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Interview with Dr. Henry DePhillips about Telemedicine

Dr. Henry DePhillips is the Chief Medical Officer of Teladoc. At Teladoc, Dr. DePhillips is responsible for maintaining the exceptional delivery of clinical care delivered through Teladoc’s telemedicine digital health platform. Prior to Teladoc, Dr. DePhillips held several high-level leadership positions in health care. His positions included a previous role as the Chief Medical Officer at MEDecision, working as the Senior Medical Director at Independence Blue Cross of Pennsylvania, and a role as Head of Business Development, North America for McKinsey’s international Health Systems Institute. Dr. DePhillips is a health technology fanatic who is passionate about telemedicine and shifting health care from a provider-centric model to one that better values the needs of the patient.


1) How do you see telemedicine affecting employee burnout and workplace wellness?

What I am seeing is that telemedicine provides employees quick and inexpensive access to services that contribute to their well-being. Employees also generally perceive the telemedicine experience as more enjoyable than traveling to see a physician. Employees like what we provide, so our service grows as it is better understood by employees. When people get the care they need in a timely manner, this reduces workplace wellness issues — concerns like presenteeism — because employees now have easy access to care rather than “powering through” health conditions that could have unwanted consequences if ignored.  These consequences range from getting other employees sick to compounding personal medical issues by not seeking treatment.

2) What are some of the aspects of American work culture you see uniquely contributing to issues of presenteeism and employees “powering through” illness?

There is a combination of cultural factors here in the United States. One is financial, many American employees can no longer afford to miss a day of work. A second is functional. In many U.S. companies that have downsized staff, if someone misses work then there is no longer anyone to cover their role/position — calling in sick is simply not an option. A third is cultural considerations. In America it is a sign of toughness and/or commitment if an employee powers through their illness. For instance, it can be viewed as a “badge of courage” if you come in with the flu. Lastly, there are logistical considerations. In many cases when someone should see a doctor, they are unable to do so because scheduling is difficult given other considerations. This last factor is where I see services like Teladoc playing an important role. With telemedicine it is no longer a burden to see a doctor. With the traditional approach you generally must take time off work, schedule an appointment, travel from work to see your physician. Now, if an employee is in need of care, it is as close as their keyboard or mobile phone. An experience that used to be three to four hours can now be accomplished in 30 minutes with telemedicine — and unless you need to pick up a prescription, your experience can all take place in a virtual environment of your choosing.

3) How do you see telemedicine playing a role in helping improve the patient experience?

With Teladoc you can update your electronic medical record in minutes, request a board-certified physician to meet with you at a time that works with your schedule, interact with your physician using the digital modality of your choice (phone, video conferencing, digital photos, etc.), and have prescriptions sent to a location that is convenient for you. In my opinion, it is simply a better experience.

4) There are reports that over 15 million people now use telehealth, which is a 50 percent increase in usage from numbers reported in 2013. Who is driving this growth?

Telemedicine is still perceived as a rather new way of receiving care, so we have plenty of early adopters (now) but you are going to see increased utilization blossom as we move into the early majority. Those that would rather take a conservative/traditional approach will likely become more open to telemedicine as the technology matures. “Try it once, and you will like it for life,” really applies to our technology. We see that once users try it once they often return, at least here at Teladoc. In certain populations it is a no brainer — single parents with kids, those that travel for business — again anyone with logistical considerations will likely become lifelong users once they try it once.

5) Why do you think there is a significant proportion of physicians that have an aversion to telemedicine?

It is an evolution. It is a work in progress. Health care as an industry tends to be fairly conservative when it comes to technology. Think back to the Marcus Welby, M.D. days and we have not evolved much since then in regards to care. Health care is still a very provider-centric experience. The provider tells you the times that work for them, you go to the provider’s place of practice, the provider basically makes you adhere to what is convenient for the provider. I see telemedicine as the first major shift towards a consumer-centric approach. Under the current antiquated paradigm, a patient has to say, “I am sick, where must I go to receive care?” However, with telemedicine the patient can now ask, “I am sick, how can I most efficiently get the care I need?” And now, care is as close as the smartphone sitting on the bed stand. The doctor now comes to you, at a time convenient for you. At Teladoc, the average time between requesting a visit and being able to see a physician is 10 minutes. My job as the CMO of Teladoc is to make sure that the quality of care that people expect [from the old model] is the best it possibly can be [in the new model] as we go through this evolution. It is important to note, telemedicine is meant to address a subset of medical problems that has been specifically selected to work with telecare, problems that can be accurately and successfully treated using this form. In most cases I believe telemedicine will provide the end-user a superior experience, but there are going to be some specialties where telemedicine doesn’t make sense, and that is okay too.

Interview with Jill Gilbert about Health Technology

Jill Gilbert is a lifelong entrepreneur and the producer of the Digital Health Summit. Jill worked in the film industry for 15 years before moving on to health and technology. After leaving Los Angeles, her initial focus was the crossroads of aging and technology. She created the first comprehensive online directory and resource for senior care, the Gilbert Guide, for which she was praised as the champion of positive change in the aging services industry. In 2015, she launched another event at CES, Robots on the Runway, which focuses on the world of robotics. Her latest project is called Discover Baby Tech, a website and blog that will aim to bring together products and technology for new parents.


1) Behavior change and wearables are two buzz terms often talked about in the same conversation, yet many devices don’t truly deliver on the promise of actively helping someone change their behavior. What’s a favorite example of a digital health product that actively assists the user in building a desired habit?

Activity trackers have become synonymous with the word “wearables.” These devices (activity trackers) will certainly change some people’s behavior, primarily through awareness. Oftentimes, though, they fall short when it comes to behavior change. I’m more excited about closed-loop wearables, devices that are often condition-specific that trigger — or better yet, assist — with the desired next action to treat a particular condition. When you can engineer the need for “change” out of the usage loop, you immediately get a lift with regards to device efficacy. Most behavior change — when it comes to wearables — is going to be as good as the prompt and/or stimulus. The closer we can get the stimulus to inspire (or be) the next desired action in the loop, the closer we get to behavior change being a non-factor. Until activity trackers move our feet for us, I believe they won’t be as successful as other innovations I have seen recently in digital health.

2) It’s clear that the industry is on the verge of some significant breakthroughs. In your opinion, what’s currently being underreported regarding health technology that deserves greater attention?

Mental health is an area where digital health really can play an important role. For instance, pharmaceutical adherence is a huge issue in mental health. Many people with mental health issues suffer when they are not regimented about taking their medication. We are also making strides with regards to digital therapeutics. Cost is a major factor in treating mental health, and advances in the way we can treat people through behavioral modification platforms that are scalable — made possible because of digital health — is exciting. Telemedicine is also making an impact, by allowing patients to benefit from doctors that have excess capacity. Health technology is allowing people to get treatment who are so unwell they cannot leave the house. It is opening up treatment options for those worried about stigma. There are a lot of great things happening here, but it is not getting as much attention as one would think. Look what Lantern is doing, look what Iodine is doing, this is great stuff and not talked about enough. There is also a lot of promising technology to help with addiction as well.

3) Digital health is well-positioned as a valuable tool to help people with their entire continuum of care, with the potential of assisting people in lessening the frequency of doctor visits. What needs to happen so that consumers can have a better coalesced health experience through digital technology?

Interoperability is key. It is so important, and its lack of existence creates so much friction. Because the problem is so complex, we see people design around it (data operability), and what you are left with is disparate solutions. Literally, digital health in a lot of ways is the Wild, Wild West. Yet, on the other side you have hospital systems with antiquated legacy systems that often don’t even have APIs. We are finally making some strides though… Cisco and UCSF have partnered to engineer an integrated health platform that will hopefully get us closer, but the problem is mammoth. We need smart minds and a lot of resources to solve this problem.

4) Technology is inherently always changing. That said, what have been the constants since 2010 that are facets and/or indicators of successful digital health products? In other words, what is foundational for innovators to get right, or avoid getting wrong, in order to be successful in this space?

This sort of piggybacks off my Wild, Wild West comment. This space is inherently complex, and so in a lot of cases processes that work for pure tech start-ups — like creating a minimal viable product (MVP) — fail in this space. Especially if you hope to get FDA approval, there is a lot to navigate and that’s why we always stress strong partnerships. That said, companies still need to be bold. True innovation and breakthroughs come from mavericks who accomplish what others say cannot be done. There is a balance. The good news for innovators is that it is hard for bigger companies to take risks, so often through the “right” type of partnerships a start-up can get significant help from a larger organization. Obviously, there will be unique considerations that depend on the product. A reimbursable product is probably going to have to rely more on outside help than a consumer box product. The good news is there are great partners out there, like Ximedica, whose primary purpose is to help these types of products figure out a proper strategic path and wade through the intricacies of regulation.

5) You have set your sights on baby tech. Why baby tech? And what benefits do you hope to deliver with this next endeavor?

My ideas around baby tech came about from CES, and getting a lot of products sent my way that were meant for babies, new moms, fertility, post-pregnancy, etc. There was/are enough interesting digital baby products out there, and it was clear this is a distinct category worth addressing. Also, I got enthusiastic about it because I was about to become a new mom myself when I first saw this category get exciting. There is so much amazing stuff out there. Moms can go it alone, we have for decades, but [digital products] might help ease some of the burdens. I am creating DiscoverBabyTech.com to share what I know, create a space for product reviews, report new developments in this space and generally create a resource for moms interested in this topic. The plan is to launch next month sometime. We hope to attract people like ourselves to the site, new moms who love tech.

