…Apparently a “Pulse” in which I tell people not to read my books Why Nobody Believes the Numbers, Cracking Health Costs, and Surviving Workplace Wellness is on its way to becoming my most popular.  (Judging from our sales figures for Surviving, the marketplace seems to have reached that same conclusion on its own.)

However, it is the case that Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care presents what amounts to the business case for Quizzify, and ultimately Quizzify is how we keep the lights on to write They Said What? so far be it from me to discourage you from buying anything that makes you more likely to sign up for Quizzify.

It is with a heavy heart that I report WELCOA’s new management appears to be competent and honest.

WELCOA has apparently joined the “integrity segment” of the industry.  Alas, this is the third time in a month I’ve had to say something nice about wellness, and if this keeps up I will run out of scoundrels to expose.*  My carefully cultivated Larry David-meets-Erin Brockovich image could morph into Dale Carnegie-meets-Mary Poppins.

By all accounts, their new executive director, Ryan Picarella, is not only competent and honest.  As an added bonus, he even knows how to spell.

This last item may not sound like a ringing endorsement, sort of like Benjamin telling Mrs. Robinson he considers her to be among the most attractive of all of his parents’ friends. However, at WELCOA it represents a huge improvement, because the previous ED, David Hunnicutt, was both grammatically and phonetically challenged. Alert readers may recall that Mr. Hunnicutt claimed that WELCOA was founded by the inventor of the all-you-can-eat self-service restaurant, Warren Buffet. And our “This Is Your Brain on Wellness” feature would almost not be possible without some of Mr. Hunnicutt’s wellness-meets-Yogi Berra sentence constructions.

Here are the four datapoints behind my read of the tea leaves that WELCOA is joining what is becoming a slightly crowded integrity segment.

First, if you google Mr. Picarella, you’ll find that he comes from outside the wellness industry.  People outside the wellness industry are more likely to actually review the data than industry insiders. And as invariably happens when someone with a triple-digit IQ reviews the data on “pry, poke and prod,” they realize most of it is made up.

Second, the WELCOA website has a new look, reflecting the pivot to the integrity segment.  It is about wellness culture now, with “pry, poke and prod” finally banished to the attic with the crazy aunt and the Koop Award committee. WELCOA is positioning for the next generation of doing wellness for employees instead of to them. Or as we say in Cracking Health Costs, “Would a general leading an army into battle rather have troops with low morale, or troops with low cholesterol?”

Third, if you follow this industry carefully, you’ll see WELCOA has distanced itself from the American Journal of Health Promotion, the wellness industry trade rag featured in previous columns here for accidentally telling the truth on two occasions, one of which they walked back when they realized they had made a true statement.

Fourth and most importantly, they have removed David Hunnicutt’s Nebraska/Health Fitness Corporation (HFC) write-up from the WELCOA website.  As word of “Cancergate” and Ron Goetzel’s botched data falsification and cover-up spreads — the state of Nebraska recently fired HFC — WELCOA apparently wants to be on the right side of this scandal. We applaud them for that.

Never thought I’d be using “WELCOA” and “applaud” in the same paragraph…

Finally, I do hear a lot of buzz in this field, and the buzz around WELCOA is distinctly positive these days.  Members of the Welligentsia, who used to send me anecdotes for inclusion in “This Is Your Brain on Wellness” now routinely tell me what a great job they are doing.

And for that, I swallow hard and very reluctantly wish them well.

*Fortunately, as I learned a few weeks ago, I can still count on Ron Goetzel and his cronies to come through in the clutch when I need new material.  For instance, they recently doubled down on dishonesty by attempting to circulate a poison pen” letter about me to the media and somehow thinking it wouldn’t be exposed. After it did get exposed, they admitted it had no basis in fact.

Mind you, I’m not calling anyone liars here. I’m just saying that a beam of light leaving “honesty” wouldn’t reach this cabal for several seconds.  And I love being the subject of their innumerate rants. It is the closest I will ever come to realizing my childhood dream of being on Nixon’s enemies list.

Or it may be they aren’t consciously lying, in which case their math skills couldn’t get them a job as the “before” muppet on Sesame Street.

Occasionally our posts are totally pukey and I’m afraid this is one of them.  

Employee Benefit News just listed Cracking Health Costs as one of their must-reads for benefits professionals for Summer 2016. So we have to do the thing which we hate doing most on They Said What, which is be polite.  So, thank you to Employee Benefit News.  (Cracking Health Costs, along with its companion, the trade-bestselling Why Nobody Believes the Numbers, can be purchased on Amazon by clicking through on the titles.)

