This is a suggestion for an enormous make work program, not anything that would remotely stimulate the economy. Indeed, if the decade long Great Depression is any guide, New Deal make work programs prolonged an economic downturn that should have only lasted a couple years.

Moreover, the idea that social workers, teachers' aides, nurses' aides, case workers, playground attendants, day-care workers, home care workers, senior centers, after-school programs, athletic leagues, music, and art lessons "are not luxuries" but instead are "investments that can make the U.S. economically competitive as we confront an increasingly dynamic global economy" has no basis in economic reality.

So long as we are not building more bridges to no where, infrastructure investments at least have the potential to make our businesses more economically competitive. Government health care, after school programs, midnight basketball programs and the like do not.
 

Yes, let's attend to the type of infrastructure that will make DUI legal representation "more economically competitive" - and lucrative - rather than social programs that might merely reduce the number of "alleged" people who drive on the infrastructure and kill and maim others (as well as themelves) after having imbibed on alcohol, which is not a luxury but a dependency.

Once again little Lisa's bro revises the New Deal as merely "an economic downturn that should have lasted only a couple years." Once again little Lisa's bro is blowing through the wrong end of her saxophone, with his not so subtle pre-emptive efforts at right wing preparation to dump on President Elect Obama even before he takes office with the theme that the current economic crisis is not as bad as the Great Depression and should last less than just "a couple years." Little Lisa's bro's backpack of lies is like a neocon cornucopia that keeps on revising.

By the way, shouldn't the Iraq War have "only lasted a couple years" and not longer than WW II? Oh, that's right, it was a short war when George W announced "Mission Accomplished;" the aftermath is mere clean up. And let's not talk about Afghanistan's even longer war.
 

Shag:

If Mr. Obama's genuine purpose is to enhance economic growth and that claim is not simply a lie to sell government growth, then one would assume that he wishes to implement policies that actually enhance economic growth.

Government health care and make work government jobs do not make our business more competitive and enhance business growth. The effect is quite the opposite as we divert hundreds of billions of dollars in business investment capital to finance these luxuries.

If concentrated on items that actually impact business and trade, infrastructure improvements have the potential to make our business more competitive and enhance business growth in the long term. However, they will do nothing to pull us out of a recession as demonstrated by the New Deal and the frequent recessions during the 50s when the interstate system was being built.

If Obama is serious about enhancing business growth, he should reduce the operating costs on business imposed by government to free up money to invest and hire employees. Reagan did this in 1981 and the economy was booming two years later.

Unfortunately, I have no great faith that Obama or the left are at all serious about economic growth. Rather, as demonstrated by Professor Dudziak's post, the left is simply making the mother of all wish lists for their preferred expansions of government.

This small business owner who has to live with the consequences sincerely hopes Mr. Obama proves me wrong. However, for now, my money is staying out of the markets and thus not being invested in business growth in a vote of no confidence. I am not alone.
 

"Stimulus plan could be mother of all 'Christmas tree' bills:"
 

This small business owner who has to live with the consequences sincerely hopes Mr. Obama proves me wrong

Proving you wrong really isn't all that difficult. You should set the bar a little higher.
 

"Proving you wrong really isn't all that difficult. You should set the bar a little higher."

So that little Lisa's bro would crawl UNDER the bar?
 

So that little Lisa's bro would crawl UNDER the bar?

# posted by Shag from Brookline : 2:19 PM

Over or under, it does not matter. No matter how much of a beating he takes, it does not stop him from declaring "MISSION ACCOMPLISHED."
 

"Bah! Humbug!" said the Scrooge of Woodland Park.
 

However, for now, my money is staying out of the markets and thus not being invested in business growth in a vote of no confidence. I am not alone.

# posted by Bart DePalma : 10:24 AM

Over the last 5 years everything you have touched has turned to shit. If I had money in the market I would be thrilled to hear this news.
 

See what I mean about trolls? Bart has posted three comments on this blog post; correct or incorrect, all three were responding to the post. Three of the usual suspects around here have posted six comments; all six of them constituted unresponsive personal attacks on Bart.

Though, frankly, it's not difficult to see why; the post itself was rather hard to defend. If the purpose of the proposed federal spending is economic stimulus, then one would think (hope!) that the recipients of the largess would be chosen not based on the simplistic notion that gender or racial balancing constitutes "fairness," but based on how effective the spending would be at stimulating the economy. I mean, if someone can make the case that hiring school nurses is actually "equally important to a vibrant economy" as building bridges, great. But that case needs to be made on economic terms, not on complaints that there aren't enough female construction workers and so it isn't "fair" to spend so much on construction projects.

