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356
We suggest that diabetic drivers should be inform the licensing authority only:
(a) (b) (c) (d)
required
to
if their diabetes becomes insulin-dependent; if they develop serious diabetic complications which affect their ability to drive; if they have serious associated cardiovascular or cerebrovascular disease; if they experience hypoglycaemia on oral hypoglycaemic
drugs;
(e)
if they wish to hold HGV
or
PSV licences.
These categories should be made clear on the driving licence application form and on driving licences. Such cases could then be considered individually and this would obviate the present legal necessity for all patients with diabetes to declare their condition for their driving licence. We thank Mrs S. Dickson and Mrs M. Oliver for valuable secretarial assistance and Dr J. F. Taylor, Chief Medical Adviser, Department of Transport, Swansea, for helpful criticism and advice.
Requests for reprints may be addressed to J. M. S., Department, Royal Infirmary, Edinburgh EH3 9YW.
Diabetic and Dietetic
REFERENCES 1. Frier BM, Matthews DM, Steel JM, Duncan LJP. Driving and insulin-dependent diabetes. Lancet 1980; 1: 1232-34. 2. Road Traffic Act 1974. H. M. Stationery Office, London. 3. United Nations Agreement on Minimum Requirements for the Issue and Validity of Driving Permits (APC). Geneva, 1975. 4. Raffle A, ed. Medical aspects of fitness to drive Medical Commission on Accident Prevention, London, 1976.
Round the World From
our
Correspondents
United States THE WASTEFUL WORLD OF ASBESTOSIS
THE remarkable utility of asbestos has contributed to its ubiquity in this country-in, for example, insulation and brake linings, and as a constituent offillers, pipes, refrigerators, and roofing compounds. Many individuals in all walks oflife have been exposed to asbestos in workshop, factory, and home, and many industries have been involved primarily or secondarily in the manufacture and distribution of asbestos products. Since the dangers of asbestos were recognised claims for compensation for asbestosis and its sequelae may, it now seems, devastate not only many companies but much of the economy in a country where a common response to injury is to sue. Claims for damage caused by asbestos, from the sufferers themselves or from their families, are mounting at a rate which is alarming the companies involved and, even more so, their insurers, who are uneasily aware that their resources may be quite inadequate to meet the claims-especially since an enormous number of such claims are yet to come in. It seems that the average settlement has recently been$75 000 (in one case, the damages awarded were $850 000). No consistency is to be seen in the amount courts award in settlements. One expert is predicting some 200 000 excess cancer deaths from asbestosis over the next two decades, so the prospects are
grim.
Some 12 000 suits have been filed against some 260 companies, some very large and leaders in the industry, and others small firms with very limited resources which face bankruptcy. Most suits are against industrial companies which have been using asbestos directly. Behind the physical and mental sufferings are strong feelings that in many cases industry was lax in instituting measures to protect workers, casual in its industrial relations, and remiss in not disclosing the potential hazards to the workers. All these suspicions tend to promote suits for "punitive" damages, thus raising further problems because, on the one hand, jury awards made on this basis are often very high and, on the other, such damages are not covered by insurance. This is a special worry to the larger industrial firms, which deny any such laxity. So some are seeking to bring suits against other defendants, and
the Federal Government might be involved, since there are allegations of foot dragging and failure to set and enforce standards. In this connection it is interesting to note the current opinion of the U.S. Supreme Court in relation to byssinosis, the "brown lung" disease of the cotton industry. The Occupational Safety and Health Administration, no favourite of the hard-faced Administration backers, had ordered various measures to reduce the levels of cotton dust in mills, in order to lower the incidence of this form of chronic bronchitis. The National Cotton Association, the industry’s organisation, had challenged the rules on the ground that the cost of instituting and maintaining these measures was quite disproportionate to the health improvement that might result. The Court would have none of this, and seemed to rule that the improvements were needed regardless of cost to protect the workers. This decision, stated by some to be the most important Court decision in years on safety regulations, has been greeted with satisfaction by the workers, sourness by industry, and stony disapproval by the Administration. Even so, because in effect the ruling said that cost-benefit analysis was not a relevant factor, it still leaves some loopholes. Nevertheless, to those considering the Federal Government’s actions in relation to asbestosis, this decision is of considerable interest. But who to sue beyond the Federal Government? Stockholder groups are considering suits against managements for failure to warn of liability to litigation for asbestos injuries. It is said that some of the insurance companies who will be hard hit are looking closely at the tobacco industry. While no successful suit has been brought against this industry on the grounds that its products cause lung cancer, some see a much better chance of involving the tobacco industry in the light of the evidence that pulmonary asbestosis causes lung cancer only in combination with cigarette smoking. All these troubles are intensified in this country by the lack of any national health programmes, by the sluggish processing, and by the difficulty of obtaining an award (and the meagreness of such awards) under the Workman’s Compensation Act, so those affected prefer to pursue their claims in the courts. There might, it would be thought, be various ways in which an increasingly disturbing situation could be tackled, but not it seems by an Administration whose activities are directed to cutting down every form of welfare payment. So, for the moment, we must look to the courts, whose case load will rapidly increase. But in cutting back all sorts of Federal grants, including those to education and the arts, it is the President’s belief that exuberant private industry will, with generous grants, make up for the missing Federal funding.
