Balkinization  

Wednesday, October 31, 2007

OK, Then, Senator Rockefeller -- At a Minimum, You Should Make Sure the Suits Against the Government Can Go Forward

Marty Lederman

There is much that I question, or disagree with, in Senator Rockefeller's explanation today of why his bill would provide telecom immunity from liability for unlawful conduct.

Most importantly, before concluding that it would be "unfair" to subject the companies to the liability the law calls for, shouldn't we make certain that the certifications presented to them, asking for their assistance, actually complied with the terms the companies knew FISA required? Senator Rockefeller writes: "If American business -- airlines, banks, utilities and many others -- were to decide that it would be too risky to comply with legally certified requests, or to insist on verifying every request in court, our intelligence collection could come to a screeching halt."

Yes, that's right. But that's why the statute doesn't require the companies to take any such extraordinary measures. If the companies were presented with certifications that satisfied the statutory prerequisites on their face, and that were not patently fraudulent, they should be able to rely on such government representations. (Of course, if the companies did rely on such FISA-compliant certifications, courts presumably would quickly dismiss the cases against them on that ground -- which leads one to wonder why they need immunity from such suits.)

But before any such immunity is conferred, Congress should at the very least ask whether the certifications made to the telecom officials and lawyers, about the ostensible lawfulness of the NSA program, included an Attorney General certification that "all statutory requirements have been met," as required by 18 USC 2511(s)(a)(ii). If, as appears likely, such surveillance was being conducted outside FISA, and in particular if it was premised on a so-called Commander-in-Chief authority to disregard FISA, it's hard to imagine how the AG could have made such a certification to the companies. More importantly, perhaps, and as the Senate Intelligence Committee Report itself suggests, during the period in 2004 when Jim Comey and Jack Goldsmith were threatening to resign because the NSA program was so patently unlawful, the certifications to the telcoms were signed not by the AG, or by the Acting AG, but by White House Counsel Alberto Gonzales. That is to say, it appears that the certifications issued during that period were manifestly inadequate under the statute, and the absence of an AG signature should have put the telecoms on clear notice that something smelled to high heaven. (Perhaps they were told that the AG was not available to sign because he was incapacitated in the hospital? Wouldn't that be something?)

If the telecoms went ahead and facilitated the NSA surveillance anyway, even when presented with certifications that were signed by Judge Gonzales, and even when (?) the certifications did not specify that "all statutory requirements have been met" (on this, I'm guessing, of course), should Congress really be eager to assume good faith and to afford them immunity?

In any event, Judge Rockefeller is absolutely correct about one important thing: the telecoms are not the real problem. The legality of the conduct of the government officials is what is truly important here. That's why this is the most important part of Senator Rockefeller's Op-Ed:
[L]awsuits against the government can go forward. There is little doubt that the government was operating in, at best, a legal gray area. If administration officials abused their power or improperly violated the privacy of innocent people, they must be held accountable.
That's exactly right.

And therefore, if Congress does grant the telecoms immunity, it must also, at the very least, take steps to ensure that the lawsuits against the government can proceed. Senator Rockefeller therefore should insist that his bill incorporate Senator Schumer's bill that would establish an express statutory cause of action to challenge the NSA program, and should also insist on a statutory amendment limiting the scope of any "state secrets" privilege to allow courts to adjudicate the legality of the NSA program without publicly revealing technological capabilities that must remain public.

Comments:

In any event, Judge Rockefeller is absolutely correct about one important thing: the telecoms are not the real problem. The legality of the conduct of the government officials is what is truly important here. That's why this is the most important part of Senator Rockefeller's Op-Ed:

[L]awsuits against the government can go forward. There is little doubt that the government was operating in, at best, a legal gray area. If administration officials abused their power or improperly violated the privacy of innocent people, they must be held accountable.


If?

