Just Follow the Money and the Research!

Robert Topp, RN, PhD has over 35 years of experience in academia as an endowed research chair and Associate Dean for Research at several universities. He has been the principal or co-investigator on over $3 million of extramurally supported research projects, which has resulted in over 160 publications in peer reviewed journals and over 300 presentations at professional scientific meetings. His expertise in the areas of scholarly writing, research methodology and statistics is sought by numerous professional academic and health organizations. Dr. Topp has collaborated with a variety of health-care providers and healthcare product companies to generate evidence supporting the efficacy and cost-benefit of their services and products.

Episode Highlights:

2:41 – The doctor nurse. “As you said, I'm a nurse and I have a PhD, so I'm a doctor nurse. Everybody wants to know, how did a male get into nursing? Well, I was 18 years old and trying to figure out the curriculum I wanted to study in college. I looked at nursing and it was 95% female, so that seemed like a pretty easy choice to me. As I got into it, I discovered that I really enjoy taking care of people and making people's lives better. As a nurse, I would take care of my four or five patients on the floor and go home knowing I made a difference in four- or five-people’s lives. Then I found out that if I got more advanced degrees, I could cast a wider net. Some of the manuscripts that we've published have had impacts on practices across the nation, and even globally, and I can support or contribute to improving people's lives at a much broader area. That’s how I got to doing a lot more research in this area of healthcare and behavior change. As you know, a lot of our work involves people changing their behavior by doing rehab, changing their diets or trying to increase mindfulness, but getting people to change is really hard. We know how to get people to live longer and healthier but getting people to adopt those behaviors is the hard part. How do you do that? One of the studies I did with a healthcare insurance company that trying to increase compliance of their constituents in taking medication - how do you get people to take the medication on time? They tried sending a letter to the individual patient and to their physicians, but that didn't have any impact. Then they thought, why don't we send a letter to their spouse? Lo and behold, when you send the letter to the spouse that their husband or wife isn't taking the medication, their compliance increases.”

7:10 – Finding the patient’s motivation behind behavior change. “A lot of providers want to know how to get people to change their behavior, to exercise more, to take their medication, to do what they know will help them feel better. The answer? The one thing that has no effect on somebody's behavior is knowledge. If you give them a pamphlet to read, video to watch, or podcast to listen to, that increases their knowledge, but it isn't going to have an effect on their behavior. But when you think about what drives behavior or what motivates people, you think about their social network. How is that social network supporting or inhibiting them from changing their behavior? How do they perceive the behavior as giving them something they want? If they engage in this behavior, will they achieve a personal goal or achieve some objective they want? It has to be important to the individual, not to the provider. If the provider says, if you do this behavior, you're going to live longer – that could be something they don’t really value. But if you say to the patient, if you do this behavior, you'll be able to play with your grandkids and take them out for ice cream. Lo and behold, they're motivated to do it.”

13:49 - Skills and education along the way. “Well, strangely enough, my PhD is not in nursing. It's in exercise physiology because, back in the Stone Age when I was in graduate school, there weren't any PhDs in nursing. Mine is in exercise physiology and health education. During my doctoral program, I was a research assistant for the Ohio State University College of Nursing. I learned a lot of in-the-trenches-skills on the nuts and bolts of research. How do you come up with a question? How do you operationalize that question into data collection and an intervention? And then how do you take that data and work with it to answer your original question? I had a great experience there and really launched my career. I also did a post doctorate at the University of Pennsylvania, home of the Fighting Quakers, and that gave me a really good insight into high powered research going on at that level. Great experience.”

20:11 - You need the evidence for sales. “I was approached 25 years ago by Performance Health, and the driving force there was Phil and Herm. He was the owner and had the vision that the only way we can increase sales is if we have evidence to support the efficacy of the product. This was interesting at the time because they were selling elastic bands and had an 80-95% penetration in the market, so what are you going to be able to do? Well, he was interested in taking those elastic bands and applying it in different ways to different exercises or types of therapy. We constructed some studies and showed that these elastic bands built strength just as well as weight machines or barbells, but they were much more acceptable to people who had weak knees. Then, this company bought BioFreeze and there was not a whole lot of research on the efficacy or what BioFreeze does. We did one of the first studies to show that BioFreeze could actually decrease pain and we published it. Herm and Phil were really forward-thinking visionaries in the healthcare space. If you want to sell your product, you've got to have evidence to support it, and that evidence has to be research-based or empirical. You just can't say it works – you need to show the impact of it through three things: Does it save money? Does it decrease morbidity and mortality? Does it increase quality of life? If you have a product that you can't prove with a research article that it does one of those three things, you're probably not going to sell it.”

23:18 – Research can push the product and marketing. “Dr. Tim Tyler is a physical therapist in New York that developed an exercise with one of the products that Performance Health developed. It's called the Tyler Twist. I'm not sure how it works, but it has a dramatic impact on tennis elbow, which is a hard thing to treat. This particular exercise emphasized the stretching and strengthening of the muscle that's at fault. Because of that, he wrote an article on it that Reader's Digest picked it up and got it into the public domain - then Performance Health sold out. One of the things they awarded him was a golden piece of latex to work with for the Tyler Twist. That was probably one of their biggest success stories showing that research pushed the product and marketing. Once it got into the popular press, it took off.”

32:38 – Just follow the money… and the research! “As healthcare costs increase, consumers and health insurance companies want to pay for things with a high probability of success. When you're picking out treatment options, which one is going to work with this particular patient? Well, here's some evidence to support - treatment A is the most effective with this patient. As we move forward and get into genomics and AI predictive analytics, that'll become even more precise. You've heard of precision medicine, where we're targeting the intervention to this individual's particular genetic makeup and possibly their social cultural background, trying to use our healthcare dollars effectively and judiciously to get the biggest bang for the buck. That's based on what the evidence say will work the best.”

Episode Resources:

Robert’s Website 

Robert’s Email