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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:

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” ( 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, 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

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. 

Interview with Apple about Health and Fitness Apps

Apple’s App Store is the go-to marketplace for all iOS device users, including iPhones and iPads. This digital distribution platform, maintained by Apple, allows users to browse and download a wide range of different types of useful (and not so useful) applications. The App Store started in 2008, roughly a year after the first iPhone was sold. The original iPhone was launched with only built-in apps, but based on consumer demand and smart business principles, Apple began letting independent developers build and profit from iOS applications (which they are able to sell through Apple).  Although the App Store was a tremendous hit right from launch, profiting from app development is known to be a precarious proposition (as documented in the Fast Company article, Striking It Rich In The App Store: For Developers, It’s More Casino Than Gold Mine). Despite the risks, the App Store launched with roughly 500 apps, and presently is home to over one million. It is estimated to have over 40,000 health and wellness apps in the market, but the usefulness and utility of a majority of these apps is consistently questioned (ex. Time’s article: Bad News About Your Favorite Health Apps: They Don’t Work). The information for this interview took place over a three hour period, with seven employees from the app store speaking specifically about health, wellness, and medical apps. Apple has not endorsed this interview and it is comprised as a composite of various responses from the various individuals. 

1. What makes a good wellness or fitness mobile app? When a developer asks you for advice on how to build a great product what do you tell them?

There isn’t one recipe for building a great app. We work with various developers at varying capacities. Ultimately, our job is to ensure that Apple’s marketplace is curated in a way that maximizes the user experience.  Obviously, everyone benefits when we can help developers produce their best work, which is true across all of our channels. Apple is known for usability, so in that regard we would like that tradition to carry through to anyone developing on our platform. Therefore, a good wellness or fitness app is one that ensures a great user experience for the intended audience. In addition to that, it must create utility that the end-user otherwise would not have. There also has to be a sensibility about cognitive load and user-centric design. Is the app really solving a problem or creating one? Is the app creating value by innovating or improving upon something else, or is it simply crowding the marketplace? These are questions worth asking. When we reach out and work with developers, it is usually because we’ve identified potential, but we also see opportunities where we can help the app improve. We have different teams that work with developers directly on coding issues, as well as a team that helps identify user interface improvements.

2. How can digital health app developers go about app store optimization (ASO) and does Apple support this type of app promotion?

As a rule, Apple does not help developers with app store optimization. There are services outside of Apple that claim they can assist with this, but it is really about simple fundamentals and multivariate testing their marketing. There aren’t that many variables involved so an app creator can simply play around and see if tweaking any of them creates a lift and/or improvement in sales.  This includes trying different app icons, changing the app’s title, making sure the description of the app uses relevant keywords a potential user of the app would search for, and really paying attention to the wording in the first two lines of the description to make sure any relevant information about the app is relayed quickly to catch the consumers attention quickly.

3. I come to the table with allegiances to the Quantified Self (QS) and Health 2.0 communities, yet it seems that much of the popular health and fitness apps today are more content focused, and from where I sit it seems like Apple is not really tapped into these communities (with the exception of Rock Health).  Why do you think that is?

Interpreting our lack of visibility in the QS and digital health communities is not necessary a fair judgment, and a little misleading. We are here to support anyone who makes a good app and to develop relationships with key individuals. Outreach into these communities isn’t necessarily a function of the App Store. If you look at it from simply a demand standpoint (meaning we get plenty of health and fitness app submissions per day), clearly we are covered. So there isn’t really a need for us to go out to these communities and drum up business. Furthermore, we like to work with a wide range of developers, span from big corporations to lone developers. There are a lot of groups out there making great apps.

4. What is the biggest challenge facing the Apple App Store today?

Like most innovative organizations, we have a flood of work and limited staff. We get a tremendous amount of product submissions daily, which means that we tend to be in a perpetual state of triage. Our internal systems are custom built so we don’t benefit from system upgrades that someone might see if they were running a third-party SaaS system. We do the best with the resources we have. We genuinely care about the people developing these products. Like any entrepreneur, often these individuals have invested significant time, money, and energy into their product… some have gone as far as to find themselves in sink or swim situations. We try to help the best we can, but we just do not have the current capacity to help everyone.

