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Tag Archives: Wellsteps
We’ve posted many times on the subject of wellness as seen through the eyes of employees who have been harmed or just really annoyed. And Slate carried a number of comments from other employees, who said things along the lines of: “I’d like to punch them in the face.” We also often write about employees who “out” vendors whose advice is truly bad.
Of course, we have also posted on the viewpoints of wellness promoters, our favorite lines coming from the very stable genius Michael O’Donnell, the former Prevaricator-in-Chief of the wellness trade association’s magazine, who contributed the following nuggets:
- “Wellness is indeed the best thing since sliced bread, up there with vaccines, sanitation and antibiotics.”
- “[Wellness] can prevent 80% of all diseases.”
- “Workplace health promotion may play a critical role in preserving civilization as we know it.”
This, on the other hand, is the first time we’ve posted from the viewpoint of a wellness coach, Barb Ryan Tessari.
Here is her take:
And this is why wellness can be such an epic fail:
A few observations about what makes it much more complicated and nuanced than wellness vendors would have us believe:
Hmm…So much for Wellsteps claim that employees “are suffering from I-don’t-care-itis.” It’s just the opposite — employees care about too many things, so sometimes their own needs come last. (As an aside, I always listen to my father’s stock market advice because in the stock market, the only person whose advice is as valuable as the person who is always right is the person who is always wrong. So when planning your wellness strategy, listen to Wellsteps!.)
ER and doctor visits often lead to expensive testing for chest pains, stomach issues, breathing problems or generalized aches and pains when the underlying cause is extreme stress/anxiety. I know their story. I know their stress. Many doctors don’t even ask the question.
Newly diagnosed diabetics (or pre-diabetics) are not sent to nutritional counseling, but instead the doctor prescribes metformin and merely instructs them to stop eating carbs.
Some doctors, whether intentionally or unintentionally “fat shame” their patients. I have heard the employees’ stories often, which delays care and certainly doesn’t empower a patient to make changes in self care
It seems many primary care doctors specialize in sending patients to specialists. And specialists don’t talk to each other. The focus seems to be to figure out what is wrong within the scope of their practice. There is little “connecting of the dots” to see if one problem could be connected to another. Patients are passed from one specialist to another and the employer and employee are paying the bill – not to mention the loss in productivity.
This is one of the reasons we frequently highlight Interactive Health in these postings — their whole business model is to brag about how many patients they send to the doctor for more tests for “newly discovered conditions.”
I have several new posts ready to go — the usual suspects acting out in their usual hilarious fashion — but this is a serious post.
It is time for wellness vendors to stop harassing employees about their weight.
A new article summarizing the voluminous data on the futility and harms of weight-shaming just appeared. It doesn’t contain new data, but rather presents the existing evidence in a clear and compelling format.
This article finds fault in the physician community, but the wellness industry (the outcomes-based companies and their enablers at the Health Enhancement Research Organization (and their enabler-in-chief, Ron Goetzel) is even worse because they tie money to weight loss. They give employees a financial reason to binge before the first weigh-in and then dehydrate themselves and crash-diet before the last one.
This does nobody any good, except of course the outcomes-based wellness vendors — like Interactive Health, Wellsteps, Wellness Corporate Solutions, Staywell, Bravo, Total Wellness, Star Wellness, Health Fitness Corporation and probably a host of others. And there is a special dishonorable mention for HealthyWage, whose entire business model is corporate crash-dieting contests.
They aren’t going to agree to stop on their own, any more than Monsanto stopped making DDT on its own volition. They need to have it made clear that this behavior won’t be tolerated any more.
A starting point is this linkedin post. Like it, comment on it, share it. Once we get to 100 likes and comments, and we’re already more than halfway, I can probably generate media attention.
Is your wellness vendor snookering you? There are certain facts that vendors are not exactly forthcoming about. This is because facts represent an existential threat to the “pry, poke and prod” industry. See how many facts you know — and how many they’ve suppressed — by taking this quiz.
You’ll earn more points, the closer you are. You don’t have to be exact — and honestly I’d worry about you if you got the exact answers to every question. I’d love you for it, but I’d still worry about you.
- Wellness vendors claim they can save significant money by reducing hospital admissions for diabetes and heart attacks, because those admissions are very common. How many admissions per 1000 covered lives does the average employer incur in a typical year?
The Health Enhancement Research Organization claims a certain savings figure for wellness PEPM. But that’s before taking into account vendor fees, extra doctor visits, tests, and prescriptions, compliance issues, employee time needed, overhead and basically anything else. In other words, what is the PEPM savings figure that at Bain & Company we used to refer to as “profit before cost”? Answer to the nearest one dollar. Hint: the answer is somewhere in this quiz.
To eventually save money someday, you first need to improve/reduce the risk profile of your population. According to eternal optimist and wellness promoter-in-chief Ron Goetzel, what is the maximum percent improvement in a risk profile that a company can expect after 2 to 3 years of wellness programming @$150 PEPY?
Speaking of Ron Goetzel, he said “thousands of wellness programs” fail to get good outcomes. What round number did he claim have succeeded?
And speaking of Ron Goetzel again, he finally admitted it was “hard” to force employees to change behavior. How many “very’s” did he put in front of the word “hard” in that admission?
