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Cancergate: Did a Koop Award Committee Member Commit a Crime?

As part of the cover-up of Health Fitness Corporation falsely claiming to save the lives of 514 Nebraskans with cancer, someone doctored their Koop Award application to remove the evidence of that claim and replace it with a literally and figuratively much more benign statement. For reasons described below, this may not even be legal. We are offering our assistance to Ron Goetzel to help him find the perp.


What would Dr. Koop say?

After Health Fitness Corporation (HFC) admitted lying about saving the lives of 514 alleged Nebraskan cancer victims who turned out never to have had cancer in the first place as part of their Koop Award-winning wellness program, someone tampered with their original award application to try to erase that lie. The “514 early-stage cancers” they claim to have cured morphed into “514 polyps.”

At the 2015 Great Debate, Ron Goetzel (who runs the Koop Award Committee) insisted that the Koop Committee knew nothing of the original lie about finding 514 cases of cancer, even though that line appeared twice in the original Koop Award application.  The Koop Award Committee also saw nothing suspicious in HFC’s marketing materials, which, incredibly, still resided on the HFC website for years after HFC was outed.  HFC finally took it down, an obvious admission of guilt on their part (to go with the actual admission in the newspaper), given how much they had ballyhooed it in the past. Naturally we have copies of the entire “case study” if anyone would like one.

Admittedly, that original lie was a little hard to spot in that case study. You needed to actually open your eyes:

nebraska life saving catches

nebraska cancer cases

And a lot of people did open their eyes.  The claim made its way into Google…and all the way to CalPERS:

nebraskacancergooglesearch

The Koop Committee missed this, though. Claiming to know nothing and see nothing — the Sergeant Schultz defense — is a Koop Committee favorite. However, the initial oversight doesn’t explain why Ron has called Nebraska a “best practice” three times even after he was shocked, shocked to learn that lying was going on in here.

Rewriting History

I want to be very clear: we are not accusing Ron Goetzel of sneaking back in and rewriting the original applications (including forging a section of a letter from the governor of Nebraska) to cover up the lies told by Health Fitness Corporation, which sponsors his award.  He could lose his job at Johns Hopkins if he did, so he wouldn’t.  Quite the opposite, both of us would want to get to the bottom of this!

Clearly, though, someone with the same coverup agenda and with the same access to the same Koop Award site rewrote the original HFC/Nebraska award application. Specifically, someone replaced “514 new cases of early-stage cancers” with these employees having only “benign polyps” in order to make it consistent with the denial that the Committee knew anything about HFC’s lie:

nebraska polyps

Owing to the previous doctoring of original evidence in the Koop Award (for which Ron Goetzel did admit responsibility), we now know to keep screenshots of originals.  Note the difference in the last sentences. The original is claiming “514 new cases…of cancer” below. This is the original that Mr. Goetzel insists did not appear in the application. And yet, here it is.

nebraska cancer koop award

This bungled evidence-tampering shows our book, Surviving Workplace Wellness, is right: “In wellness you don’t have to challenge the data to invalidate it.  You merely have to read the data.  It will invalidate itself.”

The doctored paragraph has now replaced the original paragraph in both places where it appears.  Ours is the only extant copy of the original screenshot.  We learned long ago that you need to capture screenshots because these people always cover their tracks when they get caught lying.  And since most of wellness is a lie, they have a veritable Pennsylvania Station of tracks to cover.

Cancergate?

The perpetrator is in a lot of trouble:  In the application, this altered phrase appears in a letter from then- Governor Heineman’s office in support of the Koop Award.  Obviously that’s not legal. The reason we assume Ron Goetzel didn’t do it is because he would have had to get permission from Johns Hopkins, and they would not have let him forge official state documents while using their affiliation in his title.

Goetzel’s History of Rewriting History

We don’t know who the perpetrator is, but one reason to doubt that Ron Goetzel is the guilty party is that he was already caught doctoring original Koop applications, and it wasn’t fun for him. Hence, one could assume he would be unlikely to do the same thing again.

So Mr. Goetzel is a victim here too because of the Koop Award’s shattered credibility. He should be as horrified as we are, and we should work together on this, and offer our help.  We urge, demand, insist that as the leader of this committee, Ron Goetzel get to the bottom of this!  He needs to find out who tampered with this letter from the Governor, turn him in to Nebraska authorities if indeed that is illegal, apologize, and rescind that Koop Award.

We can’t investigate this ourselves without his cooperation. Even if we knew who it was, we can’t convene the wellness industry ethics committee because in wellness, there is no ethics committee.  That’s because in wellness, as this website has repeatedly shown, there are no ethics.

They Said What? makes list of three top healthcare websites

OK, so maybe this news got pushed off the front page by the other prizes announced this week, but They Said What? made the list of Tom Emerick’s three favorite websites.

