The diagnostic test for asbestosis had been developed by ILO in 1980. It was proposed that HRCT would be more sensitive than the ILO scheme. Evidence from: O Huuskonen et al. Scandinavian Journal of Work, Environment and Health. Apr (2001) Vol.27 #2 p 106. Greater sensitivity would lead to more claims but these would be lower value claims. The Radar report is available to subscribers: 1#5 9

Genetic differences must be accounted for in studies of smoking risk of renal cell cancer. Innate risk of  cancer varies with the ability to metabolise environmental toxins, some of which may be carcinogenic. Evidence from: JC Semenza et al. American Journal of Epidemiology. May (2001) Vol. 153 #9. p 851. In this study there were clear differences of rsik between those with a high capacity to acetylate toxins and those with an impaired capacity, regardless of smoking history. Innate vulnerability is not a defence but may be used to discover and bolster causation arguments. The Radar report is available to subscribers: 1#5 1

The study compared lung cancer risk in an occupational cohort with the relevant normal population in the USA. Workers were exposed to silica in sand dust. The potential effects of radon exposure were reduced to a minimum. Evidence from: K.Steenland et al. American Journal of Epidemiology. April (2001). Vol. 153 #7 p 695. The report provides exposure estimates and the strength of association between exposure and lung cancer. Dose response trends were looked for. Given the number of people exposed to silica dust at higher than the recommended level it would be possible to estimate the attributable case load. The Radar report is available to subscribers: 1#4 11

The paper reports an estimate of the normal incidence of hypospadias (a male genital malformation observed at birth). Evidence from: HEVirtanen et al. APMIS Feb. (2001) Vol. 109, #2 p 96. Changes in incidence would alert researchers to look for an environmental cause.. In Finland, there has been no change of incidence between 1970 and 1999. This paper provides a useful baseline against which to assess any change. The Radar report is available to subscribers: 1#4 9

Pain hypersensitivity could explain disability where tissue damage is absent. This preliminary study provides tentative clues about this phenomenon and its potential prognostic power. MWerneke et al. Spine. April (2001) Vol. 26 #7 p 758 A proposed new method for predicting chronicity of low back pain following an acute attack. The authors propose that centralisation of pain within weeks of the acute attack may indicate a better outcome. Centralisation phenomenon is where the pain migrates from the distal or peripheral to the proximal or central. The authors conclude that the negative assessment of centralisation in the first few weeks is a useful predictor of continuing (long-term) pain and disability. However, the study was either not well designed or poorly reported. Comment A semi objective test would be very useful in selecting back pain cases that ought to be managed more closely. The method proposed here is not validated by this study, but it is likely (given the desire to find a

Reflex sympathetic dystrophy can be a devastating condition. This report provides data for reserving and cost benefit calculation of mitigation measures. Evidence from: A Zyluk. Journal of Hand Surgery. April (2001) Vol. 26B #2 p 151 A study of outcomes, following treatment for Reflex Sympathetic Dystrophy. 146 cases were assessed for functional capacity and pain, both before treatment and again at 11 months after treatment. Diagnosis was confirmed in the presence of diffuse pain and at least three of: swelling, discolouration, abnormal skin temp, limited ROM. 64% of cases were described as having a good outcome. Of these only a third were completely free of pain, but 100% had full range of motion restored and 80% had some reduction in grip strength compared to normal values. Comment Of the 46% with poor outcomes it is not known how many were misdiagnosed. Patient attitudes were not recorded. Some loss of comfort can be expected a year after treatment even for good outcomes. However it

This report of a public meeting involving officials, academics and campaigners. Evidence from: HSC/DETR At-work Road Safety Conference. The Barbican, London. 5th April 2001. Campaigners are intent on blurring the distinction between Motor and EL insurance when the driver or passengers are “at work”. The Radar report is available to subscribers: 1#4 1

Evidence from: Andrew@reliabilityoxford.co.uk Bias is a term that is commonly referred to in epidemiological studies. It is a technical term and does not imply a partisan desire for or attempt to produce a particular outcome. Bias is simply any factor that can distort the outcome of epidemiological work from its true value. There are a number of types of bias to consider: • failure to record or identify factors (confounders) that could result in the same effect or prevent the effect of the causal hypothesis under study. • inappropriate selection of study population. • diagnostic and exposure measurement techniques can be under or over sensitive, under or over specific and plain wrong. • measurements may be systematically biased. For example, an observer may improve in the accuracy of his observations with practice. If more cases than controls are observed at the beginning of the study, the results could be biased. Bias is particularly likely in studies that rely on exposure memory and/

Evidence from: DJ Hendrick. Clinical and Experimental Allergy Vol. 31 Jan (2001) p.1. An editorial on occupational asthma. The author notes that 11% of incident cases of occupational asthma are in fact reactive airways dysfunction syndrome I.e. no allergen involved. Triggered by irritants and viruses. Comment An important distinction, and one which is increasingly suspected for childhood asthma.

