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False positives for dummies (and smarties)

Wellness vendors love to brag about the number of sick employees they find through their screenings. Screening employees against their will, overdiagnosing them, then bragging about how many of them are sick is called “hyperdiagnosis.” Most of those “newly discovered conditions,” to use Interactive Health’s phrasing, are false positives.

No surprise here, given they perform about 40 tests. Doctors, as it turns out, don’t understand how to interpret lab results. If doctors — with four years of pre-med math and science requirements, four years of medical school, and likely four more years of residency – can’t do this, it is a very safe bet that unlicensed, unregulated, unsupervised wellness vendors would demonstrate even less ability to distinguish false positives from true ones. We’re talking about outfits that can’t even distinguish the words “cessation” and “recession.”

And speaking of not being able to distinguish things, if you haven’t already done so, take the Interactive Health IQ Test.

Here is another quiz: what is wrong with this list of vaccinations from Star Wellness:

Yet another quiz, from Cerner:

This one might be a little harder, since Cerner was so oblivious that they put this screenshot right on their brochure. This person’s blood pressure is 110/85, which Cerner says is “in the moderate risk category of pre-hypertension.” They overlooked the ever-so-slight detail that the “pulse pressure” of this unfortunate employee is only 25, a level typically found only in ICU patients with DNR orders.  More likely, Cerner’s employee simply didn’t take the reading correctly, and no one at Cerner knew enough about blood pressure to realize the error before the brochure went to press.

…And yet we are trusting this industry — whose ethical and competence lapses consume 50 pages in the leading law-medicine journal — to interpret our lab results?

These examples illustrate two realms in which wellness vendors can mess up. The first is in the actual testing, as with Cerner. The second in the interpretation, as with Interactive Health. Star Wellness is in a league of its own, having outstupided virtually every other vendor in wellness, which is stiff competition indeed.

Lab test science for dummies and smarties

Scientific error is largely but not entirely based on the innate inaccuracy of finger-pricks. Wellness vendors like to tout these fairly painless blood draws because they don’t scare employees away, hence creating more revenue potential. However, finger pricks are somewhat unreliable. First, there isn’t a lot of blood to begin with. Measuring multiple blood values requires diluting the specimens so that each reagent has enough to work with. And it’s Labs 101 that every manipulation of the blood – dilution being a prime example — increases the potential for error.

Another “manipulation” is the very fact of pushing the blood through the skin. This can contaminate the blood, and also causes something called hemolysis, the rupture of red blood cells.  Hemolysis can seriously skew results for many blood values. And yet it’s extremely doubtful that your vendor has figured out how to mitigate hemolysis, largely because they’ve never heard of it. Test this hypothesis simply by asking a vendor how they mitigate hemolysis in a finger-stick test.

Don’t be surprised if you get a non-answer. Remember, wellness vendors are not trained in screening–or in anything else for that matter. One of the attractions of becoming a wellness vendor is no one is tasked with educating, licensing, regulating or supervising you in any way.  Becoming a wellness vendor is the healthcare industry equivalent of applying for a zero doc loan, except with a lower chance of being turned down.

Venipuncture is more accurate than finger-sticks, but even so, the level of training that wellness vendors receive – as little as five days, provided you have a background in “municipality administration, finance or sales” – does not inspire confidence that they will get this right.  Many variables are involved, in collection, handling, storage, transport and interpretation of the specimens.  Each sample is like a little lab experiment, one that’s been repeated many times and has a standard protocol, but is not a pure algorithm. Technique, time of day, employee activity and diet before the test, elapsed time between collection and analysis, and even ambient temperature during transport influence the outcome.

Lab test arithmetic for Interactive Health and smarties

Nonetheless, let’s give the vendors the benefit of the doubt and assume their tests are 90% accurate, because in all fairness, most finger-stick tests don’t purport to measure values that specifically involve red blood cells. Glucose is one such accurate-enough test – assuming the employee has really fasted.

