The Strange Case of the C. Everett Koop National Health Award

The late Dr. C. Everett Koop was the most revered Surgeon General in history, perhaps even the most revered Cabinet member.  His calling card—indeed, his claim to fame – was his integrity.  A Reagan appointee, he acted as though he reported to no one other than the American people and his own conscience.  His penchant for candor and scientific independence fueled the federal government’s groundbreaking steps to raise public awareness about HIV/AIDS at a time when the tendency was to demonize and diminish.  He resisted incessant political pressure and refused to take positions or produce data that he knew to be false.

This drew strong support from both sides of the aisle, and even his detractors never questioned his honesty.  (Exhibit A:  The two authors of this posting, whose political views have little else in common other than respect for strong, independent-minded politicians.)

Dr. Koop’s legacy stands in sharp contrast to the eponymous award dispensed by The Health Project, whose committee members have turned their back on their founder. The last thing Dr. Koop would have expected is to see is *his* award bestowed upon  people who know that they don’t deserve it.  The 2012 award was given to three recipients for work done in Nebraska:  a vendor that claims wellness programs don’t even have to exist to save money, an outfit that can’t even spell the name of its own founder, and a state employee benefits plan that is under investigation for sky-high administrative costs.

Among the extravagant statements that formed the basis for the award (like claiming more than $20,000 in savings for every person who reduced their risk factors for a year, even though per-person spending is only $6,000), they claimed to have made 514 “life-saving catches” on employees with otherwise undetected cancer.  This data was obviously wrong to begin with — that cancer rate would have been at least 40 times greater than Love Canal’s.  Nonetheless, it sure sounded good, and the Governor of Nebraska himself was all-in too, so an award was issued.

The problem was that even though the Project’s Koop Award Committee was willing to overlook the ”error”, the perpetrators ended up confessing.  They admitted that the 514 people who they claimed had cancers on which they made “life-saving catches” did not in fact have cancer at all.  Rather, they had mostly benign polyps that had small chances of someday turning into cancer.  To say Nebraska’s program made “life-saving catches” would be only slightly more accurate than saying that preventing someone from boarding a plane saves their life because the plane might crash.

Even by the gauzy ethical standards of the wellness industry, where every single vendor claiming savings can easily be shown to be making them up, besmirching the name of history’s most revered Surgeon General for dishonest commercial purposes elevates malfeasance to a new plateau.  Koop Committee members, allegedly the field’s leaders (and two of whom we know to be highly ethical), but also naturally including BP’s wellness muses, Mercer and Staywell, must have asked themselves the question:  “How would America’s Family Doctor have reacted to having his award given to people who publicly acknowledged falsifying data?” and, shamefully, decided his reaction wouldn’t matter. So they let their friends in Nebraska keep their award.

For its part, Nebraska refuses to return the award voluntarily, recalling the immortal words of the great Senator S.I. Hayakawa during the debate about whether to return the Canal Zone to Panama:  “We stole it, fair and square.”

The health services blogosphere was atwitter with outrage, and LinkedIn polls of the ethical wellness rank-and-file were unanimous in opposition, as this decision benefits Nebraska at the expense of the rest of the industry.

It also appears that the Committee is hoping the lay media won’t notice this desecration, because they’ve successfully gambled that most of the field’s other exaggerations (about phony life- and money-savings claims) would be unnoticed outside of the industry.  However, those tales of fancy were too technical to interest a lay audience.  Here’s a guess that they’ll lose the gamble this time both because these misrepresentations of a dread disease are so cavalier…and because unlike other wellness vendors, these perpetrators have now admitted them.

We can only imagine what Dr. Koop, who unflinchingly confronted ideologues of all stripes in pursuit of the public’s health, would say.   We hope that the lay media will say it for him.

Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness. An iconoclast to the core, he is the author of the Khanna On Health Blog. He is also the Wellness Editor-At-Large for THCB.

