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Ron Goetzel’s “Dumb and Dumber” Defense Deflects Latest Koop Award Ethical Scandal

By Al and Vik

Oh, the twists and turns as Ron “The Pretzel” Goetzel tries to wriggle out of all his ethical stumbles.

This time around, we thought we had nailed both him and his cabal handing out the ironically named C. Everett Koop Award to themselves and their friends based on made-up outcomes.  Specifically, this time they gave their sponsor (Health Fitness Corporation, or HFC) an award based on data that was obviously made up, that no non-sponsor could have gotten away with submitting.  This was the third such instance we’ve uncovered of a pattern of giving awards to sponsors for submitting invalid data while making sure that the award announcement contains no reference to the sponsorship.  (There are probably others; we’ve only examined 3, which might explain why we’ve only found 3.)

How obviously was the data made up?  Well, take a looksee at this slide, comparing participants to non-participants.  This is the classic wellness ignorati ruse:  pretending that non-motivated inactive non-participants can be used as a valid control for comparison to active, motivated participants.  The wellness ignorati would have us believe that any healthcare spending “separation” between the two groups can be attributed to wellness programs, not to inherent differences in motivation between the two groups.   Unfortunately for the ignorati, their own slide invalidates their own argument:  in 2005, the label “Baseline Year” shows there was no program to participate in, and yet – as their own slide shows – participants (in blue) significantly underspent non-participants (in red) nonetheless.  In Surviving Workplace Wellness, we call this “Wellness Meets Superman,” because the only way this could happen is for the earth to spin backwards.

total savings chart

Given that the 2005 baseline label was in plain view, we just assumed that HFC did not indeed have a program in place for this customer (Eastman Chemical) in 2005, which is why they called 2005 a “Baseline Year” instead of a “Treatment Year.”  Not actually having a program would logically explain why they said that didn’t have a program, and why they used that display or variations of it like the one below for 4 years with the exact same label.  Presumably if they had had a program in 2005, someone at HFC would have noticed during those 4 years and relabeled it accordingly.

Originally we thought the Koop Award Committee let this invalidating mistake slide because HFC — and for that matter, Eastman Chemical — sponsor the awards they somehow usually win.  But while trying to throw a bone to HFC, the Koop Award luminaries overlooked the profound implication that the year 2005 separation of would-be participants and non-participants self-invalidated essentially the entire wellness industry, meaning that is is an admission of guilt that the industry-standard methodology is made up.

Slide1 (1)Goetzel the Pretzel to the rescue.  He painstakingly explains away this prima facie invalidation.   Apparently the year 2005 was “unfortunately mislabeled.”  Note the pretzelesque use of the passive voice, like “the ballgame was rained out,” seemingly attributing this mislabeling to an act of either God or Kim-Jung-Un.  He is claiming that instead of noticing this invalidator and letting this analysis slide by with a wink-and-a-nod to their sponsor, none of the alleged analytical luminaries on the Koop Committee noticed that the most important slide in the winning application was mislabeled — even though this slide is in plain view.  We didn’t need Edward Snowden to hack into their system to blow up their scam.  They once again proved our mantra that “in wellness you don’t need to challenge the data to invalidate it. You merely need to read the data.  It will invalidate itself.”

We call this the “Dumb and Dumber” defense.  Given two choices, Goetzel the Pretzel would much prefer claiming sheer stupidity on the part of himself, his fellow Koop Award committee members like Staywell’s David Anderson and Wellsteps’ Steve Aldana, and his sponsor HFC, rather than admit the industry’s methodology is a scam and that they’ve been lying to us all these years to protect their incomes.

Still, the Dumb-and-Dumber defense is a tough sell.  You don’t need Sherlock Holmes, Hercule Poirot or even Inspector Clouseau to detect a few holes in the Pretzel’s twisted logic:

  • How could no one – no member of the Koop Award Committee or employee of Health Fitness Corporation (which used this as its “money slide” for years) – have noticed this until we pointed it out for the third time (the first two times not being as visible to the public)?
  • In early 2012, this slide was reproduced–with the permission of Health Fitness Corporation–right on p. 85 of Why Nobody Believes the Numbers, with the entire explanation of its hilarious impossibility. We know Mr. Goetzel read this book, because he copied material out of it before the publisher, John Wiley & Sons, made him stop.  So we are curious as to why it has taken until now for him to notice this “unfortunate mislabeling.”  Hmm…would the fact that it was just exposed to the world in Health Affairs have anything to do with this sudden epiphany?  We’re just sayin’…
  • If indeed it was just an “unfortunate mislabeling,” how come HFC has now expunged all references to this previously highlighted slide from their website, rather than simply change the label?

As regards the third point, we would recommend that next time Mr. Goetzel invokes the Dumb-and-Dumber defense, he coordinate his spin with his sponsor.

But let’s not overlook the biggest point:  the entire Koop Committee – including “numbers guys” like Milliman’s Bruce Pyenson and Mercer’s Dan Gold — is apparently incapable of reading a simple outcomes slide, as they’ve proven over and over.

So, as a goodwill gesture, we will offer a 50% discount to all Koop Committee members for the Critical Outcomes Report Analysis course and certification. This course will help these committee members learn how to avoid the embarrassing mistakes they consistently otherwise make and (assuming they institute conflict-of-interest rules as well to require disclosure of sponsorships in award announcements) perhaps increase the odds that worthy candidates win their awards for a change.

