Proceedings of the Interdepartmental Workers' Compensation Task Force Conference on Occupational Diseases and Workers' C...

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Material Information

Title:
Proceedings of the Interdepartmental Workers' Compensation Task Force Conference on Occupational Diseases and Workers' Compensation, 1976
Physical Description:
ix, 884 p. : ; 24 cm.
Language:
English
Creator:
United States -- Interdepartmental Workers' Compensation Task Force
United States -- Congress. -- Senate. -- Committee on Labor and Public Welfare. -- Subcommittee on Labor
United States -- Congress. -- House. -- Committee on Education and Labor
Conference:
Interdepartmental Workers' Compensation Task Force Conference on Occupational Diseases and Workers' Compensation, 1976
Publisher:
U.S. Govt. Print. Off.
Place of Publication:
Washington
Publication Date:

Subjects

Subjects / Keywords:
Occupational diseases -- Congresses -- United States   ( lcsh )
Workers' compensation -- Congresses -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
bibliography   ( marcgt )
conference publication   ( marcgt )
non-fiction   ( marcgt )

Notes

Bibliography:
Includes bibliographical references.
Statement of Responsibility:
prepared by the Subcommittee on Labor of the Committee on Labor and Public Welfare, United States Senate and the Committee on Education and Labor, House of Representatives.
General Note:
At head of title: 94th Congress, 2d session. Joint committee print.
General Note:
Conference held Feb. 10, 11, and 12, 1976, at University of Chicago, Chicago, Ill.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 026374184
oclc - 02540882
lccn - 77600811
Classification:
lcc - RC963.7.U6 I57 1976
ddc - 368.4/1/00973
System ID:
AA00024895:00001

Full Text







94t Cogrs JOINT COMMITTEE PRINT



PROCEEDINGS OF THE INTERDEPARTMENTAL WORKERS' COMPENSATION TASK FORCE CONFERENCE ON OCCUPATIONAL DISEASES AND WORKERS' OOMPENSATION, 1976





COMMITTEE ON LABWAD

UNITED S'TATES SENATE





CIO, ILL.LA


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COMMITTEE ON LABOR AND PUBLIC WELFARE
HARRISON A. WIaLLIAMS.E New Jersey, Obefrmas
JENNINGS RANDOLPH, West Vir~ginj, flACOB 5, JAVITS, New York CLAIBORE PEI1J, Rhode Island RIMEB.I SCHWHIKER, Penneylvants EDWAR M. K7ENNEDXMsaksta RIR' ,,J..Oo
GAYLORD NELSON, woinesia J. =190 .Ihwt B"' x.:, hMaryland
WALTfE F. MONDALE, Minnesota ROBERT T. STAPPORD, Vermont THOMAS F. MAGLETON, Missouri .Alfle LAXAleT, Nevada ALAN CRANSTON, California WYTE. Ar D. RATHAWAY, Maine JON A. neansf iiow hadash t'..I i' I 0.4


JAY B. Cownsa, Miteys Counsel




qualRson A. Wnz p"e,, sn..ew Jerer, ,oAsiones M GH"61 RANDOLPH, V16es J AMB K. AM; Awork1
CLAIBORNE PELL, Rhode Island RICHARD S. SCHWEIKR, Pennsylvait GAYLORD NEL80x W1 ia IoE~l"', h
WILLIAM D. HATHAWAY, Maine ROBERT T. STAFFORD, Vermont
WALTER F. MONDALE, MfinnesotaL JOHN A. DURKIN, New Hampshire DONfALVELlstre, Cjonned
DON Z~xxanxA*. Minrf*s Labor Donesel



























COMMITTEE ON EDUCATION AND LABOR
CARL D. Pwarn4 Kentuear, Cairman
PRANK THOMSO, 5A, New.Terser ALBERT H. QUIET, Minnesota
ZOERN H. DENT, Pennsylranta JOHN M. ASHBROOK, Ohio DOMINICK V. DANIELS, New Jersey ALPHONEO BELL,, California JOHN RADEMAB, Indiana JOHN N. 15RTHMBOHN, ltnels JAMES G. O'HARA, Michigan MARVIN L6. ESCH, Michigan
ATTGUTTR'TT F. HAWKINS, California EDWIN D. ESHaLEMAN, Pennsylvania WILaLAM D. FORD, Michigan PETER A. PEYRER, New York PATSY T. MINK, Hawaii (on leave) RONALD A. ARASIN, Connecticut LLOYD MEEDS, Washington JOHN BUCHANAN, Alabama
PHTTLLTP RTTRTON, California JAMES M .TEF7ORDR, Vermont JOSEPH M. GAYDOS, Pennsylvania LARRY PRESSLER, South Dakota
WTTLT.AM "BTTLT" CTLAY, Missnuri WTILTIAM F. GOODT.TNG, Pennsylvania SRTLT1Y CHTRHOT, New York VTRGTNTA SMTTH, Nehraska MARIO BIAGGI, New York
IK ANDREOWS, North Carolina WITLTIAM THMAN, Flida JAIME BENITEZ, Paerto Rico MICHIAEL BLOUIN, Iowa
ROBERT CORNELL, Wisconsin PAUL SIMON, Illinois
EDWARD BEARD, Rhode Island LEO ZEFERETT, New York GEORGE MILLER01, Caliornia RONALD MOTTL, Ohio
TIM HALL, Illinois















































































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FOREWOR






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CONTENTS


781re
Foreword ---------------------------------------------------------- v
)Days Of proceedings:
First day, February 10, 1976 --------------------------------------- I
Second day, February 11, 1976 ------------------------------------- 73
Third day, February 12, 1976 ---------------------------------------- 149

APPENDIX
Report of proceedings ----------------------------------------- ------- 243
Magnitude of the Occupational Health Problem, the, by Nicholas A.
Ashford, Ph. D., J.D., Massachusetts Institute of Technology, Cambridge, Mass ------------------------------------------------------- 286
Multiple Factor Interactions in Occupational Disease, by Irving J. Selikoff,
M.D., Mount Sinai School of 'Medicine of the City University of New
York ------------------------------------------------------------- 303
Medical: Aspects, by Thomas F. Mancuso, M.D., research professor, Graduate School of Public Health, University of Pittsburgh ----------------- 326
Occupational Disease and High-Risk Groups, by Sheldon W. Samuels ---- 438 Ocenpation and Disease-A Guide for Decisionmaking, a contractor's
report of a National Institute for Occupational Safety and Health project to aid State agencies, physicians, and others in making decisions
regarding occupational disease compensation ------------------------- 447
Legal Aspects of Occupational Disease Coverage, by John H. Lewis,
attorney ------------------------------------------------------------ 696
Administrative Aspects of Handling Occupational Diseases, by J. T. Noblin, chairman, Workmen's Compensation Commission, Jackson, Miss -------- 720 Mancuso, Thomas F., M.D., statement by ------------------------------ 730
Black Lung, a Study in Occupational'Disease Compensation, by Nancy M.
Snyder and Mark E. Solomons, U.S. Department of Labor ------------ 742
Programs To Protect Workers With Occupational Diseases, by Ronald W.
Conley, compensation task force, and Joseph Halpern, University of
Denver ----------------------------------------------------------- 808
Costs of Occupational Diseases, by Peter S. Barth, University of Connecticut, and Frederick C. Collignon, University of California, Berkeley- 860
(1x)













































1 1


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91 fj 4

P11CftE01NGS- OF THE INTERDEPARTMENTAL WORK-0
PX"XSATION TASK FORCE CONFERENCE
ON OCCUPATIONAL DISEASES AND WORKERS'
M, A:

tvilglixi', !ON AIVARV 10y 1976
US.SEXATEl"
&L TAsiK FoRcE ov OcCUPATION
PkxmFNTL-. ALD-rgmsm
lip i WGRXjh&'GD3UYJW8ATT01q,
i
-Oiiraviant: to, -natiee,' gt 9 aan.1 at the Uni vewi z of Cbicag Center for Continuing Education, 1307 East 60th j4owar4f tit 'ding.
t ofi44011 f J. nn, Jr., J.D., bir tor'presi
,Chairmom Bu-iv.'m 1h 'M Bunn and I am the D livetot
140 oititili6titfAl Tinskj"Iroio8v l 6rnd*or6-f s" Compensation- The -TwiijPre8idoikiiI TiW Vbrde'whieh has its one of its i p6
ftlv gA16151 166,kiiig, itt: the wo karW compiensationsystem and coming up wito spggestiops, recommendations, and ideas. Ji'0& Of' th04 ia vWttothe workerg"compengatibn !!;, vstem and 6ne of VW1 hwa's" t&-, uski fbr e js conceiened, with -) ig the occupational di*M44fti.'And'thN'is th purpose of thiR tonf rence, to convene a nwnber of Teople knowledgeable in the fiel&,to look at the workers' ftY*hAtf61a'prdb1&h as it, relates to occupatioh disease from Various. factions and various points of view.
*4U[icteAtehind, a'vingthi:ty-e:6tmeetin is to have an exchange bfi*w 'Ifhim p-e6phw, who I-eprestt nicarly4very:group who'ha-9 an 1ftr"'1iWW0j coniponatioir. We hai-ve tAried to kwp it well btdant*d and have people froth, orgarliiod labor,*,,frbm manWMent, the itiduft6d industi and, SO dn And, we hope that
V! ihedieAl'ProfesSiotf
1110r fli of the 1, te Aainge W46:,:. ovel' idleas that will be helpout 'port.*.,
'A word of caution to the people, participating on the panel and those 4 V 4 a at tho4ppropriate time from the audience may have in
Ufiity t6 ask &,question, And that is we are on a very strict time C+4Uj& lk td Iho,96 6f you w ho present papers and'those of you'who dikb6 pa, 1,4 ftnA: tho8d of you who participate from the panel. you "b* vj- Sti' = 4 e the moderator or T will stop
atAhe apjyi 6priiate tim
iitKihd:,c%1ft alne if, Ve are .. rumung behind our schedule as outlined on. the agepd#.
41M. tia *&,hdve-to b6 yery Ough on this is bemuse of the fact in 'Iew ftys, a:nd if we'start lag behind .7 have po Much to. cover. a 9mg
114H,111. 06*a t thtWqjrh it, All of It is vital and it ioJinportant that





2

The general format of the program will be one in hc ae will be presented and then there will be a discussan h then will be open for roundtable discussion from th ep1 eeo the panel. At the conclusion of the alloted time for thate ilb another 20 minutes in which there will be audience priiain h first 10 minute wil6t the E'yi ve r ',epecnw


At the conclusion of that time, we wIstop ,gel t hvpu sion of the 10-minute time segment an move an to smth m
At this time I would like to introduce the panelists adtoe l connected with the Ocupationlsa se Coferencm eraeafw of these people who are not here, some of them haveflgtthtav been delayed. Nevertheless, I will go through it and itouealo the people whether they are here or nat. The firt person is'Ir.Marvin 1-4 Amdur. Dr. Amduri h iee of the Bufilo Medical Center, a position which he hsocpe o many years. He is a graduate of the University pf Iufl eh O Medicine.
Next iss Dr. Nicholes Ashford, who is with the Msscut U i tute of Technology, as a senior research associate. Next is Dr. Peter S., Barth, head of the Depactetkfsxnnp at- the Universaity of ,Connecticut. Dr. Bartlh is fomr tcu Director of the N~ational Commission, on State Wrmns ql pensation Iaws.
Le me point out all of these people have very~distigiw k grounds and if time would permit I could spend consider~ in i, ing their papers and beeks they have written. Due totetm 6n~ we will dispense with tha4.
.The next is Dr. Monre Berkowitz, who is a profesoofenp" at Rutgers University.
Next is Dr. John:S& Burton. Dr. Burton wasChairmno h tional Commission on State Workmen's CompensatinLwad A the present time is an associate Professor of industrial ltis 4 public policy at the Upiversity of Chicago. Next is Dr. Fred E.Collignon, acting assistant 1rfso ~. ~ Department of City and Regional Planning of the Uniest fClf fornia at Berkeley. He is also doing a considerable amouto qmc for the task force, J
Next is Dr. Donald, IF. Conlev. He is the researchdietrfr* task force. Dr. Conley formerly was in the- research ae ihIW Next is Dr. Morton Corn. Dr. Corn is Assistant Setar flb' for Occupational Safety and Health, a position whichht eenlwsomed. Dr. Corn comes to OSHIA from the Universityo itbrh and we are pleased to have him here representing teSceayO Labor.
Next is Dr. Ernest M. Dixon. Dr. Dixon is the medias ieco o the Cel anese Corp. He -is a doctor of medicine. Next is Dr..- Philip Enterline who has published exesvladi extrem-ely well known, and I1 am sure all of the peopeariptin on this panel realize his snecialit-y is in the field of bi



8

b e sesor of biostadisfies at the Graduate School of Public IHalth etfiWlversity o Pitteliurgh.
Rexis Dr. John Finkles. Dr. Finkles is-the Director of the National bvtitas for Occupational: Safety and Health' inbfids Mr. Russell Guy. He has not arie yet but he will be here. W Quy to an attorney and employed by Bethlehem Steek.
Netis Dr. Joseph Halpern who is the associate iredthe dom the OmA lo 14-Social Researeb and Development at the- University of
1M a nisi Mr. Olarence Johnson Mr., Johnson is currently senior raiT pn&*last and 'geneda consel..for the. Arganaut Insurance Co.
064il 1at chairman' of the workmen's compensation section, Ameriean Bar Association..
I~~ Aoirw I alaykow is assistant general counsel for the American
r~n6 Asoiation.
.AN!4tj#Dr.Donald 'Lassiter. Atr this time Dr. Lasiteir is or Special
isint~rleath withOSA
4A~q~s*r. olm 1Eewin. MitLewis is an attorney in Florida." He is "4* worGeneral Goanselds'o the National ommission on State Worken's Compensation Laws.
1 vmfn tre is Mr. Xlie McMahan from here in Chicago*. He
ly m eebrasks anulpractices law here. *.
DrThomas' F., Mancuso, research professonat the Graduate
SdtblofPbkieaithias th nvriyo Pittslmigh.
NexisMr. Tony Mazzoethi. Mr. Massocchi has beed anp ofiial
W*4hi abort movemeftb since 1950 and is the citizenship-legishiive dieb, 1or *he Oil, Chemicsl and Atomic Workers International
'11wgisMr .: Noblin, chairman of the Workmen's Compensation 0dA~8q*R se acson, Miss' He is aso president of the Inderna*ekSAw~ashinnof Inddsrial Accident. Boards and Commission 1)-Nef is aug Bfen NovicoffE: Judge NoviceHf is the residing iudge ..L&LNebask court. 1Net is Dr. John F. Osterritter, consultadtednloacupational health 1-aloyedn New Yofk.
Pa NdrisPt: Workert,. Robertedwho is the indicaldirector with the Exon Corp.
Next is Mr.: Sheldon Samel director ot health shd safety and digoameoneder E.Ulk eat -fthe AFL-CIO. q<(Aiawond-dlse-whd is~net, here.i Mr. Richard Schubert, who is an aissistan vice President for business affairs for Bethlehem SteeL He is "3~ rnr UnderT o 1 Sertr *Tf Laor a* wil j i lae thi

nhe next. i& Dr. Irving Selikoff., Dr; Selikoff isapr6fessor of medich6elandliAsgsociated vith the Mt. Sinai Hospital inL New York. H4e i$ttey distinguished in the field of occupational disease. I fwe6t i4 Ms, Nancy M. tSnyder, Associate: Director for Coal Mine Workers' Compensation with the U.S.: Department: of Labor.
Mir.MarkE. olomnsout, of-the Office of theL Solicitor in the I S. Department of Labor. He is now dealing with the black lung programt.




4

jid*i thit; itdipated in; the a] P;ooAak;A be here fo: ke entire agenda at this t*iftFD7M jjfi)1ik6.WV11 qROCRM
alsoliketotak6tblWfitwttojtkaaikithdimf ojjbaioli thfttispiii muiy ilibaim btdibw iMAndih. W=,,,f*W M t .19 "ffjj
great deal 61ithm, Ihe'detdils efl 066) jurittewI ')4(f Ir
If 1 .1 i
',)Ao& -Mvik- jun6 Robitmaij jvho-it fit 03. the isthave had an o A itv to a know.You hav,4k
toan; ert e"Pkon&&ndWiA' awwrRML '"' WPQWb10M*MNW1k
ond else1or the jeonfawiceid6mitg -AAw fqrmt,141
to her for a zmat amount of work.
thinkit'119
that you were given a series of issues on wh ch at Ais ovo mssio ny WqWil11TY1b 118deblaicofigmWAS,04 tive to these issues, if you don't have/tbtwot*&wif3wilt(,*QRW,,.twA good' iddn'to *ectheni4sadtit isyour. attenticin- At, 6he) bia od iev4 f ima, Win 0#4 ii thinking about those as we go along. .; ,-iq-J fjoit) P?11101fl-10 P TC1)111:A*1T
If Ahere"dre:'auy. i0theit 138dfd/,WW rABd1 tO Id" AMA"Aft 0 consensus, we will
Wee
an articulation, hf,
-/Hhai iimahff,16fth&paneLh&9 not
.at the. 'ApWV
to my left, and she wi 11 present you -with any paper you might noMW"
w-ho, -hat spbnt t a, g re ", d m I c ot t U*D 0 tM1cannot be here. In view of the fact he has spent s*muw1Ai=dpYthit hb i's uuitbleto atteindj 5. 1 o,, ..I,, I I 4 1: .i
We are very fortunate -to have with us the IAb6r for OSHA" Dr, WorfA)n Cdrfi.!-AbAh% comments. ROMYZ
Dr C6Rx.,Mr. Chairminisdies4nd enhWea U6igtdA.
During the early plwmb*6f. Chi& t O'grew
participants w" b*tehded td thWSeerstaryrof Ik4bori4obw WhO k,reed toweldom6,us! a1l6-,11-standihur6Mr- hisi) law pad-vAnv" yot 1-68'. rbgmu. at Aab6ing 1with uk,, today. ilwAtell w-kis Ivid,69fCOAS successful examination of ideas related to these i mportmt: The good wishesof &mtary of Lalc& Di6r. 1&W:Wfth%W,
His.Oonlrn f6r: dCtU0&t*dAaJraifbtr &Dd,41cWth fis i do I am very pleased tom'-form yWj caimWed-tis th4ved -iqf XRWPW and, sa fetr hazards mi fliv i wark ehvi
rtto OSHA*ovurningthei* 9Qk1sj'!9"tS ahie to
Wn. not Wing
1 -.8 R.A) Vrwc 1 ,
fora.good,.MW MZ .1
WKy am the "lojeft U thebo'W:er,= ; xw ifiv& in 66 *WNSUVIA tbe pw"ption 6f otie Servitig. in the share some of the daily concerns of my office with you.











gh t heBllo, ihts.nsectsiond 2B of-hathtgaes th rgh t aaf nd eashfus envromit &3fas-0ilt o"NW.1wa ot o sreths a rat ere yapeitdb ;4* 0ICI ve pfesinalitte fdd.,whs ha o safetyestatistis where aodathe

r bae rit..d 4te h

.wor~~~~~m 0%aome. of ge hell r~~edgtory problv ocaz L~p, Ah. 10: p-reti toe. Aftr xal we dodsirect s so e Mq~q pfored i 195 re cingtlid in thealh area of l occu e
aly, M het.ri~Wsn ind my brief lateure nthn polar

gs coneted wherl the 1977s budge
q Wfflyutilze ureffecivnes ashe: prgo caoutnc reac Wv~w, w hae dta: chaive any videasuriemet of irnt u priorities~ knowlmanl y aedy mtaytlsadctowore dt eflici es
t~ifuzzin lems shoui ldy ot deiscoupra u rom ra
4hic4 cueobem eand$a laing som ase-Cho thati

pod .j~q, nOp oienbase for occupational diseases red h
Art~ee, hO-o iesfingl-g efts caon be ast w
"'4 ~ ~ t chevmical agts ein indutry. Kep&h
amles The realcalegts osr
C aiuab nd industrial envroents n hrol w
.mmon masolycim of thereuaoy

qQXM tWPa b~e34npranch oxprevntve, mdcn
=e In the betofalposbe& olds, pei
Ccrrnc of wrreadIsese




6
then, and when illnesses do occur, how do we care for those vietimo industrial disease fThat Iihagsmie16 the second: part oS. 4,er@ag Workers' compensation-ite abrngth and'wesifesses in its ie operational noder414 the companion subjectof h t me.t..
HI can only reflect on the fact that 20 csums years aowe graduate student at Harvard, the to-pie of workea: compensetft at thatatime one of the most provocative and controversid;0gtfa, and mypperception is it hasn't changed muchkin those 2 ye
Another aspect of the assessment of the problem is thtk .0U
fdotors asociated with these two topics. Prom my standpofitlse is inceasn pressure, in view of dwindling f-hnds 'in what hE 8~ called crisis of expectations of the, l4st to yeAks, to look very at the dollar values of every thing we ste domn, include g-.Intl OSHA is now required b-y Executive order to- Ifiifayiha statements. What are the benebatsighat will stcrne from one'~g,~t efforts? It is really not sufficient to talk about the qutalitative A, tientief health. Welars bein g urged to place edonomie6 vahimlm&C benefits. A practice which. has, been widespread idt the publid"e] field for years.:
It is essential to know the incidence of disease to do this. Or *# guessing at the magtitixde of the' "tle ansyedhn
d~ivd'ta te dn~t-wllbe "gaesstimts. So I sethO dd4 pinin this down in that area.
tFinally I would like to close my opening-reharks, which' A didate to you the sense of need -1 feel for clariicationt~ of'the edb6 6 the agenda here, by a quotatidhi thdi'gaW me'somel' aorceI whan 11 was a gradriate student. It is -engraved illi *th wllVrfh Harvrrd Medical School and iss Pas8terit quotation: "IUf isAoAn the arti long. Experiment is difficult and. decision is perilonl!? I think in my mihd this conference is an experiment, and id rtf in that difficult stage of setting thingsout, and I hopeO up with enough from this confereitee,o we can. go toA dealshlumaking, which I think-wo, will all age e on -the tb&si)f dissing thday,) will be perilous. Buit,'I think we ein improe" present situation and 1:hope this conference will be a maj&.d6 t of that improvement,
*Rwish, you well for a,,good contferpite and welesms or u.
Ohairnan'Bvww. Thank youl 1 (idth.
Before we get into the actual progtit ,thbte are two,.h!& pointsplI wIA to stake.-A couple Ptnade, psfre, bt thii
First, f all, the modeMati- ik chief ta-listficulA,.siA be in clhsrge of ,thAtte~ssion-sund his. y gtidn with toreg t6 ;f on the panel will be fh fk 1 itt'TMTafb:ard' STHfar? RI8 into ai subjecA tiatter being dealt w:;ith'at a later ses, h e. n hy rupt and ask you toget back to the main pointof that i act as a backup to hilix, and if I sense itisgoing-far' f Ied also mnterrupt.
last name so that the reporter may have that to-attribute theretro to the proper person.
Kep 'in mind" again We ar6 trying -to adesserious issues arid this is a format, or an effoft toward tryn to- imrve the handaliihg of workers' compensation cases in the occupational disease area.







7

01s.~~~ b toiat Ih asorewould like aoPeetteDrco fNOH h




thAa ............... the hargn t ave prehanI..
r garp wet i will gie i itl o ethn to hl-inhis difaummary i" to~~call th, atninso rhesaelistsepeiofr theBun




