PRINCIPLES OF TOXICOLOGY

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508 OCCUPATIONAL AND ENVIRONMENTAL HEALTH Occupational health policies can have a major effect on people’s employment and require careful consideration of fairness and equity. Informed consent is generally accepted as a fundamental element of medical ethics. In general medical care, patients cannot be coerced into accepting tests and treatments. The same is true in the workplace setting, but this principle sometimes clashes with job requirements. For example, employers can compel employees to submit to drug testing, within certain guidelines. Occupational health illustrates the difficulty of balancing individual autonomy with the requirements of employers and government. Several professional groups have issued codes of ethics for occupational health practice. The most widely accepted is the International Code of Ethics of the International Commission of Occupational Health (ICOH), issued of 1992. Selections from this Code are presented here: • Duties and obligations of occupational health professionals • a. Knowledge and expertise. Occupational health professionals must continuously strive to be familiar with the work and the working environment as well as to improve their competence and to remain well informed in scientific and technical knowledge, occupational hazards and the most efficient means to eliminate or to reduce the relevant risks. Occupational health professionals must regularly and routinely, whenever possible, visit the workplaces and consult the workers, the technicians, and the management on the work that is performed. • Commercial secrets. Occupational health professionals must not reveal industrial or commercial secrets of which they may become aware in exercising their activities. However, they cannot conceal information that is necessary to protect the safety and health of workers or of the community. When necessary, the occupational health professionals must consult the competent authority in charge of supervising the implementation of the relevant legislation. • Information to the worker. The results of the examinations, carried out within the framework of health surveillance, must be explained to the worker concerned. The determination of fitness for a given job should be based on the assessment of the health of the worker and on a good knowledge of the job demands and the worksite. The workers must be informed of the opportunity to challenge the conclusions concerning their fitness for work that they feel are contrary to their interests. A procedure of appeal must be established in this respect. • Condition of execution of the function of occupational health professionals • Professional independence. Occupational health professionals must maintain full professional independence and observe the rules of confidentiality in the execution of their functions. Occupational health professionals must under no circumstances allow their judgment and statements to be influenced by any conflict of interest, in particular when advising the employer, the workers, or their representatives in undertaking on occupational hazards and situations that present evidence of danger to health or safety. 20.7 SUMMARY AND CONCLUSION Occupational and environmental illnesses include a wide range of health conditions. • These are common, with an estimated 300,000 new cases annually in the United States. • These include pulmonary, dermatologic, muscoskeletal, neurologic, and reproductive conditions, as well as cancers and others. • Cases of occupational and environmental illness are usually clinically indistinguishable from cases of the same illness that are not exposure-related. • Occupational and environmental illnesses are highly preventable.
Occupational and environmental medicine is a medical specialty that • Diagnoses and treats occupational and environmental illnesses • Provides medical assessments of fitness, risk, and attribution to cause • Collaborates with other professionals, such as industrial hygienists, to achieve primary prevention • Offers screening and surveillance programs to achieve secondary prevention • Provides training and education regarding workplace hazards • Confronts challenging ethical dilemmas and functions in accordance with widely accepted codes of ethics REFERENCES AND SUGGESTED READING REFERENCES AND SUGGESTED READING 509 Fischbein, A., “Occupational and environmental lead exposure,” in Environmental and Occupational Medicine, 3rd Ed., W. Rom, ed., Lippincott-Raven, Philadelphia, 1998. Ch. 68. Hamilton, A., Exploring the Dangerous Trades, Little Brown, Boston, 1943. Rom, W., “The discipline of environmental and occupational medicine,” in Environmental and Occupational Medicine, 3rd ed., W. Rom, ed., Lippincott-Raven, Philadelphia, 1998. Thacker, S. B., and R. L. Berkelman, “History of public health surveillance,” in Public Health Surveillance, W. Halperin and E. Baker, Jr., eds., Van-Nostrand-Reinhold, New York, 1992. US DOL, BLS, Bulletin USDL 99-358, Workplace Injuries and Illnesses in 1998. December, 1999. Walsh, D. C., Corporate Physicians: Between Medicine and Management, Yale Univ. Press, New Haven, CT, 1987.
