Before the storm: Informing and involving stakeholder groups in workplace biomarker monitoring

The social, legal and ethical implications of advances in biomarker indenti fication have been discussed by scholars and environmental researchers, but not by the "everyday" professionals and workers who may eventually make an d be affected by decisions about their workplace applications. Through the use of a hypothetical scenario, this study introduced members of various pr ofessional and occupational groups to the potential uses of biomarkers rese arch on biological monitoring in the workplace. The purpose was to obtain o pinions about how events would proceed based on the scenario, leading to a broad discussion of potential uses and abuses of biomarker-based health mon itoring. Six professionally homogeneous focus groups, comprised of I) compa ny health professionals, 2) third-party payers, 3) attorneys, 4) human reso urce managers, 5) non-unionized workers, and 6) unionized workers, particip ated in focus groups presented as "think-tank" discussions in Greenville an d Charleston, S.C. Participants were given a fictitious "newspaper article" about the use of biomarker-based monitoring at a chemical plant and were a sked to comment on what they thought would happen next. The discussion expa nded to a general consideration of biological monitoring and its legal, soc ial and ethical ramifications. Data was analyzed through the " immersion/cr ystailization" method. Few participants reported any knowledge of biologica l monitoring prior to the focus group session. Some had initial difficulty understanding the concept and how it differs from other means of measuring environmental risk. Although biological monitoring was previously unknown t o many participants, occupational groups were relatively consistent in the issues they raised about its use in the workplace. In all groups, questions about potential discrimination against employees were raised. The general consensus was that the use of biomarker-based monitoring would result in co nflict and litigation without regulations to protect employees from discrim ination. Although most participants saw potential health benefits resulting from the preventive advantages associated with this technology, their conc erns about its misuses were paramount. Perceptions varied as a function of occupation. Nonunionized workers expressed the most concern about discrimin atory uses of biological monitoring. Unionized workers, who said they belie ved the union would support their interests, expressed much less concern. H ealth professionals (company physicians and nurse practitioners) were most alarmed about the "extra work" a monitoring program would create for them. Human resource managers concentrated on the company's "damage control" effo rts. Attorneys emphasized that the reliable use of such tests would establi sh a causal relationship between exposure and personal injury. The results of this project illustrate that people who are most likely to be affected b y biomarker-based biological monitoring in the workplace readily understand and are alarmed by its legal and ethical implications. It is unlikely that this technology will be fully accepted as an environmental risk assessment tool or as a prevention strategy without stringent protection of workers' rights. This study demonstrated the value of focus groups in obtaining opin ion data about an environmental risk issue that it not yet well known to th e general public.