Evidence from: DP Gross et al. Occ. Env. Med (2006) Vol.63 p 404 – 410 “Does functional capacity evaluation predict recovery in workers’ compensation claimants with upper extremity disorders?” Epidemiology (2006) Vol.17 p 506 – 511 “Transient Exposure to Coffee as a Trigger of a First Nonfatal Myocardial Infarction” H Nishiura et al. Epidemiology (2006) Vol.17 p 576 – 581 “Still Protected Against Smallpox? Estimation of the Duration of Vaccine-Induced Immunity Against Smallpox” MMWR Weekly August 18th (2006) “Adult Blood Lead Epidemiology and Surveillance — United States, 2003–2004” Federal Institute for Risk Assessment. Press release 31st Aug 2006. “Indications that styrene has a tumorigenic effect in humans” GESTIS international database on hazardous substances Environment Agency Press Release 17th August 2006. “Fire & Rescue Service’s role in pollution prevention recognised” Further detail: 6#5-6

Evidence from: Weightmans 4th May 2006. “CIT Robberies raise PI claims” USEPA “High Production Volume Information System” PD Darbre. J Applied Tox. (2006) Vol.26 p 191 -197 “Metalloestrogens: an emerging class of inorganic xenoestrogens with potential to add to the oestrogenic burden of the human breast” Food Standards Agency Project T07011 “Immunochemical reactivity to peanuts and nuts in allergic individuals” EFSA Scientific Report (2006) Vol.84 p 1 – 102 “Dimethoate” USEPA “Ships as Artificial Reefs” Further detail: 6#5-6 54 BB

The report identifies best practice for case management and finds good evidence that this approach is cost effective. It is an approach that is increasingly being adopted by the larger firms. Evidence from: HSE Research Report RR493 “The costs and benefits of active case management and rehabilitation for musculoskeletal disorders” The report lays out the key qualities of a case manager. Further detail: 6#5-6 51

Research clearly shows that being out of work leads to reduced health. Return to work leads to improved health. Evidence from: G Waddell and K Burton. The Stationery Office 2006. “Is work good for your health and well-being?” When people return to work from unemployment their health improves. Returning to work from unemployment improves health by as much as unemployment damages it. Further detail: 6#5-6 50

The government have made a clear decision that compensation for loss arising out of the coexistence of GM and non-GM production should be borne by the GM sector. The paper outlines various options for financing that obligation. Private insurance is not considered a viable option at this time. There is no consideration of the situation where a GM crop is damaged by the presence of a non-GM contaminant. Evidence from: DEFRA July 2006. “Consultation on proposals for managing the coexistence of GM, conventional and organic crops” Whilst Defra remains open to the idea of an insurance market developing, it does not see this as a solution in the short-to-medium term. Therefore, the issues around a possible insurance market have not been explored in this paper. Further detail: 6#5-6 47

The report presents a very extensive analysis of evidence but seems to us to have jumped to precautionary conclusions e.g. that RCF could cause mesothelioma or lung cancer. Evidence from: CDC/ NIOSH May 2006-123 “Occupational Exposure to Refractory Ceramic Fibers” Much is made of the formation of pleural plaques in those with high exposures to RCF. By analogy with asbestos. Further detail: 6#5-6 45

Should the employer be vicariously liable for the wrongs committed by the employee? Yes. Even if the wrong is criminal, a limit on vicarious liability would have to be explicitly stated in the statute. Evidence from: Majrowski v Guy’s and St Thomas’ Trust [2006] UKHL 34 Vicarious liability is a common law principle of strict, no-fault liability. Under this principle a blameless employer is liable for a wrong committed by his employee while the latter is acting in the course of his employment. Foreseeability is not an issue. It is no defence that the employer had taken all reasonable measures to prevent the wrong. The principle is implied in all statutes unless the statute specifically limits it. Further detail: 6#5-6 41

