August 11, 2014
The Wellness Industry Pleads the Fifth
by Al Lewis
The author has repeatedly pointed out major problems with wellness claims but says the industry won't respond. Now, he's upping the ante.
The wellness industry’s latest string of stumbles and misdeeds are on the verge of overwhelming the cloud’s capacity to keep track of them.
First, as readers of my column may recall, is the C. Everett Koop Award Committee’s refusal to rescind Health Fitness Corp.’s (HFC’s) award even after HFC admitted having lied about saving the lives of 514 cancer victims. (As luck would have it, the “victims” never had cancer in the first place.) Curiously, HFC’s customers have won an amazing number of these Koop awards, which are given for “population health promotion and improvement programs.” Why so many, you might ask? Is HFC that good? Well, HFC is not just a winner of the Koop Award. HFC is also a major sponsor. Perhaps it was an oversight that HFC omitted this detail from its announcement that both Koop Awards were won by its customers for 2012.
Second, the American Heart Association (AHA) recently announced its guidelines for workplace screenings. They call for much more screening than the U.S. Preventive Services Task Force does. As it happens, the AHA guidelines were co-written by a senior executive from Staywell, a screening vendor. Not just any vendor, but one that had already been caught making up outcomes.
Third, although the American Journal of Health Promotion published a meta-analysis that showed a degree of integrity rare for the wellness industry, it then hedged the conclusion. The analysis showed that high-quality studies on wellness outcomes demonstrated “a negative ROI in randomly controlled trials.” But the journal then added that invalid studies (generally comparing active, motivated participants to non-motivated non-participants) showed a positive return. The journal said that if you averaged the results of the invalid and the valid studies you got an ROI greater than break-even. However, the averaging logic leading to that conclusion is a bit like “averaging” Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.
How does the wellness industry respond to criticisms like these three? It doesn’t. The industry basically pleads the Fifth.
The industry knows better than to draw attention to itself when it doesn’t control the agenda. The players know a response creates a news cycle, which they will lose — and that absent a news cycle no one other than people like you are going to read my columns and notice these misdeeds.
One co-author of the AHA guidelines wrote to my Surviving Workplace Wellness co-author, Vik Khanna, and said the AHA would respond to our “accusation” but apparently thought better of it when the lay media didn’t pick up the original story. (As a sidebar, I replied that saying a screening vendor was writing the screening policy was an “observation,” not an “accusation,” and recommended the editors check www.dictionary.com to see the difference.)
Similarly, in the past, I have made accusations and observations about the wellness industry both in this column and on the Health Care Blog…and gotten no response. So to make things extra easy for these folks, I dispensed with statements that needed to be rebutted. Instead, I asked some simple questions. I said I would publish companies’ responses, which would create a great marketing opportunity for them…if, indeed, their responses appealed to readers.
I posted the questions on a new website called www.theysaidwhat.net. I got only one response, from the Vitality Group. The other wellness companies allowed the questions to stand on their own, on that site.
To ferret out responses, I then did something that has probably never been done before: I offered wellness companies a bribe…to tell the truth. I said I’d pay them $1,000 to simply answer the questions I posted about their public materials, which would take about 15 minutes.( If someone makes me that offer, I ask, “Where do I sign?” but I’m not a wellness vendor.)
Here’s how easy the questions are: Recall from a previous ITL posting that Wellsteps has an ROI model on its website that says it saves $1,358.85 per employee, adjusted for inflation, by 2019 no matter what you input into the model as assumptions for obesity, smoking and spending on healthcare. The company claims this $1,358.85 savings is based on “every ROI study ever published.” Compiling all those citations would require time, so I merely asked the company to name one little ROI study that supports this $1,358.85 figure. Silence.
I asked similar questions (which you can view on the click-throughs) to Aetna, Castlight, Cigna, Healthstat, Keas (which wins style points for the most creative way to misreport survey data), Pharos, Propeller Health, ShapeUp, US Corporate Wellness and Wellnet, as well as their enablers and validators, Mercer and Milliman. Propeller and Healthstat responded — but didn’t actually answer the questions. Healthstat seems to say that rules of real math don’t apply to it because it prefers its own rules of math. Propeller – having released the completely mystifying interim results of a study long before it was completed – said it looks forward to the study’s completion and didn’t even acknowledge that questions were asked.
In all fairness, one medical home vendor sent a response expressing a seemingly genuine desire to understand or clarify issues with its outcomes figures and to possibly improve their validity (if, indeed, they are invalid). As a result, I am not adding the vendor to this site; the idea is not to highlight honest and well-intentioned vendors. (The company would like its name undisclosed for now, but if anyone wants to contact it, just send me an email, and I will pass it along to the company for response.)
Likewise, there are good guys – Towers Watson and Redbrick, despite their high profiles, managed to stay off the list by keeping their hands clean (or at least washing them right before inspection). Allone, owned by Blue Cross of Northeastern Pennsylvania, even had its outcomes validated and indemnified. I will announce more validated and indemnified vendors in a followup posting.
As for the others, well, I am not saying that their historic and continuing strategy of pleading the Fifth when asked to explain themselves means that they know their statements are wrong. Nor am I saying that they are liars, idiots or anything of the sort. Something like that would be an “accusation.” Instead, I am merely making an “observation.”
It isn’t even my observation. It is credited to Confucius: “A man who makes a mistake and does not correct it, is committing another mistake.”