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Ever wonder why students don’t just grade themselves? For your answer, look no further than HealthFair.com’s self-assessed grade:
And yet by any standard other than their own, HealthFair completely flunks the test. Literally, their “basic package” proposes more “D”-rated tests (and “D” is a failing grade by US Preventive Services Task Force standards) than any vendor we’ve ever seen. They would lose their wellness vendor license tomorrow, except for the fact that wellness vendors don’t need licenses.
The first four all get “D”s. Here are the screenshots if you don’t believe that any vendor could possibly offer so many inappropriate tests at all, let alone in the “basic” package.
The abdominal aortic ultrasound test is such a stupid (where “stupid” is synonymous with “profitable”) idea for the non-elderly population that the USPSTF doesn’t even bother to say no:
Along with their “D” as a general screening tool, The EKG gets a whopping “I” for individuals at risk, but since HealthFair’s basic package includes no basic tests to see who is at risk, and by law they can’t ask about history, they would still have to screen everyone whether or not they are at risk:
By earning another “I”, the peripheral artery disease test does well by HealthFair’s standards. The USPSTF concludes that researchers don’t know enough about it to recommend it, which doesn’t stop HealthFair.
As for “hardening of the arteries,” the USPSTF doesn’t bother to grade it due to the fact that no one uses this test as a screen…except wellness vendors. But even the American Heart Association, not exactly shy when it comes to screening people for cardiac disease whose treatment can enrich their members who treat it, disses this test:
Speaking of D-Rated tests, sorry, guys. If you want a D-rated PSA screen — a screen not even recommended by its own inventor — you have to insist that your employer buy HealthFair’s “advanced” package:
That brings us to the H Pylori screen, Healthfair’s groundbreaking, earth-shattering, pushing-the-envelope leap forward in the wellness vendor competition to out-stupid one another.
Where to start…
First, the US Preventive Services Task Force doesn’t bother to offer a recommendation on it, largely because no self-respecting doctor would ever screen patients for this. Shame on the USPSTF for consistently failing to anticipate all the ways in which wellness vendors can misunderstand basic clinical science!
Second, most of us who harbor H Pylori have no symptoms. So why screen for something that’s not causing problems? That’s why this is a test, not a screen. If you have an ulcer or symptoms that suggest an ulcer, go to the doctor. Even then, the doctor probably won’t even bother to test you, since most people get relief simply from well-tolerated, commonly used, proton pump-inhibitor medications–some of which don’t even require a prescription. It is only if the first-line medications fail that most doctors will even test you.
Third, there is a significant school of thought that says H. Pylori is beneficial. Screening us for something we’re better off having in our bodies represents a new frontier in the wellness industry’s answer to overdiagnosis, which we call hyperdiagnosis.
Fourth ironically, given the wellness industry’s obsession with employees’ weights, it is even slightly possible that killing off H. Pylori contributes to weight gain.
Fifth, what exactly are we supposed to do, if it turns out we harbor H. Pylori? Get a course of antibiotics to clear the bacteria out of our system? That’s a great idea. We’ve always maintained that one of the problems with America’s healthcare system is that patients don’t get to take enough antibiotics.
The good news for the pharmaceutical industry is due to the nature of H Pyroli, hiding in our stomach mucus, it takes a lot of antibiotics to ferret it out, plus a bunch of other pills. Is this a great country or what?
Sixth, the H Pylori tests themselves are among the most complex, unhelpful and inaccurate commonly used tests in existence.
Finally, half the world’s population has it. Given the expense and inaccuracy of the test and the prevalence of the bacterium, why not eliminate the middle step and just put all your employees on antibiotics?
One of us is a screaming libertarian. And even he thinks the cowboys that populate the wellness industry need to be reigned in with some regulation, before they screen the American workforce to death. The regulation would be very straightforward: employers and vendors must disclose the USPSTF recommendations to employees before making them take these tests. If after this disclosure, a few employees still insist on getting these D-rated or off-the-charts-inappropriate screens, congratulations! Your screening program will have just done something useful: identified employees who are totally incapable of making an intelligent decision.
To those of you who are reading this and thinking: “Haven’t I heard this song before?”, the answer is, you have. HealthFair is the “Intel Inside” for the screening jihad offered by SSM Healthcare, the Sisters of Saint Mary health system we “profiled” a few weeks ago, thus once again proving that wellness mantra: great minds aren’t the only ones that think alike.