5. How can mHealth and digital health developers benefit from iOS 8 and Healthbook?

There is no way to answer that. Apple will not discuss future products and releases, so all that can be said is that the blogosphere has been wrong before. People that work for the App Store get very little information about  internal workings of the company. This is primarily to protect us, since we are an external facing team. Anything in active development could potentially change, so it could be harmful for us to discuss something not yet released because it is subject to change. Of course, the future is going to be exciting. Take the M7 chip for example, it’s really impressive the way it’s being used by health and wellness developers. We principally focus on what is possible now, and that is what developers should be focused on anyway. The present is as exciting as the future.

Interview with Mike Leveque about Fitness Innovation

Mike Leveque has a decade of executive leadership experience in health and wellness innovation. He previously was the President and Chief Operating Officer of Star Trac Fitness and is currently the Chief Operating Officer of MYZONE. MYZONE is a chest strap and monitoring system that displays heart rate, calories, time and effort to a LCD monitor, while simultaneously creating an online logbook of all physical activity that can be viewed anywhere in the world through the Internet.

1) The MYZONE device relies on heart rate and time as the primary data sources by which to track an individual’s overall activity. When compared to accelerometers – aside from the obvious advantage that the MYZONE device is able to more effectively capture effort from activities where movement is limited (ex. spinning, group training, etc.) – what additional advantages does heart rate tracking have over the standard tracking offered by traditional pedometers/accelerometers?

First of all, the pedometer is limited to the movement of the device. If you are wearing a pedometer on your foot and exercise on a Krank Cycle, you will not log activity. Additionally, there may be cases where a bumpy road triggers step credit on a pedometer. Lastly, the pedometer/accelerometer can only calculate a standardized step credit. For example, let’s say a user is cross country skiing, the “steps” credited will be nowhere near equal in intensity to a similar amount of “steps” while taking a walk on the beach at the same velocity.

In the 2008 Physical Activity Guidelines for Americans from The Center for Disease Control, it is recommended that every adult exercise each week for one hundred and fifty minutes at moderate intensity  or seventy-five minutes at vigorous intensity. Never does it recommend a certain number of steps, because there is simply no accurate way to measure the intensity of physical activity via a pedometer or an accelerometer.

A recent report from Flinders University in Australia has found that there is an unbalanced relationship between steps and high-intensity training. In the report Dr. Norton states, “Most physical activity guidelines recommend a 30 minute daily walk but we found that it would take 50 hours of walking to achieve the same aerobic fitness that you could get from just one hour of high-intensity (or vigorous) activity.”

Heart rate monitoring provides a level of accuracy that pedometers and accelerometers cannot. Every body reacts differently to exercise and the beat of your heart is the only accurate way to measure effort during physical activity. This accuracy allows our MYZONE software to provide user-generated content to track metrics such as average effort, time in user specific zones and caloric expenditure during exercise. Because the MYZONE software logs the user’s age, gender, weight and every heart beat during a workout session, it can utilize those four variables to calculate the calories burned during a particular session. This is much more accurate than the algorithms used by pedometers and accelerometers.

2) At the Quantified Self Conference this year Gary Wolf made a comment eluding that corporate wellness is somewhat degrading the sanctity of self-tracking. He was then reticent about the sentiment but my interpretation is he was alluding to the potential damage program parameters can have on motivation and personal drive when it pertains to the positive benefits tracking can have on wellness. In other words, limiting autonomy and confining options (ex. a company that only offers step challenges) might actually end up doing more harm than good. How important do you think it is to let the individual set their own health and wellness goals (opposed to them being mandated)?

I believe most reasonable executives would agree that utopia would be providing regular health assessments, thoroughly educating each employee individually on their results and then allowing them to set the most appropriate health and wellness goals that motivate them to achieve a better future state. However, a wellness program that is customized to each employee is neither practical nor cost effective for most companies. So then the question becomes, is the net benefit positive of a standardized program where the goal or goals are set by the firm? After taking into account the human cost of capital and other direct costs, the vast majority of studies agree that there is a strong return on investment of any wellness program that encourages increasing regular physical activity, even if the participants are not able to set their own goals.

3) When it is difficult enough to get the layperson to understand the existing wellness vernacular, what is the added value/utility of introducing a new branded concept like MYZONE Effort Points (MEPs) for measuring and tracking physical activity? How does this improve upon the existing lexicon and contribute to a better user experience?