The Wishful Thinking Factor, totally coincidentally abbreviated as WTF, is defined as: Total claimed cost reduction/total number of risk factors reduced. What is the average WTF for the last six Koop Award-winning programs, on average? (Hint: the real ratio of savings to risk reduction is about 0.05x, since even if savings does not lag risk reduction, a maximum of 5% of spending is wellness-sensitive.)
Speaking of risk reduction, employees in the most recent Koop Award-winning program, Wellsteps/Boise, originally tallied 5293 risk factors. Approximately how many risk factors did those same employees tally after participating, excluding dropouts?
In a participants-vs-non-participants study design, what percent of the perceived savings is due to the invalidity introduced by the study design itself in which unmotivated employees are used as the control for motivated employees, rather than health improvements attributable to the actual program itself, according to all four studies conducted on this topic, including three by wellness promoters?
If you use Interactive Health as a vendor hyperdiagnosing the stuffing out of your workforce, what is the annual percentage of employees that will likely be told they have “newly discovered conditions” that “require” a doctor’s intervention?
Of 1000+ wellness vendors, how many are validated by the Validation Institute?
- 2. Yes, only 2. All this wellness fuss is about 2 admissions per 1000 employees. Derivation: the roughly 150,000,000 employees and dependents covered by commercial insurance (mostly from employers) generate roughly 150,000 heart attacks and 120,000 diabetes events. See the HCUP database and enter “410” for heart attacks and 250 for diabetes admissions for the ICD9 for the most recent full year (2014). Scoring: Give yourself 1 point for guessing 4 to 10 and 2 points for guessing fewer than 4.
- One dollar. $0.99 PEPY. As is well-known, they tried to walk this figure back once they realized they had told the truth. Scoring: Give yourself 1 points for guessing $1.00, since the answer in the hint was on that very same line.
- 2%. That’s a few dollars PEPY in savings. (Looks like the HERO report was pretty close, its own protestations notwithstanding.) And you paid $450/employee over 3 years to achieve it. Actually it was 1% to 2%, but we asked for the maximum. Scoring: Give yourself 2 points for 2% or less, 1 point for 4% or less.
- Only 100. Besides Johnson & Johnson, Mr. Goetzel has never disclosed any of the other 99 without others making the observation that they self-invalidate according to their own data. Scoring: 2 points for 200 or fewer, 1 point for 400 or fewer.
- 4. In The Healthy Workplace Nudge, Rex Miller gets Ron Goetzel to admit that “changing behavior is very very very very hard.” Gosh, Ron, do you suppose this might explain why an employer population’s risk factors never noticeably decline? Scoring: 2 points for 4, 1 point for 3 or 5.
- Infinity. That’s because of the next question. The 21% risk factor increase for Wellsteps more than offset the trivial risk reductions achieved by the previous years’ winners. The actual WTFs for the previous years will be the subject of a future posting. Scoring: give yourself a point if you guessed that the WTF was 5 or higher. That would be 100 times the actual figure and still way below the wellness fantasy-league figure.
- 6397. Risk factors rose 21%. And yet somehow, even though the risk profile was deteriorating sharply, the risk profile of the population was also improving enough for Wellsteps to claim that healthcare costs declined 30%. 30% is enough to wipe out wellness-sensitive medical events for the entire Boise teacher population and about 30,000 of their closest friends. (Wellsteps originally admitted that costs increased, but took that slide down when it occurred to them that telling the truth would be inconsistent with their marketing strategy.) Scoring: 1 points for 5500 to 6000 or 6600 to 7000, 2 points for 6001 to 6599.
- 100%. It turns out that the participant-vs-non-participant study design is responsible for all the perceived savings that wellness vendors claim for programs. The New York Times just explained how, in the landmark University of Illinois study, both the “gold standard” RCT methodology and the invalid par-vs-non-par methodology were used and had completely different results. This also happened three other times (summarized here) — with Newtopia, Health Fitness Corporation, and a study done by the chairperson of the Koop Committee showing how feeding diabetics more carbs would reduce their costs by improving their health. Literally, 4 studies — all of which were run by people trying to show savings — showed exactly the same thing. Scoring: all or nothing — 1 points for 100%.
- 45%. This is because running 40 inappropriate tests on every employee makes it inevitable that at least 1 or 2 of those tests reveal a false positive. Scoring: Give yourself 2 points for guessing between 40% and 50%, 1 point for 30% to 39% or 51% to 60%.
- Four. All four are honest and make modest claims they can defend or valid contractual representations. AND, they actually screen according to guidelines! (In the wellness industry, doing something appropriate merits an exclamation point.) They are: It Starts With Me, Splashlight, Sustainable Health Index, and US Preventive Medicine. That’s <1% of all wellness vendors. Scoring: give yourself 1 points for 8 or fewer.
0-2 points. Has your wellness vendor sold you a bridge too?
3-5 points: Your wellness vendor is blocking your internet connection
6-9 points: Nice work!
>9 points: Send your fifth-grade math teacher a thank-you note for doing a better job than the wellness vendors’ teachers did.