Once in every great while, when we’re least expecting it, a company comes along that makes us reconsider our viewpoint–and ponder the possibility that maybe we’re wrong about wellness. Maybe, finally, we’ve discovered a company that will motivate employees to get well. Maybe a company that adheres to screening guidelines. Maybe even a company that will solve America’s healthcare crisis.
Star Wellness is not that company.
Quite the contrary: If you are an employee of an organization that has retained this outfit, your best course of action is simply to pay the fine and have nothing to do with these people. Or take the tests to secure your money, and then don’t open the envelope with the results in them, because due to false positives, you are equally or more likely to be harmed than helped by taking their full panel of tests.
Star Wellness says doctors “typically order these tests during a routine physical.” If you find a doctor that does so, please contact the licensing authorities because for many of these screenings, a doctor would be sanctioned for routinely ordering and billing for these tests on all patients. However, this being the wellness industry, there are no authorities…but there are plenty of tests. Not being doctors, wellness vendors are allowed to harm employees up to the limit of HR’s willingness to pay them to do so–and, being wellness vendors, they take full advantage of this budget. (Among other things, the higher the budget, the more vendors can pay the employers’ brokers–and hence the more likely they are to keep the account.)
Leaving aside all the tests they do that the United States Preventive Services Task Force (USPSTF) does not recommend doing annually if at all (which is to say, most of them), let’s focus on the ones the USPSTF specifically recommends not doing. In each case, we’ll use screen shots because otherwise no one would believe that any preventive services vendor could possibly be this out of touch with preventive services guidelines.
PSA screens for prostate cancer. Perhaps Star Wellness’s internet connection is down because nobody does these any more. Even the guy who invented the test recommends not doing it.
Carotid artery screening. Seriously? Even the Highmark/Goetzel Penn State program, the industry’s most coercive and ill-conceived program ever, didn’t recommend those.
Our favorite is abdominal aorta screening. These screens are so not-recommended for the <65 population that the USPSTF assumes nobody,no matter how stupid or dishonest, would ever do them. So they don’t even bother to waste valuable electrons posting non-recommendations of this screen for the <65 population. It would be like recommending not parking your car on a railroad crossing. Instead, all of their recommendations start with the assumption that people being considered for these tests (tests on individuals, not screens on everyone, by the way) are over 65 to begin with.
Even their basic tests are mostly USPSTF not-recommended as screens (and certainly not annual screens), but more interesting is some of the misinformation they’ve piled on top of these tests.
They say these tests are a “$350 value.” Since a checkup including tests costs $200 or less, the whole PCP profession would be going bankrupt if their math was right — and if doctors were actually doing these screens.
Of course they also make up their savings figures (all this overscreening somehow saves $250/employee net of the costs of the overscreening itself), but lying about outcomes is embedded in wellness vendor DNA. We can’t fault them for that. It isn’t possible to compete in this field without making up outcomes.
But they did make up at least one other statistic. As noted above, they said that 75% of Americans are deficient (or, more specifically, DEFICIENT!) in Vitamin D and need supplementation. However, the CDC and the rest of the triple-digit IQ grownup crowd say the opposite. The CDC notes that only 8% of Americans are deficient, while the Journal of the American Medical Association and the USPSTF also don’t recommend screening and supplementation.
In addition to not understanding preventive medicine guidelines, Star Wellness appears to not understand the (very few) regulations putting even the slightest of constraints on the wellness industry’s overdiagnosis-today-overdiagnosis-tomorrow-overdiagnosis-forever ethos. One of those very few constraints (ironically, a misguided one) is: wellness vendors can’t ask about family history. And yet, here they are…asking about family history. Now it’s possible they aren’t asking about family history and they mis-stated their own position, in which case by their own admission, they are doing this screen on people without a family history, people who shouldn’t get the screen at all. Their other screen on this slide, C-Reactive Protein, is also not recommended by USPSTF.
Not all the news about Star Wellness is bad. We always try to end on good news, and the good news is – if Star Wellness is to be believed – their needles are among the least contaminated in the entire industry!
Sal, Wyoming’s not a country.
Star, Vitamin B12 is not a vaccine
While we’re on the subject of vaccines, according to the CDC, the biggest categories of people who are supposed to get Hepatitis A/B vaccines include toddlers and street drug users. If you are routinely hiring enough people fitting those criteria to be considering an on-site vaccination clinic, I’d say wellness isn’t your biggest problem.