atM. An : lietora
dfistrtted ~ ~~s toufalerrettehquistion fo an elstadeks.
tp=itio in eacptina diseaiois. I~ ~ ~ ~ ~ agi seupaionawil dia ihtemgiueo h rbe.As
~~~~~~akyou nsefo h omti ilb e offh careful attnti pWfrm icols shorbenio q eeac massae for teia 'r PlicyAltrnatvesat MT And Iwoaldeie o oeadth question fo~yont ke it rsh4 mnorlid beoeNc ae addeepahi ques iaprn.,
ap"PI~te- the magitue fre the nextu8atondieas
p MA~tinkyoyiil ntie Dorshord inhis adpe asroi a efintio and1:esk ons thaowl eepay iarfu atlterto to



t'Ho and ............s eg th e .
quetin:Whto Departtme ofeabortes ureiate
4 *u he esutin mrdtmeant orLabor, NISHan
a~~~~~ Centafte a er oresHalth Stastistcsan
No.~~~~ ~n coopwcn ete at eraeeoe inmedtelen, coa i
dar *'~~~~~c wbcet1t eradill be give, thi nkx tog it yer? A04 Uo-uesti is alosewh shud later s ind ur discussio asketoaddessparicuar ueDrnsshfor whl om wpillagiver anel HOW&- A-i-stratiwih the mantu ofbr the prbleof I~~~abo~cul havsic fte eat e ofLrenme my paer "Ahe
su theNatiave eente aske ifIHealSasieve wanthI e Soc~kSieuriy, minstrink thpae qsin is, deWhaet, is it e 6vant tolyi belev oft -htw hv e
Fu~awwlit regard ~ E the otrers' cmesto sste t be apo~int if h sharsibloe appreci ateion or thesmagnitud .1 pwJ- oud: ik o ntrdue. nlikerindustrial jury a su mamyl~~ot~~hia dae ea disease maynihave: mutie preo upationald dieaesaybechrate

o~hefiuch-needh rfmofrthwrers complicate at stemato thatoedaptionl dieas aturbem oflthe pnsroblem. ry ubtn
ti~voporion f ocupatona disase ay hve mltipe eigy
ylhe.compicaed b nooccuatinal actrs nd ay iic




todanoe.In-diioocuaina iesemybecaaceie
byln ltny eidswih utercmliaeateps ocm










p abe seoused o thoccpins,6 hliinttA'Wll' tdcupaesnal sase iidctdb th, et &~b), &dt ta din aity wodrquie an pneddtett wh atmoingmpetant. Fthem tntti,6
die esemiromica hhevsilec tod bohtewr.niomn Aromainort uderlying qutin irnii our*WI din hde t w atetmu oe, et aiayht idef~f tofh prblent issnrdbe ft Aentrk fo 0sus~:o tepotit i ino thefiie wokrs'cmesaion sysptem.a'dsee cohenetian impotant thelgrapi hdt ffrit n sen11Ii
quired ~ ~ ~ ~ ~ ~ In foyetn nteptetce
lateo ddt saethaot t he dlN4 eat nkami r't1Y isteseer whcmpwntsfetedy iso olltinlot tion nigerlyn prntetspton ib ouiscsinttti ~oeC whichd we toatht~ ned to ko the nkgniitud ofrtheroe, twotheexe thagetvoral ontd iso~ie-~f probles aorkers chomnicisature, wysem ayi eupoe, fVoo palo opams opata sin.gi e1e~itbtb;Sm Onied th ting scer Whte or notit sftia
occuatroal morag much eniontr
Ths wo arebis htresbythneIoMde cuatilk n
ocupatahto diseaseinudsae ofteaiempolmad Ui worer' pyns.cladmna elbi Hou re ret the probems ofa 'or.-rsn oc~ainl'~i, thatobtere are three kindso liues: woaLes, cdwtha mem b* ost efpidmemiloicledec for thtsms cOefo the c cpaWtrona setting, e p~otinfd -i highpaconeain o fin muotenvitiat hazseeeshveis Other eidemtiolpocalevenescha calorein alo rovdiudes y insighton especiayiwmu aoepyno diseasewihi*acpe s aind






of tfie Osjul Act there waff no s diata,;on the incid e of owuplitional i ess
Pot 66d to- hij i '
,HA71; in:the UnitOd States. IzAftft if file, Os ct hat b6en th initiation of new, reoordidefi s'whi6h require firms to.'record each P Ongldi e among their empl4ees. Yet the Orgig dit 6hoctioxi under the. -new statistical re rd
Owle ;tetidus d6ficiencios: in the, implementation of accurate .0, :'dence of occupational
VWPU"MR9 j t"Ifts with"re;gard to ithe MCI
Acc ordimfr to BLS statistics OccuPatiOnal illness accounted for under
i*rbov 'th %Aal incidence: dfwe meAland
uPztiR ilbless
d*I V-%UjVV7,I iP%&,b#tWemjftIy 11 197-1; and .1972. IMe
late) up ion
i 8#ft at"" &I illness.
teglev6d t67rughly 133,000 cues of 'cupationkl
OPOVMbf whkh were _f the relativelynonserious
rmkfitiq fo I tx&mplei SOCCOUnted: lor 33.9 percent L of IM
& .- fisfiftol only 600 deaths -from: occupational
inwmo *040 ir*wkded ftfing tl* list t months of 1971, Yet, other
iltdibW thAUt-he-trAW.Mcidefi&:()f th more rious Of dMtP9fift9-dU&m s6betAfitiaa Y" gmtA
390BOO'iew eam:of
&kMA dMitally. Igpidianiolp&AFinal : Beg of excess Mortall
A_ _AL 4, t .. I "I
MUM "WO&VAill 6641ta illi ttstrift suggest Mt ag-many as 1001(w hO it) M dt of oecuj utional disease. 111ftus we are wow4meklmlh*64 dl ftifi,6ccupitimild am ;;Odh ran
lrdwia*6v I-1.000 io ,00.wo aumallye IMere ij in&. rect evidenew0it ,*WId"tM-dhnu&Ay WA. rious the ing6riance indtng "i"'atesthat the exc4p AN"j, Id.. Am" : terms, is su. ntial. amopg cert. in
ex&ia ri& ig on th6 order ofinagnitudo of 0 the of deaf thwhichwe f am, in other words, the probability of w3 et eetem facing members: of c;rtaiii hazard 60 Z04M *g in tciW6 grmte than twice the norm for a
MuOkid-fthort & AwA from t.he geneftI population.
pati6i 'd f wtoi F well play a far
i0dou Iij aj L e virpftnl W
:doreAg r6le than! ig-prm ntly realiied in thicausation of the
Bd siiid health probl'"s which face us. The statistics I
to ltiai. are a di&Mit w of getting to this figure of 100,000
qW4, i0mift, le did eWry. ear.m the United States. Heart
Oth6 IM.11ise of in the United States, is only 25
lot, iined known physiological and environmental factors
O#erv 6 t hy on, serum cholesterol and cigarette
Ooi gh pertens
il 16wn, t.,quite possibly substantial proportion of tbo 115 lpekint 6f heart dimm risk wMch is presently. unaccounted lor',oWdU related tostreas present in both t e wor and general AMV
-what extent t1w stress is inearred by exposure to toxic
',. Poflutiol Wor rem om the Psychosocial aspects of the work
Mwnew& .U V 'ry dilficult to determine. In this regard it is. inter-









ho hae reinth strditona Japanese vineialus,.mld~ln ofth thabuthloe t f heart disease.in act ay hve averylarg


I has worr r ei la stres.ult tht. n cmea isuther eond leadigrause of dAt )of
the Amewihan anlftllehbtahg ae of. 3(e5000 Theriqqidenc rao idly witaindthtraitiona Japin es v00ues1pdc not nt* 0 trpesebt byans 1968 p. therpsionk ofths.d4fsude aWt 1percent.worInreatd imtredinsi.nd C(ae o the esd eaing prvlgs afpeus. dealth i8.th nt4:te toa th trus incncetl of 36cance. Tincifo o f acr<, W

Teo Iderask fraice of sa pvos azinlthsougs eebeso

science reported that there is..-abundant evidence thateg tmor ity of. malignant neoplasxnasprobbhly over; 90,peeato h*4a indeed maintained or promoted by .spepcifac enyvrnetajers 1Many of the eknam; environmental causes of cance.o uphsc m chenidal agent ts that directly concern thoeonviromena ~~ip sessions, aerginogenesis must therefore be regarded, soeo~b ms signiificant potential consequences of environmentalcnaint:e' "Of the '80 or 90 peent of esner wh.elh could:b ~iown caused,..itis, not presently known how much. is ocutonalj12d There seeImy to be -a general gonsensurs aman pance eewhw
envronental1ists that one-quarter to one-h of tifgr iM]a plicae b qpeopational,factors. .,
Th etp ertince of chiemfistp, asbestos workers,-nego~ qruaw iniers, an most recently rubberw'orkers handling-inl well as other occupational.gous amply. docume cess cancer of various types is indeed occupationallrlae. 1)
This next piece of evidence is something I pickeu qi?, it from my involIvement in occupational disease.; Ili 1~sIwa ~d 7 statistician for the National. Air. Pollution Contpp dii~~b that he had observed that'chemists as a grouLp 'die 5yassqo,4a physicists or mathematicians whose mortally.4n ondt c& teristics were essentially -identic. al. These findings wol1p~t~idd chemicals in general as.,a cause. of death a.nd woul~se-t aeh suggestion that only a few che micals -are -doing thehmiprbvlk
Te recent work on cancer .variations by ,geogrpialrgo-uh United States :released this. year provide es even Ioesbtnito that a substantial portion of canc er in our society. uut rm h n dustrial process. The high cancer inci dence rates, aou~ht ae by the way, are found in what is now becoming knw ste)iie belt from Washington,. I).C., to. Boston; in, Ga d hcg i the mouth of the Mississippi-New Orlean~s where tednp -hm icals accumulate: and in Oakland, Calif. Cancer i ifrn ih














cute ares a Ingit~s teityvidigestedtowrhe m iedo 164clithiaadisdi oign ff chn telnhiepolm 1,~ ~ m 1 fPfiu igniaen ie rep orke byo the National Canter &o~~ k i ti aprpitel 5idhpaer, inaer in althe nn deth Uniedtats onie fith Chmnths ofn1du ste Te rt the
nyro woighritnhsppri.a endwnt yteto
a~ a stateia flSt kdteewsanyaSpretrs
ainer I 6 ope yo fecaea Imontinue 195 to larmeaed io~~ris r& o'id;ng l oiey tadehai other anoede weon do. sI 130 tmxte awhe ofe heia resrtry isymst hgh6 coeentrepted iThr 4u~j~o ueas re pon in the nitedStates ndushaves Iecome excjor ,!~r;n n hara isabilito hrnduial eboehiti an e emthysemisare
*&Otr i3O~n ting dheiseae mte Uite Stesh. The acouneltion the thftlted-Waumber ofdablsisudrsociale wihseiiaeoi softecurmiyl andushave .*w~~~ye sine knbrocuaionldeizr I, hl thruggers suew levi-t

oe r,th potioanta of petrohemicals pnteUiedSaema
ned yearly ineeerd oe notl parov1te ncsldelaof canerch bsceriby o litc peios man y eexpestsd ta ,4*~~~ eiif thoer th neext2 tpilatiadm sigecaioantl o Aide,*"cosiable ediosatabeathtygeablems toad heicoa regulati u genpeal ohemalt proes. QkW ret anresiraor dsasetic plaues the watorkrnalsote fw~~o"jo elated. oth spercific disease suche ancoalorersh
is and genral e mpnhsm and ch7rnie brntis- can Now, snal oy riin.ultm oet this poir ths endan t: evaenion Oa& inat d~~isa cance, and treiaoy sas w-ereen mrfac
relatedou tham eligimbers of ouatonaly chaused tau 4 tte nuber6,0. hus, the pulicht serv cniue etimte fasme svL*T5*r)00n rma int bce unreasnabkole.e Lwie of,0

the fa~tes aryin wisaye outh f ied tts hyacon o h
............... in m e ..... disabilities -under......................... ........ socialiecurity and hav

..................... ev r ............. iiiiii W orld... W ar 11, alth ou g h th ere iiiiiiiii~iiii~~ii~ii~iiiii~i== ===.......... m e evi- i

iit6 4 fa l t a ..................... b een reach ed ......................... '
.........................ing rate equals that of petrochemicals prodie o ....................... A lho g .............. doesiiiii notHiiiH~ii prove i~i aia s l e
Vbs -hsosraion 'cupe with.........y..............................t


IP4i

Ahmial:';n ohe suresofpoluio cntibit sgnfianlt

,oivcpitoa nd, nioneta eat poles adhec t Wpfpir of0-ur:enmlhelh roles ..Mueh of the i~ii resp iiirt y disease whih............eris ls





12
Mental illness is another, leadm g public health, prOblem.
be far more extensively job related than n*, re^lJ*d;, TW-o
contribution of occupational stress iand hazardoUs,, mup I nu ior monotonous working conditioias. to. the p Of =011tal
roluooooal:
not well understood. C I
At the present time, though, the incidence of %neaw hift4h4woulems is known to be substaiiiial. among eo0n, Recent evidence that certain.prev f6ki is of
as schizophrenia-may. lbe caused, by. chemiua, Wnts. adclw sawther dimension potentially of great importance to. th6 posaib1e,1fiftb&*O[a* occupational factortanA mental hidalth PrObIm'-s.."
The Di cher study recently' a
y mo: pil
showed that 31 Peremt ofmedicaJ:cmditions.,found,'M. were probably of oempatimal brigiin; 1, and, an, sdditi it of suggestive history. The probable occupational 2&4 per 1,00 workers. This i's impoTtantbe ause,'oblygtpere ht)6f this occupational illhess. was r &ftedonthe: lo er, ,16g:wtcfW*sh percent was found in workers ,coiwpbmsati
The occupational disense,,.profiliB in the stii4y, diseases; once; thofightlo -cozziprise the i btdk account for only 18 percent Hearbnk-16saASIDISr 99 *msmt. of r 1 Lr) 1 The remaining 54 p6itent xm explained by toxic eff ects,: eye con- editions ;' allemlai ttud diwa s I -arthe tal and connective tissu6g."Ilds s irvey iorr6bor tw -whatithe*Ykka epidemiological studies _msted. A large, amount ot serioiiidiow couldbe of occ'ftpationai o gm,.
The above.discussion'touchas only lightly 40n.th"aturi and dh4& sions of ocCupationaf and: enivironmentaidiseSSO., Th&M,&r%,iof(emt* numerous detailed epidemiological, studied sliftkingspizific oempitional hazards to disease. For eiiample, chrdm'ater' zand; arwftic-linlmd C Honest people will differ asto, -where aii the sp&firnm,*N1Menw fi6m suggestive to conclusive- any pArticular 9tudy of th6 Owbicil
pants of this conference wil.1 have, or knuv 'Of,: additional. iAf6fvthfian sources.
My own observation-is a's follows': J[nithe 41,vewwdunng iviiiehAl have been writing and speakinkonthese T havelvitnes d)btu4
after study reveal more and mor6A&ease to be-of occupationzf, MAitij
am afraid we are sittink on top of!s very rm l and,,u fbrhinatWy large occupational: disease problem.
Those who argue honestly about the -validity of anypartimlogriAndy will serve the valuable f unction'6f -e couivVng avonsibl(* ieiarch efforts. However, the'policy quesfiow is really focused on whatqual of evidence is required in orderlto tAike politicaLand, aniWi6rativi action.
The present costs of workers' compensation. of courses d6-notTe&ct compensation for most oocupationaldisease.- The, piroiected ,( wm1d depend upon whether impaarment swell as disability'w-eve Compen-L sated and on compensation schedules -for various &-grem of, fimetifflal disabilit-.y. It is worth notingthat chronic disease ivhich: can I wo-rker impaired for many yeari, ,Mn with his: tondifibii woiseilfmp over time-could ran up the cost, of: workers' compefisationl evear if compensation were conservativelyawarded in meh. hikanm




13

.. "disease imposes a large social cost an those affida It
So SuIrprISe, thereore, that mnenalising these oots thosih
pompentin would also belarge.
ea.Thank you. Our furs at thi paper is
woas you heard is a profsso ot kinstad....at the
Saae of.a Public Health at th1 Uniprsityft 1ittalmrgih.
F" lame lk Ashford has written a book- I hope l am
nd n IA think this is a veyformidale maage t given to Dr.
bat is to estimate the.do--oan dms
sahe tUaited states I ifweg the worer congenstr clarlne factor that stanl be cosdrdis at what os,
diseamiatobe
a9V -ith T- Asaturd'safnt of occupational dise.se
as wv'ch s caused solely or partially by ccunpainal father
this' is Abe deiia inosnt full-coerage work comPWMW -' "Um think we Aus asaeu oee, to separate

posem A-ad. that the wa piterpret souse of Ir.
commnts.Mrk wed on th terma environmental Think of thsas b. something in mank~
pJim,= I befiewe tis is the sense inwhch for example, the
SL ~ that so 80pent ofcnce is of environentalarigia was
qwas, eling Ashford'spaper, and to ilustaten mypoint,Ibhapto an artials in the J*nuary 15 issme ofthe New alam
PWedici n nmraity among Mormnan d non-Marmnsu
asuonshave a much lower mortality ate from nedrl aRl amkee, a fact attributed by the antharn to tinr way of lf-T. O fAmn tobacco ia alcohol. They didn'tmention, or psil

A44. J K M 0 8isam my view largely environmental, but probably
O~edt9 hnaustrial ytronemsW
is true that there certainly, for some diseass there is an up#Wgand I think cancer is one xmle lis isonathingr that we
Wou. ay 1975 was an unusual year. 'There wes a fiu epidemic.
appaadlythe reason for some of the ober-atiousthat appqrmAs the original papW Dr. Ashford preparedthin we have to keep these trends parely in parapectives and in4 theme has been improvement in the lifeaexpeclancy of the
A ~worker.
It1930, for example, at ag 25, a mainentering the labor force could lokforward to 41.8 years of lie. In 1950, it was 44.9 years, and in 197, 48.So, we are maki-ng some improvement in spite of the increased
isls ]malzaton
11 erailyth situation now is probably better than that which would
haebeen found 20 or 30 years ago. OSIIA must already have had
som impact, and moreover, occupational health efforts date back mn thi -.mm y...at I asa 9A =dNnOIpoably a,i-meeetaon















T fhlly isnooin f't them varato many as1 tucti~. # teced azrdsbilytn th enirmeall suthiwtr16f uncovcaneer aId' kno 6 f hlheiatil fondtkit W b alarmnfacntdre oterlvrontextftaisfmetin i miii, i for g some rrsswhern involdi in tSoe " Smofths ars ocuatoaby- aeth appO a'aiv 1
vons ~ ~ ~r when herasnd ht fvai
woul hbe occueipactonl whereas. ifkes femakaibil 1 ofth rfacto inorlatosmutbeivovd
Whatis inh mirrnit' prablytsigifiecatinlhd
hom ale ca ri mortl y is as lagea busiessane moraliets th tfl wes besm ocp of~~ tosecs i al occupational as, po eape or tal inlences
said clall this, tr is obvitou api Iaito don't*H withi the U becttes uch thuht. Peopleaitin u~ studiedgometphing vartogra icoroar ointdiesyit6htcs of d ofnortalis45tyhromg chroni broanhtawr ve w6*4 chan e nionebr. Ashd, tihs notsqenl p ol ie mayapdieawithi .B.b&e., u to otisiviO64 Ian iggngwenh realot th ats f ditoswr o a~gpl itmigat the ocptimeal the die..i eae aidi,-h sbi*

atio inemlesnpern worlt msae estithegorpi ir&
robnmntlemnfute s e osnst










0,, hu~ 4 aention. An I won ie sder ble arih
ofr atipsmle occpaioa hath. pobleng popxilat
*'eq~~19,.40 Doiny. wit rd.orf and tp' theis.e futer ami #U~~s poil;4x.na te Ifink it woul be ty.oeriblyimeaon
rdsthe peeraltncesiae ofayb e.evenonacr1
d6t h'eop:f .cure,.wr'ps omea 1W.~~q gqxt-cmet, I D.ce rds audtuteen. Sou e n rnrj ", I ink o~ee a ten rpoeof th mee tas coldrb mnee adeoah. ould'tel udscp
-Bbai unde.s expa~wnder woe coprts
'lefo reetssc asthe 4 nube .of c
t hbs, re relym tool difficultol ranlat intoa
Afford as mad a. goodefforthe an OMWOU~w, th dt ona hie l',Itikis assigd betralypl.
nMaph youas drteEnterline, for thatdencour
ko no.,uretolonre secnd discsbn, Dr.
q pcial, Assditant_O forest Affirs atmestheoC
Health Arclminstration.eDon
ao#44iH saqdWnie briefly some pupsof thio petig
0 4 A ~ilordo rough because, nowD. wdcelu h Q1 dd ii 5 anuesate: myoresnato d

A.shlord presented scusse the magnit oude t a Y ieoal sae as inodifct by' thaae sto alabl

o knwt ha extntdoe nee tood ko
911ure of, the problem in border t maeffor and ce
wqgmzps o to there stuaons asinhcened et rya.
Yxxx=6e lharge yucer.intferblem. rthencreai g ibutngw fatrs tof occupatonall dielsatD dise &'sster h. i 'venta expsurestan lrgHeat numbers f wores.c
-whe staisic hemntoedecportfat pit
take, thanmbr ofddcuptionall5 iuefe y reelatdn death u
natilre ofccupational lread disease per yeartdb the retaalal v






in' reported detthi of befw 160, -fitpercent of A11hekztAi86M;iS -dheklbiina, ihif 80 is of environmenW. origin, of n4d'
of heart disease or.,canc& IW: 6 jf9ii can be contributed a'eartiih'
.: I .
This automatiWI letive the rob fiali t6ftPZ Vlri fi 611fless of how Want t6.:divvy that Up."If 'it. ii 66' Vhb* ''*4 10 ... t. I
begin to find other muses fok i*ch asq46 r
t
mental:causes I "thai proporbi wi: 91iAnk. -1*1
scientists in the 'ecology fi6ld agr M: li, lkik ('OorOioft.a cited with environmental factors, Tlio im6bikA di to occupational environment, either: i of & reft 4f will not be known forinlany yo ml, ." t, we' ftding specific instances of direefly, u s6 ediii 77_T
exposum
fi T;,10 fTi
But at this time those are''largely 16ftov r- 9-U
I won't mention the incidence of th-e ib of 5.2 ')rpefift 1A except to reitemtefhe fact evein x'stimll inck&ft is 6i" dsb :
5.2 percent that raised some 'a ='iety Wig [ -01, LY
T
Keyossaat the Cancer ln#itii w, a %W" Mi'm mw M
IF think many can takeisElue; with: t6'i;e1hibility, ftifdt
nation reported and with eAmpolations; based on suWhn infoii WfiA However, no softer Aitistics. *ro'itvAilliblt.''O CIO e*7V A4*ics i f i I I I hl;ot f
lacking the same liability.
And I think we need to look'ok. the
r "sed in his jq br concerning t6 *TrAt r1ri e r, lnin to 0 &.M,
magnitude and nature of th 6WI '6rqei-;b- I
solutions. There 'is a'sec6hd queition,16 thu th6d#h,,,IwbAU to find out?" Thatis, A what point does obtamimigr, reliability Cu
cally feasible. _V
I think this necessitates 166kifik'a 14,htAi4ri.' 1316k i of inventory approi&, Alid it 1 1 1 ()
is bhO:IOMMn*tj
0 1, It
13LS are currentV, indiiitori#g ii te %, 0 Ii. k)* latter queAions6oA66rhih#Ith Wmakpittide 6fffid ptbbINA" an inventory approach to find ottt d6e 16
4 dift, 6e Ifti
bow can this dstal;p4hap; all th6m,-dht& iddi4e.'Cofti W:b* Ofi problem'.
And T believe llo*a4 Bunn *ffil, jadtr ititivdiied DtVDW 113lumcner wbo will provide additional comments on this. 14, WI
Chairmaii B-uww. With no fOrtheir ft& V6hOf.
Dr. Dirscum To -di"ft WRIT
and its severitv; to.knwthe bwkuhl fdOYmi; igob,611-ally U Ordweb fibsence of en- iroftmeintO st&AdhI'd# "apolicaMe., t6 16b 14 OjkT4,-%
ow the occupati6Ti -of tbbse &&dM'V 6f iJ digit w M
the many contributing factors that can be identified with VAii AW &M 6 11A 11
ease; to know all these thiiiOl 1, thiftIt it it, obvtqrii' #MtZ IM TU range -of occ-upations.1 di&& is nbt v ittl thkt I *ihfitb% 'A J"t"YT
body can use it..
W6rkerw Corhmilsation wq 4, dau 6RSO Preghw&* bona lid "U86d to Priorities
tolhealth.
ernment functions. And there would be an actual proposal then to,






hthim4Ad~nfmtion, andJe, when one'looks for utilization, of laePsiation as a major resource for majorocatna disV or Inay statistical data, one does not find stich: a systeih. And I
i~ateq~eidnshould baked, why not t
Avproposeh the 'edson is because workers' compestioil answJR.P& erent: that one cannot collate disease data, for ample,
oiurisdichenhs. Or that the mass of the claim is 3 ust pimlyao costly to process ,considering the way claims are prcse
**t&p~potsintended. Or that the diagnostic poeure are too UtiMXIM t;r. that esusal'testors are not suffciently elucidated by
thwOkit~onto ben'haddl in planni prevention programs.
[rmAsualpha conclude that even if all these problems were ignored, I~kbdii a orild. be dwelop~ed, that occupational safety and health
psead-eratestors probably wouldn't pay any attention to it
I f 1,aW is good reason to accept that all of these'are in part ait~m y th aft sengahie: is fairly shortsighted, aid I hope I eiri" captain this?- Me I SiR.I. has undertaken an evaluation of various
a axehodsfor national ocqupational injuries and disease Sysagyp~opsin a rfrmance model which we feel will be as stop B&A.ewdNIOSH and jthe program opdration. qh.Ivt we eks with An examination of 16 potential resources. JNkww agh dsoeoteend the Bureau of Labor
imat ng which is the only onie now in operation proviling some basic purposes of the national estimates, was another. I .ma~k 6 .*,& Wni.hkM thoothit it. But, eabhwas considered from thao~point sfemigting gaipse And proved modifications that could a gdthfWi*I G1'overwhent progiTzhp in setting priorities. or in
es vmw aniitted thdi iformation abbut Job injuries and Aiw *ane tdokden in a vari ty of ways .and a nation~asystemi would only be a -partial answer to. a indj'lr lbddi, moreover, we, emb dWhat rentedhIipodshe than hew and bettirdati basisi, the critical q as 40 theep -wtould be aO evnent gradyd ed to link=the better dati to the wars'df the' (16vermnent progr m sad to ob8 tl4 see taptit4H-the des igd' opei-ation of this Ystem.
humn alk'tdygaps and tira firoblems in -the worklAftogan hdim irmwe am tg ahead an poosingit as one kawhyd1 of1eViding diWuse stid injury iadidw sswt en
WI&8@9 s6*ertY, an& 4 way of providing for seveist possible c a shdehiLbrtr elm nreed hti siicli A syAm.
@h'palaioncovered 'by- wobrs' compensation is a, problem. Yet& cluster of States does have good coverage.' However, to say in any 8t thabb StMtbs% we know by ceasesbr aniy other method the populto
at Vdid4# gxaly tagerae te workers' compensation system and Ihwit 0 gspeY61tates. I
Limits on allowed-or. scheduled conditions also represent probems b64rth wlt) ort1over, fulanoomplet recognition of theocua tidh8%Wovis tbedr prblem thani State leislative restrucions, kM ff WW tt etentty onPhysicinedetoanprcc. SiAle] Itiw p hig laif be, structued'so a to furnish
n..... mAs for cal anslyin we view this aspect of workers'




J?

f ompeusation as a fsvqra le e tjf Aqv
system., -Assuming w16' ,ou4,mg 4 acco dingtqnaflono- d 1* IS, 4 it i I
you about n9w was, from [A"
stPA4,9i: Jarst Q-1 -00 1*0
O&UPational titles and nuio rA It J PIS
"itor 1 eiric '4 ,
nurner exid e of *4 qncupf4opal di" Tmd