The most comprehensive expose of the “pry, poke and prod” industry is likely to have broken the 1000-download threshold by the time you read this.
Published by the leading law-medicine journal, it is their second-most-popular paper of all time. Curiously, while this is the oldest law-medicine journal in the country and has covered a multitude of topics over many decades, the most popular paper of all time is also a smackdown of pry, poke and prod programs.
Because TSW doesn’t lie (that’s part of the reason we are so unpopular amongst the HERO crowd and its sycophants), I would acknowledge that the methodology they use to measure popularity favors more recently published articles, and ours is “only” a year old. Even so it is quite a feat because, while we are close on the feels of #1, there is a big gap between us and the #3 article.
In the structured world of law, as opposed to the “Wild West” of wellness, there are rules. That’s why I chose the leading law-medicine venue for this expose.
One rule of evidence is that some of the best evidence — one of the few exceptions to the hearsay exclusion — is what’s known as an “admission against interest.” An admission against interest is “a statement by a party that, when uttered, is against the party’s pecuniary, proprietary, or penal interest.” It’s even more compelling if it is captured electronically, as on a live mic, or in print.
The best example is Robert Durst accidentally admitting that he killed his wife during a bathroom break while being interviewed for a documentary, when he was still miked. You’d have to be, as Larry David might say, pretty pretty pretty pretty stupid to make admissions against interest when you are miked or in print.
One would think.
And yet the wellness industry’s entire modus operandi is to do exactly that. All that remains is for someone like me to point these things out, take a screen shot (the equivalent of Durst being miked), and then sit back, make some popcorn, and watch them react. Reacting is also a form of evidence. Reacting the way a guilty person would react is prima facie evidence of guilt. (To use the examples from the TSW landing page, think OJ and the white Bronco or Lance Armstrong and just about anything he said or did after being accused.)
Needless to say, the wellness industry’s very stable geniuses never step out of character when it comes to guilty reactions. This runs the gamut. Sometimes, as with Bravo, they pull down the incriminating screenshot immediately after being outed. Or, as with Interactive Health, they simply excise the incriminating data from their “research report” and call it a “research summary.” (And also they try to bribe me not to talk about them any more. I’m just sayin’…)
Or, as with Wellsteps, they act out with unsupported and creatively spelled recriminations.
Or sometimes simply trying to erase history. This is the specialty of Ron “The Pretzel” Goetzel, twisting and turning his words to do exactly that, not realizing that we keep screenshots. Here is the “before” and “after” picture of him erasing the smoking-gun evidence that a program’s “impact” was due entirely to separation into participants-vs-non-participants rather than pry, poke and prod. Note that from 2004 to 2006, separation between participants and non-participants increased almost 20% — before there was even a program to participate in.
Before (what really happened):
In order to maintain the fiction that participants-vs-non-participants is a valid study design, Ron simply removed the labels from the x-axis:
Lest anyone domiciled in a state where marijuana is now legal think the first one was a mistake and was corrected as soon as they noticed, they actually repeatedly reprinted and reused the original in many forums, like this one:
Sometimes, and this was my favorite of Ron “The Pretzel” Goetzel’s twists and turns, he literally rewrote history, in the form of forging a letter from the Governor of Nebraska, once he admitted the initial claim of saving the lives of 514 cancer victims was exposed as a fraud:
Here is your assignment: pass this along to everyone you know and ask them to read the article. Then hopefully it will be time to write the history of wellness the way it should be written. And keep a screenshot in case Goetzel tries to rewrite it.
Note that this personal blog post does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I co-founded. I am referring, of course, to the Needham Frisbee Club, where everyone is welcome to join and play and become fitter — since fitness at any size, not corporate crash-dieting contests, is the key to health.
By now, many facts are well-known about weight and weight loss programs:
- Variations in body size do not correlate with variations in willpower
- No one really knows why the country has gotten fatter since 1986, reversing the trend through 1985, and without understanding the causes of this fairly sudden reversal, it’s not possible to address it. (We do know that the lowering of cutoffs in 1989 created an additional 30 million “overweight” people in the U.S. overnight. http://www.cnn.com/HEALTH/9806/17/weight.guidelines/)
- It is much better to be “fit and fat” than to try to diet your way to health
- The vast majority of people who lose weight gain it back
- 1/3 to 2/3 gain back more than they lose
- No wellness vendor has discovered the secret to weight loss that has eluded researchers for decades
- The often quoted 90-95% failure rate of programs is likely underestimated.
Further, while perhaps not proven, there is growing evidence, also here, and here, that weight cycling may be hazardous to health. (This would likely be particularly true when an employer ties incentives to gaining weight for the first weigh-in in order to lose it by the second weigh-in.)
And, yet, a number of the workplace wellness industry’s very stable geniuses have chosen to body-shame employees. The individuals and companies listed below are the wellness industry’s leading body-shamers, charter members of the Body-Shaming Hall of Shame. No surprise that wellness luminaries are leading the charge towards body-shaming, as their industry has repeatedly been called words like “sham” and “scam” by Pulitzer Prize-winning media outlets not otherwise known for name-calling.
