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121: Do No Harm, But Also Sell Shoes? The Doctor vs Brand Problem
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In this solo episode, Sarah takes the “doctor vs brand” framework that went viral on Instagram and runs it as a real-time case study on a real company. The target is Cadense, an adaptive shoe that claims to help with foot drop, toe catch, and neurologic walking difficulties using “variable friction” tech, basically a glide-to-grip outsole design meant to reduce toe snagging while still giving traction during stance and push-off. Sarah breaks down what foot drop is, who this type of device might help, who it might put at risk, and why any rehab-adjacent product should be judged on more than vibe, testimonials, or white-coat authority.
Then she gets into incentives, the part everyone wants to ignore until it’s their wallet. She walks through Cadense’s ambassador, coach, and affiliate pathways, and uses the full checklist to evaluate where Cadense lands on the clinician-led spectrum, including what they disclose well, what they oversimplify, and what they should tighten up if they want to be truly “do no harm” about a product that can literally change someone’s fall risk. Finally, Sarah looks at the actual research (yes, it exists, no, it’s not robust yet), explains what a five-person pilot study can and can’t prove, and lays out the line she personally won’t cross, recommending a product case-by-case versus becoming financially tied to a medical-ish purchase decision.
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RESOURCES
Instagram Post: When a Doctor Becomes a Brand
Cadense, Official Website
Cadense Coaches Program, Clinician Partnership
Pilot Study of Cadence, A Novel Shoe for Patients With Foot Drop, Evora et al. 2019
NIH Clinical Trial, Variable Friction Shoe vs AFO (NCT06234124)
Global Wellness Economy Reaches $6.8 Trillion, Global Wellness Institute
Recommended
Transcript
Introduction & Mission
00:00:00
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts.
00:00:15
Speaker
or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt? Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices. Let's dive in.
Doctor vs Brand Framework Introduction
00:00:45
Speaker
Hey everybody, welcome back to the Movement Logic Podcast. I am Dr. Sarah Court, I'm a physical therapist, and I am your host for today. We're going to do with something a little different than usual.
00:00:56
Speaker
This episode is going to be sort of a field test, if you like, of the doctor versus brand framework that we posted about on Instagram recently.
00:01:08
Speaker
Because that post went viral. Ha ha So what we're going to do is use the exact list of criteria that go into the difference between behaving like a doctor versus behaving like a brand on social media.
00:01:25
Speaker
And we're going to apply it to a real company. The company is called Cadence. And this company makes an adaptive shoe that claims to help with foot drop and neurologic walking difficulties.
00:01:40
Speaker
Before we get into it, I want to tell you about our Barbell mini course. Here's important things to know. Number one, it's free. Number two, we are going to ask for your email, but we're not obnoxious emailers and we send out useful stuff.
00:01:57
Speaker
And the email also how you hear about all of our courses and new programming. We've got a new piece of content that's going to be coming out this year that we're super pumped about. So it's kind of a no-brainer to get on the mailing list if you like our stuff, right? If you like this podcast.
00:02:14
Speaker
Number three, the actual content of the barbell mini course is incredibly useful. Yes, it's working with barbells. You're going to learn how to do squat, deadlift, the bench press.
00:02:24
Speaker
You could also use dumbbells for that. There's no reason why you couldn't. We just like teaching with barbells because likely you're going to get to the point if you want to keep getting stronger where you're going to need to switch over to barbells. So we just think it's a time saver to just start there.
00:02:42
Speaker
We also give you a bunch of content about things like progressive overload, reps and reserve, these concepts that we use in our lifting weight journey to make sure that our lifts are as effective as they can be and that we can get as much positive impact from them as we can.
00:03:00
Speaker
So if that sounds interesting to you, go ahead and click the link and grab your Barbell mini course and get on our mailing list.
Personal Update & Social Media Insights
00:03:08
Speaker
I also just want to take a moment, and this is just me personally, to let you know a lot of you, if you're listeners of the podcast, you know that I have been going through chemotherapy and radiation treatment for this recurrence of my metastatic breast cancer. But I had a PET scan a couple of days ago and I am like 80% clear in most areas, 100% clear in some areas, which is excellent news. So I'm in a very, very good mood because of that. And I want to say thank you to all of you for your support and your good wishes. This is going to be something that I'll probably be dealing with for the rest of my life.
00:03:46
Speaker
And i wouldn't recommend it, but I am grateful to have the support that I have. All right, so let's get into it. So first of all, I need to recap what happened.
00:03:57
Speaker
Over on Instagram, which is the only social media platform that we're actively on, I posted a carousel called, When a Doctor Becomes a Brand. The point of the post wasn't to claim that, you know, doctors are bad or never trust clinicians.
00:04:13
Speaker
It was just that sometimes a doctor will build an online platform and their incentives start to shift and they start behaving less like a clinician and more like a brand.
00:04:24
Speaker
And when that happens, there are patterns. So the goal of the post was to point out these patterns so that people can spot them in the wild, if you were. So here's the points that we listed because we're going to, in this episode, use this list for our real life field test of this company, Cadence.
00:04:43
Speaker
So the list from the Instagram post was this. If you are a doctor, you say, first, do no harm. If you are a brand, you say, first, buy my product.
00:04:56
Speaker
A doctor looks at your symptoms, history, goals, and more to decide if a treatment is appropriate. A brand is confident that everyone should be doing this or taking the supplement. Yes, even you.
