The Peterson Health Technology Institute (PHTI) recently published an exhaustive study demonstrating what we’ve been saying (and guaranteeing) all along: Virta is unique among diabetes vendors in that it actually has an impact, while digital diabetes vendors don’t.  (Diathrive, a diabetes supply company, also saves money but supplies are a different diabetes category.)

PHTI did a great job as far as the report went.  And Livongo and Omada have accepted their conclusions. By “accepting their conclusions,” I mean declining my bet. Sure, they did some perfunctory whining about not looking at the data the right way yada yada yada in one of those “he said-she said” articles, but at this point everyone (at least everyone with a connection to the internet) knows they lose money.

That brings us to Vida.  Until now Vida has flown under the radar screen, but the sound-alike name gives them the opportunity to be confused with Virta.  That strategy was coupled with a brilliant two-part strategy regarding the PHTI report:

1. Don’t submit any studies to PHTI
2. Complain that PHTI didn’t look at their studies.

To the first point, PHTI lists cooperating vendors who submitted articles. (Virta submitted 12 to Vida’s 0.)  To the second point, that aforementioned “he said-she said” article notes:

Vida says its diabetes programs are clinically proven to [reduce Hb A1c], as reflected in its body of peer-reviewed publications and the satisfaction of the “tens of thousands of members” who have found success with its diabetes program.

Not to be too semantic here on the latter point, but of course the people “who have found success” with your program will be satisfied.  The question is what percentage have “found success.”  In their case, according to this article, the percentage who dropped out or were lost to followup or didn’t complete their Hb a1c tests was…hmmm…I can’t seem to find it.  Am I missing something here?

Results: Participants with HbA1c ≥ 8.0% at baseline (n=1023) demonstrated a decrease in HbA1c of -1.37 points between baseline (mean: 9.84, SD: 1.64) and follow-up (mean: 8.47, SD: 1.77, p<0.001) . Additionally, we observed a decrease in HbA1c of -1.94 points between baseline (mean: 10.77, SD: 1.48) and follow-up (mean: 8.83, SD: 1.94, p<0.001) among participants with HbA1c ≥ 9.0% (n = 618) .

Bookmark this paragraph because we will be coming back to it.  Turns out one could teach an entire class based on this paragraph alone, comparing Vida to Virta. And Part 2 will do exactly that.

Peer Review

Here is the Validation Institute’s summary of so-called “peer-reviewed publications,”  in Part 5 of their 9-part series on validity:

Vendors have realized that prospects consider the phrase “peer-reviewed” to settle all debates about legitimacy. Part Five will take you inside the thriving peer-reviewed journal industry to show you how peer reviews are bought and sold.

Often, vendors will brag about being peer-reviewed. Most prospects of vendors will then assume that the data was carefully vetted and reviewed by independent highly qualified third parties before seeing the light of publication because, after all, no journal would ever publish an article that was obviously flawed, right?

Well, certainly not for free.

Indeed, probably 95% of journals have turned article submission into a profit center. The euphemism for this business model is “open access.” Open access means that instead of the subscriber paying to read these journals, the author pays to publish in them.  In other words, vendors are placing ads. Livongo at least had the good sense to at least pretend their journal was real, by buying some space in something called the Journal of Medical Economics, which sounds pretty legit, right?  Not open-access, right? Um…

Well, Vida didn’t even bother to pretend it wasn’t open-access when they placed an ad (technically called “sponsored content”) in JMIR Formative Research. It actually includes the word “open” in the logo…

…and lest there be any doubt about where their vig comes from, JMIR even publishes their price list, which they call  an “article processing fee.”

Also, have you ever heard the phrase “investigator bias“? Well, here is the list of authors and funders. Notice a pattern?

Congratulations to Diathrive Health for achieving validation from the Validation Institute (VI). That itself comes with a $50,000 Credibility Guarantee.

In rare cases of VI-validated organizations – such as Virta Health or Sera Prognostics or Acacia Clinics – I add my own “Best in Show” guarantee and offer a $100,000 reward for a successful challenge.

Any diabetes vendor mentioned in the Peterson Health Technology Institute report (other than Virta, which “won” in that report for its diet/coaching offering, which is not at all competitive with Diathrive) can challenge my statement that Diathrive has better and more validly measured savings than they do on the cost of supplies from a vendor that also incliudes coaching support.

Rosencare, based on the industry-leading results at Rosen Hotels, has achieved excellent results overall with Diathrive, but the specific cash-on-cash savings that are guaranteed would be actual diabetic supply prices offered by a company that also provides coaching.

Here are the terms to earn the $100,000 reward.

Terms and Conditions of Challenge

Selection of Judges

There will be five judges, selected as follows:

• Each side gets to appoint one, drawn from members as of 4/17/24 of The Healthcare Hackers listserve with 1300 people on it, from all walks of healthcare.
• Two others are appointed objectively. That will be whichever health services researchers/health economists are the most influential at the time the reward is claimed. “Most influential” will be measured by a formula: the highest ratio of Twitter followers/Twitter following, with a minimum of 15,000 followers.
• Those four judges will agree on the fifth.

Using the criteria below, judging will be based on validity of the measurement. Measurements deemed invalid, such as those described on the Validation Institute site, are a disqualifying factor the challenger.

Written submissions

Each side submits up to 1000 words and five graphs, supported by as many as 10 links; the material linked must pre-date this posting to discourage either side from creating linked material specifically for this contest.

Publicly available materials from the lay media or blogs or the Validation Institute may be used, as well as from any academic journal that is not open-access.

Each party may separately cite previous invalidating mistakes made by the other party that might speak to the credibility of the other party. (There is no limit on those.)

If a challenger is “validated” by a third party whose alleged outcomes have been invalidated on this site in the past, those other invalidations may be presented to the judges to impeach the credibility of this alleged validation.

Oral arguments

The judges may rule solely on the basis of the written submissions. If not, the parties will convene online for a 2-hour recorded virtual presentation featuring 10-minute opening statements, in which as many as 10 slides are allowed. Time limits are:

• 30-minute cross-examinations with follow-up questions and no limitations on subject matter;
• 50 minutes in which judges control the agenda and may ask questions of either party based on either the oral or the written submissions;
• Five-minute closing statements.
  

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Entry process

The entry process is:

1. Challenger and TheySaidWhat deposit into escrow the amount each is at risk for ($10k for the Challenger, and $100k for TheySaidWhat). Each party forwards $10,000 to the judges as well, as an estimate of their combined fees and/or contributions to their designated nonprofits.
2. If the Challenger or Service Provider pulls out after publicly announcing an application, the fee is three times the amount deposited.
3. The escrow is distributed to the winner and the judges’ fees paid by the winner are returned by the judges to the winner, while the judges keep the losers’ fees.