News News
No Undue Influence 'The tobacco industry would love to see this thing delayed forever," he added, "but we've done everything possible to ensure no undue influence is brought to bear on the process, and there really hasn't been." EPA biostatistician Steven Bayard, Ph.D., manager of the passive smoking risk assessment program, said limitations on resources within the agency have slowed progress somewhat, but noted that the passive smoking assessment is moving faster than other comparable health risk assessments. Bayard said the report has been revised and expanded to include additional studies and to take account of extensive comments from the science advisory board and the public. The new revision will include eight new studies on lung cancer risk from passive smoking, including the largest case-control study ever done, and more than 50 studies on risk of childhood respiratory disease. The studies have been subjected to a more critical review this time around, Bayard said. "There are a lot of potentially confounding variables in this research," he said. "Some studies are of higher quality, and we've tried to give these more weight in our analysis." Vol. 84, No. 7, April-1, 1992
Only IS substances are now classified as Class A carcinogens, including asbestos, benzene, and radon. The designation means a substance is known, through sound scientific evidence, to cause cancer in humans. Because tobacco smoke is exempt from regulation under the Toxic Substances Control Act of 1976, EPA is prohibited from doing anything to control exposures to it. But the agency's risk assessment, and a policy guide that is being developed as a companion document, are certain to influence the smoking policies of other groups, Axelrad said. "Everybody, from corporate decision makers to state and local governments you name it, will probably make use of it," he said. The Occupational Safety and Health Administration, which regulates workplace air quality, would have a much stronger mandate to control tobacco smoke exposures in work settings, said OSHA health scientist Deborah Janes. The EPA document would join a 1991 report by the National Institute for Occupational Safety and Health that calls for restricting, or, preferably, banning, smoking on the job.
Guidelines Released On Acute Pain Management
Downloaded from http://jnci.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on May 30, 2015
Robert Axelrad, director of EPA's Indoor Air Division, said the board was never asked to rethink its recommendations. He said the board agreed with the draft report's conclusions, but suggested it could be improved. "They thought we could have done a better job in a lot of areas to make it a stronger document," Axelrad said. 'The only reason it's going back to the board is that when they submitted their earlier report, they asked for another look at our draft to see how well we'd implemented their recommendations."
The Agency for Health Care Policy and Research, a part of the Public Health Service, recently released the first of a new series of federally sponsored medical care guidelines. The guidelines, on acute pain management, call for aggressive pain management before, during, and after surgery. Failure to control pain not only causes unnecessary suffering but can delay recovery and prolong hospitalization, according to the accompanying AHCPR report. "This guideline discusses the actual physical damage that a patient can sometimes suffer as a result of pain," said Health and Human Services Secretary Louis W. Sullivan, M.D. "And it shows that inadequately managed pain can inhibit recovery, prolong hospitalization, and thus potentially contribute to higherthan-necessary costs." According to
Challenged OSHA Anti-smoking groups such as ASH have challenged OSHA in the courts to force a workplace smoking ban, but have so far been unsuccessful. Janes said OSHA is developing recommendations on indoor air quality, but cannot simply regulate smoking because it is linked to other air quality issues such as biological pathogens, solvents, carbon dioxide levels, temperature, and lighting. However, "if EPA publishes their risk assessment, there's going to be more pressure" on OSHA to regulate tobacco exposures, she said. —By Tom Reynolds
Dr. Louis W. Sullivan NEWS
481
News News
Not "Big Brother" The clinical practice guideline was developed by pain management experts assembled in 1990 under the sponsorship of AHCPR, an agency established in 1989. The guideline was then tested in hospitals and other settings. Sullivan said this effort is not "Big Brother" telling doctors how to treat their patients. "We will provide the best information and guidance we can, derived from a cooperative process, and based on solid research. It will be up to our health care professionals to review and apply this new information in the best way possible for patients," he said. "This pain guideline - and another to come on cancer pain - will be watershed reports," according to Assistant Secretary for Health James O. Mason, M.D., Dr. P.H., "And many future reports on Alzheimer's disease and senility, congestive heart failure, AIDS, and stroke will peacefully revolutionalize American medicine." The acute pain guideline is the first in a series of 16 guidelines commissioned by the AHCPR. The cancer pain guideline will be released within the next year. AHCPR will distribute the guideline to physicians, nurses, medical and nurs482
ing societies, health professional schools, insurers, consumer groups, and others. A patient guide, which is available in English, will be provided soon in Spanish. The clinical practice guideline and the patient's guide are available without cost from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; or by telephone at 1-800-358-9295. —By Julie A. Steele and Ellen Taylor
Awards, Appointments, Announcements The University of Miami Sylvester Comprehensive Cancer Center honored Patti LaBelle as "Cancer Awareness Spokesperson of the Year" last month at a gala in Miami. LaBelle, winner of the 1992 Grammy Award for Best Female Rhythm and Blues Vocalist, was recognized for her efforts to increase public awareness about the early detection and diagnosis of cancer, and the need for cancer research. A research laboratory also was dedicated in LaBelle's name at the university's Papanicolaou Cancer Research Building. LaBelle also serves as national spokesperson for National Cancer Minority Awareness Week, April 12-18. Marilyn Tucker Quayle was national honorary chairperson for the Miami gala, which celebrated a 5-year campaign to raise funds for cancer research at Sylvester center.
