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Life imitates The Price We Pay

If there’s one thing you learn from Marty Makary’s blockbuster expose The Price We Pay (other than Quizzify being a great vendor, on page 226), it’s not to get a peripheral vascular screen at a community center.

Here are his exact words from his trip to a community center hosting a screening session for peripheral vascular disease:

The person from the cardiology group was conducting a test that measures how the blood flow in the legs compares to the blood flow in the arms. The rationale: Something might be wrong if the blood pressure is lower in the legs. It could be caused by a narrowing of the arteries, a plaque that slows blood flow. It might warrant further investigation.

There’s just one problem with that notion: This test should not be performed unless a patient has serious symptoms, like crippling leg pain. For anyone else, it’s likely to lead to medical care they don’t need, which can be expensive and dangerous. That’s exactly why independent medical experts do not recommend the type of peripheral vascular screening I witnessed that day.

So, thanks to the chronic shortage of other subject matter for these periodic blogs now that wellness vendors have finally learned not to brag publicly about their stupidity, imagine my glee when a brochure from Life Line Screening arrived in the mail last week urging me to:  get peripheral vascular screening at a community center.

Not only that, but my special “priority code” meant I “qualified” for a large, exclusive, discount (“Only $149”). I was very pleased to hear that — just like achieving Mosaic on JetBlue, Titanium Ambassador in Marriott, and something like Executive Platinum Emerald Diamond Palladium Plutonium Selenium Sodium Fluoride on American — I had also achieved “Status” with Life Line.

Needless to say I wanted to brag about this achievement to all my friends-and-relations who also got this mailing. But my ego took a hit when I learned that apparently they too received high-priority codes and qualified for this exact same exclusive discount.  Trying to figure out what we all had in common to earn this special treatment, we concluded that this it was being offered — exclusively — to people who are comprised of protoplasm.

In addition to the peripheral vascular disease screening, rated “D” by the US Preventive Services Task Force in my 40-64-year-old group, they are offering the following additional “vital screenings,” with the USPSTF rating in parentheses:

For those uninitiated in USPSTF screening ratings, “D” means “don’t screen for this,” because of the overwhelming likelihood that positives will be false.

How overwhelming is this likelihood? Let’s take an example. Suppose you perform a test that’s 90% accurate to hunt for a previously undetected, symptomless, disease in 1000 people. Suppose further that about 1 in 1000 adults 40 to 64 has this undetected disease. A 90% accurate test is also 10% inaccurate. So, including the one person who actually has the disease, about 100 of the other 999 will test positive — despite being disease-free.

Those 100 are going to be totally stressed out for no reason, probably follow up with more tests, and possibly even get surgery. Here is the math:

Continuing with my USPSTF grading lesson for Life Line, “I” means “Incomplete,” not enough data for a recommendation. I don’t have to tell you what “A” and “B” mean because those ratings don’t apply to any of Life Line’s screens. That’s right. None of Life Line’s tests are recommended by the specific entity charged with recommending tests.

Needless to say, I couldn’t pass up the opportunity to call these Very Stable Geniuses. My call was answered by a Life Line employee who announced: “My name is XXXX. I’m going to be your Preventative Healthcare Advisor.” When I asked if these tests had an A Rating from from the US Preventive Services Task Force, she replied: “Very very very true. Also an A-Plus rating from the Better Business Bureau.”

She also assured me I could keep my clothes on, which I know the staff and guests of the Wellesley Community Center will appreciate.


The benefits of screening

Hmmm. Let’s look at each of these five claims in turn.

  1. “Early detection.” Check. Detection of more false positives than every wellness vendor except possibly Interactive Health, which specializes in them. (See “Interactive Health gives clueless wellness vendors a bad name.“)
  2. “Prevention of disease progression.” Screening might possibly detect something but it doesn’t prevent anything. Here’s what might prevent something: spending that $149 on a new pair of sneakers and running in the opposite direction of the Wellesley Community Center.
  3. “Peace of mind.” Try telling that to all the people who are getting false positives.
  4. “Savings with more affordable screenings.” I called my Preventative Healthcare Advisor to ask about that one. Turns out, as noted below, I can practically retire off these savings.
  5. “Control, no insurance required” ?  “Required” is synonymous with “coverage” in this case. Just like “true” was synonymous with “false” about the USPSTF A ratings.

So…doctors don’t do these screens, insurance doesn’t cover them, and yet somehow, somehow, these screens are… “vital“? Time for another call to my preventative healthcare adviser to find out why, if these tests are so vital, doctors don’t do them. She explained that:

  • Doctors will only do these tests for: “a reason” (shame on doctors!)
  • But by then it might be “too late.”
  • Doctors don’t do these tests routinely because they cost “$5000 to $8000,” instead of $149. That’s why the brochure lists “savings” as a benefit. You could save thousands right now by doing these screenings! Likewise, think of all the money you’re saving this month alone by not living in a $5000/month apartment.
  • “Insurance companies are all about the money. They try to control our lives. That’s why they won’t pay for these tests.” (There is actually an element of truth to this one. Insurance companies are all about the money. Not unlike Life Line, which is clearly in business for their health, since they aren’t in it for ours.)

Postscript: I did check in with a primary care physician, who observed that she’s heard of doctors doing tests without “a reason.” But advertising that they do tests for no reason? That was news to her. She said they could lose their license. I pointed out that wellness vendors don’t need licenses, or for that matter even GEDs. Just the willingness to check their ethics at the door of the Wellesley Community Center. Plus a soupcon of protoplasm.

The evil genius of Arkansas’ teacher wellness program

Arkansas recently contracted with an out-of-state vendor called Catapult Health to come in to the state’s schools and “play doctor” with the teachers, asking them personal questions, taking their blood and then telling them everything that’s wrong with them. This is a classic example of a “pry, poke and prod” program.

