Author Archives: bsekula

Warren Buffett is a jackass!

Everyone loves him.

I think he is a jackass. Actually, I think he’s a Grade A Jackass.

I don’t begrudge people being successful or making money. The point of this post is not to denigrate him for his success. I think he is a jackass. I think he knows it and I think his “Aww shucks” persona is part of it.

Here’s why

Our healthcare system is a mess. If you think it’s a problem now, wait 10 years and see how bad it is then. Our “kick the can” approach will result in costs that are exponentially worse.

Let me explain this from the perspective of type 2 diabetes.

According to this report, the global pharmaceutical demand for type 2 diabetes will more than double in less than 10 years – from $27B to $64B.

Note, this is ONLY the pharmaceutical demand – no other direct or indirect costs.

It’s only going to get worse. This report states that type 2 diabetes is already the most expensive condition to have and treat. Can you imagine what 10 years will do to the cost?

In my talk on why all organizations need to implement a type 2 diabetes strategy, this is one of the first slides – an image of a tidal wave. It’s appropriate and disturbing.

There are two important reasons the type 2 diabetic tidal wave is coming:

Our approach to treatment
Our living environment

When it comes to treatment, the standard approach for a type 2 diabetes is to prescribe medication to control blood sugar. This isn’t treatment. It’s population health management – prescribe medication, ensure they are taking it and maintaining blood glucose control within recommended ranges. Since this is not addressing the problem, diabetics stay diabetic.

The second issue is our living environment. To illustrate, let’s put every US adult into one of two groups. In Group 1, we put all of those with type 2 diabetes, pre-diabetes or at risk and in Group 2, we put everyone else. There will be more people in Group 1 than Group 2, which means more than 50% of the population either has or is at risk for type 2 diabetes. It also means that it is literally easier to be unhealthy than healthy.

This is asinine.

We have a system (our living environment) that facilitates unhealthy behavior and another one (treatment) that, quite literally, does nothing to help or fix people once they become sick.

Sidebar : 15 years ago, and regardless of where you live, you likely had to go out of your way to drive by or see a dialysis clinic. Now, they are nearly as prevalent as Starbucks.

So what does this have to do with Warren Buffett and why do I think he’s evil?

He’s a major player in this system, from soup to nuts.

Among all of Berkshire Hathaway’s holdings, you will find the following:

This is $49.4 B in holdings.

From every aspect of type 2 diabetes, Berkshire Hathaway is heavily invested. From the environment that facilitates us getting sick to the population health management approach, Berkshire Hathaway is profiting at each and every stop along the way.

This is why I think he’s a jackass!

He knows the difference and I think his statements on these types of things are intentional. He doesn’t want to answer tough questions, so he comes off as “Aww shucks.” When pressed, he calls the associations “spurious,” which is wrong. He plays dumb or says things demonstrably not true.

He owns $18 Billion in Coca-Cola and millions more in fast food, beverage and snack foods
He owns a big chunk of Sanofi SA, the makers of Lantus, which holds spot #10 on this list of the 20 largest revenue producing drugs in the world
He has a $2.1 Billion stake in DaVita, the second largest dialysis provider in the world (behind Fresenius). Lantus does nothing to improve your condition, so people get sicker, eventually needing dialysis.

It’s a dubious circle of profiteering and his fingers are all over it.

He’s not here to help people. He’s here to make money. And he’s doing it off the backs of sick people. The same people he had a hand in helping get sick, he’s profiting from a mechanism that doesn’t treat them.

Is he a nice guy? Don’t know. Never met him.

But you don’t become what he has become by being lucky, harmless and innocent. You have to be smart and he understands, which is why he says things demonstrably false and/or plays dumb.

And before you jump on this “People are just making bad choices” soapbox, understand this. Yes, people are making bad choices, but there is more going on. We have more than 50% of adults in Group 1. If it were 15 or 20%, I’m be more inclined to listen. When it’s over half the population, it’s not just bad choices.

