THE SIZE, SCOPE AND DEFINITION OF THE PROBLEM

To define any problem, its size and scope first need to be examined. This provides a basis for assessing how serious the problem is and in setting priorities to target specific areas. There is often dispute about the size and scope as various agencies or groups define the problem in different ways. The goal of this panel of speakers is to look at the data which exist and to look at the similarities and differences in the data to assess the scope and magnitude of the musculoskeletal problem in the U.S. The data to be reviewed will include national injury data from the Federal Government, national compensation data from a major insurance carrier, state compensation data from a state which is a sole provider of workers' compensation, and injury data from a single company which has competed a comprehensive review of all its injury data. The strengths and limitations of each data set will be discussed. This is the first time these existing data sets have ever been placed side by side for comparison to paint a comprehensive picture of the data. While case definitions will be discussed in this conference to some extent, a detailed discussion of the case definitions will occur in the following session.

Developing an ergonomics policy solution requires a careful characterization of the problem. A science based, broadly accepted definition of the problem is being sought. Presenters will discuss the validity and limitations of different approaches to defining the problem and measuring it.

Session Arrangers

Scott P. Schneider, CIH, Ergonomics Program Dir., Center to Protect Worker's Rights

David G. Sarvadi, Esq. CIH, Attorney at Law, Keller & Heckman

Presenters

William L. Weber, Acting Asst. Commiss. for Safety, Health and Working Conditions, BLS
Job-Related Musculoskeletal Injuries and Illnesses as Reported in the
BLS Survey of Occupational Injuries and Illnesses

Tom B. Leamon, PhD, VP & Dir., Res. Center for Safety & Health, Liberty Mutual Insurance
Ergonomics: A Congruent Concern of Labor, Business and Government

Barbara Silverstein, PhD, Research Dir., Washington State Dept. of Labor & Industries
Upper Limb and Low Back Musculoskeletal Disorders: State and National
Estimates based on Workers' Compensation Accepted Claims

Gordon R. Reeve, PhD, Corporate Epidemiologist, Ford Motor Company
The Incidence of Ergonomic Disorders Among Workers at a U.S. Automobile Manufacturer

Discussants

Eric Frumin, Dir., Occup. Safety & Health, UNITE
David G. Sarvadi, Esq. CIH, Attorney at Law, Keller & Heckman

Mr. SCOTT SCHNEIDER, Center to Protect Worker'>s Rights (CPWR)

Good morning. Just hang tight for a little longer, and we'll get a break pretty soon. I know it's hard to sit in chairs for a long time, but we have a break scheduled in about 40 minutes.

We're going to start off this panel here to talk about the size and scope and definition of the musculoskeletal disorders problem. I think whenever you are talking about a problem, the first thing you have to do is really define what we are talking about and how big is this problem? We've heard a lot of discussion so far this morning about what a significant problem this is. And I think in order to really appreciate that, you have to look at the numbers. And there's a lot of different numbers out there. And what we're hoping to do this morning is to give you a quick survey of some of the most important data that we have showing the size and scope of the musculoskeletal disorders problem.

What we're going to do is to first look at some national data, the most important being the Bureau of Labor Statistics data, their annual survey. And the detailed data just came out last week, so we're very lucky to have Bill Weber here to talk with us about it. And then we're going to have Tom Leamon talk about the data from Liberty Mutual, which is national data also but it's data from the worker's compensation system which is a very different ball game. And then later after the break we'll have Barbara Silverstein talk about the data that she has on worker's compensation data from the State of Washington, which is a single payer system so they have all the data on all workersYall worker's comp data for that particular state. And then lastly, we're going to have Gordon Reeve talk about the data that he has collected from an exhaustive investigation of musculoskeletal injuries within one company - Ford. So I think we'll have a variety of very interesting perspectives today, and get a very comprehensive look at what do we know about the size and scope of this problem.

So let me start out by introducing Bill Weber who is the Acting Assistant Commissioner for Safety, Health and Working Conditions at the Bureau of Labor Statistics. He's been at BLS since 1972, and he's going to talk about the data that was just released from the 1995 annual survey. Bill.

