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AngioScreen gets caught in the Deplorables Award dragnet.
Dumb-de-dumb-dumb.
In the wellness industry’s very stable genius pandemic, AngioScreen is Patient Einstein.
The Deplorables Award, as many of you might remember (you’re excused if you’ve forgotten — it’s been 2 years since a vendor was deemed worthy enough to qualify) goes to that vendor whose combination of dishonesty and patient harms would make Ron Goetzel blush. Angioscreen is all that and more — the kind of outfit that gives clueless wellness vendors a bad name.
Angioscreen had earned the pole position for 2021’s award even before this month’s Journal of the American Medical Association (JAMA) reminded us that — for the third time in as many plate appearances (2007, 2014 and now 2021) —they struck out with the US Preventive Services Task Force (USPSTF). They gave Angioscreen’s go-to carotid artery screen a “D.” In no uncertain terms, JAMA and USPSTF say: “Don’t do these screens to your employees.”
I “profiled” Angioscreen years ago…but never gave them a Deplorables Award on the assumption that they would asymptotically approach irrelevance on their own merit. After all, what benefits manager would ever retain this outfit? Surely no actuary would be dishonest enough to be paid to “find savings” in these screens, and no consultant or broker would be corrupt enough to take money to pitch them, right?
Surely someone would notice that right on their very own website, they cited the fact that the USPSTF gives them a “D.”
And surely someone would notice that Angioscreen’s other business is convincing hospitals to screen communities in order to find new well-insured patients to admit for major surgery…and make the obvious inference that the same screens that are designed to generate admissions can’t also reduce admissions, right?
Haha, good ones, Al.
The hospitals nailed this
Angioscreen is a surgery-generating machine. Here is an employer, who at least had enough sense to withhold his name, bragging about the major vascular surgeries his employees underwent for asymptomatic carotid artery stenosis (CAS) thanks to Angioscreen:
Two of our employees were found to have blockages in their carotid arteries. Through follow-up visits with their physician, these employees found arteries that were significantly blocked that required surgery.
Maybe the employees really needed the surgery? In the immortal word of the great philosopher Brittany Spears, oops. The National Institutes of Health warns against precisely this:
Despite a D recommendation from the USPSTF… many surgeries or interventions for asymptomatic CAS continue to be performed [due to] free screenings.
Wait, you might say, maybe those patients needed those screens to avoid a stroke.
Haha, good one again, Al:
- As JAMA says, “only 11% of strokes” are caused by internal carotid stenosis. Since only about 1 in 1000 employer-covered people has a stroke, you’d have to screen almost 10,000 <65 employer-covered people to possibly have a slight chance of preventing a stroke with a major surgery.
- If Angioscreen’s test is 95% accurate (in their dreams), you’d also refer 500 false positives to their doctors, and some would undergo risky, painful, and expensive major vascular surgery as well, probably like those two in the mercifully unnamed employer above.
The employers got snookered for a change
Funny that Angioscreen wouldn’t attach a name to that reference site, because it’s only a slight exaggeration to say Angioscreen’s customer list includes practically every non-Quizzify-customer (the latter tend to have triple-digit IQs, making them poor prospects for Angioscreen) in the Fortune 500. Here it is:
You might say, that’s not many. True, but that excerpt is only a tiny fraction of the total – I didn’t want to hog the internet by listing all of them.
Perhaps you see some employers on that list that make you think: “Why would a smart, capable company like so-and-so be an Angioscreen customer?” I asked myself the same thing, as I was surprised to see a Quizzify customer on the list. So I asked them, mentioning my surprise.
Turns out they were every bit as surprised as I was. They had no idea they were on that list and had never heard of Angioscreen.
But wait…there’s more. Now how many inappropriate screens would you pay for?
Another reason I had originally demurred from bestowing this award on them was that I also thought that maybe after a while their conscience would get the better of them, and they would stop doing these screens. Perhaps they might pivot from decidedly harmful screens into the more mundane screens that are simply a useless waste of money.
