Archive for Tom Emerick

Number of Men Diagnosed With Prostate Cancer Drops

That news is according to an article in the WSJ by Melinda Beck, but it’s not for the reason that first jumps to mind.

Per the article, “The declines follow the U.S. Preventive Services Task Force’s recommendations against routine testing for prostate cancer, first for men aged 75 and older in 2008, and then for men of all ages in 2012, on the grounds that the benefits likely don’t outweigh the harms.”

Repeat, the benefits of prostate screening likely don’t outweigh the risks.

In short, the diagnosis rate is down because apparently more doctors are following new guidelines on prostate screening. At last…at long last.

But there is a joker in the deck. Every wellness program I’ve looked has not adopted the USPSTF’s prostate screening guidelines. (There may be some that have adopted the new recommendations, but I haven’t seen them.)

It’s worse. I asked a wellness vendor why they were persisting in promoting prostate over-screening. His reply made my stomach churn. He said if his wellness company changed the guidelines, they’d have to admit they were wrong in the first place. So they are keeping flawed recommendations in order to save face. I’d name the vendor but I agreed to keep what he told me in confidence. Alas.

If you have a wellness program and the vendor is not following that guideline you need to give them a big nudge.

P.S. Years ago I asked my primary care doctor to stop doing PSA tests on me.

Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon.


Theranos is revolutionizing medical blood samples? Not so fast.

Blood testing startup, Theranos, founded by Elizabeth Holmes, has been promising to revolutionize how medical blood samples are taken and tested. Theranos and she have won award after award.

Not so fast says an article in the NYT written by James B. Stewart. Writes Stewart, “She [Holmes] has been showered with rapturous media attention. Time named her one of the 100 Most Influential People in the World this year.”

Why? The Theranos model had the promise of being able to do an abundance of accurate blood readings from a single drop of blood. Wow? Great news for the needle-averse. Who doesn’t have a needle aversion?

Alas, the facts aren’t looking so good. Seems Theranos ignored peer reviews in a rush to get to market.

Further, some…”of the company’s central claims, and the one most exciting to many investors and doctors, is being called into question.”

Here’s the kicker, “Theranos has acknowledged it was only running a limited number of tests on a microsample of blood using its finger-prick technology.”

When it comes to revolutionary new methods in the world of health care testing, caveat emptor….buyer beware.

Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon.

Two case studies on why workplace wellness fails

Henry David Thoreau once famously said, ”Most men lead lives of quiet desperation….”

People who lead desperate lives don’t make good subjects for wellness programs, nor, for that matter, lifestyle advice from doctors. Below are two real life examples of ordinary people I’ve chatted with about matters of personal health. After both of these conversations I was quite humbled.

Case 1

I had a chance conversation with a pleasant but overweight woman I’ll call Donna, a cashier in a big city grocery store, who was about 50 years old. We were having a nice chat and I asked her if she had opportunities to exercise after work. Donna said that after being on her feet all day she had to go home and put her feet up. That prevented her from having much of a social life too. Donna said she would never have a better job, that she’d never buy a new car, nor afford vacations or holiday trips. Her rent was so high it was all she could do to makes ends meet. Donna said her only fun in life was buying a take-home pizza and a six pack of beer once or twice a week. Take that away and Donna said she had nothing. Truthfully, and sadly, in my heart I could not blame her.

Case 2

A few years ago I had a lengthy cab ride in Baltimore and struck up a good conversation with the cab driver, a friendly middle-age man I’ll call George. He asked what I did for living which resulted in a good chat about personal health. George smoked, had high blood pressure, diabetes, and was overweight. He said he’d tried to get those things under control but just couldn’t. The interesting part of the story is why he couldn’t control his health risks. George said he’d lived in Baltimore all his life and had the same set of friends since grade school. One night a week they’d go bowling, eat huge meals, and drink way too much beer. Also, once a week or so they’d go to a sports bar and do the same thing. George truly believed he’d have to give up his lifelong friends if he were to cut out that lifestyle. He knew it was slowly killing him, but he just wasn’t willing give up. It was hard to blame him either.

Those are two true stories of people trapped into a lifestyle they can’t or won’t willingly forfeit. Huge numbers of people are in the same boat.

Some people are going to comply with doctor suggestions on lifestyle without any help at work. But, if Thoreau were right, there are many people out there like Donna and George.