Mr. Scott Schneider, CPWR

Thank you, Bill. We have a question and answer period later on in the day after all four speakers. And I want to try and keep, and have our speakers present sequentially right now so they don't cut into your break. So with that in mind, let me introduce Dr. Tom Leamon.

Dr. Leamon is Vice President and Director of the Research Center for Safety and Health for Liberty Mutual Insurance Company. And he's responsible for the Research Program in Ergonomics and Human Factors of Loss Prevention at Liberty Mutual. Tom.

Mr. Scott Schneider, CPWR

Okay. Thank you very much. We're going to take a break for 15 minutes so you can get up and stretch, and be back here at eleven o'clock. I believe there's refreshments in the exhibit hall next door. Thanks.

Okay, we're going to move on now to the last two speakers of our panel this morning to talk about the size and scope and definition of the musculoskeletal disorders problem. The last two speakers on this panel are Barbara Silverstein> and Gordon Reeve. Barbara is the Research Director for the Safety and Health - SHARP - Safety and Health Assessment and Research for Prevention Program for the Washington State Department of Labor and Industries. She's done work on ergonomics for many years in a lot of different industries, including construction, I'm pleased to say. And she's going to talk to us and show us some of the data on musculoskeletal disorders from the workers, comp system in Washington State.

Mr. Scott Schneider, CPWR

Okay. Thank you, Barbara. Our last speaker on this panel is Dr. Gordon Reeve who is the Corporate Epidemiologist for Ford Motor Company. For the last couple of years, they've been undergoing an intensive look at all the injury data at Ford, and a re-design of their injury surveillance system. And he's going to talk about the musculoskeletal injury problem at Ford Motor Company.

Mr. Scott Schneider, CPWR

Okay. Thank you very much, Gordon. Now we're going to move into the discussion phase for this workshop. And to kick off that discussion we have two what we're calling discussants, which is kind of an odd term. But we felt it's important for people to look at the data, and then to have some people that we had assigned to put their views forward on what this data means and how it should be interpreted. And to do that, today we have two people who are briefly going to give their views, and then we'll open the floor up for discussion and questions.

And the first of those two people is Eric Frumin. Eric is the Director of Occupational Safety and Health for UNITE, which is the Union of Needle Trades Industrial and Technical Employees of the AFL-CIO. He is also the Chair of the Bureau of Labor Statistics Labor Research Advisory Committee. So, I'll turn it over to Eric now.

Mr. ERIC FRUMIN, UNITE

Well thank you, Scott. And I want to say it's a pleasure to be invited to speak at this conference and to give it a chance to give one person's feedback on what the previous speakers have told us about. I want to congratulate the members of the auto workers for turning out in such large numbers here today, and keeping us all on a short leash about what's really important here. And I want to make a very quick announcement. Linda Rosenstock from NIOSH asked me to announce that copies of her presentations are available outside.

We've seen some good news and bad news here today. The good news is, first of all, that we have a lot of agreement among people coming from pretty different places about what the scope and magnitude of this problem really is. We saw, for instance, in Tom Leamon's presentation that 3% of his cases are from cumulative trauma disorders. So Liberty Mutual's numbers, guess what, are not all that different from the Bureau of Labor Statistics. So we're not really very far apart. So when we hear about, oh my goodness, you know, the science isn't there, or we don't know quite what we're talking about, or we're looking at the elephant's ear rather than its foot or something, I think actually we're not that far apart in a lot of basic ways.

