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The Great Debate Part 7: Penn State Strikes Back…Goetzel Runs Away
If you are just joining us now, you can start at Part 1, where you can also easily download the audio. The entire commentary thread can be found by clicking on “The Great Debate” on the home page.
As we delve into the Q&A, a parade of questioners demand to know why their own employers’ programs are so bad. They are far from alone, as most employees hate “pry, poke and prod” wellness, which is why bribes and fines have to keep rising.
Of those questioners, the most dramatic was a Penn State professor. Those with long memories may recall the Goetzel/Highmark wellness program that was being imposed on Penn State faculty and staff made the national news in 2013, due to its shocking invasions of privacy and general overall cluelessness. I covered in a Harvard Business Review essay entitled The Dangers of Wellness Programs: Don’t Become the Next Penn State.
1:16
Penn State Professor Matthew Woessner takes the mike. First he undercuts Ron’s previous answer by observing that my pointing out errors is a key part of peer review.
Then the fun starts, as he talked about the “terrible damage” the wellness program did there. It “destroyed morale.” Ron agrees that Penn State was “an awful program” but says he had nothing to do with it “in any way” even though he was in the room during their press conference in which they “took [the] offensive” in this.
Are we seeing a pattern here?
- He ran away from Steve Aldana and Wellsteps, even though they’re on the Koop Award Committee and he just gave them an award for harming employees and lying about it
- He ran away from the HERO report even though he’s on the board of HERO and wrote his famous letter supporting it.
- He’s running away from Penn State even though he was right there as a core member of the team when they called a press conference.
1:20
The moderator, again coming to Ron’s aid to prevent this debate from becoming a rout, observes that just because one college complains, not all college programs are bad. There are thousands of colleges and only one complained. Therefore, all other colleges must have good programs, according to “4th grade math.”
Professor Woessner jumped on that comment. He pointed out that the faculty at his alma mater, Ohio State, also hate their wellness program. The faculty is “livid” at Ohio State.
This was one of the biggest smackdowns of the afternoon, thanks to Prof. Woessner. It was a far better retort than anything I could have or did come up with.
1:22
Vik Khanna gets a question in. He points out that his wife’s employer’s program, where the vendor is Provant, is also awful. (Noticing a trend here?) Vik did an 8-part series last year on this Provant program. It involves checkups (that are more likely to harm you than benefit you, according to the New England Journal of Medicine), annual cholesterol tests (that healthy people are also not supposed to get according to the USPSTF guidelines), and a bunch of other stuff, like telling employees to drink 8 glasses of water a day, which is yet another myth.
Ron says Provant has a bad program because it doesn’t adhere to USPSTF guidelines, though none of the Koop Award winners adhere to those guidelines either. He repeats one of his themes of the debate: “There are a lot of lousy programs out there, including the one you’re part of.”
1:23
I point out that Ron gave an award to Nebraska, which was decidedly a lousy program. They had admitted lying about saving the lives of alleged cancer victims who never had cancer in the first place.
1:24
Ron says Nebraska won the award because they had “solid evidence they improved the health risk profile of the population.” Yet, according to their own figures, a mere 161 out of 19,000 state employees (<1%) shed a risk factor. He calls their evaluation methods “excellent.” This means in wellness it is “excellent” to claim $4.2-million in savings when 161 people reduce a risk factor and you admit lying about cancer. This entire lying-about-cancer thing has now morphed into a rewriting of history, as noted on an earlier installment.
Though just a sidelight in this debate, Ron Goetzel just admitted that he has no idea how to evaluate outcomes. This program accomplished nothing, according to their own data, and yet claimed massive savings. Somehow in Ron’s universe, this is award-worthy because his colleagues ran the program.
By the way, this program was awful, whether Ron says so or not. (The vendor is a sponsor of the Koop Award, so Ron won’t admit it.) Surviving Workplace Wellness devoted an entire chapter to it. Here is a snippet:
1:26
Yet another employee subjected to yet another worthless wellness program complains to Ron about it, “suffering through 4 sessions with my health coach.” He blames her and her program for being bad and says she needs to change her behavior.
Shame on you for being a bad employee! You need to take a time-out. (You and most of the rest of the country.)
1:28
The AARP lobbyist, Debbie Chalfie, adds AARP to the list of organizations that have multiple concerns about wellness. Ron adds programs with surcharges to the long list of programs he doesn’t like, even though Bravo hired him to allege massive, self-invalidating, savings at Graco by doing surcharges. If the name “Bravo” rings a bell, it’s because that was the outfit that used to brag about how they could generate immediate savings by surcharging employees until we pointed out it probably wasn’t a wise idea to boast about that.
I use one of my prepared zingers here. If all these programs fail — Ron’s colleague Michael O’Donnell says the figure is 95% — “that’s not an industry. It’s a lottery.” Literally, excluding oil producers, no organization in the US would undertake any investment whose biggest promoters admit a 95% chance of failure. And yet, due to the lies told by wellness vendors and their consultants, lots of companies do.
