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Journal of the American Medical Association on the Harms of Overscreening

They Said What has always noted the complete and utter worthlessness of screening the stuffing out of employees. The wellness vendor response to this observation?  To double down on overscreening. One recalls the immortal words of the great philosopher Inspector Louis Renault: “Owing to the seriousness of this crime, I’ve instructed my men to round up twice the number of usual suspects.”

Here is one such vendor, the lucky recipient of a follow-up profile to be published next month.

Their litany of tests before my initial observations about their overscreening were published:

Their current roster of tests, setting a new wellness industry record:


However amusing it may be to remark on the rampant epidemic of very stable genius-itis in the wellness industry (and it is), screening the stuffing out of employees is no laughing matter. It is harmful. Here is the current Journal of the American Medical Association on the harms of screening. Unfortunately the entire article is behind a paywall, but the abstract basically highlights the wellness industry business model:

Overused tests and treatments and resultant downstream services generate 6 domains of negative consequences for patients: physical, psychological, social, financial, treatment burden, and dissatisfaction with health care. Negative consequences can result from overused services and from downstream services; they can also trigger further downstream services that in turn can lead to more negative consequences, in an ongoing feedback loop.

This is of course exactly what hyperdiagnosis is all about — and the poster child for hyperdiagnosis is none other than the winner of the 2017 Deplorables Award, Interactive Health. A single Interactive Health display captures it all, the breathless braggadocio about sending employees to the doctor because they flunked one or more of the 43 tests that Interactive Health runs, with no regard for the harms that JAMA has identified:

So, in all seriousness, can we please, please stop the hyperdiagnostic madness and start screening according to the US Preventive Services Task Force guidelines?

A Review of Netflix’ The Bleeding Edge

The wellness industry is the Maginot Line of workplace health. While wellness vendors are imploring employees to eat more broccoli, and hyperdiagnosing the stuffing out of them to find “newly discovered” conditions that are mostly false positives and harmless out-of-range readings, really bad stuff has been happening that has somehow eluded this industry’s attention. One would be the opioid epidemic, which no vendor seemed to notice. Except Optum, whose HRA basically advises employees to get more pills for their pain.

(Do you know more than Optum does about opiods Take this quiz and find out.)


The other would be the explosion of harms caused by the healthcare industry itself, and that is the subject of The Bleeding Edge, a well-received new documentary (Rotten Tomatoes rating: 89%) on Netflix. (In case anyone is keeping score at home, Quizzify is also about harms caused by the industry…and already educates employees to avoid most of what The Bleeding Edge covers.)

The Bleeding Edge follows victims of three different kinds of implants — vaginal mesh made by Johnson & Johnson, metal-on-metal hips made by Johnson & Johnson (are you seeing a trend here?), a birth control device financed in part by the current head of the FDA — along with briefer cameos for CAT scans and the DaVinci robot.

Interviews of victims of these implants (including one who started out as a spokesperson for these implants) are intertwined with surgeries and images of devices gone haywire inside the victims’ bodies, and expert talking heads about how this could be allowed to happen. (“More evidence is required to remove a device than to approve it.”)  The experts are very well-credentialed and include the long-time head of the FDA, David Kessler, and bestselling author and Johns Hopkins accountability guru, Dr. Martin (“I love what Quizzify is doing”) Makary.

Perhaps the most compelling interview, though, is with the aforementioned former spokesperson for the birth control device-turned-victim advocate. Switching sides like this never happens. Most people pick a side and stay on it, facts be damned. Switching sides after seeing new facts is almost unheard of — it would be like Ron Goetzel not only admitting that wellness doesn’t work, but blowing the whistle on his friends at Wellsteps and Interactive Health.

The difference was that this spokesperson was also a customer…until her device went badly astray as well.


What is the FDA doing about this?

So what, as the film describes, is the FDA doing to put the kibosh on all this? Four things:

  1. Facilitating approvals of new devices on almost no evidence
  2. Laughing out loud on videotape at the idea that they may get in trouble because some people could get harmed
  3. Hiring industry executives to regulate their friends and companies they have invested in
  4. Firing experts who advocate for disclosures of hazards.

