Michael O’Donnell is devoting the entire editorial page in the March issue of his wellness promotion journal to a moving plea for me (and Vik) to stop bullying Ron Goetzel. (Several people were thoughtful enough to send me an advance copy.) It’s not fun to be bullied. I know how Mr. Goetzel feels because a number of Penn State’s employees told me how upsetting it was to be bullied into disclosing intimate details about their sex lives in order to avoid $1200 fines. Oh, wait a second! Hmm…that was a program conceived by Ron Goetzel (and his Highmark cabal).
Despite repeated requests from the targets of this anti-employee jihad, Mr. Goetzel never apologized for his role in the Penn State debacle. In sharp contrast, I will be the first to apologize for the specific instances of bullying that I’ve done. (See the “prequel” for how this all came to be.) After all, two wrongs don’t make a right. (As a brief aside, I’m not sure our interactions could be classified as “bullying.” Victims of bullying are people who have repeatedly expressed a strong interest in being left alone, like the Penn State faculty did. By contrast, if a boxer decides to step into the ring time and time again expecting not to be knocked out with one punch but keeps getting knocked out with one punch, he can’t claim the other boxer bullied him.)
I apologize for questioning Mr. Goetzel’s ethics after he called his sponsor Health Fitness Corporation a “best practice” in wellness after HFC admitted lying about saving the lives of 514 alleged cancer victims who it turned out never had cancer in the first place. (HFC also didn’t disclose their sponsorship of Mr. Goetzel’s award that they won.)
I apologize for asking him 11 questions about his own statements that would have been difficult to answer since they highlighted their inconsistencies. As penance, I am perfectly happy to answer 11 questions that he might have about my statements to be published alongside of his answers to my questions.
I apologize for forcing him to admit that his client (the very same Koop Award sponsor, Health Fitness Corporation) had snookered him and his Koop Committee (including Michael O’Donnell) another time as well, with an outcomes claim that was obviously falsified but that somehow none of the self-proclaimed analytical experts on that Koop Award Committee noticed until the 4th time I pointed it out.
I apologize for pointing out that yet another Koop Award winner (and, of course, board member), Staywell, was also making up outcomes and also snookered his Committee.
I apologize that the business and lay media has treated his industry badly as a result of my and Vik (and others) bringing their misdeeds to their attention. The LA Times was very mean in calling wellness a “scam.” Shame on them! And the Incidental Economist? Really, I’d expect more civility from the New York Times’ economics blog. Huffpost? All Things Considered? Sheesh! What do you expect from liberals! Newsmax? The Federalist? Those right-wingers should be ashamed of themselves! And Harvard Business Review? RAND? Seems like everyone in the media is bullying Mr. Goetzel’s wellness industry. They should apologize too.
I apologize for observing that almost every award that his Koop Committee has given out in the last 5 years went to a company that was somehow connected to the Committee, either as a sponsor or through the Board of Directors, but didn’t disclose that connection in their award announcements.
I apologize for noting the sharply constrasting irony that Dr. C. Everett Koop himself was a man of great integrity.
I apologize for offering (scroll to final paragraph) Mr. O’Donnell, Mr. Goetzel, and all the other members of the Koop Committee half-price for my course in Critical Outcomes Report Analysis, so that they could learn how to analyze outcomes, which given the number of times they’ve all been snookered and embarrassed, is training they apparently could really use. I’m not saying it’s their fault they can’t do simple outcomes analysis. It’s possible that their mothers simply didn’t listen to enough Mozart when the Committee members were in their respective wombs.
I apologize for taking exception to being compared to “a climate change denier” and a “tobacco executive lying to Congress” in Mr. Goetzel’s webinar in which my work was singled out for typically fallacious criticism.
I apologize for actually believing him when he said he wanted to “respect the dignity of employees,” and offering to co-author an open letter to the Business Roundtable and others saying exactly what Mr. Goetzel said–and he declined. (Read that thread and you make the call. I studied his essay and tried to capture it in this letter…and offered him the opportunity to edit it, rather than sign it as is. I also apologize for not realizing why this offer was objectionable.)
