Review of the Department of Labor's Site Exposure Matrix Database (2013) / Chapter Skim
Currently Skimming:
4 Findings and Recommendations
4 Findings and Recommendations
Pages 95-110
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 95... ...
nuclear facilities and occupational diseases that may result from exposure to them. Where possible, the committee was to identify any toxic substance–disease links missing from the database, to highlight other databases that might be used to supplement it, to comment on the review process for Haz-Map, and finally, to evaluate the National Library of Medicine's peerreview process for the Haz-Map database, which is the sole source of the toxic substance–disease links in SEM.
|
From page 96... ...
Although the committee is appreciative of the enormous amount of work that has gone into the development and maintenance of Haz-Map to assist health providers in identifying and possibly preventing occupational disease, the committee identified several limitations to the database links in the Haz-Map "Diseases" field that is imported into SEM. These include the lack of transparency in data sources used for determining each toxic substance–occupational disease link and the criteria for establishing those links, particularly for noncancer endpoints; the lack of a clear weight-of-the-evidence approach; the lack of peer review; overreliance on textbooks such that information may be neither comprehensive nor up-to-date; and the lack of clarity on which toxic substances and fields have been updated by the Haz-Map database developer.
|
From page 97... ...
However, the committee also identified major weaknesses in SEM, including difficulties in accessing information; the lack of detailed exposure information; poor handling of complex exposures, e.g., exposures to mixtures; the lack of clarity for why certain links are missing; incomplete or inconsistent exposure profiles for particular locations and jobs; disregard of epidemiologic studies of DOE workers; and the sole use of Haz-Map for toxic substance–occupational disease links as discussed in Chapter 3. In particular, the committee found that the use of Haz-Map as the sole source of disease causation in SEM to be problematic.
|
From page 98... ...
from Haz-Map is imported into SEM and is used by DOL claims examiners. The committee found that focusing on only the "Specific Health Effects" field in SEM as imported from the Haz-Map database field "Diseases," without consideration of the EEOICP claims process, was difficult because its review lacked context.
|
From page 99... ...
Many information sources are used by Haz-Map to support the toxic substance–occupational disease links, as discussed in Chapter 2. However, the evidence used to support each link is not cited, nor are all available sources of information on adverse effects associated with a toxic substance necessarily used.
|
From page 100... ...
Among the databases and documents that evaluate health effects for individual toxic substances or groups of related chemicals is the EPA's IRIS database and background documents, the Agency for Toxic Substances and Disease Registry's (ATSDR's) toxicological profiles, NTP OHAT toxicology reports, the background document preamble for the Occupational Safety and Health Administration permissible exposure limits, IARC monographs, the California Environmental Protection Agency's (Cal/EPA's)
|
From page 101... ...
Including appropriate citations in it would increase user confidence that the links were accurate, up-to-date, and scientifically rigorous. Because the toxic substance–disease links in SEM are imported from Haz-Map it might be easier to modify the latter rather than ask DOL staff to research the evidence base for the imported Haz-Map database links.
|
From page 102... ...
The expanded database allows users to see a list of all the toxic substances and all the health effects in it, but this option is not immediately evident on the SEM homepage. The committee also notes that it is difficult to find toxic substances or diseases in the database if the user misspells a word or does not know the correct terminology, and possible alternatives are not suggested to help the user.
|
From page 103... ...
An expert advisory panel could perform several important functions with regard to SEM, but the committee believes that the primary function of the advisory panel would be a peer review of its toxic substance–occupational disease links. The expert advisory panel should be broad based, external to DOL and its current SEM contractor, and its membership should include such expertise as epidemiology, occupational medicine, toxicology, and industrial hygiene.
|
From page 104... ...
• Periodic review of a sample of the toxic substance–disease links from both accepted and rejected claims to determine whether SEM links are actually assisting in the claims process and, if not, what improvements could be made in the toxic substance–disease links or what other infor mation might be added to the SEM that would help claimants and claims examiners, such as available monitoring information, disease terminol ogy, or results of cohort studies of DOE workers.
|
From page 105... ...
The expert advisory panel would review all the information in the substance profile, along with the con tractor's recommendation and either approve the recommendation or modify it as necessary. This final recommendation on the appropriate toxic substance–disease link would then be entered into SEM by the contractor.
|
From page 106... ...
Given the wealth of health effects information available on toxic substances, the IOM committee believes that a transparent process for identifying, screening, and evaluating this information must be done by a group of experts using a weight-of-evidence approach. The expert advisory panel would also be ideally situated to review the public submissions of disease-related information (and exposure-related if the panel has appropriate expertise)
|
From page 107... ...
The committee notes that some links between toxic substances found at DOE sites and diseases associated with them are not in SEM, such as the link between asbestos and ovarian cancer. The committee notes, however, that given the lack of exposure information in SEM -- including period of use and intensity and frequency of exposure -- it is difficult to ascertain whether occupational exposures were acute or chronic and were sufficient to result in chronic occupational disease.
|
From page 108... ...
Haz-Map is used for SEM because it provides causal toxic substance– occupational disease links in an easily captured field. Haz-Map is a unique database, and the committee was unable to identify any other databases that explicitly link occupational exposures to toxic substances to occupational diseases.
|
From page 109... ...
As discussed above, the committee strongly recommends that an expert advisory panel be established to review the evidence on any potential toxic substance–disease link. Such a panel, using a weight-of-evidence
|
From page 110... ...
110 REVIEW OF THE DOL'S SITE EXPOSURE MATRIX DATABASE approach, could determine how to assess inconclusive, inconsistent, or conflicted studies for purposes of evaluating whether there is a causal link. The panel may wish to develop its own criteria for weighing evi dence or use criteria established by other authoritative organizations, such as IARC, NTP, and IOM.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.