The Practice of Medical Toxicology

Our plain-English summary of The Practice of Medical Toxicology, by E.G. Comstock (1978).

The study

• Author: E.G. Comstock
• Published: 1978
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1978 conference paper described the author's private medical toxicology practice in Houston, Texas. The author reviewed the records of 212 consecutive cases seen in the office. Evaluations included a history and examination. Further tests were done when required, and literature searches were frequently needed. The role of toxic substances in each illness was rated as none, probable or positive. Of the alleged exposures, 73.1 percent came from the workplace. Plaintiff attorneys referred more than one third of cases, physicians one fourth, insurance companies 11.7 percent and defense attorneys 10.4 percent. Respiratory complaints were the most frequent. In 15 cases the question was cause of death. Toxic substances were judged unrelated to the illness in 55 percent of cases. They were judged probably related, meaning more likely than not, in 39 percent and positively related in 6 percent. Litigation was under way or considered in 90 percent of cases. Asbestos appeared only as a name in a list of alleged substances, with no readable asbestos-specific results. The author concluded that clinical toxicology needs more emphasis in medical training.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective review of case records from one physician's private medical toxicology practice (conference paper)
• Who was studied: 212 consecutive cases seen in a private medical toxicology office in Houston, Texas; dates of the cases not stated (paper presented in 1978)
• Exposure: a wide range of toxic substances alleged to have caused illness, mostly at work; asbestos is listed among inorganic substances in the inventory, with no asbestos-specific count readable
• Main results:
  • Among the 212 cases, 73.1 percent of alleged exposures originated from the workplace
  • Physicians referred one fourth of cases, insurance companies 11.7 percent and defense attorneys 10.4 percent; plaintiff attorneys referred more than one third
  • The respiratory system was the most frequently involved complaint
  • In 15 of the 212 cases the issue was cause of death
  • Illness was judged unrelated to toxic substances in 55% of cases, probably related in 39% and positively related in 6%
  • A 'probable' rating meant causation was not proven beyond doubt but was more likely than not
  • Some type of litigation had been initiated or was being considered in 90 percent of cases
• The authors' conclusion: The author concluded that experience in this practice affirms the need for more emphasis on clinical toxicology in the medical curriculum and wider recognition of medical toxicology to allow early consultation
• Limitations the authors state:
  • Exposure had usually ended weeks to years before examination, so unequivocal proof of a link to toxic substances was rarely possible

Topics

Medical terms in this study, explained in our Lexicon: Plaintiff.

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