Document 1gpeDZJwJpVNk6Ng8O58maDBE

M ay 13, 1955 D r. G eorge L . M aison H iker L aboratories, Inc. P . O. Box 3157, T erm inal Annex L os A ngeles 54, C alifornia- Dear George: ...................... A t the risk of being objectionably p ersisten t, I am im pelled to respond to one or two of the rem ark s in your la s t le tte r and to two fea tu res of D r. K arr's le tte r . Both your attitude and that of D r. K arr m is s e s com pletely the e sse n tia l point in m y approach to this m atter. I shall attem p t to c la r ify th is la te r . In ad d ition , D r. K arr r a is e s so m e objections to m y p osition on tech n ical (p hysiological) grounds, and questions m y p rofession al view point as to the u se s of therapy. I shall not go into the fo rm er objection s in any d eta il. P erhaps I m ay plead that m y know ledge of and ex p erien ce with the m etab olism of lead in the hum an body is not n e g lig ib le , and that the data in our hands on the lo n g term r ele a se of lead follow ing the term ination of occupational, nonoecupational (children) or experim ental human exposure a re probably m ore ex ten siv e than the com bined data from other so u r ce s. The quantities involved, and the quantitative influence of various m easu res fo r speeding up the ex creto ry lo s s , including that of "Calcium D isodium V ersen ate, " are fa irly w ell known to m e. (Incidentally we plan to study th is m ore com p letely in an exp erim en tal subject now availab le, and are w aiting to do so only until the subject reaches a suitable point (suitable fo r eth er exp erim en tal reason s) in h is situation follow ing the term ination of his exposure). T herefore, if D r. Karr does not knew of the existen ce cf evid en ce to show that prolonged and'V irtually continuous" u se of the agent would be req uired to a cco m p lish a sa tisfa cto ry rate of elim in ation , I can provide him with certain r eferen ces. A study on his part of the quantities involved and the length of tim e required for elim ination of lead absorbed and retained follow ing prolonged experim ental ingestion of lead (in exp erim en ts involving m uch sm a lle r quantities of lead than th ose retained by m en hi certain lead trades) m ight be enlightening, as m ight an exam ina tion (or re-ex a m in a tio n ) of so m e inform ation published by us in 1933. (R eferences, including the la st are given b e lo w .) It is p rop er, o b v io u sly , fo r a p h ysician to tr e a t c a s e s of le a d poisoning w herever and w henever he finds them . I have not inveighed against this ancient duty of the p h ysician . D r. K arr's im p lication that I do not go along with such therapy, and h is and your r efer en ce s to m y attitude as equivalent to the abandonm ent of the v ictim s of w ar and v en ereal d isea se, a r e irrelev a n t and even , if I m u st sa y so , flippant, although I do not think N9762 D r. G eorge L. M aison - (2) -*M ay 13, 1955 they w ere so intended. What n eith er of you take into account, if you are aw are of it, is that the ph ysician who is resp on sib le for the m edical supervision of m en in the lead trad es, has a resp on sib ility - a very d irect m ed ico -leg a l and p ro fessio n a l resp o n sib ility , w hich he cannot avoid through eith er ignorance or incom petence or denial of resp o n sib ility , or bv looking the oth er w ay - fo r the con d ition s under w hich th e m en w ork . It m ay take tim e and effort and patience on his part to educate the ow ners or m an agers o f the b u sin ess on what th ey a r e doing o r failin g to do, and in bringing them to do what is n e c essa ry , or it m ay require him , as an honest man, to give up the job, if he finds them intractable and in sen sitiv e to th eir duty. We are now beyond the point when an industrial ph ysician can be regard ed among h is own colleagu es as com petent and p rofession ally aw are, if he is w illin g tc t r e a t ooccupational d is e a s e and ig n o r e th e con d ition s, w h ich in d u ce it. I know, b etter than eith er of you, that we have poorly trained,ignorant and ir re sp o n sib le p h ysician s in industry, and that the blind p r a c tic e s o f the p ast continue to e x ist. B ut tim es have changed and a re changing rapidly, and fa r fr o m b e in g " fr u s tr a te d 1* in m y " v iew p o in t, " I a m m o s t p le a s e d th at the efforts of recen t y ea rs w ithin the p ro fessio n , to r a ise the standards and to r e a li s e the. s c o p e of o c cu p a tio n a l m e d ic in e , a r e s u c c e e d in g . In th is c h a n g e , the em phasis is on preventive m ed icin e, and the ind ustrial p h ysician is the p rim e m em b er of the team that a p p ra ises and c o rr e cts the th reats of the industrial environm ent. At p resen t, to the extent that the lead trades (those in w hich th er e a r e p h y sicia n s - som e have no p h y sicia n s) a re giving r is e to a high in cid en ce of lead poisoning, the fau lt, in la r g e part, r e sid e s in the doctors, who are too la zy , too ignorant and or com plaisant to know th eir job and to do it. The techniques of recognizing the hazard, m easuring it, ' and dealing w ith it, m e d ic a lly , a r e a v a ila b le. T here is no m y ste ry in it. M oreover, the techniques of environm