Where possible, we have provided contact information, that you can use to let the appropriate people know how you feel about endorsing body-shaming in the workplace. Obviously, one can never eliminate discrimination based on body type, but hopefully this exposé, and creating the Body Shaming Hall of Fame, will reverse the trend towards employer support of weight discrimination in wellness programs.
Troy Adams, Wellsteps
Wellsteps is known in general for harming employees, and won a Deplorables Award in 2016 for harassing Boise School District employees. Mr. Adams cemented his and Wellsteps’ candidacy for this list by declaring: “It’s fun to get fat. It’s fun to be lazy.” After receiving many complaints, he took that article down. But he never apologized and Wellsteps continues to pitch “wellness or else” programs in which employees are fined if they can’t lose weight.
Ignorance of physiology (fines and incentives have never cured any disease known to mankind) is quite consistent with the rest of Wellsteps’ philosophy. They also have no understanding of arithmetic (costs can’t increase and decrease at the same time), drinking (it is OK to have wine with dinner or a beer at a ballgame), smoking (smokers don’t take their first steps to quitting by smoking only on weekdays), nutrition (“one more bite of a banana” will not improve your health), and arithmetic again.
You can let Wellsteps’ largest client know how you feel about this by writing to the Boise School Committee at Jeannette.firstname.lastname@example.org and copying the editor of the local newspaper, Rhonda Prast, at email@example.com.
Michael O’Donnell, American Journal of Health Promotion
Michael O’Donnell served, until recently, as the prevaricator-in-chief of the industry trade publication, the American Journal of Health Promotion, which might as well be called the American Journal of Self- Promotion, for the simple reason that – despite the overwhelmingly poor economics of “pry, poke and prod” programs and their strong likelihood of harming employees – they have published only one single sentence critical of wellness…and when that was discovered to have slipped through pre-publication review by their thought police, they walked it back in the next issue.
Mr. O’Donnell was voted into the Hall of Shame thanks to his proposal to charge employees for insurance based on BMIs, a “pay what you weigh” approach, like ordering lobsters or sending a package.
- Prospective new hires should be subjected to an intrusive physical exam and hired only if they are in good shape. OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.” Hence, he would waive the physical exam requirement for mattress-tester, prostitute, or outcomes analyst for a wellness company – because those jobs require only excessive lying.
- Employees above his ideal weight would pay per pound.
- He would “set the standard for BMI at the level where medical costs are lowest.” Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.
If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?
We aren’t making this up. Here is an excerpt:
He claims that all these weigh-ins and fines will create an “insanely great program” for employees, whether they like it or not.
Vitality Group, Johnson & Johnson – and Ron Goetzel
Where would a wellness-related Hall of Shame be without Ron Goetzel? Name a debacle or scandal in wellness, and his fingerprints are on it. Penn State, Nebraska, McKesson, Bravo/Graco, and of course Wellsteps come immediately to mind.
He was also the very stable genius behind the Johnson & Johnson Fat Tax. The Fat Tax was supposed to be a game-changer, ostracizing overweight folks with the misfortune of working for publicly traded corporations. In this scheme, companies would weigh their employees and then disclose those weights to shareholders. The shareholders would presumably reward those companies doing the best job of reducing employee weight, creating more profit for the wellness vendors, like Vitality or Johnson & Johnson, who would help employees lose weight. Ultimately it would be a tax, in that every employer that did not hire a wellness company and/or fire fat employees would see its stock price tumble, making wellness a mandatory fee.
While this “fat tax” would go a long way towards achieving the Wellness Ignorati’s goal of monetizing body-shaming, bringing financial disclosure into the picture raises all sorts of regulatory issues. Could you force employees to be weighed in order to meet SEC disclosure rules? What if employees cheated on the weigh-in, as employees are wont to do? Would that create a Sarbanes-Oxley violation?
There are three ironies here. It turns out that companies that are obsessed with prying, poking and prodding their employees, like McKesson, watch their stock prices tumble. And companies specifically obsessed with goading their employees into crash-dieting contests, like Schlumberger’s chart below, have the worst stock performance of all.
Second, it turns out that Vitality can’t get its own employees to lose weight, and yet they want you to hire them to get your employees to lose weight.
Finally – and this shouldn’t come as a surprise to anyone – there is zero correlation between employee weight and corporate performance.
Mr. Goetzel works for Johns Hopkins and often places their name on his essays. If you have an opinion on whether Johns Hopkins should be supporting institutionalized body-shaming, you can express your opinion by writing to Dean Ellen MacKenzie at firstname.lastname@example.org .
Dr. Delos “Toby” Cosgrove, president of the Cleveland Clinic. After commenting that he would not hire smokers at the Clinic, he added that he would not hire obese people if he could legally deny them jobs.
So he doesn’t want to work with obese people, except if they happen to be president.
Dr. David Katz coined the term “oblivobesity” because apparently, he feels we have not yet made larger people feel bad enough about themselves to force them to do something about their weight – the difficulty of which has apparently been overstated because, according to Katz writing in the Huffington Post:
“There are rare cases of extreme weight loss resistance and such, but by and large, we can lose weight and find health by eating well and being active. Really.”
He deftly rebuts 30-plus years of consistent and conclusive research to the contrary by adding “really” to the end. Because everyone knows that makes a statement true. Really.
