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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

Orriant publishes wellness data in Journal of Workplace Health Management and no one cares

Orriant, Ray Merrill

Category:  Wellness

Short Summary of Company’s Marketing Claim:

“A New Scientific Study Proves Wellness Works”

Materials Being Reviewed:

http://www.orriant.com/File/4072ee6c-2bcd-43a5-83b6-e9035c8c0f1a

Questions for Orriant and Ray Merrill:

When you say “a new internationally-published study proves wellness works,” are you taking into account that the “international” journal publishing the work has a Zero impact factor, meaning that essentially no one believes anything they publish has enough value to cite?

ANS: Refused to answer

Are you attributing the fact that “participants had fewer health claims than non-participants” to your program, rather than to the obvious non-observable variable that participants are motivated whereas non-participants are not?

ANS: Refused to answer

Are you familiar with Health Fitness Corporation’s demonstration that participants will outperform non-participants even in the absence of a program? (See the year 2005 below — no program but participants outperformed non-participants nonetheless.)

total savings chart

ANS: Refused to answer

You also note that “those with the greatest health risks” had the most improvement.”  Are you familiar with Dee Edington’s work that says those with the greatest health risks will improve the most even in the absence of a program, due to the natural flow of risk?

Dee Edington's Diagram

ANS: Refused to answer

Non-participants’ medical costs were “2.9x greater” (about $4000 vs. about $1400).   This, of course, is the record for the hugest savings ever claimed from a wellness program.  Since government data shows that wellness-sensitive medical events account for only 4% of total costs or about $200/person, where did the other $2400/person in savings come from?

ANS: Refused to answer

Why didn’t the authors plausibility-check the entire population using a wellness-sensitive medical event analysis?

 ANS: Refused to answer

Viverae wellness primes its own pump for an EEOC wellness lawsuit

Viverae

Category:  Wellness

Short Summary of Company:

“Viverae gives our clients a platform for managing healthcare costs by motivating their employees to make healthy choices. Our comprehensive wellness programs address your organization’s goals to meet your employees where they are.”

Materials Being Reviewed:

viverae

viverae500

Questions for Viverae:

General:  What customers have actually signed up for this and are willing to admit it?

ANS: Refused to answer

Provision #2: Since your biometrics are out of compliance with USPSTF guidelines, wouldn’t a customer be risking an EEOC lawsuit by “requiring” every employee to do this against their will, subject to a large fine?

ANS: Refused to answer

Provision #4: Isn’t this the same as saying “If you sign up for two years, we’ll give you a third year maybe at a 20% discount if you do everything perfectly, but by doing so you waive your right to cancel after one or two years” ?

ANS: Refused to answer

Provision #5: Has any customer of Viverae or any other wellness vendor with 1000 or more employees completed HRAs and submitted to biometric screens at a 100% rate, as you require in Provision #2?

ANS: Refused to answer

Provision #6: How could a health plan get a positive return on this program by offering people $720 apiece, when wellness-sensitive medical events account for less than $200/person in claims spend?

ANS: Refused to answer

Speaking of Provision #6, if your very own website says savings are $500/person (I’d be curious what legitimate academic research supports that), how can you guarantee savings when the cost of the incentive alone is $720?

 ANS: Refused to answer

 

 

Dr. Aetna Will See You Now

Aetna

Short Summary of Intervention:

“Aetna is launching a pilot program to test the benefits of new FDA-approved, prescription weight-loss drugs combined with lifestyle support. – See more in this news release.

Summary of Aetna’s key points:

Self-insured employers can sign up for this program in which Aetna will outreach to obese employees and recommend use of the drugs Belviq and Qsymia

Questions for Aetna:

You are only offering this program to self-insured employers. If this is, as your title says: a “strategy to improve health status and reduce costs,” why are you denying this program to your own fully insured members, where the cost savings would accrue directly to your own shareholders while the health status improvements would benefit your own members?

ANS: Refused to answer

Does it concern you that neither drug in your pilot is approved in Europe and that JAMA Internal Medicine says the drugs have been associated with serious harms and that these well-respected JAMA physician editorialists state that these drugs should not have been approved for use in the United States?

ANS: Refused to answer

How does your description of these drugs on your sales slide as “safe and effective” square with the question above?

ANS: Refused to answer

Why, over the course of the 70-minute webinar (for which attendees were charged $300), didn’t you mention the JAMA essay or any other safety concerns?

ANS: Refused to answer

In addition to omitting mention of the potential harms in the JAMA article, none of your materials mention that the (many) known side effects include impacts on memory, attention and language. Wouldn’t those side effects be of concern to an employer who is interested in, as your materials say, increasing the productivity of the employees taking the drugs?

ANS: Refused to answer

Does it concern you that these drugs have been by and large rejected by patients and physicians, with sales for Belviq “well below even reduced Wall Street expectations” while Qsymia has been described as ”flailing” ?

ANS: Refused to answer

Does it concern you that, of any drug on the market, Belviq has the highest ratio of payments to doctors to overall sales?

ANS:  Refused to answer

Suppose an employee’s doctor won’t prescribe these drugs. Many doctors refuse to prescribe these drugs because of the side effect profiles (hence the very low sales figures). In that case, will you pressure the doctor to prescribe the drugs, get a list from the manufacturers of doctors in the area willing to prescribe the drugs and encourage the employee to switch doctors, or pressure the employer to tell the employee to drop out of this program they were just recruited into at your request? In other words, if the doctor doesn’t comply, will Aetna play doctor?

ANS: Refused to answer

Are you aware of any other health plans that will recommend name-brand drugs to members who call and say that they have obesity or any other disease?

ANS: Refused to answer

Are you aware of any other health plans that, rather than wait for members to ask for drug recommendations, outreach to members who have a disease in order to recommend proprietary name-brand drugs?

ANS: Refused to answer

Are you aware of any other health plans that outreach to members who do not have a disease, but only a high BMI, to recommend proprietary prescription drugs, especially prescription drugs that “have been associated with serious harms”?

ANS: Refused to answer

You said on your webinar that people who go off these drugs will “gradually regain weight.” In that sense, other than the $2400/year cost and “potential for serious harm,” how would this result different from any other diet, in that people who stop adhering carefully will gradually regain their weight?

ANS: Refused to answer


Any responses, apologies, retractions, changes etc. by the vendor are listed here:

June 23, 2014: Note from Ed Pezalla at Aetna, Vice President for Pharmacy Policy and Strategy:  “Thank you for reaching out and inviting additional dialogue.  We have a new article about the program that addresses many of your questions.  We expect to publish the article in the next week or so in Aetna’s Health Section.  I can send you a link once it is posted.”

August 11, 2014:  Ed Pezella sent an article that would “answer some of the questions“.    I am having trouble locating the answers in that article but perhaps that’s because I can’t find my reading glasses.

October 2015: Qsymia sales still “flailing.”   May be off the market by 2017.  Belviq struggling as well.  Aetna could have avoided this entire embarrassment in the first place if they had simply asked us if pitching obesity drugs to its customers was a good idea.  Come to think of it, they didn’t have to ask us.  They could have asked anyone with an IQ over 80.

May 2016: STATNews finds that obesity drugs — specifically these two — have been abject failures in the marketplace.

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