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It’s time for the 2017 Deplorables Awards, lovingly bestowed on those vendors who do the best job making other vendors look good.
The good news is that you don’t have to actually win the Deplorables Award to sue me. Runners-up are eligible too. Here is my address for hand-service delivery most of the year:
890 Winter Street #208, Waltham MA 02451
In case you decide to sue me between June 22 and August 8, use:
8 Paddock Circle, Chilmark, MA 02535
And don’t leave out my attorney:
Josh Gardner, GARDNER & ROSENBERG P.C., 33 Mount Vernon Street, Boston, Massachusetts 02108
I don’t know how much more I can do for you, other than lick the envelope. So go for it. Don’t make me beg.
But, remember, unlike your usual business model, in court you are required to actually tell the truth (I would be happy to explain to you how that works), meaning there is no chance of your winning — or likely even avoiding summary judgment, since none of the evidence is in dispute. It’s all your own writings. Oh, and I do my own cross, which means you won’t be able to find an expert witness. Anyone who knows enough about wellness to be an expert witness also knows enough about wellness to know that attempting to defend you would be a humiliating, on-the-record experience.
And there is always the chance that some annoying jerk might blog about it…
The 2017 Runners-Up
Imagine a four-square matrix with competence on one axis and integrity on the other. The people and organizations we’ll be highlighting today would intersect with the companies mentioned in Monday’s posting at only one single point.
Springbuk and Fitbit
As many of you recall, earlier in the year we analyzed the study done by Springbuk that secretly financed by Fitbit. Or maybe I need new glasses, because I just couldn’t find the disclosure in the Springbuk report that this paean to Fitbit was financed by Fitbit, the way Nero used to have the judges award him Olympic medals.
Coincidentally, the study showed Fitbit saving gobs of money because employees taking more than 100 steps a day spend less money than those taking fewer. However, a simple tally of one’s own footsteps shows that it is impossible not to take 100 steps a day unless you are both:
- in a hospital bed; and also
- on dialysis.
This 100 steps-a-day threshold was repeated many times in the study, with no explanation of how that number came to be. However, it turns out we owe these two outfits an apology. Fitbit and Springbuk have told a number of people privately (not publicly, in order to avoid an embarrassing news cycle) that they didn’t really mean to say that 100 steps a day constituted activity. They meant to say that taking 100 steps a day implied you had your Fitbit on. My apologies for failing to read their minds that their conclusions were based on reading people’s minds to determine whether they wore the Fitbit deliberately, or simply forgot/remembered/cared to put their Fitbit on.
They never did explain — privately or publicly or to anyone — how employees who took an average number steps during the baseline year could show huge savings by taking an average number of steps in the study year too.
They also never explained how these two statements didn’t completely contradict each other, even though I specifically asked them to in a personal letter, excerpted here:
Third, can you reconcile this statement…:
“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”
“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk.
National Business Group on Health
Next up is the National Business Group on Health. Last year they made the list for criticizing the US Preventive Services Task Force for not demanding enough screenings, in a country that is drowning in them. Not content to rest on those laurels, this year they earned an Honorable Mention for inviting Dr. Oz to keynote on the role of quackery in corporate wellness, and perhaps tell us about his latest lose-weight-by-eating-chocolate miracle diet.
HERO of course also earns a runner-up award. 2017 will be remembered as the year they finally came to grips with the realization that a business model based on fabricating outcomes requires that perpetrators possess that critical third IQ digit. Without that extra “1”, an organization trafficking in math that can at best be considered fuzzy is going to be outed.
This year’s set of lies? By way of background, their 2016 poison-pen letter insisted they had fabricated that data set showing that wellness loses money without disclosing that it was fabricated — and also never reviewed their fabricated data before publication. Early in the year, I had the insight that, wow, this “fabricated” Chapter in their guidebook is so much better than the other chapters that something is amiss. No one at HERO can analyze data competently…and yet, here it was, a competent data analysis.
I did something I had never thought to do before, which was look up the actual author of that chapter. It was Iver Juster MD. He was a great analyst even before he read all my books, took all my courses, and achieved all my certifications in Critical Outcomes Report Analysis.