Yes, we know it isn’t always about Quizzify but #4 specifically relates to the hazards of CAT scans. The FDA apparently fired nine employees for advocating what we here at Quizzify have educated patients on — right on our landing page quiz — for three years: the radiation hazards of CT scans, especially repeated scans. Your doctor isn’t telling you about this risk possibly because everyone at the FDA who would have told them is gone.

Likewise, the FDA takes a hands-off approach on the DaVinci robot, another Quizzify whipping boy, though we weren’t the first to question their integrity. The FDA let the company put the robot into the hands of completely inexperienced surgeons, and multiple cases have been reported in which a woman’s insides literally fell out following the surgery.

Many doctors — especially “leading experts in the field” — get directly or indirectly compensated to use and pitch these devices. Your doctor could be one of them, and it’s not like he or she is going to volunteer the information.


What should employers do?

It seems that the only people who truly advocate for the patient are the patient and the patient’s family. Everyone else involved in the care conversation makes more money when employees buy more things on the employer’s dime. (This is not to say all providers or device manufacturers are corrupt, or anything close to that, of course. But with all this money at stake, shareholders interest and patients’ interest could be at great variance. One need only look at stock prices to see which side usually wins.)

Likely much the opposite of what they are doing now. First, stop obsessing with screens and risk assessments. Prying, poking and prodding doesn’t work, so get over it. Start focusing on things that matter, like the harms described in this film and like what Atul Gawande says:

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year…Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

At the very least, employers should slow down before encouraging the opposite, incentivizing employees to use lower-cost settings to get things that they may not need, and may even harm them. Obviously (with the exception of childbirth, which is going to happen anyway), removing the economic disincentive to get more stuff means people will get more stuff.

Instead, educate your employees, using Quizzify or some other tool like Quizzify (good luck finding one), that, as we say at Quizzify and as anyone who watches The Bleeding Edge will say:

Just because it’s healthcare doesn’t mean it’s good for you.


 

 

 

The evil genius of Arkansas’ teacher wellness program

Arkansas recently contracted with an out-of-state vendor called Catapult Health to come in to the state’s schools and “play doctor” with the teachers, asking them personal questions, taking their blood and then telling them everything that’s wrong with them. This is a classic example of a “pry, poke and prod” program.

This is followed by admonishments to take more steps and eat more broccoli.  They then refer teachers into lifestyle and disease management programs “at record rates.”

Sounds terrible, but the good news is that this program isn’t going to cost taxpayers anything because, as Catapult Health’s website says:

Phew! At least it’s free to taxpayers because Catapult’s expenses and profits are “already in your budget” and “fees are processed through your health plan.”

Except that the state of Arkansas is its own health plan. There is no “Don’t worry. Insurance will pay for it” here. The state is self-insured, meaning they pick up the tab, not some nameless insurance company.


But, hey, at least this program will save money, right?

The return-on-investment for the state is allegedly 3.27-to-1, as shown by the so-called “Harvard Study,” conducted by Katherine Baicker.

Except that the Harvard study has been proven wrong, not just by the nonprofit, nonpartisan highly respected RAND Corporation (and I myself chimed in as well), but by an ace researcher named Damon Jones, part of the prestigious National Bureau for Economic Research. His work showed that wellness accomplishes virtually nothing other than the expenditure of money. (Don’t worry—insurance will pay for it.)


But, hey, maybe Prof. Jones is wrong. After all, why should he care what Prof. Baicker thinks, right?

Um, because he reports to her? Yep, he’s an associate professor at the exact same school of public health where she is now dean.  Just guessing here, but it would seem a subordinate would have to be pretty darn sure of his findings (and they are rock solid, and completely in agreement with all the other recent research, summarized here) to publicly humiliate his own dean.

Even Prof. Baicker doesn’t defend her findings any more. She says: “It’s too early to tell.”  That means she is running away from her very widely cited signature study, upon which essentially the entire wellness industry’s economic justification is based.  This would be like Arthur Laffer, whose Laffer Curve created supply-side economics, which has been used to justify two tax cuts, saying “well, maybe it’s not right. I dunno. Let’s wait and see.”


But, hey, at least forced wellness improves employee health, right?

