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GENETIC SCREENING AND THE HANDLING OF

HIGH-RISK GROUPS IN THE WORKPLACE

WEDNESDAY, OCTOBER 14, 1981

HOUSE OF REPRESENTATIVES,
COMMITTEE ON SCIENCE AND TECHNOLOGY,
SUBCOMMITTEE ON INVESTIGATIONS AND OVERSIGHT,

Washington, D.C. The subcommittee met at 9 a.m., in room 2325, Rayburn House Office Building, Hon. Albert Gore, Jr. (chairman of the subcommittee) presiding.

Present: Representatives Gore, Walker, and Shamansky.

Mr. GORE. The subcommittee will come to order. I'd like to welcome all of you here this morning.

The increasing costs of making improvements in the workplace environment and the financial burdens posed by workers' compensation and similar statutes have provided many industries with a strong economic incentive to engage in preemployment screening. Such screening utilizes our increasing scientific knowledge of human variation in an effort to identify those portions of the potential workforce which are at highest risk. By selecting employees in a manner which minimizes the number of these so-called hypersusceptible workers, companies hope to decrease the incidence of occupational illness and thereby decrease the associated costs of compensation.

This morning, we begin a series of hearings which will explore the difficult issues raised by research into human variation and the application of such research to occupational settings. The subcommittee will review the methods by which high-risk groups are identified and the consequences that such classifications have for individual workers and for society at large. We will attempt to address a number of the broad scientific and policy questions:

First, how should we define high risk. Studies of asbestos workers by Irving Selikoff indicate that they are, as a group, five times as susceptible to lung cancer than other workers. They are clearly a high-risk group. Among asbestos workers, however, those who smoke are at still higher risk-perhaps up to 10 times that of their coworkers. By focusing on asbestos workers who smoke, however, do we tend to ignore the hazards faced by all who work with asbestos? Do we create a false sense of security among asbestos workers who do not smoke?

Second, how sensitive and how accurate are currently available screening techniques? Which techniques represent reliable predictors of risk? What protection should be available to job applicants who are labeled by such tests as susceptible? What protection

should be available to workers who fear loss of employment or transfer to a lower paying job?

Third, what do these tests measure? Do they attempt to identify some genetic attribute or will they reflect in older workers the effects of chronic exposure to industrial toxins?

Fourth, what types of new genetic screening techniques loom on the horizon? Which have been tried? What results have been obtained?

Fifth, how do we insure that screening will not be substituted for improvements in the workplace environment? Will plant managers view the removal of high-risk workers as a panacea for occupational exposure problems?

Finally, does the increasing use of workplace screening techniques shift the burden of occupational hazards from the employer to the employee? Instead of modifying the workplace so that it is safe for all employees, are we simply modifying the composition of the workplace to fit the existing environment? What policies should we make for the pool of high-risk employees who cannot find work? At what point does screening according to innate characteristics constitute invidious discrimination?

In addition to focusing on the broader issues, the subcommittee will focus on two specific illustrations of workplace screening: preemployment back X-rays conducted by the railroad industry and job selection based on sex in the chemical industry.

The value of preemployment back X-rays has been a matter of some debate among occupational physicians. Their use has been based on the assumption that certain developmental abnormalities detectable with X-rays accurately predict an increased incidence of low-back injury. The high incidence of such injuries poses a serious health problem for employees and a significant financial burden for employers. This case provides an excellent illustration of both the incentives to screen workers and the serious ethical and legal issues which invariably arise from such programs.

The efforts of companies to select workers for high-risk jobs based on sex illustrates additional problems which workplace screening programs create. In this case, companies in the chemical industry have excluded fertile women from certain jobs based on the presence of reproductive hazards. The scientific basis for concluding that women are at risk is not disputed; however, the legitimacy of such screening has been questioned in the light of scientific evidence pointing toward the existence of reproductive hazards to men as well.

These issues are, of course, difficult ones to resolve. With that in mind, I want to make it clear that these hearings are not in any way designed to point an accusatory finger at any group; rather, we will be focusing on specific examples of workplace screening because of their value as illustrations of the types of problems which are arising with increasing frequency in widely varying contexts, and because of our anticipation that such practices will become much more commonplace in the future.

The ultimate concern of this subcommittee in this series of hearings is with genetic engineering, and the use of medical screening techniques to identify genetic variation in the population. It is the potential identification of genetic preferences and the selection of

workers on the basis of genetic criteria which stirs the most serious concerns. The cases which we have selected for review during these first 2 days of hearings can be seen as models for analysis for more sophisticated testing. It is to this advancing genetic technology that the subcommittee will turn in later hearings this fall.

