As an oncologist, I was troubled to read “What if the Cure is also a Cause?” in the Feb. 15 edition of the Washington Post.

Improving workplace safety and strengthening the regulatory system designed to protect workers has been a major focus of my life ever since my brother was killed due to unsafe working conditions. The Post article, outlining the risks of occupational exposure to chemotherapeutic agents in my own workplace, made this cause all the more urgent.

NIOSH issues alert

In March 2004, the federal government issued an alert through the National Institute for Occupational Health and Safety (NIOSH) that chemotherapy drugs can cause cancer and pose a risk to those who handle them. NIOSH officials and members of a hazardous drug advisory panel saw this alert as the first step toward addressing what could be a serious workplace health problem.

The next step was to be a study of actual exposures at three university hospitals. Blood and urine samples from pharmacists, nurses and technicians were to be analyzed for the presence of chemotherapy drugs like cytoxan and ifosfamide.

The study is on hold. The proposal was submitted twice to the Office of Management and Budget (OMB) and both times withdrawn after the OMB raised questions about the scope of the study design. The article raised troubling speculation that pharmaceutical companies and hospitals, concerned about liability, may have influenced the delay.

NIOSH issued the alert on chemotherapy drugs because human and animal studies have shown they have the potential to cause cancer and reproductive problems. Chemotherapy drugs, by necessity, are very strong. They can cause secondary cancers and blood disorders in patients. Some studies have found a higher than expected prevalence of cancer and reproductive problems in oncology health care workers. This raised the question whether industrial exposure to chemotherapeutic agents is hazardous.

OSHA first issued voluntary guidelines for handling hazardous drugs in 1986. They call for the wearing of gloves, gowns and the use of biological safety cabinets. OSHA still has no regulatory standards for chemotherapy and NIOSH says adherence to guidelines is spotty.

Now there is no way to accurately estimate how much harm the careless handling of these drugs has caused. Cancer can take many years to emerge and the connection between past workplace exposure and the diagnosis of leukemia or cancer may never be made.

NIOSH will continue to discuss the three-hospital study with the OMB. Meanwhile, health care workers face daily exposures.

Unsafe conditions affect all workers

My brother died a cruel violent death at a concrete plant. He fell 25 feet to his death, from a cement tower, while shoveling gravel off the hopper to clean it. The company claimed he just “wandered up there on his own” at the end of his driving shift rather than being assigned this unpleasant task because he was the “new man.”

Our family’s grief was compounded when OSHA passively accepted this implausible story. After admitting no wrongdoing, the company paid a $6,000 fine for repeat violations. From the OSHA website, we learned that this company had multiple serious violations issued only months before my brother was killed. These were informally settled with reduced fines called “abatement” only a few weeks before his death.

I have come to realize that my brother’s death was not just an isolated case of “bad luck.” In 2002, 4.7 million workers were injured, 5,500 were killed and an estimated 50,000 died from occupational diseases. On an average day, 150 workers lose their lives as a result of workplace injuries and diseases and another 12,000 are injured.

OSHA does not have the funding or staff to adequately oversee the safety of the 100 million workers under its jurisdiction. OSHA’s current budget of $475 million amounts to about $4 dollars per worker. Federal OSHA has only about 900 safety inspectors and can only inspect workplaces on average once every 100 years.

The Bush administration has done nothing to correct this situation. It has killed dozens of worker protection measures, including rules on cancer-causing substances, reactive chemicals and infectious diseases like TB.

Unsafe working conditions can affect us all, even those of us who are not employed in traditional “blue-collar” risky occupations.

Workers’ Memorial Day, April 28, is a day to “mourn the dead but fight for the living.” As I mourn my brother’s death I also fight for improved working conditions. The life I save may one day be my own.