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Total Wellness’s Total Package of Totally Inappropriate Tests
Total Wellness is very concerned about “fostering a positive culture in your office.”
And what better way to “foster a positive culture,” and “recruit talented employees to your workforce” so that they can “improve relationships with one another” than by screening the stuffing out of them?
To start with, don’t just ask your “talented employees” that you just “recruited” if they smoke. That would be too easy and obviously they would all lie, right? Isn’t lying exactly what talented employees do the day after you hire them? Of course! And isn’t deceit what a positive culture is all about? Of course! That’s why you have to test their nicotine 7 ways to Sunday.
And if those tests are too easily gamed, here’s another one — just in case a few of those lying, cheating employees manage to pass the first set of tests, a la Lance Armstrong. And we wouldn’t put it past them to game the test. After all, they are “talented.”
When you’re done with nicotine, screen them for body fat. Nothing spells “talented employee” like an absence of body fat.
But wait…there’s more. Total Wellness offers a package of seven additional tests that aren’t recommended by the US Preventive Services Task Force. Now how much would you pay?
A lot, as it turns out (not even including follow-up from false positives). The more inappropriate tests you authorize, the more money they make.
Total Wellness is able to do this through their “partnership with Clinical Reference Laboratory.” Translation: they charge you, send some of the money to this other outfit, and keep the rest.
Let’s go test by test down their list.
First are two sets of tests that the USPSTF doesn’t even bother to evaluate because it would never occur to them that anyone, even a doctor, would use them as a screen.
Chem-20s aren’t even recommended as screens by the doctors who get paid to do them.
No one bothers to recommend against CBC screens…because CBC tests aren’t screens. A CBC is a test that actual doctors, not wellness vendors, order for patients who are not feeling well. Get it? As has been well-established for two decades, it’s not a screen. it’s a test. It’s useful for finding the sources of symptoms in a patient who presents in an actual doctor’s office, not for telling healthy people they’re sick. By analogy, if you think you broke your arm, the doctor might x-ray it. That’s a test. But even the dumbest wellness vendor wouldn’t propose X-raying all your employees as a screen to see if their arms are secretly broken.
Assuming a CBC were used as a screen, it would be much more potentially hazardous than if a doctor were to do the test. Since apparently Total Wellness doesn’t understand the concept of false positives anyway (a prerequisite for being in the screening business is not understanding false positives), they would likely misinterpret the results.
How did Total Wellness manage to get a license as a wellness vendor without knowing the difference between a screen and a test? Simple — you don’t need a license to be a wellness vendor. That means wellness vendors are allowed to charge employers to perform screens on employees that would get doctors in a lot of trouble if they tried to bill insurers for them.
We’d encourage you to visit their site to see a few more proposed screens that the USPSTF doesn’t recommend doing, like TSH, homocysteine, CRP. But let’s end with the mother lode of the screening industry: screens that the USPSTF specifically recommends not doing, but are very profitable for vendors.
The good news is, Total Wellness isn’t overselling this test. They say it is “possibly an indicator of ovarian cancer cells,” which makes the test literally less than useless, due to the overwhelming number of false positives and false negatives from such a test. That’s why no grownup doctors use it as a screen and that’s why the USPSTF says:
You may say: “Yes, but this ‘D’ recommendation doesn’t apply to women with the BRCA mutation.” Alas, by law, wellness vendors aren’t allowed to ask an employee whether she has a BRCA mutation or any other family history question, dramatically the reducing the already abysmal odds that a screening vendor might do something useful.
Let us close with my favorite test:
Ask vendors why they do it and they’ll say exactly what this one says: this test is “non-invasive and painless.” Sure. In that respect it’s not unlike palm-reading. The more relevant adjective that applies to both: useless.
If you want to get technical, “D” means less-than-useless.
We do like to close on a high note. Total Wellness is right in that this screening program would indeed help your employees “improve relationships with one another.” Forcing your employees to participate in this costly and misanthropic jihad might lead them to use their “talents” to all get together and revolt–just like at Penn State.
