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Not expected to come down hard against OSHA regs
The Institute of Medicine’s new report on the impact of proposed federal regulations aimed at protecting health care workers from becoming TB-infected on the job is expected to make print by the end of the first week in January.
Onlookers holding their breaths might have been forgiven for comparing the wait on the IOM report to a certain other process holding the nation’s attention last month.
"The IOM report will be sort of like the impact of the Supreme Court of Florida’s decision on the presidential election," says Ed Nardell, MD, chief of pulmonary medicine at the Cambridge (MA) Hospital and TB control officer for the Massachusetts Department of Health. By that, Nardell means that if the IOM comes down hard against new federal regulations, it’ll be tough for the Occupational Safety and Health Administration (OSHA) to keep pressing its case for passage of the new rules.
Tantalizing hints suggest that’s not about to happen, however, and that the IOM report, like the popular vote, will probably reflect a broad consensus — suggesting that neither the pro- nor the anti-OSHA forces had succeeded in winning committee members over to their respective viewpoints.
Besides, coming down for or against the proposed OSHA regulations wasn’t really the IOM committee’s charge, says Marilyn Field, the health policy expert at the IOM who acted as project officer for the IOM report. "We weren’t asked to make recommendations, but rather to try to answer three questions," she says. Those questions were:
— What are the occupational risks of TB?
— How closely are employers already following the 1994 Centers for Disease Control and Prevention guidelines?
— What are the likely effects of passage of the proposed new OSHA regulations?
"The fact that we weren’t really asked to address the question of whether the OSHA rules would be good or bad frustrated some on the committee at times, I think," says Field. "As you know, the evidence base is limited and mixed for a number of these questions. That made it hard to do traditional scientific research."
Besides, drawing such sweeping conclusions would take lots of time and money, two resources allotted to the committee in only modest portions, Field adds. "This was, in fact, a short-term project on a small budget," she points out.
The IOM committee met just three times, in April, August, and September. After the third meeting, the committee went to work and wrote its report, which by last month was out the door and off to a three-layer process of review.
First, Field says, a set of experts subjected the report to a peer-style review. Next, a coordinator was charged with sifting through reviewers’ comments and passing on final changes in the text suggested by reviewer comments. Finally, the edited report was due to be sent off to a National Academy of Sciences-appointed monitor, whose job was to make sure the reviewers had done their jobs properly.
All that was expected to take time; with Christmas holidays looming, Field was guessing last month that final publication of the report would likely be delayed until at least Jan. 10, more than a week past the originally scheduled end-of-year deadline.
The report will reflect a "considerable amount of consensus," says Field. "The aim is to reach a consensus, but not just to arrive at the lowest common denominator of agreement," she notes. "I think we’ve done that." Enough agreement was reached that no committee members felt the need to insert signed dissenting opinions, as they might have done, and everyone emerged feeling satisfied their point of view had been presented satisfactorily.
The report is expected to run seven chapters long, counting background papers presented in draft form at the three meetings. In length, it should about equal last year’s IOM report on TB (titled "Ending Neglect").
At the OSHA offices in Washington, DC, project officer Mandy Edens, MPH, was sanguine as the last days of the year ticked by. "I guess if the report concludes that there’s no TB in the United States, and thus no need for an OSHA standard, we’d have to pull back and reconsider," she says. "But if you read the other IOM report on TB, it says plainly that now is not the time to stop worrying about TB."
Edens was equally unflappable about the prospect of an anti-regulatory Republican moving into the White House. "We’ve had stuff passed under other Republican administrations," she says.