Research suggests link between Navy and silicosis
There is little equivocation in the conclusions of the key research by Philip Jajosky, MD, MPH, the former public health researcher who was ordered to leave his post as a public health researcher with National Institute for Occupational Safety and Health (NIOSH) in Morgantown, WV. Jajosky concludes that there is a direct link between dusty work on Navy ships and the subsequent sarcoidosis diagnoses of military veterans.1
In a point that seems certain to inflame Jajosky’s superiors, he concludes that lay veterans of the Navy are reliable sources for identifying work-related risks for lung disease and can be relied upon to "propose disease-related research hypotheses." That is a direct contradiction to NIOSH’s refusal to pursue the course suggested for years by a Navy veteran convinced he had found a source of occupational lung disease.
Jajosky conducted the research after the Navy asked NIOSH to determine if Navy work environments have been associated with lung diseases — some of which may have been reported as sarcoidosis. He used a case-control approach involving the modern personnel database of the Naval Health Research Center, and he also computed sarcoidosis rates using total Navy manpower data. He says previously published military data from the 1940s and 1950s were juxtaposed with current findings to gain a broader historical perspective.
The study describes sarcoidosis as "a diagnosis of exclusion, which is to be assigned only after known causes of sarcoidosis-like disease have been carefully eliminated. This is difficult when the typical clinical manifestations caused by a fibrogenic agent like silica are modified by the presence of other materials in mixed-dust exposures." In general, the study says, some sarcoidosis diagnoses may represent new work-related diseases whose causes are yet to be identified, or diseases whose causes are already known but were not carefully ruled out or were never considered.
The findings suggest the link that NIOSH had denied for years. An unexplained peak of military sarcoidosis rates appeared in the 1960s and the 1970s, along with a decline in the black/white ratio of these rates from 17:1 to 6:1. The research also revealed a decreased risk for sarcoidosis diagnoses among men who worked only on "clean ships," those with few jobs that involved grinding or other tasks creating a dusty environment. The sailors did not use respiratory protection.
Jajosky writes that "these findings are consistent with the original hypothesis that preventable, environmental exposures may cause [or increase one’s susceptibility] to sarcoidosis-like disease in naval settings." The study is the first to find work environment associations for sarcoidosis in a military setting, he says.
"The historical progression from descriptive sarcoidosis studies to detection of military work environment associations should be extended to include clinical studies of those veterans still living who are at high risk for lung disease, particularly generations of veterans with high rates of sarcoidosis," he concludes.
Jajosky goes on to conclude that "workers with firsthand experience are well suited to identify work-related hazards and propose disease-related research hypotheses."
Reference
1. Jajosky P. Sarcoidosis diagnoses among U.S. military personnel: Trends and ship assignment associations. Am J Prev Med 1998; 14:176-183.
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