processing of infqrx atiop. 'And that led iista bmasid ro 'ht bel lj[ i V W, m" Ymv 8 A wo tw A)"- a i '
a morbidity,, d iiii
would 'Nb o'-pp, k 8
.. pro. a- IvIotIR 4 "am,
b tU Ved r '7G64iiijxi6nf fie It -h
an annual -saiiiple wo 14 require o certified States X4*
the submits o,4.?f &A
q"
611 the Ai an I t- -at risk.'*6ph,
p nt' a pbpu a ioir
me%ni f
v go into
ace C I
'We w- uld- fii nur
Crucial. aspect' uf It to- rqaf, .,04 ca ng.; JAg and, qua j Y. e of,$az "
control te, program Ali, 41~ *"*KNW
s* plin
promise, the nation, g__ CIII
wouldial'i to C6-opex! .
Solut ions to this'are not readi y app*irq4t,,ReWidjaM Af j6v disease is: recognizpd,.g a-, i, Pi edjj.i -,qertaiw If4 know ho-w much is T6 rdp&ifi W' Imi hiMurr
trievWe'systehi along*thelin 6 s bt 'a nation; I CeA, I established on, an annual, s4raple. w*icm Cijj row ve
been.discussed'ma4y.,tir4c .,aixd theAeeO cedures is. no lessappi fV I I
Perhaps eshow'd go-, h ,our,
W I aJ -OiA TJ41
our national esfima ,fromfhxl, 4ust ,rof.:Stat s_ williug, fied and, aheaA. A delk* us 4aj,
90 alii;cp cltty qq 1Y 9xi$t& vAlt!"
j
The potential beiieAtri. pf tl ,- rw, Comm M;Ltionlipridew "W withAbe detail of qntribntiory, tAh, to# ; Oaf
are in those records in ;L.'smaU,,44v*terq. the. cooperatioliek, nt I M
tion we now h4v,,e 184plie4-,to 914 -,aip wp4w, h
A 0
throu ghthe Bar -'4- 41.
In.-f4d"Ma q rit, tqj4t-9r4 *e W"P..
we.need to ponsi
The lasfque4ii w 4.
raw, t w W_.2v(0q m
we do obtainit Se,
-Ar wp,01*0
N! this woul Ift
grams? Well' I thin be a Justi 6 on
gvej9p 4uch a potpp j pt
04. *n DW
-we;,
,1!1 6onelus* Rr
"t uu* gh, t i pQjRowd 7 4
i ude','! p f wu p at ion# pj, L"
e,rp I I.E.A ':
_404








sn hi cotret wewreorape 'ih tmvlbile nefts: 6 Cov siset theoerm enud't unep a tvI 6 i ekof'eopat~han' ha --st disease teoggnt pro e or,

thit~~ Chaht o, sirman make ao oea



t h e valuators in o n dersa n r.
is of rase, t Wasios, ampt





.son did weo traziowheedsid lie iprevbtth 'B and woilesl co'mpensa






and wen yo eia hnet
C d e te upsios, aied y erprenttinema ys trho erpopulation. At becuepthbe pur

J .IfM 'M~nE R.,T 40, ok etesedr wsth s ai linge in stage tworaof
kii~~~~~ix anhtatwa the diiiul a en h envonmeniltalo V66t~~~~~ confWOS _'n teronet thepyicans wr ithgave
J~witk tht'.istibuiono wotrers thult hadte hiest xproble
6- tom' bo ised, ampe:s nd aplet dpa~ ~ ~ cU6l~; 4a weirkd; backwardnd youca only ~ 900 e or soeope,td e ar tion~ha Iat was suprse atte the numberd1i &ia
.119A & litter'p~m" n d bsu t on he yothe h an I o'
id t I thik hat eaoncblude thre fismanrt
i~w'any oppofrstuity for' therqueions.
oceed~ a tothioudtbl Drt Ahorth that~~~~~ whdy oprmse h wnepeat toi me comnso
Ott 6-&- 6& t10 n'will lea offthe discussion.- u-eas tepr

I -I Ti I' r A
p f ~ f of l 6 W ik B e P i p se Y d r o o t mi e t e 0

-nrntt6 h scin~wt! gv c~p~ibnal dieisitigos, w wbuld, bo
t~w ph 'hd theihigest expo
gaynplieg- o workers thi



Di, m
hfr tht as urrse t h 1ni1br

diese:w, on -bt te ohr adI o'











Ther th e twrg pintio of thish co mereheehi oneer i,








bael ae a. '1e h Selikoff as 0 notuhth ofebur 6.i Thfeene ancuo perre and liae CM :T Itopisa quit clerio tha whlegAshfingvnn orrW Se~q
ti








givbemees if otrs cmonstonitms perproieCn w psntive ben ghiv ern To aysoe o rietv IeW e~wAl sose.t suda be selfeden -utheviwons'o*a bie otfeed' yte iscst cane sfteer or o h'xa~ ne constdrainta.r lcduohm Acchoraaingl if th rcis ofne seeallviulbo ateried sontribtan fltonsdn to-dim tisq q the proeeins ouldeindiate thereresn thi, a
prvearei dpwrit as criticalreview of re fat or yO the e proceedin ado -e I~ 1 Q foot disc usts ere unro' giv menteti or i w, wwP- 1
i. 0












papers adou that accoriyte prepsi ofe~ vtiewpoIins ofpthen rom nder coide s&M qr ,4y viof reality.l

Iarent tht the recor wville so':'e indicat
unhumiiiiiiiiiiiiiiiiii 'e'osler itoo:e' 6 ~ ap~ i ~dy ~ d
q u a t e 1 h a v e p ol.................... ................................................................................ ....................................................
dayiiiii~i FeNi 7.h f4
ThAhor a vial!o.&CSRS61Yh~y 3

baeyawci eikf W otqw odugmt


Febuay.6.The Micsopapr,&Ri ,:ie ay i liiitalq i08 pages, wliinot Iiaiilabl I asflebruW, 3
itis quiiiliiiii=itclathtwieAhodI eioj nfacs xwtu gii~!ive vies f o ots opesr hi arfta te ie
ii nt ha e-ieenigieniid ysiriiisiriiiiito:iiie ai!a
spne tsol lo-esl-vdn htayPrpfv ht
beiiiiiiiiii of.... h isusnscnb svrl ic mcrbdb teie constraits that re lacediiiiiiid
if up eisiif
Acodigy i rcedns fth ofeecei*toth
iliiiiii(i





21
44 point I wish to make is in regard to Mr. Ashford's
viewed this paper, I have tried to constantly keep in mind
St. Paul wluch was directed toward the in-habitants of
gip*11n. ormnthians II, chapter III Paid debates at length on
Chartyinaconcludes in verse -13, "And now abideth faith, hope,
494 t~qethree;- but the getest of these is charityy"
opAsI 00 ith charit tat Iconsider that Mr. Ashford, lacking inih into an understanding of medicine and biology, perceives ret HI~p% dime --o-a dmension, that is oblivious to the perspeti" *0 isqpnes may. yragto perception of reality.
.xgnores, or is ignorant of, the biological fact tat man's
4"Clit" lendownent determ ines -man's resistance or vulnerability
t saes. He gives little credence to the reality that man's
4 4 geneTis~dowmnent inexorably operates over stan's entire ljfQT ad pla~y_ a. majppr role in determining his life, experience,
apd seas experience, and ultimately determines inlrge patbt the tune of and the vaieer. in which -he. will die.
.Abford has chsnto ignore,. or is ignorant of, a vast'
le a biolpicalliterate dealing with the effets of soeialat* Wp Ja a'heath and well-being.
Binfly one might refer t4 work of. R. 11. Rahe,'whi da
VM g.44 thei h on health ptts This inet ti
sod 6:mi n Thoi.l i Stockhlmn, Estshd in ,
Keonee of'and! miiS'es mn de inhg with Negroes and Mlexiean Me iw 9 r~t41. in, 49plig:g with: native, Hawins-l e
Set s ha early Aionstrated that aly kai. marriage, divorce., 'health, and 14 'other.
1erJsts, example jaldeeton, sexual dB$4tul-,
p q=qs friendd, and. 14 other events; work events, fdr'
A ired, retirement and 5i other changes; and financisl,
eVW*1Jor easmple, maj or change, in financial state, mortgage or loan ojr IA~ and two other events all can -be scaled and related to the
a ha4e in health,, independent of the cultural setting
Mso ic the study subjects found themselves.
oghMr. Ashford inter alia indicates awareness of the fact ttt e other 'factors may be operative, th weigt of this discussion 4 q p-oA: prlankwsociated. factors in disease cansality. It is to conI angeeslnce to this discussion that I feel impelled to interject

epd4, it is because of the purpose o~f this conference that I believe it1 *4importaRt, that the record show that other social-psyhological realities. ar significant. determinants of disease anddiablty. ?, T hose realities of our onlture play a role in precipitation of arterioMaleoti cadioasclardisease, Rahe et al., 1974; hypertension, Harburget l.;accidents, Selzer;: and diabetes, amongotediassae.
To eav a ecorcl that implies that work alone, ori oh n, is ai
detct~inntof isase and disability, is a monocular view; one lackng i eropectve anda leading to distorted view of reality.
Auieot o cideMr.Ashord -that I make these comments. Simply buse tesop qo mins are dironten toward eliatingmnmbin in,





22

disease causality an'd woYker7 and self-evident, that thismore balanced view of xemfity. be part of the record, C,4tailily, if- it Is sociefy9i Ii *it disease and death be iiiternifi7kd as ".9,, cost of, MLor
business socidi should be mado clearly aware 6f thoi alloca'tional inappropriateness of such decisions.
And for the sake of Mr. Ashford'or anyone"jalsel, IEhivO I'm 1144 bibliographies which de'al with this subj*,' axid. 1-*ffi vbe'.,g-IiOlo, make them available for the recorded
Chairman Ruzix. Just i momerit- let me m rrtr L 1%etti' 'I[Ir I 0
which I think possibly only, caji:'res0hi4LJ I I couple points'raised, w.
No. 1 was the question as, to wfiefli6ir or'nqt there any formal pape rs in Tespowsd to the prmeipa p Papers, &xid th. e answer tothat is, that it is not ctdteIn- I's if anyone wishes to prepare, I formal T"Pob-4616i.* presenteA to the Task.7orce, we 'Wrill'be letsed, W "00
Second to cleax uplho type ofiisk fojr661
gressional. task-forw.Ilt ig a,'Pre'sidential taskjoroe. 1
And insofar as the thne for ondmg" to tb 6. pri ci
MP b 'irtu 16 064mi0ft'
think that triat liag gotten ini,6 the rem d ly vi e6f, that. Dr. Dininah made and Dr.- biiiidah: is theiff6diftl W&kkoo lot ALCOA andwe appreciateit*& mucli.
An 11 hifn ffie-oai 'bjt
at this poinfl" I -W-1
'Dr. FtwmxA Thanky!Dftfb] SOM i)ftt
Mr. Samuels..
Mr. SAmTELs. Dr.r Dinman'g i" xhfiyi e, t, is bf 46tbt fromi :.. i"tfi .1[4
several- pointsof viiew p cu arj V si1660_ lie- ,qu&;es: chaj7Qes that Dr. Ashford is ignorant of medioW6-and hiolf OP
The Corinthians-knew'; bui I)r. Dinn2fim dOW: h(4,-41at
there are. sowere liMIkations to."man'g institutional -en'dowiu0dV9MkVft.i though part of that endowiiient,419 gelietici ..tho: 06ri "iwwuwwand latter-day biologist's "have confirmed, and' J)r learn ad. that the ma hine f b6d-y has' hirinito conthlually adjust-. More; the Corhithimiis: kilew but. Di ., DiAtian iwl I not perceive that change fr6m welizbeing. to. i' !jE;. dpi "- Yev continuoiLsly a ff ected by new atid -of b6n 1eite*rnfLI, Muome*Wr aWMAdl described by Dr. Ashford-." 0A W J! I
Now if Dr. Mh ford hftisnot been pre6Ieefi6i*fi' t61 C04MV4WISH that "ve f m whi h ih faet6r (if bi6jb ft
U111 rW ro Art,4it*4 1
or even if he has clifficult- 'M drawing conelit9ions-fioifi stch.f*etoftJ then I would -ho that, Dr., inffiaji ii; k which the Corinthians were aware: namely that coficlusi6mlo&hadbb t more e than'the premise from Vhi h theylfam Arawne lfti: this
world garbage enters our ialculition', b"Usie mostly, fbageiqItVWR.,-, able, and thus it comes as n osur' th&_, .-y iA wr Ah9votod 1 6*! garbage. Th' m neasi is ost of us u I tolerate But io'riiakt 'R a. ilif
th ratibft 6-f
criticism frow one, who' is consciously 'involved in gene.
4k
statistical garbage, through'the. spofi6rsIip Of stu&ekolt, 4ei-I
stroys hope-, abandons charity and is beyond the ie'Alm: 6f faith.
I would suggest, Dr. Dimm", that ou r&eio Corinthi" "-well
as the Aristotli Plato, and The9phm ment.that, regime with. modern readinIgs" A7akti thc.'sdine veit: Carl,46n,. Cannon and Dubos. T wilt supply' -ou with 9 bibli
















-.K-- hank yo In onts~ e ase, nob redeign acndrne
.eid from th dirthat rm n'edb
er ndIablis ehae whefud ncon
F~mlbi~m is woisgeao heatThesater igils arfound
aen anhnth porobldesaofinstes
1 threat tohes sotresfudinnncua
toie to anser I hn eae
Rq% m~g~i. ,, t Ipthen magitea ofu problem and PR PAWl Eneln11r rleare

iiox anA en .c thof the mecandismrs e-ave frnd col

is.,onfrene-wanse the questions Mr. Buntin sksed CW a~Ltions thisat. Asr ha given dlbrtl
prepred misto hasvotd bweeng ontraite bynhi Ceraily a.ossiito ofa occprtiol r disease,d 'mr d iatory iseall cued by ocuptional fors

i f~es ttthe raftesres he eave th workeforce." our lea olaus!a fD.Ah
rxase 'A~~~i>rs? wyi Aiefouldtsuggestcthosemdiseses b atona feato. ecauserthen wre haved b W resslrs'uch LsCUosSoIL







In other weirds, iwo is occupational in origin, or is it th aea41yeti a r~zfor a disease derived from the workplace Now I snapect that this uncleardiesoronthtasbn: elear in the past but I think is be underlies the exchange between Dr the interrelationships between occuptoa nenvrmntl ease. Became, these interrelationshipsa rciajmte r ~i becoming quite important
We had our first hint of this back as a s13 hnD.c~~i. reported on the wife and child of a.PCBwokr ni tele; forties our colleagues were reportingbrlim inlgo aa"
beryllium lung disease among wivesobeylu rkt," pf
as people living about their plants. Adi swl nw htwti asbestos, we are now finding a great delo aain ialngd among family contacts with as around asbestos plants.
What about these bystander disesePolwhartemlvs not working with an agent which is txc u ipywrigm h same industry. These 4 million workesi h osrctoli-utY1 for example, who themselves may nobewrigit sets
certainly work in the industry mnwhihtotid falabsol, used. Or the chemical industry, where twsrznl ozd4 of the workers are actually chemical prtrad2 r3 ecn are maintenance workers, carpentersansofrhSottw to'
dealing with now an area the boundreofwihaentu P
clear as they previously were togt1 e I would like to address
OSIIA, the Bureau of LaborSttsis I Hanoheagms
cooperate .in the. development and colcinadanlsso aa
Well, if they aren't doing it so farIdntkowa:ve r,047 to tell them to do. I am sure that Johnl nla stiknaofho as well as Mort Corn.
How can we develop better estimate fdsae ti n lttfi to do. Take three or four specific discae.Abso' hr h'ibi Health Service has calculated there former workers who regularly workwihabmtsItoud'elioe enough to do the appropriate surveytomkthanlssr mates of the prevalence of diseaseoif UMr.I morbidity.
We have known about silicosis for5 'a M cu~x Itik is in the room; Mark suggested 5 yeasgo tih ba amrod idea to do a survey to see how muchslcssteei nte fi4
States. He published th is in a paper ans:a obnhsbe be Here is a disease that has been withusa-vrlogtnead.oby has gone back in the mines and otheraeswosi d-pudk
substances are used to. find the incidnef oth'tatiwl before us.
Take lead. Lead is perhaps the fhrtd~aefrwihrc'ntm was given. This came up 100 years. agan IS1nd01k n
not tell us today how much lead disesetrei- hlitA9a It would be no trick to do a survey to
















for6 thene t cofeen om yeaoromsubncet ies.Ltssyw
biooi prtolemst that Dr. Dinmavanumfere of, Ite tl tod A- avf a two refereced in heeodwinch I Ad o hav oevr
likto eWtoe ove Icnreviewse them. e ad hiot abno eibreor ofn woe enapleced Now Ih wuieturou
bae n opaae s.I.nc. codies.Thrarinyuflehntlad
Thef iguredo pisae 4r atthte o thePbliaciae ealwra neu as is exactly ern ete the sameo mehnim Itforwaso ifear lagte xtnd to inu Caliorahd one up.ogtsmelaso he'' 6 1i000 dehs achea a sae of occuato owa o a
efhat. The bais fore his was xlane ging tc thens reporar tistics wer done bha Jone agerl and ws based oipno lokngt sthought a Thrh uch btte asi cldbe .Iafund f iti 1eewl
in resons FtoX Wan Byoks. redpeated crtiis oftoeo tecn Lloyd ud in- NISHhas com weu wietoha a sote bttrinewhattibn












patiouilieqs4iteion o bsri .
i26




for thalliu a ie es onpatoalasion, clsnto the frat.lseast hing thse wit how! Tfnk Iehpe. eshfodee the deurfinitires to.:qud ortes "tBly caguirsed? Maybe "morae tha 50e pre 1 j a morit ,ecbnt. p ikbe o' i nedw.q
Fialy Ixtau w ou. W ae acmight r od e 4 Q hecupatnel ow.~ote on fasudt. ht onsW
Mr M~zzonent wouldlikecpunation th'u weirn dtht ipohrcgn thes thi boinaation.
Ass i cationl d cous, require thideary .mpa. yexas win thoud aen tinh' e defnto tom vaublf 9is

which "a rity culd. Mbe eveorek ther r temary sries but. pleae dnt own glme of a th0

:rhivi
Theainkl aeeoegsr'uwol lo eur D. itryb no. doWe't try at teolash. gt

Dr. Enterline~~~~ talk abu nuac cmaysai vr ailable I would tasluel truseto all moti .ty e~r,
bing used-tha is h tirdp rp ae .........i m, ak


ae compnscail becauveyspe thae we ade ad j~r fo0t reordelid. Againty layrtawolst ocupation is listed Itis clarsftioagood f our, nm ronexprie arty whayt9ma1

lhat wol o.iTye
I think beteng those time moatvesy we would 1nowtik eaely whaois oc rrin soesatis daa woklace. nd itW
mnterated thate ht would ev lo m to make thr art foml,$ whichia efesrreoud wbe feotd okth thirdae p arts!, Qf>rasedon daa thes themosel.sse'oc mr ie i TeNationTatld bce ofisr couldas rqie, -andt ceex4ainly hinto prie eperisone toefne lot tue'asideld t a f h thea war ify n the ytmoeateo is cetha. ~tiri t ev* Ow

sn~fc copneinr~il eas the eabbor mvomentaddfreprnenting eople, wnnin twcordd caes os occupationissed. t questit1rte domtensatd saneatvwfctr
tinkbtwei hos' io ilnlimoos we oud bgintisooim






iito pr v d expertise..to..d.fine.the.................. ii&:.......

'Tewytesstmoeaeii s.ta A mte,9 yer;IiIm




















14. athi aspet somewhat ltne r et Mnn
Ing is, li ether p igcu th siseo th'4peo h prpl~l b in le w arepkd, taslkY that t(f4eit fbe'sda
ItA 11R&4 thscodfi~ pladt tie, isU o meta idnss het~s It Un;so tipil 6f6 thec ba6kltte
ewnteht;h Iatrn aI afrakd,
wh the story is.esg
v~difR it iscmorecimportant tossee thatithe itihibit fiotix know haad syo eti mper esltn~ sc If wb abcmplsha, Is 4.etAhnkthik conferen 'opnainwr
Dr yzm hank you oldb Mr.in Burtonotntalof
-*I r irka Sofr sgetngt aqesi T ga COlP otaworigbasicallyy bnmtnifeyouegoIto
tac tikltatel o %oh erfatorsh to hte rntmna

hp isa e a e st u with d thee fastosrvton *191 ditl e anlytotytdeiecupina disease case sol "ebtaflietr .'f Then aiscussou ouhkth reaktofD.acs Mfi1~** h' ed sh l dfr ht. by hdiiatt rmi iennta Mi ~ Of thatat sewae youte
Orthinis anesheri snse thatsoexrml prtn s











cods, nd th knrellitentody
toreatste -fwdt in teurm ofpr. thneieenswx.AqqW deluing wthedtonocpi4ml disease problemsand
fsadi toeimnte aboautit soeoocuain!if 49P"b4
worplce, Iatoasgn the buadoe ncenbu.tesQ
quesionbl het you clstn tode the h -oeI edaqq h
Inr eingthru Dr. S oikofe's ]



commpets onerning infterr eltoh 4

certain gdisease bei ms win to~iiiii, ca st.............term..f....ua....al............ o




amdehaps liovprmp asiizingithe-stytiso ift youwtakeefo exawple, the intomineo seate ~ minrspl hch it asig in hbr fmdicated intnem quinene wsnoeter ans thesaedfiton





I niii~i rea in throu h...............aper....tced.w th.......:
comment buteri ifte reiohisk bewe iaete4mk
brohite, fo xa plfortunae enuecgf rnhti.aog

had employees coming to me for~okr copnainwei bronchitis, which was really dus tbtefcthysodaqi o
didn't smoke they wouldn't have brociiIy tbea itePg corned about paying the additional piu.Sn rYifsc t work standards on my workplace, whel nraiyteybudb~qp something about cigarette smoking, Iaanwudb ocrw,
The more, I see of, these kinds of fnigtemr er 'ia comments today about the interrelatinhptemoerscaA* about the ability of us to use one paiclrdfnto.A .D pointed out if we become too broad intedfnto w a1fn ur Selves to a great extent dealing wihtemor ob aua D
having proper resources to allocate to eysnu rb f we are all aware.
I would simply sum up my concernshr idsyta er t long way from being able to develpadfntoofcupUpl disease, and in fact, will not be abletodsoinlweeern, y we are not able to define the disease prleitlf
Dr. FINIKLEA. Doctor MasoI
Dr. MANCUso. I should like to comninrfec.toh, rgraphic variation of cancer in variousSae n ~iiis1cn~'e this to be very important and Dr. Ineln eerdt t
While there is a. geographic variatini ae'a eae n l black and white, the emphasis is marked excess of -males versus femae.wrideiiey- i"
higher rate for males versus females ftesm:olrnteeem ties. The excess for males must be du otecnr1uino cua tion. That is the most maior difference ht=b on.Btuq






4Swo opposed in the community b bt in addition the
q p eah dy or more onweekdays, had a continuing
alatelon of Exgh-level dust fats, inistl gase, nds
to cuptonal cancer does exist. I amsu
occupata cancer risk may be much higher than present y res
Apd, wi takkes a tremendous measure to influence the rate. for
pic' ~ o'Uy'Where a county has a predominant tVeindustry, t*'ou4j .may ref ect occupational cancer contriQute by that
#vt g~pin, s may be 'a .conservative estimate. The geographic v ,paternindicated by Dr. Ashfoird is very important and
Mjd trelae totesatistics mentioned. I would appreaieto the problem of developing data that goes with
d- I seatlas to me focus should be on the source of that data.
lwieP4 lok arefully. at the accuracy .and completeness of the data
rates td the insurance industry which has been
g# qlir&d yity 4nd, other sources of information devel-J''olj~~rek atrow this out for discussion and I. have not
until this moment relative to another idea, relative to
the eveopmntof a tEiP8r party approach to the ascertainment of
pattirn~ofillness.
f P4 Wutryis. covered by Blue Cross and Blue Shield, then you
",i Raishapaeans of identifying patterns of illness occurring for "'On"' Paicuaroccupational group in that particular industry. Instead
49 4, a1 population which relates to the total population Partiari industry or plant, you break it down by counting
hP partic lar departments and occupation that departDu would m. effect lbe getting a morbidity pattern of the
qp oiness occurring in that particular industry. Of course, o
o idntiy in this type of circumstance certain cumulltYA7 Ya identifjr his employer, his position, and so on and so
C 'tm.payig there does exist some means to obtain and to
"o'W Aiis ha ppening to the working population.
There is also the social security approach which I think we can
li paatsome otherime.
Wp sust have an opagoing system of ascertainn whether a PatppQ q~iea,.s..eo is. different and the disabihty is different in a particular
apany or. particular plant, and fothtto go on, you can detr 4xe wha t might be the cause of it. adoei-vtlstsicwhr ,Th~,ise o different that what is being oei ia saitc hr we, provide demographic dlata. I thinkit is a way something could be
r.INwum.- Thank you. Doctor Amdur.
J~r. AMNT. Iam not entirely certain one can define occupational "sease. ITndit ?so mnuch easier to define environmental disease. I yid cer sY "Psuggest ,environmental disease, of course, would be a 'device to include any and all types of disease which may have in some
ingtppeg oeopupationa contributions.






vdtii 4
f6iP f A.
-x4xe t4 W ]NOW
4ti, 611 ai
be in g' rt-elit V- el 11n)m I= =
cp r t ry 4-31 sm s-e re is no coinparisontm L
XODRIT 1 _4 the
... .. T fk ,,
W
wom M-P t6v
U ii1q i* I 'of 491 f a bi W1 846%i
L
are talking ib6ut men or C"EM 13 MOW
."M j I n many inAances ue ftP0
is. hardly, worth p3cording -as a. d6vi MMOUM A"bil#y1or w W46 Idu'-pi" eta... I
ilK pe Ple
Fr 1. %.. , ; : "F ,
'Of6myenience.
Ther j. ''oc''
are many
sician rather than
ability. Andthe,4tte;udm 5 W
'61.it'on iat : d '&;g
coi V nsati ro Mi L;
be r4 d4hk Jb6
110 P MI'MIR j le, wi vu
without the matter' of h*111na) he viift iiiWe6a-hi 464r"V&
-outside of his emplqyTnea T Al
&tting the addiiio'fial'mh torinai6h 'ar6t"8i*abb4.1E)r. FnxKLEA. D90or Corn!
r ave u6stign It ifi ri jig,
D .- CoRiv I h aj via ii be*
shortage of P Ysieizns bfe i 'i Mose -sb
"data com*
ing in will provi&. a Work, =K Lr ,.developed, -what is the reaction in'teinigor 11n, better data be developed imbq ediately
of silot Atudies of: S.I. theA W:'
P cliiOifidxtioiis
basis for sea in I itude d.
g,,up the, mW q ";(M'proklle 6
studies?
As an example, some of the material. ou)n de* tffliig VA
economic impacts of certain agents nif 68 S.ig. lei we. should have 68 intensive pilot studies of the tonal disease, in those same clamiffioati lr hi* ij
that?
]KY y intent tro
Dr. Fiw A. An- Co S m the #knd f
Dr. SLrLrKoFF. I am not as pessimistic.. 9 4 Dr.
would rather. channel in ideas with' t ihi bir
1' 1. ;Otf t.
payer and the instance lusine ses an ,rve Iii k d 6f
flii )vas2i 116i im f I 00A ate informiti6n i) th next yekr Olt two, I blo,
sonle leads by selection of ruaterial th: will!, thii tehd 16 6e and I mean ibere are many inaccots;66 ohos 4t th6l, Astmi P tj we. even'knew which doctors wm beink -PiVi for:. sC diagfios 6f 'ikh hepatitis, we may learn a gooddeal about mangy e&cts of the inil
eal industry. for.ezaTple. 7
I thiwnkwv'e ELre coDstandy Aim ij : td ai L ul &A slid '-Yri ii#JW36 : 1 1. g t4effis, tbAt are, I itft idY- in, operitn ;, Lnd e6cfivid
0 bt am eaidy *Ai filji g oit, *O;a f b
f 1,
I would like to refer to on6 ffiq Ai& TbW'As &&Iodtt- t&
industry. There is in our history m the United States a little-known






fac. I 199 te Mtrpolitan Life Insurance Co. bega a study of it~fg fntbrh s/OSwo Iter. Ita wet on to131. 3o wr as