Ron wraps up this section of the debate with yet another admission that wellness doesn’t work: he says “programs are very hard to implement effectively.” On this point we would agree. But as a former corporate CEO of a NASDAQ company, there’s no way I’d devote more than $100/employee to a program that probably wouldn’t have worked, had no evidence in favor of it other than what wellness vendors say, and could easily have backfired like every program described in this debate so far.
Further, we have a great culture at Quizzify, one that I have posted about on Linkedin. A great way to wreck that culture would be to start pestering employees about stuff that is none of my business and doesn’t affect me, the customers, or the shareholders.
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Wellsteps Presents a Confederacy of Wellness Vendors
When a true genius appears, you can know him by this sign: that all the dunces are in a confederacy against him.
–Jonathan Swift
Wellsteps’ Steve Aldana has “endorsed” a confederacy of 25 wellness vendors, including his own company, Wellsteps. Alas, in the world of the Welligentsia, in which an increasing number of employers reside, an endorsement from Mr. Aldana earns about as many points in a vendor selection process as neat handwriting.
There are usually not enough hours in a week to both do my Day Job running a fast-growing company (Quizzify, which plenty of thought leaders have endorsed, so they don’t have to endorse themselves), and also play wellness-meets-whack-a-mole with the Ignorati. Fortunately, this week does have enough hours, thanks to the time change. (The wellness industry is lucky that “falling back” is not a regular occurrence.)
I haven’t heard of many members of this confederacy, but I’ve heard more than enough about the ones below. Each link takes you to our own “endorsements.”
Keas Meets Lake Wobegon: All Employees Are Above Average (in Stress). This is the best argument for requiring that wellness vendors attain a GED.
Provant: “In the Belly of the Beast” A nine-part series that one line can’t do justice to. We would simply note that you do not have to drink eight glasses of water a day. Indeed, you probably shouldn’t if you expect to get anything else done.
Staywell’s Wellness Program for British Petroleum is Spewing Invalidity. It wasn’t just that their savings claim was mathematically impossible. That’s just the threshold for wellness savings claims. Staywell also somehow saved BP 100x as much as Staywell’s own website says is possible. And because they have a “special relationship” with Mercer (meaning they pay them), Mercer “validated” this fiction for BP, at BP’s expense…
Staywell, Mercer, and British Petroleum Meet Groundhog Day. They won a Koop Award. Since Staywell and Mercer are both on the Koop Committee and their results are completely invalid and they are obviously lying, they satisfy all the award criteria.
Total Wellness’s Total Package of Totally Inappropriate Tests. They could lose their license for subjecting employees to this panoply of US Preventive Services Task Force D-rated quackery, except that in wellness the only license you need is a license to steal from unsuspecting HR directors. This leads to…
…Total Wellness: The Best Argument for Regulating the Wellness Industry. Total Wellness isn’t about to lose this Race to the Bottom without a fight. Watch as they try to out-stupid Star Wellness in their quest for that prize.
US Corporate Wellness Saves Money on People Who Don’t Cost Money. We call this Seinfeld-meets-wellness, because it’s about nothing: even if you have absolutely no risk factors, these Einsteins will still save you a fortune. And someone should also tell them you can’t reduce a number by more than 100% no matter how hard you try.
Virgin Pulse. This outfit acquired ShapeUp, which gives harmful crash-dieting programs a bad name. Don’t take our word for it. It’s in the Pittsburgh Post-Gazette.
Vitality’s Glass House: Their Own Program Fails Their Own Employees. These people might have more luck selling you a crash-dieting program if they could get their own employees to lose weight.
Wellness Corporate Solutions Gives Us a Dose of Much-Needed Criticism. We don’t want to spoil the punchline.
And that brings us to Wellsteps itself, which earns its “endorsement” from its own CEO by making so many appearances on this list that there is barely enough room for the rest of the confederacy. If you only have time for the Executive Summary, this is the one to read. But squeezing it all into one place requires sacrificing the laugh lines, and if there is one thing Wellsteps excels at, it’s providing laugh lines.
Wellsteps ROI Calculator Doesn’t Calculate an ROI…and That’s the Good News. Watch what happens when Wellsteps meets Fischer-Price. No matter what variables you enter in this model, you get the same result.
Wellsteps Stumbles Onward: Costs Go Up and Down at the Same Time. This isn’t possible even using wellness arithmetic. Eventually Wellsteps solved this problem by simply deleting one of the slides. But because we long ago learned that doctoring/suppressing data is one of the wellness industry’s signature moves, we took a screenshot before we did our expose.
Prediction: Wellsteps Wins Koop Award. In 2015, I went out on a limb to make this prediction, noting Wellsteps’ perfect Koop Award storm of invalidity, incompetence, and cronyism.
Wellsteps: “It’s Fun to Get Fat. It’s Fun to Be Lazy.” This one was penned by Dr. Aldana’s waterboy, Troy Adams, who apparently during his self-proclaimed “11 years of college” never learned that “fat” and “lazy” aren’t synonyms. Paraphrasing the immortal words of the great philosopher Bluto Blutarski, 11 years of college down the drain.
