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Thomas G. Grumbles (conoco) Date Jt: f66: RF 6 l2ee.<t'i+ u'2^'o]e TCluf\ A^P0/** VVV 000012323 I An ICWU Member writes: Dear Dr. Cullen: At the recent ICWU Health and Safety Leadership Training institute you discussed some advantages and problems that company-sponsored medical testing can bring. Can you provide us with a factsheet we can use on this subject? Dear ICWU Member Many companies perform physical examinations and/or laboratory tests on employees before employment and at some intervals during employ ment. Although the union and individual workers have the right to get the results, an effective health and safety committee should understand what the exams are for. what results really Indicate and how the results will be used by the company. The purpose of this factsheet Is to teach you how to think about medical tests so you can bargain for the most effective program which will protect both the health of the members and their jobs and financial security. Kinds of Tests Any examination or test may show one of three things: 1. Some tests show how an organ, like the lungs or liver, is working. Examples: Breathingtestsshow how big the lungs are and how quickly air can be blown out Liver function tests (blood tests) show whether liver cells are all right and whether the organ Is able to eliminate bile as it should, etc 2. Some tests measure the amount ofa chemical that Is In the body, in other words, the extent of exposure. By Itself, this kind of test tells nothing about the effect of the poison, only Its amount. Example: A blood lead level, urine mercury level, radiation badge, etc. 3. Some tests look for special markers of a reac tion to a chemical. The value of this kind of test ft. depends on the relationship of the marker to an occupational disease. Example: A blood test looking for antibodies (immune responses) to a plastic additive like TDI (isocyanate): a skin test to see If you react to chromate. RULE: The interpretation of a test depends on which kind it is. An abnormal testoforgan function doesn't explain why the organ Isn't working. A high level ofa poison in blood or urine doesn't prove that a particular organ is affected. The presence of a marker doesn't by itself prove the existence of any disease state. Issues involved in Medical Tests Regardless of what kind of test it is. certain questions always need to be answered: 1. What Is the quality of the lab or person doing and interpreting the test? For example: A "normal" X-ray read by an un trained reader may not be normal at all but show asbestosis. A low blood lead level in an uncertified lab may falsely underestimate a high blood lead burden. Remember. The quality oftestsvaries enor mously -- it should never be taken for granted that results are reliable until the expertise of the lab and/or reader Is verified. 2. How sensitive is the test for the problem? For example: An X-ray of the chest is a very poor indicator of some lung problems like asthma. In other words, you can have severe asthma and still have a normal X-ray even if read by an expert. We say -- the X-ray is not sensitive for asthma. Another example is blood and urine tests for chemicals. Often the result is "none detected." To interpret this you must know what the smallest amount is that the lab could detect The test maybe insensitive to small amounts which still might be very toxic. 3. How specific is the test for the problem? For example A liver function test may be abnormal because ofa blood or muscle problem. We say this test Isn't too specific for the liver. Another example is the marker tests. Often a worker