This month (meaning next month, but it already feels like December around here), we are donating this space to Quizzify, where we are reposting Quizzify’s Greatest Hits of their Six Things Employees Need to Know series. One a weekday for the next month, interrupted only by our annual awards.
Antibiotics are America’s most overused prescription non-opioid. Here’s what your employees should know about them. [SPOILER ALERT: They don’t.]
(1) Do not demand an antibiotic if one is not offered
Americans get enough antibiotics without asking for more. Official statistics show that half of all antibiotics are the wrong dose, wrong duration, or wrong drug – including a quarter that should not have been prescribed at all.
My personal tally is probably 75% wrong, in one way or another, as in this harrowing example, one of the highlights of which is a dentist asking me; “So, what’s your favorite antibiotic?
There is nothing, nothing in Quizzify, that suggests the correct way to prescribe an antibiotic is to ask your patient what their “favorite” is. Quite the opposite, taking the same antibiotic multiple times is a good way to create antibiotic resistance.
Dentists, with Exhibit A being my former one as noted above, are major overprescribers. With a few exceptions, of course.
And if a telemedicine doctor prescribes one, consider this: how can they possibly be sure you have a bacterial infection? There’s no in-person exam and no culture. You guessed it – they are also major overprescribers.
(3) If an antibiotic is proposed, ask some questions
“Are you sure this is a bacterial infection?” is the best. If you get an answer like: “This is just to be safe,” or something similar, your best bet may be to get the prescription, but maybe only fill it once the culture is completed and is positive for bacteria. Or maybe whatever you have will go away on its own. Or ask (and call back if needed) what new symptoms might lead the doctor to think this is bacterial, and start taking the antibiotic then.
There is also a decent chance that whatever antibiotic the doctor guesses at before the culture is completed is the wrong one. Or is an overly powerful “broad spectrum” antibiotic when the culture reveals a specific organism that should be targeted.
(4) “Finish your entire course even if you are feeling better” is an urban legend
The one thing drilled into us when we are prescribed an antibiotic is that stopping early gives the hardier bacteria a chance to rebound.
At the risk of insulting the 76 million canines in this country, Wellsteps fabricating its outcomes is the “Dog Bites Man” headline of the wellness world. it really shouldn’t make the front page, especially in an industry as idiot-intensive as wellness. Yet transparently fabricating outcomes is their signature move, so I do like to make sure they get credit for it.
Even so, it’s impossible to do the “There’s nothing to see here. Move on” routine where Wellsteps is concerned. Wellsteps’ problem is that they aren’t remotely smart enough to lie without being caught. They may or may not be the most dishonest vendor, and they may or may not be the stupidest vendor, but they are certainly the stupidest dishonest vendor.
This time, in a last-minute quest to win their third Deplorables Award in 5 years, their very stable genius CEO, Steve Aldana, attempted to doctor the evidence of their cluelessness that won them their second Deplorables Award. His plot was foiled because he hadn’t realized that technology had advanced to the point that a skilled hacker, equipped with state-of-the-art hardware, could take screenshots.
Here is a screenshot of the original evidence of the harms done to teachers in the Boise School District:
You might ask: “What harms done?”
You can’t tell at first glance, because their original display scrambles the people whose risk scores increased with those whose risk scores decreased. Wellsteps does deserve credit for obfuscating outcomes in this manner, a brilliant application of their limited intellect that completely fooled the Koop Award Committee.
Unscrambling those datapoints to discern the actual net change in risk scores requires use of another application of another advanced technology – a spreadsheet.
Unscrambling those increases and decreases revealed that, in fact, risk scores had dramatically deteriorated on Wellsteps’ watch. This spreadsheet copies the the three columns from Wellsteps’ version and then unscrambles the improvements and deteriorations, to create totals of both:
6397 risks (red) increased, while only 5293 (green) improved. Of the 5293 that “improved,” 2134 were people with normal glucose reducing it further, potentially making some of them hypoglycemic. Nothing screams “productivity improvement” like hypoglycemic teachers trying to control a roomful of kids who’ve just finished their juice-and-cookies.
In all other cases – BMI, blood pressure, cholesterol – the average low-risk person (or even middle-risk person, in two instances) showed an increase in risk factors (in red), as would be expected due to regression to the mean. Our suspicion in glucose is that Wellsteps simply miscalibrated their equipment or misadded their figures. Or they made some other rookie mistake, rookie mistakes being another of their signature moves. The reason you can be fairly certain of this is that it is statistically virtually impossible that an entire cohort of 2134 people whose glucose was already low would go even lower, especially when all the other “normal” starting values spiked higher.
So instead of teachers suffering from hypoglycemia, the likelihood is that Wellsteps was suffering from hyperstupidemia.
Removing those 2134 glucose decreases from the calculation means, almost literally, that twice as many risk factors inreased as decreased.
This was major news, a full-page article in the Boston Globe, as the headline below shows. But the Boise School District wellness coordinators, either embarrassed because they hadn’t realized their teachers were being harmed at considerable cost, or because they were suffering from Stockholm Syndrome, never reported this to the Boise media.
Now here is Wellsteps’ new spin on their outcomes. Wellsteps decided the only way they could show results that weren’t a complete embarrassment was to omit the large majority of participants, because their risk on the whole increased. Instead they would just show the small minority whose risk decreased, riding the regression to the mean (“RTM”) train to hoodwink gullible prospects into thinking they actually accomplished anything other than killing a few billion electrons.
Ironically given their level of overall ignorance, they can’t claim ignorance of RTM. Mr. Aldana himself, – whom epidemiologists have determined is Patient Zero in the wellness industry’s epidemic of cluelessness – actually admitted that he understands the concept of RTM and how it applies here:
“In just one year, many employees will move from one [risk] group to the other,” he explained, “even though they did not participate in any wellness programs or any intervention whatsoever.” That movement, he continued, “reflects changes in health risks that occur naturally,” making it possible that some high-risk people become low risk “even though your program didn’t do anything.”
He called the author of the article citing this quote, the late, esteemed, highly respected health/science writer Sharon Begley, a “lier.” Though he never said exactly what she was lying about, of course.
He also accused Sharon and me of violating the Law of Conservation of Mass, “creating BS out of thin air.”
To close on a conciliatory note, in that very same article, Mr. Aldana made an observation which with I and readers of this column would concur: “I agree there is some real crap out there being sold under the guise of wellness.”
Hear, hear! So I think we can also all agree that it’s time to rid the industry of “liers” that sell “real crap.” And we can also agree to apologize to all who have been victims of Wellsteps’ schemes or invectives: teachers, Boise taxpayers, Sharon Begley, honest vendors, relatives of the deceased electrons, and, of course, our collective 76 million dogs.
They Said What? 