*6reul: these studies united tePnslais
Deprtmnt reported the study in 19 aathtpot
.... ............

T~kyul& hae6ae years of intepsiv exs r eas ther is ~~~~ Awnrl ttaime, and mnueh of the disease we ar sein now s reate to herery excessive asbestosis in the early hirtiea.
was utilized, if at all, by insurance companies perhps t calulat thiciated. I don't know., You are entitled to that,
&6 ini toenthe Governmett scientist and the Aerican iw&W ir:x~o enitld t kinew the rsults of this kid of information b6Mtt itM, at setly to the subject under discussions that is, preenton f ocuptinal disease.
Thankyou. Mr. Massoechi?
mr,', =mnr.Theright to Imow. Would always sggest befo anyempoye beeliibe to ensure himself of workers' compensation
Snowthatistheemployee be arare of the sulstances thkt-hwo~k~wih. hisis a condition that does not exist in the wrk0%60Cia woid emadidentification of all substances by the geei
S...........indicate that substance exists, measured
toxiit te wokplee, and whether there is monitoring inth
am:~~~n It kiyosabhlish that you start narrowing the prob1T~r-4r~dist~y pople for the Arst time become aware of the t~ibit -of ubsta c hy dedl with. You are able to ins *, e the neesssay, 6orettion Y u r able to deal with the questions of potenti riiik thttexist.




.:'N meknos yt wat oe works with. The rburden of proof is on a
kth -knows .....ing about his own environment. Therefore, ...............onal doctor, lhave no fear that the doctor
*IR-s ulateon tearms-'beeause the personal physician knows hotingabot O, uatinal. disease. He could not even begin to underg~tid17tstye o evionment the person he sees comes out of. He ray.kn~whe orksat YZ factor, but he assLumes like Dr. Enterline meniondltha thngsare better. I think we are worse off than we wm: *ruse w ar woking with different substances. There are wide gaps-in nowedgeandone then, of course, can't begin to identify the s~eof wupaionl~dsease.
I want o make after comment on cigarette smoking. Homicide iod, ficie ae scialyacceptable;- are socially acceptable so far as .thr egaett idusrygoes. When something is socially acceptable, yea c"t~cang th gound rules. When the worker walks into the worklam wesayyoucan smoke-you have free choice. 'Society allostheprootio smoking. The employer's responsibility is to Vompv wih th law. Te law says the workplace shall -be free of any h~fZ~iAS,=d hatis heessential characteristic. If acoa mier-choses to smoke that is his choice. That doesn't zamAhe soul run anextra risk when he enters the coal mine. If we fm4, oet hold ot moe,. we should outlaw the cigarette industry adid mak amoking a inal offense.
I'tin Ow wole joking. question 'has to be put inoprpr perspecivein te qestof-worke rkeomnonsation.











niude ep uo itrr IOne omenti Dar' plfody donr'tum .4 Whid loeads wh m secn tontn that

all god.Iedntink west hav nto pnluejut oa i~s Inl wll talkan mok httment blat Dr. Thsb hejssyn Stote anf vocational saaes e korkrs'eer ollri thed lawe ite ths supoed to ored be.oom
Dr. ischpre I think you wall fmdogite d ol usto h W
5.yer ae uon 8t easeo wemy dotate kniw tisic Ied thi y slcfnd thatnt the vilItik ra n~d84 that thoepethe av besvraltoIdnt sp I hiav anoheoment about Dr cihtersieofgngothl inarespiratoretdiseasestindiIsthiom worer' copnato hikf almokmg can pad doeis cupontised tn a Da. Oiouly, tlessyo wl fpant la feen frmwa.ia pepare agoi tor enso. MidanSes ae keigmnydoe tiis thn weu getl to ha there ie ofl wemc] oof-t oftha rouepratery adsasehu If it n' icasek ohte:4,a problm.e you oein of gyr itandea vIuae aothen comes inou conacete wmkn.ifiiki:i eius respiratory disease, n threfore he sl ewrotita 4ia Tha sn wher Idpar compnwit the sugcer n teseprtr
riopht tre smok.i theeoe f hnepye gs hihosoe:. indicton are ift yo lh oo t the workers gigta:tecs more incdecto respiratory disease if ueysoig ndta sh polm do e noton o goei and thereforelh can'ts ge it. I Dr. FINkeA.s will hae ocu in. Wenac withwa a]o a b paurtiato disee thereoe the asntldtobCmesw Mr.t BROOK.r I amt srckan with the teery maetafek opened th, whoend heroes sai th e awes satrdies idctos ae diffrn rouleof attevidences inta duyheae tione bingies of lay rallofy thosease of ev mkhnhrri each dof usn to erfb e e diste with I o'1olwng htlgc all moing into an hae tt i ater di ha etoetoadec Howiciadon we reespn toayon in am aene or ise o
to sayc we won' know c dei it aot 20ver is etneD sfr Tee worker comenesaidtonlwrs systemcins isoig aske dotrati ifrnsytem thle ompviensa Itinkwrei~opn advisedly-forb a citefi discovered wich he te eas e anism. We aespn dfiutody eonizamage trth osmtinehv ytoo all 1e 111n't Unow Weitlabt 20 yeasfonw Th. wrkr'..m enai..sstmisasedt.udet....ich a
a ,o tru ai.ijr.yte ,te...nain- n s -h tv r adisdy fo cetfcdsoeywihhs udsaedormm

ais'm W hvedifiulyrcoizmgth fiiiiiuniliti'iprtofth presentandithatiayibeiiatililirililiuliiiiiiiiw



















psuq whe we. narrow deintions, Wolto bring il t o htp swe ele a bot iha n @4n a anmer f ndutisadocuainen tM04 we satexek esthe on lv ersmnitue o h rbes XW inda Awolh ofe act yppourae somhingti;netksmtigo ide alesig he acciea dinjury. Istisetbihekn1 throg
TISMargeST. Iv i h~x hn we envlo morend tptatupme -AU emA it e refine the efinitiononcrn wltpeastob the hs sokstem. nato aa oraly siae u oa proband oobserationha or omme If woulhoeprblm
1 diseasem s ha may bekes idmentifiaabl wi alyaeate-ad tW mnded eernfvn Iisee ar if isnsurnce pQAt in mennection whtwnedokowiwith tevra diveleo
eaw istole whees we puse tanubo aores induilteswhr dtv -a insuancfethed insurancelcompaies gnztin hi
iDo etyaseonHath eypiren inOcptoa diernc i thb rathe d szably hodtiiger rat hthrontIti tWeeve inusrial insualcpedicae uosdrain]rhte
bhqeean BoUi. Excriusen meco an moment [Patbeoewyfex 0-44r.7FIwxK. I te wa qcm etiongro th indtri ?
comp nies arHosing Cnlrintnetionll oraonzngoe

Ith~ikt perapse may bredomehant oerl ability, odtacfrmt insuracersompai e I ftessepri foumink to gh ou ori the mcto ae alpratieta i o oedl eisent.al steacdna nuy hn hsi n ftecaiia









.Several. points I would'lik& WA ia:C.I mokn-iqaf Dischei- report anid- thie cedints 1y+ mind, there is adistiction item elrc'lne a4imdfe ~*S system today in eftetw eaes -hei irtofln lines and illjury.
You are in Dr. IDikher't reporti4%kot-rvi
in his measures are conditions woseobbmy i ~kisti 66
to the period of rerdrence.
The recognition of the, debupatioadsef,6itevg Mrt lem we a re W ced with If reddgtiied ar ~& h trf~ Statistics will collect and. report -it. hi f aeiof-f sRiE)t0 fi-out endp l think, the.'apprach toilnsreoitn 'Jbe an ad hoc operations as welhave be-fssn%6. .4,Y J)
Dr. Finans. Thank-yoit
MVr. Sentrniar. I wyoul. lilgr to comn ifynB.
-definition of occupational dipease ti ipMm okm alwto start with defmnitioni of occuptoadiesbtltndPthi definition has to beinterrto ito smtig iope0 ~rin the frame of the worker' compersto a.Illt t sm~ to know, as Dr. Ashford said, epssenti~l nocp6it~a,'-~ caused solbly otr partially by oceupatoa vtrs 'hn-w aet ay this is something that is due to thepcla
.something that is due to a trislt of the lica ~g.Ohri~l miay tend to include such thing"ash comn e@%1 ~Itik niany other items that are pateMty fotocptitabteifrwb in origin.
But, unless that definition uis o of hdteewl t a ksa to draw many of these environmentalfitr ioty net&a& pational scheme, and this is going toices or1tg6&Mi"
-system and this is something we do not-a.
We have many employees now thatiol iet a l-hwOU
that occur on the job therefore: are rltd oteJb n:i i rdividual has a common cold and sayhegti rtta mm
to whom he sits, there are many empj~gwowud im oa ,claim based on that Or that my arthis a fgiao@ t W when none of us accept arthritis as anoeptna im
I think tha definition is somethingthtmsberaltdio ov thing the law itself can live with anth rcioamklwfsd can also live withi.
Dr. FINIKLEA. I think we have cometsumio 'e.roudlk to urge that the panel members continieti icsina at~i in the day, and there may be further nu h himwoll ifs of the panel may want to put in thereodnthsmtr.
I would like to move briefly to trimgt drs h hv
which we. were assigned at the begifil go h a"-etw"A assigned them some imie Ago.
I think we were asked first of alltocmupwha fiilz 1ai problem and'Dr. Ashford tried to addessti atr'
There was a g cood deal---i 1Nmmjrzfg h rstls6 u i" sion-I think there was a rd deal o gmin "'h at~r i







,casedRopyar, partially by occupational factors.Te.
g of. CJIMT1a on ,how.to. define, Prtially. This 'wa:bae
wps., 5 on bie brd,- an r 6f conunentator et 1; ee OMI~ihd t largely. On the other and, somes of thely e
*A4A'~jpg~, J~twquldgrealy increase the litgosesf
-o".A arive ata, asnanimous definition o ies. u
y, ark~rg.e ged tthe -deainition.advanced yAhod


Therewas aso seas.cpee 'hsfnton thel net beap '0136,Rd cakpeniseaatioelut i watrnledioa I~~t W tothtcudbute legally agw.ri tiyhv notbe


measres r etimaes re available to indicate the extent and chrA~sfor prsenela view. I think in general people fel h



"RY r0446 qO~~wW>ight aprp e here we iareaeastwo
theaeebya iinallmitit OW. whe
iq eaasa aswth etiatse s
190~ri~f o. reiduls ,'n p aimllr o efImndod es ant thhpese
40Q&9q -*I~oPneption -toawber dta ouler deve icln
hto he~~ aelitwnd auiecepfelt ta en%

I~~~~~ bul as lk opjt othere4 was o inuty~ en that
evrtte ioration wha sl requied.hoe h
as aredth Fdea aenieivov

t ~ ~~ Vato what coul be Wrdoeth destingpe
aWi4 urther dW5-eineA th pble mn Di hin Itwoul NTai toses that m aeigt bed huefLce felt thmotf
pimwwa t~w z, stio d ystem ifraIn hin anyr of oth
o4n ut the rey techniumaepon
fom hesyser no i place iny he gle
vfoW ieldth focuses on t ~ih inceqide.te !I of takWe tt ei su a c n uty a







Is 6ii
.Ltre W hul URe Andstie stAie HA VA oAA Mlr theaireecs abopulAlhuhItik't wasare hat he can o ime & it


infomai o shul be exlrd.... oe ahiiitan w
to7 years.'Thee was soie s h oraial her of the industries, either bysadrd8dsr4 lcasiiai some other maechanism to -assign priorities tohnutis'ha h;- N studied. This was not uanimoifsly agreed upon.
We will c1ose on that quick summary whichw ihlIcAt as we discuss this during luneh. *think we also discussed garbage, religier danmbrf41 factors, Aad we arived at less forceful conelse abotth but mnaybe'soinewhat more humorous ones'[Whereupon general announcements weremds60ai'~ 1uh
and the luncheor excess was taken.],


Chairman Bui Bforewb: get into the....
are severalher eomnnto I would like tomaebft:btkto the fornial agenda..t
There'iskon pero tha petta great deal There iskblo ansu h ia ind every prodnfhs UI3 oi
one hathasust entered into the process. A
i times goneby, know .... amue about! the................
overloo Thd, a ie e, Ahyorter ti
Patricia Sullivan, and it may be ne&May1t781 blo~ bc she is a court reported ttkinig .9ll this dowL n 8fhA Itiwi this is tremendous undertAking on -her Pa very much. *
I would also like to recognize lin the pluimig rcesadb,"i. ticular the office proceedings, the. work done btewm ~s i o~ staff in looking- at the various definditionso 3uyb d4K which we touched on this morning,9 and lookigtlh' Vrdi *y medical determiniation are handled in various
I would also like to thtnk'Mr. Jim Im oor1
pared a rather interesting sumr of the States.
And finally, or not finally,. but, before I get ote1stRM 6o the ladies I have to recognize,: who has worksdeydI IAii up at the -main registration desk,. and I'am sure hv enhrcm ing in and out of the sessioA. Th6.t is IMrs. GerMiAr
The last item is by way of recognition of %th ait'.epftt6 staff of the task force in the Washington ff as ela h' people who have been working with this proe~tt0iia %ssistance and ratherinn- research data that~g'ae i ~cuoto





a87

heyare here and I would, like the people on, the staff of
thet~kforce, as well as the field people, to.,.stand for a second and
thn'beseated. [Pause.] Thank you.
Nw e will1 get into the program antd I will hand it over to Dr.
Roam*. Good afternoon. Probably everybody in the room has
Ab~ii 13Ago he is burning to say about this morning's program.
t e4 o 8 push on and light into the topic we have for this
'By VAof introduction, even though it is slightly repetitious perhaps I odd like to read through the charge we have this afernoon a .WAN ad, through about four changes thathmere distribute to -tio dindite& planning this conference. Became, I think it woul be g~ot6kroj this in mind as we hear Dr. iSelikoff nd Dr. Mfancuso dn
th ~ol hat discuss their papers. And, if we direct partiularl u
inte of what they have to offer and maybe our own com4" t~to 4 objects, the session should be more profitable.
Fiis vxssummarized siftfly this afternoon as a session which
46uld ~ i Aavtthe problems -and -methods of relating a -disease to a vbk~k at on That, is -pretty simple as a sample of what. we are
ot -,~t saout:- the problems and methods of relating a disease to
Aece
na re elaborate and later version it came out this way: to focns
-6n h6'thdecison is to be made whether or not and to what extent a-voikerisability is related to work. What evidence is required, whit rearh is needed, and how and by- whom and when this reTli*sew lastverion becomes more organized and: dlaborate, but
11tib suggested we are' oing to deal with how medical decisioc,-7 tto be made as to whether or not and to what extent a workh dieawr illness is related to work.,ot
J .-Mbiv t IOddaor-th specify we -better light into questions of multipleAkto inkrhtianfs. It suggests we use illustrative prohlemdiseases for
subject. That we deal with, maddical moniioring, recordhpolibinpof hazard' exposureshAndethakwietalk o:th
%ujet~ftrals basis for guidelines and peamptibner-*:
t~fFurlun makihy about how these disediebrard haddhd,in prvate p t eand try to order some -priorities ahd iniprb erdentg a ML to
uia su~ifoly hithat effort with, the rol of the public and of
if,~ ~ d olii b -hdw many oft you have the last verson, the on ve, I V*&J~r::o,,~taa our kuide now., It has maneuverd itself irit beiRe worddvi eris store' familiar to those whd have dealt with Worker'S* _C1Oftre s Inksma'tters in, the. past. The, introductory statement of the chaklenge is Ithink, fundamentally the saes the firs vrion we wore given:
Whatinf~mati n edd'n how cnIt be obtined -to: determne knore, acohrately if a disease was partly or totally caused byr the
if We have a tnbrof subtitles, but that is in essence what we Are deaig ih
Our first paper this afternoon will be giVen by Dr. Irvinig Selikoff, dietor of the Environmental Science Laboratory at Mount Sinai in,







NewYor-, n he ubq64of Multiple ficts interacting AUW

Dr~k~ Sm o MThn you verYlawah, @Tor b. Lx~ -O/
In the setting of standards for permissible exposures to
lhich might cuse oceupational didse, there is hakttonlead there is noebidimy uniformity of response hid is. ftged j *p aincusono safety factors in caladating suchaadeaa decade observations have been made which suggest that 10h tiA 11bei-orect, i inadequate, meager: nd' ceasepuU -ch
Thecomlextof the work environmental ads do w gigg POO to 'oxiusacs are much more varied them eaticipaeA -qw
sidbrain ofdeccuational disease should includeamdta wIR desetu rofpotential intesctons.
And ii these II will address, myself to in the meit ped "orCI
First of al in the paper we have had the tdait eaane 4e
sances that for meet oceapationsI diseases thereapm toi panquesioning aceuae of a one-eansewane-leffctloi0 beeha
rtestlted in thres h6l limit value or mourimnmAlw~f. M
tonsor similar exposare stand ards, em set, for spabifghMaONWpe. There are TLV's for silica, vinyl chloride, bryllium astbowa --do Edlon, tetyhbidet arsenic, and- many other egant6
Nwthi ctneept of -one-eanse-onelfeet has been OSaWnt Wfao
tieone and helle destablish mucb of on l'urrent l~oiedaeA is,
his6 eytotywihMYb worth revealig.,M
The first occupational agents or first agents that wrdm
sile for ,incshut 10 diseases wer discoverh& wiround-S 10yew 40 in Grea Bitain;aitorry shad lead. They were quite spa dft -Mrbw
At this time it was also knowarthat dw- ---a mid aam
cauise I ng dise&'%. 'Ithas bedn known 'sines the early t4th a *V ant dsreould causeakdipeases of the long ad it coahI hafthal. ,n u& sAnw oken families in England waring on: the. fam eng~~j at4 as long a life adeterybody else-in the enatry?, whledea t 06 tish coal rninerwfmoreampe, and rmmbhawvdmrame Ow th1 9 miatib dullb and the blasting esp, lived at leitus er oMst
ae~ in what thiBritish called the-seeinicines.
Rwas noht; ni 916, that: Collis,, who at that timve ai cdi medical inpco of factories, clarified the situation by dib e* *oicll people epsed to silica that particular am bk- ich abrd TB tan al1 other workers exposed to: dust, andl heorth st time clarified there could be, a speciftc- effect of ,mspecifledust.i jrr
We were all very much impressed with. this and this Ad. t dntinuing effect of-adding to -the meremry and ledsituationz, gi usA this one-cause-one-effect concept.
It was in line with the, biologidal knowledge of the ties.!Muse at that time they were learning great leasn 8 o infetos m
studies, where it was learned tuberenlosis was dule td1)there -aeJus, diphtheria to the diphtheriat bacillus. and: settlet fewe Whe streptococcus. And we lea rned, we were able, to make great ste byshparmn a the o cue na fn .47..&




nn

('Wew*,govan d lng & this very. frhitful&.way ever aimed 4nd furtw, vasheeksh& to make strides a ,oecupational miedicine.
Thatwe or example, we believe, you- can determine the biological
:4 wmratees miding tht some, As inron or tin produced
litw.1~lorayreaction -while others, as berylliaim gave serious
Amd eve today I think it is very useful to follow a substance in roatn sodm osbe to study its effects and of course
"t i s generally usedin animal studies,
eaiw)r =_ And -this, will be: the- burden of MY report,-however W 1hib coDncept served to this point, there: is a growing feeling. this Matp~esetiatveandocesasionally -even inappropriate and
"iler notim!)rt .per ha of the new informative .bas been that in enealthere is in the work environment today concurrent exposure tol IW igeas,'Single agents in the %work' place are by far the
the ala Maltiplexposures are much more conw
14*1*.1 w*hoSo ecar, hqe#eete can -be varied, and often,any4-tiakWinght be useful totakeas an example toxic, Solvents There ans timamban one solvent. and additive of iinaeie effect..And if
to ikn ts they don't have the same eeeet. You
Owl-4 **ft al#4&ones t way three or four,fand unless you know what is
wm* luo had we arely do,,.these can. be confusing and diffleult
We ecetlyhadthatwiYthrvity. chloride In our only study of viay)
tense", fon pulmonary .disease. Is that v~~al I moans i ight be due, to vinyl chloride, but in*any
t V~rorest varietyrof. additives, even polyriayl-echlods parI ono A igqldi mes as: well be due to inhale ation of eaich. partieles.
T *^"fagrees additives in vinyl chloride, additives, accelerants;
svayofaten pigments as. welL: So even ins what. we think
4 Ns* qq ,4,Rwypt be so.
al inig is a good example Theso ame eeal dust, diesel fames
'4and there *a variable amounts at gulfide det.
IWO *Opadamelstersand we in fact have standa~rds for lead
IWWPeople employad in lead smokers are -also ,exposed
p ~iobvien .e mo haweryk little at this: Wiae about
I q iert partcles aud, we only use that ternu I
"Am nue abre is an mnert particle-inert particles asy absorb and aAWI pggnsas. sline, oxides ad nitrous oxides. are
a cWriss Wa know; too, the amount of, soe-called: ieet
y an, ere, ft.- majoe,; effect:o the normal 'efooctilve
mecams oftte Iungs hs has, been One, of thei factors- that has4 lyqppoppAl dNusin.o coal .workers' espiratory cases., why s P ,4erd* agodelo ise and other* -do not, and this
o~M 14,04ot. *hic*; we know very little.
11, acqdy~oipt IWud, lkff to-make. iR, that: sometunes these
pp 14gyt4 pci~~rntuirallry. We, don't have to, put more than n
a ~ ~ ~ ~ ~ ~~~b ,neswykpa.Thy ayb-present- simply as'a result of gents that arc cmied and variable.
71-790--7 4









Distomaceone earth, we all kmow is~uulyo itetobS1
-shouldn't give disease, but if you crystaietyugtaod.w:f disease. Then we not only have diatomacoserhbttiyie n ,cristabolite present.
The solvents we are involved with intewrplcae1blA clearly solvents, but very often ia solvnhilhv to hefv times benzene, but it-doesnSt go by that nm.Teei osg rae saying this contains benzene.
In recent years we have found that iti o1nyth hmclin physical nature of the material but, sizeadsaeosh aeila well. You can have the same material anvayiolyMtem0&'s physical properties and have a differentefct
Now we come to an area of more reetdvlpen n fin-creased importance, and it was alhuded oti onn neat~,o occupational and noneoupational factor ntedv f
cupational disease.
Here we have all recognized for a logtm ht-hr1r ia
variations among workers' responses toepsr nth4okpae For example, not all miners get pnesmonis adntlsa-hg get the bends...While sorde instances areknowninwhic workers exposed to aromatic amines dSevlpdbaercne, ti unusual. More commonly exposure to ocptoa acngn wl
result in cancer in some individuals and:nti tes
We have reported for example thataogabso. nuldo workers 20 percent or more will die of ugcne. htiiai way of saving four out of five won't.:W shwta1,6 -r7 e i will die of mesothelioma, which meanstha 4u o have been doing prevalence studies 0f1b tswrkrkd ~n
after 40 years of solid work 5 percent of h e aeasltl'ornal X-rays. So, there is an extraordinaydfrec, hidwldf ferences among workers in this regar d.'- I. 1,1 Ii 1. Now, what these differences are drue ow~ ferret out. We know inst a bit now'. Theeaee*dfIr6fd,.fr6 ample. There is a whole question of differneisx th#axdhs is aomng to trouble all of us with regadt 6krlcli, ,6i.
and employment. Are we to set standardfo ol'nrmhih e
work-place with regard to lead ? In theciyjqt3mnh a&mta sex related va-riations in reaction havebet~ditfe.fr hoi nated biphenv1s.
The possible effects of infections have e'pontdtofrsmth( Pnd the recent identification of the imprac finirpi-dficiency in the pathogenesis of some cases~tepyeahsattc~ muc(h needed atten tion to this field o-f resea. It has also been proposed that shlni.1araeitcdfgin vvniilexplain lung cancer response among sorh qcpeadnfi tes
Similarly, immunological resToonset incldn





*orkrsd, those suffering freom ocuatipnal. sthapo 16:kft*11q&96 aveolitia'
Thei4Wactonof the individual metabolic status and thwr or~tnlftht' s s begun to be looked at. We all have benvr bi ihi~~sed wth how little alcohol it takes for a personexod to ~rbit etrchlride to have rather severe liver reaction. A, aret o iteacstions between occupational agents and rg
the orkr are possible. An example would be the adtv esAaivsand neurotoxic solvents. This may -not- be nm Portnt or woker high on a seaffold at a constructioie fo e~a ape. utsuc siple situations may notf be the wholesoy f~t~~mpe, dugssuch as phenobarbital may alter the hepaticenzm ba ace, ifi-" cocmitant alteration of the imstabolism.
-!H evId~t tatlittle is yet known about such interactionwt ilian, 06e.Iobal causes still obsecire. These mays include hso 1606 hetos; soiated with age and nutrition. It may turn otta :6 6 atinaldisease would- not occur eept with iteato O."~re agnts -includin those in, the work place adths i~heentin he ndiidual.
u~h'it atonws identified and discuased briefly this monn b~l I Lewisaothers on the question of cigarette smoking
Wi~h 4. it'ohistory. We had seen1 in New York that 20pecn f he,6'6k in'ultion workers being fbllowed by us diedofcn ,qer. amm6cedMhis study on Jatnary 1, 1968 and by Api30 1W n doth.'romlung cancer had occurred ainong the 87 mnit .tohikr'',o ciartte smoking, desiite their many years of cua
.1 i' 6"ta' ,24 dahs.tom lung cner occed amn th 8
a;~ hitoyof ,cigarette smioking, although onl 2.8sc
'ha~b'en'exected.
