Healthy Criticism: Drs. Ardell and Goetzel

by Paul Terry, PhD
Editor, The Art of Health Promotion

In this month’s issue of The Art of Health Promotion, I reveled in my interview with Dr. Don Ardell, described as one of the “forefathers of wellness” (along with Jack Travis). I described this issue as the “Contrarians Issue” because like several other famous leaders also profiled in this issue such as Senator Edward Kennedy and Surgeon General Luther Terry, Ardell is as popular as he is polarizing when it comes to the work of wellness. Dr. Ardell derides the status quo, albeit usually good naturedly, saying the wellness field has been beholden to a medical model and narrowly focused on fitness and disease management. I disagree with Don on both counts. First, the wellness field I work in is anything but narrowly focused. Indeed, too often practitioners adopt the idea du jour without having mastered yesterday’s challenges. Just in the past several years, wellness has embraced financial incentives, then employee engagement, then a culture of health, then well-being, one after the other. Each time we betray our fidelity to the former by vowing an unrequited new love for the latter. Perhaps not coincidentally, each of these trends in wellness overlap with what Don describes as “REAL Wellness” and we explored whether tenets he espouses such as liberty and exuberance are missing or not in today’s march toward advancing well-being in the workplace.

To talk with Don directly or to watch him on stage is what it takes to truly be subjected to his rich blend of thoughtfulness, humor, coyness and occasional derision. What I’ve found most challenging about following Don’s prolific writings is when to take him seriously. As you’ll see in my interview with Don, his transitions between pithy quips, a serious aside or a delightful bout of self-deprecation can occur within a sentence. Still, unlike the ineffective critics of wellness who I describe in my closing commentary of this “Contrarians Issue,” Don always returns to what he stands for rather than dwelling obstinately on what he’s against.

Writing for the “On Language” column for The New York Times Magazine, Ben Zimmer credits Ardell for popularizing the term wellness. Zimmer describes the evolution of the term first associated with “flakiness” to that of “serious, evidence based articles on health promotion.”  Many of these emanated from Ardell and the interest he was garnering in the 1970’s was ratified by the success of the Berkeley Wellness Letter first published by Berkeley’s School of Public Health in 1984(See: http://www.nytimes.com/2010/04/18/magazine/18FOB-onlanguage-t.html?_r=0). Compared to those early days, wellness has become too oriented toward the medical model, according to Ardell, and the word has lost the luster that he associates with the writings of Halbert Dunn, the physician who coined the term wellness and who Ardell regularly credits as an inspiration (See census.gov: https://www.census.gov/history/www/census_then_now/notable_alumni/halbert_l_dunn.html ).

Getting “REAL” with Dr. Ardell
What Don is for is “REAL Wellness.” It’s an acronym that captures what Don believes improves life and health: “Reason, Exuberance, Athleticism and Liberty.” Visit the “Seek Wellness” web pages to read from over 700 essays Ardell has authored that capture what’s REAL about the approach to wellness that he espouses. Don is a contrarian who I have come to appreciate because he is on a consummate mission that he enlivens with an indomitable spirit.

When I sat down for lunch with Dr. Donald Ardell, I said, “You are my favorite contrarian.” I wasn’t surprised to see his face twinkle at the characterization, though it was just a subtle change because his effervescent blue eyes are ever bent toward a smile. His fork was patiently organizing through a small bowl of fruit which got my attention because he otherwise presents as a tall flask of sedulous energy. The source of his physical energy is obvious as he has won seven World Triathlon Championships and the week I met with him he had earned yet another Gold Medal in Minneapolis. But it is Don’s mental energy, as expressed in an astounding writing and public speaking portfolio, which I find even more captivating. My admiration for his boundless output across the globe via keyboards, soapboxes and all kinds of racing courses likely explains why I feel an unshakable affection for him even though I heartily disagree with much of what he writes.

To paraphrase what Don once said at a conference, when a word is as ambiguous as wellness, you can do what you want with it. In Don’s spirit of claiming what you want from a word, here is my take: REAL Wellness should mean “Relationships, Equity, Active (living) and Livable (communities).” When it comes to a population’s Body Mass Index and/or Happiness Index or any other health measure you care to choose, I stand ready to argue that my REAL is every bit as predictive of success as Don’s.

 
What Drs. Goetzel and Ardell Share in Common
As the profile of a contrarian such as Don Ardell attests, serious criticism plays a vital role in the advancement of science and beliefs that can shape political, community and/or corporate policies. Thankfully, there are very few negative bloggers in the wellness field compared to what is occurring in the broader cyber sphere of unfettered and increasingly ineffective discourse about politics, religion and current affairs. While many argue that the kind of “cyber journalism” enabled by the internet holds promise per the democratization of information, many others argue that questions of credibility, responsibility and the fundamentals of epistemology remain troublesome and unanswered.

A health promotion expert who has forged into the darker reaches of this cyber jungle more than anyone else is Dr. Ron Goetzel, who is a Senior Scientist at Johns Hopkins Bloomberg School of Public Health and Vice President of Consulting and Applied Research for Truven Health Analytics. Surely it is no coincidence that there is no one in the field of health promotion who holds more scientific credibility than Goetzel and who also is regularly pounced on by cyber trolls.

How can we distinguish between those with worthwhile beliefs and those simply foisting opinions? For an exemplary, albeit exhausting, case of scholars who disagreed while preserving civility and professionalism, read Ron Goetzel’s “Structuring Legal, Ethical and Practical Workplace Health Incentives” (See: http://healthaffairs.org/blog/2013/04/23/structuring-legal-ethical-and-practical-workplace-health-incentives-a-reply-to-horwitz-kelly-and-dinardo/). At the foot of Goetzel’s Health Affairs Blog Post, you’ll see where you can “track back” through the cascade of arguments that began with an article by Horwitz in March of 2013. The Blog debate continued into April of 2015.

The arguments that ensued between Drs. Goetzel, Horwitz and DiNardo concerned their views on the evidence for and against the use of worksite wellness incentives at the outset. It is telling that the debate somehow devolved into generalized criticisms and commentary about the general merits of wellness. What I found most edifying and marvelous as I followed the back and forth is how much agreement I found between and within their arguments. I would read the diligently researched points made by Ron Goetzel and I’d say, “Bravo,” I agree! Then, weeks or months later, I’d read the counterpoints written by DiNardo and Horwitz and I’d say, “Cheers, I agree!”  And so it has been when I read the prolific writings of Dr. Don Ardell. I can agree with much of his writing with enthusiasm while still civilly, but pointedly, letting him know where we disagree. Like Dr. Goetzel, Dr. Ardell can take criticism as well as he can dish it out.

Perhaps healthy and constructive criticism comes down to what DiNardo and Horwitz wrote at the outset of their most recent blog post countering Goetzel: “We ask weary readers who do not wish to continue with this exchange, but are interested in workplace wellness, to look at the evidence we provide in our appendices, and make their own judgments.” Fair enough. To paraphrase Niels Bohr, a famous physicist, there may very well be more than one profound truth when it comes to worksite wellness.

This issue of The Art of Health Promotion is available here 

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