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Asbestos-Related Diseases

Howard Frumkin, MD, MPH; David Egilman, MD, MPH; Michael Kelly, MD, MPH; David Christiani, MD, MPH; Lewis Pepper, MD; James Cone, MD; Nancy Sprince, MD, MPH; Jay Himmelstein, MD, MPH
JAMA. 1985;254(10):1307-1308. doi:10.1001/jama.1985.03360100055006.
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To the Editor.—  As members of the Diagnostic Criteria Committee of the American Public Health Association's Occupational Health Section, we were pleased to see published the report on asbestos-related diseases of the Council on Scientific Affairs.1 We were especially pleased at the disclaimer, which states that the report "is not intended as a standard of medical care" (p 2593), because a series of inaccuracies, omissions, and biases makes the report unsuitable for any such use. Specifically, we would like to address seven points.

  1. The diagnosis of asbestosis. As practitioners of occupational medicine, we strongly maintain that asbestosis should be diagnosed in any patient with a significant exposure history and with characteristic findings on physical examination (rales), pulmonary function testing (restrictive lung disease), and chest roentgenography (interstitial disease). In fact, not all three findings are always necessary. In this regard, the report is unrealistic for two reasons. First, it

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