Wellness Movement Mostly Helps the Privileged, Says Ethicist

This transcript has been edited for clarity. Hi. I’m Art Caplan. I’m at the Section on Medical Ethics at NYU Grossman School of Medicine. I am grouchy today. I came from a dinner party that I found so annoying that I wanted to just get off my chest my worries about, objections to, and dislike of the wellness movement.Many health officials in the administration are promoting wellness, trying to make sure that people stay healthy. On the one hand, what could be wrong with that? Well, I — like you, perhaps — have been subjected to many a dinner or lunch conversation. Mine was a dinner party, where I sat with a number of people, all of whom were way into wellness and talked about it all night long. There were no doctors, but nonetheless educated, smart people. I’ve never spent a more miserable time being told what these people were doing to stay well, whether it was their colonics or a special diet they had adopted, whether it was biblical, Paleolithic, or consisted of raw milk. On and on and on it went.First of all, the proselytizers for wellness are selling you things. The wellness movement right now, to me, consists of advising me not to eat or drink things that I don’t like and to spend a large amount of time talking about topics that I think are evidence-free and unproven, which I intensely dislike, all in the name of making me follow a lifestyle that I don’t want to and find almost intrusive into quality of life. No fan here. Other objections. We’re spending, in a country that has 8% uninsured Americans, $2 trillion a year on wellness? The moral priority here seems out of whack to me. Shouldn’t we be paying attention to the needs of those who are sick or who have disabilities right now, before we decide to spend fortunes on possibly effective interventions that are going to get returns 20, 30, 40, or 50 years from now, if they do? I think justice says our expenditures are all wrong. The other problem, aside from endless proselytizing and too much money being spent, is that there are pretty simple rules to follow if you want to stay well, and we know what they are. Get some exercise. Don’t engage in reckless behavior, such as binge drinking or not wearing your seatbelt. We know that it’s good to engage in moderation in all things. That goes back to Aristotle. I don’t think we need worldwide a $10 trillion industry to tell us simple facts about how to stay well, but that’s what we’ve got. The other reality is we have an emerging wellness movement that likes to talk about being happy. It says if you want to live well and long, make friends, take up a hobby, bicycle, and do things that are socially engaging. It’s become popular in wellness promotion to talk about mental happiness as key to longevity and physical well-being.When it comes to all of these recommendations, they’re recommendations that really are aimed at the rich and the healthy. I don’t see a person with disability, a mom with three kids who’s trying to figure out what to do about getting them to the dentist when she has no insurance, or somebody who can’t really take a day off from work in order to go make friends and learn how to cook or bake.The wellness movement to me not only is unjust in terms of expenditures, it’s unjust in that its focus is on the better off. It’s not wellness for all; it’s wellness for the privileged. That, to me, is the worst moral offense of the wellness movement today. If you want to tell me about why a lard and red meat diet is going to be good for my long-term health, save it. I think I know what the simple advice is to maintain health into the future. What I hope for is a health system that stops spending so much money and expending so many resources on a future that is iffy at best by way of what we know, and starts to take care of the real problems of real people, many of whom are disadvantaged today.Why is a movement toward wellness that really neglects the pressing healthcare needs of the disadvantaged, the disabled, and oftentimes the young so popular? Partly it’s because medicine has done a poor job in the very areas outside of medicine where wellness flourishes. The style of the wellness movement has features that we’re losing in medicine for a variety of reasons that you all know. Nonetheless, time, attentiveness, and empathy seem to be present in the practitioners of what I’ll call wellness. I think the other reason is medicine sometimes doesn’t have much to offer, and so people just go where they think maybe they could find a last-ditch cure or something that might get rid of their endless migraines where they aren’t finding relief from mainstream medicine.There are reasons why people seek out the wellness movement. I get it, but I don’t think that’s a reason to endorse it. Going to evidence-free efforts, things that don’t work even when medicine doesn’t have much, isn’t the best strategy.I’m Art Caplan. I’m at the Section on Medical Ethics at NYU Grossman. Thanks for listening.