Home Benefits and harms of wellness initiatives
Article
Licensed
Unlicensed Requires Authentication

Benefits and harms of wellness initiatives

  • Clare Fiala , Jennifer Taher and Eleftherios P. Diamandis EMAIL logo
Published/Copyright: March 26, 2019
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 57 Issue 10

Abstract

Wellness projects are large scale studies of healthy individuals through extensive laboratory and other testing. The “Hundred Person Wellness Study”, was one of the first to report results and lessons from its approach and these lessons can be applied to other wellness projects which are being undertaken by major companies and other organizations. In the “Hundred Person Wellness Study”, investigators from the Institute for Systems Biology (ISB) sequenced the genome, and analyzed the blood, saliva, urine and microbiome of 108 healthy participants every 3 months, for 9 months, to look for subtle changes signifying the transition to disease. We discuss some of the possible shortcomings of this approach; questioning the need to “improve” biomarker levels, excessive testing leading to over-diagnosis and over-treatment, expected results and improvements, selection of tests, problems with whole genome sequencing and speculations on therapeutic measures. We hope this discussion will lead to a continued evaluation of wellness interventions, leading to strategies that truly benefit patients within the constraint of limited health care resources.

Keywords: direct to consumer testing; over-diagnosis; over-testing; over-treatment; patient safety; technology; wellness initiatives
Corresponding author: Eleftherios P. Diamandis, MD, PhD, FRCP(C), FRSC, Head of Clinical Biochemistry, Mount Sinai Hospital and University Health Network, 60 Murray St., Box 32, Floor 6, Rm L6-201, Toronto, ON M5T 3L9, Canada; Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; and Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada, Phone: +(416) 586-8443

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Verily. Project Baseline. 2018. https://www.projectbaseline.com/. Accessed: 2 January 2019.Search in Google Scholar

2. National Institutes of Health. All of Us Research Program. https://allofus.nih.gov/. Accessed: 3 Jan 2019.Search in Google Scholar

3. Lake Nona Institute. About Lake Nona Life Project. 2018. http://www.liveworkparticipate.com/about-lnlp/. Accessed: 2 Jan 2019.Search in Google Scholar

4. Prince ND, Magis AT, Earls JC, Glusman G, Levy R, Lausted C, et al. A wellness study of 108 individuals using personal, dense, dynamic data clouds. Nat Biotechnol 2017;35:747–56.10.1038/nbt.3870Search in Google Scholar PubMed PubMed Central

5. Providence St Joseph’s Health. P4 medicine. http://future.psjhealth.org/scientific-wellness/p4-medicine. Accessed: 2 Jan 2019.Search in Google Scholar

6. Institute for Systems Biology. P4 medicine. https://systemsbiology.org/research/p4-medicine/. Accessed 2 Jan 2019.Search in Google Scholar

7. Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M, et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007;357:2109–22.10.1056/NEJMoa0706628Search in Google Scholar PubMed

8. Pezaro C, Woo HH, Davis ID. Prostate cancer: measuring PSA. Int Med J 2014;44:433–40.10.1111/imj.12407Search in Google Scholar PubMed

9. Jaffe AF. Troponin – past, present, and future. Curr Probl Cardiol 2012;37:209–28.10.1016/j.cpcardiol.2012.02.002Search in Google Scholar PubMed

10. Hood L, Lovejoy JC, Price ND. Integrating big data and actionable health coaching to optimize wellness. BMC Med 2015;13:4.10.1186/s12916-014-0238-7Search in Google Scholar PubMed PubMed Central

11. Hickner J, Thompson PJ, Wilkinson T, Epner P, Sheehan M, Pollock AM, et al. Primary care physicians’ challenges in ordering clinical laboratory tests and interpreting results. J Am Board Fam Med 2014;27:268–74.10.3122/jabfm.2014.02.130104Search in Google Scholar PubMed

12. Choosing Wisely. Society of General and Internal Medicine recommendation. 2013 September 12. http://www.choosingwisely.org/societies/society-of-general-internal-medicine/. Accessed: 2 Jan 2019.Search in Google Scholar

13. Ponka D. The periodic health examination in adults. Can Med Assoc J 2014;186:1245.10.1503/cmaj.141125Search in Google Scholar PubMed PubMed Central

14. Diamandis EP. The failure of protein cancer biomarkers to reach the clinic: why, and what can be done to address the problem? BMC Med 2012;10:87.10.1186/1741-7015-10-87Search in Google Scholar PubMed PubMed Central

15. Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Vitamin D supplements and prevention of cancer and cardiovascular diseases. N Engl J Med 2019;380:33–44.10.1056/NEJMoa1809944Search in Google Scholar PubMed PubMed Central

16. Whitlock EP, Garlitz BA, Harris EL, Beil TL, Smith PR. Screening for hereditary hemochromatosis: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2006;145:209–23.10.7326/0003-4819-145-3-200608010-00009Search in Google Scholar PubMed