Some of the points that Barbara Silverstein made I thought were quite important. First, regarding the effect of compensability on the numbers that we end up with. I mean, this was a session about what are the actual numbers, and what are the things, the factors that affect whether a case shows up in someone's count or not. And we know that in Washington and in other states, whether or not a case is compensable has everything to do with whether it's going to show up in the worker's comp systems. Tom Leamon talked about the question of behavior. People making decisions about whether or not they are going to go back to work after their injury, after something injures them. Yes, that's true, that's a factor, people's decisions about pain and so forth do affect that. How much that affects the numbers in the scheme of things we don't really know very well. But my hunch is it doesn't affect it that much because whatever the variation is in people, we know there's going to be a range. Some people are more stoic and are going to put up with pain or for whatever reasons than others. I doubt that that's going to affect things much. Probably worth investigating but certainly not worth spending much time on trying to figure out whether that's something we need to figure out in order to set an OSHA standard, or whether to start an ergonomics committee in this or that workplace, or whether an insurance carrier should be reading the riot act to their client because there's a 30% lost work day injury rate. We don't have to worry about that one too much more. We have a lot of work to do before worker behavior and worker decisions on return to work becomes the focus or the obstacle to getting something done and preventing the initial injuries. What are the behavior of employers and insurance carriers? We saw in Barbara's presentation some initial numbers about claims going down, about the rate of rejection of claims going up and her reference to administrative changes in the state workers' comp law. There's no question from our experience in the labor movement that the behavior of insurance carriers or self-insured employers has a tremendous affect on whether or not claims end up in the system, whether or not, excuse me, cases end up in the system. Whether workers file claims in the first place, whether workers are educated to file claims, whether workers are threatened, harassed, fired and otherwise abused and mistreated for filing claims. So, on the employer side a little behavior modification would probably help and it probably does have a major effect, so when Barbara talks about her numbers being the lower-bound numbers - the minimum numbers, let's understand that we're really talking very much about a bedrock minimum number and the actual numbers, the actual experience is probably much worse.

What about on the insurance carrier side? The Center for Office Technology recently produced a document comparing compensability of ergonomically related - did I get it right, Tom? Ergonomically related disorders in 50 states and that showed again quite a variation just in terms of how the state law behaves, certainly what the insurance carriers are going to do in treating claims and whether those cases are going to show up in the system. We have some states which, with active collaboration of the insurance industry certainly, have made is very difficult for workers to get compensated. Virginia is only now in the position of reinstating the compensability of repetitive trauma cases after a two-year blockade. In New York an evaluation of our members showed a hundred percent, or ninety-nine percent, controversion rate by insurance carriers. I think employer or insurance carrier litigation over workers' occupational disease comp claims is the biggest single source of litigation in the State of New York, even more than landlord tenant or parking meters, or anything else, it's the insurance carriers fighting over worker's comp claims for occupational diseases. So we found a hundred percent controversion, or 98% controversion of these claims. And guess what? Every single one of them ended up being approved. So it's not like they weren't happening. It's just that the law made it difficult to recognize the cases.

So, enough on the comp data. They're way underestimated. But interestingly, they're not way out of whack with what employers are reporting on the log to BLS. So as bad as things are, we're not really in the dark here like we used to be. We know a lot and we know enough to move ahead. Barbara made some comments on gender distribution, and the BLS data also show that there's a disproportionate number of cases among women. I want to say something about that, most of our members are women. Our experience is that, I don't know what you want to call it - bias - just differences in job assignments, sometimes even in job bidding and applications for different types of jobs in different industries has a lot to do with whether or not women end up in jobs that are high risk jobs. We have a small number of men working as sewing machine operators, and I haven't seen anything to indicate they're any less likely to develop tendonitis or carpal tunnel than the women who work around them. On the other hand, I think one of the reasons this whole problem of cumulative trauma repetitive motion cases is so difficult for some people to accept is because a lot of the people affected, a disproportionate number are women. And it shouldn't surprise us in the 1990's that sexism is alive and well in the offices of people who can't quite stomach the idea of taking care of injured workers.

The cost issues that Barbara talked about regarding cumulative trauma disorders, those costs are very high. Gordon Reeve made the point about the high cost to Ford for the disability associated with repetitive trauma cases. Again, very important - it's a common theme not only in the data presented here, but we know this in experience with many different employers, and I would expect in many different insurance carriers in addition to Liberty Mutual. I just want to point out that the medical costs, not only the lost time cost but the medical costs associated with these disorders are pretty high too. And we haven't heard an, or we haven't seen much on that issue here today. And that would be useful to us, I think, to find out about.