So what do I think Warren Buffett should do?

I don’t care what he does; I’m here to make a point: You should view him differently, with his fingers all over this mess.

If I could give him some advice, this would be it:

I would tell him to exert as much influence on the American Medical Association as he possibly could. The objective would be to fundamentally disrupt how we “treat” type 2 diabetes. This would require us to shift from the management approach to something that fixes the problem. In this case, it would be a significant focus on improving insulin resistance.

The second thing I would tell him to do is exert major influence on the recommendations from our government regarding food consumption. There needs to be less of an influence on calories and a larger influence on the quality of food eaten. It’s not that calories don’t matter but they have become more important than the quality of food. Anyone that tells you 100 calories from Coke is the same as 100 calories from broccoli is part of the problem (Buffett has made this exact comparison).

These two things would go a LONG way to stemming the tide. People would get sick, get treated and leave the system. No more kicking the can down the road! This would also be detrimental to his holdings. So I’m guessing he won’t do them.

Finally…

One has to wonder: How many type 2 diabetics unknowingly worship the ground he walks on because of his advice or their 401k.

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Why and How to Implement a Sleep Strategy in your Organization

The scientific literature has well-established the association between a lack of sleep and health-related issues. Basically, sleep deprivation is associated with every chronic condition on the planet. While the scientific community has known about this for some time, it is starting to receive some much-needed media attention.

The alarm clock is ringing. Have your employees slept enough?

Between people with a platform (Dr. Oz, Ariana Huffington, etc… – regardless of what you think of them), gadgets that track sleep quality, and sleep aids – supplements, sounds, etc…, it is rare that a few days pass without a news story talking about sleep and its impact on health. This is good news because it certainly wasn’t that way five years ago.

Saying all of this, I think it is imperative that companies start addressing sleep with their employees, because things that are detrimental to employees are ultimately detrimental to the company. While federal and state regulations address issues within segments of the working population (drivers and pilots, for example), this is a small percentage of the working population. Data from the American Trucking Association show there are just under 7 million adults with a CDL. And for the record, I’m not advocating regulations on workers. I’m advocating a greater corporate focus.

I’m advocating this because research suggests it should be addressed. And since most of us spend the majority of our waking hours at work, the corporate world is an excellent avenue.

This article is in two main parts: 1) A discussion of the reasons why your company should implement a sleep strategy; and, 2) An outline of a strategy that you can use.

“After all, the light is seductive. The longer we stay awake, the more we learn. That’s why Americans are the brightest as well as the sickest people in the world.”
Wiley and Fomby, Lights out, Sleep, Sugar and Survival, pg 105.

Why you should implement a sleep strategy

We will start with some statistics, courtesy of the Institute of Medicine.

Sleep deprivation costs the average company $50 per month, per employee. In 2006, the total direct and indirect costs were $130B. When you correct for the number of working adults and then correct for 12 months in a year, this is the figure you get. Think about that figure for a minute and then consider it was published in 2006. A decade later, it’s probably higher.

Further, data from the MMWR indicate:

46% of adults suffer from sleep-deprivation at any given time
38% of adults reported they had unintentionally fallen asleep at least once within the previous two weeks
6% of adults reported they have accidentally fallen asleep while driving at least once during the previous two weeks

Is it any wonder why rush hour traffic is such a nightmare? Between these statistics and the volume of people getting on the roadways at the same time, it might be surprising there aren’t more accidents!

A negative impact on health

The research is clear and consistent. I’m not going to go through and list all of the chronic conditions, diseases and/or disorders associated with a lack of sleep. The list is too long.

But I can illustrate it for you. Take all of your employees and put them into one of three groups: low, medium or high healthcare costs – the costs to your company. Track them over time – three to five years should be sufficient. You will see two things: 1) The risk for chronic conditions increases across categories; and, 2) The association between sleep and these categories becomes stronger. This means that sleep becomes more important as health conditions get worse.

