The Wellness Industry’s Terrible, Horrible No-Good Very Bad Week

flying cadeuciiJust 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.


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6 replies »

  1. The back story would take a while. We were both participants in the industry. In particular, the part of wellness being embraced by the wellness true believerts since the Pepsico story, disease management, is credited by Google to my invention. (Pepsico lost money on wellness but made money on disease management.)

    We both independently figured out this stuff didn’t work. Vik figured it out substantively whereas I kept finding that vendors were making up numbers. Surviving Workplace Wellness has our story.

    We both sell consulting services and books and various other things. If we sell something, we will certainly disclose it in a posting. Like if we said “Surviving Workplace Wellness is a terrible holiday gift for people you don’t like,” we would mention that we wrote it.

    For 2+ years our postings (with the occasional piece of good news about something that did show savings) have been finding fraud. We aren’t shy. We uh, take appellations and kick posterior. Even though we name names, we have never been threatened with a lawsuit (despite basically begging for one) and only rrarely do the perps even attempt pathetic defenses. We have a website, http://www.theysaidwhat.net, which also calls companies out by name. They don’t fight back. They don’t even want to enter the ring. Their strategy has been to ignore us to avoid creating a news cycle. (How’s that working out for ’em?)

    For instance, I’d love to hear what Kate Baicker has to say about significant digits and the precision of her 3.27-to-1 ROI declaration, her shifting position on this issue, her reconciliation of how studies could find savings and weight loss despite basically telling people it was OK to eat sugar, and how if the impact “could be” in the billions, no one has found it yet and in fact most peoiple have found the opposite. Smoking, for example, was easily found in the 1950s to cause cancer. You only needed a small observational study to notice that. Likewise very high blood pressure. Things that matter that much are readily findable.

    But we aren’t going to hear from her. She probably regrets having stepped into this ring, which is a lesson that other wellness defenders have wisely learned.

  2. John you aren’t suggesting that Al & Vik themselves have something for sale that they’re not telling us about?

    because aw, hell yeah, they do – and if Matt actually had anyone doing any moderating around here he’d oblige posters of such lengthy opinion pieces to put disclaimers right up front.

    (fwiw, I thoroughly enjoy their posts, and agree with much of what they are saying. I just feel, as you seem to, that they should be more forthright about their own agendas)

  3. This is directed to you both. For the benefit of readers who aren’t familiar with your work, can you give a little of the back story here?

    Are you opposed to all wellness programs? Only some wellness programs? Weren’t you once both active participants in the industry you’re taking down?

    I’m guessing a lot of people who haven’t been following this one are going to be trying to understand how you can be opposed to programs that on their face sound harmless and well-intentioned..

  4. This stuff never gets old. These columns are to the rest of the blog what Andy Rooney used to be to 60 Minutes.

    And now, Kate Baicker is caught in the dragnet. She is actually a good researcher though you’d never guess it from her little foray into wellness. And it’s not the ciime — it’s the coverup. She should just throw in the towel and stop giving these guys fodder.

    One thing is not disputable: “Kate Baicker and the Significant Digits” would be a great name for a rock band.

  5. “valid commercial science” — Bobby, wellness vendors all over America are right now trying to figure out what that phrase means, because they have no operational familiarity with it.


  6. “averaging Ptolemy and Copernicus to conclude that the earth revolves halfway around the sun.”

    Rim Shot!

    LOL. Love it.

    “Wellness achieves a 3.27-to-1 ROI.”

    I come from a forensic science world wherein if you publish a “.27” your auditors will demand that you produce empirical evidence that you can consistently differentiate between the surrounding .06 and .08. It’s called “significant figures rounding,” a staple of contractual and regulatory specs in valid commercial science.