Developing a Framework for Sensible Regulation: Lessons from OSHA's Proposed Ergonomics Rule

Injuries caused by workplace activities that involve repetitive motion, known as musculoskeletal disorders (MSDs), increasingly concern workers, employers, and regulators because of their frequency and high treatment costs. The Occupational Safety and Health Administration (OSHA) recently proposed a national rule designed to reduce the workplace risk of MSDs. OSHA estimates there were about 626,000 MSDs in 1997, representing about one-third of all serious nonfatal workplace injuries and illnesses. OSHA estimates the proposed rule will cost $4 billion per year and generate$9 billion per year in benefits. Yet, OSHA does not provide sufficient evidence that private markets are failing to reduce MSD risk without government intervention and does not convincingly demonstrate that the rule will result in more good than harm. Unless OSHA effectively addresses some of the more serious flaws in the proposed rule, OSHA should not proceed with the final regulation. OSHA should more carefully evaluate the nature and extent of MSDs in the workplace than it did in the proposed rule and use improved economic analysis to target serious MSDs that employers can reduce at low cost. Furthermore, OSHA should include new provisions to improve employer access to information about reducing workplace risk of MSDs. The rule's ergonomics program requirements should apply only to those MSDs which employers do not have sufficient incentive to reduce without government intervention.

The Mismatch between Australian Population and General Practice Medical Workforce

Aims: To review and analyse Australian general practitioner's workforce data for the 2000 to 2010 period by comparing this to Australian population trends and to make informed recommendations about GP workforce planning. Study Design: Descriptive analysis of the available Australian government data on GP workforce and the Australian population between 2000 and 2010. Place and Duration of Study: Griffith University, Australia, between April and November 2011. Methodology: Australian GP workforce data for the 2000 to 2010 period was obtained from the Australian Department of Health and Ageing (DoHA) website and population data was obtained from the Australian Bureau of Statistics website. A descriptive analysis of workforce trends using variables of interests such as overseas trained GPs, gender, age, professional services during the 11 year period was compared to population trends data. A new GP Workforce Index ratio (GPWIR = No. of GPs <35yrs 砎o. of GPs 35yrs to 64yrs of age) was derived from the data and calculated for each year of the study period. Results: The ratio of female to male GPs has increased by 35% and the percentage of overseas graduates has increased by nearly 35% in the 11 year period, an indication that the 0.12% number of GPs as a percentage of Australian population between 2000 and 2010 was only sustained by increasing the intake of foreign trained graduates. Vocationally registered GPs have increased by 20% in same period. The GP workforce index ratio (GPWIR) decreased from 0.223 in 2000 to 0.118 in 2007; this was followed by a slight increase from 0.120 in 2008 to 0.128 in 2010. Conclusion: The impact that an increase in the number of female GPs graduating from medical schools may have on the overall number of GP services available to the Australian population requires further study, since it was noted in the literature that female GPs are more likely to work part-time than male GPs. The GPWIR may be a useful indicator for evaluating the proportion of the <35yrs old GPs as a proportion of overall GP workforce. Lower GPWIR may be associated with GP workforce shortage. GPWIR increased in the last 3 years of the study corresponding with an improvement in GP supply. In this study, the GPWIR proved to be more effective in predicting overall National GP workforce shortage trend than the DoHA GP per Population ratio of 0.71:1000 (Primarily used for regional and rural workforce shortage prediction). The Department of Health and Ageing may need to keep supporting rural and remote migration of GPs and also maintain an increase in the number of students entering medical schools.Griffith Health, School of Nursing and MidwiferyFull Tex

Assessing the Quality of Regulatory Impact Analyses

This study provides the most comprehensive evaluation of the quality of recent economic analyses that agencies conduct before finalizing major regulations. We construct a new dataset that includes analyses of forty-eight major health, safety, and environmental regulations from mid-1996 to mid-1999. This dataset provides detailed information on a variety of issues, including an agency's treatment of benefits, costs, net benefits, discounting, and uncertainty. We use this dataset to assess the quality of recent economic analyses and to determine the extent to which they are consistent with President Clinton's Executive Order 12866 and the benefit-cost guidelines issued by the Office of Management and Budget (OMB). We find that economic analyses prepared by regulatory agencies typically do not provide enough information to make decisions that will maximize the efficiency or effectiveness of a rule. Agencies quantified net benefits for only 29 percent of the rules. Agencies failed to discuss alternatives in 27 percent of the rules and quantified costs and benefits of alternatives in only 31 percent of the rules. Our findings strongly suggest that agencies generally failed to comply with the executive order and adhere to the OMB guidelines. We offer specific suggestions for improving the quality of analysis and the transparency of the regulatory process, including writing clear executive summaries, making analyses available on the Internet, providing more careful consideration of alternatives to a regulation, and estimating net benefits of a regulation when data on costs and benefits are provided.

Assessing Regulatory Impact Analyses: The Failure of Agencies to Comply With Executive Order 12,866

None.Environment, Health and Safety, Regulatory Reform

Specific binding of luteinizing hormone to leydig tumor cells

A radioimmunoassay was used to detect luteinizing hormone (LH) bound to washed Leydig tumor cells. Tumor cell suspensions were incubated with LH at 37&#176; and washed repeatedly by centrifugation with isotonic 0.9% NaCl solution. The tumor cells contained large quantities of LH even after they were washed sufficiently to produce a 106-fold dilution of unbound LH. Six washings (106-fold dilution) were no more effective in removing LH from the cells than three washings (103-fold dilution). Binding was not influenced by the temperature at which the cells were washed. The extent of LH binding was related to the number of cells, with approximately 5300 &#177; 960 molecules of LH bound per cell. LH binding was also proportional to the same concentrations of LH which produced a steroidogenic dose response curve. The binding constant of 1.5 &#215; 10-8 m was considered to be higher than that expected for nontumorous tissues. Tumor cells bound more LH than did erythrocytes or thymocytes under the same conditions

Cessation of steroidogenesis in leydig cell tumors after removal of luteinizing hormone and adenosine cyclic 3',5'-monophosphate

Luteinizing hormone (LH), but not follicle-stimulating hormone or prolactin, was shown to enhance steroid synthesis of Leydig tumor cells in vitro. Adenosine cyclic 3',5'-monophosphate (cAMP) duplicated the effect of LH. Removal of LH from the medium within 1 hour of incubation by washing the cells had no effect on the rate of steroid synthesis previously stimulated by LH. Under these conditions, addition of LH antiserum was required to reduce steroid synthesis. In contrast, removal of cAMP by washing the tumor cells caused a rapid termination of the previously induced steroidogenesis. Cycloheximide reduced the steroid synthesis initiated by LH. These results suggest that (a) steroidogenesis may be controlled by short lived factors (proteins), (b) LH may be required continually to elevate cAMP levels to maintain steroid synthesis at stimulated rates, and (c) that LH is probably bound to the tumor cells