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For this year’s Deplorables Award, the winners were given a chance to fact-check in advance, and declined. No need for them to have wasted the effort — only one person, Keith McNeil, has ever found a material mistake in any They Said What posting
As in past years, we convened our panel of distinguished judges to address the age-old question about “pry, poke and prod” wellness programming: how is this stuff even legal?
After they get done contemplating that — and wondering why they’re the only people in the industry who seem to have ethics, an internet connection, and a triple-digit IQ — the judges reviewed the candidates for the coveted Deplorables Award. While any wellness vendor is eligible, they ruled out It Starts with Me, and US Preventive Medicine, since those vendors, whose claims are validated by the Validation Institute, apparently didn’t get the memo that you can’t succeed in this business without lying.
Ruling out those two dramatically narrowed the field down, to only about 1000. Narrowing the field even more, a few, like Provant, took themselves out of the running by going bankrupt. (Individuals are not eligible for the Deplorables Award, so we also need to rule out Ron Goetzel, despite his best efforts to make a late run at the trophy.)
This year, as in previous years, it boiled down to a battle between the very stable geniuses at Interactive Health vs. the people with very good brains at Wellsteps — more than coincidentally the 2017 and 2016 winners respectively. It was a close one. There are very fine people on both sides. Together with Mr. Goetzel, they constitute the wellness industry’s Axis of Genius.They both fabricate outcomes, flout guidelines, and harm employees, so it came down to a simple race to see who, in the wellness industry’s epidemic of very stable geniusitis, would be Patient Einstein.
The case for Wellsteps is compelling. To begin with, after a few proud possessors of high school diplomas observed that their fabricated ROI model will always return a “savings” of $1359 if you zero out inflation even if the smoking and obesity rates go from 0% to 99%, in 2018 they reprogrammed the model so that instead of always returning a “savings” of $1359 in the final program year regardless of what assumptions you input, an obvious rookie mistake that only an idiot wouldn’t notice when designing an Excel spreadsheet model, the model will always returns a “savings” of $1356 in the final program year, regardless of what assumptions you input.
Ah, much better, thank you.
Don’t take our word for it. Here it is. Note that for some reason the actual trendline on the graph doesn’t show up any more. You need to read the fine print instead. Here is what happens if you reduce smoking and obesity from 99% to 0%…
…and here’s what happens if your population already has 0 smokers and no obesity, so no improvement is possible:
If those columns of numbers at the bottom of each chart look identical, it’s because they are. This happens no matter what numbers you enter. (You are no longer allowed to enter increases in smoking or obesity like I used to do, so don’t even try. SPOILER ALERT: If you could, you would still get $1356 in savings.)
And, almost a decade after they first posted their ROI model, it still doesn’t calculate an ROI. Hello, do you see an actual ROI on this screenshot? At this point we’d settle for a phony one. (A real ROI estimation model can be found here.)
Their CEO has been featured on They Said What this year, with his take on the National Bureau of Economic Research’s invalidation of wellness outcomes. He accidentally admitted it was valid.
He claims to have spent “11 years in college.” Yet, even though that’s 4 years longer than Bluto Blutarski, he still can’t add the two columns of numbers he published that showed how badly his Koop-award-winning program for the Boise School District failed. Here are those two columns, a comparison of risk factors in the baseline year vs. one year into the Wellsteps program:
Here’s what happens when you actually add his two columns up — turns out there was a dramatic deterioration in Boise schoolteacher health status.
So it looks like that was, to paraphrase the immortal words of the aforementioned great philosopher Bluto Blutarski, 11 years of college down the drain.
The case for Interactive Health is equally compelling. After winning the Deplorables Award last year, they decided to double down on cluelessness, and so in 2018, they started a “smoking recession [sic] program.”
No one could figure out what they were talking about — apparently including the creators of their smoking recession program, who eventually took it off their website. My hunch was that they were trying to get smokers to switch to Parliament, which features a recessed filter, on the theory that the smoke would take longer to get into people’s lungs.
Later in the year they solidified their front-runner status with three more postings.
- A college intern was able to invalidate their claim that younger workers had more mental health issues than older workers, and that therefore you needed to pay Interactive Health to screen them;
- Next came Interactive Health-meets-Barbie, where they told someone whose HRA showed her to be severely anorexic that she was in a “healthy range.” We noted the irony that this is a company that wants to send almost half your employees to the doctor to treat “newly discovered conditions”…and yet here was someone who appeared to really have a condition that needed attention…and they missed it altogether;
- And just last week they cemented their candidacy by providing a cornucopia of misinformation about the EEOC.
That brings us back to the original question: how is it even legal to harm employees and completely disregard clinical guidelines, as these two companies are wont to do? Well, it turns out that, starting in 2019, it may very well no longer be. No, I’m not referring to the EEOC rule change. That will make companies liable to their employees for fining them, but it will still be legal to screen the stuffing out of them.
The good news is that apparently there will be a move afoot in the next session of Congress to prevent wellness companies from attaching penalties to screens that violate US Preventive Services Task Force guidelines — which is to say, most of Interactive Health’s and (according to Wellsteps’ CEO, Steve Aldana, himself), Wellsteps’.
If this bill were to pass, three things would likely happen:
- Employees would improve on health status;
- Employers would save money on wellness;
- Wellsteps and Interactive Health would throw up on Dean Wormer.
In a recent video that we urge everyone to watch, Steve Aldana of Wellsteps (proud recipient of the 2016 Deplorables Award) recently admitted that “wellness is the most researched topic in healthcare.”
He is absolutely right about that. There are dozens of studies showing that wellness loses money and often harms employees.
And he would know because he has produced a ream of research showing that Wellsteps’ very own program is arguably the worst program on the planet. I say “arguably” because Wellsteps’ Boise program may not be the worst program on the planet. It is only the worst program on the planet according to its own documented findings. I never thought I would say this, but I applaud Mr. Aldana! His willingness to tell the truth is admirable.
