With the title “The Role of Worksite Health Screening," the American Heart Association’s policy statement could have easily been published 10 or 20 years ago. After verifying that the publication date was indeed 2014, I dove in hoping to find a nuanced approach, a sophisticated tool that would refine the broad-swath approach of yore.
I was sorely disappointed.
The statement begins by citing the high costs of cardiovascular disease as a compelling financial reason to pursue prevention. Indeed, this would be a strong argument, if prevention cost less than care – not a foregone conclusion for any illness.
It’s well known that treating high blood cholesterol for everyone who meets the criteria costs more than treating the heart attacks they would have. Treating high risk patients has a different calculus. And as a side note, this is the same American Heart Association that recommended lowering the treatment threshold which made more people would need cholesterol-lowering drugs.
So, before I have finished the first paragraph, I am wondering whether the statement is a re-hash of weak and disproven arguments.
The policy statement pins hopes onto screening programs to “prevent the development of non-communicable diseases.” Even in their brightest heyday, screening programs could not prevent disease. They can only tell a person whether he has risk for or signs of disease. Action based upon the screening test result is another matter entirely. The statement addresses this by citing studies showing positive return-on-investment for wellness programs. The problem is that the studies cited are outdated, have been retracted, debunked.
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The scientific basis for broad-based health screening programs has been eroding for many years. With 10 PhDs, one MD, and one attorney as authors, surely this policy statement has the benefit of the latest thinking. Two of the authors work for companies that sell worksite wellness programs: Johnson & Johnson Wellness and Prevention (Fikry Isaac, MD); and Staywell (Paul E. Terry, PhD). One author works for AHA; the rest are professors at various universities.
I assume that AHA’s stringent vetting process succeeded in avoiding any actual or potential conflict of interest. Nevertheless, it seems unwise for the AHA to issue this policy statement – clearly at odds with the current thinking about screening programs – with authors whose companies or, in the case of the professors, whose past or future clients stand to gain by selling more screening programs.
The rest of the policy statement goes into great detail about how to sponsor and administer screening programs. For example, one table lists factors to consider in selecting a vendor. This only makes the policy statement look like a step-by-step “how to” rather than a scientific “why to.”
Unscrupulous (or simply uninformed) vendors can use this policy statement and the AHA’s credibility to sell programs that should have been shelved long ago. If only science had a good PR firm, more employers could be doing programs that have positive impact on health and on costs.
Linda K. Riddell is principal consultant with
