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When a true genius appears, you can know him by this sign: that all the dunces are in a confederacy against him.
Wellsteps’ Steve Aldana has “endorsed” a confederacy of 25 wellness vendors, including his own company, Wellsteps. Alas, in the world of the Welligentsia, in which an increasing number of employers reside, an endorsement from Mr. Aldana earns about as many points in a vendor selection process as neat handwriting.
There are usually not enough hours in a week to both do my Day Job running a fast-growing company (Quizzify, which plenty of thought leaders have endorsed, so they don’t have to endorse themselves), and also play wellness-meets-whack-a-mole with the Ignorati. Fortunately, this week does have enough hours, thanks to the time change. (The wellness industry is lucky that “falling back” is not a regular occurrence.)
I haven’t heard of many members of this confederacy, but I’ve heard more than enough about the ones below. Each link takes you to our own “endorsements.”
Keas Meets Lake Wobegon: All Employees Are Above Average (in Stress). This is the best argument for requiring that wellness vendors attain a GED.
Provant: “In the Belly of the Beast” A nine-part series that one line can’t do justice to. We would simply note that you do not have to drink eight glasses of water a day. Indeed, you probably shouldn’t if you expect to get anything else done.
Staywell’s Wellness Program for British Petroleum is Spewing Invalidity. It wasn’t just that their savings claim was mathematically impossible. That’s just the threshold for wellness savings claims. Staywell also somehow saved BP 100x as much as Staywell’s own website says is possible. And because they have a “special relationship” with Mercer (meaning they pay them), Mercer “validated” this fiction for BP, at BP’s expense…
Staywell, Mercer, and British Petroleum Meet Groundhog Day. They won a Koop Award. Since Staywell and Mercer are both on the Koop Committee and their results are completely invalid and they are obviously lying, they satisfy all the award criteria.
Total Wellness’s Total Package of Totally Inappropriate Tests. They could lose their license for subjecting employees to this panoply of US Preventive Services Task Force D-rated quackery, except that in wellness the only license you need is a license to steal from unsuspecting HR directors. This leads to…
…Total Wellness: The Best Argument for Regulating the Wellness Industry. Total Wellness isn’t about to lose this Race to the Bottom without a fight. Watch as they try to out-stupid Star Wellness in their quest for that prize.
US Corporate Wellness Saves Money on People Who Don’t Cost Money. We call this Seinfeld-meets-wellness, because it’s about nothing: even if you have absolutely no risk factors, these Einsteins will still save you a fortune. And someone should also tell them you can’t reduce a number by more than 100% no matter how hard you try.
Vitality’s Glass House: Their Own Program Fails Their Own Employees. These people might have more luck selling you a crash-dieting program if they could get their own employees to lose weight.
Wellness Corporate Solutions Gives Us a Dose of Much-Needed Criticism. We don’t want to spoil the punchline.
And that brings us to Wellsteps itself, which earns its “endorsement” from its own CEO by making so many appearances on this list that there is barely enough room for the rest of the confederacy. If you only have time for the Executive Summary, this is the one to read. But squeezing it all into one place requires sacrificing the laugh lines, and if there is one thing Wellsteps excels at, it’s providing laugh lines.
Wellsteps ROI Calculator Doesn’t Calculate an ROI…and That’s the Good News. Watch what happens when Wellsteps meets Fischer-Price. No matter what variables you enter in this model, you get the same result.
Wellsteps Stumbles Onward: Costs Go Up and Down at the Same Time. This isn’t possible even using wellness arithmetic. Eventually Wellsteps solved this problem by simply deleting one of the slides. But because we long ago learned that doctoring/suppressing data is one of the wellness industry’s signature moves, we took a screenshot before we did our expose.
Prediction: Wellsteps Wins Koop Award. In 2015, I went out on a limb to make this prediction, noting Wellsteps’ perfect Koop Award storm of invalidity, incompetence, and cronyism.
