Database

The Whiplash Book was the first result of the 2001 ABI whiplash research programme, directed by Andrew Auty, Chaired by Kate Lotts. The book was based on a detailed review of the evidence on causation, diagnosis, prognosis and intervention. A summary of those findings is presented in the attached pdf file. The only difference of view of note was the finding that manual therapy had a useful role to play in rehabilitation. It was conceded that this could in principle sometimes be useful when cases were deteriorating after 2 weeks, but  evidence was absent. For all other cases there was emphatic evidence that there was no measurable benefit. Manual therapy was kept in the guidance because it could not be said that it was always useless. This sentiment was perhaps misplaced; based on a medical view of the world rather than a common law view of the world. The Radar report is available to subscribers: 1#9 1

Intervention before sickness absence would be the prerogative of the employer, it would be difficult to involve liability insurance until actual harm had been done. Evidence from: I Vaananen-Tomppo et al. International Journal of Rehabilitation Research. September (2001) Vol.24 #3. p 171. State employees in Finland have access to rehabilitation services at their usual place of work. The gatekeeper is a fully qualified occupational physician or psychologist, as appropriate. The trigger is any report of a threat to the ability to perform normal duties. Very often the service is triggered before deterioration to the extent that the employees requires time off work. Interventions and return to work programmes take place at the usual place of work. This study was designed to assess the cost benefit ratio of this system. The reference population consisted of those who did not ask for help, but went off sick. The analysis presented here is hard to understand, but suggests a cost benefit ratio

Evidence from: P Boffeta et al. Scandinavian Journal of Work, Environment and Health. August (2001) Vol.27 #4 p 227. A case control study of a proposed association between exposure to titanium dioxide dust and lung cancer. This was a small study, the main result was: for those classified with high exposure for 5 years OR = 1.0 (95% CI = 0.3 to 2.7). Comment Although not a powerful study, the result provides some confidence that any association between Titanium dioxide exposure and lung cancer is very weak.

The most significant source of exposure is exhaust from combustion engines; especially in confined spaces. However, carbon black is also used as an ingredient in composite materials and as such is handled in huge quantities. This study sought associations between exposure to carbon black and bladder cancer in long shore men. Evidence from: R Puntoni et al. The Lancet. August (2001) Vol. 358 #9281 p 562. A study of a proposed association between occupational exposure to carbon black and, bladder cancer. Carbon black has been assessed by IARC as being a possible human carcinogen. 2286 long shore men (Dockers) employed between 1933 and 1980 were the subjects of this study. Of these 596 spent a significant time carrying paper sacks full of carbon black. The work was very dusty. Cases were identified using the local cancer registry for a period between 1986 and 1996. Occupational hygienists assessed exposure as having been: 858 low, 709 moderate and 534 high for members of this population.

MF Jeebhay et al. Occupational and Environmental Medicine. Sept (2001) Vol.58 #9 p 553. A selective review of occupational seafood allergy. In general seafood processing seems highly energetic and manually involved. This creates the potential for extensive skin contact with fish proteins and the production of respirable protein aerosols. The author finds that most types of seafood have been found to cause occupational allergy:

Evidence from: K Turjanmaa. Allergy. September (2001) Vol. 56 # 9 p 810. An editorial on the subject of latex allergy. Allergy to natural rubber latex (NRL) has been known for over 20 years. While there remains no universal consensus on how to diagnose latex allergy- guidelines have been issued by the European Academy of Allergology and Clinical Immunology (EAACI) Allergy (1993) Vol. 48 supplement 14:57-62. Skin prick tests are believed by the author to be the most reliable, but allergen assays are non-standard. That is, the materials applied to the skin to test for allergy differ in allergen composition and concentration. EAACI are working on a revised guideline, now is the time to influence it. Comment Insurers may wish to consider becoming involved in the development of a standard for diagnosis. A widely accepted standard would reduce uncertainty. In fact latex contains a number of allergens, some of which are shared by a wide range of plants and other organisms. A diagnosis of late