Causation and financial compensation

Our plain-English summary of Causation and financial compensation, by P. Kotin (Regulatory Toxicology and Pharmacology, 1986).

The study

• Author: P. Kotin
• Journal: Regulatory Toxicology and Pharmacology
• Published: 1986;6(2):108-15
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001204).

In plain English

This article is the written version of a talk the author gave at a 1985 conference on causation and financial compensation. It is not a new study. The author outlined general steps for judging whether the environment plays a role in human disease. The author then described two methods developed with colleagues for workers occupationally exposed to asbestos. The first was a nomogram (a chart-based scoring method) for measuring nonmalignant lung impairment due to inhaled asbestos. It used three lung function tests (FVC, FEV1 and DCO) and a chest X-ray. Applied to data on 586 asbestos-exposed subjects, its sensitivity was over 90% for definite asbestosis without airflow obstruction, and its specificity was over 80% among cases eligible for the method. Fifteen cases clinically diagnosed with asbestosis showed no evidence of pulmonary fibrosis. Fifty cases diagnosed as "no asbestosis" did show it. The second method gave each lung cancer case a "risk apportioned to asbestos" between zero and one. The author noted that the nomogram measures impairment only, not disability. The author concluded that science can increasingly quantify impairment and apportion risk among multiple causes.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: conference presentation describing a general framework and previously developed methods (no new study)
• Who was studied: 586 asbestos-exposed subjects whose data were analyzed with the nomogram method (reproduced from an earlier paper by the author and colleagues); no location or dates given
• Exposure: occupational asbestos exposure (no fiber type named), with cigarette smoking considered as a second factor for lung cancer
• Main results:
  • The impairment method used three lung function tests (FVC, FEV1, DCO) and the posteroanterior chest radiograph
  • In the 586 subjects, sensitivity was over 90% for definitive diagnoses of asbestosis without airflow obstruction, and specificity was over 80% for cases judged eligible for nomographic evaluation
  • 15 cases clinically diagnosed as asbestotic had no evidence of pulmonary fibrosis
  • 50 cases diagnosed as 'no asbestosis' had evidence of pulmonary fibrosis and would have qualified for some compensation by the method
  • The lung cancer method used degree of asbestos and smoking exposures, timing, and evidence of pulmonary fibrosis, and produced a 'risk apportioned to asbestos' between zero and one
  • The apportioned risk was set to zero without sufficient evidence of asbestos exposure (and likewise if the lung tumor was a metastasis from another organ)
• The authors' conclusion: The author concluded that laboratory and clinical sciences can increasingly quantify impairment from disease and apportion risk where several causes may be involved, with social and cultural factors added to decide disability and compensation
• Limitations the authors state:
  • The nomogram measures impairment only, a medical conclusion; disability evaluation also involves sociocultural factors

Topics

Medical terms in this study, explained in our Lexicon: Causation.

Related studies

• Research needed for mesothelioma. Financial compensation after death is no panacea — E. Lanzetta (2003)
• The cost of compensating asbestos victims under the Occupational Disease Compensation Act of 1983 — F.B. Siskind (1987)
• The American compensation phenomenon — A. Bale (1990)
• Asbestos disease and compensation — R.E. Sweeney, B. Castleman (1979)
• "Hope in another direction": compensation for work-related illness among women, 1900-1960--Part II — A. Bale (1989)
• Approach to asbestos worker compensation plan alleged to be flawed — K.T. Kelsey, D.C. Christiani (1985)

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