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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?
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:
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.
In this hyperpartisan era, conservatives and liberals agree on only one thing: forcing employees into outcomes-based wellness programs is one of the worst ideas in the history of ideas. If you scroll down our feature In The News, you’ll see wellness gets equal treatment by right-wing publications like Newsmax and The Federalist as well as left-wing publications like Slate and Mother Jones.
Opposing forced wellness has already propelled one candidate into elective office: Matthew Woessner, whose leadership in Penn State’s faculty revolt against the punitive “pry, poke and prod” plan proposed by Highmark and Ron Goetzel, was elected President of the university’s faculty senate. Matthew is a self-described Republican libertarian.
In keeping with the bipartisan nature of wellness, it is fitting that the first Congressional candidate to take on the wellness industry is, conversely, a Democrat, Jenny Marshall. Jenny (as she likes to be called) is running against Virginia Foxx (R-NC5), who chairs the House Committee on Education and the Workforce. A powerful combination of this lucrative committee chairmanship, lack of ethics and a gerrymandered “safe” district (at least until voters find out about this bill), allows Foxx to “represent” the American Benefits Council rather than voters in her district. Indeed, I suspect she has nary a single constituent who supports employees being pried, poked and prodded into submission. It is not at all clear how this bill would benefit her district.
Any controversy over whether forced wellness saves a nickel or even improves health has long since been laid to rest. Hence, the American Benefits Council’s enthusiasm for forced wellness is all about making programs so onerous and unappealing that employees prefer to pay the $1000 fines rather than be subjected to the indignity and potential harms of being pried, poked and prodded by unlicensed, unregulated wellness vendors.
On the other hand, these programs can be very lucrative for employers, who can claw back large chunks of their insurance premiums forfeited by non-compliant employees. Vendors have already figured out how to offer “immediate savings” for employers through collecting these fines from employees.
Unless Foxx’s bill becomes law, this lucrative, misanthropic, anti-employee loophole will be closed December 31, thanks to the ruling in AARP v. EEOC, which will prevent employers from forcing employees into “voluntary” wellness programs.
Foxx’s HR1313, known colloquially as the Employee DNA Full Disclosure Act, would override this common-sense federal court decision. Worse, it would allow employers to force not only employees but their children into these programs. And not just prying, poking and prodding them, but collecting their DNA as well. Yep, your children’s DNA is fair game if this bill passes. It is so onerous that even much of the wellness industry opposes it, though they stand to benefit from it.
It is headed for a floor vote sometime this spring, having been voted out of her committee on — get ready — a straight party-line vote. (So much for the GOP standing for individual rights.)
Jenny Marshall fights back
Jenny has posted a summary of this bill right on her campaign website. Asked for a comment, she replied: “Foxx’s bill could very well be the worst proposed legislation in the history of Congress. Its intrusiveness would make Orwell blush. I can’t figure out why she would want to invade the privacy of her constituents like this, other than raking in big dollars from lobbyists. For too long now, Foxx has turned a deaf ear to the wants and needs of the people of our district, and for that betrayal should be voted out of her seat.”
If this bill passes, the very stable geniuses at “outcomes-based” wellness vendors like Bravo, Interactive Health, Wellsteps, Corporate Wellness Solutions, and Staywell will be able to trample employee rights to privacy, fine them and harm them — for no reason other than to enrich their own coffers, and those of their corporate overlords. Absent this legislation, millions will be thrilled to be freed from their anti-employee jihads on December 31 — and employers can find kinder, gentler conventional programs, a la Redbrick or unconventional ones like Limeade (and/or Quizzify, of course) instead.
The way to keep this bill from passing? Vote Foxx out of office. Shed no tears for her. She will get a lucrative job, possibly representing the American Benefits Council in their quest to collect fines from employees — just like she does now.
Only starting in 2019 her paycheck will come directly from them, as opposed to indirectly, as it does now.
Interactive Health has once again proven themselves worthy of the 2017 Wellness Industry Deplorables Award.
How do we know this? They recently announced the industry’s first “smoking recession program.”
I don’t smoke, but it would be worth taking up the habit just to see what is entailed in this Smoking Recession Program, because otherwise they are keeping the contents under wraps, presumably so that previous winners of the Deplorables Award don’t copy them.