The “back story” of the JAMA wellness smackdown, part 2

Part 2 picks up where Part 1 left off, as coincidence would have it.


Soeren Mattke (as mentioned in the last installment) and I were quite relentless in trying, quixotically, to get Professor Baicker to explain her results. Its popularity could have landed her many profitable speaking and consulting gigs, but she evinced no interest in cashing in, or even in defending her position. Indeed, the four times she spoke publicly on the topic, she didn’t do herself, or her legions of sycophants in the wellness industry, any favors. In each interview, she distanced herself more and more from her previous conclusion. Here are her four takeaways from her own study “proving” wellness has precisely a 3.27-to-1 ROI:

  1. It’s too early to tell (um, after 30 years of workplace wellness?)
  2. She has no interest in wellness anymore
  3. People aren’t reading her paper right (Shame on us readers! We’re only reading the headline, the data, the findings and the conclusion, apparently)
  4. “There are few studies with reliable data on the costs and the benefits” (um, then how were you able to reach a conclusion with two significant digits?)

Individually or in total, these comments sounded an awful lot like retractions, but she (and her co-author and instigator, David Cutler) claimed those comments didn’t constitute retractions. Whatever they were, she wasn’t exactly doubling down on this 3.27-to-1 conclusion.

The industry at this time — 2013 and 2014 — came under a lot of criticism for basically being somewhere between hilariously worthless and a fraud. (Here is some comprehensive documentation of the fraudulent and harmful activity in the wellness industry. Wellness is a classic example of the observation that every cause starts out as a movement, becomes a business, and degenerates into a racket, the poster company for the last being Interactive Health.)


Here’s where it gets interesting. Due to this relentless criticism, instigated and sometimes written by me (most of which is catalogued here) with credit to Soeren Mattke and Jon Robison as well (with Pulitzer Prize-winning LA Times columnist Michael Hiltzik piling on multiple times), Ron Goetzel and his colleagues urged Professor Baicker — who had previously claimed to have no more interest in wellness — to get a grant from Ron’s friends at the Robert Wood Johnson Foundation and do an actual controlled study of workplace wellness to set the record straight. As a strategic gambit, this showed a level of professional judgment worthy of Gary Hart.*

Obviously if you are perpetrating a fraud and you know it, you don’t urge people to investigate it. Mr. Goetzel at this point (or at least shortly thereafter) knew that his industry was a fraud, going so far as to erase some accurate data and disown inconveniently accurate conclusions he had forgotten to suppress.

He even forged a letter from the governor of Nebraska to cover his tracks. (To be completely accurate, he did not forge the signature on the letter. He merely doctored the wording in a letter that was already signed to say something much different than the letter said when it was actually signed. Maybe that’s not technically forgery. Who knows?)

And yet that’s exactly what Mr. Goetzel did. Maybe he thought she was as corrupt as he is, but she has an excellent reputation in this industry. My suspicion is that she accepted his offer for exactly the opposite reason that he made it — to clear her name after her ill-considered 2010 meta-analysis.

Way back in 2016, I predicted how this gambit would turn out — that Katherine Baicker was not going to mail it in this time but rather do a high-quality study of the type she is known for.

Her now-famous outcome was preordained for four reasons:

  1. In this industry, as Michael O’Donnell pointed out in the trade journal where he formally served as Prevaricator-in-Chief, the higher quality the study, the lower the ROI, to the point where RCTs invariably show negative ROIs. (Owing to the embarrassing accuracy of this unintended finding, Mr. O’Donnell walked it back in a subsequent editorial.)
  2. Kate Baicker was not going to sully her legacy by being known as the Typhoid Mary of wacky wellness programs, just to please her sycophants.
  3. She picked the most clueless vendor imaginable to carry their water. This selection couldn’t have been an accident.
  4. No wellness study since Johnson & Johnson (which was probably also wrong–just not obviously from the data presented) had shown even a remotely positive outcome. This list includes PepsiCo, Barnes Hospital, Nebraska, Vitality, Newtopia, Health Fitness Corp, Health Fitness Corp again, Boise School District/Wellsteps, McKesson, Connecticut, and the University of Illinois. All were epic fails, according to their own data. Not to mention that the wellness trade association itself published a case study showing wellness loses money and then ran away from it.

Where does the wellness industry go from here?  They’re hoping for Tiger Woods, wiser souls are channeling Gary Hart, and probably what we’ll get instead is Harold Stassen. (Look it up.)


*For those of you who aren’t old enough to remember, here’s what happened. Dogged by rumors of philandering, the front-running Democratic presidential candidate urged reporters to follow him around. It took about a day for reporters to discover he was indeed philandering. It only took another few weeks for him to withdraw from the presidential race.

As predicted, the wellness vendors are not conceding defeat

Like Japanese soldiers at the end of World War II (including the one who briefly took the seven stranded castaways prisoner), many wellness vendors are refusing to concede that the war is over. Here are three examples.

First is Vitality Group. Their oxymoronic Chief Actuarial Officer, writing in Employee Benefit News, claims that the BJ’s Wholesale Club study was inadequately focused on healthy behavior change

Healthy behavior change should be the central tenet of wellness programs, since short-termism is woefully inadequate for an area as complex as health. To this end, conceptually simply — yet scientifically-robust — interventions have been found to be effective drivers of behavior. 

