To hear Vida Health’s CEO Stephanie Tilenius talk about what she’s hearing from payers, providers, and employers about at-risk value-based models, the shift to virtual care, and the growing importance of mental health services as a culture-builder for businesses forced into a part-virtual-part-in-office world, you get a sense of how her past work leading the various payments and commerce businesses of Google, eBay, and PayPal probably comes in handy. For example, the shift to virtual care, she says, is, “like the Internet in 1999…It’s happening.”

We get an update on exactly how Vida Health is making it happen themselves, and how they expect their newly expanded at-risk model will help. Vida’s always been fees-at-risk on physical outcomes related to diabetes management, hypertension, etc. BUT the mental health side of their offering (which experienced 6000% growth year-over-year during the pandemic) is now at-risk on outcomes too. With so much happening across the industry to move to value-based models, we deep-dive with Stephanie to hear what she’s hearing from her clients, including client-and-investor Centene and hear about growth in the employer market where she sees a major shift in how employers are thinking about healthcare as the new sexy job perk. “Instead of snacks or transportation or other benefits,” says Stephanie. “It’s all about healthcare.”

On the heels of a $40M Series B funding round led by Bayer, One Drop CEO Jeff Dachis stops by to hit the highlights about how the digital health platform is touching the lives of 1.6 million users in nearly 200 countries. Focused on chronic conditions like diabetes, pre-diabetes, hypertension, etc. One Drop is unique in the BIG direct-to-consumer business they’ve built through partnerships with Walmart and Apple stores. While Jeff says their growth capital will go toward expanding their heath plan and employer business, there’s also room for growth with Bayer, which could help expand the company’s core operating platform into other therapeutic areas like cardiovascular disease, oncology, and women’s health.

Filmed at Frontiers Health in Berlin, Germany, November 2019.

By WILLIAM H. BESTERMANN JR., MD

New Scientific Breakthroughs Can Provide a Longer Healthier Life

Twenty-one years of follow-up comparing usual care with a protocol-driven team-based intervention in diabetes proved that healthy life in humans can be prolonged by 8 years. These results were achieved at a lower per patient per year cost. Aging researchers have been confident that we will soon be able to prolong healthy life. This landmark study shows this ambitious goal can be achieved now with lifestyle intervention and a few highly effective proven medications. These medications interfere with the core molecular biology that causes chronic disease and aging. These same medications will likely produce similar results in patients with congestive heart failure, chronic kidney disease, arterial disease, history of heart attack, hypertension, and angina. Simple medical interventions can extend healthy lifespan today.

Better Chronic Disease Management Can Improve Health and Lower Costs

90% of health care costs come from chronic diseases and aging which are both related. The same biochemistry that causes aging causes chronic disease. Eating processed food, gaining weight, smoking cigarettes, and sitting on the couch accelerate aging and chronic condition development. Those activities switch on genes that should be quiet. Eating real food, avoiding cigarettes, activity, lisinopril, losartan, atorvastatin, metformin, (and spironolactone) are now proven to extend healthy life by 8 years in patients who are at high risk of health catastrophes and early death! These medications all cost $4 a month except for atorvastatin which is $9 a month. The benefits continue even when best practice treatment stops probably because these treatments block signaling from dangerous genes that are inappropriately and persistently turned on.

Progress Will Require Extensive Health System Reengineering

Having better health and reducing health care costs can happen today. Surprisingly, the biggest barrier to progress is our current health care system. It is arranged around catastrophes, organ systems, and hospitals. These concepts are 100 years old. Chronic disease begins decades before the catastrophe, and it is related to aging. Age is the greatest risk factor for a heart attack. The same biochemistry that causes accelerated aging also causes heart attack and strokes. It makes little sense to see a cardiologist for a heart attack and a neurologist for a stroke. They are caused by the same molecular biology. The leading health care systems are beginning to recognize that. The interventions that slow aging and chronic diseases development impact every cell in the body. Every young person who is overweight or smokes has activated genes that make accelerated aging and chronic disease more likely. If these genes are switched on prior to having children, that risk is passed on to the next two generations.