This is followed by admonishments to take more steps and eat more broccoli.  They then refer teachers into lifestyle and disease management programs “at record rates.”

Sounds terrible, but the good news is that this program isn’t going to cost taxpayers anything because, as Catapult Health’s website says:

Phew! At least it’s free to taxpayers because Catapult’s expenses and profits are “already in your budget” and “fees are processed through your health plan.”

Except that the state of Arkansas is its own health plan. There is no “Don’t worry. Insurance will pay for it” here. The state is self-insured, meaning they pick up the tab, not some nameless insurance company.


But, hey, at least this program will save money, right?

The return-on-investment for the state is allegedly 3.27-to-1, as shown by the so-called “Harvard Study,” conducted by Katherine Baicker.

Except that the Harvard study has been proven wrong, not just by the nonprofit, nonpartisan highly respected RAND Corporation (and I myself chimed in as well), but by an ace researcher named Damon Jones, part of the prestigious National Bureau for Economic Research. His work showed that wellness accomplishes virtually nothing other than the expenditure of money. (Don’t worry—insurance will pay for it.)


But, hey, maybe Prof. Jones is wrong. After all, why should he care what Prof. Baicker thinks, right?

Um, because he reports to her? Yep, he’s an associate professor at the exact same school of public health where she is now dean.  Just guessing here, but it would seem a subordinate would have to be pretty darn sure of his findings (and they are rock solid, and completely in agreement with all the other recent research, summarized here) to publicly humiliate his own dean.

Even Prof. Baicker doesn’t defend her findings any more. She says: “It’s too early to tell.”  That means she is running away from her very widely cited signature study, upon which essentially the entire wellness industry’s economic justification is based.  This would be like Arthur Laffer, whose Laffer Curve created supply-side economics, which has been used to justify two tax cuts, saying “well, maybe it’s not right. I dunno. Let’s wait and see.”


But, hey, at least forced wellness improves employee health, right?

Apparently not. Forcing people to get annual wellness checkups doesn’t benefit them, according to the New York Times, the New England Journal of Medicine, the Journal of the American Medical Association, and Consumer Reports. (Before dismissing the credibility of those sources due to possible political bias, keep in mind that Newsmax, The Federalist, and Laura Ingraham hate “pry, poke and prod” programs too.)

Forced wellness also takes teachers away from the classrooms to be pried, poked and prodded, stresses them out, and adversely impacts morale.

Further, sending “record rates” of employees into lifestyle and disease management is classic hyperdiagnosis – braggadocio-fueled misunderstandings of the arithmetic of lab results, resulting in large numbers of people getting told they need coaching and care they don’t want or, in general, need. Nothing makes a wellness vendor happier than to hyperdiagnose as many employees as possible.


But, hey, maybe teachers are a special case. Maybe the impact of “pry, poke and prod” programs is different for them?

It sure is. The single school district for which the data has been compiled is Boise, Idaho. According to the wellness vendor’s own data, the health of the teachers got somewhat worse as a result of this pry, poke and prod program. (The vendor, an outfit called Wellsteps, also admitted that they flouted clinical guidelines and fabricated their only positive outcome. They also previously admitted that costs went way up as a result of their program. They later suppressed that admission. Wellness vendors are not known for their integrity.)

So the health of teachers may deteriorate, creating more medical expense. but don’t worry. Insurance will pay for it.


But, hey, at least the teachers like it, right?

According to Catapult, employees love them. Ask the employees and you might get a different impression. indeed, I was tipped off to this program by an Arkansas teacher who hates it, like most of her colleagues do — and that’s before they learn that they are actually paying for it…keep reading.

Obviously if teachers wanted to submit to a “pry, poke and prod” program, the state wouldn’t have to threaten them with massive fines – almost $1000/year, which appears to be close to a record for any pry, poke and prod program anywhere — for refusing to let a private, out-of-state corporation play doctor on them at state expense.


But, hey, at least the state taxpayers save money by fining the teachers who don’t want to play doctor, right?

Actually, wellness makes claims costs go up, probably by more than the fines. There are lots of unneeded lab tests and other tests. For instance, the state of Connecticut admitted that in addition to throwing away all its money on the actual wellness program, they spent more on health care.  The state comptroller who administered the program said the increased spending was “a good thing.” I guess he wasn’t worried because insurance was paying for it.


But, hey, at least the teachers don’t pay for it.

Actually they do. The state’s human resources department brilliantly figured out that they could launder their wellness spending by hiring this outfit. By paying extra to Catapult (a multiple of what an effective wellness program would cost), the state is able to pick up the tab for wellness using the extra paperwork of a medical claim, as opposed to an outsized administrative expense in a separate line item. The latter would clearly need to be picked up by the taxpayers…and the state would have an incentive to control this highly visible figure.

By contrast, paying for “pry, poke and prod” as a medical claim will never be noticed, like Steve McQueen and David McCallum sprinkling the dirt from the tunnel around the stalag.  On the other hand, it will increase overall medical spending by 2-3% (the cost of the screening plus the added hyperdiagnosis expenses).

Here comes the evil genius part: at the next contract negotiation, the state can limit wage increases (or reduce benefits) by pointing out how high the health spending is.

So the teachers get pried, poked and prodded, hyperdiagnosed with hidden illnesses most of them don’t have – all against their will…and then they have to pay for the privilege in reduced wages.


Wow…the teachers are getting screwed. But, hey, at least they can’t sue the state, right, so taxpayers won’t have to pick up that bill as well?

Starting in January, this program will be in blatant violation of two laws, the Americans with Disabilities Act and the Genetic Information Non-Discrimination Act. Those laws disallow forced wellness checkups, but allow so-called “voluntary” ones.