Funny thing about the wellness industry. Every other industry’s “research” always make their product look good. For years, cigarettes were safe–according to the tobacco industry. The oil and gas industry often publishes research showing there is no global warming. And Monsanto executives are probably the only people on earth who think Agent Orange is harmless.
Sure, critics can and do “challenge the data” those other trade groups publish, but to the credit of those organizations, at least they don’t accidentally disprove their own message in their own “findings.”
Quite the opposite in wellness. About 40 seconds in, Mr. Aldana says: “Critics of the wellness industry say that the studies are flawed.” No, Mr. Aldana, we are not accusing you of being “flawed,” or even of lying. We are accusing you of telling the truth, for once. The wellness industry is unique in that its own data is its own worst enemy. Remember the saying: “In wellness, you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself.”
While he showed great integrity by reporting the Boise outcomes accurately (and even exposed his results to a wider audience, albeit under duress), that display of integrity turns out to be out of character. Alternative fact-tellers need to have long memories, and his is apparently quite short. When he first reported the financial results, he made the impossible claim that Boise’s healthcare costs fell by a third, due to his forced wellness program even though flouting clinical guidelines and giving out questionable advice also caused a 20% increase in risk factors:
But his report was so long that by the time he got to the end of it, he had completely forgotten this alleged savings claim…and accidentally admitted costs actually increased. (He later suppressed the latter finding, but I always anticipate cover-ups by wellness vendors so I take screenshots before posting anything. It’s been said that the beginning of the end of “pry, poke and prod” was the day a millennial taught me how to capture a screenshot.)
Yes, you might note, the participants did marginally better than the non-participants (though the latter seem to have the momentum). And that brings us to his next claim in the video, where he laments the lack of randomized clinical trials. Actually, there have been two, the most recent one highlighted in the New York Times recently. And, yes, of course, they show “pry, poke and prod” has no impact. The NYT article specifically demonstrated that participants-vs-non-participants is an invalid methodology that will always show savings even if nothing happens. A vendor called Newtopia also did an RCT…and showed the same thing. 100% of savings was caused by the act of separating the two groups based on motivation…and when you re-combined them, there was no savings.
The wellness trade magazine had also previously admitted this, though as noted Mr. Aldana has a short memory.
Mr. Aldana closes by claiming that if I am right about wellness losing money, then all these CEOs and CFOs who still think it saves money are “idiots.” Well, if he says so. And this is not the first time he has dissed his own clients. When he was caught flouting clinical guidelines, he claimed his customer made him do it.
This statement — that “we must be right or else we would have been outed before” — is akin to Paul Manafort’s original defense to tax fraud charges: “If he was committing such large-scale fraud, why didn’t the IRS audit him?” Manafort’s attorney quickly backed off that defense. Like Paul Manafort and the IRS, the only thing that a company still using one of these vendors in the “Axis of Genius” proves is that the wellness industry excels in snookering them.
Please feel free to email a colleague about Mr Aldana. Not because we are asking you to, but because he is:
Those are my principles, and, well, if you don’t like them, I have others.
Rufus T. Firefly
Ron Goetzel seems to have very flexible principles, but let’s be kind and call them memory problems. How do we know this? He has taken completely contradictory positions on 14 occasions, having apparently forgotten the second time what he said the first time.
I know what you’re thinking: “Only on 14 occasions?”
Of course not, silly. I’m talking about 14 occasions during a single 90-minute period.
That 90 minutes was the so-called “Great Debate” between him and me a couple of years ago. Who won? Well, you don’t see him posting this debate on his website, do you? I didn’t post this until now because only recently has transcription software become sufficiently accurate. You can read/listen by clicking through on the time stamps in each section, any one of which also give you access to the entire thing.
These 14 snippets feature two sets of statements that would seem to be at complete variance with each other. While I’m not calling anyone a liar, it does seem that Ron is forgetful. Very very forgetful.
On his own willingness to correct his own mistakes
Minute 08:28 “Anytime we hear about things that are wrong, we look into them and try to correct them.”
Except when he forgets to do so, as in when he gives out awards to his friends who have publicly admitted lying and harming employees.
On the Penn State wellness program debacle
Minute 13:03 “I had nothing to do with Penn State.”
He might have forgotten that he participated in their press conference “taking the offensive in the wellness controversy.”
On his concerns for informing the wellness debate with facts
Minute 29:54 “And by the way, in doing research, we look for limitations. We look for critiques….I welcome public peer review.”
Except when he forgets to welcome critiques and public peer review, as when he circulates letters to the media telling them not to publish my critiques.
On my misdeeds and lack of qualifications to do peer review
Minute 30:38 “Some of the stuff that Al talks about and points out is right on the money and I agree and I said so in the Health Affairs blog that I’ve written, but some of the stuff is really out there. It’s outlandish.”
Except that he can’t seem to recall even a single “outlandish” example.
Al: “Ron, I appreciate your giving me credit for being qualified to do peer review. Would you say that I’m the most qualified person, in terms of number of mistakes found, to do peer review?”
Except when he is about to admit that I am…
Al: “Well, who has found more mistakes than I have?”
This might explain why he and his cronies always “forget” to ask me to peer review. Though for his most recent Health Affairs article, he did remember to list me as someone who he did not want to peer review his article. I reviewed it anyway — after publication…and, like most of his stuff, it spontaneously combusts upon exposure to any possessor of a triple-digit IQ.
On throwing his Wellsteps friend, Steve Aldana (proud recipient of the 2016 Deplorables Award), under the bus
Minute 34:03: “I’m not gonna answer for Steve Aldana.”
Hmm… he seems to have forgotten this bold statement when he “answered for” Steve Aldana after I blew the whistle on Mr. Aldana’s Wellsteps debacle in Boise. Ron defended him even though it meant acknowledging that Wellsteps is arguably the worst vendor in wellness history, as measured by self-admitted harms to employees, lies about outcomes, and misapplication of clinical guidelines.
On applying for the million-dollar reward
Minute 34:33 A million dollars is a lot of money and I’ll take it.
Except he forgot to apply. Even when I raised the reward to $3 million.
