In employee health services, almost everyone with internet access is giving out awards for something-or-other. Wellsteps, for example, gave out 25 of them at once, including several to companies that no longer exist, along with an award to itself. Therefore, it can safely be assumed that a beam of light leaving Wellsteps wouldn’t reach due diligence for several seconds.
Not so with Valid Vendor of the Month Award, given out by our alter-egos at Quizzify. These awards are real. How can you be sure? Not just that each of the Valid Vendors are validated by the Validation Institute, though that’s a great head start.
More specifically, Quizzify is so confident of its Valid Vendor selections that they are placing 33% of their own fees at risk for the performance for each Valid Vendor of the Month. While many vendors won’t even put a third of their own fees at risk for their own performance, Quizzify is putting a third of its own fees at risk for another vendor’s performance. The ground rules –and all disclosures—are at https://www.quizzify.com/valid-vendor-awards
Below is Al Lewis’s story, reprinted from Quizzify.
I recently met Bill Miller, who runs Drexi. Drexi is a tech company disrupting the pharmacy space with next-generation PBM services compelling enough to win the 2020 Health Value Award from the Validation Institute, as was announced this week (3/30). They also have direct-to-consumer memberships that offer discounts on brand and generics at participating chains, bypassing the standard PBM markup that they charge for “managing” your purchase of a few pills.
Bill told me this. “Sounds great,” I replied, “But it wouldn’t work with me.”
“Why not?” he asked.
“Because I was paying $136 out of pocket for 90 5-milligram zolpidems (Ambiens) at CVS. I tried Optum’s mail order. Same exact price. Then I heard I could purchase them through the dispensary at my PCP’s practice and pay only $18.40.”
In case there is someone reading this who has never been snookered by a PBM “negotiating” for you, here’s what a receipt looks like, for a covered benefit for a generic medication:
Now let’s compare my CVS receipt for $136 — the price that my PBM had thoughtfully and painstakingly procured on my behalf with CVS, no doubt after several tense negotiating sessions in a smoke-filled room – to the receipt from the dispensary at my nonprofit physician practice.
I bought these zolpidems for a mere $18.40, knocking fully 86% — 86% — off the CVS price. No way Drexi can beat that, I thought.
“Well, let me at least try,” Bill offered.
“Fine,” I replied, using the tone of voice I normally reserve for a wellness vendor buttonholing me at a conference to explain that while every other wellness vendor lies and loses money, they really do get behavior change and dramatically reduced costs.
Bill searched on Drexi for “90 5-milligram zolpidem”.
“Is there a Walgreen’s near you?” he asked.
Indeed there is. Turns out that, had I used a Drexi card, I could have gone right across the street from the CVS to the Walgreens and paid $10.40, which I made a note to do in April. This would be a 43% reduction off my 86% reduction. What a savings! What a story!
But wait…there’s more. Now how little would you pay?
That wasn’t remotely the end of the story, as it turns out…I’m pretty close to a Wegman’s, where it turns out I could have gotten those very same 90 pills for: $3.60. This would be a 67% discount off my 43% discount off my 86% discount. Here is the Drexi screenshot.
Yes, way cheaper even than Walgreens. But I live fairly close to a Walgreens, and it’s a much more pleasant bike ride, so I figured I would just go there. I was already way ahead of the game with the $10.60, and it was a nice day for a ride. (Just in case anyone is keeping score at home, I didn’t do anything irresponsible. This trip took place on a date early enough in March that I still could reasonably expect my 401k to support my retirement.)
And the envelope please…
Between the time Bill Miller showed me the Walgreens price and the date of my visit, Drexi had negotiated an even better deal with Walgreens: I paid – get ready — $3.25.
Was this a perfect experience? In the broad sense in which that word often gets used these days, yes. On the downside, the pharmacy tech did spend a little bit longer processing my card than typically with my regular insurance. (That may be because I was a first-time user.)
Note: there is an admin fee. The retail-user fee (that I pay) is $7/month for unlimited prescriptions. Since I am saving about $15/month off my already deep-discounted price from my PCP practice, the extra $7 is a no-brainer for me. Plus, Walgreen’s is closer, stays open later, and usually runs a 2-for-1 sale on my go-to OTC remedy, Refresh Plus lubricant eye drops.