One of the many things wellness vendors don’t understand, along with facts, data, math, and wellness, is irony. It is indeed ironic that a company which couldn’t get its own employees to lose weight is complaining because a program couldn’t get employees to lose weight.  Vitality’s “healthy behavior change” caused employee eating habits to deteriorate — once again, according to Vitality itself.

Next you have Steve Aldana of Wellsteps claiming in Kaiser Health News that:

for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

Except that his own study did exactly the opposite. It turned out that taking Wellsteps’ advice will increase your risk factors and cause your self-perceived health to deteriorate.

Finally, Jim Pshock of Bravo was also quoted in that article, complaining about the level of incentives not being great enough to get people to do things they weren’t going to do anyway. Urging employers to give away more money is exactly the opposite of what Bravo typically does, which is fine employees the maximum possible and then brag about how much money employees can save immediately because many employees refuse to participate, preferring to lose the money than to let Bravo play doctor with them.


They missed the best argument against the validity of this study

Ironically, the one legitimate argument that none of the wellness promoters have made is that Professor Baicker picked the dumbest wellness vendor imaginable, Wellness Workdays, to conduct the study. Along with Wellsteps, Bravo, and, of course, Interactive Health, they comprise the wellness industry’s Axis of Stupid.

Wellness Workdays is a classic wellness vendor. That is to say, they won’t be winning a Nobel Prize anytime soon, or even a spelling bee. Let’s start by examining their analytic and clinical prowess.

To start with, their “White Paper” doesn’t just quote the infamous 3.27-to-1. They’ve upped the ante to 6.00 to 1, maintaining the two significant digits while almost doubling the savings.  How? They’ve added the 3.27-to-1 for healthcare savings to the 2.73-to-1 for absenteeism reduction from that same 2010 study. Those two separate conclusions were reached from almost totally different studies. Anyone can tell that from reading the original.  Anyone, that is, except Wellness Workdays.

Their analytic qualifications are matched only by their clinical qualifications. One member of their medical advisory board is Chief of Allergy and Clinical Immunology at the Indian River Medical Center in Vero Beach, Florida.  While this expertise is not exactly central to the mission of the pry,poke, and prod industry, in all fairness it should be noted that the Indian River Medical Center runs one of the better allergy programs in all of Vero Beach.

Another is an OB-GYN in Colorado.  Perhaps this advisor will develop a protocol for employees who want to be screened and induced at the same time.  A third consults to orthopedists at “Lennox Hill Hospital,” a role that probably doesn’t require too much heavy lifting, because there is no hospital by that name.

lenox hill

This guy is also an expert on steroids and other performance-enhancing products, and has “published rseveral esearch studies.”

wellness workdays

So they can’t spell, can’t proofread, can’t understand study design, and can’t cobble together a qualified advisory board.  In other words, to paraphrase the immortal words of those great philosophers Gilbert & Sullivan, they are the very model of a modern clueless wellness vendor.

They also appear to have forgotten to update their website since they didn’t get the outcomes they are “driven” by:

As for BJ’s Wholesale Club, I suspect they got suckered into this. Who volunteers to become the next Pepsico, a case study of how wellness programs fail?

In any case, we think Professor Baicker’s study is first rate, and apparently there is another one coming up, a sequel.

Or perhaps, since this is in conjunction with Wellness Workdays, to rseveral esearch studies.

 

 

Wellness imitates Dilbert

Incredibly, events unfolded almost exactly this way at Penn State during their well-publicized wellness debacle 5 years ago.  It was even funnier in real life because while exercise does of course promote wellness, faculty and staff were very restricted in their use of campus recreational facilities. Making those free to employees and dependents was not part of their wellness initiative.

No, instead employees were being forced into an outcomes-based wellness program, one that was supposed to save “millions of dollars.”

Coincidentally, while the Penn State HR department — ably assisted by Ron Goetzel, who later denied having anything to do with them despite being in their press conference – was trying to force employees into these programs, the Penn State bakery announced an expanded selection of pastries and desserts for the upcoming semester.

Penn State’s was, to paraphrase the immortal words of the great philosophers Gilbert & Sullivan, the very model of a modern forced wellness program. Sure, they violated clinical guidelines. That seems to be the price of entry for wellness. More head-scratchingly, women had to disclose whether they intended to become pregnant, or else pay a $1200 fine. This requirement was so Highmark could – to use the Highmark representative’s own words in a rather contentious faculty meeting — “help” them. That would be like offering to “help” the proverbial little old lady cross the street — but if she declines assistance, saying: “OK, then pay me $1200. The choice is yours.”

(Full disclosure: Highmark has now abandoned their old outcomes-based wellness program in favor of a much lighter and more appropriate program, and we wish them the best at it.)

Back to the storyline…

There is something about forced outcomes-based wellness programs that brings out employers’ inner stupid, and Penn State was no exception.  Consider: almost by definition women who are planning to become pregnant have thought about it and have done the basic research. It’s the women who accidentally become pregnant who may possibly have the need for assistance. And even the dumbest HRA wouldn’t ask the question: “Are you going to accidentally become pregnant?”

