All Is Not Well With Wellness
By Catherine DiDesidero, CPT, Critica Art and Media Director
It’s hard to argue against “wellness.” After all, who doesn’t want to be well?
And so, whenever a program or treatment has the name “wellness” in it we cannot be faulted for assuming it must be a good thing. Unless, of course, what is being advertised as promoting wellness has absolutely no scientific basis and has never been shown to work, is known not to work, or, worst of all, has been shown to be harmful.
The concept of “wellness” seems to have arisen from a desire to get American medicine off the concept of “illness” and “sickness.” Doctors are trained in medical school to diagnose and treat diseases. And of course, given that 100% of us will ultimately die of something, being sick is inevitable. But increasingly we know that there are some things we can do to prevent illness in the first place. Those with a clear scientific basis include not smoking cigarettes, using sunscreen, avoiding asbestos, limiting alcohol intake, exercise, and avoiding highly refined sugary foods. Unfortunately, with the complexities of human physiology, the abundance of diseases, and the burgeoning number of medical tests and treatments, medical schools have very limited time to focus on disease prevention. So, it is a valid point that we often cannot rely on our physicians to spend a lot of time with us on how to stay well.
As usual in the health field, when doctors don’t do something important, it is open season for everyone else to develop their own approaches, including wellness programs. These are often packaged with impressive sounding scientific terminology, like “anti-oxidant,” “immune system support,” and “cognitive enhancer.” Sometimes, advertisements for wellness programs even state that “clinical trials show…” that whatever is being promoted actually works.
I was recently startled to see an article in “The Week,” spotlighting actress and “health guru” Gwyneth Paltrow in which they called her ideas about well-being “quirky.” Others have written about the absurdities of most of Paltrow’s recommendations on her GOOP website (See here and here for examples). She seems to see “toxins” everywhere without a basic understanding of what a toxin actually is, and she recommends all kinds of “alternative” foods and lotions, none of which have the slightest basis in scientific evidence. To call her ideas “quirky” is decidedly generous. Words like “ridiculous,” “absurd,” and, in some instances, “possibly harmful” seem to me far more apt.
Her endorsement of celebrity fitness “expert” Tracy Anderson is troubling to me as well. As a personal trainer myself, I will concede that there may be some people who benefit from Anderson’s advice and methods. But many aspects of what she advocates have no basis in science. For example, she claims that her “method” can help women lose weight in specific parts of their bodies, whereas abundant scientific research has shown that it is virtually impossible to select a particular part of the body for weight loss.
How do we Know if it Works?
It turns out that the whole area of “wellness” could use an infusion of sober thinking and scientific inquiry. Aaron E. Carroll, Professor of Pediatrics at Indiana University School of Medicine, called attention in a recent New York Times op-ed piece to a startling piece of wellness research. Usually, studies of wellness programs are done using what is known as the “observational” method. In other words, researchers compare health outcomes for a group of people who choose to enter a company’s wellness program to those who choose not to. I’ve emphasized the word “choose” for a reason, as you will see.
Many of these studies do indeed show that people who enroll in wellness programs have better health outcomes, use medical services less often, and stay on the job longer than those who do not. But do these studies really prove it was the wellness program that produced all this benefit? Could it be that people who volunteer to enroll in wellness programs are different in important ways from those who don’t? Maybe they are already healthier, for example, or less likely to smoke cigarettes, or are thinner or younger.
The only rigorous way to know for sure if these so-called “confounding” variables are influencing the results of an observational study is to use a completely different study method, called the randomized clinical trial, or RCT. Here, people are randomly assigned to a wellness group or a control group before they start the experiment and then after a prespecified period of time, say several months, the results are tallied. Because of random assignment, the people in the two groups should be the same on all variables except the one under study—that is, being or not being in a wellness program.
Just such an RCT was done, Carroll reported, at the University of Illinois. The wellness program consisted of “wellness activities, including classes on weight loss, exercise, tai chi, smoking cessation, financial wellness and more. They were even offered financial incentives of various amounts for completing screenings and participating in activities.” And the results? There were no statistically significant differences in any outcome between those who were randomly assigned to the wellness program and those randomly assigned to the control group, which did not get any wellness activities.
Carroll further notes that the Illinois researchers went one step further and re-analyzed the data using the observational method. When they did so, there were differences between people who were assigned to participate in wellness programs and people who were not involved in the study at all. This shows that the observational method, the one usually used to study the effects of wellness programs, does not always yield accurate results. The RCT done in Illinois demonstrates that the wellness program had no beneficial effects at all. “In a nutshell,” writes Michael Joyce in Health News Review, “every time the observational study suggested a benefit from participating in the [wellness] program, the RCT analysis did not; in other words, no cause-and-effect benefit” [italics the authors]
Are they Harmless?
Were it just that some wellness programs appear to be a waste of time and money, we might overlook them as expensive but benign. But in some instances, “wellness” is harmful. For example, a study published last month in the medical journal JAMA Oncology looked at data from a cohort of people with cancer who used “complementary medicine” treatments for their illness. Compared to cancer patients who did not use complementary treatments, those who did had higher refusal rates of conventional treatments like chemotherapy and radiotherapy and, most ominously, higher death rates. It was not the complementary medicine per se that increased the risk of death, the study showed, but rather refusing conventional treatment.
California gynecologist Jen Gunter believes that wellness “has become a false antidote to the fear of modern life and death”. She points out, for example, that dietary supplements “make up a $30 billion a year business despite studies showing they have no value for longevity.”
The wellness industry, then, capitalizes on our fear of the inevitable—getting sick and dying—by scaring us that toxins are everywhere and only its products can save us. Very little of this has any scientific standing. Nevertheless, people continue to take vitamins unnecessarily, to join wellness programs that may offer no more benefit than whatever they were already doing, and to follow the advice of false prophets like Gwyneth Paltrow. What can be done?
Several things, I think. First, medical schools need to understand that the patients their students will someday be taking care of are susceptible to the influence of wellness gurus, often to the detriment of their patients’ health. Medical students must be trained to be respectful of different ideas and approaches, but also to be able to counsel people on what is and is not scientifically-based.
Second, the media must stop treating people like those at GOOP as if they have a reasonable, alternative point of view or are merely “quirky.” In fact, they are pushing useless products and ideas that may cause harm.
And finally, we have to do a much better job of explaining to everyone what constitutes a sound scientific study and how scientists conclude that something does or doesn’t work. The difference between an observational study and an RCT is not something we all know, but we should. Critica was designed in part to help with that.
Science tell us that if you exercise regularly you will lower your risk of having a heart attack. If you use sunscreen, you will decrease the chance you will get skin cancer. If you never smoke cigarettes, you are very unlikely to get several forms of lung cancer. Those things may not be all that much “fun,” but they are the real approaches to wellness.