The two main benefits of MYZONE Effort Points (MEPs) are standardization and gamification. Since MEPs progressively reward a user for increasing effort in their personal heart rate zones, we have created somewhat of a golf handicap in the awarding of points to users. For instance a deconditioned user may rapidly enter their higher point earning zone but they will fatigue more quickly than a well-conditioned athlete. A well-conditioned athlete, with an efficient cardiovascular system, may have a hard time approaching the high point earning zones but they can maintain durations in their lower zones for much longer than a deconditioned user might. The benefit is the system rewards general effort and standardizes for various levels of physical fitness .

Many users need an increase in their motivation to achieve their goals. Through gamification, MEPs allow MYZONE users and their fitness facilities to encourage attainment of health and wellness targets by establishing user challenges, goals setting and rewarding goal achievement. Cycling various user groups through individual and/or collective challenges has proven to engage and maintain club member participation in an exercise program while simultaneously creating the stickiness of the member to the associated fitness facility.

4) Current science suggests that if you can get an individual intrinsically motivated to stay healthy (ex. focus on the benefits of general well-being), adherence to behavior change will generally be longer lasting when compared to an individual who was extrinsically motivated (ex. the carrot of winning a weight loss challenge). If this is true, what role can technology play in fostering intrinsic motivation?

Utilization of technology is an effective mechanism to provide an individual with user generated content (UGC) of their physical activity and its related outcomes. UGC, such as duration of a training session, intensity of a training session and an accurate caloric expenditure total, helps educate the MYZONE user as to how effective an exercise session has been. It creates a currency by which all future sessions can be compared.

Since the MYZONE system can be linked to a body composition analyzer, a MYZONE user can track important biometric information, such as weight, BMI, body fat percentage and muscle mass to gauge whether or not they are benefiting from their current regime. MYZONE and devices like it can also provide the user a basal metabolic rate calculation to help the user regulate food consumption to achieve their health goals. It is through this increased availability of information that an individual can track their activity and make better decisions.

5) What currently excites you the most about the accelerated advancement of personal technology as it pertains to health management? What do you see on the horizon that you believe is going to be a game changer?

Accessibility of data as it relates to physical fitness will allow fitness facilities to add gamification to their offering. When deployed correctly, gamification will support the club’s efforts to attract, integrate and retain members at levels the fitness industry has never seen. In addition, personal technology will aid in the club’s outreach to provide richer feedback to corporate clients. The holy grail of technology as it relates to fitness is linking activity to lower health care costs and ultimately lower insurance premiums. Once this happens and information is accessible to all individuals, the fitness industry should grow exponentially.

Interview with Ari Meisel about Self-Tracking

Ari Meisel is a productivity optimization expert who coaches clients on optimizing, automating and outsourcing every task possible. Ari’s Achievement Architecture coaching program is an optimization framework design that helps individuals and teams improve their effectiveness and reduce the amount of time they spend on tasks. Ari’s personal website The Art of Less Doing has become a go-to resource for those seeking to improve productivity either in business, life, and/or health. Ari also has courses on wellness and productivity available from Udemy.

1) There is a lot of talk about what it might take to cross the proverbial chasm with regards to making bio-hacking more commercially viable. In your opinion, what do you think is important to get right regarding bringing the benefits of self-tracking to a wider audience? What’s currently missing?

Nowadays you can track everything… from how many emails you have sent, to how many calories you have burned… or even how many calories you have eaten if you have the right sensor. It’s so easy to do this stuff without even thinking about it now, which is great… which is the first step. The second part of it though is making this data actionable, and as far as I’m concerned there are very, very few products that provide the lay person with any sort of usable data. It is one thing to see that you’re losing this many calories today, and this many yesterday, and so on and so forth, but what does the average person do with that? Unfortunately, there are not a lot of ways that people can correlate this data and make it actionable. There is a really great website called Tictrac where you can do drag and drop corollaries; Tictrac is a step in the right direction.

2) You’ve made mention that you have some particular effective shortcuts for improving running speed? This is my gratuitous, self-serving question: I’m a Clydesdale runner who has been stuck at 8:45 minute miles for a few years now despite various training regimens. What do you suggest for someone like me that might help me move the needle?

The obvious ones are H.I.I.T. (High Intensity Interval Training) programs, workouts that involve high intensity drills with short periods of rest… there are a lot of different interval workout types that help you increase speed and efficacy from sprinting to plyometrics. I think that fartlek training is really good too, and not only because it has an awesome name. What I have actually found to be extremely effective as far as speed, and I know it sounds like stupidly obvious, but I recommend increasing leg strength. Once I started doing really heavy squats and box jumps my speed went from a mile PR of 6:17 to running one mile in 5:45. In my opinion, you simply add more horsepower when running isn’t the only thing you do to get better at running. Adding plyometric and explosive movement training makes your runs feel like every time your foot hits the ground you’re on a rubber band and ready to go again once you hit that next stride.