So, using the very unlikely assumption that women completed the HRA honestly, Penn State’s forced disclosure requirement would have identified 100% of the people who did not need “help,” while missing 100% of the women who might.  If you’re keeping score at home, that’s 100% false positives and 100% false negatives. That’s a lot even by wellness industry standards. Eat your heart out, Interactive Health.

And did I miss the memo where carriers were anointed the prime providers of medical “help”?  Has anyone ever said to you: “You don’t look so good today. Better call your health plan”?

See https://theysaidwhat.net/2016/04/22/the-story-of-an-employee-who-benefited-from-wellness/ for the back story.

The wellness industry’s terrible, horrible, no-good, very bad year

OK, this time I’m not the one causing the kerfluffle in the wellness industry, though I will confess to being a force multiplier.

Not since 2014, when the very unstable morons at the Incidental Economist made fun of the very stable geniuses who give out the Koop Award and also unequivocally concluded wellness loses money — combined with continued fallout from the Penn State debacle and the Nebraska scandal — has the wellness industry had such a bad year. And it’s only February.

Let’s review what’s happened so far in 2018. First, a federal judge ruled that voluntary wellness programs need to be — get ready — voluntary. The EEOC’s responded with the legalese equivalent of:  “Fine, be that way.”

Next, WillisTowersWatson did something that might get them in hot water with the very stable wellness industry leaders: they were honest. They published a study revealing that employees hate wellness even more — way more — than they hate waiting for the cable guy to show up.

Finally, the very unstable National Bureau of Economic Research conducted a controlled study finding basically no impact whatsoever of a wellness program.  More importantly, they specifically invalidated the “pre-post” methodology.  Even more importantly, they specifically invalidated 78% of the studies used in Kate Baicker’s “Harvard Study” meta-analysis.

Here is an interesting piece of trivia. The lead researcher is an assistant professor at the Harris School of Public Policy. Why is this interesting trivia? Because Katherine Baicker — the Typhoid Mary of Wellness, whose THC-infused 3.27-to-1 ROI is the basis for essentially every subsequent genius wellness outcomes claim — is now the dean of that very same Harris School.  I’m just guessing here, but I’d say it’s gotta be a trifle embarrassing when your own subordinate publicly disproves your own study. I mean, it’s one thing for me, RAND, Bloomberg, and anyone else with five minutes, internet access and a calculator to do it, but…your very subordinate?

On the other hand, the researcher, Damon Jones, just demonstrated not just amazing competence, but amazing integrity as well. In other words, he has no future in wellness.


The Wellness Empire Strikes Back

How does the wellness industry respond to these smoking guns threatening their entire revenue stream? Apparently, there is little cause for concern on their planet.

Let’s start with America’s Health Insurance Plans (AHIP), the health insurance industry lobbying group. Here is AHIP’s oxymoronic Wellness Smartbrief (January 26), on the NBER research. Yes, it summarizes the same wellness-emasculating study as the one above, though you could never guess it from the headline:

Continuing, AHIP said:

Offering incentives for completing wellness activities might be more cost-effective than offering incentives for wellness screening, a recent study of a comprehensive program found. 

Perhaps AHIP has been infiltrated by Russian trolls, because here’s what the NBER article actually said about “completing wellness activities”:

We…do not find any effect of treatment on the number of visits to campus gym facilities or on the probability of participating in a popular annual community running event, two health behaviors that are relatively simple for a motivated employee to change over the course of one year.

AHIP continues:

Wellness programs might attract mostly employees who are already fitness-conscious, but the potential to attract healthy employees whose medical spending is already low could nonetheless be a boon to employers, the researchers found.

And on the subject of “the potential to attract healthy employees” being a “boon to employers,” the authors actually said:

We further find that selection into wellness programs is associated with both lower average spending and healthier behaviors prior to the beginning of the study. Thus, one motivation for a firm to adopt a wellness program is its potential to screen for workers with low medical spending. Considering only health care costs, reducing the share of non-participating (high-spending) employees by just 4.5 percentage points would suffice to cover the costs of our wellness program intervention.

In other words, you can apply some workplace eugenics to your company by using wellness to weed out obese employees, employees with chronic or congenital diseases, and so on. Good for you!

Soon, if AHIP and others have their way, there will be no need for guesswork in eugenics: employer wellness programs will be able to screen these employees out based on their actual DNA.


AHIP’s take on AARP v. EEOC

And now, AHIP’s take on this landmark case, their ace reporters scooping everyone with this February 2 headline on the December 20th court ruling:

Here are more typical headlines on that court ruling, headlines that came out the same month that the court ruling came out. Perhaps AHIP used the interim six weeks to focus-group various verbs until they settled on…tweak???


AHIP:  It’s not just the headlines

One prominent healthcare executive recently attended an AHIP conference and reports:

I just returned from one of the dumbest meetings I’ve ever attended in Washington. Report of a new “study” by AHIP. Turns out people don’t mind health costs all that much, they just want more benefits. And everything is hunky-dory with their health plans, people like them so much. They love wellness benefits and crave more. Prescription drug prices have been nicely controlled thanks to the competitive marketplace (no, I am not making this up or exaggerating for drama). For every $1 employers spend on benefits workers get $4 in value. Priorities for SHRM rep: Fitbits for all employees, solving the outrage that only 20% of her employees got an annual physical. 85 cents of every dollar spent on health care goes to chronic disease.

