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. 

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.

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.