Apologies to HERO and the Wellness Ignorati!
(March 18) Due to vacation schedules, we are taking a brief time-out from both our “profiles” of vendors and our serial analysis of the HERO report (Part 1 was our most popular posting ever — don’t forget to “Follow” us so as not to miss a single installment.).
This posting is to apologize to the HERO Wellness Ignorati. A comment our posting on the HERO report said we shouldn’t call the Wellness Ignorati “ignorant.” We aren’t calling them ignorant and we apologize if we were misunderstood. Since it has sold almost 6000 copies despite Wiley’s decision to price it to finance their retirement accounts, we thought by now most people had read Cracking Health Costs. That was the book in which the term was coined. It emphatically does NOT mean “ignorant.” We would never call them “ignorant” and the Ignorati are anything but. Quite the contrary, they are smart enough to realize that facts are their worst nightmare.
Or as Tom Friedman said in today’s New York Times, “We wouldn’t be human if we didn’t outright ignore facts that make a laughingstock of our hopes.” (I actually did the opposite. See the blog post: Founding Father of Disease Management Astonishingly Declares: “My Kid Is Ugly.” Dee Edington did something very similar. Both of us were simply not willing to sacrifice our integrity for filthy lucre.)
The Wellness Ignorati are more than smart. They are brilliant. They have elevated fact-ignoring to an art form.
They realize that enough people seeing this site will derail their HR-financed gravy train, so they keep to a strict strategy of not even acknowledging that facts exist. Example: us. Not a mention of our existence in their entire report. A brilliant strategy for them, and one that flatters us immensely. Obviously, in the massive tome they just published, if they thought we were wrong, they could have said: “They Said What and its authors offer a competing view, but it’s wrong because…”
Fact suppression is of course the opposite of what we do — we want facts to be front-and-center. We welcome transparency and debate, though the latter is tough because people either repeatedly decline (Ron Goetzel) or, after the debate, wouldn’t agree to release the recording (Michael O’Donnell).
Instead they simply disappear us. This is despite the fact that the two of us (plus our colleagues like Jon Robison and Tom Emerick) have sold more books, been interviewed in more major publications, authored more articles in high-impact journals than all the Ignorati combined.
I’ll close with a f’rinstance. We copied a screenshot from that report showing that the Ignorati finally admitted that “pry, poke, prod and punish” programs damage morale. This guy looked at that screenshot, and put a comment on our post that this screenshot didn’t exist, but rather it was our propaganda. Someone else said the screenshot was out of context, so we invite everyone to read the context.
The bottom line is, of course the HERO Report is correct about the cost of morale damage. Coincidentally, I am writing this from State College, Pennsylvania. I am here as an honored guest of the Penn State Faculty Benefits Committee, feted for my role in helping to free them from the Goetzel/Highmark forced wellness program (featuring those immortal testicle checks). Try telling Penn State there’s no morale impact. (For those of you thinking of sending your kids here, do it! I’ve never been to a university where the professors were more passionate about teaching their students than PSU–despite what happened to them in 2013.)
“Everyone is entitled to their own opinions, but not to their own facts.”
–Daniel Patrick Moynihan
A Short Painless Primer on the Value of Screening
At the risk of knocking our second-most-widely viewed posting (the first of several analyses of the HERO report) off our front page, this is a brief and amusing lesson on the value of screening
If you like this, you’ll love this–it will also tickle your funny bone.
HERO Report: Wellness Industry Leaders Shockingly Admit that Wellness Is Bad for Morale
(March 14) This is the first in a series looking at the strengths and weaknesses of the HERO Outcomes Guidelines report, recently released by the Wellness Ignorati. One explanatory note: A comment accused us of insulting the Wellness Ignorati by calling them that. It is not an insult. It describes their brilliant strategy of ignoring facts and encouraging their supporters to do the same. We are very impressed by the disclipline with which they have executed this strategy, and will be providing many examples. However, if they prefer a different moniker to describe their strategy, they should just let us know.