Primary care teams organized to address chronic conditions and more rapid aging will provide lifestyle advice and medication that interfere directly with the biology that is causing the problem. The further upstream these individuals are when identified, the easier it is to slow aging and delay chronic disease onset. The path to better health at lower cost lies in the outpatient setting with primary care teams that are well-versed in molecular biology.

Tactics Lag Technology

Medical education and science are in some ways like fundamentalist theology. There is a body of thought that is established dogma and it is very difficult to dislodge. Another way to say it is tactics lag technology. Generals get their soldiers killed by fighting with methods that were appropriate for the last war. It is no different in medicine. There is a 17-year delay between new medical research in its broad application in medical practice. Even then there is substantial variation. Putting stents in patients with stable angina is like marching soldiers shoulder to shoulder into machine gun fire. There are many scientists developing new medications and devices. There are very few working to figure out how to combine the best medical and lifestyle tactics to develop evidence-based care processes consistent with best practices. Perverse financial incentives are also a huge barrier. The winners under the current system that is designed around organ systems, specialists, and big hospital systems are afraid of change that may impact their income, prestige, power, and influence. You can have a longer healthier life, but these barriers must be overcome to make that possible. When that happens, the new system will serve everyone much better and there will be plenty of money to care for those who are less fortunate. Here is an example of the care that we could have.

Prominent Scientists are Working on Extending Healthy Life

Prominent scientists have been working intensely to slow aging and delay disease. They have been optimistic that answers are right around the corner. These leaders met in a 2015 workshop, and concluded: “There was consensus that there is sufficient evidence that aging interventions will delay and prevent disease onset for many chronic conditions of adult and old age.” Most of those scientists have been looking for new drugs and similar answers and they have been making progress, but a new study shows that we can have those benefits now.

Healthy Life Extended 8 Years in High-risk Patients in Denmark

A team providing evidence-based care consistent with best practices prolonged healthy life. A Danish group just reported a 21-year follow-up of the randomized, controlled Steno-2 trial which compared usual care with an intensified multifactorial intervention in patients with type 2 diabetes and small amounts of protein in the urine. These patients were chosen because they have a very high risk of heart attacks, strokes, and other expensive diabetic complications. The protocol for the intensive intervention included metformin, atorvastatin, angiotensin converting enzyme (ACE) inhibitors and aspirin. Control targets for blood pressure, LDL cholesterol, and glucose were aggressive. This medical protocol coupled with life style advice produced a “disease-free life extension of 8 years.” At the 13-year mark there was a 4-fold reduction in heart attack, a 5-fold reduction in stroke, a 6-fold reduction in dialysis, a 3-fold reduction in amputation, and a 3-fold reduction in blindness. That is the holy grail. That is not just extending lifespan, that is extending healthspan.

Better Care Is Cheaper Care

Even though aggressively treated patients in this study were healthier longer, their medical care was less expensive. Usual care patients cost €10,091 per year while aggressively treated patients cost €8,725. The overall cost for the two groups was the same, but that was because half the usual care patients were dead at the 13-year mark. The main cost in the aggressive treatment group was brand-name medication. The excellent drugs used during the first 8 years of the trial were very expensive and still under patent. Now these disease-modifying medications are much less expensive and the difference in cost between intensive and usual care should be greater. It is also very likely that the overall results can be improved. New science tells us that spironolactone is another disease-modifying drug that should be added to the protocol. Cutting back on sugar and carbohydrate intake can also make a big difference.

