Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

e-Newsletter – October 2010

Welcome to WOEMA’s new 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 newsletter via email every other month with contents appearing on this website. It includes links to pertinent information. — Peter Swann, MD, FAAFP, Newsletter Editor


• WOEMA President’s Message
• WOHC 2011 is Sept 8-10 in Las Vegas!
• Balmes Receives OEM Award from WOEMA
• ACOEM Election Opens November 1!
• News You Can Use from the Literature

President’s Message 
by Paul Papanek MD MPH FACOEM

Some of you — but not many, I’m told — missed our recent Western Occupational Health Conference in Newport Beach, one of the greatest occupational medical conferences ever held. Dr. John Howard, our Keynote Speaker, regaled us brilliantly about six big trends in our field.  Mr. Herb Schultz, Director of the federal office responsible for implementation of Health Care Reform for all of Region 9, invited WOEMA to partner with him in crafting the Occupational Medicine portions of our new medical world. We heard terrific talks about utilization review, pain management, how GINA will fit with workplace wellness, a DOT update from Dr. Hartenbaum, and a great clinical session chaired by Dr. Levy on ACOEM’s new upper extremity treatment guidelines.   The presentations are available here on the WOEMA website, and worth a second look.  Dr. Leslie Israel deserves the highest praise for chairing this wonderful meeting.

Still, next year’s WOHC at the Bellagio Hotel & Spa in Las Vegas figures to be even better.  So, please pre-mark your calendars now to join what will likely be a record-breaking turn-out at WOHC September 8-10, 2011.

At this year’s conference, I had a chance to talk about why I think our field of Occupational Medicine is upward-bound, despite the current gloomy economy and recent small downturns in the ranks of OEM physicians.  There is a lesson for us from the European Union, where there is an astonishing trend in the past 20 years.  In every developed country that adopts national health care reform, Occupational Medicine has prospered.  In fact, demand for Occupational Medicine services typically grows by a factor of ten or more.  Indeed, in many European countries, the per capita supply of Occupational Medicine physicians is as much as 50 times higher as in the United States.  The reasons are not really surprising.  Workplace preventive services and disability management have been recognized as huge drivers of both public health and productivity enhancement.The task now for the House of Medicine in America is to steer the direction of health care reform toward realizing those potential gains here.  We’ll need smart regulations, and we will definitely need to strengthen residency training through the Complementary Pathway, to train many more mid-career physicians for our specialty. Even then, I predict we may not have enough Occupational Physicians, since in most EU countries, even with their bigger supply of Occupational Physicians, they believe they still have a shortage.   This really is our time. Here’s a link to my remarks on this subject at the recent WOHC.

Something new for WOEMA – we’ve just convened the first meeting of the WOEMA Advisory Council, composed of nearly two dozen former WOEMA leaders.   Our Board has long recognized that WOEMA’s former leaders represent a valuable source of wisdom and community influence, and are likely to be very helpful in carrying out our advocacy and educational work, and perhaps to help with establishing an even bigger WOEMA legacy.  My thanks to all of them, particularly to Drs. Robert Orford and Dean Gean for agreeing to spearhead this effort.

On the subject of WOEMA leaders, please don’t forget to vote in the upcoming ACOEM Board elections. You may be aware that – astonishingly – the percentage of ACOEM members who vote is still fairly low.  So, a swing of 20 or 30 votes can be pivotal.  And, of course, I want to remind you that two terrific WOEMA leaders are running for the Board and deserve your careful consideration – Dr. Dean Gean is running on the annual slate, and Dr. Sachin Kapoor is running for the newly created position of Young Director.

On the subject of California politics: WOEMA, as a specialty society associated with the California Medical Association (CMA), was recently informed that CMA has endorsed one of their former Trustees as a candidate for the California Assembly.  Dr. Richard Pan is running in the fifth assembly district in Sacramento, and is the first CMA leader in recent memory to be running for political office and to receive CMA’s formal endorsement.  You’ll be interested to hear that I contacted Dr. Pan and asked him to review WOEMA’s legislative and advocacy agenda, and was pleased to learn that Dr. Pan was already familiar with WOEMA’s work.  Furthermore, he gave our advocacy agenda his strong endorsement.