3) A bit outside the realm of health and wellness specifically, but knowing your expertise encompasses systematic lifestyle improvements and predicated on the assumption that generally people want to fix everything at the same time — and quickly — when a coaching client comes to you and wants to improve wellness and productivity at the same time, where do you usually have them start?

What’s the difference, really? The truth is productivity and wellness go hand in hand. It’s so funny because I invariably have somebody come to me for coaching on one of these and we always work on both. Basically, I can make you as technologically efficient from a productivity standpoint as you can possibly be, but if you’re not sleeping well enough and/or not eating right, there is going to be a limit to how much you can produce, or how happy you are going to be with your results. For instance, some come to me and say they want to be a speed reader, which most people can certainly do, but at the same time if you can increase mental focus, retention, and memory by reducing stress and improving well-being you’re going to be a faster reader because part of being a faster reader is not having to reread things.

My method is to tackle the biggest problems first. This methodology quickly addresses the low hanging fruit. So I start with “What are your biggest productivity challenges? Give me the three top things that frustrate you.” Always, always the answers I get back are inevitably two productivity things and one wellness thing or two wellness things and one productivity thing. So they’ll say something like, “I’m not sleeping great and I have to finish X number of things by the end of the day.” It’s always that mix. So if you ask somebody “what is stopping you from being the best you can be?” the answer usually covers productivity and well-being. I’m also a big believer in moving the needle at the onset of our engagement, and quickly, because progress begets progress. The worst that somebody can do is to stagnate and as long as they are doing something, even if it’s a tiny thing, that’s progress.

4) The buzz last year regarding bio-hacking was enabling, through technology, users to make better correlations by aggregating different tracking devices. There are a few options such as Open in an attempt to increase the benefit of tracking, but so far I’m unaware of any solutions that are super user-friendly. What strategies and/or tech do you use to increase the value and utility of tracking multiple modalities?

I have already mentioned Tictrac. I find that if you ask the right questions, a lot of the time people can give you the answers about the real issue. But I say that at least with half of my clients, a lot of it involves putting those trackers in place and then letting me read the values. So whether it’s RescueTime to see how often they are checking their email; or Fitbit to track activity I won’t even ask them to look at their own data at first. In my experience I find it is more helpful if I help my client first amass data and start by making recommendations based on their data as a first step in our relationship. I can help them better understand their data after they’re comfortable with it. People usually come to me because they are overwhelmed. They don’t have the time to do the things they want to do or they’re overwhelmed because they are stressed. These are compounding issues so I don’t want to introduce a complex solution just yet. I can introduce a sophisticated set of tools but take on the heavy lifting of interpretation until we make some progress. Not to beat a dead horse but fatigue is not an isolated issue. Are you not sleeping because you’re working too late, because you didn’t get enough done for the day and you are stressed, or are you tired because you’re eating too late and you’re eating really badly… or are you sleeping poorly because you don’t have the right environment in your bedroom? You need data to make a diagnosis and cause will rarely be just one thing.

5) One of the many valuable qualities of the content you curate is your intimate knowledge of the latest technologies that enable shortcuts and optimization. What’s out there, either now or on the horizon, that really excites you regarding wellness innovation?

I dream all day about finding new and interesting ways to use two particular services: one is and the other one is Zapier. Zapier has identical functionality to but it’s much more business focused. has like 60 different services, everything from Twitter to Facebook, Gmail and stuff like that and services that 90% of the computing-using world uses. Zapier has those things as well but it also has things like Salesforce, MailChimp and PayPal and a lot more business focus things. So will do so much regarding automation but Zapier really lets you drill down and get some unbelievably detailed things done. Through these websites I’m always trying to think of ways I can automate things to make them more efficient.

These kinds of things really get me really jazzed up. The great thing about automating some of these processes is it actually allows you to track things a lot better as well, because you know when the requests were made; you know how long it took to get them done and you can correlate those things a little bit too if you’re tracking your own productivity. It’s a lot easier to go back and see how and when things have happened and how often you did them through these services. They also let you compile things in effective ways. For instance, you can have Zapier set up that every time you make a sale on PayPal the sale is added to a Google spreadsheet, so right there you can make a data set that you wouldn’t have had otherwise. There’s a whole lot of creative ways that you can use this functionality to make your life easier.