- Whereas Paul Terry and Ron Goetzel had insisted that Iver fabricated the data, Iver said, of course he didn’t — whatever made me think that? (“If it wasn’t real, I would have disclosed that,” he observed. Of course he would have. Iver has tremendous integrity.)
- The Board discussed and reviewed his chapter at length, and made helpful suggestions, for which he was quite grateful. This review process required “countless hours,” just as the HERO document says:
The number of transparent lies HERO tells could make a president blush. In the immortal words of the great philosopher LL Cool J, they lied about the lies they lied about.
Even though 2017 was an off-year for them in terms of the number of lies, they still told enough to be named a runner-up.
Wellness Corporate Solutions
Next is Wellness Corporate Solutions, famous for its crash-dieting contests. WCS now offers a water-drinking contest. The idea is to set up a “challenge” for your team to drink more water than other teams. They call this a “healthy competition.” I guess they didn’t get the memo that forcing yourself to drink when you don’t want to drink, just to make more money, is anything but healthy. Here is a novel idea: drink when you are thirsty. Evolution 1, WCS 0.
Perhaps as an encore, WCS, Dr. Oz and the National Business Group on Health could team up to offer a chocolate-eating contest.
I looked into this outfit to see where they get their ideas. The CEO previously ran something called the Washington Document Service. That qualifies her to run a wellness company. As Star Wellness says, to run a wellness company successfully, your background needs to be in sales, or “municipality administration.” After all, what is more central to administering a municipality than documents?
What fun would a list of runners-up be without Wellsteps, the proud recipient of the 2016 Deplorables Award? While their streams of consciousness weren’t as memorable in 2017 as in 2016 (“It’s fun to get fat. It’s fun to be lazy“), they get credit for trying. Their 2017 weight-loss campaign was headlined: “This campaign is not really about weight loss, it is about helping you apply the behavioral secrets of those who have lost weight.”
So if your kids ever want you to teach them how to ride a bike, say: “It’s not really about riding a bike. It’s about helping you apply the secrets of people who have ridden bikes.”
And what secrets are we talking about? What person who has lost weight doesn’t brag to everyone or even write a book? If there is a secret to weight loss, like eating chocolate, Wellsteps owes it to the country to tell them. Don’t make us beg.
Odds and Ends
No Koop Award winner this year, but an honorable mention to past winners and runners up for their commitment to wellness:
Sounds like in 2018 the logical winners would be Philip Morris, or maybe The Asbestos Corporation of America.
Veering briefly into the public sector, kudos to Representative Virginia Foxx, (R-NC5) for introducing the Required Employee DNA Disclosure Act. Even HERO thought it was a dumb idea…and their threshold for thinking something that increases wellness industry revenues is a dumb idea is quite high, having all rallied behind the Johnson & Johnson Fat Tax, in which companies would be required to disclose the weight of their employees.
Next up…the winner of the 2017 Deplorables Award
August 2021 Update — we aren’t just “outing” the worst. Instead we are claiming to be the best: The reward now applies to any behavior-change vendor — diabetes, wellness etc. — vs. Quizzify. You get $3 million is yours is found by the 5 judges (and remember, we only appoint one!) to be better than Quizzify.
Here are the specific rules.
Almost any behavior-change vendor is eligible to claim the reward. A “behavior change” vendor would be one whose value depends on employees doing something voluntarily or with an incentive/penalty, paid via an admin fee. Eligible categories include wellness, diabetes, weight loss, mental health, sleep, coaching, EAPs, “challenges” programs, fitness, nutrition, navigation, patient-centered medical homes, and price-shopping companies.
We say “almost any” because behavior change vendors that we work with are ineligible because we help them dramatically increase engagement. For instance, Sera Prognostics enhances its guarantee if Quizzify is also used, and we enhance ours.
Whether a vendor fits into the category of behavior change should be self-evident. The best example of companies that add value not through voluntary behavior change would be alternative PBMs. Aside from a new card and presumable better terms, the change is invisible to the employee. The employee still gets drugs.