30 replies »

  1. Even if you don’t want to :waste any more time reading this blog,” one of our Alert Readers did just find a remaining link. HFC purged most of its online references to this analysis, but the internet is unforgiving if you forget to purge all of them. Use this link and scroll all the way down. This is the HFC submission to the Koop Award Committee. Since they sponsor the Koop Committee (helps to be a sponsor, if you want to win Koop awards for fabricated findings), once they see this comment they will probably have their friends on the Koop Committee purge this link too, but if you act quickly you can view this slide at http://www.thehealthproject.com/documents/2011/EastmanEval.pdf

  2. Hmmm…that is the slide Obviously if I simply made that up and attributed it to them, they’d sue me. Plus I don’t have enough imagination to come up with a slide in which a vendor takes credit for savings from programs that don’t exist. One would think that would be a stretch even in the integrity-challenged wellness industry.

    I could dig up the actual original (which by the way, that is) but before I do , I’d like to test your receptivity to facts to make sure I’m not wasting my time. If you answer this question correctly, you can contact me and I will direct you to the slide (which they don’t deny presenting, by the way).

    Where was President Obama born?
    (a) Illinois
    (b) Hawaii’
    (c) Kenya
    (d) Mars

  3. I am looking for information, but you still have no evidence that these slides actually belong to the Health Fitness people. I won’t be wasting any more of my time reading this blog.

  4. Good question. Health Fitness Corporation attributed savings to a program that did not exist. They claimed savings in 2005 for a program that started — by their own admission, on their own slide — in 2006. See the second display on http://theysaidwhat.net/2014/07/23/healthfitness001/

    Remember, that is their own slide, not our interpretation of their data.

  5. Please help me understand: “The 2012 award was given to three recipients for work done in Nebraska: a vendor that claims wellness programs don’t even have to exist to save money, an outfit that can’t even spell the name of its own founder, and a state employee benefits plan that is under investigation for sky-high administrative costs.” The link to “wellness programs don’t even have to exist” is a link to your own website. The graphic is not labeled or referenced in any other context. Please provide.

  6. Here is the latest: The mystery of why Health Fitness Corp, despite admitting lying about saving the lives of cancer victims, was not forced to give back their Koop Award may be solved: Besides being a winner of the Koop Award, they are also a sponsor of the Koop Award.

    Sort of like the old Hair Club for Men ads where Sy Sperling would say: “I’m not just the president of the Hair Club for Men. I’m also a client!”

    I’d like to add a Koop Award to my resume. Ron, what’s the going price?

  7. I was just writing a minor post on my minor blog, in which I tried to use high-performance computing as a snare to opine on the virtues of childhood measles, diptheria, tetanus and polio vaccination. I referenced our courageous, stalwart Surgeon General C. Everett Koop, then did a quick search to check his date of birth (1916). That lead me here.

    Sigh. This is awful news, all of it, including the comments, which confirm the veracity of the post. The comment from the woman with the relative whose insurance was dropped is especially sad. It reminds me why I loathe that term, “coaches”. Sports teams have coaches. They are legitimate, and don’t claim to be more than they are. In contrast, all manner of life coaches seem to be charlatans. The excetions are those who have psychology degrees and clinical training or have been employed as social workers, marriage counselors, religious or community center support group leaders, etc. Sadly, many individuals, and corporate benefit administrators (with large budgets), choose to pay good money to deceitful wellness organizations and so-called health coaches instead.

    This Ron Goetzel, whom Al Lewis linked to the Nebraska incident and the Penn State wellness program travesty sounds like a real prize. If government regulators truly cared about consumer protection, they would red flag him.

  8. Behavior change is both complicated and challenging. Change requires addressing both the individual and their environment. Empowerment and engagement are simply not enough. In addition to empowerment and engagement, enablement, expectations, emotions, education, enforcement and reinforcement, energy, effectiveness and evaluation must be addressed as well.

  9. Like many I have positive memories of Dr. Koop, and I too recall his early leadership on AIDS. It is a shame that his name is being misused: it tarnishes Dr. Koop’s legacy, makes an entire state look inept (at least in this program but what about others?) and undermines other, properly done research.

  10. As a portfolio manager who owns and follows healthcare stocks, I’ve always wondered why if wellness is so great and fast-growing, wellness companies don’t go public. But as an avid reader of your wellness postings, I now know. Any I-banker who handled an IPO for one of these vendors would end up getting sued once the truth came out. This is the best example yet.