The Same Interventions Produce Dramatic Results in Heart Attack Patients

Heart muscle dies in a heart attack and it is replaced by scar tissue. That injury activates the healing process. Once activated, those genes stay switched on. As a result, scar tissue forms in the entire heart, more heart muscle cells die, the heart becomes larger, and then weaker. It is unable to pump blood adequately and congestive heart failure develops. That whole process becomes a vicious cycle. Without proper treatment, heart failure patients die within five years. ACE inhibitors, angiotensin receptor blockers, spironolactone, metformin, and beta blockers interfere with the molecular signaling that causes progressive deterioration and can even reverse it. High-intensity statin therapy has a beneficial effect. These factors come into play every time a heart attack occurs, and these interventions interfere with the biology that is causing the disease. Our current system is not designed to make sure that every patient gets those interventions every time. As a result, a comparison of intensive management (getting the right $4 drug every time) vs usual care (628 patients in each group) showed huge differences. 98 people died of cardiac causes in usual care and 12 in aggressive care. Death from all causes was even more impressive with 188 deaths in usual care and 16 in aggressive care. If these interventions aimed at cardiovascular disease also dramatically reduce all-cause mortality, there are other diseases in play. The right care saved $21,900 dollars a year or $60 dollars a day. Sixty dollars a day! Just for doing a better job with controlling blood pressure, glucose and cholesterol with the right medication. Just for making sure that every patient gets the right care every time.

Why Does this Approach Work Better?

These interventions work better because they impact central signaling pathways that seem to be involved in aging and all chronic diseases. Rapamycin is the acting ingredient in the more modern drug eluting coronary artery stent. Placing a stent in a coronary artery damages the artery and activates inflammation and scarring. Rapamycin acts on the Target of Rapamycin (TOR) to inhibit stent blockage with scar growth, inflammation, and ongoing atherosclerotic disease. Metformin blocks that same signaling directly. Lisinopril, losartan, atorvastatin and spironolactone block it indirectly. Rapamycin has a local effect in the stent. The other medications impact it in the entire arterial system. Oncologists use rapamycin in cancer treatment. Common gene networks link the causes of cardiovascular diseases and cancer. Rapamycin slows aging in multiple animals. Metformin does the same thing. These disease-modifying medications don’t just impact cardiovascular disease and cancer. They slow progress to blindness and dialysis. TOR is a master metabolic switch that coordinates nutrient supply and growth factor signaling with normal growth in children. It is inappropriately reactivated in later life contributed to cardiometabolic disease development and cancer.

The active ingredient in nitroglycerin is nitric oxide (NO). When a stable angina patient places nitroglycerin under his tongue, nitric oxide quickly moves into the bloodstream and dilates the arteries. That reduces heart work and provides more blood supply. Viagra also provides more available nitric oxide to dilate another important artery. Every one of the disease-modifying agents mentioned in the two studies above increases nitric oxide availability to improve function.

This science and these medical effects show that chronic conditions and aging are related. Taken together, we can begin to talk about a unified hypothesis of chronic disease and aging.

What Would the New Health Care System Look Like?

The new health system would provide access to outpatient primary care services without deductibles or copays. It would provide free access to the proven disease-modifying medications listed above. The demand for facilities can be reduced because blood pressure and sugar can be monitored at home and adjusted over the phone. Care can be more convenient with fewer face to face visits. Protocols, primary care teams, and population health tools are essential. The population health tool helps the team identify patients who have not been seen, have not had a test within the appropriate time frame, are not at goal, or are missing a disease-modifying medication. Without protocols and systems there is no way to know how you produced excellent results and there is certainly no way to standardize and scale it. The new science described here is producing dramatically better results than usual care. It can be standardized, scaled and industrialized. Until someone shows better financial and clinical outcomes, that has to be the standard of care.

We Can Have Better Health Now-But It Isn’t Just Going to Happen

The health care system in the United States could provide better care for all people and save money doing it, but that is not just going to happen. Thousands of people are dying, becoming disabled, and going bankrupt because leaders have not done what they need to do at every level. There has been a roadmap to progress since 2001, but in spite of calls for change, there has been little progress. You need to hold leaders accountable at every level.

Dr. Bestermann is the founder and president of Epigenex Health, Inc that provides a comprehensive solution to improve health and lower cost for patients with cardiometabolic conditions.

