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 practice. In the pre-employment stage, preventive or predictive testing can be performed. Preventive testing aims to avert accidents that may occur if a medically unfit worker undertakes a job that he is unable to perform. For safety sensitive jobs, routine testing of a worker's functional 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 asymptomatic persons with a family history of sudden death from hypertrophic obstructive cardiomyopathy. Predictive testing hopes to forecast the risk of a worker developing an illness. The aims may vary. One aim may be to 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 costs. A pertinent question to consider is whether the test undertaken is to benefit the individual or to fulfil some administrative or financial need. Among exposed workers, screening may be conducted for biomarkers of exposure or effect. As the aim is to prevent the onset of clinical illness, the physician must take responsibility for initiating requests for screening. The appropriate response to the effect of technical and societal advances on ethics is the updating of ethical guidelines by the profession. However, in the context of unvalidated biomarkers being used for screening, it may be necessary to require a regulatory body to ensure that the tests are accurate and effective, and that they are not used to discriminate against individuals.