A long-since forgotten essay on the history of hospitals by Lewis Thomas includes the story of a doctor who claimed he could diagnose typhus by examining inpatients’ tongues. He would examine their tongue…and a few days later they would indeed develop typhus. Turned out the doctor was spreading the typhus pathogen by feeling all the patients’ tongues without washing his hands.
Keep this anecdote in mind as you read the following.
Seems like I’m not the only one to show that Interactive Health’s numbers never, ever, ever, ever add up. And it looks like you don’t have to have taught economics at Harvard to do it, or even be old enough to rent a car. Rather, a triple-digit IQ is all it takes. Tom Rosenbaum, a “data analytics intern” at AP Benefit Advisors in Maryland, completely invalidated one of Interactive Health’s more headscratching claims.
By way of background, Interactive Health’s strategy is to convince HR departments that their company is simply overrun with ridiculously unhealthy employees whose medical spending will explode at some point in the future…and send almost half of the employee population to the doctor to allegedly prevent that from happening. That, of course, requires screening the stuffing out of them today, at considerable expense.
I’ve asked them repeatedly on Linkedin to please explain:
- how the US Preventive Services Task Force can be so misinformed about so many Interactive Health screens being so inappropriate and
- how their own panel of 43(!) tests is clinically proven to somehow save money by increasing (not a misprint) the number of employees who think they are sick, and the corresponding number of doctor visits.
Their “response” is invariably to delete my comments. Here is one example:
Quite the contrary to “the impact of heart disease growing by the minute,” heart health is actually, shockingly, one of the major public health/medicine success stories of our generation. Deaths due to heart disease, and heart attacks themselves, are down by about 2/3 since 1969. I merely tried to inform their posting with a fact, but by the time you see their posting, facts will have been deleted. [Update: they already are deleted, along with many supportive comments I received on this posting. Usually they delete my comments within minutes, so I’ve started posting them at night so they can stay up for a few hours.]
Enter Tom Rosenbaum
Their new revenue-maximization strategy is to tell employers it’s not just older employees they need to worry about. It’s younger employees too. And it’s not just medical issues that plague the younger workforce. It’s also mental health issues. Their specific language:
Workers under 35 are more likely to struggle with mental health issues, such as stress, depression and anxiety.
Tom decided to fact-check this particular item using actual data. It turned out:
- 5.39% of older workers had claims for these mental health items, vs. 5.33% of younger workers
- Older workers spent 32% more on antidepressants than younger workers
Of course, it is possible that Interactive Health’s data is different than everyone else’s, and here’s why. According to their White Paper:
Here’s perhaps the reason why their customers’ employee stress levels are so much higher than average. If someone tells you that you have a “condition” and you “should be directed to a doctor,” you’d be stressed out too.
Something very similar happened to me when I let Interactive Health fiddle with my calves and tell me they were tight and could cause problems — one went into spasm shortly afterwards.
Luckily I didn’t let them anywhere near my tongue.
They Said What has always noted the complete and utter worthlessness of screening the stuffing out of employees. The wellness vendor response to this observation? To double down on overscreening. One recalls the immortal words of the great philosopher Inspector Louis Renault: “Owing to the seriousness of this crime, I’ve instructed my men to round up twice the number of usual suspects.”
Here is one such vendor, the lucky recipient of a follow-up profile to be published next month.
Their litany of tests before my initial observations about their overscreening were published:
Their current roster of tests, setting a new wellness industry record:
However amusing it may be to remark on the rampant epidemic of very stable genius-itis in the wellness industry (and it is), screening the stuffing out of employees is no laughing matter. It is harmful. Here is the current Journal of the American Medical Association on the harms of screening. Unfortunately the entire article is behind a paywall, but the abstract basically highlights the wellness industry business model:
Overused tests and treatments and resultant downstream services generate 6 domains of negative consequences for patients: physical, psychological, social, financial, treatment burden, and dissatisfaction with health care. Negative consequences can result from overused services and from downstream services; they can also trigger further downstream services that in turn can lead to more negative consequences, in an ongoing feedback loop.
This is of course exactly what hyperdiagnosis is all about — and the poster child for hyperdiagnosis is none other than the winner of the 2017 Deplorables Award, Interactive Health. A single Interactive Health display captures it all, the breathless braggadocio about sending employees to the doctor because they flunked one or more of the 43 tests that Interactive Health runs, with no regard for the harms that JAMA has identified:
So, in all seriousness, can we please, please stop the hyperdiagnostic madness and start screening according to the US Preventive Services Task Force guidelines?
