Institute For The Future

Predicting health in the workplace

At the Institute, we are deliberate about not making predictions. We forecast what the future might look like based on the implications of trends we see emerging today. Perhaps it is this aversion to predicting the future that makes me uncomfortable with Cincinatti-based start-up Allostatix's sales pitch:

 

The Allostatix Load Test™ measures whole body health and how the body is responding to the accumulation of stress and poor lifestyle habits based on the scientific concept of allostasis (maintaining stability through change) and allostatic load. This breakthrough test predicts health and wellness 3 to 5 years into the future with up to an 85% accuracy by looking at how all of the body systems work together. (emphasis in the original)

 

Interestingly, I didn't express any discomfort with such a claim back in March, when I wrote about another company that offers to predict one's future health.

So what is really bothering me? I have to admit that my gut reaction to the idea of using allostatic load as an indicator of future health was one of skepticism. What can Allostatix's "unique and proprietary system" of blood work and biometric measurements really reveal? Elevated cortisol levels? What if I am stressed out about having blood drawn?

I am not a scientist, and although I have studied physiology, I will not begin to claim a deep understanding of allostasis. Here is what I know: When under stress, the body's autonomic nervous system releases hormones—cortisol and adrenalin—in response. Here is what I have learned in writing this post: Allostatic load refers to a measurement of how one's body is affected—harmed—by long-term exposure to stress and the resulting release of these hormones. Wikipedia explains:

 

The term Allostatic load was coined by Bruce McEwen (2000) and refers to the physiological costs of chronic exposure to the neural or neuroendocrine stress response. It is used to explain how frequent activation of the body's stress response, an essential tool for managing acute threats, can in fact damage the body in the long run. Allostatic load is generally measured through a composite index of indicators of cumulative strain on several organs and tissues, but especially on the cardiovascular system.

 

McKewen is a professor of neuroendocronology at the Rockefeller University (and serves on Allostatix's scientific advisory board). You can read an article about allostatic load that he wrote for a lay audience here. I am not sure about how widely McKewen's ideas have been accepted in the scientific community, but an abstract of a paper he published in 2001 in the Proceedings of the National Academy of Science lists more than 30 subsequent articles that cite to his research; a PubMed search for "allostatic load" returned 245 hits.

Okay, while my digression into allaying my doubts about using some measurement of allostatic load as a predictor of future health has been informative, I am still left with a nagging feeling about Allostatix. What's that about?

I think that what is really bothering me about Allostatix is that employers are its primary target audience. The sales pitch is largely focused on providing employers with information that perhaps goes beyond merely justifying or measuring the efficacy of corporate wellness programs:

 

Allostatix provides you with insight into the health of your workforce while supporting development of a wellness culture that can increase employee wellness, decrease morbidity and mortality, enhance productivity, and reduce absenteeism and presenteeism.

 

 

You can track allostatic load changes for employees who participate in wellness programs versus those who don’t to determine how your programs impact overall load scores--without having to rely on data supplied by your wellness program providers.

 

 

Quantifiable changes in the science-based Allostatix Load™ score can be correlated to wellness program participation, meaning you no longer have to try to calculate “claims averted.” You can see ... invaluable information for motivating behavior change or reinforcing participation in wellness programs, with the goal of moving employees toward healthier lifestyles with lower medical costs.

...

Allostatix can help you identify individuals who may not be incurring medical expenses now, but may be on a costly future health trajectory. You can use this information to guide insurance decisions, refine wellness intervention spending and motivate employees towards a healthier lifestyle.

 

Don't get me wrong, I am all for employee wellness programs. But phrases like "motivating behavior change" and "reinforcing participation" make me uncomfortable. They remind me of a Business Week cover story—entitled "Get Healthy-Or Else"— that we have used on some of our maps to represent the idea of healthism, which refers to the moral responsibility that society imposes on individuals to maintain good health. Will employers use the information from Allostatix Load Tests punitively against employees who do not score well?

 

 

I guess the bottom line is that Allostatix does put an emphasis on

preventive care, and lifestyle and behavior change, all of which

represent a critical shift in how we think about health and health care in this country. In fact, Allostatix is a signal Health Horizons will be taking into account as we pursue our current research agenda.