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Note that this blog post is my personal posting and does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I am most closely associated, and of which I am one of the founders. I am referring, as everybody knows, to the Needham Frisbee Club. People who play Ultimate 3 times a week don’t need no stinkin’ checkups.
Why Wellness Vendors Hate Information: A New Theory
I have no clue why wellness vendors hate information so much. Perhaps they are repressing childhood memories of being bitten by a librarian.
A far-fetched theory, perhaps, but there is simply no other explanation for half the things half these very stable geniuses insist upon doing. In many cases, reams of information demonstrating the futility, fallacies and even harms of what they do is right there — begging to be googled — and yet no one in the wellness industry (or at least the wellness companies “profiled” on this site — there are plenty of exceptions listed at www.ethicalwellness.org) does.
Before we get into the checkups, consider some other information gaps, like the eight-glasses-of-water urban legend. Anyone with an internet connection can easily learn that you do not have to drink eight glasses of water a day, and the whole meme was completely made up. 70 years ago someone estimated that humans require that much water a day — but also that basically everyone with access to water already gets that much without having to force themselves to drink when they aren’t thirsty.
Yet try telling that to a wellness vendor (excluding the ones who have signed the Code of Conduct, of course). One vendor, Provant, even provides an infographic in case the employees they are harassing can’t count to eight:
Wellness Corporate Solutions — no stranger to these pages — has gone one step farther. Along with their crash-dieting contests, they offer what they call “healthy competitions” to see who can drink the most water:
Water-drinking “healthy competitions” may or may not make employees “more aware of their health status,” but they certainly make employees “more aware that this meeting better end really soon.”
Maybe WCS should combine those two competitions — along with their massive overscreening campaigns — to create a competition to reward employees for doing the most stupid things to themselves.
Failure to understand that thirst is your brain’s signal that you need a drink of water is not an isolated oversight. Wellness vendors take great pride in their ignorance of wellness generally. Consider their propensity to screen the stuffing out of employees. There are clinical guidelines for optimal screening frequencies and lists of biometrics that should be screened for, that most wellness vendors (It Starts with Me and Limeade being two huge exceptions) have apparently never laid eyes on. If it helps, here they are:
There are a few subtleties beyond these words. “People at risk for diabetes” (under “Diabetes test”) would include people with high blood pressure or family history (which wellness vendors can’t ask about). It would also include people who are overweight or obese. Additionally, “members of certain ethnic/racial groups may be at increased risk at a lower body mass or a younger age.” Otherwise, it’s quite clear that cardio screenings should begin at 35 for males and 45 for females, and take place “at least once every five years” after that.
Some people should get that frequency, others a higher one. But like most other things in healthcare, the answer is not the same for every employee of every age and every health status, and you do not just screen people because you make money on each screen, so the more you screen, the more you make. Otherwise you end up like Interactive Health, one of the most expensive vendors, positively hyperventilating about all the false positives they’ve found:
Finally, let’s once again review the aforementioned crash-dieting contests, a staple of many wellness programs besides Wellness Corporate Solutions. Schlumberger, for example, pays out thousands of dollars to the team which does the best job packing on the pounds in December and then taking them off in January. “Just plain fun,” is how their ironically named vendor, HealthyWages, describes it. None of these vendors have apparently seen the CDC’s advisory memo warning that crash-dieting is futile, likely counter-productive, and possibly harmful.
What about annual checkups?
Let’s cut to the chase: there is not one shred of evidence that annual checkups are a good idea for asymptomatic working-age employees. There are many good reasons to go to the doctor — you notice a change in some aspect of your body, you want to develop a plan to improve your health, you need help managing a chronic disease, or even that you’re sick — but here’s what’s not among them: the earth completing a revolution of the sun.
New England Journal of Medicine says that while the major benefit is “less patient worry,” checkups “may actually be harmful.”
“Less worry” is not necessarily a good thing. An employee (name on request after an NDA — not a made-up person) had a checkup in order to collect a wellness incentive…and as a result of being told not to worry, ignored heart attack symptoms about a week later.
