Biohacking and the Workplace
Protecting Modified Worker Health
Hank sits across from you in your office, nervously shuffling a packet of papers. “The test results say that I have a single nucleotide polymorphism in the DNMT1 gene,” he says. He hands you a printed page from the National Library of Medicine website. “That page says I’m at increased risk for losing my hearing.”  You scan the page, reviewing the abstract. You remember some of the terms from classes taken years ago, but this is not familiar territory. Still, who else at your facility, or your company, could make heads or tails of this kind of scientific literature? Every department Hank is qualified for requires hearing protection. He has been wearing ear plugs in his current role for seven years. He eyes you nervously. “I don’t want to cause any trouble. You know I need this job. But I want to be able to hear my granddaughter play her violin. So, what do you think we should do?”

Are you ready for these kinds of questions? Industrial hygienists are the leading experts on protecting worker health, providing advice on subjects of ever-increasing complexity, and explaining the context in which this advice can be leveraged to minimize risk. With this responsibility comes the need to prepare for change in both the workplace and society.
Advancing technology presents new industrial processes and agents to understand; new processes, controls, and materials to characterize; and new topics to master. Our practice is constantly evolving to provide the best information and judgment to our stakeholders. Much of this change is easily digested—adjustments to occupational exposure levels based on new toxicology data, the development of an innovative new instrument, or the meticulous validation of an improved analytical method. More esoteric developments demand growth from many professionals. Recent examples include evolving concepts of the exposome, a revolution in predictive statistical methods, and predispositions from asynchronous exposures. The same approach applies to adapting evaluation techniques to protect workers who may be unusually vulnerable to certain risks, or who have been modified in a variety of emerging ways.  VULNERABLE AND MODIFIED  Occupational exposure limits and other risk-related concepts are often intended to protect most (or nearly all) workers from occupational illness. Even so, some workers do not fall into these categories for reasons such as chemical hypersensitivities or conditions such as cystic fibrosis. They are a small fraction of those present in the workplace, but their presence is not new, even if our understanding of these conditions has improved. Wearers of medical devices and those who have declared as pregnant are also understood to require additional protections. Collectively, we can consider these individuals to fall under the general category of “vulnerable and modified”—cases where caveats apply to routine guidance, as these conditions require special attention and care when evaluating exposures. Our rapidly advancing understanding of genetics, microbiomes, medical devices, and other topics of individualized health is already hitting home. With only a vial of saliva and a few weeks of waiting, people can obtain an individualized genotyping report, arming themselves with an unprecedented level of personal data. The internet allows patients to find information about their specific genetic conditions and predispositions.  In 2013, the actress Angelina Jolie announced that she had opted for a prophylactic bilateral mastectomy based on the results of genetic screening. With a family history of breast cancer, the presence of the BRCA1 gene informed her decision to reduce her risk of developing the disease. As a public figure, Jolie helped enhance the public’s understanding of specific genetic predispositions and  is suspected to have contributed to an uptick in targeted genetic screening. Just a few years later, genetic screening is prevalent enough that concerns have been raised about the privacy of these reports. 

Diabetics, for whom medical devices have long been a way of life, are now advancing from multiple daily finger-sticks to continuous glucose monitors worn on the arm or abdomen that constantly stream analytics to their smart phones. Backed by robust medical recommendations, the widespread adoption of implantable medical devices is now an estimated global market of $20 billion, driven in part by increasing adoption among an aging workforce. More than ever before, hardware is a part of healthcare. On the horizon are biomedical tattoos, gene therapy using CRISPR-based techniques, and other unimaginable innovations that stand to markedly improve the health of workers while also presenting a host of complications that will affect the basic practice of industrial hygiene and risk management in the workplace. It’s reasonable to expect that patients empowered by internet search engines and other resources may raise difficult but important questions about how they’re protected at work. 