Until recently, “voluntary” meant “do wellness or pay a big fine” like this one. But thanks to a lawsuit by AARP, the rules are changing in January so that “voluntary” must mean voluntary, like a dictionary would define the word.   (This summary has the links to all you need to know about the case.) To get these fines back, teachers will be able to sue the state, possibly even as a class action, and possibly being awarded punitive damages. Exposure to lawsuits could cost the state millions more in addition to its current expenditure on Catapult Health.

And that doesn’t even cover the costs of a possible teacher walkout, like the one in West Virginia that was spurred in part by – you guessed it – their wellness program.

But, don’t worry. Insurance will pay for it.

Colon cancer screening should start at 45. (Not!)

If there is one thing the US healthcare system is really really good at, it’s rooting out hidden disease via massive hyperdiagnostic screening campaigns. But there is always room for “improvement” by finding some unsuspecting cohort — in this case, 45-year-olds — that was getting just a little too complacent about the fact that virtually no one that age dies of something that could have been found — and also prevented or addressed — via a non-USPSTF-recommended  screen.

Serves them right.

The American Cancer Society (ACS) recently decided that, because the rate of colon cancer has been increasing in the 45-to-49-year old cohort, that screenings should start in that age group. The “alarming” 22% increase in relative risk during this century translates into an increase in the absolute rate of colon cancer in the <50 cohort from 0.006% to 0.007%. Yes–0.001% more of the <50 population in this country will get colon cancer now than 18 years ago. I’m surprised they didn’t recommend calling out the National Guard.

Further, many of that 0.007% experienced symptoms, and hence would be getting a colonoscopy as a diagnostic test, not a screen. And others in that age grouping had a family history and should get screened regardless of what the “average” person should do. Suppose those two categories account for half of the colon cancer population. That leaves roughly 0.0035% of the 45-to-49-year-old population who could possibly benefit from a screen.

As with the other “alarming” colon cancer figures that have been published in the last few years, your chances of having your life saved by a colon cancer screening at that age is about the same as your chances of being struck by lightning.

And a screen is far from a lifesaver in general. Quite the contrary, statistically speaking it is likely to find the slow-growing tumors while missing the more aggressive, faster-growing tumors that begin between screens.


The Hazards of Screening

That trivial benefit must be weighed against the nontrivial harms. The risk of a complication, such as a perforation, is estimated between 1.6% and 1.8%. (In all fairness to the ACS, they aren’t insisting that the screen be done via a colonoscopy, though the non-invasive screens have such high positive/inconclusive test rates that they often lead to colonoscopies.)

Unless I have the decimal point in the wrong place, that means the rate of complications is a whopping 320 times the likelihood of something being found. Oh, wait a sec — make that 3200 times.

OF course, the worst complication is death, and the mortality rate from colonoscopies (0.02%) appears to be, on its face, much higher than the rate of lives that would be saved. However, once again, though it kills me to say it, in all fairness the mortality rate, and for that matter the complication rate, increases with advancing age, meaning the younger you are, the less likely you are to die from this screening. So maybe the mortality rate in the 45-50-year-old cohort isn’t any higher than — and might even be slightly lower than — the rate at which early detection will save lives.  I feel much better knowing this. Don’t you?

And what is it about colon cancer that brings out people’s inner very stable genius?  Here is the Cleveland Clinic on the subject:

colon cancer

Newsflash: 144,000 is not “1 out of 19 people in the United States.” It is barely 1 out of 19 people in greater Cleveland.


The best argument against screening 45-year-olds

Nonetheless, when it comes to screening 45-year-olds for colon cancer, the best argument against it is that Star Wellness is for it.  By way of background, Star Wellness is best known in wellness for not knowing anything about wellness. They take great pride in that, boasting that anyone can become a wellness vendor. All you need, they say, is a background in “sales or municipality administration,” five days of training…and of course a certified $65,000 check payable to — get ready — Star Wellness. No surprise that Star was leading the wellness industry’s race to the bottom until they got outstupided by Total Wellness, Interactive Health, and Wellsteps.

But Star Wellness is not willing to lose this race to the bottom without a fight.

Not content to offer the full range of USPSTF non-recommended screens, they are practically hyperventilating over this opportunity to add yet another one. They use the example of ovarian cancer screening to justify more colon screening. Here is the USPSTF on the subject of ovarian cancer screening:

The USPSTF found adequate evidence that screening for ovarian cancer can result in important harms, including many false-positive results, which can lead to unnecessary surgical interventions in women who do not have cancer. Depending on the type of screening test used, the magnitude of harm ranges from moderate to substantial and reflects the risk for unnecessary diagnostic surgery.


While we’re on the subject of Star Wellness…

Sal, Wyoming’s not a country.

Star, Vitamin B12 is not a vaccine.

star vaccines

And remind me why we are lining up employees to get Vitamin B-12 shots, vaccines or no vaccines?

While we’re on the subject of vaccines, according to the CDC, the biggest category of people who are supposed to get Hepatitis A/B vaccines include street drug users.  If you are routinely hiring enough street drug users to be holding vaccination clinics focused on Hepatitis A/B, I’d say Vitamin B-12 deficiencies are not your biggest problem.

 

Should your employees get annual checkups?

Note that this blog post is my personal posting and does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I am most closely associated, and of which I am one of the founders.  I am referring, as everybody knows, to the Needham Frisbee Club.  People who play Ultimate 3 times a week don’t need no stinkin’ checkups.


Why Wellness Vendors Hate Information: A New Theory

I have no clue why wellness vendors hate information so much.  Perhaps they are repressing childhood memories of being bitten by a librarian.

