Alternative Medicine in the Workplace
Richard A Lippin, MD
settings are ripe for the application of alternative medical interventions
for a variety of reasons. Included among them are a shared interest
in prevention hy hoth the occupational and alternative medicine
communities, economic incentives hy corporations as major purchasers
of healthcare to reduce healthcare costs and improve employee
productivity, and the willingness of corporations to be dfferentially
creative in their approach to delivering and purchasing health-care.
This paper describes the US workforce in transition, provides
an overview of occupational medicine including current programs
and emerging issues, describes the current applications of alternative
medicine interventions in the workplace, and argues forfuture
expanded application of alternative medicine in workplace settings.
(Alternative Therapies in Health and Medicine. 1996;2(1):47-51)
IS OCCUPATIONAL MEDICINE?
inquiry into the application of alternative medicine in the workplace
should begin with the recognition that this activity falls within
the specialty of occupational medicine.1 This branch of preventive
medicine is concerned with:
maintaining, restoring, and improving the health of workers through
application of the principles of preventive medicine, emergency
medical care, rehabilitation, and environmental medicine
a productive and fulfilling interaction of the worker with the
work through the application of the principles of human behavior
This definition highlights the multifaceted nature of this growing
specialty in medicine and provides a framework for successful
and responsible application of alternative medicine in the workplace.
characterize and plan for alternative medicine at the worksite,
it is important to describe the basic sociology and demographics
of the US workforce.
to workforce expert and sociologist Ross Koppel, the civilian
US workforce now totals more than 125 million, with adult men
representing approximately 55.6% of this force and adult women,
nearly 44.4%. White men no longer dominate the US workforce; the
numbers of women and ethnic minorities continue to increase. The
numbers of working older people, very young workers, and workers
from other countries are also increasing.
the average number of hours worked by an individual per year is
increasing. In her book The Overworked American: The Unexpected
Decline of Leisure, Juliet Shore reported that with more women
holding down “real jobs” and the continuing need for
labor at home, the total hours worked by Americans of both genders
has increased since 1969 by 163 hours per year to nearly 2000
hours (on average and not counting another 900 hours of work done
at home).2 In addition, workers are expected to change careers
two to five times during a productive lifetime.
industries employ approximately 29.3% of working individuals;
service-producing industries including government employ more
than 25.7%; and 45% of workers are employed in offices.3 The number
of agricultural workers dropped from 7.1 million in 1960 to 3.1
million in 1985. The need for new personnel in environmental protection,
energy development, and healthcare will increase openings for
professional workers. Expansion of retail trade will lead to a
greater number of salespeople; the hospitality, computer manufacturing,
and robotics industries are growing as well.
number of businesses with a small number of workers exceeds the
number of firms with large labor forces. Large firms are more
likely to use some form of on-site occupational health facility;
small businesses are likely to use the services of outside healthcare
consultants because of the lower costs of ad hoc external medical
a large extent, occupational medicine programs are driven by federal
and state regulations—pertaining to workplace safety and
health as well as hiring, personnel, and benefits practices—that
have accelerated over the past 20 years. Among the more important
laws relevant to alternative medicine are the Occupational Safety
and Health Act (OSHA) of 1970 and the Americans with Disability
Act (ADA) of 1992. Both laws directly address human health and
capacity issues that influence the requirements of occupational
OCCUPATIONAL MEDICAL PROGRAMS
fundamental reality of the workplace as a site for medical services
is that it is convenient for on-site employees who live in an
increasingly busy society. This phenomenon and fundamental health
economics increase pressure on employers to provide more primary
healthcare at the workplace. Because the American workforce is
essentially healthy, the more logical goal of occupational medicine
should be to prevent illness rather than to treat the ill and
injured. The various kinds of health-related activities that may
be undertaken as part of an occupational medicine program are
For regulatory and other reasons, occupational health professionals
engage in a wide variety of examinations and evaluations.5 Examples
include: (1) preplacement surveillance exams targeting specific
exposure, (2) return-to-work and fitness for duty, (3) pre-expatriation
and repatriation, and (4) periodic health maintenance evaluations.