as uk~tedat the time that 'th combination of the twofc tor--abesosgretly increasing the liung caner risk' ofcrtt smokrk h-d~aslirp, mltiplying eet. It vwa' cabilatedthta a's&6s "1O~k~wo smoked cigarette's had eight times the riskcm P. re. th same age who did not work with asbe~ts'
92 hiesth .,r ofmen who neither worked with asbestos norsoe
4 alog,-range study, and in '1967 we followed ,6
O'ii6 workers who didn't smokecgrtsh
''f_ d WEfollowed these people for the next 5 years hdi J~i~o6 *' 1y~nq aswe expected, of the 9,000 with a history of ciaet h fre should have been. 31 deaths 7 occur
t47 of&who didn't smoke cigarettes over the 5 yearpeid frouv the pner,te set by the United States, that includes. smkes ffier& h4 been 7.5 percent deaths due to limg cancer.An ler Putofe 7.5 were probably due to smoking in thegera p~p a~ip. 1ut.waonly saw in the 2,066 nonsmokers over the5yer fhsiih lung cancer. So there certainly can't be in"ho
candrofrbt without the carette smoking. Certainly, nocra
cr Ih A, cmbination of this, this is very markedly so.Ths ldbta ve sn~c bena mplified by studies among uranium minrs n







a42


thin drphi mes in benexit 2 er a nhm )r.n onmoes Oneo thagaakie pltion. ing earien ap egu k to"tat teiacde of riatnexsd us maatno m land asUi byownciuitin atposurt benzhe inte-ya A. A
Itheiwk days ousteto y tbe wasi Dr. that O e o thnennt desttns Dis etohnDr ei san owrt it thIneer nget ie flsenn o-u Mroes e manyny t yoanhep~nded upbigalt iodrow riw ith prior o beudti.Myfrto tuA osp ofith phiopes last notfudam aetalyate ffc4 tth'ii ofted matrs day yestar r er sos ago. I hawtndn Iaper that ofremsid.ent Iraen ar fewif onpae Ihvet
didss tHtwhisisreal wihee thoeraction o ilnsad a.Aee :arinly tove at priod tof betime.vrdal Hisiloasphsure nll fuaemeall ifrnttaie. rms oftiple facto exosre. And Iatb aidd n in ann ae nsmwa rasty, buat he are many tha e indunsonprsf ti ductsdefomcemias a e lmoie rtd u to eSna%"I Wirsou c o e til exposuresItikw on o n-m eorlha s is otll her e the pastio w sb takygvnmme r ceticlo an sipero but cetinly vita is r okr ht a cheiscindexued ue. mr hn n.Mnytmsmutv multop multipl expsuet of nd Ividnt utal kn bu e lia idsples suc her as r. Seliko teidusre mw p r lycts mcis al tru e i batrale dit e wr laesd uy hs.Whrcepectitoacu vexrsuhrnc ouhas rgasshr inole. the oascurrenidsr a uhMr puisic and oldmaler and femtailey thritte aretdaAcod sqrl tw o fr tht r t a rticur wnel kn as-oeefetrx~o
-strc mulisadpl is Bufe to mnivany otexpsr.ihee exms c ineao of ,eiosae-wt occupational ad n pwe
Si bility ohe is trul dr



m" oft apentiaye hazrdous ageont,loavess Ihn vableu chractisis ofvd The ndviurrLc s nwloess nelh' yuaol patten eae Tituion penygoexmlsI-pr hagy an other papectsuflariabwele knwresIegetmttr
Asr of azardn o theupawoker isd whaeta a th e nl r w vaiablt fhmnrsos stuydaai.dtrii n


actio of...p te...lly.h.ar.ou.ag.nt..ne.ust..osider.. ii




vaibecaatrsiso!h niiul w srsiao =




43

nufmied exposure one must .consider the Mpsxble
l~an 4ndhvidual. pecuiArities of work hsabits lead g
iptoke, thdC 8Additive exposure. from off-job activities
Th cmplexity of health embuatider-is a vr real yor em n
*r"1WjhAs g amhg& of tim. Simple tests and 6srvations over the
ihvel beew supplanted by vastly more complicated
aimredmethods.
19@ a the Nwtinta ommission on AStt Workmen' CoT'madranes: Me" produced unfamiliar and eften Indeterminable phda i toxic hazards. Occupational diseases ementated. with gralonged
Amapoted agnisor to fortultous itImbinations of atrps, have
pe spetaines of the *,accident" concept.
n mdcal lgowledge have facllitated the tran tea
W~id6- an' $e, thely have also enlarged th lst of disease ha iyb
44W ~ta Thesimple ealuAe-illeet concept ot the past has yeddto an nfowka side l~a :iteractize forces that mnay reult iimaretor death.
1W,*dd*6 aPhanlei," ealtaumental, cultural a phsilogcles flene

ev~luatoo extent of impairment have become accordingly complex for mm

Pbijs tatstatement modst clearly ennites the theme of this
Mi li'T~O.it is readily qvident our meiat teekis difficult. Theet in occupational medicieis a limited todhd41agicat
it 16r e cl surveillance analyia mthods. When dour con*6& An her of chetmiedI substancesake l few f. ~ jj' helave established and confirmed ability to assessrcim i~id lu ~jifl the magnitude: of tle problem is readily apparent..
Thi brhp e to several additional matters of great concern to ime.
kre4dariprctc- and, standards for four things: medical surA- I e- u i.hygiene monitoring, epidemiology, and the impact
%!I~fi at surveillance. At -this point I would like to ofler a
..NU6 lemh P"96let'suse that termn and' let's forget biologitikI moni6f 66 _1. People don't want to be biologically monitored, they
De A care of as People by medical individuals.
am t :dby all kinds of new surveillance schemes and diffring
nts under new standards. I certainly agree to the importance H! oi 6 Jr jndgment and not circnmseribn individuals initiative,
1011 of any uniformilty will create a ni ht-marish set of probfem'sniqiiter CEas in any effort to assess the worth and vale of
Thsis Teially true when one considers the multiple exposures
ited requirements. One can envision a man employed
eitise, of a year has 10 different chemicals to which he has Tit 8 nsrreumysrelacnd having 10 examinations, and
li al bled and X-rayed to death. And the poor- physician onthe
othe han rio khbing -hat he is doing half the time seeing the l%* vAt hii door cosaty.
It des1 drive, 1hysicians up the wall a.nd we are already finding in
I neekiab they arie being. whfwilling to cooperate" because 6t this
I feel we tiedd a uniformd basic core meiansrelac cee
Consisting of appropriate history, physical examinations, probably













lto fasfciiy inur of nduory cetmtes And esaishta a shw-em ree.Thoptwivl e oe onhertuapidevniry esr 11d wl provide a basefor pbpy




Second-,- in th arao yin mntrnw
in that ielace istanenhiy of potential expfrwih.8A





of preelse aalytical moitoring. We ow have muc niqueor haeciic tist r estsbrie, o bk a the padtdw cn onlaygs; as wih t ty hloe eureWaw weul cad ier tacrcnut alle t th umngsl tosi whicha
withel an sam ecftons.Iymnind toepi havce tor bel concerned with an lodaof othe uknows, tld iendtr, tacheaerial amnise a vaaio of~ cand elh-r stand. ardildtatecopriason hisnch veyofe ore ot il froanS
n ehoidem rospyv or intthe epidemiology of both one annillne, anud poid ta matefr naporaiae tb notd itaeo the area but whgenwee nitrn, s trulysomrir outh ast ableld bsfenhtr of medicalislrveillare and a ac
poque tata Imake juis leased, ti elo aka the bestem. ofepde tilhe ofst onl crudnl es q alithtteexwuelvls eeA
In thisacnec tonpth s a eepned toe auini




ad lo onerdthetresulot of or ueillanc e atow aers oiassrentat itpsuis suceng n thepingiiul to pinata of mthewerrfno, tac maeriluciada corrections afctnd fml
ithdriepecttoerkr's, whchyoenanot ualifiati and asesingilr ri the gre emat ibualr toft occupation alhat anlldesus, tecnolfogicat ntrll toa.T is elues thesteofher, nte st of onertuch er sar insre lega, mo ruatrco& ih being duaevalih obetvl on aewhlly vifar and ratedrkeCoietal prophaer recgtionsedhbs of ocuptonldiolgc she ieo the equaetion aser was meioned hsfornadingbohsrt link ing-em the reslems If seo magvianwersn ii eil


offig.uer is ahnlgeal ned ory ah long luterm follow-rn]e~
ive of cocrnsc isisrnlerl oaecnm-rz
i ngiiiiiiii~iiiiiiiiiii d e l wi~iiiiiiiiiiiii iiiiiiiiiiiiiiiiiiiiiiii i thi~ii ob jectiv ely o n~~i~~iiiiii a w h olly........................................ fair and........ ....... ...tiona l b asis.l....................iJi iiii" ......... !!iij!..


C e ta nl proper..ecogni.ion.of.......................n.t....np..
side of the equation, as was mentioned this morning,.is...........
link.........h.....n.t..........b..e.m...I..se.............................n theii
on.......................................... i s a great need for a long-term follow-up on the natural~i~iii
iii st r o f...........................he..om..ns.tio........









Me -rue mpat inbot ecooai and hu tersona endea e otre "ould beear oes diece tope shesnanb.
p Iouldsayit s crtly ipsil td systa ih sa ifitonal b o asessenton the inat somllte comentifom& ,Of s I Smlik hasprsete agentsanii





We sm efwt~s a onseuenet ompinerationo h mpc f sftial aiid~lnutionshipawa, the inlecrfocuainexpo re y elo hupw i al othr eniro miial n servtona e ndo histown,

Ana,~~~~~~~ pont bvougraeteftshout tha Fesietere may bhe numbers
guii~ mor to stabish ento rindjustmend satsta nay
s.~~~ i Thn o.Nwcudetermivite es menes ino
-tre depe--mprn&lr a hw ,1 but myanlyisreaestohi pb Dr. wkosb.I amconernd e dath Dratedatof hesnted p~srtiular i reasons o atstics fgr mokn 96 tot 1971 disegad p .ropr prspctie bcaue mdterinfuing "diecseaing smokingprta tiL f okngi rlaio t frerrin opnacontrsihwvr ird lamiond Te daa taokrs aend peted at fors nsmoersin

1.,ThW*.not acompabetween smokers andsu nonsmokerssm plgnt~~~~~inr Selkof study shows lk t pitu that the bedfrencs 11zaes henthee i a urter a different rfatimtilalysis: ore donelkaf' baedoapbiseadt
The~~chifferened wnteaayiill treadin theatgivingcthe adhie, ast reprelysen eite D lif a







lishddtahatapperedin ersoonc amecsog thesmoks.oseve base U~n ag-s~cif whte al reatv rskda of 5 mn the Unone'smbghaits an Ia oberveditwo csresadndepcd
Uiiswo~ ~ ~~~Yo have tepit mreern toI comprare, thoer5..,
thlep~t i ajute a driedfrm arldDon' so ing caner
k~y'. t'in oth ae o moesan h rt ornnmoes a. uc loe xaiato ccr bten mkesad os tkr
Wnon mbetos orkes. Snce r. Slikof's tudyshowithaith


maoit f ores ee mkes heepetd ae hn ht ol

b6 dri sokes~wold: e adiffren rat, Siilaly,.his
*ouldWw aply fr thenonsmkers
The *tul idultinstht er dne bse 9 pblshd at
Ao~n inDr. elioff' an Dr Hamonds orginl reort tf



obs~vod expetedfigues-nd wil red thm, ivin th ad juee'fiuef-Onte riialdta s ereene b r.Slio i n












the populationandused t d omr the eLTh beve.



gmerop s bcomposd s o, oth e raxedrU mea, 30-06 wi ...........
the4re e annsimaons osre waexpha_1Ptd M4 and theretimatrion ofs thee1pea

Ther he ilatve on th o
onlathve rimo knonmkr relaie to t] ol iet syfrh~ smokingr an dthie of d jstmhen ismdteear dio asbestos xpre.iv Ino manly ob t tiy n hsde o 'xa

petge the study populationvddntsmkrad o vb : teg uartesoknge ocmar h td data, isatextenaire Nropws the oe p foith swoudlkeran oske.Inti"oos on eeis ourscoimao fectncacrfo h sow tivelynhigereiatho rate u et d ung nmmke haready bno oaaalbsee in dieffer fostaddua f thein Unite c tategoymkr and other countrieat Further imont nw eaiet the study of one particul',0 pmouin ofd tat plaonst is dteive tsep eaddrto o srrondingsare Ith itsy socioeouisternsa-if yh


ac terstics a plyeltI toul the o k eaietote(mot sm eeics of medical a tinn




ofs bengred ie oetred. it Sae n dfeit oii tinty, occuationaldcaner cauntrbes.
Wurht in m conerndo aoaiurpat in the ntdS h
coan io be very easl n isied. ro thinkmuit h mutrinalexposre its caaivec c a




an iterpettion ofpl smokting a ith poiisoah omay l ~ the lckl of applicaioantin.- oflme the same@aemits

requ Iredonend bu in the scientific invesigat cn refer i toIrmikfsed tukDr.Slkf ; ~n~f1njtWM] ill were n ith wiliteatue agan oi will bemsedrti o boas epatoe or nsmoker wsit]apist okr'opnain

wictheyaare derivingstat datna.pi tosmkn tde- Ia nt a.......... tiii
wii il l i t ............... t he...................................a r a teiz e .....................................................

boya mkronnmkrwtotseiynteiieifo
w h. i chiiii t h e y ............... d e r i v i n .................... ........................................... O ne.............................................
t h a t "...................................

















resitane. lo ofit as apeaed in P sychoiogy fed, whc finliseiiininrk"ew nd sensation a teee he
e vsdieryq inbeingy.e.
XaIEW bsouisomgabensr, icersi ea
The~r h-as be. Coseunfeescnt resolve sealla the! prsas Bqshd cannil only act toi itouesactl a confe reea h s t sort.sitac and the effect eem nze ehas been dis;ea o ete cas
-,srve illanc T herey sn tmntrn
4mw2' identification oh subnces. s So d

wm~ b veyver rlta t to aesnipat oof any~t weeti
n~lmsdii'sde an"oherpolisnt I n t moin bteei R qbug evdenw ut~o sug>wt wh is igh e rwro but I donvry,'er diliiMhdbimeo whamking doe storesnt o

Th > fagrees with ony. Adwre whoi hadmte to~~~~~~ IMtmn ntesn bemaddrese inse fah ion sce- oint

I* ti tb, ud dtdmtryn identifywhere thant. ineed emd
*Ou~e occuwopenation ieascially shey ee msve very very brhad apprachtan jha*, wprkols>ne-typisdiecased s weoav ben dsust n
I wold lke tdealihsothiny fr abackgrounin geras hn
wiII c" aoter"conereeths ath onel tatens t assume forwr.Ta Y)~~~~~~ ( w rdos'reone heas ben dimasend orected vocus











asIiitalkei the sese.. ng thisrn..ing, and r .
Weu develop for msees it anu moalen got
StrceonIhe. be ne heipena oIna t o cedb the prpeoce a espngsop sand ~ iin.zq related o the ossie seeialrpng, tod eatain a eae ards afnoesreoonte.teoret *
Prevetveo sfndrdusele an Iimmabepair tatwG= arnd th ovespelstiaplly.hgie
sotandar bye prausiegetatepe toB lisaseadasdiIasth wre tere ist o mch possible interactipone tcas in ohrwr
PeetvstadadI kind of de-spair hahin wathe so pa isai

of PVC standards, aswell as 13ebmo enseryi SA air
Sitting in a room with 18 scientists 1ngtlphr wr 5 .p what to do inestablishin standards An then eitoueaieua ti on of the niultiple fheters, that stes factod, as ela otcqa ties of the individuals and hew w ca n evre aoti4c~y-e-b lishing standards and standards that reliabilitheidsrCA I6 with
I gesmvo-veivlcncern is we have broadener h es~iehr where we don't have the ability to:.-o anythingwtru otCm pelling needs.
Dr. Ross rqm Philt
'Dr. ENTEanv. If yon can't handle causes oataimh6.n youi handle twro, three, four at a time?9
In the case of smokng, it doesn't appear based nterwC~Lta if voii stop smoking, if a person stops smokinthywit e 1n cancer.
If we vparalysh, we have to agree Writh the anai t'dALhy oleted it. We have t f sree with what the analysis a.Btlf~h t analysis., it shows nonsmoking asbestos workers:aea ikQsapn smoking is not a solution to stop the incidence T think it is interesting once we getD~r. SELTwRF. Wha re vOur re-asons for thatasupin1
..r. ErEL,,. wrote down.he has a double..
Dr. SELIKOFF. YoH re Smething of a statisicin o' eyt Tf you are Dr. EFrERLINE. You gaVe a rtiGo of 1.3.
Dr. SEULKOFF. I a m sorry. thait was not based ontht
Dr. ENrERUNE. He R&r TaG rtoof 2Dr. SEUxOFF. Noz it was not based on L-2. Itwm,59
Tn taking smoking into consideration, whichT wl xli.bti isn't right to say nonsmoking asbestos workers hv n osdrbe




49
sed4risk of- luF cancer whent for almost 11yearsonsolobervatioss f*Anioig A&l&OO~workers: showed only two death Thatblis no
drifgnfinntincrease in the risk of lung cancer.
'here shoud be no misase'of faets. I share his apprhension ,)r. EWYERUNE. I88 can sewhy people are confse. One analysis
i YonPsvop smoking-r. marr Nt if youstop smoking.
1ENERWE. If Ou te Or smoked.
Dr. antry. ont kow anything about stoppn
TAi. Ernn The same data siialyzes in a different way. You have dutible r~ik even if you zie~r smoked. D~r. SktMKOiiT will repa, you: can' sa dou40ble risk based on two eases in 10 years of observation. As you say, let's get more data. When
asgve aStatement, based on j1 versus 2 in a population of 2,000,
6et1idotht.ftislitil yougetmordata.
I".iscHR. woul like to suggest this is throwing up a cloud of
ae dit is not
1Or. Iorn.Before we get-through though, I would like to hear '-. Eterline's resetion to Irv's statexihent you can't draw the concluAN~il 88- liAiitft two esses over onre suspected. How do you respond?9
13i-*1V-NiL1. You act repon-whatever data you have. Even when
-otieT "1~r, to ti bter tan the other, we have to aet on what we U"'., 1 Wihi %o act.'That is the situation. On that I weald 'accept
Irvs dtIy, f or what it is worth.
D.IOINwEg.-I didn't th ink 'T would hear a biostatistician draw that
-66nusin of 2. ovr 1~in a pudation of 2,000.. Would you publish
'EiTZdI The question is if you must act. Let's suppose you
Mn~tna eelsion.
T% akeour grandmother. It is obvious your grandmother is dying of
er are two techniques: one has a 45-percent chance of
p~csa n the other has a 42-percent chance of success. The difference i~nt tatstcflty significant. Which treatment would you, give V The
*5 r 42T Itit that may 1e the situation we fmnd ourself in.
VbucE. I giv up, which treatment do you give your
grv O~oherI
.That depends if you want to keep her or not.
eters.If there is no statistical difference
tumems.Would you flip a coin ? I would not, I would take
Dr Romu. You stand a 50-percent chfise of being right.
ha s Strww. Iet me interruptira -ad bring to your -attention that $here are certain key issues in the course of the afternoon tat wewn
"ft me reemphasize these for you.
(7) information is needed and how can it he obtained to more 9 e turately determine if a disease was partly or totally caused by the ork eni-viroinefit .
(2): Should impartial expert evaluations, medical andvother, be itfilized to: assess the compensability of a disease I












D-esr Cow.d Rketr s ofpW tipp4, 'dp 'ithoateu meed edo aa ap cons. IFtin what getiic ed, edw neeos andm vdlkalswm. figasUn? Ia ,J ; ~ aridwo Ir Myancus will spa to soemn sv' in the uret@ blmesaipsr

woul ge intrte inwl hen Ao4h., h
andh, Ihtet atschIp1sow4 pesuti~ots n 4pent w r~, (I

prDpr. onTs-Ayopitels tha. YOuN dontA tal aout. thatmjb oafy Icot Ithkwhaetge dita that moey hat is- n
t fie Terefis amn atitud air~ rbeq a4te

prouic e.
Dr. CutORN. fa I can. efer, Iaout can sieA JWw
sed1pecnofcptlcsI want to thank himt personallytti tou hmdor' patckaotn th un h o Btwa le Dr Bow rw. sat moe.atr oe notw elpolmF kly. yous areld hr satiueta saying fororhL having, wokes'c Dr. SELNIKfF I suct thser worlugetyo edth4p~hQ4 are late ta no spetfcageent.rd justnotreal. Isharet is discomfrrut. ]~.Cr srpyt evf I wthn allof usan woud. Teorld is t rlike--~t ~te he fts re we ahaveofr a cmbrintiomorwbtw r p thee wil bhem aftrn faromiagnts tody hn o ey pro wil now loge m myte o inomtinI hdeefe orc wat meiof an t ive level san of mlcton o V disease wasinasso iat wit h orks copnain savalIrgr Vrerylafew mesuemcaents are, dept r cluets i wIthn lo peios ofld clinicald ateitIS nTh maes 20ar 30 yaeasmito in vlent thew pastrr4









LS apptid e tio f-t isc tha w it ega t nwr Ii


ev l ite cid is gongo bedon
i pro't~l i'tha itrer doeasemrn atis:a 4
eif wue en, usetmtofhel hinghw bn nreaed 86.tdve-jut monto m The we will nt have thue kint of ibii aptervue o elsof teapg e ornour icampte dew
JLIlvev te to mnfigne th ata think indus.tobpdnw-headtily .&s~fe~doesn't kows that tb donthte fMoniting daatq timb
U0Ob6* if waiertant trf climot wrh thingseelemn t-what
W doiagaind o doiabiity ThWel thee wisl nae blanugee
P i. W*Va basessiven expsue ista b hn uty now mean sypythe,


-bliy Nor can individual workers' difficulties be protected from
intensity of expaBuse, and each case is gaingp to haire
to,4504pi an ts Own merits.'iThis is dilicult for worker's pensetlou q*vbuseybut, it is, this is, really the situation. I wedld rather life
be eftm',but unfortunately it is not.
tsk ,d]taeMfY this moment to speak to medibal
Medical:surveillance is going to be, Ithink, a, darn
good.#wig aW have examination underway in industry. It has
Tpat the last 40 years of history and it would not be difficult
In aA4)t.AsurveiIance for occupational disease.
-iiiii....iii.iii. .iii. is going on now is medical surveillance.
swters I just studied in Indianapolis were doing. biological
Peoplewere examine& He stuck his arm ot, blood was
to~hoMInanin dn. 'That is not medical snrveillaneit is clinical
.TT id**',-Akeasway the potential for medical enrvaillamae This,
i*[&,~m jprootie that unions an the cippasill bave te

W ~ low8 ans ea my lY is in New, Jersey doing a atudy
i6AJe4 Chemical feetories that Tony Mangb eksaferred.
I fi, da surveillae. And look at what hpee o h
eqppanag apany like Allied 'lical gave us a
Lea hag -the- chemical workers in 1t pats
Nots tha, but giving it to us recording to ength ot
eoft t man 2 days ago, 4 days ago, to help, aus in medical
a~~ ne4w a tiny word, but as 1'any suspeatq, it is

%S rp ip regard to~the, epidemtiologip, addsl
spu a oi 11ike it tp be much -better, bu le's us
_W P y, Je~~st;ile se:Cmy








I Olt







r
Dr. Rowja& Mr. MaMs4nUv U:Fn TI ;fM b
n
I th before wa P*u
Mrj AR
mechanism for.shifti fbe bur*ik f PrOO IPRT
in. the compensation sYs wp. hayo % MI*1 C* Purl
o U' disei se, and heXe aa.'EhAve
ce a on*l
hem speakers fluctuated O Pwp u bw awrib Ug'satwPell
diseme, and I think-the'reason -Isve Uave- bpeapqvg A;MIW different senses today. : :: I k &", f ".., .. ....
r 4v it T
There: is-,..,oaly. aiw Senae M. W1404 it 4'reley-OW'O -M
weheard 4b6a determining cawati*Anil empps*e,",#UI disease work related? Is it cau': sed by on x um t4rfAigk
i assume prosubiptionp howot,no
Now, for: scientists 1 PJAM W
determination. They want to know for purposw9f, Wie4t and rehabilitation, and all the multiple factors, this iareaRy:obl .,rweho*:Ito:thviiwi:.:-,'.:-.t'l, : ,,,;,Ii
The second sense in which a definition'Of discussed is-purely for the assi h Of
burden t"Carises fronx
sooi ty the responsibility for payiungi tim"d. nf tho&,, diseaAd Mhl p aying .. ....... ... ..
I thi-nk implicit mi all our thoughts. not. awpomeftl St as we night think, is there ift, some: eftnection, j&a tion of: law, I there.should be -soine: oDnRedtiobc between; CSU3AUCjW =at assi nent of financial responsibility,,_:. U.iq
A, rue h 'ofwhat I heard today.:.Suggests.. thepnibkw rwo amx" v with in that connection, i4not necessy.6&* viabl It. MDAY, -not terminable. We can, say a disease is OiiapatiOMLIOlem,41119W wk MAT*04 it, is work related even if it results: IU,11 i 0111
We can equate whether-a disease is occupational.h6bmne"' itaiddoW it greater among thowe workers,. withoutAny attentiowto thweotiae OtK ,Butthenwee'ant tmatit., : .. We could.also say a disMsekis o6cuptionaI+wavs&*GAMJIV
tionaLAny6uewh6work ina:mrtain inAtistryKvillbq W"ted-10FI l"W is ill. That is in economic judgment and has n(Ahin 'to do vdM"WiWi nectihg to the
import.wherf we4aaf-,with iptoswmptiMsjr the I)roper sense in law nwrely. a d#vke to shift-the bu-rden something. from to hii4hlhr IWaiti4Jntilt
dompensatioYi av4n4ih 5blAbtfi tiorig haV6
an unfairly inf orm itio 44
orig-irt and is' V,6t* r elated, 3 on 9, 1 tonal disea;8& iWho a06 ceftai' riteTia, wi)I',Wpr4iq3Oed'TP' until'the!,on6'WIkg iijod- th th tesl 6nAibiii "I That it wit Iii10.11
Presumptions cRV_ be used in a definitionalwow in whi me*ly-, des M-ibeA 96rhethr'nig aii(VNmri6f be'dihp& Q:
Tn caseof diseases whw causes arepultiple fAMICW19W 6,A16
ifVOU e ec I a presny'n"
or'not- Dt Ihit dli**
O-H W C's *4k f Y"011 are. 14
.0ated. '' * ''
n Rise Ai
ti&OLr4ii ,4kbP0iqoe;C* 1 1 ",
-rs- Ieirigufiwe Tf Is I C1 11 40
should lose sight of in these discussions.









glece r i,; nd eldtheempoyer liable. Th~e Sr6 ~so wo c sht go the other way. So, the questionso N66tio o:,sfet stndadsis very much up in the air and lawyes M, er muc awae ofit. e will see a lot more litigation in tha
Tonymad a ointearierI didn't agree within When he said C.D ii At beg~cmpenated I ill agree O.D. is not being fully compen
XLE150 Sttes th Logshremren's Act provided for eneupatioa dfigseproisins.Clams rebeing made. There is not a coal operate ijfti~tunty wo wll ay e is not paying pneumocomnss ceases
Mr."S~itrm Culd aska legal question of Mr. Guy?9 If a gies tibA iht a OSHA heaig anid there is such presumptioand the 96hoyeas ltera wrkerd evelops a. disease related to h e~ir~riert whch ws tobcntrolled, what is the company's lea

Mr.Gu~.'Tdo't hin th cmpahny has any other than the existig
*6rers:(*penat-on tats.Are you talking about willf ul violation h 6r'e: smestaute tht old that, biut I don't think that is inth sameconextof wat ou re alking about.
