APPENDIX DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Mr. EARL F. PASBACH, PUBLIC HEALTH SERVICE, CENTER FOR DISEASE CONTROL, Morgantown, W. Va., July 28, 1980. Staff Director, Counsel, Subommittee on Labor Standards, Congress of the United States, House of Representatives, 617 House Office Building Annex No. 1, Washington, D.C. DEAR MR. PASBACH: Thank you for your recent letter and for the list of questions in followup to my testimony before the Subcommittee on Labor Standards in May of this year. I attach comments to your questions. With best regards. Yours sincerely, JAMES A. MERCHANT, M.D., Dr. P.H., Director, Division of Respiratory Disease Studies. Enclosure. Question. To your knowledge, what epidemiological studies have been completed on occupational diseases other than byssinosis, asbestosis and benzine? Answer. The list of epidemiological studies on occupational diseases is vast and would include several volumes if they were all provided for your review. The diseases of principal interest to our research are those resulting in respiratory disease, both neoplastic and non-neoplastic. A list of the diseases and assorted agents is attached for your information. A comprehensive report on these diseases is being finished at the present time and should be available for your review by the end of this fiscal year. Question. Who are the scientists that are making or that have made such studies? Answer. We feel we have identified many of the most knowledgeable scientists in assembling this report. There are some obvious omissions such as Dr. Selikoff, who had agreed to write two chapters but because of illness could not complete his assignment. The authors of the chapters are included for your review. Comprehensive bibliographies on all of the occupational lung diseases will be attached to our final report. These bibliographies should provide you with an extensive list of scientists working in these areas. Question. Have you reviewed such studies? Answer. The purpose of our detailed report, of course, is specifically to review studies on occupational respiratory diseases. Although this review is not exhaustive, I believe you will find it to be an indepth review which covers the most important papers on these subjects. Question. If so, would you consider them individually and state whether or not you believe such studies could form a scientific basis to establish rebuttable presumptions and the proof of workmen compensation cases regarding the occupational disease in question? Answer. Depending upon the strength of the epidemiology and the nature of etiology of the specific disease, one may or may not want to recommend rebuttal presumptions in helping to assess workers compensation cases. With diseases of multifactoral etiology such as the pneumoconioses, the airways diseases, and the neoplasms, rebuttal presumptions could be used if the epidemiological data support their use. In certain diseases such as the immunological diseases, like Farmers Lung, or the infectious diseases, such as anthrax, very specific diagnoses can be made and, therefore, presumptions would not be needed. However, for most occupational respiratory diseases, it is my view that presumptions may well be useful. Question. While there are many occupational diseases, what percentage of them have been the subject of scientific epidemiological studies? Answer. Almost all of the occupational diseases have been subjected to some epidemiological investigation. These studies are, of course, referred to in the various chapters in our report. Some diseases have an extensive epidemiological literature. This is the case for coal, asbestos, silica, cotton dust, and a few others. A number of occupational diseases, however, suffer from inadequate epidemiological study, the only reference being small and often poorly controlled studies. Question. To your knowledge, what efforts have the medical research community made with respect to epidemiological studies of occupational diseases? Answer. The medical research community has over the last 10 years, since the formation of NIOSH, made a concerted effort to improve the epidemiology of occupational diseases. In fact, I believe it is safe to say that epidemiology is the basic discipline of our Institute. This has resulted in greatly increased efforts to conduct well controlled epidemiological studies in a number of occupational diseases. Although we have made a good deal of progress, there is a great deal to be done particularly in regard to medical surveillance and record linkage of various available data sets. Question. Do you have any ideas how a plan to make adequate epidemiological studies of occupational diseases could be effected? Answer. One important area of our Report to the Congress is consideration of epidemiological studies. In fact, we have devoted one entire chapter to epidemiological methodology, as well as a number of other chapters on methods used to evaluate lung disease. These chapters, I feel, will provide excellent reference. Question. Do you have any idea as to what type of medical training a medical student should have in the field of occupational disease before he receives his medical degree? Answer. Clearly, occupational medicine is not taught consistently or sufficiently in most schools of medicine. My view is that occupational and environmental medicine should be a major part of the preventive medicine curriculum. Also a part of that curriculum should be more indepth courses in epidemiology. Unless very great strides are made in the occupational medicine curriculums in medical schools, graduating physicians in this country will continue to receive a medical degree with very little knowledge of occupational factors in causation of diseases. Question. Do you think the Government has put enough time and money in the epidemiological studies of occupational diseases? If so, do you agree with the programs now being carried out? If not, could you detail how much monies could be most effectively spent? Answer. When one considers the magnitude of occupational exposure in our modern technology and the over 80 million workers exposed to some occupational agent, the amount of funds for research in this area would appear to be quite small. While any additional resources for research in occupational health would be well spent, I would especially suggest that funding be provided for epidemiological studies of occupational diseases and to support the adequate training of young professionals to fill the tremendous gap existing in occupational health manpower. Question. The idea of placing occupational disease under the authority of a special federal court has been considered. Do you have any thoughts on this proposal? Answer. I am not familiar with that proposal and do not feel qualified to respond. Question. Do you have any other thoughts in the area of occupational disease that you would like to share with the Subcommittee for this report? Answer. My only other observation would be that a great deal needs to be done to provide an equitable system for compensation from occupational exposures in this country. It is my view that these changes will require the force of legislation in order to be effected. LISTS OF PRINCIPAL AGENTS TO BE CONSIDERED IN SECTIONS OF ORD REPORT III. A. Silicosis (chronic and acute): "Free Silica" (silicon dioxide) : quartz flint granite sandstone slate diatomaceous earth D. Coal Workers' pneumoconiosis and pneumoconiosis due to carbon coal carbon black lamp black E. Beryllium and compounds F. Pulmonary reactions to man-made fibers and miscellaneous pneumoconiosis including "mixed dust" pneumoconiosis: metallic iron iron oxides iron ores: limonite fibrous glass mineral wool (silicates) aluminum and aluminum oxides antimony barium cobalt rare earths silver tin tungsten carbide zirconium IV. Occupational asthma and rhinitis: Animal danders: cat mouse ΟΧ horse Feathers: chicken Invertebrates: cockroaches locusts moths grain weevils |