The union representative comes to talk to you in private. “Some of the crew are a little concerned about Larry’s ability to serve as confined space attendant,” he tells you. “That heart gizmo—what did you call it?” “An implantable cardioverter defibrillator. ICD,” you say. “Right, that.” He nods. “Anyway, they’re worried that he might have an episode and pass out. Or that it might interfere with the gas monitor. Or that someone might hack it, and they might be in danger. They know it’s unlikely, but doesn’t that put the entrants at increased risk?”
BIOHACKING Not all of these advances are the domain of prescriptions, devices, and services approved by regulators. Given economic pressures and the conservative pace of regulatory approval for an overwhelming number of therapies and devices, many individuals rely on their ingenuity to address specific concerns. These do-it-yourself treatments or modifications are the domain of those seeking improved “bioautonomy” by assuming a degree of personal risk. Colloquially, this collection of practices is known as biohacking. Biohacking pertains to the modification of biological systems using hardware, software, or the lesser-known wetware (existing biological structures and mechanisms). A cochlear implant is hardware. A nutritional guidance algorithm is software. The proximal tubules in your kidney are wetware. Biohackers seek to study or influence biological systems, including their own bodies, for understanding or improvement, sometimes by any means available.  Biohackers may perform at-home polymerase chain reaction (PCR) testing to find the horse meat in their lasagna, perform a CRISPR treatment in hopes of improving their muscle development, or grow bioluminescent yeast to brew glow-in-the-dark beer. In 2019, an online community of diabetics developed an algorithm for automatically dosing insulin by sharing data between continuous glucose monitors and insulin pumps, closing the loop on an “artificial pancreas” to ease the pressure of constant vigilance required by their condition.  Projects like this are neither speculative nor for the squeamish. Considered cosmetic bordering on guerilla, biohacks are almost always done without anesthetic or medical oversight. Nor is biohacking without acknowledged utility. Trades dealing with electricity have been known to coat neodymium magnets in the bioinert coating parylene-c and implant them in fingertips to provide haptic sensation in the presence of strong electric fields. This modification has been held anecdotally responsible for the prevention of significant shocks when encountering unexpectedly live parts.  Finally, biohacking is not the sole domain of amateurs. Dr. Phil Kennedy, a neurologist, implanted electrodes in his own brain to further his research on the neurological basis of language when no other patients were an option. Dr. Josiah Zayner, a biophysicist, transplanted his systemic microbiome in a hotel room using a non-surgical procedure he designed himself. Any comedic value presented by projects either whimsical or frivolous is overshadowed by the (perhaps anecdotal) success of the dedicated and highly qualified.
Paul asks to speak with you privately at the construction site. “I’m worried about my sun exposure,” he explains. “My mother-in-law was just diagnosed with melanoma, and I’ve never been much for sunscreen. We’re working out here all day, you know? So I got myself one of these skin monitors.” Embedded in his arm is a personal UV sensor. As you watch, he cycles the display on his phone to show “182% TLV.”  “UV is a carcinogen, right?” he asks. “So, don’t you have a duty to protect me?”
SHARED TERRITORY  The use of devices to monitor and quantify health-related values is familiar to industrial hygienists. Innovation in sensor technology has driven development of education and guidance, which has led to advancements in professional practice needed to accommodate unprecedented data streams and improved hazard control. Biohackers are, in this matter, kindred spirits—seeking insight into their health or bodies using the best available methods. But complications arise when technology allows laypeople to monitor exposures, a task traditionally reserved for professionals. The same desire for information and involvement that drives informed patients can easily extend to informed workers. Seeking to understand their exposures, they can use personal devices to collect measurements without their employer’s knowledge. These consumer-grade products lack the precision and reliability of most fit-for-purpose instruments used by a skilled professional. Many industrial hygienists have already been on the receiving end of data gathered from well-intentioned but potentially questionable smartphone applications for noise or vibration. The bioautonomy mindset that motivates biohacking could easily lead employees to monitor their exposures without the employer’s knowledge, which presents a number of difficult questions, especially when monitoring is conducted by the litigious, the vocal, or the misinformed. The possibility of worker self-monitoring presents as much potential for conflict as it does opportunity to partner with employees to develop informed opinions, gain insight about their