A far-fetched theory, perhaps, but there is simply no other explanation for half the things half these very stable geniuses insist upon doing.  In many cases, reams of information demonstrating the futility, fallacies and even harms of what they do is right there — begging to be googled — and yet no one in the wellness industry (or at least the wellness companies “profiled” on this site — there are plenty of exceptions listed at www.ethicalwellness.org) does.

Before we get into the checkups, consider some other information gaps, like the eight-glasses-of-water urban legend. Anyone with an internet connection can easily learn that you do not have to drink eight glasses of water a day, and the whole meme was completely made up. 70 years ago someone estimated that humans require that much water a day — but also that basically everyone with access to water already gets that much without having to force themselves to drink when they aren’t thirsty.

Yet try telling that to a wellness vendor (excluding the ones who have signed the Code of Conduct, of course). One vendor, Provant, even provides an infographic in case the employees they are harassing can’t count to eight:

Wellness Corporate Solutions — no stranger to these pages — has gone one step farther.  Along with their crash-dieting contests, they offer what they call “healthy competitions” to see who can drink the most water:

Water-drinking “healthy competitions” may or may not make employees “more aware of their health status,” but they certainly make employees “more aware that this meeting better end really soon.”

Maybe WCS should combine those two competitions — along with their massive overscreening campaigns — to create a competition to reward employees for doing the most stupid things to themselves.

Failure to understand that thirst is your brain’s signal that you need a drink of water is not an isolated oversight. Wellness vendors take great pride in their ignorance of wellness generally. Consider their propensity to screen the stuffing out of employees. There are clinical guidelines for optimal screening frequencies and lists of biometrics that should be screened for, that most wellness vendors (It Starts with Me, US Preventive Medicine, and Limeade being three huge exceptions) have apparently never laid eyes on. If it helps, here they are:


There are a few subtleties beyond these words. “People at risk for diabetes” (under “Diabetes test”) would include people with high blood pressure or family history (which wellness vendors can’t ask about). It would also include people who are overweight or obese. Additionally, “members of certain ethnic/racial groups may be at increased risk at a lower body mass or a younger age.” Otherwise, it’s quite clear that cardio screenings should begin at 35 for males and 45 for females, and take place “at least once every five years” after that.

Some people should get that frequency, others a higher one. But like most other things in healthcare, the answer is not the same for every employee of every age and every health status, and you do not just screen people because you make money on each screen, so the more you screen, the more you make. Otherwise you end up like Interactive Health, one of the most expensive vendors, positively hyperventilating about all the false positives they’ve found:

Finally, let’s once again review the aforementioned crash-dieting contests, a staple of many wellness programs besides Wellness Corporate Solutions. Schlumberger, for example, pays out thousands of dollars to the team which does the best job packing on the pounds in December and then taking them off in January. “Just plain fun,” is how their ironically named vendor, HealthyWages, describes it.  None of these vendors have apparently seen the CDC’s advisory memo warning that crash-dieting is futile, likely counter-productive, and possibly harmful.


What about annual checkups?

Let’s cut to the chase: there is not one shred of evidence that annual checkups are a good idea for asymptomatic working-age employees.  There are many good reasons to go to the doctor — you notice a change in some aspect of your body, you want to develop a plan to improve your health, you need help managing a chronic disease,  or even that you’re sick — but here’s what’s not among them: the earth completing a revolution of the sun.

New England Journal of Medicine says that while the major benefit is “less patient worry,” checkups “may actually be harmful.”

“Less worry” is not necessarily a good thing. An employee (name on request after an NDA — not a made-up person) had a checkup in order to collect a wellness incentive…and as a result of being told not to worry, ignored heart attack symptoms about a week later.

The Journal of the American Medical Association says offers of health checks did not reduce any kind of mortality, but “may be associated with more diagnoses and drug treatments.”

Choosing Wisely says: “Annual checkups usually don’t make you healthier,” and “tests and screenings can cause problems.”

None of this takes into account the cost of annual checkups — which often lead to more unneeded and expensive tests and prescriptions, as JAMA notes — but we have definitely observed that wellness vendors and even some HR departments don’t really care about costs. It’s not their money. Here is Reuters on the high and unneeded cost of prevention.

Here is The Incidental Economist on the same subject.

Meanwhile, I’ve yet to find a wellness program that does not either pay employees to get checkups or fine them if they don’t — or shunt them into a worse health plan unless they submit to an annual physical.

I would also note that, however useless annual checkups are to begin with, they are likely even more useless if someone is visiting the doctor because their benefits department is forcing them to do so, against their will.

Finally, there isn’t exactly a surplus of primary care doctors. Why are we paying healthy employees to take up clinician time that unhealthy employees might actually need?


What is the argument in favor of checkups?

If checkups don’t actually prevent anything, why make employees undergo them? Two reasons have been proposed. One is that employees can “build a relationship” with their PCP.  This of course assumes that neither the employee nor the PCP ever retires, moves or changes jobs. It also assumes that somehow the things that affect employees can be prevented by having a “relationship” with a PCP. However, if you look at the list of the most frequent reasons for hospitalization among the working-age population, it’s kinda hard to find anything that fits that description.

Can you think of any disease in your own life that would be cured by a relationship with a PCP? I can’t think of only one problem — chronic heartburn — that my PCP could have prevented. But she didn’t. The PCP was perfectly happy to keep me on Prevacid, which, as Quizzify teaches (right on the home page quiz!), is likely harmful in long-term use. Fortunately, I happened to run into a yogurt salesman one day, who told me about active-culture yogurt. Within days my heartburn was gone, never to return.

