A good rule of thumb: people who challenge the US Preventive Services Task Force — but lack the requisite knowledge, credentials, relevant education, support in the literature and any rationale to do so other than protecting their own revenues — should at least spell its name correctly.
Overscreening is central to the wellness vendor business model. If screenings were to conform to US Preventive Services Task Force (USPSTF) guidelines designed to balance harms and benefits in the best interest of the public, the whole industry would collapse.
There are three ways wellness vendors can preserve their overscreening revenue stream against this onslaught of the USPSTF’s scholarship and research. The first is simply to shut up and hope no one notices. That strategy works quite well, because when it comes to screening recommendations, many human resources directors trust their advisers, often an Animal House–type mistake [WARNING: hyperlink rated PG]
The second is the blame-the-victim strategy embraced by Optum’s Seth Serxner. According to him, vendors like Optum really, really want employers to send them less money to do less screening (perhaps their salespeople are on a negative commission schedule?) — but employers nonetheless insist on screening the stuffing out of their employees. His specific statement: “Our clients won’t let us screen” appropriately. Employers “deliberately” want to overscreen. Of course, neither he nor Optum, in followup conversations initiated by Optum (saying I made them “look bad” by quoting Mr. Serxner), shared any examples of this despite repeated requests. (The unabridged statement is on the “Great Debate” tape, which hasn’t been posted yet.)
Healthmine’s Bryce Williams has a third strategy, which is to publicly announce Healthmine’s decision to flout the USPSTF guidelines. He says he is right and everyone else — specifically including the “US Preventative [sic] Services Task Force” — is wrong. A real doctor making this pronouncement might be risking his or her license. Fortunately for Mr. Williams, being a wellness vendor doesn’t require a license, so regardless of the harms a wellness vendor inflicts on employees, no one can take it away.
In addition to spelling the name of the group he is attacking correctly, we might also recommend that he not misquote the sources on which his faulty argument is based. We’re just sayin’…
For starters Mr. Williams declares: “One out of every two people in America has at least one chronic condition according to the CDC, and many more are at risk for developing one.”
Here’s what the CDC really said: “One out of every two adults has at least one chronic condition.” And if you dig deeper, you see that this list of chronic conditions cited by the CDC includes arthritis, mental illness, eye disorders and asthma, none of which Healthmine’s hyperscreening is going to reveal.
He also claims that “chronic diseases account for $3 out of every $4 spent on healthcare.” Here’s what the CDC really said: $3 out of every $4 “is spent on people with chronic conditions.” That is a much broader statement. It would include someone with borderline hypertension giving birth. That figure also includes the retiree population, where chronic disease is far more prevalent than in the working-age population relevant to wellness. In any event, we long ago eviscerated Mr. Williams’ cherished myth and just this week showed that essentially none of the top 25 hospital admissions has anything to do with screening, broccoli, or Fitbits.
Most importantly, Mr. Williams was apparently absent the day the teacher explained arithmetic. Suppose you screen 1000 employees for a 1-in-1000 hidden pathogen or disorder and your test is 90% accurate. 900 employees will test negative, as they should, and the remaining 100 employees will test positive. Since only one of those hundred employees actually has whatever you are screening for, your false positive rate is: 99%. In addition to costing a fortune to follow up on all those false positives, imagine the angst and harms from overtreatment that can befall those 99%.
If you do work out the false-positive math, you’ll see it costs at least $1 million to find and prevent a heart attack via a workplace wellness screen. And that assumes half the at-risk employees identified in the screen change behavior, whereas the last company to win a Koop Award, McKesson, had roughly 1% do those things.
None of this is to say that the USPSTF can’t be challenged. But a challenge shouldn’t be based on misspellings, misquotes, and misunderstandings of the way arithmetic works.
Mr. Williams closes with a quote that hopefully someone can explain to us because we can’t decipher it. He asks: “Which is more expensive: Over-testing or over-screening? We don’t have a definitive, quantitative answer. But let’s make sure we are asking the right question.”
We have no idea what the “right question” is, except that it’s not the one he’s asking. My vote would be: “Why are these people allowed to deliberately harm employees and there’s nothing anyone can do about it?”
You left out that one of their biggest arguments is to do more screening because the cost of screening is coming down. That seems like a bad reason to do more of it.
Good point. The concept of buying more of something you shouldn’t be buying at all (or you should only buy rarely, in the case of screens) because the price is coming down is what fueled the 1980s epidemic of cocaine in the US.