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Friday 19, November, 2004, 12:30-18:30, (16:00-17:00, Q&A) No.3 CR Saturday 20, November, 2004, 09:30-18:30, (16:00-17:00, Q&A) No.3 CR Sunday 21, November, 2004, 09:30-12:30, No.3 CR Poster Sessions Lundy Braun1, Sophie Kisting2 1Africana Studies, Environmental Studies, and Pathology, Brown University (USA) [not-attended] 2Occupational and Environmental Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa [not-attended] ABSTRACT For nearly 50 years, workers suffering from asbestosis have made claims against governments and the asbestos industry for damage to their health. Yet, criteria for assessing damage and impairment vary worldwide. This variability stems from in part from the lack of a simple method to diagnose asbestosis and determine its severity in an individual, the complex and variable natural history of disease, and the contentious and polarizing context of litigation within which disease is defined. The legal system depends on the notion that disease is an easily definable, uniform, and predictable state. A diagnosis of asbestosis is best made using evidence from clinical examination, an individual's history of exposure to asbestosis and symptomatology, radiographic changes, and decline in lung function. However, the history of worker's compensation is characterized by deep distrust between workers and industry that has influenced the degree to which various parties accept the experience of physician and patients. Consequently, there has been increasing reliance on seemingly more objective X-rays and measurements of lung function. There are several problems with an exclusive reliance on these two technologies. First, embedded in this lung function testing is the assumption that, because a test generates quantitative data, it provides easily and reliably interpretable information. In some cases, this has led to the use of rigid numerical criteria for impairment. Second, lung function testing can be discriminatory because of the widespread practice of "race correction." Third, diagnosis of asbestos using radiography as a sole criterion can be problematic because pulmonary fibrosis, including severe fibrosis, can exist in the absence of radiological evidence of damage. Rather than privileging any one particular tool or method of diagnosis, we argue that a holistic approach to diagnosis and determination of impairment, that combines patient experience, clinical assessment, radiology, CT scans, and lung function should be employed in evaluating patients for compensation. |