As long as we are thanking Employee Benefit News and purging our system of excess politeness, we gotta give them two thumbs up for publishing “Why Employers Should Ditch Biggest Loser Contests.”  We received about 28 inquiries from that one. This is helpful for the unique Quizzify sales strategy, which is to strategically sit around and wait for the phone to ring. And it did. And it does.  (Not throwing a lot of money at sales and marketing allows us to keep costs and prices down.)

And we are very grateful to everyone who has been contacting us both from that article and others…but not half as grateful as you will be when you implement a program that employees actually like so much that they don’t call you to whine about it.

That may not appear to be a resounding statement of confidence in our own offering. However, we are in the “integrity segment,” which means we can’t lie. Plus, in the wellness field, no other company can claim ALL of the following: decent participation with modest incentives, good feedback, few/no complaints, the moniker of the leading medical school (Harvard), and the Validation Institute-validated guaranteed certainty of actual savings.

Actually no other company can claim more than one or two of those.  But that doesn’t stop them.

The first line in this Employee Benefit News essay says it all.  And yet these contests still exist, thus showing that some corporate IT department directors should be fired, for failing to connect their organizations to the internet.

And, as our recent HealthyWage-Schlumberger write-up showed, the results are fabricated anyway.  The odds that the HealthyWage results were legitimate are about the same as the odds of winning the lottery 1000 times.

A young friend of mine participated in his first wellness program recently.  Being too young and idealistic to understand how the wellness industry works, he actually thought he would learn something, so he didn’t lie on the health risk assessment. (I am not allowed to use the name of his company. He is not so young or idealistic not to realize that dissing his company’s eminently dissable wellness program could get him fired.)

Since he listed “diabetes” as his disease, he got a call from a coach to “help” him with it.  He was young and idealistic, so he answered the phone. She was very impressed with how well he managed it. His BMI is about 22, and his hobbies include basketball, which he played at the college level, and swimming.  She said if he kept this up, he might be able to get off insulin.

“Off insulin? I can’t get off insulin,” he replied.

“I’ve seen many people get off insulin,” she said.

It turned out that his diabetes coach had never heard of Type 1 diabetes. He spent the next 15 minutes explaining to her the difference between Type 1 and Type 2 diabetes.  “Al, my company is billing out my time at $500/hour, I’m putting in 60-hour weeks…and spending my time explaining to diabetes coaches how diabetes works.”

If the people who run Schlumberger’s wellness program were actually producing drilling equipment, oil slicks would cover most of North Dakota by now.

Recently we observed what a fabulously stupid, pointless, counterproductive and harmful idea it was to run a crash-dieting contest.  We used HealthyWage as an example of a company that does this, and should be avoided.  We recommended doing wellness for employees instead of to them, by –to use one example — subsidizing gym memberships.

Schlumberger somehow interpreted this advice in a way which was the opposite of what was written. They signed up for an inter-corporate crash-dieting contest run by HealthyWage–which they financed by cancelling the employee gym membership subsidy.

A team from Schumberger was able to crash-diet their way to a highly precise 16.59% weight loss. That put them in a 6-way tie. Yes, 5 other teams also crash-dieted their way to a 16.59% weight loss.

The odds of 6 teams losing precisely the same amount of weight?  Suppose that a team can crash-diet its way to between a 10% and 20% weight loss.  As measured to 2 digits to the right of the decimal point, there would be a 1-in-1000 chance that two winning teams would achieve the same exact 16.59% weight loss. But six did. That’s a 1-in-1 quadrillion shot.

That means the odds of winning Powerball are about 1000 times better than the odds that HealthyWage knows how to read a scale.

For years, people have been arguing:

(1) Whether you should limit your saturated fat or limit your carbs and not worry about the saturated fat;

(2) How much salt you should consume.

On the first, if we had to pick, we would choose the Gary Taubes/Nina Teicholz side, which is that poor quality carbs (refined flour, white rice, and sugar), not fats or even saturated fats, are the bad guys for most people.  On the second, we quite firmly believe that for most people without high blood pressure, salt is fine in moderation.

However, we have two perspectives, overall, that get very little attention.

