Last year, we soundly criticized the American Heart Association (AHA) on this blog for its proposal to lower the thresholds for treating cholesterol and getting larger numbers of Americans to swallow statins. We also exposed wellness vendor StayWell, for its mathematically impossible claims of success in British Petroleum’s wellness program. Proving that great minds aren’t the only ones that think alike, StayWell and the AHA have now joined forces. Specifically, the AHA invited the CEO of StayWell, Paul Terry, Ph.D., to help write its workplace wellness policy statement, sort of like Enron inviting Bernie Madoff to help design its financial plan. You don’t learn of this fox-in-the-henhouse conflict of interest unless you read the table on the penultimate page of text.
Naturally, Mr. Terry parlayed this windfall to StayWell’s advantage. The statement: “currently available studies indicate that employers can achieve a positive ROI through wellness” is footnoted to two studies authored by: Paul Terry, along with other Staywell executives. One wonders how a StayWell executive writing policy for the AHA based partly on StayWell’s own articles passes the AHA’s own test of “making every effort to avoid actual or potential conflicts of interest that may arise as a result of an outside relationship.”
How did this conflict of interest get by the peer reviewers? Look at the list of peer reviewers. Prominent among them is Ron Goetzel. Readers of THCB may recall Mr. Goetzel not just from his central role in the Penn State debacle, but also from the ”The Strange Case of the C. Everett Koop Award,” in which it was documented that his committee gave the ironically named award to a sponsor of the award (without disclosing that conflict), even though that sponsor had admitted lying about saving the lives of 514 cancer victims, who, as luck would have it, didn’t have cancer. (The sponsor, Health Fitness Corporation, a division of the equally ironically named Trustmark, has won the Koop award several times, thus proving the cost-effectiveness of their sponsorship.)
If this litany were not enough to dismiss the policy statement forthwith, there is small matter of the actual policy itself, a full employment act for wellness vendors and cardiologists alike, advocating more screening of more employees more often, while ignoring more self-evident facts than Sergeant Schultz. Specifically, they cherry-picked the available literature, continuing to cite the old “Harvard study” whose lead author has now walked it back three times. Except that they didn’t call it the “old Harvard study,” but rather a “recent [italics ours] meta-analysis,” despite the fact it was submitted for publication in 2009, and the average year of the analyses in the study was 2004. Some studies began in the 1990s and were able to use sleight-of-hand to “show savings” despite presumably — in accordance with the conventional wisdom of the era — getting people to eat more carbohydrates and less fat. No wonder Soeren Mattke of RAND Corporation dismissed the Harvard data as archaic in his interview with CoHealth radio in February 2014.
Likewise, the AHA ignored not just our own fusillade of uncontested deconstructions right here on THCB, and in Surviving Workplace Wellness, of every vendor that has claimed positive outcomes, but also all the documented health hazards of these programs in practice.
The statement, straight out of the 1990s, that “there is consensus that conducting health screenings in the workplace is a promising strategy” might come as a surprise not just to THCB readers, but also to the United States Preventive Services Task Force, whose screening guidelines are roundly ignored by wellness vendors, as well as to the RAND Corporation and Health Affairs, where a Pepsico analysis showed just the opposite of this consensus.
The cherry-picking was complemented with very questionable interpretations of their own cited sources. The statement that “screenings may be even more cost-effective for high-risk individuals” was supported by an article that concluded that “the cost-effectiveness of mass screening may not be justified.” The phrase “even more cost-effective” in this context is like saying some airplane seats have “even more legroom.”
They then go on to describe a number of supporting studies in detail. As has been the wont of the wellness defenders since the 1990s, they ignored all three Biostatistics 101 study design parameters. They cite a Highmark study comparing active motivated willing participants to non-motivated non-participants. This is like splitting a group of 100 smokers into 50 who want to quit and 50 who don’t, and then claiming that the invariably higher quit rate in the first group is due to a program, not the pre-existing desire to quit. More than coincidentally, Highmark has also been highlighted as an example of how not to measure outcomes.
In addition, there is the classic “last man standing” fallacy in another of their cited studies. They only measured people who completed the assessments in three consecutive years, which by the authors’ own admission, was a minority of the population. This is like the weight control programs in which the survivors who stay to the end lose weight, but everyone else has dropped out. By definition, a self-selected highly persistent population is not reflective of the whole.
That study also incorporates the equally classic “natural flow of risk” fallacy to claim credit for risk reduction in the high-risk population, ignoring Dee Edington’s observation that risk ebbs and flows on its own. Consider this example (figure 4, page 9) to demonstrate Dr. Edington’s point. The author has laid out the natural flows of risk (combined with the “last man standing” and participants-vs-non-participants fallacies, since this chart included only volunteers who stuck with the program). You can see that even though nothing happened in the population as a whole (though tens of millions of dollars were alleged to be saved), high-risk people declined in risk while low-risk people increased risk factors — in almost the exact proportions claimed in the AHA-cited study, which did not make this level of detail available.
We are convinced that these obvious fallacies did not accidentally get overlooked. Indeed, we have previously coined the term ”the wellness ignorati” to describe industry defenders whose strategy is to deliberately ignore facts. This is not an accusation but rather a compliment. It is a brilliant strategy, on full display in this AHA policy, based on the accurate assumption that most human resources executives aren’t trained to critically analyze biostatistics while most benefits consultants choose not to. Indeed,ignoring facts is the only strategy that can keep this industry alive, because, as this AHA critique has just demonstrated, facts are the wellness industry’s worst nightmare.
Al Lewis and Vik Khanna are co-authors of THCB’s first book, Surviving Workplace Wellness With Your Dignity, Finances, and Major Organs Intact.