I want to say a couple of more things about Tom Leamon's presentation. He's referred in general terms to the BLS numbers versus the numbers collected by the workers' compensation industry. And he made reference several times to the workers' comp, to the BLS data and then went on to present some of the data from Liberty Mutual. And there were some things that he discussed that I thought were quite useful observations in terms of helping us move ahead. First of all that intervention, as he pointed out, can make a difference for a substantial proportion of cases. So, if in fact, the work of Liberty Mutual indicates that intervention works then we're in much better shape than some would lead us to believe. Because there is an argument afoot here that intervention is still so speculative that we just don't know enough to move ahead. So that was a helpful observation, and his data appeared to support that.

One of the problems, excuse me, and the other point that he made that I felt was useful in looking at his abstract, is he said that the demand for a precise value of a risk factor in what is often a very variable process, that demand to try to pin down exactly what the risk factor is, that can lead us astray. That's a very important observation. If we try to put too fine a point on this thing in order to take the first steps, or the second steps, or the tenth steps, or however many steps it takes to prevent these injuries, well all we're going to do is obstruct the process. So let's go with the inference, for me anyway, is let's use the information we have and move with it. There were a couple of problems in Leamon's presentation though. One was that for all the good intentions in this conference and for all the massive information that Liberty Mutual has, we really got very little of it here today. And I would hope that one lesson of this conference is to identify the places we can move next to get additional information. We saw only a very few analyses from the Liberty Mutual data. They are the largest carrier. Leamon's operation in research and development there is substantial. Probably rivals that in terms of staffing and resources of the BLS, and I would hope that in the not too distant future, Liberty Mutual and every other worker's comp carrier which collects interest on employer premiums covering workers with cumulative trauma disorders and other ergonomically related disorders would do the kinds of analyses that will help move us ahead. What we got today was, unfortunately in my view, superficial.

On the other hand, what we saw from Ford was the result of a very detailed careful analysis which confirms the Washington data, confirms the BLS data and gives us encouragement that we're not far apart in this business. If other employers would make half the effort Ford did, we'd be much better off in terms of having some pretty clear guideposts about where to go. I don't think we need a whole lot more effort in order to start moving down the road that some of us are committed to. I don't think we need to get from every employer in the country, or I certainly don't think OSHA or NIOSH needs from every employer in the country or every Fortune 500 company, the kind of data that we got from Ford, for a number of reasons we could go into later, but if the employers and the insurance carriers opened up the books and told us what was actually going on, we would do a better job. And hopefully over the course of this week and as we move into the future we'll get better information from these sources which have just not been available to us in the past.

Finally I just want to point out that with regard to the BLS data, yes, it's true that the BLS collects numbers from OSHA that are, excuse me, from employers that are, in a sense, the government's numbers. OSHA says, as Gordon pointed out, hey, this is what you've got to write down, this is what you've got to put on the log. And if you don't want to be one of those employers in 1986, or since 1986 who OSHA nailed at $10,000 a pop for not writing down an injury or an illness on the log, you better write it down this way. Okay, well that's true. OSHA does tell them that. On the other hand, those are all people with names, with job titles. I don't think employers go around in large numbers in this country soliciting visits to plant medical. I may be wrong, but that's not our experience. And when people show up, most of the time they show up because something real is going on. And if those numbers then end up in the BLS survey then something real by and large, is going on even if we're quibbling about whether or not the symptom existed for one day or seven days or whatever. There's too much similarity between what the employers are reporting to BLS and what Leamon and Ford and others are finding in the employer comp and worker's comp system for us to say, well this is just OSHA's invention and they're sort of putting employers hands on the log and forcing them to write down something that doesn't exist.

