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The Great Goetzel-Lewis Debate, Part 2: The Debate Ends Almost Before It Begins
This is Part 2, my opening remarks. These and all future annotations will be synched to the main debate tape, which is downloadable from the Population Health Alliance website. “Synched” meaning that the exchanges being annotated below can be found at the points in the tape noted in bold.
Click here if you haven’t already listened to/read Part 1.
20:40
I got a chuckle for my opening line but Ron clearly won the style points on opening lines.
You’ll note my opening statement contains no unsupported claims, whereas his entire opening statement was nothing but unsupported claims. I am all about proof and examples — all of which are in the public domain, easily sourceable, and on this site. Many come right from him and his cronies, in their multitudinous gaffes. Ron isn’t debating me as much as he is “debating” against his own industry. The walk-backs, disavowals, concessions etc. make my presence almost superfluous.
22:00
I review Penn State’s ill-fated wellness program. This is a layup. Worst program ever, and Ron’s fingerprints are all over it. I get some laughs for my riff on testicles, which were a major focus of the Penn State program, along with a disproportionate number of questions about ladyparts.
23:00
Ron interrupts (with my permission) to say: “I had absolutely nothing to do with Penn State.” I observed that he was in the room defending it, and gave chapter and verse , referring to the screenshot below and quoting the title. He must have assumed I didn’t see that article. But at the time many journalists contacted me, dumbfounded that Ron, Highmark’s Don Fischer and Penn State’s Susan Basso were still defending it.
The exact quote from that article, in which he was in the room, on the call:
23:40
I review Nebraska. Because I did not anticipate the pants-on-fire Wellsteps-Boise Koop Award in 2016 — the type of lying that gives lying a bad name — I call Nebraska “the most dishonest program ever” …and yet Ron gave them a Koop Award and steadfastly refused to rescind it (since the vendor was a sponsor of the award) even after they admitted lying following my expose of their lies. [Postscript: Ron has now completed the rewrite of the history of this program. Fortunately we took screenshots along the way, documenting each time he tampered with the original application.]
24:10
I quote Ron’s co-authored HERO guidebook — which of course, in a major gaffe (gaffe is defined as “accidentally telling the truth”) — admitted wellness loses money. If this debate were in a court of law, the case wouldn’t even get to the jury. It’s called estoppel. If you have said something on the record, you can’t turn around and say the opposite. So the debate is technically over, legally speaking.
His response (actually the moderator jumped in to defend him) was, that was just one data set. No, that data set was quite representative of the decline in events that takes place regardless of a program, and in any case, who deliberately plants an invalidating data set in their own propaganda? No, these people just didn’t notice that the costs on Page 15 exceeded the savings on Page 23. And they are the self-professed experts in measuring outcomes.
Costs ($1.50 PMPM):
Savings ($0.99 PMPM):
25:00
I reference two proofs. First, the one that says wellness can’t work. Next, my proof that the official government database shows quite literally no impact of workplace wellness on cardiometabolic inpatient admissions this century. Ron accepts this proof. He is caught. His own employer, Truven, holds the contract for managing this database. If he claims the data is flawed (it isn’t), he disses his own employer. So the debate is technically over, mathematically speaking. He just admitted wellness has been completely ineffective. Game, set and match to me. However, wellness apologists don’t understand fifth-grade math (hence this site), so few people in the room understood that the debate had ended.
25:45
I reference the million-dollar reward that we’ve offered to anyone who can show that wellness has broken even. Of course, Ron hasn’t claimed it. I offered the reward because even people who don’t understand mathematical proofs understand that someone who backs his claims with $1-million must believe them. By declining to collect the $1-million (the reward has rules and is a legally binding contract), Ron is admitting he and his cronies are lying about the effectiveness of wellness.
26:14
I point out that RAND and the New York Times are both on my side. The Times, I noted, “was laughing at you folks for how bad your analysis was.” I continue with many more examples of both the left wing and right wing media skewering wellness. “You guys are running out of wings.” Ron attempts no rebuttal even though I had offered to let him interrupt me if I said something inaccurate. But there’s nothing inaccurate about my portrayal of the mainstream media’s position on workplace “pry, poke and prod” wellness. It’s all here. They hate it.
