Today’s Lesson: Anything you are even thinking about doing something that might possibly be stupid, read this website first. It could save you a lot of money.
The University of Pittsburgh Medical Center (UPMC) just led a $17-million investment round in Vivify. Did they just make a $17-million error because they overlooked some stuff that was in plain view, right here on They Said What?
We don’t want to be judgmental here because it is quite possible we, not UPMC, are the ones overlooking something. It’s possible that UPMC did indeed read They Said What? but nonetheless decided:
“Who cares if their own numbers contradict each other? Who cares if their numbers also violate every rule of fifth-grade arithmetic? Who cares if this study result doesn’t make any sense on multiple levels? And who cares if the principal investigator can’t spell ‘principal investigator’? Heck, anyone can misspell their occupation. Vivify has other attributes.”
Here is that Vivify study, parsed in all its glory. You make the call. Worth $17-million or not?
And here are the results of UPMC’s wellness program. The good news is, UPMC can’t do any worse with Vivify than they did with their own wellness program.
UPDATE FEBRUARY 29th:
Usually our updates are “the vendor took the material in question off their website, and didn’t even have the courtesy to thank us for pointing out the errors.” Today’s update is more like the dog-not-barking-in-the-nighttime. These people haven’t even fixed their spelling error yet.
If enough wellness promoters keep insisting wellness fails, at some point we are going to have to believe them.
Usually we publish our own arguments against wellness. But today I posted a blog on Insurance Thought Leadership (ITL) that sums up the wellness promoters‘ arguments against workplace wellness instead. You can read it in its entirety here. It’s a bit “straighter” than our usual biting wit, since ITL, like Quizzify, is a standalone corporate enterprise rather than an individual hobby.
And TSW is indeed a personal hobby of mine (and Vik’s), not a cash cow. The second most frequent question* I get is: “How do you make money off this site?” The answer is I usually don’t, but almost every time a company sues a vendor or consultant, I become the expert witness, which is profitable — and, I might add, invariably successful. Cases never even get to trial. Why? Well, you’ve seen how smart these people are in everyday life. Trust me when I tell you they don’t exactly grow a brain during depositions. Plus they aren’t allowed to lie.
*The most frequent question I get is: “How did you get to be so tall?”
Highlights of the ITL piece, in case you’ve worn out your click-through button from all our other blog posts, would be as follows. For the most part, they are just a summary of what you already know:
- Ron Goetzel says most programs fail. (This is new as of last Friday.)
- Michael O’Donnell says most programs fail.
- Michael O’Donnell’s own meta-analysis says, when measured using an RCT design, programs fail
- Michael O’Donnell also offered a math lesson showing that employees working out during business hours fails to save money. It actually costs $5200/employee/year.
- The HERO Report shows a hypothetical of program economics, failing.
- At HERO’s insistence, we substituted more realistic numbers from Mr. Goetzel…and dramatically increased the loss.
- The most recent award-winning program, McKesson, admits it failed (as most of the previous award-winning programs did).
- The vendor that insists companies should publicly report how many fat employees they have, couldn’t get its own employees to lose weight.
- The most expensive, presumably gold-plated, program failed. (And that’s before adding the $500/employee program expense.)
Further, the promoters are starting to admit that maybe, just maybe, I am — as Michael O’Donnell eloquently put it — not an idiot.
Today’s STATNews (a must-read if you don’t already) highlighted a meta-analysis in the February 25 British Medical Journal showing that diabetics should not try to control their hypertension if the systolic blood pressure isn’t over 140. Otherwise they are raising their risk of death. Literally, if wellness vendors had their way and diabetic employees did what they are told to do, some diabetics would die.
Not to overstate this: the effect is subtle and on an absolute basis (as opposed to “relative risk”) very few diabetics in wellness programs would die due to the program’s advice. But the correct figure for a wellness program is that zero employees should die as a result of it.
This hypertension-diabetes link is news to everyone, which is why it is in STATNews. Many protocols for patients need to be readjusted. Quizzify, for example, will have this information made into a question today, reviewed by Harvard Medical School tomorrow, and in our quiz on Monday, assuming HMS doesn’t notice a nuance we missed. The information will also be properly sourced and linked. And the action will be to read the information and discuss with one’s physician. It won’t be a simplistic “do this” or “don’t do that.”
