WHAT IS WELLNESS CARE?
IT JUST DEPENDS WHO YOU ASK
"Throughout most of human history, people have consulted doctors only when they were sick. Not too long ago, the 'if it ain’t broke don’t fix it' mindset changed. It became customary for everyone to have a yearly checkup with a doctor even if they were feeling perfectly well. The assumption was that this process would find and fix any problems and insure that any disease process would be detected at an early stage where earlier treatment would improve final outcomes. It would keep your body running like a well-tuned engine and possibly save your life. We have gradually come to realize that the routine physical did little or nothing to improve health outcomes and was largely a waste of time and money. Today the emphasis is on identifying factors that can be altered to improve outcomes." Alternative Medicine hater, Dr. Harriet Hall, from Science-Based Medicine's article, Rethinking the Annual Physical.
"From a health perspective, the annual physical exam is basically worthless. The appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests. This lack of evidence is the main reason the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services — does not have a recommendation on routine annual health checkups." Oncologist and vice provost at the University of Pennsylvania, Dr. Ezekiel J. Emanuel, writing for the New York Times (Skip Your Annual Physical)
"There is evidence that an annual physical examination is ineffective in finding hidden disease in healthy people." From our own government's health.gov website (Personal Health Visit)
"How can a procedure so contraindicated by research be so common?" From a 2017 issue of The Atlantic (When Evidence Says No, but Doctors Say Yes)
CNN has an entire section of their website devoted to wellness, describing it as "News and lifestyle reporting about our overall mental and physical health including mindfulness, happiness and life balance." NBC has a similar section on their site called "Better," as does almost every major media outlet. It seems that while they may love to pick on Gwyneth, no one wants to be completely left out in the cold concerning wellness. Listen to what Sara Wilson wrote just a few weeks ago in Quartzy (Wellness Worship: How did Wellness Become Our New Religion?)
"During my five years working at Facebook, I watched wellness grow from a fringe interest for a mostly female audience to a multi-trillion-dollar industry encompassing nutritional supplements, on-demand massage, period-friendly underwear, CBD-enhanced teas, mushroom elixirs, and then some. (If the mysterious powders I put in my morning smoothies and obscurely-scented candles I light every evening are any indication, it’s also an industry to which I have made hefty personal contribution.) All $35 bath bombs aside, there’s lots to celebrate about wellness. Practices like acupuncture, yoga, meditation and healthy eating are all mainstream today for a reason —they can seriously improve our lives, even if we don’t always understand exactly how they all work."
In other words, "wellness" is one of those ooey, gooey, make-you-feel-good-all-over terms that by seemingly encompassing everything, has lost its direction, essentially leaving it with no meaning at all. Writing for the NY Times last month (Worshiping the False Idols of Wellness), OB/GYN, Jen Gunter, said this. "Before we go further, I’d like to clear something up: Wellness is not the same as medicine. Medicine is the science of reducing death and disease, and increasing long and healthy lives. Wellness used to mean a blend of health and happiness. Something that made you feel good or brought joy and was not medically harmful — perhaps a massage or a walk along the beach. But it has become a false antidote to the fear of modern life and death. The wellness industry takes medical terminology, such as 'inflammation' or 'free radicals,' and levigates it to the point of incomprehension. The resulting product is a D.I.Y. medicine for longevity that comes with a confidence that science can only aspire to achieve."
It's an interesting statement considering doctors (not to mention PHARMA) can't stand it when patients do their own research. The medical community does not want patients to truly understand what INFLAMMATION or FREE RADICALS are, what they do, and why individuals might be interested in addressing them non-pharmacologically (the only way they can truly be addressed in the first place). What do they want? From what I hear in my clinic from patients who told their doctor straight up they were not going to follow their advice, I'd say they want lemmings. But I regress.
Today we are going to discuss something Dr. Gunter touched on that is absolutely correct. Wellness should not be "medically harmful". But all too often the concept of medical wellness (not to be confused with alternative wellness) is just that; harmful. Huh? Allow me to show you just how harmful "medical" wellness can be. Although PHYSICAL EXAMINATIONS of various sorts (including ROUTINE BLOODWORK ---- HERE is a list of others) have been touted as lifesaving "wellness" measures for decades, what we instead see in real life has been just the opposite --- the explosion of a dangerous and deadly phenomenon known as OVER-DIAGNOSIS & OVER-TREATMENT that was in the news again just the other day (HERE & HERE).
