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Keeping in Trim: Nailed Doc Docks Nails-Reply

B. J. Divine, PhD; K. S. Amanollahi
JAMA. 1986;256(13):1726-1727. doi:10.1001/jama.1986.03380130054023.
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To. the Editor.—  In their March 28, 1986, article, "Epidemiologic Support for Ethylene Oxide as a Cancer-Causing Agent," Hogstedt et al1 assert that there is a strong indication that ethylene oxide is a carcinogen even at low-level exposures. The evidence presented in the article to substantiate this claim is very weak and certainly lends no credence to the authors' theory.The major piece of supporting evidence for this claim appears to be the results of the study at plant 3, where there was one leukemia death vs 0.16 expected. The single case of leukemia for plant 3 occurred in group C, where workers had multiple chemical exposures and the lowest ethylene oxide exposures. What does stand out as significant is the fact that for all three plants the leukemia cases were observed in individuals with multiple chemical exposure and that no leukemia was observed in exposure groups A and

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