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In Reply: In response to Mr Roy, we do not believe that there are inherent biases in our self-report method. We specifically addressed this issue in our article. In particular, we believe that the self-attribution method works well for pain-related conditions like headache and back pain and is less prone to overestimation bias when compared with alternatives. For instance, we have previously estimated lost productive time by ascribing all such time to conditions identified by the respondents.^1-3 We found that such estimates of lost productive time for headache, however, were higher than in our current study. We do agree that diagnostic validity is a challenge for other conditions and are currently addressing this issue for back pain and arthritis using diagnostic questionnaires.

We agree with Roy that a simple categorization of occupations by broadly defined employment categories is limited. A specific analysis by occupation and industrial categories and other work-related . . . [Full Text of this Article]

Walter F. Stewart, PhD, MPH; Judith A. Ricci, ScD, MS
AdvancePCS Center for Work and Health
Hunt Valley, Md

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