Us. Bestselling author Nortin Hadler MD. And now RAND’s wellness uberguru, Soeren Mattke PhD.
What do we all have in common? Calling Aetna out on its phony savings from collecting its employees’ DNA to predict their future health. (Curiously, insured members who want a DNA consultation with a real doctor will find that it is not a covered benefit.)
Let’s make one thing clear: Aetna’s DNA program savings are invalid, period. It is not possible to save $1400/person (or any amount) in the first year (or any year) of a wellness program. And especially not if the people in the program were healthy to begin with, as these employees were. The cohort had a couple of risk factors for metabolic syndrome, which itself is a grouping of risk factors that might lead to a cardiometabolic disease. In other words, they were at risk for being at risk. You and I should be so healthy.
I suspect the reason Aetna picked $1400 as the fabricated first-year savings figure is that the program costs $500, and when HR people ask: “What’s your ROI?” you want to be able to respond: “Between 2-to-1 and 3-to-1” — and hope you are dealing with people who will actually believe whatever they are told. Where are these people? Trump rallies? I can’t find any. When we market Quizzify, even though our savings are 100% guaranteed, our prospects still make us demonstrate exactly where the savings will come from and how they will be measured. And the only thing guaranteed about this Aetna program is that it will lose money.
If you read the article carefully, as we did (unlike the peer reviewers), it actually self-invalidates, just like most other wellness vendor studies. There is no meaningful difference in health indicators between the control and study groups at the end of the period. Hence there can be no savings attributable to the program.
The logic is also rather twisted. Literally, they claim that if they tell you that you’ve got a gene for obesity, you’ll try harder to lose weight. Come again? When I was a kid, I saw a horserace on TV and told my mother I wanted to be a jockey. But my mother pointed out that at my growth trajectory I was likely to reach 6’5″. (I did.) So I immediately gave up that dream. Had I applied Aetna’s logic instead, I would have doubled down on riding, and maybe put a brick on my head.
Highlights of Dr. Mattke’s Criticism
Along the same themes as myself and Dr. Hadler, Dr. Mattke wrote a Letter to the Editor of the Journal of Occupational and Environmental Medicine (JOEM). Keeping in mind that because Dr. Mattke is employed by a nonprofit whose entire credibility depends on its reputation for neutrality and objectivity, it’s fair to infer that, however critical his comments, he is being very muted in his critique.
Also–though fairly discredited due to this and other obviously invalid articles — the JOEM is an “academic” journal, with standards for decorum that preclude calling people “losers” or accusing them of having small hands. So Dr. Mattke is doubly constrained in this letter. One can only imagine what he really thinks.
Four key points:
(1) He “congratulates” Aetna on designing a rigorous randomized control trial (RCT) to begin with (they did), but “wishes they actually applied that rigor to the analysis”;
(2) He points out that instead of following through on that design, they compared participants to non-participants. He says they need to look at “the eligible population, not the cohort of the eligible population that volunteered to join.”
(3) Only 11% of the invited employees joined (would you give your DNA to your employer?). “This highly selected group may differ in important observable and unobservable characteristics from the population, posing a substantial threat to validity.”
(4) “The study didn’t report the cost of the intervention.” Hey, if my wellness program cost $500 per participant, I wouldn’t either. ( I know it’s not always about us, but Quizzify costs $38 or less.)
He has other points as well, but with my 60-year-old eyes, they are hard to discern from the free online version of the letter, and I’m sure as heck not going to pay for it. Now that I’ve seen enough examples of what they use it for, the idea of sending money to these JOEM people is about as appealing to me as donating to Trump’s campaign.
Time for Aetna to Fess Up
Aetna is a fine organization in other ways. They do a lot of good things and have other excellent initiatives, in other divisions of the company. They should just call this DNA fiasco a mistake and move on. Instead they’ve been insisting that the figures are real. At some point a “mistake” becomes a lie, and Aetna is rapidly reaching that point.