New 'wonder drugs': A wellness Rx filled with challenge, opportunity

Message to employees: Quick fix small part of overall wellness plan

Employees must be taught a broader definition of the word "health." There are pills that can bring a diabetic's elevated blood glucose levels within a normal range. There are pills that can lower dangerously high blood lipid readings within a matter of weeks. And, if we can believe recent headlines, there may eventually be a pill that gives our muscles the same benefits as exercise.

The quick fix. The easy way out. It's human nature to gravitate to the path of least resistance. And these recent medical marvels, say wellness professionals, make it that much harder to convince employees to adopt a lifelong commitment to a healthy lifestyle.

"It is natural that people tend to look for quick fixes," says Susan B. Frampton, PhD, director of the Tanger Center for Health Management at Beth Israel Deaconess Medical Center in Boston. "It's kind of a standard in our culture."

Lewis Schiffman, president of Atlanta Health Systems, a wellness consulting firm, agrees. "When it comes to most things, people tend to take the easy way - the path of least resistance. It's easy for people to be seduced by the notion that the medical industry can take care of their health." However, he warns, "I would never encourage anyone to outsource the responsibility for their health."

It's not quite that simple, insists Wayne Burton, MD, corporate medical director of First Chicago NBD. "I think it's a temptation [for employees] to not be compliant with medications or with exercise and diet," he says. "That's why we have a problem with relapse or recidivism, and that's the focus of our disease management programs - compliance."

Pharmaceuticals are often not the first option tried, he points out. "The initial focus of most physicians for many diseases is lifestyle. Whether you're talking about elevated cholesterol or blood pressure, in many cases it can be controlled through lifestyle changes. Medication is only relied upon once lifestyle changes prove ineffective, unless the problems are so severe the employee needs to start medications early on along with behavioral changes. In all too many cases, it's difficult for employees to change their lifestyle, so they end up on medication."

Even if an employee is fully compliant with his medications, and all of his biometric readings are normal, that does not mean he is healthy, insists Schiffman, and this is the message we should be giving employees. "Drugs do not give people health, no matter how wondrous they are," he says, "because health is more than the absence of illness. Drugs can reduce or eliminate symptoms of illness, but they don't provide or restore vitality. Health takes into account things like energy level, attitude, vibrancy and the amount of mileage a person can get on their moving parts."

Frampton agrees. "Yes, it's true you can achieve what's considered a 'normal,' healthy blood pressure level, for example, by taking medications. It's also true that there are side effects to those medications. I don't know that you can say there is a pharmaceutical product that has no cost."

The key issue is that if you need to make behavioral changes that must be sustained for the long term, then most short-term fixes are not going to work, she notes. "Maybe [drugs] can help people to get a jump start, to see some initial quick results, which can make them want to continue with whatever behavior change they are aiming at. But it's not in their best interest to become dependent on drugs; there are side effects, and there are negatives," she says. (The lure of quick initial results can be used as a launching pad for other programming. See the related story on p. 111.)

Frampton makes it clear she is not arguing against pharmaceuticals; she is only insisting on a sense of balance. While the temptation of the quick fix does make the wellness professional's job more challenging, she notes, pharmaceuticals also bring clear benefits. "When used together in conjunction with behavior change and other tools, they can really increase effectiveness," she says. "There just needs to be a balance between pharmaceuticals and the health behaviors we have control over. As wellness professionals, we have to help people work on that balance."

Wellness professionals must keep in mind that there's not one right way to approach being or staying healthy, says Frampton. "Some folks are not going to make a behavior change simply because they have a certain diagnosis," she explains. "For them, they may initially be more dependent on medication. There are others who are ready to make relatively radical changes and who want to use diet and exercise to ameliorate chronic conditions. For them, we want to encourage that. You have to work with the individual employee and be able to assess [their stage of readiness], help them understand what balance will work for them, and tailor your approach to them."

The wellness provider should work closely with both employees and their health care providers, adds Burton. "Wellness professionals should realize that it's really important - with the employee's permission - to work with the provider and support their efforts as well. They need to be coordinated and integrated."

"I would also invite them to discuss with their doctor alternative non-drug therapies, and when appropriate, to try them," says Schiffman. "For example, St. John's Wort rather than Prozac if they're depressed, or Kwai garlic, to help lower cholesterol." (Editor's note: Be aware, however, that even "natural" remedies can have side effects. See the article on St. John's wort and feverfew in this month's Health & Well-Being.)

That still leaves the issue of motivation. What do we tell employees who are reluctant to make a long-term commitment to lifestyle change? "You have to help them create a new vision for themselves that incorporates things like being vibrant, feeling alive, looking attractive, maintaining their youth, and enjoying living in their bodies," says Schiffman. "You ask people simple questions, like: 'How do you want to feel when you wake up, during the day, and when the day is done?' 'How do you want to look?' 'Do you want to be able to play sports with your children?' 'How long do you want to stay young?'

Motivation is primarily a mental process, Schiffman explains, and the difficulties that employees run into occur because they often apply different standards to their own health than they do to other areas of their lives. "For example, you usually don't find people saying 'I don't feel like going to work,' and then actually not going," Schiffman observes. "They don't feel like it, but usually they go anyway. Most people don't feel like taking care of their kids every day, but they do it anyway. You can explain to people that you don't have to feel like working out or taking care of your health in order to do it."

Pharmaceutical companies can prove to be effective allies, notes Burton. "A key part of our education program is imparting self-responsibility," he notes. "Most employees want to do the right thing, but they need information; it can take a lot of time for an employee to better understand what they need to do.

"The programs we're doing [in conjunction with pharmaceutical companies] are emphasizing lifestyle changes, management of the disease, and the proper use of medication. The key is to emphasize the non-medication components for those who can go that route, and appropriate use for those who must take medications."

Burton says the pharmaceutical companies with which he works "support that approach absolutely," and that he selects the health educators, who are totally independent of the pharmaceutical companies.

However you structure your health education programming, Frampton recommends you share this "Golden Rule" with employees: "What's the least amount of medication you can get by with if you change your diet, and increase your exercise? Maybe that's the goal that you set," she says. n

Wayne Burton, First Chicago NBD, 1 First National Plaza, Suite 0006, Chicago, IL 60670. Telephone: (312) 732-6434. Fax: (312) 336-0029.

Lewis Schiffman, Atlanta Health Systems, 2516 Wawona Drive NE, Atlanta, GA 30319. Telephone: (404) 636-1131.

Susan Frampton, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. Telephone: (617) 667-4671. Fax: (617) 975-5175. E-mail sframpto@bidmc.harvard.edu.