First, Do No Harm

In the discussion about a reported increase in “repetitive stress injuries,” some accuse the government of idly standing by while more and more American workers are injured on the job, by the job. A closer look tells a different story.

Repetitive stress injuries at work can be a significant claim for individual workers. These injuries, however, represent less than 5% of the total number of workplace injuries and illnesses. It is also worth noting that the number of new cases being reported is going up far less than in years past, not at a rate of epidemic proportions. More important, it is not at all clear what actually is being reported as work-related repetitive stress injuries.

The medical professionals treating these workers must adhere to the scientifically based medical principle: diagnosis before treatment. In this group of patient complaints, we do not have a diagnosis. No one fully understands the cause of repetitive stress injuries, how to treat them or how to prevent them.

My organization represents 1,500 orthopedic surgeons practicing in California. Many of our members are specialists in injuries to the hand, knee, back and shoulder and regularly treat workers with these complaints. It is our conviction that there is no scientific basis at this time that would warrant broad regulations and/or legislation on repetitive stress injuries.

While we acknowledge that these injuries may well be work-related, we see no scientific evidence that they are singularly work-caused. That would help explain why two employees, working side by side, performing the same work tasks in apparently the same fashion, present different outcomes. One employee develops an alleged “repetitive stress injury” and the other does not. If these injuries are work-related, not work-caused, workplace solutions alone are unlikely to be the answer.

This does not mean we should do nothing. A group of orthopedic surgeons from four Eastern states has made a proposal to Labor Secretary Robert Reich. They recommended, and we strongly agree, that the government should move ahead with additional research into the clinical problem of repetitive stress injuries.

It is possible that any regulations issued now might place significant burdens on employers without assuring any appreciable benefits in return, either for employees or for the public. It might require employers to expend resources on new equipment, retooling or redesign. We might well find after making those changes that some employees are still developing repetitive stress injuries and some are not, just as it happens today.

We should encourage further sound medical research into the cause, possible cure and the prevention of these injuries.

Suggesting treatment before an accurate, scientifically based diagnosis is bad medicine. We must pay heed to the honored doctrine: First, do no harm.