17. Choosing Wisely. American college of medical genetics and genomics recommendations. 10 July 2015. http://www.choosingwisely.org/societies/american-college-of-medical-genetics-and-genomics/. Accessed: 2 Jan 2, 2019.Search in Google Scholar

18. Lemke AA, Bick D, Dimmock D, Simpson P, Veith R. Perspectives of clinical genetics professionals toward genome sequencing and incidental findings: a survey study. Clin Genet 2013;84:230–6.10.1111/cge.12060Search in Google Scholar PubMed PubMed Central

19. Kalia SS, Adelman K, Bale SJ, Chung WK, Eng C, Evans JP, et al. Recommendations for reporting of secondary findings in clinical exome and genome sequencing, 2016 update (ACMG SF v2.0): a policy statement of the American College of Medical Genetics and Genomics. Genet Med 2017;19:249–55.10.1038/gim.2016.190Search in Google Scholar PubMed

20. MacArthur DG, Manolio TA, Dimmock DP, Rehm HL, Shendure J, Abecasis GR, et al. Guidelines for investigating causality of sequence variants in human disease. Nature 2014;508: 469–76.10.1038/nature13127Search in Google Scholar PubMed PubMed Central

21. The New York Times. Kolata G. The online gene test finds a dangerous mutation. It may well be wrong. 2 July 2018. https://www.nytimes.com/2018/07/02/health/gene-testing-disease-nyt.html. Accessed: 2 Jan 2019.Search in Google Scholar

22. Vos J, Menko FH, Oosterwijk JC, van Asperen CJ, Stiggelbout AM, Tibben A. Genetic counseling does not fulfill the counselees’ need for certainty in hereditary breast/ovarian cancer families: an explorative assessment. Psychooncology 2013;22:1167–76.10.1002/pon.3125Search in Google Scholar PubMed

23. Hirschberg AM, Chan-Smutko G, Pirl WF. Psychiatric implications of cancer genetic testing. Cancer 2015;121:341–60.10.1002/cncr.28879Search in Google Scholar PubMed

24. Houfek JF, Soltis-Vaughan BS, Atwood JR, Reiser GM, Schaefer GB. Adults’ perceptions of genetic counseling and genetic testing. Appl Nurs Res 2015;28:25–30.10.1016/j.apnr.2014.03.001Search in Google Scholar PubMed

25. Voorwinden JS, Jaspers JP. Prognostic factors for distress after genetic testing for hereditary cancer. J Genet Couns 2016;25:495–503.10.1007/s10897-015-9894-9Search in Google Scholar PubMed PubMed Central

26. Sido B, Hack V, Hochlehnert A, Lipps H, Herfath C, Droge W. Impairment of intestinal glutathione synthesis in patients with inflammatory bowel disease. Gut 1998;42:485–92.10.1136/gut.42.4.485Search in Google Scholar PubMed PubMed Central

27. Coupland C, Morris R, Moore M, Arthur A, Hippisley-Cox J.Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: cohort study using primary care database. Br Med J 2016;352:i1350.10.1136/bmj.i1350Search in Google Scholar PubMed PubMed Central

28. Andermann A, Blancquaert I, Beauchamp S, Dery V. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bull World Health Organ 2008;86:317–9.10.2471/BLT.07.050112Search in Google Scholar PubMed PubMed Central

Received: 2019-02-01
Accepted: 2019-03-05
Published Online: 2019-03-26
Published in Print: 2019-09-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Blood biomarkers in neurology: “a call to arms” for laboratory professionals
  4. Reviews
  5. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis
  6. Laboratory medicine: health evaluation in elite athletes
  7. Prostate cancer screening: guidelines review and laboratory issues
  8. Opinion Papers
  9. Extra-analytical sources of uncertainty: which ones really matter?
  10. Benefits and harms of wellness initiatives
  11. Genetics and Molecular Diagnostics
  12. Analytical and clinical validation of a novel amplicon-based NGS assay for the evaluation of circulating tumor DNA in metastatic colorectal cancer patients
  13. General Clinical Chemistry and Laboratory Medicine
  14. Pre-analytical practices for routine coagulation tests in European laboratories. A collaborative study from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM)
  15. Preanalytical robustness of blood collection tubes with RNA stabilizers
  16. Continual improvement of the pre-analytical process in a public health laboratory with quality indicators-based risk management
  17. Comparison of six commercial serum exosome isolation methods suitable for clinical laboratories. Effect in cytokine analysis
  18. A multicenter study to evaluate harmonization of assays for N-terminal propeptide of type I procollagen (PINP): a report from the IFCC-IOF Joint Committee for Bone Metabolism
  19. Correlations between serum and CSF pNfH levels in ALS, FTD and controls: a comparison of three analytical approaches
  20. Dynamics of extracellular matrix proteins in cerebrospinal fluid and serum and their relation to clinical outcome in human traumatic brain injury
  21. Free light chains in the cerebrospinal fluid. Comparison of different methods to determine intrathecal synthesis
  22. Reference Values and Biological Variations
  23. Reference interval by the indirect approach of serum thyrotropin (TSH) in a Mediterranean adult population and the association with age and gender
  24. Next-generation reference intervals for pediatric hematology
  25. Hematology and Coagulation
  26. Preliminary evaluation of a new flow cytometry method for the routine hematology workflow
  27. Diabetes
  28. Trueness assessment of HbA1c routine assays: are processed EQA materials up to the job?
  29. Infectious Diseases
  30. Utility of procalcitonin for differentiating cryptogenic organising pneumonia from community-acquired pneumonia
  31. A high C-reactive protein/procalcitonin ratio predicts Mycoplasma pneumoniae infection
  32. Letters to the Editor
  33. Evaluation of reference change values for a hs-cTnI immunoassay using both plasma samples of healthy subjects and patients and quality control samples
  34. Outlier removal methods for skewed data: impact on age-specific high-sensitive cardiac troponin T 99th percentiles
  35. Comparison of precision and operational performances across six immunochemistry analyzers
  36. Evaluation of the possible interference of abiraterone therapy on testosterone immunoassay
  37. Erroneous thyroid and steroid hormones profile due to anti-streptavidin antibodies
  38. Reference values for 24,25-dihydroxyvitamin D and the 25-hydroxyvitamin D/24,25-dihydroxyvitamin D ratio
  39. Pre-analytical error in a hematology laboratory: an avoidable cause of compromised quality in reporting
  40. Stability of tubular damage markers epidermal growth factor and heparin-binding EGF-like growth factor in urine
  41. Blood from heparin tubes is an acceptable alternative to assess hematocrit determination
https://doi.org/10.1515/cclm-2019-0122
Keywords for this article
direct to consumer testing; over-diagnosis; over-testing; over-treatment; patient safety; technology; wellness initiatives

