Wednesday, August 26, 2015

Me and Burgers

I love hamburgers but lately I only eat them at home. I do not want to seem like a wuss but it seemed to me that when I ate burgers outside my home my microbiome let me know that they were displeased with my selection. Some of the people I know thought that I was just being picky when I said that I preferred meat that did not have added antibiotics or hormones.  Today's Washington Post made clear that my microbiome led me to a healthier choice.

Sunday, August 9, 2015

Coca-Cola Funds Global Energy Balance Network

WHO is recommending limits in sugar intake because of the worldwide increase in people who have excess weight. Drinking one typical can of sugar sweetened beverage exceeds the limit. Nevertheless, it seems that Coca-Cola is interested in research that documents that excess weight is not due to bad diets but to not enough exercise They just funded the Global Energy Balance Network to lead this work. 

Thursday, May 7, 2015

How to Reach the Hispanic Community...

Here is the link to my article that appeared on May 6, 2015 in El Mundo, Section on Business and Innovation, Madrid, Spain. .  The translation is below. 

Reaching Everybody

I was having a conversation with the CEO of a major company about how to reach 57 million peple in the United States. When I mentioned that I was talking about reaching the Hispanic consumer there was a pause and a palpable change in the conversation. The enthusiastic CEO went into automatic mode accentuated by polite comments that indicated interest and understanding. Then the entire project was handed off to the person responsible for Diversity — a death knell for meaningful work.

The Chief Diversity Officer is a C suite position without budget responsibilities that lacks the clout that is necessary to execute. These positions are meant to deflect challenges to the status quo rather than define the possibilities and the opportunities in a growing market. With neither a place in the chain of command nor the portfolio that could make the necessary investments it is a place where ideas go to die. The Diversity person is there to make the company appear like they are doing something to serve their diverse consumer base.

Just like EEO Offices of decades past or the more recent renaming of similar offices as Minority, Disparities, Equity, or some other politically palatable name of the moment these offices do little more than develop plans and do training. Most companies take a 20th century approach and establish an employee group that is made up of the targeted community to advise them; hire outside expertise on the targeted group; create an advisory group of stakeholders; create a diversity, health equity, multicultural, or alliance development office; translate existing documents, webpages, etc. to the target language; add pictures of the target group; add food selections at corporate cafeterias that cover a variety of countries; and, sponsor “Month of…” events.

While these may be well-intentioned the totality of activities make it obvious that what has been accomplished is mostly veneer. Even worse they can be seen as a defensive response devoid of the tools to create the type of meaningful inclusion that produces financial results. This is bad for business and for our economy.

Reaching Hispanics or any target group means reaching individuals with an image, work, and product that resonates with who they are and what they want. It takes more than a diversity office to do that…it takes leadership and the commitment by every person in a company.  That leadership is hard to come by when Hispanics are one in six persons in the U.S. but at Fortune 500 companies are less than 2% of the CEOs and less than 4% of the Boards of Directors.

Trust and brand loyalty go hand-on-hand and today each individual wants to know that a company knows who they are and what they want. Too often I hear that Hispanics are too diverse and because of that it is hard/incorrect/disrespectful to get a single message that resonates with everyone. That type of strategy reveals a lack of understanding of the American marketplace.

With the rare exception of being in a building that is on fire and yelling ”Fire,” it is unlikely that a single word can reach everyone. The era of the single message went the way of having only a handful of major networks. Each person wants and expects to be reached with a message that is tailored to them; that is why Google has been so successful. Google knows each of their users and craft messages for them.

So when I am asked how do you reach Hispanics? It’s the same strategy that you use for everybody—use language and images that are meaningful to the individual, make clear that you understand what they want and desire, and as a result earn trust and respect. You do different things at different times. Reaching everybody is no longer a one shot deal.

Thursday, March 5, 2015

Big Data and You

El Mundo, one of the most prestigious newspapers in Spain, created a daily supplement on innovation and entrepreneurship (title Innovadores) and as an advisor to Bankinter's Future Forum I wrote this article on "Big Data and You."
Here is the translation:

Big Data and You

We all accept that there is an abundance of data that are used to define everything about us. The data that are collected are then harvested by all types of entities and put together in ways that communicate more to others than we may want to share. But with the promise that the data cannot be traced back to the individual we release much of what is private about our lives. Nowhere is this more evident than in the health care setting where data are being merged from different sources to produce predictive models for deciding upon the type of treatment an individual should receive.

The use of big health data has been heralded as a giant leap forward in that information from different people can be used to give a fuller picture of what are the risk factors that we need to pay attention to. With these aggregated data and the risk profiles they provide health care providers at every level are equipped with an array of protocols about how to treat a patient. These data can also provide new and compelling alternatives to what would be considered the usual standard of care.

