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RAND’s Soeren Mattke Piles on Aetna’s Fabricated DNA Wellness Program Savings
Us. Bestselling author Nortin Hadler MD. And now RAND’s wellness uberguru, Soeren Mattke PhD.
What do we all have in common? Calling Aetna out on its phony savings from collecting its employees’ DNA to predict their future health. (Curiously, insured members who want a DNA consultation with a real doctor will find that it is not a covered benefit.)
Let’s make one thing clear: Aetna’s DNA program savings are invalid, period. It is not possible to save $1400/person (or any amount) in the first year (or any year) of a wellness program. And especially not if the people in the program were healthy to begin with, as these employees were. The cohort had a couple of risk factors for metabolic syndrome, which itself is a grouping of risk factors that might lead to a cardiometabolic disease. In other words, they were at risk for being at risk. You and I should be so healthy.
I suspect the reason Aetna picked $1400 as the fabricated first-year savings figure is that the program costs $500, and when HR people ask: “What’s your ROI?” you want to be able to respond: “Between 2-to-1 and 3-to-1” — and hope you are dealing with people who will actually believe whatever they are told. Where are these people? Trump rallies? I can’t find any. When we market Quizzify, even though our savings are 100% guaranteed, our prospects still make us demonstrate exactly where the savings will come from and how they will be measured. And the only thing guaranteed about this Aetna program is that it will lose money.
If you read the article carefully, as we did (unlike the peer reviewers), it actually self-invalidates, just like most other wellness vendor studies. There is no meaningful difference in health indicators between the control and study groups at the end of the period. Hence there can be no savings attributable to the program.
The logic is also rather twisted. Literally, they claim that if they tell you that you’ve got a gene for obesity, you’ll try harder to lose weight. Come again? When I was a kid, I saw a horserace on TV and told my mother I wanted to be a jockey. But my mother pointed out that at my growth trajectory I was likely to reach 6’5″. (I did.) So I immediately gave up that dream. Had I applied Aetna’s logic instead, I would have doubled down on riding, and maybe put a brick on my head.
Highlights of Dr. Mattke’s Criticism
Along the same themes as myself and Dr. Hadler, Dr. Mattke wrote a Letter to the Editor of the Journal of Occupational and Environmental Medicine (JOEM). Keeping in mind that because Dr. Mattke is employed by a nonprofit whose entire credibility depends on its reputation for neutrality and objectivity, it’s fair to infer that, however critical his comments, he is being very muted in his critique.
Also–though fairly discredited due to this and other obviously invalid articles — the JOEM is an “academic” journal, with standards for decorum that preclude calling people “losers” or accusing them of having small hands. So Dr. Mattke is doubly constrained in this letter. One can only imagine what he really thinks.
Four key points:
(1) He “congratulates” Aetna on designing a rigorous randomized control trial (RCT) to begin with (they did), but “wishes they actually applied that rigor to the analysis”;
(2) He points out that instead of following through on that design, they compared participants to non-participants. He says they need to look at “the eligible population, not the cohort of the eligible population that volunteered to join.”
(3) Only 11% of the invited employees joined (would you give your DNA to your employer?). “This highly selected group may differ in important observable and unobservable characteristics from the population, posing a substantial threat to validity.”
(4) “The study didn’t report the cost of the intervention.” Hey, if my wellness program cost $500 per participant, I wouldn’t either. ( I know it’s not always about us, but Quizzify costs $38 or less.)
He has other points as well, but with my 60-year-old eyes, they are hard to discern from the free online version of the letter, and I’m sure as heck not going to pay for it. Now that I’ve seen enough examples of what they use it for, the idea of sending money to these JOEM people is about as appealing to me as donating to Trump’s campaign.
Time for Aetna to Fess Up
Aetna is a fine organization in other ways. They do a lot of good things and have other excellent initiatives, in other divisions of the company. They should just call this DNA fiasco a mistake and move on. Instead they’ve been insisting that the figures are real. At some point a “mistake” becomes a lie, and Aetna is rapidly reaching that point.
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Major New Study Shows Wellness May Be Hazardous to Your Health
Our book title Surviving Workplace Wellness was intended to be figurative, but a new study shows it should be taken literally.
In the issue of Annals of Internal Medicine published today, a study of tens of thousands of people shows that a low BMI is associated with a higher death rate than all except the highest BMIs in women. In men, the lowest quintile of BMIs is associated with the highest death rate.
The study also shows that BMI is a poor predictor of death, as compared to body fat composition. This conclusion mirrors that of another study published last month.
Once again, the wellness industry strikes out. Their obsession with reducing BMI might actually be leading to a higher death rate among their customers’ employees. We say “might” because the study was careful to say that low BMIs “were associated with” a higher death rate, not “led to” a higher death rate. Wellness vendors and consultants love to conflate correlation and causality, but we can easily resist that urge, thanks to our triple-digit IQs.
