Tag Archives: validation institute

Are Your Vendor’s Claims Valid? (Part 2)

The first installment covered regression to the mean. This installment features the fallacy of using non-participants as a control for participants.  This “control” fallacy led the Food and Drug Administration to reject this methodology more than half a century ago. 

And, as we’ll see through examples below, correctly so.

The news of the fallacy and its rejection never reached the employee health services industry—or maybe it reached the industry altogether too well. Either way, vendors of wellness, diabetes, disease management and orthopedic programs routinely compare participants with non-participants, or measure just on participants alone.  Buyers don’t insist on controlling for participation bias, largely due to lack of understanding. Vendors not validated by the Validation Institute (VI) rarely offer to control for participation bias. Such a control would undercut their own performance claims, because participants always outperform nonparticipants. 

Indeed, one of the most dramatic savings figures was achieved simply by separating employees into participants and non-participants, without even giving “participants” a program to participate in.

Participation bias is even more invalidating in employee health services than in drug trials. The latter usually require only taking a pill and tracking results. The former require very active participation. Further, those who initially volunteer and then drop out are never counted as participants. Often, the dropout rate is never even reported. The result is what’s known in the industry as “last man standing” programs, because the only people whose outcomes are counted are the initial voluntary participants who stuck with the program the entire time. 

This study design is a recipe for massive invalidity. Not surprisingly, it has been proven four times that 100% of the alleged outcome of a program using this study design is attributable to the design, rather than to the intervention itself. 

This explains why VI-validated programs – programs that self-select to apply for VI validation because they actually accomplish something – make such modest claims, as compared with invalid vendors. It’s because modest claims are what they actually achieve…but modest valid claims trump massive invalid claims.

“Accidental” proofs of study design invalidity

The beauty of the first two proofs below is that they constitute what a litigator would call “declarations against interest,” meaning that the perpetrators’ own statements invalidate their own arguments. The wellness promoters who conducted these studies accidentally proved the opposite of what they intended to prove, without acknowledging it in the first case, or realizing it in the second.

 These two cases, discussed at length here, are summarized below:

  1. Using the same employee subjects, a program measured outcomes both ways: through a high-quality randomization and also through participants-vs-non-participants; 
  2. As mentioned, participants were separated from non-participants but not offered a program to participate in.

In the first case, a large group of employees without a diagnosis of/history of hospitalization for diabetes or heart disease was divided into:

  1. Group A, to whom invitations to participate would be offered;
  2. Group B, employees “matched” to the invited group using demographics and claims history, for whom nothing special was done.

See also: Are Your Healthcare Vendor’s Claims Valid?

The population was separated before any invitations were issued to Group A, making this a valid — and extremely well-designed — comparison. The “invited” Group A then included both participants (about 14% were willing to submit to the program, of which almost a quarter dropped out, leaving 11%) and non-participants.

The intervention was to use people’s DNA to tell them they were at risk for diabetes or heart disease, and then coach them. Because there were no hospitalizations or ER visits specific to those events beforehand as part of the study design, it would be arithmetically impossible to reduce the relevant hospitalization rate of 0. And yet “savings” of $1,464 per participant was claimed for the first year for the “last man standing” group of the 11% of Group A invitees who actually completed the program, vs. those Group A invitees who declined the invitation.

A cynic might say this massive savings figure was chosen because the program itself cost $500…and a program needs to show an ROI well north of 2-to-1 to be salable.

Using the valid randomized control methodology, the participants, dropouts and non-participants were then recombined into the full “invited” Group A…and compared with the control Group B. Though no cost comparisons were offered, there was essentially no difference-of-differences between these two groups in any relevant clinical indicators. While all changes in both groups were fairly trivial, the latter three trended in the “wrong” direction for the Group A vs. the Group B control.

Along with the fact that there were no relevant hospitalizations to reduce in the first place, the near-total absence of change in clinical indicators makes it impossible for any savings to be achieved, let alone $1,434 per participant, perhaps the highest first-year claimed savings in history. 

This excerpt courtesy of the Validation Institute. For the smashing (and needless to say, hilarious, this being the wellness industry) conclusion, click through here.

Employers: Don’t Pay for ‘Never Events’

The initial installment in this series expressed concern that too narrow a focus on wellness diverts companies’ attention from more compelling opportunities to save money and improve employee health outcomes. This installment starts with a related  shocker: By far the most costly inpatient diagnosis code, septicemia, is not addressed by any wellness program in the country.

