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Winning a Deplorables Award is no easy feat for a wellness vendor. You have to out-lie, out-harm and generally out-stupid many worthy competitors. Yet this year’s competition wasn’t even close. Fitbit might have won on lies and stupidity alone, but no one was ever harmed by wearing an activity tracker. Interactive Health clobbered them in harming employees. Like Wellsteps (the 2016 Deplorables Award Winner) they managed to do that multiple ways. This award covers the harms, the lies, and the stupidity. Truly the perfect storm of workplace wellness.
Interactive Health’s signature move is conducting mass screens so inappropriate that doctors doing essentially the same thing — paying people to take this panoply of tests and then billing insurance — would lose their licenses.
Needless to say, when you do all sorts of inappropriate tests, you find all sorts of non-existent problems, and send all sorts of employees to all sorts of doctors. This isn’t simple overdiagnosis. This is classic hyperdiagnosis as described in our 2015 posting.
This is what we wrote in that posting, and it appears Interactive Health is the poster child for it. As compared to overdiagnosis, which is the unfortunate byproduct of well-intentioned efforts to help patients who present with symptoms, hyperdiagnosis is:
- pre-emptive — employees aren’t asking to be diagnosed, don’t have symptoms, want to be left alone, and often aren’t even old enough to have the stuffing screened out of them yet;
- either negligently inaccurate or purposefully deceptive (and IH has been requested many times to stop doing inappropriate screenings but they continue unabated);
- powered by pay-or-play employee forfeitures for non-participation, of the type about to become illegal in 2019;
- all about the braggadocio – wellness companies love to announce how many sick people they find in their screens…
…And here is Interactive Health doing exactly that:
What do you do after you round up all sorts of unsuspecting employees with inappropriate screens? Obviously, you bombard them with inappropriate advice, of course. Specifically, the huge percentage of employees at risk for diabetes — thanks to those “a1c tests for everyone” (which of course are specifically not recommended by the USPSTF) are supposed to drink full-fat dairy, not skim. And absent hypertension, they are also not supposed to avoid salt. Quite the contrary, maintaining US-average salt consumption appears to be protective against diabetes. (Not to mention that salty snacks often substitute for sweet ones.) We had no trouble finding these studies online. Hopefully Interactive Health will use some of their award money to purchase an internet connection.
Fortunately, most employees pay no attention to Interactive Health’s 1500-word single-spaced tomes, so it’s unlikely their antediluvian advice harmed anybody.
Third, speaking of harms, they also harmed me when I went in to be screened. Not just by announcing my PSA score when I specifically asked not to be tested for PSA, but by stretching my calf far enough to send it into spasm.
The English language already has 450,000 words, the most of any language. And yet none of those words adequately describe the amount of lying done by Interactive Health, even after they’ve been caught.
They are claiming “amazing results” based on one study by an unknown, now-defunct consulting firm that couldn’t even pay its internet provider. (The consulting firm had also made up a set of qualifications in which, other than articles and prepositions and conjunctions, every word was a lie.)
Once the lies were initially exposed, they paid me to stop writing about them for a while. I agreed, provided that they stop lying — meaning that I can write about them ad nauseam.
The smoking gun for the initial lie was that they accidentally admitted that they didn’t really reduce any risk factors. You can’t save a gazillion dollars by reducing employees’ wellness-sensitive medical events if you can’t improve employees’ wellness. According to their own figures (and of course excluding dropouts and non-participants, whose risks likely climb), their risk reduction was quite trivial. How trivial? The Wishful Thinking Multiplier — savings divided by the number of risk factors temporarily reduced — exceeded $50,000.
After that expose, they sealed their front-runner status for a Deplorables Award by simply trying to suppress the evidence. They took the trivial risk reduction displays out of that study, and now only make available the bowdlerized version, which they call a “research summary.” The only way you can get the raw risk reduction data is by scrolling down this post. Rule one in wellness whistle-blowing: always take screenshots.
And most recently, they’ve become strong proponents of Wellsteps’ strategy, bragging about how many high-risk employees became low-risk without mentioning that roughly as many low-risk employees became high-risk. Suppose you flip 100 coins. It’s not enough to say that of 50 heads, 25 became tails. You also have to admit that 25 of the tails flipped to heads. At the end of the day, nothing changed. Here are the heads-to-tails, from their website. (By the way, this is also not true, even on its face.)
Ask any employer what is the “new smoking” in terms of employee hazards and mortality. Most will say opioids, of course. Not Interactive Health. For them the “new smoking” is…
Hey, Interactive Health, maybe you can find a smart person to explain this particular statistic to you:
- According to the CDC, the number of annual deaths caused by smoking: 480,000
- According to the CDC, the number of annual deaths caused by sitting: 0
Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID. Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.
Take The Interactive Health IQ Test
Which of these images is most unlike the others?
I usually say the reason I can’t expose all the lies in wellness is that there aren’t enough hours in a day. Unfortunately for Interactive Health, today there are. (In your face, Arizona residents!)