I appreciate all of our witnesses coming today and tomorrow too. We will begin with a panel of three people: Dr. Ernest E. Dixon with Tabershaw Associates in Rockville; Dr. Hans Weill, professor of medicine at Tulane University; and Mr. Sheldon Samuels, health director for Industrial Union Department for the AFL-CIO. And we will start with you, Dr. Dixon.

At this point in the record, I would like to ask unanimous consent to include the opening statement of my colleague, Mr. Walker, who may wish to deliver it when he arrives. He's driving en route from Pennsylvania this morning and is going to be here in a short time.

[Opening statement of Congressman Robert S. Walker follows:

OPENING STATEMENT OF CONGRESSMAN ROBERT S. WALKER Mr. Chairman, the hearings we shall begin this morning are an attempt by this committee to clarify a number of troubling issues which now face our society. We are becoming increasingly aware that the blessings of modern technology are often mixed.

The more we learn about the potential effects of chemical, electrical, magnetic, and radiation upon the human system, the more we realize that there are new, and sometimes insidious dangers in both the workplace and within the home.

Research is making great strides in identifying these threats. As each new threat is identified we are attempting to develop an effective response.

Today we will be hearing about new techniques which may help to identify individuals who are predisposed to certain problems. The validity of these tests and techniques have been questioned in the past by various parties. We cannot, and will not make any determination as to their validity in these hearings. We will study the testimony to determine if the techniques show promise for future alleviation of similar problems through avoidance of hazardous situations for individuals who are particularly susceptible.

In the past there have been proposals that the Government should regulate screening of this type. It is my belief that such regulation is both unnecessary and undesirable on this particular issue. I think Thomas Jefferson was absolutely correct when he said, “That Government governs best which governs least.”

Before we hear from our first witness today I would also like to add that there are both moral and ethical questions which are raised by the use of these techniques. While I have a predisposition against governmental regulation, I also realize that we in the Congress carry a heavy burden in our determinations of the proper governmental response to threats against the health and welfare of the American people. This has been an area of some controversy in the past. We hope that this hearing will either resolve that controversy, or else lead to new approaches to reduce the controversy in the future.

Mr. GORE. Without objection, we will also include the entire text of the prepared remarks of this panel of witnesses and I'd like to invite you to proceed, Dr. Dixon. Thank you for coming.

[The biographical sketch of Dr. Dixon follows:

TABERSHAW OCCUPATIONAL MEDICINE ASSOCIATES, P.A.

TABERSHAW SERVICES, INC.

CURRICULUM VITAE

ERNEST M. DIXON, M.D.
Senior Occupational Health Physician

EDUCATION:

University of Virginia, M.D., 1947.
University of Cincinnati, Doctor of Science, 1957.

SPECIALTY STATUS:

Certified as a specialist in Occupational Medicine,

American Board of Preventive Medicine, 1960.
Fellow of the American College of Preventive Medicine,

1961.
Senior Surgeon (Lt. Col.), U.S. Public Health Service

Reserve (Inactive)

EXPERIENCE:

1981

1965-1981

1963-1965

1962-1963

1958-1962

1957-1958

1956-1957

1954-1957

Senior Occupational Health Physician,
Tabershaw Occupational Medicine Associates, P.A.
Corporate Medical Director, Celanese Corporation,
New York, N.Y.
Chief Medical Officer, American Telephone and
Telegraph Company, New York, N.Y.
Headquarters Medical Director, Western Electric
Company, New York, N.Y.
Director of Medical Services, American Cyanamid
Company, Bound Brook, N.J.
Chief Physician, Cyanamid Research Laboratories,
Stamford, Conn.
Plant Physician, American Cyanamid Company,
Fortier Plant, New Orleans, La.
Fellow in Occupational Health, The Kettering
Laboratory, University of Cincinnati. The
third year of this Fellowship was devoted to in-
plant, preceptorship training in various medical
departments of the American Cyanamid Company.
U.S. Public Health Service. Internist of
industrial toxicology research team.
Private practice - internal medicine, Roanoke,
Va.
Lieutenant (j.g.), United States Naval Hospital,
Portsmouth, Va. Officer-in-charge of cardiovascular
unit of Internal Medicine Service.
Intern and resident, University of Virginia Hospital,
Charlottesville, Va. (Internal Medicine and Pathology).

1953-1954

1950-1953

1949-1950

1947-1949

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