Here is the government’s official ranking:


Septicemia due to contamination, which is just one of many avoidable hospital errors, shows that there is a major opportunity to save money by directing employees to hospitals that are most likely to avoid errors. To back their commitment to avoiding errors, such hospitals also usually offer a “never-events” policy, meaning they agree not to be paid for events that are their fault and that should never happen. So your employees will be more likely to have a safer experience—and, if they don’t, you don’t pay. (To be fair to hospitals, not all septicemia is contracted there. At the same time, many blood infections contracted in hospitals are not primary-coded as septicemia.)

The opportunity for you would be to highlight hospitals within your network that agree to a list of specific items that make up a never-events policy. “Highlighting” might include waived deductibles or co-pays for employees who choose highlighted hospitals over others, thus noodging more employees to safer hospitals.

What is included in a “never-events” policy?

The Leapfrog Group, which is the nation’s leading arbiter of hospital quality, has a policy that requires hospitals to undertake five steps following a never-event:

  • apologize to the patient;
  • report the event;
  • perform a root-cause analysis;
  • waive costs directly related to the event;
  • provide a copy of the hospital’s policy on never-events to patients and payers upon request.

Examples of never-events culled from this complete list are:

  • Certain hospital-acquired infections/septicemia
  • Wrong-site/wrong surgery/wrong patient
  • Objects left in body
  • Wrong blood type administered
  • Serious medication errors
  • Air embolisms
  • Contaminated or misused drugs/devices
  • Death

Any given never-event is rare, but in total 5% to 10% of inpatients suffer a significant adverse event during their stays. The consequences – in cost, suffering and lost productivity – could be substantial.

No need to take my word for the cost: The Leapfrog Group provides a Hidden Surcharge Calculator that can be used to estimate the financial impact of hospital errors.

Do hospitals in your network have a never-events policy?

At the very minimum, by default they have such a policy for Medicare, which doesn’t pay extra for certain never-events. Medicare still pays the standard diagnosis-related group (DRG) case rate but doesn’t reimburse “outliers” separately if the added hospital time was caused by a never-event. Obviously, the DRG rates are set a little higher to begin with. So hospitals that do a good job – typically Leapfrog-rated “A” and “B” in the Hospital Safety Score report – embrace this payment scheme, while others would have been better off getting paid the old-fashioned way.

Some hospital systems extend this policy to employers – or will, if you or your carrier ask and you are a large enough customer, and their quality is high enough that the economics work out for them.

Leapfrog A-rated hospitals are therefore the most likely to be willing to negotiate a never-events policy for your employees. These hospitals aren’t necessarily the name brands in your marketplace. In Washington, for example, Virginia Mason Medical Center (VMMC) is the hospital consistently earning the highest Leapfrog scores. Not surprisingly, it was among the first hospitals in the country to offer a never-events policy to employers. The hospital was highlighted in Cracking Health Costs for its many best practices. VMMC is one of the few hospitals that Walmart, Lowes and other jumbo employers will actually fly employees into, to ensure the best care. And yet you’ve never heard of VMMC, have you?

So what should you do?

You still need to offer a wide local hospital network to employees. It simply isn’t worth the inevitable pushback to require a narrow hospital network.

Instead, just ask existing network hospitals to offer you a never-events policy, or let you become part of a policy they already offer to employers. There is plenty of precedent of this. For years, the state of Maine has tied hospital payments for its own employees to quality and safety standards, including Leapfrog standards. And Maine, despite being among the poorest states, consistently ranks #1 or #2 in Leapfrog quality ratings. Coincidence? I think not. Particularly if you can contract in conjunction with your local business coalition, you have the chance to influence hospital safety, just like Maine did.

Additionally, you can follow the lead of those other jumbo employers named above and contract with the country’s safest hospitals for any employees who wish to make the trip. Yes, I know, you aren’t a “jumbo employer.” But a firm named Edison Health helps small employers with the contracting and logistics of such arrangements. It also offers a tool, validated by the Validation Institute, to help you figure out if medical travel would be a worthwhile endeavor for you.

This type of contracting requires a little work on your end, but if all you want is discounts and coverage and don’t want to put in the work, you could punt to an exchange. On the other hand, you self-administer your health benefit for one good reason: to influence employee health, and this is a clear opportunity to do so. By contrast, wellness is a LOT of work…and likely increases your costs in the short run. Wellness will take years to pay dividends, if any, whereas you can start influencing employee hospital choice immediately.