Once again, wellness vendors have been presenting as facts (“diabetics need to lower their blood pressure”) information that in some cases just ain’t so. Plenty of doctors do that too. The difference is that doctors can’t fine patients for not submitting. Bad medicine is one thing. Bad medicine that employees are forced to participate in by vendors who have no training, no oversight and no licenses — but who have a direct line to their employers — is something else altogether.
We have addressed this in a previous posting. Employees and people in general should only be penalized for not doing things — like buckling their seat belts and vaccinating their kids — where the science is both totally settled and totally overwhelming.
Unlike Quizzify, the amount of time that will elapse before wellness vendors fix this will be measured in months or even years, not days or weeks. Their whole “risk factor” model, in which they get graded by finding risk factors and then reducing them, has to be re-thought with respect to diabetics. Systolic hypertension at 140 or below needs to be treated as good, not as a risk.
It would be one thing if this were an isolated incident, but wellness vendors do this type of thing all the time, harming employees because they either don’t understand what they are doing or know that what they are doing is wrong, but is profitable. And of course being demonstrably wrong and harming employees isn’t going to cost them their licenses because wellness vendors don’t need licenses.
Aetna’s Employee DNA Collection Obsession Combines Junk Science, Junk Arithmetic, and Junk Integrity
It seems like most of my columns should or do start with a line like: “Just when you thought it couldn’t get any worse…”
Well, this time it really can’t get any worse. Aetna’s obsession with collecting employee DNA has truly reached the pinnacle of junk science, junk arithmetic, and junk integrity. (Not to mention junk privacy, as our guest-posting privacy expert noted.)
Junk Science and Junk Arithmetic
By way of background, we have already chronicled not just the junk science of using employee DNA to predict and prevent diabetes, but also the inability of their partner organization, Newtopia, to understand fifth-grade math. Nonetheless Newtopia wants us to trust their understanding of PhD-level science — and also trust them to store our DNA. (Like many vendors who were absent the day the teach taught arithmetic, they took their fuzzy math off their website following our instructional posting. We never received a thank-you note for this free consult, in case you were wondering.)
That same posting covered their reference site-from-hell, in which only a small fraction of employees participated, and the customer complained about the price tag, which is the wellness industry’s highest, @$500 per employee.
That price tag means claiming an ROI at the industry standard level of 3-to-1 requires fabricating far greater savings than wellness vendors usually fabricate. For instance, Ron Goetzel says programs should cost $150 and save $450. (Note: in all fairness he doesn’t say that any more. After our initial exposes, he retreated to a 1-to-1 ROI, as he admitted during our debate. Most recently he’s even backed off that. Now he says most programs fail.)
But showing that industry-standard ROI on a $500 program requires concocting savings approaching $1500/employee in the first year alone, an industry record. And did we mention that ROI was achieved on employees who were specifically selected for having nothing wrong with them to begin with, other than the possibility of getting metabolic syndrome at some point later in their lives? (Or as we originally wrote, these employees were “at risk for being at risk”.)
Oh, yes, and there was no clinically or statistically significant improvement in the set of health indicators that Aetna measured? And that Aetna was a co-author of the HERO study showing wellness loses money?
We said all this — posted it right on The Health Care Blog. Then the most amazing thing happened. One of the members of the editorial advisory board of the Journal of Occupational and Environmental Medicine (JOEM) –a trade journal with a long and glorious history of publishing suspect claims about the wondrous world of workplace wellness — essentially apologized in the comments. Specifically, he agreed the study never should have gotten past peer review. This wasn’t just any member of their board. This was the only member, Nortin Hadler, who has an actual national reputation in population health, having written many successful, influential and well-reviewed books on screening, overtreatment, and the harms of pushing people into the medical system.