TSW occupies a unique niche, Rachel Carson-meets-wellness-meets-Dave Barry.  As an added bonus, all of our wellness statements are true, which makes us unique in the field (and explains why we have been blacklisted by many conference organizations).

Most importantly, we are in august company with the other two selected sites.  Not Running a Hospital and The Doctor Weighs In are both take-no-prisoners websites as well, and we recommend both.


Disclosure:  I co-authored Cracking Health Costs with Tom Emerick.  I don’t exactly expect a Nobel Prize for integrity here for simply pointing that out, but typically wellness vendors don’t disclose things like, oh, I don’t know, sponsoring the committee that gives their customers awards or even mentioning that the program they are “applauding” is their own.  Although in this case — Health Fitness Corporation and Nebraska — full disclosure would have also required them to admit that the entire thing was made up.  And therein lies the problem wellness vendors face.  In wellness, ethics is more than just a slippery slope.  It’s more like Half Dome coated with WD40.

 

 

Koop Award Committee-meets-Sergeant Schultz

Ever wonder why no one notices that wellness results are completely made up?

Wonder no longer.  it all starts with The Health Project, which gives out the C. Everett Koop Award.  This month is award season, meaning some of the award’s sponsors or committee members gets to ingratiate themselves with customers.  In honor of this month, let’s review previous years’ awards, and see the self-invalidating, but somehow unnoticed, details that call to mind the immortal words of the great philosopher Sergeant Wolfgang Schultz: “I know nothing.  I see nothing.  I hear nothing.”

To that iconic phrase, the Koop Committee adds: “I notice nothing.”

separated at birth

2014: British Petroleum (BP America)

Last year, the award went to British Petroleum.  BP’s candidacy wasn’t exactly a longshot, since both its vendor (Staywell) and its consultant (Mercer) are on the Committee AND are “sponsors” of this volunteer committee.    By the way, if you’re looking for any disclosure on the award announcement of those connections when you click through on the first sentence above, you’ll need x-ray vision, since there is none. No one seems to have noticed this omission.

Besides not understanding ethics, apparently Mercer and Staywell don’t understand arithmetic: their “rigorous analysis” claimed almost $20,000/person in savings for active participants who reduced a risk factor. Besides being mathematically impossible, clinically laughable, unchecked for plausibility in violation of their own HERO guidelines, and not adjusted for dropouts and non-participants, this figure, as the screen shot below shows, is  over 100 times more than Staywell itself says is possible.  Once again, no one seems to have noticed this glaring contradiction.

staywell grossmeier quote

2013–GRACO (honorable mention)

Ron Goetzel has written at length about Graco, as have we and others.  By starting the measurement in 2009, the year after the program started (as opposed to starting the measurement two years before the program started — see the 2011 award winner, Eastman Chemical), and “forgetting” to count revenues added by an acquisition. Mr. Goetzel was able to tie the growth in Graco’s revenues to the “bottom line performance” of its wellness program.  Of course, when you actually start measuring the year the program actually started (2008) — which coincidentally was also the year before the recession knocked 29% out of Graco’s revenues — and then adjust for the 2012 acquisition’s added revenues, Graco organically grew at about the same rate as everyone else.  Wellness had nothing to do with it.  Graco’s salespeople did not exceed their quotas because they ate more broccoli.

graco sales

Here’s what else didn’t happen due to its wellness program:  savings.  As our post showed, Mr. Goetzel didn’t notice that the cost trend for children (none of whom were in the wellness program) outperformed the cost trend for wellness participants. This means, of course, that the favorable trend among participants couldn’t be attributed to wellness, since the trend for a cohort without access to wellness was even more favorable.  It’s all right here.

Oh, yes, and it also turns out that Graco’s insistence on making its employees go to the doctor was more likely to harm them than benefit them. That’s not us–that’s the New England Journal of Medicine.

2012:  The State of Nebraska

We’ve already chronicled this one at length.  There were quite a number of glaringly obvious rookie mistakes that escaped the notice of the award committee, either due to incompetence or perhaps the fact that the state’s vendor, Health Fitness Corporation (HFC), was also a sponsor of the award.  See if you can find that sponsorship disclosure in their press release “congratulating” the State and LL Bean (the other winner, also a customer of HFC).  You’ll need an electron microscope to go with your x-ray vision.

HFC actually admitted lying about saving the lives of cancer victims who as it turned out didn’t have cancer, but still got the award because, according to Ron Goetzel at the 2014 Datapalooza conference, apparently this particular lie didn’t count because it wasn’t on their application, just everywhere else. It was impossible to miss, but Ron said he didn’t notice.  Is this a great country or what?