If indeed a vendor considers itself to be a behavior change company and Quizzify looks at it and says, no, this is not behavior change, the vendor may announce that Quizzify rejected their application. The vendor may then apply to the Validation Institute to arbitrate whether it is a behavior change company or not. If it wins, Quizzify agrees to pay for its validation.
Selection of Judges
There will be five judges, selected as follows:
- Each side gets to appoint one, drawn from Brian Klepper’s listserve with almost 1000 people on it, from all walks of healthcare.
- Two are appointed objectively. That will be whichever health services researchers/health economists are the most influential at the time the reward is claimed. “Most influential” will be measured by a formula: the highest ratio of Twitter followers/Twitter following, with a minimum of 15,000 followers.
- Those four judges will agree on the fifth.
Using the criteria below, the judging will be based largely on value per dollar of the program spent on the program and incentives. In the event this is considered to be roughly a tie, the judges will consider the validity of their measurement and whether they are validated by the Validation Institute.
Each side submits up to 2,000 words and five graphs, supported by as many as 20 links; the material linked must pre-date this posting to discourage either side from creating linked material specifically for this contest.
Publicly available materials from the lay media or blogs may be used, as well as from any of the 10 academic journals with the highest “impact factors,” such as Health Affairs, published within the last five years.
Each side must:
- list their average prices;
- speak to compliance with ACA, ADA, USPSTF, and Choosing Wisely;
- allow the other to test its materials (for example, taking the health risk assessment) and review them as part of the submission.
Each party may separately cite previous invalidating mistakes made by the other party that might speak to the credibility of the other party. (There is no limit on those.)
The judges may rule just on the basis of the written submissions. If not, the parties will convene online for a 2.5-hour presentation (or, at the discretion of the judges, in-person at the World Health Care Congress), featuring:
- 10-minute opening statements, in which as many as 10 slides are allowed;
- 30-minute cross-examinations with follow-up questions and no limitations on subject matter;
- 60 minutes in which judges control the agenda and may ask questions of either party based on either the oral or the written submissions;
- Five-minute closing statements.
The entry process is:
- Applicant puts $3000 into escrow, at which point an NDA is signed and Quizzify/Quizzify guarantors (“Quizzify”) demonstrate liquid assets exceeding $3 million. Applicant may either go forward at this point, or forfeit the $3000.
- Applicant adds $27,000, at which point earning assets exceeding $3,000,000 are placed in escrow, though the income from the escrow does not go to the applicant. Assuming the $3,000,000 is sufficiently secured, applicant may either go forward, or forfeit the $30,000. If not secured, Quizzify pays the applicant $100,000.
- Applicant adds $270,000 to the escrow within 30 days, at which point the entry process is completed. Both sides then have 30 days to submit materials and 7 days to rebut. Online argument then takes place, if needed.
- Judges are paid from the escrow, 50-50 from Quizzify’s and applicant’s shares.
- If the applicant pulls out after publicly announcing he or she is applying and before adding the $270,000, there is a $50,000 liquidated damages fee, tripled if it has to be procured through litigation. If Quizzify pull outs, there is a $150,000 liquidated damages fee in favor of the applicant, tripled if it is procured through litigation.
- The winner collects the escrow.
June 2021 Update: Virgin Pulse’s one-page outcomes report is eligible. They can win just by defending one single slide with as much backup as they want.
March 2021 Update: Wellsteps can claim double the reward ($6 million) for half the entry fee ($150,000) simply by showing that their ROI calculator is more accurate than Quizzify’s.
January 2021 Update: Omada is claiming outcomes on their home page that are textbook examples of both regression to the mean and participant bias. They are aware this is not valid. They can claim this reward by defending their specious claims.
December 2020 Update: This reward is now applicable to any actuary or other self-proclaimed expert who claims that their published analyses of the wellness/diabetes/disease management industries showing favorable outcomes and savings are better than mine showing losses and general cluelessness.
