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.

For the second time in four years, Quizzify saved me a world of hurt.  This time around was thanks to our Doctor Visit PrepKits, our companion app to Classic Quizzify, our healthcare trivia quizzes.

While the quizzes teach health literacy between clinical visits, the PrepKits teach health literacy specifically for clinical visits.  You just enter a keyword, like a symptom, and the PrepKits tell you what you need to know, how to prepare for your visit, questions to ask the doctor and much more.

You might say “Well, our employees can just google on symptoms or ask their doctor.”  Unfortunately, if I had just googled on “Swollen calf,” the first hit would be “no cause for concern.”  (Try it.)  And my doctor was quite convinced the PrepKits’ take on “swollen calf” was rather alarmist, but agreed to see me anyway.

Bottom line: Absent Quizzify2Go’s admittedly alarmist but nonetheless quite accurate advice that I should seek care urgently, I would have ended up in the hospital, with a procedure and a six-month recovery.

See how Quizzify once again saved the day…and turned a likely tale of woe into a minor inconvenience.

https://www.quizzify.com/post/how-quizzify-may-have-saved-my-life-again

And then imagine how many of your employees might have a similar experience. All you need is one, to pay for all of Quizzify.

PS Please put comments on Linkedin – I’ve migrated all the comments there. 

There are precisely 3 pieces of useful information on these labels. Everything else ranges from useless to misleading.

And yet how often do you read those labels when selecting a product?  And do you ever not believe the information on them?  Well, it’s time to start reading these labels critically.

The food companies are “teaching to the test.”  They are maximizing the perception that their products are healthy, instead of actually trying to create healthy products. Often the two goals are at odds with each other.

Please do not comment here. I’m taking all comments on Linkedin.  This link takes you there, and then if you are still interested, you can link to the full blog post.

https://www.linkedin.com/posts/al-lewis-%F0%9F%87%BA%F0%9F%87%A6-57963_nutrition-workplacewellness-wellnessthatworks-activity-7150844902359121920-fWh0?utm_source=share&utm_medium=member_desktop

The good news is that you can take 7 steps to curtail your likely increase in spend. This link will show you how…

SPOILER ALERT:  This is the ideal use case for Quizzify.

If you are like most benefits leaders, you are wrestling with the question of whether to cover the new generation of GLP-1 drugs for weight loss, or just for diabetes.

Covering, not covering, and covering with precertification each have major drawbacks.  This posting explores those drawbacks…and offers a fourth option, where you can steer only the better candidates to those drugs, to strike the right balance between cost and coverage.

And you can join our joint webinar with US Preventive Medicine (Sept. 7th at noon EDT) by registering here.

Those of you who’ve been reading this blog for years recall the old days of the outcomes-based wellness fad – led by Bravo, Wellsteps and of course Interactive Health – where the “idea” was that if you paid people enough, they would lose weight.

The predictable thing happened: employees gained weight in order to get paid to lose it again. There was even a cottage industry of coaching employees on how to gain weight, with this satirical blog post being (presumably) accidentally clicked on more than 100,000 times by employees googling on “how to cheat in a corporate wellness program.” The “recommendations” in that blog post could harm employees.

Employees cheated on those wellness programs just to make (or avoid losing) $500 or $1000 in extra taxable income.  Imagine how much cheating there will be to get access to Wegovy (or Ozempic), a  $12,000+ value equivalent to maybe $16,000 in extra taxable income.

Further, it is much easier to cheat because you aren’t being paid to reach a goal weight, as in wellness. . If your BMI is 28, you need only gain ten pounds and, well, the indication for Wegovy is a BMI of 30…and you would qualify.

No one has ever claimed that artificial sweeteners are a health food. The argument usually runs: “Well, they aren’t as bad as sugar.”

Or are they? We aren’t going to “take sides” here generally, but rather just make 8 observations – 4 pro and 4 con – regarding the study just released that recommends not consuming Splenda, the brand name of sucralose. Let’s start with the arguments against Splenda.

1. The study claims some very specific harms and risks

To quote a cogent summary of the study in MedicalNewsToday:

The results showed signs of genotoxicity. The researchers also found that sucralose caused leaky gut or damage to the gut lining. In addition, they observed the genetic activity of the gut cells and discovered that sucralose caused an increase in gene activity linked to oxidative stress, inflammation, and carcinogenicity.

The linkage to leaky gut syndrome – in which digestive matter well on its way to the usual exit venue leaks into your perineum – was the one we found to be, to use a technical clinical term, the grossest.