On his failure to observe that his own guidebook showed wellness loses money
Minute 45:14 “I was not involved in the chapter that looks at healthcare costs.”
Oops! He forgot that he and the other HERO board members and other collaborators spent “two years and countless hours of research and discussions” on this, as the first paragraph of the guidebook claims, and as the chapter’s author gratefully acknowledged. Also, Ron is considered HERO’s resident expert on study design and outcomes. He claims to have published 171 articles, mostly involving study design and outcomes. And yet, he says he simply passed on reviewing a chapter on study design and outcomes in his own organization’s seminal guidebook on this topic, because over two years he couldn’t find the time. Or maybe he just forgot.
On walking back his own guidebook
Minute 45:26 “Those numbers [in his guidebook] are wildly off…Every number in that chapter has nothing to do with reality.”
He must have forgotten this when he claimed the same thing in the Chicago Tribune: that wellness could achieve a 1-2% reduction in risk in 2-3 years. That works out, optimistically, to achieve almost the same $1 per employee per month gross savings “in reality” (before vendor and screening fees, of course) that his very same guidebook claims.
On the Nebraska scandal
Minute 53:54 “Yes, state of Nebraska did win the Koop award. They won the award because they had solid evidence. They improved the health risk profile of the population following a cohort population over time.”
His memory is playing tricks on him again. Their “solid evidence” quite conclusively demonstrates the opposite. Of 20,000 state employees, only 161 more reduced risk than increased it.
On his ability to evaluate the Nebraska outcomes
Minute 53:59 “They also use excellent methods in doing economic evaluation.”
He forgot that these “excellent methods” contained so many rookie mistakes that the Validation Institute uses this “economic evaluation” as the issue-spotter for their Advanced Critical Outcomes Report Analysis Certification. The entirety of Chapter 8 of Surviving Workplace Wellness is devoted to all the hilarity in this program’s design and outcomes. Indeed this program would save a ton of money if laughter were the best medicine. Here is the Omaha World-Herald’s write-up.
On programs that penalize employees with surcharges
Minute 01:00:55 “Health promotion programs that are evidence-based and that work are not surcharge programs that you [a questioner in the audience] described, and I agree.”
He forgot that he disagrees, and defends punitive surcharge programs (or at least to tries to)
On how programs don’t need to save money
Minute 01:15:57 “An ROI of one to one is good enough for me.”
He might have forgotten he told people to “expect a 3-to-1 ROI.”
On his commitment to improving population health
Minute 01:15:57 “You give me a dollar, you get a dollar back, but you have to document that you’ve improved population health… You have to show that you’ve improved population health. Not just one or two people, the entire population.”
On Medicare’s wellness program
Minute 01:25:43 “Randomized clinical trials show population participated in the program versus control had significantly improved health outcomes, did not cost Medicare a dime, cost neutral.”
He might have forgotten that the actual conclusion was: “Utilization and expenditures actually increased among participants, mirroring the experience in the corporate world.”
I’ve often recommended that Ron have his statements reviewed by a smart person before publishing them. I would now add, a smart person taking notes.
Special Bonus Feature: Ron “endorses” Quizzify…until he doesn’t.
Minute [42:57] “Did go on the [Quizzify] website. It was a lot of fun, very clever.”
See the punchline in the comments. Glad to know he thinks employee health literacy is worthless.
Note that this personal blog post does not necessarily represent the views of any organization with which I am affiliated, other than the one with which I co-founded. I am referring, of course, to the Needham Frisbee Club, where everyone is welcome to join and play and become fitter — since fitness at any size, not corporate crash-dieting contests, is the key to health.
By now, many facts are well-known about weight and weight loss programs:
- Variations in body size do not correlate with variations in willpower
- No one really knows why the country has gotten fatter since 1986, reversing the trend through 1985, and without understanding the causes of this fairly sudden reversal, it’s not possible to address it. (We do know that the lowering of cutoffs in 1989 created an additional 30 million “overweight” people in the U.S. overnight. http://www.cnn.com/HEALTH/9806/17/weight.guidelines/)
- It is much better to be “fit and fat” than to try to diet your way to health
- The vast majority of people who lose weight gain it back
- 1/3 to 2/3 gain back more than they lose
- No wellness vendor has discovered the secret to weight loss that has eluded researchers for decades
- The often quoted 90-95% failure rate of programs is likely underestimated.
Further, while perhaps not proven, there is growing evidence, also here, and here, that weight cycling may be hazardous to health. (This would likely be particularly true when an employer ties incentives to gaining weight for the first weigh-in in order to lose it by the second weigh-in.)
And, yet, a number of the workplace wellness industry’s very stable geniuses have chosen to body-shame employees. The individuals and companies listed below are the wellness industry’s leading body-shamers, charter members of the Body-Shaming Hall of Shame. No surprise that wellness luminaries are leading the charge towards body-shaming, as their industry has repeatedly been called words like “sham” and “scam” by Pulitzer Prize-winning media outlets not otherwise known for name-calling.
Where possible, we have provided contact information, that you can use to let the appropriate people know how you feel about endorsing body-shaming in the workplace. Obviously, one can never eliminate discrimination based on body type, but hopefully this exposé, and creating the Body Shaming Hall of Fame, will reverse the trend towards employer support of weight discrimination in wellness programs.
Troy Adams, Wellsteps
Wellsteps is known in general for harming employees, and won a Deplorables Award in 2016 for harassing Boise School District employees. Mr. Adams cemented his and Wellsteps’ candidacy for this list by declaring: “It’s fun to get fat. It’s fun to be lazy.” After receiving many complaints, he took that article down. But he never apologized and Wellsteps continues to pitch “wellness or else” programs in which employees are fined if they can’t lose weight.
Ignorance of physiology (fines and incentives have never cured any disease known to mankind) is quite consistent with the rest of Wellsteps’ philosophy. They also have no understanding of arithmetic (costs can’t increase and decrease at the same time), drinking (it is OK to have wine with dinner or a beer at a ballgame), smoking (smokers don’t take their first steps to quitting by smoking only on weekdays), nutrition (“one more bite of a banana” will not improve your health), and arithmetic again.
