~ M-7lolume 35, Number 12, December 1993
.~~ . .- .
: . .,r.
and a range of 0 to 8% adenomas and 0
'Letters to the Editor to 6% carcinomas.
In the multidose study rats (but not
~CUders are invited to submit letters for publication in this department . Submit them hamsters) also were exposed to RCF l .
t' tona e POB 370 B M ,
ourna! f Occupa 1Md'' tcme, ox , ry n awrPA
o Concentrations used were 50% of the
Letters should be typewritten and double spaced and should be designated MTD (16 mg/m'), and two lower doses
(ieation." that were multiples of the projected oc-
cupational and environmental exposure
Synthetic Mineral Fibers* total lung tumor incidence of 13 .0% . levels (9 and 3 mg/m3) . An air control
Air controls had 1 .5, 0, and 1 .5% ade- group was also evaluated, but the chry-
To the Editor: We applaud the efforts of noma, carcinoma, and total lung tumor sotile asbestos control group was not
Bunn et al' to avoid the errors of omis- rates, respectively . Chrysotile asbestos repeated in this study .
sion that occurred with asbestos by re- controls had 10 .1, 8 .7, and 18 .5% ade- In presenting the results of this study,
porting interim and final data from on- noma, carcinoma and total lung tumor Bunn et al listed the results of the RCF
going studies of animals exposed to syn- rates, respectively. Bunn et al also cited I MTD study for comparison and con-
thetic mineral fibers (SMF) . However, an average historical control total lung cluded that the MTD study results (total
we would like to comment on what we tumor rate of 2 .9% in Fischer 344 rats lung tumor rate = 13%) were the only
believe to be errors of omission and
interpretation in this article .
Bunn et al report the results of Ther-
mal Insulation Manufacturers Associa-
tion (TIMA}sponsored multidose in-
halation studies of fiberglass, mineral
wool, and refractory ceramic fibers
(RCF), which used rats as the experi-
mental model. In the fiberglass study, Looking for a career change with a future?
according to the authors, no significant
EG&G Idaho, Inc., the prime operating contractor for the U .S .
increase in pulmonary tumors or me-
Departmentof Energyatthe Idaho National Engineering Laboratory
sotheliomas was observed . They con-
(INEL), has an immediate opening for an Occupational Physician
clude, based on these finding and others, on the staff of the INEL's Occupational Medical Program (OMP) . The
that ". . . animal inhalation studies have OMP provides occupational medical services to DOE and its contractors
failed to find an empirical relationship at the INEL, involving approximately 10,000 employees .
between fiberglass exposure and dis-
ease." We believe that the definitive an- QUALIFICATIONS : MD P if meeting the licensing
imal study on fiberglass has not been requirements of the St % `' r, - d certification in occupa-
done and, therefore, that the authors' tionaUaerospace medlca <<: ~ r i dicine, internal medicine,
conclusion is premature . or family practice is des~
The TIMA studies were designed sub- RESPONSIBILITIES : P : 1al medical services to
sequent to the evaluation of other -
INEL employees pre j ._?-- ~ - iodic physical examina-
TIMA-sponsored studies on RCF in tions,diagnosisandtreaf , aalinjuriesandon-the-job
which rats and hamsters were exposed illnesses, medical cert -sHA health surveillance
by inhalation to the maximum tolerated examinations, and retu ~`t : ork ev.~~ .- _~ns .
dose (MTD) only . In the earlier studies, BENEFITS : Forty hourw' week, u„i ; ,titive salary and excellent
the authors selected these two species as benefit package . A Masters of Public He?!th Program leading to
appropriate for evaluating the carcino- board cerfificatir`r l+ , :>c. upational Medick, I ,,_~Iable . Idaho Falls
genicity of these fibers. In the hamster areaisunst~ :- • ~ , -adoorrecreationa . :- - . 7 t" Ps,locatedin
study, 42% of those exposed to the thevicirn*, c f rf y, Jackson Holeand ti, - p &Teton
MTD of "RCF I" (kaolin) developed
mesothelioma, whereas no mesothe- Employment Scrvicy`5
liomas were observed in the air control (GLA-002), EGAG Idahq Inc, R0 . Ro . 1625 . Iciaho Falls, ID
nor in the positive control animals ex-
8341 ~ 5-:3127 .
posed to chrysotile asbestos . Pulmonary
~; ,iortunlty employer. U .S. ciN a
tumors were not observed in any group
On the other hand, in the MTD rat
study, the incidence of inesothelioma
(1 .6%) was not significantly elevated.
