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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.

Goetzel, Koop Committee, Staywell, Mercer, BP America meet Groundhog Day

Perhaps the strategy of the leaders of the wellness ignorati (who constitute the Koop Committee) is to overwhelm us with so many lies that we don’t have time to expose every one and still get home in time for dinner.

No sooner have we finished pointing out the numerous (and unrebutted) implausibilities and internal inconsistencies in Ron Goetzel’s posting on the value of workplace wellness, than the Koop Committee (Mr. Goetzel and his cabal) feeds us even more red meat:  They gave the 2014 Koop Award to British Petroleum.  However, apparently only British Petroleum wants to tell the world about it. The Koop Committee hasn’t even updated its own website to list 2014 award winners.

Recall that we’ve spent months excoriating Goetzel and his sidekicks (Wellsteps’ Steve Aldana, Milliman’s Bruce Pyenson, Mercer’s Dan Gold and the rest of them) for doing three things in the Nebraska award, for a program that prima facie seems to be in violation of Nebraska’s state contractor anti-fraud regulations:

(1)   Gave it to a program where the numbers were obviously fabricated and later admitted to be

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor sponsors the Committee

Perhaps what you are about to read isn’t their fault.  Perhaps their mothers simply failed to play enough Mozart while the Committee members were in their respective wombs, but here’s how they applied the learning from the Nebraska embarrassment to their decision to award British Petroleum.  This time they:

(1)   Gave it to a program where the numbers had already been shown to be fabricated

(2)   Gave it to a program whose vendor sponsors the Committee

(3)   Forgot to disclose in the announcement that the vendor (Staywell) sponsors the Committee

(4)   Forgot to disclose in the announcement that the vendor sits on the Committee

(5)   Forgot to disclose in the announcement that the consulting firm (Mercer) sponsors the Committee

(6)   Forgot to disclose in the announcement that the consulting firm sits on the Committee

 

mercer staywell sponsorship

I suspect we will be writing a similar analysis again next year, when once again, the Committee will attempt to demonstrate the value of sponsoring a C. Everett Koop Award.

Ron Goetzel and Co-Authors Claim Workplace Wellness Evidence That a CSI Couldn’t Find

Questions for Ron Goetzel and co-authors based on September 2014 article

Category:  Wellness

Short Summary of Goetzel Article’s Marketing Claim:

“Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes.”

(This study was paid for by American Specialty Health, a successful and well-regarded company in the alternative network business that also, not surprisingly, has a wellness subsidiary.)

Materials Being Reviewed:

The study in question appeared in a recent issue of the Journal of Occupational and Environmental Medicine.

Most of these questions were originally asked by Jon Robison of Salveo Partners, in this post.

Questions for Ron Goetzel (who has not answered any relevant follow-up question asked of him about his Koop Award either, meaning now he has forfeited $2000 in honoraria)

Is it ethical to claim “no conflict of interest” in writing this article when a wellness company paid you for it and when you and most co-authors make their living in the wellness industry?

ANS: Refused to answer

Can you explain your reasoning for listing (see below) the Koop Award-winning State of Nebraska as a “best practice wellness program” after they admitted lying about saving the lives of cancer victims who never had cancer, and after it turned out their savings figures were clinically and mathematically impossible, and after it was exposed that the state’s wellness vendor sponsors the Koop Award?

list of best practices

ANS: Refused to answer

Why didn’t you disclose that literally none of these “best practice” programs (especially Nebraska’s, which deliberately waived all age-related cancer screening guidelines) follow US Preventive Services guidelines and therefore companies that follow these best practices on balance are more likely to harm their employees through overdiagnosis than benefit them?

ANS: Refused to answer

You describe (among others) a Procter & Gamble study from two-decade-old data as “recent”. Can you define “recent” ?  Can you name anyone at Procter & Gamble who even remembers this “recent” study?

ANS: Refused to answer

Why do you still cite Larry Chapman’s 25%-savings-from-wellness-programs allegation even though readily available online government data below shows wellness-sensitive medical events account for only 8.4% of a typical employer’s hospital cost (about 4% of total employer spending), thus making it impossible to save 25%?

hcup8point4percentslide

ANS: Refused to answer

Why are you still citing Prof. Baicker’s article when she herself has backed off it three times, it’s never been replicated, and all attempts to replicate it, including the most recent attempt to replicate it (in the “American Journal of Health Promotion”), have shown the opposite and she herself says “there are very few reliable studies to confirm the costs and the benefits”?