[Postscript: You can now add Slate, STATNews, and many others to list of publications which have skewered wellness, all linked from here.]
27:25
I point out the many instances in which Ron’s own cronies have gone rogue. Altarum, Debra Lerner, and Michael O’Donnell (three times) are all examples of Koop Committee members who deliberately or accidentally dissed wellness. And I reiterate that the HERO Report, that Ron co-authored, admits wellness loses money. This report was signed by 60 wellness apologists. Basically the entire industry admitted failure, in the industry’s biggest-ever gaffe. See our 8-part critique of that ill-fated venture.
Thus ended the two prepared opening statements. By the way, a shout-out for Fred Goldstein, the moderator. In reviewing this tape I had clocked Ron’s “5-minute” opening speech at 9 minutes, but I was allotted the same length. The next installments will cover the rebuttals.
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News flash: The Wellness Ignorati are ignoring facts for a change
There has to be a limit, even to deception
The Wellness Ignorati got their name by ignoring facts. Facts, of course, are the wellness industry’s worst nightmare. They ignore them In order to avoid creating news cycles that might reach human resources departments despite the best efforts of their consultants and vendors to shield them from actual information.
And they’re at it again.
First, Atul Gawande wrote a scathing article in the New Yorker about massive overscreening earlier this month. As Mitch Collins noted in The Health Care Blog, not a peep in response from the perpetrators of those hyperdiagnostic jihads. Nor has their been any response to Mitch’s article itself. Literally, no one defends wellness industry practices. And yet somehow all the laws are on their side.
Speaking of which, Mitch mentioned the famous Nebraska debacle, in which the vendor, Health Fitness Corporation, lied about making “life-saving catches” of “early-stage cancers.” Since HFC was a sponsor of Ron Goetzel’s Koop Award, Ron naturally gave them that prize for these lies.
However, we’ve thrown down the gauntlet. HFC, come on out and fight. Give us your side of the story. How was this not a deliberate lie designed to score political points in Nebraska? If it was a mistake, why didn’t you change it and apologize? How do those 514 cancer non-victims feel? And Mr. Goetzel, why do you not only keep defending HFC, but have even upped the ante? They’ve been promoted from “best practice” to “exemplar” in your most recent webinar.
As long as wellness vendors are silent, we won’t shut up.
Speaking of non-responses from Mr. Goetzel, where is the correction of or explanation for the massive mistake in Mr. Goetzel’s most recent wellness program evaluation? All those readers have been misled by his blog into thinking Graco’s costs/employee are $2280/year when in reality the cost per employee contract holder — according to Mr. Goetzel’s own blog — is about $11,100, like almost every other company. (That includes spouses and dependents but any reasonable dependent ratio would yield more like a typical $5000 to $6000 per employee rather than $2280.) I know he knows about this mistake because I’ve submitted a comment to his blog, which shockingly hasn’t been posted.
So, please, could someone actually respond for a change, even if it’s just to accuse us of bullying.
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7 Take-Aways from the HERO-Goetzel Webinar in Defense of Wellness
This is the sixth in a series on the HERO disinformation campaign around wellness ROI. The other six installments can be found here.
They said what?
This afternoon HERO and Ron Goetzel conducted an entire Groundhog Day-type webinar as though They Said What, the entire media, and 2015 don’t exist.
They talked about the “confusion in the marketplace” (to quote their invitation) without once even mentioning the source (us) of the confusion in the marketplace. Actually all we did was point out that they contradicted themselves in their own report. They created the confusion by inadvertently telling the truth.
Time to make the pretzels
Here are some of the things they are still saying, that they know to be somewhere between misleading and lies. Apparently Mr. Goetzel lived up to his billing as Goetzel “the Pretzel” by basically twisting “wellness loses money” into wellness makes money,” though he admitted to some “controversy” around the latter point.
First, he is still quoting the Kate Baicker 3.27-to-1 ROI, that he knows to have been thoroughly discredited. We’ve blogged about that extensively–this link will take you to a series of other links. To wit:
- She’s walked it back 4 times.