One possibility, suggested by Alert Reader Jon Robison, is that a great way to quit smoking is to lose your job and no longer be able to afford the habit.
Another possibility is that Interactive Health wants smokers to switch to Parliament, which offers a recessed filter.
Interactive Health’s idea behind the recessed filter is probably that because your lungs are farther away from the smoke, you live longer.
If you haven’t already done so, sign up for the webinar on AARP v. EEOC on January 18. You’ll be joined by thousands of other industry executives and HR professionals. We will be covering not only what happened, but how you can make lemonade out of it.
In the immortal words of the great philosopher Dizzy Dean, don’t fail to miss it.
Winning a Deplorables Award is no easy feat for a wellness vendor. You have to out-lie, out-harm and generally out-stupid many worthy competitors. Yet this year’s competition wasn’t even close. Fitbit might have won on lies and stupidity alone, but no one was ever harmed by wearing an activity tracker. Interactive Health clobbered them in harming employees. Like Wellsteps (the 2016 Deplorables Award Winner) they managed to do that multiple ways. This award covers the harms, the lies, and the stupidity. Truly the perfect storm of workplace wellness.
Interactive Health’s signature move is conducting mass screens so inappropriate that doctors doing essentially the same thing — paying people to take this panoply of tests and then billing insurance — would lose their licenses.
Needless to say, when you do all sorts of inappropriate tests, you find all sorts of non-existent problems, and send all sorts of employees to all sorts of doctors. This isn’t simple overdiagnosis. This is classic hyperdiagnosis as described in our 2015 posting.
This is what we wrote in that posting, and it appears Interactive Health is the poster child for it. As compared to overdiagnosis, which is the unfortunate byproduct of well-intentioned efforts to help patients who present with symptoms, hyperdiagnosis is:
- pre-emptive — employees aren’t asking to be diagnosed, don’t have symptoms, want to be left alone, and often aren’t even old enough to have the stuffing screened out of them yet;
- either negligently inaccurate or purposefully deceptive (and IH has been requested many times to stop doing inappropriate screenings but they continue unabated);
- powered by pay-or-play employee forfeitures for non-participation, of the type about to become illegal in 2019;
- all about the braggadocio – wellness companies love to announce how many sick people they find in their screens…
…And here is Interactive Health doing exactly that:
What do you do after you round up all sorts of unsuspecting employees with inappropriate screens? Obviously, you bombard them with inappropriate advice, of course. Specifically, the huge percentage of employees at risk for diabetes — thanks to those “a1c tests for everyone” (which of course are specifically not recommended by the USPSTF) are supposed to drink full-fat dairy, not skim. And absent hypertension, they are also not supposed to avoid salt. Quite the contrary, maintaining US-average salt consumption appears to be protective against diabetes. (Not to mention that salty snacks often substitute for sweet ones.) We had no trouble finding these studies online. Hopefully Interactive Health will use some of their award money to purchase an internet connection.
Fortunately, most employees pay no attention to Interactive Health’s 1500-word single-spaced tomes, so it’s unlikely their antediluvian advice harmed anybody.
Third, speaking of harms, they also harmed me when I went in to be screened. Not just by announcing my PSA score when I specifically asked not to be tested for PSA, but by stretching my calf far enough to send it into spasm.
The English language already has 450,000 words, the most of any language. And yet none of those words adequately describe the amount of lying done by Interactive Health, even after they’ve been caught.
They are claiming “amazing results” based on one study by an unknown, now-defunct consulting firm that couldn’t even pay its internet provider. (The consulting firm had also made up a set of qualifications in which, other than articles and prepositions and conjunctions, every word was a lie.)
Once the lies were initially exposed, they paid me to stop writing about them for a while. I agreed, provided that they stop lying — meaning that I can write about them ad nauseam.
The smoking gun for the initial lie was that they accidentally admitted that they didn’t really reduce any risk factors. You can’t save a gazillion dollars by reducing employees’ wellness-sensitive medical events if you can’t improve employees’ wellness. According to their own figures (and of course excluding dropouts and non-participants, whose risks likely climb), their risk reduction was quite trivial. How trivial? The Wishful Thinking Multiplier — savings divided by the number of risk factors temporarily reduced — exceeded $50,000.
