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Six Things Employees Need to Know about the Coronavirus

Once again, we will be re-posting from Quizzify. This post also turned out to be very popular and we even incorporated a couple of extra suggestions from readers to update the blog post. We will also have some quiz questions available next week.

Here are Six Things Employees Need to Know about the Coronavirus

Highlights for those who don’t want to click through (though we aren’t contagious):

  1. wash your hands for 20 seconds at a time
  2. unless you recently washed them, keep your hands away from your nose and mouth
  3. your odds of getting the flu are vastly greater than getting coronavirus, at least for now — even if you had the flu vaccine (though that is a good idea in general)
  4. facemasks don’t work
  5. there are no magic potions or other preventive formulas
  6. go about your everyday lives

That’s the information for now. Check back next week. We might have question sets to distribute.

And the emphasis is on “for now.”  In the immortal words of the great philosopher Yogi Berra: “It’s tough to make predictions, especially about the future.”






Six things employees should know about nutritional supplements

Dear They Said What? nation,

Occasionally we re-post from Quizzify here. This particular posting was quite popular, so we thought it worthy of a repost. Also quite popular on The Skeptical Cardiologist, which is one of our favorite blogs. If I knew how to create a blogroll, they would be on it.

The majority of your employees take nutritional supplements, whose consumption just reached an all-time high. That increase means someone, somewhere – maybe even your very own wellness vendor – is telling them this is a good idea.

Or maybe they are thinking: “Hey, what harm can they do?”

Plenty, as it turns out. Here are six things employee should know about nutritional supplements. In the case of close calls, we yield to the optimistic views of the supplementarians, on the theory that they are more likely to whine and we don’t want to get into any he said-she said comment fights with them.

1. Most benefits of supplements with none of the risk can be achieved with a regular multivitamin

There is plenty of evidence for the health benefits of virtually all vitamins and minerals and even a couple of supplements, so much evidence that we have room to highlight only a few.

Examples include fish oil for menopausal women with dry eye or possibly people at high risk of heart attack. Or folic acid for pregnant women and iron for pregnant women who are anemic. Or Vitamin D for people who have dark skin, live in cloudy climates, avoid all sun exposure and/or don’t each much dairy. And of course, Vitamin B12 for vegans. (Vitamin B12 is found only in animal products.)

Women likely benefit from small combined extra amounts of calcium and Vitamin D…but as noted below, don’t overdo it.

The 10% of the population who drink to excess really should be taking daily multivitamins. This is partly because alcohol interferes with absorption, and partly because they aren’t getting enough calories from real foods.

30-second shameless plug: this is where Quizzify comes in. Most heavy drinkers — like most other employees with something to hide — lie on health risk assessments (HRAs). About 3% of your employees will admit on an HRA they drink too much, whereas in reality the top 10% of adults consume 73 drinks/week. Even assuming the HRA provides correct nutritional advice (most don’t), 7% of your employees who need this advice won’t receive it.

Quizzify, on the other hand, specifically asks and answers the trivia question: “What extra vitamins should you take if you drink heavily?” So the other 7% get this valuable information…without needing to disclose their drinking habits.

With these exceptions, most people should be getting enough vitamins in a balanced diet, but a few cents a day of an “insurance” multivitamin pays for itself just in the psychological benefit of not worrying about that. However, the story changes when we talk about megavitamins, and especially when we talk about other supplements.

2. Almost every megavitamin which once showed “promise” in fighting cancer, heart disease, etc. doesn’t. Quite the opposite, they may cause harm.

Niacin, once thought to have magical properties against heart attacks, has been completely debunked. Vitamin E supplements could prevent cancer in some women but cause it in others, depending on genes. Men who are concerned about prostate cancer (meaning all of us) should specifically avoid Vitamin E supplements, which likely increase the odds of it. Vitamin D in large quantities is the latest to be debunked, just last month. Taking too much may cause osteoporosis, rather than prevent it.