Yet accurate or not, glucose is one of the least cost-effective blood values to measure. An employee in the lower part of the diabetic range now (meaning most of them) wouldn’t crash for years no matter what you do. Sure, you can find them, treat them, and get them to check their glucose daily, but it’s doubtful you’ll change anything other than how much money you spend on preventing a complication or hospital admission likely not to occur until after retirement. (Annually, only about 1 in 1000 <65 insured people end up with the hospital with a primary diagnosis of diabetes.) It also turns out that for the vast majority of diabetics (those who are not insulin-dependent), daily glucose testing is a waste of time and money.

And do you really want employees to obsess with keeping their blood sugar down? Does it increase productivity if employees have low blood sugar?

But at least the science of the glucose test itself is accurate enough, assuming the employee has fasted and assuming you retest several times before coming to a conclusion. Let’s look at some predictive tests (including mammograms) whose accuracy is more like the mainstream 90% and see what happens when you apply lab test math in those circumstances. Heart attacks are the best example. If you, as an employer, could predict and prevent a heart attack, that would be cost-effective…or would it?

Maybe 2 in every 1000 employees will have a heart attack next year. Of those, at least 1, if not more, fit one of the following descriptions:

  • already have a known CAD diagnosis, diabetes, or metabolic syndrome (and hence screening won’t yield any new insights) or
  • are among the many people whose heart attacks are completely unpredictable from a standard blood test.

Optimistically, then, you’re looking at a 1-in-1000 chance of actually finding someone this year who would otherwise not be found and would have a heart attack unless it is predicted and prevented. It doesn’t help your accuracy that the Genetic Information Nondiscrimination Act does not allow inquiries about family history, which is a very major risk factor.

Let’s further assume that — highly optimistically and despite not being able to inquire about family history — the cardiac tests that a wellness vendor runs on an employee can predict a heart attack with 90% accuracy. Anyone who could predict heart attacks with 90% accuracy would win a Nobel Prize, so this is a very generous assumption.

Watch what happens when that 90%-accurate test is performed on a population of 1000 employees. First, the good news: there is indeed a 90% chance that the employee who would infarct can be found. That’s 1 positive. Next, the bad news. A 90%-accurate test is also 10% inaccurate, which means about 99 of the other 999 employees will have a phantom heart attack “predicted.” We can send this Excel spreadsheet on request:

100 employees in total will test positive. 99 of those will be false. And yet all 100 will be sent to the doctor, and likely given a barrage of further tests and possible stents. Lab test arithmetic explains why it costs about $1-million for an employer to prevent a heart attack assuming it can be prevented at all.

What does this mean for employers and employees?

Simple: testing decisions should be left to employees and their doctors. Employers should not play doctor with their employees.

Overtesting creates overdiagnosis, which in turn requires overspending on overtreatment. Example: A bank sent its top executives to a hospital for testing. The 16 executives tested were informed of a total of 18 new diagnosis, in addition to diagnoses they already had. The bank spokesman admitted “it’s still too early to see savings,” while the hospital spokesman candidly admitted that this executive screening program “offers another source of income” to the hospital.

Next is one of the wackier ideas to come down the pike, the celebrity-fueled myth that employees should get tested for ovarian cancer. This test doesn’t approach any baseline level of accuracy, so the USPSTF rates it a D.

Even the wellness vendor that advertises it the most, Star Wellness, admits it is “notoriously difficult to detect in its early stages.”  Insurance won’t pay for the test, and as Star says, it is “not readily available from doctors.” Perhaps there might be a reason for that?

It also means that you shouldn’t encourage mammograms for the <50 population, following USPSTF guidelines. That decision can be between them and their doctors. Mammograms in younger women are notorious for generating false positives.  In one well-regarded study, of 2100 women screened for 11 years starting at age 45, 690 received a false-positive along the way, and 75 underwent an unnecessary biopsy.

On the other hand, you don’t want to discourage mammograms, on the off-chance that an employee really does have cancer. Staying out of a conversation in which you have no expertise is the best idea.

Another good rule of thumb in these situations is, look at what Interactive Health does…and then do the opposite. This is their result from testing the generally healthy population of young employees, testing them for 40 things, 39 of which (except blood pressure) are not recommended for young employees due to the preponderance of false positives. So their rate of positives is not much lower than their 45% rate overall.

They are, of course, fully aware that most of their positives are false. I know this for two reasons.