But we must proceed with great caution.  Recent research[1] funded by the National Heart Blood Lung Institute in the U.S. documented that commonly used risk assessments of atherosclerotic cardiovascular disease (ASCVD) overestimated the risk by 37 to 154% in men and from 8 to 67% in women. That translates into a huge amount of people getting treatment they did not need.

Big data are the results of combining lots of smaller bits of information. How big data are gathered and how they are merged can become a problem. This is made worse if at the point of care risk scores replace talking to the patient or the ever elusive listening to what the patient says. The promise of health care providers to “Do no harm” can be compromised by the overreliance on tools that are meant to add to the clinical conversation and not dominate them.

Jane L Delgado, PhD, MS,
President and CEO
National Alliance for Hispanic Health
Washington, DC

[1] Andrew P. DeFilippis, MD, MSc*; Rebekah Young, PhD*; Christopher J. Carrubba, MD; John W. McEvoy, MB, BCh, BAO; Matthew J. Budoff, MD; Roger S. Blumenthal, MD; Richard A. Kronmal, PhD; Robyn L. McClelland, PhD; Khurram Nasir, MD, MPH; and Michael J. Blaha, MD, MPH. An Analysis of Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort. Ann Intern Med. 2015;162(4):266-275. doi:10.7326/M14-1281

Tuesday, December 30, 2014

Fruits and Vegetables Should be Desirable and Affordable

Today the Alliance released the 2014 Healthy Americas Survey, a bilingual phone survey with a nationally representative sample of 846 respondents fielded from February 16th to March 2nd of this year. The Downloadable version of the 2014 Healthy Americas Survey is available at the Alliance’sHealthy Americas Institute website at

The findings show that access to care is part of the solution for achieving the best health outcomes for all. While there are obvious steps people can take which are critical, e.g., drinking less soda and sugary drinks and eating more fruits and vegetables, these options are not as simple as they may appear.

There is a huge amount of creative talent and dollars that are spent on getting people to buy sugary drinks. It would be wonderful if we could spend as much on advertising for fruits and vegetable and other healthy options as is spent on options that are not as healthy.  While PSAs are helpful they are few and far between and often play in the off-hours to fill in the time when no one wants to buy advertising time. Moreover, fresh fruits and vegetables are often financially out of reach for families with modest means.

We need to make it desirable and easier for everyone to eat in a healthier way.  

Tuesday, December 23, 2014

It’s Not About the Base— It’s About Quality

Quality health outcomes are not just about the denominator, big data, or public health data; it is about the individual. The allure of numbers is strong because numbers can be analyzed and the implication is that the data are objective. Nevertheless, our quest for precise data and measurements is often futile as too many times visually intoxicating three-dimensional charts tell us nothing about what is happening at the point of care.

Our measurement system must be radically different from what it is today. We should stop using the medical, economic, or business derived terms of “patient” or “consumer”  and focus on the person or individual. For the first time, technology and individual use of powerful computing devices (smartphones) give us the capacity to move beyond groups to individual focus.  

At the very least quality health measures should be publicly reported and include more mortality and morbidity outcomes. Additionally measures must be sufficiently nimble to:

  1. Rapidly reflect new science.  
  2. Rapidly include new technologies.
  3. At a minimum be analyzed by race, ethnicity, and gender.
  4. Encourage care that is tailored to the individual.
  5. Avoid the tyranny of big data when caring for the individual.
  6. Address that quality is defined in different ways by each person. 
Our future care depends on having measures that matter to each one of us.

Thursday, June 19, 2014

The Naming of Biosimilars

At the cutting edge of all our progress in personalized medicine is the development of  biologics. These are medicines that are manufactured or extracted from biological rather than chemical sources. Biologic is used to describe the structure in the original or innovator medicine that was developed and biosimilar is used to describe the medicines that are developed that are similar to the original biologic.

Biologics and biosimilars hold great promise for the next generation of personalized medicine but only if we are able to track their effect on individuals. These are powerful new medicines. Consumers should know what they are getting and healthcare providers should be able to track the effects of what their patients get. While it is good to have these new medicines it is essential to be able to track them once they are given to patients.

To make this point we sent a letter to the FDA Commissioner today that was signed by over twenty-one partner organizations reaffirming the importance of giving each product a unique name . The value of what we know about the impact of these products would be substantially diminished if we are unable to track the products once they are approved. 

It is good science, good practice, and common sense that each product should have s prefix or suffix added to its name so it can be tracked. All that is needed is a distinguishable name. That should be an easy call for the FDA to make and one that responsible companies should applaud.