And then last of all, let's look at what the BLS numbers actually represent. We know that there are problems with employers not writing anything on the log, or writing half of what really belongs on there. But let's just assume for argument's sake that what's on there is 80-90% of what's going on in the work place, some large number. BLS is a good outfit when it comes to doing a survey. They know how to take a sample, they know how to calculate their results. We should have reason to be confident within the limits that I've described, that is - under-recording - that those numbers mean something. They're collecting reports from employers on about a half a million lost work day cases a year. So when they talk about back injuries, when Weber talks about back injuries and overexertion, and shoulder strains, sprains and tears - did I get it right? - accounting for a third of what is hurting American workers, that's not a shot in the dark. That's not someone's invention here. That's a quarter of a million employers putting pen to paper and sending in reports on a half a million cases to the BLS. And that half million is about one-fifth of all the lost work day cases BLS figures goes on every year. And if you do anything in the area of quality control or any other activity where you have to rely on a statistical sample to know what's going on, hatching original data on one-fifth of the whole is a large number of cases to work with. So I think we have good reason to have some faith in the BLS numbers, and I say that with having argued with people from Maine to California about whether what employers report to the BLS is real or not. Yeah, there are problems with it. But when they're collecting that many numbers and they add up that closely to what the insurance carrier and Ford is saying, we're on to something here. Let's move ahead. Let's get the rest of numbers that we can from employers, from insurance carriers. Let's keep the discussion honest, and we'll be able to set an OSHA standard within a short period of time. Thank you.

Mr. Scott Schneider, CPWR: Okay. Now we'll get a different view from David Sarvadi who's an Industrial Hygienist and an attorney with Keller and Heckman, and who's been working with the National Coalition on Ergonomics on these issues.

Mr. DAVID SARVADI, Keller & Heckman

Thank you, Scott. I see P.J. standing over on the side giving me the high sign that lunch is waiting, so I promise you I won't take more than 2 or 3 minutes here. Let me say that our concern at the National Coalition on Ergonomics has not been over the question of whether back injuries represent a significant problem in the occupational setting. That has been true since I started working as an industrial hygienist in 1974. I think it has been that way probably for nearly all time. Clearly back injuries are a significant problem. My current difficulty with the hypothesis that we can do all of these wonderful things and cure back injuries is that reports from the Department of Health and Human Services on low back pain and treatment for low back pain seem to indicate that we don't know a whole lot more about that aspect of this than we did in 1972 which is basically, Arest until you feel well enough to get up and do the work and then go back to work. One of things that the Coalition has been very concerned about in terms of the representation of data set to the world and let me say, I agree with Eric that given the BLS's statistical approach and the volume of information that they're getting, even if the absolute numbers are not right, the trends are probably correct. If we can't make that statement and agree to that, then we probably ought to give up on the science of statistics, because they are doing a pretty good job of trying to get to that basis. But let me say, the problem that we have had with the characterization of the problem goes to the question of what this increase represents over the last ten years. If you remember Dr. Rosenstock's presentation before this session got started, she talked about a large number of the cases being back-related, and about a large increase in reported illnesses. What the public perception of those two things is that they are the same, that they are describing the same occurrence. And the fact of the matter is that they are not. In fact, I think that Dr. Silverstein's data shows that the number of cases of back injuries over time is relatively stable, at least in the last couple of years. And one of the questions that I have for BLS and for other people that are working on this question, is what, in fact, has happened since 1972 in terms of back injuries? The other thing I think that is coming through here, and for those of you that have started to surf the Internet this may hit closer to home than for the others. One of the problems with data is that you have to be able to analyze and accumulate and use those data before you start to get to information. And we've had a lot of data presented today, and we've had a lot of data presented over the last several years about these kinds of cases. But I fear not much information has come out. And I think today's presentations from all of the participants have begun to lend themselves to identifying the information that's contained in the data.

The second problem that we've had at the Coalition with these data is the aggregation of back injuries with repetitive, so called repetitive trauma cases in describing the scope of the ergonomics problem. I don't think they necessarily lend themselves to the same kinds of interventions that Eric was talking about that can fix those things. And so there's a misperception that if we set up these ergonomics programs we'll be able to deal with all of these kinds of cases. In my experience with my clients, that's not necessarily the case. So, the question of generalizing to the larger group of all employers from the specific experiences of a few is the public policy question that we have to deal with. Are we going to go to Ford and use their system as a paradigm for all other organizations. And if we do, what is it going to cost us to do that and how is it going to benefit the people that are going to pay for it - that is, the people who actually work on the shop floor. And the one thing that I always have to remind myself because I'm somewhat removed from it now, is that eventually all of these things get paid for by the people who put the parts together and make the parts, and push them out the door.