The Journal of the American Medical Association says offers of health checks did not reduce any kind of mortality, but “may be associated with more diagnoses and drug treatments.”
Choosing Wisely says: “Annual checkups usually don’t make you healthier,” and “tests and screenings can cause problems.”
None of this takes into account the cost of annual checkups — which often lead to more unneeded and expensive tests and prescriptions, as JAMA notes — but we have definitely observed that wellness vendors and even some HR departments don’t really care about costs. It’s not their money. Here is Reuters on the high and unneeded cost of prevention.
Meanwhile, I’ve yet to find a wellness program that does not either pay employees to get checkups or fine them if they don’t — or shunt them into a worse health plan unless they submit to an annual physical.
I would also note that, however useless annual checkups are to begin with, they are likely even more useless if someone is visiting the doctor because their benefits department is forcing them to do so, against their will.
Finally, there isn’t exactly a surplus of primary care doctors. Why are we paying healthy employees to take up clinician time that unhealthy employees might actually need?
What is the argument in favor of checkups?
If checkups don’t actually prevent anything, why make employees undergo them? Two reasons have been proposed. One is that employees can “build a relationship” with their PCP. This of course assumes that neither the employee nor the PCP ever retires, moves or changes jobs. It also assumes that somehow the things that affect employees can be prevented by having a “relationship” with a PCP. However, if you look at the list of the most frequent reasons for hospitalization among the working-age population, it’s kinda hard to find anything that fits that description.
Can you think of any disease in your own life that would be cured by a relationship with a PCP? I can’t think of only one problem — chronic heartburn — that my PCP could have prevented. But she didn’t. The PCP was perfectly happy to keep me on Prevacid, which, as Quizzify teaches (right on the home page quiz!), is likely harmful in long-term use. Fortunately, I happened to run into a yogurt salesman one day, who told me about active-culture yogurt. Within days my heartburn was gone, never to return.
The second argument in favor of checkups, proposed by the CEO of Bravo Wellness, Jim Pshock, is as follows:
The hope is that the [Bravo] program will get people to proactively see their physicians to manage their health risks. Yes, this will, hopefully, mean more prescription drug utilization and office visits, but fewer heart attacks and cancers and strokes.
It isn’t his money, so he is perfectly fine with employees “hopefully” spending more on drugs and office visits. On the other hand, there is no information supporting his claim that all this spending and all these checkups will prevent all these diseases. Quite the contrary, 100% of available information reaches the opposite conclusion — especially JAMA, which specifically measured mortality due to heart attacks, cancers and strokes and found no improvement. You’ll fine zero information suggesting the contrary finding, no matter how hard you search.
Perhaps when he was a toddler, Mr. Pshock’s parents threw him into an entire cage of librarians.
What is the best frequency for checkups?
The literature is quite adamant: not at all. That seems a bit extreme and I would bet the people who write these articles do occasionally get a checkup. For the most reasonable compromise I would turn to Quizzify, the leading health literacy vendor. They recommend a simple mnemonic: get two checkups in your 20s, 3 in your 30s, 4 in your 40s, 5 in your 50s, and annually after that. Quizzify’s advisory colleagues, doctors at Harvard Medical School, approved this recommendation too. As with most other questions, this one carries the HMS “shield.” (Quizzify also reports that this question is the one most likely to be removed by its customers, which is an option for all questions in their database before they get seen by employees.)
So what’s the solution?
In three parts, it’s:
- Screen according to guidelines
- Send employees to the doctor at age-appropriate and health-appropriate intervals
- Pay the fines on overdue books.
It’s time for the 2017 Deplorables Awards, lovingly bestowed on those vendors who do the best job making other vendors look good.