  1. Here is a list (scroll down) of the top 25 hospitalizations for people insured by employers, in order. Obviously, if 38% or 45% or whatever huge percent really had these “newly discovered conditions” and the employer didn’t discover them, they’d crash, right?  Do you see anything on here that could have been “discovered” and prevented by a wellness vendor?
  2. They also follow my postings, where I have made this quite clear, Exhibit A being this one. And as Confucius said: “If you don’t correct a mistake after it is pointed out, you are creating a lie.”In that case, Interactive Health’s “mistakes” could make a White House correspondent blush.

Update October 30

Yes, Interactive Health is that stupid.


Interactive Health meets Barbie

This just in.

Probably the easiest $1040 ($20/week for 52 weeks) anyone ever made, so I think this person owes a debt of gratitude to Interactive Health.

I just completed my Interactive Health health assessment. I didn’t want to, but $20 a week off my insurance premium is $20 a week. I entered 80 pounds and a waist circumference of 15 inches, because it’s none of their business. My dashboard says my BMI is “Underweight” (no kidding! 5’8” and 80 lbs!) but my waist circumference is “Healthy Range”. If I was a living Barbie doll maybe! I don’t think even Scarlett O’Hara had a waist that tiny.

Yes, Interactive Health is wrong, as is their wont. This time it’s because someone who weighs 80 pounds and is 5’8″ is not in a “healthy range” and should be referred for medical assistance immediately.

The irony, of course, is that Interactive Health loves to send employees to the doctor, bragging about their 45% rate of “newly discovered conditions” that need medical attention, following one of their hyperdiagnostic screening crusades.  And, yet here is someone screaming for medical attention, but frankly, Scarlett, Interactive Health doesn’t give a damn.

Addendum: Someone asked me: “Why don’t the grownups do something about these people?”  The answer is they are: “doing something” The NCQA is giving them highest honors.


PS  Yes, there is a thing called a Scarlett O’Hara Barbie.

We interrupt this program…

I have several new posts ready to go — the usual suspects acting out in their usual hilarious fashion — but this is a serious post.

It is time for wellness vendors to stop harassing employees about their weight.

A new article summarizing the voluminous data on the futility and harms of weight-shaming just appeared. It doesn’t contain new data, but rather presents the existing evidence in a clear and compelling format.

This article finds fault in the physician community, but the wellness industry (the outcomes-based companies and their enablers at the Health Enhancement Research Organization (and their enabler-in-chief, Ron Goetzel) is even worse because they tie money to weight loss. They give employees a financial reason to binge before the first weigh-in and then dehydrate themselves and crash-diet before the last one.

This does nobody any good, except of course the outcomes-based wellness vendors — like Interactive Health, Wellsteps, Wellness Corporate Solutions, Staywell, Bravo, Total Wellness, Star Wellness, Health Fitness Corporation and probably a host of others.  And there is a special dishonorable mention for HealthyWage, whose entire business model is corporate crash-dieting contests.

They aren’t going to agree to stop on their own, any more than Monsanto stopped making DDT on its own volition. They need to have it made clear that this behavior won’t be tolerated any more.

Action Steps

A starting point is this linkedin post.  Like it, comment on it, share it.  Once we get to 100 likes and comments, and we’re already more than halfway, I can probably generate media attention.


Is your wellness vendor snookering you? Take this quiz to find out.

Is your wellness vendor snookering you? There are certain facts that vendors are not exactly forthcoming about. This is because facts represent an existential threat to the “pry, poke and prod” industry. See how many facts you know — and how many they’ve suppressed — by taking this quiz.

You’ll earn more points, the closer you are. You don’t have to be exact — and honestly I’d worry about you if you got the exact answers to every question. I’d love you for it, but I’d still worry about you.

  1. Wellness vendors claim they can save significant money by reducing hospital admissions for diabetes and heart attacks, because those admissions are very common. How many admissions per 1000 covered lives does the average employer incur in a typical year?

  2. The Health Enhancement Research Organization claims a certain savings figure for wellness PEPM. But that’s before taking into account vendor fees, extra doctor visits, tests, and prescriptions, compliance issues, employee time needed, overhead and basically anything else. In other words, what is the PEPM savings figure that at Bain & Company we used to refer to as “profit before cost”? Answer to the nearest one dollar. Hint:  the answer is somewhere in this quiz.