How silly of me.
Quite the contrary, once they realized they had stumbled upon a huge untapped market for employee hyperdiagnosis, they added several more inappropriate screens:
If “Ankle Brachial Index” screening sounds familiar, it’s precisely what Marty Makary warned us against in The Price We Pay as the poster-test for generating unneeded and harmful surgeries.
If ”peak systolic velocity” sounds unfamiliar, it’s because it’s such a stupid idea for a screen that the USPSTF has never even bothered to recommend against it, on the theory that no one would screen their asymptomatic patients for this. A doctor would literally lose their license for routinely doing these screens and billing insurance for these.
And, just in case there is still any employee naively of the mistaken impression they are living their lives diagnosislessly, there’s the D-rated ECG/EKG. These are not supposed to be done because they — get ready — often “reveal” abnormalities that don’t really exist or are harmless…but once revealed, generate follow-up tests.
Fortunately, this next inappropriate screen costs extra, which might discourage a few employers.
Of course, if you indicate to a real doctor something that might suggest you are at risk for an aneurysm, you should get tested, and if the aneurysm is truly large and life-threatening, be referred for this surgery, despite its mortality rate exceeding 7%. That’s different from an unlicensed vendor playing doctor by screening unsuspecting employees for no reason other than to earn “supplemental” fees. Or, as one commentator put it:
My main objection, however, is that I’m uneasy about taking people off the street who think they are perfectly well and subjecting them to a procedure from which 1 in 14 will die.
Ya think?
And so it is with great honor that I bestow the Deplorables Award on Angioscreen as the fourth recipient of this august distinction, joining Wellsteps, and bankruptcy court denizens Interactive Health and Provant. (The latter avoided a Deplorables Award only by going bankrupt after our initial expose, before we had time to bestow the award.)
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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:
- Facilitating approvals of new devices on almost no evidence
- Laughing out loud on videotape at the idea that they may get in trouble because some people could get harmed
- Hiring industry executives to regulate their friends and companies they have invested in
- 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.
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Hyperdiagnosis: The Wellness Industry’s Anti-Employee Jihad
Healthmine just released a survey bragging about how many employees were diagnosed through wellness programs. That reminded us of our popular 2013 posting on The Health Care Blog called Hyperdiagnosis. We are re-posting and updating it below.
By now we are all familiar with the concept of overdiagnosis, where “we” is defined as “everyone except the wellness industry.”
Wellness vendors haven’t gotten the memo that most employees should simply be left alone. Instead, they want to screen the stuffing of employees, at considerable cost to the employer and risk to the employee. The wellness vendors who overscreen employees the most win awards for it, like Health Fitness Corporation did with the Nebraska state employee program.
We call this new plateau of clinical unreality “hyperdiagnosis,” and it is the wellness industry’s bread-and-butter. It differs from overdiagnosis four ways:
- It is pre-emptive;
- It is either negligently inaccurate or purposefully deceptive;
- It is powered by pay-or-play forfeitures;
- The final hallmark of hyperdiagnosis is braggadocio – wellness companies love to announce how many sick people they find in their screens.
1. Pre-Emptive
Overdiagnosis starts when a patient in need of testing visits a doctor. By contrast, in hyperdiagnosis, the testing comes in need of patients, via annual workplace screening of up to seventy different lab values–most of which, as They Said What? has shown, make no clinical sense. Testing for large numbers of abnormalities on large numbers of employees guarantees large numbers of “findings,” clinically significant or not. The more findings, the more money wellness vendors can add on for coaching and the more savings they can claim when they re-test.
