Demystifying Medicine One Month at a Time

Tag: screening

Big Brother (er, Your Boss) is Watching You

corporate health raceJulie Appleby of Kaiser Health News wrote a nice story about the growing trend of employers that offer wellness programs to their employees.

There are a multitude of reasons why employers do this: mainly, it’s with a binary goal of encouraging employees to lead healthy lifestyles and in turn save money on health insurance premiums — both for the employees themselves but also as a business cost.

As Appleby’s article points out, neither the wellness benefits nor the savings are all they’re cracked up to be. First, the tests that are offered are not always recommended by the best available medical evidence — they’re superfluous in many cases and wind up costing time, money, and anxiety when they return a result considered ‘abnormal.’ Secondly, the evidence regarding workplace wellness programs is that they don’t save money — to the contrary, offering unnecessary testing to people that don’t need it simply adds to our national health expenditure.

All of the above is debatable, of course — proponents of testing cannot be swayed from the viewpoint that ‘catching things early’ is an unalloyed good. What’s not debatable is that as workplace wellness programs grow, more companies are using them as carrots and sticks — offering discounts on premiums, cash bonuses, or higher cost-sharing to those that don’t participate.

To get a flavor of how some employees view these types ‘optional-but-not-really-optional’ programs, I offer a couple of comments from NPR’s website in response to Appleby’s article.

From silicon28:

“Biometrics are growing,” as a way to help workers know if they face health challenges “they may not even know they have,” said Paul Coppol…”

That is complete baloney. Biometrics… including the current ones through my workplace insurance that are now tied to the “rebate” on our premium (a nice way to coerce everyone into the program to keep from paying a penalty, in reality) are all about saving money for the company and the insurance provider. Actually assisting the individual? Not even in the top ten reasons as to why this strange “big brother” monster keeps growing. I’m currently eating the $300 per year that I was initially supposed to have as a “reward” for being involved; now it’s tied to actual readings with BP / cholesterol, etc. that I have to “pass” before I can receive it. Even though I’m fully involved with my healthcare and none of these would be problematic, I’m not about to let the company that far into my HIPPA privacy. This entire phenomenon should be making people very, VERY afraid of what the next steps are that are coming…

From Averal:

Tying health insurance to employment is insane.
So what’s to keep your employer from finding something wrong with your performance, attitude, or SOMETHING.
when they discover you have early stage disease that has the potential to cost them a fortune to treat?

“Well he was a really nice guy, and he did his job, but it just wasn’t cost effective to keep him on the payroll.”

It’s well worth a look — click over and read the article.


Dear Glass:

I loved your recent piece on unnecessary screening tests in the Atlantic.

“Letters! We’ve got letters!”

You explain things so simply and clearly. Kudos!

One question, though. I understand when you say in general that CT scans for lung cancer screening can be dangerous. Excess radiation exposure, incidentalomas, cost, etc. I get it. But for those occasions when someone gets a lung tumor discovered early, don’t you think the screening is actually worth it? I mean, how can finding cancer earlier NOT prolong life?


Paula from Paducah

Good question. Two related answers.

The first is the concept of lead-time bias. [Look at figure 2 in the article linked here.]

Simply defined, lead-time bias gives a the false impression of prolonged life, because the time of diagnosis occurs earlier. But in diseases for which the treatment we have doesn’t alter the course of the illness (like lung cancer), we do not actually prolong life. So the “early” diagnosis is in fact an artifact.

Reason 2 is that lung cancer discovered on screening CTs is usually too far advanced to make early treatment meaningful in terms of survival benefit. Put another way, even if you know earlier that you have the illness, it doesn’t make a difference (in aggregate) for people with the disease.

This stuff is hard because if you’re the one (or you have a family member or friend) with the disease, it seems logical that it HAS to make a difference to find the information sooner rather than later.

Sadly, at this point, it’s just not true.

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