Does Wellsteps Understand Wellness? They are demonizing even the slightest consumption of alcohol, among many other misunderstandings. Shame on me for enjoying a glass of wine on a Saturday night!
The Back Story of the Scathing STATNews Smackdown of Wellsteps and the Koop Committee. This one leads to several other links.
The Koop Committee Raises Lying to an Art Form. It turns out Steve Aldana is not stupid: he apparently has heard of regression to the mean, but just pretended he hadn’t so he could take credit for it with the Boise Schools, who were not familiar with the concept.
if Wellsteps Isn’t Lying, I’ll Pay Them $1 Million but let’s just say I’m not taking out a second mortgage just yet.
An Honorable Mention goes to another vendor on this list, in the form of the Don Draper Award, for this advertising gem, aimed at ensuring that even the stupidest member of the Ignorati, and/or HERO Board members, can catch their name:
To quote the immortal words of the great philosopher Rick Perry, even a stopped clock is right once a day.* And, yes, on that Wellsteps list there is one standout vendor, US Preventive Medicine. It has validation from the Validation Institute. As you read their validation, note that while they show an enviable reduction in wellness-sensitive medical events, they don’t claim an ROI. This is testament to the integrity of both USPM and the Validation Institute.
*If you are a regular reader and didn’t find this quote amusing, read it again. If you are a wellness vendor, find a smart person to explain it to you.
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Right-wing media attacks “pry, poke and prod” programs
Who says the country is hopelessly divided along partisan lines? Yes, the liberal lamestream media attacks wellness. (Most recently Slate.) That is to be expected. Sheesh! But here is Laura Ingraham’s blog taking on wellness.
The author, Pat Barone, observes the discrimination, invasion of privacy, and lack of regulation and oversight — along with the total hypocrisy of relabeling “forced” as “voluntary.” This is easily the best of the AARP lawsuit articles, because it puts the lawsuit in the context of “pry, poke and prod” programs generally. As one member of the TheySaidWhat? Nation, Mitch Collins, often writes: “This should be required reading in HR departments.”
This is not the only example of the right-wing media attacking wellness. Newsmax, the Federalist and others have done so as well. A complete listing of all media coverage of wellness is here.
It’s nice to know that the two sides are willing to reach across the aisle on this one, if only to strangle the legislators of both parties who have been bought off by the Business Roundtable.
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In workplace wellness, fat-shaming is the new black.
This posting is a request to self-anointed wellness industry leaders to pleeease stop picking on people because of their weight. It’s like you’re still in kindergarten, no offense intended.*
2016 was the year in which weight-shaming, weight discrimination and a generally dismissive and outright misanthropic attitude towards two-thirds of the country’s employees became a wellness industry thing. This started in January at Davos, where the head of a wellness vendor named Vitality announced what quickly became known as the Fat Tax.
Here’s how the Fat Tax would work. Companies would tell shareholders how many fat people they employed. Employers, presumably feeling shame over this disclosure, would be motivated to pay a “tax,” in the form of a fee to a wellness vendor — such as, coincidentally, Vitality — for screening and weight loss programs.
In addition to the out-of-pocket fee, employers would pull employees off the job for an hour too, to obtain this screening. In addition, there would be all the administrative time — making the rules and exceptions, catching cheaters (see below), getting the auditors involved, and so on.
All this for what, again?
J&J would have people believe that shareholders are demanding thinner employees. In reality, of course, shareholders could care less about the weight of employees, for the simple reason while weight makes no difference to most businesses (as we’ve proven), the cost impact described above of mass weigh-ins and disclosures would be quite high.
More important is the morale impact. Suppose an employee owns shares and the stock price is down. Next, suppose that shareholders have just been informed how many employees are overweight…and the guy in the next cubicle is obese. Suddenly, that employee can start blaming his co-worker for the loss in value of his 401K.
Your stock price is down, you need to rally the troops. Instead, the troops are turning on one another.
Incredibly, this idea did originally have momentum: along with a few drug companies that make obesity drugs that saw a potential market opportunity in the Fat Tax, IBM and even Pepsico were willing to put their names on it. The Fat Tax cabal also knows the value of the Harvard name: they paid a little-known instructor at the Harvard School of Public Health (HSPH), so that they could co-opt that moniker, just like the sugar industry used to do. Only the latter had a big enough budget to bribe two full professors rather than one lowly instructor.
However, the momentum quickly died once word leaked out that the very same Vitality that wants to collect money from others to administer weight loss programs couldn’t even get their own employees to lose weight.
Oh, and if you guessed that Ron Goetzel’s fingerprints were all over this one — just like almost every other debacle since Penn State — you obviously know the way the wellness industry works.
Ah well, as management guru Peter Drucker said, the only thing worse than a poorly conceived idea is a poorly conceived idea that is poorly executed.
Actually he never said that, likely because he was never enrolled in Vitality’s program.
Possibly because of the initial exposure the Fat Tax idea got, hazardous crash-dieting competitions came back into vogue this year. Crash-dieting competitions are the type of thing that gives idiocy a bad name. Let’s leave aside the fact that employees cheat, as this article shows. They don heavy clothes, fill their pockets and down bottles of water before the initial weigh in, and do the opposite before the final one.
