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Just because it’s healthcare, doesn’t mean it’s good for you

Wellness is about pushing employees into the healthcare system, almost always both against their will and their better judgment.  This story is a perfect example of the consequences of how too much healthcare can be hazardous to your health, and why your best defense against overdoctoring is knowledge.

Once you start asking questions, doctors have to start answering them.  While many doctors welcome that, others start fidgeting.  If your doctor is one of the latter, it’s probably time to switch.

I myself get occasional bladder tumors.  Ironically — and once again, showing the unintended consequences of wellness — I got bladder cancer from eating more broccoli, which of course is exactly what wellness programs would have us do.  (And which, in all fairness, is generally a good idea.)  The problem was that the broccoli was grown in a garden that was way too close to railroad ties, which leach creosote into the soil.  Creosote causes bladder tumors.

So every few years, one grows back and has to be scooped out “non-invasively” (that’s easy for the doctor to say).  And every year I go in and get checked, also “non-invasively”.  After my last check, the urologist — a new one, whom I had never seen before — suggested a CT scan of the kidneys and ureters.

I asked her why, and she said, because I had had bladder cancer for 15 years and never had this scan.

I replied: “Well, I founded a company, Quizzify, that educates on overutilization.  CT scans have 500 times the radiation of x-rays, and that particular set of views is likely to spot tumors on my adrenal glands that are completely clinically insignificant, and yet once spotted will be tracked and possibly removed, for no good reason other than that they are there.”

She said: “OK, why don’t we just start with a urinanalysis.”

Quizzify Q in B and W

Quizzify Q&A is your tool to save employees’ time & money

From a hazardous and likely counterproductive $1000 scan to a $10 urinalysis in 30 seconds.  That’s what knowledge is worth.

 

 

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:

  1. It is pre-emptive;
  2. It is either negligently inaccurate or purposefully deceptive;
  3. It is powered by pay-or-play forfeitures;
  4. 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:

compass health title I feel fine syndrome

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:

compass health screen shot2

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.

Total Wellness’s Total Package of Totally Inappropriate Tests

 

Total Wellness is very concerned about “fostering a positive culture in your office.”

total wellness culture

And what better way to “foster a positive culture,” and “recruit talented employees to your workforce” so that they can “improve relationships with one another” than by screening the stuffing out of them?

To start with, don’t just ask your “talented employees” that you just “recruited” if they smoke.  That would be too easy and obviously they would all lie, right?  Isn’t lying exactly what talented employees do the day after you hire them?  Of course!  And isn’t deceit what a positive culture is all about?  Of course!  That’s why you have to test their nicotine 7 ways to Sunday.

total wellness nicotine

And if those tests are too easily gamed, here’s another one — just in case a few of those lying, cheating employees manage to pass the first set of tests, a la Lance Armstrong.  And we wouldn’t put it past them to game the test.  After all, they are “talented.”

total wellness cotinine

When you’re done with nicotine, screen them for body fat.  Nothing spells “talented employee” like an absence of body fat.

total wellness body fat

But wait…there’s more.  Total Wellness offers a package of seven additional tests that aren’t recommended by the US Preventive Services Task Force.   Now how much would you pay?

A lot, as it turns out (not even including follow-up from false positives). The more inappropriate tests you authorize, the more money they make.

Total Wellness is able to do this through their “partnership with Clinical Reference Laboratory.”  Translation:  they charge you, send some of the money to this other outfit, and keep the rest.

Let’s go test by test down their list.

First are two sets of tests that the USPSTF doesn’t even bother to evaluate because it would never occur to them that anyone, even a doctor, would use them as a screen.

total wellness cbc

total wellness chem 20

Chem-20s aren’t even recommended as screens by the doctors who get paid to do them.

No one bothers to recommend against CBC screens…because CBC tests aren’t screens. A CBC is a test that actual doctors, not wellness vendors, order for patients who are not feeling well.  Get it?  As has been well-established for two decades, it’s not a screen.  it’s a test.  It’s useful for finding the sources of symptoms in a patient who presents in an actual doctor’s office, not for telling healthy people they’re sick.  By analogy, if you think you broke your arm, the doctor might x-ray it.  That’s a test.  But even the dumbest wellness vendor wouldn’t propose X-raying all your employees as a screen to see if their arms are secretly broken.

Quizzify

Helping employees achieve health shouldn’t include lying to them. Quizzify them instead.

Assuming a CBC were used as a screen, it would be much more potentially hazardous than if a doctor were to do the test. Since apparently Total Wellness doesn’t understand the concept of false positives anyway (a prerequisite for being in the screening business is not understanding false positives), they would likely misinterpret the results.

How did Total Wellness manage to get a license as a wellness vendor without knowing the difference between a screen and a test?  Simple — you don’t need a license to be a wellness vendor.  That means wellness vendors are allowed to charge employers to perform screens on employees that would get doctors in a lot of trouble if they tried to bill insurers for them.

We’d encourage you to visit their site to see a few more proposed screens that the USPSTF doesn’t recommend doing, like TSH, homocysteine, CRP.  But let’s end with the mother lode of the screening industry:  screens that the USPSTF specifically recommends not doing, but are very profitable for vendors.

total wellness ovarian

The good news is, Total Wellness isn’t overselling this test.  They say it is “possibly an indicator of ovarian cancer cells,” which makes the test literally less than useless, due to the overwhelming number of false positives and false negatives from such a test.  That’s why no grownup doctors use it as a screen and that’s why the USPSTF says:

total wellness ovarian

You may say: “Yes, but this ‘D’ recommendation doesn’t apply to women with the BRCA mutation.”  Alas, by law, wellness vendors aren’t allowed to ask an employee whether she has a BRCA mutation or any other family history question, dramatically the reducing the already abysmal odds that a screening vendor might do something useful.

