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Role of the Primp Care Physician in Occupabon~1 and Environments Medians

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Not only in antiquity hut irz our own times also laws have been passed in well-ordered cities to secure good conditions for the workers; so it is only right that the art of medictrze should con~trz~rute its portion for the benefit and relief of those for whom the law has shown such foresight; indeed we ought to show peculiar zeal, though so far we have neglected to do so, in taking precautions for their safety, so that as far as possible they may work at their chosen calling without loss of health.

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Role f the Primary Care Physician in Occupational and Environmental Medicine DIVISION OF HE'S PROMOTION AND DISEASE ~~ION INSTITUTE OF MEDICINE NATIONAL ACADEMYPRESS Washington, D.C. 19~38

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee appointed by the members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. The study was supported under contracts with the Environmental Protection Agency (Grant Nos. R813648~1 and R813648-01-0~; the National Institute for Occupational Safety and Health, Centers for Disease Control; the National Institute of Environmental Health Sciences, National Institutes of Health; and a grant from the Charles A. Dana Foundation Incorporated (OPVT~658- 001~. Additional support was provided by the National Research Council (NRC) Fund (ALOC- 8897-001 ), a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from a consortium of private foundations including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation, the William and Flora Hewlett Foundation, and the John D. and Catherine T. MacArthur Foundation, the Andrew W. Mellon Foundation, the Rockefeller Foundation, and the Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of United States science and technology and with public policy issues with technological content; and the National Academy of Sciences and the National Academy of Engineering endowments. Translated excerpts from De Morbis Dzatnba (Diseases of Workers) by Bernardino R:unazzini are reprinted in this report with the permission of the Classics of Medicine Library O1983 Special Edition copyright. A reprint ofthe Latin text ofthe 1713 revised edition, with translation end noses by Wilmer Cave Wright, published by the University of Chicago Press, 1940, copyright 1940, by the New York Academy of Medicine. Woodcuts from The Book of Trades (Standebuch) by lost Amman and Hans Sachs (New York: Dover Publications, 1973, with an Introduction by Benjamin A. Rifkin) are reprinted in this report with the permission ofthe publisher. The woodcutswere originally published in Frankfurt am Main in 1568. Publication No. IOM-88{)5 Available from: National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418 A charge of $3. DO for postage and handling is required. Printed in the United States of America

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coMMIrrEE ON THE ROLE OF THE PHYSICIAN IN OCCUPATIONALAND ENVIRONMENTAL MEDICINES Bernard D. Goldstein (Chair), Professor and Chairperson, Department of Environmental and Community Medicine, UMDN{/Robert Wood Johnson Medical School, Piscataway, New~ersey Joseph M. Cannella, Corporate Medical Director, Mobil Oil Company, New York, New York David S. Citron, Director of Medical Education, Charlotte Memorial Hospital and Medical Center, Charlotte, North Carolina Molly Joel Coye, State Commissioner of Health, New Jersey Department of Health, Trenton, New Jersey Neil I. Elgee, Clinical Professor of Medicine, Summit Madison Medical Group, Seattle, Washington Robert A. Fried, Luther L. Terry Preventive Medicine Fellow, Association of Teachers of Preventive Medicine, Washington, D.C. Peter B. Mutt, Partner, Covington and Burling, Washington, D.C. George W. Jackson, Director of Employee Occupational Health and Chief of the Division of Occupational Medicine, Duke University Medical Center, Durham, North Carolina Alan A. McLean, Clinical/Associate Professor, Department of Psychiatry, Cornell University Medical College, Westport, Connecticut Clifford S. Mitchell, Resident Physician, Department of Medicine, Francis Scott Key Medical Center, Baltimore, Maryland Linda Rosenstock, Director of Occupational Medicine, Universiny of Washington, Seattle, Washington James L. Weeks, Deputy Administrator for Occupational Health, United Mine Workers of America, Washington, D.C. David H. Wegman, Professor and Head, Department of Work Environmen. ~ College of Engineering, Lowell, Massachusetts Stanford Wessler, Associate Dean of Postgraduate Programs, New York University School of Medicine, New York, New York Consultant Kathleen M. Rest, Pew Health Policy Fellow, Boston University, Boston, Massachusetts *See Appendix B for further information on committee members and the consultant. v