There is limited evidence to support the theory that mismatch between work demands and functional capacity would increase the risk of a pain problem. The evidence is highly inconsistent but the theory cannot be discounted altogether. Evidence from: HH Hamberg van Reenen et al. Scand. J. Work and Environ. Health. (2006) Vol. 32#3 p 190 – 197 “Is an imbalance between physical capacity and exposure to work-related physical factors associated with low-back, neck or shoulder pain?” Further detail: 6#5-6 40

Regulations provide very clear guidance as to the types of interventions required to protect workers from injury or adverse symptoms caused through the use of display screen equipment. This review examines all the literature related to assessing the benefits of these and other interventions. No clear benefits could be found for any interventions, save for a possibility that alternative pointing devices could be beneficial. The accuracy of the DSE regulations could be called into question. Evidence from: S Brewer et al. J Occup Rehabil. (2006) Vol. 16 p 325 – 358 “Workplace interventions to prevent musculoskeletal and visual symptoms and disorders among computer users: A systematic review” The most positive finding here was possibly that DSE style interventions had not been shown to do harm. Further detail: 6#5-6 39

A review of research into work hours and postures while using a computer keyboard. The review finds that hours and posture are associated with adverse upper limb symptoms often enough to consider that an association is meaningful. Symptoms are not the same as injuries. Evidence from: F Gerr et al. J Occup. Rehab. (2006) Vol.16 p 265 – 277 “Keyboard use and musculoskeletal outcomes among computer users” The authors conclude that exposure measurement is a key weakness of studies of proposed links between keyboard use and upper limb symptoms. As it stands there is a slight balance in favour of a conclusion that longer hours of use increase the rate of adverse hand/arm symptoms. Further detail: 6#5-6 38

The claimant succeeded in demonstrating a relevant breach of duty. The causal relevance of breach of the Display Screen Equipment Regulations is bolstered by this judgement. Scientific support for this judgement is far from clear. Evidence from: Denton Hall Legal Services v Kathryn H Fifield [2006] EWCA Civ 169 Perhaps the regulator intended that the courts assume a causal link whenever there is evidence of a breach of duty? Further detail: 6#5-6 36

Evidence from: HSC Paper MISC/06/23 “Update on the SFAIRP infraction case and next steps” In practice, no EC member state actually applies the standard stated in Article 5(1); it is an unattainable ideal which leads, in practice, to SFAIRP type decisions at every point in the EC. The UK is among a very few jurisdictions which explicitly states how the ideal is approached in practice. Further detail: 6#5-6 34

One conference presentation was selected for reporting here. It clearly states the limited knowledge base available for the accurate regulation of vibration exposure. There is little doubt that vibration exposure can be harmful. However, in our view, current Regulation of exposure must have been developed on the basis of something other than just objective scientific evidence. Such Regulation may be of questionable relevance to proof of negligence and causation in civil cases. Evidence from: NIOSH publication No. 2006-140 “Proceedings of the First American Conference on Human Vibration” We do not know whether there is any disorder specific to whole-body vibration, or what disorders are aggravated by exposure to whole-body vibration. We do not know the relative importance of vibration and other risk factors in the development of back disorders. Further detail: 6#5-6 33

Sleep disturbance is known to affect safety performance in drivers. Some forms of sleep disturbance are innate and should lead to reassessment of suitability to hold a commercial vehicle license. Evidence from: CHEST (2006) Vol. 130 p 902 – 905 “Sleep Apnoea and Commercial Motor Vehicle Operators” Well managed obstructive sleep apnoea should not be a bar to holding a license. The guidance provides an incentive to drivers to engage with medical help (which has been shown to be very effective in these cases) and demonstrate compliance with prescription. Further detail: 6#5-6 32

The EC scientific committee once again find that there is next to no evidence of adverse health effects of exposure to electromagnetic fields. Evidence from: EC Scientific Committee on Emerging and Newly Identified Risks 19th July 2006 “Preliminary opinion on possible effects of electromagnetic fields (EMF) on human health.” Further detail: 6#5-6 31

