Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

e-Newsletter – April 2010

Welcome to WOEMA’s new monthly e-newsletter. After over 50 years, gone is WOEMA’s printed newsletter for this new electronic format. WOEMA is committed to providing on-going communications to members while reducing its carbon footprint by eliminating paper usage. WOEMA members receive the full version of the newsletter via email every other month and may also access contents on this website. It includes links to pertinent information. — Peter Swann, MD, FAAFP, Newsletter Editor 

In this issue:
• Message from the WOEMA President
• James Seward elected to the ACOEM Board of Directors!
• American Occupational Health Conference
• CME Webinar – April 15• Journal Watch and Test Your Occ-Q
• WOHC 2010
• News You Can Use from Dr. Gean

Message from WOEMA President
by Paul Papanek, Jr., MD

We’re working in an astonishing time for American medicine — a time in which the President signed national health care reform legislation. And I’m proud to say that WOEMA also had a small hand in this. Nearly two years ago, WOEMA recognized that health care reform was on the horizon, and we began a lobbying campaign for the health reform bill to include several provisions that would benefit American workers and the practice of Occupational Medicine. We pushed for such initiatives as mandated coverage of workplace preventive services, incentives for employers to adopt health and productivity management (HPM) programs, more funding for Occupational and Environmental Health training, reimbursement for use of electronic records in Occupational Medicine practice, and several other planks.  Partly as a result of our work, ACOEM adopted its national lobbying initiative — Healthy Workforce Now– and took these ideas up to Capitol Hill.   By this time next month, we’ll know to what extent this important work may have paid off for our specialty, and for the well being of America’s workers.

In other lobbying activity last year, WOEMA pushed for stronger standards that would involve Occupational Physicians more closely in planning for workplace safety.  We’re proud that as a result of our work ACOEM and Federal OSHA have just this month begun conversations about a strengthened OSHA Standard for Hazard Communication, through a set of revisions that would require the involvement of occupational health professionals.

This year will likely stand as a watershed year for Occupational Medicine-indeed for all of American medicine. WOEMA and ACOEM will continue to press for state and national initiatives that will increase recognition of our specialty and reward the value that Occupational Physicians bring to the nation.   More to come.

Some other bits of news —

First, annual dues for WOEMA and ACOEM members will increase modestly next year.  The WOEMA Board, which had not raised WOEMA dues for over five years, voted last month to increase our Component dues by $10 starting in 2011.  Your Board recognized that WOEMA has added extra services with more value for our members since our last dues increase.  We now accredit our own CME activities.  We’ve funded our own lobbyist, and have thereby gained political visibility.  We’ve rebuilt our website.  We now offer online educational webinars and other educational opportunities. These are successes we’re proud of, and we hope that you will agree that this modest dues increase reflects not just the higher cost-of-living, but also added value for your WOEMA membership.

Second, we want to remind our readers that AOHC in Orlando is nearly upon us.  The conference appears to be filling up fast.  Make your reservations soon.  We look forward to seeing many of you in Orlando at the beginning of May.

I’m pleased to report that James P. Seward, MD has been elected to serve on the ACOEM Board of Directors. He joins other WOEMA members currently serving on the ACOEM Board including Pamela Hymel, MD, Warner Hudson, MD, Bob Orford, MD and Michael Fischman, MD. Seward is Medical Director at Lawrence Livermore National Laboratory and Clinical Professor of Medicine at the University of California in San Francisco. He is also a Clinical Professor of Public Health at the University of California in Berkeley. Dr. Seward is Chair, UCSF Occupational Medicine Residency Advisory Committee and Co-Director, UCSF-UCB Joint Residency in Preventive Medicine. He received his MD from the University of California, San Francisco, his MPP (Public Policy) from the University of California at Berkeley, an MMM (Medical Management) from Tulane and an A.B. from Harvard. Dr. Seward is certified by the American Board of Preventive Medicine in Occupational Medicine and by the American Board of Internal Medicine. I’m confident Jim will represent us very well on the ACOEM Board.

WOEMA CME Webinar:

“Occupational Lead Poisoning: New Guidelines for Clinical Management”
Airing Thursday, April 15, 2010 • 12 noon PT

Speaker: Paul J. Papanek, Jr., MD, MPH, Occupational Health Service, Los Angeles Medical Center, Kaiser on the Job

1) The California Dept. of Public Health published a new Guidance Document in 2008 on acceptable blood lead levels, which occupational physicians should be familiar with. Its key changes are:
(a) Blood lead levels should be kept below 20 mcg/dl
(b) Physicians can use Medical Removal Protections to accomplish this
2) Brief overview of lead toxicity and clinical presentation.
3) Epidemiology of lead poisoning in California, using Southern California data.
4) Other clinical approaches founded in the OSHA Lead Standard.
5) Pedictions for changes to the OSHA Lead Standard.

Journal Watch & Test Your Occ-Q

This special feature brings you a concise review of a current topic pertaining to the field of Occupational and Environmental Medicine. Targeted at front-line practitioners, these reviews provide the tools to stay abreast of our ever evolving field. This month’s topic: NSAID Prescribing Precautions.”

Once you review the journal article, test your Occ-Q by taking the short quiz at the bottom of the page.

Western Occupational Health Conference

September 30 – October 2, 2010
WOHC 2011 “
Directions for a New Decade” 
Newport Beach Marriott Hotel & Spa

WOHC is widely respected as one of the premier national meetings focusing on the complex and evolving field of occupational medicine. Registration brochure coming soon! Hotel accommodations: $189 per night.

