The study finds weak evidence of a moderate link between exposure to loud noise and risk of acoustic neuroma. Evidence from: CG Edwards et al. Am J Epidemiol (2006) Vol.163 p 327–333 “Exposure to Loud Noise and Risk of Acoustic Neuroma” Acoustic neuroma (AN) is a slow growing benign tumour of the sheath of the eighth cranial nerve (hearing and balance), in close proximity to the brain. Exposure to loud noise at work is still commonplace. AN is indivisible, but rare. Insurers could estimate the number of cases attributable to loud noise at work and could judge for themselves how good any claim is likely to be. Potentially problematic for claimants is that hearing surveillance could be the main reason that AN is associated with noise exposure: accelerated diagnosis. Further detail: 6#1 15

The EFSA Journal (2006) Vol.357 p 1 – 46 “Migratory Birds and their Possible Role in the Spread of Highly Pathogenic Avian Influenza” This European Food Safety Authority paper concludes that not enough is known/certain about avian influenza in wild birds to ensure that the right public health and commercial protection measures are put in place. Poultry keepers should increase bio-security measures, there should be more proactive monitoring of wild birds and vaccination programmes should be considered. Trade may need to be restricted but wild birds could be more effective at spreading disease than trade mechanisms and so reduce the benefits of such measures. Migration and movement patterns were too uncertain to be sure of this. The clearest recommendations were that poultry holdings should not be built in the vicinity of wetland areas and that new vaccines and how to use them, should be researched. Comment The definition of ‘wetland’ and ‘vicinity’ would be of interest to an

The report discusses the powers of detention in cases of contagious disease. People with an unusually virulent from of influenza could be detained in hospital as a health protection measure. Evidence from: R Martyn. Medical Law Review (2006) Vol.14 p 132 – 143 “The Exercise Of Public Health Powers In Cases Of Infectious Disease: Human Rights Implications” Considerable judgement is required to initiate the detention order procedure. Those who advise on such matters had better have suitable financial protection even though control actions are the responsibility of public authorities. Further detail: 6#1 13

The report emphasises the vulnerability of those who live in care homes. It also points out that animal vaccines may become ineffective if not updated (approximately) annually. Evidence from: I Stephenson et al. British Med Bull. (2006) Vol.75+76 p 63 – 80 “Influenza: current threat from avian influenza” The report details the state of knowledge at that time. Vaccination of farm animals could reduce the risk to humans. But it could also go wrong if not done properly. Further details: 6#1 12

Potassium Octatitanate whiskers are bio persistent and cause significant lung inflammation. Evidence from: T Oyabu et al. J Occup Health (2006) Vol.48 p 44-48 “The Effect of Lung Burden on Biopersistence and Pulmonary Effects in Rats Exposed to Potassium Octatitanate Whiskers (POW) by Intratracheal Instillation.” Potassium Octatitanate whiskers (K2Ti8O17) (POW) are typically of 5 μm in length and are classified as refractory ceramic fibres (aka Fybex). They are used as an asbestos substitute. Further detail: 6#1 11

The asbestos exposure history for the GB working population is unknown. In the model presented here, relative asbestos exposure in occupational groups is assumed to correlate in some way with mesothelioma rates in those groups. After correcting for age and smoking effects, the model finds that the asbestos-related lung cancer: mesothelioma ratio is 0.65: 1 for the GB working population as a whole. Evidence from: AJ Darnton et al. Ann Occ Hyg. (2006) Vol.50#1 p 29 – 38 “Estimating the Number of Asbestos-related Lung Cancer Deaths in Great Britain from 1980 to 2000” As a rough estimate, allowing for deaths which occurred after age 74 the authors propose 11,500 asbestos related lung cancers in all in that period, compared with 17,491 total mesothelioma cases. Asbestos was responsible for around 3% of all lung cancer deaths. Further detail: 6#1 10

European Environment Agency Report No7 (2006) “How much bio-energy can Europe produce without harming the environment?” The report explores the potential for purpose grown feedstock for power and heating and the potential for recycling biomass wastes. Some wastes, their storage, transport and uses could present environmental liabilities and risks to persons. The main exploitable biowaste streams are solid agricultural residues (e.g. straw), wet manures, wood processing residues, the biodegradable part of municipal solid waste and black liquor from the pulp and paper industry.

The European climate is expected to change slowly i.e. decades not years. Several risks have been identified and measures could be taken to reduce the associated liabilities. Evidence from: Environment Agency. March (2005) “The Climate is Changing: Time to Get Ready” The report lists several areas where liability exposure change would be expected by extrapolation from current experience, but slow changes to exposure are readily accommodated in experince ratings. Further detail: 6#1 8

Fluoride is added to drinking water to prevent dental caries. In practice fluoride concentrations exceed recommended levels and may cause harm to teeth and bones. Evidence from: Committee on Fluoride in Drinking Water, National Research Council ISBN: 0-309-10128-X, “Fluoride in Drinking Water: A Scientific Review of EPA’s Standards” Safe and harmful levels are detailed in the report. An effect on children is described. Further detail: 6#1 7

Provided they were non-smokers, lung cancer cases with an environmental exposure leading to daily urinary excretion levels of more than 24 nmol of cadmium could argue that cadmium was the most likely explanation for the cancer. Cadmium exposure maps for the UK are publicly available. Evidence from: T Nawrot et al. Lancet Oncol. (2006) Vol.7 p 119 126 “Environmental exposure to cadmium and risk of cancer: a prospective population-based study” The paper also suggests a synergistic effect with smoking. Blood tests would identify those at significant risk, and would suggest causation in non-smokers. Further detail: 6#1 6

