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Institute for Environment and Health (pp iii + 155, £10.00) 2002. Leicester: MRC Institute for Environment and Health. ISBN 1 899110 36 4
“The whole world’s odd except thee and me, and even thee’s a bit peculiar at times”
That traditional Yorkshire view has become increasingly important in the past 20 years as studies of why one individual falls ill while another stays healthy have shown the considerable influence of personal factors in the avoidance and causation of disease. It is reasonable to expect that health at work will be subject to the same range of individual factors and that they will be very important in determining the onset of work related diseases due to mechanical or physical stress, to allergens, and to chemicals.
The UK MRC Institute of Environmental Health is to be congratulated on recognising the importance of individual factors, both in their own right and as a counterpart to the averaging effect of epidemiology, by publishing this account of a discussion on major causes and consequences of individual factors in determining the range of responses to occupational exposure to chemicals. The obverse in determining what happens to the individual worker, namely variation in exposure, was left for another occasion.
The 13 original contributions, all by active British scientists or clinicians, cover the nature of the UK workforce, its general exposure to chemicals, and the surveillance schemes through which information about diseases related to chemicals may come to light (except for the wasted opportunities afforded by legal actions). Variation in the height, weight, body composition, and physical fitness of UK workers, related to age and ethnicity are discussed next, followed by six detailed chapters on the nature and magnitude of variation in lung function, xenobiotic metabolism and the implications of pre-existing diseases, current medical therapies, alcohol (but little on drugs or smoking), nutrition, and pregnancy. The final discussion brings together current views, albeit rather tentative, on the importance of individual factors in occupational health and how changing patterns of employment may affect the workforce in future.
Individual sections are tidy and clear accounts of what is known in the area covered. The anticipated “Recommendations” are a concise list of practicable ideas about confirming the importance of factors that we do understand and means to identify the existence of some that are suspected but remain to be proven.
The strengths of the book, which covers an area of proven medical and scientific importance, are that it is one of the very few recent attempts to remind us of the centrality of the individual and his or her characteristics in determining susceptibility—here to occupational exposure to chemicals. Its weaknesses are the virtual absence of consideration of immunological and psychological factors, the common problem of relating the impressive detail of differences in xenobiotic metabolism to the occurrence of chemically induced diseases, and the understated theme that is likely to underlie much work in this area in the next few decades, the libertarian approach to “Privacy” as an aggressively advanced argument against the collection of personal information likely to benefit the worker, the employer, and the nation.
Read and appreciate this IEH report as a clear reminder that the range of health and disease in the real world reflect the individual as much as the population, and as an encouraging stimulus to learn more about what it is to be an individual.
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