One More Nail in the Wellness Industry Coffin

The wellness industry coffin already has enough nails in it to have created its own gravitational field, which sucks the intelligence and integrity out of all except a very few vendors.

All those nails need to make room for another one: the most egregious case of “publication bias” in the history of nutritional science, casting doubt on a great deal of corporate wellness dogma.

Bottom line: We can add vendor dietary advice to the ever-expanding list that includes PSA tests, annual checkups, BMIs, biggest-loser contests and a whole lot of other misinformation that vendors have been charging us for (yet somehow claiming savings on) lo these many years.

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First a bit of background. A researcher named Ancel Keys was the founder of the saturated-fat-will-kill-you camp.  As described in Nina Teicholz’s The Big Fat Surprise, he excelled at suppressing the findings of, and blacklisting, researchers whose conclusions opposed his. (This, of course, is exactly what the Health Enhancement Research Organization often tries to do to me–but not often enough as far as I am concerned.)

Dr. Keys was in a pickle. His own co-authored study — that rarity of rarities in nutrition, a controlled study over a long (54-month) period using a large sample size — found exactly what his critics had been saying: substituting polyunsaturated vegetable oils for animal fat increased, rather than reduced, the death rate.

Worse, the substitution also reduced cholesterol–meaning that use of cholesterol levels as a proxy for health was out the window. And worst of all, the more the subjects’ cholesterol declined, the higher their risk of death.

So naturally he suppressed his own study, much to the chagrin of the lead author.

Fortunately, the lead author kept all the data, and it was recently discovered in his son’s basement. Sharon Begley wrote it up last week in STATNews.  I’d urge everyone to read the whole article.  It doesn’t prove that saturated fat is good for us, but it does prove that it’s time to stop assuming that it’s bad for us. Likewise, it doesn’t prove that cholesterol doesn’t matter but it does prove that wellness vendors need to stop obsessing with it.

It’s not just that the study was excellent.  Plenty of excellent studies have reached the same conclusion. What makes this one the most compelling addition to the saturated-fat-is-not-the-villain genre is this: it was conducted by someone trying to show the opposite–the most powerful type of conclusion.  (In that same vein, we’ve been able to show that the wellness industry’s participant-vs-non-participant study design is completely invalid merely by reporting results from wellness true believers mistakenly thinking they showed the opposite.)

So What?

The implications for the wellness industry are staggering.  First, they need to stop micromanaging employee diets. Sure, you can encourage them to exercise and make smokers pay a premium if they don’t take steps to quit…but leave people’s diets alone (except for sugar).  There is simply too much controversy out there to present controversial hypotheses as facts, cajole employees into going along with the dietary fad of the month, and then let the vendor make up outcomes proving that they saved money.

Second, beyond cutting way back on sugar (a substance that ironically Dr. Keys was perfectly fine with despite overwhelming evidence to the contrary even back then), there is no best diet. The effect of dietary composition must be minor, and/or it varies by individual. Otherwise an effect would have shown up by now.  It took about 100 patients for doctors to conclude smoking causes lung cancer. A famous study needed only 180 people to show very high blood pressure caused strokes.  Meanwhile regarding saturated fat, we have humongous numbers of observational and controlled studies, and country-to-country natural experiments, with basically nothing to show for them other than conflicting hypotheses.

And yet thousands of companies are paying wellness vendors to browbeat employees into eating less saturated fat.

Third and most importantly, this study was suppressed by its own author. It makes you wonder how many studies that show exactly what we’ve already proven — that wellness loses money — have also not been published because the investigator didn’t like the result.

Or, the publisher didn’t like the result.

The American Journal of Health Promotion and the Journal of Occupational and Environmental Medicine make it a point to only publish positive findings. Between them they have published precisely three negative articles, not including the ones they’ve misinterpreted as positive but were obviously negative, like Aetna’s.

One of the three was a highly favorable review of Cracking Health Costs, which JOEM had to publish because a member of their advisory board wrote it. Another was by Debra Lerner, which they had to publish because it was Debra Lerner. And the AJHP has only published one, which Michael O’Donnell later spent 2000 words walking back after he realized that admitting “randomized control trials show negative ROIs” was probably not the best choice of words if your entire career is dedicated to showing wellness is good.

Even studies published in Health Affairs, invariably showing no benefit of wellness, always seem to include a spin on the findings if they are published by wellness apologists:

• The Connecticut state wellness program study showed wellness made costs go up, but the study authors spun this into concluding that the program was successful because the very fact that these costs went up means someday costs will go down;
• A study published in January showing the futility of using financial incentives to generate weight loss (which is a dubious-enough goal on its own) found no impact, but concluded that we just haven’t found the right incentives yet.

The bottom line: aside from substituting water for soda and getting rid of as much sugary stuff as possible, changing employee diets probably isn’t going to matter much, and certainly paying/fining them to make those changes is a waste of time and money.  Smoking and exercise should be the focus.

Most importantly, the focus should be on creating a workplace that makes employees happy to be there, a goal that seems all but forgotten in the rush to “show savings” that don’t exist.