  11. I remember back when I was first intrigued by the wellness industry nearly five years ago. Had no idea what lay under the surface of the impressive reported patient outcomes. This type of flagrant misconduct is crucial for employers and their employees alike to understand. Where’s the press? Thanks for another well-documented expose, Al. Apologies to C. Everett Coop!

  12. This is Al Lewis again — Someone wrote to me separately and because she is covered by the state of Nebraska, did not want her name used in the comment:

    “I find this extremely interesting because last year a family member of mine was on the Nebraska wellness program and he completed all 3 steps that were required of him, but then after the fact they told him he could not sign up for it again this year because he did not perform any of the coaching talks. That was a lie, he performed all 3 coaching events, but we had no way to prove it. I think they purposelly wanted him all the role because he has a lot of health issues therefore it cost them a lot of money. Now we are paying over $1000 MORE in premiums this year and more for prescriptions because he could not re-enroll in the wellness program. At first I couldn’t figure out how they could have lost record of all 3 coaching events, but now I know, they no longer wanted him in their program because it was skewing their results.

    Thanks for exposing this scam.”

  13. My monthly newsletter is called Courageous Leadership, but this month I flipped it around and told the story of the “Current Wars” and how Thomas Edison would earn my “Uncourageous Leadership” award (http://tinyurl.com/lfjh8bd)

    While I certainly can’t blame the State of Nebraska or their vendors from submitting an application for an award, I do think they could be eligible for the next time I write my “un” newsletter. Or perhaps the award should go to The Health Project.

    I took a moment to read the critique (or should I say cheerleading squad) posted on the website regarding Nebraska’s application (http://tinyurl.com/mn5kjlq) and there is not a single questioning comment but complete acceptance of the reported data.

    I am personally always amazed at ROI that exceed anything more than 1. I equate it to financial investments. If I get a 10% return on my financial investments, I’ve had a great year…that is 1.1:1 yet we are suppose to believe that in the space of 2 years, there is a 2.7:1 return. Remarkable.

    I’d like to see wellness programs target data analysis to smaller and more manageable successes and measuring them with greater discipline to truly measure the success of their programs.

  14. Actually it was Benjamin Disraeli but otherwise points well taken…

    And, Gary (and everyone else), yesterday I did write to everyone I know on the committee and the governor’s office, as I promised, to elicit a response but the response from the wellness industry clubhouse is always to trumpet their literally unbelievable accomplishments and then when someone points out the impossibility or the lies or whatever, assume no one will notice. rebuttals would just draw attention to the issue, and attention is the last thing they want when their position is indefensible.

    So far that strategy is working.

  15. “Lies, damned lies, and statistics.” Thank you, Mr. Clemens.

    Since most folks aren’t able to easily parse the numbers in studies/award attributions/et al, figuring out which are the lies and which are the real number is … challenging. And when wallahs from one expert segment or another trumpet the results of [something], most media coverage of it – if there is any – suffers from the same cut-to-the-conclusion-and-swallow-it-whole involuntary response.

    Patient “engagement” is the current healthcare unicorn. However, patient *empowerment* would actually move the needle. Empowerment requires that patients step into a fully-participatory role, which also requires getting outside enough knowledge to be able to parse if what you’re being told is lies, damned lies, statistics … or useful, actionable advice.

    I’m working on that one: empowerment. I could care less about unicorns …

  16. Thanks for staying on this issue, Al. I am a Nebraskan and am appalled at the response (or lack thereof) from our state officials involved with this boondoggle. It absolutely is related to serious CYA concerns by the people that signed off on the program/vendor to begin with and not wanting to admit the dollars spent were mostly wasted.I sadly agree with James D that media coverage on this has been and will be nonexistant given the more “pressing” headline news items both nationally and locally. I won’t bother listing our local news headlines to demonstrate our current main priorities.If anyone is familiar with the Change.org program and has the time to start a petition, perhaps that would be a way to put more widespread pressure on the Koop/Nebraska people involved to do the right thing. What has happened to the ethics of admitting a mistake and taking responsibility in this country? Sure seems like we’ve allowed the lawyers and spindoctors to take control and the news media is no longer the watchdog to keep things honest. Very sad and frustrating and the repercussions are unavoidable, one way or the other.