And that’s why Drexi is the April Quizzify Valid Vendor of the Month.
It’s human nature to look for a cure or treatment for a serious disease. People tried to ward off the plague with garlic. Those with long memories might recall Laetrile, for example. Laetrile was relatively harmless – at least in comparison to chloroquine or hydroxychloroquine, which self-medicating people have already died from. That stuff, newly approved to treat COVID-19 by the FDA, is figuratively flying off the shelves — in what appears to be nothing more than the latest coronafad. (If that is not a word, it should be.)
It is featured in our current quiz, which also introduces our first picture questions. Meanwhile, here are Six Things you and employees should know about this latest coronafad.
(1) All the studies are small
And all the analysis is rushed. But studying the impact of an intervention on an acute condition doesn’t take years, the way a diabetes prevention study might.
There is also a rule of thumb in these situations that if an impact is big, it should show up in a small sample. The best example of that how few patients were needed to conclude that smoking caused lung cancer or that severe hypertension caused strokes. (In both cases, those weren’t even acute events. Yet the results were known relatively quickly because they were so clear.)
(2) The French study, which launched this, was not controlled
Yes, hydroxychloroquine was given to a small group of patients, and yes, they improved. But the results were largely anecdotal. In normal times, no respected journal would even let it get to peer review. But these aren’t normal times. Nonetheless, there is something called a “meta-analysis,” where multiple results showing minor changes can be combined into one ersatz study that would be statistically significant.
(3) The most recent study, from China, was also small and shows no impact
Unfortunately, the reverse was true here. The “confirming” study showed the opposite.
Of the 15 patients who got treated, 13 tested negative (you probably know this already, but “negative” is good, as this brief video demonstrates) after a week of treatment. That sounds promising — except that of the 15 patients in the “usual care” control group, 14 also tested negative. This is why control groups are considered the “gold standard.” Most of us over 60 had our tonsils out as kids, to make earaches go away…but it turns out earaches would have gone away anyway. There was no control, merely pre-post.
That sample of 30 is too small to say that the drug does not work. However, it can clearly be stated that it doesn’t work well in an undifferentiated population hospitalized with pneumonia. It can’t be ruled out that it has a positive impact if administered at an early stage, or on some cohort (younger people or women might be examples of discrete cohorts).
However, people with mild cases need to consider the side effects…
(4) …There were side effects in that study
The more serious the condition, the more side effects are tolerable. So chemotherapy and HIV drugs have substantial side effects…and yet get approved by the FDA because the alternative may be death.
Hence, an approved (though not for this use!), powerful drug that somehow treats both malaria (caused by a parasite) and allegedly coronavirus (caused, of course, by a virus) could be expected to have some side effects…and indeed it appeared to, in the study group.
Once again, though, some patients in the control group got complications too. Because the patients were so ill, attribution to the drug itself would have been difficult even in a larger sample.
(5) These side effects in general are serious and substantial
For malaria, this drug was researched multiple times, because during World War II so many troops in the South Pacific were getting it.. While showing some promise as a treatment, the side effects were unbearable for many subjects, even prisoners who were promised early release if they followed through.
The dose that triggered these toxicity effects was a small fraction of the dose in the French study, though the specific French formulation should be safer in similar dosages.
(6) This looks like a massive case of confirmation bias
Probably within weeks, this drug will go the way of zinc, elderberry concentrate, essential oils and other immune “boosters” as just another coronafad. It may find some niche in treatment of certain small segments in which the benefits (if any) exceed the possibility of harm, but for the rest of us the reverse will certainly be true.
If you want to indulge in a harmless or even potentially beneficial albeit useless coronafad, try the sips of water every 15 minutes. This allegedly washes down the virus, the way you might drink milk to wash down a cookie. (This isn’t the way viruses work, but that’s a blog for another time.)
The wellness industry has been encouraging us to do this for years. Water, water, everywhere. The only possible risk is tripping and falling on your way to the bathroom.
