials. Although the joint probe into the attorney firings by Inspector General Glenn A. Fine and OPR is not criminal, the allegations against Goodling raise the possibility that a crime may have been committed.

Justice spokesman Dean Boyd said Goodling "reviewed assistant U.S. attorney applicants for offices that were headed by interim or acting U.S. Attorneys and may have taken prohibited considerations into account during such review. Whether or not the allegation is true is currently the subject of the ongoing OIG/OPR investigation."


So let's get this straight: It is up to the DOJ to decide whether Congress will be able to give immunity to Ms. Goodling. Whom, if anyone, would "we" trust in the current DOJ to make that decision? I can imagine that the Inspector General would be reluctant to grant immunity, but why should his decision control? Even those of us who are rabidly partisan shouldn't really be consumed by a desire to see Ms. Goodling go to jail (unlike others I could name). It will be more than enough to see her testify, under oath, in public before the Senate and House Judiciary Committees, and to use her testimony to nail others who are for more important than the 33-year-old graduate of Regent '99.

Isn't it clear that an independent prosecutor should be appointed (but by whom and under what authority) since everyone in the DOJ is hopelessly conflicted out?



Comments:

I thought I heard that the DoJ could recommend, that the Congress should seek their advice. But I have also heard that certain types of immunity have to be okayed by a local judge. Someone had up a blog post covering the different forms of immunity and what the usual process would be. Isn't is also possible that the Congress can do whatever they want? If they can impeach, that includes the ability to demand testimony.
 

nolo here --

18 USC § 6005 is the operative
immunity statute here:

now, mr. gonzales may seek an order
from the DC district court,
deferring, for no more than
twenty days, the testimony
of ms. monica goodling, as is his right,
under 18 USC § 6005(c). . . but to do so,
he must assert one of the enumerated bases
therefor. . . . all of those would be
political kryptonite, to him, and
more importantly, to the white house.

so i think he'll have to cave, and let her
take the immunity, and testify - that's
the interplay of the 5th amendment and
the federal scheme of immunity.

so -- DoJ won't be able to
stop the conyers immunity deal,
and subsequent testimony of
ms. monica goodling. that is
my opinion. i set some more
detail out, on this, over at
my own blog -- click my name.
 

Nolo beat me to it. DOJ can't prohibit immunity when it's offered by a congressional committee. Nor can a district court judge: 18 U.S.C. 6005 requires that a judge "shall issue" the immunity order if Congress follows the proper procedures in voting for one.

I discuss all of this in detail - and explain why it's unconstitutional - in an article available on SSRN.
 

This is very helpful. So is the consensus that the Post article is simply wrong and that the DOJ is powerless to stop the grant of immunity?
 

Hanah:

I discuss all of this in detail - and explain why it's unconstitutional - in an article available on SSRN.

Only the freedom from self-incrimination is Constitutional. Anything else is the creation of legislation. The "immunity" deals are a governmental response to the conflicting constraints of the freedom from self-incrimination, and the desire of courts and/or Congress for obtaining information (in this case, through compelled testimony). It is up to the co-ordinate branches to decide how to get what they think they need to get done done, by providing frameworks and procedures whereby they can get the testomony they want without impinging on the Fifth Amendment's guarantees to all. The Constitution is silent on whose "needs" are first and foremost as to when and whether testimony can or shuld be compelled.

[from Hanah Volokh's article]: "I argue that the congressional immunity statute violates separation of powers doctrine. The statute unconstitutionally allows a committee of Congress to dictate prosecutorial decisions to the executive branch and to make changes to legal rights and duties without using the legislative process laid out in the Constitution. The decision whether or not to prosecute and the decision of which evidence should be used in pursuing a conviction are matters within executive branch control. Congress can make binding decisions in these areas only by statute."

Congress can remove entirely the power of the executive to offer immunity if they wish (they may choose a different solution to the competing 'needs' and rights conundrum, or they may abstain completely and just let the judiciary sort it out WRT any convictions based on compelled testimony using only Fifth Amendment law). Or they can specify the conditions under which it is granted, including "only on Thursdays in months with 'R's in them". If they choose to grant immunity themselves under rules and conditions they provide, it hardly takes away any Constitutional prerogative of the executive.

Cheers,
 

Arne:

It's true that immunity as it's currently practiced is a creature of legislation. But Congress can't just pass any statute it can dream up. My argument is that the statute allowing congressional committees to grant immunity (18 USC 6005) is unconstitutional under existing and widely-recognized separation of powers doctrine. Chadha says that Congress cannot delegate lawmaking power to one of its committees, and Bowsher says that a congressional agent cannot have a hand in executing the laws. Whether an immunity grant for an individual is characterized as a legislative or an executive act, it violates one of those precedents.

