A Broadside Against Workplace Wellness Programs

Assume a vendor finger-stick test that you get at your company’s “health fair” is 96 percent accurate. Further assume that vendors are seeking silent disorders that on average have a 1 percent prevalence. Do you suppose your odds of a false positive in those circumstances are 4 percent? To use a technical clinical term, nope. Out of 100 employees, the single employee who is actually afflicted with this disorder should test positive.

Unfortunately, 4 of the other 99 will also test positive even though they are fine…because a 96%-accurate test is also 4%-inaccurate. This means of the 5 people who test positive, only 1 has the disorder — a false positive rate of 80 percent!

…Those false-positives make overdiagnosis (finding and treating maladies that don’t exist) the rule, not the exception. Nonetheless, a lexicographer would say overdiagnosis doesn’t even begin to describe the likely result of these companywide disease treasure hunts, because overdiagnosis is merely the inadvertent occasional side effect of good faith efforts by doctors to help patients. So we need a new word to describe what goes on in wellness: hyperdiagnosis

The poster-child example of hyperdiagnosis? Nebraska’s Koop Award-winning wellness programfor state employees. To win the Koop Award, the state ended up informing fully 40 percent of people who agreed to be screened — and remember, people who volunteer to be screened to save money on insurance will likely be the healthier segment — that they had some kind of cardiometabolic condition.

Somehow almost none of those 40 percent ended up doing anything about their condition…and yet, they lived to tell the tale. Also, the perpetrators claimed large savings simply by finding all this illness even though they didn’t do anything about it.

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Comments (12)

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  1. Bart says:

    Could that false positive be used against you in medical underwriting?

  2. Matthew says:

    “…overdiagnosis is merely the inadvertent occasional side effect of good faith efforts by doctors to help patients.”

    With every major workplace having wellness programs for their employees, I am sure we will soon be seeing problems with companies trying to prevent this overdiagnosis. Every corporation diagnosing their employees at a 4% false positive rate is a major issue.

    • Thomas says:

      Some places also will recommend over the phone counseling if you are one of the employees who are at risk.

      • Andrew says:

        That’s why you shouldn’t take those wellness surveys lightly whenever they ask several questions about your day-to-day mood. The phone counselors will call you on a regular basis to check up on you.

        • Jay says:

          Well everyone at one point or another feel stressed at their job. However, admitting to it on a wellness survey will only cause worry for that employee.

          • Bill B. says:

            That is when 4% of employees who are stressed will be diagnosed as a false positive for a workplace risk.

  3. Thomas says:

    “Out of 100 employees, the single employee who is actually afflicted with this disorder should test positive.”

    Which would be the case if most workplace wellness programs are perfectly accurate. Unfortunately, this is not always the case.

  4. Bill B. says:

    “You are “walking around feeling fine without a clue that [you have] a debilitating or terminal condition.”

    A common side effect of the WebMD, hypochondriac society od today.

  5. Andrew says:

    “To win the Koop Award, the state ended up informing fully 40 percent of people who agreed to be screened that they had some kind of cardiometabolic condition.”

    They are setting a high bar for winning the wellness program awards.

    • James M. says:

      Whoever has the highest rate of hyperdiagnosis wins!

    • BHS says:

      That’s what it takes to win? Diagnosing everyone? Gracious. That really legitimizes the Koop award…sort of like what Obama winning the peace prize did for the Nobel prize.

  6. Devon Herrick says:

    That’s an interesting analysis, which hopefully will encourage health plans to design better wellness programs. In research test and retest are standard mantras. Surely retesting the five people would quickly identify the single individual who actually has the condition.