Naturally, ShapeUp is one of the worst offenders. As you can see, they automatically associate “improved health” with lowering BMI.
So is workplace wellness killing people by getting them to reduce their BMI? Unlikely. It’s not just that the link may not be causal. There is a more important reason: ironically, wellness is too ineffective to harm people. Since basically no one ends up actually keeping the weight off using the pay-for-performance methods embraced by wellness promoters, there is no meaningful long-term reduction in BMIs. So even if low BMIs caused premature death, employees have nothing to fear from these programs.
And even those poor Highmark employees subjected to ShapeUp’s get-thin-quick scheme advertised below probably have nothing to worry about: the “163 employees” mentioned above only represent about 1.5% of participants, and given that Highmark fired ShapeUp, it’s likely that most of them gained the weight back anyway.
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Read what Actual People Say about Workplace Wellness
Visit this website, www.conscienhealth.org. Read the posting, and then go to the list of the people working with them. What you’ll see — uniquely in this field — is no one in this group has an ax to grind. There are no “hidden agendas” trying to push people into various wellness or diet programs.
Quite the contrary, these are real, qualified, dedicated people. And they are driven by science and evidence, as opposed to profit. Their mission is to bring science to bear to the subject of food, health, and obesity. They wish to educate people that:
(1) Being overweight/obese is not a personal failing, but rather is driven by a set of variables that are far more complex than the wellness industry could ever understand;
(2) Calories in-calories out may work as math–but biochemistry isn’t math, and that’s what the wellness industry doesn’t understand;
(3) Paying people to lose weight, telling them that they just have to “work harder” at it, or “change their attitude” etc. are failed solutions.
Naturally they have no use for the workplace wellness industry…and especially for the Johnson & Johnson “Fat Tax,” which we recently deconstructed in Harvard Business Review.
Read for yourself.
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Does the New York Times Now Support Corporate Fat-Shaming?
To my knowledge, the New York Times didn’t just get hacked. It’s not April 1st yet. And, as anyone who has been following politics knows, it certainly isn’t a slow news day.
So I am out of explanations as to why — in their upcoming Sunday Review feature ironically labeled “Gray Matter” — they would encourage corporate fat-shaming. The Times is a publication to which we have previously given multiple accolades for being way out in front of the emerging consensus that conventional wellness –and corporate fat-shaming in particular — doesn’t work. And yet…
Jumping the Shark
Three researchers from the University of Pennsylvania published a study in Health Affairs showing that you can’t fine or pay people to lose weight. It was a great study, and completely confirmed our own findings. Had they left it at that, it would have been one more nail in the “corporate weight loss challenge” coffin. But instead of reaching the obvious conclusion, based on the clear data, that incentives and penalties don’t work, they concluded that we simply haven’t found the right incentives yet.
No mention that maybe, just maybe, if it were possible to lose weight via behavioral economics, you wouldn’t need to treat employees like lab rats to get them to succeed at it.
Next, they did a small, non-peer-reviewed study of 281 employees in their own organization, and found that 15% of them would take some extra steps during a day if you paid them and then fined them–as compared to the alternative, which is what a normal organization would do: get really annoyed that these researchers are pestering their employees about the way they walk.
Oh, yes, and — exactly as most people, like Jon Robison, would predict — as soon as the incentives/penalties ended, the participants returned to their previous walking patterns.
The major questions left unanswered in this whole situation are:
(1) How do employees feel about being treated like the aforementioned lab rats?
(2) Why is it necessary to draw attention to employees’ weight, if they are getting the job done?
(3) Why should an employer care about any of these findings in the first place?
We can answer the last: they shouldn’t. First, there is no correlation between employee weight and corporate performance. Second, almost no medical spending is avoidable by wellness programs.
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Finally, Some Pushback against the Proposed Johnson & Johnson “Fat Tax”
Usually it’s an uphill battle to get high-end business media outlets to publish opinion pieces. Not so with the Johnson&Johnson Fat Tax. Here is Insurance Thought Leadership on this topic, and here is Harvard Business Review.
Some background on the cabal that is proposing it. Vitality Group can’t even get its own employees to lose weight. PepsiCo’s program is notorious for losing money. And of course Ron Goetzel now admits that way more than 90% of wellness programs fail.
And yet they are trying to get companies to stigmatize overweight people, pry into their personal lives to learn whether they are depressed, and monitor their sleep…all so shareholders can “pressure” (their word) employers into doing wellness.
Visit the links and let readers know what you think.
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Laura Ingraham’s blog slams wellness
Who says the country is polarized? In wellness, bipartisanship rules!
Having just been eviscerated by the Guardian on Monday, today wellness got quite literally its worst coverage ever — from the blog of Laura Ingraham. Yes, the very same Laura Ingraham who has her own radio show and guest-hosts The O’Reilly Factor. This may be the only instance ever in which the left-wing Guardian agrees with the right-wing Laura Ingraham.
The wellness industry is running out of wings.
