When George Orwell wrote 1984, it never occurred to him that Big Brother would be in the private sector. But he was covered by the UK’s National Health Service, not Aetna, so he had no way of predicting what has just happened.
George Orwell’s problem was that he never met Aetna’s Mark Bertollini, who’s promoting another similar Dr.Aetna-Will-See-You-Now concept: employer-based genetic testing to predict diabetes and heart disease.
By way of background, you may remember Aetna’s previous brainstorm, roughly translated as: “Let’s ferret out obese employees at other people’s companies (not our own) and pitch them two drugs that probably never should be been approved by the FDA in the first place, and tell employers that productivity will go up even though the FDA insert says productivity will decline.” That program turns out to be only Aetna’s first step in what is turning into the most intrusive jihad in the insurance industry. Next up is this genetic testing tool, where for about $500 extra, Aetna can possibly predict what might happen down the road to some employees.
This tool could be coming soon to a workplace near you, thanks to a new loophole: While the EEOC forbids use of genetic information in hiring, firing or other employment decisions, the law does not prevent employers and their vendors from offering employees the opportunity to voluntarily learn about their genetic medical risks. And the EEOC has recently “clarified,” under pressure from the Congress, the White House and the Business Roundtable, that a wellness program threatening large fines for non-compliance is “voluntary.”
There almost isn’t enough space on the internet to describe everything wrong with Aetna’s idea.
First, genetic testing may not work. For one thing, your genes are not static. Genes get turned on and off over a lifetime through interaction with their environment. Food, alcohol, exercise, stress, even the air and water you take in are all elements in a complex genetic mosaic that changes over time. Any genetic test done today is just a snapshot of risk. Woe befall the employee who thinks he or she is “safe” thanks to Aetna’s test…and abandons a healthy lifestyle, only to end up with a heart attack or cancer.
Second, so far it hasn’t worked. Curiously, the one employer Aetna offered up for interviews is itself in the lab business, Jackson Laboratories. Of 170 eligible Jackson employees, only 19 people are still in the program a year later, having lost on average 7% of their body weight. (Of any group of 170 obese people, about 19 would lose 7% of their body weight a year later anyway.) Jackson isn’t happy with the program — or its price tag. What makes it especially surprising that this poster child employer couldn’t put on his game face for this photo op is that Jackson Laboratories likely has customers or partners that are in the genetic testing business and would reap a windfall from employer genetic testing.
Jackson’s reaction validates the third point: if a lab company doesn’t like a program involving lab tests, why would any employer want to do this? Like all screens, genetic testing requires periodic vigilance at a very high cost, to have any possible diagnostic value. A claim that periodic genetic screening for common ailments (as opposed to diseases such as cystic fibrosis) will save money and lives is completely without evidence. (Inconclusiveness is an improvement over Aetna’s aforementioned obesity crusade, where the evidence clearly went the wrong way.)
No less a genetics expert than Frances Collins, the head of the NIH and former head of the Human Genome Project, has said that “most diseases are not single-locus genetic diseases and often are quite complex, involving many genetic loci as well as environmental factors.” Indeed, even supposedly common problems that wellness vendors rush to diagnose so they claim to have done something, such as metabolic syndrome, lack a genetic component that anyone actually caring for these people takes seriously.
Further, employers who engage in these activities expose themselves to legal risk because they are entrusting wellness vendors to safeguard information that employees consider both deeply private and potentially actionable. Staywell has already been breached, so it’s definitely possible.
Fourth, if genetic testing for heart disease or diabetes had any predictive value, the US Preventive Services Task Force would be endorsing it. Quite the contrary, it is so unaccepted that the USPSTF hasn’t even evaluated it.
Finally, why would an employee want to do this other than to avoid a fine? Employees’ biggest complaint about wellness is the massive invasion of privacy. So what does Aetna propose? Invading their privacy even more. Ironically, most employees insured by Aetna who actually want genetic testing for diabetes or heart disease from their physician would have to pay for some or all of it themselves. If Aetna thinks genetic testing is such a good idea, why not just cover it?