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Institute of Medians Stab James V. Warren, Study Director Enriqueta C. Bond, Director, Division of Health Promotion and Disease Prevention Kyung-Sook Lee, Research Associate Wallace K Waterfall, Editor Linda DePugh, Administrative Assistant Contributors of Commissioned Paperer Nicholas Ashford, Associate Professor of Technology and Poliq, Center for Technology, Policy, and Industrial Development, Massachusetts Institute of Technology, Cambridge, Massachusetts Edward Baker, Deputy Director, Centers for Disease Control/National Institute for Occupational Safepr and Health, Atlanta, Georgia Leslie I. Boden, Associate Professor of Public Health, Environmental Health Section, Boston University, Boston, Massachusetts Mark Cullen, Associate Professor, Medicine/Epidemiology, Yale Occupational Medicine Program, New Haven, Connecticut Ray Demers, Associate Professor, Wayne State University, Department of Family Medicine, Center for Occupational Health, University Health Center, Detroit, Michigan Frank Goldsmith, Dean, Harry Van Arsdale School of L abor Studies, Empire State College, State University of New York, New York, New York Warren Heffron, Professor and Chairman, Department of Family, Community and Emergenq Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico Patricia Honchar, Chief, Surveillance Coordinating Activity, Office of Director, Centers for Disease Control/National Institute for Occupational Safety and Health, Atlanta, Georgia Thomas Kottke, Assistant Professor, Department of Cardiology, University of Minnesota, Minneapolis, Minnesota Bany Kelly, Director, Occupational Health Program, Department of Family and Community Medicine, University of M~chusetts Medical Center, Worcester, Massachusetts Daniel Masys, Director, Lister Hill Center, National Library of Medicine, Bethesda, Maryland Raymond Neutra, Chief of Epidemiology, State of California Deparunent of Health Services, Berkeley, California *See Appendix A for abstracts of the commissioned papers. v'

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David Parkinson, Chief of Occupational Medicine, Department of Community and Preventive Medicine, Health Science Center, State University of New York at Stony Brook, Stony Brook, New York Graham Ward, Assistant Research Professor of Medicine, The Cardiovascular Institute, Boston, Massachusetts Other Contributors Norbert I. Berberich, Chief, Curriculum Development Group, National Institute for Occupational Health and Safety, Cincinnati, Ohio Henry Falk, Director, Division of Environmental Hazards and Health Effects, Centers for Environmental Health and Injury Control, Centers for Disease Control, Atlanta, Georgia Barry Johnson, Associate Administrator, Agency for Toxic Substance and Disease Registry, Atlanta, Georgia Kathryn Kahler, National Correspondent for Newhouse Newspapers, Washington, D.C. Marvin Kuschner, Dean of the Medical School, Health Science Center, State University of New York at Stony Brook, Stony Brook, New York Frank Mitchell, Chief Medical Officer, Agency for Toxic Substance and Disease Registry, Atlanta, Georgia Anthony Robbins, Professor and Director of Vaccine Project, School of Public Health in the School of Medicine, Boston University, Boston, Massachusetts August Swanson, Vice President, Division of Academic Affairs, American Association of Medical Colleges, Washington, D.C. Ralph Yodaiken, Director of the Office of Occupational Medicine, Occupational Safety and Health Administration, Department of Labor, Washington, D.C. Sponsors ' Representatives Scott R. Baker, Special Assistant to the Assistant Administrator, Office of Research and Development, Environmental Protection Agency, Washington, D.C. Stephen Foster, Program Officer, The Charles A. Dana Foundation, New York, New York Carl Keller, Epidemiologist, National Institutes of Health, Bethesda, Maryland Max Lum, Health Educational Specialist, Agency for Toxic Substance and Disease Registry, Atlanta, Georgia Melvin L. Myers, Deputy Assistant Director, Centers for Disease Control/National Institute for Occupational Safety and Health, Atlanta, Georgia . . v::