The “prequels” to this posting are:

1. Springbuk wants employees to go to the bathroom
2. Fitbit Throws a Bit of a Fit, Part 1
   

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Fitbit might just have taken the lead in the wellness industry’s race to the bottom. They are using the “dumb and dumber” defense to deflect their ethical shortcomings. This defense has been shown to work, in the sense that Ron Goetzel still has a job.

In Fitbit’s case, they have no choice. If they claim to be intelligent, that would mean they dramatically overstated the value of Fitbits deliberately, as opposed to out of pure, sheer, unadulterated ignorance. In turn, that would mean that the folks at Fitbit could be facing a little taxpayer-financed vacation in the federal hoosegow. That’s because public companies aren’t allowed to deliberately misrepresent their product to shareholders, which is precisely what this press release does.  Stupid is OK. Dishonest isn’t.

Here are a few more morsels from that study:

• There were 22,259 employees in the employer population. Only 905 were in the study population. So the entire analysis of savings was based on projection from 4% of the population.
• For some unexplained reason, the control group –the people who did nothing at all — enjoyed a dramatic 9.3% reduction in medical claims costs, vs. an “expected” increase of 5.8%, a 15.1% swing. So doing nothing turns out to be a great strategy to achieve double-digit savings.
• Speaking of doing nothing, perhaps our favorite tidbit from this study is that an employee could stay in bed for up to 182 days a year  — meaning take 100 steps a day or less, getting up just to eat and pee, as described in the original Springbuk study — and “save” 21.8%.
• It’s also possible that employees simply forgot to put on their Fitbits the other 183 days of the year, which is why they didn’t appear to take 100 steps on those days. However, that possibility is not acknowledged anywhere in the study. That could be because it wouldn’t make for much of a study to say: “We compared people who forgot to put on their Fitbit for fewer than 182 days to people who forgot to put on their Fitbit for more than 182 days.”

Therefore, whatever the other criticisms of this study, no one can accuse them of lying or even exaggerating when they say:

Speaking of which, let us now just focus on the 374 people (about 2% of their entire population) who did take more than 100 steps a day for a whopping 274 days out of the year or more. Their savings are massive:

Even the healthier subset of employees can reduce healthcare costs by a quarter by wearing a Fitbit, but that’s nothing compared to “low steps” employees who walk only 6477 steps a day, about the same as everyone else in the country. Those lucky employees can slash costs by more than half by continuing to walk an average number of steps, but this time wearing a Fitbit.

Oh, wait a sec. They were wearing a Fitbit in the baseline year too. Otherwise, how would we know how many steps they took? So they didn’t do anything in order to save massive sums of money.

Come again?  This conclusion seems wacky even by Fitbit/Springbuk standards. So let me repeat it: these people did basically nothing in the study year that they didn’t also do in the baseline year…and yet they somehow set a record for greatest cost reduction ever achieved in a year, 50.7%.

Then, these employees broke their own record. This next chart is for employees with “>=365 days” of use over the course of a year. (Not sure how they could have worn a Fitbit for “greater than 365 days” since the baseline for this two-year study was 2013, but maybe every year is a leap year on Springbuk’s planet.)

You read that right: a 58.6% reduction in spending for those 133 people taking the average number of steps everyone else takes in both years.

How much is a 58.6% reduction in costs in terms of utilization reduction? That means that simply by continuing to be average, these 133 average everyday folks wiped out the equivalent of all their hospitalizations and ER visits and specialist visits besides. Of course, we won’t know because Springbuk never plausibility-tested the result. As they say in journalism, it was a story too good to check.

Or, if Springbuk and Fitbit understood the concept of attribution as described in Biostatistics 101, they would realize that one can attribute only reductions in wellness-sensitive medical events to a wellness program, since those are what a wellness program is designed to avoid.  If only those events can be avoided, they must have wiped out heart attacks and diabetes for these 133 people, their spouses, and roughly 5000 of their closest friends.

If anyone is interested in the real health impact of activity tracking, I’d recommend this JAMA article. It’s the only one on the topic which is not financed by people connected to the industry. Researchers attached activity trackers to some at-risk overweight/obese people to see how much weight they would lose (which would mean a reduction in their risk and possibly a slight reduction in their healthcare costs).  The study’s result? The study population gained weight.