For this RCF 1-exposed group, there n EGz G ldaho, Inc.
was a 6 .5% incidence of both pulmo-
nary adenomas and carcinomas for a G•
1174 Letters to the Editor
statistically significant findings . This rates were individually within or near (n = 4) of the 22 workers with greater
comparison of the MTD and multidose historical control values), if fiberglass than 20 years since first RCF exposure
study results is improper. The multidose was slightly less carcinogenic than RCF, in a production job .
study was not well designed . A well- it might not produce a significantly ele- Bunn et al give the impression that
designed study would have repeated the vated total tumor rate at the MTD . definitive studies on fiberglass indicate
MTD concentration as well as the posi- Given the dramatic response to RCF no hazard . This is clearly not the case.
tive control . observed in the hamster (42% developed The animal studies have not used the
To summarize the above findings on mesotheliomas), the inclusion of the rat appropriate methodology and species to
rats exposed by inhalation to RCF : the only in the fiberglass (and mineral wool) evaluate cancer risk . Epidemiological
study of rats exposed to the MTD of study is inappropriate and suggests se- evidence indicates an increased lung
RCF found that the total lung tumor lection of a relatively nonresponsive spe- cancer risk among workers employed in
rate (but not adenoma, carcinoma, or cies for study . fiberglass and mineral wool production .
mesothelioma rates) was significantly el- Bunn et al also state that "No sub- For some of these studies, the role of
evated compared with air controls . The stantive evidence of long-term adverse potential confounding factors associated
multidose rat study of RCF found no effects has been published in workers with the elevated lung cancer risk could
significant increase in tumor rate at any exposed to man-made vitreous fibers ." not be determined . In our opinion, a
exposure level . However, there have actually been sev- more cautious view of the carcinogen-
Given these findings, it is not unex- eral studies published that have dem- icity of these fibers should be expressed,
pected that the multidose rat study of onstrated increased rates of respiratory lest we repeat the mistakes that occurred
fiberglass (with exposure concentrations tract cancer in SMF manufacturing with asbestos.
of 30, 16, and 3 mg/m') would produce workers. Shannon et alz observed a sig-
no statistically significant findings of nificantly increased risk of lung cancer Loretta D . Schuman, PhD
pulmonary tumors or mesotheliomas . If in 2,557 production workers in a Cana- Peter F. Infante, DDS, DrPH
fiberglass had the same carcinogenic po- dian glass wool plant . For plant workers Occupational Safety and Health
tential as RCF, one would not expect to overall, the standardized mortality ratio Administration
observe tumor rates at half the MTD (SMR) for lung cancer was 199 (P < Washington, DC
that would be significantly above con- .05). The authors believed that such an
trol levels, because this was true of the increase was probably too large to be * These views do not necessarily reflect
rat response to RCF . Because the rat attributable solely to smoking. For those those of the Occupational Safety and
response to RCF was only significant at workers with more than 30 years since Health Administration.
the MTD (and adenoma and carcinoma first exposure, the SMR was 270 . Signif-
icantly increased death rates from res- References
piratory tract cancer in fiberglass and
mineral wool production workers were t . Bunn III WB, Bender JR, Hesterberg
TW, Chase GR, Koozen JL Recent
RET V nN1® shown in large studies in the United
studies of man-made vitreous fibers . J
States (16,661 SMF workers) and Eu-
Occup Med. 1993;35 :101-113.
rope (24,609 SMF workers) .3-5 For ex- 2. Shannon HS, Jamieson E, Julian JA,
ample, for fiberglass production workers Muir DCF, Walsh C. Mortality experi-
RETURIV® Plus whose first exposure had occurred 20 ence of Ontario glass fibre workers-
Occupational Health Manager (United States) or 30 (Europe) years ago, extended follow-up . Ann Occup Hyg.
