Welcome to another episode of “10 Words or Less,” in which I ask brief questions of interesting people and request brief answers in return. I’m Michael Prager, an author, professional speaker, and lifestyle and wellbeing coach. I began this interview series in 2002 while working at the Boston Globe, so today’s guest joins a long and distinguished list. He’s an outspoken leader on corporate wellness programs who holds undergrad and law degrees from Harvard, and in 2013, Forbes Magazine named him one of “13 To Watch” in health care. Here’s my usual proviso: “10 Words” is an ethic, not a limit, so please, no counting. As an old college buddy used to say, "If you think it’s so easy, let’s see you do it."
This is the edited version of a video interview conducted Nov. 23 and already posted at MichaelPrager.com. To explain the delay in posting: The interviewer encountered a mishap that kept him on bed rest for most of December.
Name Al Lewis
Born when, where March 4, 1956, New York City
Anything notable about the date? "Eisenhower was being reinaugurated, not that anybody cares."
Where do you live now? "Newton, Mass.”
Family situation "I’m on my third marriage. The second wife died, unfortunately. I’ve been married 6 years. I have two children. One is a prosecutor in Suffolk County, Mass. The other is a dancer in New York City."
Principle work "I’m a health-care consultant, broadly speaking. Two sub-points of that: One is CEO of the company Quizzify. We call it Jeopardy meets Health Benefit Education meets Comedy Central. It’s a series of quiz questions that help employees understand how to navigate the healthcare system and avoid over-treatment."
Got it. You said there were two. "The one that, for better or worse, I’m best known for is, I’m troublemaker-in-chief at the website TheySaidWhat.net, which catalogues all the lying and cheating and harms done in the wellness vendor industry."
An early influence outside your family "My economics teacher, Elisabeth Allison. She was the first person to recognize that I was smart enough. She helped me with my self-confidence, and realized I could do this stuff. At Harvard. Her husband is Graham Allison, a well-known guy at Kennedy School of Goverment."
The first public event that made an impression on you "When I went to a Scoop Jackson rally in 1976, for the Massachusetts primary. All the unions were there, the hall was full, and he said he was going to reopen the Boston Navy Yard, and they all cheered. Then he said he was going to reopen the Quincy Navy Yard, and everyone cheered. Then he said he was going to reopen the Gloucester Navy Yard, and everyone cheered. But then someone yelled, “but Senator, they haven’t closed it.” So he said, “Well if they do close it, I’ll reopen it!” And everyone cheered."
What did you want to be when you grew up? "I originally wanted to go into finance. When I was in college, a friend of mine and I started a stock brokerage firm in Harvard Square. It actually got a very nice write-up in your old publication, the Boston Globe."
What was the name of it? "Dillon and Co. His name was Bill Dillon. I was the “and company.” We did spectacularly well for a while, but the problem was we grew really fast and didn’t adhere to the regulations. So they came in one day and just shut us down one day. That was when I had my first interaction with the press. Janet Wu, now at Channel 5 here in Boston, interviewed me, and the interview went really, really badly. She came in to do a feature, and ended up doing some kind of expose. Like we had Playboy magazine in the office, so she said we had pornographic literature. That was when I learned, the hard way, how to deal with the media."
What did your folks do for a living? "My mother was a school nurse all her life, and my father was a psychiatrist."
Your first paying job "I stacked produce for a supermarket chain Gristede’s. It was kind of a precursor to Zabar’s."
Some wisdom you retain from that work "I learned how you could get people to buy things by marketing better. We had these big oranges that sold for 49 cents apiece that they shipped us by accident. In those days, no one would spend 49 cents for an orange. So I sliced one up into about 10 pieces, put a toothpick in each piece, and people would come along, take the sample, and we sold out of the oranges."
So you’re the guy who started supermarket sampling? "Just as much as Jerry Seinfeld started the umbrella twirling, yes.”
Where does your brashness come from? "I never used to be brash. I used to be a team player until I got blacklisted by the wellness industry for actually doing math. But having established the brashness, I’ve found it is very helpful in positioning in an industry when I find people tend to be overly polite, and allow things to pass by that shouldn't be allowed to."