00:05:10
Speaker
A doctor is comfortable saying we don't actually know yet, but a brand has to be always confident and never have a doubt. A doctor will stay in their lane and will refer out to others when it's appropriate, but a brand will suddenly cover all of the lanes and become an expert on hormones, bones, nutrition, mindset, trauma, nothing that they actually have studied or gone to school for.
00:05:40
Speaker
A doctor will change recommendations when better advice comes along, but a brand can't update their message because they're selling a product. They can't change the product, so they can't change the message.
00:05:53
Speaker
A doctor will talk honestly with patients about the various risks, trade-offs, or limitations of a particular type of treatment, medication, surgery, and so on.
00:06:04
Speaker
But a brand is going to talk about benefits. It's going to show you testimonials, and it's going to talk about transformations. Finally, a doctor measures success in each of their patients' health outcomes, but a brand measure success in numbers, volume, sales.
00:06:24
Speaker
Big wellness is a trillion dollar business. All right, so that was the carousel.
Social Media Dynamics & Disagreements
00:06:30
Speaker
And apparently it hit a nerve because it blew up like 650,000 views and counting kind of blew up We heard from a lot of clinicians, doctors of all different types who were like, thank you.
00:06:45
Speaker
Right. They felt that we really hit on this differentiation in a really clarifying way. We also got pushback a lot from, from doctors who did not like what we were pointing out.
00:06:58
Speaker
And they said things like, how am I supposed to earn a living? I don't know, by being a doctor. You're a brand and a physical therapist, so you are a hypocrite.
00:07:11
Speaker
Well, yes, Movement Logic that is a brand. I mean, ah I guess we're a brand. I'm a physical therapist. The only thing we sell, though, is an evidence-based weightlifting program, which is well within my scope of practice, and occasionally like a t-shirt or a mug, maybe.
00:07:30
Speaker
There were some pretty loony responses, is if I'm honest. There was one doctor who went off on a tangent about how there should be no health insurance and everyone should pay for everything out of pocket, which was not only, you know, really unrelated to what we were talking about, but completely unhinged.
00:07:47
Speaker
Now, here's what happened just a few moments, I think, after I posted that carousel. And this turned the story from a framework post into a live demo. And it actually pointed out one thing that I left off the list. So i then, a few minutes later, saw a post from Vonda Wright about how heavy lifting was required for bone building.
00:08:11
Speaker
Now, we already know from more recent research that while heavy lifting, yes, does improve bone, so does moderate lifting and possibly even lightweight lifting.
00:08:22
Speaker
So I commented, respectfully-ish, that the research doesn't support that framing and that Bone can respond to a range of loading strategies, depending on the context. Instead of engaging with the evidence that I was putting forward, and I listed even the study that I was talking about, instead of engaging with that, her response was to ask why I was undermining women's potential which if you know anything about myself, Laurel, movement logic, that couldn't be further from the truth.
00:08:57
Speaker
So I replied that I wasn't and that she should read the research. And then she blocked me. And so that was one more thing to add to the doctor versus brand list, because brands will just block you, whereas doctors will engage with you. A clinician acting like a clinician says, let's talk about the data, right? Let's discuss this.
00:09:19
Speaker
A brand acting like a brand can only say, don't threaten the message and cut you off. So this is why we feel that this framework and this understanding is really important for us, for everyone who listens to this podcast, everyone on social media, the influence heavy world that we live in and understanding that we are seeing a fair amount of sort of bleed over between people who should be trustworthy,
Cadence Shoes Evaluation Plan
00:09:49
Speaker
right? The way we think of doctors as trustworthy and the incentivization
00:09:54
Speaker
of let's say being a little less trustworthy and getting dollar signs in your eyes, right? All right. So today we're going to use this checklist that we made against a real potential brand opportunity for me, Sarah Court, as a physical therapist.
00:10:14
Speaker
Just as a heads up, I'm not seriously considering this, but it struck me as a perfect kind of case study. Use these points from the Instagram post, determine where on the doctor versus brand scale it would put me if I started promoting this product.
00:10:30
Speaker
So the brand is called Cadence, and I'll link to you all their website and Instagram in the show notes. They make an adaptive shoe that claims to help with foot drop and other walking techniques.
00:10:43
Speaker
difficulties. So we are going to evaluate their messaging using this framework. Do they behave like a clinician-led product or do they behave like big wellness?
00:10:56
Speaker
How strong is the evidence? What claims are they making that seem reasonable? What claims are they making that are maybe a little too confident? And if someone like me as a physical therapist were to align with them, what would I need in order to feel good about it?
00:11:14
Speaker
So once again, because I feel like this really can't be emphasized too much, the Global Wellness Institute estimates that the wellness economy was about 6.8 trillion in 2024.
00:11:27
Speaker
Now, if you don't know how many is a trillion, because it's it's a lot, it is a million million. That amount of money warps incentives, even for legitimate products. So I'm not doing this to be cynical.
00:11:41
Speaker
We're doing it to be competent. Now, before we get into this, full disclosure, Movement Logic is a brand affiliate for a company called Verse that makes exercise equipment.
00:11:54
Speaker
And specifically, we promote their Agile rack, which is a, the first that I've seen, foldable rack that you can use at home.
00:12:05
Speaker
So as a product, right, this is within both of our scopes of practice. It is relevant to what we teach, which is barbell lifting. And for a lot of people, that means lifting barbells at home. We actively encourage women to buy barbells if they don't want to go to the gym.
