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.

No doubt you’ve seen the latest on colonoscopies, from the New England Journal of Medicine.  The bottom line, so to speak, is that they don’t do anything…or do they?

It was a large, multiyear randomized control trial, which would normally be considered the Gold Standard.  And it concluded that the rate of colon cancer cases was not much lower in the invited group than in the control group, while the all-cause death rates were almost identical. It was good enough for the leading medical journal in the world, so shouldn’t it be good enough for us?

However, the subset of the invited population that actually got the colonoscopies did enjoy a much more noticeable reduction in cases and all-cause death rates.

But as we’ve learned in wellness, comparing participants to a reference or “passive control” group is not valid, because participants always outperform non-participants.

And we can credit Ron Goetzel’s brilliant analysis for that. He proved that participants will even outperform non-participants when there isn’t a program to participate in, as noted below, where the groups were separated in 2004 but the program didn’t start until 2006…at which point the participants had already dramatically outperformed the reference group.

And yet, this time the rebuttalists may have a point. Unlike in wellness, where there is clearly a state-of-mind difference between people who want to participate in a program and people who don’t, it’s hard to imagine that same amount of difference in a decision to get a colonoscopy. Some people just don’t want them, even if they are otherwise conscientious about patrolling their health.

Needless to say, Quizzify has deconstructed the pro and con arguments. You can read about that here in Part One of our series on colon screening.

Or you can cut right to the chase and see our elegant solution here in Part Two. You’ll see in Part Two that our solution has, in the immortal words of the great philosopher Zero Mostel, something familiar, something peculiar, something for everyone. It’s…

There is an old joke: “How can you tell if a vendor is lying about ROI?”

Answer: “They’re claiming an ROI.”

That’s not entirely accurate. Some vendors really do achieve savings. This is particularly true with vendors that just reduce the cost of something you need to buy anyway, like Quizzify for ER visits, where in most states 50% reductions in ER Bills are routine for employees using Quizzify2Go. Or Diathrive for diabetes supplies. Or any number of vendors for drugs, my personal choice being Drexi/AMPS, home of the $2.76 90-pill Ambien supply.

But, for behavior-change vendors, you need to be the judge to translate vendorspeak into English. Examples:

• “We retained independent actuaries to validate our savings” translates as “We paid off some actuaries to fabricate our savings.”
• “We reduced the risk level for many of the highest-risk employees” omits “…but they would have come down anyway due to regression to the mean.”
• “We achieved tremendous savings vs. trend” needs the asterisk: “because how we choose the trend determines the savings.” (This one, by the way, was a real quote from a well-known consultant.)
• “We compared participants to matched non-participants, and found that…” Hard stop. Invalid.

Fortunately, in the next 3 weeks, you’ll have four opportunities to learn how to distinguish valid from invalid measurement.

On August 31 at 2 PM EDT, I’ll be joining Virta Health on a webinar, kicking off the discussion with this very topic: Outcomes Measurement for Dummies…and Smarties. And you can learn why Virta is so valid that I am putting up $100,000 as a “Challenge” for anyone who thinks another vendor’s outcomes are better. Sign up here.

If you really want to dig deep, join Health Benefits Nation in Orlando, hosted by The Validation Institute. This September 14-16 conference in Orlando covers the gamut, but specifically, there is a two hour session on valid measurement starting at 1 PM on the 14th. 

Besides digging deep, the Validation Institute is my forum for, uh, naming appellations and kicking posteriors. And of course, I invite people to sue me if they don’t like what I have to say about them.

We will also have case studies where you need to spot the lies, rather than have me tee the lies up for you. Because that’s what happens in the real world. Lies told by “independent actuaries” aren’t going to invalidate themselves.

Actually, they usually do, but only if you look hard enough…and that’s what this session is all about.

One more vendor is about to join the pantheon of validity, Medencentive. I’ve been over their numbers up, down and sideways, as have many others. They are a health literacy vendor. Not like Quizzify (though they are a Quizzify customer) because they go deep on literacy with people who have specific conditions already, whereas Quizzify is educating on all the points where employees and healthcare meet, as the four examples on the homepage show. They will be hosting a webinar on September 13 at noon EDT. You can sign up here.

Finally, if anyone is anywhere near Houston on the 21st of September and is an early riser, register for The Healthcare Digital Dilemma, where I and several of the leading lights of the field — Josh Berlin, David Carmouche and others — to discuss this “dilemma.” You want to do more digital health…and yet you know most of it doesn’t work.  We’ll be discussing how to find the solutions that do.

If you were one of the almost 8000 people to read the post  Virta Health becomes the first diabetes vendor to save money, you may be wondering what exactly they do that no other diabetes vendor is able to do, to get me to put $100,000 at risk for the first time for a vendor other than Quizzify.

Part of the reason is that Quizzify and Virta are the peanut butter-and-chocolate of diabetes.  

Virta reverses diabetes, while Quizzify helps pre-diabetics and diabetics avoid hidden sugars. That’s no easy task because 74% of processed foods contain them.  This even includes some products that claim to contain “NO ADDED SUGAR,” but in fact are bursting with added sugars. So that I want to encourage our clients to adopt Virta, and vice-versa.

The other part of the reason is that their savings are measured validly. While plenty of vendors claim to save money and some vendors measure validly, very few are in the intersection set.

Virta and I and the Validation Institute are doing a webinar on valid measurement generally, and you can attend that webinar both to learn about valid measurement and to learn about Virta’s own results using valid measurement.

Please join us for that webinar at 2 PM EDT, August 31st.

Time to bring your dental benefit into the 21st Century.  You may not look twice at it because it’s a small part of your spend, but it’s a big part of your employees‘ spend.

Further, unlike most of the stuff we cover in Quizzify, dental issues don’t go away on their own. Quite the opposite, they get worse in an exponential manner. An ignored 50% covered tooth issue can become a much larger 80%-covered medical issue.

Fortunately, there is plenty you can do about this at pretty much no cost. Read our article in Employee Benefit News, and then join the Linkedin conversation here (rather than comment below).