COERCIVE WELLNESS
Penn State administrators recently introduced a new health plan (opens in a new tab) requiring nonunion employees (faculty, clerical staff) to visit their doctors for an annual checkup, undergo several biometric tests (opens in a new tab) (fasting lipid profile and fasting glucose (finger stick), height, weight, body-mass index, waist circumference, and blood pressure) and complete an extensive online health risk questionnaire (opens in a new tab). This is all in the name of health maintenance and risk management and it represents an increasingly popular type of effort to control health care costs.
There’s many a slip twixt the cup and the lip in this plan, however, with not all of the elements being discussed regarding the Penn State venture.
The invasions of privacy in the health risk questionnaire stimulated blowback (opens in a new tab) by a group of professors who objected to the penalty ($100/mo) that would be imposed for noncompliance with the questionnaire. Usually these kind of plans offer rewards for compliance, but here was something new - punishment for noncompliance. After a few weeks of heated public meetings, not to mention publicity in the New York Times, the penalty was eliminated (opens in a new tab), but the overall elements of the plan stayed the same.
A few days later, Rep. Louise Slaughter (Dem., NY) asked the EEOC to investigate (opens in a new tab) the potential invasion of privacy involved in the questionnaire. She asked that there be an investigation on the potential for illegal discrimination and that protective guidelines be developed. This follows her long interest in the ways genetic information might be used to discriminate.
OK, it seems the privacy police are on the job, but what about the evidence basis for the routine checkups, the screenings, and the validity of the biometric indicators??? Where are the evidence police in this new world of coercive wellness? Speakers at the recent Dartmouth conference on Preventing Overdiagnosis (opens in a new tab) not to mention at our Selling Sickness conference would have a lot to say about the weak, contradictory, and conflict-of-interest-filled evidence behind some of these tests and measures. Let's hope valid evidence counts as much as privacy in the new world of wellness.