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Here it is. Get ready:
Eat more broccoli.
The real idea is that we’ve (“we” in this case is Quizzify, though normally this blog represents only my own views) taken the 5 classic questions to ask your doctor before a test or treatment…and made them downloadable into an Apple Wallet. Just scroll about 2/3 of the way down the Quizzify landing page using your iPhone and you’ll see this. Click “Add to Apple Wallet.”
And since some people (including myself) are reluctant to question those authority figures wearing white, we anticipate that with the last line of the version in the Wallet: “If you’re reluctant to ask these questions, blame us!”
This will work best in conjunction with Quizzify. We have a lot of quiz material on questions you might ask about specific tests and procedures…and we have questions reminding people to ask these questions generally.
You may also want to do this in conjunction with posting the actual Choosing Wisely poster in break rooms:
One might ask: “This is such a screamingly obviously good idea. Why didn’t anyone in the wellness industry already think of this, given how enamored they are of sending employees to the doctor for no reason other than to brag about how many employees are sick?” Except that I can’t answer snarkily because I didn’t think of it either. Credit goes to Quizzify’s tech guru, our “Millennial-in-Chief.” He built the infrastructure to download our surprise-billing avoidance consent form into an Apple Wallet, and then suggesting adding this too.
Someone suggested that I call my Congressman to pass a law against Interactive Health, but I think the Justice Department is the more appropriate route. No, not because they’re harming employees — there is no law against employers harming employees in the name of wellness. Quite the contrary, the most recent Koop Award went to a vendor, Wellsteps, which did exactly that.
Rather, I would propose an antitrust action, because Interactive Health is attempting to create a monopoly on stupidity.
Yes, it seems like hardly a day goes by without the irresistible force of Interactive Health’s corporate IQ colliding with the immovable object of reality. The thing is, their moles pop up faster than I can whack them on Linkedin, so here is a tasting menu of their greatest hits. You can’t find most of these observations on Linkedin for the simple reason that they delete them.
This was originally going to be a comprehensive retrospective of all their nonsense (Exhibit A for the Grand Jury to review), but in the two weeks since I started writing it, yet another mole popped up. This one could top the list if not for their “smoking recession program.”
- An analysis of 2017 member data revealed that those clients who test all employees for Hemoglobin A1c identified up to 3 times more individuals at risk for pre-diabetes versus other testing. As a result, inclusion of Hemoglobin A1c testing for all employees is often a strategic recommendation for our clients.
Since pre-diabetes is a risk factor for diabetes (and only a fraction of pre-diabetics become diabetic, after 5 to 10 years), they are hunting for employees who are “at risk for being at risk.” Who amongst us is not at risk being at risk for something? But that doesn’t mean they’ll end up with diabetes, any more than every kid who steals a cookie from a cookie jar becomes a bank robber — even if every bank robber did in fact at some point in their childhood steal a cookie from a cookie jar.
Using testing guidelines so contrary to the US Preventive Services Task Force that a beam of light leaving USPSTF guidelines wouldn’t reach them for several seconds, Interactive Health takes great pride in “identifying 3 times more individuals” than companies that test employees according to guidelines. Cue Inspector Louis Renault: “Owing to the seriousness of this crime, we are rounding up twice the number of usual suspects.”
One might be excused for assuming that the point of screening would be to “round up” the most appropriate employees, rather than the largest number of employees. One might also be excused for thinking Interactive Health is simply stupid, when in reality they are fully aware they violate guidelines, recognizing that their typical customer doesn’t realize this and is willing to, in the immortal words of that great philosopher the Queen of Hearts, believe six impossible things before breakfast.
in case anyone else is interested — we know Interactive Health isn’t — the USPSTF recommends screening only overweight/obese 40-to-70-year-olds for HbA1c. That’s to prevent exactly the kind of hyperdiagnostic employee harassment that comprises Interactive Health’s signature strategy: more tests = more revenues. They make Wellsteps look like an honest, intelligent vendor, which is no easy feat.
We also thought of contacting the Health Enhancement Research Organization (HERO), to let them know there was a vendor making the industry look bad (or look even worse), but it turns out that for HERO, cluelessness is a feature, not a bug. Specifically, HERO has highlighted a case study by Interactive Health, which would be like Bernie Madoff highlighting his investment in Enron.
Update. Alas, I’m afraid there won’t be an investigation into their stupidity. At this point, they are so far ahead in the race to the bottom that it would be impossible to empanel a jury of their peers.
…a cover story in one of the most respected magazines in the US which spells the end of Interactive Health, Wellsteps, Total Wellness, Star Wellness, Wellness Corporate Solutions and every other vendor whose business model is to screen the stuffing out of employees.
Meanwhile, I know of one company where the staff is popping champagne corks. Wonder what that company could be?
Folks, if you want the news, you’re going to have to subscribe to it.” From now on, TSW is only going to carry summaries, likely a few days late now that fall frisbee season is taking up my weekends. Here’s what you missed Friday:
- In a completely unanticipated* move, the EEOC is pushing out its proposed rulemaking date once again, this time to June 2019. That means new rules likely won’t be formally in place until 2020.
- Of course what’s another week of news without yet another expert observing that wellness vendors’ obsession with weight loss is harming employees?
- Speaking of yet anothers, yet another celebrity is urging mass screening for yet another USPSTF D-rated screen, this time ovarian cancer. Early-stage ovarian cancer is pretty darn undetectable — except of course by wellness vendors. Total Wellness says its test is “possibly an indicator of cancer cells,” a ringing endorsement indeed. Another vendor pushing these screens, Star Wellness, says these tests are “not readily available from your doctor,” as though that’s a selling point. (It reminds me of a kid I knew in high school who used to brag about not brushing his teeth.) Maybe doctors know something that Total Wellness and Star Wellness, which thinks Vitamin B12 is a vaccine, don’t.
Got news? Clue us in. (How do you think we found these nuggets?)
*Except by me
Too much healthcare can be hazardous to your health, as three findings released last week have shown.
- America’s Epidemic of Overtreatment
Health Affairs reports an epidemic of overtreatment. Author Shannon Brownlee proposes that patients “start asking uncomfortable questions,” to determine if treatments are appropriate. The problem is that employees don’t know what uncomfortable questions to ask, unless one counts: “Do you mean to say I’m not eating enough broccoli?” The questions don’t have to be uncomfortable. They get more comfortable, the more one learns about healthcare. Seems simple enough, and yet 99% of employers still don’t offer employee healthcare literacy education.
2. America’s Epidemic of Innumeracy
It would help if doctors knew the first thing about interpreting lab test results before recommending these treatments, but apparently they don’t. The Washington Post reports that professionals reading lab test results don’t understand false positive arithmetic. As a result, your employees may be getting diagnosed and treated for conditions they don’t have. Wellness vendors don’t understand it either. As compared to real medical professionals, the difference is that the they take great pride in their ignorance, and brag about how many false positives they find. I’m talking to you, Interactive Health.
No, they don’t. We’ll post on false positive arithmetic next week.
3. America’s Epidemic of Overprevention
As reported on They Said What Thursday, it looks like too much spending on prevention can backfire. Specifically, spending more on employee healthcare, and sending more employees to the doctor, does not deliver better outcomes, fewer ER visits, or even more HbA1c checks for diabetics. Quite the contrary, the correlation, though weak, goes in the “wrong” direction.
Bottom line: looks like Quizzify had it right all along: just because it’s healthcare doesn’t mean it’s good for you.
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.