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Ron Goetzel’s “Dumb and Dumber” Defense Deflects Latest Koop Award Ethical Scandal

By Al and Vik

Oh, the twists and turns as Ron “The Pretzel” Goetzel tries to wriggle out of all his ethical stumbles.

This time around, we thought we had nailed both him and his cabal handing out the ironically named C. Everett Koop Award to themselves and their friends based on made-up outcomes.  Specifically, this time they gave their sponsor (Health Fitness Corporation, or HFC) an award based on data that was obviously made up, that no non-sponsor could have gotten away with submitting.  This was the third such instance we’ve uncovered of a pattern of giving awards to sponsors for submitting invalid data while making sure that the award announcement contains no reference to the sponsorship.  (There are probably others; we’ve only examined 3, which might explain why we’ve only found 3.)

How obviously was the data made up?  Well, take a looksee at this slide, comparing participants to non-participants.  This is the classic wellness ignorati ruse:  pretending that non-motivated inactive non-participants can be used as a valid control for comparison to active, motivated participants.  The wellness ignorati would have us believe that any healthcare spending “separation” between the two groups can be attributed to wellness programs, not to inherent differences in motivation between the two groups.   Unfortunately for the ignorati, their own slide invalidates their own argument:  in 2005, the label “Baseline Year” shows there was no program to participate in, and yet – as their own slide shows – participants (in blue) significantly underspent non-participants (in red) nonetheless.  In Surviving Workplace Wellness, we call this “Wellness Meets Superman,” because the only way this could happen is for the earth to spin backwards.

total savings chart

Given that the 2005 baseline label was in plain view, we just assumed that HFC did not indeed have a program in place for this customer (Eastman Chemical) in 2005, which is why they called 2005 a “Baseline Year” instead of a “Treatment Year.”  Not actually having a program would logically explain why they said that didn’t have a program, and why they used that display or variations of it like the one below for 4 years with the exact same label.  Presumably if they had had a program in 2005, someone at HFC would have noticed during those 4 years and relabeled it accordingly.

Originally we thought the Koop Award Committee let this invalidating mistake slide because HFC — and for that matter, Eastman Chemical — sponsor the awards they somehow usually win.  But while trying to throw a bone to HFC, the Koop Award luminaries overlooked the profound implication that the year 2005 separation of would-be participants and non-participants self-invalidated essentially the entire wellness industry, meaning that is is an admission of guilt that the industry-standard methodology is made up.

Slide1 (1)Goetzel the Pretzel to the rescue.  He painstakingly explains away this prima facie invalidation.   Apparently the year 2005 was “unfortunately mislabeled.”  Note the pretzelesque use of the passive voice, like “the ballgame was rained out,” seemingly attributing this mislabeling to an act of either God or Kim-Jung-Un.  He is claiming that instead of noticing this invalidator and letting this analysis slide by with a wink-and-a-nod to their sponsor, none of the alleged analytical luminaries on the Koop Committee noticed that the most important slide in the winning application was mislabeled — even though this slide is in plain view.  We didn’t need Edward Snowden to hack into their system to blow up their scam.  They once again proved our mantra that “in wellness you don’t need to challenge the data to invalidate it. You merely need to read the data.  It will invalidate itself.”

We call this the “Dumb and Dumber” defense.  Given two choices, Goetzel the Pretzel would much prefer claiming sheer stupidity on the part of himself, his fellow Koop Award committee members like Staywell’s David Anderson and Wellsteps’ Steve Aldana, and his sponsor HFC, rather than admit the industry’s methodology is a scam and that they’ve been lying to us all these years to protect their incomes.