Mr. ~ums I dn't eaneligible for workers' compensation.L t say s hirdpart sui. Wat is the legal iresponsibility for a corp is vry revaentin setting standards, but it utit ly
'U,:.d Yu hve o barin mind most of the workersdopna tion %00 proibi sevralsuits between ,employer and emplye OPPteAThee i nolibility unless the employee ecan establs
r xurs. If ou antto make a comment, please state you
fi~LXAN Gen Mitelman. If I understand Shelly's ques tip th loyerembrces some occupational standard a nd ( Y~gm ,40 i de~eiiane te employer was wrong. The substancei 1H ws. rallytoxi. AsI understand the compensation statits
Invove ca shw he got a disease from a substance fro the',0-Ikia-e h wil clletvorker's compensation. !H -u,. 1 thouht h wastalking about third party liability. th any hir p'rtyliailiy wrkers' compensation doesn't apply. W am tllda abot neligece er se.
V1 *'N. heseareluestions whether standard are responi ble qaii M-hAirdsan. i i asolute. You can guess.
OU*, P w asWkig i the context of an employee serving a
rrutplease ? Tommorrow we will I, t~vw,,j-,i Oterittrabout his paper-dealing with presuip tionw~t elpts.F~rtsWekson I as tryintzrto ke our emar 'thsftc~in ore foiisd.on the question of what informatin is needd an ho canit. e ofatineod fn dletermnine mnore ftecurately f disasewasparly r slel cul hv the work environment.








Anf' ue ~hFe AlaRsta mntes atoa' u (op oui prm 4j wfl .
medical surveilance.We rally a' aknyf chronic disease. And yon have to ran brpopebyjoq" l
employmenAt.n,
How are you going to survey for somehnrn176ta a "
been pertinent in19744 i t 'N In the same vein I wanted te a pratesa&O 4.0UO just before I st aited for Chicago. W e haeagoptabae vT, coating and sbestos asa addtv.I is a sml rut* t-p t
men each, year. I have heanidoing thesefo 4 ya&1A8~r"n six arrived, and I called the emploe qpgrkd4hr tat-e
two men. le said he ealv had si mni h cma working elewhere andi the other guy chne hsepljn point out that oe you startthe survilnems Mly question -is, wherqin lies the en oe'.olgaipP 441 ployee that changed his job and is workigfraohrlOe has another exposure, and from then onli ostknwba Sure may be. Des the doctor or enmployrhva3biutgt hun and say you have something that ha b e ace lr Y, UNIDENTIFED AOICE. If the employer osoto ui-Q1
do it for him.
Dr. Fokww.W Th1ese problems of the cagn ok M3-W v
many, any women of cluld-bearing age oig no os 1JA
will be exjposed to agents at or above :ee s drs very, well be adver~se effets on their offpig hs fo6 m part of the compensation system. Thesetr fet nih!~i4t drug industry, that have resulted in largeaad ntefi fWd party suits that we talked about earlier. Ti sa raw more information on because of our conern Chairman' Buww. I would like to respodbif the comp system should be expanded t nld n y defects. I tend to think that the compenainsse Sat compensate employees. The child is notaemly. b I
mean there shouldn't be some way of convna.tn hidf iora mere that does revive damage as a r tesul i~e wrlI work place. Allowing the child to recovrwudntb workers' compensation claim. Possiblyareorycudb:i ,OIn
the way of a common law tort claim.1 n vnt tuab IU61 to expect workers' compensation to pickth e hl' lmn Mfs. SxYDER. To answer the question oi okynilfyad the U.S. 'Department of Labor in writineiesfrth z 1
program decided on the last operator, wc yniN U
Mahan is trying before the Supreme Cour tti ie O ld *~ gone to prorating liability for work mines, but that would have been impossil.W okht goe*h the longest period of service. But, we didgwihtels'Oaao .fr many reasons, including record keeping adteamrr~e nm den of trying to trace the history of a stelcmayo olOPn and the emnloyee's duration of wo~rk in opa morathi



















thUonetfain dsr cosiuinl, yrgtnwadw
etips deemiig h weitc e r andntr nt h
debr In ae ageifpe buctos ittpe neatina !&enesuc sards. V1Y1 rcblephX1,wrouldlietio n lay beoeexouei190sm(t1se scupeity ng eise id thi d urnya.Weral
Vs 4 Which& wyre should po-d ber compinin re

Oxd~gstwilt neical standi~ar aeods beai~esn Atog
winkis llke. tom kees for ilg eodofteil twes e gtwsp o the Stats..s farra.
s one fdih easordes' cior ca prbea s ifr 16ft 010Akhvlem vn int legi ma atr taihl sasil plnfr2
imblem i Wtrinju w h station re ob sfl R* eans edtarhfisae q Man..Vf#14 honhase imewa0 puresentg ailt o ih a oed laclungrastc of 4c pensab le ewloedtrog
s.ab79RTH'shad l orsofcn





56O'


cssare decided on the basis bf whtv piE A r'ddo Iq"
I personally feel that there is a etry, very -dfth ,fiiiimU andlI think that is complicated by what wa msBis a set of standardscall them Federal if yetill,%%uV sit f which will be operative'thf:oughedE the Coudit ,inchijk.**J* propriate, presumptions, so that this problem bil treWd* t
degree of uniformity throughout the country.
Chairman Brxx. Let me interrupt, if I inky fore it ht n eral discussion. In response to. your question dalig ~ig t. States have done, I would like to hoid this dia edgiointi &ai" the legal -and administrative way in whibh: Stthandl.19* will be coming up tomorrow and the next day., .
Second, tomorrow we have a, special present low,
Sape is going to present to the committee on the po '~~ legislation. So, if you will indulge us, 6M ,th@, tohod" it until tomorrow.u IEf
Dr. ROBirr8. We will have two more questions.
Mr. OmswxcK. I am mindful of the facs thdacn i"1
disease is not very good and costly, and yet oceuatioas i&94*' costly in themselves. The question ariss then .as to what kindsr strategy can be adopted to reduce the incidence of didsg froII toxic substances. ( .C
One question I had was smppose I atre epoee t6 dueiA stance fr10 years. A-t I half as likely t6 a~ttalkees1 posej6.A compared to a situation in which I have viirried for 20 yeasfI h answer to that question is yes, that I am less than half as 1 yj hg raises the question of what labor policy mnay bemoef.nahat e66bthL 1nA the incidence of illness for the same level of toxie subsab*A. t kies.
Dr. ROBEICE. That.question is going to bl6 dt with 4
onx Thursday wheri we turn our .attention to Otograss to worker from occupational disease.
Mr. SHEUrN. Jack Sheehan. I want tersay I: smno MaefeA port my colleague in the steet industry, Di&' "itlirtb.fdosr. shine of the apprehension he has with vdgg t o the 18~fi A .fsh multiple factor interaction: My apprehension'about iti a MIWdog which the scientific comnt eisto see thereare multiple N at work in the work place, the impact on workers' compensation think can be very serious. Listening to my friend from :Senitor avits' saff 'in tersof Senate bil, and I am beginning to ionder whether Ithprfisd$ that bill, as it relates tocompensatioh fot"cuatoa di 9 e very adequate or inadequateon the-baisi that 11w Vareo oigtoeo 0k for causaion or say a substance has cha*sea diseas,'an only onth basis will you award cmestion tmywl be 1e have t& mg with even greater force intat ~hironetr tianbtb' One other comment I would'H like to maeiwere *we dohardt least a promulgateW ST tnad hhsadr a env






ti'"60t to bein with, any disease that has resulted from
dn, that perhaps we should allow tort liability in that
"i ebmfteht the chairman made with regard to the fact th&
t,0 4! W6Ma mayr be e~oe might opoe the door to- another
"IR wonerin*6&0 willful violation of the standards
t thb~up.* r- .*j
onrWe will now turn to Dr. Mancuso who will talk about d~bdqsiSpets qf thisubjbct *e are covering -this afternoon.
Ih ill Icoverin 20mnt6 vt 6 he toth in 110 pages I den't

oN myelfd.1 am going to try. It' will not be as orderly 48'
itW.emreading the document, it would take you about 2 house
-zq f thematte is rcogme tis was a very important
*rid 4a0dterid 'ths&l w ould provide whatever input
was ty puviewas a eat of it.
-rtt fthe ocuent, the outline of the document has a background
And edcl spc L o feruda haality inection, and illaborated
thd ediclwpoblemg The ones I1 used related to beryll ium
vtdak *Then I disdase at-gaa length multiple exposunes
M thd'Iiscsse idustia-'ences.And then the matter of aVudThW and ocepational diseaak Then I discussed the OSHIA standaddefeaeopenisation, made' s series of: broad 'overall redommendaorkoii ommient anid a satmmkady.
-I)OMapifi to ad nowwithip the 20 minutes tim-e, with the 16fN.obwa;I mgig to selectively'read certain paragdaphs
certan' whch gve he principal point I was trying to gt
areasyq 11 think that is the only posble way I c an' do it.
Inthe background section I have:' The inediedl-legal problems Raited with the administration of the State compensation las
ePresdueqd~ntia events derived mainly from the Dasic' ul
bewp;tbemploye and the empidyers in* terasfte chia reahrds ofAdhwl~geinformation and 'etperitee, that codastitatq
*4aiktor informed fudgmest and directing in comipeasatibe cases.
Historically there has always been this, tebaendous, gap between
preoteedl ad technical resources available to the employers M4e4tAilabl to the, n sho the job. Justine in compenaetion reeQui ty for both parties,.
2 lankof recgaition of occupational toxic effects also extends her q, poe f the several hundred thousand chemical trade name
Ided, baidustrjy, whose chemi-cal, composition is not mde
.te lw orker, nr to his, doctor,: nor to the Government
are 0 isnegal requirement that such information: relatvetth
RpmposAio and the toxic qualities of the chemicals in the
44A~4, euts he filed, with NIOSH for assistance m evaluating
8 Efighre hp eerbeery an ieglreqwirement for there protestyd' strd cemialsprir t their use M industry, relative to
aeqJ4#0rinei NXet4on the workews.
.mwa Lx .....s.-s.. s..vy t~oeatev mu h S~wunmary. -which







occupational illness -or- disability, ;r, hia:,w &w a4& death. benefit when, thewoTker doesWt k !Q w. th
04 .
really know the chemicals, the hazardoiis saib ti ce's'to'beerx Prev-1ously exposed Auring, his emplo_,vmejRt; told and can't find out ther 04emipsbthatarv IA i)w x%4, that he is exposed to ist'"work; when he hjts np ll )MM, the harmful effects, the to 4cil ajA'canceIr",
chemicals at work T
How can -a worker: file cluim for an.. oee!lpq ORWO
own:doctor doesn't Inow the- and. tmrc
place-what the working conditions are; when 'his owwun know the trade name products uwd nor, imi tbLe mRip,101
each trade product nor, lmow the: toxic, Oe 'P f
chemicals?, pf QO,
How can the worker know abo t the harm I cts ofi W64$
there, is no -nlairit doctor,, er:if the doqtor dpepalt] #4)X;FPXV MU
Anti a]
postures, or. if there is no m of medical rwA itiqR 9% owww'm'.7.7 illnesses, no system of nvironmentaj:.monitqri g uq Stem coloiriesd information, where.rworcls,%, not, xdipa"te tial information even if -in exi *: n(*.ava AS .' I il4b1P0UA';WP 'd HOW can, a worker t ec _ize, an oem.P4691ftal i lln Ox to, of chemical& when the ind haS not boen, rVe qvuW 1,
ustry tar4ft4"
adequate eXDPrimefital.testing.-of,,th6 thousmcls,+of,,cWmi"I their u % in industrve.- when there 'have mA bom, the. lrwoess", aftwNfflos not. onlyof th 0 individual OhemicnJs, but: even TWre 1WIPWtotAwthe combinations of the thousands of. inJustaial d6mnimls xwoddn
How can a worker file a Camponsation-cliodm whewth&
tion laws do ilot. properly recogidw the swpadf." SUDW
anddisease; when State. edmpensationlaws.. b&Oe'uot kWb*d6Wt industrial co-mplp.xit*, por With th-,knoWn scientifiddeve dels*od he0th effects of chOhicalsl! i
How canft, worker:fik a,:cnmpen-,qdtionAai64 whtmithe *vokwjs intiiiiidated b-v the flenrv;f 16sing1iisil'oh. when-4wh thp &Ilawjvw plovees'fesr that the w1aiowle dgvMmt+ *f t1w hWth tvmblehfi orri*YJ Poft, Of R' Off)' 'I
conipensati6n:0aiAirm cause, fhe nW)Mi6 lhei 4jaboxilm
diqeoura", the: ftli q of clitinw9i F
NowJ-shoul&liko t 6" to-c6ttain
mil Rt. be crfttrollod'ft1t&ti** to ie6g9ti6n' A61roftjVAj&W jEANOW 4) f I pt
The attitude. of the comT)any, to hea1t01Mbl0is4t6A
mentor denial Pft6d6R,-9Ytd thi-_ 000riolh%'Costs Of k Mflueltee''tho oi tgbgert 6 -f thg
(juA1Ay41ftd4eV61 bf. 6rfdma*c o) incl-thtoh aWtef 4AA MdMt-bf4h Of
and envik6ytthontAl' if Ali f,
tion of work4elidedai8polsie Abdillftogs. Oil PA XT
O'f 6itilbal jitwih 10 (t)
things, as to how thev impinge on each other.
s&smid th6) inatvrW1
Old 1P AN" YA "r fbM ifi4W bn,
health effecte'l6f : t1h1P 'fdhg%, b f 1+01fi6eq 1= Wfid e 4
ability of thie%4iftatl6n; I&LItt id k
the ddip*iiw1tj*1Ohj w tn=' na n =it M5
cofick-nin# 114 f Idtiv P*O&Sg %6 X6to O'




0 Cw
Of XPU-5 61 mi s eT in uri S
10 ;'Che' ical '7'or oth i k)u
utp Me edboitidn, or lackof recognition 0 workdb]$41.kliem thdW kre.* two'ways: to approach: this parSwitsel as I*hope
d'the# O'e haw yow 64n. im rove the-IMA One is th d6t0td .. iffholt 11undalnerital problem. It:doesiA make
L
66811 1 110* well you:tujie the law if & hundred ocfH*8t df 6 fiot 'r6ic 6ffil& d or there isno system in it
S, t6 19hyIv ad e pttvide compensation -a all
NOW is; -not edrupensated?. My *hole theme
bwqic: e'm, ifdr th6,meffical- recog"hition of occupaWy Th6i individft),-aidby the, doctor in the comve hanigrii, within indu
*Wd6;4dtIIii he' n c stry and
Wn
thri cif iny particular con ccern.: Unless YOU aDOYA Iiz* -the: gitps, txisf nor do: y6u, realize t& ifim 4t t 6 bi*ach thep4Aicular gapIt6f tolfiy te oMthendati6n f Vrriay because I* 'f dm ke sure 1,have time to cover that and then:in the limited
M ifwbO&ih &Mt points
41 6-ug Pi- bbleiiist)f'yhnlti'le'exposur( s in the'work 61pos;ed to molte thait one substance in the itbmu it It- eq I ifficiiiWond wrong;to assume there isn
I ffii ls drbffie or: of zvpartkular syndrome tOa cerVC, -e pwe to-v6rk ouit semis of presumptions and

I iv recomnl6ndgikis pertAfting io filling some gap& One is f&&: vK,6444RI iecurnyappfroach an- d Coumay not realize it., niii of what Dri. I rts or Dixon was re!eriffkoelftt record Of all 0M ,poyoe records submitted"'by 1, ityl-sinde 1937.These quarter-I
&V 6k6d by", Ift secun y
-ry i ism ofeadi emttt6d by .is+ cofiipany CJntain 6'" e:
ee I., P soPAM wmity n Em&'r of eaich employee for the period
*Iedven.: Thii appliM io all'itidustries nationwide and
d0bir I'eAch, y r
0 ea
d ti e, precisely 66, dates, of em I nt Awe tdbytnehi.of eoth itidividuar, it ca lWy-ly t&
-biA a somrity
( Affik rked-by, h dato-and s' wrid A*i' 1:
p6pulati it risk for any individ fk#A)th6ti tM effiPl6yee 61k
&N ial swtirityhasclaw fied byt industrial
'If ftii6i ocht6 it# thtkp, tiftieulaitype of, iiidii4ry and Ltd
fbr! 60,6h' o
tAet 4 q&tjtjj jnplqyey% and, silso pmvide the
8 QA
paw r,:. OW
thb e'*hi& ; Ve 414 4Wh6 *#Ive PMZ06rlO amployeilixt, a 'it IA9Aditi6ito:deaWf)0,ne initiated disability covet&
and that is identified in length by social security number.







,whic isugfma and pu rvid anl Ura l Iaawa einpoyeewith a social security number; htAye

logia sudy; that all the death that lav cnm
ca deter mined by social serenity atrictybyOdt,.' Ineseeo, the basic requirements for the odc fe Ol studist any plant coovered by-social securiy.mne 97q out bysocial security internally by, its owrearhi40, poit i that ethe Social Seewrity Adminiato ii* ovecoes the destruction of the personnel~rcrso alt6 duigthe pas 86 yearsad makes posble.shsb~ rpaedly that epidemila stuie an exi l.AIO emlyed, for example in 137 1.989, 190:t uh 92. fotand followed through 1975, and for n xtrC cassof death. So that, in ekeat, if one wrthe multiple employers &!id What -as h~ua0 hnivdalassplped asn & quie plan6334thtesxb bee dne. I lave been doing it. for a anmbro.yap' w ama be donal .
Tepoint of the matter is there arelsm U-aOO t
fiitl should be done if one wants to: conie Wap myfrt recommendation is that: the research e~tet Seuiy Administration should- conduct, as at9 t meta operations the necessary: industrial pdno idsrii s to prqvie gsg.1gppg mraity pattern for the corresponding rd i ..............
goisand types of industries and geogral Thscan -be worked out inn cooperation cead it can provide the means over tieolar 4
just at did happen to a worker employed nacranid
Thsecond recoommendation is one of deppant 11 tknto develop, the use of. social secutu itiiy lna with industrial mortality studiesto6....... abiityprofiles hy type of -industr and o
Tepoint is that a naional system, remoc n i whichcan be developed and applied andea indx he estimation of the. magnitude of -thwrkQ14edaean ilnes.Now,. I have another relcommendato ih-es >ae roducts. I would recommend thatwhtoa o nae>roducts with lsting of, chemical C'Ope~be'k mltcnque resource for thg evahinowrke ne~es;the necessary legal- requirements be e rn
unifr compliance for complete data by7lo th~e d name products; thait the necessm or iooiad b~~ .Piedby appropriate governentaecW 9 h o h
r?,ents; that. a system of ident~mo ti ~ a, b %
litate rapid response to -requests-1ol faMWA U M ratv to the evaluation of, inedel problm-iwMOr 4
to:theworker through Is medical.F e1W leg reurd. by comnpensation authorities..-... P




61
4 few'.9 *4 t* Ie# and under my medical services recomlaxa"Nave reco' lnxidtid,- that all the professional ifidutri
hp. it ring, and ey mon riluatipzi of the epep 64. of the company, that ch
'XI:i_ 11 su semees
ependont. C04U-A4ors to function -with the industrial
RU ,
0061i on medecAil semee's" and compensations
7,r s -,7OM'e;giveu Irree choice Qf physician, medical and
Mpowa. I inand th't r safeguards: be
MI3iqx, ii iht6'of the worker.
in My PIS U I belie''e'tha- tv hen a' stand;I iion: Cd that st
e, 4jadpthere it a vio a n a 4p
o worked in that location 0
1114168S wh "Os '6 mp
Wjj t46006 assoplaw with that toxic agent, that conip6ngaM d
t
("q 116
hell rwi goin t eact. ii ,g oTo
Ob M"A)r. Mancas6 s.paper was
Ii ogiUoh -which we"take.'With the passage and I-I& th A mom an.
0 o -fr I iA' th 5,ye4i ago
h denti&ation ahd trol h *6hal* disUrs associated sta.
-b 'Th' advghces have coin b6th
W r
Th; the atoryan s DerC1 tho 61Wc. It:
bw1iia l th4 th em achi ents I*gin to, j us I thb
t (Ms 0 jd'
victinrApp, wuled'and ignored inthe'p8A
0 a can =.Z.
,6 A ll'- ,.,
1 1 6ef :'I ith coke
( qp es Cancer W oven
A OA cots areppi i47PA -Iun 'dancer, i asal 1W 9
e
.-C-41 Ile-stsbli,41;2 is thb d:) d.f PeA
between onep -. 6- 1 expsu l ind evi
*d' : "1 4 Ilaical. dis asebbtvoZ I lipiiti8al I#J ilv" 91,11 d A"co: f
e Xpogure an is very
it, Offers 66'AIIII inte"t" an OPpomni'T.
flW Tv6nti, i tiz th* x mig q sruccesidul
e' c p owsu r* e o rtfh 6 &-am t "'a r L t c I i ift I
-9.91 Ojxnen0 0
an t di
11 4hc s An& e6ntiol ease.
o is ISS 6 E91'I
h ie n guarsn ntv or V
6 tobr4k
Ri6iim hIt fin-d 61it i it is PO', -at Mast
1. J .,
db i A,
VA -816iWderman t: it wi can Okpect 10 death
A b. :64fii.
Wf 61 A46 U* can b ts to"' ch jb .hi7. V6 46 6 i
Z Possi I I,
th iiadeiir Of IIA14hal y
'411& Wgt
MOD Isease, I n
't yt q ay61 e now, shoilId occur-'*it' 9
LL
Ev%, I th t ,the of A concurrent F' a, -1
that h a.' r4r6 modi
liar na x reTaAt M "T
4 J Jffl 4 0 g ..4
_T 1' M h 'r
41 ineall xktises 611 Ide'T
e tha iri*- aini 6 As
Rrowy.1, R, ;4 We is, poji ica4y.
IF







TO 1'91MIIOIX)1 011


P-lug
InI[itely one-eig t o 6iths
wor h -t* aroma. 'T
.tbom iv. AT, Tq @35, gon a in
-phoma," ibe incidence OT
3P IP .
i t
erg,
NXI ]I 0
exists. 'oi up&
similar estimates, -but of course not..
Mancuso dem t
-'Proaf Y, py- it
0 'rj Is

N s
90 it,
Y' tp
ID Pt
tZen may :r
id Ur
YP
Un! hy unsu erpam Tae

7dI y17
,pro ys
gpq T7, --T;
th.
9;'
e 'A
Y,
bi
PAP
this Pk

jP
a4, 'OU L ,r
p, Vng, mj
4M
"TOSTg. Ali
A k
OPI emio Ogi Nc i an ry
levej; *'Uot OLT PO 'W If, g)
M*11
p
s lqPgCL-.A imm"
0- ec
P I u

,far
j AP ytur' e qf l9w 4. W'OPUIPIj*-1 1
of an pgr
y g
stan-ce uch chiradiri tl0n couIS9"S elon"t0Qi of published data. In additional instances data may exist in the hands






gagqr but hrot published beesuse at a spectrum of reasons'
IVMA ~ as ofMICN *1 w apparent pertinence at the titad40fthe original 1. to Saimple time.,a Bo, Rports of research ho progress often:
VAMaJ;-+1.exo~ue.Datergeneration and rtreving systms are
aodv o-e these problems.*Mor6 diffcul to the develotma, at community ad personalevels. First steps. have
-ono higid-risk group, of asbestos workers have been
foou urvillance it Mserial'6beervation. The: group is-iden-pw. 4mdand, baseline 61linica1badiologies1 and p-coo Ca
ljwill be completed. There is no reason to 'iee what
o ol oever, W2l taeaysincant difference in tl 6
amlvwinl hi Lisile, Ky., large. groups of cutrrnt: and
Natdeworkers have beie brought adkoeei o
V~~ijaiy ady. Ad intensivee, study presumably isl a dore& 84.xprinee suggests nonewed the a-Vslable toals prve dposs fsa~isarcoma and related neoplasms early enough t allo
JWIA~aise trestagents,Prayedfully new ones will- be evolved
IjiNVIjj~. o sales I canronly make thee pits: DrMah(sho 11 p~~gseis dis- ast important,,tenet of a national health police whc orkmeii's compensation is onlias."laidhead e
*4,jgb A easommnanity resources includmg whateer is generated by
cqroraz phyaiesa nation. cannot beresticted, to these resources,
abst~ice o remore- people from the same plant, rith
p na,,wVes not!-pinked up clinicekly or reported by the
wx ~On-whlis ins rpersed by BL$ or, compensation,
44rx6hip d of defenpire reseach conichwhed by som eros
latevey :Meaninuglooa at t his time for the definition of igh
Iq~"' Zwl in, Wisnai n17 and, in the first quarter of 1971,Man% of. aepatioubl cancer was reported. Examlso
dtheia search pight'be, the Asarco studypof arseniea
O*V(leshirdeatudy of .mayl chloride risk..
1kW41 mistbea epidemiol ogical method andVtilizatioA i of Oil
(desonbied hg Dr, Manonso)l are 8cabat ta oddaeea
60 a Andling high-rish groups T'eey tanhs method
tiiato of the worker -that he is in a high-risk geoupy andb .4 hstwametar. The mWakift9k af:skppause at stork in
bialeopyxunot be left in their hands of theimnaided, worker,
y, Jn sx lnsytemtie study.
Gilfaib bad reors mstno ongr e kptinperible form in
company files, but must systematically be fed, into: a- broader

PAodeguisOSHA *6werscompensatonjAnd national health madrequieapartmelments.or)k even c Ollectie: tota.'None, of thmee
higsl~Vekhol 1at this ttimneca be welded without cracks intowhich workeei4 miJOliesin high-rishgroups-fall.
a q cthod rm iaon Ihsoial xsted as tAn, imntvocr
rect conditions.Th kevone incident shows clearly this failure. The







Travg1jors' Iwiurance!C% inspected- thefife I don't know., -what, bWrveportsays jbutaaq.oWhig.,64t IMIW 4w. only ehauge initb6 plut wasU)nev dedricifight !tat *f_1(jTf
WorkeW. 9mpenWwinjmudtinowlbe we6. zsjmqVof Ifib"q eeoAonfic justim for, the *Q&erv. c=t sontainisw* t for sources now subsidizing the,en*loye rithroVh W36MPOOAOOV and as an integral part of a total health carwdefiftrvli
V
focuses the management diseas&.rath4 -tUxij hileviati0% &f
In conclusion, theefibidpbAdt, LwouMlike.ta hW1W 14 d&
the. implication oftho-,,ihWti.fabtoic .,iiit-tivAiom iTh( e DMJ)"?
Joi j com U kliq
on e f a4rtOr: should.. be rewi&L, W ILd :, .. POM 66, Multif actorsyaems.ake nota reftsmto abtw it woudDA &W( *W' the cause is. That is because people mi9u&wthi46Piw&ti -1VQ k6vw excuse to do uething4 Apprdximate idmfificitidn 14 itho rft4di UTRY be all that the preeWon, of tW subject,, natter. 1*1 is*tta the Greeks in Corinth. were-tx g tx>,my, Thits, 16#1144OAdilk:.
tion is a factor as well4s, Ei discrete"hgentj
Thank you ,, _V1 "I 'I... I F
-are: rea4y'4or owhindntstkjr Dr We qu
1 ers of the panel.
'hosp W
Dr. ExTvffAwF.As youmay, know 'mod 4.)PIM
some kind of record review oft each.patient thq disc4wg .: There are. two, centriii points one, at, the, Vhi"ruity- OV i A and one at the Pitt9burgh hospital utilization, p"jedi It, I
The:point is-thm isondconputev tare-* 4ewrd 16tevsq. discharge
enter that tape for any particular disease. t;Q*VIRMI
For, example; I lubh d, at lead i POMRM
yeex. While 1 C8n'TgetAhs,-nainm,,of the, fOO&I a ]is, 06sSih16U1A1T& W11"eL the cases are d()Mjhg'frO)M.j bring Sto4v
,ystem has.o
generally to point out the medical care s r
RY a; hi it
to' producee, this, ty pie, idata not, on i qPftSjW)bjMi= 8= s as- w4ffl. Ther3e'ldfipriodit(w.dollugm*c dsAhat-comb(CAWOft"