You can let Wellsteps’ largest client know how you feel about this by writing to the Boise School Committee at Jeannette.firstname.lastname@example.org and copying the editor of the local newspaper, Rhonda Prast, at email@example.com.
Michael O’Donnell, American Journal of Health Promotion
Michael O’Donnell served, until recently, as the prevaricator-in-chief of the industry trade publication, the American Journal of Health Promotion, which might as well be called the American Journal of Self- Promotion, for the simple reason that – despite the overwhelmingly poor economics of “pry, poke and prod” programs and their strong likelihood of harming employees – they have published only one single sentence critical of wellness…and when that was discovered to have slipped through pre-publication review by their thought police, they walked it back in the next issue.
Mr. O’Donnell was voted into the Hall of Shame thanks to his proposal to charge employees for insurance based on BMIs, a “pay what you weigh” approach, like ordering lobsters or sending a package.
- 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 outcomes analyst for a wellness company – because those jobs require only excessive lying.
- Employees above his ideal weight would pay per pound.
- 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?
We aren’t making this up. Here is an excerpt:
He claims that all these weigh-ins and fines will create an “insanely great program” for employees, whether they like it or not.
Vitality Group, Johnson & Johnson – and Ron Goetzel
Where would a wellness-related Hall of Shame be without Ron Goetzel? Name a debacle or scandal in wellness, and his fingerprints are on it. Penn State, Nebraska, McKesson, Bravo/Graco, and of course Wellsteps come immediately to mind.
He was also the very stable genius behind the Johnson & Johnson Fat Tax. The Fat Tax was supposed to be a game-changer, ostracizing overweight folks with the misfortune of working for publicly traded corporations. In this scheme, companies would weigh their employees and then disclose those weights to shareholders. The shareholders would presumably reward those companies doing the best job of reducing employee weight, creating more profit for the wellness vendors, like Vitality or Johnson & Johnson, who would help employees lose weight. Ultimately it would be a tax, in that every employer that did not hire a wellness company and/or fire fat employees would see its stock price tumble, making wellness a mandatory fee.
While this “fat tax” would go a long way towards achieving the Wellness Ignorati’s goal of monetizing body-shaming, bringing financial disclosure into the picture raises all sorts of regulatory issues. Could you force employees to be weighed in order to meet SEC disclosure rules? What if employees cheated on the weigh-in, as employees are wont to do? Would that create a Sarbanes-Oxley violation?
There are three ironies here. It turns out that companies that are obsessed with prying, poking and prodding their employees, like McKesson, watch their stock prices tumble. And companies specifically obsessed with goading their employees into crash-dieting contests, like Schlumberger’s chart below, have the worst stock performance of all.
Second, it turns out that Vitality can’t get its own employees to lose weight, and yet they want you to hire them to get your employees to lose weight.
Finally – and this shouldn’t come as a surprise to anyone – there is zero correlation between employee weight and corporate performance.
Mr. Goetzel works for Johns Hopkins and often places their name on his essays. If you have an opinion on whether Johns Hopkins should be supporting institutionalized body-shaming, you can express your opinion by writing to Dean Ellen MacKenzie at firstname.lastname@example.org .
Dr. Delos “Toby” Cosgrove, president of the Cleveland Clinic. After commenting that he would not hire smokers at the Clinic, he added that he would not hire obese people if he could legally deny them jobs.
So he doesn’t want to work with obese people, except if they happen to be president.
Dr. David Katz coined the term “oblivobesity” because apparently, he feels we have not yet made larger people feel bad enough about themselves to force them to do something about their weight – the difficulty of which has apparently been overstated because, according to Katz writing in the Huffington Post:
“There are rare cases of extreme weight loss resistance and such, but by and large, we can lose weight and find health by eating well and being active. Really.”
He deftly rebuts 30-plus years of consistent and conclusive research to the contrary by adding “really” to the end. Because everyone knows that makes a statement true. Really.
He also continues to illustrate his postings with pictures of headless fat people. And then there is his defense of Dr. Oz.
Please feel free to contact us about additional “shamers” you would like to add to the list along with the reasons why.
Often I don’t have time to write a full blog in my own words, but fortunately I usually don’t need to. It’s enough to quote the words of the very stable geniuses in the wellness industry verbatim. Being quoted verbatim, of course, is one of these geniuses’ worst nightmares.
Among the most stable of the wellness industry geniuses is Steve Aldana, CEO of Wellsteps, winner of the 2016 Koop Award as well as the 2016 Deplorables Award. How does he report the National Bureau of Economic Research’s complete evisceration of wellness industry research methods? Let’s take a looksee at the highlights of his posting.
First, it appears that two opposing studies, “one for and one against wellness,” came out “at the same time.”
One the one hand, someone — apparently he doesn’t know who — seems to say that there “wasn’t much improvement” at the University of Illinois. And something must have been wrong with this result, because “these results contradict over 90% of publish [sic] studies.”
“At the same time,” a publication no one has heard of found the opposite: health behaviors improved for “over 2 full years” in — get ready — one of Wellsteps’ very own accounts.
This is a textbook example of a false equivalence, the wellness version of: “You also had some people that were very fine people on both sides.”
To begin with, the researchers in the first group weren’t just any old researchers. This was the National Bureau of Economic Research (NBER). And the NBER didn’t say “they didn’t see much improvement.” Their specific words were that the causal effects were — get ready — nearly indistinguishable from zero for nearly every outcome.
Further to say this conclusion “contradicts over 90% of published studies about wellness,” would be like saying Galileo’s findings “contradicted” over 90% of published studies about astronomy.
The study’s actual conclusion used a slightly different verb:
Our 95% confidence intervals rule out 78 percent of previous estimates [of the effect of wellness] on medical spending and absenteeism from the prior literature. [Let me translate that, in case the words are too long for the very stable geniuses at Wellsteps to understand: you and all your very stable friends have been geniusing about savings for decades now.]