After that expose, they sealed their front-runner status for a Deplorables Award by simply trying to suppress the evidence. They took the trivial risk reduction displays out of that study, and now only make available the bowdlerized version, which they call a “research summary.” The only way you can get the raw risk reduction data is by scrolling down this post. Rule one in wellness whistle-blowing: always take screenshots.
And most recently, they’ve become strong proponents of Wellsteps’ strategy, bragging about how many high-risk employees became low-risk without mentioning that roughly as many low-risk employees became high-risk. Suppose you flip 100 coins. It’s not enough to say that of 50 heads, 25 became tails. You also have to admit that 25 of the tails flipped to heads. At the end of the day, nothing changed. Here are the heads-to-tails, from their website. (By the way, this is also not true, even on its face.)
Ask any employer what is the “new smoking” in terms of employee hazards and mortality. Most will say opioids, of course. Not Interactive Health. For them the “new smoking” is…
Hey, Interactive Health, maybe you can find a smart person to explain this particular statistic to you:
- According to the CDC, the number of annual deaths caused by smoking: 480,000
- According to the CDC, the number of annual deaths caused by sitting: 0
Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID. Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.
Take The Interactive Health IQ Test
Which of these images is most unlike the others?
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. $3 million is yours if found by the 5 judges (and remember, we only appoint one!) to be more cost-effective than Quizzify.
Here are the specific rules to claim the reward.
Almost any behavior-change vendor (e.g., Virgin Pulse, Bravo, Accolade, Livongo) 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.
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 The Healthcare Hackers listserve with more 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 ten years.
Each side must:
- list their average prices per employee per year
- 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.
Here is the original offer and how it is changed.
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.
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.
Hilarious, that is, unless you are one of those unfortunate souls who are:
- paying their bills;
- believing their outcomes; or
- taking their advice.
The first and third are closely related in the sense that one would think with their fees –which rank among the wellness industry’s highest due to their industry-leading embrace of hyperdiagnosis — they could afford to train their employees in wellness.
However, since they apparently forgot to check that box, I’ll do it for them. I owe them this favor, having recently made unflattering observations regarding their botched cover-up of their invalid outcomes reporting.
First the good news
No one can accuse Interactive Health of wasting money on excessively silly, excessively gimmicky, excessively readable user interfaces. Here is the advice they give to employees, all 1350 words of it, starting with Page 1.
But wait…there’s more. Page 2
And for all those employees who simply have too much free time on their hands at work, Page 3.
More good news. They do tell this employee, after informing her that she has metabolic syndrome, to “avoid sugar.” Credit the law of averages with that — if you write 1350 words, it is likely that 2 of them — 0.14% — will be correct. These two words are in the middle of the second page, so I’m sure she saw them. Who wouldn’t?
Next, the bad news
To prevent that metabolic syndrome from progressing to diabetes, the letter also recommends “lowfat or nonfat dairy” in the diet. However, according to the the journal Circulation, people with the most dairy fat in their diets had a 50% lower risk of diabetes. Likewise, a study of 18,000 women showed lower obesity among those who consumed full-fat dairy. Journal articles are likely beyond Interactive Health’s grade level, so here are two lay summaries and two lay books:
- The Skim Milk Scam: Words of Wisdom from a Doctor Dairy Farmer
- Lowfat Dairy: Zombie Guidance
- The Big Fat Surprise
- The Bad Food Bible
It’s not just dairy fat, where the science, though perhaps not definitive, is settled enough that even the dumbest wellness vendor should know not to tell diabetics to switch to skim milk. It’s also saturated fat in general, where the change in scientific understanding over the last 10 years has caught many wellness vendors by surprise, and they haven’t had time to react.
If consumed in large quantities, perhaps saturated fat may be a heart disease risk factor nonetheless. Who are we to say? However, if it were a culprit of any significance — like trans fats or cigarettes or family history — that conclusion would be definitive by now, given the massive amount of research that’s been thrown at this question. Even if saturated fat were a minor risk factor, there is still one overriding reason Interactive Health shouldn’t be telling people with metabolic syndrome to eat less fat: what the he** do they think people will eat instead? There is a whole body of literature on how telling people to eat less fat helped create the obesity epidemic.