The wellness industry is the Maginot Line of workplace health. While wellness vendors are imploring employees to eat more broccoli, and hyperdiagnosing the stuffing out of them to find “newly discovered” conditions that are mostly false positives and harmless out-of-range readings, really bad stuff has been happening that has somehow eluded this industry’s attention. One would be the opioid epidemic, which no vendor seemed to notice. Except Optum, whose HRA basically advises employees to get more pills for their pain.
(Do you know more than Optum does about opiods Take this quiz and find out.)
The other would be the explosion of harms caused by the healthcare industry itself, and that is the subject of The Bleeding Edge, a well-received new documentary (Rotten Tomatoes rating: 89%) on Netflix. (In case anyone is keeping score at home, Quizzify is also about harms caused by the industry…and already educates employees to avoid most of what The Bleeding Edge covers.)
The Bleeding Edge follows victims of three different kinds of implants — vaginal mesh made by Johnson & Johnson, metal-on-metal hips made by Johnson & Johnson (are you seeing a trend here?), a birth control device financed in part by the current head of the FDA — along with briefer cameos for CAT scans and the DaVinci robot.
Interviews of victims of these implants (including one who started out as a spokesperson for these implants) are intertwined with surgeries and images of devices gone haywire inside the victims’ bodies, and expert talking heads about how this could be allowed to happen. (“More evidence is required to remove a device than to approve it.”) The experts are very well-credentialed and include the long-time head of the FDA, David Kessler, and bestselling author and Johns Hopkins accountability guru, Dr. Martin (“I love what Quizzify is doing”) Makary.
Perhaps the most compelling interview, though, is with the aforementioned former spokesperson for the birth control device-turned-victim advocate. Switching sides like this never happens. Most people pick a side and stay on it, facts be damned. Switching sides after seeing new facts is almost unheard of — it would be like Ron Goetzel not only admitting that wellness doesn’t work, but blowing the whistle on his friends at Wellsteps and Interactive Health.
The difference was that this spokesperson was also a customer…until her device went badly astray as well.
What is the FDA doing about this?
So what, as the film describes, is the FDA doing to put the kibosh on all this? Four things:
- Facilitating approvals of new devices on almost no evidence
- Laughing out loud on videotape at the idea that they may get in trouble because some people could get harmed
- Hiring industry executives to regulate their friends and companies they have invested in
- Firing experts who advocate for disclosures of hazards.
Yes, we know it isn’t always about Quizzify but #4 specifically relates to the hazards of CAT scans. The FDA apparently fired nine employees for advocating what we here at Quizzify have educated patients on — right on our landing page quiz — for three years: the radiation hazards of CT scans, especially repeated scans. Your doctor isn’t telling you about this risk possibly because everyone at the FDA who would have told them is gone.
Likewise, the FDA takes a hands-off approach on the DaVinci robot, another Quizzify whipping boy, though we weren’t the first to question their integrity. The FDA let the company put the robot into the hands of completely inexperienced surgeons, and multiple cases have been reported in which a woman’s insides literally fell out following the surgery.
Many doctors — especially “leading experts in the field” — get directly or indirectly compensated to use and pitch these devices. Your doctor could be one of them, and it’s not like he or she is going to volunteer the information.
What should employers do?
It seems that the only people who truly advocate for the patient are the patient and the patient’s family. Everyone else involved in the care conversation makes more money when employees buy more things on the employer’s dime. (This is not to say all providers or device manufacturers are corrupt, or anything close to that, of course. But with all this money at stake, shareholders interest and patients’ interest could be at great variance. One need only look at stock prices to see which side usually wins.)
Likely much the opposite of what they are doing now. First, stop obsessing with screens and risk assessments. Prying, poking and prodding doesn’t work, so get over it. Start focusing on things that matter, like the harms described in this film and like what Atul Gawande says:
Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year…Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.
At the very least, employers should slow down before encouraging the opposite, incentivizing employees to use lower-cost settings to get things that they may not need, and may even harm them. Obviously (with the exception of childbirth, which is going to happen anyway), removing the economic disincentive to get more stuff means people will get more stuff.
Instead, educate your employees, using Quizzify or some other tool like Quizzify (good luck finding one), that, as we say at Quizzify and as anyone who watches The Bleeding Edge will say:
Just because it’s healthcare doesn’t mean it’s good for you.