Bad lifestyle choices can be terribly complex. It is virtually never lack of the kind of information wellness vendors push.

Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon at the low price of $9.05.

Do annual physicals do more harm than good?

A good story with the title above was on CNN. The author is Nadia Kounang.  Click here to read the full article.

This is not a new question. Leading physicians have been asking this question for decades. Yet the public and professional wellness vendors persist in having blind and uninformed faith in what is an expensive and potentially harmful ritual.

Says Dr. Ateev Mehrotra, an associate professor of health care policy and medicine at Harvard Medical School, “This specialized visit hasn’t proven anything in terms of staying healthful.”

He further says the annual physical, “…make sense in theory, but it hasn’t borne out in reality.”

According to the story, “…more doctors are saying the annual physical is unnecessary — and can even be harmful.”

Personally, in my career running benefit plans for large corporations, I’ve seen first hand numerous people seriously harmed by the annual exam, through  false positives on unneeded tests that resulted in medical harm to employees. Plus, such false positives cause stunning and unnecessary anxiety, as in “we-said-you-had-cancer-but-oops-my-bad”.

This is a good time to take a good hard look at this ritual and consider if precious health dollars could be used better elsewhere.

If your wellness vendor is recommending this for your employees, you should drop that vendor ASAP. Period.

Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health“, is now available on Amazon at the low low price of $9.05.

Exchanges have a wobbly future—the math doesn’t work

A number of employers of all sizes are rushing into exchanges these days – often after heavy prompting by their consulting firm or broker. Part of the expectation is that they can cap their future health plan costs, and give active employees more options through participating in exchanges. Sounds great, doesn’t it?

The problem is the math doesn’t work. In addition, this approach has been tried before and flopped miserably.

The previous iteration of this was in the early 90’s and was called “cafeteria” plans. The same claims were made: “No longer will your costs be at the mercy of healthcare inflationary trends. You can control how much you want to increase your subsidy each year – that is, if you want to increase it at all.” This failed because the math worked against the strategy then too.

Let’s take a steely-eyed look at the numbers. If a company puts employees into an exchange because it wants to cap its costs going forward, that creates a reverse leveraging effect on employee payroll deductions. Here’s an example. Assume premiums (or self-insured budget dollars) are $10,000 per employee per year and the company contributes 75%. The company pays $7,500 per employee per year (PEPY) and the employee pays $2,500 per year. If plan costs increase 10% over two or three years, and the company’s contribution stays flat at $7,500 PEPY, the employee cost will increase by $1,000 per year ($10,000 x 10%). That means the employee payroll deductions will go from $2,500 to $3,500, or an increase of 40%!!

If costs go up another 10% in the next year or two, and the company contribution remains flat, the employee payroll deduction will increase another $1,100, for a total of $4,600, or a total increase of nearly 85% over a few years.

What employers quickly realized in the 90’s was that if they didn’t keep increasing their subsidy level at a market rate, the cost to employees became intolerable.This reality led to the demise of so-called cafeteria plans.

If that is not enough, consider this. Some benefit managers hope exchanges will lead employees to choose less costly plans, ones with even higher deductibles. However, in an era in which 80% of plan dollars are being spent by 6-8% of plan members (called outliers), that notion is flawed. Why? The 92% who aren’t spending much may choose plans with higher deductibles and copays, but the outliers won’t. Period. The result is having about the same claim dollars as before but collecting less in employee contributions, an unsustainable proposition.

Further, some outlier spending is deferrable. An outlier-to-be in a high deductible plan can switch to a low deductible plan in the following year, have an expensive surgery, and then switch back. That, of course, is the definition of adverse selection.

A private exchange may look like a good fit for your situation, but beware. Also if your consulting firm owns an exchange, beware.

Alas, considering the rush into exchanges today, it looks like history is doomed to repeat itself.


Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon.

A Small Indiana Town Scarred by a Trusted Doctor

The NY Times has written yet another story about how another rogue doctor has done serious and seemingly deliberate harm to patients for profit. The author is Julie Creswell.

This villain is a “cardiologist, Dr. Arvind Gandhi, [has been] sued by two former patients who accused him of performing unnecessary operations.”

The lawsuit cases are growing.  Now…“293 patients around Munster, Ind., …have filed lawsuits against Dr. Gandhi and two other doctors in his practice claiming that they performed needless procedures.”