Interview with Dr. Howard Jacobson about Nutrition and Scientific Inquiry

Dr. Howard Jacobson is a health educator and contributing author to T. Colin Campbell’s new book Whole: Rethinking the Science of Nutrition. He holds a Masters of Public Health and Doctor of Health Studies from Temple University, and a Bachelor of Arts degree in history from Princeton. Howard also founded as a resource for busy parents trying to raise fit and healthy children. He speaks, coaches, and consults on marketing for small and green businesses, health and fitness for individuals and families, and permaculture and planetary sustainability.

Here are my 5 questions with Dr. Jacobson and his answers:

1) A number of articles have been written over the past 10 years that raise concerns about clinical studies that address public health, food, and nutrition- related issues.  As examples, an essay written by Nobelist, James Watson, plays down the importance of anti-oxidants in diets (New Scientist,  March 16, 2013); a New Yorker article from December, 2010, entitled  “THE TRUTH WEARS OFF – Is there something wrong with the scientific method?” describes the difficulty in repeating and validating complex drug, public health and related clinical studies. Do you believe there is a single source of truth that applies to the global population regarding nutritional information?

I believe there is a really thick veil between us and the “Truth”, so the best we can do is be really respectful regarding what we do know. I look at Truth as a dinner guest. You invite Truth to dinner with the utmost humility. In my opinion, that is how you glean Truth from scientific study. You ask Truth to come for a visit, with the hope of getting yourself a little closer to true objective reality. Given there are so many ways of asking questions it seems to me the most respectful thing to do is to encourage  people to ask lots and lots of questions in various different ways – from micro-concerns to global issues and everything in between – then look at all the information you’ve amassed and try to create nested priorities. When claims are made off isolated studies (as discussed in the article you mentioned THE TRUTH WEARS OFF), they’re often reputed as fact and acted upon, only to find out as time passes that the benefits are only applicable in a scientific setting, or worse, they cannot be replicated. Given that goes on, I think a strong case can be made for judgment through diversity. You can approach scientific inquiry like an ecosystem. An overabundance of one type of organism is going to create havoc. You need diversity in any system so when weird things occur, and they will, you will have enough information you can rely on the preponderance. In this sense, when you come up with a counter-intuitive study – instead of sensationalizing it and broadcasting it as Truth – nest it as part of a holistic approach to inquiry and weigh its significance. So in the case of nutrition, we can look around the world and see that the people who tend to be slim, healthy, and live long lives are those that tend to eat a lot of complex carbohydrates, very little processed food, and not that many animal products. There is a large body of evidence to support this. So using this as a starting point, in my opinion, it is ridiculous to promote a 70% fat and protein diet when it flies in the face of a really robust empirical observation. I believe it is fair to be suspicious of purported evidence and mechanisms discovered in isolation that contradict more holistic observations that have proven evident through more vigorous means.

2) What advice do you have for consumers of this type of information in making nutritional judgments given the criticism that nutritional advice seems to come from a very diverse group of researchers and evaluators?

I’ll approach the question like this, given we live in a very unnatural society and we have the power of choice, how shall we eat? So someone might suggest let’s eat like a caveman… well, but wait, we do not live in that paradigm. We are not roaming the earth essentially working out eight hours a day, at least not most of us, that lifestyle involved a lot of physical labor. We now have unique demands that are specific to the environment we’ve created. It is a bigger issue than just being anthropological in nature however. We have power over our environment and ecosystem, so shouldn’t we make choices that are sustainable? That is one issue. Another is that as individuals we’re all different. If you are eating in a manner that is sustaining you in a healthy way, you are at a healthy weight and all your biomarkers are optimal, then maybe you do not need advice? I’m not a doctrinarian saying there is a single approach and everyone should eat a certain way. I will close by saying in spite of what I have just said, I think as individuals there is an obligation to be considerate of the fact we operate in a system larger than ourselves. For instance, there are a lot of ways to make a living. Some of these occupations might be harmful to other people but be financially advantageous. The spectator might look at an individual in one of these occupations and think that person is happy because of wealth and/or other measures, but pull back the lens and it proves to be a much bleaker picture. You can use this analogy regarding our food choices as well. Nutritional advice might be suitable for an individual but in the context of societal concerns be terrible (i.e. unsustainable farming practices, workforce exploitation, etc.). For these reasons I do suggest that the context of the information you consume is important to consider. Think beyond food choices that sustain only you, but choices that sustain your community, as well as the Earth.

