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.”