PC and LAN Software
the SMR values were 129.5 (P < .01) 1987 ;31 :657-662 .
Ginic Visits and 173 (P < .05) for US and European 3. Enterline PE, Marsh GM, Henderson V,
All Medical Surveillance workers, respectively.l7te authors of the Callahan C. Mortality update of a cohort
(Audio, DOT, Drug Saeen, Blood US study suggested that some other of US man-made mineral fibre workers.
Bome Pathogens, and Ann Occup Hyg. 1987;31 :625-656.
contaminant in the workplace
all other - User Defined) 4. Marsh GM, Enterline PE, Stone RA,
may have caused the excess respiratory Henderson VL. Mortality among a co-
Scheduling, Random Sampling tract cancer . hort of US man-made mineral fiber
Managed Workers' Comp RCF production workers are the sub- workers: 1985 follow-up. J Occup Med.
w ject of an ongoing epidemiological study 1990 ;32 :594-604 .
Strong, Flexible Billing being conducted by Lockey et al .b In- 5 . Simonato L, Fletcher AC, Cherrie J, et
Consolidated and Discounts terim results of this longitudinal mor- al . The International Agency for Re-
bidity study showed an increased prev- search on Cancer historical cohort study
Technical Support for of MMMF production workers in seven
alence of pleuritic chest pain and de-
Electronic Data Exchange European countries: extension of the fol-
Customization creased pulmonary function, both
low-up . Ann Occup Hyg. 1987;31 :603-
associated with duration of exposure .
Chest radiographs revealed that the 6 . I-ockey J, LeMaste :s G, Rice C, et al . An
H M T prevalence of pleural plaques overall in industry-wide pulmonary morbidity
the 602 RCF production workers was study of workers manufacturing refrao
Health Management Technologies, Ine .
2.4% (n = 12), whereas the prevalence tory ceramic fibers and RCF products.
1042 Country Club Dr., Suite C
in the 139 nonproduction workers was OSHA Docket No. H-020A, Exhibit 1-
Moraga, CA 94556
1-800-647-7007 0% . Pleural plaques were seen in 18 .2% 52 (TIMA Inc 1990a).
JOM • Volume 35, Number 12, December 1993 1175
The Authors Reply that male Fischer 344/N rats can de- sumed to not possess significant carcin-
velop fibrosis and pulmonary neo- ogenic potential by that route of expo-
plasms with a known carcinogenic fiber sure. This is a fundamental principle in
To the Editor: In response to the letter under the conditions of the experiment. carcinogenesis bioassays .
from Drs Schuman and Infante, the au- This was adequately demonstrated with Drs Schuman and Infante stated,
thors would like to comment on several chrysotile asbestos in the original RCF "Given the dramatic response to RCF
factual and scientific issues. While we MTD study and subsequently with cro- observed in the hamster (42% developed
recognize that the scientific process can cidolite asbestos, using almost identical mesotheliomas), the inclusion of the rat
and does allow for honest disagreement protocols. only in the fiberglass (and mineral wool)
in procedure, presentation, and inter- Drs Schuman and Infante also study is inappropriate and suggests se-
pretation, we take exception to the opin- seemed to imply that the proper way to lection of a relatively non-responsive
ions expressed by Drs Schuman and evaluate lung tumor data is to analyze species for study ." For the following rea-
Infante and sincerely believe that the benign and malignant neoplasms sepa- sons (detailed below) we disagree with
research under discussion withstands rately. Not only do most researchers feel this opinion as well : scientific judgment
the highest levels of scientific scrutiny . that pulmonary adenomas and carcino- then and now supports the protocol ; the
The scientific process and the resulting mas should be combined for statistical ultimate outcome ofthe RCF inhalation
chronic studies discussed not only in- purpose,' it is well known that the Na- studies show the rat as the better model ;
volved seeking advice from some of the tional Toxicology Program (NTP) rou- and interim data from the RCF study
leading scientists in the field, but also tinely combines benign and malignant available at the time the fiberglass study
advanced the understanding of fiber neoplasms for analysis. The reason for was initiated gave no indication of final
toxicology . this approach is that the progression study results .