And while probably not as dangerous, let's take a look at what the experts are saying about "Corporate Wellness" --- the umbrella of programs provided to employees of various companies for the express purpose of keeping them "well" (and hopefully keeping health insurance premiums from growing more rapidly than they already are). Interestingly, the dual-degree program I was working on at Kansas State University (nutrition and exercise physiology) prior to deciding on a career as a chiropractor was Corporate Wellness.
- "Most news coverage of the new Kaiser Family Foundation annual survey on employer-sponsored health plans has focused on the fact that growth in premiums in 2013 was as low as it has ever been in the 16 years of the survey. But buried in the details of the report are some interesting insights into how employers think about controlling health care costs. One example is that they’re very fond of workplace wellness programs. This is surprising, because while such programs sound great, research shows they rarely work as advertised." From a 2014 article in the NY Times called Do Workplace Wellness Programs Work? Usually Not.
- "Employee wellness programs have long been billed as something of a magic bullet—a low-cost means to a happier, healthier, more present, more productive workforce: a win-win-win-win. It’s a tantalizing promise, and over the past decade businesses large and small have rushed to cash in. Part of the push, of course, has come from a big, swinging stick: soaring employer health care costs. But part has come from a carrot too: The Affordable Care Act allows employers to tie up to 30% of a worker’s insurance premium (or 50% in the case of smokers) to health outcomes such as weight loss and smoking cessation achieved in wellness programs. (In other words, employees who don’t meet health goals pay more.) The result is that workplace wellness programs are now practically universal in corporate America—a fixture of modern work culture as familiar as the on-site cafeteria or the 401(k) plan. And the wellness industry behind them has created an $8 billion industry." From a 2017 article in Fortune (Corporate Wellness Programs: Healthy or Hokey?)
- "Corporate wellness programs, which began in the 1970s, mushroomed after the 2010 passage of the Affordable Care Act (ACA), also known as "Obamacare." The law offered companies incentives to embrace participatory wellness and prevention programs. In theory, companies could reduce their health care insurance costs by detecting or preventing serious disease sooner and adopting a culture of health in their employee population. But after billions of dollars have been spent on tests, screenings and wellness promotions, the central question remains: Do wellness programs work? The growing army of wellness consultants, vendors and screening firms suggests they do. They offer studies backing their claims that wellness programs save or make employers money and improve employee health outcomes.... But primary prevention — encouraging people to avoid obesity and chronic disease by exercising and leading healthier lifestyles — doesn't seem to lower costs.... many of the studies the wellness industry relies upon have serious methodological flaws and are typically conducted by wellness vendors themselves." From the Chicago Tribune's July 2016 article by Mark Taylor (Do Workplace Wellness Programs Work?)
- "According to a 2015 Kaiser Family Foundation survey, 50 percent of large firms (defined as having 200 or more workers) annually offer or require employees to complete what’s known as a biometric screening, and more than half of those companies offer a financial incentive to employees who participate. Some even make participation mandatory for employees who enroll in company-sponsored health insurance. Half of large employers surveyed offer health risk assessments (HRAs), which are questionnaires intended to identify high-risk behaviors. Biometric screenings and HRAs are just two types of workplace wellness programs, a broad category that can also include smoking cessation courses, lifestyle coaching, and weight-loss competitions. They’re a waste of time and money, they don’t improve health outcomes, and they’re a front for shifting costs onto employees." From the 2016 article in Slate, Workplace Wellness Programs are a Sham
- "The press and trade publications strongly endorse workplace wellness programs as a good investment for employers, and even the normally skeptical academic world has joined the bandwagon. For example, a 2010 review by a Harvard economist stated that wellness programs returned three dollars in health care savings and three dollars in reduced absenteeism cost for every dollar invested. But our research tells a different story. The recently published RAND Wellness Pro-grams Study, which included almost 600,000 employees at seven employers, showed that wellness programs are having little if any immediate effects on the amount employers spend on health care. This has been further confirmed by our new analysis of 10 years of data from a Fortune 100 employer." From the 2014 study by the Rand Corporation (Do Workplace Wellness Programs Save Employers Money?)