Sign up here to join our mailing list and to receive the new Coronaquiz IV: Busting the Myths and Gobsmacking the Fads…featuring (you guessed it) chloroquine.
And visit https://www.quizzify.com/coronavirus to play all four coronaquizzes to identify knowledge gaps and obtain accurate, up-to-date information.
Dear They Said What Nation,
We are all corona all the time now.
Here is our latest coronaquiz, and all our previous coronaquizzes, now all in one place. These are all freely sharable (with attribution, please) to get the word out. This latest quiz covers, among other things, the unexpected greatest hazard of grocery-shopping. Normally we would tease this to get more click-throughs, but we are actually going to give you the answer here both because desperate times call for desperate measures and also we are already getting tons of click-throughs.
The answer is: the handle of the shopping cart. Imagine how many other people have been grasping that handle all day. You’re distancing yourself from other shoppers, using self-checkout, shopping at off-hours…and yet you are physically embracing the #1 item — hard plastic — where the virus survives the longest.
Fortunately, for just that reason, my local Stop & Shop thoughtfully provides a dispenser of wipes…
…so you can disinfect your hands before you wheel your cart out into the parking lot.
In my opinion, it would also be helpful if the dispenser actually contained wipes, but maybe that’s just me.
A special shout-out to the organizations that have stepped it up in this crisis by making these quizzes easily available to members
Among wellness vendors, these quizzes are being made easily available by Sonic Boom and US Preventive Medicine. (Now let’s not always see the same hands.)
Among wellness trade and professional organizations, by National Wellness Institute and WELCOA. (HERO is apparently still pursuing a more traditionally broccoli-centric agenda, though they did thank us graciously for our offer to share our quizzes with their members. Not.)
But the biggest shout-out goes to Melissa Burkhart and the gang at Futurosolido. At considerable expense, they have made Spanish versions of the first two quizzes available on Quizzify and their own http://www.futurosolidousa.com websites.
Dear They Said What Nation,
Here are two updates for you.
First, on Tuesday you will have an opportunity to query arguably the country’s leading authority on corona, as profiled here in the New Yorker. (Disclosure: he is my brother-in-law.) Yes, the Validation Institute is doing a webinar on Tuesday at 2 PM EDT– as a Friend of Al, it is free if you enter PRESS in the promo code. His name is Dr. Ian Lipkin, the John Snow Professor of Virology and Immunology at Columbia. If you recognize the name, it’s because he’s on TV fairly often.
Examples of rumors floating around the internet that you might ask him about: can you get re-infected? Are there two strains? Does the virus mutate? Could hydroxychloroquine prevent it? (This is a real thing — it sounds like something would make up.)
Second, two employee Q&A sets are now available. The original one is now updated — lots of material can change in two weeks. So if you haven’t circulated this one yet, now is a good time.
The sequel is still good to go. It covers why your employees might want to color their fingers like this.
There have been a zillion hits — we are allowing complete reuse of it with nothing other than attribution required.
There are certainly ways to avoid coronavirus risk altogether, such as isolating yourself. But sometimes you just have to go to work, or interact with others. While you should be very concerned, keep in mind that in the last 30 days there have been many more cases of and deaths from the flu than coronavirus, though that could certainly change in a future month.
At this point, if you are reading this, you know the basics about hand-washing, not touching your face etc., but maybe there are 6 simple risk-reduction “hacks” you are not aware of.
(1) Mark your fingers like this
Use an indelible marker or tie a string or rubber band around your fingers, especially on your right hand. This will remind you not to shake hands, and to wash your hands or sanitize them if you do. If you are left-handed, you should probably do both hands.
(2) Use humidifiers at work
Most workplaces are very dry. Viruses can stay airborne longer in dry air. (Winter air being drier is thought to be one of the reasons flus are seasonal.) To oversimplify, the viruses attach to water droplets and fall to the ground faster in humid air.
Nor do you want to overdo it. If the air feels humid, it’s probably too humid. Other pathogens — molds in particular — thrive in moist areas. However, very few workplaces have this problem.