The second argument in favor of checkups, proposed by the CEO of Bravo Wellness, Jim Pshock, is as follows:

The hope is that the [Bravo] program will get people to proactively see their physicians to manage their health risks. Yes, this will, hopefully, mean more prescription drug utilization and office visits, but fewer heart attacks and cancers and strokes.

It isn’t his money, so he is perfectly fine with employees “hopefully” spending more on drugs and office visits.  On the other hand, there is no information supporting his claim that all this spending and all these checkups will prevent all these diseases.  Quite the contrary, 100% of available information reaches the opposite conclusion — especially JAMA, which specifically measured mortality due to heart attacks, cancers and strokes and found no improvement. You’ll fine zero information suggesting the contrary finding, no matter how hard you search.

Perhaps when he was a toddler, Mr. Pshock’s parents threw him into an entire cage of librarians.


What is the best frequency for checkups?

The literature is quite adamant: not at all.  That seems a bit extreme and I would bet the people who write these articles do occasionally get a checkup. For the most reasonable compromise I would turn to Quizzify, the leading health literacy vendor. They recommend a simple mnemonic: get two checkups in your 20s, 3 in your 30s, 4 in your 40s, 5 in your 50s, and annually after that. Quizzify’s advisory colleagues, doctors at Harvard Medical School, approved this recommendation too. As with most other questions, this one carries the HMS “shield.” (Quizzify also reports that this question is the one most likely to be removed by its customers, which is an option for all questions in their database before they get seen by employees.)


So what’s the solution?  

In three parts, it’s:

  1. Screen according to guidelines
  2. Send employees to the doctor at age-appropriate and health-appropriate intervals
  3. Pay the fines on overdue books.

Congressional committee votes to allow employers to genetically screen children

We cannot make this stuff up.  HR 1313, The Preserving Employee Wellness Programs Act, has a provision specifically designed to screen children for genetic defects.  Don’t take our word for it.  Here is the language of Section 3(b):

Notwithstanding any other provision of law, the collection of information about the manifested disease or disorder of a family member shall not be considered an unlawful acquisition of genetic information with respect to another family member as part of a workplace wellness program.

This wasn’t an oversight due to some obscure language — the entire bill fits on a page. It just passed the House Education and Workforce Committee and is headed to Ways and Means. We need to stop it now.  It basically says, you can ignore the Genetic Information Non-Disclosure Act as long as the genetic testing is part of a wellness program.

Tomorrow, Quizzify will become the first wellness (really, employee health literacy) vendor to formally oppose it, and tell Congress and the Business Roundtable to keep their hands off our children.

Corporate Care Management Rounds Up 25 Times the Number of Usual Suspects

You may recall Phantom Tollbooth, a classic of children’s literature. Among other things, the book features a dish called “subtraction stew,” where the more you eat, the hungrier you get. Likewise  the more cancer cases Corporate Care Management  (CCM) finds, the more money they save.

With math like that, it’s no wonder that 5% of their case study population of 600 was told they have cancer or precancer. And that was just in 2015 alone.

In Casablanca, Captain Renault told Major Strasser: “Owing to the seriousness of this crime I’ve instructed my men to round up twice the usual number of suspects.” Turns out Inspector Renault had nothing on CCM. In a typical year maybe 0.2% of the working-age population would get a valid cancer diagnosis for the cancers they screen for. That means CCM rounded up 25 times the number of usual suspects. To put this in perspective, at this rate we’d all get diagnosed with cancer twice during a 40-year career.

casablanca

 

 

 

 

 

And the savings?  Over $20,000 per alleged cancer victim. That means CCM saved more than $1000 per covered employee, which is more than most employers spend on cancer — simply by finding more cancer cases to spend money on. (Care for a second helping of Subtraction Stew?)  And, yes, of course, this screening includes the USPSTF D-rated prostate screens, a staple of the wellness industry.

ccm-prostate

This cancer-finding is all accomplished on the basis of a letter-writing campaign. (For instance, men were instructed on three different occasions in 2015 to get their prostates screened.)

One other nuance: the 5% cancer incidence rate — 30 people — is based on the total 600 employees. Yet the company sent out only 146 “welcome packets,” meaning that less than a quarter of the employees actually responded to the letters.  Of those 146, almost a quarter (30) allegedly had cancer or precancer.  This proportion even tops the previous high for cancer hyperdiagnosis, which was the Nebraska wellness program (before Ron Goetzel and Health Fitness Corporation admitted they had made the whole thing up).

ccm-cancer-statistics

While it wasn’t clear what the other 454 people did with those letters, here is a question for your consideration: would you even open a letter with a return address of: “Corporate Care Management” ?  As a patient, those are three words I hope never to see adjacent to one another over the course of my natural lifetime.

Lest I forget, here is what the actual letter looked like. I don’t know about you, but if I ever received letters with this design from an outfit with this name, I’d get a restraining order.

ccm-new-years


And apparently I’m not the only one who would prefer to be left alone.  The Maytag repairmen used to be the loneliest people on earth.

maytag-repairman

But CCM’s nurses might give them a run for their money.  Here are the utilization statistics they presented to this very same client with 600 employees:

ccm-outreach-title

ccm-outreach

Yes, that’s correct. they completed one conversation.  Although that may be because the other 599 employees are too worried that if they talk to these people, they’ll get treated for cancer so CCM can save even more money.

 

Ever wonder what it’s like to actually participate in a wellness program?

Do you know anyone who is actually in a “pry, poke and prod” wellness program run by one of the 50 vendors “profiled” on this site?  If so, try asking them what they think…and then compare those opinions to what the vendors want them to think. A few tidbits of the latter are listed below:

But none of these vendors ever ask the flesh-and-blood employees how they feel. Turns out there’s an excellent reason for that: employees hate “pry, poke and prod” programs. Here are four sets of vignettes to that effect.