- "Workplace wellness programs cover over 50 million workers and are intended to reduce medical spending, increase productivity, and improve well-being. Yet, limited evidence exists to support these claims. We designed and implemented a comprehensive workplace wellness program for a large employer with over 12,000 employees, and randomly assigned program eligibility and financial incentives at the individual level. Over 56 percent of eligible (treatment group) employees participated in the program. We find strong patterns of selection: during the year prior to the intervention, program participants had lower medical expenditures and healthier behaviors than non-participants. However, we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-reported health status in the first year. Our 95% confidence intervals rule out 83 percent of previous estimates on medical spending and absenteeism. Our selection results suggest these programs may act as a screening mechanism: even in the absence of any direct savings, differential recruitment or retention of lower-cost participants could result in net savings for employers." From the National Bureau of Economic Research (What Do Workplace Wellness Programs Do? Evidence from the Illinois Workplace Wellness Study)
- "Though a 2002 article in the Annals of Internal Medicine found that a majority of the public still feels that a comprehensive physical exam is a good idea, research has consistently shown these annual physical exams don’t save lives. Does this surprise you? It shouldn’t. Think about all of the physical exams or checkups you’ve had over the years. Did your doctor ever find anything surprising or earth shattering? Was the doctor’s office visit discussion mainly around what you already knew—lose weight, eat healthier, exercise, and stop unhealthy habits such as smoking? Based on the medical evidence and research, it appears that some tests which we used to do in the past either need to be adapted or no longer performed simply because we know more." From Dr. Davis Liu's 2013 post on the blog, Kevin MD (Comprehensive Annual Physical Exams Have No Scientific Value)
The last bullet from Kevin MD is not only telling, but echoed the findings of the study above it --- that the employees who are most active in wellness programs tend to be the people who need it the least --- they're the people who are already "well," and are already eating healthier and exercising more than their "unwell" cubicle mates without any sort of program. This brings us to yet another area that encompasses "wellness". Well child or well baby visits.
A dear friend of mine who happens to be an MD once said to me in a moment of frustration, "why in the world would a sane person ever take a well baby into an office filled with sick people?" In today's society, such a statement could almost be considered both uncaring and sacrilegious (at the very least, it's polarizingly politically incorrect). The statement is doubly polarizing thanks to the steady stream of half-truths and outright lies people are being fed concerning "Preventative Care" (my friend was obviously not a pediatrician, earning a huge chunk of his income from seeing "well" babies and children).
Ask yourself a simple question. In light of what we've seen so far, why are we as a society so high on "Well Baby Visits" in the first place; particularly in relation to what we know about routine examinations in general? Speaking of routine examinations, what exactly do we know about the "wellness" physicals so heavily pushed and promoted by the medical community as well as the professional organizations that act as their mouthpieces? Beyond the links I left you earlier, let's take a look.
- "What are the true benefits of this practice? Careful reviews of several large studies have shown that these annual visits don’t make any difference in health outcomes. In other words, being seen by your doctor once a year won’t necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm." Dr. Amy Shipp from a 2015 edition of Harvard Medical School's Health Blog (A Checkup for the Checkup: Do You Really Need a Yearly Physical?)
- "Although they increased the number of new diagnoses, general health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes. Important harmful outcomes were often not studied or reported." Conclusions of a 2012 study on nearly 200,000 people from 16 studies published in the British Medical Journal (General Health Checks in Adults for Reducing Morbidity and Mortality from Disease: Cochrane Systematic Review and Meta-Analysis)
- "Null Hypothesis: Annual physicals are a necessary preventative measure for healthy adults. Alternative Hypothesis: There is no need for an annual physical if you are a healthy adult. Annual physical exams were endorsed by the American Medical Association in 1922 and have become part of a routine, for many, as a preventative measure and, for some, a reassurance that they are healthy. The research presented disproves the null hypothesis and accepts the alternate hypothesis that annual physicals are not necessary for healthy adults." From a Penn State blog, Science in Our World: Certainty and Controversy (Annual Physical Exams…Are They Really Necessary?)
