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1 Dept of Pulmonary Disease, Dokuz Eylül University, Izmir, Turkey. 2 Dept of Environmental and Occupational Medicine, University of Aarhus, Aarhus, Denmark. 3 Dept of Public Health, Katholieke Universiteit Leuven, Leuven, Belgium.
To the Editors:
At this year’s annual congress of the Turkish Thoracic Society (TTS), a mini-symposium was devoted to the occurrence of silicosis in the textile sector in Turkey. Clinicians from four cities reported on a total of 35 subjects with silicosis: 20, 10, four and one cases from Erzurum, Izmir, Tokat and Diyarbakir, respectively 1–4. Nearly all patients were young males in their early twenties or even younger. They had been employed, often as undeclared workers, for only a few years in small workshops where denim jeans undergo jet sandblasting to give them a "worn-in" appearance. This job involved working long hours under very poor hygiene conditions, without any serious respiratory protection, and often far away from home, e.g. in Istanbul.
As no thorough occupational history had been taken or because silicosis was not suspected in these "textile" workers, several patients had initially been misdiagnosed as having tuberculosis (or sarcoidosis). So, depressingly beautiful images of high-resolution computed tomography scans or lung biopsies were projected, showing textbook presentations of acute silicosis (alveolar lipoproteinosis) or accelerated silicosis.
Two patients had started sandblasting when they were aged 13 and 14 yrs; both worked little more than 3 yrs and they died within a year of diagnosis, aged 18 and 19 yrs.
These two instances of silicosis in jeans sandblasters had already been reported at the 2005 congresses of the TTS and the European Respiratory Society, and they have now been published 5 (except for the fatal outcome). The suspicion of an epidemic now appears to be verified: an informal poll of 
30 participants in the mini-symposium at the TTS yielded another 15 cases from various other places in Turkey.
The Turkish labour authorities have been alerted, but their reaction is slow and it is difficult to intervene in this largely informal sector. In principle, the solution to the catastrophe caused by sandblasting jeans is simple. This practice should be stopped. Sandblasting is a well-known risk of silicosis 6 and it is no longer allowed in many countries. Of course, unsafe and unhealthy working conditions accompany and characterise many other sectors of the globalised economy 7. However, it is particularly outrageous to see poor young people lose their lives simply to allow rich young people to follow the fashion of wearing artificially worn-in jeans.
Fur clothing is being boycotted because it costs animal lives. We should no longer accept to wear jeans that have been "stonewashed" using methods that kill humans.
REFERENCES
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