And finally let me suggest an alternative to Dr. Silverstein's interpretation that the change in the number of claims in the BLS data was due to the '94 push for a regulation. I think most of us recognize that when you go into an ergonomics program in a plant you'll see an increase for a couple years before you see a decrease, at least in the frequency. My interpretation would be that the reason that we saw the decrease in '95 compared to '94 is the efforts that employers were making in '90, '91 and '92 after all of the publicity that we saw. I, too, have no proof for that, but given no proof I'm able to make that conclusion myself.

So finally let me say that I agree with Eric that we have at least an ability to talk about these things now, and we are coming to a consensus where we have information. But we still have a long way to go in terms of comparing what happens in the workplace in situations where people have jobs that are creating situations they could become injured in, compared to what happens when they do those same activities off the job and in their normal daily life. That is, what's the background incidence of back cases that we have to deal with from people just living day in and day out. I'm not sure that we have the information that we need to answer that question. And with that, I'll stop. Thank you.

Mr. SCOTT SCHNEIDER, CPWR

Okay. We have about 15 minutes for questions and discussion from the floor, so, remember those instructions that you heard earlier which is, please use the microphone, please state your name, rank and serial number, and be respectful. And I'm interested to hear some comments on today's session.

Questions & Answers> from this Session 4

Dr. Sue Rogers: Hi. Sue Rogers, consultant in ergonomics from Rochester, New York. Just a question for those of you who are looking at your databases. Is there any way that you can tie changes in manufacturing processes or in job design, shall we say, to some of these injuries. I think what I see is that some of the management programs that we have out there make a huge difference in the way people can do work compared to what they use to have, is flexibility for altering the work load to their capabilities. And I wonder if either Barbara's data set of Gordon's allows us to look at those issues when the production rate has gone up or whether the downsizing has created fewer people to fill in. Barbara alluded to the specific thing of temporary employees which has gone up tremendously in manufacturing. So, maybe you could just address that issue if it's in the database, if it's something we'd be able to test against.

Dr. BARBARA SILVERSTEIN: I'm not sure that it's in our workers' comp database to look at that. It's possible to look at industry trends and the labor market and where that's gone and trying to have some surrogate measures for what's going on with worker's comp data, but there'd be an awful lot of assumptions that would go into that that make me a little nervous. It's not out of the question to look, however.

Dr. GORDON REEVE: Just commenting briefly on the Ford data sets, we have fairly detailed information about where people worked in this database, and probably the most important thing to do is not to try to look at overall trends in a plant, because no matter how much progress you make in a few selected areas, there's always the inevitable bad process that makes it back into the plant. It's amazing how you need to put constant energy into this process. One of the things that we're looking at in Ford through the UAW-Ford National Joint Committee on Research is to look at some of the 3,000 ergonomic interventions that we've done on Yon small scale portions of each plant and operation with our local ergonomics committees, and then to see what we had before and after in terms of injury rates and also in terms of cost information, and also the actual, ergonomic or the job safety analysis scoring that goes along with that. So we're in the process of planning to go forward with that now that we have the data well established at Ford.

Ms. Peg Seminario: Peg Seminario from the AFL-CIO. Just a comment and an observation from the four presentations that were made. I would agree with Eric Frumin that if you look at the different data sets and different perspectives, that when it's laid out in front of us that there is a lot of similarity between the data sets whether coming from BLS or whether coming from worker's compensation. And perhaps it is more the perspective of where the person sits to which that data in then put for public discussion, as to where the differences come about. In looking at Tom Leamon's presentation I noticed while we're discussing ergonomics that the one piece of that that was pulled out of CTDs - upper extremity - which I think all of us agree is smaller in scope, much smaller in scope than the problems of back injuries and manual handling. If we can come to some agreement that what we're talking about when we're talking about these kinds of injuries and illnesses that go beyond the upper extremities, it also has to include backs. It absolutely has to if we're really to get to the heart of what is the biggest part of this problem, then I think we make some progress about at least defining problems that we're trying to deal with. And we'll just ask the presenters here if everyone does agree that when we're talking about ergonomic injuries and illnesses that we are trying to address in a public policy context that we indeed are talking both about the upper extremity problems and the back problems.