By MERCEDES CARNETHON PhD

This month, we saw historic turnout at the polls for midterm elections with over 114 million ballots cast.  One noteworthy observation regarding voter turnout is record rates of participation by younger voters aged between 18 to 29 years old.  Around 31 percent of people aged 18 to 29 voted in the midterms this year, an increase from 21 percent in 2014, according to a day-after exit poll by Tufts University.

Surely their political engagement counters the criticism that millennials are disengaged and disconnected with society and demonstrates that millennials are fully engaged when issues are relevant to them, their friends, and their families. Why, then, do we not see the same level of passion, engagement and commitment when young adults are asked to consider their health and well-being?

I have had the privilege of being a member of the National Heart, Lung and Blood Institute-funded Coronary Artery Risk Development in Young Adults (CARDIA) study research team. In over 5,000 black and white adults who were initially enrolled when they were 18 to 30 years old and have now been followed for nearly 35 years, we have described the decades-long process by which heart disease develops. We were able to do this because, in the 1980s when these studies began, young adults could be reached at their home telephone numbers. When a university researcher called claiming to be funded by the government, there was a greater degree of trust.

Unfortunately, that openness and that trust has eroded, particularly in younger adults and those who may feel marginalized from our society for any number of valid reasons. However, the results—unanswered phone calls from researchers, no-shows at the research clinic and the absence of an entire group of adults today from research studies, looks like disengagement. Disengagement is a very real public health crisis with consequences that are as dire as any political crisis.

As a public health researcher who has been documenting trends in obesity and heart disease for nearly two decades, a number of frightening patterns have arisen.  One pattern is that three out of every four adults are now overweight or obese and the average age of onset of obesity-related illnesses such as diabetes is falling.  Heart disease and chronic heart failure are developing in middle-age—a time that compromises financial well-being secondary to missed days of work managing illness. The negative implications for caring for growing families and aging parents are obvious.  A frightening harbinger of our future are the children and adolescents who see and feel the impact of these illnesses, but who don’t know how to prevent them because the research studies that have identified risk factors have little relevance to their lives today.

The reason they do not have these answers is related to the second startling pattern that young adults are even more difficult to engage in medical and public health research than their older counterparts. I have led and been a member of many research teams and we are extremely grateful for the retired grandmothers and the reluctant, but willing, grandfathers who donate their time to answer questions about their health and allow us to poke, prod and test them.

Due to their participation, we have identified the major causes of cardiovascular disease in the population. However, our knowledge about the evolution of obesity and cardiovascular disease in young adults is limited to studies that were formed in the 1980s before our social and cultural landscape was dotted with mobile devices, online communications and concerns about safety and privacy.

Young adults certainly have many competing responsibilities, including finishing their education, starting first jobs and building their own families. To saddle them with another responsibility seems unfair.  However, just as participating in our political system is one of our many rights and responsibilities as citizens, participating in our public health system should be, too. Ultimately, the goals of public health are to protect the health of all citizens and promote wellness. The national fervor and debate about health care demonstrate the passion people have for health. We need for young adults to stand together and show up to participate in their health with the same fervor and passion with which they showed up at the polls.

Mercedes Carnethon is the Mary Harris Thompson Professor of Preventive Medicine and Chief of Epidemiology at the Northwestern University Feinberg School of Medicine and a Public Voices Fellow with The OpEd Project.

Livongo Health is creating a tech-based service that aims to supersede the glucometer. Headed by former Allscripts CEO (and THCB interview regular) Glen Tullman, it raised another $20m from Kleiner Perkins, DFG & General Catalyst today. I grabbed 10 minutes to talk to Glen Tullman this morning. he had very interesting things to say not only about his business but Cerner, Epic & open systems too.
[youtube]https://youtu.be/4w-pHj91PKM[/youtube]

Last week, Dr. Bob Kocher and I took to the pages of the New York Times to detail a health care success story in Southern Texas.  In a region once featured for its extreme health care costs and poor health outcomes, a group of physicians motivated by new incentives in the Affordable Care Act has started to change the equation. The Rio Grande Valley ACO Health Providers achieved eye-popping savings in their first year – coming in $20 million below its Medicare baseline and receiving reimbursements totaling over $11 million while also achieving better health outcomes for its patient population.