It's an interesting question whether it would be constitutional for Congress to pass a statute prohibiting the executive branch from granting immunity. That kind of statute would be different from one actually requiring the executive to prosecute. (The latter kind do exist, and raise interesting constitutional questions of their own.) My argument in my paper is that the ability to grant immunity is rooted in the executive branch's prosecutorial discretion, which lets prosecutors choose how to allocate their resources and go about their jobs. They can decide not to prosecute for a number of reasons - lack of time, lack of evidence, belief that the crime is not all that serious and resources should be invested elsewhere, or (in the case of immunity) the hope that by not prosecuting this guy they'll have a better chance at convicting another guy.

It is this discretion that can be upset by a congressional immunity grant. The attorney general decides to go ahead with a prosecution, a congressional committee calls the potential defendant as a witness and grants immunity, and suddenly the prosecution is impossible. In my view, that's an unconstitutional interference with executive branch prerogatives.
 

Professor Levinson: My understanding is that Congress is legally powerless to stop the committee's immunity grant. But of course they always have political bargaining tools they can use to try to prevent the committee from issuing the grant / calling her to testify under compulsion. Actually, my first thought upon hearing that DOJ had started investigating for a possible prosecution of Monica Goodling was that this was a ploy to keep Congress from compelling her testimony after all -- it's a lot more difficult for the committee to politically justify interfering with an ongoing criminal probe than simply the possibility that DOJ might prosecute one of its own. And once the whole thing blows over, DOJ can drop the prosecution on the belief that nothing illegal happened.
 

Hanah:

Thanks for your response to my admittedly less-than-well-researched blatherings. I look forward to reading your article when the full article is available.

It's true that immunity as it's currently practiced is a creature of legislation.

Yes.

... But Congress can't just pass any statute it can dream up....

Quite true, but the only real limitations are constitutional.

... My argument is that the statute allowing congressional committees to grant immunity (18 USC 6005) is unconstitutional under existing and widely-recognized separation of powers doctrine.

I noted that aspect of your argument, and brought up my absurd hypothetical to counter it. Your claim seems to be that something that is not done by the entirety of the legislature, passed by both houses, and signed by the president cannot have legal effect. I disagree (mostly because we have various different actions that Congress can take that don't follow this form, from confirmation of officers and ambassadors to setting their own rules, which are nonetheless legal). Of note is the fact that while the Senate must give "advise and consent" to presidential appointments, the nature of this "advice and consent" is not specified; the Senate may establish its own "rules" for the requisite "consent" (e.g., the "pink slips"). In addition, the legislature has, usually without issue, delegated or authorised, depending how you look at it) rule-making to the executive, which "rules" (e.g. CFR) have the force of law, yet are not passed in such a manner, and are in fact much less "democratically passed" than a majority vote of a congressional committee. As long as the enabling legislation is there, what is the problem with letting it say that the committee may vote by majority vote to decide exactly who should be issued subpoenas? It may even be permissible to say that individual Congress members should have such privilege just like they have staff cars.

... Chadha says that Congress cannot delegate lawmaking power to one of its committees, ...

See above. Issuing a subpoena is not a "lawmaking power". In fact, less so than issuing regulations with the force of law and sufficient to be authoritative enough to cite in legal briefs.

... and Bowsher says that a congressional agent cannot have a hand in executing the laws....

The question is how direct a hand. In Bowsher v. Synar, the fact that the Comptroller General would specify which programs to cut (or fund) and not the president seems to have been crucial. But in issuing subpoenas, Congress doesn't decide who to prosecute and who not to prosecute. Prosecutions are still available in all cases; the only restriction is that no person's forced testimony may be used against them in a criminal proceeding, but that is a Constitutional restriction.

... Whether an immunity grant for an individual is characterized as a legislative or an executive act, it violates one of those precedents.

It's an interesting question whether it would be constitutional for Congress to pass a statute prohibiting the executive branch from granting immunity.


I don't see why they couldn't. What they give, they may take away.

That kind of statute would be different from one actually requiring the executive to prosecute....

Quite true, but perhaps not as you think. As I pointed out, the decision to prosecute is independent of the decision to compel testimony (the North case notwithstanding; there they screwed the process up).