Still, the Dumb-and-Dumber defense is a tough sell.  You don’t need Sherlock Holmes, Hercule Poirot or even Inspector Clouseau to detect a few holes in the Pretzel’s twisted logic:

  • How could no one – no member of the Koop Award Committee or employee of Health Fitness Corporation (which used this as its “money slide” for years) – have noticed this until we pointed it out for the third time (the first two times not being as visible to the public)?
  • In early 2012, this slide was reproduced–with the permission of Health Fitness Corporation–right on p. 85 of Why Nobody Believes the Numbers, with the entire explanation of its hilarious impossibility. We know Mr. Goetzel read this book, because he copied material out of it before the publisher, John Wiley & Sons, made him stop.  So we are curious as to why it has taken until now for him to notice this “unfortunate mislabeling.”  Hmm…would the fact that it was just exposed to the world in Health Affairs have anything to do with this sudden epiphany?  We’re just sayin’…
  • If indeed it was just an “unfortunate mislabeling,” how come HFC has now expunged all references to this previously highlighted slide from their website, rather than simply change the label?

As regards the third point, we would recommend that next time Mr. Goetzel invokes the Dumb-and-Dumber defense, he coordinate his spin with his sponsor.

But let’s not overlook the biggest point:  the entire Koop Committee – including “numbers guys” like Milliman’s Bruce Pyenson and Mercer’s Dan Gold — is apparently incapable of reading a simple outcomes slide, as they’ve proven over and over.

So, as a goodwill gesture, we will offer a 50% discount to all Koop Committee members for the Critical Outcomes Report Analysis course and certification. This course will help these committee members learn how to avoid the embarrassing mistakes they consistently otherwise make and (assuming they institute conflict-of-interest rules as well to require disclosure of sponsorships in award announcements) perhaps increase the odds that worthy candidates win their awards for a change.

Goetzel, Koop Committee, Staywell, Mercer, BP America meet Groundhog Day

Perhaps the strategy of the leaders of the wellness ignorati (who constitute the Koop Committee) is to overwhelm us with so many lies that we don’t have time to expose every one and still get home in time for dinner.

No sooner have we finished pointing out the numerous (and unrebutted) implausibilities and internal inconsistencies in Ron Goetzel’s posting on the value of workplace wellness, than the Koop Committee (Mr. Goetzel and his cabal) feeds us even more red meat:  They gave the 2014 Koop Award to British Petroleum.  However, apparently only British Petroleum wants to tell the world about it. The Koop Committee hasn’t even updated its own website to list 2014 award winners.

Recall that we’ve spent months excoriating Goetzel and his sidekicks (Wellsteps’ Steve Aldana, Milliman’s Bruce Pyenson, Mercer’s Dan Gold and the rest of them) for doing three things in the Nebraska award, for a program that prima facie seems to be in violation of Nebraska’s state contractor anti-fraud regulations:

(1)   Gave it to a program where the numbers were obviously fabricated and later admitted to be

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor sponsors the Committee

Perhaps what you are about to read isn’t their fault.  Perhaps their mothers simply failed to play enough Mozart while the Committee members were in their respective wombs, but here’s how they applied the learning from the Nebraska embarrassment to their decision to award British Petroleum.  This time they:

(1)   Gave it to a program where the numbers had already been shown to be fabricated

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor (Staywell) sponsors the Committee

(4)   Forgot to disclose in the announcement that the vendor sits on the Committee

(5)   Forgot to disclose in the announcement that the consulting firm (Mercer) sponsors the Committee

(6)   Forgot to disclose in the announcement that the consulting firm sits on the Committee


mercer staywell sponsorship

I suspect we will be writing a similar analysis again next year, when once again, the Committee will attempt to demonstrate the value of sponsoring a C. Everett Koop Award.

Ron Goetzel and Co-Authors Claim Workplace Wellness Evidence That a CSI Couldn’t Find

Questions for Ron Goetzel and co-authors based on September 2014 article

Category:  Wellness

Short Summary of Goetzel Article’s Marketing Claim:

“Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes.”

(This study was paid for by American Specialty Health, a successful and well-regarded company in the alternative network business that also, not surprisingly, has a wellness subsidiary.)

Materials Being Reviewed:

The study in question appeared in a recent issue of the Journal of Occupational and Environmental Medicine.

Most of these questions were originally asked by Jon Robison of Salveo Partners, in this post.

Questions for Ron Goetzel (who has not answered any relevant follow-up question asked of him about his Koop Award either, meaning now he has forfeited $2000 in honoraria)

Is it ethical to claim “no conflict of interest” in writing this article when a wellness company paid you for it and when you and most co-authors make their living in the wellness industry?