After repeating a number of facts from pulmonary adenoma to carcinoma First and foremost, the protocol de-
about which there is no disagreement, is a continuum and differential diagnos- sign, including the animal model, was
Drs Schuman and Infante expressed tic criteria used in making these diag- developed using scientific judgment that
their opinion on several issues that we noses are somewhat arbitrary and have has subsequently been reaffirmed . In
would like to address specifically . Those little bearing on the eventual biological conducting a chronic bioassay the ani-
issues are: 1) the design of the refractory potential of these lesions. mal model selected should be sensitive
ceramic fiber (RCF) multidose study, 2) Another statement of Drs Schuman
the analysis of tumor data, 3) their spec- and Infants deserves comment . They
ulation that a concentration of fiber state " . . . if fiberglass was slightly less
glass higher than the maximum toler- carcinogenic than RCF, it might not
ated dose (MTD) might be carcinogenic produce a significantly elevated total tu- PHYSICAL MEDICINE RESEARCH FOUNDATION
in the rat, 4) their opinion that the rat mor rate at MTD." First, one fiberglass
7TH INTERNATIONAL SYMPOSIUM
model was an inappropriate choice and composition (MMVF 11) was tested at Vancower, Onada • June 10 -12,199f
is a relatively nonresponsive species, and an exposure level higher than the RCF Repetitive Strain Injuries, Fihromyalgia &
5) their comments regarding epidemiol- in the RCF MTD study (246 . WHO f/cc Chronic Fatigue Syndrome; Current Concepts
ogy studies. in Diagnosis, Management & Cost Containment
vs 187 WHO f/cc for RCF 1) and the
Drs Schuman and Infante asserted resulting lung fiber burdens were ao- •Dc Mdrsw Chalmers, Associate Professor, Head,
that the RCF multidose study was not tually twice as high as in the RCF ani- Division of R6eumatology, University of British
well designed because the MTD dose of mals at the end of exposure .' Despite •Dn Frederlck Wolfe, Cfinkal ProfessorofMedicinq
RCF and the positive control were not this high lung burden of glass fibers, no Univrsiry of Kansas, USA;
•Dr.Irv5alil, ProlessorandHead, DivisionoFlnfectious Diseases, University ofToronto, Canada
repeated. These exposure groups were fibrosis or significant increase in lung ;
included in the RCF MTD study and tumors was observed . If fiberglass was •nr . Geoffrey Littlejohn, Associate Professor of
Medicine, Monash University, Australia
were not repeated in the multidose study only "slightly less carcinogenic than
because the two studies overlapped in RCF" one would have expected to have CALL FOR PAPERS & POSTERS
time by one and a half years and were at least observed some lung fibrosis at The Physical Medicine Research
conducted in the same laboratory, with the MTD concentration, but in fact no Foundation in association with the
the same exposure system, using the fibrosis was seen in fiberglass exposed Divisions of Rheumatology and Infectious
same source, species, and strain of rat . animals. Fibrosis has been observed in Diseases, University of British Columbia
is inviting clinicians and researchers to
Further, the lung burden studies docu- every fiber inhalation study that has re- submit abstracts for review . Issues include :
ment the excellent and consistent con- sulted in lung tumors.3 In fact, lung causality, functional capacity
trol of dose by RCC. We see no scientific fibrosis was observed at noncarcino- determination, prognosis, treatment and
justification whatever (and none was of- genic levels of RCF as low as 75 f/oc, compensation adjudication.The deadline
fered by Drs Schuman and Infante) for less than one-third the fiber concentra- for submission is February 1, 1994 .
repeating the high dose because the For abstract guidelines, exhibit and
tion of the MTD dose of fiberglass. Thus
registration information contact :
overwhelming fibrosis and tumor re- not only is there no scientific basis for
Marc 1. White
sponse rates clearly indicate what should Schuman and Infante to speculate that
happen . fiberglass is only slightly less carcino- Physical Medicine Research Foundation
Similarly, we find little reason to re- genic than RCF in rats, the data clearly N510- 207 LVest Hastings St .,
Vancouver, BC V661H7 Canada
peat the positive control . The reason one refute such a premise.