As with anything else for sale on the web, there is a business model here that may not always be in the consumers’ best interest. This is particular true for Vitamin D, where the “Doctor” who touts the stuff the most gets paid handsomely by the industry.  He thinks the dinosaurs didn’t die due to the asteroid that hit the earth. He thinks they died of a Vitamin D deficiency due to the lack of sunshine afterwards.

And monitor your own wellness vendors. Interactive Health, for example, tests every employee for anemia.  (See “Interactive Health breaks its own record for stupidity.”)

This is contrary to the advice of clinical guidelines, which oppose anemia screening except for pregnant women, where evidence is mixed. Employees who then take iron supplements risk stomach pain, nausea, vomiting and serious long-term complications.

The good news? It is just slightly possible large amounts of Vitamin C do offer modest benefits with respect to common colds, and that those possible benefits outweigh the possible harms. But just large amounts, like 200-400 mg., not massive amounts. Not the 1000+ mg. that the proponents tout. 

3. If you have to go to GNC to obtain a supplement, or order it through the mail, it has no value and may cause harm.

CVS and Whole Foods want to make money too, and fancy supplements are expensive, high-margin items. So if a supplement has even the slightest inkling of value, they’ll stock it.

As a random example we picked because we like the name, consider horny goatweed, as a treatment for erectile dysfunction (ED). Along with the name, it also has a great back story, something about Mongolian herders observing goats getting aroused after grazing on it.

Horny goatweed is actually proven to work, though — and not just on goats. It also works on rats. For the rest of us mammals, there is zero evidence. Plus, ED is one of those conditions where, if something worked, we’d know about it by now.

At least the likelihood of harm is pretty low to other than your wallet.

4. There is no such thing as FDA approval for supplements

Supplements are notorious for lax quality control, unproven health claims, and contamination. Did we mention unproven claims? The FDA has no say in the matter of unfounded health claims.

It’s also not entirely clear that these pills contain the ingredients they claim to contain in the quantities they profess to contain. These supplements turn out to be much harder to manufacture to specs than regular synthetically derived pills.

5. They may interact with “real” drugs you are taking

Just because supplements are derived from natural sources doesn’t mean they don’t act like real drugs inside your body. And, like real drugs, they can interact with other drugs. For instance, if you are taking Vitamin E and Advil or Advil PM or a baby aspirin, your risk of bleeding profusely in an accident goes way, way up, because all are blood thinners. The risk isn’t just accidents — small everyday bruises may become big bruises.

Make sure you list supplements when describing to your doctor what you take…though it’s questionable whether (aside from the basics, like that blood-thinning example) the doctor would be aware of these interactions. There are too many to track, and some interactions simply aren’t studied.

It all comes back to this: a one-a-day multivitamin/mineral supplement is more than enough for most people. Not just for the benefits, but for avoidance of the risk of interaction, side effects and unknown long-term impacts.

6. There is one “supplement” that benefits almost every body system and has no side effects

You guessed it – exercise, the key to health and longevity. If there were a dietary supplement that provided even a small fraction of the benefits of exercise with none of the work, we’d know about it by now.



2020 World Health Care Congress to Feature Wellness Debate!

It looks like the Mother of All Wellness Debates will be held March 29th in Washington, DC, at the World Health Care Congress.

This is a particularly timely issue because the EEOC is, even as we speak, drafting proposed rules defining “voluntary” to replace the 1984-type rules (where “voluntary” means “forced”) tossed out by a federal court in December 2018. There is a tension between protecting employee civil rights (as EEOC is tasked with doing) and allowing employers to fine employees (or move to high-deductible plans and then “incentivize” them to earn back their deductible) who don’t lose weight or otherwise toe the line. Or even to participate in these so-called “pry, poke and prod” programs, whose clinical value is dubious and often provide misinformation or violate clinical guidelines.