Dr. TOM LEAMON: Yes, Peg. I'm sure we are. And I think it depends where you draw the line on ergonomics. And of course it's being drawn in the last few years in a rather peculiar sense, and that's one of the reasons the publications from Liberty have been concentrating on showing this relatively small size in more segments of cumulative trauma. The big ones looking at them we have a very large sample, maybe 10% of the worker's compensation business, and it's really clear, manual materials handling, slipping and falling and then struck by/struck against. And the interventions on all those are ergonomics, and so I couldn't agree more. If I can just crave your indulgence -- I was hoping someone would ask a question so I could reply to Eric a little. It reminds me of a time I was driving and I was coming to a bend, and I swung a bit wide, and as I came around the bend a young women in an open-top car came around and we just missed each other, and as she passed me she shouted pig. So being a true, red-blooded whatever I am, I turned around and shouted cow. And at that moment I turned the bend and ran into a pig. What I'm responding towards, I think it's a very serious comment and I certainly didn't communicate it properly, is I think Eric was coming up with sometimes I'd describe as a knee-jerk reaction. When I'm talking about work behavior, I'm not, repeat not, falling back on the old idea of blame the worker. I don't think it's a policy issue. I don't see it as an OSHA regulation issue, I see it as a science issue. How on earth can I develop a criterion only based on biomechanics of the workplace if these other factors are major? And in my opinion I disagree entirely with Eric, I think they're very major; until we start to look at the whole problem and coming up with the idea that this number of repetitions is going to do something, I don't know what we're trying to control. Because I do know that people with pain respond differently, and yet we count it at different parts of the continuum. So it's a science issue that unless we accommodate those in some form eventually, then the interventions are never being validated against the real issues. And secondly, and finally then I'll shut up -- for people who don't know, and I assumed everyone did, Liberty Mutual peer reviews all its research. Every single piece of work which we do at the Research Center appears in the scientific literature for use by both sides of industry, and anyone around the world who might like to use it. And finally I would imagine every paper published in the last ten years which has looked at carpal tunnel syndrome or low back pain has used Liberty data to establish the size and scope of the problem. I don't think I'm aware of any paper which doesn't quote our work when it's trying to establish the significance of these. So I really think it's kind of unfortunate to suggest we're doing research work and not sharing it. There is a principle that Liberty spends several millions of dollars a year on, and it's one we aim to continue.

Mr. DAVID SARVADI: Part of the reason this conference was structured this way was to solicit contrasting views. So let me offer some contrast to the conclusion that 'somehow we ought to aggregate these data.' The problem with aggregating the data is that sometimes it masks the solutions. So my suggestion is that if you really want to get at the problem of backs, then we better focus on backs. And we had better do a better job of identifying the things involved in back injuries and in the workplace that we can pay some attention to, rather than trying to look at a large problem that talks about upper extremities and backs in the same breath. Clearly the programmatic approaches that lots of people have adopted, can come up with solutions. That is not the same thing as saying that as a public policy matter, we ought to come up with a regulatory approach that uses the same kinds of conclusions. Let me stop there.

Dr. BARBARA SILVERSTEIN: I don't advocate aggregating data, per se, into one big lump. But I do think it's important to have both sets of data, those related to manual handling and those related to repetitive motion, for lack of a better descriptor at this point. I think it is true that there are many solutions that can address both of those things simultaneously. That the effort that a company has to put in to developing an ergonomic process or program can just as easily look at both of those things simultaneously. And so I don't really see the reason why we wouldn't address both of those problems, recognizing that they are two problems and that the data should not be aggregated, per se.

