OSHA and Ergonomics: Sympathy Over Science and Sense

The Occupational Safety and Health Administration (OSHA) has received the go-ahead from Congress to continue efforts to develop ergonomics regulations for general industry. Since 1995, OSHA has been precluded from issuing new proposed regulations, and a proposed rider to OSHA's 1997-1998 appropriations bill would have extended the ban until the National Academy of Sciences could complete a peer-reviewed study of the alleged causal relationship between repetitive hand use and upper extremity disorders such as carpal tunnel syndrome ("CTS").

However, this past July leaders of the House Appropriations Committee, the Labor, Health and Human Services and Education Subcommittees, and other agencies reached a compromise agreement which permits OSHA to develop a proposed standard, but prohibits OSHA from issuing any proposed or final ergonomics regulations prior to October 1, 1998. The agreement dispenses with the review and report to Congress by the National Academy of Sciences. Thus, employers have reason to be fearful of any ergonomics regulations OSHA might eventually issue, because they may not be based on valid scientific facts.

To Regulate, or Not To Regulate

Proponents of regulations argue that occupational hand activities involving one or more "risk factors" such as repetitive motions, awkward/extreme wrist postures, forceful exertions, and vibration cause CTS and other alleged "cumulative trauma disorders." They claim that regulations which force employers to minimize or eliminate the "risk factors" from the workplace will prevent CTS. This claim is highly speculative, however, because the premise that hand usage can cause CTS has not been scientifically proven and is hotly debated in the medical field. The only sure consequence of ergonomics regulations will be a tremendous economic burden on business and industry. (One study, by National Economic Research Associates, estimated that the proposed federal regulations would cost the trucking industry alone $6.5 billion a year.)

The saga began when OSHA issued its Advanced Notice of Proposed Rulemaking ("ANPR") in August 1992, after thirty labor organizations petitioned OSHA to develop regulations. Labor, OSHA, and other proponents of regulations supported their position -- and still do -- by citing published medical/scientific literature dating back to the mid-1980's and statistics which purport to find relatively "high" rates of hand/wrist/arm disorders among workers in certain jobs. However, after stating in its 1992 ANPR that ergonomics regulations would prevent "cumulative trauma disorders," OSHA in February 1994 mailed a "Dear Colleague" letter to industrial engineers across the nation seeking their help, in anecdotal form, "to demonstrate the utility and effectiveness of Ergonomic Interventions." Scientific proof of successful interventions did not exist.

Similarly, it came to light that most of the research and data cited by the proponents of regulation is of dubious validity due to methodological flaws. For example, many researchers did not use electrodiagnostic studies, which are universally regarded as the "gold standard" for diagnosing CTS, to confirm that the workers being studied actually had CTS as opposed to other conditions which cause the same symptoms. (The statistics which refer to an "epidemic" of CTS suffer from this problem, thus overestimating the occurrence of the problem and the need for purportedly curative regulations.) Of the studies which used electrodiagnostic techniques, most are beset by other problems, such as the failure to consider whether the workers with CTS also had diabetes, rheumatoid arthritis, or one of many other conditions known to cause CTS. The few methodologically sound studies have found that individual factors such as age, gender, obesity, general physical condition, and psychosocial health are more predictive of CTS than is the nature of the work. Such findings may explain the fact that even in jobs where researchers purport to find "high" rates of CTS, the overwhelming majority of workers do not get CTS.

The state of the science prompted the American Society for Surgery of the Hand to prepare a "Society Position Paper," which it published in The Journal of Hand Surgery (April 1995) and also sent to OSHA. The Society expressed its concern about:

premature rules and regulations on so-called 'cumulative trauma disorders'. . . based on our conclusion that the current medical literature does not provide the information necessary to establish a causal relationship between specific work activities and well-recognized disease entities. Until scientifically valid studies are conducted, the Society urges Government to exercise restraint in considering regulations designed to reduce the incidence of these conditions, as premature regulations could have far-reaching legal and economic effects, and could have an adverse impact on the care of workers.

Postponed Regulation

On June 12, 1995, OSHA withdrew the draft proposed regulations it had issued on March 13, 1995, claiming that interference by the Republican Congress had made it impossible to publish an appropriate standard. Soon thereafter, President Clinton signed a budget rider barring OSHA from proposing new standards before the end of the 1995-1996 fiscal year. A proposed rider to the Department of Labor's 1996-1997 appropriations bill would have prevented any activity towards developing an ergonomic standard, but it was defeated in the House by a vote of 216 to 205.

Given new life by the House vote, proponents of regulations sought to buttress their case. In August 1997, the General Accounting Office published "Worker Protection -- Private Sector Ergonomics Programs Yield Positive Results." This report consists of case studies (i.e., interviews and observations, not scientific investigation) made at a grand total of five (5) employers. In addition, the National Institute for Occupational Safety and Health ("NIOSH"), which is the investigative criteria organization for OSHA, reviewed the published medical/scientific literature and in August 1997 published its conclusion that work-relatedness of CTS is supported. The NIOSH report has been harshly criticized; according to Laurie Baulig of the American Trucking Association and co-chair of the National Coalition on Ergonomics, the document illustrates the need to refrain from regulation until more research is conducted.

With the review by the National Academy of Sciences dispensed with, organized labor and OSHA are claiming victory. Even the moratorium on issuing a standard does not deflate their spirits: according to an OSHA spokesman, "we're currently at the very early stages of the process [of developing ergonomic standards], and the moratorium fits with our time frame."

On the Horizon

One wonders why OSHA is only in the "very early stages" of developing a standard, and will take a year to complete the task, if the scientific knowledge needed to prevent "cumulative trauma disorders" has existed for over a decade and in fact provided the foundation for the draft regulations OSHA issued and then withdrew over two years ago. The problem is not business and politics, but lack of good science. Unfortunately, however, this fact is not likely either to deter OSHA from developing a standard or to prevent OSHA from continuing to issue citations for alleged ergonomics violations under the "general duty" clause of the Occupational Safety and Health Act until a standard is developed.

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