Apparently not. Forcing people to get annual wellness checkups doesn’t benefit them, according to the New York Times, the New England Journal of Medicine, the Journal of the American Medical Association, and Consumer Reports. (Before dismissing the credibility of those sources due to possible political bias, keep in mind that Newsmax, The Federalist, and Laura Ingraham hate “pry, poke and prod” programs too.)

Forced wellness also takes teachers away from the classrooms to be pried, poked and prodded, stresses them out, and adversely impacts morale.

Further, sending “record rates” of employees into lifestyle and disease management is classic hyperdiagnosis – braggadocio-fueled misunderstandings of the arithmetic of lab results, resulting in large numbers of people getting told they need coaching and care they don’t want or, in general, need. Nothing makes a wellness vendor happier than to hyperdiagnose as many employees as possible.


But, hey, maybe teachers are a special case. Maybe the impact of “pry, poke and prod” programs is different for them?

It sure is. The single school district for which the data has been compiled is Boise, Idaho. According to the wellness vendor’s own data, the health of the teachers got somewhat worse as a result of this pry, poke and prod program. (The vendor, an outfit called Wellsteps, also admitted that they flouted clinical guidelines and fabricated their only positive outcome. They also previously admitted that costs went way up as a result of their program. They later suppressed that admission. Wellness vendors are not known for their integrity.)

So the health of teachers may deteriorate, creating more medical expense. but don’t worry. Insurance will pay for it.


But, hey, at least the teachers like it, right?

According to Catapult, employees love them. Ask the employees and you might get a different impression. indeed, I was tipped off to this program by an Arkansas teacher who hates it, like most of her colleagues do — and that’s before they learn that they are actually paying for it…keep reading.

Obviously if teachers wanted to submit to a “pry, poke and prod” program, the state wouldn’t have to threaten them with massive fines – almost $1000/year, which appears to be close to a record for any pry, poke and prod program anywhere — for refusing to let a private, out-of-state corporation play doctor on them at state expense.


But, hey, at least the state taxpayers save money by fining the teachers who don’t want to play doctor, right?

Actually, wellness makes claims costs go up, probably by more than the fines. There are lots of unneeded lab tests and other tests. For instance, the state of Connecticut admitted that in addition to throwing away all its money on the actual wellness program, they spent more on health care.  The state comptroller who administered the program said the increased spending was “a good thing.” I guess he wasn’t worried because insurance was paying for it.


But, hey, at least the teachers don’t pay for it.

Actually they do. The state’s human resources department brilliantly figured out that they could launder their wellness spending by hiring this outfit. By paying extra to Catapult (a multiple of what an effective wellness program would cost), the state is able to pick up the tab for wellness using the extra paperwork of a medical claim, as opposed to an outsized administrative expense in a separate line item. The latter would clearly need to be picked up by the taxpayers…and the state would have an incentive to control this highly visible figure.

By contrast, paying for “pry, poke and prod” as a medical claim will never be noticed, like Steve McQueen and David McCallum sprinkling the dirt from the tunnel around the stalag.  On the other hand, it will increase overall medical spending by 2-3% (the cost of the screening plus the added hyperdiagnosis expenses).

Here comes the evil genius part: at the next contract negotiation, the state can limit wage increases (or reduce benefits) by pointing out how high the health spending is.

So the teachers get pried, poked and prodded, hyperdiagnosed with hidden illnesses most of them don’t have – all against their will…and then they have to pay for the privilege in reduced wages.


Wow…the teachers are getting screwed. But, hey, at least they can’t sue the state, right, so taxpayers won’t have to pick up that bill as well?

Starting in January, this program will be in blatant violation of two laws, the Americans with Disabilities Act and the Genetic Information Non-Discrimination Act. Those laws disallow forced wellness checkups, but allow so-called “voluntary” ones.

Until recently, “voluntary” meant “do wellness or pay a big fine” like this one. But thanks to a lawsuit by AARP, the rules are changing in January so that “voluntary” must mean voluntary, like a dictionary would define the word.   (This summary has the links to all you need to know about the case.) To get these fines back, teachers will be able to sue the state, possibly even as a class action, and possibly being awarded punitive damages. Exposure to lawsuits could cost the state millions more in addition to its current expenditure on Catapult Health.