The good news is that you don’t have to actually win the Deplorables Award to sue me. Runners-up are eligible too. Here is my address for hand-service delivery most of the year:
890 Winter Street #208, Waltham MA 02451
In case you decide to sue me between June 22 and August 8, use:
8 Paddock Circle, Chilmark, MA 02535
And don’t leave out my attorney:
Josh Gardner, GARDNER & ROSENBERG P.C., 33 Mount Vernon Street, Boston, Massachusetts 02108
I don’t know how much more I can do for you, other than lick the envelope. So go for it. Don’t make me beg.
But, remember, unlike your usual business model, in court you are required to actually tell the truth (I would be happy to explain to you how that works), meaning there is no chance of your winning — or likely even avoiding summary judgment, since none of the evidence is in dispute. It’s all your own writings. Oh, and I do my own cross, which means you won’t be able to find an expert witness. Anyone who knows enough about wellness to be an expert witness also knows enough about wellness to know that attempting to defend you would be a humiliating, on-the-record experience.
And there is always the chance that some annoying jerk might blog about it…
The 2017 Runners-Up
Imagine a four-square matrix with competence on one axis and integrity on the other. The people and organizations we’ll be highlighting today would intersect with the companies mentioned in Monday’s posting at only one single point.
Springbuk and Fitbit
As many of you recall, earlier in the year we analyzed the study done by Springbuk that secretly financed by Fitbit. Or maybe I need new glasses, because I just couldn’t find the disclosure in the Springbuk report that this paean to Fitbit was financed by Fitbit, the way Nero used to have the judges award him Olympic medals.
Coincidentally, the study showed Fitbit saving gobs of money because employees taking more than 100 steps a day spend less money than those taking fewer. However, a simple tally of one’s own footsteps shows that it is impossible not to take 100 steps a day unless you are both:
- in a hospital bed; and also
- on dialysis.
This 100 steps-a-day threshold was repeated many times in the study, with no explanation of how that number came to be. However, it turns out we owe these two outfits an apology. Fitbit and Springbuk have told a number of people privately (not publicly, in order to avoid an embarrassing news cycle) that they didn’t really mean to say that 100 steps a day constituted activity. They meant to say that taking 100 steps a day implied you had your Fitbit on. My apologies for failing to read their minds that their conclusions were based on reading people’s minds to determine whether they wore the Fitbit deliberately, or simply forgot/remembered/cared to put their Fitbit on.
They never did explain — privately or publicly or to anyone — how employees who took an average number steps during the baseline year could show huge savings by taking an average number of steps in the study year too.
They also never explained how these two statements didn’t completely contradict each other, even though I specifically asked them to in a personal letter, excerpted here:
Third, can you reconcile this statement…:
“The materials in this document represent the opinion of the authors and not representative of the views of Springbuk, Inc. Springbuk does not certify the information, nor does it guarantee the accuracy and completeness of such information.”
“This demonstration of impact achieved by integrating Fitbit technology into an employee wellness program reinforces our belief in the power of health data and measurement in demonstrating ROI,” said Rod Reasen, co-founder and CEO of Springbuk.
National Business Group on Health
Next up is the National Business Group on Health. Last year they made the list for criticizing the US Preventive Services Task Force for not demanding enough screenings, in a country that is drowning in them. Not content to rest on those laurels, this year they earned an Honorable Mention for inviting Dr. Oz to keynote on the role of quackery in corporate wellness, and perhaps tell us about his latest lose-weight-by-eating-chocolate miracle diet.
HERO of course also earns a runner-up award. 2017 will be remembered as the year they finally came to grips with the realization that a business model based on fabricating outcomes requires that perpetrators possess that critical third IQ digit. Without that extra “1”, an organization trafficking in math that can at best be considered fuzzy is going to be outed.
This year’s set of lies? By way of background, their 2016 poison-pen letter insisted they had fabricated that data set showing that wellness loses money without disclosing that it was fabricated — and also never reviewed their fabricated data before publication. Early in the year, I had the insight that, wow, this “fabricated” Chapter in their guidebook is so much better than the other chapters that something is amiss. No one at HERO can analyze data competently…and yet, here it was, a competent data analysis.