The reason the NBER was able to be so conclusive is that, to quote one of our Alert Readers, Robert Dawkins: “They foolishly included a valid control group.” Kudos to Mr. Dawkins for that very unstable moronic observation. (In any event, far from contradicting other research, the study is quite consistent with most articles on wellness not written by someone feeding at the employer wellness trough.)
The other journal, which published an article “at the same time,” found an improvement in healthy behaviors. That journal is called Health Promotion Practice. And if you haven’t heard of it, you’ve got company. Their “impact factor” is the lowest in an industry whose journals are notable for low impact factors. I googled quite extensively, and it appears — get ready — that no article from this journal has ever been cited, excerpted or even had the fact of its very existence even grudgingly acknowledged in the lay or scholarly media.
By contrast, the NBER article has been picked up everywhere — except of course by the wellness industry. See if you can find any reference to this article — or AARP v. EEOC, which was also national news — on the Health Enhancement Research Organization website.
Turns out there’s a reason no one cites this journal. It’s because it’s so genius. Exhibit A is this very same article, a rehash of the Boise School District findings that somehow overlooked the key finding, which is that the employees got unhealthier during Wellsteps’ program. Instead, the author — displaying not the slightest intellectual curiosity as to how this could possibly be true — reports the most genius findings we’ve ever seen in a journal:
- only 3% of Boise School District employees smoke, and…
- …they smoke only 4 days a week.
Perhaps — just playing devil’s advocate here — the other 17% of Boise employees who smoke (Idaho has a 20% smoking rate) might have lied on their health risk assessment? The “tell” is that everybody knows smokers don’t smoke only 4 days a week. Obviously, they smoke 5 days a week, with time off for weekends, major holidays and Beethoven’s Birthday.
Very stable genius that he is, the author (both a friend of Wellsteps’ Mr. Aldana, according to the disclosure statement, and also a genius who has already been profiled on this site for his previous insights) also admits that with a high non-participation rate and a 20% dropout rate:
There exists the possibility of selection or dropout bias that could have influenced the results reported.
Ya think? Maybe just a tiny bit?
But wait…there’s more
We’ve highlighted Mr. Aldana’s phrase “at the same time” describing how these articles were simultaneously published. We repeated the phrase in three separate places above for emphasis because — get ready — these two results were not published at anything like the same time.
To begin with, Mr. Aldana has been very stably geniusing about his Boise results for more than two years now. (See my article from September 2015 accurately forecasting that, thanks to the number of obvious errors and self-immolating contradictions, this study would win a Koop Award. And of course the Boise employees got harmed.)
This article, using that same data set, was published last July, whereas the NBER article just came out a few weeks ago. Perhaps in some geologic sense July 2017 and January 2018 are “the same time,” but imagine if the rest of the world defined “at the same time” as “six months apart.” For instance, let’s join Sherman and Mr. Peabody in the Wayback Machine and set the dial for June 1944:
Eisenhower: “OK, we’ll storm Omaha and Utah Beaches, and you guys can storm Juno and Sword Beaches at the same time, and then we’ll hook up and say…”
Churchill: “…Merry Christmas, chaps.”
For a good time, try googling on Wellsteps.
This completes our year-end series on the Goofuses and Gallants of the wellness industry. See:
- Announcing the 2016 Deplorables Awards
- Wellness Industry Stars of 2016
- So Many Candidates for the Deplorables Award Countdown, So Few Numbers between 1 and 10
- Wellness Stars of 2016, Part 2.
Are you smarter than an award-winning wellness vendor? Take this quiz and find out.
Q: How is the first unlike the second?
The first, Wellsteps CEO Steve Aldana, claims that it’s bananas that provide magical powers. And unlike Popeye and spinach, he doesn’t think we need to consume massive quantities. “Even one more bite of a banana” is all it takes to reduce overall costs by fully a third, despite their admission that costs for individual employees increase by about the same amount over the same period.
Yes, you read that right, and, yes, is it mathematically impossible for a number to go up and down at the same time. I noted in Wellsteps Stumbles Onward that Wellsteps had accidentally told the truth on the second display showing increasing costs, thus totally contradicting the first. The second display subsequently disappeared.
Perhaps Wellsteps deliberately made up the first slide to fool people (in this case, the Boise School District). The more charitable explanation, which shows Wellsteps in a better light, is that they didn’t deliberately lie when they said costs increased and decreased at the same time. Instead, they were simply confused by their own stupidity.
Lying is a Business Strategy
Wellsteps’ Linkedin group is called Wellness is a Business Strategy. I was banned from posting on it, accompanied by the following invocation of the First Amendment:
“It has come to our attention that an outspoken critic has entered false data into these calculators in order to make a point. We certainly support free speech; however, we wonder how valid the point can be when it is based on false data?” [Where “false data” is defined as “any data”]
Sounds like they support free speech…except when they don’t. Speaking of supporting free speech, they claimed in bright red letters — for no apparent reason other than they were probably suffering withdrawal symptoms from having gone a whole week without lying — that they had convinced Linkedin to ban us from posting. And yet many of you clicked through from linkedin. So here we are, posting.
Stupid is a Business Strategy
Wellsteps’ ROI model doesn’t generate an ROI. It doesn’t even generate a savings projection. What does it “generate”? One number: $1359. Yes, it always gives the same answer ($1359 savings per employee) if you zero out “annual cost increases” in their model to control for inflation. So anyone can see this model simply makes no sense, notwithstanding Wellsteps’ insistence that it is “based on every ROI study ever published.”
How stupid is Wellsteps’ model? Even Ron Goetzel refused to defend it. And when Ron Goetzel won’t defend stupid data fabricated by his friends, you know it’s bad.
Harming Employees is a Business Strategy
To win the Deplorables Award, outlying and outstupiding other vendors is a dicey strategy due to all the competition trying to do the same thing. So Wellsteps decided to boldly go where no vendor has gone before: they acknowledged, even bragged about, harming employees. Sure, plenty of vendors harm employees–by enticing them into crash-dieting contests, flouting clinical guidelines or giving them worthless nutritional supplements and billing their insurers. But no one had ever documented the before-after harms of wellness as conscientiously as Wellsteps did, which I helpfully displayed in detail.