Besides providing an opportunity for the physician to detect occupational
and nonoccupational risks and diagnoses, and provide data for
individual and group analysis, these examinations allow the physician
to interact with individual employees to discuss lifestyle and
Often, on-site occupational health programs also provide palliative
care for limited, uncomplicated conditions. This care is geared
primarily toward maintaining workplace productivity. For example,
the practitioner may provide medication for mild upper respiratory
infection, mild gastrointestinal upsets, menstrual cramps, headaches,
and mild skin conditions.
The primary responsibility of the occupational physician is the
management of occupational illnesses and injuries that can be
both complicated and prolonged.
In corporate settings emphasis on fitness and wellness programs,
including scientifically based exercise, recreation, and a wide
array of health education and behavioral change seminars, is growing.
Employee assistance programs, which began in the 1970s, have successfully
addressed many mental health issues affecting workers but often
have failed to address adequately the major issue of workplace
The workplace can be viewed as a logical, accessible location
for delivering a wide range of primary and secondary preventive
medical services including medical screening and immunizations.
Many safety-sensitive industries (such as transportation, nuclear,
and chemical) conduct drug and alcohol screening.
Occupational physicians and other health professionals are in
a unique position to advise employees on appropriate uti
lization of the external healthcare community and serve as ombudsmen
and advisors in this regard.
Occupational physicians may also participate in planning, providing,
and assessing the quality of employee health benefits.
AND EMERGING ISSUES IN OCCUPATIONAL MEDICINE
of the trend in the 1980s toward corporate restructuring, which
led to corporate downsizing, workplace stress has increased. In
addition, the cost crisis in healthcare is forcing companies to
use the workplace to emphasize prevention and the importance of
managing both nonoccupational and occupational illnesses and injuries
in a cost-effective manner. The Circadian Group, based in Cambridge,
Mass, has stated that in order to be competitive in the 21st century,
US industry must move from a machine-centered technology to a
human-centered technology that requires increasing reliability
on human performance, with an emphasis on protection of human
assets. These issues all affect planning for occupational medicine,
including alternative practices, at the worksite.6
work-related issues that may prove amenable to alternative medical
practices are described below; potential alternative medical approaches
to these problems are presented in the following section.
1983 the National Institute of Occupational Safety and Health
(NIOSH) listed 10 leading work-related diseases based on their
frequency of occurrence and amenability to prevention (Table).
Although viewed by some as highly controversial, these 10 remain
on NIOSH’s priority list, a list that has been borne out
in part by recent so-called epidemics in occupational medicine,
including occupational stress and cumulative trauma disorder.
Cumulative trauma disorder appears to be a disease of our times,
representing a clash between human anatomy and laborsaving technologies
that require less gross muscle work but more repetitive small
muscle and hand work than in previous eras. It strikes carpenters,
musicians, butchers, meat packers, auto workers, gardeners, construction
workers, supermarket checkers, assembly line workers, writers
using computer keyboards, and others who use their hands repetitively
with the wrist bent.
diseases based on frequency of occurrence and amenability to prevention
• occupational lung disease
• major injuries including amputations and fractures
• occupational cancers
• disorders of reproduction
• cardiovascular disease
• noise-induced hearing loss
• neurotoxic disorders
• psychological disorders
• dermatologic conditions
• musculoskeletal injuries
By some estimates, the incidence of cumulative trauma disorder
among US workers is 1 in 10. The US Centers for Disease Control
and Prevention has reported, however, that no accurate, reliable
data exist on the frequency of work-related cumulative stress
disorder for two reasons: (1) inadequate training of health professionals
to recognize these conditions and (2) underreporting of recognized
cases. The accuracy of surveillance could be improved by establishing
standard definitions for work-related musculoskeletal injuries.