We encourage everyone to pick up a copy of this report, the magnum opus of the Wellness Ignorati. Unlike the Ignorati, we are huge advocates of transparency and debate (which they call “bullying”). We want employers to see both sides and decide for themselves what makes sense, rather than spoon-feed them selected misinformation and pretend facts don’t exist.
The latter is the strategy of the Wellness Ignorati. Indeed, they earned their moniker by making the decision to consistently ignore inconvenient facts. (This is actually a smart move on their part, given that basically every fact about wellness is inconvenient for them.) For example, they just wrote 87 pages on wellness outcomes measurement without admitting our existence, even though we wrote the only book — an award-winning trade best-seller — on wellness outcomes measurement. Observing the blatant suppression of facts and the loss of credibility that comes with blatantly suppressing facts is just one of the many reasons to read this report. In total, their report provides a far more compelling argument against pry, poke, prod and punish programs than we ourselves have ever made, simply by bungling the (admittedly impossible) argument in favor of them.
There is too much fodder for us to deconstruct in one posting, so over the next several weeks we will highlight aspects of this report that we think are especially revealing about the sorry state of the wellness industry.
In terms of getting off to a good start, the Ignorati are right up there with Hillary Clinton, with their first self-immolation appearing on Page 10. Remember our 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.
And sure enough…
Ironically, the first self-immolation is the direct result of that rarest of qualities among the Ignorati: integrity. We were shocked by the revelation that the Ignorati actually realize that employee morale and a company’s reputation both suffer when companies institute wellness programs – but here is the screenshot. Both morale and reputation are listed, as “tangential costs.”
Try telling a CEO that the morale of his workforce and his corporate reputation are “tangential” to his business. We ourselves run a company, and we would not list low morale as a “tangential cost.” Quite the opposite — our entire business depends on our employees’ intrinsic motivation to do the best job they can. If their morale suffers, our profit suffers. That’s why we would never institute a wellness program. The last thing we want to do is impact our morale in order to measure our employees’ body fat. Obviously, it is harder to hire and retain people if you value body fat measurement over job performance, and we are pleased to see the ignorati finally admit this.
Why, having now read this revelation in the ignoratis’ own words, that wellness is bad for morale, would any company still want to “do wellness”? Or as we say in Cracking Health Costs, “If you’re a general, would you rather have troops with high morale or troops with low cholesterol?”
The fact that employees hate wellness isn’t exactly a news flash. Anytime there is an article in the lay press, the public rails against wellness — or “bullies” the wellness industry, to use the term that the Ignorati use for people who disagree with them publicly. You don’t have to look far—just back to HuffPost on Wednesday. Or All Things Considered.
Obviously, if you have to bribe employees to do something (or fine them if they don’t), it’s because they don’t like it. If employees would rather sacrifice considerable sums of money than be pried, poked and prodded, they are sending you a message: “This is a stupid idea we want nothing to do with.”
The news flash is that this whole business of “making employees happy whether they like it or not,” as we say in Surviving Workplace Wellness is now acknowledged – by the Ignorati as a group — to be a charade.
HERO seems to have exhausted their integrity quota pretty quickly, because after that welcome and long-overdue and delightfully shocking admission, they slip back into character.
Specifically, in their listing of costs, they conveniently forgot a bunch of direct, indirect and “tangential” costs. Like consulting fees. Generally, the less competent and/or honest the consultants, the more they charge. (For instance, we can run an RFP for $40,000 or less, and measure outcomes for $15,000 or less — and do both to the standards of the esteemed and independent GE-Intel Validation Institute. Most other consultants can’t match either the price or the outcome.) We’re not calling any consulting firm incompetent or dishonest other than pointing to a few examples that speak for themselves, but it does seem more than coincidental that the consultants involved in this report have conveniently forgotten to include their own fees as a cost.
