Document KJdrqp223mMkELj53k0R0322o

MEMORANDUM to: CC: FROM J. R. McGill - E-l-14 D. L. Warren, M.D. - E-L-9 SXj. m. Dixon, M.D. - MacMillan Medical Center H. M. Cole - E-L-12 B. J. Sasser - E-L-13 E. C. Irby, M.D. - E-L-9 Si ~ J/<$ DATE: February 25, 1991 SUBJECT: 1991 Medical Directors Forum C2^s*.'ca- Z'TieJUL, ft*************************************** At the Forum Meeting last week, a number of subjects came up with information which should be useful to Reynolds. Since the Pepperidge Farm (Campbell Soup) OSHA fine of $4.2 million, there has been renewed interest in ergonomics and cumulative trauma diseases. It was estimated that 60% of the OSHA reportable cases were due to cumulative trauma. Back injuries accounted for 40% of this. The general feeling was that there is nothing new about this problem, only the perception. Companies which have carried out training programs have not seen any decrease in cumulative trauma disease (CTD) . OSHA has no expert and no real data in this area. As I understand it, it is being supervised by a toxicologist. Campbell Soup has hired two expert consultants and plans to take OSHA to court. The--subject of Non-Ionizing Radiation came up. Apparently, NIOSH feels there is a problem. The Bell Telephone Companies have studied radiation from video display terminals and found no relationship between exposure and miscarriages, the linemen and cable splicers have been studied because of their exposures. There has been no evidence of brain tumor or leukemia in their study. Non-ionizing radiation comes in two forms. Electrical fields generated by voltage charge - this has no importance. And then magnetic fields generated by electrical flow. As you will remember, reduction pots generate 75-100 gauss. Dr. Craig Wright has estimated 200 gauss. This needs to be compared with the average background level of the earth's magnetic field of .5 gauss. Movement through the earth's magnetic field increases this dosage tremendously so that jet supersonic travel would increase this exposure logarithmically. And lastly, there is no practical means of shielding against magnetic fields. Man-made mineral fibers came up in our discussion. This was discussed by the doctors from BP American and Corning Fiberglass. The Swiss study with very high doses of refractory ceramic fibers showed 33% of the hamsters developed malignant mesothelioma. As I TX TINER RMC0021874 Memoranum to J. R. McGill 1991 Medical Directors Forum Page 2 February 25, 1991 understand it. Carborundum is doing a study of its former employees. Active employees'have shown only a small difference in forced vital capacity in the exposed versus the non-exposed. There were no cases of interstitial fibrosis but 2-1/2% showed pleural plaque, the significance of which they were not sure. As Corning said, its fiberglass filaments have one problem and that is itching. It is difficult to get a significant exposure at work and they are not really of the respirable range. As a matter of fact, there is no requirement for labeling. There is a micro fiber made by Manville used for filtration and aircraft insulation which represents 1% of the U.S. fiberglass production. This runs .1 to 1 micron and is respirable. In animal studies, a significant number of mesotheliomas were produced. In summary, there is no evidence of human disease except for pleural plaques and minimal pulmonary function changes. In animals, a significant number of mesotheliomas were produced. Considerable time was spent on Managed Health Care. Some of the Bell Companies now use Employee Assistance as a "gate keeper" for admission to substance abuse treatment. Other companies are in the process of implementing this. Alexander and Alexander did a five year study at McDonnell Douglas which proves the advantage of EAP managed admissions. I'll try to get a copy of this study. Without EAP approval, some companies require the employee to pay 20%. Some companies like Kodak, U.S. Steel and General Mills at some of their locations are getting into complete general medical care for employees and dependents. The problem of whether to pay for non-FDA approved (experimental) treatments came up. One or two of the companies applied the following four criteria to make an exception. 