  1. Last month, we collected some comments from an article in Slate about wellness. Just when we thought the news cycle on that article had run, more employees weighed in.  Still, those are just comments, not in-depth experiences.
  2. Getting into the belly of the beast, Vik Khanna posted a ten-part series on the Provant program he and his wife were forced to submit to subject to a major forfeiture. This program sucked up 6 hours of his time and provided tidbits like “drink 8 glasses of water a day,” which of course is a total myth . This myth dates from a misinterpreted finding from 1945. It is now perpetuated only by some wellness vendors (not all of them — incredibly a few have now procured internet connections), as well as presumably Poland Spring, Aquafina, Dasani, Kohler and American Standard.  Obviously if the human race were that dehydrated we would have gone extinct long ago.   Provant water
  3. In addition to Vik’s regular journal entries, every now and then, someone writes in detailing their own experience in being forced to submit to one of these programs. Here is one of our favorites, someone complaining about Optum’s program. No wonder Optum is so opposed to the Employee Health Code of Conduct. I’d be opposed too, if I offered Optum’s program.
  4. Finally, here is the program du jour.  In their alleged attempts to create a culture of health, these vendors are creating cultures of resentment, distrust, and deceit.  We’re copying-and-pasting the opening paragraphs of this rant, but would encourage you to click through to the whole thing.

News Flash, The Dodo Bird is Still Alive

Well another year has rolled around and I was talking to the person who’s experience with their wellness program I had discussed below. Lo and behold, the problems I had originally documented continue unabated. This is a common example, and explains why so many wellness programs should be discontinued.

It was time for next years enrollment period for her insurance and she needed to get a number of points, schedule a coaching visit and get her biometrics and lab work completed to qualify for the premium differential.

The lab work requirement upset her as she had just gotten all the lab work done by her PCP the month earlier, but no, those lab results couldn’t be used. So the vendor repeated all the lab work her PCP had done and more, most of which were absolutely unnecessary based upon USPSTF guidelines. But hey let’s go ahead and waste some money and do a few unnecessary tests.  That’s become the norm for many a wellness program.

The story continues here.

HealthFairs USA: A wellness program that defies description

The English language contains 450,000 words, the most of any language, but apparently it needs a 450,001st.  Why? Because whoever invented the first 450,000 words had obviously not reviewed HealthFairs USA’s wellness program, which no existing word comes close to describing.

First, they test for cancer — with 99% accuracy!  This precision may seem impossible but their claim is correct in that 99% of the words in the clipping below are indeed spelled accurately. (This is actually a better track record than the rest of their website, in which they describe their “unparallelled” customer service and how they “minimize your companies risk” and “build company moral.”  They also advertise “less call-outs for sickness,” by which I suspect they mean “fewer absences.”)

preventest-check-swab

Besides the slight problem that this statement is beyond absurd about a zillion different ways, Preventest lacks FDA approval (and — equally surprisingly given their accuracy — a Nobel Prize). That doesn’t stop HealthFairs USA from submitting claims to insurance companies and promising “no out of pocket cost” in most cases:

preventest-insurance-reimbursement

By the way, there is no FDA-approved genetic “check swab,” or test of any kind, let alone one with 99% accuracy, for any cancer. And few cancers on this list even have a genetic component. (Bladder cancer, for example, is 100% environmental.)


But wait…there’s more. Now how much would your insurance company pay?  HealthFairs USA is selling worthless nutritional supplements and submitting insurance claims for those as well:

preventest-supplements

Let’s review what they’ve told us so far: they perform useless, non-FDA-approved tests and sell useless, non-FDA-approved supplements to employees who don’t need them, and then submit bills to third party payors.  Can anyone spell insurance fraud? I doubt they can, since they can’t even spell “alleviates.” (So much for their 99% accuracy target.)


How does this benefit employees?

preventest-how-does-this-benefit-me

Lots of ways. Employees can submit to more frequent screenings.  And I’ve always said the problem with the US healthcare system is that employees don’t get screened enough. (not!)

Or, they can take medications. It’s not clear which ones, and there aren’t any “medications” that are FDA-approved for preventing most cancers in any case. But whichever ones you take, I’m sure they’ll figure out how to bill the insurance company for them. Most importantly, you can “have risk reducing surgical procedures.” Let’s see…what word can describe a wellness vendor recommending surgery for employees tagged by non-FDA-approved cancer screens for a possibly elevated risk of cancer?

Hmm…maybe we need a 450,002nd.


Indeed, a true wellness program might consist of warning employees not to get anywhere near HealthFairs USA, so clearly these people don’t have any accounts of any sophistication, right?  Right?

Wrong. Here are their accounts:

That means they are submitting insurance claims to their insurers on behalf of their employees, as directed and incentivized by their human resources department. I’m not a practicing attorney, but I am a practicing non-idiot, and as such my opinion would be that Coca-Cola and others look into this posthaste.

Plus, it’s not like they’re completely fraudulent. They have references from stellar companies with outstanding reputations:

healthfairs-wells-fargo

Full disclosure: I’m not 100% sure that it is actually illegal to submit insurance claims for useless, unapproved, possibly harmful, USPSTF D-rated screens and useless, unapproved, probably harmful, supplements for employees who have no diagnosis, no recognized medical necessity and aren’t seen by a real doctor.

Quite the contrary, my opinion may only be 99% accurate.

 

 

Why do employee wellness industry leaders hate employees so much?

I would like to express my gratitude to the editor of the American Journal of Health Promotion, Michael O’Donnell.  He recently decreed that “despite common lore, I am not an idiot.”  Coming from a man brilliant enough to singlehandedly create entire alternative universes of arithmetic and statistics, “not an idiot” is mighty praise indeed.

michael-odonnell-not-an-idiot-quote

I’m unsure exactly what “common lore” he is disputing, unless he means that the Phi Beta Kappa committee at Harvard also thinks I am an idiot, relatively speaking, because they snubbed me until I was a senior.