VaryflovNe wl!
toinduAryindto:omitpatiorkdlgvo dpith$Lt-could b&".i
Dr. ROBEWS. A.Ak f drtWi, questio'ns-4r, bonhihigftu in pow* [Pause.] If ]ja'. Vhfle, Y()U jr6 orgaiki2in to, Dr. Mancusoi ihelly g
&OM im the
offeredd now.
Dr. BF&Kowrrz-J *ould liklato, &A Mj (SaMW6-,Vfi&V
out on, the' quest; i 6f the; rble.bf 1 VW*eA ICOM M*& l iiV of Dr. Mancusols paper. Is there, ft,Yolia larld*tfsdi = $tU414 with ith lihiitkUms ied to determine (cv m b6fak* it.
imiatatto MY
ry g to continue VW
MX. SAXUELS. I am t ing to see if we are goin this -little, gme'wbdch4o&m7t g sliA, in reidi tiliU6 to 0618ft /IwAi it
U, Ai tbM& tv" t, dov it i thftw *96ing.
Ja.6b 0 th i nekb:to'be )Oaj (
ckgamtte we neid to
Mtion the _". j
worker'Er, compel 31 ejl (atr
adjustment when a wor"r, is bwtCUP
'4'






Jv Vr4WOM existed whiA-w6 OW 604P leA4: 4
-kn tb dli aig
Me savidenot 6ti th6, buisof *hich'ath Awaild' ht*h
iftotrOtIatithief itwividual'his v idlb hyeologibai hisp rTy tbodt: *ihdthe i N isi (A *rettes or 0&Dnafhi wit
Z..-Y owvdUld, rely:6h the'syit&6 Ut pr6feIr't6, hi tdons [built irrV6 4 Tord w6uld kill think it *bifl& Nt
474 tyM Wnl touipetisaiion thai- it wo* uld'be dnradoqvate way kod,&ovide, *4 sPpV4fkihte il
OVA ;400 qqrM the situatioAt"
'41: A6A% lhirtk! workers'- eoM ation dait eV4 be an
-148eizi thil bro&de4';vedfu 01''00cupittl6v2d ditea 6'.
4b4t, piffeg Foit bf wdrk6ml. C014(yn, ati6tl 14'somd,:Vzowl t, thit i man gets $36! it weik, fdr, lieing-: fully 1&n1v"hk ihat is a, dWiila tiv th thetompan.
CL@Od",.Jaejj l ry",thin, k 44kails .10
'tgrw I don't think,, the 4orWrls kix,boen tw, ft iive f6r iftduitry to"
bs Tay( tho provdim, 11 think th o finploft0A
fit aft y -Whkt if the k y gdt $366i WJA? '"It *b-Wld tot beAnIffiahtivel?
I Cho '-bnj waty ly"n aro read*,iit 016,pru
k of the ajinaJs of the AssMatkfttCPolltiW 'and 'Ri) ittl
IM6 th" a+eryAd *p &perw'wrftteiY'b Wiltim, NP
6t the gio gt:la rleaderg in pajr lovd d1titho edfrif Part lity;
w the t dent
an4 he, ked-at workers' compensation as a means and he used ther wuleftifaof cxyrredtinwtl; v6miYA.'d ihe
A w4ker14 "ConlJoaRM16A
N.. Ibo6d-, dt'higt6fid
which,
qw. Ifigtr, '6T
t 66 161detg lii ioli ifi' CineirffittL th6y
1A
Xrt stablish the right qf a
O i tdo W'Mdit'and say 'If tN c k
on 191 Ith *OokiBi ikrk6a
t
ii iftf h 6 feol $41Hkit dittit
JC Th ''
I tW inaglbtldi A' hW be ( faildA# ftb9ttv
r*h*t -he *as
16off p6fi
ni- -don h T hib ikevA12,3kbt
ffi i4HUndt'
IQ
4th&t
TA M P, n of La or to i!nPAbqhefitv'VeTT U.$ De artmen
ShecWttoEitio alsif6tyI ajid HeAlth AAt. Wh&6Ver &P7 t, w ve
1&0" 1 thd
i tQry is, t4at this histidriF-1Y6UM -be UVAAW 11%6 b hW
-t 118S.Tot
41
W" V1 71
46k9'afOUIA ttan
ImARO W- W 1660r at;we jii( Wtict gilo





66
up thezw-f auIt-,qox"ptof.thoxg*or IMF, U.
to ay..._thi re.44 gjp tWgnWM that we, shqvlk no-f! S Uh, mA:
fault ,aspea PI
workplace Corrections it r ight be that undi rfjgort4iA, that thejxnp Iit mul4 e.: ma haA f
aaces -the beneiRts also be4U.Motivw, A(M)e
Maybe in tW senw, -it could.f be, a indneA
a .. mmtr4f?3VW = Iaxw
bine the no-fault cowoptwiW,* fpnoWv# *WoW pexbapAW could lend an' ffi &ntive to woA[ilace co"COAQU, 13 t I J, 'if f f I:W".Io* 4-1
Chairman Buxw.. Wa wholo .* mar, wo, w* talift Wk4*A*mq into the mbjeet or oUe'of tbe-,"bjedto, Qf tW program interrektiomW p, whIch,.., wiU *&VwjW i p*001A W subjects. Amd rather Uiswtryr4oigat furthemi4pAWs,-, bla *hA system is adequateorltoti
tho progmminterrdataotahipstpo'Lltbf tbe &Roddvo .,IV:F!-(na-jmXq .,a
Dt-,AsHtPoRb,,Tt
elinicalcmapational diwW4* the wgirkeW ompen4atioli vNm W4
herendY dequa4. ig aa inAefifivil for iWVroviu# ",=p*q"AbeWA14
Mr. TKATmYxow.,JA9Wt OU& -the, OQM Wt"JOPO *441jw
provide, economic i6ce*ivJ rtoAIid4cef Pr"Intr4j"IYO-A
has had a, irorydofinitmlwed jnJ7ProVWUC.:: th" bIC06AY44FAI-Apt was not thepurpopexrftUe "st'qo
The -.Purpw:qf thq-sy" ,,wm to-t4m 4
trying to provides 64440W -,qtWWPwJtgWaW t4terhagmAp of Ployment a-Ad injury" W-, P omOloywojW, smd care. ft
!Vol I 1W
happen to kno*.-fr9iR In Qwr* experwam and xmykemmwo Yw remember that in Verrhont there was an extremely he2kvyp gtq** quarry exposure And Aust. disosoUzamd, audl IiapPPsW4q*pMp there to discussthe posrAbility, of O"UtW9 4,00imp"144 that time the coonpens4tion law 44 114 provjdW IP ever for th d* m. If k, silicosis case, I Oan rfidj sAmi4W4*4 IP 410
t improvementr
he ,in this Arpa,,. -Jor) (0 tan,
I think what we hfiVAJ3rAW nff zln
recognizing s6me of tb new, Ai4i4 ,w1dich t"A
reRareh. I -think we fMgWtP -Yee09WO, t4awi IFO rivWY
important. I think as A TWdt. offhii e9af4mmepor
I jvqto fyrtber t ejfqrk
an incentive. to,,WIO$,Hi an *qmt .Andsio far as benaAtsAreqQnPerW-dJ-I* [T Current beneAts. Shwa-,.10T!O th -bwfitog M coun ryw e. We are r tal I ring #b'Oot th
a. few years ap. 'yf
Them"4M4,10bof sm*oua M .4 .fl ho it
Ment w.e,.,WIU resolve Uiew.A II*rOejflr '411P, P4N
4, :. ly 11='
recogpizipgthe owffitionsag*ay i ; r,
no.quostion, tb; .y qml oqop pens or am. p*pW wc
but how do you find them 1 How do you prevent them.t).,I
Dr. Buwmw. We are really very closW
norniequestaionath will, q;jop -vp qp ho Arl 40,
because is wy, tueory, Tf PWWW 104, t* PRW"ONOW"W" rot






IhAnWibida peatsofthi&Ofobl becameafterallthit4the
19miamwe are in. Ithink-it would b& useful. ft)r M e
M rb.
an AnMW to,. 11. you were to take 400 cases of OadupaflaW igswkq-100 1(d "ease -whv*,h mik4t occur amang tht; warkin
9
th6se, 'could be tried, back, in, an un;, WOO to thle"vempational factor t Hbw many-couldo bo tftoed bg& m antun a; non
to' -Oceupadbnal factor?
Aw&fhb* ShbW iw6uld YOU hflf b to. say! as it practical' Inatteir; you efti"Wide*O the cauael I
-44%vo*ritlipfaivr6bitm aiYd'ThoiWe Aom6 senaeoUthe insW4, but V.,116111kerA %,that f6rin)aa-* way; f
it 0 firming: u owh, w. Aerkr.- ffAimn s. On w Iospitwi ivaM floor of th6100 -cuw perhaps .13ut we fillgkkee
s"A9 *fttdsmAfind6ftrm1ned r Pottiondue:to our lgrlot tnec
Wou bo tri tot i.,aomt nonWeAoAlflmw 06 cause;DI-. Bvwmw. IA's take it one step further.
4 JBq o.- -disability -ve libel u
A6wvfti Lhbout I perne it: of: ouT
Iwo" vWAk&Tli1tt4SA ementiof our anipl"'who4re'disaMed
PtgxAN. I would rather approach it from the way Mr.--S el occupational AisoisN tfiat identify, to aiy'
'How mriany:
'Ttr. Bt*okow. That is,'what J-ain) askin I
If 6Dki.11 PftfAr":1%6W Ixrewry4 -very, diffiaultto: Aiagnoee,,That is-the
vm wiwmedimil-V 11
Rbs*hm It thktik @3* 1 wehad, lbwAvt to, the comments fromf the 02dbmwe
;1W.Mo m. I just wanted to ask Tom Mancuso in Telation to hisilast
*Vtib W 66hs;4iftd lkno*,thatl theselhave very much, pp 'talking dboiLt tbday in, workers;., compensar" Ji6imindsmudt Ftg)-he1nc1uded1)hi recorrimendxtiong I would: like IWAilow4ofiffla io e- tbo-at-how his thinkittg goes..
vecommieivdatioft, fo -malke the industrial *wdioal opi-4tvati d TIt bfiflmminpan:rfunotion.
Aext e has the same recomn*ndaOmwithregar ta, industrial
jifl& Jvwir4 thttt thett i s 6R; in 6d teft&nty, -for medical:do*Nji 1-or hea;d0arters of ItJie -cwnpany to
ta Atilkies
4M*rW"rM&4h&dl i *sibnoveith iifiiall.fAantbperatidurinithat
fthoWt& VJW ftWih"str';Mt4t1 ;ffi Wlargeiv bit ffiffk ftijf Jhjh& tljj jhi# JA STMn lants that do n6t*ave 66 1 SdMc6l nOW'Or'dO You* 100k% rd twk= 994) th, tiaW, the itiedi 1 &fid, jidustri &I -h*kne
ieimgo w4ko6kintwIther 1i ant ftsan! Ojftide: eoh#Wt4 %441=gtil hAhi /.RUM-Witfilth& 'ifixp 6veknmt'af, the
biAllpri: *1(.fm oft qo 'It _A




A C% ft

J)r. MA x au. s o, I Th, sak YiDu. I)v6li4o.gladdozespoldliI I ITO M811
-JL A
istratimi Thwoouv airly e4w1y, stft: dependently td. A
are,. pnya pwsct ce Adiw(filc 96* carefully the entire; 14
dwuibent, oxAW4%l1A&-*zy4%14" anythingrelotiveto the FedeftLOoT me4 ,,or) sup i dthtr-,,' tion iiRterceding with TOPIVato PT4,aim of, *Wialrw It i .11U, ;All
in faot 1 havwles4ed in, tbm:Aim Oiea of.xe(*)gW1M gaw ia&pbp& eneb of physicians and I am ieflectiny-bot ,.7Pwand id(WA gragridwit4 wonyve&rs: of inJustmm'T InWjcia* 4
oe dso f and
change and fiiy proposal is not-just small. plavft ijb, t and aly suggestion relittos to & bR$icphe4**iqwft 10
e xemogwzed A, Wt a 4oationof beiagoW pAy physi*icanr-11 aw*reReo6R ',,w M41 I TMO
)4nd lmrii %*,let
sonal iuany,*q,Tht Oinvmi 'Made Qverthe.,Xe#in%( i*WJ=J11 re has developedim ftuuaWy *-Ieeling- *gxiost 0.
doctor. 16* ""%., iniT 34
I Aean Thbr6ffl -no,
LetIV make, it, as qW360 i# tboj wW, &fhw Arz4ispieious linuatriftl,,pky=, ians, bob this wnntry_ Uvd A0 I 04M *40MM4 come back 'nd say-1 know that, and probably be#Oztb"'xWmatYM in tb s.jpoW 47,
-The fact, is QuAve denjing. wwh. &1*0blem! Of inernaw
working with. That has been dissipated al*d has
The question comes to mind, that is one point 00 secohdquitstioncmWes up..1 AAowJr9m, plants, but far too many times icross'th,6 eveunot beiug MWV11 Midi as OCdqAW0MJ I &e"Q or rRIAWIftthat particular lant during thai'particula.r time period.. nere i4lwo,40m tiohltUeso tcho
The oint-ofthe
ntleing a Mlaried. hidividiial is W. iqW.aMiopl 'O"t"6*0ta "Ydne, else; thatL16 mouldi.wt I plant can dismiss him in-24, hotirs if they s*wAt.JAo nObbeAipr*d%*h I belieire phYsiciam" the ixfduStAa11OCWOWS1W4M* 86111" to. the difficult problems of intdrpretatimi!af inediftl dig
The point I am making is you stop the conflict that exists.
lsb&iind xnanagea.*ntst 'k
;as a,, 0)
rewarch. physic. Ym c4ruxeO0116,01sr
labor bmdAmanagetneAft MOO (10K riab
-PtMOUt ePdf4-.WWWiA -tvakfe) of id (hD
-deph. MM -Oh
resolve' WbOtWefl* ialwX f map#**
ad
.withwbrkerg -c Wr i,, J J 'ff r f hrv,?
iA prjv*tl pftetieoj 11 is not, %up0ioRk .have, 4 wholo, series, of saft"rU4104- 44 W24PRpdvpt
doeWt bp;ve j* pAy gtteqtioiR. Ora gyqq% a4444lorabtitianer-:R46 W4 T
pendent in his Judgment, speaks as A,,PPiv#0oPPZ,"tWOW! ,*W can call the Shots as they are whether they-'are or notA. vork'related.






Stimo. Jer Us,,W.'resolve our differences and that TthInk,
16 Y having a separation relative to the industrial Medigal

CWIF FfICQUI.dl'aLsk:,iLconpleques&6ns-I Who wvaldpa the ;ogsi and.. who: could: and, wmldfirrd iaoQd rnAuageoment, or IAbor or at what p6int wuld
*4t4wy woe.
Mi 1p ifqw. UJ& always happeris'whenever% them is a new propqVO)Th ;*of pourse-not -a- new idea. Many.people have thought
A decided: to bripgit, t4surface.
4vith an idea, the questioll is at is !et, lost in exact mechanisms. AWAdionportao"Wrt irmine, whether the idea h'
4jthp pd tof vW, of wiukeWcdmpenkati01 11 feel
It Mona occupational disease 'ill be recognimd if the physician top p iAd, jyidual gms tothe physician with fuR re6dgn ion
t-an:.visualize, wholo series of things. j now the com any pays for it themselves. The indusfi y pays 4n*16jneat.,Yo cafi set
66* desigm-all I am saying is this is one step in the procedum
'A e tpweptand sti-gma of thi so-called, company doctor ker participation-and freed
k.PKQCA of, ww OM 0
ng a p ysician and having the physician independent.
AT t j Samuel$ may have 'misspolrela. I
WOU tq e.rWg,.,thorword., is, .:olear on that.*dJPer4p$, Owre are:& willioU workers. -who are. and
Xp Otp ASbq#oS.LXyunderstanding is! the;Auniber is

af IN expowd in theiro"upaban. "tJs. thei poin Id td m&k First of all, the
NIOw. j tl var &.3
V n0e
Wur(* for many of the e stae6tics of the numl*r of workers: exposed
o- J AO$j X- NJOSU ji asn't yet cloarly defied whatexposure,

I Ore.,: occaSionally Youi i see exposed,
Vq popure,. etim t e aaj dilv& to: discuss
196 6ntuct'a worker h4s,
no '16wwin actthe-degrwtawl h?wworkeris':Put
A I)ir ,, Tafx4 1with, 'something I potentially hazardou, it is" a
-.q;,np poiAt become knore: important when'vou
1*0 4; 4* Y limited contact with this f&r resulting iseaft long latency.1 20, 30
can, in some conditions 0,
*4k tW .1murp 'o,"owthen onjytb-e,,,*orkers dimzfly involved, in,
POP lions:. of,,: comatruttjon.:vorkers are exposed
It. -oSe jiq ,of/qonstwucti6w workers- turn over very greatly.
Am*rmally high rate:of turnover. laot, simply-e4ch. worker that has anunmediate ,9" *hi 4ndirect contact
-.,%sbes orworker, bu ml=riqg The
im, wMm you jacknwledg& the Ar*40C wgqr ths .
,o Qne reol
expogamV.- accumulative
i i aWorld wa t u, and, the
4b Iwo. expoaedjoiaiahbrt periO4 ottilne
I Es'! mplyt a;nt9efd t o g e t t h a t o I I f






Mr.iSAmrU& Thel, ht1!,Vq%'tr
POI fink
I I 3'[ j I I t 1A -(4:. t4xdiwo l el
aboutt the shipyard wo
You t rker. In another meeting IVMR
Ass "njt SeeretAry f ort Realtik 4*yv sira(* th identify!!somewhitte-Oeiuy.:woikebfwh6- woiio6dii4i]-. #h &i I qh World, War, Ily: why l twat c"'t send'Aimm worked in'the shipyards in World War II at d)t Tot',bfug inthe:air, whether you worked 4i"W with It or W6t; Ahkt W1 in
home that you ought to contact. It-io*tT-giW ki'lij .t U",A)1Vqj1L 4)
And tkeianeww
wouldn't ansWert6 qttestion4 bft1th6vm*e#1A fgO*41kMkt% 3hiakaboat the ataountlof mcuieiythdVede-rk1G'6Wr&dihA1W6 %A"
to p&yR %U-workemfiled-ft t6impetsAi6tt 8afin., And'Ar I IW] ff" 9) Y.R 41 TIT iyesy 'L .
-Dr-_Bmi*;* I I diAnft craemn to, be,&*ioA lbtiff "i Ift 1kfjk low 4.j jW,
and it is important to point out th6y'&06V4J
mates mostiof us &PendkM:,-Thzt,4s1t 8aY;Aosw1vj 'it of
1 ol
1U, Cori Ahil"i *6*16 h
D Is V#iwylth lit Pff
lhqf gtb) aVWTRe 10mi6odU Okj& cnlabrl ,ih lighted bn
( a(4 S 01 U011%
4 g.uva
I Y-iistithe issue i6f-Varti4AiOAHq4s Al 6t ilP &IedW of social securi-tydata.- rft;tnl idiftbiflty, hiotti'l*, ot JJOW tow dlsgbilqt ,
& a 4a
security beniffits, are4honkht;h tifativd ii tAb e., i x)
If you read the paper -by Na4cy Snyder and Mr.
will see, for exam ile4 jworkersiia Ooble f6V6N&qW P620 tM
-black1ung *6iild t bib b1i 64 r tth iporffi#4no' us
I under social-semfityrkW81
evidently there is an issue of how useful thAV*db1dJTW1t&. Ahat data,,foripinnitig!d6 vmterttiiiv &4bji Me,
AAeeonal,66n4rn I i4d is thnt'tfttt6h of k6bWolow 4*abig discussion has been about disease of long
e are mindf d there J&Pe'tkdvsF6idh 4 Y*,*14;6 4MOO e
th market sliam iiot 1WJTtg1,ftWo*3 ('butif o4lde &ttlsve q social. SOcMitY ,gjventkVk- I h, *of 6micvbe-&6-thiqvkAw%,..
*illibawtftfie =_C)00trock 4but, Tif 14 *i7H*iv1d Our:pointsoh wrtainiseiriowar4ibleim.
Fin&RT -s!i!atitd1*Avhw6&&tW1*d. mhi6
how to. & this:gt
TZ
.a 0 1
work.A can my itiOlma4rid
"Ay1fl%# WM t,
'Partjdttj4Lrf7bUbSt4jOW )6r, rik i6imoheri IdeAlib ing Irmk.- Ift i tibt fte

khsi
'411.,and ipoinb out Awhati td)&&t
Dh, Roimm, ListadrW to( Oni Barth, it 16d#64, toi6iefn ii people in the audience have probablT not




....... 7 1 .. .
that have ben presentedand that hae been prepred for thi
c o n f e r e n c e .iii iii i iiiiiiiiiiiiiiiiiii iiiiiiiiiii i ii i
iiiiiiiiiiiiii p i l l yliiiiiiiiiiiiiiiiliiiiiiiliiiiiiiii
laer
Itoor oeo h paeso hesafmyhv oeetacpe


0 to ouet n myhv nopruitiomk hmaal
leitepol eei h uine
I = f tispatclo hte h paeshv o ieso
theik owndocuents
Ch~a uw etm a ed hv eylmte muto h
pai orihgnrlpbi.Teeaeafwppr fwihw
have adiinlois
WhtIwudsgeti!h esn h ih -aea neeti
cetiiae ih hc ihMs oisnadsewehro o

threisa eran apr.Do'tepet er mch e ont av @
grea iW f exess
Dr. ~wn I wnt o ak a uesion Dr.Manusoyou adesom

comnt-ocofdeta i of reors I wouldik ikyuwa





1 lioj; !e4 -!

4r
441


Ij

JJ IfJA fimb T
-III"ji i I rIob 1.1.wolippl q Ift, I i ..'
)i l )j j'f fali 1"n'D




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1(r.



1; Iiao
foal]
-47 o f I



LO
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all



IV, I k f kk wi 'r) !RAP i 9'v)W


























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RIOWNGS-AWYTH19 UTERDEPAU
MENTAL, WORK.
oPAT NAL: D1SEASE9,,.4NbujW
WIP71-j VqATIONv 1976
06
to
OW QtjMAjr,,-3fABAUA3LY iLUf'J.M 'A
Wpf tn o "41 L! I t- i o
014 WvFA. ox
SAUG
jp ;Jpwjf ift 4 aga, 1U.
ii, Coftfereh ce met, pur uai#jo, t6 ,Jjnil Vmy drQhiogq owwr Bducadon, 180.7 E&A 6otg.
yAt Two mornmg. Will be joiliAg'Us'In
Coe
or another on the agenda. One will be, Dr. .-MArilyn
ftat NAOSM, Dr4 -H1QtC UG4 Wolek" 'With the Dimotoir Of
*N10S and will present Dr. Osterritter the, appropriate tbw, for
*Jph Uuoll6r, is seate& to xqy-i mghtq
*P4-4WWi&WrPPft"tM*94be, SeMW7.414or aincet1*Am#tnut
Atthig time I will turn the program over to the moderator,
and 9" morning.; WoUvW& rarfelaViry !rA Ain
f mp and-that:ix.-On
!W"*!i itho" lyw-don7t, got in, mo4 jw
*Q" abulabout.WW JwppenPd'yesWv4.Yb6fomwe dig d: happen yeEterda caused enou Aurw iwhot, di gh reactwia "
I Wt to Aptak
d Vb bavetha
OOfefdn we to w 44W. as the A rpt op portunk
was, apparent 4ky t atlhe medical
Nkk mi 4*1 19045ei' W0. $et a, pi nt ac;w0A: dingumis-of the
diseaAWis-different Hom identification andca4ml foetorp, An J Wj* i:.4iC%" Tx0or 4wiwg froatho staWpoint: of rQW lawyer' in workers, t, 0*oaf the 0a,"W Iaot;rJaimpprtant not just'shnPly"S
rob"21.0;A A
)a regw*r
n1*VffWW-WW ropoa with thb Aeed for alf0sUre-datA4 "bAb4ftkeA-,1hA )&rq am%*nW, to doses on toia what
f 144tRymomlovexpoom WQW(WevA to# -A0o** wlwre:we
. . ..... ...
YT Pajut a -few of -VSr.,WflA0A. tA VW4 ypstor4fty
(44bj W,1 0, 4bQ r
R*Pjqker,#q4f Jain
(73)




74
have to deal with causes as a routine part of their practice. DiW in fact does not generally include causation, if an effective treatment can be carried out without getting at the etiological data.
There are a few exceptions such an infectious disease where it is almost routine to get the causal factor.
T h e b 0 lb 1W AA M(** U tt 4 WD e&)e*'6 f IWA 066WM
a dwwriavt h n9t Ty t h 4p8e,
aitt IrMIT t WC1 19
Pmn$no o a d fi
0' 1 Mbl
W Cmd/nkoveA4biii 6 at h
needs to do the job right. J7 I /P I Tlkill 34 1
He doesn't know much a-bout the exposures in pliChikan(F doesn't know much about the meaning ofllwxa. He doesn't know what to do with the data even if he had it.
Therefore, understand itcan get into thepicture. In 4d, I think that was one of the essences of the proposals, tMi' n latiops made by-Dr. Alancuso and think
there was g tlr ij fw*ij. _sAmwW a ttion.
T4Preft r9A1 ffiikhl Is ch'- HyMaafig-in the United States and- I think it -w ts- rather nicely that the high risk group, at least, should
be funn O-lod topla&s Vh
C This *6tld inof het', I tiow
sharp., incroa46"dini th6 u4ber i of 'Aai V, anal tAerdira 144K fit!crease-., 3n, 1*1,d! hmerett'votild;bo, imsotiOM: *1thJ'AW4MJdMW in
Thereftke 4 tw'A) bo6b#mv6k)kWs
y4ne uld, b6 dftlinkt, iith hnit
oil negatiTe
The element I think was dominating yeste!*Y, 4sl OdIA
'th 15 g-d
e processhir in ani em qdifibtty lfaghiW axiEll
X 1,
J and -would I E61 to hoik li ore: ftbm, the 1Ww rsF)aidq-dPdhViM6W4;6ft what they meant by presumption I i1i (sil iv#aii OWU ivor4wtitid yesterday.: f I -i I t I w F I I I i it.
-wotild,1ike:61'ndi th
Buij; idthe'e9tabli" OdR WWgi bu
groupsps w6uld. mt be,,hiterfetftig *ithi tho 1dod&L-pAf6ftt Ndwlp since the bulk of their interest is in non-occu"ationalaiwajo.6ny".
Ye4ordia- 'ailmWdn'tabovOthe
y,,there
epidemiologist and his role, and, hkhtlf ihg:,h* hr19kfg#atOpgJ(vofttftd ,to, ma:ke'thapcqnf,,this. olwW'thp,- deMm 1, ti, And -iifi ftol 1 Pla: 40 I ". 9n al
it I do the same thing-I am not interested in the indi ila i. At that p intl ii;Wmd
Of, Inforrritition' abAitW6 lgrhtlplag: I indick" Vtov*wy;, 4t *& i*f priobabli4ia dat t IM W6 us ., I (IT 0%
-wd go boyondrth6teftno"Aha t;1dO)wn'tvjCh e i ft ffi-Vi &A1 vAil d; I *e
call for, such as
actually i th
'i*1194i"Oh. hohe- i15 "noti IMAIAO i atveaupitMAA -dW ihs thw 9oft]
-Seouiii.f qf'th6i Mhtfi igy sj the' Orikfty l
physician had in mind soM ftil )60W tfia11,dFtW9WHwhad11h kkil
T -dii6bilft or lfifflik lot 11111ing, oit i Aliath
9





7&

t]* diagnootira, data to aneipidemicil6gist jig impiortatit
-fismaild oUt4wis. dAtA. sYstenis that v eroreeoranwn&
W4 40 at4WFion t of nualityv, will reveal there are some,
ACE" .0tQrs that need itobe talii ijito acco=.
9 to go ost to, the problem of, g6delmes. for dtandardizing.
*60 proce.dure%,.,
-wW men Ulthce we Ated. to
tioned Yestardo in med- eal survel
t hok Awdiad surveillanoo procedures, and I -will
go onqste further. We betteg'get: guidelines also:fiordiW oses, so flux
WN *varyeillonZ relutivelystandard-muw
IWAAM as possible into,
e i onw f as eaxly
L ation,-system,,.,
14 t ement in my comment lias withthe role of
C n"4ionx -.preventive medicine. So far, .1 thimk ,Ihe
qM y,Orn ai i# rvie Bsor, ass,
w W:se instance govern
p 'mQiQprqy-jsicoQf piedi(AISerVICeS.
me be*a done yprnment to le
ttl h:ois- ebjy GO gislate
4e i nce thus: far, set
t ;Urvew-a' req.
ance,4h Welines,
Oxe esfor sarvei1l e gtu
ful
1,,s aqds of, practice have, been Ott well shunned.
*as a matter rre. to 810
ihin-'k -thqAde i a, of fact,, 1'.. e. Profess nal
ddi eS one and
Aqv, 4 Idtf1p: lias been. d
*se AU,
7f tify. the 1& workers who
4
Spec
M*nnfT ,Qe tem ei axLdo, could be
ys 'for s4iv '11
Wit Pw= and iiW be a
Vernmen.
ou play a
t 0 W ies, in. States C Id
A 41f 3 1'. ,ipj ect to,, h6, phyikiaji that
Arms- I
ILA t *
M Y Wei as a reseal& i, I am 611i ng about some resea. rch
liatyqp Ibe needed to develop i!wh a program withirkthe
qg compTim On w would want to en not
P4' biology 4wdecl to deftp,.Mk.L grQ s,. 'but some I el VRI procedures,
sure t, z qU9 lty'of reafite c are cmsiste4
rpretati ins theatre tApn. with
ur%,, gUl e ii that the: 16nnation is. use to COMMIMIk6--and. I thipl this I$ O;Ie of the important--to
Qw ff,6.rkers who are atyisk who do not have pre 66 1 Aizess -that it is, 'Ao,
'na.- CAD MUI= 90T-;
devilop better ex -da an.. better, laguosis
posture ta
4" t -a uun icatea. individual papes where
AUrip I I is, GPM
ind 'on.paxt of th6 Uloasej,
the wo* s,
h=
P- usiei l Ompensata prevent
itIj tj r tAC .,wood
11 N
x0pose YOU er- p a, y 1 ng fok lus 4
-41 the i
A
Pf this A=rec
dud,
XWEr"4
In ky wmi. at you may, ;oa are moreli4o.
the long this wouldbef em( c move
In
wo rsf cOmpensation could make in this decade.





76
likelio, eoninwr&) ouj'
T-hehAAhing.,1 4 o6d qi tw
tioli.yon-sn, haiiiW *iih ehTmie dehiyed'eiWW 01M I dlDnkl'thirnk you
like to hear more about t6 i R& JP.
thab! Orasumably4night,.,&a nge th6 *uy 9whi taksAM we have at least a hint they are coming into the s Oilaoqggib
-;Dr.-BrRToN. 1T ,hiinkybu;Di ve.lim8i!likoff, ) f a 4Wq 31
Dr.' Sv.LvKovr.1;1 ymuld liketo, ptdft d aliot* th W41OH4
that were so vvR41 N4 out now-V bt- sthei ,o)'11 r) no ().g
,Yesfo tdiy Wel- hoard, -from i'Shi lly-,(Abbtit 't li '06gi6ii WOW Wore"Us OOUd&%11rig,, the' 'po sibllity 6f. hit&V61iffik calls, long delayed cases* people periods; of lori clinkat I hey, CIO "Ili 4'i
Xaiuie gfv(%,, usL firtt f 101
-g dise *h6re Vie,,joa Aod ftl*j dfilhMal 64 AW 1901
years. apart. By the MMOItAbif, itldo -gi*w.O; WwtiW ilitot 'AO-in 1 soiv6 th'10, M dr 90'
jthf 64 qy d, f"T
witli. mucl left:rlimr_ ffiiagnbiS.i.PO jthA* e9; y fl6h of IlAcqit 1 dio "h-h'-* 4katfv
d$e"W 10 .40
anfcak this questionn -isqrip W., a- 106 bof6i W i MUMM Y corredy68tord OWIOHA' o1t I )p
Now, -where d609 *;OA cOTh*6SiUoWUkd WriyA
what is occupational disease at that L
AS)OVWUS.'DoesAho Ogefite io 4611- AM I k,
9TOUp give., *S A4" 0SPO s (I W, 191'iia
T ite i fbita
di "duil.: 11' "*h )'be:ki'-'dhd oiq C
Min
he- lad nof'bten
If' 6d't,6 6efi-fiieth To il s
would not havethepotentW whic4 canbe congdd 9'
panieg thIg
sense. F ot. re
or exa gu AA ii iAKI,
o:, 1i i Rd "',W H C U I
i see w h4hei 6 cer ppe 1f
opy. Wbqftj
40*r eysiose' Sly' h
anAth('3-qii&t!on in infiiiiAd is',whekh WU.LJtL.u t
tem, also I then h -a abilityy 6f Pih.e TP16 n thig
a t
.jjjj!t t1l, d'
"a. .Sa WT "hi Mi
est r -y: a, It ed andnob6ty:
this--stotod; ihai n answer, to ,Soihe' C -d i6i t; pl oyer ok ''' of bu''s" eit ti b'' h A
gL 104 1 Y,1_64-4 S Y,
es out: Of wd tM G. Mhiir., i 111
J.a6 profits but *N6 Giibr f
Xisk h nco ne o 'h di Mgc O,r at
)obA, but sphiione, is 40ifig to ftk6 th6 i' f r4.1 V C)
g16I& f6! ineLois._-,
Dges this meai r
then no one has A es sbo-lat
.6 M fill,
iness T _MeAM;
doeWt qL46f in 16 T i d
ithe'A016s'doils't rk6ig 66 n*0 A ft 'd r
6M amp"16y'' 4 V&d 106 ftr diskk ibut biLffiff I elffie
responsibilitvAN61". J7 --lift





77,
,r ,J
rtant emaideratioitg. mria begr #A the,