Senator Rockefeller has been read in on the TSP since the beginning. After pulling a "shocked, shocked" act when the NYT disclosed the TSP to al Qaeda, Rockefeller made a great show of submitting hundreds of questions to the NSA about the TSP and personally observing the program for himself.

Consequently, exactly what is it about the legality of TSP that Rockefeller does not personally know?

If there is something "illegal" about the TSP, why doesn't he say something?

What Rockefeller is really saying here is that the United States cannot afford to cripple the source of its critical signals intelligence by subjecting the telecoms to frivolous lawsuits, but subjecting an Administration of the opposite party to frivolous lawsuits is simply good politics.

What a piece of work this man is.
 

What is the cause of action against the government? AFAIK, the "lawsuits against the government [that] can go forward" amount to demands for admission and injunction against future snooping against the individual party who brought the suit.

.

If there is to be immunity, why not eliminate altogether the statutory causes of action against the telecoms -- looking ahead for the next need to snoop for national security, of course. Just in case there is domestic to domestic exchange of terrorist-related or other subversive communication.
 

if Congress does grant the telecoms immunity, it must also, at the very least, take steps to ensure that the lawsuits against the government can proceed.

It's not clear to me that Congress can do so. The government continues to assert the state secrets doctrine, which appears to be a corollary to executive privilege. I'm afraid that any immunity bill containing such a provision would offer the appearance of a remedy only, not the substance. The ONLY way to attack this issue is through the telecoms.
 

It's really shameful that the bloody flag of 9/11 is being waved to justify this incredibly broad grant of immunity. As EFF said, if the only thing at issue here was patriotic cooperation by the telecoms in the immediate wake of 9/11, they wouldn't have even filed suit.

What possible justification can there be for a blanket grant of immunity based upon what the telecoms are doing this week or last week or the week before? If we truly need to revise our privacy laws, then go through the democratic process and change them.

Do we really want to set the precedent that it's ok for major corporations to break the law, provided they're willing to spend the cash to lobby Congress for amnesty after the fact?
 

I think mark field is on the right track here -can Congress pass a statute that authorizes suits against the government w/r/t NSA spying? Specifically, can Congress pass anything that gets over the Sixth Circuit's finding that the plaintiffs did not have standing to sue? http://www.techlawjournal.com/topstories/2007/20070706.asp
Standing is, in part, a constitutional requirement, right? I don't recall if the Sixth Circuit ruled on standing as a constitutional doctrine or as a prudential one, but this could be a problem as well. Thanks, Professor, as always for your insight.
 

From 2002 to 2006 Sen Rockerfeller received $4050 from the telcoms. From March to June 2007 he received $42,850.
Need we say more.

hal lewis
 

From 2002 to 2006 Sen Rockerfeller received $4050 from the telcoms. From March to June 2007 he received $42,850.
Need we say more.


I'm very opposed to Rockefeller's position here, but there's an obvious reason for this: the Democrats became the majority party and Rockefeller became the chair of the committee. I don't think we need to posit monetary corruption, just (?) the more insidious attitude by which Washington insiders protect those whom they perceive as "their own".
 

It's not clear to me that Congress can do so. The government continues to assert the state secrets doctrine, which appears to be a corollary to executive privilege. I'm afraid that any immunity bill containing such a provision would offer the appearance of a remedy only, not the substance.

Mark, respectfully, the state secrets privilege is not a claim of executive privilege. It is a judicially created privilege which dates back to Totten v. US and which is recognized by the federal cours pursuant to FRE 501. Congress clearly has the power to change it, limit its scope, or eliminate it altogether. I don't see any reason why the courts wouldn't follow Congress' directive if Congress limited or eliminated the privilege.
 

Rockefeller is a textbook fascist - as in binding the corporations and the state into one.

Context so that doesn't sound wild-eyed:
I'm on the complaint list here in Maine in case of PUC vs VZ. Haven't had a cell phone since I signed on. I have owned and operated a small ISP - first in Maine - for nearly 15 years.