How long ago was that? "In 2012, when my first book came out, "Why Nobody Believes the Numbers." It was extremely respectful. You couldn’t find a bad word about an individual or a company in it. In my naivete, I thought I would be embraced by the industry for identifying all these errors and helping them mend their ways analytically. But instead, I was no longer invited to any conferences, no longer able to publish, etc."
How did that feel? "At first it was upsetting, but then it became liberating, and I developed a new set of friends. People who would write and call: “Hey, you wouldn’t believe this one. ... Or this one.” You, of course, are very familiar with the movie “Spotlight,” [about the Globe’s coverage of the Catholic Church’s pedophilia scandal and coverup]. On a much smaller scale, thankfully, I found that the same thing was happening. It wasn’t just one rotten wellness company, it was one after another after another after another that were making up their numbers, lying to their customers, and more importantly, harming the employees."
Have you always been a lightning rod? "When you’re 6-6, you kind of attract it. [Laughs.] But I worked in corporations, and worked my way up, and at one point I was the chief executive at a NASDAQ company. In 1993, I was the youngest executive of any NASDAQ company. Now, it was a pathetic NASDAQ company, but it was a NASDAQ company nonetheless. ‘How pathetic a company was it?’ you might ask. Every time I would come to work, I would assume they were writing to tell me we’d been delisted. And yet, it succeeded. In 1996, Modern Healthcare listed us as the top performing stock in our industry for 1995. "
That’s pretty legit! "That’s legit, but by that time, I’d been fired. You know, sometimes you see at the Emmys, someone gets an award for a show that’s been canceled? That’s what this was like."
Please place your wellness outlook on the political spectrum "I myself am a dyed-in-the-wool Democrat. My partner in crime, Vik Khanna, is a libertarian. We have hardly ever voted for the same candidates. Wellness is the only thing, I’m fond of saying, that the reviled left-wing media, like the New York Times, and the reviled right-wing media, like the Wall Street Journal, agree is a bad idea."
Do companies have a valid stake in healthier employees? "Without question, companies with healthier employees, on balance, will do better than companies with less healthy employees. The issue is transitioning from unhealthy employees to healthy ones. That’s where the problems start. Let’s distinguish between two things: Wellness done for employees and wellness done to employees. I think everyone agrees that wellness done for employees is a good idea, and at Quizzify, we absolutely try to do that. Wellness done to employees, prying into their personal lives with health risk assessments, poking them with needles, prodding them to go to the doctor when they’re not sick and then punishing them when they don’t do that? Bad idea."
Is ROI the best way to evaluate wellness? "I think yes. Typically, people say, how come the rest of healthcare doesn’t need an ROI, and I say, that’s pretty obvious. If an employee has appendicitis, you rush him to the hospital. You don’t say, “What’s the ROI?” If a vendor says, “You know, a burst appendix could be very expensive for you. Let’s take out all your employees’ appendixes,” you have to work out the math. You have to see if that makes sense. So of course, something like that, that’s optional and preventive needs an ROI."
The thing about that is that a time of crisis is not the time to think about ROI. But there’s plenty of time, by people who aren’t surgeons needed to save someone’s life at a moment’s notice, who could do the figuring for the next time an employee’s appendix bursts. "But if, in fact, Michael, if it were the case that it was remotely cost effective to do what you’ve described, and that it actually benefitted the employee’s health, I would be all for it. In terms of cost-effectiveness, you can go back to [the journal] Health Affairs, there’s an article called “The Million Dollar Heart Attack Screen.” [Turns out, this article was written by Lewis and Khanna. Here it is.] It costs a million dollars to avoid a heart attack through screening all your employees. Then there’s the issue of harms. The U.S. Preventive Services Task Force, which is the ‘governing body’ here, has a list of screening intervals that are appropriate for health. They weigh the harms against the benefits, and they say, don’t screen more than this because you’re going to find things that don’t exist and force people into the system. Wellness vendors almost always ignore those guidelines. So they screen the stuffing out of people, and it’s bad for their health."