ANS: Refused to answer

Can you explain your reasoning for listing (see below) the Koop Award-winning State of Nebraska as a “best practice wellness program” after they admitted lying about saving the lives of cancer victims who never had cancer, and after it turned out their savings figures were clinically and mathematically impossible, and after it was exposed that the state’s wellness vendor sponsors the Koop Award?

list of best practices

ANS: Refused to answer

Why didn’t you disclose that literally none of these “best practice” programs (especially Nebraska’s, which deliberately waived all age-related cancer screening guidelines) follow US Preventive Services guidelines and therefore companies that follow these best practices on balance are more likely to harm their employees through overdiagnosis than benefit them?

ANS: Refused to answer

You describe (among others) a Procter & Gamble study from two-decade-old data as “recent”. Can you define “recent” ?  Can you name anyone at Procter & Gamble who even remembers this “recent” study?

ANS: Refused to answer

Why do you still cite Larry Chapman’s 25%-savings-from-wellness-programs allegation even though readily available online government data below shows wellness-sensitive medical events account for only 8.4% of a typical employer’s hospital cost (about 4% of total employer spending), thus making it impossible to save 25%?


ANS: Refused to answer

Why are you still citing Prof. Baicker’s article when she herself has backed off it three times, it’s never been replicated, and all attempts to replicate it, including the most recent attempt to replicate it (in the “American Journal of Health Promotion”), have shown the opposite and she herself says “there are very few reliable studies to confirm the costs and the benefits”?

ANS: Refused to answer

How can you cite RAND’s negative article as supporting the conclusion that “wellness can achieve positive financial outcomes”  even though the author Soeren Mattke has specified that the modest health improvements among active participants produced no “positive financial outcomes”?

ANS: Refused to answer

Likewise, how can you cite the Pepsico health promotion study in Health Affairs in support of that same conclusion when that study concluded exactly the opposite: that health promotion had a negative ROI?


ANS: Refused to answer

Guest question submitted by Dr. Jon Robison:  On p 931 you say that the RAND study found weight reduction — of course, only on active participants, excluding dropouts and non-participants — that was “clinically meaningful” and “long-lasting.”  How does that square with this slide from that very same RAND study showing exactly the opposite? (Since this chart may be difficult to read,we’ll highlight the key finding, which was that by the 4th year the average active participant had sustained weight loss of only a few ounces.)


ANS: Refused to answer

Is Mercer Cooking Staywell’s Books At British Petroleum?


Short Summary of Intervention:

Comprehensive wellness program offered to all American employees of British Petroleum.   Staywell was the vendor. Mercer was hired by British Petroleum to validate the savings claimed by Staywell.

Materials Being Reviewed

Summary of key figures and outcomes:

No visuals were provided. A review of the articles is recommended.

Questions for Staywell and Mercer

You claimed that spending would have increased by 10.5% instead of 7% across the entire company, absent the wellness program. Since only 1139 people reduced their risk factors (not including non-participants and dropouts whose risk factors might have increased), are you saying that by reducing a risk factor, those 1139 people were responsible for the entire difference in trend for the 62,000 employees and dependents versus the original trend you projected?

ANS: Refused to answer

The savings you are claiming works out to about $17,000 for each person whose risk factors declined, almost the equivalent of avoiding one heart attack for each person who reduced a risk factor. Are you suggesting that most of those 1139 would have had heart attacks otherwise, even though fewer than 200 American BP employees had a heart attack the previous year?

Note to Staywell’s and Mercer’s actuaries: if costs decline $17,000 every time someone reduces a risk factor and your spending is about a third of that level, you can wipe out your healthcare bill by getting a third of your employees to reduce a risk factor.

ANS: Refused to answer

How does $17,000 in savings for BP employee reducing a risk factor reconcile with Staywell’s own website claiming only $100 in savings for each person reducing a risk factor in a multi-employer study?