Wellsteps: “It’s Fun to Get Fat. It’s Fun to Be Lazy.” This one was penned by Dr. Aldana’s waterboy, Troy Adams, who apparently during his self-proclaimed “11 years of college” never learned that “fat” and “lazy” aren’t synonyms. Paraphrasing the immortal words of the great philosopher Bluto Blutarski, 11 years of college down the drain.
Does Wellsteps Understand Wellness? They are demonizing even the slightest consumption of alcohol, among many other misunderstandings. Shame on me for enjoying a glass of wine on a Saturday night!
The Back Story of the Scathing STATNews Smackdown of Wellsteps and the Koop Committee. This one leads to several other links.
The Koop Committee Raises Lying to an Art Form. It turns out Steve Aldana is not stupid: he apparently has heard of regression to the mean, but just pretended he hadn’t so he could take credit for it with the Boise Schools, who were not familiar with the concept.
if Wellsteps Isn’t Lying, I’ll Pay Them $1 Million but let’s just say I’m not taking out a second mortgage just yet.
An Honorable Mention goes to another vendor on this list, in the form of the Don Draper Award, for this advertising gem, aimed at ensuring that even the stupidest member of the Ignorati, and/or HERO Board members, can catch their name:
To quote the immortal words of the great philosopher Rick Perry, even a stopped clock is right once a day.* And, yes, on that Wellsteps list there is one standout vendor, US Preventive Medicine. It has validation from the Validation Institute. As you read their validation, note that while they show an enviable reduction in wellness-sensitive medical events, they don’t claim an ROI. This is testament to the integrity of both USPM and the Validation Institute.
*If you are a regular reader and didn’t find this quote amusing, read it again. If you are a wellness vendor, find a smart person to explain it to you.
The second-most frequent question I get (after: ”Why are you such a jerk?”) is: “OK, you’ve convinced me that ‘pry, poke, prod, and punish’ doesn’t work. What should we do instead?”
While Quizzify is one answer to that question, my ex-wife was quite clear that it is not always about me, so when a really good philosophy of what-to-do-instead becomes available, I make sure that others know about it. (For example, How to Build a Thriving Culture at Work, by Jon Robison and Rosie Ward.) Dee Edington and Jennifer Pitts have also come through with a book of great scope and outstanding insights called Shared Values—Shared Results: Positive Organizational Health As a Win-Win Philosophy. Stylistically very different from Surviving Workplace Wellness, Shared Values-Shared Results reaches the same conclusion: it’s not easy, and perhaps impossible, to maximize the output of your workforce and organization in general, and you certainly can’t do it with simplistic ‘pry, poke and prod’ programs alone.
Instead, Edington and Pitts make what should be―but is apparently not given the current state of the wellness industry―a self-evident statement that poor health is a complex problem. By contrast, the implicit assumption underlying wellness programs is that employees with health risks and diseases will be motivated to manage those risks and conditions once those conditions are identified (and the employees bribed), and that they will love you and love your company for it. This book, completely correctly, espouses an alternative viewpoint.
Another way of putting it: What Edington and Pitts call “tame problems” can be easily solved once identified. Example: someone tells you your shoe is untied. Other problems―such as poor health―they describe as “wicked.” Wicked problems are “influenced by many factors” and require “highly creative solutions.”
Or, as HL Mencken put it: “For every problem, no matter how complex, that is a simple and understandable solution…and it’s almost always wrong.” (Are you listening, Donald Trump?)
And therein lies the difference between wellness vendors and Edington/Pitts. The former refuses to recognize that “behavior change” based on “risk factors” is a facile, misguided, and counterproductive attempt to achieve the latter. The best example is Total Wellness, the quintessential example of a vendor believing that you can achieve a culture of health by screening the stuffing out of your employees.