Putting it all together, Aetna’s proposal is exactly the opposite of what the wellness industry needs. Instead of more respect for employee privacy, it’s offering less. While experts bemoan overscreening, it’s offering more. And now that even the wellness industry trade association agrees that wellness loses money, it wants employers to pony up an extra $500/person.
And yet somehow Aetna maintains this is a great idea that employees will embrace and that employers will financially benefit from. Mr. Orwell himself would be very pleased with their doublespeak.
First, our colleague Linda Riddell posts about our series on HERO. In case you missed it, HERO, a wellness industry organ, exclaims in its own report that wellness damages morale and loses money. But, companies should do it anyway. As Linda notes, it is time to get past the nonsense and on to the serious business of fixing workplace wellness.
In a separate EBN article, Andrea Davis looks at companies taking alternative approaches to the usual poke, prod, pry, and punish programs popularized by, well, the people and organizations behind HERO. Her big take away is that it’s starting to look more and more like a new day is dawning in wellness, as companies start to pivot away from doing things to their employees and do more things for and with them.∞
HERO (the wellness vendors’ trade group) says: “Employees are not uniform in their receptiveness to wellness programs.” That’s like saying: “Republicans are not uniform in their receptiveness to the Clinton campaign.”
Take a look at Huffpost — especially the comments— to see what employees really think, not what HERO wants you to believe they think. With more than 23,000 views, this Huffpost was probably the most widely read posting on wellness anywhere in all of 2015.
These comments are unexpurgated (except for Huffpost’s own obscenity filter, which we suspect got quite a workout). You can add your own.
Then urge your HR department to redesign your wellness program. Tell them to ax your “pry, poke, prod and punish” vendor. If the vendor makes a fuss, bring us in and we can find all the lies they’ve told you in their outcomes reports and threaten to sue them.
Then your company can start doing wellness FOR its employees instead of TO them. Read Jon and Rosie’s book to get some guidance. If you get depressed by the amount of work you have ahead of you, take a breather and read Surviving Workplace Wellness to tickle your funny bone– If laughter were truly the best medicine, wellness would be a blockbuster drug.
This is the sixth in a series on the HERO disinformation campaign around wellness ROI. The other six installments can be found here.
This afternoon HERO and Ron Goetzel conducted an entire Groundhog Day-type webinar as though They Said What, the entire media, and 2015 don’t exist.
They talked about the “confusion in the marketplace” (to quote their invitation) without once even mentioning the source (us) of the confusion in the marketplace. Actually all we did was point out that they contradicted themselves in their own report. They created the confusion by inadvertently telling the truth.
Here are some of the things they are still saying, that they know to be somewhere between misleading and lies. Apparently Mr. Goetzel lived up to his billing as Goetzel “the Pretzel” by basically twisting “wellness loses money” into wellness makes money,” though he admitted to some “controversy” around the latter point.
First, he is still quoting the Kate Baicker 3.27-to-1 ROI, that he knows to have been thoroughly discredited. We’ve blogged about that extensively–this link will take you to a series of other links. To wit:
- She’s walked it back 4 times.
- RAND’s Soeren Mattke has attacked it (and those of you who know Soeren–he is a very thoughtful and polite guy–you really have to be way off-base to get his dander up).
- Another researcher has pointed out that many of the studies in her meta-analysis were basically made up.
- Many of these studies were claiming reductions in diabetes expense and obesity at the same they were telling people to eat more carbs and less fat, exactly the opposite of what would reduce diabetes incidence and possibly obesity. And yet somehow money was saved…
Second, the Ignorati are still quoting the American Journal of Health Promotion meta-analysis and Mr. Goetzel pretzeled his way around the accidental conclusion of that paper that high-quality studies show a negative ROI.