Interview with Mitesh Patel about Health Incentives

Mitesh Patel is a practicing physician, as well as a faculty member at both the Penn Medicine Center for Health Care Innovation and Penn’s Center for Health Incentives and Behavioral Economics.  Dr. Patel is also an Assistant Professor of Medicine and Health Care Management at the Perelman School of Medicine and The Wharton School at the University of Pennsylvania. He is well known for his research on behavioral economics where he and his colleagues are discovering ways to improve and elicit healthy behavior.  Dr. Patel’s thought leadership has been featured on CNN, NPR and in The New York Times, and his scientific findings have been published in several prestigious journals including the Annals of Internal Medicine, the New England Journal of Medicine, and the Journal of the American Medical Association.


1) As a physician interested in health, what do you make of the recent UCLA study that suggests BMI is a poor performance indicator? Although the extremely high recidivism rates we hear in lay media are generally inflated, programs that focus solely on weight loss programs seem to be falling out of favor. Is there a better approach to gauging and influencing toward behavior that contributes to wellness?

The challenge with using BMI is akin to the challenge of using any kind of score or metric for a population of people. There is always going to be a gray area. For instance, someone with a BMI of 29.9 is overweight, but someone with a BMI of 30 is obese. Even though there is a very, very small amount of difference between the two, when you categorize someone through this lens it can be classified as a significant difference. So this challenge I just described with BMI will be comparable with a lot of other standard measures.

So what many companies, employers and insurers are trying to do is find more holistic ways of looking at people’s health.  That is where it gets complicated, someone might have a low BMI, but have diabetes, and the right intervention is weight loss. This is an example of why using any metric in isolation is challenging. I do believe outside the context of the BMI measure, losing weight for overweight individuals is generally known to be beneficial. There is generally never harm in getting your BMI down to a lower range if you are above 25. However, that said, you certainly can find people with a BMI of say 32 that live to be over a hundred, but on average people in our current population are healthier if they lose weight.

A common problem with some wellness programs is they are often one-size-fits-all. For instance, lose 10 pounds and get a reward, but really we need to do a better job at personalizing to the individual. This highlights the importance of paying attention to how these programs are designed. We are facing complex problems, and oftentimes we are meeting these problems with solutions that are frankly too simple.

2) Outside of monetary incentives, what do you believe is most important for a company/organization to get right to best set themselves up for positively supporting employee well-being?

This brings us back to the importance of the overall design of the program. Is the program designed in a way that it will produce the results the company is expecting to get? Let’s say the goal is to increase everyone’s activity level, so the company gives everyone a free Fitbit, sets up a leaderboard to see how much everybody is doing and then creates a competition because competition can drive people to change behavior. The problem with this hypothetical solution is the program will motivate the people who are the top of the leaderboard — the people that tend to be already motivated — and demotivate the 95 percent of people that are not at the top of the leaderboard. I don’t think this is the right approach because it excludes the people you want to reach the most. We have done a couple studies where instead of setting a high bar, we set a threshold instead. For instance, in one study we set the threshold at 7,000 steps. The average American gets 5,000 steps, so the goal (in this particular study) is about a 40 percent increase in steps for most users. What this does is create a program that will reach more sedentary people than simply people who are already highly motivated to begin with.

3) What excites you the most about how technology is being used today to influence healthy behavior? And, where is it failing?

I think technology possess great potential to help us change behavior. One of the main reasons is that we could not measure these behaviors up until [roughly] 5 or 10 years ago. We didn’t know how many steps people took, we didn’t know if they took their medication (we can now with connected pill bottles), weight measurements were self-reported and often inaccurate. Technology has given us the opportunity to passively monitor, and we can now do that at a large scale. We can measure thousands of people with very low manpower because it can all be automated through technology.  The greatest promise of technology is being able to, on a large scale, automate this idea of passively hovering and get a rich data set so that we can see what is working (and what is not). Furthermore, we can do this while the only expectation for the participant is to continue doing what they are doing, which if you think about it is a big deal.

Where technology is failing is we have not taken the step beyond measuring. How do we actually get people to change their behavior using technology? I call this the “technology delusion.” People sometimes think that you can take someone who is overweight — who is inactive — give them a wearable device and all of a sudden they are going to be a new person. This might work for me or you who are engaged with this stuff, or Quantified Selfers, but it will not be true for people that have an inherent lack of motivation. These devices have not been shown to increase motivation in at-risk populations. That is why the studies I am a part of couple a behavioral change strategy with a technology. The technology is good for recording, maybe helping with feedback loops, but the behavior change component is what is often missing from organizational workplace wellness strategies.

4) There is research to suggest that extrinsic rewards are episodic, and in some cases extrinsic rewards can alter motivation in ways that are counterproductive. Most of this research is based on carrots (incentives) opposed to sticks (penalties), does using the fear of loss mitigate any of the risks generally associated with extrinsic motivation? Besides proving to be more effective, are there other attributes to penalties that position it as a better choice than rewards?

Intrinsic motivation is of course desired, if we can get people to increase that kind of motivation it is where we would start. The problem is it is fairly hard to influence intrinsic motivation, and then sustain that increase. The person really needs a good reason, many times that reason relates to a family event, or a life-changing event; whatever it is, the intrinsic motivation has to come from within the individual.

Extrinsic motivation, giving somebody some type of reward, is generally meant to jump start new habits and then hopefully we can remove the extrinsic motivators. There are some that believe you have to leave the reward in place to see sustainable behavior change. We have found evidence that people who get extrinsic motivation that’s well-designed get better results than our control groups. Furthermore, in some instances we have removed extrinsic motivation and we don’t really see that those people do worse than the control group either. We performed one study where we positioned the reward as a loss, allocated the money up front, and then took it away if the participant did not meet their goal. What is important here is that the lever was not a penalty — no one lost money out of their pockets. So this was not a stick per se but more like a “frozen carrot.” We told all three groups in that study at the end of the month they will get a check in the mail, and they could earn about $42 (a month). The reward was the same among the two non-control groups, but for one group the incentive was framed you get something for your behavior, the other group it was framed you start with a reward but it can be taken away. What was nice about that was it was a reward kind of masked as a penalty, and it made people feel like the money was theirs, a concept called the endowment effect. We find time and time again when people have skin in the game they are more likely to change their behavior.

5) Addressing the potential negative aspects of penalties, how do you coalesce your findings of successfully using the fear of loss to elicit behavior change, with the ethical notion that people should not be (or at least feel) penalized for personal choice?

Certainly there are ethical things to think about when one group is going to get something and another group is not. Those concerns should be discussed and addressed. One way to determine if the reward is causing harm is asking the question, “Do people disengage?” People are generally concerned about framing a reward as a loss, the belief being a group (subjected to the loss) is not going to like it or consider it punitive. We found in our study that even with a frozen carrot, 96 percent of people finished the study and stayed actively involved even 3 months after we turned off the incentive. This engagement is much higher than you would see in many wellness programs currently in use. If the incentive was perceived in a way so punitive that it made participants drop out that might give us pause. However, because of the success of the study it makes us believe that this method is scalable. I am not saying it will be for everybody. We still need a way to make these incentives more personalized. Some people will respond better to losses, some to gains. What we learned at the population level is it appears more respond more favorably to losses, but at the individual level a patient-centered approach will help us further by identifying the right incentive for a particular person, which in turn will increase efficacy. 

Interview with Laura Putnam about Employee Well-Being

Laura Putnam is a well-respected consultant, trainer and speaker on the topic of workplace wellness. She also writes on the topic for publications such as The New York Times and Entrepreneur, as well as authoring the book Workplace Wellness That Works. Laura is the CEO of Motion Infusion, a consulting and training firm that provides workplace wellness solutions to foster positive behavior change as well as improve employee engagement, performance and well-being. Laura has received various accolades for her work including the American Heart Association’s “2020 Impact” award.


1) As the workplace wellness industry tries to shift financial evaluation of wellness programs from ROI (return on investment) to VOI (value of investment), what are some ways you have seen organizations evaluate program success that are removed from these two equations that are still meaningful and measurable?

In the shift from ROI to VOI, we might say that there are three evaluation “buckets” to consider. The first bucket, which is what an ROI approach has primarily focused on, is medical cost-containment and risk reduction. This includes tracking the impact of wellness programming on medical costs, disability costs, workers compensation costs, rates of injuries, types of injuries and recovery time. The second bucket is productivity and performance, which includes effects on absenteeism, productivity, energy levels, team collaboration and customer loyalty. Finally, the third bucket is becoming an employer of choice. Companies now recognize that they cannot be competitive, especially when it comes to retention and attraction, without well-designed wellness programming. The reality is that employees, especially Millennials, expect their employers to care about them as people and to also care about making the world a better place. Data points in this third bucket include measuring rates of retention and attraction, job satisfaction scores, levels of employee and leadership engagement, quality of life for employees and even level of connection with a higher purpose.

In order to address the productivity and performance bucket, companies like Goldman Sachs and Google offer wellness programs that help employees to become more focused, more competitive and ultimately more resilient. In lieu of a potentially stigmatizing “reduce your stress” types of programs, they offer “I can become a more effective employee” types of programs. Goldman Sachs’ resiliency program, which is sold as a means to “sharpen one’s competitive edge,” attracts over 500 employees every quarter. The legendary “Search Inside Yourself” program, launched at Google, trains employees how to become both more mindful and emotionally intelligent. In both cases, the companies are less interested in ROI on medical costs and are more interested in performance enhancement.