I will return the compliment.  Michael O’Donnell is not an idiot either.  Quite the contrary, he and his Koop Committee buddies knew exactly what they are doing when they gave their friends at Wellsteps awards for harming employees.  Bottom line is, these people simply hate employees, and happily throw them under the bus whenever it’s profitable to do so. While Boise is a great example, Penn State still reigns supreme.

While we could write a post about almost any member of that Committee, this post focuses only on one member, Mr. O’Donnell.  Still, it’s hard to dislike the man given all the kudos he throws my way. For instance, in addition to not being an idiot, I am also praised above as: “close to being accurate.” Since we disagree on everything, he is therefore acknowledging that he himself is many light-years from accurate — as Wellsteps and every other Koop award demonstrates.


Michael O’Donnell’s Anti-Employee Jihad

Michael O’Donnell also said, as you can see above, that I am not a “misanthrope.”  However, in this case, I can’t return the compliment.  His new editorial is a misanthropic anti-employee jihad.  First, he says prospective new hires should be subjected to an intrusive physical exam, and hired only if they are in good shape.  OK, not every single prospective new hire — only those applying for “blue collar jobs or jobs that require excessive walking, standing, or even sitting.”   Hence he would waive the physical exam requirement for mattress-tester, prostitute, or Koop Committee member, because those jobs require only excessive lying.

Second, he would fine people for not meeting “outcomes standards.” In an accompanying document, he defines those “outcomes standards.” He specifies fining people who have high BMIs, blood pressure, glucose, or cholesterol.

Finally, he wouldn’t hire smokers at all, because they are so unworthy and untalented. Meaning Humphrey Bogart never should have been cast in Casablanca.  Ernest Hemingway and George Orwell should have piled up rejection letters. Roger Maris should get his asterisk back.*  Rihanna, Simon Cowell, Adele, Brad Pitt, Obama, Churchill, Einstein. Sinatra, Twain, Kidman.  Sheesh!  I agree with you, Michael. What a bunch of losers.

And thank goodness Watson didn’t smoke or Moriarty would likely still be at large.

sherlock-holmes


A Unique Way to Charge Employees for Health Insurance: By the Pound

Almost every nonsmoker would be caught in his dragnet too, as he would “set the standard for BMI at the level where medical costs are lowest.”  Since people with very low BMIs incur higher costs than people with middling BMIs, Mr. O’Donnell would fine not only people who weigh more than his ideal, but also employees with anorexia.

If employees didn’t already have an eating disorder, what better way of giving them one — and hence extracting more penalties from them — than to levy fines based on their weight?  Hopefully, he would allow people with wasting diseases like cancer to appeal their fines.

Employees above his ideal weight would pay per pound, sort of like they were ordering lobster or mailing packages.

Yes, I have a hard time believing anyone would disdain employees that much too, so here is the screenshot:

odonnell-bmi

He claims that all these fines will “enhance morale” for employees, whether they like it or not.


How would Michael defend his anti-employee jihad?

The Wellness Ignorati don’t engage with me, for obvious reasons given their self-immolating comments when they do. So I’ll provide his rebuttal. It would be, as he said in the first screenshot above, that I am once again “creating controversy where it does not exist.”  Clearly, his editorial and white paper are mainstream, and I’m just causing trouble again for no reason.

Michael wonders why, in his own words (echoed by Ron Goetzel), 90% to 95% of wellness programs fail.  He says it’s because employers don’t spend remotely enough money on them. He recommends up to $300/employee/year…and what better way to reach that spending target than to make them go to the doctor, and set up expensive weigh-ins, inspections and fining procedures?

While Michael O’Donnell may not be an idiot, I’m not sure I could say the same about any CEO who takes his advice.



*Maris should get his asterisk back because, as a smoker, he still holds the record for “Most home runs by a player who never should have made the team.”

Are you smarter than a wellness vendor? Take the Interactive Health IQ test and find out.

I’ve raised the bar for getting “profiled” on this site. Life is too short to simply highlight every wellness outfit that tests inappropriately and then lies about their outcomes.

Nor can you get on this list simply with bold proclamations of fatuous statements, like Interactive Health does:

interactive-health-sitting-smoking

Hey, Interactive Health, we get that you don’t understand statistics in general, based on the mind-boggling excuses your consultant offered about your completely invalid savings report (“Al, the [massive] savings on Page 4 have nothing to do with the [trivial] risk reduction on Page 9. It’s a completely separate analysis.”).

Even so, maybe you can find a smart person to explain this particular statistic to you:

  • According to the CDC, the number of annual deaths caused by smoking: 480,000
  • According to the CDC, the number of annual deaths caused by sitting: 0

Here are some other differences between the two activities: Chairs don’t carry excise taxes or warning labels. If you’re under 18, you can buy a chair without a fake ID.  Workers are allowed to sit inside the building. Chairs don’t make you clothes smell, cause lung cancer or dangle from the lips of gunslingers in old John Ford westerns. Sitters aren’t assessed health insurance penalties. Your Match date will not feel misled if he or she catches you taking a seat, even if your profile didn’t disclose that you sit.

Sitting isn’t the “new smoking.” Opioids are the “new smoking.” But since you don’t help employees understand the risks of opioid addiction, it’s probably because you don’t understand these risks yourselves. Quizzify has produced a painkiller/pain reliever awareness quiz that you might benefit from. Welcome to 2016. THIS is what’s harming and even killing employees, not sitting.