Edington and Pitts don’t just take the opposite approach. What makes this book a must-read is its “how-to” quality: they go on to describe the Five Pillars that can make this happen. I found the most critical to be Pillar Two, on workplace stress. Vendors market stress management programs, which reminds me of the North Carolina senator who—when India experienced a famine in the mid-1960s—proposed sending them tobacco, to “ease the stress of starvation.” By contrast, Edington and Pitts argue that stress management should be built in, not added on.
And yet the work needs to get done, and sometimes getting the work done can be stressful. Quizzify, for example, recognizes this, and our policy tries to balance stress and output. Weekend emails are allowed ―but only those requesting short answers, like “How do I access this document you wrote?” as opposed to “Can you write this document?” Staff is advised to expect that 3-4 weekends a year will involve fire drills…but during the 10 holiday weekends a year, emails are shut down. Even during those long weekends, upward communications are allowed because sometimes it’s raining, meaning maybe an engineer or designer is home…and wants to code or design. Stress would be created if supervisors didn’t respond to short-answer questions during those periods. The coder or designer might want some brief feedback or have a question. Different people have different work habits, and Quizzify’s weekend workflow policy tries to allow people to work according to their own habits while not imposing them on others.
See? As the book describes, creating a culture that gets the work done while avoiding undue stress is not simple, and not every company would solve it the same way. That’s why a great deal of Shared Values describes the process―or “journey” as they call it―to getting to the cultural ideal, and that’s why a great deal of their prescription involves listening to employees.
The most important line in the book about the failure of a culture-of-heath to “take” is a bit buried so it’s worth noting separately: “Many ‘culture of health’ efforts today are focused on strengthening or increasing the scale and scope of wellness,” and as a result the “responsibility for creating this culture of health falls to the wellness, human resources or medical director.” In combination, these two sentences describe exactly why these cultures don’t “take.” Indeed, the entire book is about the importance of doing the opposite: starting with the C-Suite ensures that much if not most of the company will buy into a culture of health. Making it another “program” does the opposite.
Of course there are some places where we disagree. I think the book gives vendored “pry, poke and prod” programs a free pass and suggests that they may be part of the solution, instead of calling them out as the enemy of a cultural shift. (The aforementioned Total Wellness is the poster child for this conflation.) Likewise, benefits consultants, attempting to quantify everything and often — as in Mercer and Staywell — appearing to represent the vendors, should be called to task as well. They don’t make money in a culture of health. They make money by bringing in vendors with complex RFPs, and then evaluating their outcomes. Their worst nightmare would be companies following the advice in Shared Values.
It is brilliant how the authors peeled the onion, layer by layer, to get to the core issues of individual and organizational engagement and health. First, the secret sauce is to keep the employees and the organization involved and thus creative and engaged. Engagement begins with recognizing health as a complex issue by collaboratively creating sharing values and outlining desired results―then packaging them into a shared vision. Systems and designed thinking are needed from all stakeholders to plot the course for the merger of positive individual and organizational health.
This book provides rich information about what both individuals and organizations can do to move from current and best practices to emerging next practices. These strategies help evolve the culture and population in healthy direction. The final section of the book provides a compelling case for more meaningful and engaging (and they mean “engaging” quite literally) evaluation measures and methods. Engage everyone in outlining what outcomes truly matter, involve them in collecting rich information and communicating about successes and opportunities for improvement. Finally, include them in creating grassroots and native approaches to help support thriving employees and organizations. The authors emphasize that this level of engagement is at the heart of a win-win philosophy.
If corporate wellness didn’t already exist, no one would invent it. In that sense, it’s a little like communism, baseball, pennies, or Outlook.
After all, why would any company want to purchase programs that damage morale, reduce productivity, drive costs up…and don’t work 90%-95% of the time? And that’s according to the proponents. What the critics say can’t be repeated in a family publication such as ours.
Still, those are the employers’ problems. However, the employers’ problems become the employees’ problems when employees are “voluntarily” forced to submit to programs that are likely to harm them. (As the New York Times recently pointed out, there is nothing voluntary about most of these programs.)