He also continues to illustrate his postings with pictures of headless fat people. And then there is his defense of Dr. Oz.
Please feel free to contact us about additional “shamers” you would like to add to the list along with the reasons why.
In this hyperpartisan era, conservatives and liberals agree on only one thing: forcing employees into outcomes-based wellness programs is one of the worst ideas in the history of ideas. If you scroll down our feature In The News, you’ll see wellness gets equal treatment by right-wing publications like Newsmax and The Federalist as well as left-wing publications like Slate and Mother Jones.
Opposing forced wellness has already propelled one candidate into elective office: Matthew Woessner, whose leadership in Penn State’s faculty revolt against the punitive “pry, poke and prod” plan proposed by Highmark and Ron Goetzel, was elected President of the university’s faculty senate. Matthew is a self-described Republican libertarian.
In keeping with the bipartisan nature of wellness, it is fitting that the first Congressional candidate to take on the wellness industry is, conversely, a Democrat, Jenny Marshall. Jenny (as she likes to be called) is running against Virginia Foxx (R-NC5), who chairs the House Committee on Education and the Workforce. A powerful combination of this lucrative committee chairmanship, lack of ethics and a gerrymandered “safe” district (at least until voters find out about this bill), allows Foxx to “represent” the American Benefits Council rather than voters in her district. Indeed, I suspect she has nary a single constituent who supports employees being pried, poked and prodded into submission. It is not at all clear how this bill would benefit her district.
Any controversy over whether forced wellness saves a nickel or even improves health has long since been laid to rest. Hence, the American Benefits Council’s enthusiasm for forced wellness is all about making programs so onerous and unappealing that employees prefer to pay the $1000 fines rather than be subjected to the indignity and potential harms of being pried, poked and prodded by unlicensed, unregulated wellness vendors.
On the other hand, these programs can be very lucrative for employers, who can claw back large chunks of their insurance premiums forfeited by non-compliant employees. Vendors have already figured out how to offer “immediate savings” for employers through collecting these fines from employees.
Unless Foxx’s bill becomes law, this lucrative, misanthropic, anti-employee loophole will be closed December 31, thanks to the ruling in AARP v. EEOC, which will prevent employers from forcing employees into “voluntary” wellness programs.
Foxx’s HR1313, known colloquially as the Employee DNA Full Disclosure Act, would override this common-sense federal court decision. Worse, it would allow employers to force not only employees but their children into these programs. And not just prying, poking and prodding them, but collecting their DNA as well. Yep, your children’s DNA is fair game if this bill passes. It is so onerous that even much of the wellness industry opposes it, though they stand to benefit from it.
It is headed for a floor vote sometime this spring, having been voted out of her committee on — get ready — a straight party-line vote. (So much for the GOP standing for individual rights.)
Jenny Marshall fights back
Jenny has posted a summary of this bill right on her campaign website. Asked for a comment, she replied: “Foxx’s bill could very well be the worst proposed legislation in the history of Congress. Its intrusiveness would make Orwell blush. I can’t figure out why she would want to invade the privacy of her constituents like this, other than raking in big dollars from lobbyists. For too long now, Foxx has turned a deaf ear to the wants and needs of the people of our district, and for that betrayal should be voted out of her seat.”
If this bill passes, the very stable geniuses at “outcomes-based” wellness vendors like Bravo, Interactive Health, Wellsteps, Corporate Wellness Solutions, and Staywell will be able to trample employee rights to privacy, fine them and harm them — for no reason other than to enrich their own coffers, and those of their corporate overlords. Absent this legislation, millions will be thrilled to be freed from their anti-employee jihads on December 31 — and employers can find kinder, gentler conventional programs, a la Redbrick or unconventional ones like Limeade (and/or Quizzify, of course) instead.
The way to keep this bill from passing? Vote Foxx out of office. Shed no tears for her. She will get a lucrative job, possibly representing the American Benefits Council in their quest to collect fines from employees — just like she does now.
Only starting in 2019 her paycheck will come directly from them, as opposed to indirectly, as it does now.
Often I don’t have time to write a full blog in my own words, but fortunately I usually don’t need to. It’s enough to quote the words of the very stable geniuses in the wellness industry verbatim. Being quoted verbatim, of course, is one of these geniuses’ worst nightmares.
Among the most stable of the wellness industry geniuses is Steve Aldana, CEO of Wellsteps, winner of the 2016 Koop Award as well as the 2016 Deplorables Award. How does he report the National Bureau of Economic Research’s complete evisceration of wellness industry research methods? Let’s take a looksee at the highlights of his posting.
First, it appears that two opposing studies, “one for and one against wellness,” came out “at the same time.”
One the one hand, someone — apparently he doesn’t know who — seems to say that there “wasn’t much improvement” at the University of Illinois. And something must have been wrong with this result, because “these results contradict over 90% of publish [sic] studies.”
“At the same time,” a publication no one has heard of found the opposite: health behaviors improved for “over 2 full years” in — get ready — one of Wellsteps’ very own accounts.
This is a textbook example of a false equivalence, the wellness version of: “You also had some people that were very fine people on both sides.”