Now the question may be: Is this a chicken or egg thing – the “correlation is not causation” line of thinking. While unearthing the cause of this association is important from a research and scientific perspective, it shouldn’t matter to you – at least not in this case. The association between sleep and health is strong. And whether a lack of sleep causes worsening health or vice-versa, improving sleep in your employees will improve their health and have a positive impact on your company.

In our experience, the overwhelming majority of sleep quality issues arise because people have bad sleep habits. Addressing these habits within your employee population will result in happier and healthier employees. This will also allow you to identify and help those needing medical attention for a sleep disorder – obstructive sleep apnea, for example.

In summary, why you should implement a sleep strategy within your organization is as simple as basic math. Multiply the number of employees you have by $50 then multiply that by 12. This will give you an estimate of the financial impact sleep is having on your company. Is that a significant dollar figure? Probably so!

How to implement your Strategy

It starts at the top.

There needs to be a strategy and consistent message from the executive suite, through all departments all the way down to employees farthest from the CEO. This is important for every organization, from the mom and pop shop to those with thousands of employees.

Identifying your strategy

The message to your employees must be effective, so it needs to have at least two qualities: 1) It must work; and, 2) It must be something they are willing to do (translation – easy to implement). On the surface this probably makes sense and may even sound easy but don’t let that fool you. If both of these aren’t met, you are wasting your time.

Regarding the first, and including the corporate strategy, there needs to be clear understanding that “burning the candle at both ends” is not expected of your employees – even your best employees. Occasionally, when under a deadline this is acceptable but it cannot be the norm. Your strategy also needs to address this and the bad habits referred to above with clear and easily understood action items.

Anecdotally, I feel there are more and more references to employers offering “nap time” as a benefit. This is a bad idea from a scientific perspective. A frequent need for naps indicates a chronic lack of sleep. Providing “nap time” as a benefit only encourages bad behavior.

Regarding bad habits, most are unaware of the process our body goes through in preparing to sleep. As the sun sets and we transition to night (light to dark), our body prepares us to fall asleep. The problem is, most of us do things that interrupt this process – keeping it from working like it should. This starts a night of what should be restorative sleep behind the curve – always trying to catch up, then the alarm goes off. Whatever strategy you select, it must address this issue and educate your employees on what they should be doing.

Finally, and importantly, your strategy must address these issues so your employees can easily follow the recommendations. If it is too hard to use or understand, no one will use it, which wastes the time you’ve invested.

Communicating Your Strategy

Whatever works best for your organization should be the strategy you use, but it must be clear this comes from the top. Not all employees know the CFO but all employees know the CEO. The message should come from him or her.

From there, it is about consistency. You can’t just say it once and hope things change. You need to figure out the frequency and different modes to get the message to your employees. Email should be part of the strategy. Your newsletter should be part of it too. Get creative – print posters and place them throughout the office – near the elevator or stairs, in the hallways, in the breakroom, etc.

In an ideal situation, you can determine a way to give scores, create groups and then have competitions. You can even display the group scores, so everyone knows where their group stands. It’s human nature to want to win and this will increase engagement.

A final part of your communication strategy, especially if you are able to create a competition, is to check in with your employees frequently. Get their feedback. Ask them if it works or if they like it. If the reviews are negative, make changes. This shows you take their feedback seriously, which will also increase engagement.

In the end, well-rested employees are happy and healthy employees. This may be difficult to measure but easy to feel as you walk around.

All of this can be achieved and should be something you strive to do.

Get a copy of our Sleep Tips

On a final note, sleep is one of the main topics in The Academy. You can have our Sleep Tips sheet. It is high-res and pdf, so you can print large copies for placement around your workplace. It addresses five of the most frequent bad habits we have seen in our years of implementing The Academy.

To get your copy, fill out the form below and we’ll send it to you immediately.

Type 2 Diabetes is killing your company

And you may or may not know it!

