Encouraged by the Affordable Care Act, our employers have started –- there's no other way to put this – "playing doctor." But it turns out there is a reason real doctors go to medical school -- to learn real medicine. Most employers know so little about real medicine that if, instead of your own human resource (HR) department, your own physician dispensed this advice, he or she could lose their license. If you value your health, you should ignore much of what these programs tell you, beyond giving up smoking, eating better, and exercising more.
The Health Risk Assessment Will See You Now
First, let's consider the forms you complete, which are called health risk assessments (HRAs). To begin with, HRAs almost invariably recommend more "preventive" doctor visits. But the Journal of the America Medical Association (JAMA) concluded that preventive exams do not reduce sickness or death, but may "increase the number of diagnoses and the use of medications."
That's not even the most egregious example of ignoring medical evidence. The PSA test for prostate cancer is one of the most common HRA recommendations, even though the U.S. Preventive Services Task Force and leading medical societies strongly recommend against it. Other completely discredited HRA recommendations include routine meningitis vaccines and lung CT scans for non-smokers, an expensive, uncomfortable and hazardous test far more likely to find false positives or cause cancer down the road (through introducing radiation into your chest) than to actually be beneficial. This transgression is so profound that any physician who owned a CT scanner and made that same routine recommendation might be sent to prison. These HRA examples aren't outliers-they are all endorsed by the National Committee for Quality Assurance despite their lack of scientific basis.
It gets worse.
Blood draws –- euphemistically called biometric screens –- are becoming much more frequent. Yet, added to JAMA's observations about the lack of value of more preventive care are a chorus of experts like the National Heart, Lung and Blood Institute saying blood draws are already too frequent because, as one author put it, America already has an "epidemic of diagnoses." An organization called ChoosingWisely.org lists 130 overused tests, many of which are very popular in these biometric screens. And the Wall Street Journal convened an independent expert panel that reached exactly the same conclusion: screen less, not more.
Is Nebraska a Giant Toxic Waste Dump? However, less screening means less activity and fees, so HR departments, consultants and wellness vendors are screening more despite the advice of all experts. The best example of why you don't want to be screened? Consider what happened to the state employees of Nebraska. The state government's insistence on cancer screening ended up "finding" cancers among its employees at an impossible rate perhaps 40-60 times that of Love Canal, leading virtually all of these employees to get debilitating, harmful and expensive treatments for cancers they mostly didn't have. The state at first bragged about this diagnosis rate, and ultimately won an award for their program, even though the state's vendor subsequently refused to comment when confronted with the data showing massive overtreatment.
The irony is that any individual receiving these or any other diagnoses via a screen probably thinks they are being helped, not harmed. For example, a screen detected a lump in my sister-in-law's thyroid. Against my strenuous objections, after a couple more equally suspect positive diagnostic findings, she had it removed -- and was thrilled to find she didn't have cancer, when in reality she should have been really upset that she lost her thyroid due to a screen that never should have taken place.
The illusion that she or anyone else is being helped is easily punctured, but only by looking at the "big picture" of overdoctoring, which is well-documented in the literature. So before you submit to a workplace screen, ask your HR representative if he or she has read Overdiagnosed, Overtreated, or Overdosed America (those are three different books), or is familiar with federal screening recommendations. Nebraska's HR staff probably isn't: those aforementioned 5199 wellness program participants received 2940 new diagnoses in total (and presumably treatments and drugs) –- truly an "epidemic" diagnosis rate approaching 60%.
There is, finally, an even bigger irony: For your employer, all these new diagnoses, screens, trips to the doctor, cancer scares, and treatments are for naught. "Playing doctor" drives employer costs (meaning ultimately your own costs) up, not down. The earlier belief that these activities save money has long since been debunked. Most wellness vendors don't even claim savings, while others simply lie about their outcomes. Even Nebraska, whose unnecessary treatments and drugs added millions to their spending, alleged savings, presumably to protect their funding stream.
You can't blame your HR people. They aren't trained in biostatistics any more than biostatisticians are trained in HR. The fault lies in two other places. First, senior management. As in many other situations in your workplace that don't capture their attention, they've delegated responsibility by saying, basically, "do something," leading to the adoption of facile, trendy solutions over thoughtful ones.
HR department's consultants and brokers don't make money when your company does wellness initiatives for you, like serving better food cheaper, subsidizing your own healthy pursuits and allowing you stretch breaks. Consultants and brokers only make money when they convince your company to do things to you, like screens. Unfortunately, as this broker strategy White Paper verily shouts in 40-point font: "What future does the broker have unless they [sic] ...create new revenue streams?"
With senior management pushing action for action's sake on one hand, and brokers pitching HR departments to protect their own incomes on the other hand, we employees don't stand a chance. So fill out the form, roll up your sleeve, collect your money -- and then quit smoking, eat better, and exercise more. But stop there or you're statistically more likely to get harmed than helped.
Al Lewis, an outcomes measurement consultant, is co-author of the new book Cracking Health Costs: How to Cut Your Company's Healthcare Costs and Provide Employees Better Care (Wiley, 2013). Vik Khanna, a health and wellness consultant, writes the "Khanna on Health" blog.