As almost everyone in the wellness industry knows, we have offered a $2 million reward to anyone who can show that conventional annual “pry, poke and prod” wellness saves money. I’m feeling very generous today, what with the holidays upon us, so let’s make the reward $3 million.
Even more importantly, let’s loosen the rules — a lot — to encourage applicants. You’ll find the $3 million reward is not just more generous, but also far easier to claim than the previous $2 million reward.
Loosening the Rules
Except as indicated below, the rules stay the same as in the previous posting, but with the following relaxed standards. Most importantly, I’ll now accept the burden of persuasion. It is my job to convince the panel of judges, using the standard civil level of proof, that you are wrong, as opposed to you having to convince them that I am wrong.
Next, let’s expand the pool from which the judges can be drawn. It wasn’t very nice of me to allow you to choose from only the 300 people on Peter Grant’s exclusive healthcare policy listserve, since obviously no one invited into a legitimate healthcare policy listserve thinks wellness saves money.
In addition, you can also choose among the 200+ people on Brian Klepper’s email list and the 70 people on the Ethical Wellness email list. And to make it totally objective, we will add as judges whatever two bloggers happen to be the leading dedicated health services research bloggers at the time of the application for the award, as measured by the ratio of Twitter followers-to-Twitter-following, with a minimum of 15,000 followers.
So judges are chosen as follows: two bloggers chosen by objective formula, plus we each choose six people from among the other 520, with the other party having veto rights for 5 of them. That gives a total of 4 judges, who will choose a fifth from among those roughly 500 people.
This means I only name one of the five judges, so I can’t “stack the deck,” not that I would need to.
The original rules included the requirement of defending Wellsteps’ Koop Award. After all, the best vendor should be exemplary, right? A beacon for others to follow? A benchmark to show what’s possible when the best and brightest make employees happy and healthy?
However, now you have another option. You could instead just publicly acknowledge that the Koop Award committee is corrupt/incompetent, since that possibility cannot be ruled out as a logical explanation for Wellsteps winning that award. Your choice, but, one way or the other, the Wellsteps award must be addressed in your entry.
Next, you may bring as many experts with you to address the adjudication forum (a Washington, DC venue to be chosen later) as you wish to bring. I, on the other hand, will be limited to myself. (The judges may also, by a supermajority of 4 to 1, declare a winner, with no in-person presentation needed.)
Further, you no longer have to defend the proposition that wellness as a whole has saved money. You can, if you prefer, simply acknowledge that most of it has failed…except you. Meaning that, if you are a wellness vendor that has been “profiled” on this site in the last 2 years, you can limit your defense to your own specific results. You don’t have to defend the swamp.
That new loophole allows, specifically, Interactive Health, Fitbit, Wellness Corporate Solutions, and especially Wellsteps to get rich…if what I have said specifically about them is wrong. I have $3 million that says it isn’t.
Special Offer for HERO
Ah, yes, the Health Enhancement Research Organization (HERO). The belly of the beast.
Let me make them a special offer. Paul Terry, the current HERO Prevaricator-in-Chief, has accused me of the following (if you link, you’ll see they had enough sense not to use my name, likely on advice of counsel, given that I already almost sued them after they circulated their poison pen letter to the media):
I’m convinced responding to bloggers who show disdain for our field is an utter waste of time. I’ve rarely been persuaded to respond to bloggers [Editors note, in HERO-speak, “rarely” means “never” — except for that intercepted Zimmerman Telegram-like missive], and each time I did it affirmed my worry that, more than a waste, it’s counter-productive. That’s because they’ll not only incessantly recycle their original misstatements, but worse, they’ll misrepresent your response and use it as fodder for more disinformation.*
Tell ya what, Paul. let’s debate disinformation, including your letter.
I have asked you on multiple occasions to clue me in as to what my alleged disinformation actually is, if any. That way I can publicly apologize and fix it, should I choose to do so. Before applying for this award, you need to disclose this alleged disinformation. You can’t just go around saying my information is made up etc. without specifying what it is.
By definition, “disinformation” is deliberate misrepresentation. To my knowledge, as a member of the “integrity segment” of the wellness industry, I have never, and would never, spread disinformation.