  3. To eventually save money someday, you first need to improve/reduce the risk profile of your population. According to eternal optimist and wellness promoter-in-chief Ron Goetzel, what is the maximum percent improvement in a risk profile that a company can expect after 2 to 3 years of wellness programming @$150 PEPY?

  4. Speaking of Ron Goetzel, he said “thousands of wellness programs” fail to get good outcomes. What round number did he claim have succeeded?

  5. And speaking of Ron Goetzel again, he finally admitted it was “hard” to force employees to change behavior. How many “very’s” did he put in front of the word “hard” in that admission?

  6. The Wishful Thinking Factor, totally coincidentally abbreviated as WTF, is defined as: Total claimed cost reduction/total number of risk factors reduced. What is the average WTF for the last six Koop Award-winning programs, on average? (Hint: the real ratio of savings to risk reduction is about 0.05x, since even if savings does not lag risk reduction, a maximum of 5% of spending is wellness-sensitive.)

  7. Speaking of risk reduction, employees in the most recent Koop Award-winning program, Wellsteps/Boise, originally tallied 5293 risk factors. Approximately how many risk factors did those same employees tally after participating, excluding dropouts?

  8. In a participants-vs-non-participants study design, what percent of the perceived savings is due to the invalidity introduced by the study design itself in which unmotivated employees are used as the control for motivated employees, rather than health improvements attributable to the actual program itself, according to all four studies conducted on this topic, including three by wellness promoters?

  9. If you use Interactive Health as a vendor hyperdiagnosing the stuffing out of your workforce, what is the annual percentage of employees that will likely be told they have “newly discovered conditions”  that “require” a doctor’s intervention?

  10. Of 1000+ wellness vendors, how many are validated by the Validation Institute?


  1. 2. Yes, only 2. All this wellness fuss is about 2 admissions per 1000 employees. Derivation: the roughly 150,000,000 employees and dependents covered by commercial insurance (mostly from employers) generate roughly 150,000 heart attacks and 120,000 diabetes events.  See the HCUP database and enter “410” for heart attacks and 250 for diabetes admissions for the ICD9 for the most recent full year (2014). Scoring: Give yourself 1 point for guessing 4 to 10 and 2 points for guessing fewer than 4.  

  2. One dollar. $0.99 PEPY. As is well-known, they tried to walk this figure back once they realized they had told the truth. Scoring: Give yourself 1 points for guessing $1.00, since the answer in the hint was on that very same line.

  3. 2%. That’s a few dollars PEPY in savings. (Looks like the HERO report was pretty close, its own protestations notwithstanding.) And you paid $450/employee over 3 years to achieve it.   Actually it was 1% to 2%, but we asked for the maximum. Scoring: Give yourself 2 points for 2% or less, 1 point for 4% or less. 

  4. Only 100. Besides Johnson & Johnson, Mr. Goetzel has never disclosed any of the other 99 without others making the observation that they self-invalidate according to their own data. Scoring: 2 points for 200 or fewer, 1 point for 400 or fewer.

  5. 4. In The Healthy Workplace Nudge, Rex Miller gets Ron Goetzel to admit that “changing behavior is very very very very hard.” Gosh, Ron, do you suppose this might explain why an employer population’s risk factors never noticeably decline? Scoring: 2 points for 4, 1 point for 3 or 5.

  6. Infinity. That’s because of the next question. The 21% risk factor increase for Wellsteps more than offset the trivial risk reductions achieved by the previous years’ winners. The actual WTFs for the previous years will be the subject of a future posting. Scoring: give yourself a point if you guessed that the WTF was 5 or higher. That would be 100 times the actual figure and still way below the wellness fantasy-league figure.

  7. 6397. Risk factors rose 21%. And yet somehow, even though the risk profile was deteriorating sharply, the risk profile of the population was also improving enough for Wellsteps to claim that healthcare costs declined 30%. 30% is enough to wipe out wellness-sensitive medical events for the entire Boise teacher population and about 30,000 of their closest friends. (Wellsteps originally admitted that costs increased, but took that slide down when it occurred to them that telling the truth would be inconsistent with their marketing strategy.) Scoring: 1 points for 5500 to 6000 or 6600 to 7000, 2 points for 6001 to 6599.

