Textbook of Occupational Medicine Practice, 2nd Edition. David Koh, MBBS, MSc, PhD, Chia Kee Seng, MBBS, MSc, MD, and Jerry Jeyaratnam, MBBS, MSc, PhD, Editors. 2001, 534 pages. World Scientific Publishing Co. Inc., Singapore, $42.
This occupational medicine text is a small-format paperback, comparable to the well known Levy and Wegman, McCunney, and LaDou texts. Like the first edition five years before, this second edition sets out to “provide information on the interphase [sic] between the health practitioners’ needs and occupational medicine.” It targets medical students, general practitioners and other clinicians interested in occupational health, postgraduate students in occupational health, and occupational health nurses. The first edition has been used, according to the editors, as the standard text in occupational medicine courses in Singapore, Malaysia, Indonesia, Vietnam, and Jordan.
The book is divided into two sections. The first, Clinical Occupational Medicine, contains 14 chapters, organized primarily around body systems. The second, Special Issues in Occupational Medicine, includes nine chapters that cover a range of topics: occupational cancer, health screening, disaster planning, disability assessment, shift work, health promotion, prevention, legislation, and corporate travel. With few exceptions, the authors are drawn from the medical faculty of the National University of Singapore, the home institution of the three distinguished editors, or from other institutions and agencies in that country.
The book is nicely produced, and comfortable to hold and to read. Many of the graphics are excellent. Clinical case studies are plentiful, and they add a great deal to the text. However, serious shortcomings limit the utility of the book.
The book’s worldview seems not to extend outside the examination room. While the sharp clinical focus may have its virtues, there is virtually no discussion of occupational health programs. If you are a clinician responsible for establishing a factory-based medical program or a hospital-based occupational health service, you will want to know how to staff the program, what services to offer, how to deliver these services efficiently and economically, and how to communicate with both clients and patients. This book provides no such information. If you are a clinician working at the corporate level, you will want to know how to harmonize occupational health with other corporate functions such as human resources, benefits, and environmental management, and how to represent occupational health to senior management. This book provides no such information.
No matter where you work in occupational medicine, you will likely want to collaborate with occupational health nurses, industrial hygienists, and other colleagues. This book is strangely silent on professional collaboration. The only reference to industrial hygiene comes in a paltry three-page section on “engineering controls”—and industrial hygiene is not mentioned by name! But this is better than the discussion of occupational health nursing, which is nonexistent. In addition, many occupational physicians confront labor-management issues, and need to respect and work with labor unions. This book says nothing about labor unions. Overall, readers of this book could reasonably conclude that there is almost nothing to occupational health beyond the diagnosis and treatment of disease.
How then does the book do as a purely clinical text? Not very well. Again and again, throughout the clinical discussions, essential questions go unanswered. For example, in the discussion of solvent neurotoxicity, how much solvent exposure is necessary to cause acute disease? Chronic disease? What are the primary routes of exposure? Which solvents are most hazardous? In the discussion of work-related tuberculosis, what preventive strategies are recommended for health care workers? In the discussion of upper-extremity musculoskeletal disorders (imprecisely referred to as “repetitive strain injuries”), the treatment discussion consists of a single paragraph, with no evidence-based recommendations, no references, and no practical clinical guidelines for work limitations, medication use, physical therapy, and surgery. Overall, most readers will find that this book provides insufficient information on etiology, pathophysiology, diagnosis, treatment, and prevention, for each disorders it discusses.
This problem is not helped by the scanty and outdated references. There are two references on chronic solvent encephalopathy, dated 1983 and 1985. The “repetitive strain” references are current as of 1989, and omit such standard sources as the exhaustive 1997 NIOSH review. The cancer references reach 1994, and omit mention of the rapid advances in molecular carcinogenesis and genetics during the 1990s. Overall, little updating appears to have occurred since the first edition. Readers will not find this book a current review of the relevant literature.
We have very few occupational medicine textbooks from the industrializing countries of the “south,” despite the critical importance of these countries in modern occupational health. In this book, from Singapore, a lucid discussion of the challenges of occupational health in poor countries would have been more than fitting. Instead, this topic is omitted—a notable departure from other leading occupational health textbooks. Another missing topic is workplace injuries, a major cause of morbidity and mortality at work. Epidemiology is not explained. And primary prevention is mentioned only in passing. The range of omitted topics in this book is broad.
Finally, there is the question of originality. The cancer chapter begins with a two-page case study of the recognition of bis-chloromethyl ether (BCME) as an occupational lung carcinogen. Where did this case study come from? Two references are provided, neither of which supplies the story line or the quotations in the case study. On the other hand, the case study bears an uncanny resemblance to the opening two pages of the cancer chapter from earlier editions of the Levy and Wegman’s textbook, a source not cited here. One wonders.
The target audience for this book—-medical students, occupational health nurses, clinicians interested in occupational health, and occupational health postgraduate students—need a concise, up-to-date, complete, and rigorous occupational health text. They will need to look elsewhere than this book to find it.