False Prophets in Occupational Medicine

Originally published on Monday, 26 October 2015

Leadership in our field requires finesse, patience, and deep insight. That makes many people uncomfortable, because they want a fighter, who can dash in guns blazing and set things straight. But the field we work in a very complicated, highly structured setting, full of regulations, management systems, compensation eligibility requirements, reporting requirements, rigid definitions, and accountability. It doesn’t matter that these systems often fail us; we still have to work within the system to have a hope of the right outcome. Push too hard and the structures break or jam and then who gets hurt? Usually the injured worker, that’s who.


Anyone can shoot from the hip and react to events as they unfold. A truly transformative leader in occupational medicine knows the score, understands the problem, acts from a position of insight, and thinks before acting.

Elsewhere in this series on leadership, we talk about transformative leaders in occupational medicine, such as Alice Hamilton, Harry Mock, Irving Selikoff, Ernie Mastromatteo, and Joel Gaydos. We must recognize that there are also false prophets in occupational medicine, just as there are in any field.

Some would have you believe that occupational medicine is just like any other field of medicine, that all “occ docs” love their workers as their own patients, that nobody ever lied or misrepresented data, and that the company has every worker’s best interest at heart. Rubbish. There is a long history in our field of cowards hiding health problems, ignoring hazards, being too pliant towards the priorities of employers, sending injured workers back before they are ready, “reclassifying” medical treatment as first aid or keeping it off the books entirely to make the employer look good, and resisting sensible regulations. But I am convinced that these lapses are not what occupational medicine is about and that the weaker among us are not the majority.

A lot of these abuses happened under the name of occupational medicine but did not or do not reflect the values of those of us in the community of qualified occupational medicine specialists and practitioners. Bad practice occurs in many medical fields when practitioners are untrained or acting outside their scope of practice. Even more bad practices occur when physicians are outside peer networks and subject to influence because they are functioning in isolation. I am convinced that our record is no worse (if no better) than other fields of medicine. But we do have a tendency to beat ourselves up more about mistakes made in our name, even if we are not necessarily responsible for them.

There are false prophets who would have you believe that our field is inherently dishonest, that we in occupational medicine are always biased against the worker, toadying up to employers, and apologists for industry. Does this fit with your experience? Didn’t think so. These are the hardest false prophets to deal with, because they are sometimes right in the positions they take but too often they are horribly wrong.

Because they have themselves convinced, they can be vicious in their methods. These false prophets too often act unethically themselves, using ad hominem attacks, publishing junk science, giving a platform to quacks, and attacking the very institutions, such as ACOEM, that are part of the solution to keeping occupational medicine on the straight and narrow. I have to admit that I am very passionate about the cowardice of smear tactics, because I been smeared myself by false accusations and I know hard it is to assert the truth in the face of propaganda and to regain your reputation.

By now most people with long experience in occupational medicine will be thinking of some specific names. At least, I hope so. But if I write this blog and name names, it will be remembered only as a diatribe, a personal attack, and maybe as a hit piece against that particular person. That would be a mistake. The whole point is that these are methods that are best discouraged by ignoring their venom, refuting them.

A sensitive test for false prophets is to watch what they do and say to people and institutions that are attempting to make things better. Organizations like ACOEM and its component societies provide the framework for a civil society within the community of occupational medicine practitioners. If there are relentless attacks on our institutions, such as ACOEM and ICOH, even on initiatives to make things better, is this not evidence that these false prophets are not really interested in making things better but in bringing the house down?

That is why I took a stand, during my term as President of ACOEM, against some of these false prophets and defended ACOEM so vigorously when it came under attack – in my opinion falsely. We need to stand up for ourselves, because occupational physicians do good and we are needed in society.

Beating up on good people with accusations of iniquity does not change their behavior in any constructive way. People of conscience do not respond well to shame, especially when they do not deserve it and cannot relate to the people who did the bad things. People respond best to encouragement, positive role models, and leading by example. That is why it is just as or more important to hold up as shining examples the contributions of our many positive role models, than it is to dwell entirely on the misdeeds of asbestos apologists, the damnable reprobates who falsify IMEs, and the mistakes and alleged misdeeds of people like Robert Kehoe, who was very wrong about the toxicity of lead in the 1950’s (but who genuinely thought he was right).

We do need to understand the dark corners of our history to prevent misdeeds from happening again, but bias against workers is not the history of occupational medicine, just as prefrontal lobotomies are not the history of neurosurgery. (This is a local example, by the way. That whole sordid chapter in American medicine was rooted right here in Washington DC.) To say that a community of professionals or a professional field is evil is not only unjust but it paralyzes the will to make things better. If you continually beat on people for the perceived errors of the past, they will shut down and not only ignore their tormentors but fail to hear the constructive messages of positive role models.

The simple fact is that occupational physicians are always in the role of advisors and consultants, never in a position of authority to make things happen, other than in their own small chain of command in the occupational health service. That means that our leadership cannot come from the authority of power but must come from the authority of persuasion and knowledge. There is a limit to what we can do, but if we do our jobs right, we can do a lot and make things better.