The effect of public controversy on occupational health problems: byssinosis.

The effect of the byssinosis controversy on surveillance programs in the cotton textile industry is reviewed. The federally regulated format for industry medical surveillance guarantees neither automatic reduction of cotton dust exposure for high-risk workers nor wage rate retention for workers who are transferred to less dusty job sites. The absence of universal guidelines for worker management, combined with doubt over the severity and prevalence of byssinosis, encourages employers to evaluate medical surveillance programs primarily on the basis of their economic impact. When employers use the programs to control their losses, the potential costs of worker participation are increased. Comparisons with medical surveillance programs in the coal industry suggest that health benefits to workers can be guaranteed in the context of disputes over occupational diseases if industry, labor, and government agencies all participate in program design and operation.