In all fairness to Interactive Health, they recommend eating only less dairy and other saturated fat, not less total fat. However, that is a subtlety that can get lost in those 1350 words brimming with all sorts of random advice. For instance, on the subject of abnormal thyroid function, the letter says: “Talk with your healthcare provider about possible treatment options for this condition.” Sound advice indeed — if in fact the person in question had abnormal thyroid function, but according to this report (bottom of Page 2), her “thyroid was normal.”
More bad news
Even though this person does not have high blood pressure, the letter also recommends eating less salt. For people without high blood pressure and especially people like her who have other diabetes and cardiac risk factors, avoiding salt is likely a bad idea.
Other than the answer being different for different people and different ethnicities (subtleties overlooked by almost all wellness vendors, which prefer to give blanket advice), the science is unsettled. It does, however, increasingly point to the importance of salt — something humans have been consuming in large quantities ever since way before the Roman Empire paid its soldiers in salt — in the diet. This is especially the case for people with, or at risk for, diabetes or heart disease (which this person is). In particular, for people without hypertension, reducing salt intake to a level much below the US average:
- is associated with higher risk of death among diabetics
- may increase insulin resistance
- may increase risk of death from heart disease
- may increase total and “bad” cholesterol
Among other limitations, most of these studies are correlative, not causative, and rely on self-reporting rather than controlled environments. So we can’t conclude with certainty that avoiding salt is a bad idea. Nonetheless, my suspicion is that companies paying Interactive Health millions of dollars — and basically forcing their employees to choose between submitting to them or losing money — have assumed that the advice they are giving employees is settled and likely correct, rather than controversial and likely incorrect.
Other studies, generally older ones, recommend low-salt diets to prevent high blood pressure, so it is still at least arguably fair to say salt science is conflicted. But the overriding reason for Interactive Health stop telling employees at risk for diabetes to eat less salt and less saturated fat is, what the he** do you think they are going to eat instead? Since most proteins come with saturated fat (and salt), there is only one thing left to eat: carbohydrates.
The bottom line is that anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes.
Fortunately, most employees will have the good sense to ignore their advice, if for no other reason than it is quite a Herculean task to plow through it all. How do I know this? By definition, any employee reading this blog is more health-conscious than average. And yet the particular employee who, after reading my blog post on them, sent me this letter originally sent me only the first and third page. She hadn’t even realized there was a second page, since Interactive Health printed it on the back of the first page.
Ironically, that was the page where it said “avoid sugar.”
The “coaching” call
In addition to the letter, this employee did receive a coaching call, described as follows:
When they called to offer me advice they simply said, “ Do you know you have high cholesterol?” I said, “yes.” Then she proceeded to ask me what I was going to do about it . I said : “I thought you would tell me what to do.” She had nothing to say. Then I received another call a few weeks later as a follow up and I wanted nothing to do with them as they had already discredited themselves with the first call.
In yet another installment (which will have to wait until 2018 since December is devoted to highlighting the best-in-shows of the wellness industry and of course the Deplorables Awards) we’ll explain how Interactive Health translates ignorance of clinical guidelines, bad dietary advice and massive hyperdiagnosis into quite literally the most inflated savings in the wellness industry this side of Wellsteps.
I usually say the reason I can’t expose all the lies in wellness is that there aren’t enough hours in a day. Unfortunately for Interactive Health, today there are. (In your face, Arizona residents!)
PS For my next and final posting in the Interactive Health trilogy, it would help if anyone could send me some of their outcomes reports. Obviously I won’t use your name or the name of your accounts. The advantage for you is if I use your stats, it’s like getting a free consult.
When we last left our antiheroes, we were counting the number of lies their consulting firm told in their report underpinning Interactive Health’s financial savings model. We found ten. That may not seem like a lot by wellness standards, but those were in just two little bullet points. The only people who tell more lies in fewer words have Twitter accounts.
After publication, we discovered a new tidbit about Zoe Consulting. Along with the adjectives “top-tier” and “nationally recognized,” which they used to describe themselves, another would be “hunh?” Yeah, I know, not technically an adjective but Zoe is not technically a company.