So far, all we have noted is that Aetna has combined junk science with junk math. Next is where the junk integrity comes in. Just to set the stage by recapping the points above:
- Aetna must have already known their outcomes are made up because no one in population health –and very few people not in population health — could possibly think you could save $1400/person on healthy people in 12 months without doing anything other than assigning an “inspirator” to tell them to eat more broccoli, DNA or no DNA;
- They did already know wellness loses money because they co-authored the HERO report saying wellness loses money;
- If they genuinely had no idea their outcomes were made up, they would have learned that when they read my proof — a mathematical proof, not open to dispute like a scientific proof;
- And if they still doubted it, they could have read the comment by Nortin Hadler.
What does a wellness vendor do in these situations? Simple. It recalls the words of the French General Ferdinand Foch: “My left is collapsing. My right is in retreat. I shall attack.”
Their PR department called Bloomberg, had them assign a reporter completely new to the wellness beat, and then wheedled a complete puff piece out of her, crossing their fingers that the reporter wouldn’t google this thing, which would have created a front-page story.
In the Bloomberg paean, Aetna’s thesis is that best way to motivate people to lose weight is to tell them their genes make it very difficult to lose weight. If that logic doesn’t resonate with you, you have company. Here is a quote from that article — one single quote — that basically invalidates the entire remainder of the story, puff piece or not:
George Annas, a bioethics professor at Boston University, cautions against reading too much into DNA tests. “The chance that they have a genetic test that can determine if you’re prone to be fatter than other people is very, very unlikely,” he said. “What [Newtopia] really seems to be saying is that if you tell people that you have a genetic condition that may predispose you to be overweight, that may motivate people.” For some, he said, DNA testing could have the opposite effect: If someone is predisposed to gaining weight, then why bother dieting or exercising?
Speaking of things which have almost no chance of happening, here are two more. First, we’ve asked JOEM for a formal retraction, given that the study was admitted by Dr. Hadler (who hadn’t seen it pre-publication) to be blatantly wrong. Second, Aetna isn’t likely to apologize either, any more than they did for their last foray into wellness, which involved pitching some of the most controversial drugs on the marketplace to patients who weren’t even sick and didn’t ask for them. Instead, they will probably double down on DNA.
The behavior of both JOEM and Aetna can be explained with an old Chinese proverb: “When you are riding a tiger, the hardest thing is getting off.”
A list of the medical field’s worst ideas would include annual checkups, chest x-rays, and PSA tests. All are panned in the literature and/or by the United States Preventive Services Task Force (USPSTF), because the potential harms/hazards exceed the benefits. Alfred Ortiz, an employee of the San Antonio Fire Department, had the unbridled temerity to refuse to submit to those items, plus a bunch of other unspecified screens involving various and sundry other precious bodily fluids no doubt also panned by the USPSTF.
If your personal physician wanted to do these things to you (and most wouldn’t), you could refuse. Not so if your employer insists. A federal court has just ruled that — even if the employee wellness program is, to use a technical legal term, really stupid — you can be fired if you don’t submit to it.
And this San Antonio Fire Department program was indeed one of the dumbest. It included:
The justification was that these tests, designed for “early detection of serious medical conditions,” were needed to see if Mr. Ortiz could “perform his position’s essential duties.” However, my google search revealed no cases in which a house burned down because a fireman had an enlarged prostate.
If fire departments seriously want to test skills related to “essential duties”, why not a job-specific triathlon? They could make employees (1) run up 5 flights of stairs in a firesuit carrying a heavy hose; (2) retrieve a cat from a tree; and (3) attend a career day at a junior high school. But don’t endanger their health to please a wellness consultant or vendor.
Partly I suspect Mr. Ortiz’ lawyer didn’t cite or even suspect the hazards of overscreening and overdiagnosis. People who make their livings in other fields tend to assume that people who run wellness programs know the first thing about wellness, notwithstanding our 80 posts to the contrary. A plaintiff attorney overlooking the hazards of overdoctoring ends up in a tough debate on privacy-vs.-alleged job requirements, instead of a much more winnable debate on the employer’s right to gratuitously harm the employee by “playing doctor.”
Mr. Ortiz caved, and went back to work, but the ruling was quite clear that he could have been fired if he hadn’t caved.