(3) Avoid contact with hard surfaces
One would think that viruses would live longer on soft, cushy surfaces than hard, shiny ones. That’s quite counter-intuitive. If you met someone for the first time, you would certainly open their door, but you wouldn’t jump into their bed. (Cue sophomoric joke here about swiping right.)
And indeed beds and other soft surfaces do harbor all sorts of other microscopic life forms, most of which wouldn’t harm you or we’d all be extinct by now. For instance, you should swap out your pillows every year or so because dust mites like to set up housekeeping in them. But for cold, flu and coronavirus, it’s the hard, shiny public surfaces that will get you.
(4) Reduce the number of hard surfaces in public places
Prop open doors. Door handles (or pushing on revolving doors) are probably the #1 surface that people come into contact with, without thinking twice about it.
Obviously, this isn’t always practical. One could do it for the break rooms but perhaps not the restrooms. In that case, perhaps wrap tape around the door handles. Viruses die sooner on softer surfaces, and since people think of softer surfaces as carrying more germs (they do – just not coronavirus), they will be more likely to wash afterwards.
(5) Check the ingredients in your hand sanitizer
Good old-fashioned alcohol should be the main ingredient — at least 60%. Many, for aesthetic reasons, prefer better-smelling or faster-drying active ingredients. Those will offer some protection, but alcohol rules.
(6) Play the Quizzify coronavirus quizzes…and send them to your employees
Like with The Pink Panther and arguably The Godfather and National Lampoon’s Vacation, the sequel — which is just coming out now — is better than the original.
Once again, we will be re-posting from Quizzify. This post also turned out to be very popular and we even incorporated a couple of extra suggestions from readers to update the blog post. We will also have some quiz questions available next week.
Highlights for those who don’t want to click through (though we aren’t contagious):
- wash your hands for 20 seconds at a time
- unless you recently washed them, keep your hands away from your nose and mouth
- your odds of getting the flu are vastly greater than getting coronavirus, at least for now — even if you had the flu vaccine (though that is a good idea in general)
- facemasks don’t work
- there are no magic potions or other preventive formulas
- go about your everyday lives
That’s the information for now. Check back next week. We might have question sets to distribute.
And the emphasis is on “for now.” In the immortal words of the great philosopher Yogi Berra: “It’s tough to make predictions, especially about the future.”
Dear They Said What? nation,
Occasionally we re-post from Quizzify here. This particular posting was quite popular, so we thought it worthy of a repost. Also quite popular on The Skeptical Cardiologist, which is one of our favorite blogs. If I knew how to create a blogroll, they would be on it.
The majority of your employees take nutritional supplements, whose consumption just reached an all-time high. That increase means someone, somewhere – maybe even your very own wellness vendor – is telling them this is a good idea.
Or maybe they are thinking: “Hey, what harm can they do?”
Plenty, as it turns out. Here are six things employee should know about nutritional supplements. In the case of close calls, we yield to the optimistic views of the supplementarians, on the theory that they are more likely to whine and we don’t want to get into any he said-she said comment fights with them.
1. Most benefits of supplements with none of the risk can be achieved with a regular multivitamin
There is plenty of evidence for the health benefits of virtually all vitamins and minerals and even a couple of supplements, so much evidence that we have room to highlight only a few.
Examples include fish oil for menopausal women with dry eye or possibly people at high risk of heart attack. Or folic acid for pregnant women and iron for pregnant women who are anemic. Or Vitamin D for people who have dark skin, live in cloudy climates, avoid all sun exposure and/or don’t each much dairy. And of course, Vitamin B12 for vegans. (Vitamin B12 is found only in animal products.)
Women likely benefit from small combined extra amounts of calcium and Vitamin D…but as noted below, don’t overdo it.
The 10% of the population who drink to excess really should be taking daily multivitamins. This is partly because alcohol interferes with absorption, and partly because they aren’t getting enough calories from real foods.
30-second shameless plug: this is where Quizzify comes in. Most heavy drinkers — like most other employees with something to hide — lie on health risk assessments (HRAs). About 3% of your employees will admit on an HRA they drink too much, whereas in reality the top 10% of adults consume 73 drinks/week. Even assuming the HRA provides correct nutritional advice (most don’t), 7% of your employees who need this advice won’t receive it.
