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Presumption on top of presumption [Editorial]

When it comes to the potential for on-the-job dangers, few workers can match the risks faced by firefighters. That they willingly run into places the rest of us would flee in terror, all to save our lives and property, is nothing short of remarkable. For that, we owe them not just gratitude but some degree of certainty that we will take care of them if their selflessness results in debilitating injury or disease.

The difficulty is in determining just how much certainty we owe them. As The Sun's Scott Calvert and Luke Broadwater reported on Sunday, local governments are reeling from the costs of caring for firefighters who have developed cancer and other chronic diseases. State lawmakers have steadily increased the number of conditions for which a career fighting fires is presumed to be the cause for purposes of workers' compensation claims, and local officials and attorneys who argue the cases say that effectively guarantees firefighters payments for treatment and lost wages no matter what other risk factors may be at play.

Although the potential costs to taxpayers are high, the general philosophy or presumption law is sound. It is generally impossible to prove definitively that any one firefighter's cancer was caused by job-related exposure, but the state is making the policy choice to say that it would rather pay for some cases that aren't warranted rather than fail to pay for some that are. That's why Maryland has had presumption laws on the books for nearly 30 years and why more than 30 other states have them. Another good reason for the presumption laws is that they give local governments a real incentive to invest in advanced equipment and training to reduce firefighters' levels of exposure in the first place.

But if the state is giving the benefit of the doubt to individuals that their diseases are job-related, it needs to make certain that there is a statistically significant link between firefighting and the medical conditions that receive the benefit of presumption under state law. And on that score, Maryland's legislators are falling short.

When the General Assembly voted to revise its presumption list in 2012, it did so after examining a University of Cincinnati meta-analysis (that is, a study reviewing the published scientific literature on the topic) that found a "probable" link between firefighting and multiple myeloma and non-Hodgkin lymphoma. The study ranked the links between fire fighting and increased incidence of brain and testicular cancers as "possible" and did not address breast cancer at all. Another recent study by the National Institute for Occupational Safety and Health found no statistical link between breast cancer and firefighting.

But none of that seems to have mattered to Maryland's legislators, who added all five to the list (while dropping pancreatic cancer) in 2012. As part of that law, legislators delayed the addition of the new cancers to the presumption list until the state could hire an expert and study the matter. That never happened, but the law went into effect anyway.

Michael Rund, president of the Professional Fire Fighters of Maryland union, argued against letting the lack of a study delay the law in a February 2013 letter to Gov. Martin O'Malley. At the time, he said the two sides should give "serious consideration" to the NIOSH study, which had not yet been released, and that the state could change its policy depending on the outcome. But now that the NIOSH study — by far the largest of its kind — found no link between fire fighting and most of the cancers on Maryland's list, Mr. Rund calls it "just another one of several studies."

There may never be complete unanimity of scientific findings on matters as complex as these, but that doesn't mean the state should employ no standards whatsoever. Essentially, this policy question involves two layers of uncertainty: whether a particular cancer or other condition is associated with firefighting and whether a particular individual's cancer was caused by his or her exposure on the job. The decision to provide the most generous standard for evaluating the latter uncertainty is appropriate only if the state is applying due scrutiny to the first. That isn't happening. Legislators need to decide with their heads, not their hearts, what standard of evidence is needed to include a condition on the presumption list and stick with it.

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