stress is another problem at an epidemic level in this country.8
Stress clearly is the major cause of productivity decline in the
US workplace, with three stress-related disorders—chronic
pain, hypertension, and headache—accounting for 54% of all
absences, or $15.7 billion of the $80 billion loss in wages every
year. Although definitions of job stress vary and more objective
measures must be developed, 30% of adults report high job stress
nearly every day, and an even higher percentage, once or twice
a week. In a 1991 study by Northwestern National Life Insurance
it was reported that more than one third of the respondents were
considering changing jobs because of job stress. In California
the prevalence of claims for gradual mental stress more than doubled
from 1980 to 1982, whereas claims for all other disabling injuries
actually decreased by more than 10%. Furthermore, mental disorders
are the most prevalent (21%) of disabling conditions among recipients
of Social Security Administration funds for disability. When the
New York Business Group on Health polled 201 personnel and medical
directors of small, midsize, and large corporations, the results
were that depression affected 24% of their employees on the average,
and led to an average loss of 16 days of work annually.9 Violence
in the workplace, including homicide, is also a growing concern.
a June 1991 letter10 the author proposed a new research model
for the common cold that implicates stress, suggesting that although
the presence of a virus may be indisputable in each case, it does
not necessarily play a causative role and that, anecdotally, a
direct correlation has been found (by the author) between periods
of intense stress and the onset of a cold. The situation is proposed
to involve a parasympathetic breakthrough or payback phenomenon
that others have misdiagnosed as being caused by a virus. The
phenomenon produces symptoms typical of an overactive parasympathetic
nervous system, including increased mucus, sweat, and tear production;
generalized muscle aches; and nausea and diarrhea. Related to
this hypothesis, in August 1991 Sheldon Cohen and colleagues at
the University of Pittsburgh reported an association of psychological
stress with increased incidence of the common cold.’5
topical issues that are emerging in occupational medicine are
air quality, multiple chemical sensitivity, environmental tobacco
smoke exposure, shift work, vigilance and fatigue, and travel,
especially international. Upper respiratory infections still account
for a large percentage of lost work days, and back injuries make
up 20% of occupational injuries in the United States, costing
as much as $30 billion each year. Some sources predict that 80%
of the working population will at some time during their careers
experience significant low-back pain. Some 20% to 25% of all the
back claims in industry account for 90% of the costs of such injuries.12
The National Safety Council estimated that in 1986 approximately
10,800 deaths resulted from accidents in the workplace. In addition,
1.9 million people sustained work-related disabling injuries,
and total work accident costs for 1984 were estimated at $32.4
OF ALTERNATIVE MEDICINE INTERVENTIONS IN THE WORKPLACE
medicine is practiced infrequently in the US workplace, with some
notable exceptions such as massage, acupuncture, and informal
nutritional interventions. Procedures that promote alertness,
relaxation techniques, and arts-medicine (a study of the relationships
between human health and the arts) interventions are beginning
to be used as well.
Among the more successful alternative medicine interventions in
the workplace is on-site massage therapy. Although precise statistics
in the field are not yet available, Elliot Greene, past president
of the American Massage Therapy Association, indicated in a 1995
letter (to the author) that more than 80 companies, many of which
are Fortune 500 companies, are using massage therapy to counter
such ills as musculoskeletal problems, stress, and poor ergonomic
design of furniture. The association itself has grown from 1500
members in 1983 to 22,000 members in 1995, with accredited schools
increasing from 12 to 60 during the same period.
offering on-site massage include Apple Computer in California,
Merrill Lynch and NBC in New York, the Dallas Herald Tribune,
SmithKline Beecham and Conrail in Philadelphia, Ben and Jerry’s
Ice Cream in Waterbury, Vt, and Wampler Longacre Chicken Company
in Virginia. The latter provides an around-the-clock massage therapist
for more than 1000 workers in its large poultry plant in an effort
to decrease the incidence of cumulative trauma disorder. A typical
on-site massage takes about 15 minutes and costs much less than
a full-body treatment, with charges based on the length of the
session. The client remains fully clothed and sits on a stool
or a specially designed chair. The finger pressure techniques
used in this approach are adapted from traditional massage and
Oriental styles of acupressure massage.
the growing popularity of office massage appears to be linked
to a dramatic increase in repetitive stress injuries related to
intensive use of computers; the emphasis is on massage of the
neck and shoulders.’3
an unpublished 1993 manuscript, Field and colleagues of the Touch
Research Institute, based at the University of Miami School of
Medicine, reported preliminary findings of a job stress study
designed to assess the effects of massage therapy on job-related
stress and anxiety and also productivity and job satisfaction.