I did something I had never thought to do before, which was look up the actual author of that chapter. It was Iver Juster MD. He was a great analyst even before he read all my books, took all my courses, and achieved all my certifications in Critical Outcomes Report Analysis.
- Whereas Paul Terry and Ron Goetzel had insisted that Iver fabricated the data, Iver said, of course he didn’t — whatever made me think that? (“If it wasn’t real, I would have disclosed that,” he observed. Of course he would have. Iver has tremendous integrity.)
- The Board discussed and reviewed his chapter at length, and made helpful suggestions, for which he was quite grateful. This review process required “countless hours,” just as the HERO document says:
The number of transparent lies HERO tells could make a president blush. In the immortal words of the great philosopher LL Cool J, they lied about the lies they lied about.
Even though 2017 was an off-year for them in terms of the number of lies, they still told enough to be named a runner-up.
Wellness Corporate Solutions
Next is Wellness Corporate Solutions, famous for its crash-dieting contests. WCS now offers a water-drinking contest. The idea is to set up a “challenge” for your team to drink more water than other teams. They call this a “healthy competition.” I guess they didn’t get the memo that forcing yourself to drink when you don’t want to drink, just to make more money, is anything but healthy. Here is a novel idea: drink when you are thirsty. Evolution 1, WCS 0.
Perhaps as an encore, WCS, Dr. Oz and the National Business Group on Health could team up to offer a chocolate-eating contest.
I looked into this outfit to see where they get their ideas. The CEO previously ran something called the Washington Document Service. That qualifies her to run a wellness company. As Star Wellness says, to run a wellness company successfully, your background needs to be in sales, or “municipality administration.” After all, what is more central to administering a municipality than documents?
What fun would a list of runners-up be without Wellsteps, the proud recipient of the 2016 Deplorables Award? While their streams of consciousness weren’t as memorable in 2017 as in 2016 (“It’s fun to get fat. It’s fun to be lazy“), they get credit for trying. Their 2017 weight-loss campaign was headlined: “This campaign is not really about weight loss, it is about helping you apply the behavioral secrets of those who have lost weight.”
So if your kids ever want you to teach them how to ride a bike, say: “It’s not really about riding a bike. It’s about helping you apply the secrets of people who have ridden bikes.”
And what secrets are we talking about? What person who has lost weight doesn’t brag to everyone or even write a book? If there is a secret to weight loss, like eating chocolate, Wellsteps owes it to the country to tell them. Don’t make us beg.
Odds and Ends
No Koop Award winner this year, but an honorable mention to past winners and runners up for their commitment to wellness:
Sounds like in 2018 the logical winners would be Philip Morris, or maybe The Asbestos Corporation of America.
Veering briefly into the public sector, kudos to Representative Virginia Foxx, (R-NC5) for introducing the Required Employee DNA Disclosure Act. Even HERO thought it was a dumb idea…and their threshold for thinking something that increases wellness industry revenues is a dumb idea is quite high, having all rallied behind the Johnson & Johnson Fat Tax, in which companies would be required to disclose the weight of their employees.
Next up…the winner of the 2017 Deplorables Award
Recently we described how to cheat one of those worthless, hazardous corporate crash-dieting contests, like the ones run by Wellness Corporate Solutions or HealthyWages or Virgin Pulse (nee ShapeUp). But we didn’t interview any employees who actually did.
Journalist and wellness expert Pat Barone, writing in LifeZette (Laura Ingraham’s popular online magazine) managed to do just that. She found some employees who “confessed” (bragged about) the ways they snooker these vendors — and of course their own employers –every year, starting again in most cases next month.
These employers, like Schlumberger, think they are creating a culture of wellness when in reality they are creating a culture of deceit, diet pills and dyspepsia. Why would any employer sponsor one of these contests? Simple: in wellness, stupid is the new black.
I don’t want to spoil your fun reading the article by giving away all the punchlines, but the keywords are carbs, sodium, and rocks. All the things that employees should eat, as part of a healthy diet. OK, maybe not too many vitamins but certainly lots of minerals.