The savings number made for an impressive headline.

But as is often the case, other information had to be left on the cutting room floor. We dive a little deeper into the RGV ACO below:

The Central Role of Information Technology

Dr. Jose Pena, Chief Medical Director of the Rio Grande Valley ACO, emphasizes that one of the first and most difficult tasks for the newly-formed organization was developing an IT infrastructure that would serve their needs.  “Using what was there wasn’t really an option,” says Dr. Pena, “so we built our own infrastructure.”

Forgoing a single EHR solution, the Rio Grande Valley now operates on a mix of cloud and office-based systems. The ACO developed software to identify metrics from various EHR systems, migrate that information to the cloud, and view real-time performance of providers. “IT accounted for 40% of our costs,” says Dr. Pena, “but the importance of proper reporting – to our leadership team, and to CMS – was at the top of our list.” The ACO identifies its customized IT system as foundational to its success.

And it’s difficult to argue – the RGV ACO IT system has allowed the leadership to track outcomes across the board, seamlessly integrating information from seven different electronic health records across the ACO. The results for Diabetes control – one of the areas where RGV achieved its most impressive health outcomes and Dr. Pena noted as a special focus – place the ACO in the top 5% nationwide.

Finding the Right Types of Docs

Dr. Pena emphasized that the RGV ACO specifically chose the more aggressive “Track 2” in the Medicare Shared Savings Programs precisely because they wanted to place added pressure on themselves. Dr. Pena made the reasoning for that decision clear: “We had to motivate our physicians to change – so we had to make clear that failure wasn’t an option.” He also said that the composition of their providers was key. The ACO currently covers 8,500 Medicare patients, spread across 18 doctors and 20 midlevel providers, with plans to expand to between 13,000 and 15,000 patients by adding 10 new doctors in the next year. “We screen our doctors carefully – you really need

the right people” – that means finding providers fully committed to their patients’ health, and fully prepared to embrace the necessary change.

And when all else fails, Dr. Pena admits that financial incentives can be an exceptional motivator. “I’d say, ‘Do you want to get a call from the ER or the patient?’” he recalled. “Because if you take the call from the patient and he or she doesn’t go to the Emergency Room, then we win.” One of the areas of which the ACO is most proud is its reduction of hospital admissions – down a full 12% since the ACO formed in 2012, and a major contributor to the total reduction in Medicare costs that they drove in the program’s first year- from $14,100 to $12,000 per year.  Some have argued that RGV ACO’s success is less impressive for having occurred in a high-cost area. We will address this question in a future blog- so stay tuned.

Rio Grande Valley Health Providers was one of the first ACOs to recognize a critical asset that existed between primary care physicians and their patients:trust. While not easily quantifiable, it’s clear that the relationship between PCP and patient is unique; patients are more likely to listen to instructions from a doctor they’ve known for years than those from a hospital or health plan. RGV bet big on its doctors’ ability to change patient behavior – and that bet paid off.

But the commitment goes both ways – providers (like the one pictured below) have to repay that trust.  RGV instituted a cell phone program to ensure patients could contact their doctors; they started weekly times where patients could have medical instructions translated to plain English or Spanish; and they developed a home visit program to check on patients who couldn’t make it into the office.

This type of commitment to patient health had, for so long, gone unrewarded in the U.S. Health Care system. By flipping financial incentives, the Medicare Shared Savings Program and other accountable care initiatives – has provided an opportunity for doctors to align their desire to better patient health outcomes with their need for a financially stable practice. Rio Grande Valley has seized that opportunity and proved it is possible to step into the next phase of health delivery. Our goal is to make that opportunity available to independent primary care docs across the rest of the country.

