The WSJ recently reported the American Heart Association’s earth shattering proclamation urging people to focus on the prevention of heart disease. The AHA provides the seven steps to wellness, like a map to the grail. Does the AHA have a surprise or something novel to share with us? No, just the usual recommendations to not smoke, eat right, exercise, lower the LDL, lower the blood pressure, maintain a normal blood sugar and normal BMI. Are they kidding? Like proclaiming it again will make it work. ”We really mean it this time!”
What percentage of the AHA members dues went to the formation of this statement of the obvious which has had zero impact on the health of the American patient?
Even worse is an opinion in the NEJM from three Harvard professors as to the ethics and fairness of wellness incentives. They provide an argument that wellness programs are unfair to the disadvantaged, unobtainable to most and cost shifting to the employee. They use lofty words and flawless prose but their premise is ridiculous.
The three authors credentials include a masters degree, D.Phil., and a PhD. This means they have never treated a patient in the office with disease acquired primarily by poor lifestyle choices. They actually argue that people are incapable of wellness and they reference Kant, so as to emphasize their intellectual loftiness, in which “ought” implies “can.” They imply, because there is so much poor health, it must be that people cannot improve simply by deciding to do so.
My patients encompass the middle to upper socio-economic levels of America. They are employed, schooled and have health insurance and yet they remain stunningly unhealthy due primarily to poor choices. If the three Harvard academics could spend a few days with me in the office seeing the repetition of bad decisions they may at least have more muted opinions, if not different entirely. How many obese, diabetic, hypertensive smokers who are so despite adequate means do they see in Cambridge?
A common exchange in the real world of doctoring…
To the retired UPS or GE worker: Sir, “Do you exercise?” A pause and a blank stare, “No.” I respond, “You are retired, correct?” He processes the question and realizes my implication: with all my free time why can’t I find the time to take care of myself?
A clinician who observes the recurring ravages of poor health choices and the rare patient who makes the transformation to health by deciding to do so, might question the value of the AHA’s proclamation and the Harvard academic’s unwitnessed concern over unfairness.