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:100623617(2005)0220181203:X508,R181.2+3:A:,BenThomas:;;;;;CausalRelationshipsbetweenOccupationalandEnvironmentalExposuresandInjury:GeneralCausationandSpecificCausationNingjiaZHENG,BenTHOMAS(RiskAssessmentandManagementGroup,Inc.,Hous2ton,Texas,USA)Abstract:DemonstrationofacausalrelationshipbetweenchemicalexposureandinjuryinlitigationoftoxictortcasesisakeytowinningthecaseinCourt.Toevaluatewhetheracasehasmerit,twolevelsofcausations,generalcausationandspecificcausation,areconsidered.Generalcausationreferstothequestion,doesexposuretothetoxicantcausethetypeofinjury?Forexample,doesalu2minumweldingfumecauselungcancer?BradfordHillsninecriteriaareusedtoanalyzegeneralcausation.Thesecriteriaincludestrengthofassociation,consistency,specificity,temporality,biologicalgradient,plausibility,coherence,experiment,andanalogy.Specificcausationreferstothequestion,didthePlaintiffsexposuretothetoxicantcausetheinjuryinthisindividual.Forexample,wasMr.Smithslungcancercausedbyhisoccupationalexposuretoaluminumweldingfume?Incourt,theJudgeandjuryareaskedtomakeadecisionaboutspecificcausation,andawardordenydamagesaccordingly.Theexpertwitnessestestifyasadvisortothecourt.Ashealthconsultants,weaskfivequestionstoevaluatespecificcausation:1.Wastheindividualexposedtoatoxicant,andifso,whatwasthedose(route,concentration,duration,andfrequency)?2.Whatisknownaboutthetoxicityofthatchemical?(e.g.,Whatspecificadverseef2fectshavebeenassociatedwithexposurestothattoxicant?Howlongdoesittakeforsymptomstodevelop?Whatdoseisrequired?Theanalyzingprocessofgeneralcausationisincludedinourquestion2.)3.Didthesymptomsclaimedbythisindividualappearinamannerandtimesequencethatisconsistentwithwhatisknownaboutthetoxicityofthechemical?4.Whenexposuretothechemicalceased,didthesymptomsgetbetterordisappearinamannerandtimesequencethatisconsistentwiththeknowntoxicology?5.Whatothercondi2tionsorfactorsmighthavecausedthissymptom,andaretheyrelevanttothiscase?Byreviewingtheavailableinformationrelativetothesefivequestions,thetestifyingexperthelpsthejudgeandjurydecidewhethertheplaintiffsinjurywas,orwasnotcausedbyhisexposuretoachemicaltoxicant.KeyWords:occupation;environment;exposure;toxicology;injury;disease;causality,,,,,,(,,,,,),20031020042,(toxictort)IBMIBM,(breastcancer)(non2:,,,(DABT),Email:ningjiazheng@yahoo.com:RiskAssessmentandManagementGroup,Inc.5433Westheimer,Suite725,Houston,TX77056Hodgkinslymphoma)(acetone)(benzene)(trichloroethylene),IBM200,,52,22,,,,57(multi2plemyeloma),,,,18120054222JEnvironOccupMed,Apr2005Vol.22No.2©1994-2009ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.(generalcausation),;(specificcausation),11965AustinBradfordHill,(association)(causation),BradfordHill9[1]1.1(strength)(relativerisk),1022,:,,,1.2(consistency),,:,[2]1.3(specificity),:,[3],,1.4(temporality),,1.52(biologicalgradi2ent),:[4]1.6(plausibility),1.7(coherence),1.8(experiment),,,1.9(analogy):thalidomide[5],,BradfordHill9,,,;;,,222,,,52,?,?,,??,,,,,,5,5,:?,?()????BradfordHill9??,??BradfordHill9,,,,,,,,,,28120054222JEnvironOccupMed,Apr2005Vol.22No.2©1994-2009ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.(morelikelythannot),,,,,IBMIBM,,,,,,:[1]HillAB.Theenvironmentanddisease:associationorcausation?[J].ProcRAcadMed,1965,58:2952300.[2]PetersGA,PetersBJ.Sourcebookonasbestosdiseases:medical,legal,andengineeringaspects[M].GarlandSTPMPress,1980.[3]RomWN.Asbestos2relateddiseases.InEnvironmental&OccupationalMedi2cine3rdeds[M].Lippincott2RavenPublishers,1998.3492375.[4]DollR,PetoR.Mortalityinrelationtosmoking:20yearsobservationsonmaleBritishdoctors[J].BrMedJ,1976,2(6051):152521536.[5]HolmesLB.Teratogen2inducedlimbdefects[J].AmJMedGenet,2002,112(3):2972303.(:2004209227)(:)(155):[1]MumtazMM,GeorgeJD,GoldKW,etal.ATSDRevaluationofhealthef2fectsofchemicals.IV.Polycyclicaromatichydrocarbons(PAHs):under2standingacomplexproblem[J].ToxicolIndHealth,1996,12(6):7422971.[2]YoshikawaT,RuhrLP,FloryW,etal.Toxicityofpolycyclicaromatichy2drocarbons.III.Effectsofbeta2naphthoflavonepretreatmentonhepatotoxicityofcompoundsproducedintheozonationorNO22nitrationofphenanthreneandpyreneinrats[J].VetHumToxicol,1987,29(2):1132117.[3]RodriguezLV,DunsfordHA,SteinbergM,etal.Carcinogenicityofbenzo[a]pyreneandmanufacturedgasplantresiduesininfantmice[J].Carcino2genesis,1997,18(1):1272135.[3]Izdebska2SzymonaK,Kopec2SzlezakJ,KozlowskaE,etal.Organcytotoxici2tyofselectedpolycyclicaromatichydrocarbonsinmice[J].RocznikiPanst2wowegoZakladuHigieny,1997,48(1):13221.[5],,,.[R].(198221983).,1996.1215.[6]SwaenGM,SlangenJJ,VolovicsA,etal.MoratlityofcokeplantworkersintheNetherlands[J].BrJIndMed,1991,48(2):1302135.[7],.[J].,2000,13:1142115.[8]WuMT,MaoIF,WypijD,etal.Serumliverfunctionprofilesincokingworkers[J].AmJIndMed,1997,32(5):4782486.[9]ChenSY,WangLY,LunnRM,etal.Polycyclicaromatichydrocarbon2DNAadductsinlivertissuesofhepatocellularcarcinomapatientsandcontrols[J].IntJCancer,2002,99(1):14221.[10]KhanRA.HealthofflatfishfromlocalitiesinPlacentiaBay,Newfoundland,contaminatedwithpet