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PRINCIPLES OF TOXICOLOGY
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This book is printed on acid-free p
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vi CONTRI BUTORS PAUL J. MIDDENDORF
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viii CONTENTS 4 Hematotoxicity: Che
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x CONTENTS 12 Mutagenesis and Genet
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xii CONTENTS III APPLICATIONS 435 1
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PREFACE Purpose of This Book Princi
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ACKNOWLEDGMENTS A text of this unde
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PART I Conceptual Aspects Principle
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4 GENERAL PRINCIPLES OF TOXICOLOGY
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36 ABSORPTION, DISTRIBUTION, AND EL
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3 Biotransformation: A Balance betw
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BIOTRANSFORMATION: A BALANCE BETWEE
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BIOTRANSFORMATION: A BALANCE BETWEE
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Figure 3.5 Diagrammatic rendition o
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3.2 BIOTRANSFORMATION REACTIONS The
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TABLE 3.4 Important Cytochrome P450
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Figure 3.8 Cytochrome P450-catalyze
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oth of which are suitable for conju
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TABLE 3.6 Changes in Rat Hepatic Dr
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3.2 BIOTRANSFORMATION REACTIONS 75
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TABLE 3.7 Induction of Xenobiotic-M
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3.2 BIOTRANSFORMATION REACTIONS 79
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pyridoxal phosphate depletion by th
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Biotransformation: A Balance betwee
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een shown to be responsible for the
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4 Hematotoxicity: Chemically Induce
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Figure 4.1 Formation of blood. Matu
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TABLE 4.2 Leukemias and Lymphomas 4
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4.3 THE MYELOID SERIES 93 to contra
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function and response to stimuli, (
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Hypoxia can result from a variety o
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4.7 INORGANIC NITRATES/NITRITES AND
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Exposure to aromatic amines can be
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4.10 BONE MARROW SUPPRESSION AND LE
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4.12 TOXICITIES THAT INDIRECTLY INV
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4.15 ANTIDOTES FOR HYDROGEN SULFIDE
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REFERENCES AND SUGGESTED READING 10
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112 HEPATOTOXICITY: TOXIC EFFECTS O
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130 NEPHROTOXICITY: TOXIC RESPONSES
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7 Neurotoxicity: Toxic Responses of
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ions moving out of the cell brings
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an effect seen with some neurotoxic
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7.4 INTERACTIONS OF INDUSTRIAL CHEM
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• A study of the patient’s hist
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• Although much of the damage whi
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158 DERMAL AND OCULAR TOXICOLOGY Fi
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160 DERMAL AND OCULAR TOXICOLOGY P4
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162 DERMAL AND OCULAR TOXICOLOGY ca
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164 DERMAL AND OCULAR TOXICOLOGY ke
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166 DERMAL AND OCULAR TOXICOLOGY Fi
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168 DERMAL AND OCULAR TOXICOLOGY
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170 PULMONOTOXICITY: TOXIC EFFECTS
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10 Immunotoxicity: Toxic Effects on
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10.2 BIOLOGY OF THE IMMUNE RESPONSE
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10.2 BIOLOGY OF THE IMMUNE RESPONSE
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certain situations immunosuppressio
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10.5 TESTS FOR DETECTING IMMUNOTOXI
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10.6 SPECIFIC CHEMICALS THAT ADVERS
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10.6 SPECIFIC CHEMICALS THAT ADVERS
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animal origin have also been shown
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The mainstay of treatment of multip
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PART II Specific Areas of Concern P
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210 REPRODUCTIVE TOXICOLOGY continu
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212 REPRODUCTIVE TOXICOLOGY Underst
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214 REPRODUCTIVE TOXICOLOGY spermat
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216 REPRODUCTIVE TOXICOLOGY gonadot
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218 REPRODUCTIVE TOXICOLOGY TABLE 1
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Figure 11.3 Cycle of follicular dev
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222 REPRODUCTIVE TOXICOLOGY Figure
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224 REPRODUCTIVE TOXICOLOGY TABLE 1
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226 Figure 11.5 Developmental tree
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228 REPRODUCTIVE TOXICOLOGY is clea
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230 REPRODUCTIVE TOXICOLOGY genital
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232 REPRODUCTIVE TOXICOLOGY to occu