Nonetheless, this case is now precedent, at least in the 5th Circuit. The implications? There are no regulations, licenses, or oversight board preventing wellness vendors and employers from harming employees (at taxpayer expense this time), and now there is no case law either.
Those of you with actual jobs, families, lives etc. may still not have noticed there is a new healthcare/healthcare research daily news publication. Needless to say I noticed on the first day.
It’s free and a summary pops into your mailbox each weekday morning. And, though this publication is only a few months old, they’re already onto the workplace wellness scam (LA Times’ word, not mine). Most notably, author Sharon Begley got Ron Goetzel, of “Expect a 3-to-1 ROI” fame ($450/$150, scroll to second page), to finally admit WAY more than 90% of wellness programs fail.
Is this a great country or what?
The entire story is here. Trust us we aren’t just being polite when we urge you to read it. Yes, like most reporting should be, it quotes both sides, but it’s easy to read between the lines. It’s even double-spaced.
Highlights (taken out of context; some are quotes from others)
“A startling lack of rigorous evidence that they achieve their stated goals.”
“A lot of things are evidence-based…but wellness is faith-based.”
“Vendors’ ‘research’ has made so many elementary mistakes as to inspire voluminous criticism.” <blushing>
“Tiny if any benefits…increase in fruit and vegetable consumption [equivalent to] one bite of banana.”
“A quarter-pound of weight loss.” Not unlike Pfizer’s award-winning 3-ounce weight loss.
And of course, Ron Goetzel: “There is a group of about 100 employers whose programs have really smart ingredients…but thousands of others still don’t do wellness right and are not getting good health outcomes.” (Note: We have no clue who is in that “group,” since every recent Koop Award winner has provably fabricated savings. The 2015 winner, McKesson, didn’t even get anyone to lose weight or stop smoking.)
Here’s the clincher: If you do Ron’s math — 100 successful programs divided by “thousands” of failures — you get a failure rate similar to the 90% to 95% that leading wellness apologist Michael O’Donnell also admits to. Maybe that failure rate is OK when you’re drilling for oil, but what rational business would undertake a program that has a 95% of failing? As I said during The Great Debate: “That’s not an industry. That’s a lottery.”
Ron specifically warns against “pry, poke and punish” programs, like the ones he recently endorsed at Highmark (during our debate) and Graco. Oh, and of course Penn State.
Ron Throws Kate Baicker under the Bus
Ron also invalidated Kate Baicker’s famous “Workplace Wellness Can Generate Savings” 3.27-to-1 ROI meta-analysis, that we and RAND’s Soeren Mattke have already invalidated. Soeren did it the way a health services researcher would do it, challenging data and methods. I did it the way I do it, simply quoting her own words. She has never defended this finding, by the way.
As The Incidental Economist noted this morning, meta-analyses are squirrelly, due to bias of the authors. This particular study was co-authored by one of President Obama’s healthcare advisers, David Cutler. The President needed the Business Roundtable on his side, but the support of the Business Roundtable for ACA was and is conditioned on maintaining corporations’ ability to claw back 30% to 50% of premiums based on wellness participation and outcomes.
And–voila–an article endorsing wellness in a highly respected publication appears, to coincide with the ACA debate. In the immortal words of those great philosophers The Lovin’ Spoonful, do you believe in magic?
Ron added himself to the list of people who doubt Prof. Baicker’s finding. He admitted that: “Many [meaning ‘most’] unsuccessful programs are not reported.” In other words. that 6-year-old Health Affairs article had a publication bias built on top of an author bias.
Now that You Know Your Program Has Failed…
Hey, I know it’s not always about us, but when you’re ready to sue your wellness vendor for making up all these outcomes and savings etc., we do offer forensic consulting and litigation support. We always win (actually, settle on very favorable terms). And the more of this site you read, the more you’ll see why: against these people, it would be impossible to lose. For them, the only bigger nightmare than facts are their own words.
A brief shout-out to Koop Committee member Debra Lerner on the topic of meta-analyses. She herself wrote one on wellness…but it has no apparent author bias. Rather it was fastidious in its article selection criteria. Showing that no good deed goes unpunished, her excellent work has rarely been cited, as the wellness industry studiously ignores it. Here it is.
