THCB is excited to announce the first official e-book release from THCB Press, “Surviving Workplace Wellness” by contrarian Wellness industry observers Al Lewis and Vik Khanna.” What exactly is the “Wellness industry” anyway? How scientific is the “science” behind wellness programs? Are stop-smoking programs a good idea? Should your company really be paying to send employees to the gym?
Should you be using technology to help your employees monitor and understand their health? You may not always agree with the authors (we certainly don’t here at THCB world headquarters, where Al and Vik have started more than a few food fights) but we still think you’ll find this title a provocative examination of many of the fundamental assumptions underlying prevention and wellness today.
You can order your digital copy from Amazon.com here at the discounted price of $9.99. If you’re a healthcare insider trying to understand the controversies facing wellness or a conscientious wellness professional trying to get a handle on developing a program that works for your employees, this is the e-book for you.
Be sure to look out for upcoming releases from THCB Press in the months to come. If you’d like to be placed on the THCB Press mailing list to be notified of upcoming new releases, send us an email with “update me” in the subject line. Author inquiries and partnership requests should go to this same address. — John Irvine
Your wellness vendor says you are: But are you really sick?
Don’t take our for it that these workplace wellness programs are a complete and utter waste of your time and blood and your employer’s money, and can even generate medical treatments you don’t need. Do the arithmetic yourself. (The next paragraph does contain a little math but on the bright side if you can follow it, you can probably continue to live independently for at least a few more years.)
Assume a vendor finger-stick test that you get at your company’s “health fair” is 96 percent accurate. Further assume that vendors are seeking silent disorders that on average have a 1 percent prevalence. Do you suppose your odds of a false positive in those circumstances are 4 percent? To use a technical clinical term, nope. Out of 100 employees, the single employee who is actually afflicted with this disorder should test positive. Unfortunately, 4 of the other 99 will also test positive even though they are fine…because a 96%-accurate test is also 4%-inaccurate. This means of the 5 people who test positive, only 1 has the disorder—a false positive rate of 80 percent!
And that’s just on one test. With that kind of accuracy, it’s odds-on that if you get all the tests with all the frequencies that a wellness vendor recommends, at least one lab value will eventually be outside a normal range…and potentially thrust you into the treatment trap. The key to surviving this testing jihad without being trapped is–as with just about everything else in wellness–to start with the assumption that the vendor is wrong. This is a pretty safe bet. How safe? I don’t even know you, but if you tell me the sky is green and a wellness vendor profiled in this book tells me the sky is blue, I’d at least go look out the window.
Those false-positives make overdiagnosis (finding and treating maladies that don’t exist) the rule, not the exception. Nonetheless, a lexicographer would say overdiagnosis doesn’t even begin to describe the likely result of these companywide disease treasure hunts, because overdiagnosis is merely the inadvertent occasional side effect of good faith efforts by doctors to help patients. So we need a new word to describe what goes on in wellness: hyperdiagnosis. Hyperdiagnosis trumps overdiagnosis in four key ways, laid out in this table:
The poster-child example of hyperdiagnosis? Nebraska’s Koop Award-winning wellness program for state employees. To win the Koop Award, the state ended up informing fully 40 percent of people who agreed to be screened — and remember, people who volunteer to be screened to save money on insurance will likely be the healthier segment — that they had some kind of cardiometabolic condition.
Somehow almost none of those 40 percent ended up doing anything about their condition…and yet, they lived to tell the tale. Also, the perpetrators claimed large savings simply by finding all this illness even though they didn’t do anything about it. (These are two topics for a later chapter on Nebraska’s lies.)
Screening at the workplace itself, coupled with forfeitures, satisfies the table’s first two criteria for hyperdiagnosis. That massive number of people diagnosed with conditions—Nebraska’s program uses the words “diagnosed” and “diagnosis” even though none of these screeners are doctors—meets the third criterion. Consistent with the fourth criterion, Nebraska’s program sponsor bragged about all these sick people. Specifically, they boasted of the “life-saving, cost-saving catches” they were able to make due to “a spike in the amount [sic] of conditions diagnosed at an early stage.”
Nebraska’s vendor, Health Fitness Corporation, writes on its blog about how wellness addresses “diminished productivity” and “job stress.” Personally I’m not sure a wellness program telling me I have a disease that I don’t have would increase my productivity and/or reduce my job stress. But maybe that’s just me.
Fortunately, I’m not stressed out and my productivity is not diminished because I feel fine, but that turns out to be the worst possible news because…
…The Definition of a Healthy Employee Is One Who Hasn’t Been Hyperdiagnosed Yet
Feeling fine today? Alas, you better get your affairs in order, bid your loved ones adieu, and watch the shows you’ve TiVo-ed. Why? Because, dodo-brain, feeling fine means you have “I Feel Fine Syndrome.” You are “walking around feeling fine without a clue that [you have] a debilitating or terminal condition.” According to the Compass Health website, the major symptom of “I Feel Fine” syndrome is: “not having symptoms.”
I’ll let Compass take it from here, to display not only their epidemiological wisdom but also, this being the wellness industry, their grammatical wisdom as well:
For millennia there were no clear ways to know whether you or your employees were in this continuum. Walking around “feeling fine” without a clue that a debilitating or terminal condition was percolating in our bodies. But that is not the case today. For the vast majority of us, with a few tests we can literally know where we are on this path. The ability to act early, to reverse or remove the problem, is not only possible, but it is very likely to lead to completely curing the problem for decades, or forever in our bodies.
I must confess that I personally learned a lot from Compass. I hadn’t realized that employers’ concerns about employees feeling fine had their roots in ancient history. But there it is, right in the opening words: these concerns date back thousands of years, when employers failed to get their employees tested for “percolating” conditions before throwing them to the lions.