As noted in the link, key EEOC administrators have indicated they will be paying close attention to this debate. Further, the interest level extends to Capitol Hill.  Democratic Rep. Jamie Raskin (arguably the most influential non-senior Democrat on the Hill) and Republican Senator Lamar Alexander (who runs the Senate committee that oversees health and labor issues), have already commented for the record on this debate.

Someone needs to show up to represent the “pro” side, though — or else the debate will be a rather one-sided affair. So far the invitation to debate has not been accepted — by the exact people who spend their entire lives looking for forums to spread their pro-pry,poke,and prod message.

Let me encourage them to show up by striking a conciliatory tone.

In the past, perhaps this column has not been respectful of my potential adversaries in this debate — the Health Enhancement Research Organization (HERO) and/or Ron Goetzel.  However, I have great regard for them  — when they tell the truth. For instance, Ron Goetzel endorsed Quizzify as being “a lot of fun and very clever,” (minute 42:57 of our last debate).  And when he acknowledged I am the best peer-reviewer in the industry (minute 30:38). Or when he acknowledged that it requires 2-3 years to reduce risk by 1-2%.

I am also very very upset with The Incidental Economist (they are the New York Times’ economics bloggers). They referred to Ron’s analysis as — please excuse the technical jargon — “crap.” How dare they!

I also give HERO tremendous credit for admitting that “pry, poke and prod” programs harm employee morale and can damage corporate reputations (like Penn State).  But most importantly, for admitting that wellness loses money. It’s a rare trade association honest enough to admit their product –and once again, pardon the technical jargon used in the lobbying industry — sucks. It took real candor and courage to do that, and it is much appreciated. I have great respect for integrity.

I will reciprocate by acknowledging the benefits of “pry, poke and prod.” Screening according to established clinical guidelines, though it won’t save money, is a good idea for long-term employee health — assuming someone is able to interpret the findings correctly and assuming the findings are accurate, and assuming they aren’t already getting too many checkups.

I look forward to matching wits with them next month.

You can see the full World Health Care Congress agenda here, and register here.

New York Times features our solution to surprise bills!

Dear They Said What? Nation,


I think most of TSW Nation has already downloaded our custom consent to sign in emergency situations, in lieu of whatever they put in front of you. You can put this consent — along with some other helpful conversation-starters for other medical issues in doctor visits — right into your Apple Wallet. (Android users are out of luck until a future software update in which the Wallet App is added.)

Your Wallet should look like this (I mean, assuming you also bank at Bank of America)…


…and then tap where it says: “Billing Consent” to open this up:

If you haven’t already done so, well, today’s New York Times should be enough to convince you. 

We’d encourage you to read the whole shebang but we’d be lying if we didn’t say this is our favorite part:

But, by writing in their own limits, patients might have leverage in negotiations or even in courts if out-of-network payment disputes arise, or at least proof they didn’t agree to pay the total charges, say some advocates and legal scholars.

Patients who try this could still get hit with a large balance bill. But “the difference is you can say ‘I offered this, but they refused it,’” rather than signing the original agreement to pay all charges, said Al Lewis, chief executive of Quizzify, an employee health care education company, who is a proponent of setting your own terms.

He came up with the twice-Medicare benchmark, even putting suggested wording for patients to print and carry with them on downloadable wallet cards, because he says it’s an amount that’s defensible.

If a hospital later turns down “two times Medicare and it goes to court, their lawyer is going to say, ‘We could lose this thing,’” said Mr. Lewis.

And, while I will be very pleased to take credit for inventing the consent in question (no “fake news” in this article!), I do want to give shout-outs to Marilyn Bartlett, David Contorno and Marty Makary. They provided the peanut butter (reference-based pricing) and chocolate (“battlefield consents”) and all I did was combine them.

And thank you to Stacey Richter for being the taste-tester. I was pretty sure this should work, but she was the one who proved it would work. In the immortal words attributed to the great philosopher Yogi Berra: “In theory, theory and practice are the same. In practice, they’re different.”

Not this time.



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