Quizzify, on the other hand, specifically asks and answers the trivia question: “What extra vitamins should you take if you drink heavily?” So the other 7% get this valuable information…without needing to disclose their drinking habits.
With these exceptions, most people should be getting enough vitamins in a balanced diet, but a few cents a day of an “insurance” multivitamin pays for itself just in the psychological benefit of not worrying about that. However, the story changes when we talk about megavitamins, and especially when we talk about other supplements.
2. Almost every megavitamin which once showed “promise” in fighting cancer, heart disease, etc. doesn’t. Quite the opposite, they may cause harm.
Niacin, once thought to have magical properties against heart attacks, has been completely debunked. Vitamin E supplements could prevent cancer in some women but cause it in others, depending on genes. Men who are concerned about prostate cancer (meaning all of us) should specifically avoid Vitamin E supplements, which likely increase the odds of it. Vitamin D in large quantities is the latest to be debunked, just last month. Taking too much may cause osteoporosis, rather than prevent it.
As with anything else for sale on the web, there is a business model here that may not always be in the consumers’ best interest. This is particular true for Vitamin D, where the “Doctor” who touts the stuff the most gets paid handsomely by the industry. He thinks the dinosaurs didn’t die due to the asteroid that hit the earth. He thinks they died of a Vitamin D deficiency due to the lack of sunshine afterwards.
And monitor your own wellness vendors. Interactive Health, for example, tests every employee for anemia. (See “Interactive Health breaks its own record for stupidity.”)
This is contrary to the advice of clinical guidelines, which oppose anemia screening except for pregnant women, where evidence is mixed. Employees who then take iron supplements risk stomach pain, nausea, vomiting and serious long-term complications.
The good news? It is just slightly possible large amounts of Vitamin C do offer modest benefits with respect to common colds, and that those possible benefits outweigh the possible harms. But just large amounts, like 200-400 mg., not massive amounts. Not the 1000+ mg. that the proponents tout.
3. If you have to go to GNC to obtain a supplement, or order it through the mail, it has no value and may cause harm.
CVS and Whole Foods want to make money too, and fancy supplements are expensive, high-margin items. So if a supplement has even the slightest inkling of value, they’ll stock it.
As a random example we picked because we like the name, consider horny goatweed, as a treatment for erectile dysfunction (ED). Along with the name, it also has a great back story, something about Mongolian herders observing goats getting aroused after grazing on it.
Horny goatweed is actually proven to work, though — and not just on goats. It also works on rats. For the rest of us mammals, there is zero evidence. Plus, ED is one of those conditions where, if something worked, we’d know about it by now.
At least the likelihood of harm is pretty low to other than your wallet.
4. There is no such thing as FDA approval for supplements
It’s also not entirely clear that these pills contain the ingredients they claim to contain in the quantities they profess to contain. These supplements turn out to be much harder to manufacture to specs than regular synthetically derived pills.
5. They may interact with “real” drugs you are taking
Just because supplements are derived from natural sources doesn’t mean they don’t act like real drugs inside your body. And, like real drugs, they can interact with other drugs. For instance, if you are taking Vitamin E and Advil or Advil PM or a baby aspirin, your risk of bleeding profusely in an accident goes way, way up, because all are blood thinners. The risk isn’t just accidents — small everyday bruises may become big bruises.
Make sure you list supplements when describing to your doctor what you take…though it’s questionable whether (aside from the basics, like that blood-thinning example) the doctor would be aware of these interactions. There are too many to track, and some interactions simply aren’t studied.
It all comes back to this: a one-a-day multivitamin/mineral supplement is more than enough for most people. Not just for the benefits, but for avoidance of the risk of interaction, side effects and unknown long-term impacts.
6. There is one “supplement” that benefits almost every body system and has no side effects
You guessed it – exercise, the key to health and longevity. If there were a dietary supplement that provided even a small fraction of the benefits of exercise with none of the work, we’d know about it by now.