I apologize for asking the organizations Mr. Goetzel is affiliated with (as noted in Mr. O’Donnell’s plaintive plea, I did indeed ask them — that email is available on request) whether and how they wanted their names used in conjunction with my reporting on the Nebraska state wellness program hijinks, rather than go ahead and use the names without their permission. (They wanted nothing to do with the Nebraska ethical scandal, by the way.)
Finally, I apologize for what Mr. O’Donnell calls “slander” (since I put everything on the public written record to avoid misunderstandings, I suspect he means “libel” but doesn’t understand the distinction between the two words) against Mr. Goetzel, and would once again urge Mr. Goetzel to tell me – publicly, right here on this site — exactly what I’ve said that is false so that I can take anything off this site that isn’t true. He hasn’t done this despite two $1000 offers. Yes, we did offer him $1000 twice: the self-imposed penalty in the rules of our site means that perpetrators get one week to answer our questions or tell us why we are wrong to ask them. If they do so, they get $1000. (Not sure how many other bullies offer to pay their “victims” $1000 not to be bullied. One would expect it to be the other way around.)
I apologize for not already offering Mr. Goetzel the opportuntiy to bully me. I’d love for him to challenge my outcomes, invent a clever nickname for me that describes how I might react if my statements are ever proven to be made up, ask me questions, debate me. Exactly the type of “bullying” I do to him I’d ask him to do to me. Please, Ron, don’t make me beg!
Further, I am happy to apologize for anything else, too. Just ask me. While we are on the subject of apologies, Mr. O’Donnell deserves one too. I apologize for pointing out that the meta-analysis of wellness programs published in his own journal says that randomized controlled trials of wellness programs show negative ROIs. Obviously it was an oversight by Mr. O’Donnell that any statement admitting wellness doesn’t work would be allowed into his journal. Shame on Vik and me for pointing out that his key article actually acknowledged a fact!
Postscript: Michael O’Donnell said that he wasn’t going name me (and Vik) so he wouldn’t embarrass us. We wrote a comment and said, thank you for your graciousness but we are thrilled to be “embarrassed” by being named. My suspicion is that he didn’t name me and won’t print the comment for a different reason altogether: It might encourage people to come to this site and actually think for themselves, which is the Wellness Ignorati’s second-worst nightmare (next to facts). We’ll see.
Postscript 2: As predicted, Michael O’Donnell did not publish the comment. While it’s his publication and he is allowed to censor it, this is typical of the ignorati. My comment was only to waive my right not to be embarrassed and name myself, but we were right: publishing that would have sent a few people to this site, and they may have learned to think for themselves.
To begin with, forced corporate weight loss programs don’t work. Of roughly 1000 wellness vendors promising weight loss, only one, the iDiet, has received validation. Literally no other corporate weight loss program can check three simple boxes that are standard in medical research[.]
This urban legend based on the CDC’s call to action, appearing verbatim more than a million times on Google, is among the single biggest causes of uncontrolled healthcare spending…and is responsible for essentially the entire wellness industry.
The population health industry never ceases to delight us with its creativity. Vendors come up with ways of demonstrating their incompetence that are so creative we are compelled to use screenshots to back up our observations. Otherwise no one would believe us.
Consider Vivify. They reported on a study of in-home post-discharge telemonitoring led by a:
Not being able to spell the name of his own occupation is the good news. The bad news is, the “principle investigator” also can’t write, can’t do simple arithmetic, and – most importantly for someone who claims to be a “principle investigator” — can’t investigate. (Those shortcomings aside, this is a very impressive study. For instance, the font is among the most legible we’ve ever seen.)
There is some redundancy in the writing, but, giving Vivify the benefit of the doubt, perhaps the extra verbiage reflects the principle investigator’s concern that someone might miss the nuances or subtleties in his exposition. Examples:
- Vivify’s home monitoring system is “simple and easy”;
- The patient receives a “weight scale”;
- They had an “ROI of $2.44 return for every dollar invested”, and…
- “With appropriate connectivity, patients could engage in real-time interactive videoconferencing.”