QUALITY CONTROL
EACH year many new chemicals produced by ingenious chemists emerge in search of potential markets. They can be produced in weeks; to determine their potential for good or ill may take years and occupy toxicologists for decades. For the official laboratories of the Government to test all the new compounds would require immense and costly investment and maintenance. The practical way is to sublet the tasks to private laboratories and to industry, who report to the regulatory agencies. On the basis of such reports the use of these compounds is permitted. Recently the Federal Government has charged that the staff of one such laboratory falsified test reports and conducted thousands of faulty tests, leading to the public use of compounds whose safety has not been properly assessed, including widely applied pesticides. This does not mean that the compounds are unsafe: it simply means that their safety has not been established. Nor has the truth of the allegations been examined in the courts. There has been a wave of anti-sdence and anti-intellectualism in this country and these accusations will add fuel to the flames. The disciplining of dishonest scientists by scientists raises the same questions as are evident in the medical profession. Indeed, part of the medical malpractice problem lies in the unwillingness or incapacity of the medical profession to discipline its members.
When possible delinquencies are brought to light some physicians and scientists will try to exculpate and explain the malfeasances or even defend them. This charity may be both misplaced and undesirable.
We suggest that diabetic drivers should be inform the licensing authority only:
(a) (b) (c) (d)
required
to
if their diabetes becomes insulin-dependent; if they develop serious diabetic complications which affect their ability to drive; if they have serious associated cardiovascular or cerebrovascular disease; if they experience hypoglycaemia on oral hypoglycaemic
drugs;
(e)
if they wish to hold HGV
or
PSV licences.
These categories should be made clear on the driving licence application form and on driving licences. Such cases could then be considered individually and this would obviate the present legal necessity for all patients with diabetes to declare their condition for their driving licence. We thank Mrs S. Dickson and Mrs M. Oliver for valuable secretarial assistance and Dr J. F. Taylor, Chief Medical Adviser, Department of Transport, Swansea, for helpful criticism and advice.
Requests for reprints may be addressed to J. M. S., Department, Royal Infirmary, Edinburgh EH3 9YW.
Diabetic and Dietetic
REFERENCES 1. Frier BM, Matthews DM, Steel JM, Duncan LJP. Driving and insulin-dependent diabetes. Lancet 1980; 1: 1232-34. 2. Road Traffic Act 1974. H. M. Stationery Office, London. 3. United Nations Agreement on Minimum Requirements for the Issue and Validity of Driving Permits (APC). Geneva, 1975. 4. Raffle A, ed. Medical aspects of fitness to drive Medical Commission on Accident Prevention, London, 1976.
Round the World From
our
Correspondents
United States THE WASTEFUL WORLD OF ASBESTOSIS
THE remarkable utility of asbestos has contributed to its ubiquity in this country-in, for example, insulation and brake linings, and as a constituent offillers, pipes, refrigerators, and roofing compounds. Many individuals in all walks oflife have been exposed to asbestos in workshop, factory, and home, and many industries have been involved primarily or secondarily in the manufacture and distribution of asbestos products. Since the dangers of asbestos were recognised claims for compensation for asbestosis and its sequelae may, it now seems, devastate not only many companies but much of the economy in a country where a common response to injury is to sue. Claims for damage caused by asbestos, from the sufferers themselves or from their families, are mounting at a rate which is alarming the companies involved and, even more so, their insurers, who are uneasily aware that their resources may be quite inadequate to meet the claims-especially since an enormous number of such claims are yet to come in. It seems that the average settlement has recently been$75 000 (in one case, the damages awarded were $850 000). No consistency is to be seen in the amount courts award in settlements. One expert is predicting some 200 000 excess cancer deaths from asbestosis over the next two decades, so the prospects are
grim.
