A Reply to Rothenberg
A Reply to Rothenberg
复制标题
对罗滕伯格的回复
DOI：
10.1044/jshd.4702.220
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
J. R. Smitheran
中科院分区：
文献类型：
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作者：
T. Hixon;J. R. Smitheran
有必要对 1981 年 5 月号中的一封可能具有误导性的信件做出回应。亚利桑那大学的 Anne HB Putnam 在题为“小心……花生可能对您客户的健康有害！”（Putnam，1981）的标题下揭露了有关油吸入毒理学的信息。她讨论油（特别是花生产品中发现的油）的吸入毒理学的原因集中在言语和听力测试的正强化模式上。这种言语和听力测试中的强化有时显然是有用的，这似乎就是这封信找到 JSHD 的原因。然而，普特南已经积累了足够的关于吸入油的不利影响的毒理学信息，表明这种形式的测试中使用的花生产品由于其油含量可能对客户造成潜在危害。从毒理学的角度来看，这个建议是完全荒谬的。毒理学核心的基本概念是不良反应的剂量反应曲线。简而言之，给药剂量越大，反应或副作用越大。因此，如果剂量足够，任何通常无害的物质都可能有害。考虑一下帕特南描述的客户从吸入的花生颗粒中获得的油的“剂量”。这个量远远低于人们从花生中榨取的几乎可以忽略不计的量。 Putnam (Robbins & Cotrau) 引用的关于类脂性肺炎病理学的参考文献指出，“婴儿和儿童通常会因抵抗力而被迫吞咽鱼肝油，从而吸入油”（第 826 页）。这使得看起来需要意外地吸入相当数量的油（大约一茶匙）才能产生不利影响。购买花生产品的客户的肺部肯定不会存在这种量的油。只需考虑一下这个国家食用的花生数量，而没有将类脂性肺炎列为潜在危险。普特南的信中提出的另一个引起毒理学兴趣的基本问题是风险评估。该过程将“危害”（药剂的内在毒性）与“风险”（可能受到有毒剂量的概率）分开。吸入花生导致类脂性肺炎的危害几乎不存在，因此风险极低。从逻辑上讲，固体物体吸入肺部造成窒息的危险很高，因此吸入花生造成窒息的风险也很大。冒着听起来有点刺耳的风险，临床医生可以认真担心类脂性肺炎的发展和伤害有可能吸入花生的客户，而不担心窒息，这似乎很荒唐。令人高兴的是，帕特南担心因吸入花生而患上类脂性肺炎的客户因医疗事故而被起诉，这似乎是没有根据的。因此，这应该使她能够避免进一步涉足毒理学，并将自己限制在与言语和听力有关的问题上。
A response is necessary to a potentially misleading letter in the May, 1981 issue. Under the title," Caution.,. Peanuts May be Harmful to Your Clients' Health!",(Putnam, 1981) information concerning the inhalation toxicology of oil was brought to light by Anne HB Putnam of the University of Arizona. Her reasons for discussing the inhalation toxicology of oil, particularly the oil found in peanut products centered on a positive reinforcement mode of speech and hearing testing. This type of reinforcement in speech and hearing testing is apparently sometimes useful, and seems to be the reason that this letter found its way to JSHD. However, Putnam has accumulated enough toxicological information concerning the adverse effects from the inhalation of oils to suggest that the peanut products used in this form of testing can bepotentially harmful to the client because of their oil content. From a toxicological standpoint this suggestion is completely absurd. A rudimentary concept central to toxicology is the doseresponse curve of adverse effects. Simply, the greater the dose administered, the greater the response or adverse effect. Accordingly, any normally innocuous substance is potentially harmful if the dose is sufficient. Consider the" dose" of oil a client described by Putnam would receive from an inhaled peanut particle. This amount is far less than the virtually negligible amount one would be able to squeeze from the peanut. The reference cited by Putnam (Robbins & Cotrau) concerning the pathology of lipoid pneumonia states that" aspiration of oil is usually encountered in infants and children who are forced to swallow cod liver oil against their resistance"(p. 826). This makes it appear that an appreciable amount of oil, on the order of a teaspoonful, need be accidentally inspired to produce the adverse effect. This quantity of oil is certainly not going to be present in the lungs of a client inspiring a peanut product. Simply consider the number of peanuts eaten in this country without lipoid pneumonia being cited as a potential danger. Another fundamental question of toxicological interest raised by Putnam's letter is one of risk assessment. This process separates the" hazard"(the intrinsic toxicity of an agent) from the" risk"(the probability that a toxic dose can be received). In the case of inhaled peanuts causing lipoid pneumonia the hazard is barely existant, and hence the risk is extremely low. Logically, the hazard of asphyxiation from a solid object inspired into the lungs is high, and therefore the risk of asphyxiation from an inspired peanut is great. At the risk of sounding somewhat shrill, it seems ludicrous that a clinician can seriously worry about the potential of lipoid pneumonia developing and harming a client who has the potential to inhale a peanut, and not be concerned about asphyxiation. Happily, it appears that Putnam's fears of being sued for malpractice by a client who has developed lipoid pneumonia from peanut inhalation are groundless. This should therefore enable her to refrain from dabbling further in toxicology, and limit herself to matters related to speech and hearing.