And leave aside the fact that vendors can’t read scales. How hard is it to figure out that it is not possible for the majority of your crash-dieting teams to lose exactly 16.59% of their body weight? The odds of winning the lottery are about 1000 times better.
But the biggest problem is that corporate crash-dieting contests are much more likely to harm employees than benefit them. Money is on the line for successfully bingeing before the first weigh-in and starving oneself before the last. Companies are paying their employees to yo-yo diet. Jon Robison has recommended, and I agree, that crash-dieting contests (and other corporate weight-loss programs) should carry a label warning of potential harms.
These harms are fairly self-evident, but just to be on the safe side, Rebecca Johnson laid out the health hazards quite thoroughly in Corporate Wellness, in case anyone needs a refresher course, which apparently Omada does.
Yes, despite the perverse incentives and physical hazards of paying people to lose weight, Omada Health is proposing that health plans do just that. According to Omada, a health plan can save “billions of dollars” — that’s “billions” with a “b”, not “millions” with an “m” or “stupid” with an “s” — by trying to prevent diabetes, including paying members to lose weight. A health plan that offered members this pay-to-diet option would soon find itself deluged with enough takers to require a rate increase for everyone else.
In case anyone is wondering about Omada’s math, the median-sized health plan can’t save billions of dollars by getting people to lose weight because the median-sized health plan doesn’t even spend “billions of dollars.” And I don’t mean on diabetics, I mean in total.
Next, it appears that this year’s presidential campaign has made fat-shaming great again. One of the first vendors to jump on that bandwagon was Wellsteps, with the immortal words: “It’s fun to get fat. It’s fun to be lazy.” Eventually they took those words down, if only because a number of comments embarrassed them into it.
However, as Maya Angelou said, if someone shows you who they really are, believe them.
Finally, with his editorial in the American Journal of Health Promotion, Michael O’Donnell has out-stupided Vitality, Omada and Wellsteps: He is calling for employers to make employees pay for their health insurance per pound, sort of like buying lobster or sending packages. People say we make fun of the ideas the Wellness Ignorati come up with, but really all we do is repeat them — and occasionally illustrate them so that even the dumbest wellness industry leader can follow along:
*No offense intended to kindergarteners, that is, most of whom have better manners than this.
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The Great Debate, Part 6: Goetzel Throws HERO under the Bus
The question-and-answer period is now underway.
If you are just joining the thread, this is Part 6 of The Great Debate, a November 2015 exchange between Ron Goetzel and me, at the Population Health Alliance Annual Leadership Forum. Part 5 is here. You can download the audio here.
1:09:00
To the question: “What would you do to reduce healthcare costs?” Ron replies that he is “focused on prevention.” And that’s the issue. I point out that “too much of anything is bad for you, ours is already the most over-prevented society on earth, and these programs are all out of compliance with guidelines.” All these programs screen everybody far more than guidelines advise. Here are the guidelines. Find anything other than blood pressure where the wellness industry’s obsessive annual screens are recommended.
[Postscript: after the debate, the Connecticut study came out, showing that overprevention through wellness increases costs, as one would expect.]
1:12:20
The moderator asks how can Quizzify be the most effective company in employee health education. He challenges our 100% guarantee of savings. This is ironic. No wellness company offers any meaningful guarantee of savings, for the simple reason that it is mathematically impossible to save money in wellness.
Somehow in wellness, guaranteeing savings is a bad thing but losing money is a “good thing.” (Really, a direct quote — click on it.) It’s curious to challenge someone’s own willingness to guarantee their own results as part of their own business. Obviously, if my business judgment is wrong, Quizzify will fail. And what I didn’t say because I didn’t want to brag, is that people questioned my last business venture too, Matrix Medical. Fast forward: Matrix is now the most valuable population health company start-up of this millennium. (Before you ask me to lend you money, we mostly sold out on the “cheap” in 2013 to a private equity firm named Welsh Carson.)
1:13:40
Ron Goetzel endorses Quizzify. He went on the website and played the game. “It was a lot of fun. Very clever.” Then he asks — quite justifiably — how Quizzify can make problems like obesity and smoking go away. The answer, of course, is that Quizzify isn’t going to make obesity and smoking go away any more than wellness does. For example, consider McKesson’s Koop Award-winning program, where both weight and smoking went up. We can’t do worse than that. If we did, we could win a Koop Award.
Instead, Quizzify guarantees reductions in overall healthcare spending on “low value care.” As you can see from the demo on the website, we also educate people on hidden sources of sugar, of which there are more than you can count, but we don’t expect immediate savings from this and other nutrition/smoking education questions. Immediate savings are provided by our emphasis on avoiding low-value care.
1:15:00
Consistent with his theme of running away from his own work, Ron now runs away from his own HERO Report. Keep in mind two things as you listen to this section:
- Ron is disowning his own report. He is on the board of HERO, a tidbit which he overlooks in this hasty retreat;
- Within days of this debate, he was circulating his famous poison pen letter to the media completely owning it, and accusing me of reading it too carefully.