Recently, the head of United Healthcare’s (UHC) wellness operations (Optum), Seth Serxner, admitted that Optum’s programs consciously ignore US Preventive Services Task Force (USPSTF) screening guidelines. Lest anyone was expecting a wellness vendor to actually apologize for bad behavior, Mr. Serxner went on to blame employers for insisting on overscreening and overdiagnosing their own employees…and (by implication) overpaying for the privilege of doing so. “Our clients make us do it,” were his exact words.
Funny thing, we first asked our own clients who use Optum about why they turned down Optum’s generous offer to do more appropriate screenings at a lower price. None of them remember receiving this offer. Go figure. Then a UHC executive wrote and said we were making them look bad. I softened some of the language (like the paragraph below), and said I would happily retract the whole thing if indeed they could introduce me to just one customer — one out of their thousands — who recalls insisting on overscreening and overpaying. Never heard back…
United Healthcare isn’t alone in harming employees. They are just the first company to admit it, and far from the worst offender, as the harms of overscreening for the usual suspects (glucose, cholesterol etc.) don’t hold a candle to some of the more creative ideas listed below. Here, in order, are the ten vendors most likely to harm employees in the name of wellness.
Healthmine’s CEO, Bryce Williams, isn’t blaming the victim like United did. He has publicly announced that Healthmine flouts clinical guidelines. He says he is right and everyone else — specifically including the “US Preventative [sic] Services Task Force” — is wrong. A real doctor acting on 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 confiscate it because there is nothing to confiscate..
In addition to not misspelling the name of the group he is attacking, 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…”
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’ll 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. 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.
The employee who recorded this blood pressure is essentially dead. Cerner’s diagnosis? Blood pressure “higher than what is ideal.” Cerner’s recommendation? “Talk to your healthcare provider.” A real doctor’s recommendation? “Call an ambulance. The guy barely has a pulse.”
This is not a random mistake. This is the front cover of their brochure.
USPSTF Screening age recommendations aren’t minimums. They are optimums, the ages at which screening benefits might start to exceed harms, even if they still fall far short of costs. Otherwise you are taking way too much risk. This is especially true for colonoscopies, one of this program’s favorite screens — complications from the test itself can be very serious.
Your preventive coverage is not supposed to be “greater than health care reform guidelines.” That’s like “rounding up twice the number of usual suspects.” And you aren’t supposed to waive “age restrictions.” That’s like a state waiving minimum “age restrictions” to get a driver’s license.
Yet despite or perhaps because of this and other examples of total cluelessness and pure dishonesty, this program won a C. Everett Koop Award for excellence in wellness, not to mention the unwavering support and admiration of leading wellness apologist Ron Goetzel.
Both these outfits pitch exactly the opposite of what you are supposed to do in weight control: unhealthy crash dieting. Attaching money to this idea and setting a start date makes it even worse: along with crash-dieting during these eight weeks, you’re incentivizing employees to binge before the initial weigh-in.
Here is ShapeUp:
Here is Wellness Corporate Solutions:
Both also made up outcomes. In ShapeUp’s case they had to rescind their “findings” after their customer, Highmark, skewered them in the press. And neither seems to care that corporate weight control programs are proven not to work.
In addition to its dystopian wellness program that collects employee DNA (partnered, ironically, with a company called Newtopia) and then makes up savings, Aetna owns the distinction of launching the only wellness program whose core drugs are specifically editorialized against in the Journal of the American Medical Association. This would literally be the most harmful wellness program ever, except that the only employees being harmed are (1) obese employees who (2) answer the phone when their employer’s health plan calls them to pitch these two drugs; (3) have a doctor who would willingly prescribe drugs that almost no other doctors will prescribe due to their side effect profile; and (4) not google them. Presumably in combination this is a very low percentage of all employees.
The good news is that these drugs, Belviq and Qsymia, should be off the market in a couple of years because almost no one wants to take them, so the harms of this Aetna program should be self-limited.