A 15-minute chair massage was provided twice weekly during lunch
for S weeks. In preliminary results participants reported feeling
less fatigued and being able to think more clearly. Electroencephalogram,
alpha, beta, and theta waves were altered in ways consistent with
enhanced alertness. Math problems were completed in approximately
half the time required without massage, with approximately 50%
fewer errors by the end of the intervention; also, anxiety levels
were lower at the end of a 1-month period.
Acupuncture has been used in some smoking cessation interventions.
According to corporate medical director Peter Devine, MD, of Bell
Telephone of Pennsylvania, an auricular acupuncture “clip”
technique has been successful in some cases.
Regarding nutritional interventions in the workplace, current
practices are likely to be informal and voluntary, with workers
dosing themselves with vitamins or other nutrients that they believe
are likely to improve their health. However, if clearer proof
becomes available that such practices do promote health, company
cafeterias can be readily modified to take advantage of an increased
emphasis on nutrition and health and the link between food, stress,
and performance.’4 Because upper respiratory infections
occur frequently in the workplace, vitamin therapy, as first promoted
by Linus Pauling in 1970 and recently confirmed by researchers
from the University of Helsinki and the Linus Pauling Institute
of Science and Medicine, might be of particular interest as a
potential method of reducing the severity of colds.’5
addition, interest is increasing in the concept of chemoprevention,
or use of (antioxidant) vitamins (vitamins C and E, for example),
as a method of reducing one’s risk for cancer.’6”7
Although only a decade or two ago efforts at chemoprevention were
not regarded seriously, this approach is now being studied in
many major cancer centers around the world.” This development
has implications for prevention of both occupationally and nonoccupationally
induced cancer. The incidence of occupational cancer ranges from
0% to 5% of all cancers”; however, the public has the perception
that industrial processes contribute to and possibly cause cancer
in a significant number of cases. It may be helpful for industries
to engage in chemoprevention techniques at the workplace—supplying
antioxidant regimens to their employees to decrease the risk of
contracting cancer, regardless of the cause.
alertness is beginning to be addressed by some alternative medicine
techniques. Dr Martin Moore-Ede, president of Circadian Technologies,
Inc, and associate professor of physiology at Harvard Medical
School, has stressed the importance of alertness, indicating that
modern managers must learn how to select and train teams of employees,
schedule work and rest time, and organize work paths to ensure
that safety, productivity, and quality are maintained 24 hours
a day. Because of increased international travel, Moore-Ede also
cites the need to learn how to combat jet lag by using scientific
breakthroughs that have enabled us to control the biological clock.
For example, the discovery of the role of suprachiasmatic nuclei
in the hypothalamus in generating rhythms of sleep and wakefulness,
and the identification of the phase-response mechanisms by which
bright light (approximately 2500 lux) resets this biological clock,
have laid the groundwork for new techniques for precise control
of the timing of sleeping and waking, alertness, and performance.
The Twenty-Four Hour Society,7 a book that addresses the future
of work, Moore-Ede describes technological breakthroughs for increasing
alertness including strong doses of bright light, redesign of
control room environments, and visors that supply strategic shots
of light while the wearer is aloft. Because the alertness or drowsiness
of employees can now be precisely measured using brain wave (electroencephalogram)
and eye movement (electro-oculogram) analysis, precise design
specifications for ensuring employee alertness can be determined.
Jobs and workplaces can be designed to promote alertness by building
in such stimuli as muscular activity, light, temperature, sound,
and aroma. Interestingly, third shift workers at the Nestle Food
decaffeination plant in Illinois do not need to drink coffee to
stay awake, perhaps because an aroma promotes alertness either
by psychological association or by direct inhalation of caffeine.6
Among the most widely accepted methodologies for addressing workplace
stress are various relaxation techniques. Herbert Benson, MD,
a mind-body pioneer at Harvard Medical School, defined the relaxation
response in 1974.~’ The relaxation response is defined as
a series of coordinated physiological changes elicited when a
person engages in a repetitive mental or physical action and passively
ignores distracting thoughts. The alterations include decreases
in oxygen consumption, heart rate, respiratory rate, and blood
pressure, and increases in the intensity of alpha, theta, and
delta brain waves. These are the opposite of changes that occur
during the stress response.
