Saturday, September 02, 2006

ACOEM: Embarrassing Themselves Yet Again

It's almost Labor Day, and once again that time of year for the American College of Occupational and Environmental Medicine (ACOEM) to drive me crazy. ACOEM is the professional organization representing the country's physicians and other health care professionals who in the field of occupational and environmental medicine.

Every year, as an organization representing physicians whose main field of activity is the workplace, ACOEM identifies a topic for its "Labor Day Checklist" which is designed to provide "'quick tips' to assist both employers, employees, and the general public in improving the health and safety of workers and the workplace." Two years ago, I blasted them for making obesity their Labor Day checklist.

It was true, I pointed out, that being fat is not very healthy for anyone, and thinner workers are better, healthier workers. And it's certainly not a bad thing to educate people about how to eat better. But, I wrote,
That shouldn't be the central focus of an association that is first and formost "devoted to prevention and management of occupational and environmental injury, illness and disability."
Especially, with all of the other exclusive workplace problems that ACOEM could have been bringing to the nation's attention:
We have an epidemic of immigrant worker death, injury and illness. Asbestos-related illness remains a serious nationwide problem, and millions of workers face harmful exposure to toxic chemicals about which we know very little. Year after year, OSHA "enforces" the same forty year old chemical standards for a tiny fraction of the chemicals used in this country. Meanwhile, OSHA, the only government agency charged with enforcing safe workplace conditions is rapidly turning into a poorly funded business consulting association while thousands of workers die every year from perfectly preventable "accidents."
Last year, ACOEM's checklist focused on the hazards of airline travel -- bloodclots, food poisoning, and dry eyes -- most certainly threats that subset of workers who fly a lot, though nothing that seems to ever make OSHA's top ten (or top 1,000) list of things that kill workers. Somehow, that "checklist" failed to make it onto my radar screen (or anyone else's as far as I could tell.) Hazards faced by flight attendants and ground crews, on the other hand, might have had more impact.

Now, let's fast-forward to Labor Day 2006. This year's theme is "Controlling Cancer In The Workplace." Aha! I thought, they're back on the track of real workplace hazards. Look at the epidemic workers who are still dying of asbestos-related cancers and other carcinogens that they were exposed to decades ago. Look at all the farm workers who are being exposed to cancer causing pesticides, high-tech workers being exposed to poorly tested, high tech chemicals, hospital workers being exposed to "chemo" drugs, and the hundreds of known or suspected carcinogens that haven't been regulated by OSHA.

According to the National Institute for Occupational Safety and Health,
Based on well-documented associations between occupational exposures and cancer, it is estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in the U.S. are attributable to occupation.

Millions of U.S. workers are exposed to substances that have tested as carcinogens in animal studies.

Less than 2% of chemicals in commerce have been tested for carcinogenicity.
Hazards Magazine has an excellent report on occupational cancer that includes a handy list of occupational carcinogens from a September 2005 University of Massachusetts Lowell report that illustrates the scope of the problem (click to make it larger),

So imagine my surprise horror when I read further about ACOEM's checklist, which, it turns out
was developed in conjunction with the CEO Roundtable on Cancer, which has developed the CEO Cancer Gold Standard™ (, a series of cancer-related recommendations for employers to fight cancer.
An then there was this:
The identification of occupational cancers and the reduction of occupational cancer rates in the United States due to uncontrolled exposures has been a major public health success and how to do it is well known, but more remains to be done,” said ACOEM President Tee L. Guidotti, MD, MPH, FACOEM.
Yeah, well I'd wager there are more than a few workers out there who might not share that optimism.

On the other hand, we can probably all agree to this (at least with the exception of the last phrase):
“Cancer remains a leading cause of lost productive and otherwise vital years, including among younger workers. We know that many cancers are not recognized as arising out of work because they occur years after exposure, often after retirement. We need to recommit ourselves to prevent cancer and to make work as safe as it can be, and this year’s Checklist is a first step” he continued.
But check out the actual checklist that purports to deal with cancer in the workplace. Under "prevention," we have (in the following order): don't smoke, get more exercise and eat better. Then there are recommendations to get checkups (early detection), get access to quality care and clinical trials ("To be certain that you receive the best available care should a cancer diagnosis become a reality,") and last (and apparently least), "reduce exposure to workplace carcinogens." And why, you may ask, is reducing exposure to workplace carcinogens not listed in the "prevention" category, instead of being tossed in at the end, more or less as an afterthought?

The answer to that question may lie in the checklist's "General Guidance," to learn about and implement the CEO Cancer Gold Standard™. At first superficial glance, based on the individuals highlighted on the home page and the "Accredited Companies," the CEO Cancer Gold Standard™ seems to be some kind of spawn of the pharmaceutical industry.

But let's look deeper.
The CEO Cancer Gold Standard™ defines what CEOs and their organizations can do to prevent cancer, to detect it early, and to ensure access to the best available treatment for those who are diagnosed with cancer. (emphasis added)
"For those who are diagnosed with cancer." So much for prevention. The CEO Cancer Gold Standard™ is apparently only for the losers of the great cancer lottery.

But not so fast. Clicking a bit deeper, we find that they are, in fact, concerned with "risk reduction." In fact, the first three "pillars" of The CEO Cancer Standard™ are those three same cancer fighting Musketeers that we just read about: smoking, eating and exercising, followed by early detection and access to quality care. Only one thing missing: reducing exposure to workplace carcinogens. Also missing from the "Resources" page are any mention of OSHA, NIOSH or EPA. How could the CEO's have missed them? I'm shocked, SHOCKED.

Alls of which brings me back to pretty much the same conclusion that I wore two years ago, only replacing "obesity" with "tobacco use (and exercise and nutrition.)"

Again, I'm not saying that discouraging smoking and encouraging better diets and exercise are bad things. In fact, they're good things to advocate and they're not necessarily inconsistent with the rest of ACOEM's mission, to promote the "health and productivity of workers, their families, and communities."

But the question is whether this is where ACOEM should be putting its emphasis, particularly on Labor Day. There is not shortage of institutions -- public and private -- promoting the war against smoking or the benefits of excersize and good nutrition, whereas almost no one (with the exception of labor unions and a handful of health and safety activists and enterprising reporters) is making any serious attempt to focus the public's attention on the continuing carnage in America's workplaces, the continuing threat of workplace cancer, the attempt of corporate America and their Republican allies in Congress to take any information about chemicals causing cancer off of Material Safety Data Sheets.

Instead of spending their time and resources telling people they smoke too much and don't eat well, occupational physicians, organized by ACOEM, could use this opportunity to call attention to real threats in the workplace, and the sick, injured and dead workers that almost no one else in this country seems to know or care about. For a workplace health organization like ACOEM to just melt into the throngs and choose smoking and diet as the main focus of their anti-cancer campaign this Labor Day is once again, as one occupational physician put it two years ago, "an embarrassment to occupational medicine."

What a waste™.