The Future of Health: What Should We Measure?​

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Rolling up your sleeve for a blood draw. What questions are clinicians trying to answer using our bodily fluids? Is the system perfect as it is or can we hope for something better—perhaps less invasive AND more accurate—in the future? If we want to measure and track our daily function at home, what types of tools will provide us with meaningful information? You’ll find some surprises in this episode—including insights into low tech with high value, plus a big, bold breakdown of the Theranos story.

James Maskell: 00:07 Hello and welcome back to the Big Bold Health Podcast, making health personal in a world of disease. Today, we are going to be talking about measuring health and diagnostics. And, I imagine, Jeff, that in a parallel to us right now, the Big Bold Health Podcast is actually hosted by Dr. Jeffrey Bland, and maybe Elizabeth Holmes as Big Bold Health people changing the world. You know, the Theranos story has been in the papers, has been sort of at top of mind for anyone who’s interested in the facilitation of health creation. And so, as we get into this conversation about diagnostics, I thought maybe we could start there. What was it about the Theranos story that was so compelling to so many people for so long?

Jeffrey Bland: 00:55 Yeah, I think, James, that this is a wonderful case history for where we are, where we’re going, and some of the opportunities that are before us. The aspect that measuring things in our blood can give us insight into the status of health of the individual, has been a longstanding principle within clinical chemistry and within medical diagnoses. And, it may not be well understood by most people that in the early days of medicine in the United States, the concept of taking your blood and analyzing stuff in it to see how you were doing was not usual and customary at all. In fact, the chemistries that we use to do those tests were not really that available.

Jeffrey Bland: 01:36 The first group in the world to actually do these routinely, were this group in Minnesota, way up out in the middle of nowhere, Rochester, Minnesota, the Mayo Brothers, who thought that these developing concepts of chemistry—which in the early part of the 20th century was still kind of a new concept of applying chemistry to biology—that the measurement of stuff in the blood, chemical stuff in the blood, could be very important in developing a prognostic understanding of the patient’s status of health or disease. And, that was really what kind of differentiated the Mayo Clinic from all other clinics in the United States, maybe even in the world at large. And, they gained a reputation, because they were isolated up there in the North lands of Minnesota, they could kind of do this, and they developed a reputation that people started coming to them, hearing about their reputation. And, it became more and more of a growing theme, in which later that kind of clicked over to become a standard of care which people said, “Well really, measuring some of these things in the blood is very important,” like blood sugar to get a definition of diabetes.

Jeffrey Bland: 02:41 Remember, the early diagnosis diabetes, prior to the 20th century, was tasting the urine.

James Maskell: 02:49 Really?

Jeffrey Bland: 02:50 Yes, tasting if it was sweet. Now that wasn’t a big attraction for most clinical chemists in those days.

James Maskell: 02:55 They’d outsource that to the nurses, surely.

Jeffrey Bland: 02:57 Exactly. So, the advent of chemistry really was a step up in terms of both the specifics and the precision, but also getting away from having to taste urine for sugar, sweetness.

Jeffrey Bland: 03:08 So, the bottom line is that this concept of measuring things, chemicals, became a very important diagnostic determinant that underlies most people’s general health screening. When they go in, they’ll have their blood taken, and a whole family of different—what are called analytes—will be measured.

Jeffrey Bland: 03:27 Now, with that as a concept then, people started saying, “Well, what else can we measure?” Because, it turns out that we have 35,000 genes in our book of life, but those genes code for more than a million different proteins, which are found in our cells, tissues, and our blood. Each one of those proteins may have some diagnostic characteristic that would be of interest if we knew about them. So, this is a rich field of discovery and investigation. So, all sorts of people, clinical chemists, immunologists, all sorts of different fields of discovery, have been trying to understand what these things are that float around in our blood, what they mean in terms of how our body is functioning in terms of health and disease.

Jeffrey Bland: 04:11 With that as a kind of a background, then, people have said, “Wouldn’t it be wonderful if you could develop a technology where by just taking a finger stick of blood, in that single drop—so microliters of volume; a very small amount—that you could analyze an infinite number…that’s an exaggeration, but a large number of different things, and you would know what they meant.”

Jeffrey Bland: 04:36 Well, if you could do that, if that technology were to be developed as a breakaway, new age technology, you can imagine it would both reduce the trauma of having your blood taken, because you don’t have to puncture the vein then and take a bigger volume of blood. Secondly, it would make it accessible to be done in all sorts of places, because you don’t need a trained phlebotomist of a blood taker to puncture the skin of your finger and take one drop of blood, so it’d make it much more accessible. Third, it would make it much more convenient if you could measure many things in that one spot of blood, and therefore the cost should come down significantly, making it more accessible to all sorts of different less advantaged individuals, so that they could better get diagnostic care. So, there are all sorts of extraordinary values that could come from that technology.