... (The latter kind do exist, and raise interesting constitutional questions of their own.) My argument in my paper is that the ability to grant immunity is rooted in the executive branch's prosecutorial discretion, ...

No. It is rooted in the legislation that allows compelled testimony.

... which lets prosecutors choose how to allocate their resources and go about their jobs....

No. Because agencies and Congress may both compel testimony in "go[ing] about their jobs". You're right, there is a conflict when it's Congress doing the asking. But the conflict is because Congress's job is different. But that hardly means the executive wins, particularly when Congress could prohibit all compelled testimony as even you acknowledge.

... They can decide not to prosecute for a number of reasons - lack of time, lack of evidence, belief that the crime is not all that serious and resources should be invested elsewhere, or (in the case of immunity) the hope that by not prosecuting this guy they'll have a better chance at convicting another guy.

True. But Congress doesn't prevent that.

Cheers,


It is this discretion that can be upset by a congressional immunity grant. The attorney general decides to go ahead with a prosecution, a congressional committee calls the potential defendant as a witness and grants immunity, and suddenly the prosecution is impossible. In my view, that's an unconstitutional interference with executive branch prerogatives.

 

L.S.,

It is strange that the US Constitution that, if you don't mind my saying so, generally breathes an air of distrust, does not provide for this eventuality. Obviously in the Watergate-era, this already came up, when Nixon tried, and ultimately succeeded, to fire the special investigator. (Thank you Bork! And, BTW, is it just me or could the AG have simply told the president to take a hike. I don't see why, as a matter of law, he had to resign.)

Obviously, the US constitution provides for impeachment of the president, but not of any inferior officer. More importantly, it does not provide for an independent investigator. (Just as an example, my national (Dutch) constitution, which dates from 1814, establishes the function of procureur-général at the Supreme Court, who is appointed for life, and whose job it is to prosecute cabinet members for crimes in office.)

French Constitution (1958):

"Art. 68-1. - Les membres du gouvernement sont pénalement responsables des actes accomplis dans l'exercice de leurs fonctions et qualifiés crimes ou délits au moment où ils ont été commis.

Ils sont jugés par la Cour de justice de la République.

La Cour de justice de la République est liée par la définition des crimes et délits ainsi que par la détermination des peines telles qu'elles résultent de la loi.

Art. 68-2. - La Cour de justice de la République comprend quinze juges : douze parlementaires élus, en leur sein et en nombre égal, par l'Assemblée Nationale et par le Sénat après chaque renouvellement général ou partiel de ces assemblées et trois magistrats du siège à la Cour de cassation, dont l'un préside la Cour de justice de la République.

Toute personne qui se prétend lésée par un crime ou un délit commis par un membre du gouvernement dans l'exercice de ses fonctions peut porter plainte auprès d'une commission des requêtes.

Cette commission ordonne soit le classement de la procédure, soit sa transmission au procureur général près la Cour de cassation aux fins de saisine de la Cour de justice de la République.

Le procureur général près la Cour de cassation peut aussi saisir d'office la Cour de justice de la République sur avis conforme de la commission des requêtes.

Une loi organique détermine les conditions d'application du présent article."
 

While we are on the subject, if a president pardons someone, can they no longer refuse to testify about a subject using their constitutional right?

If they testify, can they be prosecuted for perjury if not truthful?
 

L.S.,

I'm thinking you can't pardon someone until after they've been convicted. And after you've been convicted, you can't plead the fifth anymore, because testifying would not make you "a witness against yourself". Whether this person then gets pardonned is irrelevant.
 

Obviously, the US constitution provides for impeachment of the president, but not of any inferior officer.

Article II, Sec. 4 provides for the impeachment of the President, Vice President, and all civil officers of the United States.

if a president pardons someone, can they no longer refuse to testify about a subject using their constitutional right?

You can only assert the 5th A if there is a risk that the testimony will be used against you. Essentially, if you cannot be charged with a crime, then you must testify.

If they testify, can they be prosecuted for perjury if not truthful?

Yes.
 

L.S.,

My mistake, sorry, others than the president can also be impeached. What about civil liability? If testifying truthfully exposes you to civil liability, but not criminal, can you plead the fifth?
 

This comment has been removed by the author.
 

Toute personne qui se prétend lésée par un crime ou un délit commis par un membre du gouvernement dans l'exercice de ses fonctions peut porter plainte auprès d'une commission des requêtes.

A bit off topic, but how often (and under what conditions) are such complaints raised by private French citizens?
 

If testifying truthfully exposes you to civil liability, but not criminal, can you plead the fifth?

