Sunday, May 14, 2006

The US Workplace-"The Forgotten Environment"

The 91st Annual American Occupational Health Conference, my own medical specialty’s most well attended annual conference held last week, brought me back to Los Angeles,California which I hadn’t visited in over a decade. Well, the City of Angels still impresses me as a unique but quirky American City. Their addiction to automobiles with soaring gasoline prices has got to scare them soon I hope into much more mass transit and their glitz, glamour, and botox party Hollywood/Beverly Hills “scenes” seems hopelessly out of sorts with the gravity of our nation’s current numerous crises. One irritant (actually quite dangerous especially for the elderly) demonstrating how pedestrian unfriendly this city is was the amount of time the walk sign provides you, the lowly pedestrian, after you press a button to allegedly halt the constant stream of high speed traffic to “allow” you to walk across a 4-6 lane high speed highway. I promise you, Mayor Villaraigosa and Governor Schwarzenegger the time provided requires literally running for any age group. Maybe this is the good Mayor’s or Governor’s civic wellness program for Los Angelinos?

Well more importantly is the state of the specialty of Occupational Medicine, as I perceived it through the conference and in the hallways or over coffee with my colleagues. The biggest shift in the field is a sea change in the American College of Occupational and Environmental Medicine (ACOEM) membership demographics from company and government employed occupational doctors in the 1970s (over 80 % of the membership) who actually collaborated with Safety, Industrial Hygiene, Toxicologists and Epidemiologists to seek to understand and mitigate workplace safety and health hazard to most Occupational Docs now working in for profit clinics (over 80%) mostly attempting to “manage” (i.e. reduce) workers compensation costs for mostly musculoskeletal "injury" cases. Hence, Dr. Joseph LaDou, an academic leader in Occupational Medicine from California himself, has written about “The Rise and Fall of Occupational Medicine in the United States ” and calls for radical reform including a public health model of Occupational Medicine and the dismantling of the US workers compensation system as two means to save the profession

Beginning with Clinton admin and accelerated by the Bush admin the enabling law and regulatory agency for Occupational Medicine –OSHA- has almost been completely gutted giving corporate America little incentive to retain or hire occupational health professionals. Instead companies are “encouraged” to engage in voluntary partnerships with OSHA -reminding me of faith based volunteerism that Mr. Bush believes should replace other government funded or regulated social safety net programs in other fields.

Alas published data reveals that recent trends in workplace related injuries and illnesses are not good (see
And I for one believe that work stress and depression remain at epidemic proportions due to either layoffs-“you cant have occupational heath without an occupation” and the fear of layoffs re downsizing and outsourcing trends. Although I must admit things seem a bit brighter in recent months regarding these trends. I wrote a piece in 2004 on US worker use of antidepressants in which I still believe remains excessive.

In 2004 I also wrote a review of sociologist Elaine Draper’s book called The Company Doctor: Risk, Responsibility, And Corporate Professionalism wherein I basically agreed with Draper that the US must adopt an independent tripartite model of Occupational Medicine funded by Industry, Government and labor which is the working model in many European nations. This model might save US Occupational Medicine?

A few bright spots of the conference were the opening key-note address by Dr. Paul Brandt-Rauf from Columbia University and Editor of ACOEM’s journal JOEM who urged occupational doctors to sign up now for work in environmental medicine in third world nations like Bangladesh where Brandt-Rauf and his colleagues from Columbia are doing quite remarkable work on lowering arsenic in drinking water which is a huge environmental health problem in many countries including parts of the US. My professional association to its credit had the vision to add Environmental Medicine to its worker health field in 1992 recognizing the magnitude and the importance of the global environmental moment yet not long after prompting organized labor to correctly call the workplace “the forgotten environment” hence the title of this blog piece.

Also a seed of social conscience has become manifest in ACOEM called the Section on Underserved Populations was founded just two years ago. This small section is correctly focusing on preparing migrant clinic based primary care docs in occupational medicine basics who will absorb the estimated 11-12 million soon to be legalized workers who are now working “undercover” on farms, in landscaping, hotels, garment factories, construction etc. These workers don’t currently dare call any attention to themselves by reporting an occupational injury or illness less they be arrested and deported for illegal immigrant status. Go to

Finally, if progressive dems or independents win US congressional elections in November of this year and capture the White House in 08 look for a long overdue stronger OSHA and increased activities in Occupational Health no matter what delivery model prevails.

I have practiced Occupational Medicine for over 30 years and it always occurred to me that the term “worker health” was inherently a liberal concept where workers might be viewed as assets and not expendable costs on the balance sheet despite the inherent power dominion that empoyers have over employees and the classical business definition of efficiency.

But I have always been a dreamer- I know of no other way to live?

My view of Occupational Medicine romantically goes beyond the avoidance of work related pathology which I would die very happy to see come to pass. My view is that work, being so central to human existence, is actually a prerequisite to good heath. I hold the view that job satisfaction is grossly understudied and under appreciated as a determinant of human health. One of my mentors Dr. Lennart Levi from the Karolinska Institute in Stockholm, Sweden said it well many years ago when he said-

“Work should be designed by man for man. Work should serve human needs- not vice versa. Good and healthy work should give meaning to life. This is not what work looks like to millions of workers all over the globe. Work should become man’s servant-not his master”

Dr. Rick Lippin ("Blake")


Blogger stoney13 said...

