To the Editor.—
The evaluation of Johnson & Johnson's Live for Life (LFL) Program1 is disturbing in two ways. First, the JAMA report did not adequately convey the equivocal nature of the results. Second, the report has been misused in subsequent commercial promotion.The report does not establish a causal relation between LFL and decreases in medical costs. Such a relation, as described by the authors, is biologically implausible. The authors' Table 2 shows that companies without LFL (group 3) spent about 50% more on inpatient medical costs than those with LFL (groups 1 and 2) in 1983, the last year studied. Two aspects of these data are curious. First, the savings were realized within 18 to 30 months of implementing LFL and did not increase with longer-term LFL use. Second, the savings were realized almost entirely in decreased hospital days per 1000 employees, rather than in fewer admissions.
Frumkin H. Worksite Health Promotion and Health Care Costs and Utilization. JAMA. 1987;257(20):2756. doi:10.1001/jama.1987.03390200096013