Star Wellness offers a full range of USPSTF D-rated screens. “D” is the lowest USPSTF rating, and means harms exceed benefits. Star gets extra credit for being the first wellness vendor to sell franchises. All you need is a background in sales or “municipal administration” plus $67,000 and 5 days of training and you too can poke employees with needles and lie about your outcomes. Is this a great country or what?
Also, their vaccination clinic features Vitamin B12 shots. We don’t know which is more appalling–routinely giving employees Vitamin B12 shots, or thinking Vitamin B12 is a vaccine.
Angioscreen doesn’t have the most USPSTF D-rated screens. In fact, it offers only one screen in total, for carotid artery stenosis. That screen gets a D grade from USPSTF, giving Angioscreen the unique distinction of being the only vendor 100% guaranteed to harm your workforce.
Angioscreen’s other distinction is that they admit right on their website that this screen is a bad idea. This is probably literally the only non-tobacco company in America to admit you are better off not using their product.
Total Wellness loses the wellness industry’s race to the bottom only because the winner, HealthFair, has out-stupided them. However, in addition to the usual assortment of D-rated tests, they offer screens that the USPSTF hasn’t even rated, because it never, ever occurred to them that anyone would ever use these tests for mass screening of patients or employees. Criticizing the USPSTF for not rating these “screens” (CBCs and Chem-20s) would be like criticizing Sanofi-Aventis for not warning against taking Ambien after parking your car on a railroad crossing.
Let’s leave aside for a fact that the majority of their other screens are harmful too, and focus on their screening for H.pylori, the strain of bacteria associated with ulcers. To say it is a stupid idea would be an understatement. As Clarice Starling replied when asked if Hannibal Lecter was a sociopath: “They don’t have a word for what he is.”
Likewise, this idea is too stupid for words, certainly for the small number of words we can allot to this overview blog. Visit our full treatment here. In a nutshell, the majority of us harbor H.pylori–without symptoms. It may even be beneficial. The screening test is expensive and notoriously unreliable, and the only way to get rid of it is with some very powerful antibiotics, a treatment rarely even used on patients with symptoms due to its inconvenience, ineffectiveness and potential long-term side-effects.
A Modest Proposal
So how should we as a country protect employees from these harms? Our policy recommendation is always the same, and very non-intrusive. We aren’t saying wellness vendors shouldn’t be allowed to harm employees. That would be too radical to ever pass Congress. If it did, the Business Roundtable would pressure the White House again, to preserve their hard-earned right to medicalize the workplace, and literally and figuratively, show employees who’s boss.
Instead, we recommend merely a disclosure requirement. The harms of screens or (in United Healthcare’s case) screening intervals that don’t earn at least a “B” from USPSTF should be disclosed to employees, and employees should get a chance to “opt out” into something that isn’t harmful (like Quizzify, perhaps?) without suffering financial consequences. Call us cockeyed optimists, but we don’t think employers should be able to force employees to choose between harming themselves and paying fines.
Now that the myth that there is any ROI in wellness is thoroughly both debunked and also even acknowledged by the wellness industry, vendors often fall back on the “argument” that nothing else in healthcare needs an ROI. Why should workplace wellness be singled out? The editor of the American Journal of Health Promotion, Michael O’Donnell, even asked: “Who cares about an ROI anyway?”
The answer to Michael’s question? Everyone should care. And everyone should insist on an ROI from wellness, for three distinct reasons. Each reason is sufficient on its own. So even if there were a fallacy in two of the reasons (and there isn’t), the remaining reason would still be definitive.
First, consider an employee with appendicitis. You don’t calculate an ROI. You call an ambulance. But suppose a vendor says to you: “If an employee’s appendix bursts, the cost could be $100,000. So we propose taking out everyone’s appendix preventively.”
You’d ask: “What’s the rate of burst appendixes and how much do appendectomies cost?” While that’s an extreme example (and we didn’t mean to give these people any ideas), this is basically the calculation you should make when vendors propose screens. Here’s how to do the calculation. You’ll be shocked at how much it costs to avoid even one event by screening everyone.