Yes, this “top-tier nationally recognized” outfit has disconnected both its internet and its telephone.
And don’t try to find them in person, either. The address listed for them shows this streetview. If you can’t quite see it on your smartphone, I can describe the scene: imagine Narnia-meets-Stephen King.
Interactive Health Outcomes Report
Zoe Consulting called me soon after my first expose of Interactive Health appeared in the Wall Street Journal, and offered to pay me not to write about Interactive Health’s squirrelly outcomes any more, at least on my old website. I agreed — but only on the condition that they promise to tell the truth in the future, which has proven to be an insurmountable hurdle.
By the way, good news for any perps who think they have to pay me to have their material removed. If you are honest and I make a mistake, I pay you! Or if you make a mistake and own up to it, I pay you.
This is not either situation. Indeed, we have never encountered either situation.
Here is the report in question. You’ll notice there are lots of claims about massive savings, extending to workers comp and disability too. But not a peep about risk factors. That’s why they call this a “research summary” and not a “research study”: they removed the actual research after I observed that it invalidated their financial claims. Speaking of which, here is their financial claim: after three years, costs are magically about 18% — thousands of dollars — lower than they would have been.
The “research summary” contains only one sentence about the program itself: “The findings below indicate actual costs fell below the projected costs due to the positive impact of the Interactive Health program.”
How “positive” was that “impact of the Interactive Health program”? Excluding dropouts which of course they conveniently ignore, the number of high-risk employees fell by 1.4%. Since spending on wellness-sensitive medical events is about $100/year, optimistically you’d save $1.40/year by reducing risk 1.4% — assuming the savings accrued immediately. To cover up their mistake, they removed the risk analysis.
Anticipating they would attempt this cover-up, I kept a screenshot. This screenshot is also quite useful to illustrate regression to the mean in my course on Critical Outcomes Report Analysis. (In the display below, the green represents improvement and the red represents deterioration. Obviously — meaning obviously to everyone except Interactive Health — people who are low risk can only get worse or stay the same, while people who are high-risk can only improve or stay the same. Classic regression to the mean.)
In this graphic, you can see 10% as the starting point and 8.6% as the ending point in the high-risk categories:
Instead of $1.40/year, they claimed savings of up to $3084/year — exaggerating by a factor exceeding 2000. Not 2000%. In wellness, 2000% would be rounding error. By contrast, a factor of 2000 equates to 200,000%.
200,000 is a big number. To put the number 200,000 in perspective, imagine stacking 6 Empire State Buildings on top of one other. Do that 200,000 times, and you reach the moon.
We are going to call Interactive Health liars. However, we don’t mean that as an insult, or even an objective observation (though that too). We mean that as a compliment. We have too much respect for their intelligence to believe that they could possibly be stupid enough to make a mistake of that magnitude.
However, if they would like to insist that they were this stupid (the “dumb and dumber” defense pioneered by Ron Goetzel) — and substitute what they now know to be the correct answer of $1.40 in place of the $3084 and circulate the revised result to their customers — we will publicly apologize for calling them liars. And, yes, we will pay them the honorarium noted above.
As for their botched cover-up of the initial results, perhaps that was just an unfortunate but inadvertent omission that coincidentally took place immediately after I pointed out their own risk analysis invalidated all their own claims about savings.
Postscript: Zoe Consulting’s Wisest Move
Zoe Consulting did do something right. At one point in the conversation I mentioned above, I recommended that they hire a smart person, based on the observation that a smart person would realize that the trivial risk factor reduction couldn’t possibly support the gargantuan savings claims. The CEO replied: “Al, the savings have nothing to do with the risk reduction. The two analyses are completely separate.”
If you are prone to comments like that, the wisest move is indeed to disconnect your phones and internet.
So much to say about Interactive Health, so little room on the internet. As a result this will be a two-part blog, at least.
Meanwhile, on the opposite end of the spectrum, we are going to be highlighting the most positively influential people and organizations in the field. Please go vote or submit additional nominations.