Tel : (604) 684-1148 or (604) 684-5345
uses a positive control is to verify the In addition, if a material does not Fax: (604) 684-6247
model, ie, in this case to demonstrate cause tumors at the MTD, it is pre-
1176 Letters to the Editor
to the endpoints of interest . Two recent later) . Drs Schuman and Infante clearly RCC inhalation studies were orders of
international conferences"•' have both misunderstood this fact. Even if the ad- magnitude higher than typical occupa-
concluded that the rat is the preferred ditional information on the RCC ham- tional exposures . These data further add
model for evaluating the potential fibro- ster study had been available at that to the weight of the evidence that respi-
genic and pulmonary carcinogenic time, based on the previous discussion, rable fiberglass represents no significant
properties of airborne fibers . Rats pro- the rat clearly would have been the hazard for disease in humans .
vide a better indication of the spectrum model for choice . A substantial effort was made by in-
of potential diseases which could be Regarding their comment on human dustry to brief scientists from the federal
caused by inhaled particles . In addition, studies, we are sure Drs Schuman and regulatory community during all phases
more testing has been conducted in rats Infante recognized that the transitional of the RCC study-EPA, CPSC,
than hamsters, which allows more com- statement referring to the epidemiology MOSH, MEHS, and OSHA (including
plete comparisons between studies, pro- was simply additional information for Drs Schuman and Infante). The authors
viding analysis of the strength and the readers as to why the animal studies continue to welcome informed dia-
weight of the scientific evidence. Ham- were undertaken in the first place . As logue on the results of these and all
sters have not shown the same breadth stated in the article, the purpose was to previous studies of glass fibers . We are
of response and appear to be refractory provide an update on chronic animal confident, however, that the study de-
to the induction of lung neoplasms with inhalation studies of MMVF, not epi- sign and quality withstand sound scien-
known carcinogenic fibers, eg, various demiologic studies. For a full and bal- tific scrutiny .
forms of asbestos.b anced discussion, we naturally prefer
Furthermore, the RCF rat studies that readers rely on research and reviews W. B . Bunn, MD, JD, MPH
showed not only significant numbers of that specifically address the epidemiol- J . R . Bender, PhD, MD
lung cancer, but also (biologically) sig- ogy and suggest that readers refer to T . W . Hesterberg, PhD
nificant numbers of mesothelioma were assessments by the principal research G. R. Chase, PhD
observed (no spontaneous pleural meso- investigators of the major epidemiologic J. L Konzen, MD, MPH
thelioma tumors were reported in either studies (eg, see Marsha) . We emphati- Princeton, New Jersey
rats or hamsters in the many studies cally disagree with their selective cita-
cited in our article) . Epidemiologicstud- tions that do not present a balanced References
ies of fiberglass workers do not indicate overview of the weight of the evidence
1 . McConnell EE, Solleveld HA, Boomian
a risk of mesothelioma, even though the and can be misleading . Epidemiological GA . Guidelines for combining neo-
studies date back over 50 years-impor- studies do not support a causative rela- plasms as evidence of carcinogenicity in
tant because of the long latency period tionship between glasswool fiber expo- long term toxicity and carcinogenesi ;
normally associated with the develop- sure and cancer. Both IARC9 and the studies . JNCI. 1986;76:283-289.
ment of inesothelioma . Because the rat EPAs Office of Toxic Substances10 have 2. Hesterberg TW, Miller WC, McConnell
is clearly the preferred animal model for concluded, based on extensive epide- EE, et aL Chronic inhalation toxicity ol
evaluating lung cancer potential of air- miological studies, that the evidence is size-separated glass fibers in fischer 344
rats . Fundam Appl Toxicol. 1993 ;20 :
bome fibers and also showed biolog- inadequate for carcinogenicity in hu-
ically significant mesothelioma, the rat mans. This is further supported by an
3 . Hesterberg TW, Vu V, Chase GR,
was the appropriate selection for the article in this journal by Marsh et al." McConnell EE, Bunn WB, Anderson R.