ental control are not beyond a ch iev e m ent. And if, by reason of econom ic p ressu re or because of em erg en cies, potentially unsafe exposure tc lead seem s unavoidable, the m en can be m anaged, by rotation of jobs and sim ila r proced ures, so as to avoid dangerous accum ulation of lea d in th eir tis s u e s . T his is not a m atter of guess w ork but of com p letely dem onstrated techniq ues, and th ere is no p resent valid excu se for any industrial physician in the lead trades to be unaware of them . You see , th erefore, I am talking about industrial ph ysician s and their resp o n sib ilities and th eir need to know and perform th eir jo b s. I am quite su re, from what lias alread y transpired in this m atter of the u se of "Calcium D isodium V ersonate" that the appeal of the u se of the drug (except for those exp erim en tally m inded, who are in a d ifferen t c la s s , but do not alw ays a ct in the sp irit of p h y sicia n s) lie s m o stly in the m inds of the untutored, unoriented (in the m od ern sen se ) p h ysician in ind ustry, who is not aw are of h is d irect resp o n sib ility for the conditions which he is trying to p alliate. ft 0008309 * D r . G e o r g e L,. M a iso n - (3) - M ay 13, 1955 . . One su ch a m an sp ok e on the su b ject a t the B uffalo m e e tin g . It w as a p it i fu l p er fo r m a n c e, w hich was' ju stly c r itic iz e d . T his is w hat I m ean when I / 'suggested that you m ight find y o u rselv es on the "side of the d ev il, " in the sen se that your proponents (or perhaps fo llo w ers) in this u se of the drug w ill be the ou tsid ers and the low er form s of industrial m ed ical life . I have no c riticism of the physician, outside of industry, who treats his patient in this m anner if he can do nothing b etter fo r him . I think he w ill find it p o ssib le to do som ething b etter for him , and in addition to treatm ent, in m o st in sta n ces, but certa in ly he cannot be a ccu sed of any m o ra l fault in attem pting to do what he can. I do, how ever, and sh all continue to, c r itic iz e se v e r e ly the p h ysician engaged in the m ed ica l su p erv isio n of m en who con tinue to work in a lea d trade in a dangerous environm ent, fo r prom oting the n eglect of the only m ea su res of preventive m edicine that are valid, though giving the im p ressio n , w hich is in evitab le, that-he is counteracting the d an ger. If the p h y sicia n un derstan ds h is job and h is r esp o n sib ility , he is im m oral if he depends upon th is p roced u re. If he does not understand his job and his resp on sib ility, he is ser io u sly lacking in exp erien ce, sen sitiv ity , in tellig en ce , o r d e sir e to le a rn . I have said m y s a y on th is, and I do not intend to ca rry the d isc u ssio n farth er. H ow ever, I sh all ex ert m y b est efforts (I) to learn a ll I can about th e p h y sio lo g ica l effects of the u se of "C alcium D isodium V ersen a te, " and (2) to in veigh a g a in st its u se by in d u stria l p h y sicia n s a s a su b stitu te fo r a good brand of in d u stria l h y g ien e. The lea d tra d es a r e being clean ed up in th is c o u n try a t a f a ir ly ra p id r a te , by th e a p p lic a tio n o f lo n g n e e d e d Out uOW availab le m ethods of environm ental ap p raisal. Many of them are in an ex cellen t sta te. O thers, through ignorance and inertia, a re w illing to dodge the truth about th e m se lv e s. The r esu lts to a goodly num ber of m en who w ork in th ese plants a r e m o st unfortunate. Such r esu lts w ill not be le sse n e d ap p reciab ly by anything oth er than a thorogoing nous eelsan in g in tne form of adequate industrial hygiene. This m ay be delayed by unw ise p alliative m ea su res of a variety of kinds, including the p resen t inheritant of a long lin e of inadequate m ed ical m ea su res, but it w ill not be postponed m uch lo n g er. I am concerned g rea tly for the p osition of the doctor in the in terim . We need to be w ise, so c ia lly resp o n sib le, and tech n ically sound lea d ers of thought and action in the developm ent of a sound in d u stria l so c ie ty . We cannot afford to be on the frin ge of things and even ts, sticking to our little bags of trick s, in ignorance of the m ain strea m of action and its conseqtience The therapeutic picking up of the bits and p ieces of our industrial life , which s e e m s q u ite c a p a b le o f desfcx*oying it s e l f , is so m e w h a t lik e th e a tte m p ts to erad icate m a la ria by treatin g those sick of it in an area in w hich it is ram pant. both b ecau se the therapy affects so little change in the situation, and Dncauce even in the individual c a se , a recu rren ce of the d ise a se is a lm o st gjr 0003610 / D r. G eorge L . M aison - (4) - M ay 13, 1955 certain . This does not m ean that the hum ane physician should not do what he can when and w here he can, but it does m ean that the w ise physician w ill look to the b est m eans of accom plishing h is goal and w ill not let obstacles stand in h is way if he can prevent th eir ex isten ce. W ith k in d est p erso n a l r eg a rd s, Sincerely yours, Robert A. Kehoe, M. D. R eferences: J. I. II. 15, 321, 1933 3 .1 . H . and T . Zi>, 71, 1943 O ccu pational M ed icin e 3: 156, 1947 R A K e 00086 I i