(I accept, for the sake of argument, the notion that federal stimulus packages actually are what the economy needs.)
 

David, if you don't like trolls, tough shit. Bart isn't leaving.
 

simplistic notion that gender or racial balancing constitutes "fairness," but based on how effective the spending would be at stimulating the economy. I mean, if someone can make the case that hiring school nurses is actually "equally important to a vibrant economy" as building bridges, great

This sounds more like a hobbyhorse than an actual response to the actual post. Yes, "balancing" was addressed, but it was but a small aspect of a post most generally about equality and the role of women overall.

The argument was that women have an important role in said vibrant economy, but that past actions did not properly deal with the fact or did so in discriminatory ways.

Putting aside that health care IS a fundamental issue in a vibrant economy, why you focus on this job in particular is unclear.

Finally, equality is an important aspect of this nation, so if we are going to have a major economic stimulus plan, it should be a concern, especially given disfavored groups often are economically so as well.
 

Mr. Nieporent,

Though, frankly, it's not difficult to see why; the post itself was rather hard to defend. If the purpose of the proposed federal spending is economic stimulus, then one would think (hope!) that the recipients of the largess would be chosen not based on the simplistic notion that gender or racial balancing constitutes "fairness," but based on how effective the spending would be at stimulating the economy. I mean, if someone can make the case that hiring school nurses is actually "equally important to a vibrant economy" as building bridges, great. But that case needs to be made on economic terms, not on complaints that there aren't enough female construction workers and so it isn't "fair" to spend so much on construction projects

All true to a degree, but the point of the article didn't seem to be so much about fairness, but about the realities of the distribution of gender across the workforce. If we hype up importance of construction-related stimulus, at the expense of other social investment, then not only do we fail to improve vital areas of the economy and national importance (education and healthcare), but women will be disproportionately excluded from the stimulus. At that point, the factual statement that families rely upon female-generated income more than ever before is key - it isn't necessarily about the fairness of distributing opportunity to men instead of women, but the inefficiency and negative actual economic effects such a distribution would have. If the money is targeted at projects where women aren't, there is no income going to those families. Pragmatically, does that result in a wise package that will actually improve the economy, or should the money be more widely targeted to stimulate more than just the construction field?

I would tend to agree school nurses may not be the most obviously logical choice for receipt of stimulus, but there are numerous benefits, both long term and short term:
1) kids may stay healthier, costing less in the long run in medical care, avoiding inefficiencies in the medical sector with unnecessary emergency room visits, etc, which also results in less efforts at collection, and less income directed at preventable medical costs.
2) kids will be better cared for, and hopefully grow up healthier, which allows for a more productive workforce in the future.
3) broad stimulus will put money in the hands of more people, which may result in more confidence and more spending. Even if you can get a construction job that pays well, if your nurse neighbor is going into foreclosure, you are psychologically less inclined to spend since you see so many others with tough times, you suspect you may be next. If everyone in your neighborhood is doing better, you'll have less fear. While it can be demeaning when said by some, there is a psychological component to the recession that fuels the vicious cycle that leads to depression. Although there are more tangible things that must also be done, there is no reason not to treat every cause of the crisis.
4) socially, there is a huge problem in the schools with malnurished and unhealthy children. This results in increased health care costs to society as a whole, which removes money that could be utilized more productively. A little off topic of the nurses issue, school lunches are absolutely critical, and it really is unfathomable to me personally just how many children eat their only meals at school. Nurses may help identifying problems like this, and perhaps assist in creating solutions to child hunger in America.

Overall, nurses are a great long term investment. Further, as stated above, with the dependence on female income for households at a level unprecedented in our history, ignoring the unequal distribution of females in the workforce has practical, and not just moral, ethical, or fairness-based consequences.
 

I think the letter is a very good example of what historians can add to modern policy debates. As a legal historian, I generally think that folks in our biz should be modest in our ambitions to apply "lessons of the past" to current political debates. But cautions about avoiding the gendered nature of public works projects then and (proposed) now is a good example of doing this well.

I also agree with David N. that it's disappointing that so many of the comments were directed at Bart and not the original post. At risk of compounding that error, I'll respond to one argument Bart makes in an attempt to defend the article. Public health care is very much indeed part of business competitiveness. We have only to look at the costs for the U.S. auto companies that have undertaken to provide for the health care of their retirees. Avoiding the situation where companies place themselves at an economic disadvantage if they provide decent health care is both good for the economy and good for the individual businesses that are shouldering more than their share of the burdens.
 

