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September 13, 1985

Asbestos-Related Diseases

Author Affiliations

Cambridge Hospital Cambridge, Mass
Greater Cincinnati Occupational Health Center
Norfolk County Hospital South Braintree, Mass
San Francisco General Hospital
Massachusetts General Hospital Boston
University of Massachusetts Medical Center Worcester

JAMA. 1985;254(10):1307-1308. doi:10.1001/jama.1985.03360100055006

To the Editor.—  As members of the Diagnostic Criteria Committee of the American Public Health Association's Occupational Health Section, we were pleased to see published the report on asbestos-related diseases of the Council on Scientific Affairs.1 We were especially pleased at the disclaimer, which states that the report "is not intended as a standard of medical care" (p 2593), because a series of inaccuracies, omissions, and biases makes the report unsuitable for any such use. Specifically, we would like to address seven points.

  1. The diagnosis of asbestosis. As practitioners of occupational medicine, we strongly maintain that asbestosis should be diagnosed in any patient with a significant exposure history and with characteristic findings on physical examination (rales), pulmonary function testing (restrictive lung disease), and chest roentgenography (interstitial disease). In fact, not all three findings are always necessary. In this regard, the report is unrealistic for two reasons. First, it