And that doesn’t even cover the costs of a possible teacher walkout, like the one in West Virginia that was spurred in part by – you guessed it – their wellness program.

But, don’t worry. Insurance will pay for it.

Colon cancer screening should start at 45. (Not!)

If there is one thing the US healthcare system is really really good at, it’s rooting out hidden disease via massive hyperdiagnostic screening campaigns. But there is always room for “improvement” by finding some unsuspecting cohort — in this case, 45-year-olds — that was getting just a little too complacent about the fact that virtually no one that age dies of something that could have been found — and also prevented or addressed — via a non-USPSTF-recommended  screen.

Serves them right.

The American Cancer Society (ACS) recently decided that, because the rate of colon cancer has been increasing in the 45-to-49-year old cohort, that screenings should start in that age group. The “alarming” 22% increase in relative risk during this century translates into an increase in the absolute rate of colon cancer in the <50 cohort from 0.006% to 0.007%. Yes–0.001% more of the <50 population in this country will get colon cancer now than 18 years ago. I’m surprised they didn’t recommend calling out the National Guard.

Further, many of that 0.007% experienced symptoms, and hence would be getting a colonoscopy as a diagnostic test, not a screen. And others in that age grouping had a family history and should get screened regardless of what the “average” person should do. Suppose those two categories account for half of the colon cancer population. That leaves roughly 0.0035% of the 45-to-49-year-old population who could possibly benefit from a screen.

As with the other “alarming” colon cancer figures that have been published in the last few years, your chances of having your life saved by a colon cancer screening at that age is about the same as your chances of being struck by lightning.

And a screen is far from a lifesaver in general. Quite the contrary, statistically speaking it is likely to find the slow-growing tumors while missing the more aggressive, faster-growing tumors that begin between screens.


The Hazards of Screening

That trivial benefit must be weighed against the nontrivial harms. The risk of a complication, such as a perforation, is estimated between 1.6% and 1.8%. (In all fairness to the ACS, they aren’t insisting that the screen be done via a colonoscopy, though the non-invasive screens have such high positive/inconclusive test rates that they often lead to colonoscopies.)

Unless I have the decimal point in the wrong place, that means the rate of complications is a whopping 320 times the likelihood of something being found. Oh, wait a sec — make that 3200 times.

OF course, the worst complication is death, and the mortality rate from colonoscopies (0.02%) appears to be, on its face, much higher than the rate of lives that would be saved. However, once again, though it kills me to say it, in all fairness the mortality rate, and for that matter the complication rate, increases with advancing age, meaning the younger you are, the less likely you are to die from this screening. So maybe the mortality rate in the 45-50-year-old cohort isn’t any higher than — and might even be slightly lower than — the rate at which early detection will save lives.  I feel much better knowing this. Don’t you?

And what is it about colon cancer that brings out people’s inner very stable genius?  Here is the Cleveland Clinic on the subject:

colon cancer

Newsflash: 144,000 is not “1 out of 19 people in the United States.” It is barely 1 out of 19 people in greater Cleveland.


The best argument against screening 45-year-olds

Nonetheless, when it comes to screening 45-year-olds for colon cancer, the best argument against it is that Star Wellness is for it.  By way of background, Star Wellness is best known in wellness for not knowing anything about wellness. They take great pride in that, boasting that anyone can become a wellness vendor. All you need, they say, is a background in “sales or municipality administration,” five days of training…and of course a certified $65,000 check payable to — get ready — Star Wellness. No surprise that Star was leading the wellness industry’s race to the bottom until they got outstupided by Total Wellness, Interactive Health, and Wellsteps.

But Star Wellness is not willing to lose this race to the bottom without a fight.

Not content to offer the full range of USPSTF non-recommended screens, they are practically hyperventilating over this opportunity to add yet another one. They use the example of ovarian cancer screening to justify more colon screening. Here is the USPSTF on the subject of ovarian cancer screening:

The USPSTF found adequate evidence that screening for ovarian cancer can result in important harms, including many false-positive results, which can lead to unnecessary surgical interventions in women who do not have cancer. Depending on the type of screening test used, the magnitude of harm ranges from moderate to substantial and reflects the risk for unnecessary diagnostic surgery.