  17. And don’t forget the Kardashians. I’ve always worried that, as a nation, Americans are insufficiently concerned about the fate of the Kardashians.

    Alas, WELCOA is mixed up in this too, as they also gave Nebraska an award. They are not only headquartered in Nebraska, but also according to their website were co-founded by the inventor of the self-serve all-you-can-eat restaurant, Mr. Warren Buffet. http://www.dismgmt.com/ida/2013/02/08/welcoa

    NCQA also certified this too.

    This industry already has adult supervision but the question is, who is supervising the adults?

  18. Mary, there are a handful of associations that “legitimize” corporate wellness programs – URAC and WELCOA come to mind – but there isn’t really a specific entity that is in charge of the wellness industry. At least, I don’t think there is, but I may very well be wrong.

    While I’m at it, I may as well indicate that you might be a bit too optimistic about the media at large harpooning this issue. They have far more important things to discuss – like Jimmy Fallon’s child, Oprah being denied service in Switzerland, or how popular the U.S. is worldwide. (All headlines taken from nbcnews.com.)

  19. What they brag about most in the paper is just different aspects of managed care (which, as Al notes below, often includes sending people to the doctor more often so that you can claim to have done SOMETHING). But, the amount of money they claim to have saved ($107M) is an utter fiction. It is the difference between their corporate spending on medical care over a 3-year period and “industry averages” over the same period. Here is what they don’t report: actual dollars spent on medical care by UHC and its employees; changes in the structure of the benefits plan that would have shifted some costs away from the company to employees; and, any information on wellness-sensitive events.

  20. Agreed–wheres the rebutal? There must be another side or else the popular press would be skewering these people. Is anyone “in charge” in this industry? What is the trade association?

  21. btw, much of what UHC (maybe not those two things) was indeed helptul to employees and probably appreciated by them. There are so many opportunities to find obvious errors that I shy away from those that contain a large mixture of helpful elements. I don’t want to discourage companies from doing things FOR their employees, only from doing things TO them.

  22. You have quite the eye for invalidity…

    I am familiar with it — indeed my mailbox filled up after it was announced. They had 7200 pre-diabetics whose identififcation appears to have been the ain source of the $100MM in savings. The math on that is pretty impressively impossible, all the more so considering that (1) these people didn’t even actually have diabetes; (2) two of their major interventions were making people go to the doctor (which JAMA says raises costs with no outcomes improvement) and getting more biometric screens, which is counter to most guidelines and whose math (see Health Affairs blog from March) has a negative ROI.

    So many scandals, so few hours in a day…

    Thing is, we’ve already shown this industry is junk science and junk math. It was important to add junk ethics. Next posting will be about junk employee relations. Stay tuned…

  23. Lia and William, I will write to the committee members whose addresses I have and see if we are missing information. it seems like all the information is in the public domain and they were even bragging about it. I’ll also check with the governor’s office. They have been quite vocal about this program.

  24. It is very sad to see Mr. Koop’s name being disgraced like this if we aren’t missing information. I am sure he is turning over in his grave seeing people saying they “stole it, fair and square.”

  25. Now…..are we actually expected to take this as the truth? I’m putting it out there that this seems truly outrageous.. But…I’d be happy to here their side of the story…

  26. I remember C. Everett Koop for his courage on AIDS. Back in the 1980s, the president of the United States–Koop’s boss– had never uttered the word “AIDS,” and false rumors about its means of transmission were rampant. Children with AIDS were expelled from schools. Dr. Koop stood up for people who desperately needed America’s doctor to tell us the truth: science, not prejudice or innuendo. What an extraordinary man.

    It is disappointing to hear that an award in his name is given to such an absurd program. Perhaps we need to start another awards program in Dr. Koop’s memory, honoring programs that use scientific integrity, demonstrate real benefit, and honor real courage.