The Interactive Health IQ Test

Which of these images is most unlike the others?

interactive-health-iq-test

 


No, these days to get into this column, you need to soar above and beyond ordinary wellness vendor stupidity and dishonesty, because Wellsteps has totally raised the bar…and yet Interactive Health has cleared it.


I was recently screened by Interactive Health.  They were supposed to send me a standard summary writeup, which I asked for repeatedly but never received.  Instead, weeks later, their lab sent me a lab report, with no interpretation. There are one of three explanations for this:

  1. They are too incompetent to send out summary writeups in a timely way;
  2. They think an unadorned, highly technical, lab report sent three weeks after the fact constitutes a useful summary writeup;
  3. They were about to send out their standard summary writeup, before someone noticed my name and said: “Whoa! That’s Al Lewis. He is nowhere near stupid enough to find our usual nonsense acceptable. He has already exposed our savings lies in the Wall Street Journal, and if we give him our usual writeup on his screening, he will expose our stupidity on his blog. We need to cover that up. So let’s just send him a lab report.”

By process of elimination, I originally landed on #3.  Quite flattering really. I’d make a few observations.

First, I specifically asked them, in accordance with USPSTF guidelines, not to measure my PSA. They interpreted that — as you can see from the top of that page reproduced at the very end — as a request specifically to measure my PSA. (It is on Page 2 of the report, which I can’t put my hands on right this very moment. However, the Wellness Ignorati, who still think it predicts cancer, will be disappointed to learn that it was quite low.)

Second, the glucose is slightly high because some very generous folks had just treated me to a large and delicious breakfast. A classic false-positive, the type of reading that makes wellness vendors’ hearts go all aflutter, because then they can do a followup reading and show that they improved the outcome, after it improves on its own.  Interactive Health’s lab report was completely unhelpful on this high reading. No advice offered.

Third, Interactive Health shattered the record, previously shared by Total Wellness and Star Wellness, for most USPSTF non-recommended blood tests. I don’t know what half these things are, which means neither does Interactive Health. (Total Wellness might win a second-place tiebreaker because they would still be testing for ovarian cancer — it’s still advertised on their website —  except that the only company that makes the test has pulled it from the market following FDA warnings not to use it. Hopefully, Total Wellness stockpiled some assays ahead of the recall, like Elaine did with the sponges.)

Interactive Health also tested me for calf tightness, as I mentioned in an earlier blog. It turns out my calves are tight, and right on-site they loosened them. I could feel my productivity soaring…until the left one went into spasm that night. Still, loose calves are a useful trait for some jobs, such as first baseman.


Interactive Health may have also just assumed that because they don’t like me, no one else in the industry does either.  That’s actually a fairly accurate assumption, one I am quite proud of given the integrity of most of them, with their trade association, the Health Enhancement Research Organization, leading by example in the pants-on-fire department. Indeed a good rule of thumb to determine if a wellness vendor is honest is to ask them what they think of me.

Nonetheless, I was able to find someone who was screened at a different screening and said he received an actual wellness outcomes report from these people, someone who likes me well enough to send it to me. Coincidentally, this individual had been urging me to post on Interactive Health for quite some time.  I figured, cool, I could see what a real report from Interactive Health looks like, the kind that changes employee behavior enough to explain their whopping savings claims of $54,000 for each employee who reduced a risk factor.

No such luck. He sent me exactly the same lab printout that they sent me. Only he hadn’t lost the second page, so I could count the total:  43 lab values.  “Knowing your numbers” could be a full-time job. One would think they had covered all the risk factors with all those lab values, but, curiously, the guy said his blood pressure was quite high, and they missed that altogether.

Hmm…how come he got the same completely unhelpful report I did? Did Interactive Health view my linkedin profile — as their executives are wont to do on a regular basis bordering on the obsessive –and decide that it wasn’t safe sending any of my connections their typical employee printout, on the theory that if I’m not stupid, neither are most of my connections?  If so, that would be their second fairly accurate assumption.

The only other explanation is that everyone receives the same unadorned lab report, full of letters and numbers and signifying nothing, at least to the average person without a PhD in biochemistry. My feelings were shattered. I wasn’t special. Do they send everyone else incomprehensible lab reports with 43 different numbers in them along with assortments of letters most people would associate with Scrabble…and no interpretations or advice?


Whether incompetence or botched coverup, the explanation itself remains a mystery. Nonetheless here are a few numbers and letters from his report.

interactive-health-alkaline-phosphatase

Maybe Interactive Health could interpret this for us, but I would be more confident of their ability to distinguish (for example) AST-SGOT from ALT-SGPT if they could distinguish (for example) a chair from a cigarette.


Another one:

interactive-health-cholesterol

How is anyone supposed to make any sense out of this? Most employees would think a “negative risk factor” is a bad thing,” as in “telling the truth is a negative risk factor for the profitability of wellness companies, which is why most of them never do it.” And what does “VLDLCH” mean and why isn’t it reported?  Still no interpretations.


And then of course there is the PSA test. If you don’t speak up — or even if you do speak up, as I learned — they’ll do one on you, even though the USPSTF rates it “D”, not to mention that the actual inventor of the test says the test is “inaccurate and a waste of money.”  My friend’s PSA result is listed at the bottom of this apparently random number and letter generator…

interactive-health-psa

And, yes, finally, an interpretation!

“Values obtained with different assay methods or kits cannot be used interchangeably. Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease.”

In other words, the interpretation is that this test doesn’t explain anything, so we recommend ignoring the result.

It would have been even more helpful for them to recommend ignoring Interactive Health altogether– the calves, the chairs, the cigarettes, the AST and ALT, and, to be discussed in a future posting, the fabricated outcomes report.

 



Here is the entire first page of my own results, so that you know we are not taking this out of context…

interactivehealth

 

 

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