  8. 100%. It turns out that the participant-vs-non-participant study design is responsible for all the perceived savings that wellness vendors claim for programs. The New York Times just explained how, in the landmark University of Illinois study, both the “gold standard” RCT methodology and the invalid par-vs-non-par methodology were used and had completely different results. This also happened three other times (summarized here) — with Newtopia, Health Fitness Corporation, and a study done by the chairperson of the Koop Committee showing how feeding diabetics more carbs would reduce their costs by improving their health. Literally, 4 studies — all of which were run by people trying to show savings — showed exactly the same thing. Scoring: all or nothing — 1 points for 100%.

  9. 45%. This is because running 40 inappropriate tests on every employee makes it inevitable that at least 1 or 2 of those tests reveal a false positive. Scoring: Give yourself 2 points for guessing between 40% and 50%, 1 point for 30% to 39% or 51% to 60%.

  10. Four. All four are honest and make modest claims they can defend or valid contractual representations.  AND, they actually screen according to guidelines! (In the wellness industry, doing something appropriate merits an exclamation point.) They are: It Starts With Me, Splashlight, Sustainable Health Index, and US Preventive Medicine. That’s <1% of all wellness vendors. Scoring: give yourself 1 points for 8 or fewer.



0-2 points. Has your wellness vendor sold you a bridge too?

3-5 points:  Your wellness vendor is blocking your internet connection

6-9 points:  Nice work!

>9 points:  Send your fifth-grade math teacher a thank-you note for doing a better job than the wellness vendors’ teachers did.


Interactive Health fails fact-check by…college intern

A long-since forgotten essay on the history of hospitals by Lewis Thomas includes the story of a doctor who claimed he could diagnose typhus by examining inpatients’ tongues. He would examine their tongue…and a few days later they would indeed develop typhus. Turned out the doctor was spreading the typhus pathogen by feeling all the patients’ tongues without washing his hands.

Keep this anecdote in mind as you read the following.

Seems like I’m not the only one to show that Interactive Health’s numbers never, ever, ever, ever add up. And it looks like you don’t have to have taught economics at Harvard to do it, or even be old enough to rent a car. Rather, a triple-digit IQ is all it takes. Tom Rosenbaum, a “data analytics intern” at AP Benefit Advisors in Maryland, completely invalidated one of Interactive Health’s more headscratching claims.

By way of background, Interactive Health’s strategy is to convince HR departments that their company is simply overrun with ridiculously unhealthy employees whose medical spending will explode at some point in the future…and send almost half of the employee population to the doctor to allegedly prevent that from happening. That, of course, requires screening the stuffing out of them today, at considerable expense.

I’ve asked them repeatedly on Linkedin to please explain:

  1. how the US Preventive Services Task Force can be so misinformed about so many Interactive Health screens being so inappropriate and
  2. how their own panel of 43(!) tests is clinically proven to somehow save money by increasing (not a misprint) the number of employees who think they are sick, and the corresponding number of doctor visits.

Their “response” is invariably to delete my comments. Here is one example:

Quite the contrary to “the impact of heart disease growing by the minute,” heart health is actually, shockingly, one of the major public health/medicine success stories of our generation.  Deaths due to heart disease, and heart attacks themselves, are down by about 2/3 since 1969. I merely tried to inform their posting with a fact, but by the time you see their posting, facts will have been deleted. [Update: they already are deleted, along with many supportive comments I received on this posting. Usually they delete my comments within minutes, so I’ve started posting them at night so they can stay up for a few hours.]

Enter Tom Rosenbaum

Their new revenue-maximization strategy is to tell employers it’s not just older employees they need to worry about. It’s younger employees too.  And it’s not just medical issues that plague the younger workforce. It’s also mental health issues. Their specific language:

Workers under 35 are more likely to struggle with mental health issues, such as stress, depression and anxiety.

Tom decided to fact-check this particular item using actual data. It turned out:

  • 5.39% of older workers had claims for these mental health items, vs. 5.33% of younger workers
  • Older workers spent 32% more on antidepressants than younger workers

This insight got him into Employee Benefit Adviser as likely the youngest person ever to author a column for them. And the second-youngest person ever to get mentioned in They Said What.