Patti LaB«lle
who has served as president for 11 years. Benacerraf, a Nobel laureate, will continue as president of Dana-Farber, Inc., the institute's parent corporation. Walsh, the Hamilton Kuhn Profey^or of Medicine at Harvard Medical SchocI, will continue as chairman of the Medical School's largest basic sciences department, Biological Chemistry and Molecular Pharmacology. Walsh has been on the Harvard faculty since 1986.
Gibbons to Stanford The former editor of Medical World News joined the staff of Stanford University Medical Center's Office of Communications recently as associate director. Don Gibbons had been with MWN since 1982 and editor from 1987 until last December. Gibbons succeeds Ron Goben, who retired at the end of 1991.
Yew Harvesting Walsh Named A new president recently assumed the helm at the Dana-Farber Cancer Institute, Boston. Christopher T. Walsh, Ph.D., succeeded Baruj Benacerraf, M.D.,
The chief of the U.S. Department of Agriculture's Forest Service issued last month a new national policy to guard against waste of Pacific yew trees, source of the anti-cancer drug taxol. Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on May 30, 2015
Ada K. Jacox, co-chair of the federal panel that developed this guideline, there is a changing philosophy toward pain. "In the past, postoperative pain was viewed as inevitable, to be tolerated stoically. It is now clear that incompletely treated pain can slow recuperation or even provoke complications, such as pneumonia, heart attacks, or blood clots," she said. Ideally, this guideline will dispel some of the myths surrounding pain, including: Pain is necessary and builds character; infants don't feel pain; elderly patients don't feel pain; and pain medications are often addictive when given postoperatively.
No Undue Influence 'The tobacco industry would love to see this thing delayed forever," he added, "but we've done everything possible to ensure no undue influence is brought to bear on the process, and there really hasn't been." EPA biostatistician Steven Bayard, Ph.D., manager of the passive smoking risk assessment program, said limitations on resources within the agency have slowed progress somewhat, but noted that the passive smoking assessment is moving faster than other comparable health risk assessments. Bayard said the report has been revised and expanded to include additional studies and to take account of extensive comments from the science advisory board and the public. The new revision will include eight new studies on lung cancer risk from passive smoking, including the largest case-control study ever done, and more than 50 studies on risk of childhood respiratory disease. The studies have been subjected to a more critical review this time around, Bayard said. "There are a lot of potentially confounding variables in this research," he said. "Some studies are of higher quality, and we've tried to give these more weight in our analysis." Vol. 84, No. 7, April-1, 1992
Only IS substances are now classified as Class A carcinogens, including asbestos, benzene, and radon. The designation means a substance is known, through sound scientific evidence, to cause cancer in humans. Because tobacco smoke is exempt from regulation under the Toxic Substances Control Act of 1976, EPA is prohibited from doing anything to control exposures to it. But the agency's risk assessment, and a policy guide that is being developed as a companion document, are certain to influence the smoking policies of other groups, Axelrad said. "Everybody, from corporate decision makers to state and local governments you name it, will probably make use of it," he said. The Occupational Safety and Health Administration, which regulates workplace air quality, would have a much stronger mandate to control tobacco smoke exposures in work settings, said OSHA health scientist Deborah Janes. The EPA document would join a 1991 report by the National Institute for Occupational Safety and Health that calls for restricting, or, preferably, banning, smoking on the job.
Guidelines Released On Acute Pain Management
Downloaded from http://jnci.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on May 30, 2015
Robert Axelrad, director of EPA's Indoor Air Division, said the board was never asked to rethink its recommendations. He said the board agreed with the draft report's conclusions, but suggested it could be improved. "They thought we could have done a better job in a lot of areas to make it a stronger document," Axelrad said. 'The only reason it's going back to the board is that when they submitted their earlier report, they asked for another look at our draft to see how well we'd implemented their recommendations."