Yes, we know you read this blog for the chuckles. Our most popular and funniest posts are usually the ones showcasing the wellness industry’s race to the bottom. And despite heavy competition, very few industry scams can beat corporate get-thin-quick schemes to that inexplicably coveted nadir:
- Here is Healthywage discussing its newest schemes, like “dieting for dollars” and “paying for pounds.” They also describe how to prevent “fraudulent participants,” a category presumably comprised of zombies and dead voters in Chicago.
- “In Wellness, Stupid is the New Black” shows how Healthywage can’t even read a scale.
- “Shape Up falls down trying to do math for Highmark,” about a weight-loss program so clueless that it got covered by the Pittsburgh Post-Gazette.
- Perhaps our favorite is Wellness Corporate Solutions. We won’t ruin the punchline for you.
In sum, we say: “To call corporate crash-dieting contests a joke is an insult to jokes.”
Unfortunately for those of you seeking a few chuckles, this is not that situation.
Quite the contrary, Rebecca Johnson has penned one of the best articles on corporate weight loss programs we’ve ever seen, so we can’t dismiss it with our usual clever if by now overexposed putdowns like: “She should have had this reviewed by a smart person before publishing it,” or “Perhaps her subscription to the internet expired.”
Instead, rarely have we seen more intelligent observations packed into a tighter space, more thoroughly sourced and clearly explained. To summarize:
- Corporate crash-dieting contests are much more likely to harm employees than benefit them;
- They don’t produce an ROI;
- Our mothers were right. Eat a balanced diet. There are more benefits than one would think to not obsessing with what are the “best” and “worst” foods. (Having said that, some people seem to do very well on a low-carb diet. We leave that debate to others and recommend The Big Fat Surprise to readers with an interest in that topic.)
- It is better to be fit and fat (“health at every size”) than to yo-yo diet, for sure.
She goes on to explain her particular approach to mindful eating. I myself have no expertise in that area so I can’t critique the specifics, except to say that Healthywages, ShapeUp (now Virgin Pulse), and Wellness Corporate Solutions should definitely find a smart person to explain this approach to them, even if it means having to pay for an internet connection.
We never post on Sundays. We are making an exception today on the theory that a lot of people in the Northeast are at home and would welcome the distraction. Here in Massachusetts it’s so cold that the Governor is urging people to stay indoors. Heck, we even decided to cancel Ultimate Frisbee.
This is now the seventh time that the New York Times —or its The Incidental Economist bloggers (“TIE” as they call themselves) — has observed that conventional corporate wellness doesn’t work. Links to the previous six instances follow this posting. Perhaps the seventh time will be the charm. Having covered every other angle except the actual health hazards of wellness, this TIE post specifically eviscerates “biggest loser” programs and their brethren.
HR executives may think they are “supporting” employees by holding weight-loss contests or paying them to lose weight. Unfortunately, all they are doing is reducing self-esteem, encouraging crash-dieting before weigh-ins, drawing attention to people’s weight, and — in addition to distracting employees from their actual jobs — distracting them from the one thing that benefits people of all sizes: exercise. It is much better to be “fit and fat” than fight a losing battle to keep weight off with various fad diets.
Further, the Body Mass Index, the 200-year-old metric wellness vendors still use to establish how much to pay or fine employees, turns out to be a very misleading measure of population health. (As “Brad F.’s” comment to a previous blog pointed out, BMIs may be of value if conducted as part of an actual physician-patient relationship. However, actual medicine is of no interest to wellness vendors, other than making people get useless annual checkups. Most physicians practicing actual medicine find wellness programs to be a misguided nuisance.)
Worse than The Incidental Economist says it is
The case against these programs is even stronger than TIE says. TIE supports its case by citing randomized control trials. But if RCTs are the Gold Standard, the Platinum Standard is wellness vendors’ consistent and total self-immolation in attempting to show their own program impact– despite ample opportunity to manipulate data, select motivated participants, ignore dropouts, and run ridiculously short “weight loss challenges” that end before the weight is regained. We love to cite ShapeUp as an example of that, having exposed them in the Pittsburgh Post-Gazette. (This was probably overkill on our part, but their CEO had thought a good way to get some attention might be to fallaciously attack our numbers even though his own figures were made up.)
