Envisioning 2.0

at the Medical Humanities Blog.

In an interesting post, Forrester analyst Jeremiah Owyang recently focused on a study produced by his firm indicating that people trust their “peers or people” they know more than experts.  Over the past few years, people have used data like this to explain why online media generated by non-experts seems to carry a lot of weight.  What’s most intriguing about this new analysis is that generic “bloggers” don’t get a lot of credit, while friends, family and well-respected colleagues do.

While trusting “people like me” has certainly had a lot of benefits, it does have a dark side.  Take the debate over whether there is a link between vaccines and autism.  A growing body of parents have squared off against scientific experts who insist that vaccines do not cause autism.  Parents are not buying their arguments.

Commenting on a New York Times story about the vaccination debate, Amy Tuteur, MD discussed why she believes the anti-vaccination argument is so powerful.  She wrote:

“Vaccine rejectionism has been around for more than 200 years, almost as long as vaccines themselves. Over those two hundred years not one of the myriad claims of vaccine rejectionists have turned out to be true. . . . the cultural claims of vaccine rejectionists resonate with prevailing cultural assumptions. . . . Agreement with doctors is constructed as a negative and refusal to trust is constructed as a positive cultural attribute . . .”

Sound familiar?  We’ve seen these cultural trends played out again and again in the blogosphere, on social networks and other places where people gather online to discuss various topics, including health.  However, sometimes trusting “people like us” comes at a great cost.

Earlier this week, the Centers for Disease Control (CDC) reported that there has been an unprecedented explosion of measles cases in several states this year.  Parents who have refused to vaccinate their children are a major reason measles outbreaks have jumped this year.  According to the CDC:

“Of the 64 people infected by the measles virus, only 1 had documentation of prior vaccination. Among the other 63 case-patients were 14 infants who were too young to be vaccinated. Many of the cases among US children occurred in children whose parents claimed exemption from vaccination due to religious or personal beliefs, or in children too young to be vaccinated. Disease transmission occurred in a variety of community and healthcare settings, including homes, childcare centers, schools, hospitals, emergency rooms, and doctors’ offices.”

The measles outbreak is one example of how trusting our peers can sometimes have nasty public health consequences.  Perhaps this latest news will help people better weigh the currently unproven autism risks of vaccination against the very real chance that measles can lead to significant complications for vulnerable infant/child patients.

Since early this year, Abbott Laboratories and the PR firm Fleishman Hilliard have been producing a contest designed to encourage young people to enter the clinical laboratory profession.  According to Abbott, the program, Labs Are Vital, was a smashing success.  It reached more than 1.8 million students interested in the sciences.

Students participating in the contests were asked to develop videos, T-shirts and advertisements encouraging people to start a career in laboratory medicine.  A key part of the programs’ success was the fact that Fleishman Hilliard was heavily engaged with the Facebook community surrounding the contest.  With a few exceptions, the contest sponsors were very responsive to community members’ needs and quickly answered questions.

Intimate interaction with community members was critically important, as Abbott changed the program’s various deadlines a few times over the past few months to give students more time to participate in the contest.  These changes confused community members.  In addition, Fleishman did a good job defusing negative commentary about the contest by quickly and honestly addressing criticism about the effort.

This contest illustrates that social networks have the power to “seed and grow” online communities around a common cause.  “Seeding” means providing the community with an online home.  Growth entails giving the community room to evolve at its own pace and constantly making adjustments as its needs change.

To learn more about the contest, click here.  To view the Facebook group, please click here (Facebook account required to view site).

Better late than never . . . The latest edition of the Health Wonk Review is up.  Click here to view it.

A bit of a buzz has been going around the pharma blogosphere about a new marketing campaign for the over the counter allergy medicine (OTC) Zyrtec.  Jack Friday at PharmaGossip has wondered whether it’s legal.  Yes, as John Mack, author of Pharma Marketing Blog, noted. The marketing campaign is perfectly legal as Zyrtec is now an OTC pill.

However, Mack wondered whether it is true, as Adrants reported, that Zyrtec flyers were seen on telephone poles in Boston.  He said: “I doubt this is a true story — more likely a Web 2.0 plant by crafty Zyrtec marketers.”

Well, shortly after I read these two blog posts, I left my windowless cubicle for a dose of fresh air and sunshine and what did I see?  Well, I caught a glimpse of a flyer taped to scaffolding near my office in New York’s East Village.  So, yes the rumors are true.  McNeil has instituted a clever guerilla marketing campaign once reserved for consumer packaged goods companies and underground musical acts.  I took a moment to scan in the flyer.  As you can see, someone was curious enough to respond to the marketing campaign by ripping off a section of the flyer with the Zyrtec 800 number.

Overall, this is a very, very clever campaign that’s sure to generate a lot of buzz for Zyrtec.

This morning news reports revealed that a dozen drug and device makers will be providing more information about their financial contributions to advocacy groups and physicians.  The companies responded to a letter from Senator Chuck Grassley.  He asked them to reveal whether they would be following in Eli Lilly and Company’s footsteps and disclosing monies they provide to outside individuals and groups.

According to the Associated Press: “A dozen of the nation’s leading drug and device makers have told Sen. Charles Grassley, R-Iowa, that they have plans or are working on plans to publicly disclose grants to outside groups. The details will be provided on each company’s Web sites.”

Pharmaceutical industry watchdogs say drug and device makers are seeking to head off legislation that would require them to disclose this information. “If they were doing this out of the goodness of their heart, they would have done so decades ago,” Dr. Peter Lurie of Public Citizen told the Associated Press.