The Agency for Health Care Policy and Research, a part of the Public Health Service, recently released the first of a new series of federally sponsored medical care guidelines. The guidelines, on acute pain management, call for aggressive pain management before, during, and after surgery. Failure to control pain not only causes unnecessary suffering but can delay recovery and prolong hospitalization, according to the accompanying AHCPR report. "This guideline discusses the actual physical damage that a patient can sometimes suffer as a result of pain," said Health and Human Services Secretary Louis W. Sullivan, M.D. "And it shows that inadequately managed pain can inhibit recovery, prolong hospitalization, and thus potentially contribute to higherthan-necessary costs." According to
Challenged OSHA Anti-smoking groups such as ASH have challenged OSHA in the courts to force a workplace smoking ban, but have so far been unsuccessful. Janes said OSHA is developing recommendations on indoor air quality, but cannot simply regulate smoking because it is linked to other air quality issues such as biological pathogens, solvents, carbon dioxide levels, temperature, and lighting. However, "if EPA publishes their risk assessment, there's going to be more pressure" on OSHA to regulate tobacco exposures, she said. —By Tom Reynolds
Dr. Louis W. Sullivan NEWS
481
News News
Not "Big Brother" The clinical practice guideline was developed by pain management experts assembled in 1990 under the sponsorship of AHCPR, an agency established in 1989. The guideline was then tested in hospitals and other settings. Sullivan said this effort is not "Big Brother" telling doctors how to treat their patients. "We will provide the best information and guidance we can, derived from a cooperative process, and based on solid research. It will be up to our health care professionals to review and apply this new information in the best way possible for patients," he said. "This pain guideline - and another to come on cancer pain - will be watershed reports," according to Assistant Secretary for Health James O. Mason, M.D., Dr. P.H., "And many future reports on Alzheimer's disease and senility, congestive heart failure, AIDS, and stroke will peacefully revolutionalize American medicine." The acute pain guideline is the first in a series of 16 guidelines commissioned by the AHCPR. The cancer pain guideline will be released within the next year. AHCPR will distribute the guideline to physicians, nurses, medical and nurs482
ing societies, health professional schools, insurers, consumer groups, and others. A patient guide, which is available in English, will be provided soon in Spanish. The clinical practice guideline and the patient's guide are available without cost from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; or by telephone at 1-800-358-9295. —By Julie A. Steele and Ellen Taylor
Awards, Appointments, Announcements The University of Miami Sylvester Comprehensive Cancer Center honored Patti LaBelle as "Cancer Awareness Spokesperson of the Year" last month at a gala in Miami. LaBelle, winner of the 1992 Grammy Award for Best Female Rhythm and Blues Vocalist, was recognized for her efforts to increase public awareness about the early detection and diagnosis of cancer, and the need for cancer research. A research laboratory also was dedicated in LaBelle's name at the university's Papanicolaou Cancer Research Building. LaBelle also serves as national spokesperson for National Cancer Minority Awareness Week, April 12-18. Marilyn Tucker Quayle was national honorary chairperson for the Miami gala, which celebrated a 5-year campaign to raise funds for cancer research at Sylvester center.
Patti LaB«lle
who has served as president for 11 years. Benacerraf, a Nobel laureate, will continue as president of Dana-Farber, Inc., the institute's parent corporation. Walsh, the Hamilton Kuhn Profey^or of Medicine at Harvard Medical SchocI, will continue as chairman of the Medical School's largest basic sciences department, Biological Chemistry and Molecular Pharmacology. Walsh has been on the Harvard faculty since 1986.
Gibbons to Stanford The former editor of Medical World News joined the staff of Stanford University Medical Center's Office of Communications recently as associate director. Don Gibbons had been with MWN since 1982 and editor from 1987 until last December. Gibbons succeeds Ron Goben, who retired at the end of 1991.
Yew Harvesting Walsh Named A new president recently assumed the helm at the Dana-Farber Cancer Institute, Boston. Christopher T. Walsh, Ph.D., succeeded Baruj Benacerraf, M.D.,
The chief of the U.S. Department of Agriculture's Forest Service issued last month a new national policy to guard against waste of Pacific yew trees, source of the anti-cancer drug taxol. Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at University of Iowa Libraries/Serials Acquisitions on May 30, 2015
Ada K. Jacox, co-chair of the federal panel that developed this guideline, there is a changing philosophy toward pain. "In the past, postoperative pain was viewed as inevitable, to be tolerated stoically. It is now clear that incompletely treated pain can slow recuperation or even provoke complications, such as pneumonia, heart attacks, or blood clots," she said. Ideally, this guideline will dispel some of the myths surrounding pain, including: Pain is necessary and builds character; infants don't feel pain; elderly patients don't feel pain; and pain medications are often addictive when given postoperatively.