current study. Notwithstanding, a better Fibrous glass has been tested by in- Use of animal models to study man-
understanding of the differences in halation in guinea pigs, hamsters, and made fiber carcinogenesis. In Brinkly B,
mechanisms between rats and hamsters in eight separate inhalation studies in Lechner L, Harris C, eds. Cellular and
in their responses to inhaled fibers is of rats . None of these studies identified a Molecular Aspects of Fiber Carcinogen-
obvious interest. significant increase in either fibrosis or esis. Cold Spring Harbor, NY: Cold
It is also informative to look at the neoplasms following fiberglass inhala- Spring Harbor Laboratory, 1991 ;183-
protocol from the perspective of what tion in spite of lung burdens in excess 205 .
4 . WHO . Validity of methods for assess-
information was, in fact, available in of several hundred thousand fibers per
ment of carcinogenicity of fibres. Copen-
1989 when the fiberglass inhalation milligram of dry lung tissue. It is note-
hagen, Denmark: WHO Regional Office,
study was initiated. A previously re- worthy that lung burdens in the exposed 1992 .
ported fiberglass inhalatioa study in animals in the RCC fiber glass inhala- 5 . McClellan RO, Miller FJ, Hesterberg
hamsters' achieved high lung burdens tion study are orders of magnitude TW, et al . Approaches to evaluating the
and reported no fibrosis, lung tumors, higher than those reported recently for toxicity and carcinogenicity of man-
or mesotheliomas. Furthermore, at the former glass fiber production workers .12 made fibers. Regul Toxicol Pharmacol.
time of the initiation of the fiberglass Lung samples of only 26% of workers 1992 ;16:321-364 .
inhalation study, only a single meso- contained any man-made vitreous fiber, 6 . Hesterberg TW, Mast R, McConnell EE,
et al. Chronic inhalation toxicity of re-
thelioma (not the 42% eventually ob- almost all siliceous in nature and in low
fractory ceramic fibers in Syrian ham-
served and mentioned by Drs Schuman concentration . Those that did contain
sters. In : Brown RC, Hoslcins JA, John-
and Infante) had been observed in the fibers averaged only 200 fibers per mil-
son NF, eds. Mechanisms in Fibre Car-
RCF MTD hamster inhalation study ligram of dry lung tissue, compared with cinogenesis. Plenum Press, 1991 ;531-
and the RCF rat inhalation study more than 600,000 in the highest fiber- 538 .
showed fibrosis (with the longer life span glass exposure group in the RCC study . 7. Smith DM, Ortiz LW, Archuleta RF,
for the mt, tumors would appear months Furthermore, the exposure levels in the Johnson NF. Long-term health effects in
" JOM • Volume 35, Number 12, December 1993 1177
hamsters and rats exposed chronically to be happy to answer any questions any Public Health (CEPH) was obtained in
man-made vitreous fibres . Ann Occup reader may have . 1991 .
Hyg. 1987;31 :731-754. Although a description of the pro-
8 . Marsh GM . The University of Pittsbu`gh gram has appeared in the context of
epidemiology studies of man-made min- William W . Greaves, MD, MSPH a proposed program in insurance
erzl fiber workers . The Toxicology Acting Chair, Department of medicine' and through international
Forum proceeding of the Annual Winter
meeting presentations abroad,°'b we be-
Meetingsin Washington, DC . 1992 :311-
335 . lieved that a brief summary of the man-
9 . IARC (International Agency for Re- ner in which the program is conducted
The Off-Campus Approach to Training
search on Cancer). IARC Monograph on would be of interest to the JOM read-
Occupational Health Professionals ership here in the United States.