- RAND’s Soeren Mattke has attacked it (and those of you who know Soeren–he is a very thoughtful and polite guy–you really have to be way off-base to get his dander up).
- Another researcher has pointed out that many of the studies in her meta-analysis were basically made up.
- Many of these studies were claiming reductions in diabetes expense and obesity at the same they were telling people to eat more carbs and less fat, exactly the opposite of what would reduce diabetes incidence and possibly obesity. And yet somehow money was saved…
Second, the Ignorati are still quoting the American Journal of Health Promotion meta-analysis and Mr. Goetzel pretzeled his way around the accidental conclusion of that paper that high-quality studies show a negative ROI.
Third, Mr. Goetzel strongly criticized the Penn State fiasco. Hmm…maybe we’re mis-remembering this, but we seem to recall he was one of the leaders of that jihad. Here is a article about a meeting in which he and several others “take the offensive” in the controversy. Or maybe that was another Ron Z. Goetzel.
Fourth, he said: “There’s some healthy debate going on.” But the irony is, there is no debate. Partly this is because they are steadfastly refusing to debate. And partly this is because there is nothing to debate–they admitted “pry, poke, prod and punish” wellness loses money and damages morale. The only places we disagree are how much money gets lost and how badly morale is damaged.
Fifth, he is still comparing participants to non-participants, as though he hadn’t been forced — by the existence of a “smoking gun” slide — to basically admit that participants significantly outperform non-participants even in the absence of a program.
Sixth, he pretzeled RAND’s Pepsico analysis in Health Affairs, overlooking the fact that the study concluded wellness loses money. Obviously we wouldn’t have congratulated Dr. Mattke on his huge success with that article (#2 article of the year in Health Affairs) if it had reached the conclusion Mr. Goetzel said it did.
Finally, the most notable feature was the dog-not-barking-in-the-nighttime. Not once was there any rebuttal to our observations. The Wellnes Ignorati have placed themselves in a difficult position. In order to rebut us, they would have to acknowledge our existence. But ignoring our existence — and the existence of facts generally — is the core component of the Ignorati strategy.
By the way, our source, expecting a spirited rebuttal, instead got supremely bored by the insight-free recycled and invalid material in the presentation, and dropped off before the slam-bang conclusion to the webinar. We doubt there were any other members of the Welligentsia on that webinar but if there were–and you have something to share about the closing minutes that you don’t see mentioned in here — please do.
No pretzels here
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Congratulations to RAND’s Soeren Mattke on PepsiCo study award
We are proud (but also insanely jealous) of our friend Soeren Mattke, whose PepsiCo article was named the #2 most-read for the year 2014 in Health Affairs. We, as our avid albeit narrow fan base may recall, ranked only #12–and even then that was just for blog posts, not articles in print.
Yes, we know it’s not always about Ron “The Pretzel” Goetzel and his twisted interpretations, but he seems to have come up with what appears to be exactly the opposite interpretation of what the PepsiCo study said. Don’t take our word for it — we’ve cut-and-pasted both what the study says about PepsiCo’s results and what he says about the study.
Here is what the article says about the financial impact of health promotion at Pepsico: ROIs well below 1-to-1, meaning a net financial loser, for health promotion. (DM, though, was a winner.)
As low as these ROIs are, several major elements of cost were not available for the calculation — probably enough extra cost to literally make the financial returns so meager that even if the program had been free, PepsiCo would have lost money.
Clear enough? Negative returns from health promotion at PepsiCo, even without tallying many elements of cost. Nonetheless, Mr. Goetzel pretzelized that finding in his recent wellness apologia. Listed under “examples of health promotion programs that work” as a program that is a “best practice” is: PepsiCo. It stands proudly beside the transcendant programs at Eastman Chemical/Health Fitness and the State of Nebraska.
We look forward to a clarification from Mr. Goetzel about how a program that lost a great deal of money on health promotion can be an “example of a health promotion program that work(s),” which we will duly print…but don’t be sitting by your computer screens awaiting it.
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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.
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.
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.
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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
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.
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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:
Risk reduction outcomes include the following:
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?
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?
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?
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?
They Said What? 