This idea of using wellness as a means to better oneself and make the world a better place is something I am personally interested in. I love companies like Patagonia and Eileen Fisher that are going after this third bucket of impact. They are both invested in well-being as a means to not only become an employer of choice, but as a vehicle for protecting the environment. While Patagonia does not have a “wellness program” per se, every aspect of doing business breathes well-being and is deeply connected to its mission to “use business to inspire and implement solutions to the environmental crisis.” Eileen Fisher also connects well-being with environmentalism by encouraging employees to become “sustainability ambassadors,” acting as champions of well-being and advocates for protecting the earth.

Companies like Salesforce.com and Square are using impact on the community as a metric for success. Salesforce just hit 1 million volunteer hours. Square has a clean streets initiative, where employees go out and clean the neighborhood. Leveraging the broken windows theory, the idea is that small changes can have a larger impact. So, something “meaningful and measurable” might be as simple as, “how much trash did we pick up?”

2) Big enterprises have some innate advantages to small and mid-size businesses when it comes to providing workplace wellness solutions: economies of scale, access to insurance brokers that provide various free wellness products as value-added services and better access to aggregate employee health data (to name a few). What are some of the advantages smaller companies have to larger companies when it comes to building a workplace wellness program?

In smaller organizations, there are inherently fewer leaders and fewer people. So, it’s much easier to: a) implement a program; and b) shift the culture. If a leader decides to support well-being, then it is easier for that to actually happen in a smaller organization. If an employee has an idea, it’s usually easier for them to be able to move on it. And, certainly, it’s much easier to shift the culture in a smaller organization.

One of my favorite examples is The Sioux Empire United Way in Sioux Falls, South Dakota. A single employee, Colleen Thompson, finance director, decided to take up walking as a way to lose weight and support her newfound commitment to a healthy lifestyle. Rather than just doing it on her own, she invited coworkers to join her. To this day, eleven years later, she and her coworkers are still at it. Everyday – rain, shine, sleet or snow – employees walk together, twice a day, a mile each time. To ensure that weather doesn’t get in the way, they’ve mapped out both an indoor route and an outdoor route. This story is proof that one person can really have an impact, especially within a small organization.

Another important element to this story, of course, is the championing of well-being from the president, Jay Powell. In conjunction with this twice-a-day walk, he decided to try out standing desks with a few employees. Once it proved to be an effective, he extended the offer of a standing workstation to every employee. Because of its small size, the initiative was relatively easy to implement across the office.

3) In your book Workplace Wellness that Works you build a lot of your ideas on a wide range of concepts from established thought leaders. What I particularly enjoyed is in the spirit of a true “da Vinci approach” a lot of the concepts were taken from outside the field. Avoiding folks like Dee Edington and BJ Fogg, who are three “outside” thought leaders we in workplace wellness should get to know (and a quick reason why for each)?

  1. a) Barbara Fredrickson: Dr. Fredrickson is a positive psychologist affiliated with the University of North Carolina. She has really done some incredible studies on both positivity and positivity resonance, which is positivity in the context of others. Her work has really inspired my rethinking of the prevailing “identify what’s wrong and then fix-it” model, which I think creates a depleting experience for people. It’s no wonder why so many employees are opting out of wellness at work! The research suggests that over 80% of eligible employees are choosing not to participate in workplace wellness programs. In some programs, the participation rates are as low as 1-2%. I am convinced that these low rates of engagement are largely due to the overly invasive and negatively oriented wellness programs that we’ve developed.
  2. b) Chip Conley: Chip’s work, especially his book Peak, has had a huge influence on my understanding of the role of culture and how to go about building a positive culture. I am more and more convinced that when it comes to the practice of well-being, we are less “creatures of habit” and more “creatures of culture.” Therefore, as wellness practitioners, we must become experts in culture change – and not just experts in behavior change.
    As CEO of Joie de Vivre, Chip modeled a different way of leading. For starters, he dubbed himself the “chief emotions officer.” In addition, he facilitated open, transparent conversations with employees asking questions like, “Is this a job? Is this a career? Or is this your calling?” And, “If it feels like a job, what can we do here so that it feels like it’s more of a calling?”
  3. c) Arianna Huffington: In the field of workplace wellness, we have placed such a premium on science and research and have not paid enough attention to the importance of being able to share our message in a way that resonates for people. This is exactly what Arianna does so well in her most recent book Thrive. While it is not a perfect book, it speaks to people on an emotional level. In both her writing and her speaking, Arianna uses storytelling, humor and even tonality to deliver her message. These are all the kinds of things that I believe we have to do much more of to change behaviors. It is less about reaching people’s rational minds and more about reaching people’s hearts. This is why the first step in my book is titled “Shift your mindset from expert to agent of change” – and I cite Arianna as an example of an “agent of change.”
  4. d) Michael Gervais: I love Dr. Gervais’s message of imagining what’s possible and then planning from there. This approach dovetails well with a detour from a “what’s wrong with you and let’s fix you” approach toward a “what’s right with you and let’s build on it” approach.
  5. e) Firdaus Dhabhar: Finally, I am enthralled with the research of people like Dr. Dhabar, a researcher at Stanford. His research has uncovered many of the benefits of stress – and that it’s less about stress avoidance and more about acknowledging and even embracing stress. His work underscores the fact that stress can be leveraged as energy. He advocates actually intensifying short periods of stress and then offsetting that with proactive restoration, which really is in line with a lot of the stuff that people like Tony Schwartz, CEO and founder of The Energy Project, have been talking about for a long time.

4) Speaking of a “da Vinci approach” to wellness, for those that have not read your book yet, can you explain the essence of this method? And, can you provide an example or two of the most creative ways you have seen “da Vinci” put into action?

I’m more and more convinced that the only way we are going to have real impact is if we start to integrate wellness and well-being holistically, and not have myopic standalone programs. A great way to do that is by channeling Leonardo da Vinci, the Italian polymath, and taking an interdisciplinary approach toward promoting well-being in the workplace.

On an internal level, you need to engage multiple perspectives from multiple departments. As much as possible, break down silos and reach across to as many different departments as possible:  training and development, organizational development, community outreach, IT, marketing, compensation and benefits, health and safety, facilities, etc.

On an external level, I would encourage you to move away from a one-stop-shop vendor to a team of outside partners, which might include brokers, insurance carriers and even community resources. For example, the American Heart Association provides all kinds of support for organizations that are interested in creating cultures of health.

Schindler Elevator Corporation is a great example of a company that has taken a “da Vinci approach” toward promoting health and well-being in the workplace. Rather than delivering a stand alone wellness programs, Schindler has incorporated well-being concepts into non-wellness initiatives, such as leadership development programs and safety training initiatives. These interdisciplinary programs have partnered the OD department with both safety and HR departments, as well as a number of outside wellness, learning and culture vendors.

5) We are seeing some progressive employers move the corporate wellness conversation from concerns regarding employee “wellness” to thinking about workplace wellness in terms of improving employee “well-being”. Trying to improve population health has already proven to be a complex problem for most, could broadening our focus too fast potentially have risks in the sense that complexity can be inherently paralyzing and might lead to further inaction from organizations simply trying to get started?

Yes and no. Yes, the concept of “well-being” can feel amorphous and overwhelming. Certainly, this broader mission, that encompasses dimensions beyond healthy eating, physical activity and smoking cessation, might lead to inaction.

On the other hand, I think a lot of people are tired of the worn out healthy eating, physical activity and smoking cessation wellness programs. The idea that other factors, like social connections or meaningful work, play into our overall level of well-being is really inspiring and is actually catalyzing organizations and people into action. In my experience, “better health” is not that motivating for most, whereas, becoming one’s best self is. “Wellness” is more focused on (and associated with) the former, whereas “well-being” is more linked on the latter.

The truth of the matter is that well-being moves into areas that companies have already been addressing for a long time. Therefore, this shift actually allows for an opportunity to connect with pre-existing programming (like safety training and leadership development). This is certainly what I have seen in cases like Schindler.

I think the key is for each organization to first define what “well-being” means and based on this definition, identify the areas to focus on. For example, HubSpot, a fast-growing technology company based in Cambridge, Massachusetts, organizes its well-being programming around three different areas: physical activity, healthy eating, and mindfulness/stress reduction. The City of Sioux Falls, on the other hand, has organized its programming around five areas of well-being: physical, emotional/social, career, financial, and community.

This broader landscape of well-being provides each organization an opportunity to identify its “signature” program. For example, Treehouse, a technology company based in Portland, Oregon, has designed a four-day workweek for its employees. The CEO insists that people actually take the day off on Fridays to spend time with their families or engage in leisure time activities – not work. What he has found is that employees are more productive – and the program serves as a great recruiting tool. While Treehouse cannot possibly compete with the Google’s of the world in terms of salary, they can say, “Well, if you work at Google, are you going to have a four-day workweek? Probably not. But, here at Treehouse, you will.”

Ultimately, whether we’re talking about wellness or well-being, it comes down to carving out regular practices to be embraced by all levels of employees. Companies like LinkedIn have walking meetings as a regular practice. At Eileen Fisher, employees regularly begin meetings with emotion-boosting activities like a moment of silence. At Campbell’s Soup, former CEO Douglass Conant modeled the practice of saying thank you. It is fabled that during his 10-year tenure, he wrote over 20,000 thank you notes to employees. In his view, this practice played a key role in the company’s turnaround. The company went from having lost 54% of its market value to its stock rising over 30%.