Freud once said: “People are not privileged observers of their own behavior.” Nor am I. So I can’t offer a third-person view of myself. Thus I present, in its entirety, “My Dinner with Al Lewis,” by Bob Merberg. I would say he is the best-known wellness blogger in the country who actually does corporate wellness for a corporation, except that you already knew that and in any case there aren’t any others.
It might be enlightening for you to compare his impression of me with that of HERO (“Outrageous”), Ron Goetzel (“Harmful to you, me and all of society”) and of course Michael O’Donnell (“Al is not an idiot”).
A total deconstruction of the myth that 75% (now 86%) of your company’s healthcare spend is on chronic disease
This American Journal of Managed Care posting should end that nonsense. However, as mentioned my last blog, whenever wellness economics nonsense is exposed, you can count on the Wellness Ignorati to double down. So instead of 75% of costs being spent on people with chronic disease, it’s now 86%.
Don’t take my word for any of this. Just try this exercise with your own numbers.
The Centers for Disease Control and Prevention (CDC) rid this country of malaria, and do you even know anybody with smallpox or polio? For trivia buffs, here is a brief history about them. When they do epidemiology, they do it very well, better than anyone else on earth. Likewise, their National Institute for Occupational Safety and Health (NIOSH) has been a major contributor to the dramatically lower number of occupational fatalities in the US. When NIOSH was founded in 1970, there were about 14,000 fatal work-related injuries per year. In 2014, with a workforce nearly twice as large, there were 4,679 — still 4,769 too many, but significant progress nonetheless.
But when the CDC does fifth-grade math and Statistics 101, not so much. Consider one of the CDC’s “arresting facts:’
They are actually right about this arresting fact: 7 out of 10 Americans do die of chronic disease each year. The cause of this? It’s called “civilization.”
Here is another one of their statistics:
Newsflash: You can’t fit 20% of kids into 5 percentiles no matter how much they weigh.
And in the immortal words of the great philosopher Carole King, on the whole it was a very good year for the undertaker. Diabetics die an average of 1.5 times apiece:
In each case, we kinda know what they meant. But they didn’t actually say what they meant. And I can tell you from my experience on Jeopardy that if you don’t say what you intend to say, Alex will take away your money. Not saying what you intended to say means what you did say is wrong, no matter how big you write your name.
And now, they’ve done the exact same thing for chronic disease…except that I really can’t figure out what they mean. “86% of healthcare spending is on people with chronic disease.” Even at 75%, this was already the#1 urban legend in all of healthcare. But 86%? Seriously? $6 out of every $7? Take out birth events, and it’s more like $11 out of every $12. Take out trauma, primary care, gynecology, imaging, sports injuries, and you’re already in mathematically impossible territory.
While this CDC whopper is bad news for frustrated fifth-grade math teachers everywhere, this sudden and unexplained boost from 75% to 86% is good news for the wellness industry. This timing is not likely a coincidence given the ties between the CDC and some wellness promoters. It comes at a time when the wellness industry is getting skewered in the media, employees (the actual end-users) hate wellness so much they need to be bribed or fined to submit, the industry’s own numbers don’t add up and when we change their numbers per their request, they add up even less,
Wellness industry executives never miss an opportunity to misinterpret a statistic they don’t understand, and the CDC is just begging to have wellness vendors misinterpret this as “Chronic disease now accounts for 86% of healthcare spending” — and push employers into more prying, poking and prodding. Of course, what they should be doing instead, based on the list of costly admissions below, is exactly what Quizzify proposes: educating employees on how to avoid harms of overtreatment, rather than pushing them into the treatment trap.
Funny thing, for an industry so behind the times that they still urge guys to get PSA tests (and fire them if they don’t, in one case we’ll be posting soon), wellness vendors didn’t let a minute go by before misinterpreting the CDC statistic, as we predicted. Here is Concentra, saying: “Chronic disease accounted for 86% of healthcare spending,” and if you read down, proposing more prying, poking and prodding.
