The A to Z of the wellbeing industry: from angelic reiki to patient centred care
Authors: D. Colquhoun
Journal: BMJ (2011)

Nobody could possibly be against wellbeing. It would be like opposing motherhood and apple pie. But a whole spectrum of activities comes under the wellbeing banner, from the undoubtedly well meaning patient centred care at one end to downright barmy new age claptrap at the other. The only question that really matters is: how much of it works? Let’s start at the fruitcake end of the spectrum. One thing is obvious. Wellbeing is big business. And if it is no more than a branch of the multibillion dollar positive thinking industry, save your money and get on with your life. In June 2010 Northamptonshire Healthcare NHS Foundation Trust sponsored a “festival of wellbeing” that included a complementary therapy taster day. In a BBC interview one practitioner used the advertising opportunity, paid for by the NHS, to say, “I’m an angelic reiki master teacher and also an angel therapist . . . Angels are just flying spirits, 100% just pure light from heaven. They are all around us. Everybody has a guardian angel.” Another said, “I am a member of the British Society of Dowsers and use a crystal pendulum to dowse in treatment sessions. Sessions may include a combination of meditation, colour breathing, crystals, colour scarves, and use of a light box.” You couldn’t make it up. The enormous positive thinking industry is no better. Barbara Ehrenreich’s book Smile or Die: How Positive Thinking Fooled America and the World (see Review of the Week, BMJ 2009;339:b5494, doi:10.1136/bmj.b5494), explains how dangerous the industry is, because, as much as guardian angels, it is based onmyth and delusion. It simply doesn’t work (except for those who make fortunes by promoting it). She argues that it fosters the sort of delusion that gave us the financial crisis (and pessimistic bankers were fired for being right). Her interest in the industry started when she was given a cancer diagnosis. “When I was diagnosed, what I found was constant exhortations to be positive, to be cheerful, to even embrace the disease as if it were a gift. If that’s a gift, take me off your Christmas list,” she says. It is quite clear that positive thinking does nothing whatsoever to prolong your life, 2 any more than it will cure tuberculosis or cholera. “Encouraging patients to ‘be positive’ only may add to the burden of having cancer while providing little benefit.” Far from being helpful, it can be rather cruel. The NHS, the Department for Business Innovation and Skills, the Higher Education Funding Council for England, and the National Institute for Health and Clinical Excellence have produced long reports on wellbeing and stress at work. It’s well known that income is correlated strongly with health, and it has been proposed that what matters is inequality of income. The nature of the evidence doesn’t allow such a firm conclusion, but that isn’t really the point. The real problem is that nobody has come up with good solutions. Sadly, the recommendations at the ends of all these reports don’t amount to a hill of beans. Nobody knows what to do, partly because pilot studies are rarely randomised, so causality is always dubious, and partly because the obvious steps are managerially inconvenient, ideologically unacceptable, or too expensive. Take two examples. MichaelMarmot’s famousWhitehall study has shown that a major correlate of illness is lack of control over one’s own fate: disempowerment. What has been done about it? In universities it has proved useful to managers to increase centralisation and to disempower academics, precisely the opposite of what Sir Michael recommends. As long as it’s convenient to them, managers are not going to change policy. Rather, they hand the job to the human resources department, which appoints highly paid “change managers,” who add to the stress by sending you stupid graphs that show you emerging from the slough of despond into eternal light once you realise that you really wanted to be disempowered after all. Or they send you on some silly “resilience” course. The second example comes from debt. The Department for Business, Innovation and Skills claims that debt is an even stronger risk factor for mental disorder than low income. So what is the government’s response to that? To treble tuition fees to ensure that almost all graduates will stay in debt for most of their lifetime. And this was done despite the fact that the proposed £9000 (€10 100; $15 000) a year tuition fees will save nothing for the taxpayer: in fact they’ll cost more than the previous £3000 fee. The rise has happened, presumably, because