Should Wellness Carry a Warning Label?

Anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes.

You know those "three biggest lie" jokes? The third biggest lie would be: "I'm from Interactive Health, and I'm here to help you." Hilarious... unless you are one of those unfortunate souls who are:
  1. paying their bills;
  2. believing their outcomes; or
  3. taking their advice.
The first and third are closely related in the sense that one would think, with their fees – which rank among the wellness industry’s highest due to their industry-leading embrace of hyperdiagnosis — they could afford to train their employees in wellness. See also: Healthcare: Need for Transparency   However, because they apparently forgot to check that box, I’ll do it for them. I owe them this favor, having recently made unflattering observations regarding their botched cover-up of their invalid outcomes reporting. First the good news No one can accuse Interactive Health of wasting money on excessively silly, excessively gimmicky, excessively readable user interfaces. Here is the advice they give to employees, all 1,350 words of it, starting with Page 1: But wait…there’s more. Page 2: And for all those employees who simply have too much free time on their hands at work, Page 3: More good news. They do tell this employee, after informing her that she has metabolic syndrome, to “avoid sugar.” Credit the law of averages with that — if you write 1,350 words, it is likely that two of them —  0.14% — will be correct. These two words are in the middle of the second page, so I’m sure she saw them. Who wouldn’t? Next, the bad news To prevent that metabolic syndrome from progressing to diabetes, the letter also recommends “lowfat or nonfat dairy” in the diet. However, according to the the journal Circulationpeople with the most dairy fat in their diets had a 50% lower risk of diabetes. Likewise, a study of 18,000 women showed lower obesity among those who consumed full-fat dairy. Journal articles are likely beyond Interactive Health’s grade level, so here are two lay summaries and two lay books:
  1. The Skim Milk Scam: Words of Wisdom from a Doctor Dairy Farmer
  2. Lowfat Dairy: Zombie Guidance
  3. The Big Fat Surprise
  4. The Bad Food Bible
It’s not just dairy fat, where the science, though perhaps not definitive, is settled enough that even the dumbest wellness vendor should know not to tell diabetics to switch to skim milk. It’s also saturated fat in general, where the change in scientific understanding over the last 10 years has caught many wellness vendors by surprise, and they haven’t had time to react. If consumed in large quantities, perhaps saturated fat may be a heart disease risk factor nonetheless.  Who are we to say? However, if it were a culprit of any significance — like trans fats or cigarettes or family history — that conclusion would be definitive by now, given the massive amount of research that’s been thrown at this question.  Even if saturated fat were a minor risk factor, there is still one overriding reason that Interactive Health shouldn’t be telling people with metabolic syndrome to eat less fat: What the he** do they think people will eat instead? There is a whole body of literature on how telling people to eat less fat helped create the obesity epidemic. In all fairness to Interactive Health, they recommend eating only less dairy and other saturated fat, not less total fat. However, that is a subtlety that can get lost in those 1,350 words brimming with all sorts of random advice. For instance, on the subject of abnormal thyroid function, the letter says: “Talk with your healthcare provider about possible treatment options for this condition.” Sound advice indeed — if in fact the person in question had abnormal thyroid function, but according to this report (bottom of Page 2), her “thyroid was normal.” More bad news Even though this person does not have high blood pressure, the letter also recommends eating less salt. For people without high blood pressure and especially people like her who have other diabetes and cardiac risk factors, avoiding salt is likely a bad idea. Other than the answer being different for different people and different ethnicities (subtleties overlooked by almost all wellness vendors, which prefer to give blanket advice), the science is unsettled. It does, however, increasingly point to the importance of salt — something humans have been consuming in large quantities ever since way before the Roman empire paid its soldiers in salt — in the diet. This is especially the case for people with, or at risk for, diabetes or heart disease (which this person is). In particular, for people without hypertension, reducing salt intake to a level much below the U.S. average: Among other limitations,  most of these studies are correlative, not causative, and rely on self-reporting rather than controlled environments.  So we can’t conclude with certainty that avoiding salt is a bad idea. Nonetheless, my suspicion is that companies paying Interactive Health millions of dollars — and basically forcing their employees to choose between submitting to them or losing money — have assumed that the advice they are giving employees is settled and likely correct, rather than controversial and likely incorrect. Other studies, generally older ones, recommend low-salt diets to prevent high blood pressure, so it is still at least arguably fair to say salt science is conflicted. But the overriding reason for Interactive Health to stop telling employees at risk for diabetes to eat less salt and less saturated fat is, what the he** do you think they are going to eat instead? Because most proteins come with saturated fat (and salt), there is only one thing left to eat: carbohydrates. The bottom line is that anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes. See also: Wellness Isn’t the Only Scam in Healthcare  Fortunately, most employees will have the good sense to ignore their advice, if for no other reason than it is quite a Herculean task to plow through it all. How do I know this? By definition, any employee reading this blog is more health-conscious than average. And yet the particular employee who, after reading my blog post on them, sent me this letter originally sent me only the first and third pages. She hadn’t even realized there was a second page, because Interactive Health printed it on the back of the first page. Ironically, that was the page where it said “avoid sugar.” The “coaching” call In addition to the letter, this employee did receive a coaching call, described as follows: When they called to offer me advice, they simply said, “ Do you know you have high cholesterol?” I said, “Yes.” Then she proceeded to ask me what I was going to do about it. I said: “I thought you would tell me what to do.” She had nothing to say. Then I received another call a few weeks later as a follow-up, and I wanted nothing to do with them as they had already discredited themselves with the first call.   In yet another installment (which will have to wait until 2018 because December is devoted to highlighting the best-in-shows of the wellness industry and, of course, the Deplorables Awards) we’ll explain how Interactive Health translates ignorance of clinical guidelines, bad dietary advice and massive hyperdiagnosis into quite literally the most inflated savings in the wellness industry this side of Wellsteps.

Al Lewis

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Al Lewis

Al Lewis, widely credited with having invented disease management, is co-founder and CEO of Quizzify, the leading employee health literacy vendor. He was founding president of the Care Continuum Alliance and is president of the Disease Management Purchasing Consortium.


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