00:12:23
Speaker
You can fold this product up and put it under the bed. It's really well-made. They are not a sketchy company as far as we can tell. So for all of those reasons, we feel that it is okay for us to promote occasionally a product that we think is a good product. And yes, we earn a commission on every sale.
00:12:40
Speaker
So I want to be clear that we're not out here saying you cannot have associations or affiliations at all, but it's a very slippery
Understanding Foot Drop & Adaptive Solutions
00:12:51
Speaker
slope.
00:12:51
Speaker
if you get a little too excited about the financial incentives and start to drift away from your own scope of practice, or whether you know you're actually paying that close attention to the utility of this product.
00:13:05
Speaker
Okay, I just wanted to make that point. So let's talk about this company Cadence and this product that they make. Cadence positions itself as a company that makes adaptive footwear for people who struggle with foot dragging, toe catch, and tripping while walking, especially when lifting the front of the foot is hard.
00:13:26
Speaker
They describe it as, quote, made for people who struggle with foot dragging. And the big idea is that the shoe changes how the foot interacts with the ground during the step.
00:13:37
Speaker
And Cadence calls this mechanism variable friction technology. I'm gonna explain how it works in a minute, but just to back up a little bit. So if you're not familiar with something called foot drop, foot drop is when your tibialis anterior muscle, which is that muscle right on the front of your shin, basically like kind of right on top of your tibia bone, if you're sitting and you put the front of your hand on your shin bone and then flex your ankle so that your toes come up towards your face, you should feel that muscle kind of pop into your hand.
00:14:10
Speaker
So there are a few different conditions and neurologic conditions in particular, Or sometimes there can be just nerve damage. I've seen it happen post knee replacement surgery where people lose the either motor control or the strength either in a permanent or a temporary way. And when you go to take a step, instead of your heel being the first thing that hits the ground, which is what is supposed to happen, instead the whole foot will kind of just slap the ground because the muscle on the front of the shin can't control that descent of the rest of the foot. Sometimes it means you can't even pick the toes up enough to clear the ground and then the toes catch, right, which leads to a lot of falls for people. or the whole bottom of the foot just kind of scuffs along the ground too soon. And that can also cause people to catch their foot and fall. It's a it's a serious issue for people with a lot of different neurologic conditions,
00:15:11
Speaker
It doesn't have to be a direct injury to that nerve. it can be a broader degenerative condition like Parkinson's disease, multiple sclerosis, things like that. can happen from a stroke.
00:15:22
Speaker
So this is a, in the neurologic rehab world, foot drag, foot drop, these are real major concerns. And so a shoe that might help address this for people is an interesting idea.
00:15:35
Speaker
And so let's go back to the shoe itself and talk about how it works. So what it's trying to solve is that for a lot of these people, as I was saying with neurologic conditions, they have trouble clearing their foot as the leg is swinging to come forward. So instead of foot lifting cleanly and moving forward, it'll either catch or scrape. Sometimes people hike their hip up to try to clear their foot or they'll swing their leg around in a circle or they'll just kind of shuffle.
00:16:03
Speaker
And the big problem with this is it's very tiring, it's inefficient, and it is going to increase your risk of tripping. So what the Cadence shoe does is something that they call glide to grip.
00:16:18
Speaker
And I'm going to describe the shoe to you as best I can. And it might help as well to, if you're interested, go on their website and look at it. But if you think about the front half of the tennis shoe, underneath the front half of your shoe,
00:16:32
Speaker
they have on the medial and the lateral side, right? The inside and the outside, there are two smooth, what they call like nylon pucks, kind of raised areas.
00:16:46
Speaker
And in between those two raised smooth areas, there is a lower spot that is rough, right? And so the way that they say that this shoe works, and I just wanted to be clarify, i have, I've never seen it on somebody.
00:17:01
Speaker
I've seen their videos on it. The way they say that the shoe works is as you're bringing that leg forward and there's that increased risk that you can't lift the front of your foot so that the front of the foot's gonna catch or drag, the design of the shoe, this smooth puck raised surface means that the foot glides forward instead of getting caught on the ground.
00:17:25
Speaker
So you still catch your toe, right? For some people, this is always going to be the case. so your toe still lands first, but because of the sliding quality of the bottom of the shoe, imagine like a a man's dress shoe, or if you've ever gotten like leather boots and the first time you wore them, you're like, whoa, I need to scuff these up, right? Really, really smooth.
00:17:47
Speaker
So your toe hits the ground, right? But it no longer gets stopped and then like has a ricochet effect up your body where you're caught off balance. It slides now.
Cadence Shoes Mechanics & Marketing
00:17:59
Speaker
So then the second part of this is that as you shift your weight, I feel like I need to do like an entire, let's go through the eight steps of gait. Okay. you You swung your leg forward.
00:18:12
Speaker
The toe is hitting sooner than we want, but it's sliding. The next thing that happens, is you start to put weight on that leg, right? You start to stand on that leg so that you can then pick up your other foot and step it forward, right? That's this sort of mid stance part of gait.
00:18:29
Speaker
As your body weight is then shifting forward onto that leg, the shoe, as they describe it, transitions from glide to grip. They say this is happening through a curved rocker sole and an outsole design that shifts friction as the step progresses. So the idea is, yes, this shoe slides a little bit first, but then as you start to put weight on the leg, it stops being slidey and it starts to feel like there's more friction.