While we’re on the subject of Star Wellness…

Sal, Wyoming’s not a country.

Star, Vitamin B12 is not a vaccine.

star vaccines

And remind me why we are lining up employees to get Vitamin B-12 shots, vaccines or no vaccines?

While we’re on the subject of vaccines, according to the CDC, the biggest category of people who are supposed to get Hepatitis A/B vaccines include street drug users.  If you are routinely hiring enough street drug users to be holding vaccination clinics focused on Hepatitis A/B, I’d say Vitamin B-12 deficiencies are not your biggest problem.

 

Announcing the Winner of the Wellness Industry’s 2017 Deplorables Award: Interactive Health

Winning a Deplorables Award is no easy feat for a wellness vendor. You have to out-lie, out-harm and generally out-stupid many worthy competitors. Yet this year’s competition wasn’t even close. Fitbit might have won on lies and stupidity alone, but no one was ever harmed by wearing an activity tracker. Interactive Health clobbered them in harming employees.  Like Wellsteps (the 2016 Deplorables Award Winner) they managed to do that multiple ways. This award covers the harms, the lies, and the stupidity. Truly the perfect storm of workplace wellness.


The Harms

Interactive Health’s signature move is conducting mass screens so inappropriate that doctors doing essentially the same thing — paying people to take this panoply of tests and then billing insurance — would lose their licenses.

Needless to say, when you do all sorts of inappropriate tests, you find all sorts of non-existent problems, and send all sorts of employees to all sorts of doctors. This isn’t simple overdiagnosis. This is classic hyperdiagnosis as described in our 2015 posting.

This is what we wrote in that posting, and it appears Interactive Health is the poster child for it. As compared to overdiagnosis, which is the unfortunate byproduct of well-intentioned efforts to help patients who present with symptoms, hyperdiagnosis is:

  1. pre-emptive — employees aren’t asking to be diagnosed, don’t have symptoms, want to be left alone, and often aren’t even old enough to have the stuffing screened out of them yet;
  2. either negligently inaccurate or purposefully deceptive (and IH has been requested many times to stop doing inappropriate screenings but they continue unabated);
  3. powered by pay-or-play employee forfeitures for non-participation, of the type about to become illegal in 2019;
  4. all about the braggadocio – wellness companies love to announce how many sick people they find in their screens…

…And here is Interactive Health doing exactly that:

What do you do after you round up all sorts of unsuspecting employees with inappropriate screens? Obviously, you bombard them with inappropriate advice, of course.  Specifically, the huge percentage of employees at risk for diabetes — thanks to those “a1c tests for everyone” (which of course are specifically not recommended by the USPSTF) are supposed to drink full-fat dairy, not skim. And absent hypertension, they are also not supposed to avoid salt. Quite the contrary, maintaining US-average salt consumption appears to be protective against diabetes. (Not to mention that salty snacks often substitute for sweet ones.) We had no trouble finding these studies online. Hopefully Interactive Health will use some of their award money to purchase an internet connection.

Fortunately, most employees pay no attention to Interactive Health’s 1500-word single-spaced tomes, so it’s unlikely their antediluvian advice harmed anybody.

Third, speaking of harms, they also harmed me when I went in to be screened. Not just by announcing my PSA score when I specifically asked not to be tested for PSA, but by stretching my calf far enough to send it into spasm.


The Lies

The English language already has 450,000 words, the most of any language. And yet none of those words adequately describe the amount of lying done by Interactive Health, even after they’ve been caught.

They are claiming “amazing results” based on one study by an unknown, now-defunct consulting firm that couldn’t even pay its internet provider. (The consulting firm had also made up a set of qualifications in which, other than articles and prepositions and conjunctions, every word was a lie.)

Once the lies were initially exposed, they paid me to stop writing about them for a while. I agreed, provided that they stop lying — meaning that I can write about them ad nauseam.

The smoking gun for the initial lie was that they accidentally admitted that they didn’t really reduce any risk factors. You can’t save a gazillion dollars by reducing employees’ wellness-sensitive medical events if you can’t improve employees’ wellness. According to their own figures (and of course excluding dropouts and non-participants, whose risks likely climb), their risk reduction was quite trivial. How trivial? The Wishful Thinking Multiplier — savings divided by the number of risk factors temporarily reduced — exceeded $50,000.