Insults are a Business Strategy
What the judges here at TSW especially liked about Wellsteps’ candidacy for the Deplorables Award was their track record of not just harms and deceit, but also insults. Very clever ones too.
For instance, Wellsteps’ rebutted my observation that all their data is fabricated by saying I’m full of “hot air.” Touche!
One would think that that this guy (Mr. Aldana’s crony) could have come up with a better counterargument, given that he claims to have spent “11 years in college.” If you’re keeping score at home, that’s four more years than Bluto Blutarski.
Here are a few more targets of their ripostes:
- Everyone who is overweight: “It’s fun to get fat. It’s fun to be lazy.” They skewered 2/3 of the population in 10 words. Bada-bing!
- Sharon Begley, arguably the best health/science journalist of our generation. Mr. Aldana called her a “lier.” Her crime? Quoting him verbatim.
- WELCOA‘s exemplary leader, Ryan Piccarello. For not wanting to harm employees, Ryan is apparently part of a “gang of bullies.”
Such brilliant repartee, in an earlier generation, would have landed them a seat at the Algonquin Roundtable.
Bananas are a Business Strategy
So, congratulations to Wellsteps for winning their first Deplorables Award. Darwin will take it from here, and maybe get them a new gig more appropriate to their capabilities.
For this year’s Deplorables Awards, I think we’re gonna need a bigger basket. As a result, this will be a two-part series.
Why? Because we need to accommodate all the bad hombres and nasty women who have subverted the perfect elegant philosophy of wellness into nothing more than a profit machine, with no regard for integrity, customers, or employees.
Yes, 2016 was a year in which a record number self-anointed industry leaders gave lying and cheating a bad name. In that sense it was no different from any other year, though 2016 offered even more good news and bad news:
- The bad news: not content with merely lying and cheating, this cabal branched out into harming employees, fat-shaming, and pure misanthropy;
- The good news: wellness did succeed in one way, as a “natural experiment” showing what happens in healthcare if being a provider requires no credentials beyond a GED, a driver’s license, and a pulse.
Indeed, whatever mathematician first postulated that everyone can’t be worse than average had apparently never experienced the wellness industry. (Exceptions of course, being the few that, like Quizzify, are validated by the Validation Institute or have accepted the Employee Health Program Code of Conduct.)
#10 Optum and Wellsteps (Runners-Up);
What do you do when you need to defend your blatant disregard of the US Preventive Services Task Force guidelines? Simple — you blame your customers. Optum’s Seth Serxner said: “Customers make us” do this. Optum’s PR hack said I was making Optum “look bad.”
I said: “Sure, I’ll apologize. Just name one account that will admit to insisting on paying a higher price than you wanted to charge, in order to screen the stuffing out of their employees.” Never heard from them again.
#9 The Johnson & Johnson Fat Tax gives misanthropy a bad name. (Honorable mentions to Vitality and Ron Goetzel.)
Misanthropy, greed, and weight-shaming provided the wellness industry with its key “talking points” in 2016. And nothing combined the three like the Johnson & Johnson Fat Tax fiasco. The point of the (apparently stillborn) Fat Tax was to stigmatize overweight employees, by “pressuring” (their word) companies into disclosing to shareholders how many fat employees they had. That in turn would somehow pressure these employers into spending more money on wellness vendors.
It’s not altogether clear what that disclosure would do for the actual overweight/obese employees, but somehow this disclosure was supposed to allegedly benefit shareholders. Indeed, the Fat Tax cabal is right about that in one respect: this disclosure would benefit shareholders — it would indicate to shareholders that they ought to unload their shares in a hurry, because management just disclosed it is stupid.
Vitality was a co-conspirator in hatching this scheme, which is ironic because they admitted they couldn’t even get their own employees to lose weight. And where you hear the word “stupid,” can the name “Goetzel” be far behind? This whole thing was his idea, based on the notion that “playing doctor” with employees makes stock prices increase. However, his claim that companies with Koop Award-winning wellness programs outperformed the market can easily be invalidated by anyone with a calculator and a triple-digit IQ.
#8 IBISWorld: How is wellness different from King Midas and Gold?
Here are links to the postings on the most hilarious report we’ve ever read about the wellness industry:
- New wellness industry report costs $5400 (but that includes shipping)
- New report raises the bar for cluelessness in wellness
- How is wellness different from King Midas and gold?
The answer to the question in the header? Everyone who touches wellness turns to stupid. Not just garden-variety stupid. More like fifty shades of stupid.
Mind you, most wellness industry leaders don’t need to touch anything first before reaching that endpoint, but occasionally a company like IBIS, with no prior experience in wellness, ventures into this field — and that’s where the fun starts. These IBISWorld Young Turks (literally–the writer is named “Turk”) are so excited about this industry, they practically speak in tongues:
Wellness firms may offer employers stress management courses and sessions that offer music therapy, aromatherapy, Tai Chi, and post disaster stress reduction through coaching.
Government-funded initiatives that promote wellness to cut costs related to chronic ailments (e.g., obesity and diabetes) has further exacerbated many businesses movement toward purchasing corporate wellness services.
And my own personal favorite:
The industry provides wellness programs to businesses across the United States, including small, medium and large businesses in the private sector and businesses in the public sector.
“Businesses in the public sector”? I knew that many of our legislators are for sale but I didn’t realize they had incorporated.
Healthfairs USA doubled down in 2016 on lying and cheating with an elegant new strategy: insurance fraud. They not only harm employees, but bill insurance companies directly for the privilege of paying for those harms. They offer cancer tests that are “99% accurate” (hence their multiple Nobel Prizes), and over-the-counter nutritional supplements…all of which are covered by most insurance companies because they get a doctor to sign a claim form.
