EPtalk by Dr. Jayne 3/21/24

I’ve seen several recent mentions of Vale Health, which promises to be a “national health marketplace that serves communities through trusted health system relationships and leading health and wellness solutions.” That’s certainly a mouthful.

The company was founded by former Froedtert Health executive Mike Anderes and is designed to be a consumer-facing platform. The company lists 15 founding health system members who have membership on platform advisory boards that “set guidelines for choosing quality solutions, ensure careful treatment of consumer privacy, guide our product development priorities, and create the optimal engagement experience for people they serve.”

The majority of the company’s website is still under development, with only “better sleep” having listed products. Optimal weight, healthy pregnancy, healthy skin, mental wellness, and digestive health are all listed as coming soon.

Under the sleep products page, the site promotes a phone app, smartwatch, cooling sleep blanket, and melatonin tablets. Selecting “learn more” about the products linked me out to the app’s website and Amazon for the rest of the items. The site promises to “curate the highest quality, most respected products and services to address the health needs and wellness goals of the tens of millions engaging with their providers each year.”

Given the fact that the site promotes specific branded products with sales links that clearly indicate that the company may earn a commission, this just feels icky. It reminds me of when the American Medical Association entered into an ill-fated relationship with home appliance maker Sunbeam for product promotion.

As a clinician, I’d love to see the guidelines created by the advisory boards. What led them to choose a Fitbit product as opposed to one from Garmin? What about using Nature Made melatonin versus other brands, not to mention that the use of melatonin for sleep is controversial when you read the medical literature – it’s recommended in very specific situations, which of course aren’t mentioned on the site.

If you dig deep into one of the linked pages, it says that products are chosen using product review websites, information from manufacturers, user opinion, and online research into safety certifications, etc. They “do not conduct physical assessments of the products” and apparently they also don’t post information about the relevance of the products to the current standard of care for any diagnosed condition.

I spoke to someone in the know at one of the partner organizations. They voiced concerns that it feels like the company is “the Goop of healthcare” and I don’t disagree. I’m always suspicious when organizations promote the nebulous “wellness” concept and talk about the vague “health” of a body system, which is a pretty key indicator that nothing that’s about to be presented is FDA-approved or proven in high-quality, peer-reviewed literature. It’s not surprising that when you look at the company’s board of directors, there are venture capitalists. Just one more thing that makes this feel like a money grab rather than anything else.

Speaking of money grabs, the White House is launching new efforts to address healthcare costs. A task force is being formed and will include representatives from the Justice Department, the Federal Trade Commission, and the Department of Health and Human Services. Drug and provider costs will be at the top of the list of items to address.

I’ll be interested to follow the formation of this task force and would love to see the inclusion of other types of representatives. Let’s add some patient advocates, some “average” primary care physicians struggling to keep their doors open, and while we’re at it, let’s also include real-life patients who are fighting the system daily and struggling to pay their bills. I’ve long said there’s more than enough money spent on healthcare in the US that every one of us should have high quality care at a reasonable cost. Unfortunately, a good chunk of it goes to profits and also to fraud, waste, and abuse. This is why we can’t have nice things.

The best medical article I read this week was one in JAMA Network Open that looked at the effects of tai chi versus aerobic exercise on the systolic blood pressure readings of prehypertensive patients. It summarizes a randomized clinical trial that was performed in China. Although the study was small at 342 participants, it showed that blood pressure reductions at the 12-month point were greater in the tai chi group than with group that performed aerobic exercise. A little more than half of the study participants were women, and the mean age was 49.3 years in a range of 18 to 65. The participants had to either be untreated (no western or traditional Chinese medicine treatments) or to have been off of treatment for at least two weeks. Patients were excluded if they had diabetes, coronary artery disease, chronic kidney disease, current pregnancy, or breastfeeding.

Each intervention included supervised sessions, both in person and via video, that were conducted four times per week. They involved a 10-minute warmup, 40 minutes of core training, and a 10-minute cooldown. The tai chi component included 24 standard movements of Yang-style tai chi, where the aerobic component included stair climbing, jogging, brisk walking, and cycling. The sessions were conducted between July 2019 and January 2022, which is interesting given the span across the start of the COVID-19 pandemic. Blood pressures were measured at baseline, six months, and 12 months. Researchers also looked at lipid profile, fasting glucose, kidney function, weight, body mass index, and adverse events occurring during the study, although there were no differences in the parameters between those two groups. More than 82% of participants completed the study.

I’ve been working to keep myself out of the hypertension range since having episodes of mind-blowingly high blood pressures during the COVID pandemic. It turns out that when I’m exposed to the stress of a busy emergency department or urgent care, I’ll hang out with a systolic blood pressure in the 180s. If I’m at my primary care office or any other healthcare facility, 150 isn’t unheard of. I’ve come to accept that as part of the traumatic anxiety of caring for thousands of COVID patients. At home, I’m occasionally in the prehypertension range, but that has become better in the last couple of years as I avoid salt and exercise more. I’ve never tried tai chi given the limited options where I live, but maybe I’ll have to find some online resources and see if that brings it down any further.

What’s your ideal exercise? Do you like trail running, beach walking, swimming, or something more exotic? Leave a comment or email me.

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