Hers is just the latest media salvo. Right, left, and center — the same media that used to fawn over this stuff (“everybody wins — employees are healthier and employers save money”) — has consistently been savaging these vendors and “pry, poke and prod” programs worse than we do, ever since Penn State.
Because we are an equal-time blog, we’ll review both the Guardian’s and Ms. Ingraham’s. However, read our entire posting. I will hint that, regardless of politics, you will think we are saving the best for last. (Actually, since we strive for 100% accuracy, we should say we are saving the better for later.)
The Left Wing
The Guardian published an extensive article on the privacy invasion that can accompany wellness programs. Much as I am not a fan of “pry, poke and prod,” I do think the folks who attack wellness on the basis of privacy substantially overstate their case. There are many things wrong with wellness, but we need to tell the truth on this site, since we are in the “integrity segment” of the market. And the truth is that wellness vendors don’t hand over employee personal health information (PHI) to employers. Not that we want to give them any ideas.
PHI can also be leaked accidentally, of course. Staywell wasn’t exactly forthcoming about this so you may not have heard about it, but they got breached. Hence we would recommend that you “stay well” away from them as a wellness vendor. Other wellness vendors have managed to keep hackers at bay. It could be airtight security measures on the part of the industry, but it’s more likely that hackers simply have no interest in wellness data because of its worthlessness.
Still, these wellness people have no one but themselves to blame when articles like this get published. Castlight, for example, is feeding this beast by boasting that they can predict who is going to become pregnant. The Guardian called them out on this. I have nothing against Castlight but that is eerily reminiscent of the Highmark/Goetzel/Penn State debacle when women were fined $1200 if they didn’t disclose their pregnancy plans on their health risk assessments.
And how did The Guardian write a couple thousand words on privacy without noticing Aetna’s employee DNA collection-and-storage program? In all fairness, it probably never occurred to them that a major company would ever do such a thing, so they didn’t think to look for it.
And basically every article ever published on privacy starts with the assumption that these programs must save money. Otherwise why would employers do them, given their cost and morale impact? So the Guardian never called out these vendors on lying about savings.
The Right Wing
The Guardian’s smackdown is figuratively and almost literally yesterday’s news. The news got worse today, for the wellness industry. The LifeZette (the name of Laura Ingraham’s website) skewered the wellness industry to a degree never seen outside this blog. The LifeZette article starts by pointing out that no one even pretends any more that there is an ROI from wellness. (We just covered that newfound wellness industry candor from a different angle, in Insurance Thought Leadership.)
The article also laments the lack of regulation in wellness, possibly the only time in history when any even loosely Fox-affiliated publication has opined that there isn’t enough government regulation of something. They are, of course, right. There is literally no defense of unregulated wellness industry practices that are more likely to harm employees than benefit them, just to line their own pockets. No doctor could get away with this.
Absent regulation, the article points out that companies like ShapeUp — specifically, ShapeUp — harm employees with their yo-yo dieting programs. The reporter, Pat Barone, extensively documents the harms that ShapeUp creates with its get-thin-quick “challenges,” and then notes many other harms wellness programs can cause.
We never take sides in politics on this site. Instead we frequently note — as in this posting — that both “wings” agree with us. But I will give a shout-out to this right-wing site here. Ms. Barone’s article absolutely nails the dishonest and harmful business practices of ShapeUp and others.
Usually we try to end these postings with a clever line of our own, but instead we’ll end with one of Barone’s:
The [new] alliance of ShapeUp with the two additional companies [Virgin Pulse being the lead dog], presumably means many more crash dieters wreaking havoc on their future health.
Please add comments here when you’re done reading it. LifeZette doesn’t take comments.
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Employee Benefit News Hits Another Home Run
I don’t think I’ve ever disagreed with EBN (except for columns authored by wellness vendors), or thought their reporting was anything other than totally professional and accurate, and I’m sure as heck not going to start today, because their columnist Linda Riddell JUST WROTE A STELLAR REVIEW OF QUIZZIFY.
Even her negative point was a good one, and we are addressing it. In the immortal words of the great philosopher Benjamin Franklin, “critics are our friends, for they help us to identify our faults.” (If wellness vendors had this philosophy, they wouldn’t have time for their Day Jobs.)
So read the review in its entirety…and operators are standing by. 781-856-3962. Or just visit the website and play the game for yourself. You may learn something right away, but even if you don’t, you’ll certainly see how others would.
I would also note that Ms. Riddell is not exactly an outlier here. Previous great reviews have been penned by Bob Merberg and Paul Levy, notable and highly respected bloggers in wellness and hospitals/healthcare leadership respectively. A pattern is starting to emerge.
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Could Reading Our Website Have Saved UPMC $17-Million?
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.
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Wellness Promoters Now Agree: Wellness Doesn’t Work
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.
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Today’s British Medical Journal: Are Wellness Programs Killing (some) Diabetics?
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.
They Said What? 