1. Whether it is biologically plausible. 2. Whether there is sufficient published data on this method of treatment. 3. Whether this is a protocol in a quality health care institution. 4. Has the patient already tried unsuccessfully the standard treatment for the problem. The question was raised as to whether the companies routinely placed on the OSHA log all cases which showed an STS as specified by OSHA. Only 50% of the hands were raised in response to this question. It was of interest that Alcoa lists them on the log only after a shift great enough to constitute hearing impairment. In North Carolina and Michigan apparently, these requirements are different. TX TINER^ RHC00 217 5 Memoranum to J. R. McGill 1991 Medical Directors Forum Page 3 February 25, 1991 Lastly, in talking with the Director of OSHA, several people related that the future direction would be to bring the very well designed safety programs of top management to the shop floor. He felt that the policies were not being carried out where the "rubber meets the road.'* TX TINER RMC00 21S7 6 Tesla 12. 2. HiliiTasla T 12,000. 2,000. MicroTaala W* 12.000.000. 2.000.000. i. 1,000. 1,000,000. 0.5 500. 500,000. 0.1 100. 100,000. O.OS $0. 50,000. 0.02 20. 20,000. 0.010 10. 10,000. 0.001,4 1.4 1,400. 0.001.0 1.0 1,000. 0.000,5 0.000,4 0.5 0.4 500. 400. 0.000,1 0.1 100. 0.000.05 0.05 SO. 0.000,02 0.02 20. 0.000,01 0.01 10. 0.000,005 0.005 5. 0.000,001 0.000,1 1. 0.000,000,7 0.000,07 0.7 0.000,000,5 0.000,05 O.S 0.000,000,3 0.000,03 0.3 0.000,000,1 0.000,01 0.1 Gauss s 120,000. 20,000. 10,000. 5,000. 1,000. 500. 200. 100. 14. 10. 5. 4. 1. 0.5 0.2 0.1 0.05 0.01 0.007 0.005 0.003 0.001 MiUiGeus* WG 120,000.000. 20,000,000. 10,000,000. 5,000,000. 1,000,000. 500,000. 200,000. 100.000. 14,000. 10,000. 5,000. 4,000. 1,000. 500. 200. 100. so. 10. 7. 5. 3. 1. IRPA/IHRC Guidelines on Haiti of exposure to 50/60 Ht Occupational whole Working Oay Short Tara aT o.S 5.0 mG S.ooo 50,000 General Public op To 24 Houre/Oay Pv Hours/Day o.i 1.0 l.ooo 10,000 IRPA: intamational Radiation Protection Association IRNC: Intamational Non-Ionizing Radiation Conittaa in cooperation witn tha World Health Organization (WHO) MAGNETIC HELD MATRIX February 14, 1991 - ccw Ccoant (Sea CAVEAT below !) LLHt, - Mirror Fusion Teat Facility (Hypothetical) nu (Magnetic Resonance lasting) Peak Field MRI (Magnetic Resonance laaging) Average Field ISUC - Stanford Linear Accelerator Canter Field Strong Magnetic Field* Engineering Definition Sickle Call Disease Exposure Unit, Ferrous Tool Limit Aluminum Reduction *Pot" Field - (SLAC a Hour Limit ''DOE 3 Hour Limit - Arc Welder Coamon Field Lowest Response Level In Tests Of Pacemaker Reed switches L1NL - Pacemaker And laplanted Prosthesis Guideline Pacemaker Safe* - Food And Orug Administration REMOTELY POSSIBLE OPERATOR ENCOUNTER - ZEEMAN 5100 FIELD Common Airline Security Metal Oetector Field AVERAGE BACKGROUND LEVEL EARTH'S MAGNETIC FIELD Proposed Pacemaker Exposure Limit - German VDE 0848 High Voltage Transmieeion Line - Edqe Of Riqht-Of-way Household Appliance/Tool Field - Line Printer Field Common Factory Floor Field - Eleetric Blanket Field POSSIBLE OPERATOR ENCOUNTER - ZEEMAN 4100 FIELD coamon Business Office Field * xerographic copier Field Average Residential Household Field Log-Cebin-In-The-Woods Field (No Utilities) CAVEAT Currently there are no official international standards or guidelines for vhols body or implanted prostheses exposures to magnetic fields. Above values must be viewed ae DDrovier(ons for hiah to low ranking. In many casas they represent aid-range (average, median, mode) compromises where reported measurements have a spread of one order of magnitude (Example - office equipment 10 sG to 100 mG). Almost certainly, the field levels reported in the multiple documents which were studied represent rounded values. No consideration is made in this matrix for important factors such as static vs. time-varying fields, frequency, wave form, rata of field strength change, peak strength, cumulative dose, etc. UML " Lawrence Livermore National Laboratory JSU.C - Stanford Linear Accelerator Canter ADOE * 0. s. Department of Energy TX TINER RMCOO 2127 7