Jeffrey Bland: 05:28 And then, lo and behold, this brilliant wunderkind of an individual, dropout from Stanford, Elizabeth Holmes, who has a personality second to none in terms of personal self-affirmation, decides that this technology can and will be developed under her reign, her rule, her watch, and that it will be a fingerstick technology. It’ll be accessible to everybody, it’ll be inexpensive, it will measure everything in one spot of blood, it will be done quickly, and in fact, we’ll produce a machine that can go in every home. It’ll be so inexpensive that everybody can become a diagnostician and follow serially their health throughout their life and become their own personal master of their health.

Jeffrey Bland: 06:09 Wow. This sounds like a company I’d want to invest in, right? And lo and behold, a lot of people did, raising not an inconsiderable hundreds of millions of dollars of investment capital.

Jeffrey Bland: 06:21 Now, what happened? Well, what happened is, we have to be very cautious sometimes between our aspirations, our dreams, and then the application of that in reality, and in delivery and execution. The challenge that you have when you’re trying to measure from any single bit of blood in one instrument all these different things that you want to measure, is that you have four different kinds of things you want to measure. And, just from a clinical chemistry point of view, let me just tell you what they are.

Jeffrey Bland: 06:50 You want to measure simple salts like potassium, magnesium, sodium, iron, so these inorganic elements. There’s something related to all of those, like iron with anemia, sodium and potassium relative to your kidney functions, so these are important to measure.

Jeffrey Bland: 07:06 Then you want to measure what are called organic chemicals, things like glucose, or things like uric acid, or things like urea, things that we know are associated with organ function—these chemicals of which there are literally thousands of different chemicals.

Jeffrey Bland: 07:26 Then there’s the third category, which are proteins, right? And think of all the kinds of proteins we have. These proteins are enzymes that regulate metabolic function. So, if you were to measure liver function, you might want to measure enzymes that are unique to the liver that if the liver is damaged, it would be released into the blood, and you’d measure as analytes like AST and… well, various enzymes that are liver specific.

Jeffrey Bland: 07:51 Then the fourth category are infectious organisms. You’d like to measure things like viruses or bacteria. Now, if you examine the technologies that are required to measure each of those different four categories, they’re very different technologies. They have different conditions upon which they’re measured, different pHs, different temperatures, different all sorts of things. So, to put them all in one test and to do it on one drop of blood? That’s no small challenge, maybe not impossible, but it’s extraordinarily challenging.

Jeffrey Bland: 08:22 So with that then, what happened with the Theranos example is that this is really an example of over-promising and under-delivering. And, would it have been able to have been delivered in time? I think the answer is potentially yes, over time. But, the difficulty is that the compression of the commercial world to try to make a commercial product, and try to make it profitable, and try to return an investment to venture capitalists and other investors that felt that this was going to be a quick return to success, really put undue pressure on the company that should have been in a research mode for some longer period of time. And, they should have also qualified that they’re not going to be able to run every test on a few microliters of blood. If they would have then been able to qualify properly their results, it could have been a sustaining growth company, I believe. But, it exaggerated the opportunity and produced then its own death knell through its own activities.

Jeffrey Bland: 09:22 Now, the problem for all of us in this field is that there is a spreading effect when you have something that’s that prominent and that investment-worthy that disillusions so many shareholders, and gets the government involved, and major distribution systems like Walgreens that become disillusioned, and Safeway, that you then start to have a color about all other technologies, and people get very disillusioned. And they say, “I’ve heard that before, and I’m not going to be interested.” I think that’s a shame, because there are extraordinarily robust new technologies that are developing all the time that will help move us towards that goal, to make the testing much more inexpensive and readily available.

Jeffrey Bland: 10:05 Let me give you an example to show you the good side of the curve. The good side of the curve would be genetic testing. When I first got involved in the concept of deciphering the genome as a practical assessment tool or technology… You probably know the first human genomes that were deciphered, that led to the rose garden discovery with President Clinton at that point, saying that we’ve now deciphered the book of life. It was about $3,000,000,000 to decipher the first genome. Well, that’s not very commercially practical.

Jeffrey Bland: 10:42 Over time however, with the so-called Moore’s Law—which is found in computing—that you have an exponential increase in the power of technology over time. What we’ve seen that Moore’s Law can be applied to the genome testing, and so the cost per analysis has gone from a billion, to a million, to a hundred thousand, to ten thousand, to where now I’ve had my full genome deciphered, which includes both the coding and noncoding region. Meaning the dark matter of my genome, has been analyzed for under a $1000, and it’s going to come down, presumably, to be around $100 to get your genome deciphered.

