South Africa: manganese poisoning claim meets nervous denial

A US neurologist has been accused of breaching medical ethics and being linked to consulting firms paid by the mining industry. The accusations were levelled by
lawyer, Richard Spoor, during an inquiry into deaths of workers at the Assmang ferromanganese plant in South Africa.

For background see: http://www.minesandcommunities.org/article.php?a=8879

Assmang Ltd is co-owned by African Rainbow Minerals and Assore Ltd

Manganism denial turns ugly

Fred Kockott

Sunday Tribune

16th November 2008

'IT'S an ugly business," says US neurologist Dr Warren Olanow, who is at the centre of a growing controversy over his review of diagnosed cases of manganism at the Assmang plant in Cato Ridge, KwaZulu-Natal.

The company used his review this week to declare in a Labour Department inquiry that there was no evidence of anyone having contracted manganism as a result of excessive exposure to manganese dust and fumes at the Assmang plant.

The company could face criminal prosecution if the 18-month-old inquiry finds otherwise. The inquiry was sparked by the death of an Assmang worker, Fred Wright, in January last year. It was set up to determine whether Assmang could be held criminally liable for failing to protect workers from excessive exposure to manganese dust and fumes.

Excessive exposure is said to cause brain damage, impotence and physical and mental instability.

At the time of Wright's death, doctors appointed by Assmang were examining seven suspected cases of manganism.

Although the number of diagnoses for "possible", "probable" and "confirmed" cases of manganism has since risen to 18, the company reported to the inquiry this week that a new medical surveillance programme established by Olanow had found all these diagnoses, except "one possible case", were wrong.

Unethical

But attorney for the sick workers, Richard Spoor, has objected to the review on grounds that it is medically unethical to draw such a conclusion without re-examining the sick workers or consulting the doctors who originally made their diagnosis. This has not happened.

Spoor has also questioned Olanow's credentials, saying the Manhattan neurologist is linked to consulting firms that had been paid more than $2.9 million (R30 million) by the manganese industry to produce medical research and testify as expert defence witnesses in cases where welding companies had been sued by sick workers.

And on Friday, Spoor advised the inquiry's presiding officer, Vuli Sibisi, that Olanow had been dismissed from his post as head of neurology at Mount Sinai University for failing to disclose payments he had received from industry.

Contacted later at his office at the Mt Sinai School of Medicine, Olanow told the Sunday Tribune reports that he had been dismissed or faced disciplinary action were not true.

"This is just a dirty trick to try to discredit me," said Olanow. "I have just been paid as a consultant to bring scientific knowledge of what manganism is."

Olanow said such knowledge helped the industry take the right steps to prevent manganism and ensure sick people got the right treatment.

"If you are going to make a decision, you need this knowledge. Facts are facts, and this is sincerely all I am conveying. Believe me, I don't want to see workers harmed," said Olanow.

He said he had not wanted to be dragged into the controversy over Assmang workers allegedly having been exposed to excessive levels of manganese dust and fumes.

"I got brought into it and am not happy about it. It is not my problem.
I came from the outside to try be helpful, to bring knowledge to an obviously inflammatory situation," said Olanow.

Olanow said he had not made a diagnosis "on any of these people"
(Assmang workers suspected to be suffering manganism) but was willing to see patients and give an honest opinion.

"Whether I got paid R100 million or not, my diagnosis would be the same."

Olanow said he would not express an opinion without seeing a patient or consulting the doctors who had made the original diagnoses.

This is not the case, though, with Dr Murray Coombs, who runs Assmang's new medical surveillance programme in close consultation with Olanow.

Coombs told the inquiry this week that the earlier diagnoses of manganese poisoning made by other doctors, including Dr Susan Tager, a leading neurologist at Wits University and head of the movement disorder clinic, were wrong.

Coombs said this had been established through a review of the sick workers' medical records and consultations with Olanow as a world expert on manganism.

Suffering

He said a report had since been submitted to the Compensation Commission advising that there was only one possible case of manganism, and that all the other sick workers were suffering from some "other" disease not related to excessive manganese exposure.

Coombs said there had been no need to consult Tager and other doctors who had originally diagnosed manganese poisoning because their findings were contained in the medical surveillance files.

He said it had not been possible to re-examine all of the sick workers because some had refused to submit themselves to Assmang's new medical surveillance programme.

Olanow declined to comment on these disclosures before the inquiry this week.

"I told him (Coombs) what manganism looks like, and what it isn't. If he makes conclusions based on that, it has nothing to do with me," said Olanow.

"This is an ugly business. I am just trying to keep things at a high scientific level. I would like to have as little as possible to do with all the political hot-boil of the case in South Africa," said Olanow.

Olanow would not elaborate or discuss his definitions of manganism, which Spoor has criticised as too stringent.

"What we are being told is that all seven symptoms have to be in place - that if you have five, not all seven, then it is not manganism but 'other disease'," said Spoor.

"What is this 'other disease'?" asked Spoor.

"On what basis is manganism excluded in all these cases that we have here - people brain-damaged, suffering movement disorder and all sorts of symptoms clearly associated with excessive exposure to manganese?

Some seriously ill workers have not even been told," said Spoor.