Just as the Bear Stearns implosion presaged the 2008 financial crisis, the events of the last few days, building on earlier events, are presaging the collapse of the “pry, poke, prod and punish” outsourced, vendored wellness industry.
For those readers still living in Biosphere 2, here is a brief review of how we got here. First among the precursors was Honeywell’s completely voluntary self-immolation with the Equal Employment Opportunity Commission (EEOC). We’re not sure how their benefits consultants failed to advise that all they needed to do was offer a simple wellness program alternative that didn’t require medical exams, and there was no way they’d get hit with an EEOC lawsuit. But, then again, no one ever went broke underestimating the ability of benefits consultants to misinform their clients.
Second, the Business Roundtable (BRT) decided to go to the mat with the President over this EEOC-wellness issue. They are essentially demanding to retain their Constitutional rights to deplete their treasuries while harming and alienating their employees without intrusion from the pesky EEOC.
Because this also might seem like a self-immolation on the surface, it is indeed possible that there is some conspiracy at work here, where large companies really want to retain the ability to shame and fine overweight employees into quitting (because you can’t fire people for being overweight). But, we lean towards a less sensationalistic but more evidence-based interpretation: that the BRT is simply getting lousy advice, likely from consultants whose business model depends on more companies doing wellness. Since the BRT’s member CEOs have actual day jobs, they can be excused for taking the BRT’s word for this and not investigating this industry on their own, at which point they would find that the wellness industry attracts more than its share of well-intentioned numerates and outright scoundrels, perhaps because the industry lacks adult supervision.
Third, was our popular Health Affairs posting, that spurred see-we-told-you-so pickups by the Incidental Economist and Los Angeles Times, the latter of which helpfully added the word “scam” to the discussion.
Thus, we bore witness to a perfect storm, the first-ever lay media feeding frenzy on wellness, from both the right-leaning Federalist and the, uh, non-right-leaning All Things Considered. Those would be the first times wellness in general (as opposed to specific programs like, for instance, the Truven/Highmark Penn State debacle or Nebraska’s falsified outcomes) has attracted the lay media. Additionally, the comments, even on the typically erudite All Things Considered, were merciless. Skeptics that we are, we still underestimated employee resentment of forced screenings and risk assessments.
The wellness true believers’ rebuttals were quite in character. As we say in Surviving Workplace Wellness, in this field you don’t have to challenge the data to invalidate it. You merely have to read the data. It will invalidate itself. Since most of the true believers’ “A Team” are ethically compromised, they had to go to their bench to find a rebutter. Against all those eviscerations in the major national media, they countered with: Siyan Baxter, a graduate student at the University of Tasmania, who claimed a positive ROI for wellness, writing in a journal that contains the words “health promotion” in its very title and has never once published a negative article about wellness savings. Publication bias, anyone? That isn’t even the punchline, though. The punchline is that, as our book predicted, Ms. Baxter self-invalidated. She says, right in the article: “Randomized controlled trials show negative ROIs.
Why was this candid acknowledgement part of the true believers’ rebuttal? Because she “averaged” those ROIs with studies she herself describes as low quality, to get a positive ROI. This, of course, is like averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun. In addition to her own admission that most studies of wellness are poorly designed, it’s hard to imagine real savings being achieved by these 5-to-30-year-old studies conducted in an era when, as the award-winning book The Big Fat Surprise observes, the American Heart Association bestowed a “heart-healthy” endorsement on every box of Kellogg’s Frosted Flakes.
The other rebuttal was from Professor Katherine Baicker, who is considered a deity in this field because she basically launched it with a claim, published five years ago in Health Affairs, that wellness achieves a very precise 3.27-to-1 ROI. (As with Ms. Baxter, the wellness programs Baicker found savings in were conducted during the era when the AHA apparently conflated Tony the Tiger with Dean Ornish). Having recently stated she no longer had interest in wellness, and more recently blamed readers for misinterpreting the headline “Workplace Wellness Can Generate Savings” without reading the fine print, she nonetheless decided to come out of retirement to defend her legacy.
Her defense on NPR is worth reviewing, because, as with Ms. Baxter, it self-invalidates. She said: “There are very few studies that have reliable data on the costs and benefits.” That of course is not the case – the wellness true believers’ own meta-analysis above shows that in well-designed assessments, the programs lose money. She also said: “It could be that when the full set of evidence comes in, it will have huge returns on investment, and the billions we’re spending on it are warranted.”
This all sounds a little different from the three significant digits of: “Wellness achieves a 3.27-to-1 ROI.” And it self-invalidates because as any epidemiologist knows – and as Dr. Gilbert Welch elegantly explained in Overdiagnosed — if an impact is truly meaningful enough to matter at all (and certainly if it is meaningful enough to disrupt entire workplaces with intrusive and unpopular blood draws enforced by $4,000 fines like Honeywell’s), it would show up in a small or medium-sized sample.
This means, if indeed there were “billions” to be saved — with hundreds of millions of employee-years being subject to wellness in the last 10 years — we’d know it. Instead, the “full set of evidence is in,”…and it’s game, set, and match to the skeptics.
Al Lewis and Vik Khanna are co-authors of Surviving Workplace Wellness with Your Dignity, Finances, and Major Organs Intact. Their website, They Said What, regales readers with stories of wellness innumeracy and deception.