The health care field is in the grip of a standard that drains resources while infusing little back in return. Stuck in a paradigm that was defined in 1893 and never revised with regard for the promise offered by modern information processing, ICD symbolizes many of the fetters that keep the health industries from acting more intelligently and efficiently.

We are not going to escape the morass of ICD any time soon. As the “I” indicates in the title, the standard is an international one and the pace of change moves too slowly to be clocked.

In a period when hospitals are gasping to keep their heads above the surface of the water and need to invest in such improvements as analytics and standardized data exchange, the government has weighed them down with costs reaching hundreds of thousands of dollars, even millions just to upgrade from version 9 to 10 of ICD. An absurd appeal to Congress pushed the deadline back another year, penalizing the many institutions that had faithfully made the investment. But the problems of ICD will not be fixed by version 10, nor by version 11–they are fundamental to the committee’s disregard for the information needs of health institutions.

Disease is a multi-faceted and somewhat subjective topic. Among the aspects the health care providers must consider are these:

• Disease may take years to pin down. At each visit, a person may be entering the doctor’s office with multiple competing diagnoses. Furthermore, each encounter may shift the balance of probability toward some diagnoses and away from others.
• Disease evolves, sometimes in predictable ways. For instance, Parkinson’s and multiple sclerosis lead to various motor and speech problems that change over the decades.
• Diseases are interrelated. For instance, obesity may be a factor in such different complaints as Type 2 diabetes and knee pain.

All these things have subtle impacts on treatment and–in the pay-for-value systems we are trying to institute in health care–should affect reimbursements. For instance, if we could run a program that tracked the shifting and coalescing interpretations that eventually lead to a patient’s definitive diagnosis, we might make the process take place much faster for future patients. But all a doctor can do currently is list conditions in a form such as:

E66.0 – Obesity due to excess calories

E11 – Type 2 diabetes mellitus

M25.562 – Pain in left knee

The tragedy is that today’s data analytics allow so much more sophistication in representing the ins and outs of disease.Take the issues of interrelations, for instance.

These are easy to visualize as graphs, a subject I covered recently.

Figure 1 shows how a patient’s obesity contributes to Type 2 diabetes and knee pain. There are many ways to store this information in ways that a computer program can retrieve and make sense of, including a standard called RDF that is widely used on the Web.

Figure 1. Illustrating contributory factors

In contrast, ICD obscures relationships. The standards do represent a small subset of such relationships; for instance Type 2 Diabetes has 56 ICD-10 codes that list commonly associated conditions. The paucity and gawkiness of such efforts (for instance, how do you represent multiple complications?) just underlines how desperately the health care field needs a different approach.

Wrong-side errors (such as operating on the left side when the problem is on the right) are shockingly common, but it’s still laughable to define separate medical codes for the left and right side, instead of coding left/right as a separate dimension that can be represented in the graph.

Finally, given that the doctor will select the diagnosis that gets the highest reimbursement rather than the diagnosis that best represents the patient’s condition, one can say good-bye to any analytical benefits that supposedly come from the proliferation of ICD codes. The bias of the system toward billing instead of treatment is revealed by the definition of separate codes for the initial encounter and subsequent encounters.

Researchers and analytics firms, I’m confident, will devise standards for representing disease in all its complexity. Health care institutions, eager to cut costs and find the right treatments faster, will use the new systems to track and analyze disease. It’s sad that we’ll be forcing doctors to use at least two parallel diagnostic systems–one tied to the practice of medicine in 1893 and another appropriate for 21st-century data processing.

Consider that for the last year or so, we have been treated a deluge of entreaties to reduce our salt intake, with the American Heart Association going so far as to claim that daily sodium intake should not exceed 1,500 mg. This puts it at odds with the Institute of Medicine, and now European researchers whose data indicates that the healthy range for sodium intake appears to be much higher.