Perspective #1: the lack of clear evidence is, by itself, evidence

If indeed the impact were large one way or the other on either fats/carbs or salt/no salt, we would know it by now. There is a rule of thumb in epidemiology that big effects require only small sample sizes to reveal themselves. For example, the Freis study (which, by the way, I found a mistake in–and if anyone doesn’t believe me I’ll send them the thank-you note from NIH) required only 573 veterans to conclude that very high blood pressure caused strokes. And doctors and tobacco companies knew smoking caused lung cancer way back in the 1940s, after observing only a few hundred cases.

By contrast, tens of millions of people have been observed, hundreds of thousands have participated in (usually loosely) controlled trials…and yet there is no consensus, no clear direction of the evidence. There may be a diet that is better than other diets–but for most people the composition of the diet probably doesn’t matter much within reason, beyond avoiding junk food.

Consider three things that DO matter: exercise, smoking, and sugar. (We say “sugar” as opposed to carbs generally. Carbs generally probably do matter for most people, but that statement would take us out of certainty into opinion.)  The evidence is quite overwhelming on all three of those things. If you exercise, don’t smoke, and partake of a generally healthy diet low in sugar, you’ve achieved the “80-20 rule” for good health…and we don’t know what the other 20 is.

And even this 80-20 rule (except for smoking) is likely overwhelmed by factors that are beyond your control, like family history. We all know smokers who lived forever, people who “did everything right” who died young etc.

Perspective #2: Why do we assume that the answer is the same for everybody?

Note that we said “for most people” several times above. That was not an accident. One size probably does NOT fit all. (Coincidentally, another blogger wrote on this exact topic this morning, related to obesity.)

Humans differ in many ways. Why do we assume there is a “right answer” in the case of diet?  Isn’t it possible that people whose ancestors evolved in the tropics react differently to different foods than people who evolved in very cold climates?  It’s certainly true for salt. Ethnic groups and races evolving in climates with cold winters needed to salt their foods to preserve them. They ended up consuming far more salt than we do today. Salt was the world’s most important traded commodity for centuries. Invading armies would take over the salt works. “Salzburg” was even named after salt. Conversely, ethnic groups and races from the tropics had year-round access to food, preservation wasn’t an issue…and now African-Americans in particular have high rates of hypertension.

Likewise, dairy. Lactose intolerance varies widely by global region. For example, people of Northern European descent have evolved to have a much lower likelihood of lactose intolerance than people of Asian descent, which has implications for nutrition status and hydration status. However, even amongst people who suffer from lactase deficiency, many can still drink milk in small amounts and consumption of fermented milk products, such as yogurt and buttermilk, can help them get the benefits of milk without the discomfort.

So why wouldn’t variations like this be true for many other dietary components?  Why wouldn’t some people fare better on a high-fat diet while others do better with more carbs? Why wouldn’t it be true that as long as overall diet quality and calorie content are within generally healthy parameters there are quite possibly millions, even tens of millions, of healthy ways to eat? John P. Ioannidis of Stanford, easily the leading thinker on medical research today, makes this point exactly in his piece published this week in the American Journal Of Clinical Nutrition, in which he criticizes not only the conduct of nutrition research, but the flawed conclusions that all too many people draw from this stilted and often irrelevant body of literature.

Where does this take us?

Naturally, these conclusions invalidate the business model of most of the wellness industry. Vendors tend to demonize one type of food or another. For years they were advocating low-fat diets (and finding huge savings).  Now they are advocating low-saturated fat or low-carb diets. It doesn’t matter which, because the savings are always huge, in wellness.  (The irony, of course, is that in the working-age population, most medical spending is unrelated to diet.)

There is ONE THING that OVERWHELMS the impact of everything else on health, that is NOT OPEN TO CONTROVERSY.  That, of course, is exercise.  A little is better than none, some is better than a little, and within reason a lot is better than some. But many wellness vendors would have us believe there are shortcuts to good health, that coincidentally are profitable for them. Crash-dieting contests, like HealthyWager’s, are one example. Other vendors advise us to micromanage our diets, often with a level of blatantly incorrect certitude, as in this Cerner example:

These distractions have employees and HR people believing there are automatic shortcuts to good health, when there are none. Exercise is a commitment, not a shortcut. but it is a way to good health.  Just not one that is likely to make wellness vendors a lot of money.

Worse, once the wellness apologists admit that all this lowfat/crash-dieting stuff is nonsense, it means their entire history of savings claims based on those initiatives becomes one big lie. So you can bet that crash-dieting contests and bad diet advice will remain staples of the wellness industry, right up there with annual checkups and overscreening.