No.
 

My mistake, sorry, others than the president can also be impeached. What about civil liability? If testifying truthfully exposes you to civil liability, but not criminal, can you plead the fifth?

No. Fear of civil liability is not a valid basis for refusing to testify under the Fifth Amendment, which provides that "nor shall be compelled in any criminal case to be a witness against himself. (Note, however, that one can invoke the Fifth even in civil proceedings if the testimony might lead to criminal prosecution.)

May I also say, I'm glad to see at least over here that this nonsense about DOJ having "approval" power over a Congressional grant of immunity has been thoroughly debunked. The press has thoroughly failed to understand the statute.
 

martinned:

My mistake, sorry, others than the president can also be impeached. What about civil liability? If testifying truthfully exposes you to civil liability, but not criminal, can you plead the fifth?

Nope. In fact, that's pretty much what discovery is all about; asking your opponent to come clean under oath. No privilege from discovery other than the Federal Rules of Evidence (FRE) and Federal Rules of Civil Procedure (FRCP) provide WRT irrelevant and abusive discovery.

I think the idea is that civil disputes are best handled by achieving the most "truth" and openness possible.

And the Fifth Amendment is only a right against self-incrimination, not self-destruction.

Which is why you see a lot of people lie in civil suits, despite the perjury statutes; they have to answer, and if the answer will hurt their case, some folks just make stuff up... The general response to he case where people offer mutually incompatible accounts in discovery and at trial as to crucial events is to let the jury decide who's more believable, and to let the "liar" be punished by losing their case.

Cheers,

Cheers,
 

L.S.,

That is strange...
Until a few years ago, over here it was illegal for a party to testify in a civil suit, because they assumed the risk of them lying was too great. Now, because of a Strasbourg ruling, parties can testify, but there is still an express provision in the Code of Civil Procedure that allows/requires the judge to ignore their testimony unless it is corroborated by other evidence. The notion that someone could be compelled to testify in a civil case seems quite strange to me...

(Yet another example of how different legal systems can be more different than we sometimes realise.)

In response to another question: I don't know about France, but at least here in the Netherlands a trial for crimes in office (which would be before the supreme court) has never happened. Off the top of my head, I can't think of a single example in France, either. (NB, the French constitution only dates back to 1958.)

Thanks for the replies.
 

martinned:

That is strange...
Until a few years ago, over here it was illegal for a party to testify in a civil suit, because they assumed the risk of them lying was too great. Now, because of a Strasbourg ruling, parties can testify, but there is still an express provision in the Code of Civil Procedure that allows/requires the judge to ignore their testimony unless it is corroborated by other evidence. The notion that someone could be compelled to testify in a civil case seems quite strange to me...


I've commented previously on our notion that even most documentary evidence cannot be introduced unless "authenticated" by some witness (see, e.g. FRE 901 et seq.). The testimony of humans is the sine qua non in U.S. courts, despite the fact that science has shown them to be less and less reliable and perceptive, and more and more dishonest, over the years.

Cheers,
 

L.S.,

Maybe I should have clarified that. Basically, any evidence is admissible in Dutch courts, and certainly in civil cases, because there are no juries, ever. (I.e. not even in criminal cases.) The rules of civil procedure leave the judge with quite a bit of latitude when it comes to deciding "on the balance of probability" what actually happened, although obviously, unlike juries, judges have to explain in their rulings why they ruled the way they did.

(Put formally, art. 152 of the Code of Civil Procedure states that proof can be provided by any means, except as otherwise provided, and par. 2 states that the judge alone decides on the merits of the evidence provided, again except as otherwise provided. One of those exceptions is the rule about party testimony in art. 164.)

Actually, now that I have the Code of Civil Procedure here, I see that one can be compelled to testify in a civil trial (art 165(1)), but you can plead the 5th not only if you'd end up incriminating yourself, but also if you'd end up incriminating a relative, a spouse or an ex-spouse. (par. 3)

Thus endeth the lesson.
 

martinned:

[B]ut you can plead the 5th not only if you'd end up incriminating yourself, but also if you'd end up incriminating a relative, a spouse or an ex-spouse. (par. 3)

Most states (AFAIK) have some kind of spousal privilege here as well (but this privilege is not constitutional but pragmatic). What's covered (ex-spouses, etc) varies by state.

Cheers,
 

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
mesothelioma 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
asbestos 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
asbestos 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 asbestos 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. 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.
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
mesotheliomatreated?
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.
 

Post a Comment

Older Posts
Newer Posts
Home