Jeffrey Bland: 11:20 Now how is that being done? Well, the development of technologies that we never had the knowledge would even come about, with young, new minds that are evolving new ways of looking at how to decipher the human code, based upon methodologies that were not available even five years ago. So, that’s a very exciting example of what can happen if we have the patience and the stick-to-it-ness to allow these technologies to be developed and to have the proper proof of concept.

Jeffrey Bland: 11:47 So, will we get to the point in the lifetime of people living today where we can have a very robust, simple way of using blood spot analysis for determining all sorts of analytes? I think the answer is yes. Will it be everything that Theranos talked about? Probably not. It probably won’t analyze everything in the world from a single drop of blood, but we will be seeing, and are seeing already, technologies that allow us to interrogate not just the presence of disease, but the presence of health and function, which helps us to measure not our disease characteristics but our health span. Our health span, that’s where we’re going.

James Maskell: 12:26 Yeah, one of the things that sort of I think stopped the architecture of health creation from occurring is just the fact that there’s not as many numbers, right? There’s not as much quantification of these kind of things, and ultimately, I think quantification is something we’ve spoken about with the continuous glucose monitoring and that kind of thing. What do you feel is the quantification of health that is going to be necessary for this to stand by itself and say, “Hey, this is a legitimate way of understanding health?”

Jeffrey Bland: 13:01 Oh boy. That is a really fantastic question. You’ve been thinking about this, I can tell.

James Maskell: 13:06 I have.

Jeffrey Bland: 13:07 That’s really insightful. So, the way that we have used the diagnostic tool of measuring stuff in the blood, or in tissues of the body, or in saliva, or in urine is to look at the presence of things in those biological samples that are indicative of a damaged organ, I mean a disease. So, these become indicators of disease.

Jeffrey Bland: 13:27 The first analyte, the first substance, that was measured in the blood, that was generally accepted in medicine, that didn’t analyze the damage of an organ, i.e. a disease… Let me ask you, do you know what it is?

James Maskell: 13:40 Glucose?

Jeffrey Bland: 13:41 No, because glucose measures diabetes, right? So, I’ll help you, it is cholesterol. Think of cholesterol—Is there a single disease that is diagnosed by seeing elevated cholesterol in your blood? The answer to that is no. Cholesterol was the first substance that general medicine accepted as being important to evaluate that has nothing to do with the diagnosis of disease, it has to do with the prognosis of potential disease.

Jeffrey Bland: 14:10 Let me set that in for a moment. This is a very important demarcation in the way that we use this kind of testing. In the past, testing was always used to evaluate the presence of a disease. With the addition of cholesterol to a standard blood test, now suddenly it was to assess the risk to a disease, cardiovascular disease, right? There is no disease for which cholesterol elevated is diagnosed. It tells you about the potential of a disease.

Jeffrey Bland: 14:43 Now, why that’s important is that that leads us from diagnosis to prognosis, and that leads us from disease to health trajectory, and health production. So, what we are witnessing right now is a very interesting transformation in asking the question, “What other things do you want to measure in the body’s fluids that would help us to understand the trajectory towards dysfunction?” And, well before you get to disease, that’s a measurement of your health capacity, so that you can measure that serially, meaning over time, and you can be a benchmark as to how your engaged in a health creation program.

James Maskell: 15:22 It seems to me that you have to start with the end in mind. So, with Theranos, the thing that jumped out to me from the book was that she started with the end in mind, which is first of all the big vision, right? Being able to get everything from one drop of blood, and the second thing was just how sort of comical it was that it had to fit, it had to be this size, right? That was like the focus of it. It seems to me that projects that start with the intention to be able to measure what has previously not been measured with a vision towards understanding the complexity of prognosis and health, is a starting point for a project that could yield the kind of results that you’re probably talking about, is going to be necessary for this next era.

Jeffrey Bland: 16:02 Yeah. Again, you’re speaking about this book, The Bad Blood, which really is a history of the Theranos rise and fall, and again, I think you chose a good example with that story, because the Theranos example was really trying to talk about early diagnosis, making earlier diagnosis, like earlier recognition of when you might have cancer, or heart disease, or diabetes. That’s all meritorious and valuable, but that doesn’t really tell you about health.

Jeffrey Bland: 16:31 The next stage, which is the stage we’re involved in right now, and is the focus of the Big Bold Health Podcast is, what do you really need to measure to understand the presence of health in the individual? Meaning their function. And as we said, the function is really broken down into four categories, their physical, their physiological or metabolic, their cognitive, and their behavioral, psychological function.

James Maskell: 16:54 So, for people who are listening at home who want to get a sort of a heads-up on this and ahead of the game, maybe they’re a biohacker, maybe they’re people who have been faced with some disease, have come out the other side of it and are now ready to think in this new way, what are some of the sort-of basic things that fit into that category right now today?

