BMJ  2007;334:750 (7 April), doi:10.1136/bmj.39170.612986.59

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Rotten jobs

Here are my nominations for the five worst jobs in the world for health professionals. My criteria are personal: these are jobs that seriously compromise ethical and moral standards, are difficult to justify to your children, and are likely to be a source of regret on your deathbed. Some of this work is highly paid; it would need to be. Readers are encouraged to write in and expand this list.

Head of medical services at Guantanamo Bay. Spanking new facilities in a remote location in Cuba picked because it is well away from liberal laws that respect human rights. No pesky relatives and visitors to deal with. But how to explain all those bruises and dog bites?

Research scientist at any major tobacco company. Join a powerful global industry, see the world, meet interesting people—and work out how to kill as many as possible. Creatively exercise your grey cells spinning the evidence for tobacco deaths into total nonsense, undermine epidemiology and research ethics, develop youth health and social responsibility programmes with naive, poor NGOs in developing countries, and tell fairy stories about safer cigarettes. And have people walk the other way at cocktail parties.

Biochemical weapons developer. Fool around with funky new deadly gases, see lots of upended rats, and run advanced dosage-mortality curves. Create better gourmet cuisine to deliver plutonium. The World Medical Association urges all who participate in biomedical research to "consider the implications and possible applications of their work and to weigh carefully in the balance the pursuit of scientific knowledge with their ethical responsibilities to society" (www.wma.net/e/policy/b1.htm). I interpret this as: don't do it. Some will cite national security and defence of the nation etc as a patriotic reason for doing this kind of work. If someone can explain what nation, security, defence, and patriotic mean in this globally connected world I would be grateful.

Surgeon in the commercial kidney transplant trade. Harm a poor person and save a rich one. Easy to justify the economics; however, the dirty aspects of this global organ trade are all pervading.

Sports doping doctor. High financial rewards. Free tickets to major sporting events. Major scandal if you are found out—you risk being banned from your sporting association or even struck off, but only in some countries. The World Anti-doping Code of 2003 has clearly shifted the onus from the athlete to the doctor, so you can no longer pass the buck.

Hippocrates advised: first do no harm. Sound words to live and work by. None of these jobs stack up.

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