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If you listen to the Centers for Disease Control and Prevention (CDC), you would think chronic disease is the main health problem we face, and workplace wellness is the main weapon we have to face it with. I know what you’re thinking (at least for the former): isn’t it?
Nope. The country’s main health problem — at least among those addressable by the CDC as opposed to by Congress — is something else altogether, essentially the opposite of what the Wellness Ignorati say it is. But before we reveal the answer, let’s review the CDC’s chronic disease talking points, which naturally are hilarious, as most talking points in support of wellness tend to be.
First, in the screenshot below, they quote the “arresting” statistic that “7 out of 10 deaths are due to chronic disease.” Um, that is called civilization, folks. Countries where 7 out of 10 deaths are due to causes other than chronic disease would love to have this arresting statistic. In case anyone doesn’t believe that the CDC — or indeed, that any human being other than a wellness vendor — could possibly be so stupid as to think civilization is a problem that needs solving, here is the screenshot, and here is the link.
Second, they recently bumped the “75% of costs are due to chronic disease” urban legend in the first line of the screenshot to a mind-boggling 86%. Surely even the dumbest CDC employee can’t believe this. Surely they can back-of-the-envelope an estimate that birth events, preventive care, and trauma alone account for much more than 14% of spending. Birth events by themselves account for about 16% of all hospital discharges.
Meanwhile, wellness vendors are now flogging those “7 of 10 deaths” and “86% of the nation’s healthcare cost” statistics to lobby Congress for wellness subsidies. Congress had wisely stopped funding one of the CDC’s many wellness boondoggles (Work@Health). That didn’t sit well with the industry, so they are starting a lobbying campaign. Fortunately, if their lobbying prowess is anything like their wellness prowess, the budget deficit is not likely to increase anytime soon. The letter reads:
Here is the real problem
This would all be very amusing, as the CDC and wellness vendors converge on these two statistics like monarch butterflies of innumeracy, except that our health is stake. And that (finally) brings me to the title of this posting.
The Maginot Line, as you might recall, proved about as worthless combating the Nazis as the CDC’s wellness obsession is today in combating the real healthcare problem: a massive explosion in blood-borne infections, or septicemia. While the CDC, wellness vendors, and of course the Health Enhancement Research Organization are all atwitter about diabetes and heart attacks (which none of these people can prevent and whose admissions in combination have been in check in all subpopulations for many years), consider ICD-9 038.9, Septicemia. There were 928,000 inpatient cases in 2013, the last year available.
It’s not just that it’s huge, almost twice as costly as the next most costly ICD9. It’s also exploding:
- has increased almost sevenfold;
- is now the by far the largest single diagnosis code;
- twice as costly as the second-largest…
- …and its growth is accelerating?
More importantly, why doesn’t anyone at the CDC seem to care about pathogens? This is what they are supposed to do–identify pathogens and prevent, contain or eradicate them.
Literally anyone (almost 1 in 300 people annually) could get a cut or injury or infection in the hospital, get septicemia, and, 13% of the time, die. Yet the CDC is blissfully unaware of this. If you’ve heard this “blissfully unaware” song before, the CDC’s Wellness Watchdogs also completely missed the workplace opioid epidemic. That happened right under their noses. The drugs were legal, prescriptions were filled, and PBMs paid for them.
Where was the CDC when this was happening? The same place the wellness industry was: nowhere. Most health risk assessments queried about illegal drug use and alcohol, but abuse of legal opioids? Off the table.
We can’t let the CDC overlook this epidemic too, due to their singularly misguided wellness obsession. We need to embarrass them into action–please send this note around to as many people as possible.
And if you’re wondering how the CDC (with the very notable exception of NIOSH!) has dumbed down so fast, so was I. These were, after all, the people who rid the US of malaria and rid the world of smallpox. So I did a little search on their site.
The first thing I noticed was that their workplace wellness information is “science-based.” That was the giveaway. In wellness, the phrase “science-based” means “not science-based.” To use one example, Wellsteps’ claim that their ROI model is “based on every ROI study ever published.” This translates as: “We made the whole thing up.”
Additionally, the references the CDC relied upon should look familiar. Besides being comprised of the usual serial liars, serial cheaters, and serial idiots, the list of references ends with Katherine Baicker, truly the Typhoid Mary of the workplace wellness epidemic–and hence one of the people most responsible for advising the CDC to create the Maginot Line that failed to prevent or event identify the opioid and bacteria epidemics that have taken millions more lives than workplace wellness has ever saved.
By the way, while you were reading this and the links, 6 to 12 more people (depending on how fast you read) just contracted a hospital-acquired infection, with probably 1 or 2 people dying from it.
To put that in perspective, the comparable statistics for wellness would be that 6 to 12 vendors just lied to their prospects, with 1 or 2 prospects believing them.
The Centers for Disease Control and Prevention (CDC) rid this country of malaria, and do you even know anybody with smallpox or polio? For trivia buffs, here is a brief history about them. When they do epidemiology, they do it very well, better than anyone else on earth. Likewise, their National Institute for Occupational Safety and Health (NIOSH) has been a major contributor to the dramatically lower number of occupational fatalities in the US. When NIOSH was founded in 1970, there were about 14,000 fatal work-related injuries per year. In 2014, with a workforce nearly twice as large, there were 4,679 — still 4,769 too many, but significant progress nonetheless.