Third, Mr. Goetzel strongly criticized the Penn State fiasco. Hmm…maybe we’re mis-remembering this, but we seem to recall he was one of the leaders of that jihad. Here is a article about a meeting in which he and several others “take the offensive” in the controversy. Or maybe that was another Ron Z. Goetzel.
Fourth, he said: “There’s some healthy debate going on.” But the irony is, there is no debate. Partly this is because they are steadfastly refusing to debate. And partly this is because there is nothing to debate–they admitted “pry, poke, prod and punish” wellness loses money and damages morale. The only places we disagree are how much money gets lost and how badly morale is damaged.
Fifth, he is still comparing participants to non-participants, as though he hadn’t been forced — by the existence of a “smoking gun” slide — to basically admit that participants significantly outperform non-participants even in the absence of a program.
Sixth, he pretzeled RAND’s Pepsico analysis in Health Affairs, overlooking the fact that the study concluded wellness loses money. Obviously we wouldn’t have congratulated Dr. Mattke on his huge success with that article (#2 article of the year in Health Affairs) if it had reached the conclusion Mr. Goetzel said it did.
Finally, the most notable feature was the dog-not-barking-in-the-nighttime. Not once was there any rebuttal to our observations. The Wellnes Ignorati have placed themselves in a difficult position. In order to rebut us, they would have to acknowledge our existence. But ignoring our existence — and the existence of facts generally — is the core component of the Ignorati strategy.
By the way, our source, expecting a spirited rebuttal, instead got supremely bored by the insight-free recycled and invalid material in the presentation, and dropped off before the slam-bang conclusion to the webinar. We doubt there were any other members of the Welligentsia on that webinar but if there were–and you have something to share about the closing minutes that you don’t see mentioned in here — please do.
We blogged recently that HERO was going to rebut our observations that essentially none of their report makes any sense.
The good news about HERO is that they never step out of character. After we urged people to sign up, a few readers pointed out this webinar is a:
But HERO’s invitation also states:
Unless they don’t know how many members they have, how can their webinar run out of space? Come to think of it, how does anything on the web actually run out of space?
Perhaps HERO took a leaf out of John Goodman’s playbook in Raising Arizona. (You gotta click through on this, even if it means taking you off our site.)
Wellness damages employee morale and increases the cost of insurance…and that’s according to its supporters. Really. See It’s Official: Employee Wellness Is a “Scam” | Al Lewis.
And for some real chuckles, visit On the Even Lighter Side. If you’re wondering how wellness vendors can be so stupid and dishonest and not lose their licenses, it’s because you don’t need a license to become an employee wellness vendor. ∞
This is the fifth in a series on the HERO report on wellness outcomes measurement. The previous installments can be found here
The Health Enhancement Research Organization (HERO) has invited us to debate the merits of “pry, poke, prod, and punish” wellness programs, on April 22. The invitation is reproduced below and available in full here.
They didn’t ask us to debate. (They didn’t even invite us to attend.) By contrast, we have offered to debate many times. We’ve even offered literally a million-dollar reward for them to debate their outcomes metrics with us.
Here’s what really happened. We received emails from many people giving us the heads-up that HERO is holding a webinar during which they will spin their information published in their report where they say wellness loses money and is bad for morale into the opposite conclusion. If this seems confusing, it is.
Ironically, they said that we have “created confusion in the marketplace,” when in reality they were the ones who created the confusion, by providing information that they are now trying to walk back. The report seems perfectly clear – wellness loses money. Nonetheless the Wellness Ignorati are befuddled by their belated observation that it was they who supplied this information. No surprise here. Through the years we have noticed that the Wellness Ignorati are easily befuddled, especially by information.
By contrast, no one can say we confuse anything. We have always been consistent: “pry, poke, prod and punish” programs are losers for all concerned, except the vendors and consultants who naturally are running this webinar. For the Wellness Ignorati, it’s all about the money.
One of the fundamental differences between us and the Wellness Ignorati is that we are pro-transparency and have nothing to fear from publicizing them, so we are attaching their invitation below and urging people to attend, whereas even as they disparage our observations, they refuse to mention the existence of this website.