To begin with, the researchers in the first group weren’t just any old researchers. This was the National Bureau of Economic Research (NBER). And the NBER didn’t say “they didn’t see much improvement.” Their specific words were that the causal effects were — get ready — nearly indistinguishable from zero for nearly every outcome.
Further to say this conclusion “contradicts over 90% of published studies about wellness,” would be like saying Galileo’s findings “contradicted” over 90% of published studies about astronomy.
The study’s actual conclusion used a slightly different verb:
Our 95% confidence intervals rule out 78 percent of previous estimates [of the effect of wellness] on medical spending and absenteeism from the prior literature. [Let me translate that, in case the words are too long for the very stable geniuses at Wellsteps to understand: you and all your very stable friends have been geniusing about savings for decades now.]
The reason the NBER was able to be so conclusive is that, to quote one of our Alert Readers, Robert Dawkins: “They foolishly included a valid control group.” Kudos to Mr. Dawkins for that very unstable moronic observation. (In any event, far from contradicting other research, the study is quite consistent with most articles on wellness not written by someone feeding at the employer wellness trough.)
The other journal, which published an article “at the same time,” found an improvement in healthy behaviors. That journal is called Health Promotion Practice. And if you haven’t heard of it, you’ve got company. Their “impact factor” is the lowest in an industry whose journals are notable for low impact factors. I googled quite extensively, and it appears — get ready — that no article from this journal has ever been cited, excerpted or even had the fact of its very existence even grudgingly acknowledged in the lay or scholarly media.
By contrast, the NBER article has been picked up everywhere — except of course by the wellness industry. See if you can find any reference to this article — or AARP v. EEOC, which was also national news — on the Health Enhancement Research Organization website.
Turns out there’s a reason no one cites this journal. It’s because it’s so genius. Exhibit A is this very same article, a rehash of the Boise School District findings that somehow overlooked the key finding, which is that the employees got unhealthier during Wellsteps’ program. Instead, the author — displaying not the slightest intellectual curiosity as to how this could possibly be true — reports the most genius findings we’ve ever seen in a journal:
- only 3% of Boise School District employees smoke, and…
- …they smoke only 4 days a week.
Perhaps — just playing devil’s advocate here — the other 17% of Boise employees who smoke (Idaho has a 20% smoking rate) might have lied on their health risk assessment? The “tell” is that everybody knows smokers don’t smoke only 4 days a week. Obviously, they smoke 5 days a week, with time off for weekends, major holidays and Beethoven’s Birthday.
Very stable genius that he is, the author (both a friend of Wellsteps’ Mr. Aldana, according to the disclosure statement, and also a genius who has already been profiled on this site for his previous insights) also admits that with a high non-participation rate and a 20% dropout rate:
There exists the possibility of selection or dropout bias that could have influenced the results reported.
Ya think? Maybe just a tiny bit?
But wait…there’s more
We’ve highlighted Mr. Aldana’s phrase “at the same time” describing how these articles were simultaneously published. We repeated the phrase in three separate places above for emphasis because — get ready — these two results were not published at anything like the same time.
To begin with, Mr. Aldana has been very stably geniusing about his Boise results for more than two years now. (See my article from September 2015 accurately forecasting that, thanks to the number of obvious errors and self-immolating contradictions, this study would win a Koop Award. And of course the Boise employees got harmed.)
This article, using that same data set, was published last July, whereas the NBER article just came out a few weeks ago. Perhaps in some geologic sense July 2017 and January 2018 are “the same time,” but imagine if the rest of the world defined “at the same time” as “six months apart.” For instance, let’s join Sherman and Mr. Peabody in the Wayback Machine and set the dial for June 1944:
Eisenhower: “OK, we’ll storm Omaha and Utah Beaches, and you guys can storm Juno and Sword Beaches at the same time, and then we’ll hook up and say…”
Churchill: “…Merry Christmas, chaps.”
For a good time, try googling on Wellsteps.
NY Times’ economists and Pulitzer Prizewinning LA Times columnist skewer “voluntary” wellness incentives
In the immortal words of the great philosopher Dizzy Dean, don’t fail to miss it.
Ever since Ron Goetzel’s Penn State debacle, the news cycle has been the Health Enhancement Research Organization’s (HERO) kryptonite.
To be sure, they have other enemies too — transparency, integrity, math, data, facts, employees, smart people — but those bullets just bounce off them. How do we know this? We think we’re making an impact with our exposes and whistleblowing — and yet forced, incompetent and sometimes harmful prying, poking and prodding continues unabated. When we prove that none of the wellness numbers add up and back that proof with a monster reward for disproving us, they retreat rather than fight — but then they pop up again, whack-a-mole style with yet another claim: “Oh, well, numbers don’t have to add up. It’s all about the value.” Yada yada yada.
That’s why they never respond to anything we ever write, or for that matter anything anyone else ever writes. STATNews, for example, wanted to host a point-counterpoint, but couldn’t find anybody to oppose me. Health News Review posted a podcast with no opposing views.