00:18:56
Speaker
And then in the third part where that is now your back leg and you're up on the ball of the foot to push off, the weight of your toes through the front of the sole then exposes that more frictioned area between the two hockey pucks and you get a good grip to then push off with.
00:19:18
Speaker
So what it gives you is, according to them, glide to reduce that initial catching and then grip to allow for a more controlled stance and toe off phases. That's their pitch.
00:19:34
Speaker
Now, Something I do appreciate is that Cadence lists that some surfaces are good for this and some surfaces are not recommended, as you could imagine. They list surfaces like hardwood, tile, sidewalks, pavement as generally okay.
00:19:49
Speaker
They say it's explicitly not recommended for things like ice, snow, gravel, grass. I don't see anything about carpet, but I would imagine carpet might be a problem. I'm not sure.
00:20:04
Speaker
So that's not sexy marketing, right? But it's honest. And we have to be grateful for all of the honesty that we get when there is a product on the market, right?
00:20:16
Speaker
Cadence says that this shoe is designed for people who struggle with foot clearance during swing. And they mentioned specifically stroke, multiple sclerosis, cerebral palsy, Parkinson's disease, peripheral neuropathy, which is when you have issues with nerves locally in the leg and general leg weakness.
00:20:33
Speaker
They also have clinician facing instruction pages explaining that it is both an assistive device and it is something that they developed to use with therapy, which matters then for how we interpret their claims. Because one of my first thoughts about it was, well,
00:20:50
Speaker
If it's something where we're never, ever going to get any activation of this TA a muscle again, if it's just gone for, then great.
00:21:02
Speaker
If it works as an assistive device in that sense, because it's going to allow the person to walk with a more normal gait. It's going to avoid issues up the body chain, right? Side to side and your back, things like that.
00:21:14
Speaker
And so I think that's great. if it If it works as it claims it works. But let's say you're working with somebody who has lost some strength, but there is motor control still there and there is the potential to continue to gain better strength, better control.
00:21:32
Speaker
I would not want to put this shoe on someone if it did not permit that progress to happen, if it inhibited any improvement of the person's available strength, right? Available mobility.
00:21:45
Speaker
And so what they're saying is that It's both that it will help people who are just going to be lacking this capacity. And it also allows for therapeutic use, progression of the patient's skill, ability, motor control, strength, all of those things.
00:22:06
Speaker
So here's what I think of the product. Just me personally, I think it's really interesting and I would obviously want to see it in person.
00:22:17
Speaker
and have someone use it before making any real judgments about it. I definitely think it's not for everyone. I think it's for people who are not dealing with like huge losses of things like balance, coordination.
00:22:35
Speaker
So if I think about my current patients that I see and who it might be useful for and who it might not without breaking HIPAA, I would potentially give this to someone that has multiple sclerosis, but their symptoms are are pretty moderate.
00:22:51
Speaker
They're not elderly. They are extremely physically active. They work very hard in our sessions. We've seen progress happen, but foot drop is the biggest challenge, the greatest area of weakness in their body.
00:23:06
Speaker
I might give it to that person, have them try it, see if it feels useful. I would not give it to my elderly, frail, weak, decreased endurance, decreased balance patient, because I think it would probably make them fall over, frankly. I don't think they this person possesses the the physical capability in the rest of their body to be able to tolerate this kind of sliding moment.
00:23:32
Speaker
right i don't have I don't trust that this person is strong enough to be able to do that. So like any device or product, we always have to think of it in a case-by-case basis.
Cadence Partnerships & Product Claims
00:23:45
Speaker
We can't ever just say this product is perfect for everyone.
00:23:50
Speaker
So that's who I think might benefit from something like this. So then let's talk about ways that people can affiliate themselves or work with Cadence as a brand, because this is where the sort of incentives part starts to show up.
00:24:06
Speaker
So there's actually three ways that you can become partnered, let's say, with Cadence. The first is as what they call an ambassador. Now ambassadors are people who they themselves have used the shoe and are success stories essentially.
00:24:22
Speaker
So there's an ambassador page with everyone's photograph and profiles and stories about them, right? So this is using that kind of classic community story model. We've got personal journeys, we've got testimonials. It's very inspiring.
00:24:35
Speaker
People are saying things like, you know, this shoe has changed my life. Now, the ambassador page doesn't clearly state anywhere whether ambassadors are paid or receive a commission or free products. or just purely featured. Unless it's disclosed somewhere else, it was not immediately clear to me if there was an incentive structure. In one of the other ways that you can partner with Cadence, you do get a pair of free shoes just for signing up for it. They seem willing to send you free shoes. So it seems to me that they would be incentivized to send free shoes to people that they then thought would be good brand ambassadors for them. So that's the ambassador. And then the second way that you can partner is what they call their coaches program.
00:25:14
Speaker
Their coaches program is for doctors, physical therapists, OTs, any other qualifying medical professional. It's free to join. You fill out the form. They set up an onboarding call and they position this as cues and instructions that you can use for clients.
00:25:33
Speaker
They also give you a free sample pair of the shoes so that you can try them out, see what you think. And there's lots of educational resources. So they're trying to get clinicians on board, obviously, to think of this product with their patients for whom it would be appropriate.