3) An interesting section of your book deals with reductionism and the development of the many sub-specialties that now define aspects of biology. However, those with whom I have previously discussed the question of reductionism seem to argue that because science has advanced so much and has become so complex that some kind of subdivision is a necessity (this is true in both biology and life science).  There is simply too much to know.  They are also quick to point out that in addressing broad questions, the first and essential step is to put together teams with diverse viewpoints. The team approach also seems to be at the heart of what is often referred to as bench to bed or translational research. Isn’t reductionism needed so that others can “stand on the shoulders of giants”?

Let me clarify I’m not against reductionist research. On the contrary, reductionist research is an important part of a holistic view. The opposite position would be like a left-armed man saying, “well, I am left-handed so let me cut off the right one.” To be a literate scientific society we need all types of research. What we decry in the book is people who spend their lives looking down microscopes and then try to convince the rest of us that they’re the only ones that can see the Truth.  Again, as I posit in your first question there is no “single source of Truth”.

4) You also have some interesting perspectives on reductionistic approaches with regard to addressing broad questions.  If the goal is to make a recommendation, isn’t it necessary to have some sense of the mechanism of the putative interaction?  The point being that recommendations most likely come from a reductive process or require methods or concepts that are products of reductionism (e.g., good compositional data or knowledge of what a single component in food might do). Could you give some insights in approaching food related research questions, particularly when making an association to a given health aspect it may be a necessity to only be correlative without a lot of fundamental information? 

Having a passion and conviction for something you’re involved in is very human, especially among intelligent, successful individuals. Scientists who make an important finding tend to get identified with it, and that’s okay. It is very rare for scientists, or anyone for that matter, to be truly egoless. You need drive to do meaningful work. Part of the beauty of the scientific method is the desire to prove that you are right. The challenge is separating the real Truth from rhetoric. The issue in our modern society is that through media and other means, interpretation of Truth can sometimes actually be disseminated as Truth and that’s a big issue. It’s a big issue for two reasons. One, it gives the people with money a real advantage, because with money you can basically disseminate a distorted (aka your) version of Truth. Two, and even more concerning, is that reductionism is used to create marketable products with purported benefits that rarely can be achieved (at least as advertised) in a real-world environment.

Consumers have a hard time telling the difference between marketing and science. For instance, a lot of discourse has been spinning around the Cheerios’ ad featuring a biracial couple because of the alleged proactive portrayal of a mixed race couple, when we would be better served discussing the merits of the claim that Cheerios are good for your heart. These claims about Cheerios being good for your heart are so far from any scientific truth… they are loosely based on tangential data, and turned into marketing messages based on ingredients studied in isolation. I believe this controversy is more worthy of debate. It is like the old fable of a guy searching for his keys under a streetlamp. He lost his keys in the dark but the lamp was the easiest place to look so he started there.

The spirit of Whole is to suggest that in most cases nutrition is too complex to associate an expected outcome with a single nutrient. It’s like asking, “What is the best note in a particular symphony?” You certainly can take out a single note and examine it, but the examination is going to be of little use in creating your next symphony.

5) Given the complexity of the arguments made in your book, if the reader is to walk away understanding one concept what would you hope that is?

There is almost always a larger “whole” to examine. When you’re examining anything always try to see if you can broaden the context of your inquiry. Ask these questions: In what cases is the concept true? In what cases is the concept only a half-truth? In what cases is the concept false? The laws of phenomena are so unbelievably complex that whenever we attempt to break things into smaller pieces – as useful as it is to do so – we need to appreciate that some things are lost in the process. Reductionism very often comes with a cost or trade-off, and when that trade-off is not fully explored – or worse omitted for the economic benefit of special interests – the things that society loses in the process are not mitigated by societal gain… and worse yet, the gains are usually not shared equally but rather benefit only a select group of individuals (through monetary gain). Regarding nutrition specifically, as a society we have evolved in such a way that a plant-based diet simply makes sense. Eating is a way we turn the world into ourselves. It is one of the most intimate things we do and it is a shared commonality amongst all of us, so I believe it really does behoove us to slow things down and focus on building habits that will contribute to the greater good… as individuals… as an ecosystem… and for the betterment of the planet.