PS For my next and final posting in the Interactive Health trilogy, it would help if anyone could send me some of their outcomes reports. Obviously I won’t use your name or the name of your accounts. The advantage for you is if I use your stats, it’s like getting a free consult.
When we last left our antiheroes, we were counting the number of lies their consulting firm told in their report underpinning Interactive Health’s financial savings model. We found ten. That may not seem like a lot by wellness standards, but those were in just two little bullet points. The only people who tell more lies in fewer words have Twitter accounts.
After publication, we discovered a new tidbit about Zoe Consulting. Along with the adjectives “top-tier” and “nationally recognized,” which they used to describe themselves, another would be “hunh?” Yeah, I know, not technically an adjective but Zoe is not technically a company.
Yes, this “top-tier nationally recognized” outfit has disconnected both its internet and its telephone.
And don’t try to find them in person, either. The address listed for them shows this streetview. If you can’t quite see it on your smartphone, I can describe the scene: imagine Narnia-meets-Stephen King.
Interactive Health Outcomes Report
Zoe Consulting called me soon after my first expose of Interactive Health appeared in the Wall Street Journal, and offered to pay me not to write about Interactive Health’s squirrelly outcomes any more, at least on my old website. I agreed — but only on the condition that they promise to tell the truth in the future, which has proven to be an insurmountable hurdle.
By the way, good news for any perps who think they have to pay me to have their material removed. If you are honest and I make a mistake, I pay you! Or if you make a mistake and own up to it, I pay you.
This is not either situation. Indeed, we have never encountered either situation.
Here is the report in question. You’ll notice there are lots of claims about massive savings, extending to workers comp and disability too. But not a peep about risk factors. That’s why they call this a “research summary” and not a “research study”: they removed the actual research after I observed that it invalidated their financial claims. Speaking of which, here is their financial claim: after three years, costs are magically about 18% — thousands of dollars — lower than they would have been.
The “research summary” contains only one sentence about the program itself: “The findings below indicate actual costs fell below the projected costs due to the positive impact of the Interactive Health program.”
How “positive” was that “impact of the Interactive Health program”? Excluding dropouts which of course they conveniently ignore, the number of high-risk employees fell by 1.4%. Since spending on wellness-sensitive medical events is about $100/year, optimistically you’d save $1.40/year by reducing risk 1.4% — assuming the savings accrued immediately. To cover up their mistake, they removed the risk analysis.
Anticipating they would attempt this cover-up, I kept a screenshot. This screenshot is also quite useful to illustrate regression to the mean in my course on Critical Outcomes Report Analysis. (In the display below, the green represents improvement and the red represents deterioration. Obviously — meaning obviously to everyone except Interactive Health — people who are low risk can only get worse or stay the same, while people who are high-risk can only improve or stay the same. Classic regression to the mean.)
In this graphic, you can see 10% as the starting point and 8.6% as the ending point in the high-risk categories:
Instead of $1.40/year, they claimed savings of up to $3084/year — exaggerating by a factor exceeding 2000. Not 2000%. In wellness, 2000% would be rounding error. By contrast, a factor of 2000 equates to 200,000%.
200,000 is a big number. To put the number 200,000 in perspective, imagine stacking 6 Empire State Buildings on top of one other. Do that 200,000 times, and you reach the moon.
We are going to call Interactive Health liars. However, we don’t mean that as an insult, or even an objective observation (though that too). We mean that as a compliment. We have too much respect for their intelligence to believe that they could possibly be stupid enough to make a mistake of that magnitude.
However, if they would like to insist that they were this stupid (the “dumb and dumber” defense pioneered by Ron Goetzel) — and substitute what they now know to be the correct answer of $1.40 in place of the $3084 and circulate the revised result to their customers — we will publicly apologize for calling them liars. And, yes, we will pay them the honorarium noted above.
As for their botched cover-up of the initial results, perhaps that was just an unfortunate but inadvertent omission that coincidentally took place immediately after I pointed out their own risk analysis invalidated all their own claims about savings.
Postscript: Zoe Consulting’s Wisest Move
Zoe Consulting did do something right. At one point in the conversation I mentioned above, I recommended that they hire a smart person, based on the observation that a smart person would realize that the trivial risk factor reduction couldn’t possibly support the gargantuan savings claims. The CEO replied: “Al, the savings have nothing to do with the risk reduction. The two analyses are completely separate.”
If you are prone to comments like that, the wisest move is indeed to disconnect your phones and internet.
So much to say about Interactive Health, so little room on the internet. As a result this will be a two-part blog, at least.
Meanwhile, on the opposite end of the spectrum, we are going to be highlighting the most positively influential people and organizations in the field. Please go vote or submit additional nominations.
The following axiom proffered in Surviving Workplace Wellness used to be ironclad:
“In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
I thought this axiom applied to every vendor claiming huge savings. But, alas, Interactive Health is an exception. Yessiree, it turns out you can invalidate their data without reading the data. It had been easy enough to invalidate their data by actually reading it — so much so that my original observations about them made it intp the Wall Street Journal . They counterpunched by redacting all the raw statistics on risk reduction. (They didn’t realize I kept a screenshot, which will be the subject of Part II.)