The moderator (who otherwise moderated fairly) for some reason jumped in and said Ron and the HERO Guidebook just used an allegedly hypothetical example to show losses. Since their “example” costs were $18/employee/year as opposed to the more typical $100 AND since the HERO example failed to control for the countrywide decline in wellness-sensitive medical events, the HERO example grossly underestimated losses from wellness.
Ron says “those numbers in [my HERO Guidebook] are wildly off,” and “have nothing to do with reality.” He says I “misrepresented and misinterpreted” these figures. But they are right there: A program costs $1.50 PEPM and saves $0.99. What’s to misinterpret? Ron apparently hadn’t noticed that his little Guidebook accidentally told the truth until I pointed it out — exactly like he hadn’t noticed that Eastman Chemical/Health Fitness self-invalidated. In both cases if fell upon me to point it out to these Einsteins.
Here is a posting showing what happens when you adjust those HERO figures for Mr. Goetzel’s alternative “reality” — losses skyrocket, just like Health Affairs showed in the Connecticut study.
Perhaps HERO would have more credibility telling us that wellness saves money if their own allegedly* “fabricated” example and any of the legitimate literature supported that claim. I’m just sayin’…
*The word “allegedly” is used because the example in the HERO guidebook is not a “fabricated” or “hypothetical” example. The words “fabricated” or “hypothetical” do not even appear in the chapter. Instead the example is an actual report. That’s why the Guidebook says it’s a report, and gives very specific details of the report–in the past tense, no less, as you would for a completed report. A “hypothetical” would use the present tense throughout, along with saying that it’s a hypothetical.
And like:
So Ron’s whole argument about this being somehow a hypothetical is shot, just like all his other arguments, by showing his own data.
To summarize Ron’s view so far in this debate: everyone who thinks wellness is a total waste of money — including RAND, basically all the media and every economist who has looked at it in the last six years — is wrong. Every time his own materials accidentally tell the truth and say wellness loses money, they’re wrong.
And as we’ll see in the next installment, every employee who hates their company’s wellness vendor is either in a bad program or they are a bad employee.
Basically everyone is out of step but Ronnie.
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The Great Debate, Part 5: Ron Goetzel “endorses” me…by mistake.
We are now in Ron’s wheelhouse, which is publishing peer-reviewed articles in third-tier wellness trade journals. Let’s see how he does.
For those who are new to this thread, Part 4 is here, and links to earlier installments. The recording is here. Time stamps roughly synch up.
53:30
Ron says he is a researcher, and publishes in peer-reviewed journals. He “applauds” me again for giving them the “opportunity” to correct their many errors, and says the comments I make are often “right on the money.”
It is indeed a creative use of the word “opportunity,” as in: “Last year the IRS gave me the opportunity to be subject to an audit.”
He says “that’s what the scientific method is all about, having peer reviewers critique your work and find problems.” And yet, I’ve never, ever been asked to peer review anything that he and his cronies have ever published. Go figure.
He would like “us” (meaning him and his cronies) to be able to review my work, even though I’m not allowed to peer-review theirs. He says he has “never seen an article by Al Lewis…to review.”
Hmmm…perhaps his internet is down?
Since all my work is right on this site (including links to other work, in “In the News” to Health Affairs, Harvard Business Review etc.) he is free to review it anytime, and we publish all comments. There isn’t really any need to for him to look at our material because mostly it’s his own and his cronies’ material. And you know the mantra from Surviving Workplace Wellness: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
As in his opening remarks and in his “secret” letter to the media, he once again criticizes my stuff as being “out there…outlandish,” but gives zero examples.
55:30
Ron, in the process of saying something he knows not to be true for a change, accidentally endorses me.
“Ron, would you say I am the most qualified person in peer review in terms of finding the most mistakes?”
“No.”
“Well, who has found more mistakes than I have?”
[Silence and nervous laughter from the audience.]
I point out that — despite his tacit endorsement just now that I am the best peer reviewer — none of his friends’ wellness trade journals have ever asked me to peer review anything.
And he still refuses to say why he hasn’t claimed the million-dollar reward.
57:00
Peer reviewed or not, numbers need to add up, and Ron’s don’t. In one award-winning example, Eastman Chemical, $900/person in savings was shown — with risk factors changing by only 0.17 per person, excluding dropouts.
Ron did not rebut this. Eastman was one of the two Koop Award applications he had doctored when it turned out the applicant had accidentally told the truth but no one on the award committee noticed.
58:30
Ron has already run away from most of the industry’s claims, as earlier installments of this debate have observed. Now is he running away from Wellsteps’ Steve Aldana, whom he has co-presented and co-authored with and who naturally is on his Koop Award committee. Aldana recently wrote that I was “sick” because a colleague posted my Harvard Business Review article on his linkedin group and asked what people thought of it.
[2016 Update: Ron is now embracing Steve Aldana and Wellsteps, the first company to admit to harming employees.]
59:00
Ron is turning his blacklisting of me into my “plea” to do peer review in his trade journals. I have never “pled” to do peer review in his trade journals, which are mostly useful as punchlines. I merely observe that I’ve never been asked. “You’re very good at calling out mistakes, but you’re not very good at publishing your own research studies.”
