B-Readers

Silicosis isn’t something I run across in my practice, so when I ran across the term B-reader on NPR yesterday afternoon, I had to look it up. According to this, NIOSH B Reader represents a demonstration of proficiency for physicians who interpret chest radiographs for the pneumoconioses.

Respirable silica can produce irreversible damage to the lungs, leading to silicosis, lung cancer and tuberculosis. With up to 1.7 million exposed workers in the U.S., litigation associated with silicosis, as with asbestosis, is a high-stakes contest. With all of that money involved, this was probably inevitable:

The silicosis cases of thousands of plaintiffs in the federal silica multidistrict litigation may be on the verge of collapse after three days of Daubert hearings revealed what the presiding judge called "great red flags of fraud" in their diagnoses (In re: Silica Products Liability Litigation, No. 03md01553, S.D. Texas).

The Daubert hearing conducted in this case calls into question the diagnoses made by several medical experts for the plaintiffs. In certain instances, several of the same B-readers who found evidence of silicosis had found asbestosis in some of the same plaintiffs in prior asbestos litigation. In some cases, the diagnoses were judged to be mutually exclusive: signs of asbestosis but no silica exposure previously, evidence of silicosis but no asbestos presence now, raising the possibility of fraud on the part of the physicians making those diagnoses. Judge Janis Graham Jacks remanded all of the silicoses cases, potentially affecting 10,000 plaintiffs, in part because of unreliable diagnoses (a copy of her 250 page ruling can be found here – and is actually a handy resource that contains a concise history of silica hazards and regulatory actions). There a possibility of sanctions for the plaintiff attorneys as well as prosecution for some of the physicians who offered up the unreliable diagnoses.

This case has already been a rallying cry for advocates of tort reform, which raises the concern among advocates for workers that such reform would strip away workers’ options for compensation, if they weren’t protected properly by employers (NIOSH notes that the effects of respirable silica exposure are preventable through appropriate work practices, personal protective equipment use, exposure monitoring and medical surveillance). At the same time, workers who are truly sick from respirable silica exposure are precluded from timely help because of the thousands of cases clogging the court system.

The other concern here is this is yet another example of how science, in this case radiographic screening of workers with pneumoconiosis, has been allowed to be twisted to serve some economic end.

Rope Trick

“The Capitalists will sell us the rope with which we will hang them.” – Vladimir Ilyich Lenin

This is probably an apocryphal quote, but it still expresses the sentiment nicely. Now, a second firm in Dubai is negotiating the purchase of a British-based firm which has American subsidiaries that are defense contractors. The White House has started reviewing the security implications.

Sorry, I couldn’t resist. I’ll be back to writing about environmental health shortly.

The Politics of Hypothermia

Approximately 6 million households in the cold Northeast are heated with residential oil, which is currently running around $2.40 a gallon. Out of 6 million households, you can bet there are a lot of them having difficulty paying to keep the oil tanks filled or keeping warm in the winter.

Enter Citgo Petroleum Corporation. Citgo appears to have an active community involvement program, including distributing heating oil at discounted prices this winter as part of an initiative aimed at helping poor communities in areas of the country most affected by cold winters.

The parent company of Citgo is the Venezuelan state oil company PDVSA, and Citgo’s program has the full support of the parent company. Naturally, here’s the spin put on it by the liberal Washington Post:

Venezuela, where per capita income is about one tenth that of the United States, will provide 4.8 million gallons of heating oil at a 40 percent discount to Connecticut households that qualify for state home heat assistance, state officials said. . .

. . . [t]he exports are seen as an attempt by Chavez to embarrass the Bush administration, which the Venezuelan leader says neglects poor Americans.

It’s good that our Congressional representatives know how to respond to the shame of being provided winter heating oil assistance to low-income families from a country where, as few as 10 years ago, over 50 percent of the population of its capital lived as squatters:

Last month, House Energy and Commerce Committee Chairman Joe Barton (R-Texas) and Rep. Ed Whitfield (R-Ky.) wrote Citgo to demand documents about the program. The members, for example, asked how the company selected which communities would get the oil and whether the program violated federal antitrust laws.

It speaks volumes about how our current political leadership thinks, when a humanitarian and public health gesture is viewed as a tool to increase market share (selling discounted heating oil to the poor will do that?) or a threat to national security:

“So rarely does one find Fidel Castro’s best friend in the Western Hemisphere prepared to do Americans a favor, that just possibly it’s not a favor,” said Energy and Commerce Deputy Staff Director Larry Neal.

If we are under “attack” by Venezuela here, it’s only because we’re such a big target. It’s an application of soft power at its finest, and it’s a shame that we’re blind to the lesson.