Ethical, legal, and social issues of the use of biomarkers in occupational safety and health research and practice.
Applying Biomarkers to Occupational Health Practice, Santa Fe, NM, March 24-25, 2003. Atlanta, GA: Centers for Disease Control, 2003 Mar; :20
Biomarkers are powerful tools that can be used to assess exposure, monitor and screen populations, target interventions, assess causality, diagnose disease, and provide early warnings of risks. The prevailing wisdom is that biomarkers should not be used in occupational safety and health research and practice until the ethical, legal, and social issues have been considered. What are these issues? They may be organized into four target categories: (1) the rights of participants who provide specimens; (2) validity and utility of biomarkers; (3) actions taken because of biomarker information; and (4) social implications of biomarker use. In research, the participant goes through a process of informed consent, which is the societal means of protecting autonomy and guarding against maleficence. To use a marker in occupational safety and health practice requires a demonstration of validity and clinical utility. The use of an invalid or unvalidated marker in practice can be considered maleficent (capable of doing harm) even when ethical protections are in place. In occupational health practice, many of the components of the informed consent process in research apply. Generally, a person has a right to be informed of the purposes of the specimen collection and how the information will be used. To some extent, these protected rights do not exist in practices such as post-job-offer medical placement examinations or independent medical examinations in workers compensation proceedings. The use of biomarkers has social implications that can easily have the potential to shift emphasis from controlling the environment to controlling the worker. They can be used to stigmatize groups, some with a history of disadvantages. Ultimately the use of biomarkers needs to be considered as a question of distributive justice. Are scarce public health resources being devoted to biomarker efforts when other approaches may be cost effective, less discriminatory, and just as informative? Researchers, practitioners, and decision-makers should consider this question when using biomarkers. When ethical, legal, and social issues of biomarkers are addressed, they can serve as useful and powerful tools to study and control occupational diseases.
Biomarkers; Exposure-assessment; Occupational-exposure; Workplace-studies; Risk-analysis; Occupational-diseases
Abstract; Conference/Symposia Proceedings
Applying Biomarkers to Occupational Health Practice, Santa Fe, NM, March 24-25, 2003