The commentary by Mark V. Holden that appeared in Alaska Dispatch News on Dec. 21 with the headline "Too much occupational licensing stunts Alaska economy" provided an interesting, although shortsighted, perspective on the topic of occupational licensing. While I would agree that conceptually the idea of breaking down barriers to provide opportunities for the least fortunate sounds compassionate, we cannot take a concept like that and globally apply it willy-nilly without potentially causing great harm.
The fundamental reason for any occupation to be licensed is to protect the public, not corporations. If a license proposal cannot be supported by a significant safety-based reason for enacting it, one cannot simply decide to license in order to meet a corporate objective. Why does the author accept licensing of doctors, lawyers and airline pilots? Airline pilots, by the way, are licensed by the federal government. It is easy to recognize the great harm that could occur if these three occupations could be pursued by the least fortunate, without a requirement for any formal training, testing of sufficient acquired knowledge or means to address the harm caused by ignorant or unethical practitioners.
Likewise, there are many other circumstances where a buyer or user of the service could be harmed significantly if there were not some measures to minimize incompetence among those practicing the activity. How many people would feel safe if they obtained their medications from an untrained, unlicensed pharmacist who simply put some pills in a bottle without knowing about drug interactions, when to take the medication, how many to take at a time and so on?
We license pharmacists because there is a serious risk to the health of the community, which would be reflected in major losses in the economy due to incompetence if we didn't. Still, the "100,000 lives" campaign, which most of the major hospitals in Alaska participate in, is intended to try to reduce the number of deaths each year due to errors by licensed health care workers, including doctors. To permit incompetent workers to pursue an activity they were not adequately trained to perform would trade additional jobs for deaths and injuries within the community.
Consider radiologic technologists, who perform as medical-imaging and radiation therapy specialists. They are required to complete extensive training because it is a complex subject. It also involves technology that can cause serious harm to the community it they are not adequately trained or do not maintain high-level skills.
There is good reason that radiologic technologists must be licensed or certified if they will be irradiating human patients in nearly all of the states and for several federal government entities such as the Veterans Administration, Indian Health Service or Food and Drug Administration. Due to changes in technology an untrained operator of medical X-ray equipment can expose a patient to up to 100 times the optimum dose and the computer will make the image still interpretable. We are seeing more radiation injuries nationwide in medical imaging associated with using the latest imaging technologies.
The Mayo Clinic and others suggest that between 2 and 5 percent of all cancers may be due to medical imaging, and that is due in part to improper ordering of the exams by physicians. Read Dr. S. Shiralkar's research on physician knowledge of medical-imaging exposures, and similar studies performed by other doctors. Dr. Per Hall and his group in Sweden found that those exposed as infants to radiation at the levels of a CT scan had diminished intellect. Would the author prefer to allow anyone who could just push a button to perform X-rays on himself or his family? With 3,700 cancers a year in Alaska, the Mayo Clinic data suggests that we could have more than one new cancer a week due to medical X-rays. However, since no license is required for X-ray machine operators in Alaska, that number could be higher. Alaska has the lowest standards in the nation for operators of medical-imaging devices.
In conclusion, one should be cautious about assuming a global view inferring that all or most occupational licenses should be repealed. They are there to protect all of us in an increasingly complex world. In the case of ionizing radiation, it is clear that the public in general is not well versed in identifying the risks, so their protection is completely dependent upon high certification standards for those who irradiate them.
Clyde E. Pearce has been employed in the radiology field since 1961 and has lived in Alaska almost 20 years. He has earned credentials in medical imaging and nuclear medicine. Although he works for state and federal governments as an inspector of medical and non-medical facilities that use radiation, the preceding commentary contains solely his views as a private citizen, not the views of his employers.
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