Psyched Out

Help! Wellness fever has overtaken my workplace, an outpatient psychiatric agency for the severely mentally ill. It is promoted and funded by the manufacturer of one of the atypical antipsychotics which certainly cause significant weight gain without a change in eating habits, and appear to kindle diabetes in people with genetic or health elated predisposition. (ie: I wouldn't take them if I had pancreatitis). The wellness program and its medical supporters claim that both weight and the majority of chronic illnesses can be cured and/or entirely prevented by diet and exercise. As you are well aware, this is simply untrue and not evidence based in the least. My agency touts itself as evidence based, but nobody is looking at the evidence.

For example, one of our nurses presented on "diabesity" in a mandatory meeting. She claimed that the CDC (which she cited on a slide but did not recognize by initials or full name when I cited the finding there that "overweight" BMI is correlated to lower mortality than "healthy weight") proved that 70% of people die from entirely preventable chronic diseases. I asked what diseases those might be, and she said diabetes, hypertension, asthma, cancer and heart attacks are all preventable by a healthy diet and exercise. I asked her for citations or even verbal scientific sources, and she had none, just kept spouting misinformation. I clarified that she was saying that all heart attacks are preventable in this way, and she said yes. I pointed out that every heart quits beating at some point, and that this is in fact not preventable. At all. She just ignored me

Then the pharmaceutical rep introduced their new wellness program, which we are expected not only to enroll in ourselves, but enroll our patients in as well. And everything suddenly made sense. It's a liability defense ploy. If the pharms can convince patients and judges that diabetes is really the patient's fault, and that they did their best to cure them of their evil, underserving ways, they can "prove" in court that the evidence regarding diabetes and it's related consequences are not the medicine's effect, but a personal failure. And...you guessed it! The wellness program is run not by health clinics or professionals, but by a marketing company.

So I emailed the facts (from the very CDC research she cited) to my agency coworkers, especially emphasizing that rising obesity has no correlation with, let alone causation of diabetes. Indeed, as weights have risen, diabetes rates did not change at all from 1988 - 2000, the latest year analyzed, although "obesity" tripled. I also pointed out that there is no evidence from the CDC that diet and exercise have any effect on chronic disease incidence or prevalence. The CDC study that she was referring to showed that 70% of people do die of chronic disease, but there were neither claims nor evidence that these diseases are preventable by exercise and diet, or by anything else for that matter. Chronic disease causing 70% of deaths is good news, since we are no longer dying of malnutrition, infections or infectious diseases, pregnancy and childbirth, diarrhea and other conditions that cause most deaths in poorer countries. It may just mean that people are living long enough to get these (mostly) diseases of aging.

Anyway, this week the newsletter was all about the wellness program. It included tips on how to "prevent" high blood pressure, like avoiding stress (for social workers?!) and eating right and doing exercise 90 minutes a day, excluding any movement related to work and home maintenance. So I sent an email with the American Heart Association research showing the most effective way to "prevent" hypertension is to avoid the misdiagnosis that affects up to 75% of Americans due to miscuffing. I demonstrated who needs an adult large cuff by letting people know that if they wear a medium or larger tee shirt they need a large cuff by AHA standards. I added that this means anyone whose upper arm is wider around than a standard coffee mug.

I received disciplinary warnings for providing the evidence. I was told that it was unprofessional, and that people might feel bad if they miscuff or present inaccurate data at meetings. (Wah! Maybe they should!) And that their medical provider status is more important than the actual scientific evidence from reputable sources. I never claimed medical expertise of any kind, just presented what the CDC and AHA research show. I finally agreed not to to comment publically on the wellness program or to correct misinformation to avoid a written warning.

It makes me sick inside, but I need my job so I can feed my kids more than I need to express my scholarly values, I guess.