The Yuuuuge Hidden Costs of Wellness

We  have written extensively on the direct costs of dealing with wellness vendors, which often do wellness to employees instead of doing it for them. Employers in self-administered programs tend to focus much more on cultural improvements—the “for” instead of the “to.” However, there’s not really a vendor business model in doing wellness for employees. Cultural improvements tend to be internally driven, generating few transactions of the type for which vendors get paid and brokers get commissioned.

In sharp contrast to the internal development of a wellness culture, the wellness industry is completely transactional. It’s all about the number of risk assessments, screens, coaching sessions, “biggest loser contest” participants, etc.

Further, the wellness industry is completely unregulated. It claims to offer healthcare, but it is required to know nothing about healthcare. The industry’s disregard for clinical guidelines is the stuff of legend—one vendor has even bragged about it—and it counts fines levied upon employees refusing to submit to pry-poke-and-prod as “savings.” Quite literally, you can become a wellness vendor with five days of classroom training.

See Also: Wellness Promoters Agree: It Doesn’t Work

Any time you have an unregulated industry, bad actors take over. You have the equivalent of Gresham’s Law in economics, which states that bad money chases out good, meaning that people hoard gold coins and spend paper currency. In wellness, dishonest vendors chase out honest vendors, because—aside from the esteemed Validation Institute—there is no resource a layperson can consult to know who’s telling the truth and who’s cheating. Vendors promising that wellness will generate massive savings will always win contracts over vendors who tell the truth, especially because consultants and brokers can’t seem to figure this stuff out for themselves or are chasing the greater fees that come with the easier route of making up high ROIs.

We see this at Quizzify, too. We guarantee an ROI, explicitly define how it is measured (while allowing customers to choose their own measurement instead) and have V-I validation. But we still hear: “Your fees are so low that your 2-to-1 guarantee won’t even save us $100/employee.” Um, yeah, but these very same employers actually lose at least $100/employee using dishonest wellness vendors and pay much more for the privilege.

Our past postings and articles have covered the direct damage that these dishonest wellness vendors have done to employers and employees: the fees, the harms to employees, the reduced productivity and the morale impact.  Others with different perspectives have addressed privacy/intrusiveness and economic discrimination.

But wait. There’s more.

The Indirect Harms of Wellness

Overlooked in the voluminous criticism of wellness vendors is the dog that didn’t bark in the nighttime. Specifically, there are a large number of important items that get overlooked or that are under-resourced in employer settings because of this pervasive wellness obsession. There are so many such items that ITL and I are going to run an entire series devoted to the topics below. These topics aren’t wellness, but that’s exactly the point: Wellness “harms” employees in the following ways because it distracts people in human resources from doing their jobs.

Hospital safety. It turns out to be comparatively easy to get hospitals to focus on safety: Simply don’t pay them for “never events” (shocking errors, such as surgery to the wrong part of the body, that should never occur). Hospital safety issues are very expensive and are far more common than you would think. Leapfrog Group has an entire strategy, policy and how-to guide on that.

PBMS. There’s a reason the pharmacy benefit management (PBM) industry has enjoyed the greatest stock appreciation of any industry in the last 30 years. It’s because those fancy contractual metrics they sell you are profit-making machines for them. The industry has more ways to snooker you than even wellness vendors do. The industry’s contracts take opacity to a new plateau. We’ll look at some of them in our later series and will see what can be done to get a better deal.

Overuse. While everyone is focused on preventing cardiometabolic admissions (which turn out to be quite rare to begin with in the employer-insured population), providers are running amok with spinal fusions and other procedures. Spinal fusions fail at a high rate and can entail painful complications. Even when they don’t, they are expensive and arduous to recover from. Yet, the average company spends more on spinal fusions than on any admissions category other than birth events and joint replacements.

Opioids. Marx was wrong: Religion isn’t the opiate of the masses. Opioids are the opiate of the masses. You may have a major problem and simply not know about it. Overuse of pain medication may be five to 10 times as big a problem in your workplace as overeating, so why would people spend five to 10 times the time and effort on overeating as on opioid addiction?

See Also: Triathlete’s View on Workplace Wellness

Non-inpatient spending. Aside from about 10 procedures, there is not a lot to be gained by trying to “keep people out of the hospital.” Most commercially insured people already are “out of the hospital.” Take out birth events, trauma and orthopedics… and maybe 3% of your employees end up in the hospital in a given year. Most of that 3% is simply not preventable. Yet, outside those hospital walls, a ridiculous numbers of resources are overused, misused, etc.—right under your eyes and are just completely ignored by wellness vendors. Our last post will cover this topic.