News You Can Use from Dr. Gean
by Constantine Gean, MD, MS, MBA, FACOEM


A useful review of the latest journal articles of interest to the field of occupational medicine.

Even for a well-accepted indication, herniated disc with radiculopathy, there’s no clear long-term advantage for WC patients to have surgery, but in the non-workers’ compensation (WC) group there is a significantly greater improvement with surgical treatment. This per a study of 113 patients with workers’ compensation (WC) and 811 patients without WC followed for 2 years. Patients were selected with 6 weeks of sciatica and a lumbar intervertebral disc herniation (IDH) and were followed for pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months. In the non-WC group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the WC group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome and physical function with surgical compared to nonoperative treatment. Spine (Phila Pa 1976). 2010 Jan 1;35(1):89-97

The FDA approved a new indication for Crestor (rosuvastatin), for daily use in people who have normal cholesterol, on 2/8/10 based on results of the JUPITER trial. This indication covers men 50+ years of age and women 60+ years of age with an elevated high sensitivity C-reactive protein (hs-CRP) and at least one additional traditional cardiovascular risk factor (e.g., smoking, HTN, a family history of premature heart disease, or low HDL, etc.

Physicians use a variety of strategies to say no to patient requests with significantly higher patient satisfaction when approaches relying on the patient perspective were used to deny a request, per a randomized trial involving 298 patient encounters assessing the prescribing behavior of primary care physicians receiving requests for antidepressant medication. physicians used 1 or more of the following 3 strategies that explicitly incorporated the patient perspective: (1) exploring the context of the request, (2) referring to a mental health professional, and (3) offering an alternative diagnosis. In only a minority of encounters (6% in one subset) did physicians reject the request outright. ARCH INTERN MED/VOL 170 (NO. 4), FEB 22, 2010

Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during a 12.9-year follow-up, per a a prospective cohort study of 19,220 US women 38.9 years or older with a baseline normal BMI (18.5 – <25). Over the next 12.9 years, 7,210 (37.5%) became overweight (BMI 25) and 732 (3.8%) obese (BMI 30). The relative risks of becoming overweight or obese across alcohol intake (gm/day) of 0, > 0 -<5, 5 – <15, 15 – <30, and 30+ g/d were 1.00, 0.96, 0.86, 0.70, and 0.73, respectively. Arch Intern Med. 2010;170(5):453-461.

Patients receiving 100+ mg/d of opioid had an 8.9-fold increase in overdose risk and a 1.8% annual overdose (OD) rate compared with patients receiving 1 to 20 mg/d of opioids (0.2% OD rate), per a study of 9,940 stably insured HMO patients (1997 and 2005) with noncancer pain selected if they received 3 or more opioid prescriptions w/in 90. 51 opioid-related ODs were identified, including 6 deaths., Doses of 50 to 99 mg/d had a 3.7-fold increase in OD risk (0.7% OD rate). At higher doses, risk for an adverse event was greatest shortly after the initial opioid prescription or after a refill. Ann Intern Med. 2010;152:85-92.

About 70 percent of people in the United States have been exposed to pyrethroid insectisides, with children having the highest measurements, according to an assessment of 5046 samples measuring 5 pyrethroid urinary metabolites from the 1999-2002 National Health and Nutrition Examination Survey. Non-Hispanic blacks had significantly higher concentrations than non-Hispanic whites and Mexican Americans. Environ Health Perspect : doi:10.1289/ehp.0901275

Current methods for profiling physicians with respect to costs of services may produce misleading results, per a study of aggregated claims data for the years 2004 and 2005 from four health plans in MA. The study estimated a cost-profile score (signal-to-noise ratio) with 0.0 indicating that all differences in physicians’ cost profiles are due to ‘noise’ (a lack of measurement precision) and 1.0 indicating that all differences are due to real variation in costs of services, i.e., ‘signal’. Results indicated 59% of physicians had cost-profile scores with reliabilities of less than 0.70, and authors estimated that 22% of physicians would be misclassified in a two-tiered system. N Engl J Med 2010;362:1014-21.

Two years after hernia surgery, 53.6% had some pain and 10.6% of patients continued to report moderate to severe pain. At 1 year, 62.9% of patients had groin or inguinal pain and 11.9% of patients had moderate to severe pain, per a study of 315 patients seen in follow-up, with 276 seen at the 2-year mark. Predictors for long-term postoperative pain were: absence of a visible bulge before the operation; presence of postoperative numbness in the surgical area; and patient requirement of more than 4 weeks out of work postoperatively. ANNALS OF SURGERY, Vol. 224, No. 5, 598-602

The American Occupational Health Conference (AOHC) takes place in Orlando, Florida, at the Rosen Shingle Creek Resort, May 2-5, 2010. WOEMA will be represented at the ACOEM House of Delegates meeting on Saturday, May 1 (8-12 noon) and there is a New Member Breakfast on Sunday, May 2 at 7 a.m. Also, on Sunday evening (May 2) at 7:30 pm, there is an informal gathering of WOEMA members planned. If you are a WOEMA member attending AOHC and interested in being involved in any of these activities, contact WOEMA.


The WOEMA Board of Directors and Committee Chairs following their January 30, 2010 meeting in San Francisco.