ANS: Refused to answer

How can you cite RAND’s negative article as supporting the conclusion that “wellness can achieve positive financial outcomes”  even though the author Soeren Mattke has specified that the modest health improvements among active participants produced no “positive financial outcomes”?

ANS: Refused to answer

Likewise, how can you cite the Pepsico health promotion study in Health Affairs in support of that same conclusion when that study concluded exactly the opposite: that health promotion had a negative ROI?

pepsico

ANS: Refused to answer

Guest question submitted by Dr. Jon Robison:  On p 931 you say that the RAND study found weight reduction — of course, only on active participants, excluding dropouts and non-participants — that was “clinically meaningful” and “long-lasting.”  How does that square with this slide from that very same RAND study showing exactly the opposite? (Since this chart may be difficult to read,we’ll highlight the key finding, which was that by the 4th year the average active participant had sustained weight loss of only a few ounces.)

randweightslide

ANS: Refused to answer

American Heart Association promotes StayWell while violating its conflict of interest policy

American Heart AssociationStayWell


Short Summary of Company:

AHA wellness: “The American Heart Association’s Worksite Wellness Kit encourages companies to give employees an excuse to get away from their desks.”

Staywell: “StayWell helps clients across the health care spectrum address the changing landscape like no other company. We leverage the latest technology, enhanced analytics, and deep consumer insights in an integrated portfolio of best-in-class client solutions.”

Materials Being Reviewed

Questions for AHA

Your conflict-of-interest statement says you “make every effort to avoid actual or potential conflicts of interest that may arise as a result of an outside relationship.” Why doesn’t letting the Chief Science Officer of a wellness company write your wellness policy citing his own articles in support of wellness violate that policy?

ANS: Refused to answer

Were you aware that Staywell perpetrated a scheme in which they worked with Mercer to convince British Petroleum that their outcomes were 100 times better than what Staywell itself said was possible?

ANS: Refused to answer

Why did you allow a writer to source his own articles, thus creating an AHA policy stand that is clearly in his own financial interest?

ANS: Refused to answer

Is it representative of your peer review policy not to “vet” your peer reviewers to see if they themselves were involved in scandals that are very relevant to the article they are reviewing?

ANS: Refused to answer

Why did you as an organization and the writers of that policy decline The Health Care Blog’s invitation to defend your article against observations that it was totally conflicted and based on data known to be invalid?

ANS: Refused to answer

Why did you allow the writers to cherry-pick the available literature, ignoring the overwhelming evidence against your policy and instead continue to cite the old “Harvard study” whose lead author has now walked it back three times?

ANS: Refused to answer

Why did your editors allow the writers to call this (disavowed) Harvard study “recent” even though it was written in 2009 using data with an average date of 2004?

ANS: Refused to answer

Why did your writers knowingly cite studies that no legitimate health services researcher would find acceptable due to obvious study design flaws, like comparing active motivated participants to non-motivated non-participants, claiming that an outcome on volunteers who persisted in the program for three years is representative of the population as a whole, and taking credit for risk reductions in previously high-risk people that would have happened anyway?

ANS: Refused to answer

Why didn’t you mention that the screening frequencies you are endorsing are far in excess of guidelines set by the United States Preventive Services Task Force?

ANS: Refused to answer

As an association named for the human heart, how come you didn’t publish cautions that the screening frequencies you’re recommending can lead to overdiagnosis, overtreatment and other cardiometabolic harms?

ANS: Refused to answer

Postscript:  Any apologies, retractions, explanations etc. other than answering the questions

A July 17 email from co-author Ross Arena: “I am troubled by these accusations, as is AHA.  I have included an AHA representative who will address this.”  [No AHA response followed.]

A July 17 response from us noted that technically these are observations, not accusations.  We “observed” that their screening policy was co-authored by the CEO of  a screening company.  (We offered to link them to dictionary.com to see the difference between the two words, but they declined.)