He then cites the Johnson & Johnson study (that’s the same Johnson & Johnson that just proposed the Fat Tax). That is the only study he’s ever done that I’ve not been able to invalidate on its face, so he gets his first point of this round here. Not because the study is valid. There wasn’t enough data in it for me to automatically prove that it was invalid, which is a very high standard, but that’s my standard–“face invalidity.”
So there you have it: one company in the entire universe that might possibly have saved money on wellness. And as coincidence would have it, they also sell wellness services. No publication bias there…
November 4, 2016 Update: I just found this J&J study. It is even worse than the others. Employees lying on HRAs, trivial risk reductions…and of course massive savings. It appears that all they did was increase the deductible and then give employees $500 to do wellness, thus shifting the money out of the healthspend into the incentives account, which is not included in the “savings.”
1:00:00
I point out that even though I’m apparently not qualified enough to peer review for his friends who run low-impact journals, I do get called upon to peer review for Health Affairs and other high-impact journals. And most importantly, while I’ve done only two peer-reviewed articles, one led to the dismantling of the North Carolina Medicaid medical home. The other was #1 for 2015 in the American Journal of Managed Care and continues to be cited widely. My award-winning book was peer-reviewed by some of healthcare’s leading figures: Stuart Altman, James Prochaska, Tom Scully, Leah Binder, Bob Galvin, Regina Herzlinger, and Nortin Hadler (the same Nortin Hadler who apologized for poor peer review by one of Ron’s favorite trade journals).
Most importantly, speaking of peer review, Quizzify is the only population health company that may publicly say “our content is reviewed by doctors at Harvard Medical School.”
1:02
Ron — whose entire industry loses money and can’t even guarantee not losing money — is now lecturing me on Quizzify’s guarantee of savings and how it needs to be peer-reviewed. I was not expecting to be attacked for offering an incredible, unique, value proposition, so I didn’t have a good answer. Only in wellness is saving money for customers considered a bad idea.
1:02:30
He continues to harp on peer review by his friends-and-relations, but I won the round with one simple observation: “We are not here today because of Ron’s peer-reviewed articles. We are here today because of my non-peer-reviewed articles.”
I could fill a blog with all the nonsense that Ron’s friends who run so-called “peer-reviewed journals” have published. Come to think of it, I have. Examples:
AJHP’s proposal to tie insurance premiums to weight, like ordering lobster or mailing packages
AJHP’s proposal to use wellness to dramatically reduce productivity
JOEM’s Aetna debacle
JOEM’s failure to understand how to do stock price analysis
AJHP’s “Randomized control trials show negative ROIs.” (I didn’t have to post anything here–this spoke for itself.)
JOEM’s fabricated evidence of savings
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AARP files suit against EEOC for wellness program overreach
Along with the overwhelming preponderance of the decidedly un-rigged media establishment, the AARP has emerged as the unlikely vox populi in the battle against “pry, poke and prod” programs and their ethos of “overscreening today, overscreening tomorrow, overscreening forever.”
The reason for the AARP’s interest is that often it is the older employees who have trouble losing the weight or keeping their blood pressure down — and hence get disproportionately penalized. Indeed, those two metrics do rise with age, a factoid that the wellness industry penalty/incentive schedule rarely takes into account. (Along with smoking and family history, age is the #1 risk factor for heart disease and other related medical events. What do these risk factors have in common? Wellness programs don’t change the first, can’t inquire about the second, and ignore the third. And people wonder why these programs don’t work.)
For instance, you don’t see age mentioned at all in the shocking anti-fat-employee jihad recently proposed by the American Journal of Health Promotion. Thank goodness that trade magazine has a low “impact factor,” and no one will notice or care about this rant. Otherwise, older employees would be in a lot of trouble. Further, the Johnson & Johnson Fat Tax proposal, which fortunately appears to have been stillborn, would have made employers less likely to keep older employees in the workforce as well, for similar reasons.
The AARP just yesterday filed suit against the Equal Employment Opportunity Commission (EEOC). The suit addresses both:
- Whether workers’ medical information is at risk; and
- Whether these programs are truly voluntary.
The former is less important, in our opinion. While Staywell managed to get itself hacked, most information that employees submit is fabricated (as we learned from Wellsteps’ Boise program, where almost no one admitted to smoking or drinking) and fairly useless to hackers. Or, for that matter, to employees or anyone else. So ironically, the best defense for wellness proponents against the first charge is that this isn’t medical information. It’s garbage, so who cares whether it’s at risk? (I’m being a bit facetious here.)
However, the second is clearly an issue. The Business Roundtable (BRT) has strongly pressured both the legislative and executive branches of government regarding wellness in general, and the definition of “voluntary” participation in particular.
And if you don’t think the BRT owns the former branch, consider the title of the Senate Committee “hearing” on wellness. It was not: “Do Wellness Programs Work?” Instead it was titled: “Employer Wellness Programs: Better Health Outcomes and Lower Costs.”
