Setting the Record Straight: A Response to IJOEH

An Open Letter to ACOEM Members 

An article and accompanying guest commentary recently published by the International Journal of Occupational and Environmental Health (Int J Occup Environ Health 2007; 13: 404-426) inaccurately and unfairly characterize ACOEM’s historical role and current activities in occupational and environmental medicine and are based largely on unfounded and irresponsible accusations.

We are profoundly disappointed that the Journal chose to publish this material, which, in addition to being a broad-brush attack on ACOEM and the Journal of Occupational and Environmental Medicine, maligns the integrity of some of the most respected institutions in academic medicine and many other governmental and non-governmental organizations.

ACOEM stands firmly on its record of service to our members, to the broader community of health care professionals and health-related organizations, and to the general public. We welcome critical appraisal of our work. Unfortunately, rather than presenting new evidence to inform a reasoned debate about how we as a society can best advance the health and safety of workers, IJOEH has chosen to renew many outdated, one-sided accusations about historical events. Much of its analysis of problems in the practice of occupational and environmental health has nothing to do with ACOEM or the other organizations it cites. Taken as a whole, the IJOEH article offers what is essentially a giant conspiracy theory involving virtually all sectors of our profession.

The article characterizes ACOEM as exerting a negative and controlling influence over the American political and economic systems that have affected occupational health. But in making its case, IJOEH selectively quotes history, incorporates blatant misstatements of facts, ignores information widely available that refutes its assertions, and uses quotations that do not support its conclusions.   

The list below represents just a few of the articles inaccuracies and misstatements: 

• ACOEM Governance. The article states that “Some private practice and academic occupational physicians may hold office in ACOEM, but not until they prove that they are reliable enablers of the corporate medicine agenda.”  Among ACOEM’s voting membership, the vast majority (76%) are practicing occupational medicine in community-based clinics, academic, or other non-corporate settings.  Our current board reflects the make-up of our membership, with representation from community based practice, academic medicine, consultants, and corporations.  Our officers include three in academic medicine, one consultant, and one corporate medical director.  

• Beryllium. The IJOEH article includes three pages discussing the “Beryllium Example,” but no explanation is given as to what the issue has to do with ACOEM. Beyond the fact that ACOEM did not intervene in this issue, the article misrepresents historical facts surrounding Beryllium and contains inaccurate descriptions of controversies concerning a National Institute for Occupational Safety and Health (NIOSH) study “related to beryllium exposure and lung cancer that Joe Wagoner, Peter Infante, and others conducted while at NIOSH.” The article fails to acknowledge that the controversies related to this study reflected concerns within NIOSH about scientific methods and integrity -- they were not due to external pressures from industry, and had nothing to do with ACOEM.

• Legislative History: According to the IJOEH article, the “actual history of ACOEM legislative activities remains a carefully guarded secret.”  In fact, ACOEM regularly publishes its legislative and policy activities in annual reports; in newsletters; such as CDME Review; in online communications; and in speeches, public comments, and news releases.

• Workers Compensation. The IJOEH article states that “ACOEM is central to one of the country’s worst failures in public health history…ACOEM has failed to address the problems of workers’ compensation and the under-reporting of occupational illnesses and diseases. Any change in workers’ compensation will have an immediate and lasting effect on the earnings of ACOEM members, and proposed changes will continue to cause the organization to mobilize its resources to prevent any legislative efforts adverse to the interests of its corporate clients and employers.” This is flatly wrong. ACOEM has worked tirelessly for reform of workers compensation at all levels. ACOEM stands for providing the best possible evidence-based care to injured workers, values the importance of enabling the disabled, and advocates for national consistency in processes, forms, and medical care through a variety of initiatives -- ranging from our Cornerstone Project to the current efforts of the Board Committee on Government Affairs to address under-reporting of occupational illnesses and disease. Just this year, at the request of a U.S. Senate committee, ACOEM provided recommendations for improvements to the federal workers’ compensation program.

• Controlling cancer in the workplace. The IJOEH article states that  in an ACOEM checklist published last year, titled “Controlling Cancer in the Workplace,” “preventing and eliminat(ing) exposures to known and suspected carcinogens or chemicals in general are nowhere to be found.”  In reality, the introductory paragraph of the ACOEM checklist reads: “It is important to remember that many cancers are preventable by addressing workplace exposures and individual lifestyle choices.” The ACOEM statement goes on to recommend that employers eliminate cancer-causing substances in order to protect the health of their workers.

• Statement on Mold. The IJOEH article re-publishes an internal ACOEM e-mail communicating the state of the development of the ACOEM Statement on Mold and rehashes a number of outdated accusations about conflict of interest – all of which have been fully addressed by ACOEM and others in the public arena.
  
  
• ACOEM’s role in public health. In its final paragraph, the article concludes that “The specialty of occupational and environmental medicine has the opportunity to join the public health movement.  If it does, ACOEM will have no further purpose ….”  To the contrary, ACOEM is already actively engaged with the public health community, working closely with public health professionals and public health organizations at the federal and state level to join together to advance public health as a part of our overall mission. 

Despite IJOEH’s distortion of the facts, ACOEM stands behind its record of service to the public and to our profession:

• ACOEM has a clear historical record of supporting the health and safety of workers in the public arena. From our public support of the Occupational Health and Safety Act, for which we urged swift passage in 1971, to our advocacy on a wide range of health issues facing the nation at this very moment – we have asserted our leadership in public debate. Just this year, ACOEM has advocated for several measures to enhance environmental and occupational health, such as a stricter ozone standard, an OSHA standard to protect workers exposed to diacetyl, and a ban on the importation, manufacturing, processing and distribution of asbestos products in America.

• Our advocacy work is clearly aligned with the broad goals of America’s public health community. A look at our advocacy agenda shows our demonstrated support and commitment to issues such as tobacco control, pandemic preparedness, emergency preparedness, mental health parity, and migrant health.

• We are committed to integrity in research and academic medicine. ACOEM’s Journal of Occupational and Environmental Medicine is an influential and respected publication that has demonstrated its adherence to editorial independence. JOEM’s decision in 2006 to retract an article on chromium published in 1997 -- cited in the IJOEH article as evidence of “fallibility” -- is actually a testament to JOEM’s commitment to doing the right thing. ACOEM stands for the academic freedom of researchers, as demonstrated by our strong public support for physicians such as David Kern, MD, who fought a well-publicized battle while at Brown University to protect his work from outside influence.

• ACOEM continues to lead the way in establishing consistency and quality in occupational medical practice. ACOEM is the acknowledged leader in the publication of evidence-based practice guidelines aimed at enhancing the quality of prevention and care of occupational injuries and illnesses. ACOEM’s Practice Guidelines are undergoing an in-depth update with a published methodology and transparency that is considered exemplary. We have worked proactively to correct misapplication of the guidelines by insurance adjustors, and are encouraging external criticism to ensure widespread review of our practice standards.

ACOEM’s leadership is committed to its vision of an organization of physicians who champion the health and safety of workers, workplaces, and environments. I encourage you to browse our website, read JOEM or our newsletters and position papers, scan our educational offerings, and examine the depth of information in our Practice Guidelines. In the end, I am confident you will be assured that ACOEM is a strong and effective organization fully engaged in serving you and maintaining the integrity of our profession.

Your voice within ACOEM counts. Within the next two months, our website will promote a new feature that will enable an increased level of discussion by members of the most important issues being considered by the College. Please watch for more information.

In the meantime, please stay active and engaged. As always, I am interested in your thoughts.  Please write me at RMcLellan@acoem.org. 

Sincerely,

Robert K. McLellan, MD, MPH, FACOEM
President