Mr. Mickey Long: My name is Mickey Long, and I'm an international rep with the UAW. And I also represent the UAW-Ford National Joint Committee on Health and Safety. And I just want to make a comment or a suggestion and it's part of my responsibility. The speakers talk about responsibility and ethics and things like that, and I certainly don't disagree. And I want the first and last speaker to understand that I'm not trying to disrespect their point of view, but I do have a comment, and I think what we need to do in this whole discussion that's going on here and hopefully into the future, is that we have a Rule 5 - well, really it's an expansion of Rule 3, when we talk about respect. And that is, respect for the people that aren't here - the injured workers. And I don't think we do that. Now, when I talk about respect, I could say things like respect for the intelligence of the people that are here, I won't say that because that may go with my own bias. But I think it's most important that we have respect for those workers. Peg Seminario and those of us in labor have a tendency to speak about individual cases. And certainly all of us that are here could probably talk about individual people, and how they were hurt, and how they were, if you will, abused. But there has been economic and political warfare done to these people over a long period of time. And unless and until we get to a situation where we can talk about that openly and honestly - what am I talking about? When we start there's Acatch words, there's things that are said, and as soon as we start hearing those things, we get upset, we get concerned, and it's not a problem, there's not science, it's not credible science, and there's no money if there is a problem. We have a real problem with that. And unless and until we get beyond that, and I call that a low level of discussion. Unless and until we get beyond that, we're not going to get at the problem, and we're certainly not going to get at the solution. So I would suggest that we expand Rule 3.

Mr. Rod Thorne: My name is Rod Thorne and I'm an employee of Ford Motor Company in Oakville, and I work at their assembly plant in Canada. And I'm also a union official in the local union that represents four and a half thousand hourly employees. I deal with worker issues and production standards on a full-time basis and assist on a joint ergonomics committee. I do want to make a couple comments. The first speaker of the day, I believe, I took exception to his notion that there is no epidemic in this field. I'm sorry, but there is an epidemic of injuries that are related to adverse ergonomic conditions on the job. There is absolutely no question about it. It is indeed an epidemic. And I think if you listen to the speaker from Ford headquarters, he would even agree with that statement. The first speaker also denied having a link between line speed and repetition. In the repetitive nature of the industry in relation to adverse ergonomic conditions, there is no question in my mind that a line speed is a direct correlation between the two. And the faster that those lines go, and the less work and the less volume of work that you do on those individual units, the more likely you're looking at injuries that relate to adverse ergonomic conditions. As for the business of intervention, I would clearly support that, in terms of an ergonomic process, consultation, research, identifying key concerns, key problems. Intervention for me is very important. And a previous speaker advocated also against a non-regulatory approach, that is obviously no regulations and guidelines from government bodies. The only progress I know of that we have made in this field and in any other field relates to, strictly to, adapting and legislating governmental guidelines; they are very important for working people, I believe. And lastly, I was pleased to hear the rebuttal arguments from the representatives from the AFL-CIO, the NIOSH group, the needle trades, keep up the good work. I do believe, though, that people involved in the field of ergonomics should continually try to reassess their positions and their guidelines. That I have no problem with at all. Scrutiny is very important. In some ways I believe that the guidelines that, quite frankly that we see are too inhibited. And they come down on the wrong side. So, I just thought I'd make those comments anyway. Thank you.

Mr. ERIC FRUMIN: I think it's been instructive to hear Dave Sarvadi and Tom Leamon talk about the problem of perception or portrayal, that in some settings the ergonomics problem has been defined by a portrayal, a picture, a report in the New York Times or whatever that it's repetitive trauma, cumulative trauma, going up like crazy versus this back injury problem which has been around as long as the ages, it's a 30%, 28%, 35%, hasn't changed that much in the Washington data. If that's our problem, well we're way ahead of where I thought we were. If our problem is how to show people how they have to deal withYor can and why it's in their interest to deal with both of those problems at once in the workplace, then we're not too far apart. But if our problem is that people can't handle the notion that ergonomics, as practiced by a plant manager, a steering committee in the plant, an ergonomics team, a corporate office, a union or safety committee, whatever it is, they can't handle both at once. If people are saying that that's the issue, you know, it's too much for the body to handle then we've got to wonder whether we're in a position to take a next step. I don't think, in our experience and in most people's experience, ergonomics is too tough a subject for people to use, to deal with both sides of the coin. But if some people feel that way, we better spend a little time this week exploring that subject, otherwise we're on a collision course - and it won't be pretty.