Over these same two hours, I’d estimate about a thousand employees were misinformed, harmed or harassed by wellness vendors, roughly equal numbers of  employees got useless annual checkups, employers spent about $200-million on healthcare and 40 people died in hospitals from preventable errors. But I’m being such a Debbie Downer! I’m going home to read Why Nobody Believes the Numbers to remove myself from this alternative universe.


Enter the Health Enhancement Research Organization (HERO)

HERO’s Prevaricator-in-Chief, Paul Terry, is demonstrating his usual leadership abilities in this crisis, of course. After all, HERO is the wellness industry trade association and these three items — the NBER invalidating their product, employees hating their product, and a federal judge forbidding them to force employees to use their product — represent existential threats to his “pry, poke and prod” members.

Here is quite literally his only blog post on any of these three items:

Teddy Roosevelt said, “complaining about a problem without posing a solution is called whining.” It’s a quote that also reminds me why I’ve not thought of angry bloggers who target health promotion [vendors] as bullies. Though they relish trolling for bad apples, their scolding is toothless, more the stuff of chronic whiners.

I suspect he is talking about me here as the “chronic whiner” who is  “scolding” them. Or perhaps he is referring to the “angry bloggers” at  the Los Angeles Times, the New York Times, Slate, or STATNews, since those “toothless” publications seem to be scolding wellness vendors more than I ever have.  For instance, I’ve never called wellness vendors’ offering a “scam” or a “sham.” I simply quote these very stable wellness geniuses verbatim, as above or below, or last week.

Being quoted verbatim, not angry bloggers, is their worst nightmare. (One thing I would concede, though, is that “Paul Terry and the Angry Bloggers” would be a great name for a rock band.)

Yep, looks like the implosion of his industry all my fault. Otherwise, I’m not quite sure who is the “angry blogger” he is referring to, other than to note that Mr. Terry himself seems to blog a tad angrily himself, both above, and here

Why I choose to ignore the blogger critics: We’re fortunate to work in a profession with a scant number of vociferous critics. My take is that there is one thing these few angry loners [Editor’s note: the complete “scant list” of the 220 “few angry loners” who have been “vociferous critics” can be found here] want more desperately than attention: that’s to be taken seriously. What they fail to comprehend is that as they’ve gotten ever more farfetched and vitriolic in search of the former, they’ve cinched their inability to attain the latter.

Baiting people with misinformation and offensive insults (but just a tad under highly offensive) is a pesky ploy that trolls hope will eventually land a bite that confers credibility where there is none. Even reading such drivel is a form of taking the bait; responding is swallowing it whole. Some say dishonesty should not go unchallenged and I respect their view; nevertheless, 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, and each time I did it affirmed my worry that, more than a waste, it’s counter-productive.

and especially here, a seemingly incongruous decision to “act out” by someone who claims to be “choosing to ignore the blogger critics.”

Having read years of my “drivel” alongside Mr. Terry’s posting explaining why you shouldn’t “swallow this bait,” perhaps readers might opine here: which of us, exactly, is the “chronic whiner”?

Coincidentally, when I run live health-and-wellness trivia contests, the first of our 3 rules is: No Whining. Seems to me that he would have just violated it. Indeed the only rule HERO hasn’t violated so far is #3 below. Not that I want to put ideas in their head.

 

 

 

The 2017 Deplorables Awards — Runners Up

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:

  1. in a hospital bed; and also
  2. 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.”

…with this statement:

“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.


Health Enhancement Research Organization

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.

So I called Iver. Here’s what I learned:

  1. 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.)
  2. 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?


Wellsteps

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

Should Interactive Health’s wellness advice carry a warning label?

This is the third in our series exposing the hilarious antics of Interactive Health. 


Hilarious, that is, unless you are one of those unfortunate souls who are:

  1. paying their bills;
  2. believing their outcomes; or
  3. taking their advice.

The first and third are closely related in the sense that one would think with their fees –which rank among the wellness industry’s highest due to their industry-leading embrace of hyperdiagnosis — they could afford to train their employees in wellness.

However, since they apparently forgot to check that box, I’ll do it for them. I owe them this favor, having recently made unflattering observations regarding their botched cover-up of their invalid outcomes reporting.


First the good news

No one can accuse Interactive Health of wasting money on excessively silly, excessively gimmicky, excessively readable user interfaces. Here is the advice they give to employees, all 1350 words of it, starting with Page 1.

But wait…there’s more. Page 2

And for all those employees who simply have too much free time on their hands at work, Page 3.

More good news. They do tell this employee, after informing her that she has metabolic syndrome, to “avoid sugar.”  Credit the law of averages with that — if you write 1350 words, it is likely that 2 of them —  0.14% — will be correct. These two words are in the middle of the second page, so I’m sure she saw them. Who wouldn’t?


Next, the bad news

To prevent that metabolic syndrome from progressing to diabetes, the letter also recommends “lowfat or nonfat dairy” in the diet. However, according to the the journal Circulation, people with the most dairy fat in their diets had a 50% lower risk of diabetes. Likewise, a study of 18,000 women showed lower obesity among those who consumed full-fat dairy.  Journal articles are likely beyond Interactive Health’s grade level, so here are two lay summaries and two lay books:

  1. The Skim Milk Scam: Words of Wisdom from a Doctor Dairy Farmer
  2. Lowfat Dairy: Zombie Guidance
  3. The Big Fat Surprise
  4. The Bad Food Bible

It’s not just dairy fat, where the science, though perhaps not definitive, is settled enough that even the dumbest wellness vendor should know not to tell diabetics to switch to skim milk. It’s also saturated fat in general, where the change in scientific understanding over the last 10 years has caught many wellness vendors by surprise, and they haven’t had time to react.