Second, wellness is the only thing in healthcare that employees are forced to do, subject to a financial forfeiture of penalties or lost incentives. Other activities which people are penalized for not doing include: wearing helmets/life jackets/seat belts and getting kids vaccinated. In each case, the clinical evidence/science overwhelms considerations of personal choice. (Even then, in some states personal choice still rules.)
By contrast, the only thing that’s overwhelming about wellness evidence/science is how overwhelmingly the evidence eviscerates wellness, which of course is what this site is all about. Unfortunately, wellness vendors don’t understand evidence — or for that matter healthcare itself. Many vendors have no knowledge of basics like clinical guidelines, or even arithmetic. One wonders how they can do their jobs as wellness vendors without understanding healthcare. And that brings us to the third reason that wellness (unlike healthcare) needs an ROI, which is…
…Wellness isn’t healthcare. Quite literally every other provider of physical healthcare–from heart surgeons to acupuncturists–needs to train, pass a test, get a license, take continuing education, and be subject to review by an oversight board. Not wellness vendors. You can become a wellness vendor for $67,000. “Up to” eight days of classroom and on-the-job-training are also included in that $67,000. (To put that in perspective, Four Seasons housekeepers get ten days of training.) The vendor that offers these franchises, Star Wellness, brags about how no healthcare background is needed to be a wellness vendor. A background in “sales or municipal administration” is perfectly sufficient.
So if you’re wondering why wellness vendors know so little about wellness, there’s your answer: they aren’t required to know anything about wellness. Knowing just a little exceeds the minimum requirement.
To conclude, here is our advice to workplace wellness vendors trying to justify what popular healthcare blogger Paul Levy calls the “wellness tax“: shut up and just be happy you still get to collect it, and that the authorities haven’t shut you down. (A doctor doing all this overscreening and billing for it would have been shut down.)
Don’t try to justify your hyperdiagnostic jihad on the basis of ROI or any other purpose other than enriching your bank accounts. Every time you try, you provide yet another reason why whatever college gave you a degree in anything other than advanced idiocy should lose its accreditation.
Total Wellness, having been “profiled” on this blog for being second only to Star Wellness in “playing doctor” with inappropriate employee screening, isn’t about to lose this race to the bottom without a fight.
So in order to try to out-stupid Star Wellness, Total is offering yet another test (they are now up to 8) either rated D by the United States Preventive Services Task Force or (in the case of Chem-20s and Complete Blood Counts) not rated as preventive screens at all because [WARNING: Spoiler Alert]: these two aren’t preventive screens. They are tests, but Total Wellness apparently doesn’t know the difference between a screen and a test.
For those of you who also don’t know it — and you aren’t required to because you’re not poking employees with needles to fulfill your mother’s fantasy of you becoming a doctor — a screen is done wholesale on everyone in order to hunt for disease and then brag about how many sick people you found. You’ll find plenty if you force employees to either participate or forfeit lots of money. Like Total Wellness says, you need to be “stern” about making employees submit to these worthless and harmful screens. And being “stern” means it’s wellness–or else:
By contrast, a test is what a real doctor might order — if an actual patient presents with relevant symptoms. Chem-20s and CBCs haven’t been used as screens for decades. Even the professional organization whose physician members get paid to perform them doesn’t recommend them. “These tests rarely identify clinically significant problems when performed routinely on an outpatient population.”
Here is Total Wellness’s Totally Inappropriate Screen #8, along with the USPSTF grade:
Doctors routinely performing and billing these 8 “preventive” screens could and should lose their licenses. The good news for Total Wellness is that they aren’t going to lose their license for inappropriately screening employees, for the simple reason that you don’t need a license in order to inappropriately screen employees.
Quite the contrary. Unlike in regular grown-up type healthcare, in the wellness industry any idiot can perform these screens and tests as long as that idiot can find an even bigger idiot willing to pay for them.
Is this a great country or what?