2.Inaccurate or Deceptive
Most of these findings turn out to be clinically insignificant or simply wrong, no surprise given that the US Preventive Services Task Force recommends universal annual screening only for blood pressure, because for other screens the potential harms of annual screening outweigh the benefits. The wellness industry knows this, and they also know that the book Seeking Sickness: Medical Screening and the Misguided Hunt for Disease demolishes their highly profitable screening business model. (We are not cherry-picking titles here—there is no book Here’s an Idea: Let’s Hunt for Disease.) And yet most wellness programs require employees to undergo annual screens in order to avoid a financial forfeiture.
Hyperdiagnosis also obsesses with annual preventive doctor visits. Like screening, though, annual “preventive” visits on balance cause more harm than good. The wellness industry knows this, because we posted this information on their LinkedIn groups, before we were banned from most of them. They also presumably have internet access on their own.
3. Pay-or-play forfeitures
The worthlessness, the inconvenience, and the privacy invasion make screens very unpopular. The wellness industry and their corporate customers “solve” that problem by tying large and increasing sums of money annually — now $694 on average – to participation in these schemes. Yet participation rates are still low.
4. Braggadocio
While doctors are embarrassed by overdiagnosis, boasting is an essential ingredient of hyperdiagnosis. We’ve already blogged on how Health Fitness Corporation bragged (and lied, as they later admitted) about the number of cancer cases they found in Nebraska. They also bragged about the rate of cardiometabolic disease they found — 40% in the screened population — even though they admitted almost no employee did anything about those findings, and only 161 state employees reduced risk factors. Hence, it was the worst of both worlds: telling people they are sick without helping them get better. Nothing like telling someone they’re sick to increase their productivity.
Compass Health is our favorite example of hyperdiagnosis braggadocio. We realize this screenshot is a bit tough to read, but the hilarity is worth the effort. We pulled this vignette from On The (even) Lighter Side, They Said What?‘s most popular feature.
The Definition of a “Healthy Employee” Is One Who Has Not Been Diagnosed by Compass Health
Feeling fine today? Alas, you better get your affairs in order, bid your loved ones adieu, and watch the shows you’ve DVR-ed. Why? Because, dodo-brain, feeling fine means you have:
You are “walking around without a clue that [you have] a debilitating or terminal condition.” According to Compass Health (which at this point, having been “outed” by us, had the good sense to take this off their website…but not until we captured a screen shot), the major symptom of I Feel Fine Syndrome is: not having symptoms.
We’ll let them take it from here, to display not only their epidemiological prowess but also, this being the wellness industry, their grammar and spelling prowess as well:
We must confess we learned a lot from Compass. We had not realized that employers’ concerns about employees feeling fine had their roots in ancient history. But there it is, right in the opening words: these concerns date back “millenia” [sic], when employers failed to get their employees tested for “percolating” conditions before throwing them to the lions.
So the bad news is that feeling fine may be hazardous to your health. The good news is that your ICU bed may not need a DNR notice anytime soon because elsewhere Compass says it “has programs and solutions to help your employees overcome their I Feel Fine Syndrome.” And it is “very likely” these programs and solutions can “completely cure the problem…forever in our bodies.”
And not a moment too soon, because we’re never felt better in our lives, which means the clock is ticking. That’s the good news. The bad news is, if we join Compass’s program it sounds like we need to start contributing more to our 401K’s.
Summary
We’d like to think that all our exposés have made a dent in the wellness industry’s business model, but the forces arrayed in the other direction have so far overwhelmed us. The price of screening has plummeted almost to the $1-per-lab-value level for comprehensive screens, and as with anything, the lower the price, the greater the amount sold.
Couple those economics with the advent of genetic testing as part of wellness, big and profitable fines for non-participants, and the EEOC being defanged as a sop to the Business Roundtable, and it’s clear the wellness industry’s highly profitable hyperdiagnostic jihad against the American workforce has barely begun.
By contrast, Quizzify teaches employees that “just because it’s healthcare, doesn’t mean it’s good for you,” and to only get screened according to the USPSTF guidelines. That’s a message that employees would love to hear, but that wellness vendors can’t afford to tell them.
They Said What? 