- "The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste. The researchers called it 'low-value care.' But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments. Could pointless medical care really be that widespread? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education." From General Surgeon, Dr. Atul Gawande's, 2015 article in the New Yorker simply titled Overkill
- "The past few decades have seen numerous calls to eliminate the annual physical examination. In 1979, the Canadian Task Force on the Periodic Health Examination recommended 'that the annual checkup, as practiced almost ritualistically for several decades in North America, be abandoned.' In 2013, as part of the Choosing Wisely campaign, the Society of General Internal Medicine recommended against annual preventive examinations in asymptomatic patients. Nevertheless, about one third of U.S. adults receive an annual physical (also called an annual preventive exam or periodic health exam) in any given year, and that trend has not abated. This ongoing practice is not surprising, since surveys reveal that the majority of both patients and physicians are strong proponents of the annual physical. In the face of this disconnect between expert recommendations and real-world practice, how do we move forward?" The first two paragraphs of an article by a pair of MD's (one an MPH as well) in the October 2015 issue of the New England Journal of Medicine (Improving Value in Health Care — Against the Annual Physical)
How do we move forward? We can start by answering another simple question. Since evidence has shown since the early 1960's that routine physical exams should be abandoned, why in the world are we still doing them? Maybe more to the point, why are we still doing them on babies, toddlers, and children, in the name of the 'well baby check' or 'well child visit'? Before I answer that question, allow me to show you the current recommendations of wellness visits from the site, Healthy Children (a website self-proclaimed to be "powered by pediatricians").
Under the current wellness schedule, doctors want to see your child at "2 to 5 days old, 1 month old, 2 months old, 4 months old, 6 months old, 9 months old, 12 months old, 15 months old, 18 months old, 2 years old (24 months), 2 ½ years old (30 months), 3 years....." From then on it's one wellness visit a year until your child is 21 years old. That, folks, is thirty (30) "wellness" visits before your child has finished his/her BS degree. Speaking of BS....
Ask yourself still another simple question. Why is it that even though decades of "BEST EVIDENCE" show that well visits and preventative care are unwarranted, unhealthy, and helping create a healthcare system that's become totally unsustainable for adults (HERE), they are still being trumpeted as a great idea for infants and children? That question becomes even tougher to answer in light of the gobblety gook found on these sites --- the material used to convince parents why these 30 visits are necessary. Among those mentioned by the AAP (American Academy of Pediatricians) we see (I'm not making this up).....
"...asking your pediatrician about nutrition and safety in the home and at school, tracking growth and development, discussing your child's milestones, social behaviors and learning, raising concerns about behavior, sleep, eating or getting along with other family members. Regular visits create strong, trustworthy relationships among pediatrician, parent and child."
Virtually every similar site contained similar gibberish. Why would I call this gibberish? Namely because you can get great information on these topics from the web in far less time than you'll spend at the doctor's office. Or you could get it from Aunt Susan. Or from Grandma. As for things like behavior, sleep, eating, etc, etc, they have little to do with the child himself, and everything to do with parenting (or more precisely, lack of parenting). And let's be frank with each other for a moment. Are you going to ask your pediatrician about nutrition and expect anything useful / helpful / reliable? Really? Have you read THIS or THIS? Come on folks; there's one reason and one reason only for well baby/child visits on the scale recommended. Shots.
Well Baby Visits are synonymous with VACCINATIONS --- lots of vaccinations. In other words, "wellness" means that if the medical community has their way, little Johnny / Julie is going to have all sorts of toxic junk pumped into their system beyond the MERCURY and ALUMINUM ADJUVANTS I've talked about time and time again on my site --- on a steady basis, for the rest of their lives, and with dozens more vaccines on the horizon (HERE).