Jeffrey Bland: 17:12 Yeah, so let’s start with physical functioning quickly. Physical functioning is strength, flexibility, and endurance. Are there simple ways to assess those that you don’t have to go to a doctor’s office and don’t have to do a sophisticated kind of machine testing? And the answer is yes.

James Maskell: 17:25 Can you do 40 pushups?

Jeffrey Bland: 17:27 That’s right. There’s the step test. There are different ways of examining, very easily, your cardiorespiratory function with minimum exercise. There are ways of examining your flexibility, like reach testing. There are ways of looking at your strength, as you said, like pushups or pull-ups. So, that’s one way that we can start assessing that, and we can track it over time to see if we’re improving.

Jeffrey Bland: 17:51 The second would be metabolic. Are there ways that you can examine your metabolic function? And, the answer is yes. Now there are many direct to consumer labs that are providing very inexpensive panels of tests that allow you to examine things that would show whether you have insulin resistance, or a risk towards poor insulin signaling, or you have inflammation, central features that give rise to understanding your health inventory.

Jeffrey Bland: 18:15 Third of which is cognitive. There are cognitive tests now on the internet that you can test your short-term memory and your ability to do pattern recognition. And, lastly is behavioral and psychological testing. Tests are available once again, pen and paper tests or computer algorithms, digital tests, that allow you to understand your behavior relative to certain opportunities for function and health.

Jeffrey Bland: 18:37 So, we are witnessing the emergence of a new big, bold health technology. Not a disease technology, a health technology. And, we’re going to be spending at Big Bold Health, in this podcast, going through and chronicling this revolution to make this accessible to our users, so that it will not just be some esoteric, conceptual thing out there in the blue sky, but actually delivered as a value to individuals so they’ll take charge of the most important thing we own, which is our health.

James Maskell: 19:04 Absolutely. I’m really excited to get into some of this, because I feel like at this moment in history there’s almost something unusual that has to happen to propel people to want to participate in it. But ultimately, what we’re looking for is a moment where this is just the norm.

Jeffrey Bland: 19:21 That’s exactly right. And, I think that any shift of the general zeitgeist of a population undergoes those transition doesn’t… You have the early adopters. Then you’ve got a lot of naysayers. Then the naysayers start to say, “Well, hold on. Maybe that’s not as wrong as I thought.” And then later, they come and say, “No, I always believed in that. It’s always been part of my belief system.” And, I think we’re in the middle transition. We’re beyond the early adopters, the biohackers. We’re into the kind of how do you take these concepts that came out of these early adopters and translate it into the more general health-conscious consumer so that it ultimately becomes the standard of identity for all individuals, that people have access to independent of their socioeconomic status, or their ethnicity, or their cultural belief systems, that they have access to things that will revolutionize their ability to achieve good health.

James Maskell: 20:13 Beautiful. Well, that is something that is going to be available to more people. I’m excited to be chronicling this with you. We’re going to be talking about biohacking. There’s a number of other topics that will be coming soon on the Big Bold Health Podcast, but I hope that for everyone who’s listening, that the Theranos example can serve as a warning signal of how good ideas can sort of go a little bit wrong, but that ultimately those ideas are moving us in a direction that is going to be beneficial for all of us and mankind.

James Maskell: 20:44 So, this has been the Big Bold Health Podcast. Been great to be with you here. Dr. Jeffrey Bland, myself, James Maskell. Thanks so much for listening, and we’ll see you next time.

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  • Use the Site to post, transmit or in any way exploit any information, software or other material for commercial purposes, or that contains advertising.
  • Use the Site to advertise or solicit to anyone to buy or sell products or services, or to make donations of any kind, without our express written approval.
  • Gather for marketing purposes any email addresses or other personal information that has been posted by other users of the Site.

COMPANY may host message boards, chats and other private/public forums on its Sites and on other platforms. Any user failing to comply with the terms and conditions of this Agreement may be expelled from and refused continued access to, the message boards, groups, chats or other such forums in the future. COMPANY or its designated agents may remove or alter any user-created content at any time for any reason. Message boards, chats and other public forums are intended to serve as discussion centers for users and subscribers. Information and content posted within these public forums may be provided by COMPANY staff, COMPANY’s outside contributors, or by users not connected with COMPANY, some of whom may employ anonymous user names. COMPANY expressly disclaims all responsibility and endorsement and makes no representation as to the validity of any opinion, advice, information or statement made or displayed in these forums by third parties, nor are we responsible for any errors or omissions in such postings, or for hyperlinks embedded in any messages. Under no circumstances will we, our affiliates, suppliers or agents be liable for any loss or damage caused by your reliance on information obtained through these forums. The opinions expressed in these forums are solely the opinions of the participants, and do not reflect the opinions of COMPANY or any of its subsidiaries or affiliates.

