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To screen or not to screen: the most coherent answer ever

I am a mere supplicant at the feet of the true experts in the field of screening.

Linked here is the single most coherent article on the subject I’ve ever seen, just came out today. Basically, it says: “Screen according to guidelines.” That simple sentence is the source of a great battle pitting Quizzify and the Welligentsia against the Wellness Ignorati and most of the screening industry (excluding It Starts with Me, Limeade, and US Preventive Medicine, all of which offer screening programs more or less aligned with guidelines), whose livelihood depends on employers not screening employees according to guidelines, and finding some of the wackiest tests in the world to foist onto unsuspecting employees.

Highlights of the article:

  1. Many people are overscreened and massive numbers of people get tests they don’t need
  2. Many people are underscreened
  3. Do not purchase B-to-C screenings like Star Wellness, the subject of a recent profile here, offers.

Specifically as to the third point, they called out AngioScreen as an example of companies trying to circumvent doctors by offering inappropriate screenings. AngioScreen is unique in that right on their website they acknowledge that their entire business model is built on an a screen the US Preventive Services Task Force calls inappropriate.

They also list an outfit called Matrix Medical Network as an example of a company offering inappropriate screens. Matrix Medical Network…hmmm…where have I heard that name before…oh, that’s right! I founded Matrix Medical Network. (Actually, co-founded and was an original board member and investor. And, yes, unlike wellness vendors, irony is not lost on me. See “Ironically, the wellness industry does not understand irony.“)

One way or the other, this article is worth a read because it truly draws a thoughtful line between appropriate and inappropriate screenings.

 

 

Al Lewis unplugged, uncut, uncensored…and uncombed

Wellness, Quizzify, you name it. We cover it in this Youtube episode #13 of Friends of Benefits.

Thanks to Dave Contorno and Jeff Bernhard for hosting.

Star Wellness Doubles Down on Ignorance

Once in every great while, when we’re least expecting it, a company comes along that makes us reconsider our viewpoint–and ponder the possibility that maybe we’re wrong about wellness. Maybe, finally, we’ve discovered a company that will motivate employees to get well.  Maybe a company that adheres to screening guidelines.  Maybe even a company that will solve America’s healthcare crisis.

Star Wellness is not that company.


Below, you’ll find a partial list of the clinical goodies in Star Wellness’s hyperdiagnostic candy jar. Most of these tests would never be ordered on an asymptomatic patient by a doctor, but not to worry. In 47 states, you can actually purchase these tests directly from the Star’s lab, without some pesky doctor with some silly medical degree observing that it’s a bad idea to subject healthy people to a barrage of mostly US Preventive Services Task Force C-and-D-rated tests. Instead, you can get your results reviewed by one of Star’s highly qualified, thoroughly vetted, well-trained…franchisees:

Star is seeking franchisees with backgrounds in sales, finance or (and we are using a screenshot because we don’t want to be accused of making this up):

Five whole days? Oh, wait — “up to” five whole days. So maybe a really smart municipality administrator could cover all the material in four days. That leaves one extra day to snooker employers and harm employees.


Here is a partial list of their tests. I say “partial” because you can click through on the “general health profile” and find even more tests. And many of these tests themselves include more tests. For instance, a complete blood count has 6 and the “comprehensive thyroid panel” has 7. In total, you can get more than 40 blood values measured. If these tests are 90% accurate and you are completely normal, 4 (10%) of those tests could return a value that is out of range, just randomly.

When I say they “doubled down on ignorance” of the fact that you simply aren’t supposed to go around hunting for diseases, it’s because they used to do only about half as many useless tests as they do now. So they have literally doubled down on ignorance, vs. this original list:

Where to start? First, no licensed doctor should “typically order” these tests “during a routine physical,” at least if they want to keep that license. (Star can order them because wellness vendors aren’t doctors. They only play doctor, so they don’t need a license.)

Second, these tests are not “over $350 value,” for many reasons. Besides most of them being worthless or harmful, a “routine physical” doesn’t cost $350. Capitated doctors would go bankrupt ordering these tests.

Then there is “Lyme’s Disease.” News flash: it’s called “Lyme Disease.” No apostrophe. Just as they are confused about basically everything else involving wellness, they may be getting confused about the origin of the name, so I’ll clue them in. It’s named for the town where an epidemiologist identified it, not for a Yankee who died of it.