So, keep your eyes open. This series will appear approximately weekly, subject to breaking wellness news and, of course, the occasional demands of the darn day job.

Wellness War Is Over; Wellness Lost

What if we told you that “pry, poke, prod and punish” wellness programs are bad for morale, damage corporate reputations and cost more money than they save?

You’d say: “Al, you, Tom Emerick and more recently Vik Khanna have been telling us that for years.” You might add: “And while your opinions are usually well-reasoned and based on good data, we’d have to hear the true believers’ side of the story.”

But what if we told you: “That is the true believers’ side of the story”?

Yep, the wellness industry’s leading luminaries – 39 of them, representing 27 vendors and one consulting firm (Mercer) — have all gotten together under the aegis of both their trade associations – Health Enhancement Research Organization (HERO) and Population Health Alliance (PHA) — and reached that “consensus.”

We don’t know if they simply didn’t read their own report before reaching this consensus, or whether they just all decided to tell the truth. Frankly, we’re fine either way. (This is also the second time in five months that a major wellness true believer admitted wellness doesn’t save money. The first time was a meta-analysis in the American Journal of Health Promotion that concluded that “randomized clinical trials show a negative ROI.” After we started quoting the analysis, the editor wrote a 2,000-word essay walking it back.)

Because our claim that we are laying out “the true believers’ side of the story” would otherwise require a certain suspension of disbelief, we are going to rely more heavily than usual on screenshots. We also recommend reading the report itself, or at a minimum our analyses of it. (Our analyses are going to be a 10-part cycle. Make sure to “follow” the website They Said What? to not miss a single episode.)

Page 10 of the report lists 12 elements of cost. The first element itself contains about 12 elements, making this a list of 23 elements of cost. (Add consulting fees, which were overlooked even though three Mercer consultants sat on the committee and even though page 14 calls for use of “consulting expertise,” and you get 24.)

You’ll see damage to employee morale and corporate reputations listed as “tangential costs.” But, as two people who run a company, we would call damage to those intangibles much more than tangential. Our company runs on morale. Pulling people away from their workstations to poke them with needles, weigh them, measure their waists and test to see if they are lying about their smoking habits couldn’t possibly be good for morale.

We are equally curious about the blithe dismissal of legal challenges as a tangential cost. No firm wants its name dragged across the wire services because it is being sued for its wellness program (just ask CVS and Honeywell). Getting dragged into the courts (and, hence, the media) for running a wellness program isn’t a tangential cost — and it’s an unforced error.


On Page 15, as the report discusses how to measure the return on investment, the authors select only one of those 24 costs – vendor fees – as the basis for comparison. Omitting the other 23 costs, plus incentives, makes it easier to show an ROI. The fees are listed as “$1.50 per employee per month,” or $18 a year, even though the rule of thumb is that wellness programs cost many hundreds of dollars per employee per year.


Further in, on page 23, the authors list the related savings: $0.99 per “potentially preventable hospitalization,” abbreviated as PPH. (The fact that we have to do the math on our own by comparing figures across pages suggests this admission of losses was a gaffe rather than deliberate honesty.)


The savings figures are based on reductions in event rates that (1) are about twice what typically gets achieved; and (2) somehow overlook the natural decline of 3% to 5% a year in cardiac events even without a wellness program.

Even without adjusting for those two mistakes, savings fall $0.51 PMPM short of vendors fees alone.

And losing $0.51 per employee per month is the best-case scenario. The “savings” includes benefits from disease management (which is not covered by the $1.50 PMPM in vendors fees), and omits the offsetting costs of all the extra doctor visits that come from overdiagnosis and overtreatment.

So, here are the two conclusions:

  • According to proponents’ own consensus, wellness loses money.
  • Even worse, their savings are wildly overstated (yes, according to government data), and their costs, by their own admission on page 10, are wildly understated.

Don’t take our word for either of these. Write to us, and we will send you an ROI spreadsheet that you can use to do your own calculations.

One way or the other, what RAND’s Soeren Mattke called the wellness wars are over. Wellness has surrendered.

How Will the Wellness Industry Respond?