And what about the costs of overdiagnosis caused by overscreening far in excess of US Preventive Services Task Force guidelines? The cost of going to the doctor when you aren’t sick, against the overwhelming advice of the research community?
Still, we need to give credit where credit is due, so we must thank the Ignorati for acknowledging that wellness harms morale. It took even less time for this acknowledgement than for the tobacco companies to admit that smoking causes cancer.
Pittsburgh Post-Gazette Bullies Shape-Up
In wellness, “bullying” is apparently defined as “asking hard questions, particularly to people who make claims they refuse to defend.” This time it’s not us bullying anyone. It’s the Pittsburgh Post-Gazette bullying Shape-Up, in a reprise of the last time Shape-Up challenged our numbers.
Guess who won, again? (Hint: you won’t see this link on Shape-Up’s website.)
And kudos to the Pittsburgh Business Group on Health for its forward-thinking quotes on the value of wellness programs.
Mrs. Brooks, whose business group members represent some of the region’s largest employers, said workplace wellness “has become a commoditized multibillion-dollar industry versus a value-based solution that addresses the whole.
“We need to figure out how to motivate employees. Many programs today aren’t strategic or focused and, more importantly, culturally integrated into how companies do business.”
Lewis and Goetzel: A Brief Prequel
Note: This is not as clever as our usual stuff. The sequel (in this case, prequel) is never as good as the original. Nonetheless, it’s important to know how we got to where we are and how the now-viral “Open Apology to Ron Goetzel” came to be.
I was just called “mean-spirited” by Michael O’Donnell regarding Ron Goetzel, so I thought a little background might be in order. Some people no doubt think Vik and I just popped up out of the blue and started insulting people. Michael O’Donnell’s editorial says we haven’t been willing to engage in “respectful debates” and all sorts of other stuff. So let’s climb into the Wayback Machine and set the dial for 2011. I submitted the final manuscript of Why Nobody Believes the Numbers to the publisher, John Wiley & Sons, for June 2012 publication. For those of you whose consultants and vendors haven’t told you about it (for obvious reasons), this was an award-winning trade-bestselling book on outcomes measurement, that is used in at least 5 graduate-level classrooms.
Despite being almost 3 years old, it is quite relevant today, as a new “official” welness outcomes measurement guide compiled by many of the people profiled on this site recommends 7 approaches to measurement, 5 of which my book had already completely invalidated.
Page 82-83 contain the following lines. I am using screen shots because, as is usual, no one would believe me if I just quoted text.
I genuinely believed that he was seeking the truth and that his analysis was “much better than mine.” I was the Boxer to his Snowball.
But then, over the following years, a funny thing happened. I reluctantly realized that the entire Wellness Ignorati cabal — the Koop Committee, WELCOA etc. — had no interest in facts. They simply wanted to perpetuate their existence at the expense of their customers. I had originally been very polite. for instance, when I displayed the infamous Health Fitness Corporation slide (now disowned) on p 85 of Why Nobody Believes, I didn’t name names:
And I know Ron read p. 85, because he copied pages 82-83 and used it in his own presentations until Wiley made him stop.
But you know what happened after Ron read that HFC’s award-winning slide had self-invalidated? No “respectful debates.” Nothing. (We’re still not sure how he didn’t notice in the first place.) HFC didn’t apologize and didn’t stop using the slide. Ron didn’t retract their Koop Award. (It wasn’t until our Health Affairs expose almost three years later, that Ron was shocked, shocked to discover that that infamous and highly visible slide was, to use his choice of the passive voice, “unfortunately mislabeled.” It is still a mystery who did the mislabeling. No one has stepped forward. We think it might have been the North Koreans.)