00:25:51
Speaker
And You know, it's not dissimilar to the pharmaceutical rep who drops by the doctor's office and leaves some free samples, right? And a business card. Are they allowed to give them fruit baskets? I don't know. But it's sort of like that, right? Here's a free pair. Try it out. See what you think. It's a kind of soft-ish sell. Like, just try it out. See what you think. Here's how you could talk about this product, right? We're going to make it easy for you. You're not going to have to work to find the language to talk about this product with your patient. We're going to give it to you right here.
00:26:22
Speaker
right? They do give a lot of education, not just cues on how to talk to your patients about it and how to get them walking, but they give gait training guidelines on how much time people but should be spending walking with these shoes. They give a whole progression for what they call nervous clients, where starting from going from sit to stand to actually sliding your foot and then getting into the gait rhythm. So there is a lot of education available for And there's even a two-hour CEU course that you can take to help you learn more about how this shoe works.
00:26:56
Speaker
So that's the coaches program. And the third one, and it's not clear if you have to either or, I'm sure that you could be a coach and an affiliate, but their third category is called their affiliate program.
00:27:09
Speaker
And this is a real explicit statement that if you help spread the word about their product, you can earn a commission for every pair that you sell. So that one is the only one where there's a very clearly stated direct financial incentive path built into the model.
00:27:26
Speaker
That's not automatically bad, but it is relevant and it's something to think about. If, for example, I was going to start promoting this shoe to my patients, I would absolutely tell them that if you buy this shoe, I get a commission.
00:27:39
Speaker
I believe that I've built enough trust with people that they aren't going to see that as I'm just trying to make an extra buck because frankly, Unless you're behaving like a brand and saying this shoe is for everyone, the commission that you're getting is not enough to keep the lights on. Let's just be clear about that, right? If you're if you're doing commission-based selling,
00:28:01
Speaker
ethically, then, you know, you're not trying to clear 500 sales a month or something like that, right? So let's take this time. Now we're going to apply that doctor versus brand framework and run cadence through the checklist.
00:28:16
Speaker
Okay. So our first one is doctors say first do no harm, whereas brands say first buy my product. Now, Cadence includes disclaimers about not providing medical advice, not guaranteeing results.
00:28:30
Speaker
So that's a green flag. In terms of this brand, you know, this is a company, so they're behaving like a brand because they are a brand, but they're not hiding information about the product. As we'll see, they're not hiding information. They're not downplaying problems.
00:28:49
Speaker
They do say that the shoe is not for everyone. So I think this sort of first do no harm versus first sell this product, even though they are a company, they are leaning more towards that first do nor harm side of the scale, let's say.
00:29:06
Speaker
but Our second point is that a doctor will individualize care to the person versus a brand will say everybody needs this. So they market this to a list of conditions.
00:29:18
Speaker
But it's not everyone. They're very specific that the majority of the conditions that they list are neurologic. And then they also say that it could be useful for seniors, right, who also have often balance issues, issues with walking, things like that, catching their feet, tripping.
00:29:36
Speaker
So it's not saying but everybody and their brother needs this shoe. They're saying very specifically for people who are dealing with this issue of foot drop, foot drag, whether it is from a neurologic injury, whether it is from just generalized weakness. This is the problem that we are trying to solve with this product versus something like everybody needs creatine.
00:29:58
Speaker
Instead of these broad generalizations, it is a specific product made for a specific problem. So to me, that is a level of individualization that is appropriate.
00:30:09
Speaker
Our next point, which has to do with uncertainty versus certainty, right? Even with disclaimer, brands lean towards confidence because confidence sells. This product will help you with this problem, right?
00:30:22
Speaker
I think in this instance, they actually go a little too far into the certainty and could stand to be a little less overconfident and Part of the reason I say this is because of some information that I have that I haven't told you about yet, which is their research.
00:30:41
Speaker
The good news is there is research. The bad news is you'll find out in a second. So I don't think they can be overconfident at this point until they have more research, I would say.
00:30:54
Speaker
I think the confidence level could probably be tempered a bit. If you go on their website, it's very product oriented and based. It's very much, here's the shoe. Here's a video of the shoe working. Here's what it looks like. Here's how you can talk about it. Here's ways that you can get people using it. So it gives you a lot of um education around the product.
00:31:13
Speaker
There are these ambassador testimonials, of course. There's always going to be testimonials when you're selling something. We have testimonials on our Movement Logic website because we sell a barbell lifting course and we want people to talk about their experience with it, right? And obviously we want people to talk about positive experiences with it, right? And so does this shoe company. I would like them to be a little bit more clear on...
00:31:37
Speaker
populations that it would have a harder time with it, i I would like them to say a little more clearly, hey, this might not work for you. That's why it's important that you try it with your clinician so that they can help you figure it out.
00:31:53
Speaker
That's what I would like out of them as a company. All right. Number four, are they staying in scope like a doctor would, or are they behaving like a brand and saying they have solutions for everything under the sun?
00:32:06
Speaker
They have this coaches program, right? That is for clinicians. So they clearly want clinicians involved in this. They're not trying to get Serena Williams to endorse the shoe and then just like ride her celebrity. They want doctors talking about this product in their offices.
00:32:23
Speaker
So that is doctor behavior, right? They want real people giving pros and cons, working with patients about it. At the same time, they list all the different conditions that this shoe could help with.
00:32:38
Speaker
And interestingly, on each individual page of the condition, so for example, for Parkinson's disease or for foot drop, they have a few different medical doctors and it says at the top of the page, medically reviewed by, and then the doctor's name. So they are also 100% using this kind of recommended by doctors, white coat authority as part of their marketing.