HERO and its assembled luminaries will probably ignore this gaffe, to prevent a news cycle that their customers might notice. However, if the problem gets covered broadly, they will respond. This was their modus operandi the last time they got “outed.” We had shown them in 2011 that one of their key slides, for which they even gave themselves an award, was made up. We presented our proof many times and even put it in both our books…but it wasn’t until Health Affairs shined a bright light on it that they acknowledged wrongdoing. They said that the slide “was unfortunately mislabeled” by an as-yet-unidentified culprit, but that no one noticed for four years. (Rather than relabeling the slide in a “more fortunate” way, they took the slide off the site.)

To clarify that their position is indefensible, we have offered a reward of $1 milliion for them to simply convince a panel of Harvard mathematicians that they have any idea what they are talking about beyond the fact of the gaffe itself.  Their refusal to claim this reward speaks volumes.

Implications for Brokers

The implications for brokers are profound. First, stop placing wellness programs — or at a minimum get a “release” from your clients saying that they’ve read this article but want to proceed anyway. The disclosure by the wellness industry’s own trade association that wellness loses money increases your liability because you “knew or should have known” that losses were to be expected. Second, you can probably offer your client the chance to abrogate vendor contracts, especially if the vendor was one of the 27 that reached this “consensus.” That might reduce your revenue in the short term but will cement your relationship. And you want your clients to find out about wellness’ problems from you, not from the media.

But whatever else you do, follow future installments here on Insurance Thought Leadership as we plow through this report and deconstruct more of not just their crowd-sourced math but also of their crowd-sourced alternative to reality, in which prying into employees’ personal lives, poking them with needles in blatant disregard for government guidelines, prodding them to get worthless checkups and punishing them when they don’t is all somehow going to save employers millions of dollars.

11 Questions for Ron Goetzel on Wellness

We thank Ron Goetzel, representing Truven Health and Johns Hopkins, for posting on Insurance Thought Leadership a rebuttal to our viral November posting, “Workplace Wellness Shows No Savings.” Paradoxically, while he conceived and produced the posting, we are happy to publicize it for him. If you’ve heard that song before, think Mike Dukakis’s tank ride during his disastrous 1988 presidential campaign.

Goetzel’s rebuttal, “The Value of Workplace Wellness Programs,” raises at least 11 questions that he has been declining to answer. We hope he will respond here on ITL. And, of course, we are happy to answer any specific questions he would ask us, as we think we are already doing in the case of the point he raises about wellness-sensitive medical events. (We offer, for the third time, to have a straight-up debate and hope that he reconsiders his previous refusals.)


(1)    How can you say you are not familiar with measuring wellness-sensitive medical events (WSMEs), like heart attacks? Your exact words are: “What are these events? Where have they been published? Who has peer-reviewed them?” Didn’t you yourself just review an article on that very topic, a study that we ourselves had hyperlinked as an example of peer-reviewed WSMEs in the exact article of ours that you are rebutting now? WSMEs are the events that should decline because of a wellness program. Example: If you institute a wellness program aimed at avoiding heart attacks, you’d measure the change in the number of heart attacks across your population as a “plausibility test” to see if the program worked, just like you’d measure the impact of a campaign to avoid teenage pregnancies by observing the change in the rate of teenage pregnancies. We’re not sure why you think that simple concept of testing plausibility using WSMEs needs peer review. Indeed, we don’t know how else one would measure impact of either program, which is why the esteemed Validation Institute recognizes only that methodology. (In any event, you did already review WMSEs in your own article.) We certainly concur with your related view that randomized controlled trials are impractical in workplace settings (and can’t blame you for avoiding them, given that your colleague Michael O’Donnell’s journal published a meta-analysis showing RCTs have negative ROIs).

(2)    How do you reconcile your role as Highmark’s consultant for the notoriously humiliating, unpopular and counterproductive Penn State wellness program with your current position that employees need to be treated with “respect and dignity”? Exactly what about Penn State’s required monthly testicle check and $1,200 fine on female employees for not disclosing their pregnancy plans respected the dignity of employees?

(3)    Which of your programs adhere to U.S. Preventive Services Task Force (USPSTF) screening guidelines and intervals that you now claim to embrace? Once again, we cite the Penn State example, because it is in the public domain — almost nothing about that program was USPSTF-compliant, starting with the aforementioned testicle checks.

(4)    Your posting mentions “peer review” nine times. If peer review is so important to wellness true believers,  how come none of your colleagues editing the three wellness promotional journals (JOEM, AJPM and AJHP) has ever asked either of us to peer-review a single article, despite the fact that we’ve amply demonstrated our prowess at peer review by exposing two dozen fraudulent claims on They Said What?, including exposés of four companies represented on your Koop Award committee (Staywell, Mercer, Milliman and Wellsteps) along with three fraudulent claims in Koop Award-winning programs?