Well! When you hire the fox to guard the chickens from the weasle, you'll have no eggs in the morning!

You nailed it Rick! Nailed it oh so painfully well! Occupational medicine has returned to the days when "company" doctors working for the coal ines would NEVER diagnose a case of "black lung disease" and the company insurance would NEVER pay a claim that wasn't supported by diagnosis by their "doctor" We have returned to the time of Big Business" shafting the American Worker any way they can!

Fellow blogger Rockpicker laid this joke on us and it shows, oh so well what the problem is!:

A little boy walked into the kitchen at breakfast time and turned to his father.

"Dad," said the child, "could you explain politics to me?"

"Well, son, it works like this," said the father, " I'm the head of the household so I'm like the President. Your mother is responsible for the money and the running of the household, so she's like the government. The maid takes care of cleaning and cooking in our home so she's the middle class. All we that do is to make a home for you and your brother, so you are the people, and your brother is the future."

Nothing more was said concerning politics and the child was left to concider the things his father had told him. Later that night his little brother started crying, and woke him up.

He went to the nursery and found his brother with a profoundly soiled diaper.

He went to his parent's room and found his father missing, and his mother fast asleep.

Failing to wake his mother, he went to the maid's room and found the door locked. Peeking through the key hole he saw his father and the maid in a carnal embrace!

Disgusted, he changed his brother's diaper and went back to sleep.

The next morning he went to breakfast and sat down at the table. "Dad," he said, "I think I figured out politics last night!"

"Really," said his father,"tell me in your own words what you learned"

"Well," said the little boy "The President is screwing the middle class, while the government is fast asleep! The people are being ignored and the future is in deep shit, and will stay that way untill the people do something about it, 'cause nobody else gives a fuck!"

11:10 AM  
Anonymous Dr. Rick Lippin said...

Thanks Stoney13- Do you see hope in Nov 06 elections? Also there seem to be some significant "rumblings" in the labor movement? No?-Rick Lippin("Blake")

11:57 AM  
Blogger stoney13 said...

I see a klittle hope, if we can get Bush and the Big Money's cheerleaders out of Congress. The way things look now, it looks like we are going to get that done.

Of course the elections are four months off and the Repugs are masters at the bait and switch. I don't think it's going to do them any good now, and they've got no one to blame but themselves!

Labor and the unions are finally waking up and I believe if something isn't done, we're going to see something that makes the Molly McQuires look like a bunch af school kids! The American worker is getting tired of getting fucked! Pissed off people do violent things if they get pissed off enough!

If the Democrats are going to do something it's time to shit or get off the pot!

2:13 PM  
Anonymous Tor said...

I started out in health by working as a Research Director for the Children's Bureau Comprehensive Health Care Program for Children and Youth. The remarkable thing about this program was that ALL health professionals combined their expertise in pursuit of this noble objective. The result? Health status of som 1/2 million children and youth improved every quarter, and costs DECLINED every quarter. The program disppeared when powerful lobbyists claimed that "this kind of care takes the bread out of the mouth of the family doctor". Since we only worked in slums, this was a stretch, to say the least.

The next time an organization in this country decided to pursue health, was the VA in 1995. The VA is now the highest ranked health care system in the US, scoring about 50% higher than the rest of the health sector on all relevant indicators. Cost? The VA is now 26% below Medicare costs for comparable conditions and severity.

On May 19 I'll be listening to one of the illustrious graduates of my
university, Dr. Lester Breslow. His title: The Third Era in Health: The Pursuit of Health.

So, maybe the health sector will decide to become a health sector after all. But I'm not holding my breath...

4:55 PM  
Blogger Cervantes said...

Hey Rick, thanks for the report. Of course you know that calling attention to the commodification of labor and the alienation of the worker from the work and its product is reminiscent of that dead German guy we aren't supposed to talk about lest we smack of creeping socialism.

Anyway, this is very important not only to health but to the fundamental nature of society. I have always found it very disturbing that the goal of a life's work in our society is supposed to be an affluent retirement. That's awfully sad.

6:20 AM  
Anonymous Blake said...

Thanks Tor- But you are also an expert on productivity? What about my comments on workers as assets on balance sheet? Could that EVER happen?

Thanks Cervantes (who made all this blogging possible for me)- it's time to re-read the guy you referred to. A long lost relative of Groucho?-

Rick Lippin "Blake"

8:59 AM  
Anonymous Tor said...

I'll deal with that in my next newsletter, Rick!

The human capital of the US population is currently about $300 Trillion. It dwarfs the physical capital on corporate balance sheets.

In the work force, this human capital appears at 8 AM, leaves at 5 PM, and if the emloyer is lucky, reappears the next day, and every day.

The US is now an 80% Knowledge Economy, and there is, in principle, no ceiling on the productivity of knowledge workers.

It's the key to our economic future.


12:58 PM  
Anonymous Blake said...

Thanks Tor-Appreciate your erudition and optimism-Rick Lippin ("Blake")

3:36 PM  

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