And if they have figured out how to accurately diagnose Lyme Disease, they deserve a Nobel Prize. Finally, no doctor would order a test for “Lyme’s Disease” as part of a routine physical.

The US Preventive Services Task Force doesn’t rate Lyme Disease screening because no one should be screened for Lyme Disease, and everyone other than Star Wellness knows that. (Yes, people who have been exposed to ticks or who have symptoms should be tested. But those are tests done as part of a diagnostic workup, not screens that employees are forced to undergo if they don’t want to be fined. Tests are done by doctors, not municipal administrators.)


H. pylori: The worst wellness screen ever?

First, the US Preventive Services Task Force doesn’t bother to grade it, largely because no self-respecting doctor would ever screen patients for this.  Shame on the USPSTF for consistently failing to anticipate all the ways in which wellness vendors can misunderstand basic clinical science!

Second, most of us who harbor H. pylori have no symptoms.  So why screen for something that’s not causing problems?  That’s the very stable genius of Star Wellness. By expanding tests to include panels of no clinical value whatsoever, Star Wellness can make more money, which will please them, and hyperdiagnose more employees, which will please their clients.

The fact that a real doctor would only test someone who has an actual reason to be tested explains why H. pylori is a test, not a screen.  If you have an ulcer or symptoms that suggest an ulcer, go to the doctor. Even then, the doctor probably won’t even bother to test you, since most people get relief simply from well-tolerated, commonly used pills like Zantac.  It is only if the first-line medications fail that most doctors will even test you.

Third, H. pylori may be beneficial.  Screening us to try to get rid of something we generally want in our bodies represents a new frontier in hyperdiagnosis.

Fourth — ironically, given the wellness industry’s obsession with employees’ weights — it is even possible that killing off H. Pylori contributes to weight gain.

Fifth, what exactly are we supposed to do, if it turns out we harbor H. pylori?  Get a course of antibiotics to clear the bacteria out of our system?  That makes sense.  We’ve always maintained that one of the problems with America’s healthcare system is that patients aren’t prescribed enough antibiotics. (Not.)

The good news for the pharmaceutical industry is due to the nature of H. pyroli, hiding in our stomach mucus, it takes a lot of antibiotics to ferret it out, plus a bunch of other pills.  Is this a great country or what?

Finally, half the world’s population has it.   Given the expense and inaccuracy of the test and the prevalence of the bacterium, why not eliminate the middle step and just put all your employees on antibiotics?


And now let’s play Jeopardy 

Answer: Along with everything else, this is a topic Star Wellness knows nothing about.

Question:

Their random number generator is slightly off: 222,000 people under age 45 do not suffer a stroke every year. For 18-to-44-year-olds, the actual statistic is 14,835.  And yet Star is convinced that the number should be 14 times higher, judging by their choice of punctuation mark! Let’s test their hypothesis that you can make an utterly false statement true by adding an exclamation point to see how well that works: “Star Wellness Is Run by Geniuses!”

No such luck. We’ll try a few more exclamation points below to see if we get a different result, which is very likely!

Since there are more than 50,000,000 adults under 45, you would need to screen 3000 employees to find one person who would have a stroke. If their test is 90% accurate (in their dreams), for every person they find who needs to go to the doctor to prevent this stroke, 300 (10% of 3000 — the false positive rate is the inverse of the accuracy rate) would be sent to the doctor for no reason to potentially have their arteries reamed out or some such thing. And the only way that guarantees that you’ll prevent a stroke is if the treatment kills the employee first.

That is exactly why you shouldn’t be going around screening people for this stuff — especially people under age 45.


Let’s teach Star Wellness how to do their job

Take a looksee at this illustration of a Star Wellness health fair. I’m sure this picture will appeal to every employee!

Sal, Wyoming’s not a country.

Star Wellness, Vitamin B12 is not a vaccine.

And why any employer would want to go around poking employees with syringes full of vitamins would be a mystery to most doctors. But Star Wellness franchisees are way smarter than any doctor!

At least when it comes to knowing how to administer a municipality.

Yes, yes, of course: the Penske file

When it comes to wellness, the unwillingness of senior HR executives to search the internet continues to boggle my mind. As a result, Penske Automotive’s Executive VP of Human Resources somehow missed two of the most widely circulated memos of the last five years:

  1. Annual checkups provide no net benefit for most working-age people and are a total waste of money;
  2. As of January 2019, you can’t force employees to get them by tying them to large incentives or penalties.