Center for Corporate Health and the Center for Training in Mind/Body
Medicine have become integral parts of the Mind/Body Medical Institute
that Benson directs. Other prominent leaders in the work-stress
management area are Robert Elliot of the Institute of Stress Medicine
International in Littleton, Cob; Richard Rahe at the Nevada Stress
Center, University of Nevada School of Medicine, Reno, Nev; and
Myrin and Joan Borysenko of the Mind/Body Health Sciences, Boulder,
Cob. It is also notable that Mutual of Omaha Insurance Company
recently decided to provide coverage for a program designed by
Dean Ornish, MD, a cardiologist who integrates nutritional principles
and meditation into his regimen of cardiovascular disease prevention.2’
another approach to stress reduction, the new field of arts medicine
involves the application of the arts as a therapeutic or preventive
intervention in the form of one or more types of art therapy.22
Also of interest to employers and employees is the potential for
the arts to serve as a creativity enhancer. ARCO Chemical Company,
an international corporation headquartered in Newtown Square,
Pa, under the author’s medical direction, sponsored art
and creativity workshops led by a professional artist who taught
techniques for drawing faces in a self-esteem—building exercise.
It is now generally recognized that aesthetic stimuli including
light, color, sound, rhythm, and even words may have a salutary
impact on human health.23’24 Furthermore, ARCO Chemical
Company has introduced, as part of the health education component
of its fitness and wellness program, a session called “Lunch
and Laugh,” which exposes employees to humorous stimuli
and elicits laughter to reduce stress during the lunch hour. This
program is based on the hypothesis—advanced by Norman Cousins25
and the physiological research of William Fry26 of Stanford University—that
laughing has a salutary effect that can be measured.
in 1985 the author proposed using stress-releasing techniques
at the worksite to reduce both illnesses and accidents.27 Techniques
besides laughter that are likely to reduce stress include crying,
writing, and hitting or kicking exercises.2’
APPLICATIONS OF ALTERNATIVE MEDICINE IN THE WORKPLACE
applications of alternative medicine in the workplace are limited
only by the creativity of healthcare providers and the courage
of the business leaders who control the purse strings of health
coverage. As we enter a postindustrial era in which human-centered
technology is stressed, health and human performance will be increasingly
valued in corporations whose leaders wish them to remain competitive.
at the workplace will continue to be on prevention of health problems
and on alternative medicine practices whose products and interventions
achieve this goal. Some of these approaches have been discussed
in this paper. Many other legitimate alternative medical interventions
are likely as well to have potential application in the worksite.
medical interventions are relevant to off-site as well as on-site
healthcare services. Because corporations represent a major purchaser
of off-site healthcare services, creative corporate medical directors
can assist with benefits planning to ensure appropriate consideration
of alternative medical third-party coverage. Hence, corporate
medical directors should make an effort to understand alternative
medical practices that relate to treatment as well as those that
are useful for worksite prevention practices. Off-site healthcare
services may include those that are targeted to pain management
and short-term and long-term occupational and nonoccupational
disability case management.
burgeoning area of human performance issues for employees from
executives to hourly workers also provides opportunities for alternative
medical interventions. These issues, which include alertness,
stamina, and certain cognitive or physical skills, represent a
recognition that the prevention and treatment of illness are not
medicine’s only goals. In healthy working populations, the
enhancement of human performance may be addressed. A positive
aspect of this trend is that capacity enhancement emphasizes that
which is healthy within an individual, rather than stressing pathology,
as Western medicine so often—and perhaps necessarily—does.
This approach might be described as the rebirth of medical optimism.
medicine professionals must exercise caution in the area of employee
performance and not be tempted to prioritize performance over
health, which might place the employer’s interests ahead
of the employee’s. Properly integrated, performance and
health should support one another.
of alternative medicine at the worksite are already being used
in a limited way, especially massage therapy and relaxation techniques.
Corporations, as both major providers and purchasers of healthcare,
can be an especially potent force in advancing safe and effective
alternative medicine at the worksite. Many social factors argue
strongly for advancing alternative medicine at the worksite. These
include the centrality of work in our lives, the rapidly changing
face of America’s work-force and the nature of work, and
the desire for the United States to remain competitive in a world
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