Although WOEMA has not been in a position to endorse candidates for elective office, our Legislative and Executive Committees have agreed that this information about Dr. Pan’s candidacy should go out to our members.  For more information, or for those who might want to help with Dr. Pan’s campaign, his website is:  www.PanForAssembly.com

WOEMA’s social marketing footprint continues to expand.  Check out the WOEMA Wall on Facebook, and follow us on Twitter. Thank you to all of you for your support.

WOHC 2011 is Sept 8-10 in Las Vegas!

This is an important date to put on your calendar. Make plans now to attend WOHC 2011 at the Bellagio Hotel in Las Vegas. Planning has already begun and it’s shaping up to be a winner of a conference. Special room rates of just $139 per night. Call: 888-987-6667 to reserve your room early.


Balmes Receives OEM Award from WOEMA

John Balmes, MD
 received the Rutherford T. Johnstone Award and presented the memorial lecture at the recent Western Occupational Health Conference in Newport Beach. The award is presented annually to a member or former member who has contributed significantly to the furthering of occupational and environmental medicine. [See lecture]


ACOEM Election Opens November 1

Ballots go out to ACOEM members November 1-15. Learn more about the WOEMA members who are candidates for election to the ACOEM Board of Directors and be sure to vote when you get your ballot!Constantine John Gean, MD, MS, MBA, FACOEM, for ACOEM Director and Sachin Kapoor DO, MBA, MPH, FACOEM, for ACOEM Young Physician Director 

News You Can Use from the Literature
by Constantine Gean, MD, MBA, MS, FACOEM

Workers experiencing delays and/or denials of care had nearly three times the number of self-reported missed work days than workers not experiencing these barriers (113 vs. 39 missed work days)and one third (32%) of the doctors surveyed reported an intention to decrease volume or quit treating workers’ compensation patients. These were among the findings of a 236 page California Division of Workers’ Compensation study which surveyed ~1,000 injured workers and ~800-physicians between May and July of 2008. [Read More]

Two years after fusion surgery, 26% of fusion cases had returned to work (RTW), while 67% of nonsurgical controls had RTW
per a historical cohort study comparing 725 lumbar fusion cases to randomly selected 725 controls followed from 1999 to 2006.For surgical patients, reoperation rate was 27% (n _ 194) and 36% had complications. Permanent disability was 11% for surgical cases and 2% for nonoperative controls.  For lumbar fusion subjects, daily opioid use increased 41% after surgery, with 76% (n _ 550) of cases continuing opioid use after surgery. Total number of days off work was more prolonged for surgical cases vs. controls (1140 vs. 316 days). Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor RTW status when compared to non-surgical controls. Spine, 2010 Aug 23. [Read More]
Exercise alone was similarly effective to steroid injection plus exercise at 12 weeks for treatment of subacromial impingement syndrome, per a study of 232 participants randomised to injection (triamcinolone and lidocaine) plus exercise, or to exercise only with a median of 16 weeks of shoulder pain. Though improvement was significantly greater in the injection plus exercise group at week 1, at week 12 there was no significant difference between the groups in change in total pain and disability index and no differences at week 24, 3 months or 6 months, with most patients (~85% in each group) reporting complete recovery or “improved, but still some problems.” BMJ 2010; 340:c2756 [Read More]
Being both unfit and working more than 45 hours per week more than doubled men’s risk of dying from heart disease compared compared with those who worked less than 40 hours per weekper a study of 5,000 men aged 40 to 59 years followed-up for more than 30 years, , who worked at 14 different companies. Fitness levels were assessed at the start of the study and they were. During that time, 587 (about 12 percent) of the men died as result of narrowed and hardened arteries (also known as ischemic heart disease). unfit men who worked 41 to 45 hours a week were 59 percent more likely to die of heart disease, although they were not more likely to die of other causes. Those who were physically fit and worked longer hours were 45 percent less likely to die of heart disease and 38 percent less likely to die of other causes. Heart. 2010 Oct;96(20):1638-44. [Read More]