Because great minds apparently aren’t the only ones that think alike, ShapeUp has plenty of company on the Biggest Loser List. Wellness Corporate Solutions has also been “profiled” on this site, largely for comic relief. Pfizer, where actively motivated employees lost a few ounces over a year, actually earned an award from Ron Goetezel for this stellar performance, as well as a spot on our Biggest Loser List. Our favorite example is McKesson. They also won one of Ron Goetzel’s Koop awards even though their average employee showed an actual increase in — you guessed it — BMI (and cholesterol):
If award-winning companies can’t get employees to lose weight, who can?
And where would a Biggest Loser List be without Vitality, which pitches its weight-loss program to others but can’t even get its own employees to lose weight? If wellness companies can’t get their own employees to lose weight, who can?
Where we differ with TIE is on weight control interventions for school-age kids. They quote one definitive-sounding study, with 4600 kids in it. We don’t have a problem with the actual study. However, because the long-term health and social prognosis for obese children is negative, and because this problem is so pervasive, we ourselves would insist on a much higher level of proof and more experimentation with different program designs before throwing in the towel on these interventions. (We may very well end up agreeing with TIE when all is said and done. We would just like more to be said and especially done.)
As for employers, our recommendation remains the same: do wellness for your employees, not to them. This means supporting employees who want to pursue health goals, but otherwise just leaving them alone to do their jobs. Don’t even make them play Quizzify if they don’t want to. (But they’ll want to — we guarantee it.)
The Incidental Economist/New York Times on Wellness: A Chronology
September 2014 TIE says wellness “usually” doesn’t work.
October 2014: TIE headlines: “Wellness Programs Don’t Seem to Work as Advertised”
December 2014 TIE says: “We’ve said it before, many times and in many ways, wellness doesn’t save money.”
February 2015 TIE headlines “Another Call to Eliminate Employee Weight Loss Programs”
October 2015 New York Times says: “Provide us with your...weight, or pay up.”
November 2015: TIE headlines “The Feds Are Wrong. Lots of Wellness Programs Violate the ADA.”
Usually a tease like that leads to exactly the opposite content, as in Wellness Corporation Solutions Gives Us A Dose of Much-Needed Criticism, which of course turned into the poster child for our observation that “in wellness you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
This is not that situation.
Michael Prager points out on his blog that I overstated the wellness-programs-as-fat-shaming case. Note he doesn’t say I’m wrong, but he does say I overplayed my hand, which I did. Many wellness programs fit my thesis…but some don’t. If a company’s program is all about offers rather than threats, about creating an environment conducive to health improvement instead lecturing people on their weight, about doing wellness for employees instead of to them, and about leaving people alone who don’t want to or can’t lose the weight, then I’m all for it. I should have been clearer about that.
If anyone would like to nominate an employer who has such a program, I would be happy to write it up.
And as you can see, we are also open to criticism of our positions, as long as the person writing the critique has a good point. Naturally, this industry is overflowing with vendors and consultants who probably have never had a good point in their lives…and naturally Wellsteps is leading the way. When we observed that Wellsteps’ most recent outcomes report showed costs going up and down at the same time, here is their (Troy Adams) rebuttal: We are full of “hot air.”
In the spirit of Festivus, we reprise four of the funniest vendors we’ve highlighted in 2015 that you might have overlooked. In more ways than one, these vendors didn’t get as many hits as they deserved:
- Vivify Brings Incompetence to Life.
- Keas Meets Lake Wobegone: All Employees Are Above Average (in Stress)
- Star Wellness Illuminates the Health Hazards of Wellness
and just to be fair and balanced…
Seasons Greetings from all (both) of us here at They Said What?