The telecoms do have an obligation as a service provider to require proper warrants and proceedures. That's a no brainer - DOH! And that is what Verizon did not do.

Frankly, I think the State of Maine should revoke Verizon's charter. The Maine statue violated is a "paramount interest of the State". [So Rockefeller isn't the only fascist - the Utilities and Commerce Committee is too.]

My lawsuit (via PUC and Complaint) is not against the government; it is against Verizon: keep it straight. [What I saw in Bangor during the hearing - where the State of Maine took a dive - yeah, RICO would apply, but that would assume a certain legitimacy of government that was no longer present at several levels.]
 

Dilan, I'd like to think you're right, but I'm not at all sure you are. Totten, after all, involved an alleged contract with the President to spy on the enemy. The Court refused to enforce the contract because of the military nature of the agreement. Similarly, in Reynolds the claim was a secret mission by the Air Force (this claim was later revealed to be false).

All the cases I know of have arisen out of intelligence or military activity. Can Congress order disclosure of military secrets? I don't know, but I've always associated this privilege with the Executive.
 

[Rockefeller]: [L]awsuits against the government can go forward. There is little doubt that the government was operating in, at best, a legal gray area. If administration officials abused their power or improperly violated the privacy of innocent people, they must be held accountable.

["Bart"]: If?

Senator Rockefeller has been read in on the TSP since the beginning.


So says someone who wants that to be true. But Rockefeller has denied that. Regardless, whether or not Rcokefeller was "read in" and regardless of what he was "read in" on, the legality of the actions stand (or fall) on their own legal merits.

["Bart"]: Consequently, exactly what is it about the legality of TSP that Rockefeller does not personally know?

Let's find out!

To be blunt about it, Rockefeller is a member of Congress (and one more friendly to the maladministration than he ought to be). He is not the judiciary, and in no position to decide on the legality of the maladministration's actions under the law.

Cheers,

Cheers,
 

cboldt:

What is the cause of action against the government?

50 USC § 1810.

Cheers,
 

Arne Langsetmo said...

["Bart"]: Consequently, exactly what is it about the legality of TSP that Rockefeller does not personally know?

To be blunt about it, Rockefeller is a member of Congress (and one more friendly to the maladministration than he ought to be). He is not the judiciary, and in no position to decide on the legality of the maladministration's actions under the law.


:::chuckle:::

Legislators ought to understand their own laws. If not, they can and do hire attorneys to assist them in this task.

The Constitution assumes this when it granted the House the power to impeach and the Senate the power to try and remove a President for high crimes and misdemeanors.

The judiciary is not the only branch which can interpret law. Both Congress and the President do so continuously to do their jobs. The judiciary simply gets the last word if a case or controversy is properly brought before them.
 

"Bart" DePalma:

["Bart"]: Consequently, exactly what is it about the legality of TSP that Rockefeller does not personally know?

To be blunt about it, Rockefeller is a member of Congress (and one more friendly to the maladministration than he ought to be). He is not the judiciary, and in no position to decide on the legality of the maladministration's actions under the law.

:::chuckle:::

Legislators ought to understand their own laws. If not, they can and do hire attorneys to assist them in this task.


Actually, the laws were not Rockefeller's. He wasn't around in the Senate in 1978.

But the laws are a matter of public record.

As you well know, "Bart" it is the duty to the courts to apply the laws to the facts.

And regardless of whose duty that is, that can hardly be done when the facts aren't known. Right now, with the most secretive maladministration in history, the only ones that actually know the facts are the maladministration, no matter how much the might bleat that "Congress has been fully read in" (and thus someone else whose opinion doesn't make a legal damn supposedly goes along with the maladministration's actions). This ought to be obvious. Why you pretend that this is a defence is beyond me. "But ... but ... he saaaaaiiiidddd I could do it!"..... The maladministration sounds more and more like a six-year-old child every day. Which might be what impresses you.

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.
 

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