But when the CDC does fifth-grade math and Statistics 101, not so much. Consider one of the CDC’s “arresting facts:’
They are actually right about this arresting fact: 7 out of 10 Americans do die of chronic disease each year. The cause of this? It’s called “civilization.”
Here is another one of their statistics:
Newsflash: You can’t fit 20% of kids into 5 percentiles no matter how much they weigh.
And in the immortal words of the great philosopher Carole King, on the whole it was a very good year for the undertaker. Diabetics die an average of 1.5 times apiece:
In each case, we kinda know what they meant. But they didn’t actually say what they meant. And I can tell you from my experience on Jeopardy that if you don’t say what you intend to say, Alex will take away your money. Not saying what you intended to say means what you did say is wrong, no matter how big you write your name.
And now, they’ve done the exact same thing for chronic disease…except that I really can’t figure out what they mean. “86% of healthcare spending is on people with chronic disease.” Even at 75%, this was already the#1 urban legend in all of healthcare. But 86%? Seriously? $6 out of every $7? Take out birth events, and it’s more like $11 out of every $12. Take out trauma, primary care, gynecology, imaging, sports injuries, and you’re already in mathematically impossible territory.
While this CDC whopper is bad news for frustrated fifth-grade math teachers everywhere, this sudden and unexplained boost from 75% to 86% is good news for the wellness industry. This timing is not likely a coincidence given the ties between the CDC and some wellness promoters. It comes at a time when the wellness industry is getting skewered in the media, employees (the actual end-users) hate wellness so much they need to be bribed or fined to submit, the industry’s own numbers don’t add up and when we change their numbers per their request, they add up even less,
Wellness industry executives never miss an opportunity to misinterpret a statistic they don’t understand, and the CDC is just begging to have wellness vendors misinterpret this as “Chronic disease now accounts for 86% of healthcare spending” — and push employers into more prying, poking and prodding. Of course, what they should be doing instead, based on the list of costly admissions below, is exactly what Quizzify proposes: educating employees on how to avoid harms of overtreatment, rather than pushing them into the treatment trap.
Funny thing, for an industry so behind the times that they still urge guys to get PSA tests (and fire them if they don’t, in one case we’ll be posting soon), wellness vendors didn’t let a minute go by before misinterpreting the CDC statistic, as we predicted. Here is Concentra, saying: “Chronic disease accounted for 86% of healthcare spending,” and if you read down, proposing more prying, poking and prodding.
A couple of weeks ago, Concentra decided even 86% wasn’t enough, so they added a little extra, just in case the CDC omitted a few cases of dishpan hands:
We hate to pour coffee on the wellness industry’s invalidity bender here, but someone has to provide actual facts, since the CDC seems to fear them as much as wellness vendors do. We’ve already posted the top 25 inpatient DRGs in the country for employees, both by frequency and by cost, and we’re posting them again below. As you can see, none of those conditions accounting for “more than 86% of health care spending” — nor any of their common complications — show up on this list. Instead, the overlap with anything that can be avoided with pry, poke and prod programs is almost zero. Even randomly, you’d expect more of an overlap, let alone if 86% of cost is due to things that 3-P programs address.
If that’s the case, how did the CDC come up with that statistic? It’s not sourced, so we have no idea. Our suspicion is that they’ve lumped a whole bunch more diseases in there, like maybe gum disease. So why not add tooth decay? Dandruff? Cellulite? Ring around the collar? They already list “stroke,” which is about as acute as diseases get. As we say in Surviving Workplace Wellness, every minute of delay after a stroke increases the odds you’ll end up like the Kardashians.” Likewise, they list cancer, as in: “My doctor says I have lung cancer, but we’re staying on top of it. He says I need to lose 15 pounds.” (For these two items, we do think we know what they mean. Some cancers stay with you but can be controlled, and disease leading to stroke is chronic…but that’s not what they said.)
Perhaps this 86% statistic is technically accurate for some health policy wonk parlor game where one player tries to act out a chronic disease, but it’s wrong on its face for any useful purpose involving employee wellness. For employees, it’s all about birth events, orthopedics, day surgeries, imaging, drugs, doctor visits, and a ton of one-time events, small potatoes, catastrophic illnesses, and/or none-of-the-above. While the CDC is busy lumping everything together into this 86% figure, we are recalling the opposite observation in Why Nobody Believes the Numbers that “everything in life has an 80-20 rule, and in healthcare the 80-20 rule is that 80% of the time, there is no 80-20 rule.”
Boys and girls, DO try this one at home…
Before you answer, “Oh, our consultants told us to do more wellness,” try one thing. Try what we suggested above, for your own population. List the top episodes of care in total in your own organization. Here it is for the country as a whole:
As we’ve mentioned on multiple occasions, this list is populated with things no one can do anything about, as well as things addressed by Quizzify. Feed your population all the broccoli they can eat, and make them wear fitbits 24-7. You won’t prevent a single one of those DRGs.