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.

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.

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.

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”).

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.

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.