Audiometric data analysis for prevention of noise-induced hearing loss: A new approach.

Compliance with noise regulations in the past three decades has significantly reduced workplace noise exposures, particularly in the loudest industries and occupations. However, the overall effectiveness of hearing conservation programs in preventing occupational noise-induced hearing loss remains uncertain and unquantified, while the incidence and cost of occupational hearing loss remain inexplicably high. This review/commentary critically explores this paradox by examining why the billions of annual audiograms conducted worldwide have not been aggregately utilized or applied to predict early NIHL in groups of workers or to measure the efficacy of exposure controls. Principal contributory reasons include regulation of noise as a safety standard rather than as a health standard, the inherent complexity of audiometric data, and the lack of a standardized method of interpretation for audiograms. The unsuccessful history of efforts to develop and adopt methods and tools to analyze aggregate audiometric data is described. Consequently, the Standard Threshold Shift-a regulatorily defined, lagging indicator of individual, irreversible hearing loss that is not an effective preventive metric-remains the de facto standard of care. A population-based Best Practices approach is proposed to leverage the raw audiometric data already available and turn it into actionable data for effective secondary prevention to strategically manage and reduce occupational hearing loss risk. This approach entails statistical methods and information management tools necessary to transform audiometry from a compliance-driven, individual screening test with limited preventive capability into a medical surveillance process directly linked to aggregate corrective and prevention actions.

A critique of the ACOEM statement on mold: undisclosed conflicts of interest in the creation of an "evidence-based" statement.

In 2003, the American College of Occupational and Environmental Medicine (ACOEM) published its evidence-based statement, "Adverse Human Health Effects Associated with Molds in the Indoor Environment," in its Journal of Occupational and Environmental Medicine (JOEM). ACOEM's author selection, development, peer review, and publication of its mold position paper involved a series of seemingly biased and ethically dubious decisions and ad hoc methods. The resulting position paper resembled a litigation "defense report" which omitted or inadequately acknowledged research validating the association between mold and building-related symptoms. ACOEM nonetheless released the paper as an "evidence-based" statement and then published it in JOEM without any further changes or conflict disclosure. The Mold Statement has been relied upon by attorneys and expert witnesses representing defendants in mold litigation to disclaim and invalidate individuals', families', and workers' claims of building-related health effects from indoor mold exposure.