Interview with Drew Schiller about the Future of Digital Health

Drew Schiller is co-founder and Chief Technology Officer at Validic, a health and wellness technology company that operates as digital health’s Rosetta Stone for disparate health data. Before starting Validic, Drew was the principal at a Web development firm as well as the founder and developer of a dietary nutrition website. Companies that benefit from Validic’s API are able to build products that pull data from a variety of mobile health apps, wearables and in-home medical devices. Drew is at the forefront of mHealth innovation. You can follow him at his personal blog: drewschiller.com.


1) When we first met, the ANT+ Fit SDK was being heralded as the way health apps were going to be able to communicate with one another. Obviously a lot has changed since then – but not enough. Data interoperability is still a major design hurdle for many digital health innovators. Now mobile manufactures like Google, Apple and Samsung are trying to become conduits and interpreters of these disparate data sources. How have the advent of Google Fit and Apple HealthKit affected Validic’s business model?

It has not actually changed our business model at all. In fact, it has accelerated things quite a bit. The entrance of Apple and Google into this area has created awareness. Anytime you have the world’s largest leading consumer electronics companies entering a new market, the entire ecosystem benefits. This has resulted in an accelerated interest from consumers in personalized generated data. We’re seeing accelerated interest from the investment community. These are signals digital health is here to stay — that all of these massive companies are placing huge bets. So, from that perspective, their entry has been tremendous for Validic.

Furthermore, these solutions are doing little to mitigate that a lot of digital health device manufacturers don’t use open standard protocols because they want to add additional security layers on their devices and/or they want to stream additional information that is not part of standard protocols. Also, you have fitness tracking devices that are streaming all kinds of proprietary information, and they do not want just anybody to have access to that because the analysis of that data is part of their secret sauce.

In order to actually connect with these devices at the device level, you oftentimes have to work direct with the manufacturer to get the proper SDK, the proper coding for it to decrypt the device’s serialization. In that sense, true interoperability has to happen at the data layer. So, once the data is off the device that’s where we can standardize and normalize the data. That’s where we can provide some sort of method to create interoperability. That’s where we play. We will connect directly to Bluetooth devices if that’s where we need to be. We will also connect directly to APIs in the cloud. We also have mechanisms with many companies to send data directly to us. So, we allow for interoperability wherever the data is coming from. Our methods are a different approach than a lot of other players in this space, which gives us an advantage.

2) Piggybacking off this topic, futurist Graeme Codrington made a bold prediction about Apple regarding Health Tech in a recent Fast Company article that by 2025, “There is no doubt that with their iOS 8 released Health app and their integration of myriad health apps with the Apple Watch, Apple are making a play in this space, and by 2025 are likely to be the world’s leading remote and proactive health care company.” Do you believe there is merit to assume a product company like Apple or Samsung will end up evolving into a health-care company?

I certainly think that they will have divisions of their companies that are successful, but can you name any dominant player in the health-care industry today? I mean, there is no one dominant player. So, I think that statement, albeit sensational, is a fallacy. Samsung already has a massive business building MRI machines. They build X-ray machines and X-ray equipment. They already have a pretty massive health-care business. It is not on the consumer side, but it certainly is something that’s core to their global entity.

I do believe companies like Apple will be a big factor in health care in 2025. I think that they are going to continue to make great devices. I think that they’re going to sell boatloads of them because that is the game that they’re in. If you look at what they have done with iPhones, look at what they have done with the iPad, these are transformative platforms and I think the Apple watch has the opportunity to do that too eventually. Do I think companies like Apple and Samsung are going to solve all of the world’s problems related to health care? No, I do not. But, do I think they’re going to provide a really valuable product that adds even more value to the health-care system over time? Yes, I do.

3) The narrative regarding wearables is fairly pervasive in health tech, but how is the Internet of Things (sensors outside of wearable devices) going to change health technology in ways that are currently unexpected?

One way that the Internet of Things in general is improving things is that there is now scale. The fact that sensors are becoming cheaper, and more cost efficient, and yet give higher resolution of data I think is really helpful.

You now have smart asthma inhalers that are able to measure your breathing; in real time when you’re inhaling the device it gives you the correct calculated dosage of medicine, as well as the GPS coordinates of the location that you’re taking that dosage. With this type of data we can start to look at casual factors at a population level. For instance, determine where people are having the most number of attacks and start to look at environmental conditions. At the population health level, you can ask questions like, “In this particular area, at this particular time of day, asthma rates are spiking by 50 percent. Why?” We are starting to be able to do interesting things like that at scale with these type of connections.

There is a company called Aldebaran building a prototype for a next generation robot. It is five and a half feet tall. It would be in your home and it has the ability to not only communicate with you, but also has the ability to help you up if you fall. So, this is great for in-home elder care. It also has the ability to help with medication adherence. It has the ability to help you decide the pill you’re supposed to take and it can record you actually taking it. Then, if there are any problems, it has the ability to call for help. It’s a 24-hour, always-on solution for care for people who need that in their homes.

A company called Proteus is doing amazing things with ingestibles. You wear a patch on your stomach and you ingest a pill, and when the pill is in your body it is activated and powered by the enzymes in your stomach and communicates with the patch (that’s on your skin). It tracks your dosage, the medication, and the time that it was taken. So, it knows what was in your body and at what time. This type of technology could save the health-care industry billions of dollars due to wasted and unused medication consumption.

4) Putting yourself in the role of a futurist, what are your hopes and predictions for health tech over the next decade?

We’re starting to see some really interesting things. One thing I will say about health care, is that unfortunately health care is slow to adopt new technologies. This is an industry that, for some good reasons actually, still largely relies on pagers and fax machines for everyday communication. The primary reason why adoption is slow is because new technologies that are brought into health care need to be bulletproof. They need to be perfect — or as perfect as you can get them — because when you are dealing with data and/or a message that could make or break a patient’s well-being you really need to make sure delivery is perfect.

Health care has the opportunity to have massive disruption from ideas that have taken place outside health care. I think that we are starting to see that already taking shape with the current wearables movement. Devices like Fitbits and Jawbone are now commonplace. What is exciting is we are starting to see new sensors that were developed in areas outside of health, but are starting to make their way to health care.

For example, there is a company called SunSprite that we connect with, which is a wearable tracker you wear on your person to measure the amount of sunlight exposure you get in a day. This is great for patients with Seasonal Affective Disorder. Sunlight trackers, light exposure meters, these things have been available for a long time, but never in a wearable context for health care (in this case specifically for patients with Seasonal Affective Disorder). So, that is one example of the future.

Another good example is we are seeing John Hancock Life Insurance, very recently, are starting to use wearable trackers as a metric for adjusting your life insurance premiums in real time. Just like you can go to your Progressive auto insurer and they put a device in your car, and they adjust your auto insurance rates based on how well you drive, this is something where your life insurance company is giving you a wearable tracker and adjusting your life insurance premiums based on how you live.

There is an abundance of opportunities for us to learn from other industries, and apply it to health, and apply new technologies to health in really innovative ways. I think that some of the most innovative things that we’re going to see moving forward are also better ways of making health care more frictionless and seamless.

5) Validic has had to keep up with a market that has been in a constant state of flux, iteration, and evolution. What are three key product development and/or product user experience concepts (specific to health) that you could highlight from your experience that can benefit digital health creators?

1) I would say getting the user experience right — and this is for app developers and device makers alike — in my experience patients who have a specific disease state… they’re happy to have monitoring around that disease, but they don’t want to be constantly reminded that they have a disease. So, for example, there is a company that’s developing a continuous blood pressure wearable. In their initial user testing, they had the blood pressure reading on the watch face every time you look at your wrist. Well, patients with hypertension, they are just trying to look at the time. They don’t want to be in a meeting at work wondering if the meeting is starting late and they look down for the time and they’re reminded that, oh, by the way, I have hypertension, right? So, from a user interface perspective, it’s important to provide users the quantification and provide the measurements, but don’t necessarily remind the patients of the problem. In fact, some of the user feedback that I’ve heard are things like, “Can you just not even show me the data and just send it directly to my physician because I want them to have it? It’s important that they have it, but it’s not important for me to see it all the time, right?” So, I think that getting UX right is always going to be important.

2) Patients only care about their health when they have to. So, what I mean by that is, for example, if I’m a 45-year-old, obese man and I know I need to cut down on my meat, and salt intake, and maybe drink less, certainly I already know all of that, right? But, I’m not going to be overly worried about it until I have a pre-heart disease episode where the situation highlights I need to make a change, right? This reality is a really hard problem to solve in health care. It is something that I think health-care companies often forget. They’re solving for future problems, as if people always care about what is going on today. Patients generally only care when something “happens.” That doesn’t mean that we can’t affect positive behavior change before that negative event occurs. We just need to incentivize the behavior change to something that the patient will care about. I think that’s something that is often missed, we design like the person or patient is going to care at the onset without a trigger or incentive.

3) What we’re starting to see is that patients who do use a wearable tracker are also more likely to keep track of other information. When you have a person that has genuinely adopted a wearable, you now have identified a person who has made self-tracking part of their routine. This trend is also being driven organically somewhat by the growing market share of wearables. This is important because the desirable experience for this segment is different than the casual user. If the digital health experience is tailored to this user type — knowing that the efficacy of a particular intervention can potentially have broader user experience implications — we likely can increase overall usage by lowering the adoption barrier.