This post has been removed by the author.
 

jslater said...

Public health care is very much indeed part of business competitiveness. We have only to look at the costs for the U.S. auto companies that have undertaken to provide for the health care of their retirees. Avoiding the situation where companies place themselves at an economic disadvantage if they provide decent health care is both good for the economy and good for the individual businesses that are shouldering more than their share of the burdens.

Our current public health care system is primarily financed through taxes on the wages employers pay their employees. Where do you think that an expansion of public health care will derive its funding?

Obama has already told 95% of individuals he will cut their taxes. The upper 5% can't pay the entire freight, so Obama will be coming after business again.

Imposing higher costs on business during a recession is hardly an economic stimulant.
 

nerp:

1) You make a good point concerning the lack of stimulative effect of infrastructure construction. Unemployed workers from the financial, auto, manufacturing and retail sectors do not have the skill set, desire or in many cases even the physical fitness to build roads and sewers. Instead, illegal immigrants are far more likely to be filling these labor intensive positions, leaving a large percentage of citizens unemployed.

2) There is already an enormous demand and very high pay for nurses. There is hardly any need for the government to subsidize nurses.

3) The government health insurance plan offered by Mr. Obama to be financed completely through added debt will remove investment capital from the economy and slow growth. Folks are not unemployed because they are unhealthy and need Obama-care, they are unemployed because businesses lack the investments and income to employ them.
 

(sigh)
Mr. DePalma,

1) You make a good point concerning the lack of stimulative effect of infrastructure construction. Unemployed workers from the financial, auto, manufacturing and retail sectors do not have the skill set, desire or in many cases even the physical fitness to build roads and sewers. Instead, illegal immigrants are far more likely to be filling these labor intensive positions, leaving a large percentage of citizens unemployed.

Of course, I didn't make that point. My point was to stimulate only one sector is not efficient nor beneficial to the overall economy. Infrastructure construction is one of the best uses of public money, and can stimulate further growth by giving people jobs, and stabilizing the economy. Perhaps the greatest government project ever was Eisenhower's Interstate System, which greatly benefited the efficiency and growth of the economy. However, stimulating only the construction and infrastructure sector leaves a lot to be desired, as other necessary components of the economy will suffer. Unemployed workers in the auto and manufacturing sectors could very well find (at least temporarily) a home in the infrastructure construction field. Illegal immigrants are unlikely to fill these positions, because the wages will be high enough that citizens will be interested, and the lack of employment possibilities currently in the economy will allow demand to be high for these jobs. Illegal immigrant employment is typically fueled by lack of demand and low wages for jobs, in tandem with illegal business practices by employers. Big business is pretty hush-hush about it because they wanted the low wage workforce in order to squeeze out more profits, and because there was sufficient work for Americans to choose other lines of work. Condition two is no longer true, and the federal government will not permit contractors to hire illegals with federal money. Please avoid misstating my points, I would hate for others to think that is an accurate reflection of what I said.

2) There is already an enormous demand and very high pay for nurses. There is hardly any need for the government to subsidize nurses.

School nurses are obviously different, since they are paid by the local school district, and are one of the first jobs on the cutting block. We were not discussing private hospital nurses.

3) The government health insurance plan offered by Mr. Obama to be financed completely through added debt will remove investment capital from the economy and slow growth. Folks are not unemployed because they are unhealthy and need Obama-care, they are unemployed because businesses lack the investments and income to employ them.

People are currently unemployed because consumer demand is down due to overstretched households and a credit confidence crisis that has resulted in low lending. Money is actually everywhere – investors are scared due to potential defaults. These effects have caused a cyclical effect, whereby the recession propagates itself as the house of cards falls. However, as you have made clear that you believe Fannie and Freddie are responsible for this situation, I don't expect you to accept or understand that. Investment capital will not be removed form the economy, as currently investors want dollars at 0% (and less on the secondary market). In other words, investors don't want to put there money anywhere but in treasury bonds. There actually has never been a better time for the federal government to borrow – demand is astronomical, interest on the debt is nill, the economy needs stimulation, and there are infinite problems to fix.

Anyone who supported the Iraq war and the Bush tax cuts is not allowed to complain about programs “financed completely through added debt.”