Writes Crewel, “In recent years, federal officials have brought several prominent cases against cardiologists and hospitals, accusing them of performing unnecessary procedures like inserting stents into coronary arteries.” 

My question, yet again, is why self-insured employers are not demanding their carriers/TPAs purge their networks of these kinds of bad actors. Enough is enough.


Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon.

My three favorite websites

These are three websites I read every day and from which I draw a huge amount of useful information:

  1. The Doctor Weighs In, hosted by Dr. Patricia Salber. TDWI is truly mind-expanding. She explores topics from the relationship between morality and religion to detecting post-surgery respiratory problems. If I were not a healthcare consultant I’d still read this daily.  Here is a link to The Doctor Weighs In.
  2.   They Said What?, hosted by the inimitable Al Lewis and Vik Khanna. They go about exploding one healthcare myth after another, but do so with appropriate satire, hilarious quotes, and self-immolating vendor screenshots. I can’t go to this site without learning valuable information and having a good laugh. Who doesn’t like a good satire? Here is a link to They Said What?. My advice: start with “This is your brain on wellness.”
  3. Not Running a Hospital, hosted by Paul Levy. Not Running a Hospital goes way beyond what the title implies…and way beyond healthcare in general. It too is mind expanding. He covers topics from math education to healthcare myths and back again. Here is a link to Not Running a Hospital.

I urge you to add these to your book marks and visit them often.


Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon.


Job misery is a killer

George Carlin once said, “Oh, you hate your job? Why didn’t you say so? there’s a support group for that. It’s called everybody, and they meet at the bar.”

All seriousness aside, job misery is a leading cause of death. That has been studied and reported in Europe over and over. Consequences are weight gain, weakened immune system, loss of sleep, ruined relationships, increased aging, and on and on.

If you truly dislike you job, you either need to move on or figure out a way to tolerate it. You owe that to yourself, and your family and friends.

Source:  Chapter 2 of An Illustrated Guide to Personal Health.


Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health“, is now available on Amazon.


‘Disruptive’ doctors rattle nurses, increase safety risks

This is the title of an excellent USA Today article by Jayne O’Donnell and Laura Ungar.  The article is about how bad behavior by doctors is doing harming patients.

“Whether it’s angry outbursts, lewd remarks or passive aggressiveness, bad conduct by those in the medical community is called ‘disruptive behavior.’ It’s considered such a risk to patient safety that hospitals must have a system for addressing it in order to meet accreditation standards.”

The article is full of examples of physicians disparaging patients under sedation, insulting nurses and other hospital staff, and refusing to follow safety  protocols.

Here’s one example:  “A surgeon at Vanderbilt University Medical Center in Nashville did not wash his hands before an operation, and when a nurse quietly offered him gloves instead of calling him out on it, the surgeon dropped the gloves in the trash.”

Kathleen Bartholomew, an occasional guest writer for this blog, is highlighted in this article as a patient safety advocate. She describes situations in which doctors are doing harmful and dubious surgery on elderly patients for profit and are “untouchable” in hospitals became of the the revenue they generate. Hurray for Kathleen.

You’ve read other articles here about doctors slapping and otherwise physically abusing patients under sedation.

These kinds of behaviors cannot be tolerated. Self-insured employers need to demand better care for their employees.

Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health”, is now available on Amazon.

Three Surprising Hazards Of Worksite Wellness Programs

This is the title of an entirely entertaining  Forbes online article by a truly effective healthcare leader, Leah Binder.

She lists the following three hazards:

1. Dismaying and Alienating Employees. Who today doesn’t know smoking is unhealthy?

2. Bad Programs Don’t Save Money. Too many wellness vendors simply fabricate results.

3.  Potential Harm to Employee Health. False positives on wellness-driven testing can lead to employee harm and huge wanted dollars.

Writes Leah, “I don’t come to this conclusion lightly.”  Further, “… I believe we must call out poorly-designed programs that prey on well-meaning employers and other purchasers.”

Leah points out a great book by on this topic by my friends and colleagues, Vik Khanna and Al Lewis, Surviving Workplace Wellness…: With Your Dignity, Finances and (Major) Organs Intact.


Tom Emerick

Tom’s latest book, “An Illustrated Guide to Personal Health” is now available on Amazon.