The research should provide the means to estimate the attributable case load for leukaemia, rectum cancer, lung cancer and “all” cancer. Work cohorts in this study were dental, medical, industrial and nuclear. Evidence from: WN Sont et al. American Journal of Epidemiology Feb (2001) Vol. 153 #4 p. 309 In practice the results were of doubtful statistical significance. The approach to risk adopted in radiation regulation and medicine seems far removed from an approach based on the balance of probabilities. The Radar report is available to subscribers: 1#3 4

The academic research reports on the prevalence of neck pain among British adults. Associations with ergonomics, sex, smoking, generalised pain and stress were explored. Evidence from: KTPalmer et al. Scandinavian Journal of Work, Environment and Health. Feb (2001) Vol.27 #1 p.49. Neck pain is very common and interferes with normal activity. Inaccurate causal attributions are likely to be made at a high rate. This report shows which factors are associated and which are not. It also provides data which can be used in liability exposure estimates. The Radar report is available to subscribers: 1#3 3

The review carries some weight with policy makers, it focusses on mains frequency fields. The risk in the UK would seem to be  small; even when using medical statistics. Evidence from: NRPB Volume 12 #1 (2001). ISSN 0958 5648. price £30.00 ‘ELF Electromagnetic Fields and the Risk of Cancer?’ If eventually there is some causal link uncovered, the data in this report provide a basis from which to estimate the liability exposure. The Radar report is available to subscribers: 1#3 1

The research investigated whether there were any obvious pre-placement risk factors that could be used to reduce the risk of back pain. Evidence from: P. Lee et al. The Journal of Rheumatology. Feb (2001) Vol.28 #2 p. 346. A cross-sectional study of 1,562 employees, using a back pain questionnaire and measurements of abdominal muscle strength. Lifetime and point prevalences were 60% and 11% respectively. There was no correlation with body mass index or height. Prevalence was slightly higher among married subjects. Comment It is well established that pre employment screening based on physical characteristics is not effective in preventing reports of low back pain. Prevalences were not linked to occupation. It would appear that primary prevention measures are unlikely to be effective (except for impact injuries), secondary prevention would be a sensible response.

This academic paper reports a strong association between smoking (cumulative exposure) and a diagnosis of rheumatoid arthritis. There was evidence of increasing risk with increasing exposure, but this was not systematic in pattern. Evidence from: D. Hutchinson et al. Annals of Rheumatic Disease. Jan (2001) Vol. 60 #3 Along with estimates of the incidence of rheumatoid arthritis and the prevalence of smoking habit, the annual number of cases attributable to tobacco smoke may be estimated. The Radar report is available to subscribers: 1#2 3

Evidence from: Andrew@Reliabilityoxford.co.uk A brief reminder that the key outcome measures from epidemiology are often expressed as risk or odds ratios. A ratio of 1.0 indicates that the exposure effect relationship being tested shows neither an increased nor a decreased risk. That is, there was no detectable association between hypothetical cause and effect. A ratio of less than 1.0 (but more than 0.0) indicates that the exposure might be protective against the outcome. A ratio of more than 1.0 indicates increased risk. Similarly, a standardised mortality ratio (SMR) of 100 indicates no detected risk. In terms of probabilities, a risk ratio of more than 2.0 (or more than 200 for SMR) indicates that there is a probability of an association between exposure and outcome of more than 50%. This would seem to satisfy the test of the balance of probabilities.

This academic paper reports a strong and statistically significant association between vinyl chloride and liver cancer in employees. There is a dose-response relationship. Although not directly translatable, the work can be used to estimate liability exposure in other settings. Evidence from: K.Mundt et al. Occupational and Environmental Medicine (2000) Vol. 57 #11 p 774. Risk estimates are not easily translated into other workplace settings but may be indicative by way of a first approximation.  Current case load can be converted into anticipated case load using the data in this paper. The Radar report is available to subscribers: 1#1 8

This academic paper finds a power relationship between cumulative smoking and death from lung cancer. This is as expected. The form of relationship permits the calculation of the date when risk was doubled, which may be useful in ‘injury-in-fact’ arguments, and when risk was first detectable which may be useful in ‘de minimis’ arguments. Evidence from: N.Yamaguchi et al. International Journal of Epidemiology (Dec 2000) Vol. 29, p 963. Potential exposure to insurable outcomes can be estimated using functions of this sort. Radar report is available to subscribers: 1#1 6

This academic paper reports the annual frequency of newly diagnosed occupational asthma and provides the leading identified causes. It has become clear that a task focussed approach to prevention may be more successful than an industry focussed approach. Evidence from: JC McDonald et al, Occupational and Environmental Medicine (2000), Vol. 57 #12 p 823. Radar report is available to subscribers: 1#1 4