If consumed in large quantities, perhaps saturated fat may be a heart disease risk factor nonetheless.  Who are we to say? However, if it were a culprit of any significance — like trans fats or cigarettes or family history — that conclusion would be definitive by now, given the massive amount of research that’s been thrown at this question.  Even if saturated fat were a minor risk factor, there is still one overriding reason Interactive Health shouldn’t be telling people with metabolic syndrome to eat less fat: what the he** do they think people will eat instead? There is a whole body of literature on how telling people to eat less fat helped create the obesity epidemic.

In all fairness to Interactive Health, they recommend eating only less dairy and other saturated fat, not less total fat. However, that is a subtlety that can get lost in those 1350 words brimming with all sorts of random advice. For instance, on the subject of abnormal thyroid function, the letter says:  “Talk with your healthcare provider about possible treatment options for this condition.” Sound advice indeed — if in fact the person in question had abnormal thyroid function, but according to this report (bottom of Page 2), her “thyroid was normal.”


More bad news

Even though this person does not have high blood pressure, the letter also recommends eating less salt. For people without high blood pressure and especially people like her who have other diabetes and cardiac risk factors, avoiding salt is likely a bad idea.

Other than the answer being different for different people and different ethnicities (subtleties overlooked by almost all wellness vendors, which prefer to give blanket advice), the science is unsettled. It does, however, increasingly point to the importance of salt — something humans have been consuming in large quantities ever since way before the Roman Empire paid its soldiers in salt — in the diet. This is especially the case for people with, or at risk for, diabetes or heart disease (which this person is). In particular, for people without hypertension, reducing salt intake to a level much below the US average:

Among other limitations,  most of these studies are correlative, not causative, and rely on self-reporting rather than controlled environments.  So we can’t conclude with certainty that avoiding salt is a bad idea. Nonetheless, my suspicion is that companies paying Interactive Health millions of dollars — and basically forcing their employees to choose between submitting to them or losing money — have assumed that the advice they are giving employees is settled and likely correct, rather than controversial and likely incorrect.

Other studies, generally older ones, recommend low-salt diets to prevent high blood pressure, so it is still at least arguably fair to say salt science is conflicted. But the overriding reason for Interactive Health stop telling employees at risk for diabetes to eat less salt and less saturated fat is, what the he** do you think they are going to eat instead? Since most proteins come with saturated fat (and salt), there is only one thing left to eat: carbohydrates.

The bottom line is that anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes.

Fortunately, most employees will have the good sense to ignore their advice, if for no other reason than it is quite a Herculean task to plow through it all. How do I know this? By definition, any employee reading this blog is more health-conscious than average. And yet the particular employee who, after reading my blog post on them, sent me this letter originally sent me only the first and third page. She hadn’t even realized there was a second page, since Interactive Health printed it on the back of the first page.

Ironically, that was the page where it said “avoid sugar.”


The “coaching” call

In addition to the letter, this employee did receive a coaching call, described as follows:

When they called to offer me advice they simply said, “ Do you know you have high cholesterol?” I said, “yes.”  Then she proceeded to ask me what I was going to do about it .  I said : “I thought you would tell me what to do.”  She had nothing to say.  Then I received another call a few weeks later as a follow up and I wanted nothing to do with them as they had already discredited themselves with the first call.  

 


In yet another installment (which will have to wait until 2018 since December is devoted to highlighting the best-in-shows of the wellness industry and of course the Deplorables Awards) we’ll explain how Interactive Health translates ignorance of clinical guidelines, bad dietary advice and massive hyperdiagnosis into quite literally the most inflated savings in the wellness industry this side of Wellsteps.

 

A Twofer: Interactive Health botches both its analysis and the cover-up

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.

 

Wellness Vendors Dream the Impossible Dream

Alice laughed: “There’s no use trying,” she said. “One can’t believe impossible things.”

“I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”


Six impossible things before breakfast?  The wellness industry would just be getting warmed up by believing six impossible things before breakfast. They believe enough impossible things all day long to support an entire restaurant chain:

Consider the article in the current issue of BenefitsPro — forwarded to me by many members of the Welligentsia — entitled: “Can the Wellness Industry Live Up to Its Promises?”  BenefitsPro rounded up some of the leaders of the wellness industry alt-stupid segment. Specifically, they interviewed US Corporate Wellness, Fitbit, Staywell, and HERO. Each is a perennial candidate for the Deplorables Awards — except US Corporate Wellness, which already secured its place in the Deplorables Hall of Fame (and Why Nobody Believes the Numbers) several years ago with these three paeans to the gods of impossibility.

In case you can’t read the key statistic — the first bullet point — it says: “Wellness program participants are 230% less likely to utilize EIB (extended illness benefit) than non-participants.”  Here is some news for the Einsteins at US Corporate Wellness:  You can’t be 230% less likely to do anything than anybody. For instance, even you, despite your best efforts in these three examples, can’t be 230% less likely to have a triple-digit IQ than the rest of us.  Here’s a rule of math for you: a number can only be reduced by 100%. Rules of math tend to be strictly enforced, even in wellness.  So the good news is, even in the worst-case scenario, you’re only 100% less likely to have a triple-digit IQ than the rest of us.