The American economy is at a business disadvantage because we do not have a nationalized health insurance system. Unfortunately, with that particular service, the free market fails. I think health insurance situation in this country demonstrates that the free market is unable to efficiently allocate resources in that particular market. Quite the opposite of what you are saying, I think government has shown it is the more efficient operator in that market, and should take it over. I’ll give you an overview of my theory

1) the basic purpose of the free market is to allow for an efficient distribution of goods and services from suppliers to those who demand the goods or services.

2) in the run-of-the-mill situation, consumers demand widgets. Widget makers compete to provide various widgets of various quality, in order to meet the demands of the consumers. Consumers are willing to pay for the widgets because they want them. The key here, to me, is the widget makers and the consumers interests are aligned - widget makers want to sell to consumers, consumers want to buy.

3) in the health care context, the consumers who have the highest demand are the ones the suppliers DO NOT want to supply with insurance. The consumers who have the least desire for insurance are the ones whom the health insurers want to provide. Heath insurers do not want to provide preventative care, because they fear people will use it often, thus reducing their profit margins. They do not want to provide coverage for catastrophic care, since it is expensive, but they can try to use policy language to get out of it when it does happen. They don’t want to cover the preventative care because of the repetitive costs, even though that kind of care may prevent the catastrophic coverage later. Basically, the suppliers and the consumers interests are not aligned - they are actually in opposition. This, imho, does not make for an effective and efficient market.

4) also, in a broader sense health insurance has a huge effect on the economy and on individuals. Here are a few effects i can think of off the top of my head:
a) those with insurance are billed less than those without, making health care more expensive for those who can less afford it, and cheaper for those who can.
b) insurance benefits through employers plays havoc on the labor market, by distorting and deincetivizing employee movement to more efficient jobs. If a person must always fear the change in health insurance from a new job - less benefits, wrong doctors in plan, higher premiums - it prevents the worker from taking a job that would be a better use of his or her skills and would create a higher GDP through efficient reallocation of labor. It makes it harder for small business to compete. It also makes entrepreneurship more risky.
c) it puts the US at a competitive disadvantage vis-a-vis the rest of the world, as nationalized health care in other countries keeps labor costs cheaper than here. Ask the auto companies if they would like nationalized health insurance right about now.
d) it creates an inefficient incentive for those without insurance to either put off care until it is extremely serious and expensive, or come into the extraordinarily expensive emergency room for every minor issue. Then these huge bills don’t get paid, and the hospitals have to increase fees in other areas to make up the shortfall. The only other option is to deny emergency care to human beings, something which is morally and politically repugnant.
e) following up on b) it also results in inefficient allocation as younger workers and single people will be willing ot take jobs with poor plans, and older people and families will stay with strong plans. The inability to move laterally distorts the efficiencies supposedly created by the free market.
f) entrepreneurial enterprise is benefited, since an extreme competitive disadvantage vis-a-vis more established companies is eliminated, allowing those start-ups to better compete for workers, and lowering entrance costs.

Businesses are better off not having to pay for these inefficient costs, and the economy as a whole would probably benefit from the burden of health insurance being lifted off the back of employers. Investment capital can be more appropriately directed at other sectors, which will result in a net benefit to the economy.

I don't think national health care will stimulate the economy, per se. But it certainly will assist in making the US economy more competitive and efficient, and is an excellent long term investment. (As is investment in our school children's health.) But that wasn't really what I said anyway, this had to do with school nurses, and not neglecting to take the distribution of the genders in the workforce into account. But I digress...
 

Nerp:

The American economy is at a business disadvantage because we do not have a nationalized health insurance system.

:::chuckle:::

The US economy is already more competitive and efficient than nations with government health care.

The Big Three are not in deep straights because they offer health insurance, but rather because they offer far more than their competition.

I don't think national health care will stimulate the economy, per se. But it certainly will assist in making the US economy more competitive and efficient, and is an excellent long term investment.

Care to present evidence of that correlation? Has any nation that adopted government health care experienced a concurrent spike in economic growth? To the contrary, the welfare states of the EU have been left in our dust for decades.

Unfortunately, with that particular service, the free market fails.

We have not had anything close to a free market in heath care where consumers pick and choose between medical services based on cost effectiveness for decades. Medical care has been nearly completely socialized through private and government insurance.