Let us close with my favorite test:

total wellness carotid

Ask vendors why they do it and they’ll say exactly what this one says:  this test is “non-invasive and painless.”  Sure.  In that respect it’s not unlike palm-reading.  The more relevant adjective that applies to both:  useless.

uspstf stenosis

If you want to get technical, “D” means less-than-useless.

We do like to close on a high note.  Total Wellness is right in that this screening program would indeed help your employees “improve relationships with one another.”  Forcing your employees to participate in this costly and misanthropic jihad might lead them to use their “talents” to all get together and revolt–just like at Penn State.

Health Fitness Corp wins a Koop award for curing non-existent cancers in Nebraska

C. Everett Koop National Health Award Committee,


Wellness Council of America and Health Fitness Corp.


Short Summary of Award:

The C. Everett Koop award committee’s mission is:

“…to seek out, evaluate, promote and distribute programs with demonstrated effectiveness in influencing personal health habits and the cost effective use of health care services. These programs have the objectives of

  • Providing appropriate quality care
  • Sharply reducing the alarming rate of health care inflation, by holding down unnecessary expenditures.”

Materials Being Reviewed:

The brochure in question describing the Nebraska program is downloadable from the WELCOA website.

Case Study of Award Winner for 2012: Health Fitness Corporation and Nebraska

Summary of key figures and outcomes:

Alleged cancer outcomes include the following:

cost-saving catches

Risk reduction outcomes include the following:

change in risk factors

Questions for C. Everett Koop Award Committee:

I: Alleged Cancer Outcomes

Were you troubled by the program sponsors’ decision to waive all age-related colon cancer screening guidelines established by the government, and send out 140,000 flyers, at taxpayer expense, featuring a beautiful woman much too young to have a screening colonoscopy?

age related colon cancer screenings

ANS: Refused to answer

How come, when the program reported that 514 of the 5000 (or fewer) people screened had colon cancer (in addition to the ones who would have been screened anyway), none of the Committee members with health informatics backgrounds from Truven Health Analytics and Mercer and Milliman (and from Wellsteps and Staywell, both of whose programs are also highlighted) were concerned that this alleged 11% colon cancer rate was at least 100 times greater than Love Canal’s?

ANS: Refused to answer

When Health Fitness Corporation admitted lying and reversed their story from making “life saving, cost-saving catches” of “early stage [colon] cancer” to revealing that those 514 people didn’t have cancer, why did the Koop Committee re-endorse what would appear to be outright data falsification, instead of rescinding the award?

ANS: Refused to answer

Even if the committee is allowing Health Fitness Corporation to keep its award and not even apologize, why does this claim of “life-saving, cost-saving catches” still appear on the WELCOA website even though the lie has been admitted?

ANS: Refused to answer

Wouldn’t the fact that the perpetrator of this acknowledged lie is also a sponsor of this Koop award that its own customers have won three times (including this incident) create the perception of a conflict of interest?

conflict of interest?

ANS: Refused to answer

Does anyone on the Committee think if Dr. Koop were still alive that he would endorse your position on data falsification of cancer victims?

ANS: Refused to answer

WELCOA’s website said it was founded by someone who appears to be the inventor of the self-serve all-you-can-eat restaurant. Despite his well-deserved reputation for integrity, did he endorse data falsification of cancer victims even after the perpetrators admitted it?

Warren Buffet?

ANS: Refused to answer (but did change the spelling)

II: Risk Reduction Outcomes

How do you reconcile the claimed savings figure exceeding $4-million with your own chart above showing that only 161 active participants (3.1%) reduced a risk factor? (That chart of course doesn’t include dropouts and non-participants, whose risk factors may have increased.)

ANS: Refused to answer

Dividing the total savings by 161 yields more than $20,000/person in savings. Wouldn’t that $20,000+ for each risk factor avoided imply that all 161 would have had a heart attack even though the entire eligible population only had about 30 heart attacks the previous year, while the participating population would have had about 7?

ANS: Refused to answer

How do you reconcile your statement that 40% of the population had previously undiagnosed high blood pressure or high cholesterol with your other statement that “the total number of prescription scripts [sic] filled within the Wellness Plan reduced [sic] 3% last year,” despite your reducing or waiving the copays? Shouldn’t prescriptions have gone up, if indeed 40% more people were at risk?

ANS: Refused to answer

How can you attribute the 3% reduction in prescriptions to “improved lifestyles” with the fact that your own graph shows only 161 people improved their lifestyles enough to reduce a risk factor? What happened to the thousands who were diagnosed but were neither medicated nor improved their lifestyles?

ANS: Refused to answer

How do you reconcile that same finding – that 40% had high blood pressure or cholesterol — with that same graph, showing that almost three-quarters of the population was low-risk?

ANS: Refused to answer

How do you reconcile the brochure’s claim that the “majority of employees touted how the program has improved their lives” with the brochure’s own admission that only a minority of employees (42%) even bothered to be screened once and only 25% twice despite the four-figure financial incentive?

ANS: Refused to answer


Follow-up response

Not-for-attribution response received August 1, stating that the reason the Committee let them keep their award was not because were a sponsor but rather because they did not make the life-saving claim on their application.  (They did make all the other invalid claims.)  Because they didn’t make the claim on the application, they are not in violation of the Committee’s ethical standards by making it in other venues.

Our reaction:

So it is OK if a ballplayer admits using steroids as long as he didn’t happen to test positive?


Follow-Up Response

September 2014: Nebraska listed as a “best practice program” by Ron Goetzel

Our Reaction:

Doesn’t this listing contradict your initial excuse — that you forgot to ask them about whether they made up their cancer statistics during your due diligence — because now you know about that lie and all the other lies in their outcomes measurement…and yet you still call them a best-practice program?

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