Assessment of the Scientific Basis for Genetic Testing of Railroad Workers with Carpal Tunnel Syndrome

Abstract

In 2000, approximately 20 railroad track workers who filed injury reports or compensation claims for carpal tunnel syndrome were tested by their employer for two genetic traits to determine the work relatedness of the condition. The testing involved deletions, variants, or mutations in the genetic coding for peripheral myelin protein (PMP22) and transthyretin (TTR). This article is an assessment of whether there is a scientific basis for such testing. A review of the scientific literature indicated that neither the scientific basis nor the population validity of the PMP22 or TTR tests for carpal tunnel syndrome were adequately established before use on railroad track workers in 2000. Although ethical and legal issues may predominate in this case, the absence of a compelling scientific basis undermines the decision to conduct the tests.

Genetic Testing in the Workplace: Ethical, Legal, and Social Implications

“…The court papers alleged that employees were asked for blood samples but were not told the sample's purpose was genetic testing and that at least one individual who refused to provide a sample because he suspected it would be used for genetic testing was threatened with discharge if he did not submit. In the face of a legal challenge, Burlington Northern agreed to halt genetic testing of its employees (29,51).…”

The contributions of genetics and genomics to occupational safety and health

“…Currently when employers defend themselves against claims about the work-relatedness of disease, they may try to determine whether genetic factors have contributed to occupational disease and thus mitigate their liability. This approach was taken in the much criticised US case of railway track workers claims of carpal tunnel syndrome 17. Nonetheless, conducting genetic tests in some types of workers compensation cases in the USA is an allowable component of independent medical examinations.…”

Some implications of genetic biomarkers in occupational epidemiology and practice

“…This is a test, not for carpal tunnel syndrome, but for "hereditary neuropathy with liability to pressure palsies", which may have a manifestation that includes carpal tunnel syndrome (46). The issue here is that, beyond the ethical and legal aspects at the time of use, there was an inadequate knowledge base (most particularly an absence of epidemiologic data) on which to make a decision to incorporate such a test (47). There is extensive information on the work-relatedness of carpal tunnel syndrome and less information on the role of hereditary factors (48)(49)(50).…”