Needless to say, these product attributes are very intriguing, so intriguing that you may want to learn more about the company. They are only too happy to oblige, making sure we catch yet another nuance:
The study claims the average patient’s cost declined $11,706, for a 2.44-to-1 ROI. Doing the math, that means Vivify’s post-discharge in-home self-care tele-monitoring costs…let me just get my calculator out here…$4797/patient? At that price, why rely on self-monitoring? Why not just move a nurse in?
(Note for the literal-minded: the ROI language is slightly different here than the passage we quoted, which appears elsewhere in the case study.)
The Principle Investigation
In general, Vivify targets patients with “specific chronic illnesses,” including pneumonia. (Vivify, I don’t know how to break this to you gently, but: pneumonia isn’t a chronic illness, specific or otherwise. No one ever says: “I was diagnosed with chronic pneumonia a few years ago, but my doctor says we’re staying on top of it.”)
However, for this investigation, only CHF was targeted: a cohort of 44 recently discharged CHF patients with an average age of 66. This raises the question: How did the principle investigator scrounge up a cohort of 44 discharged CHF patients with an average age of only 66? More than half of CHF discharges are over 75. It’s statistically impossible to randomly select 44 CHF discharges with an average age of 66. And – isn’t this a lucky coincidence – the study claimed a large (65%!) reduction in readmission rates but readmission rates are already much lower for younger patients. Once again, not a word of explanation.
Because Vivify’s apparent level of misunderstanding of basic arithmetic and study design boggled even our minds (which is difficult to do, given that we mostly blog about wellness), we decided to give them a chance to explain directly that we might have missed something. Further, because these explanations would have taken them 15 minutes if indeed we were missing something obvious, we offered them $1000 to answer them, money they decided to leave on the table. (Anyone have questions for me? Send me $1000 and I will happily spend 15 minutes answering them.)
This email to Vivify is available upon request.
We don’t even know what the 65% reduction is compared to. Usually – and call us sticklers for details here – when someone claims a 65% reduction in something vs. something else, they tell us what the “something else” is. Are they saying 35% were readmitted? Or 66-year-olds are readmitted 65% less than 75-year-olds?
My freshman roommate was like the bad seed in the old Richie Rich comics. Among other things, he would have a snifter of cognac before bed, whereas I had never tasted cognac and thought a “snifter” was for storing tobacco. We didn’t get along and at one point I accused him of being decadent.
“Decadent, Al? Let me tell you about decadent. I spent last summer at a summer camp – everyone was there, Caroline Kennedy, everyone – where we played tennis on the Riviera for a month and then went skiing in the Alps.” I had to admit that was indeed decadent.
“Al,” he replied. “I haven’t even gotten to the decadent part yet.”
Likewise, we haven’t even gotten to the best example of arithmetic-gone-wild: the savings claim. Remember that $11,706 savings claim above? Well, read that passage again–it turns out that represents a “90% decrease in the cost of care.” Apparently, the patients cost $12,937 when they were in the hospital, but after they went home, they only cost $1231. (We have no idea how that squares with the other finding, that the Vivify system itself costs $4797, based on the ROI of 2.44, or, as they put it, “an ROI of $2.44 return for every dollar invested.”.)
The irony is that other vendors in this space really do save money and really do measure validly. It’s one thing to make up outcomes in wellness. That’s a core part of the industry value proposition. But, unlike wellness vendors, tele-monitoring vendors other than Vivify typically know the basics: what they are doing, how to measure outcomes, how to save money–and how to spell.
If employers want to help workers live healthy and productive lives, they should think both more broadly and more simply about the strategies, with the goal of first doing no harm, according to Khanna and colleagues.
Austin and I have written about wellness programs before. TLDR – we’re not huge fans. A new paper in the American Journal of Managed Care agrees, with respect to weight loss:
Worth a read.
There is no published evidence that large-scale corporate attempts to control employee body weight through financial incentives and penalties have generated savings from long-term weight loss, or a reduction in inpatient admissions associated with obesity or even long-term weight loss itself. Other evidence contradicts the hypothesis that population obesity rates meaningfully retard economic growth or manufacturing productivity.