MCS patients did not have unusually heightened sense of smell but did have a stronger emotional response to unpleasant and pleasant smells. Combined with the results of other work it would seem that MCS cases have an unusually strong interpretation of perceived exposures. Evidence from: D Papo et al. J Psychosom Research. (2006) Vol. 60 p 199 – 209 “Chemosensory function and psychological profile in patients with multiple chemical sensitivity: Comparison with odor-sensitive and asymptomatic controls” further detail: 6#1 5

It would seem from this study that multiple chemical sensitivity diagnosis does not correlate with objective measurements of exposure. Perceived exposure may be the more important factor. Evidence from: S Bornschein et al. Psychosom Medicine (2006) Vol.68 p 104 – 109 “Psychiatric Morbidity and Toxic Burden in Patients With Environmental Illness: A Controlled Study” further detail: 6#1 4  

The House of Lords is being asked to consider a claim for compensation arising from charitable work undertaken in Bangladesh. There is some dispute as to the remit of that work and the standard to which it was performed. Evidence from: D Pepper. The Lancet (2006) Vol.367 p 199 – 200 “Bangladeshis poisoned by arsenic sue British organisation” Early assessments of liability came to the view that BGS was not proximal to the decision to drink the water. further detail: 6#1 3

This report, based on a meta-analysis of 27 publications, suggests that silicosis is related to the risk of lung cancer even among non-smokers. Evidence from: Y Lacasse et al. Scand J Work Environ Health (2005) Vol.31(6) p 450 – 458 “Meta-analysis of silicosis and lung cancer” In general it has been found that the more severe the silicosis the higher the risk of lung cancer.   further detail: 6#1 2  

The results suggest that silicosis is a prerequisite for silica-related lung cancer. Risk of lung cancer did not vary with cumulative dust exposure if there was no silicosis. There was no correction for the effects of smoking. There was some evidence that silica dust/silicosis was not the only geological determinant of lung cancer risk. Evidence from: W Chen et al. Am. J. Ind. Med. (2006) Vol.49 p 67 – 76 “Exposures to Silica Mixed Dust and Cohort Mortality Study in Tin Mines: Exposure-Response Analysis and Risk Assessment of Lung Cancer” In those with silicosis the risk of lung cancer varied with exposure; a clear rise in risk was detected once exposure to total dust exceeded 70 mgm-3 years. Respirable crystalline silica comprised around 4% of total dust in each mine. Further detail: 6#1 1  

“The health, safety and environmental risks associated with hydraulic fracturing (often termed ‘fracking’) as a means to extract shale gas can be managed effectively in the UK as long as operational best practices are implemented and enforced through regulation. “ Evidence from: http://royalsociety.org/uploadedFiles/Royal_Society_Content/policy/projects/shale-gas/2012-06-28-Shale-gas.pdf The report emphasises the need to study baseline conditions before fracking work begins. That way, changes in dissolved methane and other contaminants in ground water, aquifers and streams can be discovered with greater confidence. Induced seismic activity should be continuously monitored and used to slow down or relocate underground injection. Waste water handling is a key issue – regulators must be satisfied that the proposed controls will cope. Long term liabilities are possible: disused wells could provide a conduit for contamination. The conclusions are generic, but were develope

liquids-from-e-cigarettes-can-be-detrimental-to-health The German risk advisory service, BfR, has been assessing what’s in the typical e-cigarette. The analysis is preliminary and precautionary in nature. Besides nicotine inhalation (which users seem to accept as a risk) there are potential problems with: direct contact with the nicotine solution; dependency leading to tobacco use; potential health effects from unknown gimmick ingredients such as menthol, and poisoning of by-standers. “The BfR therefore recommends that e-cigarettes should be treated like conventional cigarettes in non-smoking areas and that e-smoking is banned in such zones.” The recommendation from us would be that companies review their smoking policy. Of particular concern is that there is an argument put forward that use of these aerosol devices helps people to quit tobacco smoking. Therefore, the story continues, they should be permitted in the workplace. This argument has not been accepted by me

Evidence of causal association and mechanism has been slowly gathering since the late 1980s. The International Agency for Research into Cancer (IARC) has now published a position statement. Their conclusion: diesel exhaust is carcinogenic to humans.  http://download.thelancet.com/flatcontentassets/pdfs/S1470204512702802.pdf  Estimates for the UK indicate that up to 1000 lung cancers and around 100 bladder cancer cases each year could be a result of occupational exposure. There are no diesel exhaust exposure standards in the UK but standards exist in the USA and it is likely that these are regularly exceeded in some kinds of work. Perhaps it would be a good time to undertake a thorough review of liability exposure and the barriers to liability exposure. The next issue of the Radar journal will begin that process. Evidence from: Lancet June 15, (2012) DOI:10.1016/S1470- 2045(12)70280-2 and DT Silverman et al. J Natl Cancer Inst (2012) Vol.104 p 1–14

An association between night shift work and breast cancer risk has been found. Many of the known risk factors for breast cancer were corrected for in obtaining this result. Although causation is not illuminated by this study, there are authoritative bodies that have concluded that night shift work is probably carcinogenic to humans. While causation probability may still be very low, it is possible to estimate the liability exposure should causation be established and assuming this research is approximately representative of shift work more generally.  Evidence from:  J Hansen et al. Occup Environ Med (2012). doi:10.1136/oemed-2011-100240 Nested case-control study of night shift work and breast cancer risk among women in the Danish military At a meeting on the 12th June (2012), subscribers to the Radar service will be advised as to the number of credible liability cases per year and the industry sectors potentially most affected in the UK. While there are no specific duty of care standa