Home
Current Issue
Past Issues
Support
About IJME
Apr-Jun2002-10(2)
COMMENT
Occupational health
physicians: unwilling or unable to practise ethically
Murlidhar V
David Kern discovered a cluster of cases of
interstitial lung disease among employees of Microfibres Inc. a synthetic
textile manufacturing company in Rhode Island (1)..Dr Kern was head of the
department of occupational and environmental health at Brown University's school
of medicine, Rhode Island, USA. At first accepted as consultants by the plant
management, the team met increasing resistance to its efforts as it uncovered
evidence of work-related causes of the disease and attempted to communicate its
findings to both workers and the union. Ultimately the plant's management
dismissed the occupational medicine team and threatened legal action if it
presented or published its scientific findings. Both the hospital and university
administrators attempted to thwart the team's efforts to publish its findings,
and colluded in summarily terminating the occupational health programme and Dr
Kern's employment contract.
The Kern saga illustrates the conflict-prone nature
of the practice of occupational medicine. Even if one tries to ignore the
politics, the potential for conflict is ever present. Private medical schools
struggling for funds depend on industry. Hence it is not surprising that the
services of Dr Kern were terminated. He got a lot of support online from
professionals all over the world, but in the end it was business as usual for
the company. In Bangkok, Thailand, Dr Orapun was head of the occupational health
department, a governmental body. She recorded cases of lead poisoning among
workers of the multinational company Seagate that manufactures PC hard disks.
The Thai government sacked Dr Orapun and her staff and shut down the
occupational health department.
The above two incidents, one each from a developed
and a developing country, are common wherever economic motives prevail and
workers are put at risk for the sake of 'competitiveness'. Threats of factory
closure or relocation are made to hold off investments required to address
health risks.
In newly industrialised economies like South Korea,
the situation is very bad for the occupational health physician. Let us take one
example. A series of cases of carbon-di-sulphide poisoning was noticed in the
Wonjin Rayon plant which had been imported into south Korea from Japan in the
1960s. Dr Rokho Kim served as an independent medical consultant in the case.
Some victims were compensated after a long drawn-out struggle between the union
and the management. One worker, who had been diagnosed as Carbon -di-sulpfide
poisoning by Dr Kim, was denied access to medical treatment by a new medical
committee (set up after the government thought that Dr Kim was too close to the
workers), and hence died of cerebral haemorrhage within two months. After the
worker died, it became a public scandal when the widow refused to have a
funeral, but instead decided to stage a sit-in demonstration with other poisoned
workers, placing her husband's coffin in front of the company gates. The sit-in
lasted four months and faced severe police atrocities.
Dr Kim's performance as an occupational physician
was at odds with the interests of business and the authoritarian government. His
harassment continued for many years. When he was to leave for Boston for his
doctoral training, at the last minute he was stopped at the airport and his
passport confiscated. He was forced to co-operate in his own investigation. He
was brought to a cell in a secret police building in central Seoul for
questioning. It was a notorious torture chamber. (In 1987, a college student was
tortured to death by drowning in such a cell.) There was a one-way mirror at the
door where superiors taped the interview for review. All this was done without a
warrant. He was asked about his college friends and asked repeatedly if he was a
communist (professing communist ideas is illegal under the National Security law
of South Korea). The accusations ranged from questioning his editorial writings
(purportedly containing socialistic ideas) to alleging that he had instigated
the company to go on strike. His family members also were questioned and
humiliated. Many years later he was cleared of all accusations except one: the
crime of 'interfering with business'.
In India even though our law does not penalise the
person for diagnosing an occupational disease, doctors take the easy way out by
not issuing medical certificates that a disease was contracated as a result of
the person's occupational risk. In 1995, to take one example there was no
occupational disease recorded in the annual report of the Workmen's'
Compensation Act (2). Studies sponsored by industry in medical colleges would
obviously not talk about occupational disease. Even if they do discover
occupational diseases in the course of the study, they are kept secret, and this
information is inaccessible even to the institution, leave alone the affected
worker. Hence in matters of occupational and environmental health, doctors must
take sides if people and society are to benefit.
References:
1. Kern David G. The unexpected result of an investigation of an outbreak of occupational lung disease. Int J Occup Environ Health 1998;4:19-32.
2.Annual review of the Workmen's Compensation Act, Government of India, 1995.
1. Kern David G. The unexpected result of an investigation of an outbreak of occupational lung disease. Int J Occup Environ Health 1998;4:19-32.
2.Annual review of the Workmen's Compensation Act, Government of India, 1995.
Dr Murlidhar V,
Occupational Health and Safety Centre, 6 Neelkant Apartments, Gokuldas Pasta
Road, Dadar (E), Mumbai 400 014.www.ohscmumbai.org.