The following axiom proffered in Surviving Workplace Wellness used to be ironclad:
“In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
I thought this axiom applied to every vendor claiming huge savings. But, alas, Interactive Health is an exception. Yessiree, it turns out you can invalidate their data without reading the data. It had been easy enough to invalidate their data by actually reading it — so much so that my original observations about them made it intp the Wall Street Journal . They counterpunched by redacting all the raw statistics on risk reduction. (They didn’t realize I kept a screenshot, which will be the subject of Part II.)
Since risk reduction is what generates financial outcomes, taking risk reduction stats out of an financial outcomes report is like the movie theater in South Korea that decided The Sound of Music was too long, so they edited out the songs.
The Wall Street Journal debacle taught them half their lesson: they learned not to publish data, because data will obviously invalidate their savings claims. Last week they learned the other half of their lesson the hard way, which is that they shouldn’t publish anything, period. On Linkedin they bragged — without any data at all — about the gobs of money they saved by discovering all sorts of undiagnosed conditions and achieving trivial reductions in overall risk scores.
Of course it’s mathematically impossible to achieve massive savings by making asymptomatic employees anxious about diseases they almost certainly don’t have in any clinically meaningful sense, and/or slightly by reducing risk factors. With that in mind, I merely asked a question or two about the whereabouts of the data to support this mathematical impossibility…and <poof> their posting disappeared from Linkedin.
Even absent the data, it’s well-known that Interactive’s modus operandi is to do exactly that — attribute massive savings to trivial risk score reductions and “newly discovered conditions.” Neither m.o. is unique to them. Indeed both are common enough to have names — the Wishful Thinking Multiplier and Hyperdiagnosis. Interactive’s brilliance is in marrying the two.
Interactive Health, the Wishful Thinking Multiplier and Hyperdiagnosis
The Wishful Thinking Multiplier is defined as:
total savings/total reduction in risk factors.
The Multiplier originated with Staywell allegedly saving British Petroleum million of dollars when only a few hundred employees reduced a risk factor — which worked out to almost $20,000 for every risk factor reduced. As luck would have it, this Multiplier was about 100 times what Staywell themselves previously claimed was even possible, which in turn was about 100 times what is actually possible. Yet, as we’ll see in the next installment, Interactive’s Wishful Thinking Multiplier leaves Staywell in the dust.
The practice of wellness vendors bragging about how many sick people they find is called “hyperdiagnosis.” It originated when Health Fitness Corp breathlessly declared that about 1 in 10 screened Nebraska state employees had cancer.
Hyperdiagnosis differs from “overdiagnosis” in that doctors try to avoid overdiagnosis, because it results in expensive and potentially harmful overtreatment.
By contrast, hyperdiagnosis is something that vendors like Interactive embrace. Indeed, Interactive practically hyperventilates every time someone tests positive for something. Since Interactive screens for everything under the sun — 38 panels, way more than most checkups and ten times what guidelines recommend — it’s tough to get out of one of their screenings without a false positive finding on something.
Here are examples of their hyperventilation in words and pictures, wisely not naming the client in their Linkedin post to avoid embarrassment:
[Their client] recently shared with their employees the successful outcomes they have achieved. First, hundreds of employees discovered new health conditions they were previously unaware of.
I’m sure the employees shared Interactive’s joy in finding out how sick they are! What employee wouldn’t be excited about such a “successful outcome”? And not just a few employees, but rather almost half are now “at risk” with “newly discovered conditions.”
A vendor bragging that nearly half the employees are might lead you to think: “Where do these people get their ideas?”
Glad you asked. Interactive bases their “proven…amazing results” on a report by an outfit called Zoe Consulting. Let’s take a looksee at Zoe Consulting, to learn more about the people they are basing their entire financial value proposition on.
Hey, Butch, Who Are These Guys?
As you can see from this screenshot, Zoe Consulting is a “top-tier nationally recognized research firm.” (Source: Zoe Consulting.) Here are the awards they’ve won (with Google’s commentary in parentheses):
- Two Koop Awards (they didn’t);
- The American Cancer Society Award for Program Excellence (they didn’t);
- The Ethel-somebody Leadership Award from UNC (they didn’t); and
- The Distinguished Leadership and Service Award from the Association for Workplace Health Promotion (they didn’t).