Of course, it is possible that Interactive Health’s data is different than everyone else’s, and here’s why. According to their White Paper:

Here’s perhaps the reason why their customers’ employee stress levels are so much higher than average. If someone tells you that you have a “condition” and you “should be directed to a doctor,” you’d be stressed out too.

Something very similar happened to me when I let Interactive Health fiddle with my calves and tell me they were tight and could cause problems — one went into spasm shortly afterwards.

Luckily I didn’t let them anywhere near my tongue.



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?

Extensive Wellness Industry Expose Reaches Popularity Milestone

The most comprehensive expose of the “pry, poke and prod” industry is likely to have broken the 1000-download threshold by the time you read this.

Published by the leading law-medicine journal, it is their second-most-popular paper of all time. Curiously, while this is the oldest law-medicine journal in the country and has covered a multitude of topics over many decades, the most popular paper of all time is also a smackdown of pry, poke and prod programs.

Because TSW doesn’t lie (that’s part of the reason we are so unpopular amongst the HERO crowd and its sycophants), I would acknowledge that the methodology they use to measure popularity favors more recently published articles, and ours is “only” a year old. Even so it is quite a feat because, while we are close on the feels of #1, there is a big gap between us and the #3 article.

In the structured world of law, as opposed to the “Wild West” of wellness, there are rules. That’s why I chose the leading law-medicine venue for this expose.

One rule of evidence is that some of the best evidence — one of the few exceptions to the hearsay exclusion — is what’s known as an “admission against interest.” An admission against interest is “a statement by a party that, when uttered, is against the party’s pecuniary, proprietary, or penal interest.”  It’s even more compelling if it is captured electronically, as on a live mic, or in print.

The best example is Robert Durst accidentally admitting that he killed his wife during a bathroom break while being interviewed for a documentary, when he was still miked. You’d have to be, as Larry David might say, pretty pretty pretty pretty stupid to make admissions against interest when you are miked or in print.

One would think.

And yet the wellness industry’s entire modus operandi is to do exactly that. All that remains is for someone like me to point these things out, take a screen shot (the equivalent of Durst being miked), and then sit back, make some popcorn, and watch them react. Reacting is also a form of evidence. Reacting the way a guilty person would react is prima facie evidence of guilt. (To use the examples from the TSW landing page, think OJ and the white Bronco or Lance Armstrong and just about anything he said or did after being accused.)

Needless to say, the wellness industry’s very stable geniuses never step out of character when it comes to guilty reactions. This runs the gamut. Sometimes, as with Bravo, they pull down the incriminating screenshot immediately after being outed. Or, as with Interactive Health, they simply excise the incriminating data from their “research report” and call it a “research summary.” (And also they try to bribe me not to talk about them any more. I’m just sayin’…)

Or, as with Wellsteps, they act out with unsupported and creatively spelled recriminations.

Or sometimes simply trying to erase history. This is the specialty of Ron “The Pretzel” Goetzel, twisting and turning his words to do exactly that, not realizing that we keep screenshots. Here is the “before” and “after” picture of him erasing the smoking-gun evidence that a program’s “impact” was due entirely to separation into participants-vs-non-participants rather than pry, poke and prod. Note that from 2004 to 2006, separation between participants and non-participants increased almost 20%before there was even a program to participate in.

Before (what really happened):

In order to maintain the fiction that participants-vs-non-participants is a valid study design, Ron simply removed the labels from the x-axis:

Lest anyone domiciled in a state where marijuana is now legal think the first one was a mistake and was corrected as soon as they noticed, they actually repeatedly reprinted and reused the original in many forums, like this one:

Sometimes, and this was my favorite of Ron “The Pretzel” Goetzel’s twists and turns, he literally rewrote history, in the form of forging a letter from the Governor of Nebraska, once he admitted the initial claim of saving the lives of 514 cancer victims was exposed as a fraud:


nebraska cancer koop award


nebraska polyps

Here is your assignment: pass this along to everyone you know and ask them to read the article. Then hopefully it will be time to write the history of wellness the way it should be written. And keep a screenshot in case Goetzel tries to rewrite it.


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