Quick Summary
There is bad news	The incidence, prevalence and costs for type 2 diabetes are probably worse than we know.
There is good news	As an organization, it is important for you to know there are options that will have a positive impact on the incidence, prevalence and costs of type 2 diabetes.

Type 2 diabetes is a problem on many levels. The employer level is one, particularly if you provide health insurance to your employees.

I will be focusing on the employer burden in this article in an effort to explain why type 2 diabetes is such a problem.

Descriptive statistics on type 2 diabetes

Before getting into the data, I need to define a few terms you may or may not be familiar with:

Type 2 Diabetic: A person diagnosed with type 2 diabetes. The normal cutoff for diagnosis is a fasting blood sugar greater than 126 mg/dL.
Pre-diabetic: A person with higher than normal fasting blood sugar but not high enough to be diagnosed as type 2 diabetic. A normal fasting blood sugar level is below 100 mg/dL. A pre-diabetic is someone with a blood sugar (at the time of testing and/or diagnosis) greater than 100 mg/dL but less than 126 mg/dL.
Undiagnosed: This is someone that should be counted in one of the two categories above. They aren’t counted, however, because they haven’t been officially diagnosed by a medical professional.

Data from the CDC and other health-related government agencies indicate that about 29.1 million Americans are either diagnosed or undiagnosed type 2 diabetics. Additionally, there are about 86 million Americans in the pre-diabetic category, which means a total of 115.1 million Americans have some form of type 2 diabetes.

What about costs?

The same report states the total direct and indirect costs for type 2 diabetes was $245B in 2012 or about $2,200 per person (for the 115.1 million with some form of type 2 diabetes). Of this total, direct costs were $176 billion and indirect costs accounted for the rest.

In terms of where costs are going, they will increase (they always do, so it is a big limb I’m going out on). The cost of doing business never goes down. So the cost to treat a type 2 diabetic (or a person with any condition) will never be cheaper than it is today.

More specifically, the costs associated with type 2 diabetes are high because the condition has a negative impact on virtually every system in the body. This negative impact significantly increases risk for nearly every other chronic disease and/or condition. For example, those with type 2 diabetes have a 60% greater risk of dementia than those without diabetes. Additionally, epidemiological studies indicate type 2 diabetics have approximately twice the risk of developing liver or pancreatic cancer than non-diabetics. The “For example” list could go on almost without end and I haven’t mentioned a whole host of comorbidities, such as neuropathy, nephropathy, vision problems and more.

For many reasons, the cost of care for a type 2 diabetic is high.

And it’s probably actually worse!

There is a progression of tests an individual goes through before being diagnosed as a type 2 diabetic. This progression doesn’t get started until he/she consistently has a blood sugar reading of greater than 100 mg/dL. This is a problem on at least two levels.

First, not everyone at risk will have their blood sugar tested. Further, if they get their blood sugar tested (as is often the case for an employer’s incentivized “wellness” program) the typical response to those with elevated blood sugar is to refer them to their physician. Follow up is generally left to the discretion of the individual, unless there is sever hyperglycemia.

Second, a simple finger stick to measure blood sugar lacks sensitivity and specificity to make an accurate judgment based on the results (false positives and false negatives). This, incidentally, may play a role in why follow up isn’t pursued vigorously.

A recent report in the Journal of the American Medical Association (JAMA) sheds light on why the problem of type 2 diabetes is likely worse than what we think (or know). By including a more appropriate test and using the same datasets, the authors concluded that 52.4% of the population has some form of diabetes.

This table summarizes the differences in the two reports.

The CDC vs JAMA reports
	CDC	JAMA
Total Diabetes (millions)	115.1	129.3
Pre-diabetics (millions)	86.0	110.8
Total Costs	$245.0B	$284.5B
5-year projected costs	$343.0B	$398.3B

Note how the data from the JAMA report are much higher across the board when compared to the CDC report. This is significant and as noted earlier, the authors of the JAMA report used the same dataset. However, they included HbA1c as a criterion, where the CDC report did not. The publication of the JAMA report lead us to write a Call to Action last year.