The last reminds me of a summer job selling Collier’s Encyclopedia door-to-door. Collier’s salespeople were instructed to say: “National Geographic won the Kodacolor Award 10 years in a row, but last year we copped the award from them.” One evening I ran into a Grolier’s salesman, who, as it turned out, used exactly the same line in his pitch, down to the exact same faux-cool-70’s-speak verb right out of The Deuce. I called Kodak to see who really won it, only to learn that no such award existed.
Likewise, one of the many reasons Zoe Consulting didn’t win an award from the Association for Workplace Health Promotion is that no such organization exists. So depending on how you count (and whether you count the Koop Awards as one lie or two), they lied six times in two bullet points, which may be a record even in the wellness industry. Seven if you count “top-tier nationally recognized research firm.” Eight if you count “top-tier” and “nationally recognized” separately. Nine for “unbiased.” To reach a round number, I’d say the tenth would be “research.” That’s ten lies already.
In other words, Zoe Consulting is a perfect fit for Interactive Health.
Stay tuned for the next installment to learn why.
Alice laughed: “There’s no use trying,” she said. “One can’t believe impossible things.”
“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”
Six impossible things before breakfast? The wellness industry would just be getting warmed up by believing six impossible things before breakfast. They believe enough impossible things all day long to support an entire restaurant chain:
Consider the article in the current issue of BenefitsPro — forwarded to me by many members of the Welligentsia — entitled: “Can the Wellness Industry Live Up to Its Promises?” BenefitsPro rounded up some of the leaders of the wellness industry alt-stupid segment. Specifically, they interviewed US Corporate Wellness, Fitbit, Staywell, and HERO. Each is a perennial candidate for the Deplorables Awards — except US Corporate Wellness, which already secured its place in the Deplorables Hall of Fame (and Why Nobody Believes the Numbers) several years ago with these three paeans to the gods of impossibility.
In case you can’t read the key statistic — the first bullet point — it says: “Wellness program participants are 230% less likely to utilize EIB (extended illness benefit) than non-participants.” Here is some news for the Einsteins at US Corporate Wellness: You can’t be 230% less likely to do anything than anybody. For instance, even you, despite your best efforts in these three examples, can’t be 230% less likely to have a triple-digit IQ than the rest of us. Here’s a rule of math for you: a number can only be reduced by 100%. Rules of math tend to be strictly enforced, even in wellness. So the good news is, even in the worst-case scenario, you’re only 100% less likely to have a triple-digit IQ than the rest of us.
And yet, if it were possible to be 230% dumber than the rest of us, you might be. For instance, US Corporate Wellness also brought us this estimate of the massive annual savings that can be obtained just by, Seinfeld-style, doing nothing:
So assume I spent about $3500/year in healthcare 12 years ago, which is probably accurate. My modifiable risk factors were zero then and they are still zero — no increase. So my healthcare spending should have fallen by $350/year for 12 years, or $4200 since then. But that would be impossible, since I could only reduce my spending by $3500. Do you see how that works now?
To his credit, US Corporate Wellness’s CEO, Brad Cooper, is quoted in this article as saying: “Unfortunately some in the industry have exaggerated the savings numbers.” You think?
I’m pretty sure this next one is impossible too. I say “pretty sure” because I’ve never been able to quite decipher it, English being right up there with math as two subjects which apparently frustrated many a wellness vendor’s fifth grade teacher:
400% of what? Is US Corporate Wellness saying that, as compared to employees with a chronic disease like hypertension, employees who take their blood pressure pills are 400% more productive? Meaning that if they controlled their blood pressure, waiters could serve 400% more tables, doctors could see 400% more patients, pilots could fly planes 400% faster? Teachers could teach 400% more kids? Customer service recordings could tell us our calls are 400% more important to them?
Or maybe wellness vendors could make 400% more impossible claims. That would explain this BenefitsPro article.
We have been completely unable to get Fitbit to speak, but BenefitsPro couldn’t get them to shut up. Here is Fitbit’s Amy McDonough: “Measurement of a wellness program is an important part of the planning process.” Indeed it is! It’s vitally important to plan on how to fabricate impossible outcomes to measure, when in reality your product may even lead to weight gain. Here is one thing we know is impossible: you can’t achieve a 58% reduction in healthcare expenses through behavior change — especially if (as in the 133 patients they tracked in one of their studies) behavior didn’t actually change.