ANS: Refused to answer

How does this unprecedented savings reconcile with the PepsiCo findings, published in a leading journal (Health Affairs) by leading researchers (RAND), that concluded applying approximately the same interventions to PepsiCo’s workforce using the same consulting firm (Mercer) actually lost money?

ANS: Refused to answer

Did Mercer notice the discrepancy between Staywell’s alleged results and PepsiCo’s (and also Staywell’s own website) and inform British Petroleum of it, since Mercer’s job was to validate this program on behalf of British Petroleum and ensure that the savings were accurate?

ANS:  Refused to answer

Since a wellness program can only reduce wellness-sensitive medical events, how come you elected not to disclose the rate of wellness-sensitive medical events across the entire population before and after the program?

ANS:  Refused to answer

Did you inform British Petroleum that there was an article on The Health Care Blog about their program that reached the opposite conclusion you reached?

ANS: Refused to answer

Staywell employees Jessica Grossmeier (who authored the journal article) and Paul Terry (Chief Science Officer) were asked privately and by many of the people who posted comments to rebut The Health Care Blog and declined. Wouldn’t it have been a useful discussion to explain to readers how British Petroleum could have saved more than 100 times what you yourself said was possible?

ANS: Refused to answer

American Heart Association promotes StayWell while violating its conflict of interest policy

American Heart AssociationStayWell

Short Summary of Company:

AHA wellness: “The American Heart Association’s Worksite Wellness Kit encourages companies to give employees an excuse to get away from their desks.”

Staywell: “StayWell helps clients across the health care spectrum address the changing landscape like no other company. We leverage the latest technology, enhanced analytics, and deep consumer insights in an integrated portfolio of best-in-class client solutions.”

Materials Being Reviewed

Questions for AHA

Your conflict-of-interest statement says you “make every effort to avoid actual or potential conflicts of interest that may arise as a result of an outside relationship.” Why doesn’t letting the Chief Science Officer of a wellness company write your wellness policy citing his own articles in support of wellness violate that policy?

ANS: Refused to answer

Were you aware that Staywell perpetrated a scheme in which they worked with Mercer to convince British Petroleum that their outcomes were 100 times better than what Staywell itself said was possible?

ANS: Refused to answer

Why did you allow a writer to source his own articles, thus creating an AHA policy stand that is clearly in his own financial interest?

ANS: Refused to answer

Is it representative of your peer review policy not to “vet” your peer reviewers to see if they themselves were involved in scandals that are very relevant to the article they are reviewing?

ANS: Refused to answer

Why did you as an organization and the writers of that policy decline The Health Care Blog’s invitation to defend your article against observations that it was totally conflicted and based on data known to be invalid?

ANS: Refused to answer

Why did you allow the writers to cherry-pick the available literature, ignoring the overwhelming evidence against your policy and instead continue to cite the old “Harvard study” whose lead author has now walked it back three times?

ANS: Refused to answer

Why did your editors allow the writers to call this (disavowed) Harvard study “recent” even though it was written in 2009 using data with an average date of 2004?

ANS: Refused to answer

Why did your writers knowingly cite studies that no legitimate health services researcher would find acceptable due to obvious study design flaws, like comparing active motivated participants to non-motivated non-participants, claiming that an outcome on volunteers who persisted in the program for three years is representative of the population as a whole, and taking credit for risk reductions in previously high-risk people that would have happened anyway?

ANS: Refused to answer

Why didn’t you mention that the screening frequencies you are endorsing are far in excess of guidelines set by the United States Preventive Services Task Force?

ANS: Refused to answer

As an association named for the human heart, how come you didn’t publish cautions that the screening frequencies you’re recommending can lead to overdiagnosis, overtreatment and other cardiometabolic harms?

ANS: Refused to answer

Postscript:  Any apologies, retractions, explanations etc. other than answering the questions

A July 17 email from co-author Ross Arena: “I am troubled by these accusations, as is AHA.  I have included an AHA representative who will address this.”  [No AHA response followed.]

A July 17 response from us noted that technically these are observations, not accusations.  We “observed” that their screening policy was co-authored by the CEO of  a screening company.  (We offered to link them to to see the difference between the two words, but they declined.)

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