concerns, and further characterize risks. Core values can guide professional practice in the shared territory of monitoring. Known risk is better than unknown risk. Exposures to agents should be controlled to the maximum extent practical, and everyone deserves to be protected from the threat of occupational illness. These principles can guide much of our thinking until norms and guidance are developed. In situations where core values are insufficient, the ethical boundaries of professional practice should govern our actions, especially when authoritative exposure limits and guidance are still catching up. CALLS TO ACTION Our basic assumptions about the employees we seek to protect may change for the vulnerable and the modified, even if our basic function of mitigating exposures does not. We need to improve our preparedness for handling unusual situations by establishing professional standards for care and frameworks for methodology. This material should be made available as guidance for professionals seeking to develop competence in this area. In January, a proposal was submitted to the AIHA Content Portfolio Advisory Group suggesting development of a Body of Knowledge (BoK) for vulnerable and modified employees. A BoK is a critical step in identifying and organizing the competencies needed by industrial hygienists to address the challenges of protecting groups that need special attention. Several sources, including ACGIH, the Institute of Electrical and Electronics Engineers, and the International Commission on Non-Ionizing Radiation Protection provide excellent guidance for wearers of medical devices concerning exposures to electromagnetic radiation. These sources can serve as templates for the development of guidance for vulnerable and modified employees. Technical guidance specific to handling genetic predispositions to occupational illness is sorely needed to consolidate and frame the rapidly growing volume of peer-reviewed literature. Ideally, this authoritative guidance will be developed by an internationally recognized group such as ACGIH or the Occupational Alliance for Risk Science. Such guidance would assist a competent industrial hygienist in referencing known occupational predispositions for specific stressors, given either a specific genetic architecture or specific agent of concern. The key to successful guidance will be usability as well as awareness of these issues among the community of practice. Once this guidance is available, dedicated professionals must commit to sharing it with their peers. Finally, we as a profession should evaluate what standard of knowledge we expect from a competent industrial hygienist in comprehensive practice. The ability to read and understand the literature of genetic predisposition is perhaps an emerging essential competency of industrial hygiene. As a community, we are more than up to the task of meeting this emerging need for those who are most at risk. We must have the courage to fulfill our responsibility to do our best to protect them.   SPENCER PIZZANI, CIH, is the industrial hygiene program manager for Pepsico Beverages North America. Send feedback to The Synergist.

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Disadvantages of being unacclimatized:
  • Readily show signs of heat stress when exposed to hot environments.
  • Difficulty replacing all of the water lost in sweat.
  • Failure to replace the water lost will slow or prevent acclimatization.
Benefits of acclimatization:
  • Increased sweating efficiency (earlier onset of sweating, greater sweat production, and reduced electrolyte loss in sweat).
  • Stabilization of the circulation.
  • Work is performed with lower core temperature and heart rate.
  • Increased skin blood flow at a given core temperature.
Acclimatization plan:
  • Gradually increase exposure time in hot environmental conditions over a period of 7 to 14 days.
  • For new workers, the schedule should be no more than 20% of the usual duration of work in the hot environment on day 1 and a no more than 20% increase on each additional day.
  • For workers who have had previous experience with the job, the acclimatization regimen should be no more than 50% of the usual duration of work in the hot environment on day 1, 60% on day 2, 80% on day 3, and 100% on day 4.
  • The time required for non–physically fit individuals to develop acclimatization is about 50% greater than for the physically fit.
Level of acclimatization:
  • Relative to the initial level of physical fitness and the total heat stress experienced by the individual.
Maintaining acclimatization:
  • Can be maintained for a few days of non-heat exposure.
  • Absence from work in the heat for a week or more results in a significant loss in the beneficial adaptations leading to an increase likelihood of acute dehydration, illness, or fatigue.
  • Can be regained in 2 to 3 days upon return to a hot job.
  • Appears to be better maintained by those who are physically fit.
  • Seasonal shifts in temperatures may result in difficulties.
  • Working in hot, humid environments provides adaptive benefits that also apply in hot, desert environments, and vice versa.
  • Air conditioning will not affect acclimatization.
Acclimatization in Workers