Work-associated illness is relatively common; deaths from work-related disease are relatively uncommon. The large volume of mainly self-reported and minor psychological and musculoskeletal morbidity attracts the media looking for attention-grabbing headlines, and the work and health community looking for substantial population health benefits. Deaths from occupational illness other than from major accidents make the front pages infrequently.
On 8 April, the media announced the untimely death of Malcolm McLaren (pictured below with Johnny Rotten). Best known for being the svengali to the Sex Pistols, he was also a recording musician and producer in his own right.
In his early career he and his partner, Vivienne Westwood, opened a fashion boutique in London, which was prophetically called Too Fast to Live, Too Young to Die. This launched one of the UK’s most prominent fashion dynasties. Westwood has been a central figure in the UK fashion industry ever since and was appointed a Dame in 2006. Their son, Joseph Corré, co-founded lingerie brand Agent Provocateur.
The Sex Pistols had a very short musical career. Together for little more than a year, their impact was explosive, and their music seemed to matter far less than their notoriety. Love them or hate them, the Sex Pistols changed popular culture forever. Thirty years later, it is sometimes hard to remember what all the fuss was about.
Mesothelioma in the media
Malcolm McLaren died of mesothelioma. The period from diagnosis to death was typically short. It is uncommon for celebrities to die from mesothelioma. Exposure to asbestos is not usually a feature of work in music, film, or TV where the proportional mortality ratio (PMR) for entertainers, producers and directors is 68.8 (occupations with the highest risks, in ship and locomotive building and the installation and maintenance of lagging or other insulation materials in buildings, typically have PMRs of more than 200).
Occasionally we are reminded that potentially fatal occupational diseases remain a continual threat. Celebrity deaths make TV news, the national front pages and obituary columns. The press coverage most mesothelioma fatalities receive is limited to a short report of the coroner’s inquest on the inside pages of local newspapers and in memoriam announcements from loved ones.
The most well-known person to die of mesothelioma was Steve McQueen. An iconic movie figure, he died at just 50. He is recognised for his performances in films like Bullitt, Papillon, The Great Escape and The Magnificent Seven, and known for performing many of his own stunts. McQueen was diagnosed with mesothelioma in December 1979. He died 10 months later.
Thirty years on, McLaren was diagnosed with mesothelioma in October 2009 and died six months later. In the past 30 years the treatment of many other cancers has transformed their outlook. For example, Cancer Research UK reports 10-year survival for breast cancer has improved from 41% to 73%. In stark contrast, Cancer Research UK doesn’t even provide 10-year survival data for mesothelioma. The median survival time from diagnosis is about a year.
Iconic figures are supposed to die in dramatic circumstances, through drug overdoses, or in some way that leaves a lasting reminder of flawed genius. These are untimely deaths, but ones that reflect their impactful lives. They are not supposed to die of a painful, debilitating, and essentially untreatable occupational disease. But mesothelioma is itself iconic – the iconic occupational cancer.
The exposure-response relationship between asbestos and mesothelioma is understood. Mesothelioma illustrates the futility of health surveillance when no intervention is possible for the diseases in question, and also the difficulty of striking a balance between how to protect low exposure to very large numbers of workers (construction) versus high exposure to small numbers of workers (shipyard laggers). It is a continual reminder of the long lead time for occupational cancer as the incidence rises years after better controls were implemented.
Health and Safety Executive (HSE) data shows that 10 times more people die a year from mesothelioma than workplace accidents (about 2,100 v about 200). The HSE estimates the occupational burden of cancer is about 8,000 deaths a year. It does not report any deaths from stress.
Malcolm McLaren symbolised dissatisfaction with the status quo and a vibrant, rebellious desire to change things for the better. Thirty years on, the 2,000 untimely deaths from mesothelioma this year should be a further call to action.
Dr Richard Preece is a consultant occupational physician.