Disclosure: we aren’t entirely sure that billing insurance companies for USPSTF D-rated screens and worthless, possibly harmful, pills constitutes insurance fraud. Our opinion is probably no more accurate than their cancer tests.
In 2014, Aetna decided to “play doctor” with obese members of self-insured customers by telemarketing their employees to pitch very controversial high-priced drugs whose sales are “flailing” because almost no patients seem to want to take them. Among other things, Aetna said these drugs increase productivity even though right on the label, the drugs warn that they could reduce productivity (attention span and language facility).
Not content with the warm welcome that scheme brought them, in 2015 they introduced a DNA-based wellness program and claimed a whopping $1464/participant in savings. What put the whop in that whopper were these two tidbits. These savings were achieved:
- in the first year alone;
- on participants who were not actually sick to begin with. (You couldn’t qualify for this study if you were already sick.)
The reason Aetna needed to fabricate such a high savings figure is that the wellness field requires ROIs greater than 2-to-1, and this DNA test sells for $500/employee. So you need to show savings between $1000 and $1500.
Also, in 2015, we were able to show the program was completely ineffective, a convincing enough demonstration that one of the board members of the journal that published the study with the $1464 claim publicly apologized.
What do you do when it turns out your science is all wrong (news flash: being told you have a gene for obesity doesn’t motivate you to lose weight) and your math is all wrong? Of course, you apologize and retract the study, and offer to return the money to the lucky few companies that signed up for your program.
Haha, good one, Al. Obviously, like all the other Deplorable Award-winners on this list, you sell your snake oil harder than ever, and that’s what gets them on the 2016 list. Whereas in 2015, they could use the dumb-and-dumber defense, this year they know the numbers don’t add up and yet they are still flogging it.
Don’t miss the slam-bang conclusion as we count down to #1. Will Ron Goetzel retain his crown, or will he be unseated as the wellness industry’s #1 Deplorable?
Yes, we realize he has already appeared on this list at #9, but many lists feature the same entities making multiple entries. For instance, the Beatles once held positions #1 through #5 in Billboard’s Top 40, so it can be done.
Not that I want to put any ideas in his head.
There are three ways to win a debate:
- Cite facts that support your position.
- Be smart enough to win a debate even though the facts go the other way.
- Break your opponent’s microphone.
Let’s consider each possibility in turn:
- Not a chance–Wellsteps won a Koop Award. When was the last time you saw a bona fide fact in a Koop Award application? Certainly STATNews doesn’t seem to have found any. And if Wellsteps had an actual fact in their favor — meaning if we were wrong about one single solitary thing — don’t you suppose they would have stumbled onto it by now? Don’t you suppose that just one of their insults would be grounded in reality? In the immortal words of the great philosopher Rick Perry, even a broken clock is right once a day, so the score is: Broken Clocks 1, Wellsteps 0.
- Smart? Hello! We’re talking Steve Aldana and Wellsteps here, not to mention Troy Adams, the originator of the Wellsteps tag line: “It’s fun to get fat. It’s fun to be lazy.“
- Bingo. That’s what Wellsteps just tried to do. When all else fails, cheat. They tried to get Linkedin to shut us down for “bullying” them by adding up their own numbers. Here is their exact “update,” which they were kind enough to put in red so you can’t miss it. To paraphrase the immortal words of the great philosopher Michelle Obama, when they go low, we go paste:
And yet you may have just clicked through to this post from Linkedin, meaning that reports of our death (me and Jon Robison of Salveo Partners) are greatly exaggerated.
The irony is, Wellsteps doesn’t understand irony
The irony is, what greater form of bullying is there than to try to muzzle someone whose only crime was to agree with Wellsteps’ own data?
The other irony is, Wellsteps’ CEO recently wrote: “We certainly support free speech:”
It has come to our attention that an outspoken critic has entered false data into these calculators in order to make a point. We certainly support free speech; however, we wonder how valid the point can be when it is based on false data?”
I guess, to paraphrase the immortal words of the great philosopher John Kerry, Mr. Aldana was for free speech before he was against it. (Is “entering false data” like “bearing false witness”? If so, we yield to Wellsteps’ expertise. And we did enter every combination of data imaginable into their “calculator.” It always gave the same answer. Try it. It’s like wellness savings measurement-meets-Fisher-Price. Just make sure to zero out inflation.)
Being in the “integrity segment” of this industry, we aren’t exactly big fans of Ron Goetzel, and the longer he lets his cronies at Wellsteps keep their Koop Award, despite it now being well-established that they harmed employees in multiple ways, the more his own sullied reputation suffers. However, we will acknowledge one thing that Ron Goetzel excels at, and that’s ignorance. He is great at ignoring facts, ignoring data…and, most strategically, ignoring us. Indeed, as the leader of the Koop and HERO cabals, he inspired the collective noun “the Wellness Ignorati.” He knows better than to debate us, because the Wellness Ignorati always lose debates, even when they break our microphone.
Here’s a similar apology, for Professor Baicker’s infamous “Workplace Wellness Can Generate Savings” meta-analysis claiming the 3.27-to-1 ROI from wellness that RAND also eviscerated:
I had been quite adamant in the previous post that this meta-analysis was likely just a gold-plated package of garbage case studies. I compared it to packaging subprime home loans into AAA-rated collateralized mortgage obligations (CMO).
That was before I looked at the individual studies comprising this meta-analysis. I realize now that comparing the Harvard Study to the CMO scam was unfair. So I owe an apology to Bear Stearns, Lehman Brothers, and Countrywide.
Next, I apologize for pointing out that Ron Goetzel, as recently as last week, is still quoting this very same thoroughly discredited 7-year-old study, as well as many other outdated analyses. For example, he insists on continuing to quote the New York Times economists’ September 2014 analysis that wellness programs “generally” don’t work, even though they subsequently made their conclusion much clearer: “We’ve said it before, many times and in many ways: workplace wellness programs don’t save money.” They then specifically criticized Mr. Goetzel’s own methodology (“industry studies based on study designs that cannot produce valid causal estimates”).