As to the first, I will give him credit for one thing. He says: “We know that when you see a doctor, eye to eye every year, it has an impact.” Darn tootin’ it does — an immediate 2-3% increase in your health spending.

Later he says: “It’s too soon to see results of decreased costs to the company from the initiative.” Ya think? This is like the Comptroller of the state of Connecticut saying that, yes, of course costs went up when they made employees get physicals, but higher healthcare costs are “a good thing.”


More on The Penske File.

Having seen no savings, Penske’s EVP decided to take the obvious next step, the step that every executive takes once a wellness initiative has been shown to be a complete failure just like the literature predicts: roll the program out to more people. In Penske’s case, that would be spouses and domestic partners.

He added: “We are going to see over time our health care costs decrease… We may not see it this year or next year, but we’ll see it over time for sure.”

Start the wait…

Any sign of savings yet?

 

 

 

 

 

Ron Goetzel Spins Gold into Straw, Part 2 (a semi-guest post by Bob Merberg)

First, congratulations to Joe Andelin, who caught just about every fallacy, alternative fact and, if there were such a thing, alternative fallacy in yesterday’s presentation. I know he did because I was on the call.

Wait, Al, didn’t you say they blocked you? 

Yes, but displaying the same level of competence that they routinely bring to their day jobs, they managed to block only my video, not my audio.


Here were our predictions we got on the nose. We predicted he would say:-

  1. The study only covered the first year — he won’t mention that the authors also said the first year suggests nothing “is trending towards savings” in future years either;
  2. He said he study contradicts many of the other findings out there — except, of course, for all the other studies testing the par-vs-non-par study design against a benchmark, all of which showed results quite literally identical to the University of Illinois result, in that the wellness program accomplished zero;
  3. It wasn’t a good program. To hear Ron tell it (literally hear him tell it — you can listen to the tape), anytime a program fails, it’s because it wasn’t done correctly. “100 employers [have] programs with really smart ingredients…but thousands of others still don’t do wellness right,” are his exact words in print.  He is refusing to name any of them, other than the old Johnson & Johnson analysis. (J&J is a wellness vendor. Investigator bias, anyone?)

The last is his go-to excuse. He said the University of Illinois program, which consisted of screenings and incentives to use the gym, was a “throwback to the 1980s.”  In reality, the program was a “throwback” to every single Koop Award-winning program, all of which feature “pry, poke and prod” programs and some kind of fitness incentive. The only thing missing from this program was the broccoli.


I was wondering where to go with the rest of this posting but then into my comments box popped my old friend Bob Merberg, who is perhaps the smartest person I have ever met on the subject of wellness outcomes measurement. His comments are better than anything I could have written (assuming I had been allowed to see the slides).  Here they are in their entirety:

Al, I’m not usually one to comment on other people’s blog posts, and certainly not one to promote my own content, but I attended the webinar and found the conclusions drawn by the presenters to be egregious. One of the presenters correctly pointed out that subjects in the treatment group were, “More likely to report that the employer values worker health and safety.”

But then — bizarrely — he went on to say, “In other words, … people felt more engaged, and had better morale, and had better feelings of satisfaction working for the employer by being in the treatment group. In my mind, the headline ought to be ‘Wellness Program Increases Employee Engagement and Morale’ as opposed to ’37 Things We Didn’t Find Any Difference In.‘” Another presenter termed this the key finding.

But feeling like your health and safety are valued, while important, is by no means a the same as morale, engagement, or job satisfaction. In fact, the study did not measure morale or employee engagement. It did measure job satisfaction, self-reported “bad emotional health,” and changes in happiness at work, and found that the intervention group experienced no significant improvement compared to the control group.

If we were to jump to any conclusions from this study, they might be that feeling valued are NOT linked to job satisfaction and other psychosocial metrics.

To promulgate that the “key finding” was improved morale, improved employee engagement, and improved job satisfaction, is at best a sign of failure to understand the study, and at worst a deception. Under any circumstances, it’s a disservice to the study subjects who presumably consented to participate in good faith science, to the researchers — who were meticulous in their methodology and transparency — and to those of us in the wellness industry who are more interested in understanding what works rather than distorting facts to serve our own self-interest.