(5)    Perhaps the most popular slide used in support of wellness-industry ROI actually shows the reverse — that motivation, rather than the wellness programs themselves, drives the health spending differential between participants and non-participants. How do we know that? Because on that Eastman Chemical-Health Fitness Corp. slide (reproduced below), significant savings accrued and were counted for 2005 – the year before the wellness program was implemented. Now you say 2005 was “unfortunately mislabeled” on that slide. Unless this mislabeling was an act of God, please use the active voice: Who mislabeled this slide for five years; where is the person’s apology; and why didn’t any of the analytical luminaries on your committee disclose this mislabeling even after they knew it was mislabeled? The problem was noted in both Surviving Workplace Wellness and the trade-bestselling, award-winning Why Nobody Believes the Numbers, which we know you’ve read because you copied pages from it before Wiley & Sons demanded you stop? Was it because HFC sponsors your committee, or was it because Koop Committee members lack the basic error identification skills taught in courses on outcomes analysis that no committee member has ever passed?


(6)    Why doesn’t anyone on the Koop Committee notice any of these “unfortunate mislabelings” until several years after we point out that they are in plain view?

(7)    Why is it that every time HFC admits lying, the penalty that you assess — as president of the Koop Award Committee — is to anoint their programs as “best practices” in health promotion? (See Eastman Chemical and Nebraska in the list below.) Doesn’t that send a signal that Dr. Koop might have objected to?

(8)    Whenever HFC publishes lengthy press releases announcing that its customers received the “prestigious” Koop Award, it always forgets to mention that it sponsors the awards. With your post’s emphasis on “the spirit of full disclosure” and “transparency,” why haven’t you insisted HFC disclose that it finances the award (sort of like when Nero used to win the Olympics because he ran them)?

(9)    Speaking of “best practices” and Koop Award winners, HFC’s admitted lies about saving the lives of 514 cancer victims in its award-winning Nebraska program are technically a violation of the state’s anti-fraud statute, because HFC accepted state money and then misrepresented outcomes. Which is it: Is HFC a best practice, or should it be prosecuted for fraud?

(10)    RAND Corp.’s wellness guru Soeren Mattke, who also disputes wellness ROIs, has observed that every time one of the wellness industry’s unsupportable claims gets disproven, wellness defenders say they didn’t really mean it, and they really meant something else altogether. Isn’t this exactly what you are doing here, with the “mislabeled” slide, with your sudden epiphany about following USPSTF guidelines and respecting employee dignity and with your new position that ROI doesn’t matter any more, now that most ROI claims have been invalidated?

(11)    Why are you still quoting Katherine Baicker’s five-year-old meta-analysis claiming 3.27-to-1 savings from wellness in (roughly) 16-year-old studies, even though you must be fully aware that she herself has repeatedly disowned it and now says: “There are very few studies that have reliable data on the costs and benefits”? We have offered to compliment wellness defenders for telling the truth in every instance in which they acknowledge all her backpedaling whenever they cite her study. We look forward to being able to compliment you on truthfulness when you admit this. This offer, if you accept it, is an improvement over our current Groundhog Day-type cycle where you cite her study, we point out that she’s walked it back four times, and you somehow never notice her recantations and then continue to cite the meta-analysis as though it’s beyond reproach.

To end on a positive note, while we see many differences between your words and your deeds, let us give you the benefit of the doubt and assume you mean what you say and not what you do. In that case, we invite you to join us in writing an open letter to Penn State, the Business Roundtable, Honeywell, Highmark and every other organization (including Vik Khanna’s wife’s employer) that forces employees to choose between forfeiting large sums of money and maintaining their dignity and privacy. We could collectively advise them to do exactly what you now say: Instead of playing doctor with “pry, poke, prod and punish” programs, we would encourage employers to adhere to USPSTF screening guidelines and frequencies and otherwise stay out of employees’ personal medical affairs unless they ask for help, because overdoctoring produces neither positive ROIs nor even healthier employers. And we need to emphasize that it’s OK if there is no ROI because ROI doesn’t matter.

As a gesture to mend fences, we will offer a 50% discount to all Koop Committee members for the Critical Outcomes Report Analysis course and certification, which is also recognized by the Validation Institute. This course will help your committee members learn how to avoid the embarrassing mistakes they consistently otherwise make and (assuming you institute conflict-of-interest rules as well to require disclosure of sponsorships) ensure that worthy candidates win your awards.