Since risk reduction is what generates financial outcomes, taking risk reduction stats out of an financial outcomes report is like the movie theater in South Korea that decided The Sound of Music was too long, so they edited out the songs.
The Wall Street Journal debacle taught them half their lesson: they learned not to publish data, because data will obviously invalidate their savings claims. Last week they learned the other half of their lesson the hard way, which is that they shouldn’t publish anything, period. On Linkedin they bragged — without any data at all — about the gobs of money they saved by discovering all sorts of undiagnosed conditions and achieving trivial reductions in overall risk scores.
Of course it’s mathematically impossible to achieve massive savings by making asymptomatic employees anxious about diseases they almost certainly don’t have in any clinically meaningful sense, and/or slightly by reducing risk factors. With that in mind, I merely asked a question or two about the whereabouts of the data to support this mathematical impossibility…and <poof> their posting disappeared from Linkedin.
Even absent the data, it’s well-known that Interactive’s modus operandi is to do exactly that — attribute massive savings to trivial risk score reductions and “newly discovered conditions.” Neither m.o. is unique to them. Indeed both are common enough to have names — the Wishful Thinking Multiplier and Hyperdiagnosis. Interactive’s brilliance is in marrying the two.
Interactive Health, the Wishful Thinking Multiplier and Hyperdiagnosis
The Wishful Thinking Multiplier is defined as:
total savings/total reduction in risk factors.
The Multiplier originated with Staywell allegedly saving British Petroleum million of dollars when only a few hundred employees reduced a risk factor — which worked out to almost $20,000 for every risk factor reduced. As luck would have it, this Multiplier was about 100 times what Staywell themselves previously claimed was even possible, which in turn was about 100 times what is actually possible. Yet, as we’ll see in the next installment, Interactive’s Wishful Thinking Multiplier leaves Staywell in the dust.
The practice of wellness vendors bragging about how many sick people they find is called “hyperdiagnosis.” It originated when Health Fitness Corp breathlessly declared that about 1 in 10 screened Nebraska state employees had cancer.
Hyperdiagnosis differs from “overdiagnosis” in that doctors try to avoid overdiagnosis, because it results in expensive and potentially harmful overtreatment.
By contrast, hyperdiagnosis is something that vendors like Interactive embrace. Indeed, Interactive practically hyperventilates every time someone tests positive for something. Since Interactive screens for everything under the sun — 38 panels, way more than most checkups and ten times what guidelines recommend — it’s tough to get out of one of their screenings without a false positive finding on something.
Here are examples of their hyperventilation in words and pictures, wisely not naming the client in their Linkedin post to avoid embarrassment:
[Their client] recently shared with their employees the successful outcomes they have achieved. First, hundreds of employees discovered new health conditions they were previously unaware of.
I’m sure the employees shared Interactive’s joy in finding out how sick they are! What employee wouldn’t be excited about such a “successful outcome”? And not just a few employees, but rather almost half are now “at risk” with “newly discovered conditions.”
A vendor bragging that nearly half the employees are might lead you to think: “Where do these people get their ideas?”
Glad you asked. Interactive bases their “proven…amazing results” on a report by an outfit called Zoe Consulting. Let’s take a looksee at Zoe Consulting, to learn more about the people they are basing their entire financial value proposition on.
Hey, Butch, Who Are These Guys?
As you can see from this screenshot, Zoe Consulting is a “top-tier nationally recognized research firm.” (Source: Zoe Consulting.) Here are the awards they’ve won (with Google’s commentary in parentheses):
- Two Koop Awards (they didn’t);
- The American Cancer Society Award for Program Excellence (they didn’t);
- The Ethel-somebody Leadership Award from UNC (they didn’t); and
- The Distinguished Leadership and Service Award from the Association for Workplace Health Promotion (they didn’t).
The last reminds me of a summer job selling Collier’s Encyclopedia door-to-door. Collier’s salespeople were instructed to say: “National Geographic won the Kodacolor Award 10 years in a row, but last year we copped the award from them.” One evening I ran into a Grolier’s salesman, who, as it turned out, used exactly the same line in his pitch, down to the exact same faux-cool-70’s-speak verb right out of The Deuce. I called Kodak to see who really won it, only to learn that no such award existed.
Likewise, one of the many reasons Zoe Consulting didn’t win an award from the Association for Workplace Health Promotion is that no such organization exists. So depending on how you count (and whether you count the Koop Awards as one lie or two), they lied six times in two bullet points, which may be a record even in the wellness industry. Seven if you count “top-tier nationally recognized research firm.” Eight if you count “top-tier” and “nationally recognized” separately. Nine for “unbiased.” To reach a round number, I’d say the tenth would be “research.” That’s ten lies already.
In other words, Zoe Consulting is a perfect fit for Interactive Health.
Stay tuned for the next installment to learn why.