Just a $40 billion difference!

From the CDC report, the cost per person with diabetes was approximately $2,200 per year. If we apply that to the JAMA report, the true cost is closer to $284.5 billion – just a $40 billion difference!

Plus the cost increase in the 5-year assessment period for the CDC data was 40%. If we apply this to the JAMA report, projected costs are nearly $400 billion. In just a few short years, we will be spending nearly a half trillion on type 2 diabetes alone.

From the abstract of the JAMA article:

The incidence of type 2 diabetes …increased significantly in every age group, in both sexes, in every racial/ethnic group, by all education levels, and in all poverty income ratio tertiles.

These across the board increases are sobering. They mean, essentially, that more than 1 in 2 adults (52.4%) over the age of 20 have some form of type 2 diabetes.

Kicking the can down the road

As bad as these numbers sound, the reality will likely be worse. One reason is our current approach to treatment, which is symptom-based. Type 2 diabetes is a problem with insulin resistance. Elevated blood sugar is a symptom of insulin resistance, yet the current treatment approach is targeted at elevated blood sugar. In spite of mounting evidence that we can improve insulin sensitivity, the current symptom-centric approach guarantees two things:

From a population perspective, the state of insulin sensitivity will not improve. In fact, insulin sensitivity will likely worsen.
For those with pre-diabetes, 25% will be full-blown type 2 diabetic within 5 years.

Given these two guarantees, coupled with the sobering statistics from the JAMA report, it is easy to conclude this will likely be worse than the projections.

So what about costs at your company?

I don’t need to state the obvious because you know healthcare costs are rising and a concern. This is the question that needs to be asked:

What effective and measurable strategies can employers deploy?

There are many programs and solutions offered by carriers, vendors, and benefits consultants in the marketplace. The problem is that most have little to no significant impact on your total spend. Additionally, most lack the ability to effectively measure results. Whether you use specific “wellness” programs, technology, gadgets, etc… or not, if you do nothing to change incidence and prevalence of type 2 diabetes in your workforce, the impact of cost control will be small.

So what if you have 1,000 employees?

Of your workforce, more than 500 will have some form of type 2 diabetes. The diagnosed and undiagnosed will account for almost 200 of these and the rest will be pre-diabetics (If you are thinking that the annual Health Risk Appraisal showed that you were well below these estimates, great. But you might want to reconsider. It’s likely that fasting blood sugar was used instead of HbA1c and there are issues with that, as discussed above).

These 500 employees will cost you about $1.1 million in healthcare expenses alone ($2,200 cost to treat X 500 employees). That’s a lot of money, even for massive companies like Microsoft, Apple and Exxon.

Sure, you can do things to control costs of prescription medications – generics, mail order, recommendations from a PBM, etc… But these are the margin things – 1 or 2% of $1.1 million is ok but not enough.

You might also consider a customized wellness plan (or maybe have). This is the type of thing they are supposed to address. The problem is, they don’t.

Good News, Finally!

To stop diabetes from killing your company, you have to stop operating in the margins. This is the only way you can bend the curve because the small cost control measures have zero impact on the incidence and prevalence of type 2 diabetes.

How do you do that?

Find something that turns the whole thing upside down! And you have to look. The right program for you and/or your company is out there. But you likely won’t find what you need from your broker, insurance provider or program administrator, because most of what they offer does not address insulin sensitivity.

Talk with a trusted adviser – your HR consultant, financial analyst or business leader. Some brokers can be helpful, but they are the exception not the rule.

At the Health Performance Institute, we offer programs that help improve insulin sensitivity in their employees. If you have questions or would like to talk with us, fill out our online form or email me directly.

If the trend in your company for type 2 diabetes (or any chronic condition) is going up and not down, the time to act is now. Otherwise, you are guaranteed to face increasing healthcare costs in the future.

You have options to bend the curve and change the status quo. But you must act now to change the future of your company!