The one wellness executive who failed to understand the news-cycle-as-kryptonite dynamic was Wellsteps’ Steve Aldana, not exactly a rocket scientist even by the standards of the wellness industry. In an attempt to get his name in the paper, he accidentally admitted that all of Boise’s Koop Award-winning numbers were fabricated. Yes, he humiliated himself, yes, he admitted he lied, yes, he could easily have been charged with defrauding the city…and yet Boise is still Wellsteps’ account.
If they had any lingering doubt, that lesson taught the rest of these people to stay out of the media even if it means taking a few punches.
That brings us to today. I’ve been scouring Google to find someone — anyone — to take the side of the EEOC in what is likely to become an extended news cycle over the definition of “voluntary” for wellness programs. So far, no one has stepped forward to support the EEOC’s and HERO’s argument that “voluntary” can mean “we’ll fine you up to $2000 if you don’t.” Instead, both The Incidental Economist (the NY Times‘ economics bloggers) and the LA Times‘ Pulitzer Prize-winning business columnist, Michael Hiltzik, come down strongly on the side of AARP, Merriam-Webster, Funk & Wagnalls and Dictionary.com.
- In 2015, the EEOC proposed a rule treating wellness programs as “voluntary” if they involved premium differences of no more than 30% of the full cost of a health plan. Worker advocates were aghast — 30% of a full-price premium could amount to thousands of dollars, and since the workers’ share of their health plan premiums often was only 30% or so, the penalty could double their annual costs. For many families, that made voluntary programs effectively mandatory.
- [The judge] observed that the 30% incentive “is the equivalent of several months’ food for the average family, two months of child care in most states, and roughly two months’ rent.” He recognized that a fee of that magnitude could be especially coercive to lower-income employees
- The biggest problem with wellness programs is there’s no evidence that they work. The most frequently cited statistic in their favor came from Safeway, whose claim to have saved on per capita healthcare costs after implementing a wellness program prompted drafters of the Affordable Care Act to liberalize the incentive rules. But Safeway’s story was soon debunked. Other supposed success stories came from wellness program promoters themselves, who were engaged in selling their wares to big employers.
- The rule allowed employers to impose huge penalties on employees who refused to participate in wellness programs, even though the Americans with Disabilities Act says those programs must be “voluntary.”
- In the court’s view, the EEOC had basically ignored the problem in its rulemaking, asserting without explanation that wellness programs backed by enormous penalties were somehow voluntary. I applauded the decision: I’ve been railing against the EEOC for two years now for blessing mandatory wellness programs over the ADA’s express prohibition.
Once again, I’d urge everyone to sign up for the January 18 webinar. There will be more clarity, you can ask questions, and you’ll hear questions from others too. What you won’t hear is a peep out of HERO. Not because we censor or blacklist adversaries (that’s their signature move, not ours — one person reports that HERO took him off the program because he admitted to respecting my work) but because they know better than to, in the immortal words of the great philosopher John Cusack, say anything.
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
2021 Update — we aren’t just “outing” the worst. Instead we are claiming to be the best: The reward now applies to any behavior-change vendor — diabetes, wellness etc. — vs. Quizzify. $3 million is yours if found by the 5 judges (and remember, we only appoint one!) to be more cost-effective than Quizzify.
Here are the specific rules to claim the reward.
Almost any behavior-change vendor (e.g., Virgin Pulse, Bravo, Accolade, Livongo) is eligible to claim the reward. A “behavior change” vendor would be one whose value depends on employees doing something voluntarily or with an incentive/penalty, paid via an admin fee. Eligible categories include wellness, diabetes, weight loss, mental health, sleep, coaching, EAPs, “challenges” programs, fitness, nutrition, navigation, patient-centered medical homes, and price-shopping companies.
We say “almost any” because behavior change vendors that we work with are ineligible because we help them dramatically increase engagement. For instance, Sera Prognostics enhances its guarantee if Quizzify is also used, and we enhance ours.
If indeed a vendor considers itself to be a behavior change company and Quizzify looks at it and says, no, this is not behavior change, the vendor may announce that Quizzify rejected their application. The vendor may then apply to the Validation Institute to arbitrate whether it is a behavior change company or not. If it wins, Quizzify agrees to pay for its validation.
Selection of Judges
There will be five judges, selected as follows:
- Each side gets to appoint one, drawn from The Healthcare Hackers listserve with more 1000 people on it, from all walks of healthcare.
- Two are appointed objectively. That will be whichever health services researchers/health economists are the most influential at the time the reward is claimed. “Most influential” will be measured by a formula: the highest ratio of Twitter followers/Twitter following, with a minimum of 15,000 followers.
- Those four judges will agree on the fifth.
Using the criteria below, the judging will be based largely on value per dollar of the program spent on the program and incentives. In the event this is considered to be roughly a tie, the judges will consider the validity of their measurement and whether they are validated by the Validation Institute.
Each side submits up to 2,000 words and five graphs, supported by as many as 20 links; the material linked must pre-date this posting to discourage either side from creating linked material specifically for this contest.
Publicly available materials from the lay media or blogs may be used, as well as from any of the 10 academic journals with the highest “impact factors,” such as Health Affairs, published within the last ten years.
Each side must:
- list their average prices per employee per year
- speak to compliance with ACA, ADA, USPSTF, and Choosing Wisely;
- allow the other to test its materials (for example, taking the health risk assessment) and review them as part of the submission.