Our conversation about  sodium, much like advice about purportedly evil saturated fats and supposedly beneficial polyunsaturated fats, exemplifies a national obsession with believing eating more or less of a one or a small number of nutrients is the path to nutritional nirvana.

A few weeks back, an international team of scientists did their level best to feed this sensationalistic beast by producing what’s become known since then as the meat-and-cheese study, because it damned consumption of animal proteins.

• The authors correlate cancer mortality with age and protein intake, but they never bother to correlate it with body mass index or waist circumference, the latter of which is an increasingly important measure of body composition. Average waist circumference of the mostly older study subjects was just barely below risk thresholds, meaning that they were fat. Abdominal adiposity induces a damaging pro-inflammatory metabolic state than abets cancer development. Cancer is predominantly a disease of aging with incidence and death rates after age 50 that are 13x greater than before.

• A lot of the key data is in the supplementary tables, which weren’t embedded in the press release, so no one noticed it. The supplementary tables reveal that almost 40% of study subjects were former smokers and nearly 20% are current smokers. These proportions are far greater than the general population; smoking promotes many more cancers than just lung, and it impacts diabetes risk. The last time 40% of American adults smoked was 1965.

• Study subjects, on average, did not graduate high school, meaning that they were at a substantial socioeconomic disadvantage for having either knowledge or incomes to cultivate and support healthy habits.

• Like nearly all junk science on health habits, this study doesn’t even mention the importance of physical capacity to mortality and the ability of physical capacity to modulate risk even in the presence of adiposity. In fact, it ignores fitness completely.

• Study subjects ate an average of 1,823 calories daily, while federal data says American adults eat about 2,200. The quality of calories consumed is described poorly. Fiber intake is not reported, and neither is how the protein was eaten. A cheeseburger made with 70% beef and eaten on a white flour roll is a different animal than grilled salmon consumed on a 100% whole grain roll, even though they might offer similar overall calories and protein content. They also do not report alcohol intake, even though it is a well-established cancer risk factor.

• The conclusion that people should depend on plant-based proteins to reduce health risks and eat less protein before age 65 is inconsistent with the consensus findings from the Institute of Medicine and with informed thinking on the role that protein plays in satiety and how it may help to reduce obesity levels. Further, sarcopenic obesity is a growing problem that may be affected not only by increasing protein intake but by getting people to engage in resistance training, starting both in middle age.

• Senior author Valter Longo founded medical food company L-Nutra, which is currently developing two products. One is a plant-based weight-loss food ProLon that the company claims will have “a potent effect in causing weight loss while optimizing the micronutrient nourishment and promoting anti-aging effects in patients.” Interesting nexus for a paper promoting plant-protein consumption.

This is what the study really says: In a population of fat, older, poorly educated Americans who somehow magically ate fewer calories than average, many of whom are or were smokers who apparently never exercised and maybe guzzled alcohol, the authors, including a senior author who stands to benefit directly from the media chittering about plant-protein consumption, conclude that (excess) animal protein is the problem.

This paper is a perfect example of ‘bridge-to-nowhere’ academic nose picking. It also reinforces growing concerns about the validity of research findings in the increasingly dubious peer-reviewed literature. If published at all, this paper would have fit better in the Journal of Irreproducible Results or the wellness literature alongside other forgettable health trivia.

To paraphrase my pal Al Lewis, you don’t have to challenge the data to invalidate it, you merely have to read the data (but you have to go the supplementary tables), and it will invalidate itself.

I’m hungry. Who’s buying the the cheeseburger, fries and beer tonight?

Vik Khanna is THCB’s Editor-At-Large for Wellness. He is also author of THCB’s next e-book, Your Personal Affordable Care Act: Making Yourself Scarce in the Dysfunctional US Healthcare System. Along with Al Lewis, he is co-author of THCB’s inaugural e-book, Surviving Workplace Wellness With Your Dignity, Finances and Major Organs Intact.