 

COMPANY has no obligation whatsoever to monitor any of the content or postings on the message boards, chat rooms or other public forums on the Sites. However, you acknowledge and agree that we have the absolute right to monitor the same at our sole discretion. In addition, we reserve the right to alter, edit, refuse to post or remove any postings or content, in whole or in part, for any reason and to disclose such materials and the circumstances surrounding their transmission to any third party in order to satisfy any applicable law, regulation, legal process or governmental request and to protect ourselves, our clients, sponsors, users and visitors.

 

Registration

 

To access certain features of the Site, we may ask you to provide certain demographic information including your gender, year of birth, zip code and country. In addition, if you elect to sign-up for a particular feature of the Site, such as chat rooms, web logs, or bulletin boards, you may also be asked to register with us on the form provided and such registration may require you to provide personally identifiable information such as your name and email address. You agree to provide true, accurate, current and complete information about yourself as prompted by the Site’s registration form. If we have reasonable grounds to suspect that such information is untrue, inaccurate, or incomplete, we have the right to suspend or terminate your account and refuse any and all current or future use of the Site (or any portion thereof). Our use of any personally identifiable information you provide to us as part of the registration process is governed by the terms of our Privacy Policy.

 

Passwords

 

To use certain features of the Site, you will need a username and password, which you will receive through the Site’s registration process. You are responsible for maintaining the confidentiality of the password and account, and are responsible for all activities (whether by you or by others) that occur under your password or account. You agree to notify us immediately of any unauthorized use of your password or account or any other breach of security, and to ensure that you exit from your account at the end of each session. We cannot and will not be liable for any loss or damage arising from your failure to protect your password or account information.

 

Limitation of Liability

 

UNDER NO CIRCUMSTANCES, INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE, SHALL WE, OUR SUBSIDIARY AND PARENT COMPANIES OR AFFILIATES BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES THAT RESULT FROM THE USE OF, OR THE INABILITY TO USE, THE SITE, INCLUDING OUR MESSAGING, BLOGS, COMMENTS OF OTHERS, BOOKS, EMAILS, PRODUCTS, OR SERVICES, OR THIRD-PARTY MATERIALS, PRODUCTS, OR SERVICES MADE AVAILABLE THROUGH THE SITE OR BY US IN ANY WAY, EVEN IF WE ARE ADVISED BEFOREHAND OF THE POSSIBILITY OF SUCH DAMAGES. (BECAUSE SOME STATES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF CERTAIN CATEGORIES OF DAMAGES, THE ABOVE LIMITATION MAY NOT APPLY TO YOU. IN SUCH STATES, OUR LIABILITY AND THE LIABILITY OF OUR SUBSIDIARY AND PARENT COMPANIES OR AFFILIATES IS LIMITED TO THE FULLEST EXTENT PERMITTED BY SUCH STATE LAW.) YOU SPECIFICALLY ACKNOWLEDGE AND AGREE THAT WE ARE NOT LIABLE FOR ANY DEFAMATORY, OFFENSIVE OR ILLEGAL CONDUCT OF ANY USER. IF YOU ARE DISSATISFIED WITH THE SITE, ANY MATERIALS, PRODUCTS, OR SERVICES ON THE SITE, OR WITH ANY OF THE SITE’S TERMS AND CONDITIONS, YOUR SOLE AND EXCLUSIVE REMEDY IS TO DISCONTINUE USING THE SITE AND THE PRODUCTS, SERVICES AND/OR MATERIALS.

 

THIS SITE IS CONTINUALLY UNDER DEVELOPMENT AND COMPANY MAKES NO WARRANTY OF ANY KIND, IMPLIED OR EXPRESS, AS TO ITS ACCURACY, COMPLETENESS OR APPROPRIATENESS FOR ANY PURPOSE.

 

WITH REGARDS TO CONTENT RELATING TO HEALTH & WELLNESS ON THE SITE:

THIS SITE OFFERS HEALTH, WELLNESS, FITNESS AND NUTRITIONAL INFORMATION AND IS DESIGNED FOR EDUCATIONAL PURPOSES ONLY. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. IF YOU HAVE ANY CONCERNS OR QUESTIONS ABOUT YOUR HEALTH, YOU SHOULD ALWAYS CONSULT WITH A PHYSICIAN OR OTHER HEALTH-CARE PROFESSIONAL. DO NOT DISREGARD, AVOID OR DELAY OBTAINING MEDICAL OR HEALTH RELATED ADVICE FROM YOUR HEALTH-CARE PROFESSIONAL BECAUSE OF SOMETHING YOU MAY HAVE READ ON THIS SITE. THE USE OF ANY INFORMATION PROVIDED ON THIS SITE IS SOLELY AT YOUR OWN RISK.