Varus alignment is a risk factor for incident osteoarthritis (OA) of the knees (OR=1.49).Varus or outward-facing alignment (knees relatively far apart and ankles closer together) was compared to neutral and valgus alignment in a 2 ½ year NIH observational, longitudinal study of ~3,000 people without OA at baseline. OA affects 6.1 percent of all adults over age 30, per the CDC. Ann Rheum Dis. 2010 Nov;69(11):1940-5 [Read More]

The AAOS endorsed the American Pain Society’s Guideline on Management of Low Back Pain – this is the first time, AAOS has endorsed another medical specialty society’s guidelines. [Read More]

The U.S. FDA has approved fingolimod capsules (Gilenya), a new class of therapy, for relapsing MS reduces relapse frequency and delays physical disability accumulation. This is the first oral disease-modifying therapy for and will be a first-line treatment. Fingolimod binds to S1P receptor on immune cells, including T cells and B cells (implicated in causing CNS damage in MS) and may induce some immune cells to remain in lymph nodes, inhibiting them from migrating into the brain and spinal cord. [Read More]

A low testosterone level was found to be an independent risk factor for premature death from heart diseaseper a study included 930 men (~1/4th with low testosterone) with coronary artery disease followed for ~7 years. One in five men (20 percent) with low testosterone levels died, compared with one in eight (12 percent) of those with normal levels of the hormone. Low testosterone was associated with obesity, risky blood fats and insulin resistance. Heart, Published Online First: 19 October 2010 [Read More]

40,000 of 150,000 annual deaths from heart disease could be prevented, and hundreds of millions of pounds saved, if the NICE Health Guidance recommendations for junk food were adopted, according to the UK Department of Health. Measures such as introduce a “traffic light” food labeling system, banning trans fats, selling low-salt and low-fat foods more cheaply than their unhealthy counterparts, banning advertising of unhealthy foods until after 9pm, modifying planning laws to restrict the number of fast food outlets (especially near schools), paying farmers to produce healthier foods, and full disclosure by the food and drink industry of all lobbying were proposed. (Download Guidance Document) [Read More]

Plaintiff Kaiser Foundation Health Plan Inc. was awarded ~$142 million by a federal jury under RICO laws because Pfizer Inc. fraudulently marketed Neurontin for numerous unapproved or off-label uses, including bipolar disorder, neuropathic pain and migraines, and misrepresented the drug’s capacity to treat those conditions. This misrepresentation influenced Kaiser’s decisions to expand Neurontin’s status in its formulary. Case # 1629, in the U.S. Dist. Court – Massachusetts [Read More]

Obesity-related direct medical costs, lost productivity on the job due to health problems (presenteeism), and absence from work costs cost U.S. employers $73.1 billion annuallyper a cross-sectional analysis of the 2006 Medical Expenditure Panel Survey and the 2008 National Health and Wellness Survey. Presenteeism accounted for the largest part of those costs: 56 percent for women and 68 percent for men. J Occup Environ Med. 2010 Oct;52(10):971-6 [Read More]

Men who were moderately active at work were 10 percent less likely to develop heart failure, while women who were moderately active at work were 20 percent less likely to develop heart failure, per a study of ~28,000 men and ~29,874 women between 25 and 74 years old were included and filled out surveys on their levels of physical activity – study had an an average18.4 year follow-up. “Low” activity was defined as office work, or any sitting job. “Moderate” included standing and walking jobs (e.g., waitress, store clerk). “High” levels of activity at work came from heavy manual labor that included walking and lifting in industrial or farm jobs. J Am Coll Cardiol. 2010 Sep 28;56(14):1140-8 [Read more]