After that expose, they sealed their front-runner status for a Deplorables Award by simply trying to suppress the evidence. They took the trivial risk reduction displays out of that study, and now only make available the bowdlerized version, which they call a “research summary.” The only way you can get the raw risk reduction data is by scrolling down this post. Rule one in wellness whistle-blowing: always take screenshots.

And most recently, they’ve become strong proponents of Wellsteps’ strategy, bragging about how many high-risk employees became low-risk without mentioning that roughly as many low-risk employees became high-risk.  Suppose you flip 100 coins. It’s not enough to say that of 50 heads, 25 became tails. You also have to admit that 25 of the tails flipped to heads. At the end of the day, nothing changed. Here are the heads-to-tails, from their website. (By the way, this is also not true, even on its face.)


The Stupidity

Ask any employer what is the “new smoking” in terms of employee hazards and mortality. Most will say opioids, of course. Not Interactive Health. For them the “new smoking” is…

interactive-health-sitting-smoking

Hey, Interactive Health, maybe you can find a smart person to explain this particular statistic to you:

  • According to the CDC, the number of annual deaths caused by smoking480,000
  • According to the CDC, the number of annual deaths caused by sitting0

Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID.  Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.



And finally…

Take The Interactive Health IQ Test

Which of these images is most unlike the others?

interactive-health-iq-test

 

 

Interactive Health doubles down on diagnoses (Part 1)

So much to say about Interactive Health, so little room on the internet. As a result this will be a two-part blog, at least.

Meanwhile, on the opposite end of the spectrum, we are going to be highlighting the most positively influential people and organizations in the field. Please go vote or submit additional nominations.


The following axiom proffered in Surviving Workplace Wellness used to be ironclad:

“In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”

I thought this axiom applied to every vendor claiming huge savings. But, alas, Interactive Health is an exception. Yessiree, it turns out you can invalidate their data without reading the data.  It had been easy enough to invalidate their data by actually reading it — so much so that my original observations about them made it intp the Wall Street Journal .  They counterpunched by redacting all the raw statistics on risk reduction. (They didn’t realize I kept a screenshot, which will be the subject of Part II.)

Since risk reduction is what generates financial outcomes, taking risk reduction stats out of an financial outcomes report is like the movie theater in South Korea that decided The Sound of Music was too long, so they edited out the songs.

The Wall Street Journal debacle taught them half their lesson: they learned not to publish data, because data will obviously invalidate their savings claims. Last week they learned the other half of their lesson the hard way, which is that they shouldn’t publish anything, period. On Linkedin they bragged — without any data at all — about the gobs of money they saved by discovering all sorts of undiagnosed conditions and achieving trivial reductions in overall risk scores.

Of course it’s mathematically impossible to achieve massive savings by making asymptomatic employees anxious about diseases they almost certainly don’t have in any clinically meaningful sense, and/or slightly by reducing risk factors. With that in mind, I merely asked a question or two about the whereabouts of the data to support this mathematical impossibility…and <poof> their posting disappeared from Linkedin.

Even absent the data, it’s well-known that Interactive’s modus operandi is to do exactly that — attribute massive savings to trivial risk score reductions and “newly discovered conditions.”  Neither m.o. is unique to them. Indeed both are common enough to have names — the Wishful Thinking Multiplier and Hyperdiagnosis. Interactive’s brilliance is in marrying the two.


Interactive Health, the Wishful Thinking Multiplier and Hyperdiagnosis

The Wishful Thinking Multiplier is defined as:

total savings/total reduction in risk factors. 

The Multiplier originated with Staywell allegedly saving British Petroleum million of dollars when only a few hundred employees reduced a risk factor — which worked out to almost $20,000 for every risk factor reduced. As luck would have it, this Multiplier was about 100 times what Staywell themselves previously claimed was even possible, which in turn was about 100 times what is actually possible.  Yet, as we’ll see in the next installment, Interactive’s Wishful Thinking Multiplier leaves Staywell in the dust.