The same thing kept happening — Nebraska, Staywell, Mercer, Milliman, Wellsteps etc. Basically most of the Koop Committee and plenty of others All of them had mistakes quietly pointed out…and none of them did anything to correct them. Politeness failed. When a “mistake” is pointed out and not fixed, it becomes a lie. In retrospect, what we did was as naive as if Rachel Carson had brought her findings to Monsanto and asked them to please stop selling DDT.
That’s why and when we started blowing the whistle, which has been interpreted as bullying. Leave a comment: what you would have done? The health of employees all over the country is being jeopardized by overscreening, overdiagnosis and overdoctoring, the evidence is being ignored by the perpetrators…what choice did we have?
Wellness Corporate Solutions Gives Us a Dose of Much-Needed Criticism
Oh, when bad things happen to good bloggers…
Shame on us! Here’s what Wellness Corporate Solutions had to say about our observations of the wellness industry:
And, in all fairness, when we went to the Wellness Corporate Solutions website, we felt quite chastened. Their website was a breath of fresh air, taking the rest of the industry to task for expecting “instant cost savings,” noting that a “focus on ROI is short-sighted.”
Further, they are totally opposed to wacky crash diets, of the type that 8-week weight loss “challenges” inspire, that cause abnormally large weight swings As most people know by now, those may be harmful and are of course ineffective at long-term weight control. The weight is likely to be regained and then some. Plus contestants often binge before the initial weigh-ins to maximize contest weight loss. That’s why Wellness Corporate Solutions quite appropriately says “stop dieting,” and “avoid making unreasonable weight loss goals.” And “banish weight-obsessive thoughts.”
We were also thrilled to see that they “respect and appreciate size diversity” because “size prejudice hurts us all.”
Finally, a company that has done enough research to realize that you can’t save money instantly by getting employees to crash-diet for 8 weeks! How exciting is that – we discovered a wellness vendor with access to Google!
Unfortunately, perhaps along the way someone at Corporate Wellness Solutions must have failed to “respect and appreciate the size diversity” of a certain Kim Jung Un, because the North Koreans appear to have hacked into their website and announced: a program that saves money instantly by getting employees to crash-diet for 8 weeks.
Naturally, this being a wellness vendor, the savings are made up. If 20% of your employees achieve a “healthy” BMI (a statement which by itself is open to a great deal of debate, since recent research overwhelmingly says it’s better to be fit and fat than to lose weight and not keep it off), for a company to reduce its total cost by 20% means that the costs for each employee who lost the weight would have to fall 100%.
And naturally, being a wellness vendor, they don’t stop there. It’s part of wellness vendor DNA to ignore US Preventive Services Task Force recommendations, while saying they abide by them. In this case, they are doing both thyroid screens (not recommended) and PSA tests (emphatically not recommended).
And, naturally, being a wellness vendor, there is no concept of learning. They did exactly the same thing that ShapeUp, Ron “the Pretzel” Goetzel, Wellsteps and others have done, which is failing to realize that we bite back. Actually, we don’t bite back as much as we allow these geniuses to bite themselves back. The wellness ignorati invariably self-immolate in the attempt to criticize us. Hence our mantra: “In wellness you don’t need to challenge the data to invalidate it. You merely need to read the data. It will invalidate itself.”
However, there is some good news about Wellness Corporate Solutions: NASA employees don’t need to worry about their job security, because these people are not rocket scientists.
Bravo Wellness Offers “Savings” by Fining Employees
With all the incompetence, innumeracy, illiteracy and downright dishonesty we’ve documented in this field and with all the employee dissatisfaction, revolts and lawsuits, one can’t help but wonder: Why?
Why would any employer do this to their employees?
Why aren’t vendors held to minimal standards of competence?
Why do vendors and consultants caught lying simply double down on the lies and/or ignore questions about their lies–knowing full well they’ll get away with it because workplace wellness has nothing to do with actual wellness so no one cares that it doesn’t work?
Why are benefits consultants allowed to lie about outcomes for their partnered vendors?
Why, after they get caught lying, do they win awards for those very same outcomes?