2011:  Eastman Chemical

Another HFC customer.  (HFC is really getting its money’s worth out of its sponsorship.) This was the one where — unlike 2013’s Graco, which started measuring outcomes the year after the program started in order to maximize the results — HFC started measuring outcomes two years before the program started in order to maximize the results.  They separated participants and non-participants in 2004 but didn’t start the program until 2006.  By 2005 the would-be “participants” were already 9% ahead…and by the time the program got underway in 2006, they were almost 20% lower-cost than the non-participants.

HFC full color

Once again, all this information was perfectly obvious at the time of the award submission, as well as highlighted in all of my books. It was also re-printed and re-presented multiple times, but somehow no one on the Koop Committee noticed until late 2014, when it was in Health Affairs.  At that point, the light being shined on him being too glaring to hide from, Mr. Goetzel had to respond.  Employing the passive voice to great advantage, Ron said the slide was “unfortunately mislabeled.”

hfc unfortunately mislabeled

Read that carefully.  If it’s hard to read, here is the source.  It’s towards the bottom.  He says this slide and other data “convinced” the Koop Committee to give them an award. That’s his story and he’s sticking to it.

Recently, for the second time, he went back into the Koop Award submissions and rewrote history. Compare the original Koop submission screen shot with the photoshopped version. Note the missing X-axis:

hfc rewritten

The original was:

HFC Eastman Chemical wellness data

His explanation didn’t indicate who mislabeled this slide, why he didn’t notice until now, why he snuck into the old files to relabel it, what the labels should have read — or why HFC never apologized, as others outside the wellness industry do when mistakes are made.

I can explain the last — just look at the wellness industry motto, on YouTube: “A Koop Award means never having to say you’re sorry.”

2010:  Pfizer

None of Pfizer’s outcomes figures stand up to even the slightest scrutiny, and Mercer did the analysis — making Pfizer a shoo-in for this award.  By their own admission only 4% of people moved out of high-risk status.  (Naturally this tally excludes non-participants and dropouts, who likely increased risk factors at a faster rate than participants reduced them.)  In other words out of 30,000 employees, 1200 reduced a risk factor.  And yet somehow Pfizer saved $9.4 million, almost $9000 per risk factor.  So if everyone at Pfizer reduced a risk factor, they’d easily wipe out all their healthcare spending.

They did some secure messaging, but only about a quarter of the at-risk population even opened their messages…and only about a quarter of them clicked through to the messaging.

Smokers self-reported at 6% before the program and 3% after it.  No one hazarded a guess that perhaps some employees were, oh, I dunno, lying?

However, no one can accuse Pfizer of lying about their weight loss results.  In particular check out this comparison, which was offered with a straight face, of employees who read their weight-loss messages vs. employees who didn’t.

pfizer

Over the course of the study, people who didn’t read their messages gained 1.6 ounces while employees who did lost 2.9 ounces.  You could practically attribute that differential performance to the calories required to open the emails.

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.

WELCOA: In the Belly of the Belly of the Beast

First, a little background.  For those of you unfamiliar with the Wellness Council of America, or WELCOA, this organization, based in Omaha, Nebraska, was founded by the inventor of the all-you-can-eat self-serve restaurant.

Warren Buffet?

Hey, it’s an honest mistake!  Anyone could misspell their founder’s name on their home page, especially when it’s one of those long foreign-sounding unpronounceable names of somebody no one’s heard of.   Besides, WELCOA in particular can’t be expected to know how to spell “Warren Buffett.”  I mean, it’s not like they’re both based in the same city or anything.

WELCOA is wellness’s perfect storm, exemplifying the standards for literacy, numeracy and integrity that have endeared the wellness industry to us humor writers.  Along with Ron Goetzel’s Koop Award Committee (chronicled at length in these pages and never shy about coming back for more), WELCOA truly does put the “Ig” in “Wellness Ignorati.”

Quizzify 3

Fun + facts = smarter, happier employees

In general, the modus operandi of the Ignorati — and especially WELCOA — is to suppress facts, because facts are their worst nightmare.  If facts are their worst nightmare, we’re their Night of the Living Dead.  We are tickled pink that we are considered so threatening that nowhere on their site is there the slightest hint that we — or any wellness skeptics — even exist.  For instance, the first time ever that the entire wellness industry (as opposed to individual debacles, like Penn State) was newsworthy enough to be covered by Health Affairs, LA Times, Incidental Economist, Chicago Sun-Times, All Things Considered, Huffpost, the Federalist etc.,  WELCOA’s lead “news” story was:  “How to Jump-Start Your Wellness Program with Big Data.”   (This editorial choice echoed the New York Post, which, on the day the hostages were freed and Reagan was inaugurated, led with “Joan and Ted to Split.”)

By contrast, we embrace transparency, and urge you to read the entire WELCOA site, especially the “premier providers,” who are kind enough to pay WELCOA for the privilege of having their creative approaches to grammar and math become TSW? fodder.  (We have a source inside WELCOA who brought our attention to the comedic potential of this material.)