On the other hand, if I did spread inadvertently incorrect information by mistake, it seems only fair to let me fix it — especially given that I have been totally transparent and generous with my time in explaining to you what yours is, and how to correct it. (I might have missed some. Keeping up with yours is a challenge of Whack a Mole-meets-White House press correspondent proportions.)
So perhaps it is time to man up, Mr. Terry. You and your cronies claim to have been collecting my “disinformation” for years, without disclosing any of it. I’m offering you a public forum and $3-million to present it…with only one of 5 judges on “my” side.
Otherwise, perhaps you should, in the immortal word(s) of the great philosopher Moe Howard, shaddap.
*As a side note, Mr. Terry writes: “We’re fortunate to work in an industry with a scant number of vociferous critics.” This “scant” number appears to include the entire media — left-wing, right-wing, centrist, and health policy. Apparently also most employees, according to Towers Watson. The good news about “pry, poke and prod” is that it truly bridges the partisan divide, in that everyone hates it.
Update February 20, 2018:
One of the very stable geniuses in the wellness industry has decided that the reason no one applies for this award isn’t that they know they’ll lose. It’s because a reward isn’t a valid offer. We would invite them to read this link.
This offer is completely legally binding. Anyone may claim the $3 million reward ($300,000 entry fee) for successfully convincing the arbitrator that it isn’t. Further, we agree in advance that if an arbitrator finds anything in here that keeps it from being legally binding, the arbitrator may rewrite it to his or her satisfaction in order to make this legally binding.
Update March to October 2018:
The new entry process is:
- Applicant puts $3000 into escrow (bank escrow fees to be 50-50 shared once escrow is completed), at which point an NDA is signed and I show tangible net worth (excluding primary and secondary residences — and any retirement accounts are accounted for net of tax penalty for early withdrawal) more than sufficient to pay the reward. Applicant may either go forward at this point, or forfeit the $3000 to me.
- Applicant adds $27,000, at which point earning assets exceeding $3,000,000 as valued at at lower of cost or mark-to-market are placed in escrow, and/or title is changed to the escrow agent, though I still receive the income until the reward is paid. If I fail to place that sum in escrow within 60 days, I pay a “liquidated damages” penalty of $100,000. The applicant is released from the NDA and may announce that I failed to deliver and they won by default. Assuming the $3,000,000 is sufficiently secured and the “liquidated damages” provision is not triggered, applicant may either go forward, or forfeit the $30,000 to me.
- Applicant adds $270,000 to the escrow within 30 days, at which point the entry process is completed, and the debate is held. Judges and expenses are paid out of the escrow.
- If the applicant pulls out after publicly announcing he or she is applying and before adding the $270,000, there is a $50,000 liquidated damages fee, tripled if it has to be procured through litigation. If I pull out, there is a $500,000 liquidated damages fee, tripled if it is procured through litigation.
- If I win the debate, the remaining escrow funds are released to me.
- If I lose the debate, the remaining escrow funds are released to the applicant.
The “prequels” to this posting are:
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.
In wellness, it is perfectly legal to lie to customers and prospects. That’s in most vendors’ DNA.* (Not all vendors — we will soon be publishing an expanded list of honest ones, and for now would direct readers to http://www.ethicalwellness.org for the original list of honest ones.)
However, if you are a public company, it is quite illegal to lie to shareholders. It’s possible Fitbit did just that. If they did, they could face major SEC sanctions.
Did that just happen? Read this link and then you make the call.
PS This is the sequel to Springbuk Wants Employees to Go to the Bathroom, which should be read in conjunction with this link.
*The irony is that one of the biggest liars specializes in collecting employee DNA and then pretending that they can save a ton of money by getting employees to lose weight by telling them it’s pretty darn impossible to lose weight, because they have a gene for obesity. Yes, you read that right and, no, it doesn’t make any sense.
Update: The link was removed at Fitbit’s request. In a couple of weeks they will defend this report and explain why they or Springbuk never responded to the requests I made for more information before publishing it. Good luck with that.