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Blood biomarkers in neurology: “a call to arms” for laboratory professionals
  4. Reviews
  5. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis
  6. Laboratory medicine: health evaluation in elite athletes
  7. Prostate cancer screening: guidelines review and laboratory issues
  8. Opinion Papers
  9. Extra-analytical sources of uncertainty: which ones really matter?
  10. Benefits and harms of wellness initiatives
  11. Genetics and Molecular Diagnostics
  12. Analytical and clinical validation of a novel amplicon-based NGS assay for the evaluation of circulating tumor DNA in metastatic colorectal cancer patients
  13. General Clinical Chemistry and Laboratory Medicine
  14. Pre-analytical practices for routine coagulation tests in European laboratories. A collaborative study from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM)
  15. Preanalytical robustness of blood collection tubes with RNA stabilizers
  16. Continual improvement of the pre-analytical process in a public health laboratory with quality indicators-based risk management
  17. Comparison of six commercial serum exosome isolation methods suitable for clinical laboratories. Effect in cytokine analysis
  18. A multicenter study to evaluate harmonization of assays for N-terminal propeptide of type I procollagen (PINP): a report from the IFCC-IOF Joint Committee for Bone Metabolism
  19. Correlations between serum and CSF pNfH levels in ALS, FTD and controls: a comparison of three analytical approaches
  20. Dynamics of extracellular matrix proteins in cerebrospinal fluid and serum and their relation to clinical outcome in human traumatic brain injury
  21. Free light chains in the cerebrospinal fluid. Comparison of different methods to determine intrathecal synthesis
  22. Reference Values and Biological Variations
  23. Reference interval by the indirect approach of serum thyrotropin (TSH) in a Mediterranean adult population and the association with age and gender
  24. Next-generation reference intervals for pediatric hematology
  25. Hematology and Coagulation
  26. Preliminary evaluation of a new flow cytometry method for the routine hematology workflow
  27. Diabetes
  28. Trueness assessment of HbA1c routine assays: are processed EQA materials up to the job?
  29. Infectious Diseases
  30. Utility of procalcitonin for differentiating cryptogenic organising pneumonia from community-acquired pneumonia
  31. A high C-reactive protein/procalcitonin ratio predicts Mycoplasma pneumoniae infection
  32. Letters to the Editor
  33. Evaluation of reference change values for a hs-cTnI immunoassay using both plasma samples of healthy subjects and patients and quality control samples
  34. Outlier removal methods for skewed data: impact on age-specific high-sensitive cardiac troponin T 99th percentiles
  35. Comparison of precision and operational performances across six immunochemistry analyzers
  36. Evaluation of the possible interference of abiraterone therapy on testosterone immunoassay
  37. Erroneous thyroid and steroid hormones profile due to anti-streptavidin antibodies
  38. Reference values for 24,25-dihydroxyvitamin D and the 25-hydroxyvitamin D/24,25-dihydroxyvitamin D ratio
  39. Pre-analytical error in a hematology laboratory: an avoidable cause of compromised quality in reporting
  40. Stability of tubular damage markers epidermal growth factor and heparin-binding EGF-like growth factor in urine
  41. Blood from heparin tubes is an acceptable alternative to assess hematocrit determination
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 17.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2019-0122/html
Scroll to top button