 

NOTHING STATED OR POSTED ON THIS SITE OR AVAILABLE THROUGH ANY SERVICES ARE INTENDED TO BE, AND MUST NOT BE TAKEN TO BE, THE PRACTICE OF MEDICAL OR COUNSELING CARE. FOR PURPOSES OF THIS AGREEMENT, THE PRACTICE OF MEDICINE AND COUNSELING INCLUDES, WITHOUT LIMITATION, PSYCHIATRY, PSYCHOLOGY, PSYCHOTHERAPY, OR PROVIDING HEALTH CARE TREATMENT, INSTRUCTIONS, DIAGNOSIS, PROGNOSIS OR ADVICE.

 

Termination

 

We may cancel or terminate your right to use the Site or any part of the Site at any time without notice. In the event of cancellation or termination, you are no longer authorized to access the part of the Site affected by such cancellation or termination. The restrictions imposed on you with respect to material downloaded from the Site, and the disclaimers and limitations of liabilities set forth in these Terms of Service, shall survive.

 

Refund Policy

 

Your purchase of a product or service or ticket to an event may or may not provide for any refund.  Each specific product, service, event or course will specify its own refund policy.

 

Digital Millennium Copyright Act

 

The Digital Millennium Copyright Act of 1998 (the “DMCA”) provides recourse for copyright owners who believe that material appearing on the Internet infringes their rights under the U.S. copyright law. If you believe in good faith that materials hosted by COMPANY infringe your copyright, you, or your agent may send to COMPANY a notice requesting that the material be removed or access to it be blocked. Any notification by a copyright owner or a person authorized to act on its behalf that fails to comply with requirements of the DMCA shall not be considered sufficient notice and shall not be deemed to confer upon COMPANY actual knowledge of facts or circumstances from which infringing material or acts are evident. If you believe in good faith that a notice of copyright infringement has been wrongly filed against you, the DMCA permits you to send to COMPANY a counter-notice. All notices and counter notices must meet the then current statutory requirements imposed by the DMCA; see http://www.loc.gov/copyright for details. COMPANY’s Copyright Agent for notice shall be annettegiarde@bigboldhealth.com.

 

Assignment

 

This Agreement shall be binding upon and inure to the benefit of COMPANY and our respective assigns, successors, heirs, and legal representatives. Neither this Agreement nor any rights hereunder may be assigned without the prior written consent of COMPANY Notwithstanding the foregoing, all rights and obligations under this Agreement may be freely assigned by COMPANY to any affiliated entity or any of its wholly owned subsidiaries.

 

Dispute Resolution

These Terms of Use shall be governed by and construed in accordance with the laws of the State of Washington and any dispute shall be subject to binding arbitration in Bainbridge Island, Washington. If any provision of this agreement shall be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this agreement and shall not affect the validity and enforceability of any remaining provisions.

 

Class Action Waiver

 

You may only resolve disputes with us on an individual basis, and may not bring a claim as a plaintiff or a class member in a class, consolidated, or representative action. Class arbitrations, class actions, private attorney general actions, and consolidation with other arbitrations aren’t allowed.

 

The arbitrator may not consolidate more than one person’s claims, and may not otherwise preside over any form of a class or representative proceeding or claims (such as a class action, consolidated action or private attorney general action) unless all relevant parties specifically agree to do so following initiation of the arbitration.

 

Severability

 

If any clause within these Terms of Service (other than the Class Action Waiver clause above) is found to be illegal or unenforceable, that clause will be severed from these Terms of Service, and the remainder of these Terms of Service will be given full force and effect. If the Class Action Waiver clause is found to be illegal or unenforceable, this entire Provision will be unenforceable and the dispute will be decided by a court.

Privacy Policy

Effective Date: March 2019

 

The following Privacy Policy governs the online information collection practices of BIG BOLD HEALTH LLC (“COMPANY,” “we” or “us”). Specifically, it outlines the types of information that we gather about you while you are using the www.bigboldhealth.com website (the “Site”), and the ways in which we use this information. This Privacy Policy, including our children’s privacy statement, does not apply to any information you may provide to us or that we may collect offline and/or through other means (for example, at a live event, via telephone, or through the mail).

 

Please read this Privacy Policy carefully. By visiting and using the Site, you agree that your use of our Site, and any dispute over privacy, is governed by this Privacy Policy. Because the Web is an evolving medium, we may need to change our Privacy Policy at some point in the future, in which case we’ll post the changes to this Privacy Policy on this website and update the Effective Date of the policy to reflect the date of the changes. By continuing to use the Site after we post any such changes, you accept the Privacy Policy as modified.