2. The quantities involved were realistic

This isn’t one of those studies where they gave rats 10,000 times what a human would consume and found an elevated risk of whatever, like toenail fungus or uromysitisis.

Quite the opposite. The amount of the chemical in question, sucralose-6-acetate, that can cause harm could easily be produced by the gut of a regular consumer of sucralose. Specifically, as one summary says:

The European Food Safety Authority has a threshold of toxicological concern for all genotoxic substances of 0.15 micrograms per person per day…The trace amounts of sucralose-6-acetate in a single, daily sucralose-sweetened drink exceed that threshold. And that’s not even accounting for the amount of sucralose-6-acetate produced as metabolites after people consume sucralose.

The other six can be found here.

Please put comments here: https://www.linkedin.com/posts/al-lewis-%F0%9F%87%BA%F0%9F%87%A6-57963_8-things-to-know-about-splenda-a-study-just-activity-7074713333819416577-A6sH?utm_source=share&utm_medium=member_desktop

Here’s something you don’t see every day: a book slamming wellness written by someone in charge of wellness at their organization.

In this case, it’s Dr. Richard Safeer, who is the Chief Medical Director, Employee Health and Well-Being for Johns Hopkins Medicine and its 60,000+ (formerly) soda-loving employees.

Eschewing and verily even dissing (“it’s a band-aid”) the old “pry, poke and prod” wellness model breathlessly promoted by fellow Hopkins employee Ron Goetzel before his own heart attack slowed him down, Dr. Safeer writes of his continuing and generally successful quest to create not just a culture of health at Johns Hopkins, but actually a healthy culture. The latter includes the former but goes much farther. You can have the healthiest employees in the country but if your culture is unhealthy, that won’t do you any good. And a poisonous culture will also impact the actual health of even the healthiest employees. (That happened to me three times in my earlier days.)

I would strongly recommend this book to anyone who wants to know what it’s like in the trenches, trying to nudge a (very) large organization into healthier habits.  It’s not remotely as easy as all those smiling faces on wellness vendor websites would have you believe. As the person in charge of wellness, you have to do your job almost totally by the strength of your ideas and persuasion, since less than 0.1% of those employees report to you, and in any event you can’t force people to be healthy. (Although there is a saying: “Wellness programs will make employees happy whether they like it or not.”)

As with most of these books although more so due to his first-hand experience and observations, the strength is in the storytelling. Starting with his first week on the job, when he noticed a big red fire truck outside the ER. Only it wasn’t a fire truck. It was a soda truck, doing quite the robust business. (He also noticed that on campus, soda cost less than water. Reversing that was an early success.) And, later, there was a fundraiser for the American Diabetes Association – in the form of a bake sale.

It’s not just about the broccoli: It’s the “building blocks.”

Those are examples of nudging Hopkins towards healthier eating, building awareness of the perils of added sugar among people who should know better already.  But two-thirds of the book is about the far more important task of creating a healthy culture through building blocks. This is a dramatically different approach than the typical flavor-of-the-month “challenges,” like who can crash-diet the fastest or drink the most water.

Quite the opposite, there is some behavior change science that when applied intentionally and methodically – and slowly enough to avoid pushback while building consensus – will be far more impactful in the long run. Pursuing wellbeing in the workplace is less about what an individual is doing for themselves (“challenges”) and more about what the organization, leaders and co-workers are doing together so that everyone feels supported and everyone benefits. Many of the stories and lessons in these chapters are about cultures, “sub-cultures,” peer cultures and “culture-killers.”

Some of the stories in these chapters are very relatable, at least for me, particularly the last. Three times I’ve fired people who were “culture killers,” as Dr. Safeer calls them – and three times the output from the remaining staff increased immediately.  One of those people was so poisonous that when I prepared to fire him over the phone, I bought one of those recording apps and drove to Rhode Island, since I thought he might threaten me over the phone, and recording calls is illegal in Massachusetts. It took half a day to make a five-minute call. (On the other hand, the surf was up, so the other half-day was well-spent.)

His reaction was the opposite – that he was expecting the call. And that brings me to my own observation about culture and hiring and firing. HIring is like a civil trial–the weight of the evidence.  Firing is like a criminal trial–beyond a reasonable doubt. We often wait too long to fire people who are disrupting the culture.

The overall message of A Cure for the Common Company: If we were each able to improve our own habits and maintain a positive outlook on our own, we would have done that by now.  Yet it’s 2023 and our workplaces are still taking the same approach of telling the employee this is your problem because you weigh too much etc. A diametically different approach is needed, particular in an era when employees have so many choices of where to work…and that’s what’s laid out in these pages.

You can order it here.