A rebuttal from Goetzel? Of course not. The Wellness Ignorati deal in secret missives to the media, not open discussion. Or, in the case of the proposed Code of Conduct urging vendors not to harm employees or lie about outcomes, stonewalling it. What they never do is, engage with this blog. We’re good enough for Slate, STATNews, and the Chicago Tribune (and that’s in the last 3 months alone), but not the Wellness Ignorati.
However, we did manage to get a thoughtful response from a third party, Michael Prager. He raises some excellent points.
First, Ron says (and has said variations of this on many occasions) “most diseases are preventable” by wellness. That statement is flat-out wrong. Had Ron said — and this is Michael’s take on what he meant to say — “most people eventually die of chronic diseases that, had they made better choices in their life, might not have developed until later in life,” then he would have been right. Fact is, heart disease and diabetes are leading killers. Just as Michael says.
Ron got it totally wrong, though, with his most-diseases-are-preventable mantra. Only a few diseases are preventable through corporate “pry, poke and prod” programs. Just look at Ron’s own HERO guidebook. It lists diabetes and heart attacks and a few other ICD 9 codes as “potentially preventable hospitalizations.” Meanwhile, there are about 14,000 other ICD 9 codes (or 60,000+ ICD 10 codes) which are not preventable through workplace screenings, though one study tried to credit a wellness program with a decline in cat scratch fever.
Think of all the diseases or other expenses or health programs you yourself (assuming you are a non-smoker) have endured in your lifetimes. How many would have been prevented by one of Ron’s pry, poke and prod programs? Or, as Wellsteps’ Steve Aldana says, by eating one more bite of a banana? (He really did say that, but the STATNews website seems to be down this very minute.)
Now, if employees were covered for their entire lives by employers (they aren’t), and if employers could get them to reduce their risks (they can’t), then corporate wellness could work, and might possibly save money.
Second, Michael also points out that I distinguish disease-related “events” from the diseases themselves. These events are — and Ron’s HERO guidebook agrees with me on this — the only place an employer actually realizes savings from wellness, offset by many other costs. However, very few events caused by these conditions take place during our actual <65 working years. Like the annual odds of a heart attack for commercially insured people <65 are about 1-in-800. Using a few generous assumptions about program effectiveness, that already-low rate means it costs companies about a million dollars to prevent one through pry, poke and prod.
Finally, you should know a little about Michael’s back story. He did in fact turn his own health around through rigorous attention to diet and exercise, and I applaud and respect him for that. He encourages others to do the same, as do I. However, “encouragement” and intrinsic motivation are a lot different from, for instance, Michael O’Donnell’s recent diatribe that employee health insurance premiums should (at least in part) be assessed on a per-pound basis, sort of like when ordering lobster or mailing a package. That system, Mr. O’Donnell says, will get employees to lose weight.
Alas, if there is one thing wellness vendors can’t do, it’s get people to lose weight. The best example would be Ron’s buddies at the Vitality Group. They couldn’t even get their own employees to lose weight.
I am shortcutting Michael’s comments, so do go take a looksee on your own. It was a thoughtful response (two words you won’t see in succession in any other TSW posting) and is worthy of a careful read.
They Said What? 
Another good post. Michael O’Donnell advocates charging employees a fee per pound of weight, eh? Tall people subsidizing short people? Or tall large-boned people subsidizing short chubby people? Brilliant. (sarcasm). I’d urge proponents of such ideas to think about it a little bit. If someone is 5’4″ and weights 300 pounds, they usually are eating about as much as two or three people that height who are slender. If cutting their grocery bills and restaurant bills by 60% or so is not enough of a financial incentive, what is?
Another thing the wellness ignorati forget is that in many/most companies over half the covered lives are spouses and dependent children. Does Michael want to drag them somewhere for a weigh-in too?
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Just to make clear because there are two Michaels, Michael O’Donnell wants to do the lobster thing, not Michael Prager.
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Yes Al, this response has some good points but also some problems – for example: “We are what we eat” is so hoary a cliche that it is universally dismissed or disdained (as Lewis does), but no other factor contributes more to physical health.” This is traditional health promotion jargon that is among other things simply inaccurate. While what we eat certainly impacts our health – and I have also dealt with this as a nutritionist in the context of a progressive, incurable disease for more than 30 years – Individual health behaviors (and what we eat is only a part of that) contribute about 25% to disparities in health in this country and elsewhere – so aside from the fact that the rather vague message “we are what we eat” is oversimplified and reductionist – the more accurate statement would be “we are what our social standing is.” – Dr. Jon
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Jon, What constitutes our physical beings, but the substances we ingest? Our bodies break them down into needed inputs and waste. Our cells die and are replaced for as long as we live, and what builds those cells, but what we ingest? Ingest some substances and we enhance our own sustainability. Ingest others and we damage it, and in extreme cases, ruin or end it.
I take your point that many factors contribute to what we *can* ingest — geography, wealth, education, among many others — but still, we are what we eat. Do you not think that people relatively unhindered by disadvantageous geography, wealth, and education would benefit from relying on the information that what we put into our bodies actually matters? I believe it does matter.
If it’s only 25 percent, then it’s the 25 percent that each individual can most directly affect.
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Michael, as I mentioned, as a practicing nutritionist and someone with a progressive, degenerative disease of course I believe that nutrition is important. But, while it may be “sexy” – saying that people “are what they eat” ends up being judgmental and, saying it is the most important contributor to health is just not valid. Individual nutrition behaviors do not make up 25% of health disparities across populations – ALL individual health behaviors make up about 25% – nutrition is part of that – an important part yes – but a smaller part – according to WHO – “If you catch the metro train in downtown Washington, D.C., to suburbs in Maryland, life expectancy is 57 years at beginning of the journey. At the end of the journey, it is 77 years.” – A distance of some 30 miles – This is why I say “you are your social standing” is more accurate (thuogh still kind of twitterrish)- yes nutrition is important – but it simply needs to be kept in the perspective that science gives it – Dr. Jon
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I am pleased to see such an erudite discussion on this site, in sharp contrast to trying to debate Wellsteps, where Troy Adams (Steve Aldana’s attack dog) counters my arguments by saying they are “full of hot air.” I am learning from both of you and am only going to step in to observe that you can’t travel 30 miles from downtown on the DC Metro. I wish you could. I could fly into BWI or Dulles.
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Agree with the sentiment Al – The folks you mention have no interest in dialogue because they are so sure they are right and so unlikely to be able to prove it – I would add that the details of that statement come directly from the WHO – who as we know also have said, if I am not mistaken that 20% US children are above the 95th percentile for weight – but the fact of the changes in life expectancy over tha distance come from Marmot – whose research is quite trusted – again not that nutrition and/or individual health behaviors don’t count – just that it is important to keep them in perspective – Jon
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Great points Jon.
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