 

How We Collect and Use Information

 

We may collect and store personal or other information that you voluntarily supply to us online while using the Site (e.g., while on the Site or in responding via email to a feature provided on the Site). The Site only contacts individuals who specifically request that we do so or in the event that they have signed up to receive our messaging, attended one of our events, or have purchased one of our products. The Site collects personally identifying information from our users during online registration and online purchasing. Generally, this information includes name and e-mail address for registration or opt-in purposes and name, postal address, and credit card information when registering for our events or purchasing our products. All of this information is provided to us by you.

 

We also collect and store information that is generated automatically as you navigate online through the Site. For example, we may collect information about your computer’s connection to the Internet, which allows us, among other things, to improve the delivery of our web pages to you and to measure traffic on the Site. We also may use a standard feature found in browser software called a “cookie” to enhance your experience with the Site. Cookies are small files that your web browser places on your hard drive for record-keeping purposes. By showing how and when visitors use the Site, cookies help us deliver advertisements, identify how many unique users visit us, and track user trends and patterns. They also prevent you from having to re-enter your preferences on certain areas of the Site where you may have entered preference information before. The Site also may use web beacons (single-pixel graphic files also known as “transparent GIFs”) to access cookies and to count users who visit the Site or open HTML-formatted email messages.

 

We use the information we collect from you while you are using the Site in a variety of ways, including using the information to customize features; advertising that appear on the Site; and, making other offers available to you via email, direct mail or otherwise. We also may provide your information to third parties, such as service providers, contractors and third-party publishers and advertisers for a variety of purposes. Unless you inform us in accordance with the process described below, we reserve the right to use, and to disclose to third parties, all of the information collected from and about you while you are using the Site in any way and for any purpose, such as to enable us or a third party to provide you with information about products and services. If you do not wish your information to be used for these purposes, you must send a letter to the Online Privacy Coordinator whose address is listed at the end of this Privacy Policy requesting to be taken off any lists of information that may be used for these purposes or that may be given or sold to third-parties.

 

Please keep in mind that whenever you voluntarily make your personal information available for viewing by third parties online – for example on message boards, web logs, through email, or in chat areas – that information can be seen, collected and used by others besides us. We cannot be responsible for any unauthorized third-party use of such information.

 

Some of our third-party advertisers and ad servers that place and present advertising on the Site also may collect information from you via cookies, web beacons or similar technologies. These third-party advertisers and ad servers may use the information they collect to help present their advertisements, to help measure and research the advertisements’ effectiveness, or for other purposes. The use and collection of your information by these third-party advertisers and ad servers is governed by the relevant third-party’s privacy policy and is not covered by our Privacy Policy. Indeed, the privacy policies of these third-party advertisers and ad servers may be different from ours. If you have any concerns about a third party’s use of cookies or web beacons or use of your information, you should visit that party’s website and review its privacy policy.

The Site also includes links to other websites and provides access to products and services offered by third parties, whose privacy policies we do not control. When you access another website or purchase third-party products or services through the Site, use of any information you provide is governed by the privacy policy of the operator of the site you are visiting or the provider of such products or services.

 

We may also make some content, products and services available through our Site or by emailing messages to you through cooperative relationships with third-party providers, where the brands of our provider partner appear on the Site in connection with such content, products and/or services. We may share with our provider partner any information you provide, or that is collected, in the course of visiting any pages that are made available in cooperation with our provider partner. In some cases, the provider partner may collect information from you directly, in which cases the privacy policy of our provider partner may apply to the provider partner’s use of your information. The privacy policy of our provider partners may differ from ours. If you have any questions regarding the privacy policy of one of our provider partners, you should contact the provider partner directly for more information.

 

Be aware that we may occasionally release information about our visitors when release is appropriate to comply with law or to protect the rights, property or safety of users of the Site or the public.

 

Please also note that as our business grows, we may buy or sell various assets. In the unlikely event that we sell some or all of our assets, or one or more of our websites is acquired by another company, information about our users may be among the transferred assets.

 

Google Analytics

 

We also use Google Analytics Advertiser Features to optimize our business. Advertiser features include:

  • Remarketing with Google Analytics
  • Google Display Network Impression Reporting
  • DoubleClick Platform integrations
  • Google Analytics Demographics and Interest Reporting

By enabling these Google Analytics Display features, we are required to notify our visitors by disclosing the use of these features and that we and third-party vendors use first-party cookies (such as the Google Analytics cookie) or other first-party identifiers, and third-party cookies (such as the DoubleClick cookie) or other third-party identifiers together to gather data about your activities on our Site.  Among other uses, this allows us to contact you if you begin to fill out our check-out form but abandon it before completion with an email reminding you to complete your order.  The “Remarketing” feature allows us to reach people who previously visited our Site, and match the right audience with the right advertising message.