Title optics aside, obviously the BRT and their cronies at the US Chamber of Commerce have no interest in whether these programs actually work. (If they did, they’d have abandoned them by now, or else claimed their $1-million reward for showing they’ve worked, a reward which we have specifically offered to them.) What they are most decidedly interested in, though, is giving their member corporations the right to collectively withhold billions from employees who refuse to let their employers “play doctor.”
In classic doublespeak in order to avoid EEOC sanctions, the BRT had the feds redefine the word “forced” to mean “voluntary,” for the purposes of wellness. Non-participants (or in the jihad described above, people who don’t lose the weight) can be fined quite literally thousands of dollars. How is this voluntary?
The some degree, the EEOC’s hands are tied by Congress and the White House, because they can only write the regulations and interpret the laws. They don’t make laws. And there is no law that protects employees from harmful programs like Wellsteps. So the AARP can only work around the edges of wellness, with challenges to privacy and voluntariness, rather than address the elephant in the room, which is that many wellness programs flout guidelines and harm employees…and there’s not a thing anyone can do about it.
Until then, we wish AARP the best. Perhaps for the definition of “voluntary,” their attorney should cite the Urban Dictionary:
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Don’t Swallow Your Gum
Rarely does a “wellness” book come along that actually teaches us stuff about personal health we don’t already know, the last one being Tom Emerick’s An Illustrated Guide to Personal Health. Typically, books that we review undo the misinformation perpetrated by wellness vendors, on the subject of prostate screening, crash-dieting etc.
Another such book that has “come along” (copyright © 2009, but I am just finding out about it now, as my internet connection has been slow lately) is Don’t Swallow Your Gum: Myths, Half-Truths, and Outright Lies about Your Body and Health. The authors are Drs. Aaron E. Carroll and Rachel C. Vreeman. If the former name rings a bell, it’s because this particular polymath is also part of The Incidental Economist. If that name rings a bell, it’s because TIE has the same impression of wellness as we do, so we often refer TSW readers to them. The only difference being, as far as I can tell, is they have Day Jobs and possibly even Lives, and hence unlike us can’t spend all their time dissing these Goetzel-infused Einsteins.
In any event, these 164 pages will teach you a ton about everyday health and well-being. Like, if your kid swallows his gum, you don’t need to pump his stomach or even turn him upside down and shake him. He’ll survive. Or whether acupuncture, Airborne, or zinc work. (Sometimes, no, and unlikely.) Or whether walkers help your baby walk sooner. (Not even close. Incredibly, it’s the opposite.)
Several workplace wellness myths are debunked, like the eight-glasses-of-water thing, a staple of Provant’s program.
More serious topics are covered as well, like fluoridated water, drinking while nursing, and giving cough medicines to children. These are sprinkled in and provide a nice balance.
Quizzify, of course, is full of similar tidbits (to lighten up some much more serious health and healthcare education issues), though in a Q&A format. Indeed, although roughly 30 topics overlap, there is only one disagreement…
…Yep, you guessed it. Quizzify is totally chill on the chances of getting sick by dipping a chip in a dip that’s been double-dipped. Incredibly and probably uniquely in my lifetime, that puts me on the same side of an argument as George Costanza. Drs. Carroll and Vreeman, by contrast, are firmly in Timmy’s corner. (“Don’t you see? That’s like putting your whole mouth in the dip.”)
We all agree that it is rude and spreads germs. Beyond that, we observe (and we are in good company here) that:
- If someone is sick enough to spread harmful germs (most germs are harmless), they probably aren’t at the party;
- If they are at the party, they probably aren’t eating;
- If they are eating, they probably aren’t double-dipping;
- If they are double-dipping, the odds of getting those particular germs when you dip are pretty remote anyway;
- And if they really are that sick, you got way more germs when you greeted the perp via a handshake or kiss.
Further, there is a logical fallacy. You can’t assume you’ve seen the double-dipper. Someone could have double-dipped while you weren’t looking. Who stares at the refreshment table for the entire party? That’s ruder than double-dipping.
On the flip side, if you go to a party, you want to have fun. If you spend your time fretting over a 20-year-old Seinfeld episode, you might as well stay home. And loneliness — this is a major observation in Tom Emerick’s book — really is a major health risk.
Mind you, the folks at Quizzify aren’t exactly Pollyannas on the subject of party dip. We recommend steering clear of it towards the end of the evening. Not because of the double-dipping risk, but rather because who the hell knows what’s going on in guacamole that’s been sitting out all night in an overheated roomful of half-soused nightclub rabble? (Yes, another Seinfeld line.)
That, though, is the exception that proves the rule. For the large but fortunately diminishing pool of employees unlucky enough not to have access to Quizzify via their employer, this book is a worthy and entertaining substitute, for topics of everyday personal health.
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Rebecca Johnson’s article in Corporate Wellness Magazine may disappoint our loyal readers
Yes, we know you read this blog for the chuckles. Our most popular and funniest posts are usually the ones showcasing the wellness industry’s race to the bottom. And despite heavy competition, very few industry scams can beat corporate get-thin-quick schemes to that inexplicably coveted nadir:
- Here is Healthywage discussing its newest schemes, like “dieting for dollars” and “paying for pounds.” They also describe how to prevent “fraudulent participants,” a category presumably comprised of zombies and dead voters in Chicago.