HealthFitness takes credit for program savings without having a program

HealthFitness

Short Summary of Intervention:

“When you partner with HealthFitness, we work collaboratively with you to develop a strategic plan for program implementation, which includes a cultural assessment and an operational plan. You can expect results-oriented programs and services delivered through a highly personalized strategy, matched to your employees and culture.”

Materials Being Reviewed:

Success at risk reduction and translation of that risk reduction into cost savings.  These excerpts are from the successful Koop Award application at http://www.thehealthproject.com/documents/2011/EastmanEval.pdf.

health fitness corp risk reduction form koop award

total savings chart

Summary of key figures and outcomes:

  • Reduction in risk factors from 3.20 to 3.03 — net change of 0.17 — over 5 years.  This success excludes dropouts.
  • 24% improvement in costs vs. non-participants, or $460/year at Eastman Chemical (currently up to >$500/year according to HFC website)

Questions for Health Fitness Corporation:

Since only about 20% of all inpatient events are wellness-sensitive, and you only reduced risk factors by 0.17 per person, and hospital expenses are at most 50% of total spending, how is it that you are able to reduce spending by 24%?

ANS: Refused to answer

Why did you take credit for savings in 2005, even though according to your own slide you didn’t have a program in 2005?

ANS: Refused to answer

Does starting the Y-axis at $1800 instead of $0 create the illusion of greater separation between the two cohorts?

ANS: Refused to answer

Your website says that comparing participants to non-participants “adheres to statistical rigor and current scientific standards for program evaluation” and “is recognized by the industry as the best method for measurement in a real-world corporate wellness program.”   Can you explain how non-motivated non-volunteers who decline financial incentives to improve their health are comparable to motivated volunteers, especially in light of the separation between the two groups that took place just on the basis of differential mindset in 2005, before you had a program?

ANS: Refused to answer

You and your customers have won three Koop Awards in the last 4 years. Do you think also being a sponsor of the Koop Award (along with Eastman, in this case) has helped you win these awards or is this just a coincidence?

wellness logos

ANS: Refused to answer

Why Nobody Believes the Numbers defines the “Wishful Thinking Multiplier” as “alleged cost saviings divided by alleged risk reduction.”  Your cost savings is $460 and your risk reduction in 0.17, for a Wishful Thinking Multiplier of 2700, the highest in the industry.  The book calculates that a risk reduction of your magnitude (even assuming dropouts also reduced risk by the same amount) could generate roughly a $8 reduction in annual spending.  To what do you attribute your ability to reduce spending by 50x what is mathematically possible?

ANS: Refused to answer

Help us with the arithmetic below, also from this Koop Award application.

eastman ROI

How is it mathematically possible to have a higher ROI ($3.62) when also including the cost of incentives in program expense than the ROI ($3.20) excluding the cost of paying incentives to employees to participate?

ANS: Refused to answer


 

Update December 2014:  Ron Goetzel admits HFC lied.  (See #5 and #6.)  The slide was “unfortunately mislabeled,” using the passive voice, as though it was an act of God (“the game was rained out” ) or else perhaps the North Koreans.  The geniuses at HFC apparently didn’t notice this “unfortunate mislabeling” for 4 years, despite it’s having been pointed out to them many times before this.

Health Fitness Corp wins a Koop award for curing non-existent cancers in Nebraska

C. Everett Koop National Health Award Committee,


Wellness Council of America and Health Fitness Corp.


Short Summary of Award:

The C. Everett Koop award committee’s mission is:

“…to seek out, evaluate, promote and distribute programs with demonstrated effectiveness in influencing personal health habits and the cost effective use of health care services. These programs have the objectives of

  • Providing appropriate quality care
  • Sharply reducing the alarming rate of health care inflation, by holding down unnecessary expenditures.”

Materials Being Reviewed:

The brochure in question describing the Nebraska program is downloadable from the WELCOA website.

