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Should the Wellness Vendor Oath Be: “First, Do Harm” ?
When Thomas Edison said: “We don’t know a millionth of 1% about anything,” he wasn’t talking about the wellness industry, because wellness vendors aren’t that knowledgeable. And much of what they “know” is harmful.
Smoking and exercise aside, taking wellness vendors’ advice 10 years ago — during the time wellness was somehow allegedly racking up its famously fictitious 3.27-to-1 ROI by making employees healthier– would have been a very bad idea. PSA tests, annual mammograms for younger women, colonoscopies at 5-year intervals, and EKGs were perfect examples of must-to-avoid screens, even if it meant leaving incentives on the table.
And yet even though most wellness vendors (Star Wellness, Bravo Wellness Total Wellness, HealthFair Services and Aetna being notable exceptions) won’t harm employees as much as they did 10 years ago, a lot of mythology still causes a lot of harm today, albeit more subtly.
Myth: “We need to ‘do wellness’ because 75% of our healthcare cost is due to preventable chronic disease.” (Ron Goetzel, in our recent debate, boosted this figure to 80% for reasons unknown.)
Fact: Have ya looked at your high utilizers and other expenses? We-can-prevent-75%-of-cost-due-to-chronic-disease is the biggest urban legend in healthcare. We’ve done multiple articles on it — there are too many fallacies to squeeze in here. Though it’s just arithmetic, this is the most harmful fallacy of all, because by causing employers to obsess with overprevention, it spins off all the other fallacies below.
Myth: “Reducing our employees’ BMIs will save money.”
Fact: The actual science is far more nuanced. Some people have high BMIs because they are healthy. And belly fat — even at “normal” weights — is riskier than all but the highest BMIs. Further, attaching money to weight loss between weigh-ins creates a binge/crash-diet cycle that is decidedly unhealthy.
Myth: “Corporate weight loss programs save money.”
Fact: No corporate weight loss program has ever saved money. They don’t reduce BMIs, BMIs are the wrong measure (see above), and the link between reducing BMIs and saving money is nonexistent.
Myth: “Screening our employees will be good for their health.”
Fact: Annual screenings are a bad idea for the majority of employees. The head of Optum’s wellness operations, Seth Serxner, just acknowledged this inconvenient truth last week. (He somehow shifted the blame to employers, for stupidly spending too much money on Optum and other vendors. That’s a topic for another post.) The US Preventive Services Task Force has a schedule of screenings that essentially no wellness vendor follows. Because so few biometric screens are recommended for working-age adults by the card-carrying grownups who comprise the USPSTF, following USPSTF guidelines would bankrupt the industry.
Myth: “Screening guidelines balance costs and benefits so at worst we’ll break even.”
Fact: Screening guidelines balance harms and benefits, not costs and benefits. The subtlety of the distinction would be lost on most wellness vendors, but it is important. (1) Unless screens are provided free, an employer will lose money even on a screening program done according to guidelines; (2) you are not doing your employees any favors by providing screening “greater than” guidelines, like the Health Fitness Corporation/Nebraska program did. You are simply raising the likelihood of harm.
Myth: “Annual checkups will keep our employees healthy.”
Fact: For wellness vendors, the annual checkup has almost mystical power. Bravo’s CEO Jim Pshock loudly credits checkups with preventing cancer. Wellness vendor bloviating aside, the science is quite settled: employees are more likely to be harmed than benefited by annual checkups.
Myth: “Our employees need to eat healthier.”
Fact: OK, there is a, uh, grain of truth here. Many people have bad diets–fried food, sugar etc. But beyond eating less fried food and sugar, the science remains unsettled. Salt, saturated fat, complex carbohydrates…all in the realm of not completely settled. What is true and remarkably overlooked is the epidemiological rule of thumb that if an impact is major, it shows up in small samples. 86 cases were needed to link lung cancer to smoking. And a famous study of 523 veterans proved very high blood pressure causes strokes. Yet after tons of controlled and observational studies — even comparing countries to one another — we still haven’t found “the answer.” That means “the answer,” whatever it is, won’t matter much in the workplace. So you’re wasting your time trying to get employees to “eat right.”
We could keep going — antioxidants are more likely to cause cancer than prevent it. Sitting is not the new smoking. And drinking eight glasses of water a day is good for you only in that you’ll get more exercise going to and from the restroom.
The biggest myth of all? Wellness vendors actually do anything of value, other than make up savings figures to show your CFO so you look good. Or as my colleague Vik Khanna says: “Love your employees. Fire your wellness vendor.”
Total Wellness’s Total Package of Totally Inappropriate Tests
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.