- “In Wellness, Stupid is the New Black” shows how Healthywage can’t even read a scale.
- “Shape Up falls down trying to do math for Highmark,” about a weight-loss program so clueless that it got covered by the Pittsburgh Post-Gazette.
- Perhaps our favorite is Wellness Corporate Solutions. We won’t ruin the punchline for you.
In sum, we say: “To call corporate crash-dieting contests a joke is an insult to jokes.”
Unfortunately for those of you seeking a few chuckles, this is not that situation.
Quite the contrary, Rebecca Johnson has penned one of the best articles on corporate weight loss programs we’ve ever seen, so we can’t dismiss it with our usual clever if by now overexposed putdowns like: “She should have had this reviewed by a smart person before publishing it,” or “Perhaps her subscription to the internet expired.”
Instead, rarely have we seen more intelligent observations packed into a tighter space, more thoroughly sourced and clearly explained. To summarize:
- Corporate crash-dieting contests are much more likely to harm employees than benefit them;
- They don’t produce an ROI;
- Our mothers were right. Eat a balanced diet. There are more benefits than one would think to not obsessing with what are the “best” and “worst” foods. (Having said that, some people seem to do very well on a low-carb diet. We leave that debate to others and recommend The Big Fat Surprise to readers with an interest in that topic.)
- It is better to be fit and fat (“health at every size”) than to yo-yo diet, for sure.
She goes on to explain her particular approach to mindful eating. I myself have no expertise in that area so I can’t critique the specifics, except to say that Healthywages, ShapeUp (now Virgin Pulse), and Wellness Corporate Solutions should definitely find a smart person to explain this approach to them, even if it means having to pay for an internet connection.
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Eureka! An actual response to these debate update postings
A rebuttal from Goetzel? Of course not. The Wellness Ignorati deal in secret missives to the media, not open discussion. Or, in the case of the proposed Code of Conduct urging vendors not to harm employees or lie about outcomes, stonewalling it. What they never do is, engage with this blog. We’re good enough for Slate, STATNews, and the Chicago Tribune (and that’s in the last 3 months alone), but not the Wellness Ignorati.
However, we did manage to get a thoughtful response from a third party, Michael Prager. He raises some excellent points.
First, Ron says (and has said variations of this on many occasions) “most diseases are preventable” by wellness. That statement is flat-out wrong. Had Ron said — and this is Michael’s take on what he meant to say — “most people eventually die of chronic diseases that, had they made better choices in their life, might not have developed until later in life,” then he would have been right. Fact is, heart disease and diabetes are leading killers. Just as Michael says.
Ron got it totally wrong, though, with his most-diseases-are-preventable mantra. Only a few diseases are preventable through corporate “pry, poke and prod” programs. Just look at Ron’s own HERO guidebook. It lists diabetes and heart attacks and a few other ICD 9 codes as “potentially preventable hospitalizations.” Meanwhile, there are about 14,000 other ICD 9 codes (or 60,000+ ICD 10 codes) which are not preventable through workplace screenings, though one study tried to credit a wellness program with a decline in cat scratch fever.
Think of all the diseases or other expenses or health programs you yourself (assuming you are a non-smoker) have endured in your lifetimes. How many would have been prevented by one of Ron’s pry, poke and prod programs? Or, as Wellsteps’ Steve Aldana says, by eating one more bite of a banana? (He really did say that, but the STATNews website seems to be down this very minute.)
Now, if employees were covered for their entire lives by employers (they aren’t), and if employers could get them to reduce their risks (they can’t), then corporate wellness could work, and might possibly save money.
Second, Michael also points out that I distinguish disease-related “events” from the diseases themselves. These events are — and Ron’s HERO guidebook agrees with me on this — the only place an employer actually realizes savings from wellness, offset by many other costs. However, very few events caused by these conditions take place during our actual <65 working years. Like the annual odds of a heart attack for commercially insured people <65 are about 1-in-800. Using a few generous assumptions about program effectiveness, that already-low rate means it costs companies about a million dollars to prevent one through pry, poke and prod.
Finally, you should know a little about Michael’s back story. He did in fact turn his own health around through rigorous attention to diet and exercise, and I applaud and respect him for that. He encourages others to do the same, as do I. However, “encouragement” and intrinsic motivation are a lot different from, for instance, Michael O’Donnell’s recent diatribe that employee health insurance premiums should (at least in part) be assessed on a per-pound basis, sort of like when ordering lobster or mailing a package. That system, Mr. O’Donnell says, will get employees to lose weight.
Alas, if there is one thing wellness vendors can’t do, it’s get people to lose weight. The best example would be Ron’s buddies at the Vitality Group. They couldn’t even get their own employees to lose weight.
I am shortcutting Michael’s comments, so do go take a looksee on your own. It was a thoughtful response (two words you won’t see in succession in any other TSW posting) and is worthy of a careful read.
They Said What? 