00:33:02
Speaker
This kind of recommended by doctors thing, is it meaningful? Is it not meaningful? It might be meaningful to a potential patient. It's not a splashy banner across their homepage that says, doctor recommended number one, blah, blah, blah. It's kind of tucked away. And it's just saying that the content has been medically reviewed, whatever that means.
00:33:22
Speaker
They clearly want doctors involved in this product. They're not saying, hey, personal trainers. Hey, yoga teachers, Pilates instructors, fitness coaches, you too can sell this shoe, right?
00:33:35
Speaker
They very much want it to come from clinicians. At the same time, they're not only marketing this to doctors. They've got a shop. You could yourself just buy yourself a pair of these shoes and start trying to walk in them.
00:33:47
Speaker
While, yes, they are encouraging doctors to be involved with this, they're not limiting the scope of their market to just the medical community. They want to get everybody who could benefit from these shoes, right? Which was this list of conditions that they're listing, including just being older. They want, obviously, as many people buying this shoe as possible, because at the end of the day, they are not doctors. They're a company, right? They're trying to sell a shoe. All right.
00:34:11
Speaker
It's about time that we talk about the research, the evidence, and what it does and does not prove. That's the first thing that personally I'm going to look for. Has this been tested? What has it been found to actually do? It's not just empty promises. I want to see some data, some facts that back it up.
00:34:29
Speaker
The originators behind this shoe started at MIT with robotic gate work. They then developed this variable friction technology, the way that the shoe is designed to glide forward and then also grip when you need it.
00:34:42
Speaker
There is a pilot study called Pilot Study of Cadence, a novel shoe for patients with foot drop by Evora et al.
00:34:53
Speaker
from 2019. twenty nineteen now Important to note, pilot study, the very first words of this study. Pilot study does not mean this is a slam dunk.
00:35:05
Speaker
It is not a this proves that this works. It is the research version of saying, okay, does this look promising enough to keep studying? Is it safe to test it further?
00:35:17
Speaker
Or is it not what we think it is and therefore let's not go down this pathway?
00:35:26
Speaker
The pilot study has five adults in it who all are suffering from foot drop because of a neurologic disorder. Hopefully already,
00:35:37
Speaker
your little hackles are going up for two reasons, pilot study, and then this next bit of information, which is five people. Five people is not a lot of people. People. People, can we agree that five people is not a lot of people?
00:35:52
Speaker
So in three of the five subjects, the device seemed to improve certain biomechanical or performance-related measures, like gait mechanics, speed over ground, and the comfort of their gait, right? If it felt more comfortable to walk.
00:36:10
Speaker
Three out of five, yes, is a majority, but it's 60%, which is still a majority. And if Cadence is using that majority to say, we have early evidence that this might help some people walk differently, that's a fair thing to say, but If you read the word science-backed and you think that it means this will reliably fix foot drop for most people, that is an overreach of what this study can prove.
00:36:40
Speaker
The way that the study took place was everyone walked with and then without the cadence shoe to assess immediate effects on gait. What the research showed was that there were some immediate short-term benefits. It reduced the magnitude of the scuffing force, right? So how hard that scuff stopped you, essentially.
00:37:04
Speaker
it It improved overall gait biomechanics in three out of five subjects. and it increased their walking speed over ground compared with regular footwear.
00:37:17
Speaker
So the obvious limitations of this is there's a very small sample size, and they were only looking at immediate effects. Wear the shoe, walk around a little bit, let's see what your walking looks like now, put on your regular shoe, walk around a little bit, and let's compare it, right? So we have no information on any long-term outcomes, like For example, over the course of the month, did this reduce the number of fall or near falls that you experienced, right? How durable is the shoe? Does it start to wear out?
00:37:46
Speaker
How quickly does it start to wear out? How soon might you have to replace it, right? Because if the idea is this is a shoe that you're going to be using for your life, you know, it's no good if you got to buy a new pair every two months, right?
00:37:59
Speaker
It doesn't tell us really with any sort of more specificity, who might benefit it from it and who might not. And it also doesn't compare it to a traditional, what's called an AFO, and an ankle foot orthosis.
00:38:14
Speaker
Jesus,
Risks & Ethical Considerations
00:38:15
Speaker
that's hard to say. An ankle foot orthosis, which is a more rigid, typically made from plastic that goes in your shoe, that also tries to create that dorsiflexion of the ankle by either completely limiting the foot from going into plantar flexion or not allowing very much range of motion into plantar flexion, right? Which is typically what somebody with a foot drop might wear. Cadence also states that there is an NIH-funded clinical trial happening that is comparing their shoes to a traditional AFO for walking and gait improvement. And that's a really good thing. That's exactly what we want. It is going to be a direct comparison to the standard tool.
00:38:57
Speaker
What's going to be more useful essentially is, is this tool potentially going to replace the current standard tool? Not, is this tool better than no tool, right?
00:39:11
Speaker
So that's cool. That's a good thing. I'll be very interested to see what the results show. So the way a doctor might talk about this research would be something like early results suggest potential benefit for some people, more data needed, right? a lot of hedging, not very much certainty in that sentence.
00:39:32
Speaker
If a brand was talking about it, and honestly, probably with not much more evidence or no more evidence than a five-person pilot study, they would be saying it's proven, it's revolutionary, everybody needs it.
00:39:47
Speaker
Cadence is sitting somewhere in the middle. They have a legitimate research story about how the product came about, but they still lean very confident in their marketing language. And confidence tends to be a big deal and tends to outrun evidence in the wellness world in particular.