You can read about that gem, and others, in our recent Fitbit series here:
- Springbuk wants employees to go to the bathroom
- Fitbit throws a bit of a fit, Part 1
- Fitbit throws a bit of a fit, Part 2
Health Enhancement Research Organization (HERO) and Staywell
I’ll consider these two outfits together because people seem to bounce back and forth between them. Jessica Grossmeier is one such person. Jessica became the Neil Armstrong of impossible wellness outcomes way back in 2013. Not just any old impossible wellness outcomes — those have been around for decades. She and Staywell pioneered the concept of claiming outcomes they already knew were impossible. While at Staywell, she and her co-conspirators told British Petroleum they had saved about $17,000 per risk factor reduced. So, yes, according to Staywell, anyone who temporarily lost a little weight saved BP $17,000 — enough to clean up about 1000 gallons of oil spilled from Deepwater Horizon.
See British Petroleum’s Wellness Program Is Spewing Invalidity for the details.
Leave aside both the obvious impossibility of this claim, and also the mathematical impossibility of this claim given that employers only actually spend about $6000/person on healthcare. Jessica’s breakthrough was to also ignore the fact that this $17,000/risk factor savings figure exceeds by 100 times what her very own article claims in savings. Not by 100 percent. By 100 times.
Fast-forward to her new role at HERO. In this article she says:
The conversation has thus shifted from a focus on ROI alone to a broader value proposition that includes both the tangible and intangible benefits of improved worker health and well-being.
Her memory may have failed her here too because HERO — in addition to admitting that wellness loses money (which explains its “shift” from the “focus on ROI alone”) — also listed the “broader value proposition” elements of their pry-poke-and-prod wellness programs. The problem is the elements of the broader value proposition of screening the stuffing out of employees aren’t “benefits.” They’re costs, and lots of them:
When she says: “The conversation has shifted from a focus on ROI alone,” she means: “We all got caught making up ROIs so we need to make up a new metric.” RAND’s Soeren Mattke predicted this new spin three years ago, observing that every time the wellness industry makes claims and they get debunked, they simply make a new set of claims, and then they get debunked, and then the whole process repeats with new claims, whack-a-mole fashion, ad infinitum. Here is his specific quote:
“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true. Then they said: “OK, we are cost neutral.” Now, research says maybe not even cost neutral. So now they say: “But is really about productivity, which we can’t really measure but it’s an enormous return.”
While other vendors, such as Wellsteps, harm plenty of employees, Interactive Health holds the distinction of being the only wellness vendor to actually harm me. I went to a screening of theirs. In order to increase my productivity, they stretched out my calves. Indeed, I could feel my productivity soaring — until one of them went into spasm. I doubt anyone has missed this story but in case anyone has…
They also hold the distinction of being the first vendor (actually their consultant) to try to bribe me to stop pointing out how impossible their outcomes were. They were upset because I profiled them in the Wall Street Journal . The article is behind a paywall, so you probably can’t see it. Here’s the spoiler: they allegedly saved a whopping $53,000 for every risk factor reduced. In your face, Staywell!
Here is the BenefitsPro article’s quote from Interactive Health’s Jared Smith:
“There are many wellness vendors out there that claim to show ROI,” he says. “However, many of their models and methodologies are complex, based upon assumptions that do not provide sufficient quantitative evidence to substantiate their claims.”
Finally, here is a news flash for Interactive Health: sitting is not the new smoking. If anything is the “new smoking,” it’s opioid addiction, which has reached epidemic proportions in the workforce while being totally, utterly, completely, negligently, mind-blowingly, Sergeant Shultz-ily, ignored by Interactive Health and the rest of the wellness industry.
There is nothing funny about opioid addiction and the wellness industry’s failure to address it, a topic for a future blog post. The only impossibility is that it is impossible to believe that an entire industry charged with what Jessica Grossmeier calls “worker health and well-being” could have allowed this to happen. Alas, happen it did.
And, as you can see from the time-stamp on this post, except at establishments favored by the Wellness Ignorati, breakfast hasn’t even been served yet.