The Changing Face of Occupational Medicine

W hen most people think about the adult fi lm industry it's likely that few have in mind the rights of workers within this industry. A paper in this month's issue of PLoS Medicine [1], however, takes just that point of view and concludes that the time has come for this highly profi table industry to self-regulate, and specifi cally to address the issue of the health of its workers. The workers whose health most needs to be protected are not those who operate the cameras or build the sets; it's the actors and actresses who run the biggest risks every day in their working lives. Infection with HIV is perhaps the most obvious and most alarming risk of this profession, but adult fi lm performers also risk infection with other sexually transmitted diseases, including chlamydia and gonorrhea [2]. As the authors conclude, " Unfortunately, the growing popularity of adult fi lm has not translated into safer working conditions for performers. It is unethical for industry executives, legislators, and consumers to continue to enjoy the profi ts, tax revenues, and gratifi cation of adult fi lm without ensuring the safety of performers " [1]. In the western world probably the fi rst time that workers' health really caught the attention of the wider public was in the early 1800s, when campaigners in the UK brought the issue of child chimney sweeps to public attention. The risks to these children's health became well known— respiratory problems, cancer of the scrotum, and deformed limbs being the most common long term risks, if the children survived the shorter-term risks of death from falling, suffocating, or burning while in the chimney. But despite widespread knowledge of these risks, it still took more than 60 years for the legislation that banned the use of children to be enacted. Enforcing the legislation took even longer, for one simple reason: cost. The high cost of mechanical alternatives to human chimney sweeps compared to children meant that enforcement was not really effective until the 1860s, when the imposition of heavy fi nes made the cost of noncompliance higher than that of compliance. One driving force behind occupational medicine, as shown by the example of the chimney sweeps, has been the idea of social justice. Its opposing force, the short-term cost to employers of protecting workers, is a recurring factor today. International bodies (such as the International Labour Organisation …