In fact, if you want it straight from the horse's mouth, HERE is the link to what the government refers to as their "Pink Book" (Vaccine Excipient & Media Summary by Vaccine), showing the toxicity your child will be exposed to shot-by-shot-by-shot if the recommended schedule is followed. What's most interesting about this is that our government also admits (HERE) that the childhood diseases everyone has been taught to fear so much, were brought to current levels before mass vaccination campaigns came online in the early 1960's.
For just a moment, however, allow me to play the devil's advocate concerning well baby / child visits. Back in the EARLY 1980's, Jefferson Starship asked a series of rhetorical questions in a song called Stairway to Cleveland. "Watcha gonna do about.... Walter Cronkite, the economic price index, romance, Ronald Regan, toxic chemicals, cancer, Mister Rogers, the end of civilization....?" And yes, "Cleveland"? I've been to Cleveland; I'm not sure I have an answer for that one. The point was, what are you going to do about it?
In other words, what is your doctor going to do if your child has FOOD SENSITIVITIES (or HERE)? What is your doctor going to do if your child/baby has developmental delay; emotionally, physically, mentally, or socially? What is your doctor going to do if your baby/child has AUTISM? What is your doctor going to do if your baby/child has some funky 'genetic' problem that's probably an EPIGENETIC PROBLEM? In fact, what's your doctor going to do about _____________ (insert the problem of your choice here)? Although we can always come up with crazy scenarios and outliers, the fact remains that according to five plus decades of peer-review, preventative care has been proven time and time again not to work like people think it should work.
Face it, studies on preventative care and wellness care show that it not only costs a bundle, it doesn't do what was originally promoted in a 1900 edition of the Journal of the American Medical Association (A System of Personal Biological Examinations of the Conditions of Adequate Medical and Scientific Conduct of Life). Why not? You can't "prevent" disease through some sort of contrived wellness program any more than you can make your patients stop going through a tub of Pralines & Cream while watching Kimmel every evening. Disease is prevented through living a healthy lifestyle, not through something someone else does for you. And as for the shots; if you believe they are everything they're acclaimed to be; great --- get them and make sure your children get them as well.
Whatever you choose to do is between you, your spouse, and your doctor. All I ask is that you seriously research both sides of the issue, because when you take little Junior to his well baby visit, not only are you only going to get one side of the story, you'll probably be browbeat as a bad mommy or daddy for even thinking those crazy ANTIVAXXERS might have a point. So, other than suggesting you nurse your baby for at least the first year (HERE), and urging you to understand the importance of MOM-TO-BABY MICROBIOME TRANSFER, my two cents doesn't matter much.
Just realize that there are people far smarter than me --- people with an entire alphabet of letters behind their names --- who believe that vaccinations and antibiotics are a significant factor in the explosion of autoimmunity and chronic illness that's crushing our nation under it's mass (HERE, HERE, HERE, HERE, HERE, HERE and HERE). Add this to the reality that you can't believe anything our government or big pharma / the medical community tells you (see my earlier link on evidence-based medicine) ---- especially when it comes to vaccines (HERE) --- it should at least give you pause. The beauty of this equation is that in the second quote at the top of the page, Dr Hall, hater of all things "alternative," revealed in her final sentence ("Today the emphasis is on identifying factors that can be altered to improve outcomes") exactly what I just told you for the thousandth time ---- that your health and the health of your younger children is up to you.
No matter what you decide on this issue, life is full of risks. Just realize that there are plenty of people out there who are raising their children without wellness visits, ANTIBIOTICS, or vaccinations; my wife and I included. Finally, be sure to read DR. ROBERT MENDELSOHN'S amazing treatise, How to Raise a Healthy Child in Spite of Your Doctor. It was Mendelsohn (a renowned pediatrician), who famously stated in his 1988 book, "One grandma is worth two MD's". Unfortunately, his book reminds me of a meme I saw the other day addressing the potential harm of wellness visits or preventative care: Your Baby's Wellness Visit Just Might be the Last Time Your Baby is Ever Well.
While I completely realize a post like this will stick in some people's craw, if you're one of those people who realizes it's a message that needs to make the rounds, be sure to like, share or follow on FACEBOOK, as it's a great way to reach the people you love and care about most!