A special Thank You to the following

This article could not have been written without their help and critical feedback. They did this in spite of their busy schedules. So for that, I am very appreciative.

	Title	Company
Hang Bower Bio @ hrQ Phone: 713-999-9380 Email	VP & Managing Director	hrQ
Juliet Breeze, MD Phone: 281-201-0657 Email Find a location	President/CEO	Next Level Urgent Care
Brian Frank Phone: 713-490-4529 Email LinkedIn bio	Consultant, Employee Benefits	USI

Book review: Talk Like TED

You won’t find this book on my 2016 reading list. It popped up a little late for that. Sometimes you have to call an audible!

I give a lot of presentations. A lot. On average, nearly 10 presentations per week, which is nearly 500 per year. Attendance ranges from 20 on the low end to about 100 on the high end, with 40-50 pretty typical.

I have several concerns for each presentation; engaging attendees is at the top of the list. If I don’t engage them, they don’t remember anything. If they don’t remember anything, it’s like I was never there.

For better or worse, I have two concurrent/immediate criteria for measuring engagement:

Where are the questions coming from? The more questions I can get from those all the way in the back, the better. The way I see it, questions equal engagement. If the back of the room is engaged, the rest of the room is too!
Talking to me after the presentation. Questions are icing on the cake for me but not everyone will have or ask questions. Plus, some people have questions but don’t feel comfortable asking in front of a group. These same people, however, will come talk to me when I’m done. This the second way I evaluate engagement – kind of a post-talk interaction. If it takes more than 20 minutes to interact with everyone that has walked up, I consider it successful.

Two other ways I measure engagement include the following (these are more long-term): First, if someone in attendance asks if I can speak to his or group. That’s positive engagement. Second, I attend a lot of networking events and frequently (one or two times per month), I will meet someone that tells me they attended one of my presentations. When you speak to 200-400 people per week, it’s impossible to remember everyone. But if they remember me and my presentation, it’s a good indication they were engaged (not to mention pretty awesome!).

Striving to get Better

After saying all of this, I’m always looking for ways to improve. A few years ago I stumbled across Carmine Gallo. Then late last year, I started reading this book: Talk Like TED: The 9 Public Speaking Secrets of the World’s Top Minds.

I read it in two weeks!

I thought it might be helpful for others to hear my thoughts on the book and how my current presentations stack up to his guidelines and recommendations.

In doing the research for this book, Carmine broke down hour after hour after painstaking hour of more than 500 TED talks. He interviewed many of the speakers and others that have given popular TED talks. In the end, he learned there were “9 secrets” of giving a great TED Talk, which, when applied correctly, can make any presentation a great presentation.

The 9 different secrets fell into three components of a great presentation: Emotional, Novel and Memorable.

Emotional – They touch the heart

Most of the time, people are nervous when giving a presentation and focus solely on the information.

Great communicators reach your head and touch your heart.

When nervous, we tend to focus on the information rather than what may draw our listeners in. There must be genuine passion about the topic because you can’t fake it. You communicate to your audience with more than just words – tone of voice and clarity, for example. A great way to connect with your audience is with a story because we connect with stories not information. Finally, you have to use the right body language – body movement, hand gestures, facial expressions, etc… – all of this communicates to the audience how comfortable and passionate you are about the topic.

In one way or another, your talk must make an emotional connection with the audience.

Novel – They teach something new

Novel means new. Your presentation doesn’t have to be “something new” to everyone or almost everyone in attendance. In fact, it can be a new solution to a problem that is old as dirt.

The brain cannot ignore novelty…

Can your delivery of “something new” give jaw-dropping results? If so, it’s a potential winner. Potential, because it can’t do this alone. A better mousetrap isn’t a better mousetrap if no one knows about it and/or buys it.

Memorable – They present content in ways I’ll never forget

If they forget what you said, did you even give them a presentation?

…if your audience cannot recall what you said, those ideas don’t matter.