Interview with Dr. Robert Rucker about Nutrition and Academics

Dr. Robert Rucker is a Distinguished Professor Emeritus in the Department of Nutrition and the School of Medicine at the University of California at Davis. A list of his accomplishments include tenure as the President of American Society for Nutrition, an American Association for the Advancement of Science Fellow, as well as an American Society for Nutrition Fellow. Dr. Rucker has over 35 years of experience researching nutrition and biochemistry. He is also my father and is the ghostwriter for almost all of the pyrroloquinoline quinone (PQQ) content found on this website.


1) One of the debated topics in nutrition is whether weight management is really just a matter of calories in/calories out; or alternatively, significantly influenced by the types of calories that are consumed. Based on your rich understanding of nutrition and biochemistry, where have you landed on this debate?

This question is not as easy to address, as some would make it.  Energy regulation – the factors associated growth, work, and maintenance of body temperature – is complex and multifaceted.  Clearly when energy intake is less than needed, body tissue becomes a metabolic energy source; however, weight gain or loss as inferred from periodically weighing oneself on a scale is not a function of a simple algorithm, particularly in the short-term.  As it relates to weight gain or loss of body tissue, each of the major components contain differing amounts of energy.  For example, a pound of stored fat is ~ equivalent to 3600 kCal per pound.  Muscle tissue is the equivalent of 700-800 kCal per pound.  Independent of its water content, a well-nourished adult has about 400-500 grams or 1600- 2000 kcal of stored carbohydrates, mostly as liver and muscle glycogen.  When or how much of a given tissue is utilized as energy sources varies depending on the timing of meals, exercise, and a need to maintain body temperature. Utilizing tissue energy also causes varying amount of water release. Thus, 2-3 days of severe dieting (e.g., generating a 3000-4000 kCal deficit) could translate into a one-pound loss or a 5-7 pound loss, as measured on a bathroom scales, depending on factors in addition to only estimating calories-in minus calories-out.

Regarding diet composition, there are a number of scenarios wherein the composition of food also plays a role in net weight gain and loss.  An obvious one is a diet high in simple sugars, particularly fructose or high fructose corn serum (HFCS).  Our knowledge of the control energy homeostasis has increased dramatically over the last decade resulting in an appreciation that food or energy intake is orchestrated by complex signals originating from adipose tissue, the pancreas, and the gastrointestinal tract, plus others.  Differences in food composition can affect these signals, which in turn can influence food intake and body heat regulatory circuits.   With respect to fructose or HFCS, both are weak stimulators of insulin and the adipose-derived hormones that control food intake, in contrast to glucose, a much stronger stimulator.  Moreover, although fructose is eventually converted to glucose, the process is not rapid and fructose, as such, is not “stored”.  And, fructose is a better “driver” of triglyceride synthesis than glucose.  Add to this that body heat regulation is very precise.  Compounds, such as fructose, that are rapidly absorbed and are not easily sequestered or rapidly metabolized can compromise body heat regulation.  Thus, calories from fructose or HFCS are less likely to allow one’s metabolic system to regulate itself at least in the short term. 

What can happen? The liver slows oxidative metabolism when there are energy excesses, particularly if an abnormal elevation in the body core temperature can result.  What the liver may perceive as an excess of potentially hazardous fructose-derived calories are converted to triglyceride and next sequestered away in adipose as a protective strategy.  In this regard, some of the energy derived from fructose is rendered ‘out of the picture’ and may even result in some weight gain, because of its conversion and “storage” as fat.  

Again, these kinds of questions are not easily addressed.  An example that I sometimes use in lectures is that over the course of a year, most in the class will consume anywhere from ~ ½ to one million calories (at a daily expenditure of  ~1500 to 2500 kCal per day, which translates into consuming a ~ton of food per year).  Given that an annual normal weight gain or loss is usually no more than a pound or two, it says a lot about the exquisite precision of food intake regulation, as well as body mass and heat regulation.  Throw in dozens of genetic factors and other variables and it is easy to ascertain that there are good reasons for controversy and our inabilities to address (easily) weight management when it deemed important.

2) Given all that you have researched, what are the three most impressive compounds you have come across (other than PQQ)? You can choose either based on their historic significance and/or the fact you have been impressed by their demonstrated physiological benefit.

In the late 1700s – Antoine Lavoisier, the so-called “Father of Nutrition and Chemistry” described that metabolism and oxygen were inexorably linked.   He also demonstrated oxygen was related to animal heat production.  Accordingly, oxygen would be one of the molecules.  In the latter part of my career, concepts related to cell signaling and secondary signaling molecules begin to be major influences.  As a consequence, Nitric oxide (NO) and 3′-5′-cyclic adenosine monophosphate are two others that I would add.  NO is an important cellular signaling molecule involved in many physiological and pathological processes; cyclic-AMP works in part by triggering the activation of certain proteins involved in cell signaling.  Knowledge regarding their underlying mechanisms of action facilitated my way of thinking about the mechanisms of action of certain dietary biofactors, such as pyrroloquinoline quinone (PQQ).

3) As the world increasingly points to poor nutrition for the rise in healthcare costs, little has been done to improve the nutritional education in top-tier medical schools. You were a nutrition professor at a top-tier medical school. Why do you think this is?

A part of the answer is that there is no medical board certification for nutrition.  There are 24 boards that certify physician specialists.  Many hospitals demand that physicians must be board certified to practice or bill for a specialty.  Accordingly, when there are nutritional issues, they are usually handled by a paramedical (i.e. a dietitian or a nurse) or occasionally a pharmacist with nutrition as a sub-specialty.

With that said, many medical schools do give nutrition training some kind of “lip-service”, although it is often less than it used to be. Most medical schools have moved to more integrated curricula and problem-based learning. At Davis there used to be a strong course in nutrition, but as the Davis medical school curriculum became more and more integrated, the visibility of nutrition was truncated.  Regrettably, as long as nutrition remains as a non-board certified area, I don’t sense that there will be a move to make nutrition more visible, even though there is seldom an argument regarding its importance.

4) On the topic of research, some of the fondest conversations I’ve had with you are discussions regarding the thoughts of intellectuals who take either side of Thomas Kuhn’s work. We have discussed articles like The Truth Wears Off and books like Laboratory Life. Do you think there is “real world” truth to be found, or do you think as seekers of the “truth” we are tasked with inventing it?

As a starting point, I agree with Kuhn’s premise that scientific advances are characterized by dynamic shifts in thinking, i.e. what he defines as paradigms,  ” universally recognized scientific achievements that, for a time, provide model problems and solutions for a community of practitioners”.  In my life time, the major paradigm shifts that have most influence my thinking as a biologist have been: 1) the Watson and Crick model of DNA and its importance, 2) concepts related to cell signaling, 3) concepts important to epigenetics (changes in metabolic regulation caused by gene expression rather than an alteration of the genetic code itself), 4) polymorphisms  (metabolic changes caused by point mutations in a gene or genes), and descriptions based on metabolic allometric scaling (ways of describing how the characteristics of living creatures change with size).  If I were to note more fundamental principles – Darwinian evolution, the principles of thermodynamics applied to biology, and the concept of nutritional essentiality in the context of given nutrients or metabolic processes would be at the top of the list.  Each of these paradigms can be described historically in the context of Kuhn’s stages of scientific development, which ends with the establishment of concepts that truly influence changes in how we think about a problem.

Regarding ‘Are there real world truths to be found?’ I certainly hope so. However, to find such truths, I would argue that one has to engage in clear rational thinking directed at seeking out evidence for the truth; a process along the lines of what Richard Dawkins implies, when he emphasizes the importance of asking the right question.  In contrast, inventors of “truth” in my experience tend to be more concerned with faith, authority, or profit (in a broad context).

Although far less philosophical, the Jonah Lehrer article in the New Yorker, The Truth Wears Off, also provides some very important perspectives that – as you note – have been the topic of several of our discussions.  With respect to nutrition, this has been an interesting period, particularly as it relates to the assessment of validity and reliability of certain nutrition-related assertions and their presumed relationship to important health issues.  In some instances, our lack of rational thinking has caused some “true believers” to promise too much.  For a premise to become health policy, the data and observations behind it must be reliable and reproducible.  Unfortunately, we too often let belief and personal perceptions over ride the facts of a given question or premise. 

With regard to why there is so much controversy as it relates to nutrition, some reasons that are developed in the Lehrer article, such as those offered by John Ioannidis (e.g., Why most published research findings are false. 2005; PLoS Med 2: e124) are provocative.  However, they are mostly statistically in nature.  Now that we have larger and presumably better databases and better tools to examine them, plus the ability to ask better questions, it should not be surprising that some amount of previously published research may not be easily or consistently replicated.

I tend not to throw barbs, if the studies in question are complex in nature and initially were carried out for a good purpose.  As an example – In studies of osteopenic bone diseases, such as osteoporosis, the highest rates for hip fracture, as an outcome measure, are often observed in those of Scandinavian decent, who are located predominately in the North Central parts of the US. The lowest rates for hip fracture are observed in those of African decent, who are located predominately in the South.  Consequently, it is not unreasonable to surmise that observations related to hip fractures made 3-4 decades ago in studies performed in Minnesota or North Dakota may not match the results of similar studies, if repeated using a contemporary and highly diverse Californian or Floridian based subject pool, some of whom may be a blend of an identifiable Scandinavian and African-derived gene pool. Further, studies for purposes of comparisons are often difficult to match with respect to the age, sex, and/or activity levels of subjects.  It is now more difficult to control environmental and epigenetic factors than in the past, because of our ability and freedom to travel or consume more diverse diets.  With more genetically diverse subject populations and more complexity in lifestyle, there is greater likelihood that there may be regression to some kind of statistical mean, i.e. less significance noted in a study than may have been noted previously. 