The practice of wellness vendors bragging about how many sick people they find is called “hyperdiagnosis.”  It originated when Health Fitness Corp breathlessly declared that about 1 in 10 screened Nebraska state employees had cancer.

Hyperdiagnosis differs from “overdiagnosis” in that doctors try to avoid overdiagnosis, because it results in expensive and potentially harmful overtreatment.

By contrast, hyperdiagnosis is something that vendors like Interactive embrace. Indeed, Interactive practically hyperventilates every time someone tests positive for something.  Since Interactive screens for everything under the sun — 38 panels, way more than most checkups and ten times what guidelines recommend — it’s tough to get out of one of their screenings without a false positive finding on something.

Here are examples of their hyperventilation in words and pictures, wisely not naming the client in their Linkedin post to avoid embarrassment:

[Their client] recently shared with their employees the successful outcomes they have achieved. First, hundreds of employees discovered new health conditions they were previously unaware of.

I’m sure the employees shared Interactive’s joy in finding out how sick they are! What employee wouldn’t be excited about such a “successful outcome”? And not just a few employees, but rather almost half are now “at risk” with “newly discovered conditions.”

A vendor bragging that nearly half the employees are might lead you to think: “Where do these people get their ideas?”

Glad you asked. Interactive bases their “proven…amazing results” on a report by an outfit called Zoe Consulting. Let’s take a looksee at Zoe Consulting, to learn more about the people they are basing their entire financial value proposition on.


Hey, Butch, Who Are These Guys?

As you can see from this screenshot, Zoe Consulting is a “top-tier nationally recognized research firm.” (Source: Zoe Consulting.)  Here are the awards they’ve won (with Google’s commentary in parentheses):

  1. Two Koop Awards (they didn’t);
  2. The American Cancer Society Award for Program Excellence (they didn’t);
  3. The Ethel-somebody Leadership Award from UNC (they didn’t); and
  4. The Distinguished Leadership and Service Award from the Association for Workplace Health Promotion (they didn’t).

The last reminds me of a summer job selling Collier’s Encyclopedia door-to-door. Collier’s salespeople were instructed to say: “National Geographic won the Kodacolor Award 10 years in a row, but last year we copped the award from them.” One evening I ran into a Grolier’s salesman, who, as it turned out, used exactly the same line in his pitch, down to the exact same faux-cool-70’s-speak verb right out of The Deuce. I called Kodak to see who really won it, only to learn that no such award existed.

Likewise, one of the many reasons Zoe Consulting didn’t win an award from the Association for Workplace Health Promotion is that no such organization exists. So depending on how you count (and whether you count the Koop Awards as one lie or two), they lied six times in two bullet points, which may be a record even in the wellness industry. Seven if you count “top-tier nationally recognized research firm.” Eight if you count “top-tier” and “nationally recognized” separately. Nine for “unbiased.” To reach a round number, I’d say the tenth would be “research.”  That’s ten lies already.

In other words, Zoe Consulting is a perfect fit for Interactive Health.


Stay tuned for the next installment to learn why.

 

Grinding my teeth

I (Vik) have not written a blog post for TSW in some time. Al is quite capable of regularly exposing the wellness industry’s foibles, an easy task given that there is an endless supply of material, and it multiplies faster than bunnies.

However, I occasionally have an up-close-and-personal interaction that is well worth recounting. My son and I recently visited our dentist for the ritualized annual cleaning and check up. We only go once a year, because as a clinician myself it’s been patently obvious to me for some time that twice yearly cleanings, the benefits of which last only until the next burger, and dental check-ups, which are just a search for billable things to fix, are no more beneficial to the health of my mouth than they are to any other part of my body. What matters is the daily routine of brushing and of avoiding sugar-laden foods. Unless you’ve been sleeping through emerging research, you know by now that I am not the only person to reach this conclusion.

Then I met K, a registered dental hygienist I’ve never previously interacted with at our dentist’s office in the St. Louis suburbs. Within 60 seconds of me reclining in the exam chair, the following exchange took place:

K: “I see that you don’t like having x-rays taken. Is there a reason?”

Me: “There is no evidence that screening x-rays have clinical value.”

K: “Do you have dental insurance?”

Me: “Yes.”

K: “Do you pay for the dental insurance?”

