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1,1,1-Trichloroethane and the Liver-Reply

1,1,1-Trichloroethane and the Liver-Reply Abstract In Reply.— Guzelian raises a number of points in his letter and provides an alternative perspective on the documentation of causal relationships in chronic diseases. We will address the points, as we understand them, in the order in which he raised them in his letter.First, Guzelian implies that patient 1 was exposed only to a low amount of 1,1,1-trichloroethane (TCA). This is incorrect. The characterization of exposure as to 1/10th of the permissible exposure level by the employer's insurance company occurred after diagnosis of fatty liver disease was made. The workplace had been clearly modified after diagnosis of disease, and the patient's job had been abolished in its previous form. Therefore, no representative sampling for his prior exposures was or could be performed. It was, therefore, impossible to determine what level of exposure was associated with the development of disease. This was clearly stated in our article1 References 1. Hodgson MJ, Heyl AE, VanThiel DH. Liver disease associated with exposure to 1,1,1-trichloroethane . Arch Intern Med. 1989;149:1793-1798.Crossref 2. Centers for Disease Control. Deaths from chronic liver disease: United States, 1986 . MMWR . 1989;38:792-799. 3. Sherlock S. Chronic hepatitis and cirrhosis . Hepatology. 1984;4:25S-28S.Crossref 4. Holzbach RT. Nonalcoholic liver disease: structural and clinical implications . Cleve Clin J Med. 1988;44:136-144.Crossref 5. Shaffner F, Thaler H. Nonalcoholic fatty liver disease . Prog Liver Dis. 1986;8:283-298. 6. Diehl A, Goodman ZA, Ishak KG. Alcohol-like liver disease in non-alcoholics: a histological comparison with alcohol-induced liver injury . Gastroenterology. 1988;95:1056-1062. 7. Batman PA, Scheuer PJ. Diabetic hepatitis preceding the onset of glucose tolerance . Histopathology. 1985;9:237-243.Crossref 8. Thiele DL, Eigenbrodt DH, Ware AJ. Cirrhosis after repeated trichlorethylene and 1,1,1-trichlorethane exposure . Gastroenterology. 1982;83:926-929. 9. Brennan TA. Untangling causation issues in law and medicine: hazardous substance litigation . Ann Intern Med. 1987;107:741-747.Crossref 10. Hackney JD, Linn WS. Koch's postulates updated: a potentially useful application to laboratory research and policy analysis in environmental toxicology . Am Rev Respir Dis. 1979;119:849-885. 11. Kramer CG, Ott MG, Fulkerson JE, Hicks N, Imbus HR. Health of workers exposed to 1,1,1-trichlorethane: a matched pair study . Arch Environ Health. 1978;38:331-342.Crossref 12. Discher D. A Pilot Study on the Development of an Occupational Disease Surveillance Method . Washington, DC: USPGO; (May) 1975. National Institute for Occupational Safety and Health, Dept of Health and Human Services Report 75-162. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

1,1,1-Trichloroethane and the Liver-Reply

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400110145036
Publisher site
See Article on Publisher Site

Abstract

Abstract In Reply.— Guzelian raises a number of points in his letter and provides an alternative perspective on the documentation of causal relationships in chronic diseases. We will address the points, as we understand them, in the order in which he raised them in his letter.First, Guzelian implies that patient 1 was exposed only to a low amount of 1,1,1-trichloroethane (TCA). This is incorrect. The characterization of exposure as to 1/10th of the permissible exposure level by the employer's insurance company occurred after diagnosis of fatty liver disease was made. The workplace had been clearly modified after diagnosis of disease, and the patient's job had been abolished in its previous form. Therefore, no representative sampling for his prior exposures was or could be performed. It was, therefore, impossible to determine what level of exposure was associated with the development of disease. This was clearly stated in our article1 References 1. Hodgson MJ, Heyl AE, VanThiel DH. Liver disease associated with exposure to 1,1,1-trichloroethane . Arch Intern Med. 1989;149:1793-1798.Crossref 2. Centers for Disease Control. Deaths from chronic liver disease: United States, 1986 . MMWR . 1989;38:792-799. 3. Sherlock S. Chronic hepatitis and cirrhosis . Hepatology. 1984;4:25S-28S.Crossref 4. Holzbach RT. Nonalcoholic liver disease: structural and clinical implications . Cleve Clin J Med. 1988;44:136-144.Crossref 5. Shaffner F, Thaler H. Nonalcoholic fatty liver disease . Prog Liver Dis. 1986;8:283-298. 6. Diehl A, Goodman ZA, Ishak KG. Alcohol-like liver disease in non-alcoholics: a histological comparison with alcohol-induced liver injury . Gastroenterology. 1988;95:1056-1062. 7. Batman PA, Scheuer PJ. Diabetic hepatitis preceding the onset of glucose tolerance . Histopathology. 1985;9:237-243.Crossref 8. Thiele DL, Eigenbrodt DH, Ware AJ. Cirrhosis after repeated trichlorethylene and 1,1,1-trichlorethane exposure . Gastroenterology. 1982;83:926-929. 9. Brennan TA. Untangling causation issues in law and medicine: hazardous substance litigation . Ann Intern Med. 1987;107:741-747.Crossref 10. Hackney JD, Linn WS. Koch's postulates updated: a potentially useful application to laboratory research and policy analysis in environmental toxicology . Am Rev Respir Dis. 1979;119:849-885. 11. Kramer CG, Ott MG, Fulkerson JE, Hicks N, Imbus HR. Health of workers exposed to 1,1,1-trichlorethane: a matched pair study . Arch Environ Health. 1978;38:331-342.Crossref 12. Discher D. A Pilot Study on the Development of an Occupational Disease Surveillance Method . Washington, DC: USPGO; (May) 1975. National Institute for Occupational Safety and Health, Dept of Health and Human Services Report 75-162.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1991

References