And yet, if it were possible to be 230% dumber than the rest of us, you might be. For instance, US Corporate Wellness also brought us this estimate of the massive annual savings that can be obtained just by, Seinfeld-style, doing nothing:

So assume I spent about $3500/year in healthcare 12 years ago, which is probably accurate. My modifiable risk factors were zero then and they are still zero — no increase. So my healthcare spending should have fallen by $350/year for 12 years, or $4200 since then. But that would be impossible, since I could only reduce my spending by $3500. Do you see how that works now?

To his credit, US Corporate Wellness’s CEO, Brad Cooper, is quoted in this article as saying: “Unfortunately some in the industry have exaggerated the savings numbers.” You think?

I’m pretty sure this next one is impossible too. I say “pretty sure” because I’ve never been able to quite decipher it, English being right up there with math as two subjects which apparently frustrated many a wellness vendor’s fifth grade teacher:

400% of what?  Is US Corporate Wellness saying that, as compared to employees with a chronic disease like hypertension, employees who take their blood pressure pills are 400% more productive?  Meaning that if they controlled their blood pressure, waiters could serve 400% more tables, doctors could see 400% more patients, pilots could fly planes 400% faster? Teachers could teach 400% more kids? Customer service recordings could tell us our calls are 400% more important to them?

Or maybe wellness vendors could make 400% more impossible claims. That would explain this BenefitsPro article.


Fitbit

We have been completely unable to get Fitbit to speak, but BenefitsPro couldn’t get them to shut up. Here is Fitbit’s Amy McDonough: “Measurement of a wellness program is an important part of the planning process.”   Indeed it is! It’s vitally important to plan on how to fabricate impossible outcomes to measure, when in reality your product may even lead to weight gain.  Here is one thing we know is impossible: you can’t achieve a 58% reduction in healthcare expenses through behavior change — especially if (as in the 133 patients they tracked in one of their studies) behavior didn’t actually change.

You can read about that gem, and others, in our recent Fitbit series here:


Health Enhancement Research Organization (HERO) and Staywell

I’ll consider these two outfits together because people seem to bounce back and forth between them. Jessica Grossmeier is one such person. Jessica became the Neil Armstrong of impossible wellness outcomes way back in 2013.  Not just any old impossible wellness outcomes — those have been around for decades. She and Staywell pioneered the concept of claiming outcomes they already knew were impossible.   While at Staywell, she and her co-conspirators told British Petroleum they had saved about $17,000 per risk factor reduced.  So, yes, according to Staywell, anyone who temporarily lost a little weight saved BP $17,000 — enough to clean up about 1000 gallons of oil spilled from Deepwater Horizon.

See British Petroleum’s Wellness Program Is Spewing Invalidity for the details.

Leave aside both the obvious impossibility of this claim, and also the mathematical impossibility of this claim given that employers only actually spend about $6000/person on healthcare.  Jessica’s breakthrough was to also ignore the fact that this $17,000/risk factor savings figure exceeds by 100 times what her very own article claims in savings. Not by 100 percent. By 100 times.

Fast-forward to her new role at HERO. In this article she says:

The conversation has thus shifted from a focus on ROI alone to a broader value proposition that includes both the tangible and intangible benefits of improved worker health and well-being.

Her memory may have failed her here too because HERO — in addition to admitting that wellness loses money (which explains its “shift” from the “focus on ROI alone”) — also listed the “broader value proposition” elements of their pry-poke-and-prod wellness programs. The problem is the elements of the broader value proposition of screening the stuffing out of employees aren’t “benefits.”  They’re costs, and lots of them:

When she says: “The conversation has shifted from a focus on ROI alone,” she means: “We all got caught making up ROIs so we need to make up a new metric.”  RAND’s Soeren Mattke predicted this new spin three years ago, observing that every time the wellness industry makes claims and they get debunked, they simply make a new set of claims, and then they get debunked, and then the whole process repeats with new claims, whack-a-mole fashion, ad infinitum.  Here is his specific quote:

“The industry went in with promises of 3 to 1 and 6 to 1 based on health care savings alone – then research came out that said that’s not true. Then they said: “OK, we are cost neutral.” Now, research says maybe not even cost neutral. So now they say: “But is really about productivity, which we can’t really measure but it’s an enormous return.”


Interactive Health

While other vendors, such as Wellsteps, harm plenty of employees, Interactive Health holds the distinction of being the only wellness vendor to actually harm me.  I went to a screening of theirs. In order to increase my productivity, they stretched out my calves.  Indeed, I could feel my productivity soaring — until one of them went into spasm. I doubt anyone has missed this story but in case anyone has

They also hold the distinction of being the first vendor (actually their consultant) to try to bribe me to stop pointing out how impossible their outcomes were. They were upset because I profiled them in the Wall Street Journal . The article is behind a paywall, so you probably can’t see it. Here’s the spoiler: they allegedly saved a whopping $53,000 for every risk factor reduced. In your face, Staywell!