Whatever The Motive, Drug Firms’ Move Is A Smart One

In April 2007, my firm Envision Solutions released a survey revealing that many Americans are deeply skeptical of drug firms’ motives for supporting non-profits.  According to the nationwide online poll, 43% of US adults believe that pharmaceutical companies fund groups like the American Heart Association and the National Kidney Foundation in order to get more people to buy their products or medicines.  This distrust threatens to sap the power of pharma-non-profit alliances and lead to greater regulation of the industry’s communications and grantmaking activities.

This is why I believe, that whatever the motive, drug firms are taking a step in the right direction by disclosing information about their financial ties to non-profits.  In fact, the benefits go both ways.  If companies and their partners do more to increase the transparency around their relationships, people will have less cause to believe they are being dishonest. In addition, it will make it much easier to recognize the benefits of these public-private partnerships.

Note:  I was inspired to write this post because of an article I read in the current round of the Health Wonk Review.  Check out the latest excellent edition here.

A couple of weeks ago, Jane Sarasohn-Kahn published a great analysis of some of the latest data from EBRI and the Commonwealth Fund focusing on the state of consumer-driven health plans (CDHPs).  In sum, the data’s not good.

Before I get into a discussion of Sarasohn-Kahn’s analysis, it’s best to talk briefly about the war of words currently swirling around CDHPs. Last year, , Gred Scandlen published a report, “CDHPs – ‘Working As Intended,’” where he noted that many studies are flawed and obscure the true benefits of CDHPs.  He argues that:

-    Recent surveys find CDHPs have continued to grow rapidly
-    High-deductible plans encourage people to take their care seriously, e.g., they are much more likely to go to their doctors to manage chronic conditions
-   “CDHP members are [not] likely to forego care due to cost”

Now, with that in mind, let’s look at what EBRI and the Commonwealth Fund found.  Most importantly, their study indicates that the healthy and wealthy are most likely to use CDHPs. Sarasohn-Kahn notes that this is not what CDHPs were designed to do. In fact, they have been touted as a means of getting more people into insurance plans.  In addition, although more affluent individuals are using these plans, Sarasohn-Kahn notes that “members of CDHPs and HDHPs are more likely to delay going to a doctor, visit a specialist, or undergo medical tests than members of comprehensive plans.”

I’m not going to take a position on whether CDHPs are successful just yet.  However, juxtaposing Scandlen’s analysis with EBRI’s research raises some interesting questions.  Most importantly, which numbers are we to believe?  Unfortuantely, there’s no good answer for this question.

A survey released this month by the Kaiser Family Foundation, the Harvard School of Public Health and USA Today, provides a great deal of information about public opinion of Big Pharma.  As it turns out, the public does not universally hate the drug industry.  Instead, people have a complex view of pharmaceutical companies.  In general, they believe drug firms do good work, but charge too much for drugs.  Some of the survey results I found most interesting include:

-    People don’t like the pharmaceutical industry, but love the drugs they take – and some of the companies that make them
-    Poorer, less educated people are more likely to have a favorable opinion of drug firms
-    Despite the furor over drug advertising, most Americans aren’t that bothered by it; however, they do think that money spent on ads contributes to the high price of medications
-    People buy drug firms’ argument that medications reduce overall health costs by limiting expensive hospitalizations and procedures

Overall, this study provides a clear roadmap for pharmaceutical industry executives seeking to get back into the public’s good graces.  Specifically:

-There is little chance that drug prices will decrease significantly in the US, mainly for regulatory and economic reasons.  However, many people think that drug firms’ programs to provide free and discounted drugs to many Americans don’t go far enough.  If the industry did more for the 41% of Americans who say they (or their families) have a difficult time paying for prescription drugs, public opinion could shift.

-44% of the public does “not trust drug companies to notify the public quickly about safety concerns” and nearly 30% believe drug firms act unethically when testing drugs on people.  This is a significant problem.  We all know drugs have risks and that clinical trials are complex.  The industry needs to be much more aggressive about communicating the risks and benefits of medications.  And, it needs to educate the public on how studies are conducted.  Research is the lifeblood of the industry and it can’t prosper if people don’t trust it to conduct research ethically.

This new study is very valuable.  It should be required reading for industry insiders and anyone who wants to understand Americans’ complex feelings about drug firms.

Image Source: Neil Caldwell, http://www.typophile.com/blog/9690

The latest edition of the Health Wonk Review is up at Workers Comp Insider.  Many thanks to Jon Coppelman for highlighting my post re: Merck’s Gardasil.  To clarify, while I’m not sure Merck and the government have been mum about HPV’s status as a STD because of abstinence-only proponents, I’m quite sure this is not an issue Merck is comfortable tackling.

This morning, the New York Times reported that “after more than a decade of struggle” the US House of Representatives passed a bill requiring most “group health plans” to provide better coverage for the treatment of mental illness.

This is an issue close to my heart, as I worked for many years on public education programs designed to reduce the stigma associated with depression and other mental illnesses.  A big part of the problem was that most insurance companies do not provide adequate benefits.  For example, people often wind up paying for very expensive “talk therapy” sessions out-of-pocket.  This was a tremendous problem for those with dangerous and debilitating mental illnesses who need more intensive treatment.  We know that drug and therapy sessions are the most effective ways to help people with a mental disorder.

Of course, there is always the issue of cost and what illnesses will be covered.  The often controversial Diagnostic and Statistical Manual of Mental Disorders lists numerous conditions as psychiatric illnesses.  I’m not a supporter of covering every one, or even most.  However, depression, bipolar, schizophrenia, acute anxiety and other major disorders should be covered without question. Conditions like jet-lag induced sleep problems should not.

The White House opposes the bill and it still must get through the Senate, so it is unclear whether the law will pass.  However, this shouldn’t diminish the fact that this is a great day for people afflicted with mental illness.