Me: “How is it any of your business how I get the coverage?”

K: “Because if you have dental insurance, the cleanings and x-rays are free, so there is no reason for you to not get them.”

Me (growing increasingly annoyed and now zeroed in like a laser beam): “The dental insurance is part of the compensation package my wife’s employer provides her. Nothing is free. There is a cost to everything.”

K: “Oh, I guess that’s right. Well, anyway, you should have the x-ray to prevent future problems.”

Me: “What your evidence that x-rays prevent problems? X-rays don’t prevent anything. It’s just a way for you to look for things that may or may not ever amount to anything, except that you can paid to deal with them.”

K (now slowly realizing that she has perhaps ventured out of her exceedingly small safe zone): “The American Dental Association….”

Me: “The American Dental Association? That’s not evidence; that’s a trade group. I am not here to get x-rays [I am completely asymptomatic and have a wonderful, clean, healthy mouth], and that’s not open to negotiation.”

K: “Well, if you don’t have x-rays at least once every three years, we will be happy to refer you to another practice [a ‘policy’ never once articulated to me in six years of going to this dental practice], and that’s not open to negotiation. I also need you to sign a waiver that you declined the x-ray against our advice.”

Me: “Have you read any of the new research about dental industry practices, such bite wing x-rays, twice yearly exams, and even flossing. There’s no evidence for any of it. The NY Times, The Wall Street Journal, they’ve all covered it. Have you seen any of it?”

K: “Finding things early [on x-rays] is how you prevent problems.

Me: “Prove to me how that’s the case. You are 100%, utterly and completely wrong, and nothing you’ve told me is evidence.”

At that point she got up in a huff and left the exam room, returning after two or three minutes to, finally, blessedly, actually do her job instead of showcasing her ignorance.

My point in recounting this exchange is this: all the hulabaloo about consumer directed healthcare is garbage if the consumer is faced with quasi-professionals like K, who is blissfully unaware of basic health economics, let alone the changing character of the science and the evidence base for her occupation. According to the Bureau Of Labor Statistics, there are 200,000 dental hygienists, and over 10 years, that figure will grow by nearly 19%. Suppose, conservatively, that each of these hygienists does two cleanings daily over 200 working days per year. That’s 80 million consumer interactions like this one where the paying customer is subjected to intrusion, clinical mythology, deception, and the threat of “dismissal” from the practice for non-compliance with a non-evidence based, but cash-producing pointless clinical service. How many consumers are willing to tell their hygienist or anyone else in a white coat (or, in her case, the custom embroidered frock) that they are wrong?

K, who apparently has either no access to the Internet or no interest in professional improvement, was the very image of an unprofessional professional, with no sense of the notion that she’s not in charge of the relationship. I’m the customer, through the good grace of my wife and her employer, who are the payers.  K did a masterful job of channeling the wellness chimera of Ron Goetzel, Seth Serxner, and Rajiv Kumar, spouting the virtues of overprevention today, overprevention tomorrow, overprevention forever.

For all her ill-informed foaming at the mouth about what’s good for me, here’s what stuck with me, and what I plan to explore further: she, on behalf of the practice, threatened to “fire” me as a client for failure to have an x-ray. There is no legal requirement anywhere in the Missouri Dental Statutes or Rules for me to submit to any radiograph. Nor do the statutes or rules state that a dental office is permitted to dismiss a client for non-compliance with voluntary and discretionary clinical service. What I’d really like to know (enterprising anti-trust lawyers should contact me) is if this is common practice in St. Louis or Missouri more broadly and if yes, how it came to be so.

Can you spell C-O-L-L-U-S-I-O-N? I’ll bet K. can’t.


A little addendum from Al. The other thing these folks do is “screen” you for mouth cancer. I declined the screen. The hygienist said I was making a mistake, that she has found 9 cases in the last three years. Doing the math, if she is average, dental hygienists are finding 600,000 cases a year of mouth cancer. No easy feat considering there are only about 45,000 new cases a year, almost all of which occur in a small segment of the population — tobacco chewers and alcoholics — to which I don’t belong.  I didn’t have to sign anything and she didn’t threaten to “fire” me, but otherwise it was the basically the same experience Vik had.

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