00:40:06
Speaker
Again, they're a company. I would expect them to be trying to sell this product that they've, at this point, spent a lot of time and money creating.
00:40:17
Speaker
If we get to our next point, which is about assessing risks and trade-offs, which is what a doctor would do versus just pure praise, which is what a brand would do. As we discussed earlier, they have this ambassador page for people who have been using the product. There are stories, testimonials, and, you know, we're humans. We love stories.
00:40:37
Speaker
Stories are how we understand the world around us. But stories are not data. And they can appeal to our emotions in a way that we perhaps downplay what the data might actually be showing.
00:40:53
Speaker
As much as they do talk about, for example, the surfaces that it works well on and surfaces to avoid, they don't actually cover every single surface that you might encounter.
00:41:04
Speaker
What if I'm trying to use an escalator? What if, as I said earlier, I'm walking on carpet? What if I'm trying to go for a hike where it's like, i don't know, rocky, something like that. So it would be good to to really quantify more of these, you know, it's good in this situation, it's not good in that situation.
00:41:22
Speaker
We don't have long-term data, so we can't really talk about that. And that would be the next level that I would want in order for me to comfortably promote a product to a patient or suggest that a patient might benefit for a product. I would like to see a lot more data on the product.
00:41:40
Speaker
It's tough because from the perspective of a company, you're not going to lead with this shoe is not for everybody and sometimes people still fall over, right?
00:41:52
Speaker
But I think it would be useful to find a way to include more of that language here. So that people understand that, yes, for some people, this is going to be something that really helps them function better.
00:42:05
Speaker
But no, it absolutely doesn't apply to every single person with this condition. And you might need to get the shoe and then go to your physical therapist and figure out how to use it.
00:42:16
Speaker
Right. It may not be as simple and natural as just putting the shoe on because. It's not simple and natural for your foot to slide when it touches the ground.
00:42:26
Speaker
The whole point of whatever part of your foot touching the ground is that there's a certain amount of friction that stops your foot from continuing to move forwards, right? You're trying to plant your foot on the ground. I would imagine for a lot of people with foot drop, especially if it's part of a chronic condition, this is going to take a massive amount of getting used to.
00:42:46
Speaker
And I would imagine that certainly you would slip around a bit to begin with. And you might not feel very confident just putting the shoes on and and trying to go for a walk. You might end up tripping.
00:42:59
Speaker
You might even end up falling. So i I would like there to be a little more discussion around that as opposed to just a page that is incentivizing doctors to get on board with this product.
00:43:13
Speaker
I would like to see something that says, even on the sales page, when you're buying, let's say you're buying the shoes for yourself, we recommend working with a physical therapist, an occupational therapist, some sort of clinician to practice using these shoes.
00:43:31
Speaker
Something like that. That's what I personally would consider a little bit more responsible, I guess is the word I'm looking for. Okay. So our next point is about whether we're measuring success by the patient, whether we're measuring success by our sales commissions, right?
00:43:53
Speaker
Cadence has an affiliate commission program. There is a financial motivation, potentially, to oversimplify and to paint with a broad brushstroke, let's say, if you were trying to make a good amount of money off of your commission sales.
00:44:12
Speaker
Now, if I was going to really behave like a brand, what I would do in this instance is I would clone this product and I would make my own version of it. I would call it Sarah Kort's shoe or something something better than that.
00:44:27
Speaker
That way... I stand to make way more profit per shoe sale than just if I affiliate myself with a company that already makes a product. So if I was really going to behave like a brand and I felt like this was a product that I could make a lot of money off of, right?
00:44:46
Speaker
Then yeah, I would create my own version and I would sell the shit out of it. And I would start behaving in all of those brand ways, like overconfidence and saying the shoe is for everybody and not worrying so much about possible limitations and testimonials out there yin yang. And I'd film cute videos of me using it with my patients and yay, you right? So that's why we care so much when we see a lot of these online doctors. And we speak specifically very often to the menopause.
00:45:21
Speaker
when we see them creating their own supplement brands, right? Creating their own product lines. When there exists a product already on the market that is not as expensive, that is much more accessible for people to use, but they're not making money off it, right?
00:45:41
Speaker
that's That's a big issue. All right, so if we go back to our example of these Cadence shoes, Let's talk about pros and cons. If I was really trying to decide, do I want to start promoting this shoe? Do I want to become a brand affiliate and, you know, get a commission off of each shoe sale?
00:45:58
Speaker
So let's talk about the pros. This is a real problem for people. There is legitimately a need to solve this problem. And I would say the current standard tool, the AFO, hard plastic orthotic, they're not great. They feel like something from the nineteen seventy s 1980s.
00:46:18
Speaker
And I would say it's about time that a product like this came along that is a shoe, right? Has the technology built into the shoe that is not so visually ugly and doesn't immediately out you as somebody who needs an assistive device to walk.
00:46:39
Speaker
Right? This just looks like all sneakers look goofy to me now. Right? So this just looks like another goofy kind of issue. So it's a real problem. Yes, the solution already exists, but this might well be a better solution.
00:46:53
Speaker
There is research. There is pilot data. And there is an ongoing NIH-funded trial, which means we're potentially going to be getting some much higher quality research coming out of that.
00:47:09
Speaker
They do include disclaimers and some surface cautions. Not as much as I would want, but again, they're a company.