I apologize for thinking that this deliberately selective misinterpretation of these economists’ previous conclusions makes him sound deceitful. And I apologize for being sure that the people who forwarded me this slide would agree with that assessment. And I apologize for once again making phony apologies.
The real apology
Now that I’ve checked off the usual Wellsteps-and-Goetzel-integrity boxes, it’s time to step out of character and seriously apologize. Here’s what I did that I really do need to apologize for: not cutting wellness professionals enough slack on giving them enough time to learn what took me several years to learn about wellness losing money.
I was once guilty myself of believing this 3-to-1 ROI nonsense, specifically about disease management (DM). Why DM in particular? I had some ego wrapped up in it because I am actually credited with inventing DM. Really. Just google on “invented disease management.” Whether or not I did (and plenty of others could share the credit), I was not just drinking the DM Kool-Aid. I was mixing it up and selling it to others.
Then, 10-12 years ago, a few people told me none of the DM savings numbers added up. I didn’t believe them. I thought it was sour grapes because they missed the boat.
True, I had enrolled a few of my own extended family members and friends into DM programs. Vendors were more than happy to offer me their best nurses, VIP treatment, you name it. Yet no one I referred thought these free programs were even worth a second free phone call.
Nonetheless, I was sure that somewhere there existed a whole lot of employees who did benefit from DM. Yes, in my fantasy world tons of people really appreciated these unsolicited calls from their health plan offering to help. After all, who among us doesn’t trust an unsolicited caller from their health plan offering to help?
In my worldview, the lucky recipients of these calls would respond: “You’re right. I should be taking my pills. Hey, thanks. I never would have thought of that on my own. And I was just about to have a heart attack, so you saved a ton of money.”
Yes, I realize this made no sense. Yet I never questioned my own findings. Basically, I ignored the warning signs about DM’s sketchy economics for years. When I finally had the epiphany, it got quite the headline:
Once I questioned my own figures, the rest because immediately obvious to me — one after another after another, sets of numbers in this field simply did not add up. Wellness was a far worse offender than DM, which does appear to roughly break even or better. No surprise about wellness. Screening costs about 10 times as much as DM and whereas people who qualify for DM are already well down the slope to infirmity, screens are performed mostly on healthy employees, who can’t generate any savings. (We of course support screenings according to guidelines, for the health of employees rather than an ROI. But most vendors ignore guidelines and screen the stuffing out of employees.)
Still, it had taken me years to have the initial epiphany…and yet now I was quite curt and dismissive with other people who didn’t immediately get it, and were defensive in support of their lifelong assumption. I was basically saying to others in the field: “You know all those savings claims? Total malarkey. Prying, poking and prodding doesn’t save any money.” I’d expect everyone else to get this right away. When they didn’t, I was not gracious with them in many cases.
Over time, a large number of folks have come around. They did it at their own speed, same as I did. Take WELCOA, for example. They were among the worst (and God bless ’em, funniest) offenders…and yet now you won’t find an organization more committed to getting wellness right, helping employees, and being honest than WELCOA. (In their case, a night-and-day change of leadership helped.) I’m not just saying this–I’m walking the walk. Quizzify is joining WELCOA’s Premier Provider Network for 2017, joining vendors I have a lot of respect for, like It Starts with Me, Populytics, and SelfHelpWorks. The first two, also like Quizzify, are validated by the Validation Institute.
Making good on the apology
A good apology comes with an offer to make it up. So if you feel like I dissed you prematurely, while you were learning wellness economics on your own, you can have one of:
- a free pdf of any of my books — Surviving Workplace Wellness, Cracking Health Costs, or Why Nobody Believes the Numbers
- half-price on a hardcopy of those books (order direct, not through Amazon, of course)
- a free analysis of any outcomes report
- a free month of Quizzify with no commitment (there is a minor asterisk on this one, please inquire)
Steve Aldana, CEO of Wellsteps, finally defended his program for the Boise School District. It took him a while presumably because he had to retain a team of biostatistical consultants to discern the flaws in critics’ arguments against it. After analyzing all the data, these biostatisticians were finally able to compile a list of the mathematical and clinical flaws in our apparently erroneous conclusion that Wellsteps harmed Boise employees and fabricated savings and raised lying to an art form.
I apologize in advance to those lay readers without a strong background in biostatistics. You may have trouble understanding the mathematical subtleties in Mr. Aldana’s arguments. But I’ll repeat them verbatim nonetheless. According to Mr. Aldana, wellness critics are:
- “Great at writing click bait”
- “Great at creating BS out of thin air”
Leave aside his creative spelling and his mixing of cliches. Focus instead on his novel interpretation of Lavoisier’s law of conservation of mass, which states that nothing can be created out of thin air. Notwithstanding Mr. Aldana’s claim to the contrary, this law would seem to particularly apply to bovine excrement, the end result of a complex biochemical and physiological process, one which he would seem to have great familiarity with, as we’ve noted multiple times in this website. However, we encourage Mr. Aldana to try to undertake this endeavor, because at least his efforts won’t harm anyone, which is more than can be said for his wellness program.
Kudos to Dave Chase for posting the STATNews expose of the Wellsteps program, so that Mr. Aldana could respond. Mr. Chase, who is producing a documentary called The Big Heist on wellness and other healthcare ripoffs, is obviously goading Mr. Aldana into writing some material for him, and Mr. Aldana obliged. Rather than create a news cycle, where the Wellness Ignorati inevitably lose, he should have followed the lead of Ron Goetzel and simply ignored me. Indeed, if there is one thing that Ron Goetzel excels at, other than doctoring data and lying about outcomes, it’s ignoring me.
In addition to calling me a lier, he also called the author of the STATNews expose, Sharon Begley, a lier. I won’t question the wisdom of alienating the media, but I would question whether someone of Ms. Begley’s impeccable credentials (listed here on her Wikipedia page) could possibly have received all the accolades and awards she has amassed for health/science reporting if indeed she couldn’t find all the obvious flaws in a Koop Award application.
The linkedin thread is pasted below and I’d encourage reading it. Don’t make me beg.