A couple of weeks ago, Concentra decided even 86% wasn’t enough, so they added a little extra, just in case the CDC omitted a few cases of dishpan hands:
We hate to pour coffee on the wellness industry’s invalidity bender here, but someone has to provide actual facts, since the CDC seems to fear them as much as wellness vendors do. We’ve already posted the top 25 inpatient DRGs in the country for employees, both by frequency and by cost, and we’re posting them again below. As you can see, none of those conditions accounting for “more than 86% of health care spending” — nor any of their common complications — show up on this list. Instead, the overlap with anything that can be avoided with pry, poke and prod programs is almost zero. Even randomly, you’d expect more of an overlap, let alone if 86% of cost is due to things that 3-P programs address.
If that’s the case, how did the CDC come up with that statistic? It’s not sourced, so we have no idea. Our suspicion is that they’ve lumped a whole bunch more diseases in there, like maybe gum disease. So why not add tooth decay? Dandruff? Cellulite? Ring around the collar? They already list “stroke,” which is about as acute as diseases get. As we say in Surviving Workplace Wellness, every minute of delay after a stroke increases the odds you’ll end up like the Kardashians.” Likewise, they list cancer, as in: “My doctor says I have lung cancer, but we’re staying on top of it. He says I need to lose 15 pounds.” (For these two items, we do think we know what they mean. Some cancers stay with you but can be controlled, and disease leading to stroke is chronic…but that’s not what they said.)
Perhaps this 86% statistic is technically accurate for some health policy wonk parlor game where one player tries to act out a chronic disease, but it’s wrong on its face for any useful purpose involving employee wellness. For employees, it’s all about birth events, orthopedics, day surgeries, imaging, drugs, doctor visits, and a ton of one-time events, small potatoes, catastrophic illnesses, and/or none-of-the-above. While the CDC is busy lumping everything together into this 86% figure, we are recalling the opposite observation in Why Nobody Believes the Numbers that “everything in life has an 80-20 rule, and in healthcare the 80-20 rule is that 80% of the time, there is no 80-20 rule.”
Boys and girls, DO try this one at home…
Before you answer, “Oh, our consultants told us to do more wellness,” try one thing. Try what we suggested above, for your own population. List the top episodes of care in total in your own organization. Here it is for the country as a whole:
As we’ve mentioned on multiple occasions, this list is populated with things no one can do anything about, as well as things addressed by Quizzify. Feed your population all the broccoli they can eat, and make them wear fitbits 24-7. You won’t prevent a single one of those DRGs.
Howard Stern isn’t as shocking as he used to be, and snippets of news that repeat every 15 minutes are only interesting the first time around. You’re stuck in the traffic already and there are many ways to tell what the weather is (cold), so you don’t need “traffic and weather together on the 3’s.” And that classic hits station repeating the same 500 songs? Newsflash: We aren’t cool any more (I now freely admit I never was) and no amount of bouncing up and down playing “air guitar” and drumming on the steering wheel to “Jumping Jack Flash” is going to change that.
So why not try a podcast on the wellness industry? This podcast will tell you, as Paul Harvey would say, the rest of the story. It covers not just outcomes issues but also some lurid history, including how I originally “didn’t just drink the vendor KoolAid. I even mixed it up and sold it.” And how I abandoned a lucrative business brokering population health when I figured out the numbers didn’t add up and I had been accidentally telling my clients they were going to save money.
Two quick fixes that the producer can’t retroactively edit in. First: I accidentally said “Health Industry Research Organization” when I meant “Health Enhancement Research Organization.” My apologies to the former. I’m sure they would be upset to have been conflated with the latter. Second, the information about the University of California system canceling its wellness program for 200,000 people and not getting a single complaint was stated in HRDive but is disputed by the UCal system. I learned about this dispute only after I taped the interview. So in the immortal words of the great philosopher Gilda Radner, never mind. (A great link by the way)
These are both pretty minor in the overall scheme of things, but our policy is to correct (or at least give both sides of) every inaccurate or disputable statement that is brought to our attention. It is called “integrity” and the wellness industry ought to try it sometime.