Sunday, May 11, 2014

Why I'm Against Wellness

I’m a physician and I’m against wellness.  Let me explain.

Wellness is the new health mantra that has much more to do with marketing than with evidence-based medicine.  Wellness institutions and practitioners are omnipresent promising benefits that are often untested or rejected scientifically.   Hospitals that years ago would have shunned new age healing arts, now offer yoga, meditation, Reiki and massotherapy.  Do they do so because they have had a Damascus Road experience and now believe that these techniques are effective?  Guess again.


Paul's Conversion on the Damascus Road

Wellness is no longer restricted to medical campuses, costly weekend retreats for emotional and physical catharses and ubiquitous yoga storefronts.  Wellness is now championed by corporate America.   Business leaders argue that keeping employees well is not only a demonstration of good corporate citizenship, but is also good business.   Healthy employees, they claim, will reduce health care costs.  I agree, but not for the reasons they offer.

Their premise that wellness program participants will use fewer medical resources sounds rational, but it may not be true, despite claims from human resource professionals who want to justify these programs.  Here’s the argument.  “If we lower employees’ blood pressure, bring their weight down and control their diabetes better, than these folks will avoid heart attacks, strokes and surgeries which will save mega bucks and improve productivity.”  

Sure it sounds right, but is it really true?  Shouldn’t corporations that know the cost of every widget be able to prove that this strategy is sound?   Last year, a major study on obesity published in the prestigious Journal of the American Medical Association concluded that overweight individuals live longer.  My point?  Just because something sounds like it should be true, doesn’t make it so. 

Many companies are now coercing employees with financial rewards and penalties depending upon their success and enthusiasm in participating in company wellness programs.  If you don’t make their health grade, then the employee will lose serious cash, which may be far in excess of actual medical costs incurred.  In other words, an unstated motivating factor here may be simply to get employees pay more health care costs.

Indeed, two studies published last year in Health Affairs, a peer-reviewed journal, strongly suggested that corporate wellness programs save company money simply by cost-shifting to employees.  Is this what is meant by corporate ‘wellness’.

The Plain Dealer (PD), Ohio's major newspaper reported last year that CVS Caremark is requiring employees to participate in its wellness program by May 1st or they will have to fork over $600 more for health care next year.  Do we really know that non-participants would drain the company’s coffers?   Realize that many employees change jobs every few years, and that adverse health effects of being obese or having elevated blood pressure may take decades to develop.   A CVS worker with a pair of love handles or modest hypertension, isn’t likely to consume more medical resources in the short term.  Yet, he would be docked on day 1 next year.  Does this policy pass the fair and reasonable test?

The PD article quotes CVS as claiming that their policy is “the most effective way to encourage our colleagues to take control of their own health…”  This statement breaks the needle on the hypocrisy meter.  The gall that CVS wants to serve as a health guardian, or should I say health police, while it sells cigarettes, alcohol, junk food and the sugary beverages that New York City Mayor Michael Bloomberg has outlawed for health reasons.  This is chutzpah of the first order. The court properly pushed back against Mayor Mike.

Sometime after the PD article broke, CVS announced that they would refrain from selling tobacco products.  What brought on this revelation?  Did they suddenly release that cigarettes were hazardous and might conflict with their healing mission?  Was it a marketing maneuver to rebrand the company?  While the outcome might be welcome, what was the motivation here. 

If a company truly believes that wellness is right for workers and business, then create a corporate culture that encourages this and provide leadership.   If it’s really as good an idea as they say, then folks over time will be persuaded to do join in.   Leave the financial rewards and penalties off the field. 

I’m not a wellness antagonist.   I support any activity that is safe and makes people feel better.  But making folks pay-to-play in the wellness game, doesn’t make me feel good.  Perhaps, I need to meditate more on this. 

First published in Crain's Cleveland Business, May 2013.


4 comments:

Bill Yancey, MD said...
This comment has been removed by a blog administrator.
SteveofCaley said...

Wellness USED to be pretty popular, until they called it Nursing and strangled it for profit. "Integrated Wellness Management" was the original concept of nursing, but it meant something back when nursing meant something other than slave labor.

Heather Von St. James said...

Hello!

I have a quick question for you, could you email me when you have a chance? Thanks! –Heather

heather(dot)vonstjames@gmail(dot)com

Tim Hackman said...

Thanks for this post. The State of Maryland is getting ready to implement a mandatory "wellness program" for state employees, effective January 1, 2015. Under the new program, employees could be on the hook for as much as $425 (for now, probably due to rise) in a single year for not complying with the program. That seems invasive and unfair, to say the least. Details on the program are here. Will I magically become healthier by being forced to see my doctor once a year and complete some mandatory "healthy activities?" No. What I'll most likely do is lie to my doctor or work with him to keep anything potentially negative off the state forms, so I can avoid as much hassle and expense as possible. In addition I'll be forced to use sick leave (costing the state productivity and money) for unnecessary appointments each year just to meet the requirements. I'm very interested to read the two studies you mention about the actual cost benefits of such programs.

Add this