00:47:19
Speaker
If we then look at our our con list, the evidence that exists is currently very small and could definitely be overstated.
00:47:31
Speaker
There is the risk of thinking that everyone with a neurologic condition would benefit from this shoe and My feeling is that's just obviously not true. There are so many other potential co-conditions going on.
00:47:44
Speaker
It's absolutely going to be a case-by-case basis. And to that end, I personally don't think they should be advertising it to the public. I think they should be allowing doctors to...
00:47:56
Speaker
select which patients they might recommend this shoe for and not your dentist or your OBGYN, but your orthopedic doctor or your physical therapist, somebody who works with bodies and movement. Yes.
00:48:09
Speaker
Because the fact that you can just go on the website and buy the pair of shoes again, obviously they're a company. It's going to be better for their bottom line. I don't love it from a risk perspective.
00:48:21
Speaker
And then there does exist this affiliate program, which means there is the possibility that the benefits are going be overstated and the risks are going to be understated if mentioned at all.
00:48:35
Speaker
If I absolutely had to decide Right now, Sarah, would you become a brand affiliate for Cadence? Or would you become a coach, which does not receive a commission, right? That just helps people work with the shoe.
00:48:52
Speaker
To be clear, I don't work exclusively with neurologic patients. But I do have quite a few. And I also work with quite a few seniors who they claim that this shoe is for. I'm not sure that I would ever recommend this shoe to a senior if it was someone who was really struggling with their gait and their balance.
00:49:09
Speaker
But there are a few of my patients that I think it actually might be useful for. And I might recommend it to them. Would it be useful to become a coach and get the educational content that they provide so that I could effectively coach my patient through how to use the shoe?
00:49:30
Speaker
Sure. And it seems to be free to join and that does not have any sort of commission making capacity. So then the question is, would I then also try to be an affiliate? Maybe.
00:49:42
Speaker
It wouldn't be a... I don't work at a clinic with only neuro patients where I see 60 different people a month and Well over half of my patients might actually benefit from from this shoe.
00:49:54
Speaker
But it starts to, it just, I can feel it in my head. It's interesting. So I don't have a problem as part of MovementLogic being a brand affiliate for the Verse Agile rack.
00:50:07
Speaker
It is a piece of exercise equipment. But now that I am staring down the barrel of whether or not I think I should be an affiliate, meaning I should earn a commission for a product that is, to my mind, a rehab product,
00:50:29
Speaker
it starts to make me feel kind of itchy. I can't lie. It makes me a little uncomfortable. I think because i view something like exercise equipment as extremely neutral, right? it's It in itself is not trying to solve a physiologic problem, except the physiologic problem of not being strong, right? That's something that we could say, everyone benefits from being strong, right?
00:50:56
Speaker
Something about this where it's working to solve a medical condition, and I'm recommending to my patients that they spend money on it. There's something creepy about that to me.
Conclusion & Future Applications
00:51:09
Speaker
to then think that I would get a kickback. I would get a commission. I would get a percentage of the money that they spent on this product. I recommend products to my patients all the time. Simple things that they can buy wherever. Therabands, right? Different type and size of balls that I want them to use for their rehab exercises. Dumbbells, things like that. I don't make any money off of that, certainly.
00:51:33
Speaker
And i would feel creepy if I did. I think my moral compass is such that If I am actively making money off of something that is potentially solving a medical problem, I don't feel good about that.
00:51:50
Speaker
If you're in the market for a rack and you want one that folds under your bed because you want to start lifting barbells at home, and I say, hey, here's this one that we really like, and then you go ahead and buy it, I don't feel bad about that commission.
00:52:03
Speaker
So the bottom line for me is that I would recommend it in certain cases, but I would not broadly endorse it. And I doubt that I would join their affiliate program because it would make me personally feel creepy.
00:52:16
Speaker
And it would make me question my own motivation around the people that I do recommend it to. That's where I land. Let's summarize why this matters.
00:52:29
Speaker
Let's talk about why it matters to be able to Get granular, pay attention to what a company is doing and how they're doing it.
00:52:37
Speaker
A lot of people have said things to us like, well, if if I can't trust this person, then I guess I just give up and I don't trust anybody. That's not the that's not the point. You need to be able to evaluate claims thoughtfully and go through what's actually being presented to you and determine, is this clinician behaving like a clinician?
00:52:59
Speaker
Or have they shifted a little too far into the brand behavior territory and it doesn't make me comfortable? So you want to ask questions like, what are they claiming? What are they saying this product is going to do?
00:53:12
Speaker
Is there evidence to support this? And good evidence, right? Not just a five-person pilot study. What is the incentive to the person who is telling me to use this product?
00:53:24
Speaker
Are they getting an affiliate fee? Is this their product? And then what are the actual risks or trade-offs of using this product? I hope that this has been a a helpful field test, thought experiment, way to work through these aspects of whether a clinician is behaving like a clinician or behaving like a brand.
00:53:50
Speaker
I will link the original Instagram post in the show notes as well if you haven't seen that yet. If you are on Instagram, it might be a handy thing just to save so that when you see another doctor selling you another product again,
00:54:06
Speaker
you can go through that list and really ask yourself, is this questionable? Is this very sketchy? Or is this actually okay? And it seems to be based in good evidence.
00:54:19
Speaker
All right. Thank you as always for listening. Don't forget to sign up for the barbell mini course in our show notes. Stay skeptical out there and we will see you in two weeks.