Other issues are barriers that we have rightly put into place for the protection and more ethical treatment of subjects. For example, many of the early paper regarding basic human nutritional requirements were reasonably correct in their conclusions.  However, the studies were often performed using institutionalized individuals (prisoners or mental patients) who could be studied for long periods or subjected to metabolic risks using protocols that simply cannot be used today. 

The ways that we report and characterize research can also present problems. Current research often uses past research as a potential starting point or platform, i.e. Kuhn’s second level of discovery before an actual paradigm emerges.  However, most research (past and present) is/was not published unless its outcome demonstrates some type of statistically significant positive effect.  It is the common practice of most journals not to publish null or negative observations.  Again, it is not unreasonable that some current replications of past work may differ, particularly when there is a better sampling of subjects and use of improved analytical methods. 

More troubling to me is the mismanagement of data by those who should know better.  The reason why some health-oriented work cannot be reproduced is because it is the product of data dredging designed mostly to identify relationships with some arbitrary level of statistical significance. If the “data dredge” is merely a search for statistical significance, it is too easy to make wrong inferences.  There is little wrong in using an arbitrary statistical endpoint to better define a hypothesis or question, but to report such findings as facts without some type of independent conformation or validation is disingenuous at best.  More egregious, of course, is reporting only selected data in order to show some kind of statistically positive effect.  There is also dishonest reporting.  When I was more involved in journal editing and management, it was troubling to discovery that work using the same pool of subjects had been published in different formats in other journals.   The issue was not so much self-plagiarism or lack of consolidation; rather, it was the implication that the observation submitted to a given journal was from different sets of independent observations. The number of independent research papers on a given substance is sometimes used as a measure that the product is safe or efficacious. One may have a different opinion of efficacy or safety with the knowledge that the reported data was from a single set of subjects, rather than multiple independent sets of subjects and each reported in separate papers.

Regrettably, the commercial nutritional supplement business is perhaps the worst offender.  Very little research is done independently and most often is driven by marketing goals.  As we now know, it is possible to buy the results that you might want from some of the commercial research outlets for publication in one of the dozens of online journals, many of which serve as “vanity presses”.  The other areas that compromise good nutritional practice are the constraints placed on the policing of the supplement industry, because of the Dietary Supplement Health and Education Act and the impact of having it as a part of our National Institutes of Health, a National Center for Complementary and Alternative Medicine.  The Center’s goal is to support research and provide information about complementary health products and practice, but what it defines as evidence-based medicine often isn’t, and credibility is given to alternative concepts, where little is deserved.

5) Piggybacking off that, as I embark on my own journey aspiring to be an expert in the field of workplace wellness, based on your vast experience, what advice can you pass down to me as I continue the search for “truth” with a drive to contribute to the greater good?

Success, particularly the effective movement of ideas, is all about “networking”.   Bruno Latour and Steve Woolgar clearly make this point in their book, LABORATORY LIFE: The Construction of Scientific Facts. I was lucky enough to be mentored by individuals who can trace their academic history back to those who discovered or defined the functions of given vitamins or nutritionally essential minerals.  What was transferred to me, as a part of that network, was a way thinking; also the importance of maintaining a high integrity. It is also essential to have a thought out, as well as thoughtful, work plan; and, as Latour and Woolgar note, one’s credibility rests on whether you are perceived as reliable.  The challenge is to maintain integrity in workplaces (e.g., the commercial aspects of nutrition and wellness) that often talk about integrity and validly, but seldom want to test for it, and that are driven in large degree by the marketing of what are sometimes shallow promises.

 

Interview with James Pshock about Workplace Wellness

James Pshock is a well-established thought leader in the area of workplace wellness. He is the president and founder of Bravo Wellness, whose mission is to deliver exceptional services and products to organizations seeking to help their workforce achieve optimal health through incentives. His experience in the health insurance and wellness industry spans over two decades. James is an Ernst & Young Entrepreneur of the Year Award winner, and is also a committee member of HERO, an advocacy group for the advancement of workplace wellness.


1) The recent documentary, Fed Up, presented evidence that lobbyists potentially have garnered a narrative regarding obesity to be too heavily focused on activity, resulting in a lackluster focus on nutrition and food intake. In parallel, there seems to be an abundant focus on physical activity with regards to workplace wellness in comparison to other areas of behavior change. In your opinion, why do you think that is?

I am not sure I completely share this observation, although it’s true most programs are activity-based (in the sense that many programs involve activities, like taking part in a step challenge or watching an instructional video) and I think in many ways it’s because activities can be measured, and because these programs are relatively easy to implement. Whereas, with food, we can think back to second grade when your mom sent you to school with an apple in your lunchbox, and you would trade it for a Twinkie, and she would never find out. You can educate people. You can give them the food, but it doesn’t mean they are actually going to eat it. And, plus, you have the complexities of allergies, and food preferences, and people who just don’t like the taste of what you’re telling them to eat.

Focusing on nutrition can open a Pandora’s Box. If you’re going to go down that path of telling someone what they ought to be eating, then you’re going to have to be willing to deal with a lot of personalization and accommodations, which is no easy feat. We tend to focus more on the “why” than the “what”, and sharing the message of personal accountability for your health… this empowers the individual with a directive, but also the power of autonomy to achieve it.

2) In a 2014 New York Times article about Workplace Wellness the author contends that programs that focus on lifestyle change potentially do not reduce costs but move them from the employer to the employee. Putting aside there is evidence to refute this claim as factual, where does the responsibility of the company end and the responsibility of the employee start?

There are a lot of deep issues loaded in this question, everything from an entitlement mentality to employees who recognize health insurance as a “benefit”. Almost any company was not founded on the premise of being a health insurance provider. Insurance is meant to be a benefit. Yet, so many people just kind of have an entitlement mentality that really shelters them from understanding the true cost. Most people are unaware of the role that they individually play in determining what that cost is. Dental insurance is a great example. Historically, dental insurance has had 100% coverage for preventative services and something like 50% coverage for restorative or repair services. Look at the statistics. The result has been a phenomenally high rate of prevention because the benefits are typically pretty inadequate for major restorative services. People take better care of their teeth. Prescription utilization versus generic utilization is another good example. For years organizations asked people to use generics and told them how much money the company would save if they used generics, but it was not until employees saw a pretty dramatic difference between the co-pays for generics versus the co-pays for branded drugs that companies began benefiting from the shift in consumerism to utilizing more generic drugs.

A final example is pension plans versus 401(k)s. For decades, the norm was to have a pension plan and your employer would pay you after you retired. And, as that shifted to a 401(k) model – you put money away, we’ll match it – it shifted the responsibility for post-retirement security to the individual versus the expectation that the company I work for is going to take care of me regardless of how I behave.

I believe we are just on the forefront of that happening in health insurance, where it’s not a cost shift thing. It’s simply shared responsibility. And, as that message of shared responsibility takes root, there are people who are going to say, “Well, you just shifted the cost to the people who refused to do anything about their personal health or their preventative risks.” And you could absolutely look at that and say, “I guess that’s one way to look at it.” But, the lens we look at it through is really more in line with the concept of transparency and shared responsibility. And for those who have a hard time accepting responsibility, they will likely be resistant to this change because their perception skews towards entitlement.  

3) For a small to midsize business (SMB) with limited resources, how does a SMB choose what aspect of wellness to focus on and what role does a company like Bravo Wellness play in that decision making process?

There is a value in having some type of wellness program regardless of the size of your organization. However, when you talk about the concept of workplace wellness, it is important to note that it is enormous and complex. For example, you might be looking at something as basic as smoking and say, “Well, you’re going to add years to the end of your life if you quit. Don’t believe us? Here, we can show you all these studies of morbidity rates improving if you stop smoking.” But smoking is not the problem, in this case it is a symptom of severe depression. I mean the last thing on their mind is living longer, and we are discussing morbidity. We are making all these assumptions that what is important to us is important to them.

There is not a one size fits all unfortunately. What I have seen is that where you might see fantastic results in one environment, you take that exact same program and put it in a different company, with a different environment and culture, and it could fail. An environment that is based on teamwork, and very collectively working towards common goals adopt things differently than siloed organizations. Bravo Wellness helps organizations think through what they are trying to accomplish. What has been surprising for me is how many companies want a wellness program, but have no idea what they’re trying to accomplish. If your goal is to try to be recognized as the “healthiest employer in your city”, what does that mean to you? Your health related costs are going up 20% a year but the health of your organization has vastly improved, that might be what you are after. An assessment needs to be done of the organization: What are they trying to solve for? How will they handle those issues that will appeal to the broadest number of people? If further down the road they still have some people who aren’t making any good choices, how will they pivot?

4) The definition of wellness coined in 1995 by Anspaugh, Hunter, & Mosley talks about wellness in the context of the workplace as ‘a composite of physical, emotional, spiritual, intellectual, occupational, and social health’; Given the complexity of what constitutes one’s “wellness” is it even realistic to expect workplace wellness programs to encompass all the components of wellness? Or is it suitable to assume that programs should focus on maximizing efficacy by doing a few things really well in concert with other wellness providers (outside of work)?