One of our favorite WELCOA premier providers is Trotter Wellness, which gets its own entry in “On the (Even) Lighter Side.“.

trotterlogo.png (359×61)

Remember that scene in Catcher in the Rye when Stradlater gets Holden to write his English composition but tells him not to put all the commas in the right places so the teacher won’t suspect he wrote it?  The good news is, WELCOA could never be confused with JD Salinger.  In their ad for Trotter Wellness, WELCOA didn’t put any of the commas in the right places.

trotterwellnesscommaless

Frankly, we’re not sure WELCOA has ever put a comma in the right place…

At the risk of ruining a joke by explaining it, it’s not just that all the punctuation is missing from the descriptor.  It’s that the exact spot WELCOA’s crack grammarians decided to place a comma is also the exact spot they shouldn’t have placed a comma, according to Trotter’s own website screenshot right above this screenshot.  That gives WELCOA both a false-positive and a false-negative rate of 100%, which even in wellness is a bit on the high side.

Along with Ron Goetzel’s Koop Committee and Health Fitness Corporation, they were a co-conspirator in the Nebraska workplace wellness fraud, thus proving that great minds aren’t the only ones that think alike.  It was actually their website that claimed the famously fictitious “life-saving catches” of the 514 victims of “early stage cancer.”

nebraska life saving catches

koop001.png (394×241)

What boggles the mind, even by the uniquely gauzy ethical standards of the wellness industry is that they still make that claim, albeit on someone else’s website.  We’ll readily admit they posted the claim originally because they didn’t realize that HFC was lying (again), and that screening about 5000 people wouldn’t yield 514 cases of cancer.  (While Ron Goetzel’s Koop Committee was also snookered, It took us about 2 minutes to figure out that the alleged rate of cancers would have been roughly 50-100 times that of Love Canal.  You could come up with this insight too, using ingredients you already have in your kitchen: an internet connection, a calculator, and a triple-digit IQ.)

But two years later – after (1) we told them this was wrong; (2) we “outed” them in the Wall Street Journal; and (3) HFC admitted right in the Omaha World Herald they made up the claim – this statement is still being made.   We must now reluctantly conclude WELCOA is deliberately lying, because nobody, not even WELCOA, could be this stupid accidentally.*

Even Ron Goetzel briefly stopped defending WELCOA and HFC.  He claimed at the Datapalooza conference in June 2014 that the reason they won his award was due to a technicality. Apparently,  because they had only disclosed this particular lie on their website and not in their award application itself, it didn’t count against them.   Even so, a few months later, the Datapalooza conference being a distant memory, Ron once again declared that WELCOA/HFC/Nebraska was a “best practice”:

list-of-best-practices.png (408×108)

Quizzify 4

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

There is too much to say about WELCOA for a single posting, so we would direct you to two places.  First, in This Is Your Brain on Wellness, WELCOA merits its own entry, of course.  But WELCOA, truly a target-rich environment, also proffered screenshots for Midland Health, Bravo, Balance, Well Nation, the Healthy Company Alliance, Trotter, and Star Wellness.

Second, you can find Chapter 7 of Surviving Workplace Wellness right here.  Even in the target-rich environment of the wellness industry, getting one’s own chapter is quite a feat.  Just to get you in the mood, here is the first paragraph of that chapter:

sww nebraska chapter

Now that we have your attention, you can click on this link and download Chapter 7, with our compliments.


*Our bad!  It turns out WELCOA may very well be this stupid accidentally.  You see, when we pointed out in Surviving Workplace Wellness that they had misspelled the name of their founder, they fixed it on their home page.  (Apparently, while many people can spell and many people have visited their home page, the intersection set consists only of us.)   But it never occurred to them to do a find-and-replace.  You’d think that someone there would have thought: “You know, since we didn’t spell Buffett correctly on our home page, perhaps there are other places we didn’t spell it correctly either.  If only there were some way of testing that hypothesis…”

And that one of WELCOA’s other luminaries maybe couldn’t spell “Buffett” either but had studied the intricacies of Word’s find-and-replace function.  And that maybe — just maybe — these two folks would have bumped into each other, like in those old Reese Cup commercials, and collectively come up with the insight that the “answer” was: run the find-and-replace function on “Buffet.”

But no such luck.  Hence to this very day, the original spelling still appears on their website, in that very same Nebraska case study.

welcoa warren buffet

We’ve just spent 1350 words observing WELCOA’s foibles, but we do like to be balanced in our reporting, so we’ll close with some good news.  The good news is, there is indeed one place where WELCOA is undeniably right:  WELCOA truly has “helped influence the face of workplace wellness in the US”…

…By putting a great big smile on it.

 

 

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