Each party may separately cite previous invalidating mistakes made by the other party that might speak to the credibility of the other party. (There is no limit on those.)
The judges may rule just on the basis of the written submissions. If not, the parties will convene online for a 2.5-hour presentation (or, at the discretion of the judges, in-person at the World Health Care Congress), featuring:
- 10-minute opening statements, in which as many as 10 slides are allowed;
- 30-minute cross-examinations with follow-up questions and no limitations on subject matter;
- 60 minutes in which judges control the agenda and may ask questions of either party based on either the oral or the written submissions;
- Five-minute closing statements.
The entry process is:
- Applicant puts $3000 into escrow, at which point an NDA is signed and Quizzify/Quizzify guarantors (“Quizzify”) demonstrate liquid assets exceeding $3 million. Applicant may either go forward at this point, or forfeit the $3000.
- Applicant adds $27,000, at which point earning assets exceeding $3,000,000 are placed in escrow, though the income from the escrow does not go to the applicant. Assuming the $3,000,000 is sufficiently secured, applicant may either go forward, or forfeit the $30,000. If not secured, Quizzify pays the applicant $100,000.
- Applicant adds $270,000 to the escrow within 30 days, at which point the entry process is completed. Both sides then have 30 days to submit materials and 7 days to rebut. Online argument then takes place, if needed.
- Judges are paid from the escrow, 50-50 from Quizzify’s and applicant’s shares.
- If the applicant pulls out after publicly announcing he or she is applying and before adding the $270,000, there is a $50,000 liquidated damages fee, tripled if it has to be procured through litigation. If Quizzify pull outs, there is a $150,000 liquidated damages fee in favor of the applicant, tripled if it is procured through litigation.
- The winner collects the escrow.
June 2021 Update: Virgin Pulse’s one-page outcomes report is eligible. They can win just by defending one single slide with as much backup as they want.
March 2021 Update: Wellsteps can claim double the reward ($6 million) for half the entry fee ($150,000) simply by showing that their ROI calculator is more accurate than Quizzify’s.
January 2021 Update: Omada is claiming outcomes on their home page that are textbook examples of both regression to the mean and participant bias. They are aware this is not valid. They can claim this reward by defending their specious claims.
December 2020 Update: This reward is now applicable to any actuary or other self-proclaimed expert who claims that their published analyses of the wellness/diabetes/disease management industries showing favorable outcomes and savings are better than mine showing losses and general cluelessness.
Here is the original offer and how it is changed.
As almost everyone in the wellness industry knows, we have offered a $2 million reward to anyone who can show that conventional annual “pry, poke and prod” wellness saves money. I’m feeling very generous today, what with the holidays upon us, so let’s make the reward $3 million.
Even more importantly, let’s loosen the rules — a lot — to encourage applicants. You’ll find the $3 million reward is not just more generous, but also far easier to claim than the previous $2 million reward.
Special Offer for HERO
Ah, yes, the Health Enhancement Research Organization (HERO). The belly of the beast.
Let me make them a special offer. Paul Terry, the current HERO Prevaricator-in-Chief, has accused me of the following (if you link, you’ll see they had enough sense not to use my name, likely on advice of counsel, given that I already almost sued them after they circulated their poison pen letter to the media):
I’m convinced responding to bloggers who show disdain for our field is an utter waste of time. I’ve rarely been persuaded to respond to bloggers [Editors note, in HERO-speak, “rarely” means “never” — except for that intercepted Zimmerman Telegram-like missive], and each time I did it affirmed my worry that, more than a waste, it’s counter-productive. That’s because they’ll not only incessantly recycle their original misstatements, but worse, they’ll misrepresent your response and use it as fodder for more disinformation.*
Tell ya what, Paul. let’s debate disinformation, including your letter.
I have asked you on multiple occasions to clue me in as to what my alleged disinformation actually is, if any. That way I can publicly apologize and fix it, should I choose to do so. Before applying for this award, you need to disclose this alleged disinformation. You can’t just go around saying my information is made up etc. without specifying what it is.
By definition, “disinformation” is deliberate misrepresentation. To my knowledge, as a member of the “integrity segment” of the wellness industry, I have never, and would never, spread disinformation.
On the other hand, if I did spread inadvertently incorrect information by mistake, it seems only fair to let me fix it — especially given that I have been totally transparent and generous with my time in explaining to you what yours is, and how to correct it. (I might have missed some. Keeping up with yours is a challenge of Whack a Mole-meets-White House press correspondent proportions.)
So perhaps it is time to man up, Mr. Terry. You and your cronies claim to have been collecting my “disinformation” for years, without disclosing any of it. I’m offering you a public forum and $3-million to present it…with only one of 5 judges on “my” side.
Otherwise, perhaps you should, in the immortal word(s) of the great philosopher Moe Howard, shaddap.
*As a side note, Mr. Terry writes: “We’re fortunate to work in an industry with a scant number of vociferous critics.” This “scant” number appears to include the entire media — left-wing, right-wing, centrist, and health policy. Apparently also most employees, according to Towers Watson. The good news about “pry, poke and prod” is that it truly bridges the partisan divide, in that everyone hates it.