Why doesn’t anyone care that much of what they say and do is wrong?
Why doesn’t anyone care that poking employees with needles far more than the USPSTF advises produces no savings?
Why put up with the morale hit from disgruntled employees and possible lawsuits?
Bravo to Bravo for admitting the reason: It’s to claw back insurance money from employees by making programs so unappealing and requirements so onerous that many employees would rather forfeit their money than have anything to do with them. Here are Bravo’s exact words:
You might say, they don’t actually “admit” it. Well, obviously they aren’t going to skywrite it. But how else would one interpret this comment? Obviously they aren’t going to save money right away by “playing doctor” and poking employees with needles. Especially because they aren’t even adhering to legitimate preventive services guidelines, such as those from the United States Preventive Services Task Force (USPSTF).
They also still subscribe to the urban legend that 75% of an employer’s spending is lifestyle-related, even though that myth has long since been discredited as meaningless and misleading for employers.
Creatinine and thyroid screens are not recommended by the USPSTF, so they shouldn’t be done at all, let alone provide the basis for claiming savings. So, we have eliminated everything except the obvious: employers get to collect fines for employees who care too much about their health and/or their dignity to submit to Bravo’s offer to play doctor.
This is the classic example of wellness done to employees instead of for them. The Bravo website is sprinkled with discussions of appeals processes for employees who face punishments for the crime of weighing too much and/or other personal shortcomings having nothing to do with work performance (and precious little to do with healthcare spending during the working years)…but everything to do with transfering wealth back to the owners.
As is our policy, we offered Bravo a chance — and $1000 — to provide an alternate explanation in a timely way, which they didn’t. Two differences between that forfeiture and Bravo’s punishments: Bravo lost their $1000 (of our money) for simply being unwilling to jot down a few words, whereas they brag about fining employees $1000 (of their money) for not being able to lose weight and keep it off, which is far harder than writing down a few words. And the other difference about the $1000? Having just raised $22-million, Bravo won’t miss it.
August Update: As a result of this expose, Bravo has taken all this stuff off their website. They no longer brag about fining employees, they no longer discuss their appeals process at length on their site and they no longer pitch their D-rated lab tests like creatinine and thyroid. This is typical vendor behavior after getting caught. Score one for They Said What.
Congratulations to RAND’s Soeren Mattke on PepsiCo study award
We are proud (but also insanely jealous) of our friend Soeren Mattke, whose PepsiCo article was named the #2 most-read for the year 2014 in Health Affairs. We, as our avid albeit narrow fan base may recall, ranked only #12–and even then that was just for blog posts, not articles in print.
Yes, we know it’s not always about Ron “The Pretzel” Goetzel and his twisted interpretations, but he seems to have come up with what appears to be exactly the opposite interpretation of what the PepsiCo study said. Don’t take our word for it — we’ve cut-and-pasted both what the study says about PepsiCo’s results and what he says about the study.
Here is what the article says about the financial impact of health promotion at Pepsico: ROIs well below 1-to-1, meaning a net financial loser, for health promotion. (DM, though, was a winner.)
As low as these ROIs are, several major elements of cost were not available for the calculation — probably enough extra cost to literally make the financial returns so meager that even if the program had been free, PepsiCo would have lost money.
Clear enough? Negative returns from health promotion at PepsiCo, even without tallying many elements of cost. Nonetheless, Mr. Goetzel pretzelized that finding in his recent wellness apologia. Listed under “examples of health promotion programs that work” as a program that is a “best practice” is: PepsiCo. It stands proudly beside the transcendant programs at Eastman Chemical/Health Fitness and the State of Nebraska.
We look forward to a clarification from Mr. Goetzel about how a program that lost a great deal of money on health promotion can be an “example of a health promotion program that work(s),” which we will duly print…but don’t be sitting by your computer screens awaiting it.


































