The responsibility to report occupational health risks.

The physician is ethically obligated to improve medical knowledge and to transmit those improvements to colleagues. Some occupational physicians are restricted from such professional communication by their employers, and some of these potential communications have major significance in other fields of medicine. For example, the failure to report the cardiovascular toxic manifestations of aliphatic nitrates in explosives and munitions workers involved a number of large U.S. corporations over a period of several decades. Most occupational physicians feel a strong obligation to their corporate employers which poses a dilemma shared by salaried physicians in academic and governmental careers. The solution to the occupational medical communication problem will be materially aided by the recent promulgation of a set of ethical principles for occupational physicians, and would be further advanced by the development of a review process for complaints and by the initiation of a public censure procedure for corporations which do not permit their physicians the opportunity to practice ethically.