Here is the BenefitsPro article’s quote from Interactive Health’s Jared Smith:

“There are many wellness vendors out there that claim to show ROI,” he says. “However, many of their models and methodologies are complex, based upon assumptions that do not provide sufficient quantitative evidence to substantiate their claims.”

You think?

Finally, here is a news flash for Interactive Health: sitting is not the new smoking.  If anything is the “new smoking,” it’s opioid addiction, which has reached epidemic proportions in the workforce while being totally, utterly, completely, negligently, mind-blowingly, Sergeant Shultz-ily, ignored by Interactive Health and the rest of the wellness industry.

There is nothing funny about opioid addiction and the wellness industry’s failure to address it, a topic for a future blog post. The only impossibility is that it is impossible to believe that an entire industry charged with what Jessica Grossmeier calls “worker health and well-being” could have allowed this to happen. Alas, happen it did.

And, as you can see from the time-stamp on this post, except at establishments favored by the Wellness Ignorati, breakfast hasn’t even been served yet.

Fitbit Throws a Bit of a Fit, Part 2: More Fitbit Tidbits

The “prequels” to this posting are:

  1. Springbuk wants employees to go to the bathroom
  2. Fitbit Throws a Bit of a Fit, Part 1

Fitbit might just have taken the lead in the wellness industry’s race to the bottom. They are using the “dumb and dumber” defense to deflect their ethical shortcomings. This defense has been shown to work, in the sense that Ron Goetzel still has a job.

In Fitbit’s case, they have no choice. If they claim to be intelligent, that would mean they dramatically overstated the value of Fitbits deliberately, as opposed to out of pure, sheer, unadulterated ignorance. In turn, that would mean that the folks at Fitbit could be facing a little taxpayer-financed vacation in the federal hoosegow. That’s because public companies aren’t allowed to deliberately misrepresent their product to shareholders, which is precisely what this press release does.  Stupid is OK. Dishonest isn’t.

Here are a few more morsels from that study:

  • There were 22,259 employees in the employer population. Only 905 were in the study population. So the entire analysis of savings was based on projection from 4% of the population.
  • For some unexplained reason, the control group –the people who did nothing at all — enjoyed a dramatic 9.3% reduction in medical claims costs, vs. an “expected” increase of 5.8%, a 15.1% swing. So doing nothing turns out to be a great strategy to achieve double-digit savings.
  • Speaking of doing nothing, perhaps our favorite tidbit from this study is that an employee could stay in bed for up to 182 days a year  — meaning take 100 steps a day or less, getting up just to eat and pee, as described in the original Springbuk study — and “save” 21.8%.
  • It’s also possible that employees simply forgot to put on their Fitbits the other 183 days of the year, which is why they didn’t appear to take 100 steps on those days. However, that possibility is not acknowledged anywhere in the study. That could be because it wouldn’t make for much of a study to say: “We compared people who forgot to put on their Fitbit for fewer than 182 days to people who forgot to put on their Fitbit for more than 182 days.”

Therefore, whatever the other criticisms of this study, no one can accuse them of lying or even exaggerating when they say:


Speaking of which, let us now just focus on the 374 people (about 2% of their entire population) who did take more than 100 steps a day for a whopping 274 days out of the year or more. Their savings are massive:

Even the healthier subset of employees can reduce healthcare costs by a quarter by wearing a Fitbit, but that’s nothing compared to “low steps” employees who walk only 6477 steps a day, about the same as everyone else in the country. Those lucky employees can slash costs by more than half by continuing to walk an average number of steps, but this time wearing a Fitbit.

Oh, wait a sec. They were wearing a Fitbit in the baseline year too. Otherwise, how would we know how many steps they took? So they didn’t do anything in order to save massive sums of money.

Come again?  This conclusion seems wacky even by Fitbit/Springbuk standards. So let me repeat it: these people did basically nothing in the study year that they didn’t also do in the baseline year…and yet they somehow set a record for greatest cost reduction ever achieved in a year, 50.7%.

Then, these employees broke their own record. This next chart is for employees with “>=365 days” of use over the course of a year. (Not sure how they could have worn a Fitbit for “greater than 365 days” since the baseline for this two-year study was 2013, but maybe every year is a leap year on Springbuk’s planet.)

You read that right: a 58.6% reduction in spending for those 133 people taking the average number of steps everyone else takes in both years.

How much is a 58.6% reduction in costs in terms of utilization reduction? That means that simply by continuing to be average, these 133 average everyday folks wiped out the equivalent of all their hospitalizations and ER visits and specialist visits besides. Of course, we won’t know because Springbuk never plausibility-tested the result. As they say in journalism, it was a story too good to check.

Or, if Springbuk and Fitbit understood the concept of attribution as described in Biostatistics 101, they would realize that one can attribute only reductions in wellness-sensitive medical events to a wellness program, since those are what a wellness program is designed to avoid.  If only those events can be avoided, they must have wiped out heart attacks and diabetes for these 133 people, their spouses, and roughly 5000 of their closest friends.


If anyone is interested in the real health impact of activity tracking, I’d recommend this JAMA article. It’s the only one on the topic which is not financed by people connected to the industry. Researchers attached activity trackers to some at-risk overweight/obese people to see how much weight they would lose (which would mean a reduction in their risk and possibly a slight reduction in their healthcare costs).  The study’s result? The study population gained weight.

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