You can opt out of Google’s use of cookies by visiting Google’s ad settings and/or you may opt out of a third-party vendor’s use of cookies by visiting the Network Advertising Initiative opt-out page.

 

Facebook

 

As advertisers on Facebook and through our Facebook page, we, (not Facebook) may collect content or information from a Facebook user and such information may be used in the same manner specified in this Privacy Policy. You consent to our collection of such information.

 

We abide by Facebook’s Data Use Restrictions.

  • Any ad data collected, received or derived from our Facebook ad (“Facebook advertising data”) is only shared with someone acting on our behalf, such as our service provider. We are responsible for ensuring that our service providers protect any Facebook advertising data or any other information obtained from us, limit our use of all of that information, and keep it confidential and secure.
  • We do not use Facebook advertising data for any purpose (including retargeting, commingling data across multiple advertisers’ campaigns, or allowing piggybacking or redirecting with tags), except on an aggregate and anonymous basis (unless authorized by Facebook) and only to assess the performance and effectiveness of our Facebook advertising campaigns.
  • We do not use Facebook advertising data, including the targeting criteria for a Facebook ad, to build, append to, edit, influence, or augment user profiles, including profiles associated with any mobile device identifier or other unique identifier that identifies any particular user, browser, computer or device.
  • We do not transfer any Facebook advertising data (including anonymous, aggregate, or derived data) to any ad network, ad exchange, data broker or other advertising or monetization related service.

 

General Data Privacy Regulation (GDPR)

 

The GDPR took effect on May 25, 2018, and is intended to protect the data of European Union (EU) citizens. 

 

As a company that markets its site, content, products and/or services online we do not specifically target our marketing to the EU or conduct business in or to the EU in any meaningful way. If the data that you provide to us in the course of your use of our site, content, products and/or services is governed by GDPR, we will abide by the relevant portions of the Regulation.

 

If you are a resident of the European Economic Area (EEA), or are accessing this site from within the EEA, you may have the right to request: access to, correction of, deletion of; portability of; and restriction or objection to processing, of your personal data, from us. This includes the “right to be forgotten.”

 

To make any of these requests, please contact our GDPR contact at annettegiarde@bigboldhealth.com

 

Children’s Privacy Statement

 

This children’s privacy statement explains our practices with respect to the online collection and use of personal information from children under the age of thirteen, and provides important information regarding their rights under federal law with respect to such information.

  • This Site is not directed to children under the age of thirteen and we do NOT knowingly collect personally identifiable information from children under the age of thirteen as part of the Site. We screen users who wish to provide personal information in order to prevent users under the age of thirteen from providing such information. If we become aware that we have inadvertently received personally identifiable information from a user under the age of thirteen as part of the Site, we will delete such information from our records. If we change our practices in the future, we will obtain prior, verifiable parental consent before collecting any personally identifiable information from children under the age of thirteen as part of the Site.
  • Because we do not collect any personally identifiable information from children under the age of thirteen as part of the Site, we also do NOT knowingly distribute such information to third parties.
  • We do NOT knowingly allow children under the age of thirteen to publicly post or otherwise distribute personally identifiable contact information through the Site.
  • Because we do not collect any personally identifiable information from children under the age of thirteen as part of the Site, we do NOT condition the participation of a child under thirteen in the Site’s online activities on providing personally identifiable information.

The HIPAA Privacy Rule

 

The US Department of Health and Human Services provides:  The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically.  The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.”

 

You acknowledge that our operation of the Site does not constitute the practice of medicine, and specifically does not create a doctor-patient relationship between you and Dr. Jeffrey Bland, PhD (the “Doctor”).  The information provided on the Site is for educational purposes only. 

 

Notwithstanding the fact that the Site does not create a doctor-patient relationship between you and DOCTOR, our preservation of your personal health information shall be HIPAA compliant.

 

For purposes of this Privacy Policy, “patients” are those individuals who have secured the in-person services DOCTOR.  If you are a patient of DOCTOR, you will be provided with a copy of DOCTOR’s HIPAA Privacy Statement, which governs the information collection practices of patients’ personal information by DOCTOR.

 

How do we store your information?

 

Your information is stored at the list server that delivers the Site content and messaging. Your information can only be accessed by those who help manage those lists in order to deliver e-mail to those who would like to receive the Site material.

 

All of the messaging or emails that are sent to you by the Site include an unsubscribe link in them. You can remove yourself at any time from our mailing list by clicking on the unsubscribe link that can be found in every communicaiton that we send you.

 

Changes to this Policy

 

This policy may be changed at any time at our discretion. If we should update this policy, we will post the updates to this page on our Website.

 

Questions About this Policy

 

If you have any questions or concerns regarding our privacy policy please direct them to:

annettegiarde@bigboldhealth.com