Total Wellness is very concerned about “fostering a positive culture in your office.”
And what better way to “foster a positive culture,” and “recruit talented employees to your workforce” so that they can “improve relationships with one another” than by screening the stuffing out of them?
To start with, don’t just ask your “talented employees” that you just “recruited” if they smoke. That would be too easy and obviously they would all lie, right? Isn’t lying exactly what talented employees do the day after you hire them? Of course! And isn’t deceit what a positive culture is all about? Of course! That’s why you have to test their nicotine 7 ways to Sunday.
And if those tests are too easily gamed, here’s another one — just in case a few of those lying, cheating employees manage to pass the first set of tests, a la Lance Armstrong. And we wouldn’t put it past them to game the test. After all, they are “talented.”
When you’re done with nicotine, screen them for body fat. Nothing spells “talented employee” like an absence of body fat.
But wait…there’s more. Total Wellness offers a package of seven additional tests that aren’t recommended by the US Preventive Services Task Force. Now how much would you pay?
A lot, as it turns out (not even including follow-up from false positives). The more inappropriate tests you authorize, the more money they make.
Total Wellness is able to do this through their “partnership with Clinical Reference Laboratory.” Translation: they charge you, send some of the money to this other outfit, and keep the rest.
Let’s go test by test down their list.
First are two sets of tests that the USPSTF doesn’t even bother to evaluate because it would never occur to them that anyone, even a doctor, would use them as a screen.
Chem-20s aren’t even recommended as screens by the doctors who get paid to do them.
No one bothers to recommend against CBC screens…because CBC tests aren’t screens. A CBC is a test that actual doctors, not wellness vendors, order for patients who are not feeling well. Get it? As has been well-established for two decades, it’s not a screen. it’s a test. It’s useful for finding the sources of symptoms in a patient who presents in an actual doctor’s office, not for telling healthy people they’re sick. By analogy, if you think you broke your arm, the doctor might x-ray it. That’s a test. But even the dumbest wellness vendor wouldn’t propose X-raying all your employees as a screen to see if their arms are secretly broken.
Assuming a CBC were used as a screen, it would be much more potentially hazardous than if a doctor were to do the test. Since apparently Total Wellness doesn’t understand the concept of false positives anyway (a prerequisite for being in the screening business is not understanding false positives), they would likely misinterpret the results.
How did Total Wellness manage to get a license as a wellness vendor without knowing the difference between a screen and a test? Simple — you don’t need a license to be a wellness vendor. That means wellness vendors are allowed to charge employers to perform screens on employees that would get doctors in a lot of trouble if they tried to bill insurers for them.
We’d encourage you to visit their site to see a few more proposed screens that the USPSTF doesn’t recommend doing, like TSH, homocysteine, CRP. But let’s end with the mother lode of the screening industry: screens that the USPSTF specifically recommends not doing, but are very profitable for vendors.
The good news is, Total Wellness isn’t overselling this test. They say it is “possibly an indicator of ovarian cancer cells,” which makes the test literally less than useless, due to the overwhelming number of false positives and false negatives from such a test. That’s why no grownup doctors use it as a screen and that’s why the USPSTF says:
You may say: “Yes, but this ‘D’ recommendation doesn’t apply to women with the BRCA mutation.” Alas, by law, wellness vendors aren’t allowed to ask an employee whether she has a BRCA mutation or any other family history question, dramatically the reducing the already abysmal odds that a screening vendor might do something useful.
Let us close with my favorite test:
Ask vendors why they do it and they’ll say exactly what this one says: this test is “non-invasive and painless.” Sure. In that respect it’s not unlike palm-reading. The more relevant adjective that applies to both: useless.
If you want to get technical, “D” means less-than-useless.
We do like to close on a high note. Total Wellness is right in that this screening program would indeed help your employees “improve relationships with one another.” Forcing your employees to participate in this costly and misanthropic jihad might lead them to use their “talents” to all get together and revolt–just like at Penn State.