Philosophic perspectives: community, communications, and occupational disease causation.

The caste in which workers and occupational health practitioners find themselves is plagued by intertwined but separable conflicts. A Cartesian model of causation, useful in the demonologies of regulation and toxic torts, is not heuristic in the revisions of health care, worker's compensation, and disability systems, nor in the prevention of violence in the workplace. Outside the caste, science progresses beyond mind-body bifurcations, the adverse effects of which are magnified within the caste. An argument is made for an ecological concept of causation, drawn from Darwin's community approach to the web of causal factors in both cultural and biological evolution, subsequently stimulated and developed by G. H. Mead and by biologically oriented and sociologically oriented human ecologists for application in the workplace. The ecological model is found in occupational biomedicine as practiced by leaders as diverse as Tichauer and Selikoff. The model integrates environmental, lifestyle, and genetic vectors in a community system bonded by communication and embracing a view of work unbifurcated from other activities.

Ethical and metaethical criteria for an emerging technology: risk assessment.

This paper examines ethical criteria for the shaping of an emerging technology applied internationally in environmental regulation: quantitative risk assessment-risk management. The role of the physician in its application, especially in the genetic testing that will be employed, underlines the importance of understanding the nature and prospects for reshaping of this technology to enable ethical practice. The Cartesian or mechanistic model (which currently dominates the technology) excludes factors of emotion, making the connection between assessment and management unfruitful functionally and ethically, and makes the model unresponsive to human needs. The emotional factors, nested and mediated in the organic hierarchy of the ecologically-defined community, constitute key psychological, social, cultural and political elements of the total burden of risk. Ethical criteria consistent with an open society are suggested for reshaping the model to enable effective management.

A moral history of the evolution of a caste of workers.

Using a dialectic method of philosophic inquiry, the actual ethical, legal, and social situation associated with genetic testing of beryllium-exposed workers in Department of Energy nuclear weapons facilities for markers of chronic beryllium disease is described. The cultural evolution of a caste system in a similar situation, and its social and biological implications, among uranium miners in the Erz Gebirge of Central Europe and on the Colorado Plateau of the United States, marked by suicide and lung disease, including cancer, is also described. The historically persistent social disease resulting from these situations. The Masada Syndrome, named from an analogous situation in biblical times, is characterized. Cultural intervention, a necessary condition for the ethical progression of the Human Genome Project, is outlined.

An open systems approach to risk assessment.

The development of risk assessment in occupational and environmental cancer control is outlined, with emphasis on the differing assumptions of Doll and Selikoff. These differences are explained by philosophic perspectives from which closed and open system approaches to assessment were respectively chosen. Open system, with negative entropy and progressive organization, are characteristic of living systems and, heuristically, should be characteristic of risk assessment models. The abuse of either approach occurs when the "habit of truth" is overcome by consciously contrived confusion, a betrayal of society by les clercs.

The ethics of choice in the struggle against industrial disease.

This article argues that broad recognition of the ethical basis for society's decisions about the reduction of the risks of workers, including notification, has been, is, and will be a more persuasive method of establishing programs implementing the rights to know and act in controlling the industrial vector in human disease than sheer power politics. If the argument is correct, then attention needs to be focused on the nature of the ethics of choice. The moral dialectic in the history of science and medicine is traced to the metaphysically assumed values of open and closed models of knowledge and action that determine how we weigh genetic and environmental factors in the process of choosing who shall live and who shall die of disease, with strong industrially generated vectors. The author suggests that we escape from the concepts of the closed systems of the past, whose grammar reflects values repugnant to the empowerment of those notified of risk, to open systems that enhance community-ecologic values of life and freedom.

Medical surveillance: biological, social, and ethical parameters.

The need for a graded response to environmental risks, including the need to extend medical surveillance, for which screening is one tool, to populations at high risk of occupationally attributable disease is discussed from ethical, social, and biological perspectives. Ethical judgments need to be understood in terms of their derivation and implications in the form of rights or criteria for moral management of such populations. These rights must be exercised in an appropriate social context enabling the right-to-know and notification. Discussion of the biological perspective heuristically is conducted in terms of "population thinking." Critical methodologic problems emanate from this approach that impact on deterministic orientations in the interpretation of individual surveillance data. Nelson's concept of "added burden of risk" is seen as a valid postulate for management of populations at risk.