Use of information: environmental standards, assessments of risk, prevention and clinical implications

Our plain-English summary of Use of information: environmental standards, assessments of risk, prevention and clinical implications, by M.R. Becklake (The Medical Journal of Australia, 1985).

The study

• Author: M.R. Becklake
• Journal: The Medical Journal of Australia
• Published: 1985;143(2):63-4
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001254).

Abstract

Information which relates morbidity or mortality to environmental conditions (exposure-response relationships) forms the basis for public health as well as for clinical action. For both types of action, the information base is the same, neither complete nor comprehensive. So, both types of action are based on hypothesis, the best available to explain the facts, but subject to review in the light of new facts. Even though the volume of information may be considerable, as in the case of asbestos, there are always gaps in knowledge to be bridged by judgement. This should be made on the basis of as complete an evaluation as possible of all the available evidence.

In plain English

This was not a research study. It was a commentary presented at a Thoracic Society seminar on occupational lung diseases in Perth in May 1983. It contained no new data. The author discussed how the same information linking exposure to illness is used both to set workplace exposure standards and to guide clinical decisions about individual patients, with asbestos as the example. The author argued that an exposure standard is a hypothesis that reflects a judgement. The author wrote that most individuals exposed above the threshold limit value, at least for dusts, will not show ill effects, and that some whose exposure has not exceeded it will. The author noted that exposure-response relationships for asbestos appear to depend on fibre type and industrial process, citing crocidolite and chrysotile. A diagnosis was likewise described as a hypothesis. The author suggested that decisions about whether a worker's lung cancer was caused by asbestos are probably better left as clinical judgements than settled by calculated odds. The author concluded that public health officials and clinicians each need to recognize the need for judgement in the other's field.

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: Commentary (symposium presentation); no original data
• Who was studied: Not applicable: no study population; a general discussion of exposed workforces and individual patients
• Exposure: Asbestos in general, with chrysotile and crocidolite discussed as examples of how risk may differ by fibre type and industrial process
• Main results:
  • The author argued that an environmental exposure standard is a hypothesis reflecting a judgement, not a guaranteed safe level
  • The author stated that most individuals exposed above the threshold limit value, at least for dusts, will not show ill effects, while some whose exposure has not exceeded it will
  • The author noted that exposure-response relationships for asbestos appear to be influenced by fibre type and by the nature of the industrial process
  • The author described a clinical diagnosis as no more than the best available hypothesis to explain the known facts of a case
  • The author discussed odds, calculated from relative risks in a population of asbestos workers, that a given worker's lung cancer was caused by asbestos, and suggested such attributability decisions are probably better left as clinical judgements
  • The author advised that clinicians should not rule out an asbestos-related diagnosis just because the workplace met current standards, and that occupational exposures should be investigated in mesothelioma cases even when no fibre exposure is suspected
• The authors' conclusion: The authors concluded that public health authorities and clinicians draw on the same incomplete information, and that each should appreciate the need for judgement in the other's field

Related studies

• Quantitative risk assessment of environmental hazards — S.L. Brown (1985)
• The contribution of environmental monitoring in the epidemiological assessment of exogenous risk. The experience of ARPA in the Emilia-Romagna Region of Italy — A. Zavatti, P. Lauriola (1999)
• An air quality data analysis system for interrelating effects, standards, and needed source reductions: Part 13--Applying the EPA Proposed Guidelines for Carcinogen Risk Assessment to a set of asbestos lung cancer mortality data — R.I. Larsen (2003)
• A ban on asbestos must be based on a comparative risk assessment — M. Camus (2001)
• Risk factors for lung cancer in Iowa women: implications for prevention — J.S. Neuberger, J.D. Mahnken, et al. (2006)
• Public Health and Independent Risk Assessment — P. Vineis (2019)

Browse more research in The Medical Journal of Australia, or return to medical research.