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234 REPRODUCTIVE TOXICOLOGY these r
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236 REPRODUCTIVE TOXICOLOGY Two imp
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238 REPRODUCTIVE TOXICOLOGY Sundara
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240 MUTAGENESIS AND GENETIC TOXICOL
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248 Figure 12.5 Example of DNA addu
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TABLE 12-3 NTP and Gene-Tox Evaluat
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266 CHEMICAL CARCINOGENESIS 13.1 TH
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268 CHEMICAL CARCINOGENESIS TABLE 1
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270 CHEMICAL CARCINOGENESIS researc
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272 CHEMICAL CARCINOGENESIS Figure
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276
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280 CHEMICAL CARCINOGENESIS 13.4 MO
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286 CHEMICAL CARCINOGENESIS make a
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288 Figure 13.8 A genetic model of
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290 CHEMICAL CARCINOGENESIS Increas
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292 CHEMICAL CARCINOGENESIS may be
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294 CHEMICAL CARCINOGENESIS • The
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296 CHEMICAL CARCINOGENESIS evaluat
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298 CHEMICAL CARCINOGENESIS In rats
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302 CHEMICAL CARCINOGENESIS with ex
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316 CHEMICAL CARCINOGENESIS similar
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324 CHEMICAL CARCINOGENESIS Knudson
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326 PROPERTIES AND EFFECTS OF METAL
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332 TABLE 14.2 Target Organ Toxicit
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346 PROPERTIES AND EFFECTS OF PESTI
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368 PROPERTIES AND EFFECTS OF ORGAN
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370 TABLE 16.1 (Continued) Water So
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410 PROPERTIES AND EFFECTS OF NATUR
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PART III Applications Principles of
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438 RISK ASSESSMENT 18.1 RISK ASSES
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440 RISK ASSESSMENT control populat
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442 RISK ASSESSMENT there are some
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444 RISK ASSESSMENT • It identifi
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446 RISK ASSESSMENT chemical poses
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448 RISK ASSESSMENT • Estimating
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450 RISK ASSESSMENT Figure 18.3 Est
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452 RISK ASSESSMENT • As discusse
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454 RISK ASSESSMENT divided by a de
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Page 485 and 486: 19 Example of Risk Assessment Appli
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Page 497 and 498: 19.6 REEVALUATION OF THE CARCINOGEN
Page 503 and 504: REFERENCES AND SUGGESTED READING RE
Page 505 and 506: 20 Occupational and Environmental H
Page 507 and 508: 20.1 DEFINITION AND SCOPE OF THE PR
Page 509 and 510: 20.4 HUMAN RESOURCES IMPORTANT TO O
Page 511 and 512: treatment, or medical removal from
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Page 517 and 518: 512 EPIDEMIOLOGIC ISSUES IN OCCUPAT
Page 527 and 528: 22 Controlling Occupational and Env
Page 529 and 530: 22.2 EXPOSURE LIMITS 525 The TLVs
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Page 535 and 536: • Hazard-specific training to ens
Page 537 and 538: 22.3 PROGRAM MANAGEMENT 533 Conside
Page 539 and 540: Figure 22.1 22.3 PROGRAM MANAGEMENT
Page 541 and 542: fundamental viability of the work p
Page 543 and 544: Figure 22.2. 22.3 PROGRAM MANAGEMEN
Page 545 and 546: • Physical assessment and fit tes
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Page 553 and 554: TABLE 22.5 Comparison of Time-Weigh
Page 555 and 556: • Housing or building code violat
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Page 559 and 560: GLOSSARY Glossary absorption The mo
Page 561 and 562: GLOSSARY 557 antipyretic An agent t
Page 563 and 564: GLOSSARY 559 chloracne An acne-like
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GLOSSARY 561 eczema A superficial i
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GLOSSARY 563 hemolytic anemia Anemi
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GLOSSARY 565 lipoprotein Any of a g
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GLOSSARY 567 necrosis Death of one
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pernicious anemia The progressive,
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GLOSSARY 571 cells have both endoth
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GLOSSARY 573 tolerance The ability
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576 INDEX Allergic reaction (contin
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578 INDEX Biotransformation (contin
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580 INDEX Children’s health statu
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582 INDEX Diet and nutrition (conti
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584 INDEX Estrogens: endocrine disr
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586 INDEX Hair, toxic agent excreti
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588 INDEX hnmunoglobulins: autoimmu
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590 INDEX Loop of Henle, structure
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592 INDEX Mixed exposure patterns,
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594 INDEX Nutritional deficiencies,
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596 INDEX Pesticides (continued) Pe
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598 INDEX Relative potency factor (
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600 INDEX Solvents (continued) phys
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602 INDEX Tumorigenesis (continued)
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