The review finds evidence for an increased incidence of breast cancer among women who work the night shift for several decades. There is no reason to conclude that the association is causal. Evidence from: Health Council of the Netherlands Report No. 2006/15E, June 29, 2006 “Night work and breast cancer: a causal relationship?” In the Committee’s opinion, the research findings do not, at present, justify recommending special measures for women who perform night work for prolonged periods in addition to the current breast cancer screening programme. If new, scientifically sound research findings were to produce evidence of a causal relationship then one could consider what specific measures need to be taken. Further detail: 6#5-6 30

The study finds evidence in support of an association between rotating shift work and death due to ischaemic heart disease. There was no association with cerebrovascular disease. Evidence from: Y Fujino et al. Am. J. Epidemiol. (2006) Vol. 164 p 128 – 135 “A Prospective Cohort Study of Shift Work and Risk of Ischemic Heart Disease in Japanese Male Workers” Compared with the day workers, the rotating-shift workers had a significantly higher risk of death due to ischemic heart disease (RR = 2.32, 95% (CI) = 1.37, 3.95) whereas fixed-night work was not associated with ischemic heart disease (RR = 1.23, 95% CI = 0.49, 3.10). Further detail: 6#5-6 28

A study of self reported fatigue among nurses’ aides in Norway. Shift work was one of the variables assessed but the main focus was on psychosocial influences. Shift work was not identified as a significant predictor of persistent fatigue. Evidence from: W Eriksen. Occ. Env. Med. (2006) Vol.63 p 428 – 434 “Work factors as predictors of persistent fatigue: a prospective study of nurses’ aides” Supervisors can help manage fatigue by varying work demands. Help with managing persistent health problems, encouraging physical fitness and cessation of smoking would seem to be legitimate roles for the employer and had the strongest predictive power in this research. Further detail: 6#5-6 27

There are no absolute measures to predict fatigue. The fatigue index allows planners to compare the likely effect on fatigue of different shift work regimes. Evidence from: HSE RR 446 “The development of a fatigue / risk index for shift workers” Further detail: 6#5-6 26

Questions are raised about the design of tests on which the novel ice-structuring protein was judged to be safe for human consumption in ice cream. No specific toxicity information is presented. Evidence from: Advisory Committee on Novel Foods and Processes ACNFP/78/2 “ICE STRUCTURING PROTEIN PREPARATION – Additional information” The report serves as a reminder that traditional testing standards may not pick up risks from novel food ingredients. Those ingredients could be harmful. Further detail: 6#5-6 21

The committee has a duty to assess, and where appropriate, approve new techniques of food preparation. Enzymes, ultraviolet and infra red irradiation techniques have been identified as being in need of review and action. Official briefings on these are available from the ACNFP secretariat. Evidence from: Advisory Committee on Novel Foods and Processes ACNFP/77/2 “Review of Novel Processing Techniques” Foods could be made harmful, e.g. by inclusion of novel enzymes, or not as sterile as expected. Further detail: 6#5-6 20

Deliberate inclusion of ingredients which contain allergens is already regulated and packaging should be labelled. Unintentional contamination is not regulated. This paper provides voluntary guidance on the latter. Evidence from: Food Standards Agency July 2006. “Voluntary: Guidance on Allergen Management and Consumer Information.” Advisory labelling should only be used when, following a thorough risk assessment, there is a demonstrable and significant risk of allergen cross-contamination. The guidance might form part of a state of the art defence. Further detail: 6#5-6 17

Hydrogen as a means for delivering energy to the point of need is most probably limited to its use in fuel cells. Fuel cells would convert hydrogen chemical energy into electricity; the only exhaust being water. Evidence from: Health and Safety Laboratory HSL/2006/59 “The Hydrogen Economy – Evaluation of the materials science and engineering issues” Risks appear to be manageable. But uptake is likely to be low; it is not cost effective yet. Further detail: 6#5-6 15

Disposable respirators provide additional protection against flu infection but they should not be reused. A used respirator is a potential source of infection. Evidence from: National Academy of Sciences 11637 “Reusability of Facemasks During an Influenza Pandemic: Facing the Flu” Uncorrected Proof Some employers and emergency response organisations might be tempted to supply respirators. Further detail: 6#5-6 14