Jana*,, there is the chance of survival-&! bettarthpce, kwisurvivlal-;tWs 1Uw*i#wJjmav have vbffil* n6f ;=der snrveillan MI. V-1 i
Foru it h", beiM dom 01ft st ratid in V e* 00"', n a th wa 1 p4op I o
W Ommk* Ilbiftsiars, under i unprotectedi. conditions, irvshipydids PMh rdbiarrehmmol devel in llwi or or,
there eve owl
Swim ?roeTessive silii 'S
MS9 r Lpidly ihat-mik-6im6 hi'ig)OxW "Immtlgi Wthaw yufdik pt lt ;Z; 4urveilISA6816r -nbt?
POW 20A bd6r1dh&iwo,-of igurviftlif -he, is, and, kyiowa-hia, ig, &V
q"* e*m-) foi i ftmulp* UA! d TB Vacci-fistim tb. Igg ; the ObAn", eloping tuberculosis. Ife will be treated for his i; c
rp*skbmq4nu6- readilydf th!ay- ii -uwlarii of Ais
they Vmre, notw 4 i he t itentlevon b en recognized in tme wo
part of t1* rk
gyAejn -thvA sth' F B&ral Bureau of Em oyeeX
lfwmiiwh&&Zr eWiwith somt constrMuti-that it, m; diamo b*n hg*e 1*en no dhtrl "iaw*"d iw Viv qMpyar& in Worbf Wim-H. Thol
thia
#my have accepted r esponsibfl rpa' ohtidnidedth.'
'Apbnsibility -Ohilt the fnim: is still iliie?
10;AP= ;*4r t itiojh qn domth'or is thdre itiso a
iqVNKtj t "does'-it-lidt include gut-veillince.
1'jft'1'6*ia1l -vhOn such lhte&ent bn
or O"T0161 ni*hl
ViW skip'PtAti6h thai is a'c fAyiAe4Vt6
b '. b&
W4 f'ihit *drket are Lt&
questions before.us with 16ht history andi ithift, #10if t W d'T -g&t-the questions
UrTZ 661ij 64r qj sn
p J
I' be
W61M ifts Reba, %re Wq
ofiog Mid vbtth' P&
11YOP Wmi
'Ie6h I AM
me i6a 9 11W 6fiftbdth Dit.
'NJ L
lw -0 mli t Su
APOASI Y
w", can I an s is likel to be-dMO iit-tb 'Prwiit
sion u way ffii, '. "11 ''. _L
S6 it a, Cl ft im 'S' Me'd4ifE
'-W 0 1 tYmk
mpunmmibii 190ii 4k fhereig o di"kb ty
jS;PemwmxblO to th' the dical bills perh s cAuld b aid 1 0310, 1$6' 11 ion (t
rx Viet
froih OC ati
UO ih
Ida to JJLO
U j IIJ
W
rV theid' a co'
r 'It i d &'J"' fi? d im'"' m
"AU ]Ala' t6 One v IS401. that
p.4'bel a 1 1") .
iWU doaW 2* 4ti've. iidp'ut re At
71
thil
ILI echani;S '6 Inon or wi, c ompe 16h SYS-1-







on, xmiKnd k basin; QAqow4&*b"*bqm may" ho 90 Or44 Y MtrOARAW
'04 1 lk:lu tr tluls) off) 4 *4&*(tA1
At lead I think A am I I
Uy.
brel A Am' Pwwt "i AMP W94 0
&SIX
,Dr.Aam"
Aft "
~i; A


71W firstwxis the -goo .0fith% qw0watift OWPOSWO'.,Aar employ"& Efuoh as, 'io OwA, f v'hrl M fe*$
"i it"M w creirul*
itself wbilo dwMaDAS Oaptaymkv; 0K. Octmwoifti OMP"Uftfits ")*Al 44
if kyow*ark from, sqv*Mj*W. ]MOWO 116*da
hiro ie.. impopw *EU Aft
cau,% there the induAyM-ApoWk *444 tbovpWm" I-Pproonung a Pxod'et 1% 9WO AN
A ,
.4F emp amp 4*1
piffee*f jW' 11; JOW-g Ajqof ,gr
'be oompensated:i6th, on the ople*My mail can V11
lastre
in their *, ,,q4r 1* 'w to it, can msure is think -Dc So.
thpP4 ]Pam. 1 20tkp
ewplqypa.mav
ther expc ,"'w".not arnmg ii 'or: was.V"Mk g4X" Of
49
Present COMDM
lvt* h t4t W WF
With th. r t, Nnthq Y M#W 'A 7

pil o y4 r, opid
boAuse, o1r. ?i i19 fixl JR-If
ibA payment treaunev
V L I .1 1
ip4r, ns ig i er &W
ii more;4 J . . . I FW3 I
f. t4f R1
-BOIL e,,c IKPPRti 1 .914
K
Tnjj
We IDJ
P4 P P P
theii co'ceivAly we c re
;0
e
roll
OSWO t thl 10
m Alf NY. Pq






86iheh6w:econohii &jIIy: i666uut! for tho'Postt*6 dhb A0 1 the''CMPOStf" hi Woffid I will h i hCqAth 16MW costs will be gre' toi.
-A*otl e pmative is to prevent the either b j efilninat41 th9VIS110ASAR61 6r efimiiiatihg th4 indiistrv vherein'the
the e bosarb ii h Ilustry" is: Tiot
by *t6s&ibtihg Ae(IiM- e; that an-einwAO ea lft'ri, N8 em oaed 2, .
inth#V A*IA14, bOc'dpi6On., 11 K6 her'that if; weptMIhqI*otMbb;, ifteptablo to'thelikbor movement. I i would V pql :
10 MthwrA ig IWxWWv6id*bI4I Otpogure'in an, industry ate. we prepared, Dlwerifi "th, e un w6rkor'to; dis asp,, th6 avoi&blediseasel
L h V4ker- ha* ;fil fle
Iight tw expose him If- to this di i a e in.his
-fortreatmint of it
bon6fits fter-he
&es iheur it?
1W. 4"Am,mrv XWI yko-v
fikb t.6-omnnitant, qi thit, I'thinkit demds on.vhat kind of law you had atithetfin6-the exposure( qok lace. Butin alt'biit-thi ee'Stii&4' 4 hxv ,, bi6adt&upationaf dikase
-of tfiese oond'iions
tif'*- iAaft is C;XPOFfeA to an.r me I
provide, he eqn, via;ke 'a clainA, within: a -Coin& yohrs,, aftr!dis &4i"? 1hat in- a ciAe,,of that &W-im- thm, .0 'that employee
tr4ftVi ; ihoev6er, was: migurin r1wtha(tithi ""Pallre, is) hi,
ured; he hablt
Or if the Offl, 1 is self _ins is
'The onlydifficulty may be ou
*QA;n4IpkwhAh*401"tb lromnow he s wha&ivij he*,: may. kit, I
Vkw#Kk-,*vibe- i hfk ven and you trwe it back ta'sothe exposure lm it: was, afid records, of exposure U044im & ding Dn IOW
*4 hLadl the: problem wwwere discussing yesterOm is concerned, ho, -would-be Mfitled to corna fimmcial condition to pay 'all Patities can sho
Hi #MjIW% "Why'vi of the problems ve'?are discussing today,
becauga 1 was 'a little bit troubled by the'figures beeft nebulous, whether. it is 50
T#64"dayll -age I was: so
? stiba I&I'Amount of these-, cases; for whichyou have present-liability, although it is interrupted-you ha've: a problem on 'LeVs 'smie p 61 before we
go ques
4 UK bwft ft, Twoo, t4o Mr. MeMathaft i a qu stion corrThe policy in, OSIIA concernhwstandavdt-to.. relate., exposure to
M
*YAW ii-suehIl, th ,exp(mnrW oeeen, if them ii a risk'asthig ii keepUig in
dxpbgqft to the, t6xic 9fabstairieei ho S
V tr
118.wxiaty- ovoeiiciu' 4kreaponaeitbothut of h
1.4 46**g Ig tiWd i ow fit igvaed th fe *iI1
kisag6e Ahd7 h",
YifAk tifido, thow tifewftd=ceg Nib aif niid ize





4$0
But asl ongsathe::m44awadoga,?*it..alto sponse,:sWit ozouot-be bwmLpq ?A way to totally (AiflaiRt6,t.hf% $Opp
assOciated withfthe 1A Oft,
Now, WttiAg .bsck to, 't tb*prq: r
tying this- "*A
as kog 40)* qW
plowed and we have a standa:td that %as been promulgated', MaOdiMl PrOfOSSiOll,, Of eoMeiho iwiIJ -1 el PCMA group biosu* hAN va$expowd W ithov spbstaupe)
A
At the, timeof the AftplQyer gDi4go0Utq4,1 Wsiups qwonwAv course, will then be forwarded4a$ Dr.; FbA"sa4
Except, under, cirqumotwwes. -for,
,other conA ts, NIOSH doe$ not ro Y;tSk*rQvpr
lance Of that worker Mnless it, p"tsins dir"fly to.$ *%drd gated by 0 SHA,, statijag. x*cords mutt e vmt t circumstances.
There are circumstances under which, NTQM vuW wpR#4# *qo.ss resmr& tools tho. followuR:workof!oo3Ooyeesriarhm W-M gR*08.
Dr, A& SheebAn. I o:) i 111-4 jefffr fjj !j)A;)q

Without relatingto the, ques0m W.(),4oW a44M;r=f
1
Will pay for tho benefd* 1or-thoaCivh0wdisWQAY APPOW time M, the flAure., ][ .wonld like )h~erj itov (m)M M"kaw gestions the:threes ,9e86j6n%*h4t3fr,1 Aww 1w.n4ift
One had,-to do with high-risk wagwy
and the other to restriRtthbtib*oFeR13Q6ur8d j Sxfety:an&H*&1th, -Act, there WAS ji IMMU
iuoxw"O d im
that. the standard 'Will not Allow: s rewnab 4 oxpwAro then withdrawal, that. tbe,, AsMosd the worker's lifetime. kxPosuro. in,, tba. work.pla4m, xn ards then must be promulgated on'the basis of tile fact'he *Mm wp"U 7
-there for the,30 or 40,yeam KuA -not ou t a f ter -1011 ye a rai L bluzk that, w e ;]iava, 10it h 44 t ,O RRWANIQUt Jaw has 'ven 4, statutory..
'.. gi
in su& a connection thatle*tho worker .the per-1od1of:his.:wo1*1ng eareer.(Whetber ourotaniamdqAt*RAW obligstioni$ .of conrso, a -matter. oUooateatjoa ,but cor6d-nAyjW4o4* the statutory. bo$w-is, there' I 1 1,
Another'point that 'Was made was with regard f6 eliAjWtje,*; risk, aadMr.. LsWterls A omwfjnUl think, to me to be one in which we are advocating etaodwds 00 twjA nate the Ask. Now I Mift tb eliminated if you insulate the man from exposure qryw..
I M1.
einiswona.through epgiftewtW*,eoq if
of I coum, f
fme.at: would: cortaiWy ppt,, $qrandl mwJ* be, OPA%*U Aiw-eo*tnW** Vrevont, e=as* of Iaxio sub.0* A
the Ions noe
,amosusing C4edisabilitar
NIOSH as aMH&
way: aq in,0040a 14 Ot be- *60M V. Few*
g.. a Prx
forej, am; advom "i t ',,m
..AeoU 1,







iiqb, and -whethqr tb; workers! cQm e4s n
jim
Yv
Vikwa ig.
c
'To, Pee I .
MPY U
ij 0. t .. 1 1 41 .1 W4 P)r
eptanWof Vthqugh, 614 argaig
1 w4 96-ball 4 M h. i9k
414k 7W ig -,r
h u6r ',W
.4 -W 1 .7. 04t
P#Ye 90 111n
f TWO or
opv4iv arpinix ni ats,
for receiving
J* f; a N'la.
e ei er in the present or in': the'f future '
T
rQ t .41: AsM. VqAjiierikan 9P(]Uc for, e ime. I am wverfi ig:,to
-U M I i
''Maky epts..
th P t
in al from
.MA Tn ,,bi la5 M in
7y,
C ure.
,,quite 9nestIy,,th(. t64 qoq q. y any oc e.:
1g: comp t4ke .9 P y
itl #1e a &in at pn, aA4 thit
WV6 ip te .,wor ers'COTIVPMWISM
onme4 of the lant compa ba (HqA'& artt&
S i iih! Ai
Wt. OF, p p mpealc Aft'' J. :1"-tj
e, ,pFov igns,, -Y raw. 4ppaTick Y into' an
W. ip. 7 tie to ie4her 1pho
441,
free
g DrArii
cja4 P;Op ft4(
al It I you Jor
4j
-eredony questioi y rWIP7Agp"eibe'miacle not only in the sm.: ants around tile

to '..com it
r,.q I ,he.jreveative 1ABI, rd F q ,f
a er. rq s l WO.
a y the gains oce as g -the
"j)ASt 40 y6ars in my humble opinion.
f M,pa
41 suggeoNi i4qrp hfy, p pec
tv 9RPrS4 qes
s *W dou 3 41 ,

44, 4rcpmm m ;ii t6ti rig h e
^aP $1qYM: I M P
V
xg '50 lq & 'Aa
t S 6C.

in u ries. e resbnrj, ese
p rovide Voluntarily over the years to research 6xic ha iitrIi to,




92
lis n
health'hi&
ce Ablf6 ia'. 161-pi
I UP;
,f tf, I A i -1 ji.
.1 ht' nd'i" fig
bi ailhii a e
lit ra hd dii W. ki4
ii
5!n e .4i M
S- d h- f6 I V% it i'l WL
ausf W1 m i dt bhl 96
':the Abi6i ''bc td 111A111*'A1' Xu9 ri
.of Safety 2hj;bjeVr ain ifrfiide a Q(" 1 aR6yi' a
scaicd4y:h&v:'8- b4ii f6tii 8'd', v4
industry. A
Institute lik t4e Du P t L b t
1911s e : I t
-ac edif4ti
Foun. a 161i ffi6' 61 25 6'
health of the Am anA 6 i id WA16ffi
er v #Ve
ITO
have hapPe 11 Msifp6d *it out lii) Vi,
OV It, i y1c
jur6d; hai"A, emm wa.
woikd : p
1 7"
for the most part.
shoiild 11 resourC6 &I ffi O'b r ae
1.. j 6f. T 07p, 0' TF-?
Nq:" th d Mt ii i:: t, '01! I ?h
44 ,to
loss
We all, as. professional d* I*ke some pf- '-tlW p Lra
Ts:ftrY,,$Ysf6n1: P, lfii i W 0 leaT e
It AAm'ding lTidl
t4io 'Aw
season awaM4
0
At timk s prqfe signals do becom mvqlveci perh, a ocates'. effh:, ,66 dv e A0
mended: tbat: lab i unions' ou h!
Tenis s, to rqresent them in the same
f th .e
C Y,
em ha-06 9 6&. S. e __.as
. ....... .
'of dispuf6d* 01 1 is'
ment 0 a1hti 1 e ,l I OID
M i f fit
But Im Rstrp aglypp, secl-tb ,akt4 ",, bi 0
tive medicilie 6 0 I , I e 1 4
business j4i9t to 16 T Z,Vt a I" d
ion,, woii .dqr c 1VI6.
course,, "Op clii 9A
heftifli''ervi'Ce's bil6k a U
T
Thank -v(?u.
C. I ( I I -. r & p f S 4
tF6dqa.4.
like to t4lk q' Vit 116bi I
through, 9, m? MJ]b&1644& W'LrAv -VOS61,4 -nil: I
66ms t IV 'j. d
altering xPdrielicii A'
and th, OP
j 0 a
.0 'i
Mr a V V ain
0T expe7e I 8 R do"- VIA
'T I
pec "a t6
cla




043
CkJ
to, expand the workers' compewe aXe --11N, nsationsystem
deferredAisabilities where fi uitioin of the WsCCUIMS Ome.20 or 30 ymrs, then going to
I X we are.
fst4l-that are calculated to pky theae beaffits U is 44
1"Jo, me to, make the long-termmedical ma practice
a e. into significance. We have tothink of recommended but
legislation that is goin up
g to berset. to handler tbowe h4bili es in the future. We are going to haven't. think-Mr.,Kal,rrpe y. states" at Was IM
41w Al the policy that effeci at
tibap pe. is going to., peprrenr ave to pay the be4ot.wbenthey
rwm. y AJA.,and other organize ions peTienced
the t*- ex
gzk, unreasonable riA:exfe asis
k04QUg pt-,(mthab of
A t4aroV ghly'different t. 4d I Wohif
concerns we-willhaV06 give& whole i9i, of thouAt' f'W *fti tj* T and.I regret to say I don't sharoAr.
thanumid view bf the adversary system.
4wf naione pfthe geotlemon, yeSteAsy begge uiot do
Nifth the fault concept. -a
no Well greed. It is a no fault, system.,
Bk4 Tit.fihdio&er"h=d,,workors'eompep, "ioiaisahigblyOyei y "N" ina(its Aswmjo nieto maake a whole, lot, of difference.
rwt_,n&t;ue -of the system arims Qut of -yestion, Vof UWt or question of causation YSvmuels,,and Dr. wpuJd like to Ozy
k*owthiiig before we -go to the next subject. A.. I -or 4n",Thw* Ydu. This *ill just take a min-ate
-pivsciAinghisreactionto certain reomnweud" 'W'
separs ion can xespg4
tb, ti -of industry medicalservioe*!K:; z("i*.4imes)foiv amaeone to:present a different. point d vie
1AJg btaat1J)ngJy ijR the "tortiQn, of: the, purpose and ipcWnt
iif the rppominendation made.
mentionn about, destrqyiAg, company I-n*al I(V .,or
b idestroymg preventive megsurm, (?r. detm g
4*ri3m whi* exist.. The. opposite is the purpose, of e pro I pIpLal I Made.
M RPPOV6110YO.'aspect4, of indwfrialme4ical rog, ky
#,"at Ra4y d"&S,'have upt exd W kf all. T' re have , -i ;,
aii of do a, ro, ,ezi ousi
,tog )4, f e
1. 4" S aoes not any way say we do not h ex&ll_ & Serv
ave ices but:,
iMD v -e
W 17t Plqlp a g, t Iced for 6# 'iif"
f I'S" gd" Oa'' il'46e4i6fi ill W1
nd "A ha i Vdi b !kn1=
t4
M '2 P! (f er. g., it g t6
14
a ns u
fil, *Mv rf ;bezuw
C
arm J J; 1 1,; t 7 1"l,
C e*Atrte 1 4

11" 01ji ),rtuf trnvi -:j-n ,J .t- i





SA

(A) The question asid? es of e :kkqn O odM 1, total knowledge of thbinkM ha4 2A X.of 8, total choice for himself 10r dehpeel ts ,a ='nOWW Y f$
(B) The question asstunes of sciety it-do' t workers and individuals in the company to thresiii individual, and the skc.Impl ponffg I ~i
orzzoRs FO 4%TITIpth l tota
Dr. RBIsErs. Yes.I
Mr. McMahir~. I think Mr. Samnels, aiiland4 i6P16 IwMY question., Perhaps I coidd puit u hyp'bthelial W81 'i'& .ift Ileasuse, I am not sure to what extent we are t aboubL liffe an heltifand t whM it tt we are.tAia "
What.I was thrkngof, let's asaewe'm Aw
gory where the risk 'ISinvitable.- Thazty hAd4 f4tadR
exficexsu, say adter 10 yesa, a ied rl 89
years thr wl be disability. But, after 5 yasthere is awoi)I
Wht oudall of you say to a VdrlIs* for eXWn 1 tw
no oecnwrdi that occupation. takr iBMr t 4)f 5P*e oiT~ i
Wouldathat be acceptable?
Doi the dial people thilf-the pAy goal istop froeting pick. Tii
Ikipeole: think men have a right Oo wokIt e
diabed ad would resgt that kind of k 46 a fti favis aeor
tha say you can work toatil -yeu, bddhime &bleds long ---34 b fully compensated for that disability 2 .
That w mypint s fat as a workA-i s ight:14 k%6W_ th b himself to a risk.
D r. RBnarts.I am sorry, we prdhably: ahould, 1rogtssea We basds many, questions, I -ann sure we: a11 feel hek b trated. feel particularly frustrated in thcnriede"ff modeiratrt in not being abi to reseb as I weakd enjap!4*Oi**F sode of Ur. Mageaso's-the impfieatone- of ThMane But, I do believe we should move on. e
It says in'the -program I am inclined at this timbe to dfer toeh of a summration. You have all been in the reem as Ihavevn. a.VW heard it, asiR'it wohid be pleumptlone -of ae aM t t of the controversial thnsthat have gone on.
I am not pleased =anRI' am sure none 0t "us ar ith which we made substantial prog:-ess *in our enia6 decide how we can reatly come up witl thU
of a man's work to either the, intial cuainof6ti. or of aggravation.
I am not sure, after hearing some of what hasgoenw
almost simplistically feel maybe there is no future frw pensation, an~d maybe we are dealing. *whso insolubl where a whole system would have to bevy~vastl changehd.
I think all of us would acknowledge it should' etew
pays for a disease that reswits from hiswork. We-are0 Paivi there is anybody to pay except all: of us. There are onl Yau

distribution the cost of occupational diseases and still retaini incntive that is totaliv effctive or as effective as we can have it to et






quy ithdisentnueany ratc 't-hat results e *occupational
We gldgto prhaget farhliI additional attention to the
6h thd,part of 'the p-gri that is to, follow. Before Dr.
F 1iibse hs rouc, would like to ask Dr. Marilyn
qto soa fpw words. Marilyn, in addition to other balls she
a e tie~this r~as litiiter,,was: its program
pkgypw, J ut wpAted to say a couple words as introdutitio n,
.~~o gul iOtratr, as to the project itself.
gcg fhe, Ithin*k high to -very well many facets of the
leesoforpm dsee to acciipation mna compensatie astrft t s paedto dea wtphaclinjury.
as~ ~~W -i at5r Ostriter is going to discuss is an outgrowth of
a of~eesting : IQSHperonneliave had with the Task Force -t}orutside consant regarding the feasibility of developing
of tidlie tatmight be helpful to those persons that
neadCtr savainate evidesico concerning occupational disease.. 'ILhr pjedtf th q frs attempt to n develop sadh guidelines by outlining obeanetho6d of establishing appropriate, evidence in; a logical: manner
i* O medt theparticular, reporting needs ot the Task. Force,
tfitoui"'hadFO: loie tompleted in b months. And that required a gfth of 3)ork onf the eatato in' what I thinh youwilaresa
vt $$066 framd foran effort-of thison
9.ttis t1 in review. T hose: of yea' who have receIved copies.:
WH his is" no-oishe~d donament. There are still sie errers
'stencies, it needs a little editing, anld so can -But, we are pret'Atthitimeahjiva as wd attool'in oider to get your
hiP icac oreceipt speafetrelDoit t6 s grop ta.booR much expertise as we hiv6 gatthdit4 here today, who under. A lirw ms, adi unerstands what it is we are try1ngt o
ht tis imeA to consider the Projec seriodelf its Isay
I asman bects, but g I NTOG the. benfit of your
pt vahlidfisit Worthe plirs fl
pt alenatie would; agghtt 'If so, how esn the
prgesqitwilbelsphsiins and State agencies and
~ 1Twoale, tilvolved in asesihgte probable work relateda pil wit to ay abdwwill get on with the main
obtor 'Seiter
ThS grid e is a hpoutad -joint effort of two
t h"'tl x iurs, and'A toW hiclwrr-Lwithsoe
.me S t as irsiar i .~l adu i s r..ii .,
w, fodveo iedeta mgtbehlpu o tt







J should liketo pointoutat;t14 tiw(64 *jq*, are not familiar with occupational health or diwasm. or. in VM) physical, examinations do thpy:4* About The purpose of, this, gai e *t.
dete ationbetwefaa." 4'. 4 jApd
disease. IM
Our first Xeaction couperni em 7as 4, at. )M
task. You may agree. er aps we "E&Adlave Bilt 6r"Z
You will recall yesterd;tqy that we.supposedl f t4 z lk
t'd: W16A of'aAo(*1j,'0i
not agree on an exac eft t
through many of those gyrdti n ardficft.' 'i tonal. disease, environmeiftal'dise' 111 diseases, why does it oecur iii some-an n we '1 (1011
T6Y jj'6&jj;0i'd6jjk"
long latency perlo 'on Al
f *i t 06
The cla:ithgadjOto,-r"brought:us'!bick.t(y ro*
there already is A 'system iji o 6ratian'that tM Wpl Wqrkl" QW0 do have. Why, not P rovid .6 -as gistaiico to*, if at I &H i Pm3siWj U Phipf make the present, systeni'More effect".1 while lookmg for lip fane,which we agreemay take, years. And ,ivho knows at th* IM 9
new system makes light of tho* chi#engep where_-h6jm"i,.1rjvyyerW and physicians, lnia-ybe asked their, advlm 7.. bc)410111: wif
I ask you to mentally remove yourself lromthisivo U*vri *z& move t6 thi6usual'dm y roonis wheree' cbmpenwti6n;hearJ'6V&Am eohducted. There: is iisdally a-. he 4 bffioori' maybe thb, daim*n4-AW j two: lawyers, maybe t*0 physiciaa,%_,4mquent1p OU ?thowi. p4fflAm*rf q not present at the same tim "V depo" bus I I
a claimant --has.an ocoupktional 0har sidapap q 4 e
Somehow the;hearingoffievmust m which-the guidais rected.f*
ThP 'COMPORPationmech ]USM
complaint of illness or disease e'"fis, made 6 rLanagement by aji 64A% acoxapanyor perso4gl_ h 3 .aja n
gie*l e exx e!c t It
epide dQlp P t
'TWO 9 1 IWIIT ?V TI" ta
iA asceqgin 4g' 0!14 if llseA a
si-5 -P
,payoA l inor
As. P "' P IPA,
e guide follows a 1091ca. pattern t 0
physical should pursue in P"Ptiea 0 na
philosophy of, occupjtt an,4 a ,, je Pp ed illn& 'Or aig6a8' t
(3'cqi1trAc Or 10ro r7
tlj
a copsi&re' bu a .16 ino
00,1jr jj09(i 111Y t(-l
e are
per s' Ad ffictm
V
The Luide starts Wit4'a co I t an t g
of th'' &i Mni. A pei loh79 iid aiw
physical examination; the routine labo Wod che
or BIPP. rental. et t
as ",1, !mofia! T,' eg I
.e I
11 "IW6 0 10
demiology Twh4t i$ lla 119. 6h W I
6 6.1 e 'r it Ott iA 'W4: 'WWe
is eod4iic f
01 rgd JoP 'te 1W E'agelff 16
11 44 'T t MAIM P fri, ")'n' Wdril 1 '10
;P I. Vff It IfIR





87

&e disease. and themedical findinrof the disease are
lilt th&6 Foducod by the agent to cha, clainiant was
8 ciitoiia bannbt be met the disease ecQn" 4 non-,
awe
kinds of extenuating circumstances and excelAions trdt
O&M '- A be
at least, 'proper. questions we bp6, wi
9141e 4 pe,4ormed, so tliat'- however must miLke the
st h th' proper material f6 niaking a decision.
i4ugh this thin I wondered about it and'a' a'frial run
vl I... r o I deals in compensation cases and a union repreen cas'es-- -to t to this methodology in prek caso'.' ''did and: found 7 -4
promising. Thisgave me an
'Tato tleasipon Pite.
bxkWn 15 s.pecific substances that were assigned on
th cdncePtu4 ap I will not go into these 16
S are no important. There i's a discussim section of ag6 existing editions
con I still do not know what they are.
al medical
d t6IE thevv6rd "awavation" did not appear iu
er. Man or 'Is al dicti
"*Mman xne H ona,
jig.,
askssing qua cations of compaefit.
4?cscia I hvjnene persmnel.'l W, ot 'nauqed
W yers werp
e was none f but theY are x1ot, iine'
%i orce IMM
ern is ing to woA much de 'nth
pe a(wo 0,-pei7sonn impaitia ItT.
zintegrity- a d
1 s,,hut f9r pny system to w rk, thesp faoto ute
0 rs must,
!jig.
&100 UL Jdxicologi il information; jobs *hereexpQsure ances may mi 1 rl igw 0,
be Ountor to
P11h. 4,mml
Toi -VAU& bibliggra ftnd..a,&ssa.rv.
ht "'t i4 e wh will f Weil a Me is not n'ecesmry or
filtia otli6 will ee. T ani sure NIOSIT is op.eA:
I 'Ve, u n om anvoneM nk.you.
Dr mdur Ttjs interesting that, -Dr Ir 3tep-ittei proPr-,
4cii i ii d&flpn Of pRges'. loin.g, 1114 1w ma& briefest
on.,
vie,.
00 e Ongand intently at this report. My first,
voters I through 4 has evoked no trnmquij res and
ginco T:116 d. that, Dr'., 0S,[kr.6fter, li. P, Mysel? identifies Wondered if lie ex d go
OiN Rfitte' T WT19npe... me' f he same
in, an I -in i 'd t d
did 911i, 0.
ATQ+(, 0 01yeir 7QU is rqt 6 pimple loar0le--a *t4h6r
Iftn ,.mA yr Of Lauides. Tt is somewhat like takeloed to tho11 i tt
'in.f r e I re. Ioi'ftih'd f obi th residpf W4pm
as tn ho v f, i r the henljoum.For soxne'it: cou T It. b6
P going M Ai
1 1. 0 17
.f worse p i a
t It: o6ifl'a. 'It ''A ilmsion t le
fit hC40h 6011 db wifli the facN th
6 weTmd to:, r )6wf I A4 oqu,;Y ij4n 4,6f OP eilovise at b*
,i#q I... 4 6 kq Ir.3
*Nr A, jl *, Wtiag(illf eis In fh 'i
ff b Niho ftd I
f The" )oqfiliwl nee
71-790--76---7








ii8
tesaymornec.e nfonaely cionhrces ofmkngmpchce, thPmers Ifegpoto was notred ah fao d60 thou knir Steat eion o pdie ad wltcigtee n'h4cie e

clytose teI rhuead ese cate ocuat oae'( n olsewhr eehgol ev
e lesso othe uidsawee notak itothcoer aniAVf iotae matate. So en-andmdiri D: Earise ts o maeth olowing cu on h eea ulc~heeMer
maybe ecedo thistcorndi imao h eiio 'a~:
York~ p Sttpweaibloine with 4of h 6re6M'~WqS
Louisianaor cosa rngt e ,enmr toutvI
By thtime reots inhpersgive nw ht11e

headowshare theav gud opressotivenddtdoih r t6-ri
leed~~~ forg ai gudighadisesetil Iblet ato t intete inllman sorce n tatgnl th opeen specifc ali .-li PiIsa' ressdt the penrlmo praciinran.-'Istyatw iadete, t nchis tr time Iductv mighta comen theqo wonia tde ptbe with thepsbstane and inte: ~ 1 W
omethin funyasem toaape s ]e rsifo ry. admsinttiv decisiorre,. cariciunadaes ,o n oiilevei e reoftcleiu~)I notied. Byth settinorth exiciteo xou ad'hie"6 v nf deisiiur ains muadess thalotl shads eey era p tese guides f s-utve411SA i 1notd o: t u-his d is esoutld esi uh-hvlue4
ableto me noweesei make spciicrrnce'Mtras thsbe~y
Mi~dsas-poucn agns I won.
nere ot the mosrlrtti onrtn and te ao rvdrP(eVW ,illon e it arsenic tor l ad mihtr






netal. Incion ofe sbtnerylu isd itn fotles~l >uros of o eratial disciol nd cnmcpesle p f, hrotedstr oth chromici id.rcin owhc. l-,i
inidcso~kn.ms' drs tesle ih bt-smwa
t'iii ..............rh a ... te.g...es...h...d-..o.h at...he..........e
doi. mt o hsi,-thyihud-sals!amnaoypoe 0
dision akn V.
e Ii K
iii~iillmeiiiiiisecficrefie cestoiheguie. iistisoei4 ie e i file.ii d ise a se -p r o d u c ingia g e ts.-.................................................................
Thysr o hems motn adteei osoeetnOa
finrihrasnc-rla ih ae evdt lutae-,ev

meas Inls~.ofbrlimiitrsigbu-ntpaic,, r
pupsso patcl dsuso ol av eetd:hxvln Choae ahr-ta hoi cd.Bt icuin ftecl!&