I have been arguing for years that the medical industry needs to move more not less to the free market. The medical savings account when done right does the trick. Only preventative and catastrophic care are socialized through insurance. For everything in the middle, the health care consumer and the government or employer jointly contribute money into a MSA. The consumer decides what to spend his MSA on and then can either keep the remainder or allow it to roll over to the next year for future medical costs or eventual retirement. The key here is that the health care consumer finally has to weigh the benefits of the care against its costs and alternative uses for the money as a consume does for nearly every other good and service in the economy.

Forbes did this for his magazine and health care costs to the business dropped significantly. My wife is now enrolled in a similar plan with her employer.

those with [health] insurance are billed less than those without, making health care more expensive for those who can less afford it, and cheaper for those who can.

The uninsured usually do not pay their bills and the difference is made up through inflating charges to insurance.

People are currently unemployed because consumer demand is down due to overstretched households and a credit confidence crisis that has resulted in low lending.

Unemployment has been rising for a year while consumer demand has only recently dipped.

Money is actually everywhere – investors are scared due to potential defaults.

People invest in business in anticipation that those businesses will grow. However, when the government talks up increasing the cost of doing business by increasing taxes, regulations, the cost of capital by running up deficits and labor costs (card check union creation), then investors keep their money sidelined and the economy tanks.

Investment is all about confidence in the future. The government needs to be making this the most business friendly economy in the world and restore that confidence. Even if the economy stinks now, the prospect of a mid to long term future with lowered costs of doing business and concurrent larger profits will draw investment.

Anyone who supported the Iraq war and the Bush tax cuts is not allowed to complain about programs “financed completely through added debt.”

The war was financed entirely through reductions in marginal tax rates with resulting economic growth and concurrent double digit increases in tax revenues with hundreds of billions of added revenue to spare reducing the deficit.
 

The Big Three are not in deep straights because they offer health insurance, but rather because they offer far more than their competition.

No. The packages are very similar. The difference is that the Big Three have been doing business in the country longer and have a larger number of retirees.
 

PMS_Chicago said...

BD: The Big Three are not in deep straights because they offer health insurance, but rather because they offer far more than their competition.

No. The packages are very similar. The difference is that the Big Three have been doing business in the country longer and have a larger number of retirees.

Not even close.
 

Bart's legendary ignorance marches on. This latest link doesn't refute PMS' charge that legacy costs are the major difference between labor costs for Detroit vs Japanese manufacturers. The link also undermines Bart's claim that "socialized" health care is an impediment to productivity. According to the Bart's cite Japanese workers on average pay $190 per month in health care costs. That is a bargain by US standards, and the Japanese are kicking our ass in the world market.

The war was financed entirely through reductions in marginal tax rates with resulting economic growth and concurrent double digit increases in tax revenues with hundreds of billions of added revenue to spare reducing the deficit.

Delusional is too good a word for you, Bart.
 

This post has been removed by the author.
 

Mattski:

Try reading the link for content. Specifically, look for the difference between the lifetime health insurance offered to current UAW members and the normal work life health insurance offered to non-union employees.
 

Not only did the tax cuts pay for themselves, but they paid for the war as well! Amazing, simply amazing. As for where this huge deficit came from in spite of it all, uh, blah blah blah Barney Frank.
 

Bart:

Try reading a full CRS report (rather than an editorial in Forbes) for content:

Big Three representatives say that they are unfairly burdened in competing with
both imports and domestic production from foreign-based automakers by their own
rising pension and health care costs. Though most are non-union operations, the
transplants also provide an equivalent level of benefits. But being newer investors
in the United States, they do not yet face a burden of health care and other benefit
costs, which have accumulated over the decades for the Big Three, as the number of
retirees increases. Moreover, the average age of current employees is higher for the
Big Three, and health care costs are correspondingly higher. Like some other longunionized
American industries, such as integrated steel mills, the Big Three face
aggressive non-union competition less burdened by these costs.
 

PMS:

I read the spin phrase you quoted. The devil is in the details of what they mean by "equivalent." The problem is that the actual figures do not show equivalent benefits.

Current UAW workers get lifetime health care, while non-union US employees do not.

Current UAW workers enjoy 95% of their benefits when layed off, while non-union US employees do not.

The CRS does not break down the other benefits of the current union and non-union workers for us to make a more detailed comparison.

As my link above demonstrated, the Japanese provide even fewer benefits to their own employees that they do for their non-unionized US employees.

No one is saying that legacy costs are not a major problem on their own for the Big Three. However, they too are part of the UAW contracts that need to be restructured.
 

Nice job! Thanks for your information. I know some wow gold in wow, cheap wow gold farmed by man.
 

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

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