Genetic screening for hypersusceptibles in industry

Epidemiologic evaluation of screening for risk factors: application to genetic screening

To assess the usefulness of screening for risk factors, we derived arithmetic relationships between screening parameters (sensitivity, specificity, and positive predictive value PPV) and risk factor frequency, disease frequency and relative risk. We evaluated these relationships in the special case of genetic markers and disease susceptibility. It can be shown that even in the face of very large relative risks, sensitivity and positive predictive value are affected by the relative magnitude of disease and genetic marker frequencies. When the genetic marker is less frequent than the disease, PPV increases with increasing relative risk but sensitivity remains low. When the genetic marker is more frequent than the disease, sensitivity increases with increasing relative risk but PPV remains low. When marker and disease frequencies are equal, both PPV and sensitivity increase with increasing relative risks, but very high relative risks (greater than 100) have to be obtained for rare diseases. Depending on the goals of the screening program, these relationships can be used to predict the relative magnitudes of false positives (low PPV) and false negatives (low sensitivity). This approach can be generalized to evaluate nongenetic risk factors in screening programs as well.

Detecting the hypersusceptible worker: genetics and politics in industrial medicine

This paper examines the development of the concept of the hypersusceptible worker, as advanced by H. E. Stokinger and his associates. It is argued that this concept enabled industrial toxicologists to organize knowledge about workers' reactions to toxicity so as to sustain a professional and methodological ideology which reflects the relationship between industrial toxicology and capitalist industry. Moreover, it is argued that it is this aspect of hypersusceptibility, rather than its practical utility to specific corporations, that is most important. Constraints on implementation of screening programs based on the ideas of genetic hypersusceptibility are also discussed.