If I had to guess, I would say this one is most important. The goal is to have them remember you and the takeaway. People aren’t going to “takeaway” something that doesn’t touch them emotionally or teach them something new. If it doesn’t do one of these two things, it’s just another ho-hum drive into work – a needle in a haystack of traffic on the highway.

So how did this book come about? Watch and listen to Carmine in this short clip. He discusses his approach and all the work he put into it. Impressive!

So if I had to grade my presentations…

This is like doing your own annual evaluations for work, but here we go…

Are they Emotional?

I think so. My talks center around health and health is very personal. I try to incorporate stories of past customers who have had success and how it impacted their lives in a positive manner. I think these are things people want to hear. The story could be something as simple as the advice we gave in response to a question.

To me, the story doesn’t have to be elaborate. It has to be effective.

Are they Novel?

Pretty much! Depending on the topic, we might ask the audience to rank-order the healthiest foods on a slide. They are always surprised by what we think. And then we back up our thoughts with real-life examples, research and information.

Are they Memorable?

Given what I said earlier, that people have met me at various functions and mentioned attending one of my presentations, I’d have to say yes.

I also mentioned this is probably the most important component of a presentation. It’s very rewarding when someone you don’t know tells you they attended one of your talks and thought it was great.

One piece of advice

If I had to give you one thing to remember about giving a presentation and the most important message in this book, it would be this: Flip the script! Boring and/or bad presentations focus on information. Flip the script. The focus of your talk should be the part that is memorable, the story or the emotional part. Then use the information to support it.

The Verdict!

I would recommend this book to anyone – from the seasoned presenter that wants to get better to the person just getting started. There is plenty here to help anyone improve.

From a personal perspective, I was glad to learn I’m not the only one that spends a lot of time preparing for a talk. From what was discussed, those with the most popular TED talks spent an enormous amout of time in prep work. They did this because they wanted to get the story just right. They wanted the audience to know they were passionate about their topic. This combination led them to be memorable.

To clarify, I know most of the information in my talks by now. It does change and get updated but it’s a small part of the whole presentation. So it is easy to do. Most of my prep work now is focused on the audience. Who am I presenting to? I learn as much about them as I can, so that it is easier to relate the information to them on a personal level.

I was also glad to learn that there is hope for me yet! Great presenters aren’t just born. They work at it. Am I a great presenter? Probably not. For sure, I’m not best suited to answer that question. I can say, however, that I’m always working to get better and tend to think I was terrible when just getting started!

I will leave you with the following:

Giving a presentation is easy.

Giving a presentation that incorporates all of these components and making it look easy is anything but easy.

About the HPI Diabetes Academy

The incidence and prevalence of type 2 diabetes continues to rise. With increases in cost of care and associated co-morbidities, people at all levels are concerned. Further, an article by Menke et al., published in the September 8, 2015 issue of JAMA, showed we may not be concerned enough. They note that more than 50% of adults have some form of type 2 diabetes, either diagnosed, un-diagnosed or pre-diabetic. If accurate, concern at all levels needs to increase. This prompted HPI to write a Call to Action.

Why we should be concerned

Beyond what may be obvious, there is one important reason everyone should be concerned: Our current approach to care does nothing to “treat” the condition. Type 2 diabetes is a problem with insulin sensitivity. Yet the primary modes of treatment are directed at controlling blood sugar, in spite of the evidence suggesting there are things we can do to increase insulin sensitivity.

Given that most people trust their health and medical professionals to provide them with the best care possible, a pharmaceutical-centric treatment approach will do little to change the trends. This, coupled with data suggesting more than half of US adults have some form of type 2 diabetes means we should be more concerned.

Costs always increase. The co-morbidities of type 2 diabetes, coupled with our approach to treatment, indicates we are in for an epidemic of kidney disorders, cancers, dementia, neurological disorders and more. For example, if progression from pre-diabetes to full-blown type 2 diabetes continues at its current pace, the 5-year cost estimates for type 2 diabetes alone are under predicted by $75B or 31%.