Some 12 000 suits have been filed against some 260 companies, some very large and leaders in the industry, and others small firms with very limited resources which face bankruptcy. Most suits are against industrial companies which have been using asbestos directly. Behind the physical and mental sufferings are strong feelings that in many cases industry was lax in instituting measures to protect workers, casual in its industrial relations, and remiss in not disclosing the potential hazards to the workers. All these suspicions tend to promote suits for "punitive" damages, thus raising further problems because, on the one hand, jury awards made on this basis are often very high and, on the other, such damages are not covered by insurance. This is a special worry to the larger industrial firms, which deny any such laxity. So some are seeking to bring suits against other defendants, and
the Federal Government might be involved, since there are allegations of foot dragging and failure to set and enforce standards. In this connection it is interesting to note the current opinion of the U.S. Supreme Court in relation to byssinosis, the "brown lung" disease of the cotton industry. The Occupational Safety and Health Administration, no favourite of the hard-faced Administration backers, had ordered various measures to reduce the levels of cotton dust in mills, in order to lower the incidence of this form of chronic bronchitis. The National Cotton Association, the industry’s organisation, had challenged the rules on the ground that the cost of instituting and maintaining these measures was quite disproportionate to the health improvement that might result. The Court would have none of this, and seemed to rule that the improvements were needed regardless of cost to protect the workers. This decision, stated by some to be the most important Court decision in years on safety regulations, has been greeted with satisfaction by the workers, sourness by industry, and stony disapproval by the Administration. Even so, because in effect the ruling said that cost-benefit analysis was not a relevant factor, it still leaves some loopholes. Nevertheless, to those considering the Federal Government’s actions in relation to asbestosis, this decision is of considerable interest. But who to sue beyond the Federal Government? Stockholder groups are considering suits against managements for failure to warn of liability to litigation for asbestos injuries. It is said that some of the insurance companies who will be hard hit are looking closely at the tobacco industry. While no successful suit has been brought against this industry on the grounds that its products cause lung cancer, some see a much better chance of involving the tobacco industry in the light of the evidence that pulmonary asbestosis causes lung cancer only in combination with cigarette smoking. All these troubles are intensified in this country by the lack of any national health programmes, by the sluggish processing, and by the difficulty of obtaining an award (and the meagreness of such awards) under the Workman’s Compensation Act, so those affected prefer to pursue their claims in the courts. There might, it would be thought, be various ways in which an increasingly disturbing situation could be tackled, but not it seems by an Administration whose activities are directed to cutting down every form of welfare payment. So, for the moment, we must look to the courts, whose case load will rapidly increase. But in cutting back all sorts of Federal grants, including those to education and the arts, it is the President’s belief that exuberant private industry will, with generous grants, make up for the missing Federal funding.
QUALITY CONTROL
EACH year many new chemicals produced by ingenious chemists emerge in search of potential markets. They can be produced in weeks; to determine their potential for good or ill may take years and occupy toxicologists for decades. For the official laboratories of the Government to test all the new compounds would require immense and costly investment and maintenance. The practical way is to sublet the tasks to private laboratories and to industry, who report to the regulatory agencies. On the basis of such reports the use of these compounds is permitted. Recently the Federal Government has charged that the staff of one such laboratory falsified test reports and conducted thousands of faulty tests, leading to the public use of compounds whose safety has not been properly assessed, including widely applied pesticides. This does not mean that the compounds are unsafe: it simply means that their safety has not been established. Nor has the truth of the allegations been examined in the courts. There has been a wave of anti-sdence and anti-intellectualism in this country and these accusations will add fuel to the flames. The disciplining of dishonest scientists by scientists raises the same questions as are evident in the medical profession. Indeed, part of the medical malpractice problem lies in the unwillingness or incapacity of the medical profession to discipline its members.
When possible delinquencies are brought to light some physicians and scientists will try to exculpate and explain the malfeasances or even defend them. This charity may be both misplaced and undesirable.