Someone who deserves more credit "The Intel-GE Validation Institute is the sole voice of reason in the economic aspect of wellness. You can’t get validated for your outcomes, your guarantees, your contract, without going through a very analytically rigorous process. And I know because, No. 1, I do validations for others, and No. 2, Quizzify had to get validated, and we [Quizzify] had to change our guarantees because they were sloppy. Even though we were paying [the institute], you can't just pay them and get validated. It has to be absolutely right. That would be on the economic side. On the clinical side, without question, the U.S. Preventive Services Task Force is doing yeoman’s work. They get criticized a lot because they’re trying to get people to cut back on screening. They don’t typically make public pronouncements, so they don’t defend themselves. We can’t get them to do anything with us because they would consider it a conflict of interest, even though we’re saying the same thing."
Something you’re sheepish about "When I am playing ultimate frisbee and it’s a big game, I am very sheepish about throwing, my forehand or my hammer throw, because I don’t want to embarrass myself in front of a lot of people."
Something people don’t understand "The idea that you can have too much prevention is something that does not come easily to people. People say, don’t you want to have healthy employees? Don’t you want to prevent them from getting sick? But in fact, like anything else out there, there’s a cost and benefit of prevention and if you do too much of it, the cost can far exceed the benefit."
But wouldn’t everyone be better off if we spent a lot more money on prevention so we could spend a lot less on fixing the things that go wrong? "Absolutely. Wellness is a pathetic and misguided attempt to privatize what should be a public activity. If we had a larger tax on cigarettes, a tax on sugar and sugar-related products, if we used that money to build linear bike paths… Yes, the government should be doing this as a public good, and not trying to foist it off onto the private sector, which is uniquely bad at doing this stuff."
But isn’t employer-provided health care just an artifact of earlier times in the US? "You know, they have private company wellness in countries, like Canada, where the healthcare system is public, and somebody has sold them this bill of goods that productivity will go up as a result of wellness. Is the teacher going to teach more kids, is the cashier going to ring up more groceries, is the pilot going to fly the airplane faster? No. In fact, the biggest impediment to so-called productivity is anxiety and depression — that’s according to the wellness industry itself. If you put these punitive programs in place, if you tell people they’re sick, their anxiety is going to go up. If they hate the programs, their depression is going to go up."
We’ve had a pretty flowing conversation. Have we dropped any thoughts you’d like to complete? "Yes, there was one other observation I wanted to make about the harms of over-diagnosis. The leader in the biggest wellness company, United HealthCare’s Optum subsidiary, said publicly, admitted, that they over-screen and over-diagnose employees. And his excuse was, employers made them do it! I have yet to find an employer that said, “Yeah, we wanted to pay more money to have our employees screened inappropriately. They tried to beg us not to, but we went ahead with. So you have the largest wellness employer admitting they harm employees."
Where did he say this? "There was a debate [Nov. 2 in Washington, D.C.] between myself and a fellow named Ron Goetzel."
How did it go? "Well, I was playing an away game, and I feel like I won. One of the reasons is that the only piece of coverage so far was by Employee Benefit News, [registration required] and it was very, very favorable. I don’t any of see the pro-wellness sites even mentioning that that coverage existed."
A question I should have asked you? "How would you solve wellness? What would you do instead?"
Answer that question, please. "We’ll leave aside the admittedly self-serving answer that I would be using Quizzify because I would be helping employees with their over-treatment and much less trying to push them into the system."
Yes, leave that aside. I’ll edit it out. "Wellness, right now, is the only thing in healthcare that has no licensing requirements, no regulation, no continuing ed., no training requirements, nothing. It is completely unregulated. They can harm employees as much as they can get the human resource departments to allow. I think there should be simple regulation, just like doctors have, that wellness programs will do no harm. If that regulation was in place, two thirds of wellness companies would disappear, and one third would be completely legitimate."
Cite a company that would be in the one third, besides one of your own. "United States Preventive Medicine is the only wellness company that has gone through the validation process with the Validation Institute. Quantum Health would be another example. All of their work is done on an opt-in basis. People call when they need their help. Both of those companies have achieved significant outcomes improvement and significant savings, as validated by the Intel-GE Validation Institute."