BIOMARKERS, SCREENING AND ETHICS

Rapid scientific advances, such as those in biomarker technology, have made a significant impact on the ethics and practice of occupational health. Biomarkers are extensively used in occupational health practic e. In the pre-employment stage, preventive or predictive testing can b e performed. Preventive testing aims to avert accidents that may occur ii a medically unfit worker undertakes a job that he is unable to per form. For safety sensitive jobs, routine testing of a worker's functio nal capacity in the actual job would suffice in most cases. However, a recently quotes application of a test is the screening for mutations of the cardiac myosin-heavy chain and troponin genes among asymptomati c persons with a family history of sudden death from hypertrophic obst ructive cardiomyopathy. Predictive testing hopes to forecast the risk of a worker developing an illness. The aims may vary. One aim may be t o exclude a susceptible worker from working in a hazardous environment . Another aim may be to avoid employment of a worker who is likely to develop an illness which could lead to higher employer health care cos ts. A pertinent question to consider is whether the test undertaken is to benefit the individual or to fulfil some administrative or financi al need. Among exposed workers, screening may be conducted for biomark ers of exposure or effect. As the aim is to prevent the onset of clini cal illness, the physician must lake responsibility for initiating req uests for screening. The appropriate response to the effect of technic al and societal advances on ethics is the updating of ethical guidelin es by the profession. However, in the context of unvalidated biomarker s being used for screening, it may be necessary to require a regulator y body to ensure that the tests are accurate and effective, and that t hey are not used to discriminate against individuals.