How wellness is defined and how you start to educate your population, you treat this as a mission. I like the fact that we’re not just saying wellness means the five biometrics mandated by legislation. Like in our case, we’re limited somewhat in that by way of regulation we really only have five things that we can tie into and have contingent incentives or penalties against. That doesn’t mean in any way we are not trying to identify other risks, educate people, and equip them to take positive action for their emotional health, spiritual health, and other things that could really have a profound impact in their life. You should put it all out on the table. Where you’re going to focus your actual interventions, after all my experience on the TPA side as a buyer of wellness programs, and then our experience in the last six years facilitating them …I have landed on saying: educate and equip, provide the tools and resources, but reward people for results, not how they chose to get there.

An important consideration is the privacy aspect of wellness, employer’s limitations on asking certain wellness questions (even if well-intended), let alone obvious legal exposure regarding spirituality and things of that nature …there’s certain angles here that no employer, after they talk to their attorney, are going to be willing to do or should do for that matter.

5) Looking back at your extensive experience in the industry, what are the key elements that contribute most to the success of a corporate wellness program? Have there been any surprises?

The sole message of equipping people versus mandating how they need to get to “wellness”, the right tools, and a focus on results is what I have become more and more convinced is critical. Trust throughout the entire organization is also important. There needs to be transparency, so the employer can share the true cost of benefits. For example, a company says, “We get charged $1,100 a month from Blue Cross. We’re paying 80% of it. But, we are willing to pay up to 90% of it if you do these things.” It is eye-opening for a lot of employees who had no idea how much the employer was already paying on their behalf and what they were basically getting for free. And that certainly adds to their acceptance of responsibility, as well as better buy-in which is at the heart of success of any wellness program that is used as a tool to improve some aspect of employee well-being.

Interview with Ben Greenfield about Elite Fitness and Endurance Training

Ben Greenfield is an ex-bodybuilder, Ironman triathlete, professional Spartan racer, coach, speaker and author of the book “Beyond Training: Mastering Endurance, Health and Life” (http://www.BeyondTrainingBook.com). In 2008, Ben was voted as NSCA’s Personal Trainer of the year and in 2013 was named by Greatist as one of the top 100 Most Influential People In Health And Fitness. Ben blogs and podcasts at http://www.BenGreenfieldFitness.com, and resides in Spokane, WA with his wife and twin boys.


1) There appears to be an uptick in reports lately about the role and importance of conscientious thought as it relates to longevity and performance. In your opinion, (when looking to optimize performance) what is the relationship between adjustments of the mind/thinking and adjustments in nutrition? We tend to discuss these subjects separately, but should they be?

When we talk about conscious thought as it relates to longevity and performance, we can talk about gut/brain access and the thought that both are pretty intimately intertwined. The two elements of the nervous system, the central and the peripheral nervous systems, are essentially connected and stay connected via the vagus nerve as we grow and reach adulthood.

Whenever you talk about optimizing performance, you have to understand that anxiety and disruptive thought patterns can affect the gut, and there is also a lot of evidence showing that what you eat can have an effect on cognitive performance. So there is no doubt that a synergistic relationship exists between the two.

2) When you’re working with clients, how do you effectively make adjustments and/or additions to nutrition? How do you determine which interventions are beneficial and which are arbitrary? When making recommendations regarding nutrition — specifically any supplement recommendations — how important are therapeutic windows, considering ADME will be unique in different individuals?

We live in an era where genetic testing, gut testing, hormone testing and full blood panel testing are pretty convenient and becoming more and more affordable too. I always recommend at a minimum to get a blood panel, and if you really want a gold standard (especially in regard to nutrition), get a gut test. Get a genetic test, too. A spectral cell analysis will give you a look at micro-nutrients and minerals. If someone is experiencing a lot of autoimmune food allergen-type issues, the tests I recommend are a Cyrex Panel 4 or Cyrex Panel 5.

Really, the goal is to get a good idea of where someone is at from a food summary standpoint. Once you put all of that information together, then you can make a decision, but until then you are taking a shot in the dark. If your budget is limited, you might say “okay, whatever, I’ll start on a full spectrum multivitamin” and skip the testing. In those cases, basically I would recommend best practices for someone based on symptoms and goals, but it is always better to test. People generally get better results when they test, and continue to retest.

Testing can also include something like heart rate variability, where you look at how the sympathetic and parasympathetic nervous systems are responding to a change or intervention. In short, you put an intervention in place and you test to see what’s going on with the blood, or gut, or salivary gland to access the response to treatment. A lot of the folks I work with are testing at least one parameter every eight to twelve weeks.

3) In my interview last year with Dr. Howard Jacobson, we discussed the downsides of using reductionist research when addressing broad nutritional questions. Presumably you make some of your assertions based on this type research. How do you mitigate any potential risks?

I am a proponent of using natural whole food sources when possible. My recommendations come down to assessing whether a supplement or dietary strategy is going to get you a lot of bang for your buck. Take phosphorus compounds for example, they likely have some sort of anticarcinogenic effect — as such I am a bigger fan of incorporating broccoli, cauliflower and onions as staple components of a diet, versus suggesting someone use a sub-level glutathione.

But ultimately there are some situations where, by taking a food group or ingredient down to its complete reductionist form, you can concentrate it and get higher amounts of it. A good example is Chinese adaptogenic herbs, something that I use. I can take the isolated compound in a tiny little packet and it’s the equivalent of 40 pounds of the whole herb, which I physically couldn’t consume all at once.

4) In my 2009 interview with Chris Talley, he indicated there would likely be future developments for those interested in hacking their myostatin levels if they’re willing to experiment with antisense therapies (note: he highlighted the potential for considerable risks, too). I saw this year you mentioned cold thermogenesis as a safer alternative (since this type of therapy might have an effect on irisin). Do you find this to be effective with your clients who are looking to gain muscle? And, do you have any other suggestions regarding reducing myostatin?

With myostatin, one of the big goals is to not be in a consistent anabolic state. I think what you are referring to with a cold thermogenesis type of approach is the upregulation of m4, which is going to essentially downregulate myostatin, helping with muscle cell growth. However, you could potentially get undifferentiated cell growth.

I like cold thermogenesis because you do get hormones like irisin that help activate m4, and yet at the same time you are getting the upregulation of AMPK. That’s actually a perfect example of a strategy I like: an anabolic approach that uses caloric cycling on certain days that have higher levels of physical activity coupled with cold thermogenesis, because strategic fasting is also a way to reduce myostatin.

5) Piggybacking off cold thermogenesis: If you ask Tim Ferriss for his cliff notes on unconventional tried-and-true tips for weight loss he’s likely to tell you ice baths, his PAGG regimen, and 30 grams of protein within 30 minutes of waking up. What are a few of your unconventional tried-and-true tips for amateur endurance athletes looking to improve performance?

If you are asking for tips that fly under the radar, I am a fan of isometric protocols like long 30-second eccentric contractions and holds for 3, 4, or even 5 minutes in lunge or squat positions. Basically, it’s filling your muscles with a bunch of lactic acid, so you are upregulating your lactic acid buffering capacity.

If someone has a lot of inflammation and muscle damage from chronic repetitive motions, I am a fan of curcumin. I have been using a lot of curcumin phytosome, and there is a brand called Meriva, which a lot of supplement manufacturers are using now. It is a form that is well-absorbed and has really good anti-inflammatory effects.

Lastly, it’s not sexy, but I am a big fan of making sure that you engage in low-level activity all day long — basically standing on your feet, getting a standing work station, or even using a treadmill desk. Avoid sedentary positions for a long periods so that all day long you are building low-level physical endurance, which you can then rely on during your interval training and endurance training. A lot of people do not understand that a lot of your available endurance simply comes from your daily routine. If you are trying to improve performance you are not doing yourself any favors by sitting at a desk all day long.

Interview with Craig DeLarge about Digital Mental Health

With a career in health and wellness spanning two decades, Craig DeLarge has held significant leadership roles for Johnson & Johnson, Communications Media, Inc., GlaxoSmithKline and Novo Nordisk. Craig recently left his management role with Merck, serving as the Global Leader of Multichannel Marketing Strategy & Innovation, to pursue opportunities in the digital mental health space. In addition to Craig’s pursuits in health and wellness, he is also a successful business coach and blogger. Craig’s coaching blog can be found at WiseWorking.com.


1) After a long and successful career in pharma, what are the major factors pulling you to now focus your energy on digital mental health?

There are 2 major factors that have contributed to my pivot. The first is that I have fortunately reached a period in my life where I have the luxury of taking a sabbatical. During this sabbatical I am bringing together my 15 years of digital health care experience with my personal interest in mental health as a professional coach/trainer and mental health advocate. I am not a psychologist, but I have experience helping people with change and personal growth. I also have a personal interest because I am a caregiver and due in part to that personal journey I have done extensive work with the National Alliance on Mental Illness (NAMI).

The second is there a major paradigm shift in health care from a pay for service model to a pay for outcome model. I am interested in playing a part in the evolution of this change. I realized I need to contribute to commercial models focused on health outcomes.

2) What has impressed you so far about the budding digital mental health space? What has been a disappointment?

As I have surveyed the space of digital technologies focused on the prevention or treatment of mental health/illness, I have been impressed with the breadth and variety of available technologies.

I won’t call this a disappointment, but what I would like to see more integration of individual technology solutions. Although there is clearly a lot more out there in digital mental health, I have yet to see many players integrate their offerings and create a holistic solution to the benefit of the patient and caregiver.

