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As an occupational and environmental medicine research physician, an important part of my work focuses on asthma, trying to figuring out how much of the burden of this disease can be laid at the doorstep of the workplace. My studies, and those of others, have consistently indicated at least 15% of adult asthma - three in twenty cases - may be attributable to workplace causes. It is a hard question to study, because health care providers rarely ask the questions that might make the connection between work activities and health problems such as asthma. Now, recent bureaucratic meddling may make it even harder to get good data on this important question.
Back in the days of the last Bush administration, the Office of Management and Budget (OMB) was widely criticized for acting as a "science censor." The highest profile incidents involved global warming, watering down a key report by the U.S. Environmental Protection Agency (EPA) and redacting testimony by the then head of the Centers for Disease Control (CDC). Sadly, the Obama OMB still seems to think it knows best when it comes to health and the environment. In its first foray against good science under the new administration, the OMB tried to force the EPA to reject new data on chemical safety. It was a particularly egregious action because it specifically meant to block studies of hormonal function, so-called "endocrine disruption" toxicology. After a Congressional inquiry in this past fall, the OMB backed-off.
Now the OMB is back at it again. On December 28, 2009 the OMB raided the National Center for Health Statistics to censor its annual health survey, just as it was about to go out into the field. This yearly study, called the National Health Interview Survey (NHIS), is a key source of U.S. health-related statistics. Each cycle of the NHIS is meticulously planned and peer-reviewed by internal and external experts. Because only a certain number of questions reasonably can be asked at any one time, the addition of any new material is fought over as intensely as payload space on a NASA mission. The 2010 NHIS is special because it includes additional occupational health data based on a series of questions on workplace factors and specific diseases. The last time such queries made it into the NHIS was over 20 years ago.
The OMB yuletide attack on the NHIS was meant to be a surgical-strike. They were after only three questions, in each case asking about a specific health condition linked to work: asthma, skin disease, and carpal tunnel syndrome. According to a memorandum circulated privately by a U.S. Public Health Service officer with the CDC who had worked closely on the 2010 supplement, the OMB threatened to delay the entire NHIS enterprise unless a key question linked to each condition was banned. That question ascertained whether the person reporting the health problem believed it might have been caused or made worse by their work.
The items that remain in the 2010 NHIS still ask whether a health care provider raised the question of work-relatedness of the condition or if the interviewee brought this up with the doctor on their own. Of course this assumes universal access to health care, up to now far from likely among workers with the lowest paid and dirtiest jobs, exactly those at most risk of asthma. The text of the NIH is now online, including spaces where the obliterated questions should have been (for example, in the case of asthma on page 7 of the 43 page survey; ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS…).
Clinicians, public health practitioners, health policy makers, regulators: these are all groups eager to see the results of the 2010 NHIS. They will be looking for valuable data on asthma, skin conditions and carpal tunnel syndrome, diseases strongly linked to people's day-to-day jobs. We know that only a fraction of persons with asthma caused by work are correctly diagnosed by cause: people whose jobs involve exposure to spray paints, reactive polymers, flour and grain dusts, cleaning products, commercial enzyme additives, animals in laboratories or agriculture, or catalysts in petrochemical processing, to cite only a few clear-cut examples. If we can't ask the people who do these jobs - the ones most likely to suspect the connection between what they do for a living and why they are ill - they won't tell us.
