Beyond reputation: debate on the role of corporate influence in occupational and environmental medicine.

In his article in this issue, Tee Guidotti casts recent works addressing corporate influence on occupational medicine as "collective act[s] of disparagement ... undertaken ... for political reasons." We move beyond the question of reputation to address key conflicts in the history of occupational medicine, including the American Occupational Medical Association's historical role in weakening the beryllium standard and the American College of Occupational and Environmental Medicine's recent efforts to limit the extent of the Family Medical Leave Act. The corporate practice of externalizing health and safety costs makes industry influence an important ongoing topic of debate in occupational and environmental medicine.

American College of Occupational and Environmental Medicine (ACOEM): a professional association in service to industry.

The American College of Occupational and Environmental Medicine (ACOEM) is a professional association that represents the interests of its company-employed physician members. Fifty years ago the ACOEM began to assert itself in the legislative arena as an advocate of limited regulation and enforcement of occupational health and safety standards and laws, and environmental protection. Today the ACOEM provides a legitimizing professional association for company doctors, and continues to provide a vehicle to advance the agendas of their corporate sponsors. Company doctors in ACOEM recently blocked attempts to have the organization take a stand on global warming. Company doctors employed by the petrochemical industry even blocked the ACOEM from taking a position on particulate air pollution. Industry money and influence pervade every aspect of occupational and environmental medicine. The controlling influence of industry over the ACOEM physicians should cease. The conflict of interests inherent in the practice of occupational and environmental medicine is not resolved by the ineffectual efforts of the ACOEM to establish a pretentious code of conduct. The conflicted interests within the ACOEM have become too deeply embedded to be resolved by merely a self-governing code of conduct. The specialty practice of occupational and environmental medicine has the opportunity and obligation to join the public health movement. If it does, the ACOEM will have no further purpose as it exists, and specialists in occupational and environmental medicine will meet with and be represented by public health associations. This paper chronicles the history of occupational medicine and industry physicians as influenced and even controlled by corporate leaders.

Manipulated data in Shell's Benzene Historical Exposure Study.

In 1983, in the face of mounting evidence of excess leukemia among workers at Shell Oil's Wood River (IL) and Deer Park (TX) petroleum refineries, Shell initiated the Benzene Historical Exposure Study (BHES). Shell's prior research had implicated occupational exposure to benzene as the source of the excess leukemia. The BHES report submission, which ultimately found no link between exposure and the excess morbidity, coincided with OSHA's planned hearings over a new regulatory standard for benzene. Over the next two decades, Shell published several papers based on or expanding the BHES data, all of which concluded that the excess of leukemia was unrelated to benzene. A review of the raw data on which Shell and its consultants relied reveals that Shell manipulated and omitted data in order to reach conclusions that exculpated it from liability and helped delay stricter benzene regulation.

Suppression bias at the Journal of Occupational and Environmental Medicine.

When the Journal of Occupational and Environmental Medicine rejected an article on corporate suppression of science on the grounds that the topic "was not a high priority" for journal readers, the author bought advertising space in JOEM to present his findings. The JOEM editor regretted he had not seen the ad to prevent its publication, and subsequently allowed the corporate-sponsored authors of a criticized study to respond to the advertisement. The editor then refused to allow the ad's author to respond in turn, suppressing scientific information with the apparent intent of protecting the interests and profits of the corporate sponsor. A reputable journal has a responsibility to eschew corporate interests and work to uncover science hidden by interests that do not prioritize the pursuit of truth. JOEM needs to re-examine its priorities.