What HPI is doing to change this

At the Health Performance Institute, we have the HPI Diabetes Academy. The main objective of this program is to improve insulin sensitivity. It would seem logical that improving insulin sensitivity would lead to changes in the need for pharmaceutical therapies. We have seen this. In our smaller pilot programs, for example, there has been an approximate 50% reduction in insulin requirement across the board, with outcomes verified by self-report of insulin usage and confirmed with post-program HbA1c testing.

Health is very personal. While our pilot programs were relatively small and we don’t know if the outcomes will last, the results are real at the individual level.

If these outcomes prove generalizable, the impact of a program like the HPI Diabetes Academy can be enormous! Our current objective is to expand and continue to validate our outcomes to determine generalizability.

2016 Reading List

Each year I make a list of the books I want to read or reread. I have typically kept this in my notebook or email system – somewhere handy. This year, I’m posting it here on the blog.

This is my personal reading list, aka reading list part 1 on the Health Performance Institute blog.

Books to read in 2016

Bad Science by Ben Goldacre

How can you NOT be intrigued by the subtitle alone? I read a lot of research. A lot. And while it can be frustrating to find well-done studies, it is nice to know someone is calling them out.

I first learned of Ben Goldacre through a TEDx talk. This one will give you an idea of what this book is all about.

I’ve read many of his articles, have seen several presentations and have scanned through this book – I’ve had it for four years! So I’m looking forward to reading this book in its entirety.

The Checklist Manifesto by Atul Gawande

Why do I want to read this book? From the inside cover:

The modern world has given us stupendous know-how. Yet avoidable failures continue to plague us… And the reason is simple: the volume and complexity of knowledge today has exceeded our ability as individuals to properly deliver it to people. We train longer, specialize more, use ever advancing technologies and still we fail.

Doing things where failure is not an option, a simple checklist can make all the difference.

Margin by Richard Swenson

Are you busy? Good! Make time to read this book. You can make time by increasing your margin – the space between you and your limits.

Influence by Robert Cialdini

Why and how do people make the decisions they make? How do they justify those decisions? Can any of this be used in our personal or professional lives?

The answer to the last question is yes!

As someone who leads a group, whether it be the team at work, your family or like-minded individuals, knowing the information in this book will help you lead or take them where you want them to go.

Secret Service by John Dijulius III

Customers are the life-line of any business. Happy customers can make a business thrive! One way to get happy customers is by delivering unforgettable customer service.

This is the first sentence from Chapter 4: What are We Really Selling?

The experience is remembered long after the price is forgotten.

What experience do you want people to remember?

Unlimited Power by Anthony Robbins

No fancy pictures or diagrams. Just 400+ pages of Tony Robbins awesomeness!

This will be my 3rd time through.

Meateater by Steven Rinella

The first chapter in the book:

This book has a hell of a lot going for it, simply because it’s a hunting story. That’s because hunting stories are the oldest and most wide-spread form of story on earth. The genre has been around so long, and has such dep roots, that it extends beyond humans. When two wolves meet up, they’ll often go through a routine of smelling each other’s breath. For a wolf to put his nose to another wolf’s mouth is to pose a question: “What happened while you were hunting?” To exhale is to answer: “You can still smell the blood.”

If that’s not enough to make you want to read the book, I’m not sure there is any help for you! 🙂

Good to Great by Jim Collins

This will be the second or third time to read this book. No explanation needed. Always makes any list of best business books of all time.

The Man Who Swam the Amazon by Martin Strel

Second time to read this book.

People that do things of super-human nature are fascinating. Swimming 3,274 miles on the world’s deadliest river in 66 days qualifies.

The Five Dysfunctions of a Team by Patrick Lencioni

Whether you know it or not, you are the leader of a team. The quicker you learn that, the better.

And if you are struggling or wondering why your team is going nowhere, then you need to identify why.