the Evaluation of Carcinogenic Risks to
Human Man-Made Mineral Fibers and The necessary ingredients for such a
Radon, Lyon, France, Vol. 43 ; 1988 . To the Editor: Efforts to meet the need
training program to succeed include spe-
10. US Environmental Protection Agency. to train physicians in occupational med-
cially designed course study guides with
Health Hazard Assessment of Nonasbes- icine throughout the world have resulted
clear-cut learning objectives, access to
tos Fibers. Health and Environmental in several approaches as alternatives to
and involvement in an actual work-site,
Review Division, Office of Toxic Sub- full-time attendance during a standard
stances. F'inal Draft . 1988. a faculty of limited size who are respon-
academic year. sive to the students' needs, and a highly
11 . Marsh GM, Enterline PE, Stone RA, Weekend programs and summer ses-
Henderson VL . Mortality among a co- motivated mature group of students ca-
sions have been in place at various
hort of US man-made mineral fiber pable of assuming responsibility for the
schools for some time. One of these, the
workers: 1985 follow-up . ! Occup Med. attainment of the study objectives .
1990 ;32394-604. program at the University of Michigan, Entering students attend a one-day
12 . McDonald SC, Case BW, Enterline PE, was recently described in this Journal in introductory session at the Medical Col-
et al . Lung dust analysis in the assess- a Letter to the Editor.'
lege of Wisconsin . This orientation ses-
ment of past exposure of man-made The off-campus program of the Med- sion introduces each component of the
mineral fibre workers. Ann Occup Hyg. ical College of Wisconsin, which to date program and the practical aspects of the
1990 ;34 :427-441 . has enrolled 637 physicians, is unique
Activity Assignments and the computer-
in that it does not require any on-cam-
pus activity other than one day of ori-
The curriculum is designed to encom-
The computer administered quizzes are entation at the beginning of the pro-
pass the major disciplines in the spe-
teaching devices to enable the students gram. The program currently is limited cialty of occupational medicine. Stu-
to assess their progress and guide them- to physicians engaged in activities re- dents must complete 30 trimester credit
selves in finding the basis for the appro- lated to occupational medicine, al- hours that include the five required core
priate answer when the one selected is though 10 nonphysician occupational
courses for CEPH accreditation and the
incorrect . All courses are concluded health professionals have been admitted
two-semester project course . Students
with a proctored final exam, which may as special students and are eturently pur- choose from the elective courses to fulfill
be administered at a college or univer- suing their course work
the remaining credit requirements . Each
sity accessible to the student . Enrollees have come from 48 of the
3-credit course is normally completed
The final project course incorporates 50 states (all but Mississippi and Mon-
every trimester, ie, every four months .
the knowledge and skills learned in the tana) and from 6 foreign countries : Can-
basic courses and requires the student ada, Panama, Puerto Rico, Saudi Ara-
to apply the principles and practices of bia, Trinidad, and the Virgin Islands .
occupational medicine to a real problem Agreements have been developed
in his or her setting . with two foreign countries, Thailand
Enrollment occurs three times a year and the Republic of Georgia, making
Health Services Administration
and all courses are offered at all times . available all educational materials in re-
Behavioral Science and Occupational
It is expected that if a student takes one turn for reimbursement for a portion of
course per trimester, he or she can com- our developmental costs over time as
Project in Occupational Medicine
plete the requirements for the MPH de- these programs enroll students. Thus
gree in 3 93 years . Two students of the 89 far, Thailand has enrolled 152 students .
graduates of the program have com- Development of the program began
Practice of Occupational Medicine
pleted the program in 14 months . Also, in 1983 with a modest grant from the
students enrolled in residency programs National Fund for Medical Education .
in which the academic and practicum Individual courses were accepted by the
Industrial Hygiene i
years are completed concomitantly nor- American Board of Preventive Medicine
Occupational Health Surveillance
mally take two calendar years to com- beginning in 1985 under its Alternative
Introduction to Public Health
plete the degree requirements. Students Pathway program for pre-1984 gradu-
Occupational Health Law
may enroll for specific courses regardless ates,z and authorization for Medical
of whether they intend to complete the College of Wisconsin's Department of For each course, there is a specially
requirements for the MPH degree. Preventive Medicine to award an MPH developed "Course Study Guide,"which
The authors or other faculty members degree was granted in 1988 . Accredita- includes the following:
or staff involved in the program would tion by the Council on Education for Course goals and objectives