No surprise there either: if people find out this website exists, they might visit and learn actual facts. Facts, of course, are the worst nightmare for the Wellness Ignorati. That’s how they earned the appellation–by employing a strategy of ignoring facts.
This is even true when they themselves published the facts.
Curiously, this is the second time in recent months that the Wellness Ignorati have written that wellness loses money. At some point if they keep insisting wellness loses money, we have to believe them. The last time, Michael O’Donnell’s journal concluded (we’ll use a screenshot):
We would attend this webinar ourselves except that we are not invited. In any event, our attendance track record is not encouraging. The last time we listened to a Ron Goetzel webinar, we were disconnected after asking that he not use our copyrighted material without attribution. Ultimately we had to get our publisher, John Wiley & Sons, to make him cease and desist.
Still, we’d love it if you would attend, and here are some questions you could ask. First about the HERO Report:
- Why did they say wellness damages morale and corporate reputations if they are now saying that it doesn’t?
- Why did they say a wellness program only costs $18/year when the biometric screens alone cost more than $18/year?
- How can they say that companies should allocate only $18/employee/year to a wellness program when their own invitation below says that to be successful, a program must be “comprehensive” and “well-resourced”?
- Why did they omit their own carefully compiled list of 11 elements of cost other than vendor fees from that $18 figure?
- If wellness only saves $12/employee/year before fees according to their own figures, how can it save money if it costs $18?
- Why are there so many rookie mistakes in this report, like “forgetting” to adjust the decline in cardiac events for the secular decline in cardiac events that the entire country is enjoying?
- If their methodology is so sound, how come they haven’t collected their million-dollar reward when all they have to do was apply fifth-grade math to a simple word problem without lying?
And while you’re in attendance anyway, there are 11 still-outstanding questions for Mr. Goetzel himself, that he has steadfastly refused to answer. Here are a few you could ask:
- Why does he keep insisting that the Nebraska wellness program – whose vendor admitting lying about saving the lives of cancer victims – is a “best practice” or “exemplar” program?
- Why does he always give Koop Awards to customers and clients of his sponsors and board members, even when they claim 100 times as much savings as they themselves said was possible?
- Who “unfortunately mislabeled” the key slide that invalidates the industry’s obviously fallacious participant-vs-non-participant methodology and why did neither he nor any other analytical luminary on the Koop Committee notice it until we pointed it out four times?
- Why has he refused to answer these questions even though Al Lewis has offered to answer any questions you could ask him?
In one respect, though, the Ignorati are finally making progress in the integrity department. This invitation is 100% Kate Baicker-free. Maybe, finally, they are accepting the reality that she has walked back her 3.27-to-1 ROI not once, not twice, not three times, but four times. (Four seems to be the magic number of times needed to point out a fact to the Wellness Ignorati before they admit its existence.)
Don’t Throw Out the Baby with the Bathwater – A Measured Response to Critics of Workplace Health Promotion and Disease Prevention Programs
April 22, 2015
1:00 PM – 2:00 PM Central Time
(Members only event)
Recently, several individuals have raised doubt about the efficacy and cost-benefit of workplace health promotion and disease prevention programs (otherwise known as wellness programs). These critics cast doubt on the very core of work site wellness efforts and have generated widespread publicity. They argue against the benefits of prevention and workplace health promotion, question the validity of ROI estimates, and aim to restrict the use of outcomes-based wellness incentives. These criticisms have created confusion in the market. This session will re-state the business case for adopting evidence-based, comprehensive, and well-resourced workplace health promotion programs. It will also review the methods used to evaluate these programs in “real world” settings, but also acknowledge the limitations of “average” programs that may not produce expected outcomes. Finally, Dr. Goetzel will comment on value-on-investment (VOI) approaches to assessment of workplace programs in contrast to the more traditional return-on-investment (ROI) models.