But wait…there’s more.

More in my blog post: https://www.linkedin.com/pulse/employee-wellness-truth-isnt-true-bob-merberg/

Mostly for fun, a time-lapsed video of my research and writing process on this subject: https://youtu.be/hQ6HqkN-VPw

 

Wellness News Roundup: Are Diabetes Management Vendors Doing the Wrong Thing?

Should a typical diabetic employees be incentivized to get his or her Hba1c down to 7?

Should copays on strips be waived to encourage diabetic employees to test their blood sugar every day?

Read this issue of Wellness News Roundup for the surprising new research.

Also in this issue: this will come as a big shock but it turns out — get ready — employees are not health literate.

 

 

Ron Goetzel Spins Gold into Straw, Part 1

I would invite everyone to join tomorrow (Tuesday’s) webinar by Ron Goetzel. He will be attempting to undermine the National Bureau of Economic Research’s (NBER) outstanding University of Illinois study, which showed — surprise — that conventional wellness programs don’t come close to changing behavior, let alone saving money. I would love to attend, but I, of course, am not invited to his events any more than he is invited to mine. Oh, wait a sec, I invite him to all my events and alert him to all my postings on linkedin so that he can correct any errors I’ve made. Sorry, my memory failed me there for a second.

Speaking of failed memories, he is being joined on this webinar by Jessica Grossmeier. If that name rings a bill, it’s because she claimed her company, Staywell, saved $17,000 per risk factor reduced — about $3000/pound shed — for British Petroleum, having forgotten that she herself claimed it is only possible to save $105/avoided risk factor. See “British Petroleum Wellness Program is Spewing Invalidity.”

Despite this being the Gold Standard of randomized control trials, he will be accusing the NBER of many errors.  (A cynic might note that being accused of making errors in a wellness study by Ron Goetzel is like being accused of cheating on your taxes by Paul Manafort. ) He will argue that:

  1. The study only covered the first year — he won’t mention that the authors also said the first year suggests nothing “is trending towards savings” in future years either;
  2. The study contradicts — you guessed it — Kate Baicker’s infamous 3.27-to-1 ROI, without mentioning that the NBER’s principal investigator, as coincidence would have it, reports to Kate Baicker, so it’s pretty unlikely he would diss her unless the data left him no choice;
  3. The study contradicts all the other findings out there — except for all the other studies testing the par-vs-non-par study design against a benchmark, all of which showed results quite literally identical to the University of Illinois result, in that the wellness program accomplished zero;*
  4. The participants outperformed the non-participants;
  5. They haven’t reported on the screening yet;
  6. It wasn’t a good program. To hear Ron tell it (literally hear him tell it — you can listen to the tape), anytime a program fails, it’s because it wasn’t done correctly. “100 employers [have] programs with really smart ingredients…but thousands of others still don’t do wellness right,” are his exact words in print.  He is refusing to name any of them, other than the old Johnson & Johnson analysis. (J&J is a wellness vendor. Investigator bias, anyone?)

What else will he argue? Tough to say. One thing for certain: he won’t mention my name — any more than Bravo did when they wrongly predicted that the EEOC rules would be replaced in January while I predicted the opposite.  Instead he uses a new vernacular for my postings:  “Industry chatter.”

He probably picked up this idea from Bravo, which uses the phrase “industry noise” to describe me.

 


Where’s Waldo-meets-Ron Goetzel: Spot the errors and you may win a big prize

So let’s make this interesting. Whoever comes up with the best smackdown of the webinar’s obvious fallacies (and omissions) automatically gets entered in the contest to win the Martha’s Vineyard vacation, with the house, car and private (well, semi-private) beach. It is otherwise open only to people who have won various Quizzify trivia contests, but being able to identify five or ten pieces of “chatter” or “noise” in this self-anointed “expert webinar” clearly counts as being health-literate.  To compete, send me an email with an attachment. I’ll pick a couple of finalists and put them on linkedin. (If you don’t want your name used — and Ron does bite back, so I don’t blame you — I will post on my own.)


*The result is also quite consistent with Ron’s observation that there is basically no change in behavior leading to risk reduction. If we are splitting hairs here, Ron found a 1-2% reduction, not 0%. Of course, that took three years.

 

 

 

 

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