3) Given your unique vantage point, what role do you believe pharma plays in supporting digital mental health initiatives succeed?

Pharma can help integrate these products with their core product – drugs – to get a synergistic 1+1-3 safety & efficacy effect. For instance, drugs are only effective if you take them. In mental health there is a lot of non-compliance. There is a chance for digital health tech to have a complementary effect strengthening compliance & support. There is also the opportunity for better use of patient’s data to create win-win therapy & outcome situations.

Another point is Pharma has the money to invest to support digital health in a venture capitalist & scale up role. Most of the big Pharma players already have innovative investment funds, and have mechanisms for investing in budding digital health technologies.

Lastly, Pharma is skilled at influencing public policy. In that respect, Pharma can help assure there is room for relevant digital health technologies to grow in their beneficial application and use.

4) One of the early assumptions about wearables specific to digital physical health was that data in and of itself would be a change agent. There is growing evidence that to improve physical wellness, the human element is still required and that digital monitoring is simply another tool to augment mentorship and coaching. Do you think the same will be true for digital mental health?

The simple answer is yes, but not in the short-term. There will come a day where artificial intelligence will be smart enough to help mental health patients. I am confident of that, but we are not close yet for two reasons. One, the technology is simply not sophisticated enough yet. Two, my generation does not possess the comfort level with technology that they would see their phone as their therapist. However, our children and grandchildren are growing up in a new world where their generation might be able to have that type of relationship with technology. There is a degree of acceptance that needs to occur for technology to supplement the human element at that level and that will not come quickly, but it is coming. In the short-term although I do not believe digital health tech can replace human mediation, I do think there is a good chance that the right technology will be great at augmenting traditional therapies. These technologies today have an opportunity to act as supplements and/or amplifiers to the experience a person has with their healthcare providers and caregivers.

5) Playing the role of an optimist but tempered by the current results of activity tracking and cognitive brain training (thus far), how much do you think can be accomplished regarding digital mental health over the next five years?

This might be out of bounds regarding the specific questions, but I would hope simply we are more accepting, less judgmental, and have erased much of the stigma around mental health and mental illness that currently exists in society.

Going back to a previous answer, I hope in five years developed comfort with these technologies allows us close the gap between our view of physical health and mental health as separate things. The two are interrelated and it is damaging to separate them. There is a rising tide of awareness, and through social media it is amplified, which is bringing awareness to mental health issues. As a leader, I want to make sure this momentum is supported and progresses.

Additionally, I think wearables will become ubiquitous and invisible, and improved in their ability to reliably measure for outcomes. Its digital health adoption will grow exponentially. As a caveat, I don’t think you will see people who suffer from hallucinatory illnesses (such as schizophrenia) really benefiting from these technologies, but other mental illnesses, like depression, bipolar, anxiety, borderline personality disorder, etc., where increased mindfulness, awareness, and social support can be an important intervention should benefit greatly. 

Lastly, I would love to see technology help the caregivers of the mentally ill. There are opportunities to support this groups and especially in the face of comorbidities they face as part of the caregiver role. My hope is that innovators can find ways to help caregivers and create technologies that works for them too.

Interview with Bob Summers about HealthKit and Fitness Apps

A long-time digital entrepreneur, Bob Summers has founded several startups over the last twenty years. His current endeavor, Fitnet, helps individuals achieve their health goals by providing easy-to-access fitness sessions through their mobile device (currently available in the App Store). Some of Bob’s previous startups include TechPad, EnergyWare and the nanoCom Corporation. Aside from being an online entrepreneur, Bob partakes in community and economic development as a member of the Board of Directors for the Roanoke – Blacksburg Technology Council and Virginia Tech Entrepreneur Club. Bob also led the installation of gigabit fiber access into Blacksburg, making it the world’s first free open access gigabit Wi-Fi network.


1) As a developer of health and wellness apps, what excites you by the recent announcement of HealthKit at the 2014 Apple Worldwide Developers Conference (WWDC)?

The conference has been a lot of fun and the energy has been really high. 5000 developers, all picked by lottery and the result is that 75% of the developers are new. The rumor mill was that Apple was going to announce a wearable but that wasn’t the case. Instead, they announced HealthKit, which I believe is the first step in that direction, because Apple needs a piece of foundational software like this in the ecosystem before they can really execute well on a wearable so that any device they come out with can be built on top of it. Any good application needs to have a good software ecosystem, and HealthKit makes sense for them given the proliferation of health and wellness apps in the App Store. There are now over 40,000 health and fitness apps and it is a terrible user experience that each time you try a new wellness app you have to fill out the same health information. The same frustration that we have when we have to fill out new paperwork with a new doctor… telling them the same stuff we have time and time again… that same experience is true for health and wellness apps. A good app may not get used just because the user doesn’t want to have to go through the process of answering the same questions they just did for an inferior app. HealthKit means this type of information is now portable, stored locally in the HealthKit repository, and users don’t have to rely on apps to talk to each other through APIs and the Internet. This will now all happen locally within the user’s phone. All of these individual apps, with unique APIs, have stifled innovation for too long. It’s exciting stuff. There are some limits since it is new. It is not yet available for the iPad, but I’m sure that will resolve itself in short order. There is clearly a lot of excitement about it so I’m sure it will evolve quickly. It excites me too because it means I’m in the right space.

2) Outside of HealthKit, what other big takeaways excited you from Apple’s Worldwide Developers Conference and the unveiling of iOS8?

The introduction of a new programming language, Swift, is the most exciting thing at the conference in my opinion. It is a programming language that is more approachable, less noisy, and extremely powerful at the same time. Why this is so exciting is it is going to bring in more developers and create more inclusivity within the developer community. Objective C, which is what a lot of folks currently develop in, is a difficult language for people to get their hands around. In my opinion, Swift is a game changer in regards to efficiency, which will allow developers to iterate more quickly, test more things, which in the end will lead to better products. It is going to bring in more developers and lower the cost of development. This is really a big deal because more competition in this space is ultimately going to benefit the end user. In my view, this is going to have a massive effect on the marketplace.

3) You have an impressive success rate at technology competitions, are there any sharable keys to your success that have helped stack the odds in your favor?

One, there is some serendipity regarding my story because I’m in the health and wellness space and that’s just a hot market right now, so one key to share is either through luck, or by choice, pick a hot market. I can take credit for really paying attention to my presentations. In competitions (pretty much all competition not just technical ones) the best presentation is going to win, right? You can have better elements than anyone there but if they’re not passed along to the judges properly then how are they going to know? So there is some salesmanship that for better or worse is important to hone before you get in front of judges. Also, experience is going to help. I’ve been at this awhile, but that said, that doesn’t mean I don’t practice each time either. Just because I have a good track record doesn’t mean I can now go in and win these things easily. I do the work (through practice, prototyping, etc.) and I’m sure that is a major component to my success. Also, I go into these situations with an open-mind, but I will then quickly focus. This is important in two ways. One, I don’t get stuck on anything preconceived. For instance, I have a great idea, but it does not fit the parameters of the competition. I spend the whole time trying to figure out how to jam a square peg into a square hole. That’s just not going to work. Two, I kill ideas quickly. Understand the challenge, brainstorm a lot of ideas, then pick the right one – not a few – but the right one and spend time making that idea great. If you pick a few ideas to consider you start to dilute your energy (and time) thinking about multiple pathways. These strategies have worked for me.

4) In your opinion, specific to health and wellness apps, where do you believe people are currently getting it right, and where is there room for improvement?

I’ve been really inspired about what Nike was able to do in the sense that they made my data usable. They took what I provided and did not just spit it back to me but gave me suggestions and added value to it. Innovators that are going beyond just collecting metrics and data are getting it right. Mobile competitors like Android will come out with their own version of HealthKit and soon applications that don’t enhance your collected data will quickly fade away anyway.

Where I think there is room for improvement is there are all these great platforms out there and none of them are really talking to each other. What a terrible experience for the general consumer, right? I am tracking my food intake over here, and my activity over here, and doing mindfulness exercises over here. Not very much out there is integrated even though, and I truly believe this from my interaction with competitors, we all want to help our clients and users. We don’t want to get in their way. We want what is best for them. Yet, we do little to make it easy for them to correlate their data and look at their health in a holistic way. In that regard, we could be doing a lot better to unify in a way that doesn’t hurt our respective businesses, while making our products work better (in collective) for the end user.

5) Your app has seen impress growth. What are your top three growth hacking strategies?

There is no secret sauce here. One is persistence. You got to want it and work at it every day. Without this strategy, I’m not sure how you make it. I don’t have any shortcuts that replace hard work. The second would be find great partners. What can you offer other people (you must give first to receive), and once you have that established how can you use what you have (and offer it through partnerships) to expand your reach and/or benefit from a competence that you might not inherently have yourself. For instance, I have partnered with fitness celebrities. For them, I have an innovative vehicle for which they can deliver content in a unique way. For me, I gain a content expert pertaining to health and fitness. It’s a win-win. Lastly, make meaningful contacts and connections and keep them updated. I do keep a list of valuable influencers and advisories and make sure I stay engaged with them. If you want a successful endeavor you need a promoter. If you are not that person, then you might need to acquire that expertise through someone that knows public relations. It’s not a secret that good PR will assist you with growth, but some forget it is a strategy that you can do well or poorly… where perhaps hoping something goes viral is more of a wish than a strategy.