Case Study of Award Winner for 2012: Health Fitness Corporation and Nebraska

Summary of key figures and outcomes:

Alleged cancer outcomes include the following:

cost-saving catches

Risk reduction outcomes include the following:

change in risk factors

Questions for C. Everett Koop Award Committee:

I: Alleged Cancer Outcomes

Were you troubled by the program sponsors’ decision to waive all age-related colon cancer screening guidelines established by the government, and send out 140,000 flyers, at taxpayer expense, featuring a beautiful woman much too young to have a screening colonoscopy?

age related colon cancer screenings

ANS: Refused to answer

How come, when the program reported that 514 of the 5000 (or fewer) people screened had colon cancer (in addition to the ones who would have been screened anyway), none of the Committee members with health informatics backgrounds from Truven Health Analytics and Mercer and Milliman (and from Wellsteps and Staywell, both of whose programs are also highlighted) were concerned that this alleged 11% colon cancer rate was at least 100 times greater than Love Canal’s?

ANS: Refused to answer

When Health Fitness Corporation admitted lying and reversed their story from making “life saving, cost-saving catches” of “early stage [colon] cancer” to revealing that those 514 people didn’t have cancer, why did the Koop Committee re-endorse what would appear to be outright data falsification, instead of rescinding the award?

ANS: Refused to answer

Even if the committee is allowing Health Fitness Corporation to keep its award and not even apologize, why does this claim of “life-saving, cost-saving catches” still appear on the WELCOA website even though the lie has been admitted?

ANS: Refused to answer

Wouldn’t the fact that the perpetrator of this acknowledged lie is also a sponsor of this Koop award that its own customers have won three times (including this incident) create the perception of a conflict of interest?

conflict of interest?

ANS: Refused to answer

Does anyone on the Committee think if Dr. Koop were still alive that he would endorse your position on data falsification of cancer victims?

ANS: Refused to answer

WELCOA’s website said it was founded by someone who appears to be the inventor of the self-serve all-you-can-eat restaurant. Despite his well-deserved reputation for integrity, did he endorse data falsification of cancer victims even after the perpetrators admitted it?

Warren Buffet?

ANS: Refused to answer (but did change the spelling)

II: Risk Reduction Outcomes

How do you reconcile the claimed savings figure exceeding $4-million with your own chart above showing that only 161 active participants (3.1%) reduced a risk factor? (That chart of course doesn’t include dropouts and non-participants, whose risk factors may have increased.)

ANS: Refused to answer

Dividing the total savings by 161 yields more than $20,000/person in savings. Wouldn’t that $20,000+ for each risk factor avoided imply that all 161 would have had a heart attack even though the entire eligible population only had about 30 heart attacks the previous year, while the participating population would have had about 7?

ANS: Refused to answer

How do you reconcile your statement that 40% of the population had previously undiagnosed high blood pressure or high cholesterol with your other statement that “the total number of prescription scripts [sic] filled within the Wellness Plan reduced [sic] 3% last year,” despite your reducing or waiving the copays? Shouldn’t prescriptions have gone up, if indeed 40% more people were at risk?

ANS: Refused to answer

How can you attribute the 3% reduction in prescriptions to “improved lifestyles” with the fact that your own graph shows only 161 people improved their lifestyles enough to reduce a risk factor? What happened to the thousands who were diagnosed but were neither medicated nor improved their lifestyles?

ANS: Refused to answer

How do you reconcile that same finding – that 40% had high blood pressure or cholesterol — with that same graph, showing that almost three-quarters of the population was low-risk?

ANS: Refused to answer

How do you reconcile the brochure’s claim that the “majority of employees touted how the program has improved their lives” with the brochure’s own admission that only a minority of employees (42%) even bothered to be screened once and only 25% twice despite the four-figure financial incentive?

ANS: Refused to answer


Follow-up response

Not-for-attribution response received August 1, stating that the reason the Committee let them keep their award was not because were a sponsor but rather because they did not make the life-saving claim on their application.  (They did make all the other invalid claims.)  Because they didn’t make the claim on the application, they are not in violation of the Committee’s ethical standards by making it in other venues.

Our reaction:

So it is OK if a ballplayer admits using steroids as long as he didn’t happen to test positive?


Follow-Up Response

September 2014: Nebraska listed as a “best practice program” by Ron Goetzel

Our Reaction:

Doesn’t this listing contradict your initial excuse — that you forgot to ask them about whether they made up their cancer statistics during your due diligence — because now you know about that lie and all the other lies in their outcomes measurement…and yet you still call them a best-practice program?